Spring Sale: Get 1 Year, Save 58%

Baby, that bill is high: Private equity ‘gambit’ squeezes excessive ER charges from routine births

Elizabeth Huffner thinks it is obvious: A full-term, healthy pregnancy results in a birth.

“When your due date has come and gone, you’re expecting a baby any minute,” Huffner said. So she was surprised to discover she was an “unknown accident” — at least from a billing standpoint — when she went to the hospital during labor. Her bill included a charge for something she said she didn’t know she’d ever entered: an obstetrics emergency department.

That’s where a doctor briefly checked her cervix, timed her contractions, and monitored the fetal heartbeat before telling her to go home and come back later. The area is separated from the rest of the labor-and-delivery department by a curtain. The hospital got about $1,300 for that visit — $530 of it from Huffner’s pocket.

In recent years, hospitals of every stripe have opened obstetrics emergency departments, or OBEDs. They come with a requirement that patients with pregnancy or postpartum medical concerns be seen quickly by a qualified provider, which can be important in a real emergency. But it also means healthy patients like Huffner get bills for emergency care they didn’t know they got.

“It should be a cautionary tale to every woman,” said Huffner, of Rockford, Illinois.

Three of the four major companies that set up and staff OBEDs are affiliated with private equity firms, which are known for making a profit on quick-turnaround investments. Private equity has been around for a long time in other medical specialties, and researchers are now tracking its move into women’s health care, including obstetrics. These private equity-associated practices come with a promise of increased patient satisfaction and better care, which can help the hospital avoid malpractice costs from bad outcomes.

But private equity also is trying to boost revenue. Dr. Robert Wachter, chair of the Department of Medicine at the University of California-San Francisco, calls the private equity encroachment into medicine “worrisome.”

“Hospitals will do what they can do to maximize income as long as they’re not breaking the rules,” Wachter said. “And it sounds like that’s sort of what they’re doing with this ER gambit.”

Surprising Bills

KHN reviewed the bills of a dozen patients in five states who said they were hit with surprise emergency charges for being triaged in an OBED while in labor. That included a woman in Grand Junction, Colorado, who said she felt “gaslit” when she had to pay $300 in emergency charges for the care she received in the small room where they confirmed she was in full-term labor. And in Kansas, a family said they were paying $400 for the same services, also rendered in a “very tiny” room — even though HCA Healthcare, the national for-profit chain that runs the hospital, told KHN that emergency charges are supposed to be waived if the patient is admitted for delivery.

Few of the patients KHN interviewed could recall being told that they were accessing emergency services, nor did they recall entering a space that looked like an emergency room or was marked as one. Insurance denied the charges in some cases. But in others families were left to pay hundreds of dollars for their share of the tab — adding to already large hospital bills. Several patients reported noticing big jumps in cost for their most recent births compared with those of previous children even though they did not notice any changes to the facilities where they delivered.

Three physicians in Colorado told KHN that the hospitals where they work made minimal changes when the institutions opened OBEDs: The facilities were the same triage rooms as before, just with a different sign outside — and different billing practices.

“When I see somebody for a really minor thing, like, someone who comes in at 38 weeks, thinks she’s in labor, but she’s not in labor, gets discharged home — I feel really bad,” said Dr. Vanessa Gilliland, who until recently worked as a hospitalist in OBEDs at two hospitals near Denver. “I hope she doesn’t get some $500 bill for just coming in for that.”

The bills generated by encounters with OBEDs can be baffling to patients.

Clara Love and Dr. Jonathan Guerra-Rodríguez, an intensive care unit nurse and an internist, respectively, found a charge for the highest level of emergency care in the bill for their son’s birth. It took months of back-and-forth — and the looming threat of collections — before the hospital explained that the charge was for treatment in an obstetrics emergency department, the triage area where a nurse examined Love before she was admitted in full-term labor. “I don’t like using hyperbole, but as a provider I have never seen anything like this,” Guerra-Rodríguez said.

Patients with medical backgrounds may be more likely than other people to notice these unusual charges, which can be hidden in long or opaque billing documents. A physician assistant in North Carolina and an ICU nurse in Texas also were shocked by the OBED charges they faced.

Figuring out where OBEDs even are can be difficult.

Health departments in California, Colorado, Massachusetts, and New York said they do not track hospitals that open OBEDs because they are considered an extension of a hospital’s main emergency department. Neither do professional groups like the American Hospital Association, the American College of Obstetricians and Gynecologists, and the Joint Commission, which accredits health care programs across the country.

Some hospitals state clearly on their websites that they have an OBED. A few hospitals state that visiting their OBED will incur emergency room charges. Other hospitals with OBEDs don’t mention their existence at all.

Origins of the OBED Concept

Three of the main companies that set up and staff OBEDs — the OB Hospitalist Group, or OBHG; TeamHealth; and Envision Healthcare — are affiliated with private equity firms. The fourth, Pediatrix Medical Group, formerly known as Mednax, is publicly traded. All are for-profit companies.

Several are clear about the revenue benefits of opening OBEDs. TeamHealth — one of the country’s dominant ER staffing companies — is owned by private equity firm Blackstone and has faced criticism from lawmakers for high ER bills. In a document aimed at hospital administrators, TeamHealth says OBEDs are good for “boosting hospital revenues” with “little to no structural investment for the hospital.” It markets OBED success stories to potential customers, highlighting hospitals in California and South Florida where OBEDs reportedly improved patient care — and “produced additional revenue through OB-ED services.” OBHG, which staffs close to 200 OBEDs in 33 states, markets a scoring tool designed to help hospitals maximize charges from OBEDs and has marketed its services to about 3,000 hospitals.

Staffing companies and hospitals, contacted by KHN, said that OBEDs help deliver better care and that private equity involvement doesn’t impede that care.

Data from Colorado offers a window into how hospitals may be shifting the way they bill for triaging healthy labor. In an analysis for KHN, the Center for Improving Value in Health Care found that the share of uncomplicated vaginal deliveries that had an emergency department charge embedded in their bills more than doubled in Colorado from 2016 to 2020. It is still a small segment of births, however, rising from 1.4% to 3.3%.

Major staffing companies are set up to charge for every single little thing, said Dr. Wayne Farley. He would know: He used to have a leadership role in one of those major staffing companies, the private equity-backed Envision, after it bought his previous employer. Now he’s a practicing OB-GYN hospitalist at four OBEDs and a consultant who helps hospitals start OBEDs.

“I’ve actually thought about creating a business where I review billings for these patients and help them fight claims,” said Farley, who thinks a high-level emergency charge makes sense only if the patient had serious complications or required a high level of care.

Proponents of OBEDs say converting a triage room into an obstetrics emergency department can help pay for a hospital to hire 24/7 hospitalists. In labor and delivery, that means obstetric specialists are available purely to respond to patients who come to the hospital, rather than juggling those cases with clinic visits. Supporters of OBEDs say there’s evidence that having hospitalists on hand is safer for patients and can reduce unnecessary cesarean sections.

“That’s no excuse,” said Dr. Lawrence Casalino, a physician and health policy researcher at Weill Cornell Medicine. “To have people get an emergency room charge when they don’t even know they’re in an emergency room — I mean, that doesn’t meet the laugh test.”

But Dr. Christopher Swain, who founded the OB Hospitalist Group and is credited with inventing the OBED concept, said that having round-the-clock hospitalists on staff is essential for giving pregnant patients good care and that starting an OBED can help pay for those hospitalists.

Swain said he started the nation’s first OBED in 2006 in Kissimmee, Florida. He said that at early adopter hospitals, OBEDs helped pay to have a doctor available on the labor-and-delivery floor 24/7 and that hospitals subsequently saw better outcomes and lower malpractice rates.

“We feel like we fixed something,” Swain said. “I feel like we really helped to move the bar to improve the quality of care and to provide better outcomes.”

Swain is no longer affiliated with OBHG, which has been in private equity hands since at least 2013. The company has recently gone so far as to present OBEDs as part of the solution to the country’s maternal mortality problem. Hospitals such as an Ascension St. Joseph’s hospital in Milwaukee have echoed that statement in their reasons for opening an OBED.

But UCSF’s Wachter — who coined the term “hospitalist” and who generally believes the presence of hospitalists leads to better care — thinks that reasoning is questionable, especially because hospitals find ways to pay for hospitalists in other specialties without engineering new facility fees.

“I’m always a little skeptical of the justification,” Wachter said. “They will always have a rationale for why income maximization is a reasonable and moral strategy.”

Private Equity’s Footprint in Women’s Health Care

Farley estimates that he has helped set up OBEDs — including Colorado’s first in 2013 — in at least 30 hospitals. He’s aware of hospitals that claim they have OBEDs when the only change they’ve made is to have an OB-GYN on site round-the-clock.

“You can’t just hang out a shingle and say, ‘We have an OBED.’ It’s an investment on the part of the hospital,” he said. That means having, among other things, a separate entrance from the rest of the labor-and-delivery department, clear signage inside and outside the hospital, and a separate waiting room. Some hospitals he has worked with have invested millions of dollars in upgrading facilities for their OBED, he said.

Private equity firms often promise more efficient management, plus investment in technology and facilities that could improve patient care or satisfaction. In some parts of health care, that could really help, said Ambar La Forgia, who researches health care management at the University of California-Berkeley and is studying private equity investment in fertility care. But La Forgia said that in much of health care, gauging whether such firms are truly maintaining or improving the quality of care is difficult.

“Private equity is about being able to extract some sort of value very quickly,” La Forgia said. “And in health care, when prices are so opaque and there’s so much lack of transparency, a lot of those impacts on the prices are eventually going to fall on the patient.”

It’s changing circumstances for doctors, too. Dr. Michelle Barhaghi, a Colorado obstetrician, said OBEDs may make sense in busy, urban hospitals with lots of patients who did not get prenatal care. But now they’re cropping up everywhere. “From a doctor standpoint, none of us want these jobs because now we’re like a resident again, where we have to see every single patient that walks through that door,” said Barhaghi, rather than triaging many cases on the phone with a nurse.

Still, private equity is continuing its advance into women’s health care.

Indeed, Barhaghi said private equity came knocking on her door earlier this year: Women’s Care Enterprises, backed by private equity company BC Partners, wanted to know whether she would consider selling her practice. She said “no.”


KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

Subscribe to KHN’s free Morning Briefing.

Fruit and vegetables: Is it better to peel them?

Many people’s default when preparing fruit and vegetables is to peel them. But often, it’s not necessary. There are important nutrients in the peel. And, what’s more, discarded fruit and veg peels contribute to climate change.

Fruit and vegetables are rich sources of vitamins, minerals, fiber and many phytochemicals (plant chemicals), such as antioxidants (substances that protect your cells from harm). Not consuming enough of these nutrient-rich foods is linked to an increased risk of chronic diseases, including cardiovascular disease and Type 2 diabetes. In 2017, the World Health Organization (WHO) reported that around 3.9 million deaths a year worldwide were attributable to people not eating enough fruit and veg.

Eating 400 grams of fruit and vegetables a day, as the WHO recommends, is difficult to achieve for many people. So could consuming fruit and vegetable peel help with this issue by adding important nutrients to people’s diets?

They can certainly contribute. For example, nutritionally important amounts of vitamins, such as vitamin C and riboflavin, and minerals such as iron and zinc, are found in the peel of seven root vegetables: beetroot, field mustard, wild carrot, sweet potato, radish, ginger and white potato. And the U.S. Department of Agriculture shows that unpeeled apples contain 15% more vitamin C, 267% more vitamin K, 20% more calcium, 19% more potassium and 85% more fiber than their peeled equivalents. Also, many peels are rich in biologically active phytochemicals, such as flavonoids and polyphenols, which have antioxidant and antimicrobial properties.

Another reason to not discard peels is their effect on the environment. According to the United Nations’ (UN) Food and Agriculture Organization, uneaten food, including peel, generates 8%-10% of the world’s greenhouse gas emissions. (Food rotting in landfills releases methane, the most potent greenhouse gas.) New Zealand alone reports an annual wastage of 13,658 tons of vegetable peels and 986 tons of fruit peels – a country with a population of only 5.1 million people.

Given the nutrient content of peel and its contribution to food waste, why do people peel fruit and vegetables at all? Some must be peeled as the outer portions are inedible, don’t taste nice, are hard to clean or cause harm, such as banana, orange, melon, pineapple, mango, avocado, onion and garlic. Also, peeling may be a necessary part of the recipe, for example, when making mashed potato. But many peels, such as potato, beetroot, carrot, kiwifruit and cucumber, are edible, yet people peel them anyway.

Pesticide residue

Some people peel fruit and veg because they are concerned about pesticides on the surface. Pesticide residues are certainly retained on or just below the surface, although this varies according to plant species. But most of these residues can be removed by washing. Indeed, the U.S. Food and Drug Administration recommends that people wash produce thoroughly under cold water and scrub it with a stiff brush to remove pesticides, dirt and chemicals.

Cooking techniques, such as boiling and steaming, can also reduce pesticide residue. But not all pesticide residues are removed by washing and cooking. And people who are concerned about their exposure to pesticides may still wish to peel. Lists of pesticide contents for fruit and vegetables are available in some countries, for example, the Pesticide Action Network produce one for the U.K. This can help you to decide which fruit and veg to peel and which peels can be eaten.

If you want to find out more about fruit and vegetable peel and what to do with it, there is lots of advice online including help on how to use peels for composting, to feed a wormery or incorporation into recipes. With a little investigation and creativity, you can help to reduce waste and increase your fruit and vegetable intake. Surely it’s worth a try? And you’ll be helping to meet one of the U.N.’s sustainable development goals: to halve food waste by 2030.

Kirsty Hunter, Senior Lecturer in Nutrition, Nottingham Trent University

This article is republished from The Conversation under a Creative Commons license.

Why did single women vote for Democrats? Republicans have an asinine theory

After the heavily predicted “red wave” in the 2022 midterm elections turned out to be an illusion, it was really no mystery why Republicans failed to capitalize on the political tailwinds that — according to conventional wisdom and political history — should have given them much bigger wins. Blame Donald Trump and Justice Samuel Alito, for the one-two punch of inciting an insurrection (which was wildly unpopular) and overturning the right to abortion (which was highly popular). Americans, it turns out, are protective of democracy and their basic human rights and turned out in huge numbers to vote for Democrats or, more precisely, to vote against Republicans, who are a threat to both. The smart thing for Republicans to do is clear enough: Stop stoking Trump’s election lies and scale back the tsunami of racism, sexism and homophobia currently fueling their party. 

But there’s no chance that will happen, of course. Let’s remember that Republicans also flirted with moderating their message after losing the 2012 election, only to go in precisely the opposite direction by nominating Donald Trump in 2016. Looking inward and engaging in self-reflection is the antithesis of everything the modern GOP stands for. So instead, the right is looking outward for someone besides themselves to blame, and they’ve landed on a favorite scapegoat: Single women. Worse, in blaming single women for their own political failure, conservatives are wallowing in a ludicrous conspiracy theory based on the premise that having an “F” on your driver’s license renders you incapable of autonomous thought. 

Yes, it’s true: Republicans are big mad that single women voted for Democrats, and their explanation for this is that Democrats of brainwashing those hapless, unfortunate women who don’t have husbands to make their decisions for them. 


Want more Amanda Marcotte on politics? Subscribe to her newsletter Standing Room Only.


“Unmarried women in America are lost, miserable, addicted to SSRIs and alcohol, wracked with guilt from abortion, and wandering from partner to partner,” wrote Joel Berry, managing editor of the popular right wing site Babylon Bee. “They are the Democrats’ core base now, and the Democrats will do everything possible to manufacture more of them.”

Mollie Hemingway, the editor-in-chief of The Federalist, was less colorful in her language, but nonetheless aired a similar claim about “the massive political incentive Democrats have to keep women unmarried.”

“No one benefits more from the destruction of the American family than the Democratic Party,” announced a headline at the right-wing Washington Examiner

Andrew Torba, who runs the far-right social media site Gab, sent out a newsletter declaring that democracy is illegitimate because “the Godless unmarried whores of Babylon select your leaders so they can continue to slaughter their children.” 

Fox News host Jesse Watters, in the most viral example of this talking point, said that “Democrat policies are designed to keep women single” and implored male viewers to get the ladies under control: “Guys, go put a ring on it.” How male Fox News viewers are supposed to talk these unruly Democratic-voting women into marrying them was left unexplained, although Watters has previously hinted at the usefulness of coercion when it comes to romance. 

While Republican politicians have generally been a bit more circumspect in their language, Sen. Josh Hawley of Missouri tipped his hand on a not-that-subtle endorsement of this conspiracy theory, retweeting conservative sociologist Brad Wilcox — who prominently drew attention to single women’s Democratic leanings — complaining that “fewer adults are opening their hearts, lives, and minds to marriage and children.” 


Want more Amanda Marcotte on politics? Subscribe to her newsletter Standing Room Only.


These accusations that Democrats are somehow preventing women from getting hitched are deliberately vague on the mechanics. Are Democrats crashing weddings and intervening when the officiant asks if anyone has cause to object? Are they rewriting dating-app software so liberal-leaning women only see video-game addicts who refuse to leave the house? Have they forced every eligible man to leave the country? 

If you dig into the comments under these angry right-wing tweets, the outlines of the conspiracy theory these commentators are hinting at become a bit clearer. Reproductive rights, equal access to education and social welfare policies (which are always more generous in the right-wing imagination than in real life) are routinely blamed for somehow tricking women out of marriage. The idea is that Democrats use basic human rights to lure gullible young women away from their true destiny and most cherished desire, which is of course to be the doting helpmeet to a Republican dude. Democrats, the idea goes, get women hooked on a sinister cocktail of equality and freedom, and therefore hopelessly addicted to voting for Democrats. 

In the real world, of course, what’s going on is painfully simple. Single women are a constituency that benefits enormously from equal pay, equal education and reproductive rights. (Married women benefit from these things, too, but a lot of them are cross-pressured to keep the peace with Republican husbands, and/or are voting their resentments toward their single counterparts.) Understanding that they have a built-in advantage with single women, Democrats have constructed a platform designed to appeal to them.

When Republicans talk about “incentivizing” marriage, what they really mean is coercion: stripping women of reproductive rights and economic equality, to create a society where women feel they have to get married to survive.

But accepting that straightforward narrative means accepting the radical notion that women have minds of their own. That will clearly never do in the GOP universe. So a nefarious and unnecessarily complicated conspiracy theory must be created that reimagines basic constituent appeal as manipulation and brainwashing. 

As with most accusations made by Republicans, the claims that Democrats somehow “control” women are pure psychological projection. It’s pretty obvious that Republicans are the ones who want to control women, and when they start talking about “incentivizing” marriage, what they really mean is various forms of coercion. Stripping women of reproductive rights and economic equality is about trying to create a society where women feel they have to get married in order to survive, or at least to have any financial security. As a not-so-hidden bonus, a woman who is financially dependent on her husband is likely to feel even less room to disagree with him politically or vote her own conscience. 

In fact, the theory that Democrats are brainwashing women into staying single is directly linked to the “great replacement” conspiracy theory, a white supremacist fiction proposing that liberal “elites” are somehow “importing” people of color to “replace” white conservatives. In both cases, the presumption that people who are not white men are lesser beings, incapable of independent thought.

As with the Big Lie, this is all about Republicans telling themselves that entire groups of Americans are not legitimate voters or citizens, and don’t deserve a say in government. Conservatives’ bitter retreat into this conspiracy theory after their disappointing midterm results strongly suggests that the Republican Party has no inclination to moderate anything about its policies or messaging. Instead, we can expect the right to double down on the fascistic assumption that people like them are the only real Americans, and nobody else gets to vote. 

Trump’s lawsuit against Jan. 6 committee is a sideshow — they’ve already nailed him

On Nov. 11, to absolutely no one’s surprise, Donald Trump sued the House Jan. 6 select committee to avoid having to testify or provide documents in response to its subpoena. That was just the latest chapter in Trump’s long history of deploying lawsuits to stall — this time as the clock runs out on the current Democratic majority in Congress and its Jan. 6 committee.

Little matter: The committee has already won the war.  

From the outset, the committee chaired by Rep. Bennie Thompson of Mississippi — with the starring role played by Rep. Liz Cheney of Wyoming — had a threefold mission. First, to uncover facts and issues that would help the American people understand what led to the Jan. 6 insurrection and who was responsible, in order to shape a response through the democratic process. Second, to frame legislative proposals aimed at preventing a recurrence of that travesty.  

As part of the legislative branch, the committee was never a route to initiate a criminal case against Donald Trump. But to the extent it established facts that could aid a potential prosecution, the committee’s third and quite collateral function was to make the evidence available to prosecutors for their independent consideration. 

Missions accomplished, on all counts

The committee’s subpoena of Oct. 26 invited Trump to tell his story under oath. The committee surely knew the former president would decline the invitation. After all, he took the Fifth Amendment 450 times on Aug. 10 when deposed in New York Attorney General Letitia James’ civil case against the Trump Organization. 

This is not a man who has a story of innocence to tell, at least not under oath. So the committee’s latest win is to have that fact confirmed yet again by Trump’s Nov. 11 court filing, where the obvious aim is to avoid testifying until the committee’s clock runs out.

Whether Trump was subpoenaed in May 2021 or October 2022, he was never going to give any substantive testimony. If he had been subpoenaed last year, he would have delayed, by fair means or foul. If actually required to testify, he would have taken the Fifth. 

The committee understood from the start that it made little sense to waste time litigating with Trump about a subpoena that would eventually yield nothing. It was far better for the panel to spend its limited resources and ever-shortening lifespan building the case of Trump’s guilt to present to the American people. There would be time enough at the end to subpoena him and show America that under no circumstances would he testify under oath.


Want a daily wrap-up of all the news and commentary Salon has to offer? Subscribe to our morning newsletter, Crash Course.


It is important to focus on the committee’s central triumph, not this last minor chapter. For weeks this summer, its hearings riveted the country and the media. The public was offered a coherent narrative laid out in hearing after hearing. It proved Trump’s central role in inciting the Jan. 6 violence, his serial attempts to overturn the Constitution, first bloodlessly and then through violence, and his admissions to aides that he had lost the election he falsely claimed to have won. Brazenly, it was that false claim that he used to inflame the mob on the morning of Jan. 6.

The committee’s powerful case became an important backdrop to last week’s surprising midterms. Testimony before the committee demonstrated to any fair-minded person that Donald Trump was the central actor in the conspiracy to end our democracy. That was on the ballot and so was he. Democracy won. Trump lost.

The legal arguments in Trump’s Nov. 11 lawsuit to avoid testifying are feeble. 

Trump’s lawsuit against the Jan. 6 committee is a rehash of already-rejected legal claims, and filing it in Florida is the same nonsensical gamesmanship that worked for him in September.

The fact that Trump filed the suit in Florida reflects the same legal gamesmanship that worked for him in September. There Judge Aileen Cannon, whom Trump appointed, ended up handling his suit over the classified documents he improperly held at Mar-a-Lago after the end of his term. Even the conservative 11th Circuit Court of Appeals swiftly reversed Cannon’s most egregious rulings.

No lawyer reading Trump’s latest court filing could miss the rehash of already rejected legal claims about his purported executive privilege or the committee’s alleged lack of legal authority. 

Trump’s claim based on the separation of powers is particularly hypocritical, coming from a former president who sought, according to compelling evidence, to corrupt and undermine the legislative branch’s constitutionally assigned authority to certify the winner of a presidential election. 

The stark fact that Trump is a former president dilutes his claim. The committee’s letter accompanying the subpoena tellingly quoted President Theodore Roosevelt during his own congressional testimony after leaving office: “An ex-President is merely a citizen of the United States, like any other citizen, and it is his plain duty to try to help this committee or respond to its invitation.”

That is simply common sense. As is the bottom line: If Trump had something to say that might be helpful to his own cause, he wouldn’t be ducking his duty to come forward. He has already lost with the committee, just as he lost last Tuesday with American voters.

The population has reached 8 billion — but experts aren’t worried about overpopulation. Here’s why

November 15th, 2022, is the date that demographers estimate humanity hit a new threshold: a global population of more than eight billion people, with population growth expected to continue climbing for the next 60 years. According to a recent report from the United Nations, the global population “could grow to around 8.5 billion in 2030 and 9.7 billion in 2050, before reaching a peak of around 10.4 billion people during the 2080s.”

The jump from seven to eight billion only took 12 years — perhaps astonishing given that it took roughly 300,000 years of human history to hit our first billion, in 1804, the same year morphine was first isolated from opium and the steam locomotive was invented. An estimated 109 billion people have ever lived on Earth, and about seven percent of all humans who have ever lived are alive today.

Though billion-mark milestones tend to provoke a sense of alarm, humanity’s population growth has actually slowed, according to the UN, and is currently at its slowest rate since 1950. There’s a slurry of good and bad news driving these trends. Thanks to increased access to healthcare and declining mortality rates, especially in infants, people are living longer — but it really comes down to where in the world you reside.

Recent global events like pandemics, wars and climate change have not outright stopped the precipitous climb of humanity’s numbers, but they have played a role in the changing dynamics of the global census. Life expectancy has dropped in some regards. In the U.S., for example, life expectancy has been on the decline for the last two years, according to the Centers for Disease Control and Prevention.

“That decline – 77.0 to 76.1 years – took U.S. life expectancy at birth to its lowest level since 1996,” the CDC reported in August, citing the unrelenting jump in fatal drug overdoses and, of course, the COVID pandemic that has claimed over 1.1 million American lives and counting. Meanwhile, birth rates in the U.S. climbed 1 percent in 2021, the first increase in seven years, according to the National Center for Health Statistics.

Fears of overpopulation — the idea that there might be so many humans that we start competing for every scrap of food like a swarm of locusts — have existed since the late 18th century.

“More than half of the projected increase in global population up to 2050 will be concentrated in just eight countries: the Democratic Republic of the Congo, Egypt, Ethiopia, India, Nigeria, Pakistan, the Philippines and the United Republic of Tanzania,” the UN predicts, with India projected to surpass China as the world’s most populous country next year.

Discussions of global population often trigger some strong, dark emotions about scarcity and who should be allowed to breed. Fears of overpopulation — the idea that there might be so many humans that we start competing for every scrap of food like a swarm of locusts — have existed since the late 18th century. In 1798, English economist Thomas Robert Malthus anonymously published his infamous treatise “An Essay on the Principle of Population,” arguing “Population, when unchecked, increases in a geometrical ratio, Subsistence, increases only in an arithmetical ratio.” In plain English, Malthus believed exponential population growth would inevitably outpace food production, increasing poverty and famine, what’s known as a “Malthusian catastrophe.”

The book spawned the concept of Malthusianism, which has since been used to justify everything from eugenics to the forced sterilization of “undesirable” citizens. Pop culture has even spun Malthusianism into a meme, if you know what Soylent Green is made of. It didn’t just anticipate colonialism and Indigenous genocide or the rise of the Nazis and their “Final Solution.” Malthusianism is still very much a problem today, with “overpopulation” being a central issue in the ongoing Rohingya genocide, among other examples of oppression.

This is unfortunate, because Malthus never seems to have advocated for violence. He wrote in his essay, “To exterminate the inhabitants of the greatest part of Asia and Africa, is a thought that could not be admitted for a moment.”


Want more health and science stories in your inbox? Subscribe to Salon’s weekly newsletter The Vulgar Scientist.


While Malthus’ pitch-black cynicism has been debunked time and again, the idea still rears its head periodically — for example, in the best-selling 1968 book “The Population Bomb” by Stanford University professor Paul Ehrlich and his wife, Anne. But these arguments tend to mathematize humans, overlooking our potential as problem-solving primates. As WIRED put it, Ehrlich’s “remedies for overpopulation were draconian: steep taxes on diapers, mass sterilization, and the addition of sterility agents to food exported to foreign populations.”

The self-described libertarian transhumanist author Ronald Bailey, writing in his 2015 book “The End of Doom,” argued that so-called Neo-Malthusians “cannot let go of the simple but clearly wrong idea that human beings are no different than a herd of deer when it comes to reproduction.” The issues of overpopulation can be addressed with increased access to education and birth control, for example, making it more of a resource distribution issue than predestined doom.

It’s true that in many countries, the population of elderly people is outpacing the young. In Japan, for example, the country with the highest proportion of older folks in the world, the rate of births isn’t enough to contend with the geriatric citizenry, where 1 in 4 people are 65 or older.

“By 2030, 1 in 6 people in the world will be aged 60 years or over,” the UN estimated in October. “Older people are often assumed to be frail or dependent and a burden to society. Public health professionals, and society as a whole, need to address these and other ageist attitudes, which can lead to discrimination, affect the way policies are developed and the opportunities older people have to experience healthy aging.”

A report from the Brookings Institute recently proposed a few means of caring for an increasingly elderly country. As the report read: “Providing opportunities for the elderly to remain in the workforce longer as well as engage in volunteering, care, and artistic activities can provide both social and economic benefits and relieve some of the fiscal pressures related to aging societies.” Japan has explored these solutions and more, following the government passage of “Guideline of Measures for Ageing Society” in 2018. It includes redesigning communities for older people while providing basic needs like stable housing and quality healthcare.

Ageing, or simply growing, societies pose numerous problems, but they aren’t insurmountable and don’t pose quite the apocalyptic threat neo-Malthusians claim. Indeed, demographers agree fear of overpopulation is a bogeyman that masks sinister ideals like eugenics and anti-immigration. Eight billion is indeed a huge number, but the problems that a surging population presents isn’t inherent in the size — it’s about how we distribute wealth and treat the other folks who share our planet.

Her child was stillborn at 39 weeks. She blames a system that doesn’t always listen to mothers

The day before doctors had scheduled Amanda Duffy to give birth, the baby jolted her awake with a kick.

A few hours later, on that bright Sunday in November 2014, she leaned back on a park bench to watch her 19-month-old son Rogen enjoy his final day of being an only child. In that moment of calm, she realized that the kick that morning was the last time she had felt the baby move.

She told herself not to worry. She had heard that babies can slow down toward the end of a pregnancy and remembered reading that sugary snacks and cold fluids can stimulate a baby’s movement. When she got back to the family’s home in suburban Minneapolis, she drank a large glass of ice water and grabbed a few Tootsie Rolls off the kitchen counter.

But something about seeing her husband, Chris, lace up his shoes to leave for a run prompted her to blurt out, “I haven’t felt the baby kick.”

Chris called Amanda’s doctor, and they headed to the hospital to be checked. Once there, a nurse maneuvered a fetal monitor around Amanda’s belly. When she had trouble locating a heartbeat, she remarked that the baby must be tucked in tight. The doctor walked into the room, turned the screen away from Amanda and Chris and began searching. She was sorry, Amanda remembers her telling them, but she could not find a heartbeat.

Amanda let out a guttural scream. She said the doctor quickly performed an internal exam, which detected faint heart activity, then rushed Amanda into an emergency cesarean section.

She woke up to the sound of doctors talking to Chris. She listened but couldn’t bring herself to face the news. Her doctor told her she needed to open her eyes.

Amanda, then 31, couldn’t fathom that her daughter had died. She said her doctors had never discussed stillbirth with her. It was not mentioned in any of the pregnancy materials she had read. She didn’t even know that stillbirth was a possibility.

But every year more than 20,000 pregnancies in the United States end in stillbirth, the death of an expected child at 20 weeks or more. That number has exceeded infant mortality every year for the last 10 years. It’s 15 times the number of babies who, according to the Centers for Disease Control and Prevention, died of Sudden Infant Death Syndrome, or SIDS, in 2020.

The deaths are not inevitable. One study found that nearly one in four U.S. stillbirths may be preventable. For pregnancies that last 37 weeks or more, that research shows, the figure jumps to nearly half. Thousands more babies could potentially be delivered safely every year.

But federal agencies have not prioritized critical stillbirth-focused studies that could lead to fewer deaths. Nearly two decades ago, both the CDC and the National Institutes of Health launched key stillbirth tracking and research studies, but the agencies ended those projects within about a decade. The CDC never analyzed some of the data that was collected.

Unlike with SIDS, a leading cause of infant death, federal officials have failed to launch a national campaign to reduce the risk of stillbirth or adequately raise awareness about it. Placental exams and autopsies, which can sometimes explain why stillbirths happened, are underutilized, in part because parents are not counseled on their benefits.

Federal agencies, state health departments, hospitals and doctors have also done a poor job of educating expectant parents about stillbirth or diligently counseling on fetal movement, despite research showing that patients who have had a stillbirth are more likely to have experienced abnormal fetal movements, including decreased activity. Neither the CDC nor the NIH have consistently promoted guidance telling those who are pregnant to be aware of their babies’ movement in the womb as a way to possibly reduce their risk of stillbirth.

The American College of Obstetricians and Gynecologists, the nation’s leading obstetrics organization, has been slow to update its own guidance to doctors on managing a stillbirth. In 2009, ACOG issued a set of guidelines that included a single paragraph regarding fetal movement. Those guidelines weren’t significantly updated for another 11 years.

Perhaps it’s no surprise that federal goals for reducing stillbirths keep moving in the wrong direction. In 2005, the U.S. stillbirth rate was 6.2 per 1,000 live births. The U.S. Department of Health and Human Services, in an effort to eliminate health disparities and establish a target that was “better than the best racial or ethnic group rate,” set a goal of reducing it to 4.1 for 2010. When that wasn’t met, federal officials changed their approach and set what they called more “science-based” and “realistic” goals, raising the 2020 target to 5.6. The U.S. still fell short. The 2030 goal of 5.7 was so attainable that it was met before the decade started. The 2020 rate, the most current according to the CDC, is 5.74.

By comparison, other wealthy countries have implemented national action plans to prevent stillbirth through awareness, research and care. Among other approaches, those countries have focused on increasing education around stillbirth and the importance of a baby’s movements, reducing rates of smoking and identifying fetuses that grow too slowly in the womb.

The efforts have paid off. The Netherlands, for instance, has reduced its rate of stillbirths at 28 weeks or later by more than half, from 5.2 in 2000 to 2.3 in 2019, according to a study published last year in The Lancet.

Dr. Bob Silver, chair of the obstetrics/gynecology department at University of Utah Health and a leading stillbirth expert, coauthored the study that estimated nearly one in four stillbirths are potentially preventable, a figure he referred to as conservative. He called on federal agencies to declare stillbirth reduction a priority the same way they have done for premature birth and maternal mortality.

“I’d like to see us say we really want to reduce the rate of stillbirth and raise awareness and try to do all of the reasonable things that may contribute to reducing stillbirths that other countries have done,” Silver said.

The lack of comprehensive attention and action has contributed to a stillbirth crisis, shrouded in an acceptance that some babies just die. Compounding the tragedy is a stigma and guilt so crushing that the first words some mothers utter when their lifeless babies are placed in their arms are “I’m sorry.”

In the hospital room, Amanda Duffy finally opened her eyes. She named her daughter Reese Christine, the name she had picked out for her before they found out she had died. She was 8 pounds, 3 ounces and 20 1/2 inches long and was born with her umbilical cord wrapped tightly around her neck twice. The baby was still warm when the nurse placed her in Amanda’s arms. Amanda was struck by how lovely her daughter was. Rosy skin. Chris’ red hair. Rogen’s chubby cheeks.

As Amanda held Reese, Chris hunched over the toilet, vomiting. Later that night, as he lay next to Amanda on the hospital bed, he held his daughter. He hadn’t initially wanted to see her. He worried she would be disfigured or, worse, that she would be beautiful and he would fall apart when he couldn’t take her home.

The nurses taught Amanda and Chris how to grieve and love simultaneously. One nurse told Amanda how cute Reese was and asked if she could hold her. Another placed ice packs in Reese’s swaddle to preserve her body so Amanda could keep holding her. Amanda asked the nurses to tuck cotton balls soaked in an orange scent into Reese’s blanket so the smell would trigger the memory of her daughter. And just as if Reese had been born alive, the nurses took pictures and made prints of her hands and feet.

“I felt such a deep, abiding love for her,” Amanda said. “And I was so proud to be her mom.”

On the way home from the hospital, Amanda broke down at the sight of Reese’s empty car seat. The next few weeks passed in a sleep-filled fog punctuated by intense periods of crying. The smell of oranges wrecked her. Her breast milk coming in was agonizing, physically and emotionally. She wore sports bras stuffed with ice packs to ease the pain and dry up her milk supply. While Rogen was at day care, she sobbed in his bed.

In the months that followed, Amanda and Chris searched for answers and wondered whether their medical team had missed warning signs. Late at night, Amanda turned to Google to find information about stillbirths. She mailed her medical records to a doctor who studies stillbirths, who she said told her that Reese’s death could have been prevented. They briefly discussed legal action against her doctors, but she said a lawyer told her it would be difficult to sue.

Amanda and Chris pinpointed her last two months of pregnancy as the time things started to go wrong. She had been diagnosed with polyhydramnios, meaning there was excess amniotic fluid in the womb. Her doctor had scheduled additional weekly testing.

One of those ultrasounds revealed problems with the blood flow in the umbilical cord. Reese’s cord also appeared to be wrapped around her neck, Amanda said later, but was told that was less of a concern, since it occurs in about 20% of normal deliveries. At another appointment, Amanda’s medical records show, Reese failed the portion of a test that measures fetal breathing movements.

At 37 weeks, Amanda told one of the midwives the baby’s movements felt different, but, she said, the midwife told her that it was common for movements to feel weaker with polyhydramnios. At that point, Amanda felt her baby was safer outside than inside and, her medical records show, she asked to schedule a C-section.

Despite voicing concerns about a change in the baby’s movement and asking to deliver earlier, Amanda said she and her husband were told by her midwife she couldn’t deliver for another two weeks. The doctor “continues to advise 39wks,” her medical records show. Waiting until 39 weeks is usually based on a guideline that deliveries should not happen before then unless a medical condition specifically warrants it, because early delivery can lead to complications.

Amanda would have to wait until 39 weeks and one day because, she said, her doctors didn’t typically do elective deliveries on weekends. Amanda was disappointed but said she trusted her team of doctors and midwives.

“I’m not a pushy person,” she said. “My husband is not a pushy person. That was out of our comfort zone to be, like, ‘What are we waiting for?’ But really what we wanted them to say was ‘We should deliver you.'”

Amanda’s final appointment was a maximum 30-minute-long ultrasound that combined a number of assessments to check amniotic fluid, fetal muscle tone, breathing and body movement. After 29 minutes of inactivity, Amanda said, the baby moved a hand. In the parking lot, Amanda called her mother, crying in relief. Four more days, she told her.

Less than 24 hours before the scheduled C-section, Reese was stillborn.

Four months after her death, Amanda, then a career advisor at the University of Minnesota, and Chris, a public relations specialist, wrote a letter to the University of Minnesota Medical Center, where Amanda had given birth to her dead daughter. They said they had “no ill feelings” toward anyone, but “it pains us to know that her death could’ve been prevented if we would have been sent to labor and delivery following that ultrasound.”

They noted that though they were told that Reese had passed the final ultrasound where she took 29 minutes to move, they had since come to believe that she had failed because, according to national standards, at least three movements were required. They also blamed a strict adherence to the 39-week guideline. And they encouraged the hospital staff to read more on umbilical cord accidents and acute polyhydramnios, which they later learned carries an increased stillbirth risk.

The positive feelings they had from speaking up were replaced by dismay when the hospital responded with a three-paragraph letter, signed by seven doctors and eight nurses. They said they had reexamined each medical decision in her case and concluded they had made “the best decisions medically possible.” They expressed their sympathy and said it was “so very heartwarming that you are trying to turn your tragic loss into something that will benefit others.”

Amanda felt dismissed by the medical team all over again. She didn’t expect them to admit fault, but she said she hoped that they would at least learn from Reese’s death to do things differently in the future. She was angry, and hurt, and knew that she would need to find a new doctor.

A spokesperson for the University of Minnesota Medical School told ProPublica she could not comment on individual patient cases and did not respond to questions about general protocols. “We share the physicians’ condolences,” she wrote, adding that the doctors and the university “are dedicated to delivering high quality, accessible and inclusive health care.”

For many expectant parents, it’s hard to muster the courage to call a doctor about something they’re not even sure is a problem.

“Moms self-censor a lot. No one wants to be that mom that all the doctors are rolling their eyes at because she’s freaking out over nothing,” said Samantha Banerjee, executive director of PUSH for Empowered Pregnancy, a nonprofit based in New York state that works to prevent stillbirths. Banerjee’s daughter, Alana, was stillborn two days before her due date.

In addition to raising awareness that stillbirths can happen even in low-risk pregnancies, PUSH teaches pregnant people how to advocate for themselves. The volunteers advise them to put their requests in writing and not to spend time drinking juice or lying on their side if they are worried about their baby’s lack of movement. In the majority of cases, a call or visit to the hospital reassures them.

But, the group tells parents, if their baby is in distress, calling their doctor can save their life.

Debbie Haine Vijayvergiya is fighting another narrative: that stillbirths are a rare fluke that “just happen.” When her daughter Autumn Joy was born without a heartbeat in 2011, Haine Vijayvergiya said, her doctor told her having a stillborn baby was as rare as being struck by lightning.

She believed him, but then she looked up the odds of a lightning strike and found they are less than one in a million — and most people survive. In 2020, according to the CDC, there was one stillbirth for about every 175 births.

“I’ve spoken to more women than I can count that said, ‘I raised the red flag, and I was sent home. I was told to eat a piece of cake and have some orange juice and lay on my left side,’ only to wake up the next day and their baby is not alive,” said Haine Vijayvergiya, a New Jersey mother and maternal health advocate.

She has fought for more than a decade to pass stillbirth legislation as her daughter’s legacy. Her current undertaking is her most ambitious. The federal Stillbirth Health Improvement and Education (SHINE) for Autumn Act, named after her daughter, would authorize $9 million a year for five years in federal funding for research, better data collection and training for fetal autopsies. But it is currently sitting in the Senate Committee on Health, Education, Labor, and Pensions.

Not all stillbirths are preventable, and medical experts agree more research is needed to determine who is most at risk and which babies can potentially be saved. Complicating matters is the wide range of risk factors, including hypertension and diabetes, smoking, obesity, being pregnant with multiples, being 35 or older and having had a previous stillbirth.

ProPublica reported this summer on how the U.S. botched the rollout of COVID-19 vaccines for pregnant people, who faced an increased risk for stillbirth if they were unvaccinated and contracted the virus, especially during the delta wave.

Doctors often work to balance the risk of stillbirth with other dangers, particularly an increased chance of being admitted to neonatal intensive care units or even death of the baby if it is born too early. ACOG and the Society for Maternal-Fetal Medicine have issued guidance to try to slow a rise in elective deliveries before 39 weeks and the potential harm that can result. The Joint Commission, a national accrediting organization, began evaluating hospitals in 2010 based on that standard.

A 2019 study found that the risks of stillbirth slightly increased after the rule went into effect, but fewer infants died after birth. Other studies have not found an effect on stillbirths.

Last year, the obstetric groups updated their guidance to allow doctors to consider an early delivery if a woman has anxiety and a history of stillbirth, writing that a previous stillbirth “may” warrant an early delivery for patients who understand and accept the risks. For those who have previously had a stillbirth, one modeling analysis found that 38 weeks is the optimal timing of delivery, considering the increased risk of another stillbirth.

“A woman who has had a previous stillbirth at 37 weeks — one could argue that it’s cruel and unusual punishment to make her go to 39 weeks with her next pregnancy, although that is the current recommendation,” said Dr. Neil Mandsager, a maternal-fetal medicine specialist in Iowa and a medical advisor to a stillbirth prevention nonprofit.

At or after 40 weeks, the risk of stillbirth increases, especially for women 35 or older. Their risk, research shows, is doubled from 39 weeks to 40 and is more than six times as high at 42 weeks. In 2019 and 2020, a combined 1,200 stillbirths occurred between 40 and 42 weeks, according to the most recent CDC data.

Deciding when a patient should deliver entails weighing the risks to the mother and the infant against a possible stillbirth as the pregnancy continues, said Dr. Mark Turrentine, chair of ACOG’s Clinical Consensus Committee-Obstetrics, which helped create the guidance on managing a stillbirth. He said ACOG has addressed stillbirth in other documents and extensively in its 2021 guidance on fetal surveillance and testing, which is done to reduce the risk of stillbirth.

ACOG said it routinely reviewed its guidance on management of stillbirth but was unable to make significant updates “due to the lack of new, evidence-based research.” While prevention is a great concern to ACOG, Turrentine said it’s difficult to know how many stillbirths are preventable.

He said it’s standard practice for doctors to ask about fetal movement, and ACOG updated its guidance after new research became available. Doctors also need to include patients in decision-making and tailor care to them, he said, whether that’s using aspirin in patients at high risk of preeclampsia — a serious high blood pressure condition during pregnancy — or ordering additional tests.

After Reese’s death, Amanda and Chris Duffy wanted to get pregnant again. They sought out an obstetrician-gynecologist who would educate and listen to them. They set up several consultations until they found Dr. Emily Hawes-Van Pelt, who was recommended by another family who had had a stillbirth.

Hawes-Van Pelt cried with Amanda and Chris at their first meeting.

“I told her I was scared to be involved,” Hawes-Van Pelt said. “It’s such a tricky subsequent pregnancy because there’s so much worry and anxiety about the horrible, awful thing happening again.”

Amanda’s fear of delivering another dead baby led to an all-consuming anxiety, but Hawes-Van Pelt supported her when she asked for additional monitoring, testing and an early delivery.

When Hawes-Van Pelt switched practices midway through Amanda’s pregnancy, Amanda followed her. But the new hospital pushed back on the early delivery.

“We intervene early for poorly controlled diabetes,” Hawes-Van Pelt said. “We intervene early for all sorts of medical issues. Anxiety and prior stillbirth are two medical issues that we can intervene earlier for.”

Hawes-Van Pelt said she learned a lot from caring for Amanda, who made her reevaluate some of her own assumptions around stillbirths.

“I had a horrible fear of scaring women unnecessarily, and then realized that I was just not preparing women or educating them because of my own fears around it,” she said. “If you can carry a human being in your body and birth that human being and take care of it, you can hear those words.”

The hospital eventually agreed to let Hawes-Van Pelt schedule Amanda for a 37-week C-section. But after Amanda was again diagnosed with polyhydramnios, she went in for a C-section even earlier. She gave birth in 2015 to a healthy boy she and Chris named Rhett. Two years later, Amanda and Hawes-Van Pelt followed the same pregnancy plan, and she delivered a girl named Maeda Reese. Amanda chose the name because, when said quickly, it sounds like “made of Reese.”

Federal agencies, national organizations and state and city officials have mobilized in recent years to address maternal mortality, when mothers die during pregnancy, at delivery or soon after childbirth. They have focused on improving data collection, passing legislation and creating awareness campaigns that encourage medical professionals and others to listen when women say something doesn’t feel right.

In 2017, ProPublica and NPR documented the U.S. maternal mortality crisis, including alarming racial disparities.

According to CDC data, Black women face nearly three times the risk of maternal mortality. They also are more than twice — and in some states close to three times — as likely to have a stillbirth than white women, meaning not only are Black mothers dying at a disproportionate rate, so are their babies.

Janet Petersen, a state senator from Iowa, said it gives her hope to see how the country has turned its attention to maternal mortality and disparities in health care. She simply cannot understand why stillbirth isn’t being met with the same urgency.

In 2020, the CDC reported 861 mothers died either while pregnant or within six weeks of giving birth. That same year, 20,854 babies were stillborn.

Stillbirth, Petersen said, is a missing piece of the puzzle. Research shows the likelihood of severe maternal complications was more than four times higher for pregnancies that ended in stillbirths, and mothers who died within six weeks of delivery were more likely to have had a stillbirth.

“We see it over and over again that stillbirth is one of the maternal health care issues that continuously gets ignored,” said Petersen, a Democrat.

Petersen was a young legislator in 2003 when her daughter Grace was born still. Devastated, she thought of her grandmother, who lost a baby to stillbirth in 1920, just a few weeks before women got the right to vote.

“I was laying in my hospital bed thinking, ‘How could this still be happening in our country?'” Petersen recalled. “And it seemed, from the medical perspective, that, well, stillbirth happens. We can’t do anything to prevent them.”

Over the next few months, Petersen heard from other mothers who had lost their babies and wanted to spark change. As an elected official, Petersen was in a position to do that. In 2004, she introduced legislation that required the Iowa Department of Public Health to create a stillbirths work group, later securing funding through the CDC to create a stillbirth registry.

But the CDC didn’t renew the funding and never analyzed the data from the registry, though a CDC spokesperson said the Iowa Department of Public Health examined the data. Officials from the department did not respond to requests for comment.

Petersen and her fellow mothers pivoted. After hearing how researchers in Norway were able to increase awareness around fetal movement, they co-founded a nonprofit aimed at doing the same in the U.S.

The group, Healthy Birth Day, created colorful “Count the Kicks” pamphlets — and later an app — teaching pregnant people how to track a baby’s movements and establish what is normal for them. Monitoring a baby’s movements is the earliest and sometimes only indication that something may be wrong, said Emily Price, chief executive officer of Healthy Birth Day. One of the organization’s main messages is for pregnant people to speak up and clinicians to listen.

“Unfortunately, there are still doctors who brush women off or send them home when they come in with a complaint of a change in their baby’s movements,” Price said. “And babies are dying because of it.”

One Indiana county, which recorded 65 stillbirths from 2017 through 2019, reported that 74% had either some chance or a good chance of prevention, according to St. Joseph County Department of Health’s Fetal Infant Mortality Review program. For mothers who experienced decreased fetal movement in the few hours or days before the stillbirth, that estimate jumped to 90%.

Although there is not a scientific consensus that kick counting can prevent stillbirths, national groups, including ACOG, recommend that medical professionals encourage their patients to be aware of fetal movement patterns. ACOG also advises medical professionals to be attentive to a mother’s concerns about reduced movement and address them “in a systematic way.”

One complaint the CDC hears too often, an agency spokesperson said, is that pregnant people and those who gave birth recently find that their concerns are dismissed or ignored. “Listening and taking the concerns of pregnant and recently pregnant people seriously,” she said, “is a simple, yet powerful action to prevent serious health complications and even death.”

The CDC, she said, is “very interested” in expanding its research on stillbirth, which is “a crucial part of the development of any awareness or prevention campaigns.” In addition to working to improve its stillbirth data quality, the agency has funded some pilot programs at the city and state level to better track stillbirths, survey people who have had a stillbirth and research risk factors and causes. The Iowa registry, she said, led the CDC to fund different research projects in Arkansas and Massachusetts, which are ongoing.

In 2009, the CDC acknowledged that fetal mortality remained a “major, but often overlooked, public health problem.” Officials wrote that much of the public health concern had been focused on infant mortality “in part due to lesser awareness of the magnitude of fetal mortality, its causes, and prevention strategies.”

But little has changed over the past 13 years. Echoing its earlier message, the CDC this year declared that “much work remains” and that “stillbirth is not often viewed as a public health issue, so increased awareness is key.”

A spokesperson for the Eunice Kennedy Shriver National Institute of Child Health and Human Development, which is part of the NIH, said the agency has continually funded research on stillbirths, even after one of its key studies ended. The agency, she said, also supports research on conditions that increase the risk of stillbirth.

As a scientific research institute, it does not issue clinical guidelines or recommendations, she said, though it did launch the Safe to Sleep campaign in 1994, two decades after Congress put it in charge of SIDS federal research efforts. That campaign, which educates parents and caregivers on ways to reduce the risk of SIDS, highlights recommendations issued by the American Academy of Pediatrics. She said the agency will continue to collaborate with organizations that raise awareness about stillbirth and other pregnancy complications “to amplify their messages and efforts.”

“NICHD continues to support research on the prevention, causes, frequency, and risk factors of stillbirth,” the spokesperson said in an email. “Our commitment to enhancing understanding of stillbirth and improving outcomes focuses on building the scientific knowledge base.”

But getting laws on the books that could raise awareness around stillbirth — even when they don’t require additional funding — has been a struggle. Petersen and Price are pushing Congress to pass legislation that would add stillbirth research and prevention to the list of activities approved for federal maternal health dollars.

Though the bill doesn’t ask for any additional funding, it has not yet passed.

In addition, the SHINE for Autumn Act breezed through the House of Representatives in December 2021. After Haine Vijayvergiya, the New Jersey mother who has championed it, secured bipartisan support from U.S. Sens. Cory Booker, D-N.J., and Marco Rubio, R-Fla., she thought the most comprehensive stillbirth legislation in U.S. history would finally become law.

Neither bill has sparked controversy.

But months after press releases announced the SHINE legislation and referred to the U.S. stillbirth rate as “unacceptable,” lawmakers and the families they represent are running out of time as this session of Congress prepares to adjourn.

“From the day that the bill was introduced into the Senate,” Haine Vijayvergiya said, “approximately 13,000 babies have been born still.”

Last month, on a brilliant fall day much like the one when Reese was stillborn, Amanda Duffy bent down to kiss her son Rogen’s head before they walked on stage.

She wore a soft blue T-shirt tucked into her jeans that read “Be courageous.” The message was as much for her as it was for the crowd on the National Mall in Washington, D.C., many of them like her, mothers who didn’t know stillbirth happened until it happened to them. Since Reese’s death, she has coached doctors and nurses on improving care for patients who have suffered pregnancy loss. Among her many suggestions, she tells them their first words when a concerned patient reaches out should be “I’m so glad you called.”

A few hundred people had gathered for The Big PUSH to End Preventable Stillbirth, billed as the first-ever march on the issue. As part of an art installation, Amanda wrote a note to Reese: “You’re pretty magical & for that I’m grateful. You’re a change maker and you are so very loved. Love, Mama.” Before she slipped the folded paper into a sea of more than 20,000 baby hats, Rogen added his own message: “Hope you are having a good time — Rogen.”

Reese would have turned 8 this month.

Before Amanda spoke, she took a deep breath and silenced her nerves. She walked onto the stage and called on Congress to pass the stillbirth legislation before it. She didn’t ask. She demanded.

“It’s time to empower pregnant people and their care providers with information that leads to prevention,” she insisted.

With the afternoon sun bearing down, Amanda and Rogen disappeared into the crowd of families marching toward the Capitol. Many carried signs. Some pushed empty strollers. Amanda was still wearing the orange-scented oil she had rubbed on her wrists that morning.

Elizabeth Warren sounds the alarm on GOP plot to “blow up the economy” to help Trump win in 2024

Sen. Elizabeth Warren on Sunday said congressional Democrats should use the upcoming lame-duck session to eliminate the U.S. debt ceiling for good, warning that leaving the borrowing limit intact gives Republicans an opening to hold the economy hostage.

“I’d get rid of the debt ceiling altogether,” Warren, D-Mass., told NBC’s Chuck Todd, arguing that the arbitrary limit “serves no function except to create leverage for people who are willing to blow up the economy.”

“And that’s the problem we’ve got right now,” Warren continued. “Many of these new Republicans who are coming in are people who are coming in with exactly one goal: Get Donald Trump elected in 2024. And they see that if they can create chaos in the economy, then they think that may move Donald Trump one inch closer to election. So, we’ve got to take that away from them, take care during the lame duck—take care of raising the debt limit or getting rid of it altogether.”

The U.S. is expected to reach the debt ceiling—which dictates how much money the Treasury Department can borrow to meet the country’s obligations—at some point early next year, once again raising the prospect of a default that would be disastrous for the U.S. economy, wiping out millions of jobs and eliminating trillions of dollars in household wealth.

Speaking to reporters on Sunday, U.S. Treasury Secretary Janet Yellen said she supports congressional action to raise the debt ceiling during the lame-duck session. Yellen has previously backed calls to completely abolish the debt ceiling, a proposal that President Joe Biden opposes.

“I think it’s just compromising the credit of the United States,” Yellen said Sunday. “Casting doubt on the willingness of the United States to pay its debt is a devastating economic self-inflicted blow.”

In the run-up to last week’s midterm elections, top Republicans in the House—including the lawmaker in line for speaker, Rep. Kevin McCarthy, R-Calif.,—suggested they would be willing to use the debt ceiling as leverage to pursue cuts to Social Security, Medicare, climate investments, and potentially other spending.

While Republicans won far fewer House seats than expected, they’re still favored to take narrow control of the chamber, leaving Democrats with dwindling time to prevent GOP debt ceiling brinkmanship.

Asked Sunday whether the Senate will to act on the debt ceiling during the lame-duck session, Majority Leader Chuck Schumer, D-N.Y., said it is “something that we will look at over the next few weeks.” House Speaker Nancy Pelosi, D-Calif., told ABC on Sunday that the House’s “best shot” at raising the limit “is to do it now.”

“There’s great risk to even discussing not doing it,” said Pelosi, pointing to the destructive 2011 standoff over the debt ceiling, which allowed Republicans to force spending cuts. “So this is dealing with fire when we’re talking about the stability of our credit rating.”

During an event at AFL-CIO headquarters in Washington, D.C. on Sunday, Congressional Progressive Caucus chair Rep. Pramila Jayapal, D-Wash., signaled that abolishing the debt ceiling is part of the bloc’s policy agenda.

Last month, dozens of congressional Democrats implored their party’s leaders to “take legislative action that will permanently undo the threat posed by the debt limit”—a call that Social Security defenders echoed.

“Democrats, including President Joe Biden, focused heavily on Social Security during the campaign,” Alex Lawson, executive director of Social Security Works, said in a statement last week. “They made sure voters knew about Republican threats to the program, and promised that Democrats would protect Social Security.”

“Now,” Lawson added, “it’s time for Democrats to keep that promise by raising or eliminating the debt ceiling in the final months of the year, so that Republicans can’t use it as leverage to force cuts to Social Security and Medicare.”

How title lenders trap poor Americans in debt with triple-digit interest rates

When Robert Ball turned 63, he was looking forward to retirement in his wife’s hometown of Savannah, Georgia. The couple had a comfortable house with a lush garden, the certainty of his pension and the hope of spending more time with their grandchildren.

That dream shattered when Ball’s wife, Gloria Ball, developed severe health problems. They faced huge medical bills, yet their bank refused to refinance their mortgage. Left with few options for raising cash, Robert Ball drove to TitleMax, a business that prospers in Georgia’s banking deserts and lends money at terms that would be illegal for other financial institutions. “I was desperate” for quick cash, Ball said. “They welcome folk like me.”

In July 2017, Ball signed a contract to receive $9,518 from TitleMax in exchange for a lien on the title to his 2006 Honda Ridgeline truck, money that the couple used to pay for Gloria’s medical needs. The terms of Ball’s contract were typical for TitleMax, specifying that he would have to repay the money plus interest in 30 days. But the store manager explained that, as long as he paid $1,046 each month, he could extend the contract indefinitely and keep his car — on which he had no other debt — from being repossessed by the company. What the manager did not mention, Ball said, was that his payments would only cover interest.

For two years, Ball made his payments diligently, court records show. Then the company told him something that nearly made him fall down: Even though he had paid more than $25,000 by then, his principal hadn’t budged.

TMX Finance, TitleMax’s parent company, calls itself a community resource to its 293,000 customers, people written off as credit risks by traditional lending institutions but who need financing to pay for life’s basic needs. As the nation’s largest title lender, TitleMax thrives on an innovative business model that lends money to risky clients in exchange for collateral: the title to the vehicle in which the customers drove to the store. In 2019, TMX Finance reported $910 million in revenue, primarily from its TitleMax brand.

Rather than seeing the company as a force for good, a growing consortium of lawmakers, religious leaders and consumer advocates believe TitleMax, and its industry writ large, to be predatory leeches on the growing ranks of working-class Americans. More than 30 states prohibit title lending or have laws inimical to the industry. In 2016, TMX Finance paid a $9 million fine, approximately 1% of the company’s revenue that year, to the federal Consumer Financial Protection Bureau, which ruled that the company misled customers about the full costs of its loans in Georgia, Alabama and Tennessee. Since then, at least five states have passed laws capping interest rates that title lenders can charge at 36% per year.

Georgia, however, has bucked this trend. Nearly two decades ago, the state made it a felony to offer high-interest payday loans that state lawmakers described as usurious. Yet state law allows title lenders to charge triple-digit annual interest rates. This has helped the industry grow like kudzu throughout the state, which is home to three of the nation’s top title lenders.

The Current and ProPublica spent seven months examining the operations of TitleMax, the dominant industry player in Georgia, based on hundreds of pages of internal company documents, interviews with current and former company officials and an analysis of storefront locations as well as vehicle lien records from the Georgia Department of Revenue’s motor vehicle division. The investigation offers for the first time a window into the scope and scale of the company in the state, as well as the impact on its target customers: the working poor and communities of color.

The Peach State is TMX Finance’s second-largest market, accounting for 20% of its business volume as of June, according to a financial ratings report by S&P Global Ratings. Only Texas, which has nearly three times the population of Georgia, was larger, representing 32% of the company’s business volume. From July 2019 through June 2022, roughly 210 TMX Finance stores in Georgia issued new “title pawns” for approximately 47,000 vehicles annually, under brand names TitleMax and TitleBucks. They represented more than 60% of the state’s total volume.

Annual interest rates in typical TitleMax contracts ranged from 119% to 179%, and title pawns — even though they are structured to last only 30 days— often remain active for multiple months, or even years.

Despite offering a product that customers say feels like a loan, TitleMax and its competitors aren’t considered lending institutions under state law. Instead, the title-lending industry works under Georgia’s pawn shop statutes, a loophole that exempts it from the usury laws and state oversight that other subprime lenders in Georgia must operate under. Title pawn contracts, meanwhile, are not amortized like home mortgages, which offer customers a set schedule to pay off their loans. Critics say this practice creates a debt trap — which is profitable for companies and bad for consumers like Ball.

TMX Finance did not respond to repeated requests for comment on a detailed list of questions about the company’s operations.

“Privately there is not a legislator in Georgia who doesn’t feel like it is a scourge on our state, but publicly there aren’t many willing to take on” the title-lending industry, said Liz Coyle, the executive director of Georgia Watch, a consumer advocacy group that has pushed for regulatory reform for title lenders for roughly 15 years. “Their clout is too great, and political will is too weak.”

State Sen. Lester Jackson, a Black military veteran who represents Savannah, has voted against more regulation for his hometown company, arguing that title lenders fill a necessary gap for his constituents, given the lack of equity in the traditional banking sector.

“Banking deserts are real” in Georgia, said Jackson, a Democrat. “Sometimes, this is all that the community has.”

​​For customers like Ball, the power imbalance favoring TitleMax in Georgia feels like being caught in an undertow.

At age 71, Ball declared bankruptcy, seeking relief from his debt burden. Even then, TitleMax pursued him. The company threatened to repossess his car, sell it and keep the profit. It then went to court to assert its right to do so — and won.

Past the gilded dome of Savannah’s city hall and along the azalea-lined Johnson Square sits an unobtrusive two-story brick building from which privately held TMX Finance and its founder and sole shareholder Tracy Young run the nation’s largest title lender.

Unlike other Savannah-based corporations, TMX Finance and its biggest brand, TitleMax, keep a low profile. No corporate sign graces its headquarters. The company rarely sponsors local charity events. When TMX Finance needed money to expand its business operations, it turned to private investors rather than a public stock listing. When it’s sued, the company moves swiftly to seal documents that might reveal even its most mundane business details.

Young, a one-time pawn shop owner, relied on this impenetrable business culture as he built the company from two retail locations in Savannah and Columbus, Georgia, in 1998 into a national juggernaut. The company now operates in 16 states and has nearly 1,000 stores. In 2019, TMX Finance reported its most successful year ever, according to S&P, with revenue topping $900 million that year. (Revenue dropped to $753 million in 2020, the first year of the COVID-19 pandemic, and then to $712 million in 2021, after the company closed operations in three states after regulations there were tightened.)

Georgia has emerged as a critical profit center for TitleMax, with some stores making more than $1 million in gross revenue per year, according to tax documents and former store managers who requested anonymity to speak about internal company procedures. That’s despite Georgia’s history as a vanguard against some parts of the fringe financial services industry.

In 2004, Georgia lawmakers cracked down on payday lending, an industry that offered triple-digit-interest loans to people in need of cash in between paychecks. They closed loopholes that had allowed the industry to evade long-standing usury laws in the state and made offering payday loans a felony. The lawmakers — many of them proud churchgoers — considered such loans to be both unchristian and unfair, according to Chuck Hufstetler, a Republican state senator who has voted for more regulation for title lenders.

The Georgia Department of Banking and Finance regulates and licenses other subprime lenders that offer loans to customers considered high risk. For instance, the 166 installment lenders working in the state are subject to Georgia’s usury cap of 60% annually, including interest and fees.

Yet lawmakers in Atlanta also passed a law that allowed the burgeoning title-lending industry to operate outside these regulations. Since then, TitleMax and at least 90 other title-lending companies in Georgia have operated under state pawn shop statutes, rather than financial or banking laws.

The bar to open a title-lending business in Georgia is low. A company must apply for a pawn shop license for their employees from the local government in the city or county where they work. With that in place, “title pawn” stores can offer customers a 30-day contract at an interest rate up to 25%. State law allows these contracts to be renewed for an additional two months at that same monthly interest rate. After that, additional renewals have a lower interest cap of 12.5% per month, but that combined rate — up to 187.5% annually — is still far above the usury caps for other types of lenders in Georgia. Title lenders have no obligation to assess customers’ credit or their ability to repay what they borrow or to report the number of title pawns issued to state regulators.

Only a few states offer similarly permissive operating landscapes for title lenders. Alabama, the only other state where the industry works under pawn shop statutes, allows title pawns with up to 300% annual percentage rates. Texas also permits triple-digit rates, with no caps on the total amount of title loans or their fees.

At least 20 states have laws that cap interest rates at 36% or less per year for title lenders — or 3% per month. Several other states have set loan terms for fixed periods or require the principal to be paid down as a condition of renewal, which limits customer costs of borrowing and title lenders’ maximum profit.

The increased regulations coincide with a growing body of evidence about the harm that subprime lenders like title-lending companies have on local communities and economies.

Illinois’s path to regulating the industry is instructive. In 2012, when TMX Finance executives identified the state as a growth market, regulators were already putting into place rules that mandated reporting from subprime lenders like title-lending companies working in the state.

In 2020, Illinois church groups and state lawmakers reviewed nearly a decade’s worth of data and became alarmed. High interest rates and fees charged by title lenders were exacerbating pockets of poverty, especially in minority neighborhoods, according to Brent Adams, the then-state official who helped devise the reporting regulations. Individual families were more indebted, and fees they paid were largely going to out-of-state lenders, leaving less money to be spent in local businesses. Moreover, customers who couldn’t keep up with their payments to title lenders would lose a working family’s most important asset: their vehicle. Without a car, a parent could be unable to hold down a job or get children to doctors or school, he said.

“It is difficult to craft a data argument for these products. Practically everyone you talk to pays three times the amount of the loan to get out of a title loan,” said Adams, who is now senior vice-president for policy and communications for the Woodstock Institute, an Illinois-based economic think tank. “Some people will say they had a good experience, but the percentage of people who report an abusive relationship with title lenders is so much higher. The disparities are extreme.”

In early 2021, the Illinois legislature passed a 36% interest rate cap, dismissing arguments from TitleMax and its industry that such a move would put them out of business. That year, TMX Finance stopped making new loans in the state. Virginia and California passed similar interest rate caps, moves that led TitleMax to close operations in those states as well, according to state officials and the company’s website.

A similar attempt in Georgia in 2020 died after TMX Finance’s then-chief legal officer testified at a state senate committee hearing that TitleMax needed to charge high interest rates given the risk profile of its customers. State senators did not press the company for more detail, nor did any senator offer up dissenting data.

Over the last 16 years, at least five attempts in Georgia to pass legislation regulating interest rates charged by title lenders or reclassify them under financial lending rules have wilted under industry pushback. TitleMax, for one, says strict interest rate caps would endanger the approximately 700 jobs the company provides to Georgians.

Tameka Rivers, a middle-aged Black woman who lives in east Savannah, has been paying off a TitleMax pawn for more than two years. Rivers said she was desperate for $2,000 back in 2019 to help her adult daughter, who was expecting a baby and needed a place to live. A single mother working two jobs to provide for an extended family, Jones didn’t have savings to help provide her daughter with a security deposit for her apartment lease. She also didn’t have relatives she could rely on for help.

Rivers remembered hearing TitleMax’s signature advertisement on the radio: “Get your title back with TitleMax,” goes the catchy jingle. That was enough for her to drive over to the TitleMax store on Skidaway Road, a mile from Georgia’s oldest historically Black university, to see if they could help.

“It seemed straightforward enough at the time,” Rivers said. “They didn’t ask me a lot of questions about my life, and, boy, we needed the cash.”

Consumer advocates in Georgia have long argued that struggling families like Rivers’ deserve better financial options than the one TitleMax and its industry offer. Yet revealing the scope of the impact title lenders have on these families is challenging because of the lack of public data on the industry.

The Current and ProPublica identified roughly 500 title pawn stores, which span the majority of Georgia’s 159 counties, including at least a dozen locations in Atlanta and Savannah, as well as in rural areas in and around Ellijay and Vidalia.

Georgia does not officially track the number of title pawns issued by these stores. The analysis of the records of vehicle liens placed by these companies reveals new title pawns for roughly 75,000 vehicles per year since mid-2019, when the state implemented a new system for tracking vehicle ownership information. That figure is likely an underestimate of the total number of title pawns, since the analysis does not include repeat customers.

The industry is thriving at a time when the number of traditional banking locations in Georgia has declined by 22% in the last decade, according to the Federal Deposit Insurance Corporation. A 2021 FDIC survey found that 6.7% of Georgians lack bank accounts. That statistic is roughly twice as high — 13.3% — for Black households.

Title lenders are disproportionately located in communities of color and low-income areas, according to an analysis by The Current and ProPublica. Roughly three-quarters are in ZIP codes with incomes below the state’s median income.

But the industry’s impact on these communities isn’t captured fully by where they have storefronts. Equally crucial is how many months customers continue to pay, according to current and former industry officials.

Back in 2009, then-TMX Finance President John Robinson explained to the company’s creditors that repeat customer fee payments were the crux of TitleMax’s business plan. We “recover in excess of 100% of the face value of the Customer Loans,” he wrote in an affidavit. “The average thirty (30) day loan is typically renewed approximately eight (8) times, providing significant additional interest payments.”

Rivers told The Current and ProPublica that she wasn’t offered a formula describing how she would pay off her pawn. Instead, she said, the store manager emphasized the relatively low monthly payments of $249. Rivers said she doesn’t recall anyone explaining the difference between a payment that covered interest and one that included paying down her principal. After the manager talked through the monthly payment, she signed a contract on the store’s digital tablet. She had access to her data via a company app, which also allowed her to make payments electronically. But she rarely used the app and generally paid her monthly payments in cash.

Ten months later, after Rivers had paid TitleMax more than the $2,000 she had borrowed, Rivers talked to the manager who had set up her contract. That’s when she realized that she had only been paying interest and still owed the original pawn amount.

When Rivers complained about feeling deceived and asked for help working out a repayment plan to get out of debt, TitleMax wasn’t willing to help, she said.

District directors have the authority to rewrite contracts, but rarely do, according to two former managers who worked in Savannah and Columbus and who requested anonymity to speak about internal company procedures.

In October, Rivers’ daughter went to the hospital for a cesarean section, and now Rivers is helping care for a newborn, as well as four other grandchildren, while trying to juggle vocational school courses. She doesn’t know where she’s going to scrape together money to get rid of the TitleMax debt, she said.

Consumers who feel taken advantage of by title lenders in Georgia have a very narrow avenue for pursuing their complaints.

The CFPB, the federal agency created to protect consumers from big financial organizations in the wake of the 2008 global financial crisis, launched its investigation into TMX Finance, in part, due to consumer complaints amassed by Georgia Watch, the state’s most prominent consumer advocate. The company denied any wrongdoing, but the CFPB ruled in 2016 that it had deceived customers in Georgia, Alabama and Tennessee by masking the true cost of title loans. This did not impact individual cases, however, and the company’s $9 million fine was not paid out as restitution for individuals, instead going into an agency-controlled fund.

At the state level, the website for the Consumer Protection Division of the Georgia Attorney General’s Office has a whole page devoted to title pawns — but it is not directly linked from its homepage.

On that page, the agency categorizes title lenders as a fringe banking product similar to a “payday loan,” a product illegal in Georgia. It recommends that Georgians in need of emergency finance consider multiple alternatives, such as asking a relative for money or approaching a credit union, before turning to subprime financial products like title pawns.

For those who don’t find alternatives, the agency’s website offers straightforward guidance: If customers think their title lender violated the law, they “should notify the local criminal authorities for the city or county in which the title pawn company is doing business.”

Outside of metro Atlanta, few law enforcement bodies across Georgia’s 159 counties have robust white-collar or financial crime department or an investigator specialized in such crimes. LaGrange Police Chief Louis Dekmar, who has led the northwest Georgia department for nearly 30 years, said he doesn’t know of any local district attorneys who have filed charges against title lenders. The probability of that happening is slim, according to Dekmar and two other veteran Georgia police officials. Title pawn customers who may be victims “generally don’t know how to report something like that,” said Dekmar, a former president of the International Association of Chiefs of Police.

Meanwhile, the state attorney general’s office has not investigated TitleMax, despite the CFPB findings of abusive practices and that agency’s ongoing investigation, according to an official in the office.

The attorney general’s office has taken action against two other title lenders. In 2017, it settled with a TitleMax rival, Tennessee-based First American Title Lending of Georgia, for more than $220,000 to resolve allegations that the company had threatened individuals who were delinquent in repayments with criminal arrest warrants and by marketing its products as “loans” instead of “pawn transactions.” In the settlement, First American admitted no wrongdoing.

In 2018, the attorney general’s office reached a settlement with Georgia-based title-lending company Complete Cash Holdings and its owner Kent Popham, who agreed to pay a total of $35,000 “in response to allegations that it engaged in unlawful practices” against customers who had defaulted on their title pawn contracts. The company earlier denied wrongdoing.

“Consumers who seek out title pawns are already in financial straits,” Attorney General Chris Carr said in a press statement at the time. “Our office is committed to protecting vulnerable consumers from companies that try to take advantage of them through illegal actions.”

On other occasions, however, Carr’s office did not act. For instance, a testy five-year civil lawsuit in Fulton County Superior Court between TitleMax and subsidiaries of Alpharetta-based Select Management Resources surfaced a number of allegations of illegal behavior, including bribery and stealing customer information. TitleMax denied the allegations, and the two sides ultimately settled and moved to dismiss all allegations with prejudice in 2019. Kara Richardson, a spokesperson for the attorney general, said her office was aware of the case but declined to comment on specific allegations against those two companies.

Coyle, the head of Georgia Watch, said she’s disappointed that weak consumer laws tie prosecutors’ hands. “Municipalities can only do so much,” she said, referring to what she calls abusive behavior by the title-lending industry.

Sitting at his tidy ranch house in a leafy neighborhood in south Savannah, Robert Ball has a difficult time describing just how shocking it was when he realized in the summer of 2019 the extent of his debt with TitleMax.

Ball had become his wife’s full-time caregiver. Gloria was frail and barely had energy to get out of bed. Doctors had told him she had little time left. His sorrow was compounded by a second fear. Amid their increased medical bills, Robert had fallen behind on their mortgage payments. “When I was coming up, there were not a lot of Black folks who owned their home. If you have that roof, that is a sacred thing,” he said. “I was facing the loss of my wife. No way I could handle losing our home as well.”

On July 1, 2019, before the Fourth of July holiday weekend, Ball went to the TitleMax store on Abercorn Street to make his usual monthly payment. He asked the manager he had dealt with for two years just how much more was left on his debt. The manager looked up his account on her computer screen and delivered the crushing news.

Ball’s principal remained at $9,516 — just $2 less than the original amount of his pawn, according to court documents.

It had never occurred to Ball that his dedicated monthly payments weren’t paying down his principal. He assumed that, like a bank loan, if he paid what TitleMax told him to, he would eventually pay off the debt.

“It was a terrible feeling. I mean, I worked my whole life, for 38 years. I thought we were going to enjoy our retirement together. Instead, we were facing this kind of catastrophe. It’s a shameful situation for people like us — to be in debt,” Ball recalled.

He argued with the manager, but that didn’t change the ledger on her computer screen.

Ball didn’t know how to get his financial affairs in order, all while tending to his dying wife. He then got some unsolicited advice from a friend: Declare bankruptcy and try to get into a debt repayment plan. In Georgia, individuals who file for Chapter 13 bankruptcy work through a federal trustee to create a court-approved plan to repay creditors, often at steeply reduced rates. This was a solution, his friend advised, to keep the family house safe.

Ball, who spent his life as a medical tech delivering blood for the Red Cross, swallowed his pride and did it.

But the U.S. trustee appointed to Ball’s case had some more unwelcome news. His TitleMax pawn couldn’t be wrapped into a settlement with creditors. The company had status as a secured creditor due to Georgia’s pawn statutes, and would have to be paid back first and at the original terms of the title pawn.

Lorena Saedi, a bankruptcy lawyer and managing partner of Saedi Law Group in Atlanta, said stories like Ball’s are not unusual. At least once a week, she sees clients who are struggling with debt traps set by title lenders, and around a third of her bankruptcy cases include title lenders.

“There is no recourse. Title lenders operate a business that, while obviously immoral, is entirely legal in Georgia. It’s a terrible place to be powerless, poor or just down on your luck,” Saedi said.

Six months after Robert Ball filed for bankruptcy, Gloria died. Ball eventually paid off TitleMax.

Now, the 75-year-old spends his time trying not to drown in bitterness. Spending time with his daughter and grandchildren helps. Yet as he crawls out of the seven-year credit shadow caused by his bankruptcy, Ball prays that his old car doesn’t break down, and that he doesn’t need any expensive medical help himself.

“I have no safety net. I only have Jesus,” Ball said.

With 10k layoffs looming, Jeff Bezos grants Dolly Parton millions and pledges his fortune to charity

Jeff Bezos is raising not more than a few eyebrows with his latest pronouncement.

In a CNN interview on Saturday, the Amazon founder claimed he plans to donate the bulk of his $124 billion fortune to charity focused on fighting climate change and supporting “people who can unify humanity in the face of deep social and political divisions.”

The recent pledge marks the first time Bezos has explicitly announced that he’ll give away most of his lifetime wealth. It also precedes a new report from The New York Times, which details Amazon’s plans to lay off as many as 10,000 employees this week. The cuts will likely affect the company’s devices business (which includes numerous Alexa-powered products), human resources and its retail unit.

Bezos, alongside his partner Lauren Sánchez, told CNN’s Chloe Melas that they are “building the capacity to be able to give away this money.” One avenue is via the Bezos Courage and Civility Award, which was awarded to legendary singer-songwriter Dolly Parton on Saturday. The $100 million philanthropic grant was previously given to chef Jose Andrés, who has used some of the money delivering food relief to Ukrainian refugees, and CNN contributor Van Jones, who is also a criminal justice system reform advocate.

“When you think of Dolly. Look, everyone smiles, right?” Sánchez said during the interview, which aired on Monday. “She is just beaming with light. And all she wants to do is bring light into other people’s worlds. And so we couldn’t have thought of someone better than to give this award to Dolly, and we know she’s going to do amazing things with it.”

Parton took to Twitter after receiving her award, writing, “I try to put my money where my heart is. I will do my best to do good things with this money. Thank you @JeffBezos #LaurenSanchez”

The country superstar is well known and beloved for her philanthropy. Amid the ongoing pandemic, Parton donated $1 million to Vanderbilt University Medical Center, which partly went towards funding Moderna’s COVID-19 vaccine. She also inspired a love of reading among children through her Imagination Library book gifting program and provided full tuition for all employees working at her theme park, Dollywood.


Want a daily wrap-up of all the news and commentary Salon has to offer? Subscribe to our morning newsletter, Crash Course.


Both Bezos and Sánchez are still deciding how to distribute the rest of his hefty net worth. Bezos — who is currently the fourth-wealthiest person in the world, according to the Bloomberg Billionaires Index — declined to share a specific percentage or provide further details on where his money would likely be spent. He also has not signed the Giving Pledge, which encourages the world’s wealthiest individuals to dedicate most of their wealth to charitable causes.

Though he didn’t confirm it during the interview, Bezos is reportedly interested in buying the Washington Commanders with rapper Jay-Z. When asked about the joint bid, Bezos told Melas, “I grew up in Houston, Texas, and I played football growing up as a kid . . . and it is my favorite sport . . . so we’ll just have to wait and see.”

As for his grand monetary plans, Bezos said, “The hard part is figuring out how to do it in a levered way.” 

“It’s not easy. Building Amazon was not easy. It took a lot of hard work, a bunch of very smart teammates, hard-working teammates, and I’m finding — and I think Lauren is finding the same thing — that charity, philanthropy, is very similar.”

Getting to ‘net-zero’ emissions: How energy leaders envision countering climate change in the future

With the U.S. government promising over US$360 billion in clean energy incentives under the Inflation Reduction Act, energy companies are already lining up investments. It’s a huge opportunity, and analysts project that it could help slash U.S. greenhouse gas emissions by about 40% within the decade.

But in conversations with energy industry leaders in recent months, we have heard that financial incentives alone aren’t enough to meet the nation’s goal of reaching net-zero emissions by 2050.

In the view of some energy sector leaders, reaching net zero emissions will require more pressure from regulators and investors and accepting technologies that aren’t usually thought of as the best solutions to the climate crisis.

‘Net-zero,’ with natural gas

In spring 2022, we facilitated a series of conversations at Penn State University around energy and climate with leaders at several major energy companies — including Shell USA, and electric utilities American Electric Power and Xcel Energy — as well as with leaders at the Department of Energy and other public-sector agencies.

We asked them about the technologies they see the U.S. leaning on to develop an energy system with zero net greenhouse gases by 2050.

Their answers provide some insight into how energy companies are thinking about a net-zero future that will require extraordinary changes in how the world produces and manages energy.

We heard a lot of agreement among energy leaders that getting to net-zero emissions is not a matter of finding some future magic bullet. They point out that many effective technologies are available to reduce emissions and to capture those emissions that can’t be avoided. What is not an option, in their view, is to leave existing technologies in the rearview mirror.

They expect natural gas in particular to play a large, and possibly growing, role in the U.S. energy sector for many years to come.

What’s behind this view, energy leaders say, is their deep degree of skepticism that renewable energy technologies alone can meet the nation’s future energy demands at a reasonable cost.

Costs for wind and solar power and for energy storage have declined rapidly in recent years. But dependence on these technologies has some grid operators worried that they can’t count on the wind blowing or sun shining at the right time – especially as more electric vehicles and other new users connect to the power grid.

Energy companies are rightly nervous about energy grid failures – no one wants a repeat of the outages in Texas in the winter of 2021. But some energy companies, even those with lofty climate goals, also profit handsomely from traditional energy technologies and have extensive investments in fossil fuels. Some have resisted clean energy mandates.

In the view of many of these energy companies, a net-zero energy transition is not necessarily a renewable energy transition.

Instead, they see a net-zero energy transition requiring massive deployment of other technologies, including advanced nuclear power and carbon capture and sequestration technologies that capture carbon dioxide, either before it’s released or from the air, and then store it in nature or pump it underground. So far, however, attempts to deploy some of these technologies at scale have been plagued with high costs, public opposition and serious questions about their environmental impacts.

Think globally, act regionally

Another key takeaway from our roundtable discussions with energy leaders is that how clean energy is deployed and what net-zero looks like will vary by region.

What sells in Appalachia, with its natural-resource-driven economy and manufacturing base, may not sell or even be effective in other regions. Heavy industries like steel require tremendous heat as well as chemical reactions that electricity just can’t replace. The economic displacement from abandoning coal and natural gas production in these regions raises questions about who bears the burden and who benefits from shifting sources of energy.

Opportunities also vary by region. Waste from Appalachian mines could boost domestic supplies of materials critical to a cleaner energy grid. Some coastal regions, on the other hand, could drive decarbonization efforts with offshore wind power.

At a regional scale, industry leaders said, it can be easier to identify shared goals. The Midcontinent Independent System Operator, known as MISO, which manages the power grid in the upper Midwest and parts of the South, is a good example.

When its coverage area was predominantly in the upper Midwest, MISO could bring regional parties together with a shared vision of more opportunities for wind energy development and higher electric reliability. It was able to produce an effective multistate power grid plan to integrate renewables.

However, as utilities from more far-flung (and less windy) states joined MISO, they challenged these initiatives as not bringing benefits to their local grids. The challenges were not successful but have raised questions about how widely costs and benefits can be shared.

Waiting for the right kind of pressure

Energy leaders also said that companies are not enthusiastic about taking on risks that low-carbon energy projects will increase costs or degrade grid reliability without some kind of financial or regulatory pressure.

For example, tax credits for electric vehicles are great, but powering these vehicles could require a lot more zero-carbon electricity, not to mention a major national transmission grid upgrade to move that clean electricity around.

That could be fixed with “smart charging” — technologies that can charge vehicles during times of surplus electricity or even use electric cars to supply some of the grid’s needs on hot days. However, state utility regulators often dissuade companies from investing in power grid upgrades to meet these needs out of fear that customers will wind up footing large bills or technologies will not work as promised.

Energy companies do not yet seem to be feeling major pressure from investors to move away from fossil fuels, either.

For all the talk about environmental, social and governance concerns that industry leaders need to prioritize — known as ESG — we heard during the roundtable that investors are not moving much money out of energy companies whose responses to ESG concerns are not satisfactory. With little pressure from investors, energy companies themselves have few good reasons to take risks on clean energy or to push for changes in regulations.

Leadership needed

These conversations reinforced the need for more leadership on climate issues from lawmakers, regulators, energy companies and shareholders.

If the energy industry is stuck because of antiquated regulations, then we believe it’s up to the public and forward-looking leaders in business and government and investors to push for change.


Seth Blumsack, Professor of Energy and Environmental Economics and International Affairs, Penn State and Lara B. Fowler, Interim Director, Penn State Sustainability Institute, Penn State

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Loss and damage: Who is responsible when climate change harms the world’s poorest countries?

You may be hearing the phrase “loss and damage” in the coming weeks as government leaders meet in Egypt for the 2022 U.N. Climate Change Conference.

It refers to the costs, both economic and physical, that developing countries are facing from climate change impacts. Many of the world’s most climate-vulnerable countries have done little to cause climate change, yet they are experiencing extreme heat waves, floods and other climate-related disasters. They want wealthier nations — historically the biggest sources of greenhouse gas emissions — to pay for the harm.

A powerful example is Pakistan, where extreme rainfall on the heels of a glacier-melting heat wave flooded nearly one-third of the country in the summer of 2022.

The flooding turned Pakistan’s farm fields into miles-wide lakes that stranded communities for weeks. More than 1,700 people died, millions lost their homes and livelihoods, and more than 4 million acres of crops and orchards, as well as livestock, drowned or were damaged. This was followed by a surge in malaria cases as mosquitoes bred in the stagnant water.

Pakistan contributes only about 1% of the global greenhouse gas emissions driving climate change. But greenhouse gases don’t stay within national borders — emissions anywhere affect the global climate. A warming climate intensifies rainfall, and studies suggest climate change may have increased Pakistan’s rainfall intensity by as much as 50%.

The question of payments for loss and damage has been a long-standing point of negotiation at United Nations climate conferences, held nearly every year since 1995, but there has been little progress toward including a financial mechanism for loss and damage in international climate agreements.

Many developing countries are looking to this year’s conference, COP27, as a crucial moment for making progress on establishing that formal mechanism.

Africa’s climate conference

With Egypt hosting this year’s U.N. climate conference, it’s not surprising that loss and damage will take center stage.

Countries in Africa have some of the lowest national greenhouse gas emissions, and yet the continent is home to many of the world’s most climate-vulnerable countries.

To deal with climate change, these countries — many of them among the world’s poorest — will have to invest in adaptation measures, such as seawalls, climate-smart agriculture and infrastructure that’s more resilient to high heat and extreme storms. The UN Environment Program’s Adaptation Gap Report, released Nov. 3, 2022, found that developing countries need five to 10 times more international adaptation finance than wealthier countries are providing.

When climate disasters strike, countries also need more financial help to cover relief efforts, infrastructure repairs and recovery. This is loss and damage.

Egypt is emphasizing the need for wealthy countries to make more progress on providing financial support for both adaptation and loss and damage.

Climate injustice and loss and damage

The conversation on loss and damage is inherently about equity. It evokes the question: Why should countries that have done little to cause global warming be responsible for the damage resulting from the emissions of wealthy countries?

That also makes it contentious. Negotiators know that the idea of payments for loss and damage has the potential to lead to further discussions about financial compensation for historical injustices, such as slavery in the United States or colonial exploitation by European powers.

At COP26, held in 2021 in Glasgow, Scotland, negotiators made progress on some key issues, such as stronger emissions targets and pledges to double adaptation finance for developing countries. But COP26 was seen as a disappointment by advocates trying to establish a financial mechanism for wealthier nations to provide finance for loss and damage in developing countries.

What a formal mechanism might look like

The lack of resolution at COP26, combined with Egypt’s commitment to focus on financing for adaptation and loss and damage, means the issue will be on the table this year.

The nonprofit Center for Climate and Energy Solutions expects discussions to focus on institutional arrangements for the Santiago Network for Loss and Damage, which focuses on providing technical assistance to help developing countries minimize loss and damage; and on fine-tuning the Glasgow Dialogue, a formal process developed in 2021 to bring countries together to discuss funding for loss and damage.

The V20 group of finance ministers, representing 58 countries highly vulnerable to climate change, and the G-7 group of wealthy nations also reached an agreement in October 2022 on a financial mechanism called the Global Shield Against Climate Risks. The Global Shield is focused on providing risk insurance and rapid financial assistance to countries after disasters, but it’s unclear how it will fit into the international discussions. Some groups have raised concerns that relying on insurance systems can overlook the poorest people and distract from the larger discussion of establishing a dedicated fund for loss and damage.

Two elements of developed countries’ reluctance to formalize a loss and damage mechanism involve how to determine which countries or communities are eligible for compensation and what the limitations of such a mechanism would be.

What would a threshold for loss and damage eligibility look like? Limiting countries or communities from receiving compensation for loss and damage based on their current emissions or gross domestic product could become a problematic and complicated process. Most experts recommend determining eligibility based on climate vulnerability, but this can also prove difficult.

How will world leaders respond?

Over a decade ago, developed countries committed to provide US$100 billion per year to fund adaptation and mitigation in developing countries. But they have been slow to meet that commitment, and it does not cover the damages from the climate impacts the world is already seeing today.

Establishing a loss and damage mechanism is considered one avenue to provide recourse for global climate injustice. All eyes will be on Egypt Nov. 6-18, 2022, to see how world leaders respond.

This article was updated Nov. 3, 2022, with the UNEP Adaptation Gap Report findings.

Bethany Tietjen, Research fellow in climate policy, The Fletcher School, Tufts University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

How taxing sugary drinks reinforces weight stigma

Newfoundland and Labrador made history in September as the first Canadian province to implement a sugar-sweetened beverage tax. Sugar-sweetened beverage taxes also exist outside of Canada, including in Mexico, Philadelphia and the United Kingdom. In Newfoundland and Labrador, the tax amounts to 20 cents per liter of sugar-sweetened beverage.

Sugar-sweetened beverage taxation is supported by many global and national health organizations, such as the World Health Organization, Diabetes Canada and the Heart and Stroke Foundation. Taxes are a popular public health policy because of associations between sugary beverage consumption and Type 2 diabetes and weight gain.

Sugar-sweetened beverage taxes are excise taxes, or flat taxes, which also make them regressive taxes. This type of taxation has real potential to have harmful effects on equity, as lower-income populations will pay a higher proportion of their income through this tax. Previous critiques of sugar-sweetened beverage taxation also include the potential harm to small business and First Nations communities.

Weight stigma

Notably absent from this list of harms is the potential of sugar-sweetened beverage taxation to create or exacerbate stigma, including weight stigma. Weight stigma in health policies has received global attention, and there are many calls to action to end weight-stigmatizing policies.

Stigma occurs, in part, when a label — such as “obesity” — is associated with negative stereotypes, leading to discrimination and loss of status. Weight stigma includes stereotypes of laziness and stupidity. It can lead to discrimination in health care and workplace settings.

Weight stigma has negative effects on mental and physical health, including health care avoidance, disordered eating, self exclusion from sport and exercise and stress. Contrary to what many people think, stigma is not an effective strategy for weight loss.

Even before Newfoundland and Labrador declared its intentions with sugar-sweetened beverage taxation, significant interest in Canada and globally led us to explore attitudes and acceptability of a tax in our province of Manitoba. We conducted an interview-based study with residents of many different locations, including a middle-to-upper class, liberal neighborhood in the provincial capital, Winnipeg.

Our participants from this location were white, food secure and primarily highly educated. In our analysis, we specifically sought out instances of weight stigma in the interview transcripts.

Stigmatizing messages

We were interested in the language participants used because people absorb the messages they hear and the images they see. They may push back, change or repeat these messages.

In our analysis of the interviews, we found that many participants repeated weight-stigmatizing messages when discussing sugar-sweetened beverages. A more overt way this occurred was through the judgment of higher-weight individuals who were buying or consuming sugar-sweetened beverages.

Weight stigma also occurred in more covert or subtle ways. For example, some participants talked about their “disgust” and other negative emotions associated with their weight and others’ weight. Many participants also spoke of their “responsibility” to lose weight or to protect their children from becoming overweight by not consuming sugar-sweetened beverages and juice.

Weight dissatisfaction is harmful to one’s health. Disgust also has justice implications for public health. Being disgusted by someone makes them seem less than human. It can contribute to blaming people for conditions caused by multiple biological and social factors and can reinforce prejudice.

Participants also described higher-weight individuals as a “burden” on the health care system and that a tax on sugar-sweetened beverages would help offset these perceived costs. While this myth of obesity bankrupting the health care system is pervasive, research suggests otherwise. In Manitoba, the health service usage for individuals classified as overweight was found to be similar to those classified as normal weight. Health care usage was only marginally higher for individuals classified as obese.

Policies and stigma

Hearing these comments repeated in our interviews indicated to us how pervasive and widespread weight stigma was in participants’ attitudes toward sugar-sweetened beverage intake. Most importantly, these beliefs informed support or acceptability of sugar-sweetened beverage taxation.

This finding echoes existing research suggesting reciprocal processes between stigma at inter- and intra-personal levels and policies. This indicates that interpersonal stigma may contribute to the creation of stigmatizing policies and that stigmatizing policies may in turn legitimize and worsen existing stigma.

Our specific research population was chosen because it was a good representation of the dominant social group in Canada — a white, middle-to-upper class, highly-educated segment of the population. This dominant population is also likely to be similar to many policymakers, further supporting the perspectives of this group within Canadian policies.

Our findings demonstrate how weight-stigmatizing comments were used in support of sugar-sweetened beverage taxation. Weight stigma has serious health consequences. If Canadian public health professionals are committed to tackling weight stigma in health policies, we need to reconsider our support for this policy.

Anne Katherine Anderson Waugh, Research Coordinator, Department of Food and Human Nutritional Sciences, University of Manitoba; Andrea Bombak, Associate professor, Department of Sociology, University of New Brunswick; Kerstin Roger, Full Professor, Department of Community Health Sciences, University of Manitoba; Natalie Diane Riediger, Assistant Professor of Nutritional Epidemiology, University of Manitoba, and Patty Thille, Assistant Professor in Physical Therapy, University of Manitoba

This article is republished from The Conversation under a Creative Commons license.

Ex-Mueller prosecutor: DOJ case against Trump “gets stronger and stronger” after latest filing

Former President Donald Trump mixed documents marked classified with other communications after his presidency, according to court filings that described materials seized by the FBI in their ongoing criminal investigation.

Trump kept one document marked “secret” and another marked “confidential” in a desk drawer of his Mar-a-Lago home office, according to the filing, The Guardian first reported. Other documents found were dated after he left the White House, including three communications from a book author, a religious leader and a pollster. 

The records could add to evidence that Trump knowingly held onto classified materials after his presidency ended. He is also being investigated for concealment of government records, unauthorized possession of national security materials and obstruction.

News of the documents came in an eight-page filing submitted by the Justice Department on Saturday. Special Master Raymond Dearie is responsible for examining whether the 103 documents seized by the FBI thus far should be excluded from the evidence collection.

“Because plaintiff [Trump] can only have received the documents bearing classification markings in his capacity as president, the entire mixed document is a presidential record,” the Justice Department wrote towards the end of the filing obtained by The Guardian.

The mixed records are significant to the criminal investigation as the two classified documents were the only ones found in Trump’s office other than those kept in a leather-bound box and one other document found by the FBI during their August 8 search.

The documents in the leather-bound box are considered to be the most sensitive documents found at Trump’s private estate. There were seven “top secret” documents, 15 “secret” documents, and two marked “confidential.” Also found in the box were 45 empty folders marked “classified” and 28 folders marked “Return to Staff Secretary/Military Aide.”


Want a daily wrap-up of all the news and commentary Salon has to offer? Subscribe to our morning newsletter, Crash Course.


Trump claimed all the documents kept at Mar-a-Lago were declassified before he left the White House but his lawyers have provided no evidence to support this claim.

The former president has also claimed that the investigation is a partisan ploy to wound him politically, as analysts expect him to announce his 2024 campaign on Tuesday. 

“None of that matters to DOJ decisionmaking. Indict as the rule of law demands it —the political consequences are not for DOJ,” tweeted former federal prosecutor Andrew Weissmann, who served on special counsel Bob Mueller’s team. The DOJ’s “case gets stronger and stronger,” he added in response to the latest report.

Terrorist funders, arms traffickers and drug runners: The global threat of rogue diplomacy

After jetting into the capital of Ghana, the international arms broker who called himself “Excellence” greeted his buyers at the Golden Tulip hotel and proposed a secret sale: millions of dollars in missiles and grenades for use against American forces.

“Who else knows I’m with Hezbollah?” Faouzi Jaber asked as night fell on the four-star hotel with a life-sized sculpture of a giraffe in the lobby.

Jaber, who was representing a top operative for the Iran-backed terrorist organization, offered to sweeten the deal. He would help the buyers secure coveted positions as special diplomats — known as honorary consuls — who can travel easily through airports and transport their bags without law enforcement scrutiny.

“I will make you a consul in your country,” Jaber said. “All of your friends will be consuls because when we travel —”

His associate cut in: “You’ll have a diplomatic pass.”

Jaber’s covert offer in the fall of 2012, recorded by federal investigators, promised protection through a little-known international program that gives countries large and small the ability to enlist private citizens to serve as volunteer diplomats around the world.

Founded centuries ago, the honorary consul system was meant as a lifeline for countries unable to afford foreign embassies but has since broadened into a mainstay of international relations, embraced by a majority of the world’s governments.

Unlike ambassadors and other professional emissaries, consuls work from their home countries, drawing on connections and clout to promote the interests of the foreign governments that appoint them. In exchange, consuls gain entry into the lofty world of diplomacy and receive some of the same protections and perks provided to career diplomats.

Under an international treaty, their archives and correspondence cannot be seized. Their consular “pouches” — bags, boxes and shipping containers of any weight and size — are protected from searches. The title and swag, which can include special identity cards, passports and license plates, open doors in industry and politics.

But corrupt, violent and dangerous appointees, including those accused of aiding terrorist regimes, have turned a system meant to leverage the generosity of honorable citizens into a perilous form of rogue diplomacy that threatens the rule of law around the world.

A first-of-its-kind global investigation by ProPublica and the International Consortium of Investigative Journalists identified at least 500 current and former honorary consuls who have been accused of crimes or embroiled in controversy. Some were convicted of serious offenses or caught exploiting their status for personal gain; others drew criticism for their support of authoritarian regimes.

These numbers are almost certainly an undercount — no international agency tracks honorary consuls, and dozens of governments don’t publicly release their names.

ProPublica and ICIJ found that convicted drug traffickers, murderers, sex offenders and fraudsters have served as honorary consuls. So have weapons dealers and those who have advanced the interests of North Korea, Syria and other corrupt governments.

Thirty honorary consuls have been sanctioned by the United States and other governments, including 17 who were designated while they held their posts. Some were members of Russian President Vladimir Putin’s inner circle blacklisted after Russia invaded Ukraine earlier this year.

Nine current and former honorary consuls identified by ProPublica and ICIJ have been linked to terrorist groups by law enforcement and governments. Most were tied to Hezbollah, a political party, social services provider and militant group in Lebanon designated by the United States and other countries as a terrorist organization.

Hezbollah’s attacks in Israel, Argentina, Lebanon, Iraq and elsewhere have wounded and killed hundreds, including 241 U.S. Marines, sailors and soldiers who perished during a 1983 peacekeeping mission in Beirut when a suicide bomber drove a truck packed with explosives into their barracks. Earlier this year, a Hezbollah operative was convicted in New York for receiving weapons and bomb-making training from the organization and casing targets for future attacks, including the Statue of Liberty and Times Square.

Former U.S. officials who have investigated Hezbollah’s financial network said the use of honorary consul status by the terrorist group is intentional, well organized and woefully unexamined. In March, the Treasury Department sanctioned a prominent businessman in Guinea, accusing him of funneling money to Hezbollah and using his honorary consul status to move in and out of the country with little scrutiny.

“Hezbollah has realized that if they use these honorary consuls … they can basically move stuff with impunity and no one is ever going to bust them — you flash your diplomatic passport, no questions asked,” said David Asher, a former senior counterterrorism finance adviser for the Department of Defense assigned in 2008 to help oversee a federal investigation of Hezbollah’s criminal network. “It’s a huge seam in our international law enforcement capabilities sweep.”

To identify terrorist operatives and other honorary consuls accused of wrongdoing, ProPublica and ICIJ reviewed court records, government and public policy reports and news archives from six continents. Reporters from more than 50 international media organizations and student journalists from Northwestern University also probed cases.

Some of the identified consuls were accused of wrongdoing previously and named to their diplomatic posts anyway. The majority of the consuls drew scrutiny while they held their positions.

In North Macedonia, intelligence officials found that two consuls allowed their offices to be used as a base for a Russian propaganda operation aimed at limiting the expansion of the North Atlantic Treaty Organization.

In Myanmar, a consul sanctioned by the U.S. and other governments reportedly used his connections to help supply weapons to the brutal military junta during its genocidal campaign against ethnic minorities.

The consuls in North Macedonia have denied wrongdoing; the consul in Myanmar could not be reached for comment.

Once accused, some consuls have tried and sometimes successfully dodged criminal inquiries through bogus assertions of sweeping legal immunity that have confused or obstructed police and prosecutors.

The lawlessness and claims of impunity have largely been met with silence: Few governments have publicly called to put safeguards in place, despite warnings from law enforcement and others.

“Consuls act completely autonomously and are not controlled by the State they represent. … The Spanish government has no chance of intervening in their affairs,” investigators in Spain wrote in a confidential 2019 report about three honorary consuls under investigation for laundering money for a suspected drug trafficker.

The handful of governments that have stepped in to review the honorary consul system, including those in Canada, Bolivia, Costa Rica and Montenegro, have reported lapses in oversight or dangerous breakdowns. Liberia once dismissed nearly all of its honorary consuls, citing reports of criminal activity.

After reporters raised questions, Germany and Austria dismissed a consul in Brazil. Another in Switzerland announced his resignation.

Thousands of honorary consuls remain active around the world, though there is no reliable count or any way to determine how often they break laws or abuse their privileges.

Retired Drug Enforcement Administration supervisory special agent Jack Kelly, who helped bring Jaber to justice, worries that dangerous consuls go undetected.

“What people actually do with that diplomatic immunity,” Kelly said, “most of the time we’ll never really know.”

A System to Empower and Protect

Honorary consuls date back at least to the fall of the Western Roman Empire, when Greece, China, India and countries in the Middle East appointed volunteer foreign liaisons to expand commerce. The arrangement caught on around the world.

In the United States, John Adams, Benjamin Franklin and Thomas Jefferson in the late 1700s referenced the use of consuls — one in London was tasked with intelligence gathering, records and studies show.

The U.S. government, however, stopped appointing its own honorary consuls overseas in 1924, opting to rely exclusively on career diplomats. It was a prescient move: Three years later, an international panel warned that awarding special advantages to private citizens enabled them to compete on an “unfair basis” with business rivals.

Honorary consuls, the panel said, should “no longer exist,” adding that most “are far busier with their personal affairs than with those of the country which has conferred the title upon them.”

Concerns about exploitation mounted, according to hundreds of pages of notes and documents from the United Nations archives. In 1960, an expert on the subject appointed by the United Nations warned that honorary consuls were not subject to disciplinary controls in the same way that career diplomats were.

Still, when dozens of governments gathered a few years later in Vienna, they enshrined in international law a valuable set of benefits that included few protocols for oversight.

Under the Vienna Convention on Consular Relations, honorary consuls were guaranteed the “freedom of movement and travel” in the countries where they served. They could communicate without restraint, their consulate records and correspondence protected from searches and their offices protected from “any intrusion … or impairment of … dignity.”

Consuls received legal immunity in matters involving their work. Though immunity was not extended to unrelated offenses, the treaty stipulated that honorary consuls would be entitled to criminal proceedings “with the minimum of delay” and “the respect due … by reason of his official position.”

Some countries, troubled in part by the secrecy rules for consular pouches — which can be moved by plane, train, car, ship or courier — insisted they would not protect them. Other countries have opted out altogether, declining to appoint or receive consuls.

But diplomacy is a delicate affair: Restricting another country’s representatives, volunteer or otherwise, can produce a reciprocal response. The vast majority of countries have signed on, and though some apply privileges and immunities differently in practice, the overarching rules have remained unchanged in the nearly six decades since.

Honorary consuls say they do valuable work for little or no pay and want to rid the system of abuse.

“Does it worry me? Absolutely it does,” said Louis J. Vella, who represents Malta in California and oversees a national association of foreign and honorary consuls in the United States. Vella has greeted visiting dignitaries and supported Malta’s Special Olympics team when it competed in Los Angeles.

“If you have a bucket of nice Granny apples and you put in a bad one, the Granny apples are going to be very upset,” he said. “It’s very bad because of the tainted image that it will give to everyone else. The greatest majority of honorary consuls do honorable work.”

Last year, the U.S. State Department pressed states to stop issuing vanity license plates to honorary consuls to prevent “further fraud or abuse.” The department pushed back, however, when members of Congress years ago cited terrorism concerns and recommended reviewing the use of diplomatic bags.

The worry among those who have long questioned the honorary consul system is that countries anywhere in the world can put a diplomatic shield around private individuals thousands of miles away simply by naming them consuls.

The title has become so coveted that an industry of online consultants emerged, promising to help deliver honorary consul appointments for tens of thousands of dollars in fees.

“Travel through diplomatic channels as a VIP-person, often with visas,” one international company, Elma Global, boasts online, saying that perks can include no “annoying customs checks” and “unlimited entry and exit privileges.”

“It’s just amazing that you can become the honorary consul tomorrow, if you want to and you’re willing to pay the money,” said Bob Jarvis, an international and constitutional law professor at Florida’s Nova Southeastern University, who has argued for overhauling the system for almost 40 years. “People buy these things or get them as a reward for supporting a political candidate, and people have no idea what they are supposed to be doing. And no one is busy checking them out.”

Elma Global said in a statement that it does not guarantee honorary consul appointments, adding, “We know that there is much scam on the Internet regarding the honorary consul or diplomatic appointments but we are very far from that.”

Around the world, media outlets and governments have occasionally described isolated incidents of wrongdoing among consuls. ProPublica and ICIJ compiled the most comprehensive accounting to date, including consuls identified in criminal or civil cases that have never been publicly reported.

The investigation, which included cases of consuls scrutinized individually or through their affiliated companies, also drew on findings from human rights groups, the United Nations, anti-corruption watchdogs and media organizations. ProPublica and ICIJ were able to identify 57 consuls who were criminally convicted while holding their positions.

The reporting not only showed how frequently the volunteer diplomats get into trouble but also how widely they have exploited their status.

Consuls have invoked diplomatic credentials to avoid searches and arrests — even to avoid tax bills and parking fines. They have stood accused of hiding cash and contraband in their offices and pouches.

One former consul in Egypt was convicted of attempting to smuggle more than 21,000 antiquities out of the country in a diplomatic container, including mummy masks and a wooden sarcophagus, a coffin used by ancient civilizations to honor their dead. Ladislav Otakar Skakal, who was sentenced in absentia to prison, could not be reached for comment.

The use of the system by terrorist financiers and supporters, experts say, is most alarming, threatening the United States and its allies.

“This honorary consul thing — that’s the theme,” said former DEA supervisor Kelly, who spent a decade investigating Hezbollah until his retirement in 2016. “It shows a real organized approach to how you’re conducting your activity in Africa and probably around the world.”

“You Are the Consul Official”

Kelly knew very little about honorary consuls in late 2008, when numbers on a cellphone being tracked by the U.S. government led him to an elusive Lebanese businessman who would quickly become a top DEA target.

Kelly was helping to lead a federal operation known as Project Cassandra, established to dismantle Hezbollah’s sprawling criminal empire. From a cubicle in a secret government facility in Chantilly, Virginia, Kelly had studied contacts on a phone used by a Hezbollah envoy suspected of helping to advance Iran’s secret nuclear and ballistic missile programs. Kelly eventually settled on a single phone number in Lebanon.

The number was for Mohammad Ibrahim Bazzi.

“‘Hey, I got this guy. He’s got to be incredibly significant,'” Kelly recalled telling Asher, the Department of Defense adviser who was also overseeing Project Cassandra.

Kelly and Asher suspected that Bazzi was a top Hezbollah financier closely affiliated with the Iranian regime who was laundering illicit money through his companies in Lebanon and Africa.

In Gambia, Bazzi was a petroleum importer and associate of then-President Yahya Jammeh, a former military officer accused by a Gambian government panel of kidnappings, rape, murder and torture. Jammeh has denied wrongdoing.

Kelly and his colleagues were focused on Bazzi’s alleged criminal activities but eventually discovered that Bazzi was an honorary consul, appointed by the government of Gambia in 2005.

Bazzi presented himself as a consul in 2017 when he stood before the Gambian government panel, accused of paying bribes to Jammeh and contributing to what officials called the “near ruin” of the country. Gambian officials said that Bazzi’s honorary consul status had been revoked several months earlier.

“He had no respect for Gambians or Gambian institutions,” authorities concluded in a final report. “In his quest for wealth, he focused only on profits mostly unlawfully obtained.”

That same year, Bazzi sought to install his son as a consul because he could “exert his influence” over him, according to the U.S. Treasury Department.

Though Bazzi was never criminally prosecuted in the United States, he was designated a Hezbollah financier and sanctioned in 2018. His son was sanctioned one year later for allegedly working on his father’s behalf.

An attorney for Bazzi declined to respond to questions. Bazzi’s son, Wael, could not be reached for comment. In 2019, the men separately sued the U.S. government, seeking to overturn the U.S. sanctions. In court records, the elder Bazzi said the government exaggerated transactions and events that had occurred years earlier and failed to provide evidence that he financed Hezbollah.

Bazzi said that one of his duties as honorary consul was to “strengthen foreign investment ties between Lebanon and The Gambia” and that he ended his relationship with Jammeh in 2016 after a series of threats. He also said he had previously agreed to work as an informant for the U.S. government and was told that he would not be sanctioned.

In 2020, a federal judge dismissed the lawsuit brought by Bazzi’s son. Last year, Bazzi settled his own lawsuit with the U.S. government. Bazzi and his son remain under sanctions, and the State Department is offering a reward of up to $10 million for information on Mohammad Bazzi and others that leads to disruption of Hezbollah’s financial network.

As Project Cassandra pushed forward, honorary consul status emerged again — this time during the operation that netted Jaber, the Hezbollah-affiliated arms broker who met with buyers at the hotel in Ghana in 2012.

The buyers were DEA informants posing as representatives of an internationally known guerrilla group in Colombia seeking to overthrow the government and strike at the U.S. forces stationed in the country.

“We fight against Americans … they are invading my country,” one informant told Jaber, according to a transcript of the conversation obtained by ProPublica and ICIJ and described in a subsequent indictment. “What we need exactly … is a good person that can provide us with weapons.”

“Hezbollah sells,” Jaber said. “… What kind of weapons?”

“You know, M14, M16?” the informant said, referring to rifles. “Grenades, pistols, rifles.”

“Explosives,” Jaber said. “Dynamite and stuff … pow, pow, pow, pow.”

For protection, Jaber offered consulships, saying, “All the high people, all the rich people, [are] all consular.”

“The best is Africa,” Jaber said, adding that “many European white men work as [consuls]” from their home countries when there are no embassies nearby.

At a second meeting with buyers three months later, Jaber said: “We go to any country in Africa. We make you consul of Equatorial Guinea [or] Guinea-Bissau. … You pay 200,000 dollar[s]. You are the consul official of the country. And you have other passport.”

In 2014, Kelly flew to Prague, where another meeting had been planned, to ensure that Jaber, associate Khaled el-Merebi, as well as the DEA’s top target, Lebanese-born arms dealer Ali Fayad, were taken into custody. Fayad and Merebi were later released by the Czech government, reportedly in exchange for five Czech nationals kidnapped in Lebanon.

Jaber, who had promised to supply surface-to-air missiles, assault rifles and grenades, move and store cocaine in West Africa, and launder the proceeds through bank accounts in New York, was extradited to the United States. He pleaded guilty in 2017 to conspiring to support the Colombian terrorist group and was sentenced to prison.

At the hearing, he pleaded for his freedom, saying he was under the influence of drugs at the time and made a “once-in-a-lifetime mistake.”

“I admit that I committed a crime, but I didn’t do it thoughtfully,” he said. “It wasn’t like I was eager to commit that crime. … I’m asking forgiveness from you and from the American nation and from the U.S. government. I do love the American people.”

In an interview from federal prison in West Virginia, Jaber acknowledged offering honorary consul posts but said the U.S. government doctored the transcripts of meetings to “entrap” him. He added that he opposes Hezbollah.

“Honorary consuls, I know how they work, I know how they are created,” he said. “Honorary consuls move drugs, money. I know many honorary consuls who get up to all kinds of foolishness.”

Quest for Justice

As the agents of Project Cassandra hunted Hezbollah’s arms and drug traffickers, New Jersey attorney Gary Osen was immersed in accounts of Hezbollah’s deadly campaign against U.S. service members in Iraq.

Osen and his legal team gathered death records, studied battlefield forensic reports and interviewed the families of fallen soldiers. The research turned up references to honorary consuls who had been linked to Hezbollah’s finance networks.

“Everybody who is a big shot in that world is an honorary consul,” he said. “It is not necessary to their operation. But it is a further lubricant.”

In 2019, Osen filed a lawsuit on behalf of more than 1,000 Americans, including members of the military killed or wounded in Iraq by roadside bombs and other weapons that the complaint links to Iran and Hezbollah.

The active case in federal court in New York accuses 13 Lebanese banks of violating anti-terrorism laws by knowingly managing and moving money for Hezbollah during the deadly attacks, including one that killed U.S. Army Capt. Shawn English while he was riding in a Humvee outside of Baghdad in 2006. The father of three had been nearing the end of a 10-month deployment in Iraq.

“Is something wrong with Dad?” 7-year-old Nathan English had asked after saluting the two Army officers who arrived at the family’s Florida home to break the news.

The complaint alleges the banks provided “extensive and sustained material support, including financial services, to Hezbollah … and its operatives, and facilitators,” as well as “vital access to the United States financial system.”

The banks have denied wrongdoing, saying in court documents that they “categorically abhor terrorism and all unjustified acts of violence. But they are not legally or factually responsible for plaintiffs’ battlefield injuries.” The banks also said the complaint did not identify transactions for anyone connected to Hezbollah.

Fransabank in Beirut, one of the lenders named as a defendant in the lawsuit, was acquired by Adnan Kassar and his brother, Adel, who has served as the bank’s deputy chairman and CEO and has been Hungary’s honorary consul in Lebanon since at least 2002, records show.

Bazzi, the sanctioned former honorary consul for Gambia in Lebanon, held an account at Fransabank and another Lebanese bank named in the case, according to Osen’s complaint.

“It’s dirty money. At what cost? How many lives?” said retired Army Staff Sgt. Robert Bartlett, a plaintiff in the case.

Like English, according to court documents, Bartlett and his convoy in Iraq were struck by a particularly lethal variation of a roadside bomb known as an explosively formed penetrator, or EFP.

The bomb in 2005 cut through the door of Bartlett’s Humvee, shearing his face from temple to jaw as smoke choked the vehicle and diesel spilled to the ground. The staff sergeant next to him was decapitated and the gunner between them would lose his legs. Bartlett, 31 at the time, has since had 40 medical procedures, including 12 major surgeries, and managed to regain some function in his face, body and hands.

“The devil wanted me dead,” he said.

The Kassar brothers and Fransabank did not respond to requests for comment.

A Power Center for Consuls

In Lebanon, where Hezbollah operates as a major political party, a provider of popular public services and a feared militia force, honorary consul titles are widely considered a sign of status.

“It’s something like lordships in the British system,” said Mohanad Hage Ali, a senior fellow at the Carnegie Middle East Center in Beirut. “If you have a connection to another sovereign state, whether you know the president or someone in his entourage, you get this honorary consul title. It’s one Lebanese way of saying, ‘I’m important.'”

One writer for a Hezbollah-affiliated newspaper in 2015 quipped in a column titled “The Homeland of the Consuls” that becoming a consul in Lebanon is secured first by “finding an independent island beyond an ocean that no one may have heard of. Second, discovering the most appropriate way to reach its king: a rare diamond, a Rolex watch, or tens of thousands of dollars a year.”

One of Lebanon’s honorary consuls is Ali Myree, nominated by South Sudan in 2019.

Born in Lebanon, Myree was living in Paraguay in 2000 when he was charged with pirating CDs, video games and software. Authorities suspected he was funneling some of the proceeds to Hezbollah, according to Paraguayan media reports.

During a police raid, authorities reportedly found film footage of terrorist attacks and interviews with suicide bombers.

Myree left Paraguay and eventually reemerged in South Sudan, where he became a prominent business leader in the long-troubled country. Myree struck a mining partnership with the president’s daughter and sent a series of payments to a general sanctioned by the United Nations Security Council and others for destabilizing the country, according to a 2021 report by The Sentry, a Washington, D.C.-based group that investigates the financing of armed conflict.

Myree was nominated to become the country’s honorary consul in 2019.

“Since the first day we had assumed this responsibility and trust,” Myree said during a celebration of the consulate’s opening in Beirut, where he posed with diplomats and a white cake that bore the flags of both countries.

Myree, who has noted that his motto in life is “the sky is the limit,” denied in a statement ever having a relationship with any terrorist organization. Myree said that piracy was common in Paraguay at the time of his arrest and that he “lacked guidance, education, legal exposure, and experience. … I am also not ashamed of my bad experience, and I do not ignore or hide it.”

He said he was named consul in South Sudan by the country’s president and that his relationships with all of his clients are “merely professional.” “I am proud of the son, husband, father, businessman and honorary consul I am today,” he added.

The Lebanese government did not respond to a request for comment. Neither did a spokesperson for Hezbollah or a local association of Lebanon’s honorary consuls, which published a list of consuls online that included Myree and Fransabank’s Adel Kassar.

That list also included a celebrated businessman in West Africa: Ali Saade.

“To Serve Guinea”

In the teeming African port of Conakry, shoeless men haul sacks of rice off the backs of flatbed trucks and stack them floor to ceiling in a cavernous depot owned by the Sonit Group, the company that made Saade one of Guinea’s richest men.

Saade, 80, was born in the impoverished nation on West Africa’s Atlantic coast, but his mother and wife are from Jwaya, one of a string of villages surrounded by olive and fig trees south of Beirut that has long been a power center for Hezbollah.

In Guinea in 1992, Saade opened Sonit after working in his father’s textile business. He settled into a pristine neighborhood several miles from the Conakry port, where women smoke sardines on abandoned oil drums and children play with crabs plucked from dirty water.

In 2006, Saade was named by the government of Guinea as its honorary consul in Lebanon, where Saade’s wife and daughter live.

Earlier this year, the U.S. government alleged that Saade and another prominent businessman in Guinea, Ibrahim Taher, were key Hezbollah financiers. The government also noted that Taher was an honorary consul for Lebanon in Cote d’Ivoire and used his status to travel in and out of Guinea with “minimal scrutiny.”

Saade stands accused of initiating money transfers from Guinea to Hezbollah and providing “unrestricted access” to the highest levels of the Guinean government for Kassim Tajideen, who was sanctioned by the United States in 2009 for financing Hezbollah. Tajideen was later imprisoned in Maryland for violating the sanction by helping to move more than $1 billion through the U.S. financial system. In 2020, he was released and sent back to Lebanon. He could not be reached for comment.

The U.S. government also alleged that Saade, Taher and others traveled in 2020 to Lebanon on a special flight with a “large amount of money” that the group claimed was for COVID-19 relief. The coronavirus had been used before as a cover for transferring funds from Guinea to Hezbollah, authorities said.

Both men were sanctioned in March.

After the sanctions, prosecutors in Guinea launched a criminal investigation.

In an interview, Saade said he acted in his capacity as honorary consul when he connected Tajideen to Guinea’s former president.

“‘Listen, Ali, as honorary consul you should do something to encourage investment,'” Saade recalled the former president saying.

Saade said he did not know that the U.S. had sanctioned Tajideen. In a statement, Saade added that he carried only $800 when he flew to Lebanon with Taher and others in 2020. “I never gave or transferred one dollar to Hezbollah,” Saade said.

Taher, 59, did not respond to requests for comment. He has previously denied the allegations, saying in a statement that he has no connection to Hezbollah and has “never used any illegal means to transfer funds out of Guinea.” He also said he has never been an honorary consul.

In July, an appeals court judge in Guinea closed the criminal investigation, saying there was no evidence of terrorism financing. The judge also pointed to a Guinean government investigation showing that Taher was not an honorary consul.

Guinean authorities have appealed the court’s ruling, according to an official.

Saade said that the Guinean government suspended his honorary consul status after the U.S. sanction but that he’s not concerned about what comes next. He said he met with Guinea’s new president shortly after the sanctions were announced.

“He reassured me that there will be no acts of injustice,” Saade said. “I acted as a consul to serve Guinea. It’s to help the country.”

Experts predict “recombinant” COVID strains that blend the worst aspects of multiple variants

Public health experts are concerned about mutated versions of SARS-CoV-2, the virus that causes COVID, that combine the worst elements of different strains. When two or more slightly different versions of SARS-CoV-2 meet, they can share genetic information and transform into beefier, more troublesome pathogens.

These offshoots, known as recombinants, can be more contagious — better at evading immunity and often better at overcoming certain medications. Obviously, this poses a great menace to hospitals and doctors’ offices, which are staring down a triple threat this winter as cases of flu, respiratory syncytial virus (RSV) and COVID surge as temperatures fall.

While these recombinants are so far rare and may disappear not long after being detected, they still pose a major threat for as long as they spread and continue to exist. Some have taken to calling these variants “Deltacrons,” as in an amalgam of “delta” and “omicron.” But what exactly are recombinants, and how worried should folks be?

“‘Deltacron’ variants are recombinants between a delta and one of the omicron variants. They’ve happened previously, but the issue now is that there are lots of omicrons out there that could recombine,” Dr. T. Ryan Gregory, an evolutionary and genome biologist at the University of Guelph in Canada, told Salon. “Delta is thought to have been more virulent, but omicrons are more transmissible [and] immune-escaping. So the ‘worst of both worlds’ (from the human standpoint) is delta severity and omicron transmission.”

“That isn’t necessarily how it would go, of course,” Gregory added. “There could be delta’s transmissibility and omicron’s severity — but we likely won’t see that because it won’t outcompete other omicron variants.”

“The thing that worries me the most [is that] recombinants are picking up additional mutations.”

In other words, these types of recombinants might combine the worst elements of both strains. The highly contagious delta variant comprised nearly all COVID-19 infections from July 2021 all the way through November 2021, according to the Centers for Disease Control and Prevention. That strain was more likely to hospitalize its victims, according to studies. Then, beginning in December 2021, omicron usurped omicron to become over 90 percent of all infections. The omicron variant and its sub-variant offspring appeared to be more contagious than delta, but did not seem significantly deadlier, according to some studies. 

“The thing that worries me the most [is that] recombinants are picking up additional mutations — not just Deltacrons. Omicron-Omicron recombinants are worrisome, too,” Dr. Rajendram Rajnarayanan, an assistant dean of research and associate professor at the New York Institute of Technology campus in Jonesboro, Arkansas, told Salon. He describes some of these differences as a “variant sandwich with the same extra toppings.”

As multiple strange variants emerge, public health experts have been wondering for months: why haven’t we seen a new variant? Slated to be dubbed “pi,” this would be the Greek letter given to a new, troublesome SARS-2 variant that is genetically distinct from previous iterations. The World Health Organization has a system using Greek letters for naming “variants of concern,” but hasn’t given such a name to anything since omicron was detected in November 2021.

The virus is still mutating, however, and its many offshoots are given confusing names with strings of numbers and letters. Recombinant strains are named XBF and XBB, for example. Some, like Dr. Peter Hotez, who co-directs the Center for Vaccine Development at Texas Children’s Hospital, have even taken to calling these the “Scrabble variants,” because B, Q and X are high-scoring letters in the popular board game. Gregory has proposed a list of nicknames for these offshoots to make remembering these names easier. BQ.1.1 is Cerberus, for example, while XBB is Gryphon.

The reason there are so many different spawns of SARS-CoV-2 is because viruses aren’t exactly graceful when they reproduce. When the virus worms its way into cells, it hijacks their genetic code, causing them to short circuit and begin making more viruses. These newborn viruses build up until they burst out of the cell, killing it, and spread out to do more damage.

But each of these copies is made somewhat sloppily — hence, mistakes, or mutations, occur regularly. Once in a while, a mutation will give a virus an advantage, making it better at entering cells, evading immune system defenses or spreading to other people. More often than not, a random mutations works against the virus’s best interest — but if a change turns out to be a disadvantage (good news for humans), then it’s unlikely the weaker virus will keep proliferating.


Want more health and science stories in your inbox? Subscribe to Salon’s weekly newsletter The Vulgar Scientist.


Some viruses change slowly, but SARS-2 mutates extremely fast. And each new infection gives it ample opportunity to develop new mutations, which may or may not help it do what wants: keep spreading and reproducing. Scientists have been monitoring for these mutations since the beginning of the pandemic and a few, such as the omicron strain, have become serious problems.

But what happens if someone gets two different strains of the virus at the same time? In that case, the viruses can trade genetic information, not unlike neighbors sharing recipes. There are no hard and fast rules saying recombinant strains are better or worse than other strains, but they can pose a unique problem nonetheless.

“If we think of the omicron variant as a family tree, BA.2 (the dominant strain in the UK in spring of 2022) is the parent of BA.5 (the variant currently dominant in the UK) and the grandparent of BQ.1. In other words, BQ.1 is a sub-lineage of BA.5.,” Victoria Easton a virology research and teaching fellow at the University of Leeds’ School of Molecular and Cellular Biology, wrote in The Conversation. “XBB is a hybrid of two omicron BA.2 lineages, BA.2.10.1 and BA.2.75. This makes XBB another grandchild of BA.2. XBB and BQ.1 are therefore cousins.”

The good news is that recombinant variants are, so far, not making up a big proportion of cases in the U.S. The latest data from the Centers for Disease Control and Prevention indicate that Typhon (BQ.1) and Cerberus (BQ.1.1) are making up more than 40 percent of cases, but recombinants like Gryphon (XBB) are still very low. They are clustered together in the “Other” category, which is an estimated 2 percent of cases.

The bad news is that emerging data (which has yet to be peer-reviewed) suggests Cerberus and Typhon are much better at escaping immunity either from vaccination or previous infections, at least compared to BA.5. That means people could still get sick, although some experts hope that infections this year may be slightly less severe.

“We are hoping that the amount of immunity that has been induced either by prior infection or by vaccination” will protect most people from getting severely ill or dying, Dr. Anthony Fauci, the White House medical advisor, told NPR. But that’s a hope, not a fact, and most of those who have suffered through long COVID would not consider it a “mild” infection.

Emerging data suggests some of these recombinant variants can evade immunity, both from vaccines and previous COVID infections, too.

Late last month, the WHO estimated that Gryphon has been detected in more than 35 countries, with Singapore and India being hit hardest, though it only had a global prevalence of 1.3 percent.

“While further studies are needed, the current data do not suggest there are substantial differences in disease severity for XBB* infections,” the WHO warned. “There is, however, early evidence pointing at a higher reinfection risk, as compared to other circulating Omicron sublineages.”

Other emerging data suggests some of these recombinant variants can evade immunity, both from vaccines and previous COVID infections, too. And as a “variant soup” threatens to simultaneously drive multiple COVID waves this winter, that gives more opportunity for recombinants to emerge and perhaps dominate.

“The XBB variant is a recombinant between two BA.2 lineage variants (i.e., two omicron variants) and was successful in Singapore,” Gregory said. “A Deltacron that combined the immune-escape of XBB or BQ.1/BQ.1.1 and the virulence of delta could be quite concerning.”

SARS-2 will keep mutating, which is expected, but our core defenses — what virologist Ian Mackay calls the “Swiss cheese model” of pandemic defense — will remain about the same. Masks and good indoor ventilation will protect against the virus, no matter how many mutations it goes through. Vaccines, monoclonal antibodies and drugs like Paxlovid may be slightly blunted by certain subsequent mutations, but they aren’t totally useless either and are still better than nothing.

It is still strongly recommended that everyone gets a booster shot. Any way we can squash opportunities for the virus to reproduce, potentially churning out more evasive strains, is a good way to slow this pandemic from becoming worse.

Abortion bans skirt a medical reality: For many teens, childbirth is a dangerous undertaking

Maryanna’s eyes widened as the waitress delivered dessert, a plate-sized chocolate chip cookie topped with hot fudge and ice cream.

Sitting in a booth at a Cheddar’s in Little Rock, Maryanna, 16, wasn’t sure of the last time she’d been to a sit-down restaurant. With two children — a daughter she birthed at 14 and a 4-month-old son — and sharing rent with her mother and sister for a cramped apartment with a dwindling number of working lights, Maryanna rarely got out, let alone to devour a Cheddar’s Legendary Monster Cookie.

On this muggy September evening, though, she was having dinner with her “sister friend” Zenobia Harris, who runs the Arkansas Birthing Project, an organization working to reduce the odds that Arkansas women and girls die from pregnancy and childbirth. In a highchair next to her, Maryanna’s daughter, Bry’anna, spiraled sideways and backward, her arms outstretched, flying. Her eyes would settle on her grilled cheese, and she’d swoop her small hand down to pick up the sandwich.

Maryanna suffered mightily during Bry’anna’s birth. (KHN is not using the family’s last name to protect Maryanna’s privacy.) She remembers telling her mother, “I don’t want to do none of this.” Nurses routinely checked to see how far she had dilated, a painful prodding of the cervix typically done before pain medications are administered.

“Nobody talks about that. I would not open my legs wide enough for them,” she said, cringing at the memory. “There were seven nurses up in there, and I was like, ‘No! Why ya’ll doing this?'”

Hours later, a doctor used vacuum suction to pull the baby through Maryanna’s 14-year-old vaginal canal, ripping apart the skin and muscle of her perineum.

The U.S. has one of the highest teen birth rates among developed nations, even after three decades of improvement. And Arkansas, roughly tied with Mississippi, has the highest teen birth rate in the country.

A U.S. map of teen birth rates from 2020, the latest data available, looks eerily like the results of the Joe Biden-Donald Trump match-up and, not coincidentally, a post-Roe v. Wade guide to legal and illegal abortion. Liberal-leaning states largely have the lowest teen birth rates per 1,000 females: Massachusetts (6.1), New Hampshire (6.6), Vermont (7), Connecticut (7.6), Minnesota (9.1), New Jersey (9.2), Rhode Island (9.4), New York (10), Oregon (10.1), Maine (10.6), Utah (10.8), California (11).

And conservative states largely have the highest rates: Arkansas (27.8), Mississippi (27.9), Louisiana (25.7), Oklahoma (25), Alabama (24.8), Kentucky (23.8), Tennessee (23.3), West Virginia (22.5), Texas (22.4), New Mexico (21.9).

Teenagers in Arkansas do not have significantly more sex than teens elsewhere, according to a 2019 risk behavior survey by the Centers for Disease Control and Prevention, but they are far less likely to use birth control. Sex education is not required in Arkansas schools and, by law, any school-based curriculum must stress abstinence.

In 2017, Gov. Asa Hutchinson, a Republican, successfully jettisoned Planned Parenthood clinics from the state’s Medicaid program. Since then, girls and women who receive medical care at the organization’s clinics cannot use Medicaid coverage to obtain contraception.

Arkansas’ trigger ban outlawing abortion went into effect the day the Dobbs v. Jackson Women’s Health Organization decision came down in June. A woman can receive an abortion only if her death is imminent. For teenagers seeking medical care to end a pregnancy, the nearest clinic where abortion is accessible is in Illinois, 400 miles northeast of Little Rock, a six-hour drive.

“If you’re from a small town in Arkansas, the idea of going to Chicago or Colorado, it may as well be on the moon,” said Gordon Low, a nurse practitioner at Planned Parenthood in Little Rock. Faced with finding a car and gas money, or dealing with a school absence, teenagers “may throw their hands up and continue with the pregnancy, even if they don’t want to.”

For Maryanna, abortion did not really seem an option even before the Dobbs decision. Like many adolescent girls in Arkansas, her extended family is filled with moms who gave birth as teens and whose children grew up to do the same. It’s the life she knows, and, at least at first, the notion of having a baby seemed a respite from the chaos of her family life.

Bry’anna’s father, who Maryanna believes is 19, is not in the picture. She was in eighth grade when her mother, battling her own stresses, took off — temporarily, it turned out — and left Maryanna and her siblings with her “brother’s baby mother’s family.” Into that stew of terrifying uncertainty, the texts from an older boy felt comforting.

They’d been texting each other for a month, with the boy “acting like he could relate to me,” she said. “He was, like, ‘Your momma gone, so you might as well do this or that.’ I just fell for it.” She remembers thinking, “Yeah, she is gone. She told me to save my virginity, but who listens to her anymore? I was just upset.”

Girls’ menstrual cycles can take years to settle into a predictable routine, and Maryanna initially made nothing of the fact that it had been months since she last bled. By then, her mother had returned and the family was living, periodically, in a motel. She considered adding water to her pee to outsmart the pregnancy test, but, she said, “Something was telling me, ‘No, you want to know the truth.'”

A few months after Bry’anna’s birth, Maryanna had sex with an older teenager who only pretended to put a condom on, she said. She gave birth to her son, Tai’lyn, in April.

The young man’s name is listed on Tai’lyn’s birth certificate, but like Bry’anna’s father, he has never paid child support.

Traditionally, teen motherhood is viewed as a symptom of poverty, invoking puzzled head-shaking by wizened adults and calls from many conservative lawmakers for young, unmarried people to stop having sex. But it is also a dangerous undertaking for a teen mother and baby.

Infant mortality rates in Arkansas are highest for babies born to women younger than 20, and the large number of teen births fuels the state’s third-highest infant mortality rate in the country. Arkansas women have the highest rate of pregnancy-related deaths in the U.S., according to CDC data, about double the national average.

For young women who continue their pregnancies, the emotional and physical challenges can be daunting. The age at which girls in the U.S. begin menstruating has dropped in recent decades, in part due to widespread obesity, but the physiological changes necessary to birth and feed a newborn require additional years of development.

“When she has her first menstruation, she is capable of becoming pregnant, but that doesn’t mean she is capable of having a child,” said Dr. Dilys Walker, director of global health research for the Bixby Center for Global Reproductive Health at the University of California-San Francisco.

Walker explained that during adolescent development, the beginning of menarche signals the start of a growth spurt that can take up to four years to complete. During that time, a girl’s uterus and bony structures, including her pelvis, remain narrow, developing slowly as she ages.

It’s a precarious moment to give birth. It’s not uncommon for girls to face obstructed labor “because their pelvis is not developed enough to accommodate a vaginal delivery,” said Dr. Sarah Prager, an obstetrics and gynecology professor at the University of Washington School of Medicine.

Going through with a vaginal birth could cause lasting damage to a teen’s pelvic area and rectum. So, teenage childbirth often ends in cesarean section, causing uterine scarring that almost guarantees she will need to give birth via cesarean section if she has more children.

“Adolescents are at increased risk for low-birth-weight babies, high blood pressure in pregnancy, preeclampsia, higher complications from sexually transmitted diseases, and increased rate of infant death,” said Dr. Anne Waldrop, a maternal-fetal medicine fellow at Stanford University.

Abortion opponents have argued in recent months that girls are duty-bound to give birth no matter how old they are. In the high-profile case of a 10-year-old rape victim from Ohio who traveled to Indiana for an abortion, James Bopp, chief counsel for the National Right to Life Committee, said, “She would have had the baby, and as many women who have had babies as a result of rape, we would hope that she would understand the reason and ultimately the benefit of having the child.”

A judge in Florida recently ruled that a 16-year-old girl “had not established by clear and convincing evidence that she was sufficiently mature to decide whether to terminate her pregnancy.”

The elevated risks of teen childbirth were not weighed.

Hajime White saw what preeclampsia can do to a young woman close-up, when it nearly killed her daughter.

Hajime lives in Warren, a lumber town 90 miles south of Little Rock, where she helps run the Precious Jewels Birthing Project, an offshoot of Zenobia’s Arkansas Birthing Project that offers support for pregnant women and girls and new moms. Hajime was in 11th grade when she got pregnant the first time; the fetus grew without a brain and died inside her. Full of grief, she married her boyfriend. They went on to have six girls, ages 17 to 30, and recently celebrated their 30th wedding anniversary.

On a recent Sunday, after playing piano for the liturgy at St. John African Methodist Episcopal Church, she met her cousin, Monique Davis, at a Mexican restaurant in downtown Warren to assess the needs of the week. Women reach out in need of diapers, breast pumps, formula, and, quite frankly, said Hajime, money.

The “sister friends” counsel their “jewels” to take prenatal vitamins and see a doctor. Self-denigration is a common response Hajime will not let stand. “They’ll say, ‘I’ll just be like my mama. I’m not going to amount to nothing.’ And I was like, ‘No! You got a life ahead of you.'”

That was the message she gave her own daughter Gwen, who became pregnant at 16. Hajime remembered how, when she was a pregnant teen, her grandmother pronounced her life ruined. “She said, ‘Everything you ever did is over with.'”

About a third of the girls who drop out of high school cite pregnancy or parenthood, and Hajime was determined to keep Gwen in school. “She never stopped because she had the support of me, her dad, her sisters,” Hajime said. Two of her daughters are in college, another just graduated from high school, and Gwen earned a degree in pharmacy tech. Her oldest daughter, Majestic, is a certified nursing assistant.

It was a surprise, then, when Gwen, pregnant with her second child at 21, felt piercing pain in her pelvis last spring. Her doctor advised standard pregnancy fare: a pillow between her legs, light stretching. By eight months, Gwen’s petite legs were swollen, stretching tight her ankle bracelets. The doctor blamed too much salt. In July, she was willing herself to enjoy her baby shower when pain ricocheted inside. She could barely breathe on the drive to the hospital.

Gwen went in and out of consciousness as the swelling moved into her chest and her face turned dark. “We would try to wake her back up, her eyes would look at us, she was there, but she wasn’t there,” said Hajime. With protein levels in her urine dangerously high, symptoms that had once been dismissed — water retention, seizures — were now full-fledged preeclampsia, a potentially fatal syndrome marked by rising blood pressure. With the baby in distress, doctors performed a C-section.

Two months later, itty-bitty Quen slept on Gwen’s lap inside an air-conditioned studio shed on her mother’s property. Gwen is still recovering. Breastfeeding after surgery has been painful, and she is advised against lifting anything.

Back in Little Rock, in between spoonfuls of Cheddar’s Legendary Monster Cookie, Maryanna said she is dead set on staying un-pregnant. “I can’t mess up again,” she told Zenobia. “I’m kinda scared of sex now. I’m paranoid. Everybody trying to trap you.”

One of Maryanna’s brothers, she confided, recently found out his girlfriend was pregnant. The couple already have an infant. “She can’t afford another baby right now,” Maryanna said. Would she make the journey to Illinois? “I don’t think she has a way out of state.”


KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

Subscribe to KHN’s free Morning Briefing.

Hospital investigated for allegedly denying an emergency abortion after patient’s water broke

The federal government has launched its first confirmed investigation of an alleged denial of an abortion to a woman experiencing a medical emergency.

In late October, the Missouri Department of Health and Senior Services opened an investigation at Freeman Hospital West in Joplin, Missouri, under the federal Emergency Medical Treatment and Labor Act, department spokesperson Lisa Cox told KHN. It was authorized by the federal Centers for Medicare & Medicaid Services, which contracts with state agencies to conduct EMTALA surveys.

The case involves a woman whose water broke early in her pregnancy, but the hospital refused to let doctors perform an abortion. She eventually sought medical help outside the state.

The Biden administration in July had reminded hospitals and physicians in the 13 states that have outlawed most abortions that federal law requires them to provide life-or health-saving medical services — including abortion, if necessary — to patients experiencing emergency pregnancy complications.

The Missouri investigation is significant because EMTALA is one of the government’s strongest tools to ensure that patients with pregnancy complications receive needed abortions following the Supreme Court’s June ruling erasing the constitutional right to abortion. The 1986 EMTALA law requires hospitals and physicians to provide screening and stabilizing treatment in emergency situations.

The July policy guidance from the Department of Health and Human Services stressed that EMTALA supersedes any state law barring abortion, and that hospitals and physicians who don’t comply with the federal mandate could face civil fines and termination from the Medicare and Medicaid programs.

HHS cited several emergency pregnancy situations in which abortion might be required to prevent permanent injury or death, such as ectopic pregnancies, severe blood pressure spikes known as preeclampsia, and premature rupture of the membrane causing a woman’s water to break before her pregnancy is viable, which can lead to serious infections and threaten her life.

Other EMTALA investigations of hospitals and physicians alleged to have denied medically necessary emergency abortions have been opened in Texas but haven’t been publicly reported, said Greer Donley, an associate law professor at the University of Pittsburgh, who studies abortion issues.

CMS does not disclose EMTALA investigations before they have been completed and findings and penalties have been finalized, and states generally don’t publicize them either. But patients or hospital staff members might talk, particularly on issues like abortion if they strongly object to the alleged denial of services.

The Missouri investigation involves the case of Mylissa Farmer, 41, who went to Freeman Hospital on Aug. 2, after her water broke nearly 18 weeks into her pregnancy, followed by bleeding and cramping. Physicians there reportedly recommended terminating the pregnancy because it was not viable, Farmer had lost amniotic fluid, and she faced a risk of serious infection. Her case is described in detail in an Oct. 19 article in the Springfield News-Leader, which Farmer, in a brief interview with KHN, said was accurate. Farmer confirmed she was contacted and questioned in October for the EMTALA investigation.

According to the newspaper article, Farmer’s physicians, after consulting with Freeman Hospital’s legal team, told her they could not offer her the standard procedure to terminate the pregnancy — dilation and evacuation — due to Missouri’s law banning all abortions, which took effect June 24.

That position was different from what Farmer said the physicians told her. “My doctors said it was an emergency, and I felt it was an emergency,” she told KHN.

Even though the law includes an exception for “medical emergency,” the doctors and hospital lawyers allegedly determined that her case did not qualify for that exception. Providers found to violate the law can be prosecuted for a class B felony, as well as have their license to practice revoked. The burden of proof is on the providers to show that the abortion was performed because of a medical emergency.

Abortion opponents argue that most state anti-abortion laws include adequate exceptions for the health and life of the pregnant woman. But physicians and hospital lawyers say the exceptions are vaguely worded, and what really matters is how prosecutors in these conservative states interpret them.

Physicians say they need flexibility in deciding when there is an emergency that requires a pregnancy to be terminated and that it’s dangerous to have politicians and lawyers looking over their shoulders. “This is medicine, not law, and it’s very complicated,” said Dr. Kim Puterbaugh, a Cleveland OB-GYN who is a past president of the Society of OB/GYN Hospitalists. Setting arbitrary limits on blood pressure or bleeding when determining if a pregnancy is “in distress, that’s ridiculous. There are too many variables.”

Democratic lawmakers in Missouri have pushed the governor, the attorney general, and state health officials for a clearer definition of the exception for medical emergencies.

Farmer and her boyfriend, who both wanted a child, called multiple hospitals in Kansas and Illinois to see whether she could deliver safely but were repeatedly told that the pregnancy wasn’t viable and that her health was at risk. She eventually got an appointment at the Hope Clinic for Women, across the state border in Granite City, Illinois, where she went into labor and received a procedure to end the pregnancy Aug. 6.

Freeman Hospital officials did not respond to repeated requests for comment.

“The Missouri statute puts doctors and providers between a rock and a hard place,” said Genevieve Scott, senior counsel at the Center for Reproductive Rights in New York. “It creates an extreme deterrent to providing care in medical emergencies, given the risk of providers facing prosecution and losing their livelihood. That clearly threatens the health and lives of every pregnant person in the state.”

The Missouri investigation could provoke a new legal showdown between the Biden administration and Republican state elected officials who favor strict abortion bans. The administration already is locked in litigation in Texas and Idaho over the July guidance on EMTALA.

A Texas federal judge issued a temporary restraining order in August saying the guidance was “unauthorized” and went beyond EMTALA in requiring abortions in emergency situations. Federal officials have appealed. But an Idaho federal judge sided with the administration’s position, and Idaho officials have asked him to reconsider his ruling.

Experts doubt whether such litigation will block EMTALA enforcement in abortion-related situations like the Missouri case. The investigation of the actions of Freeman Hospital and its physicians will solely examine whether they complied with the requirements of federal law, not state law, said Katie Keith, an associate research professor at the Georgetown University Health Policy Institute. Still, she added, the hospital could cite the Missouri anti-abortion law as a defense, setting up a court fight down the line.

Farmer’s case also is playing a role in the U.S. Senate race in Missouri between Republican Attorney General Eric Schmitt and Democratic nominee Trudy Busch Valentine, a nurse. Farmer appeared in a TV ad for Busch Valentine criticizing Schmitt for issuing a proclamation on June 24 that put Missouri’s anti-abortion trigger law into effect. “My Missouri doctors weren’t allowed to give me the care I needed, all because of the mandate Eric Schmitt put into place,” Farmer said in the ad. “Eric Schmitt doesn’t care about women like me.”

Schmitt’s campaign lawyers sent letters to the TV stations carrying the ad demanding that it be taken off the air, according to local news reports. They claimed it was inaccurate in stating that women could go to prison for having an abortion and failing to mention that it includes an exception to protect the health of the patient.

Cases similar to Farmer’s likely are happening every day in states that have banned abortions, and more EMTALA investigations will be launched, warned Sara Rosenbaum, a professor of health law and policy at George Washington University. This places hospitals and physicians in an excruciating spot, she added. CMS has said it will initiate investigations based on credible information including news reports.

An EMTALA investigation “is one of the worst things that can happen to you,” she said, speaking about providers, “because it puts a label on you that you denied what the woman needed to survive when it was clear that the baby was lost.”


KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

Subscribe to KHN’s free Morning Briefing.

Mary Trump: “Donald will burn everything to the ground” if GOP tries to move on from him

During an appearance on MSNBC on Sunday morning, Donald Trump’s niece, Mary Trump, warned that her uncle has never been more dangerous than now after the midterm election failure by the GOP was blamed on him.

More to the point, she said he has become a danger to the GOP.

Speaking with host Ali Velshi, she went on to say that the danger comes from her uncle’s fears of becoming “irrelevant.”

“What do you think happens here?” the MSNBC host prompted. “Donald Trump wants to be relevant, in the face of an election that has done something for him he never wanted: it has proved that he is potentially less relevant than he thinks he is. How do you square those things? You maintain that he maintains the dangerousness in the Republican Party, by extension the most dangerous person in America.”

“Donald becomes his most dangerous when he fears loss of relevance when he fears that he is no longer the center of attention,” she replied. “When he fears that he is no longer the one in control.”

“We don’t know just what kind of information he has on other people in his party,” Trump, a psychologist, elaborated. “What we do know is he would be willing to use it. I believe we talked about this before the 2020 election. Donald will burn everything down if he feels like he is going down — we cannot discount that, we ignore him at our peril.”

“That is why the Republican Party strategy of deciding to turn a different direction won’t work,” she continued. “One, it won’t work because he won’t let them do it. Two, it shouldn’t work because they are largely responsible for the state of the party and the dangers that this party continues to present to this country.”

Watch below or at the link:

MAGA Republicans scheme to shiv Kevin McCarthy’s speaker bid unless he agrees to their demands

House Minority Leader Kevin McCarthy, R-Calif., is preparing a bid for House speaker but conservatives on the House Freedom Caucus are plotting to block him from the position if he doesn’t give into their legislative demands.

After the “red wave” failed to materialize in this year’s midterm elections, Republicans have started to grapple with the idea that they will have a much smaller majority in the House next year than they anticipated. McCarthy’s nomination is relatively straightforward, as he only needs a majority of House Republicans to support him, but many members of the pro-Trump Freedom Caucus are preparing a two-step plan to keep him from the speakership, according to reporting from Politico.

Conservatives are pushing to postpone Tuesday’s scheduled leadership elections until the GOP is confirmed to control the House. If McCarthy doesn’t comply, their plan is to nominate Rep. Andy Biggs, R-Ariz., as an internal candidate for speaker to prove that McCarthy does not have the 218 GOP votes needed for the full-chamber vote on Jan. 3 2023, an anonymous Republican source with knowledge of the plan told Politico.

If they are able to postpone the Tuesday election, conservatives would discuss an alternative candidate to put forward in consensus, said the anonymous Republican, who also added that Rep. Jim Jordan, R-Ohio, is the most likely choice for the Freedom Caucus. Biggs is acting as a symbolic alternative for step one, according to CNN. 

“Kevin McCarthy has done nothing in two years to earn my vote,” said Rep. Bob Good, R-Va. 

Russ Vought — a former budget director for the Trump White House — made the end goal of their plans clear.

“This is about building to January,” he told far-right host Steve Bannon in a Friday interview. 

“And we have an opportunity to have a paradigm-shattering victory [on] the speakership, to either be able to get Jim Jordan in as speaker — I don’t care if he’s not running right now — or to have a coalitional-style government where every decision goes through HFC,” Vought added. 

Rep. Matt Gaetz, R-Fla., who is not a member of the Freedom Caucus, also publicly backed Jordan as the best speaker candidate, despite Jordan’s frequent statements of support for McCarthy. Speaking on Gaetz’s podcast, Vought touted the need for a “wartime speaker” in the House. 

The Freedom Caucus is also publicly pressuring McCarthy to concede to their legislative demands if he wants the speakership. Some of their demands include restoring the ability for lawmakers to depose the speaker, adding more Caucus members to the influential Steering Committee and ensuring a floor vote on any amendment if 10% of the GOP conference cosponsors it, among others. 


Want a daily wrap-up of all the news and commentary Salon has to offer? Subscribe to our morning newsletter, Crash Course.


According to Politico, these demands act as a strategy to allow members to oppose McCarthy even if all their conditions are met — they would also drastically reduce McCarthy’s control over the legislative process if elected.

However, allies of McCarthy are not convinced that the Freedom Caucus will be successful, and are frustrated by their preemptive plans. They are also warning that McCarthy will not part quietly with the speakership role like he did in 2015; his supporters are encouraging him to push back against the caucus. 

“These palace intrigue stories are premature and they are still counting votes,” said Jordan spokesperson Russell Dye when asked about the anti-McCarthy plan according to Politico. “What I can tell you for sure is that Mr. Jordan looks forward to chairing the Judiciary Committee next Congress.” 

Other representatives that are rumored to be the Freedom Caucus’ pick for speaker are House GOP Whip Steve Scalise, GOP Vice Chair Mike Johnson, and Good; however, few see them as legitimate opponents especially since Scalise and Johnson have already officially backed McCarthy’s campaign. 

“There’s a point of leverage in these leadership votes,” said House Freedom Caucus Chairman Scott Perry, R-Pa. “We want to have a conversation, devoid of the politics about who is leading, on how the House should operate, how legislation should pass.”

“There’s a fairly easy solution here,” a source close to the Freedom Caucus told Fox News. “McCarthy can support popular reforms to decentralize the speaker’s power and empower individual members, or he can roll the dice that someone else won’t make that compromise and get the speaker’s gavel.” 

House leadership aides also informed Fox News that McCarthy is expected to cut a deal with the Freedom Caucus to accept at least a few of their demands.

As it stands, the Republican majority is projected to be around 218 seats — the minimum for control of the House — to 230 seats if the GOP sweeps all remaining races, including some that Democrats are favored to win. However, these numbers still fall short of the 60 seats that McCarthy predicted from the failed red wave.

“Incompetent”: One by one, longtime Trump allies are trashing him in public after midterm failure

A growing number of Trump allies are trashing him publicly and blaming him for Republicans underperforming in the midterm elections.

Conservative commentator Candace Owens, a staunch supporter of the former president, went as far as sharing a personal story that made her question his character.  

Owens, who once referred to Trump as “the savior” of the free world, said on her Daily Wire show that she questioned what type of person he is for the “first time” after he was rude to her, according to Business Insider

Owens recalled the time she defended Trump after he did an interview in which he backed COVID-19 vaccines. In an Instagram video, she said that Trump comes from a generation before people were “able to conduct independent research” and for that reason was easily convinced to support vaccines. 

The Daily Beast ran a story headlined “Candace Owens: Trump Is Pro-Vax Because He’s ‘Too Old’ to Understand the Internet.” This angered Trump so much so that he was rude to Owens the next time he saw her in person, she said.  

“That is not being a leader, that is not owning things that you did wrong, that is not owning that you misunderstood something about your base,” she said. “That’s not growing, that’s not developing.”

She added that unlike previous elections where Trump had an energy that “was electric”, he has now become paranoid and remains in “an angry space” after the 2020 election. She also questioned his vision for 2024 and suggested “It needs to be more than, ‘I’m back.'”

Trump White House press secretary Kayleigh McEnany also weighed in on Trump announcing his 2024 White House bid, saying that he should wait until after next month’s Georgia Senate runoff election to declare his candidacy, according to The Hill.

“I know there’s a temptation to starting talking about 2024 — no, no, no, no, no,” McEnany said on Fox News. She added, “2022 is not over. Every Republican energy needs to go to grinding the Biden agenda to a halt, and that could go straight through the state of Georgia.”


Want a daily wrap-up of all the news and commentary Salon has to offer? Subscribe to our morning newsletter, Crash Course.


Fox Nation host Tomi Lahren shared similar views, agreeing with a tweet from Sen. Josh Hawley, R-Mo., saying that the old GOP is “dead” and it’s time to build something new.

“A lot of Republican voters are feeling that way,” Lahren said. “But then we have to consider a whole new mess is probably coming our way if we have a Trump announcement this week. And we’re going to talk about that later, but if we’re divided now between McConnell and Rick Scott and all the rest of it wait until Donald Trump’s name is back in the running officially.”

She added that Trump has been hinting at a run for “a long time,” but when the official announcement comes, it “will impact Georgia”.

Another former Trump loyalist, Rep. Mo Brooks, R-Ala., said that “It would be a bad mistake for the Republicans to have Donald Trump as their nominee in 2024,” AL.com reported

Brooks, who spoke at the Jan. 6 rally that led to the attack on the Capitol and was a prominent election denier, said that Trump alienates independents and Republicans because he is “dishonest”, “disloyal”, “incompetent” and “crude.”

“Even a candidate who campaigns from his basement can beat him,” Brooks said. 

Fox News contributor Marc Thiessen took to Twitter, blaming Trump for the Republican Party’s flop in the midterm elections 

“Amount McConnell spent bailing out Trump candidates: $241 million. Amount Trump spent backing his own candidates: $14.7 million… But, yeah, let’s get rid of McConnell,” Thiessen tweeted.

Fox News star Brit Hume, a veteran conservative political analyst, agreed with him and tweeted: “Spot on.”

Trump is expected to announce a 2024 presidential bid as soon as Monday night, but some of his advisors and allies are reportedly urging him to delay his announcement.

“A new election must be called immediately”: Trump flips on Truth Social after his candidate loses

Just hours after Arizona Republican Party Senate nominee Blake Masters was declared the loser in his bid to unseat Sen. Mark Kelly (D), Donald Trump raged on his Truth Social media platform that there needs to be a do-over election.

Kelly’s win, with the U.S. Senate seats in Nevada and Georgia still to be decided, appears to lock up Democratic control of the chamber and the Masters’ loss is another blow to the former president who threw his whole-hearted support behind the GOP nominee.

With that in mind — on the evening before his youngest daughter’s wedding at Mar-a-Lago — Trump accused election officials in Arizona of being idiots and of being “corrupt” despite the fact that many of them are Republicans.

“Idiot, and possibly corrupt, officials have lost control of the tainted Election in Arizona,” he wrote. “MACHINES BROKEN IN REPUBLICAN AREAS. A NEW ELECTION MUST BE CALLED FOR IMMEDIATELY!”

Why food labels showing the exercise needed to burn off calories won’t work for everyone

In an effort to tackle the increasing prevalence of obesity, the U.K. government has introduced a number of public health strategies over the years, including changes to how we label foods. For example, the “traffic light” color-coding system, which was introduced in 2013, aims to make it easier for consumers to know whether or not the foods they’re eating are healthy for them.

But some critics feel that this kind of labeling may still be difficult for people to fully understand or practically apply, and may not necessarily lead to people choosing healthier food. Given obesity is still on the rise, it’s clear current strategies aren’t working.

Recently, a team of researchers from Loughborough University proposed a different system of food labeling known as “physical activity calorie equivalent,” or Pace. This method illustrates how many minutes of exercise it would take to burn the calories in certain foods and drinks. The researchers showed that this new approach was easier for participants to understand – and may be more likely to help people avoid high-calorie foods.

But while these types of food labels have the benefit of being easier to understand, they could also run the risk of being misleading – and may not work for everyone.

The benefits

Alongside being easier to understand, the team from Loughborough also showed in a previous review that using exercise to illustrate the equivalent calories in food and drinks can help people consume fewer calories – around 65 fewer calories every time they ate – compared with other food labeling methods.

While this may not sound like much, over time it may help people over-eat less and may also result in them eating fewer high-calorie foods, such as fast food.

Other studies have shown that Pace may also help increase physical activity levels somewhat, which could be beneficial for those looking to be more active.

Using exercise to illustrate the calories in food may therefore be a useful tool for consumers as it provides understandable, relatable information that may help them better plan their meals and workouts – potentially leading to healthier food choices while encouraging physical activity, both of which are key in reducing or preventing obesity.

The downsides

While initial findings on exercise-based food labels seem promising, research is still needed in real-world settings and over longer periods of time if it’s going to inform future public health policy.

Another clear pitfall of the Pace approach is that it generalizes calories burnt. This means that the averages used on labels may not actually be true of how each person burns calories.

A variety of factors – such as the type of exercise you’re doing, how intensely you’re exercising, your age and fitness level – all influence the amount of calories you burn. The way we digest and metabolize foods is also highly individual.

This could mean that general food labels could be deceptive. It’s unlikely that the calories estimated to be burnt on the packet will apply to everyone. This could lead to some people eating more or less food than they need.

Another reason the information on these labels could be misleading is that it makes the assumption that all calories consumed are equal. For example, two foods with the same calorie content may have different levels of fiber, fat, sugars or protein.

All of these are metabolized differently, which will influence how our foods are used and stored by our body. Low-fiber, high-sugar, energy-dense foods, for example, have been associated with weight gain compared with healthier options containing a similar number of calories.

Pace labels could also inadvertently encourage people to eat more poor-quality or ultra-processed foods, as they may feel they can just exercise to burn those calories off. However, unhealthy, ultra-processed foods can still cause harm to the body, even if the calories in them are used.

Other experts feel that such types of food label will only have a short-term effect in changing food choices. Another concern is that Pace could trigger eating disorders or over-exercise in susceptible populations. It could also lead people to eat less so they can avoid doing the exercise required to burn off additional calories.

Our view

Labeling foods and drinks with the amount of exercise needed to burn them off may certainly have some benefits. However, it’s clear that a one-size-fits-all approach may be too simplistic when it comes to tackling obesity in a population. This is especially true when considering that every person’s diet, activity levels, lifestyle habits and even genetics are different from the next.

As such, strategies for reducing obesity should aim to take a more individualized approach to helping people increase their total daily movement and activity, while also helping them evaluate their eating patterns and portion sizes, as well as choosing better-quality foods.

Justin Roberts, Associate Professor, Health and Exercise Nutrition, Anglia Ruskin University and Henry Chung, Lecturer in Sport and Exercise Science, University of Essex

This article is republished from The Conversation under a Creative Commons license.

“Catastrophic embarrassment”: Knives out for Mitch McConnell after Democrats win control of Senate

The Republican Party is in total turmoil after incumbent Democratic United States Senator Catherine Cortez Masto was reelected to a second term by Nevada voters late Saturday night.

News outlets including Fox called the race for Cortez Masto over GOP challenger Adam Laxalt – who had the backing of former President Donald Trump – after a final batch of ballots from Clark County gave Cortez Masto the lead. The Associated Press noted that Cortez Masto’s advantage would hold even if “Laxalt made gains in rural Nevada counties that are still counting votes.”

Thanks to Cortez Masto’s win, Democrats will maintain their Senate majority in 2023, and they may pick up an additional seat if Senator Raphael Warnock, D-Ga., defeats Trump-endorsed right-wing candidate Herschel Walker in their December 6th runoff election.

Historically, the midterms have served as a referendum on the president and his governing coalition. Usually, the opposition bumps off large numbers of lawmakers that belong to the party in power. That has not been the case this year. Control of the House of Representatives is still undetermined because so many races are too close to call – which is unprecedented in modern political memory. Filmmaker Michael Moore predicted this would happen. And though Republicans may wind up with a majority in the House, it will likely be very slim.

Thus the GOP now finds itself adrift and humiliated.

Senator Rick Scott, R-Fla., the chair of the National Republican Senatorial Committee, proclaimed that the midterms were a “complete disappointment.” Scott added that the GOP “didn’t have enough of a positive message,” despite it having been his job to get Republicans elected.

“The old party is dead. Time to bury it. Build something new,” tweeted Senator Josh Hawley, R-Mo., who supported Trump’s scheme to overturn the 2020 election.

Yet that dismay pales in comparison to the drubbing that Senate Minority Leader Mitch McConnell, R-Ky., who sunk $230 million into a foredoomed effort to reclaim his majority leader status, is receiving.

“Mitch McConnell just learned he will not be Majority Leader,” wrote Democratic Senate nominee Charles Booker of Kentucky. “Enjoy your evening, America.”

Media Matters for America researcher Jason Campbell posted that he “just can’t get over what a catastrophic embarrassment this election was for Republicans” and that “you almost need to stand in awe of the incompetence.”

Joe Walsh, an ex-Tea Party congressman who ran for president against Trump in 2016, remarked:

I’m not a Democrat. But Democrats just kept control of the Senate. It’s official. And I’m ecstatic. Because if you support democracy, this is a damn good thing. Because my former political party is now fully anti-democracy. And I’m glad they lost.

Similarly, and perhaps more significantly, the palpable rage has come from the right wing.

“We don’t have a majority in the US Senate because Mitch McConnell sat on his hands,” said Brigitte Gabriel.

“Mitch McConnell is a very effective Democrat,” stated John Rich.

Conservative commentator Mark Levin jabbed at McConnell, “who’s the least popular senator?”

Podcaster and Newsmax host Benny Johnson complained that “our current class of Republican ‘Leaders’ are career DC corporatists who would rather have Democrats in total control of our Government than have a few MAGA/America First Republicans in their majority. If you need evidence look at the 2022 midterm results. This is betrayal.”

Lavern Spicer, a failed House candidate, called for undoing the way that American elections are conducted:

Election Reforms Needed Now:

1. No Mail-In Ballots unless you are out of the country.

2. Universal Voter ID.

3. No Drop Boxes.

4. No candidate shall oversee their own election.

5. If results are not available within 72 hours, Secretary of State is removed and prosecuted.

Trump, meanwhile, has not been handling the news well. He has declared that the “electron” in Arizona was stolen from Blake Masters – whom he championed against incumbent Democratic Senator and former astronaut Mark Kelly – in one of the numerous meltdowns that he unleashed on his free-for-all Truth Social app over the weekend. Much of the drama was unfolding as Trump’s youngest daughter Tiffany was getting married at the family’s seaside Mar-a-Lago golf resort in Palm Beach, Florida.

GOP in massive turmoil — and it’s delicious: Can Mitch and Kevin survive?

I’ve seen some circular firing squads in my time observing politics, but never anything like what is going on in the Republican Party right now. Usually it’s the Democrats ripping each other apart over an election loss, running around in circles casting blame, rushing to avoid responsibility and otherwise making everything worse. But they look like rank amateurs compared to the GOP, which is in the throes of the angriest political tantrum I’ve ever seen. I must confess to a full-blown case of schadenfreude over it. 

The unexpected run of Democratic victories — they’ve already held the Senate, will come within a whisker of holding the House and have won a bunch of state-level races too — has shaken the foundations of both MAGA World and what used to be known as the Republican “establishment,” although the difference between the two is not readily discernible these days. It’s only in times of Trump scandal or electoral catastrophe that we can still glimpse some daylight between them. There’s generally a round of hand-wringing and public disavowal from some of their important thought leaders and elected officials until they get word from the base that Donald Trump is still their daddy and they fall back into line.

I’m sure you remember the last time this happened, after the Jan. 6 insurrection when Trump incited his rabid followers to storm the Capitol, with the apparent goal of literally hanging the vice president. Why, for a few days many Republicans were very upset! Even a loyal Trump lackey like South Carolina Sen. Lindsay Graham said, “Count me out, enough is enough,” and House Minority Leader Kevin McCarthy declared that “the president bears responsibility” for what happened. There were resignations from the Cabinet and angry denunciations by dozens of Republicans who had happily gone along with Trump’s Big Lie up to that point.

Then they got yelled at in airports by their MAGA constituents and suddenly a violent assault on their own workplace didn’t seem like such a big deal after all:

McCarthy went down to Mar-a-Lago to mend fences and kiss the ring. (No word on whether he brought some of those red Starburst candies Trump loves so much.) Senate GOP leader Mitch McConnell resigned himself to Trump once again — even though he had just lost the Senate majority, thanks to those Georgia runoffs a day before Jan. 6 — and everything fell back into place. Trump was the undisputed head of the Republican Party, having cemented his leadership by attempting to stage a coup and getting away with it.

Remember the good old days after Jan. 6, when Republicans like Lindsey Graham said, “Count me out, enough is enough”? Then they got yelled at in airports and suddenly decided insurrection was no big deal.

The assumption going into these midterm election was that the party holding the White House would get routed, for all the reasons everyone has already discussed ad nauseam. But it didn’t turn out that way. As I and many others have pointed out along the way, Donald Trump is the gift that keeps on giving — to Democrats.

If Trump had kept his mouth shut and stayed out of the Republican primaries, as Senate Republicans wanted him to, it’s entirely likely they would have done better. But then again, their own cowardice and opportunism are as much to blame as he is. They had the chance to make sure that Trump would never run again by convicting him in the second impeachment trial and they whiffed. They’re still stuck with him, and the results are as bad as they have been in every major election since 2016.

Recriminations are coming in fast and furious from the right-wing media establishment, starting with the Murdoch empire. The Fox News celebrities haven’t all abandoned Trump quite yet — they’re no doubt waiting for the smoke to clear before they decide their next moves. But there’s a shiny new candidate on the scene who also says he was called by God to lead the nation. Many in the GOP have turned their lonely eyes to Florida Gov. Ron DeSantis, hoping he can save the day. That of course has finally uncorked Trump’s resentment against the man he sees as his creation, which has reportedly been boiling up for years now. Trump even claimed in a post on his Truth Social platform that he had ordered the FBI and Department of Justice to intervene in DeSantis’ very close 2018 election to ensure his win. (Trump’s former chief of staff John Kelly, has said that’s not true.) 


Want a daily wrap-up of all the news and commentary Salon has to offer? Subscribe to our morning newsletter, Crash Course.


Trump is righteously angry that he’s being blamed for all the nutcases he encouraged and endorsed going down to defeat, but even more upset that DeSantis is being held up, in contrast, as the party’s only big 2022 success. Let’s just say that the gauntlet has been thrown down and the battle between Trump and DeSantis is on. It’s not going to be pretty. Trump is already going dirty, apparently spreading rumors about DeSantis’ personal life.

Whether or not this will actually spell the end of Trump’s stranglehold on the Republican Party remains to be seen. But it’s highly unlikely that this loss will result in Trump losing control of the 40% or so of the party faithful who worship him, and that makes him as formidable as ever. All they have to do is start chasing leading Republicans through airports again and he’s back in business.

Meanwhile, back in Washington all hell is breaking loose in the Republican caucuses in both houses. Trump is blaming Mitch McConnell for losing the Senate, but somehow Kevin McCarthy (who is said to be on the horn with Trump several times a day) escapes his wrath for failing to produce the eagerly-awaited red wave in the House. Nobody knows whether McCarthy will have the votes for speaker, assuming Republicans finally manage to eke out a majority — probably by just a couple of seats — and the newly empowered Marjorie Taylor Greene Caucus is already flexing its muscles, planning to create chaos at every turn. Even if McCarthy finally gets the gavel, odds are good that he lasts less than half the time of his last GOP predecessor, Paul Ryan.

Who will be the first to declare that Donald Trump has now turned sober, serious and “presidential,” and has re-established himself as the 2024 frontrunner? Expect a rush to the microphones.

McConnell is also under fire from some senators who want to use him as the scapegoat — largely to avoid having to blame Trump. A bunch of prominent right-wing senators, including Josh Hawley of Missouri, Marco Rubio of Florida, Mike Lee of Utah, Ted Cruz of Texas, Ron Johnson of Wisconsin, Senate campaign chair Rick Scott of Florida and the aforementioned Lindsey Graham, have weighed in to say that the vote for Minority Leader should wait until after the Dec. 6 runoff election in Georgia between Sen. Raphael Warnock and Herschel Walker. It’s hard to know which of these ambitious vultures are trying to whip votes for themselves (although Scott almost certainly is) and why they think the Georgia race should be decisive, since Democrats have already won the majority. But it’s backstabbing season, and McConnell has a target right between his shoulder blades. On the other hand, Sen. Tom Cotton of Arkansas just came out in support of McConnell, a few days after Cotton announced that he won’t run for president in 2024. The games run deep.  

As you can see, the Republican Party is in serious disarray. As if that weren’t enough, Donald Trump himself says he will make a “major announcement” on Tuesday night to pour more gasoline on the fire. Word is that he will make a “very professional, very buttoned-up” speech, rather than his usual unhinged rally rant, which I have to admit is a savvy move. Trump understands that being unpredictable gets him attention and I can just see all the TV pundits declaring that he is a changed man, more sober and serious after the election debacle.

Who will be the first to declare, “Donald Trump re-established himself as the frontrunner for the 2024 Republican nomination tonight”? And who will be the first Republican official to rush to the microphone to endorse him? (Not counting Rep. Elise Stefanik of New York, who didn’t even wait for his official announcement.) I think there’s every chance that the circular firing squad will miss him, as it always does. I’m not so sure that McCarthy and McConnell can survive all this, however. Somebody has to pay for this disastrous showing and I see no reason to believe that the GOP establishment has enough self-preservation instinct remaining to save itself. In a certain sense, you love to see it.