Palestinian news outlet: TikTok in ‘partnership with the occupation’

The Quds News Network’s TikTok account was removed without notice by the video-sharing app. Is the move part of an ongoing effort to silence Palestinian content by social media companies?

With 2021 barely ushered in, the Quds News Network (QNN) found its TikTok account removed without any notice, in a move the popular Palestinian outlet claimed was related to the content it publishes.

Hamzah al Shobaki, the platform’s TikTok account manager, said the account was deleted after it shared 1,200 posts related to recent Arab normalisation deals and Israeli occupation.

The account had over 50,000 followers, 7 million views and 350,000 likes.

In response to the removal, QNN Director Ahmad Jarrar went on to charge the popular video-sharing app of being in “partnership with the occupation”.

“Deleting the account of the Quds News Network is a new stage for Palestinian content on the platform,” said Iyad al Rifa’I, head of Sada Social, a Palestinian youth initiative that documents violations Palestinian content is exposed to in the digital sphere.

The outlet has faced issues on other social media platforms in the past, claiming its critical coverage of Israel has made it a target of frequent censorship attempts.

Twitter permanently blocked QNN’s verified account in November 2019, and last month QNN said it was targeted by organised reports against its news posts on Facebook.

TikTok is just the latest social networking platform where Palestinians have had their right to freedom of expression and content suppressed.

In recent years, there have been efforts by Facebook, WhatsApp, Twitter and YouTube to stifle Palestinian voices, and pressure exerted on these social media companies – particularly Facebook – to curtail or remove Palestinian content under the guise of hate speech.



In 2019, Sada Social reported as many as 1,000 violations took place across social media platforms, including the removal of accounts, public pages, posts, and restriction of access.

In accordance with Israel’s access to information law, the Israeli government stated that from 2017-2018 Israel’s direct requests to social media companies resulted in the deletion of some 27,000 posts from Facebook, Twitter and Google, as cited by 7amleh – the Arab Center for Social Media Development.

Published six months ago, a 7amleh paper outlined systematic campaigns by Israel to silence Palestinians online, arguing there was a significant focus by governments, non-governmental apparatuses, and private companies on Palestinian content and efforts to paint Palestinian political speech as incitement to violence.

Ultimately, those efforts were aimed at “shrinking the space for Palestinian freedom of expression and assembly online” and “the space for expression about Palestinian rights and human rights violations of Israel” the authors wrote.

 

The Covid-19 Vaccine: Another Ugly Face of Israeli Apartheid

The rollout of the Covid-19 vaccine perfectly illustrates Israel's apartheid system.

by

Yumna Patel

"With military occupation in the West Bank and Gaza effectively under Israeli control, 

Israel is legally obliged by international law to provide for [Palestinians'] healthcare," 

Dr. Yara Hawari, Senior Analyst at Al-Shabaka: The Palestinian Policy Network, said.

 (Photo: Olivier Matthys/Anadolu Agency/Getty Images)

Close to 400,000 Israelis have already been vaccinated against the coronavirus, and tens of thousands of others are on track to do the same in the coming weeks.

Israel was one of the first countries in the world to begin rolling out the COVID-19 vaccine to its population, and according to the University of Oxford-run Our World in Data, is currently second in the world in vaccinations per capita.

The Israeli Health Ministry is aiming to vaccinate 100,000 Israelis per day as soon as this week, Israeli media reported, and Prime Minister Benjamin Netanyahu has made the bold claim of saying that Israel would be out of the woods “within a few weeks.”

Last month, Israel secured 8 million doses of the Pfizer vaccine — enough to cover nearly half of Israel’s population of 9 million, as each person requires two doses. Among those eligible to receive the vaccine from the Israeli government, are the nearly 2 million Palestinian citizens of Israel.

Those not eligible to receive the vaccine, however, are the more than 5 million Palestinians living under the control of the Israeli occupation in the occupied West Bank, East Jerusalem, and Gaza Strip.

The disparities between Palestinians living under Israeli occupation and Israeli citizens are constant, and simply a fact of everyday life in Israel and Palestine — laws that favor Israelis over Palestinians, and systems that actively discriminate against the latter are commonplace, and widely documented.

The apartheid system under which Israel operates inside the occupied territory, however, could not be better displayed than in the case of the COVID-19 vaccine — who gets the vaccine, and who doesn’t, is a simple matter of nationality.

“Firstly we have to be very clear: with military occupation in the West Bank and Gaza effectively under Israeli control, Israel is legally obliged by international law to provide for their [Palestinians’] healthcare,” Dr. Yara Hawari, Senior Analyst at Al-Shabaka: The Palestinian Policy Network, told Mondoweiss.

“Israel is legally required to provide that vaccine to Palestinians under occupation. We know they [Israel] have not done that,” she said, adding that Israel puts that responsibility on the PA as the service provider for Palestinians.

“That’s a real worry,” Hawari told Mondoweiss. “We know it’s likely that it will be a really slow process if it’s just left up to the PA.”

The ‘de-development’ of Palestine’s healthcare system

Unlike the Israeli government, the Palestinian Authority (PA) has been unable to secure the amount of vaccines needed to treat the more than 3 million Palestinians living in the West Bank, and 2 million Palestinians living in the Gaza Strip.

While PA officials have said that they expect to start receiving vaccines in the next two weeks via the World Health Organization (WHO), they’ve said it could be months before the vaccine is distributed amongst the general population.

The type of vaccines Palestinians will be receiving and the amount are still unknown, as they’re relying heavily on international donations for their supply, and the Palestinian government does not have the infrastructural capacity to store vaccines like the Pfizer one at the required low temperatures.

Meanwhile, Palestinians continue to live between unending periods of lockdown, as the virus rages across the oPt, with daily infection rates in the thousands and daily death rates in the double digits.

The PA’s inability to procure and store vaccines, along with its flailing healthcare system, is indicative of the decades worth of damage the Israeli occupation has done to Palestinian infrastructures, Hawari said.

“There’s this common recurring narrative that the reason the Palestinian healthcare system or other systems like education are inefficient and not doing their job because of incompetency on part of the Palestinian people or their culture — this idea that they’re stupid and can’t govern,” Hawari said.

“That’s obviously not the case. The Israeli regime has systematically targeted the Palestinian healthcare system and contributed to its de-development,” she said. “Palestinians have been forced to rely on outside help and have been prevented from being self-sufficient by the [Israeli] occupation, with the complacency of the international community.”

The most prime example of this, Hawari said, is Gaza, where the healthcare system has been on the brink of collapse for years, and has been unable to cope with years of Israeli bombardments and offensives.

“Hospitals in Gaza have been unable to cope with injuries and illnesses for years. They couldn’t cope before COVID, and now COVID has exasperated the situation and made it ten times worse.”

Apartheid at work

While Palestinians living under Israeli occupation in the West Bank and Gaza will not receive vaccines from the Israeli government, the hundreds of thousands of Israeli settlers living illegally in the West Bank are getting vaccinated every day.

Palestinian activists and their supporters have sounded the alarm over the stark disparity between who is getting vaccinated and who is not, saying it amounts to nothing less than Apartheid.

When talking about things like the COVID-19 vaccine,“there seems to be a false separation between Israel and Palestine,” Hawari said. “In reality it’s one entity where people are treated unequally within that space.”

“There is a huge amount of interaction between the populations, but totally imbalanced power levels,” Hawari continued, pointing to the tens of thousands of Palestinian laborers who work inside Israel and the settlements every day.

“The Israeli economy relies on that [labor force] Will they be getting the vaccine as well?” she asked. “If not, that poses a risk to Israel. We’re such intertwined populations, as is the case in colonial populations.”

“It necessitates providing the vaccine for everyone, and should not be exceptional to Palestine. Someone said it perfectly: we’re not safe until everyone has access to the vaccine. This isn’t a virus that knows borders.”

While Israeli officials have floated around the possibility of providing some vaccines to the PA if necessary, Hawari cautioned against being fooled by Israel’s false displays of generosity, saying, “we know they will present such a move as great act of benevolence and international cooperation, but they’re not even meeting the minimum requirements under international law.”

Hawari highlighted the fact that in the midst of the pandemic, Palestinians have “seen very little from the Israeli regime in terms of supplies and support for Palestinians and their fight against the virus. And when they did finally coordinate to allow internationally donated supplies, it was praised as a wonderful form of cooperation, when that is the minimum that is required of them.”

“We’ve seen Israel do this for decades — Israel is constantly praised for letting Gaza cancer patients in to Tel Aviv for treatment, but they are imposing the siege that prevents hundreds of Gazans from getting the necessary treatment in the first place,” she said.

“It’s a very clever spin on something that they are supposed to be doing, but that they’re not.”

In addition to questions surrounding where Palestinians in the oPt stand when it comes to the vaccine, Palestinian activists and rights groups have voiced concerns over the potential marginalization of Palestinian communities in Israel when it comes to getting vaccinated.

At the beginning of the pandemic, groups like Adalah criticized the Israeli government for sidelining Palestinian communities in place like East Jerusalem, where coronavirus testing clinics were scarce to even non-existent.

Hawari is confident that “we will see those trends” again during the vaccination process.

“It’s still early and the vaccine is just rolling out, but if you look at implementation, they’ll [Israel] be rolling them [vaccines] out in clinics. And we know that of course in Palestinian villages and towns in ‘48, the health care system is deprived so there are fewer clinics and medical professionals, so it will be a slower roll out in those areas,” she said.

“It will be easy for the Israeli government to brush this aside and say ‘every Israeli citizens is treated equally,’ but if we look at the geography, those Palestinian communities by design have been left out when it comes to health facilities, clinics, and other essential institutions.”

Palestine & the Global South

As dozens of countries around the world, like Israel, the US, UK, and countries in the EU begin rolling out their vaccines to the general population, places like Palestine and other countries in the “Global South” have been left behind.

Even before the vaccines hit the market, rich nations began stockpiling some of the most promising coronavirus vaccines. According to the organizations like Amnesty International and Oxfam, it’s estimated that despite being home to only 14% of the global populations, rich nations have already bought 54% of the total stock of the world’s most promising vaccines.

Amnesty International has said that by the end of 2021, wealthier nations will have purchased enough vaccine doses to “vaccinate their entire populations three times over,” while some 70 poor countries “will only be able to vaccinate one in ten people against COVID-19.”

“What’s happening globally is very demonstrative of the structural inequalities that exist worldwide,” Hawari said. “Places like Gaza, where it’s difficult to even maintain basic sanitary and social distancing requirements, should be prioritized in order to prevent the spread. But of course they won’t be prioritized because of prevailing structures of oppression.”

“COVID has highlighted structures of inequality around the globe,” Hawari continued, saying she thinks “it’s almost impossible to have health justice and equality within these structures.”

“A step in the right direction, specifically in regards to Palestine, would be for Palestinians to immediately be provided with the vaccine, because they live vulnerable lives, and are a vulnerable community,” Hawari said. “This priority shouldn’t be exclusive to Palestinians, but to other countries in the global south as well. Access to healthcare shouldn’t depend on whether you can afford it or not.”

Yumna Patel is the Palestine correspondent for Mondoweiss. You can find her on twitter @yumna_patel.

© 2019 Mondoweiss

Vaccines boost Big Pharma’s image,

 but won’t change its ways

SAAD HASAN

6 DAYS AGO



The development of Covid-19 vaccines in record time will not be enough to fix big pharma’s tarnished image.

In 1955, Jonas Salk, the inventor of the polio vaccine, was asked a question about who owned the patent to the drug. “Well, the people I would say,” he told a journalist. “There is no patent. Could you patent the Sun?”

The widespread availability of an affordable polio vaccine in subsequent years has almost eliminated the disease from the world, saving millions of children from paralysis and death.

A few months back, large American and European pharmaceutical companies in the race to make Covid-19 vaccines were being pushed to follow Salk’s path and keep their research in the public domain.

That would have helped generic manufacturers in countries such as India to ramp up production and deliver vaccines, even in poorer countries.

Yet none of the pharma bigwigs including Pfizer, AstraZeneca, GSK or Johnson and Johnson (J&J) participated in the patent sharing pool created by the World Health Organisation (WHO).

Experts say the Covid-19 pandemic afforded an opportunity to the industry to rebuild its image tarnished by recent scandals involving price-gouging practices and the opioid crisis.

By luck or by design, the industry seemed to have redeemed some of its reputation with vaccines produced in record time.

“Covid-19 gives a handful of companies a chance to come forward with a vaccine that may help us return to the pre-Covid normal faster than we would have otherwise,” Gerald Posner, the author of Pharma, a book that takes a deep dive into how the industry works, told TRT World.

“As a result, this will have a temporary good effect for them. But the question is: will that fundamentally change the business? — no I don't believe so. They will go back to their ways very quickly which is putting profits ahead of patients.”

Jonas Salk could have made hundreds of millions of dollars but decided not to patent the polio vaccine. (AP Archive)

With governments under public pressure for their handling of the pandemic, politicians desperately sought a magic pill that would make lockdowns disappear. The virus has killed more than 1.7 million people and millions more have lost their jobs.

The urgency to deal with a global health emergency means the scrutiny that was directed at the pharma industry until very recently will have to take a back seat, says Posner.

In 2018, a US court ordered J&J to pay $4.1 billion in damages for the talc products that caused ovarian cancer. The story of Martin Shkreli, aka the Pharma Bro, who raised the price of a drug used to treat a life-threatening infection by 5000 percent overnight, continues to rile people.

Those stories are a distant memory. Moderna and BioNtech, the startups that pioneered mRNA technology, which prep human cells to make a protein that kicks in an immune response to the virus, are enjoying overwhelmingly positive media coverage.

Though the vaccines have gone through the necessary three-tier trial process, America’s Food and Drug Administration and its counterpart in the UK have been unusually quick with approvals. For a medicine maker, an FDA nod is as good as cash — it's an official stamp of authenticity for the drug.

The industry itself has been betting on the coronavirus vaccine to rescue its image as executives have indicated in multiple interviews, hoping that it will deflect negative publicity.

“We went from having been a political piñata in January to a recognition, at least in the minds of many policymakers, that this is an industry that we must support,” Jeremy Levin, chairman of the industry association BIO, told the Financial Times, in July.

And the governments have indeed come out in full support. They have not just allowed the companies to use publicly-funded research and paid them money to accelerate vaccine development — they also spent billions of dollars to buy the vaccines.

A numbers game

Posner says it goes to the pharma industry’s credit that it hasn’t put a steep price tag on the Covid-19 vaccines.

Prices range between $3 a dose to $50 a dose with AstraZeneca’s the cheapest and Moderna’s the most expensive.

But there’s a catch here. What the industry gives up on price, it makes up in volume. Also, instead of selling the vaccine at pharmacies, the companies have struck deals directly with governments which have taken the responsibility to administer them to the public.

“They are going to vaccinate the entire population and you have to do it twice. That is a huge, huge, volume of vaccines. So even a very small profit for each dose means billions of dollars of income even at a modest price,” John Rother, the President of National Coalition on Health Care, which lobbies for health reforms in the US, told TRT World.

Rother said pharma companies in the US spend as much as 40 percent of their revenue on advertising and marketing. With Covid-19 vaccines, they don’t need to spend a dime on convincing people to buy their products.

Wealthy nations have mopped up almost all the Pfizer-BioNtech and Moderna vaccine supplies. (AP)

If the virus mutates, as is evident from different strains that have already emerged, then the Covid-19 jabs could become an annual feature, bringing in additional cash in the coming years.

Pfizer and Moderna alone are expected to generate $32 billion in revenue from vaccine sales in 2021 alone.

Two giants — AstraZeneca and J&J — say they don’t intend to make immediate profits. The caveat here is that their commitment to keep the price near cost of production lasts only till mid 2021.

AstraZeneca is also among a handful of companies which are part of the Gavi vaccine alliance that aims to distribute the shots to more than a hundred developing and low-income countries. But the distribution of its vaccine has lagged behind others.

The most publicised vaccines to be approved up until now are mRNA-based BNT162b2 and mRNA-1273 developed by the Pfizer-BioNtech duo and Moderna, respectively. China and Russia have also reported that their vaccines are effective and many countries are preparing to roll them out.

But most Pfizer and Moderna jabs have gone to wealthy nations which have mopped up the supplies months before production even started. The European Union just bought 100 million doses of the Pfizer vaccine, taking its total to 300 million. But that doesn’t compare to Canada's stockpile - enough to vaccinate all its citizens five times over.

Activists have severely criticised the practice and warned that “vaccine nationalism” can hinder efforts to stop the pandemic.

That money is at the heart of vaccine distribution was evident as Saudi Arabia and the UAE, which have not helped develop the vaccines, got a share of the precious drugs coming off manufacturing plants of Pfizer.

“I guarantee you that it is only about one thing — price,” said Posner about how the oil-rich Arab countries struck deals with pharma companies and rapidly built a cold supply chain.

“I would be flabbergasted — if we ever saw the documents — to find if those were not the highest prices paid for the vaccine.”

Former pharmaceutical CEO Martin Shkreli who raised the price of a life-saving drug by 5000 percent has come to symbolize industry's greed. (AP Archive)

Your money, their choice

Many more countries could have benefited from the first wave of vaccine distribution if patent rights and manufacturing know-how had been shared, says Dr Enrico Bonadio, an intellectual property (IP) law expert who is a Reader at the City Law School, London.

“This was an unprecedented situation. But still what we witness was that the governments in the US, UK and EU supported their pharmaceutical lobbies. Even a pandemic didn’t change their perspective,” he told TRT World.

In October, India and South Africa mounted a challenge at the World Trade Organisation (WTO), arguing that patent rights, confidential information and trademarks should be shared with the rest of the world. The West balked at the proposal.

The Wall Street Journal (WSJ) carried an editorial backing the pharma industry’s long held argument that intellectual property is to be protected because it’s their money that has gone into the expensive research.

Bonadio said he’s not surprised by the decision of pharma corporations to vigorously defend their patents. “It’s like a sacred belief for them. They need IP protection to recoup their investments.”

But that’s just part of the story. Starting from the first antibiotic, penicillin, many drugs have been funded by governments in the US and Europe through public funding.

The messenger RNA or mRNA technology behind Moderna’s vaccine comes from Washington-funded National Institutes of Health (NIH).

“From the late 1930s to 2018, the US government spent $930 billion on the NIH to fund public research that was then taken by the pharmaceutical industry. They put a patent on it, made it their own intellectual property and then charged high prices, in some cases making billions of dollars,” said Posner.

Pfizer repeatedly said that it didn’t receive anything from the $10 billion Operation Warp Speed, which was created by US President Donald Trump to hasten vaccine development.

But the vaccine was not an American multinational’s own creation. Instead, it struck a deal with Germany’s BioNtech which did the R&D for the drug partly funded by $445 million it received from Berlin.

In the past there have been cases where governments in developing countries have stepped in to forcibly take over the patents, said Bonadio.

Public pressure forced pharma companies in the late 1990s to drop opposition of cheaper generic HIV Aids drugs. (AP Archive)

One high profile case involved South Africa, which in the late 1990s decided to introduce generic drugs to treat HIV/Aids in a bid to counter the high-priced treatments sold by multinational companies.

Despite Aids killing millions of people in sub-Saharan Africa, 39 companies took South Africa to court. “That legal action was later abandoned because the companies realised their position had a kind of boomerang effect as they were being seen as greedy pharma companies,” said Bonadio.

This time the pharma companies have evaded similar scrutiny by keeping the Covid-19 vaccine price low and striking deals with governments, which are desperate to revitalise their economies.

But there’s no consolation for hundreds of millions of people in the developing world who have to wait years to get the jabs.

And there’s no Jonas Salk around to help them. 

Source: TRT World

Palestinians left deprived as Israel signs more vaccine deals

The situation in Israel and the Palestinian territories provides a stark example of a highly unequal vaccination push all around the world.

A man receives a vaccination against the coronavirus disease (Covid-19) at a vaccination center in Jerusalem, January 3, 2021. (Reuters)

Israel's has authorised the use of a third vaccine made with US drugmaker Moderna Inc., as part of its massive vaccination drive that has already seen nearly a tenth of the population vaccinated. But millions of Palestinians living under Israeli control will have to watch and wait much longer.

Israel's vaccination campaign will include Jewish settlers living deep inside the West Bank, who are Israeli citizens, but not the roughly 2.7 million Palestinians living around them who may have to wait for weeks or months.

They will have to wait for the cash-strapped Palestinian Authority, which administers parts of the occupied West Bank in accordance with interim peace agreements reached in the 1990s. Israel captured the West Bank, the Gaza Strip and east Jerusalem, territories the Palestinian seek for their future state, in the 1967 Mideast war.

The PA hopes to get vaccines through a WHO-led partnership with humanitarian organizations known as COVAX, which aims to provide free vaccines for up to 20 percent of the population of poor countries, many of which have been hit especially hard by the pandemic.

“I don’t know how, but there must be a way to make us a priority, too?” said Mahmoud Kilani to The Guardian, a 31-year-old sports coach from the Palestinian city of Nablus. “Who cares about us? I don’t think anybody is stuck on that question.”

READ MORE: Israel demolished over 700 Palestinian buildings in 2020



Israel's legal obligations

Physicians for Human Rights-Israel, a group that advocates for more equitable health care, says Israel has a legal obligation as an occupying power to purchase and distribute vaccines to the Palestinians.

"The Palestinian health system, whether in the West Bank or the Gaza Strip, is in dire condition, mainly (because of) restrictions imposed by Israel.”

In Gaza, an impoverished enclave under blockade, the timeframe could be even longer than in the West Bank.

Salama Ma’rouf, head of the Hamas-run Gaza press office, estimated vaccines would arrive “within two months”, adding that there was coordination with the WHO and the Palestinian Authority.

Heba Abu Asr, a 35-year-old Gaza resident was surprised by The Guardian's query about how she felt about others getting the vaccine first. “Are you seriously trying to compare us with Israel or any other country?” she inquired. “We can’t find work, food, or drink. We are under threat all the time. We do not even have any necessities for life.”

READ MORE: Israel injures several Palestinians protesting illegal settlements

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Mass vaccination campaign

Israel has begun to vaccinate its population at one of the quickest rates in the world, and it aims to reach all vulnerable citizens by late January. Authorities started vaccinations on December 19 using the vaccine developed by Pfizer and BioNTech.

"Ministry of Health of Israel has secured 6 million doses and first deliveries (are) expected to begin in January," Moderna has separately said in a statement on Monday.

The director-general of Israel’s health ministry, Hezi Levy, confirmed the import agreement with Moderna. Interviewed by radio station 103FM, he declined to give details of the size of the shipment and said the date of its arrival was under discussion.

Israeli media outlet The Jewish Chronicle, denied claims over discrimination against Palestinians and said Israel is not ‘excluding’ Palestinians from the vaccination programme, or discriminating between its own Jewish and Arab citizens.

READ MORE: Future bleak for the poorest despite Covid-19 vaccine on the horizon

Parents' finances differently affected by having a child diagnosed with cancer

UPPSALA UNIVERSITY

 NEWS RELEASE 4-JAN-2021

Research News

 

IMAGE: MATTIAS ÖHMAN, RESEARCHER AT THE INSTITUTE FOR HOUSING AND URBAN RESEARCH, UPPSALA UNIVERSITY. view more 

CREDIT: MIKAEL WALLERSTEDT

Mothers and fathers of children diagnosed with cancer are affected financially in different ways. While mothers' incomes fall in the short term and then rise, the adverse financial repercussions on fathers occur later. Researchers at Uppsala University have investigated the socioeconomic impact on parents of having a child diagnosed with cancer. The study is published in the International Journal of Cancer.

Previous research has shown that when a child falls ill with cancer, the parents are affected financially as well as psychologically. The available literature shows that mothers are more affected than fathers.

"Data from a research project I've worked on since 2005, studying the same parents of children with cancer over a long period, indicate that fathers are affected more, in the long term, than the evidence has previously borne out. In the new study, we've looked into the validity of these data," says Louise von Essen of Uppsala University's Department of Women's and Children's Health.

Using register data from Swedish public agencies, the researchers followed nearly 4,000 fathers and nearly 4,000 mothers of an equal number of children diagnosed with cancer in Sweden when 0-18 years old, five years before and ten years after diagnosis.

The findings show that in Sweden childhood cancer has negative short-term effects on fathers' and mothers' earnings. The long-term effects on earnings are negative for fathers, and positive for mothers. Negative short-term effects on employment were found for fathers and strong negative short-term effects for mothers. The long-term effects on employment are negative for both fathers and mothers.

As for why the fathers' long-term income trend was negative, the researchers will now examine this in detail. One theory they are pursuing is that fathers more often go on working while the children are ill, and therefore receive less support than the mothers from the healthcare services and personal networks alike. Moreover, this happens while the fathers are living under a heavy burden of stress. This might cause a relatively sharp fall in wellbeing among fathers, which may in turn result in adverse financial consequences.

"In our opinion, the findings of the study provide arguments for involving mothers and fathers equally in the care of gravely ill children, and for offering psychological support to all parents of children with cancer. That way, it would be possible to reduce the risk of any group not getting any support and, because of that, suffering from harmful repercussions like a lower income in the long run," says the first author of the study, Mattias Öhman of the Institute for Housing and Urban Research at Uppsala University.

###

Mattias Öhman et al. (2020), Socioeconomic consequences of parenting a child with cancer for fathers and mothers in Sweden: A population?based difference-in-difference study, International Journal of Cancer, DOI: 10.1002/ijc.33444

 

More women embracing 'going flat' after mastectomy

UCLA researchers find women choosing not to have reconstruction surgery are satisfied with their outcome

UNIVERSITY OF CALIFORNIA - LOS ANGELES HEALTH SCIENCES

1/4/2021

Research News

 

LOS ANGELES -- A growing number of women forgoing reconstruction after a mastectomy say they're satisfied with their choice, even as some did not feel supported by their physician, according to a study led by researchers at the UCLA Jonsson Comprehensive Cancer Center.

The study, published in the Journal Annals of Surgical Oncology, surveyed 931 women who had a unilateral or bilateral mastectomy without current breast mound reconstruction to assess the motivating factors for forgoing the procedure and to measure whether surgeons provided adequate information and support for "going flat."

Out of the women surveyed, 74% were satisfied with their outcome and 22% experienced "flat denial," where the procedure was not initially offered, the surgeon did not support the patient decision, or intentionally left additional skin in case the patient changed her mind.

The team also explored reasons given for the choice and found women pointed to a desire for a faster recovery, avoidance of a foreign body placement and the belief that breast mound reconstruction was not important for their body image.

"Undergoing a mastectomy with or without reconstruction is often a very personal choice," said Dr. Deanna Attai, an assistant clinical professor of surgery at the David Geffen School of Medicine at UCLA, and senior author of the study. "We found that for a subset of women, 'going flat' is a desired and intentional option, which should be supported by the treatment team and should not imply that women who forgo reconstruction are not concerned with their post-operative appearance."

The results challenge past studies showing that patients who chose not to undergo breast reconstruction tend to have a poorer quality of life compared with those who do have the surgery.

Attai and her team found that a majority of patients who elected to go flat were in fact satisfied with their surgical outcome. The authors believe the survey tool commonly used to asses outcomes was biased towards reconstruction. To avoid that bias, Attai partnered with patient advocates to develop a unique survey to assess reasons for going flat, satisfaction with their decision, and factors associated with satisfaction. They also identified concerns unique to these patients not captured by other validated surveys.

While a majority of the women surveyed reported they were satisfied with their surgical outcomes, 27% of patients surveyed reported not being satisfied with the appearance of their chest wall.

"Some patients were told that excess skin was intentionally left -- despite a preoperative agreement to perform a flat chest wall closure -- for use in future reconstruction, in case the patient changed her mind," said Attai, who is a member of the UCLA Jonsson Comprehensive Cancer Center. "We were surprised that some women had to struggle to receive the procedure that they desired."

Surgeons may hesitate to recommend mastectomy without reconstruction surgeons due to being less confident that they can provide a cosmetically acceptable result for patients who desire a flat chest wall, noted Attai.

"We hope that the results of this study will serve to inform general and breast surgeons that going flat is a valid option for patients, and one that needs to be offered as an option," said Attai. "We also hope the results may help inform patients that going flat is an option, and to empower them to seek out surgeons who offer this option and respect their decision."

###

In addition to Attai, study co-authors were Dr. Jennifer Baker, Dr. Carlie Thompson, Dr. Minna Lee and Dr. DiNome of UCLA; Dr. Don Dizon of the Brown University and the Lidespan Cancer Institute; and Dr. Cachet Wenziger and Dr. Elani Streja of the University of California Irvine School of Medicine.

The true cost of chemotherapy

UNIVERSITY OF EAST ANGLIA

 NEWS RELEASE 4-JAN-2021

Research News

 

Chemotherapy for breast cancer costs the UK economy more than £248 million annually, including 'out-of-pocket' personal costs of more than £1,000 per patient - according to new research from the University of East Anglia.

A new study published today is the first to investigate the total non-healthcare cost of chemotherapy to the UK.

It includes the cost of lost productivity, work absence, and personal costs such as paying for transport and parking for treatment, the cost of wigs and new bras, and over the counter medications.

The UEA research team say that better targeting of treatment could help avoid placing unnecessary costs upon patients, their caregivers and wider society.

Prof Richard Fordham, from UEA's Norwich Medical School, said: "Breast cancer is the most common cancer in women and second most common cancer overall with two million cases per year worldwide.

"Most patients require surgery, additional radiotherapy, chemotherapy, hormone therapy or a combination of these to reduce the risk of the cancer coming back. Around a third of breast cancer patients receive chemotherapy, but there are grey areas around which patients do and don't need chemotherapy.

"As well as the cost of the treatment itself, there are many societal and personal costs associated with chemotherapy. These might include taking time off work, paying for hospital transport or parking, paying for over-the-counter medications or dietary supplements, the cost of wigs, headscarves and new bras, and the cost of informal care.

"But until now it has not been known what the total cost of all of this really is. We wanted to find out what the true total cost of chemotherapy is for patients, caregivers and wider society, for treating breast cancer in the UK."

The research team collected data from sources including UK cancer registries, clinical guidelines and published patient survey data. Patient and staff views were collected through semi-structured interviews.

Key findings:

• The total cost of breast cancer chemotherapy in the UK economy is over £248 million.
• Societal productivity losses of £141.4 million - including £3.2 million lost to premature mortality, and £133.7 million lost to short-term (£28.7 m) and long-term (105m) work absence. Further costs include £3.4m associated with mortality losses from secondary malignancies due to adjuvant chemotherapy and £1.1m in lost productivity arises from informal care provision.
• £1.1 million in lost productivity arises from informal care provision.
• Out-of-pocket patient costs for chemotherapy total £4.2million, or an annual average of £1,100 per patient.

In addition, costs for the emotional wellbeing of carers could be as much as £82 million. Emotional wellbeing reflects how much additional income would be required to offset a wellbeing loss.

Dr Stephanie Howard-Wilsher, also of UEA's Norwich Medical School, said: "We spoke to breast cancer patients who had undertaken chemotherapy to better understand the actual experiences and impacts of these costs. We also interviewed healthcare staff involved in breast cancer care for their views on chemotherapy and associated costs.

"The interviews with patients really show the impact that breast cancer has on lives. They talk about their worlds just falling apart, and chemotherapy side effects like hair loss, tiredness, constipation and diarrhea, loss of taste. And they also talk about the emotional impact for their families and those caring for them.

Researcher Anna Sweeting, from UEA's Norwich Medical School, said: "Interviews with healthcare professionals showed us how patients cope with chemotherapy differently. For some patients, their cognitive function is never quite the same afterwards, they suffer with 'chemo brain'. And it also gave us insight into the impact for families, including children's mental health.

"Our work shows how chemotherapy carries significant and far-reaching indirect costs for society, as well as for patients and their carers - beyond the costs associated with the treatment itself."

"The greatest burden accrued to society is in patient productivity losses. Patient out-of-pocket expenses and costs of informal care were smaller by comparison but nevertheless significant. Better targeting of chemotherapy treatment could help avoid placing unnecessary costs upon patients, their caregivers and wider society," added health economist and former UEA researcher Krishnali Parsekar.

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'Societal costs of chemotherapy in the UK: an incidence-based cost-of-illness model for early breast cancer' is published in the journal BMJ Open on January 5, 2021.

State laws promoting flu vaccination for hospital workers may help prevent deaths from flu and pneum

Embargoed News from Annals of Internal Medicine

AMERICAN COLLEGE OF PHYSICIANS

NEWS RELEASE 4-JAN-2021

Research News

 

Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.

1. State laws promoting flu vaccination for hospital workers may help prevent deaths from flu and pneumonia
Abstract: https://www.acpjournals.org/doi/10.7326/M20-0413
URL goes live when the embargo lifts

Research suggests that state laws promoting influenza vaccination for hospital workers can be effective in preventing deaths from pneumonia and influenza, particularly among the elderly. Findings from a quasi-experimental observational study are published in Annals of Internal Medicine.

Seasonal influenza vaccines are a key defense against infection, but they can be less effective in elderly adults and chronically ill persons who are at the greatest risk. The Centers for Disease Control and Prevention (CDC) has long recommended vaccinating health care workers and several states passed laws requiring that hospitals provide influenza vaccination onsite for their employees. The effect of these laws on pneumonia and influenza mortality is unknown.

Researchers from the University of Georgia, Montana State University, and Monash University used quasi-experimental, state-level, longitudinal study designs to estimate the association of state hospital worker influenza vaccination laws with influenza and pneumonia mortality rates. In one design, the researchers conducted a synthetic control analysis to estimate a separate treatment effect for each of the 14 states that adopted a vaccination law between 2002 and 2014. In the other design, they estimated an average treatment effect using a state-level, longitudinal model in which they controlled for national time fixed effects, state fixed effects, and state-specific time trends. Each of these approaches compared differences in mortality rates between states with and without laws in place, before and after law implementation.

The researchers found that the implementation of a state vaccination law was associated with a 2.5% reduction in monthly pneumonia and influenza mortality rates during the years when the vaccine was well matched to the circulating strains. This implies that during the 2016-2017 influenza year (when 15 states had implemented laws), approximately 1,822 pneumonia and influenza deaths were averted because of the laws. The largest effects occurred among elderly persons and during peak influenza months. According to the researchers, these findings suggest that vaccination laws may be a good way to protect the country's most vulnerable populations.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org.
To reach the corresponding author, Emily Lawler, PhD, please contact Caroline Paris Paczkowski at cparis@uga.edu.

Also in this issue:
Polymyalgia Rheumatica and Giant Cell Arteritis
Robert M. Centor, MD
Annals On Call Podcast
Abstract: https://www.acpjournals.org/doi/10.7326/A20-0004

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One in four doctors attacked, harassed on social media

Amid COVID-19, it is vital doctors feel safe advocating for masks, vaccine adherence

NORTHWESTERN UNIVERSITY

NEWS RELEASE 4-JAN-2021

Research News

 

CHICAGO --- While many physicians benefit from social media by networking with potential collaborators or interfacing with patients, a new study from Northwestern University and the University of Chicago found many physicians also report being sexually harassed and personally attacked on these platforms on the basis of their religion, race or medical recommendations.

Although the data were collected before the COVID-19 outbreak, the findings highlight the intensity of online harassment before the pandemic, which has only intensified since the spring, the study authors said.

"If anything, our data is likely an underestimate of the true extent of attacks and harassment post-pandemic since so many doctors started to advocate for public health measures during the pandemic and have been met with an increasingly polarized populace emboldened by leadership that devalues science and fact," said senior and corresponding author Dr. Vineet Arora, assistant dean for scholarship and discovery at the University of Chicago Pritzker School of Medicine.

The study was published Jan. 4 in JAMA Internal Medicine.

This is the first known study to describe physician experiences with online harassment. It found one in four physicians report being personally attacked on social media, including being barraged by negative reviews, receiving coordinated harassment and threats at work, and having their personal information shared publicly. Some attacks were particularly disturbing, such as threats of rape and death, the study authors said.

Women were disproportionately affected by personal attacks and sexual harassment, with one in six women physicians reporting being sexually harassed on social media.

"We worry this emotionally distressing environment will drive women physicians off social media, which has been well-documented as a helpful career-advancement tool," said first author Tricia Pendergrast, a second-year medical student at Northwestern University Feinberg School of Medicine. "Women in medicine are already less likely to hold leadership positions or be first or last authors of research, so disproportionately abstaining from a platform used for collaboration and networking due to sexual harassment and personal attacks should be a cause for concern."

Physicians should be supported online as trusted messengers, the study authors said. The study highlights the need for medical institutions to have a plan in place to respond to this type of online harassment so physicians' careers aren't negatively impacted long term.

"Doctors and other health care workers are already facing unprecedented stress and mental health challenges from their work," Arora said. "Any stress from being online will compound that and put them at risk especially as doctors are being asked to be more vocal on social media to promote vaccination and more."

To help diffuse these types of attacks, Arora co-founded a coalition of physicians and health care professionals in Illinois, the Illinois Medical Professionals Action Collaborative Team (IMPACT4HC), which brings together healthcare workers to educate and advocate for evidence-based solutions on social media.

"It feels much easier to advocate on social media as part of a group," Arora said. "The nice thing is that on #medtwitter, you are not alone. There are many who will come to your aid. And together, we not only have a louder voice but we can support each other though this stressful time."

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The participants in the study completed a survey the study authors sent via traceable links on Twitter between Feb. 6 and March 20, 2019. The survey asked respondents to answer two questions with yes or no: had they ever personally been targeted or attacked on social media and had they ever been sexually harassed on social media. An optional text box was provided for description of such incidents. Of the 1,103 times the survey was viewed, 464 participants (42.1%) who self-identified as U.S. physicians completed the survey.

Other Northwestern study authors include Dr. Seth Trueger, assistant professor of emergency medicine at Feinberg, and Nicole Woitowich, assistant professor of obstetrics and gynecology at Feinberg. Other authors include Dr. Shikha Jain from University of Illinois Chicago and Dr. Michael Gottlieb from Rush University Medical Center.

CAPITALI$T ANARCHY 

France’s COVID Vaccine Roll Out Is Going So Slowly It’ll Take 3,000 Years

FEAR OF CENTRAL PLANNING

SNAIL’S PACE

The latest confirmed number of vaccines administered in France is just 516, where a historic scepticism combined with a delayed roll out means anti-vaxx sentiment is on the rise.



Peter Yeung 

DAILY BEAST 

Published Jan. 05, 2021 

Getty



PARIS–More than a week after France’s COVID-19 vaccine campaign was launched, only a few thousand people in the entire country have received their first injection, with President Emmanuel Macron’s vaccination strategy widely criticized for being flawed, too slow, and pandering to anti-vaxxers.

Only 516 people in France had received their first vaccine dose as of Jan. 1, according to the independent website Covid Tracker, compared with 114,000 in Italy, 238,000 in Germany and more than one million people in the U.K. That figure is now reportedly “over 5,000”, but the Ministry of Health has yet to confirm the exact number. If the French vaccine rollout’s objective of one million vaccinations by the end of January is to be reached, 36,000 jabs must be carried out each day.

In interviews with The Daily Beast, French doctors have blasted the country’s approach to the vaccine rollout, singling out “misjudged” policy decisions, a lack of information communicated to health workers, and a lack of preparation.

The French strategy initially was to prioritize vulnerable groups in retirement homes, allowing for a two-week process to carry out each vaccination, including a doctor’s consultation, the patient’s approval and the injection itself. However, a slow take-up and reports of large numbers of care home patients refusing the vaccine have forced a change of plan.

As of Monday, that recommended time period for vaccination has been reduced to one week and the focus has shifted, with doctors, nurses and carers over the age of 50 now able to volunteer to have a vaccination immediately. City vaccination centers are expected to open before the beginning of February.

Nathan Peiffer-Smadja, an infection specialist at Paris’s Bichat hospital, criticized the decision to begin vaccination in retirement homes. “It was too complicated, it shouldn't have begun there,” he said. “If anything the [slow pace of the] strategy has encouraged anti-vaxxers. Medically and scientifically, there is no reason for this to be done slowly. On the contrary, it should be done as quickly as possible.”

Inside the World’s COVID Anti-Vaxxer Epicenter
GET A CLUE
Peter Yeung


“At this pace it would take 3,000 years to reach herd immunity,” said Professor Bruno Megarbane, head of the medical and toxicological intensive care unit at Lariboisière Hospital in Paris. “But for the official authorities, there hasn't been a delay in the vaccine rollout. For them, this rollout corresponds to the official vaccination strategy—even if observers like me say there has been a delay. Especially when vaccine doses are now uselessly sitting in freezers, not being used.”

Megarbane is “confident” that the speed of vaccinations will increase, but is concerned about the lack of information being shared with hospitals. “We don't have any information,” he added. “We don't know when vaccination will begin, who can get vaccinated, or who will be allowed to carry out vaccinations.”

Some are concerned about the longer-term implications of France’s sluggish start. Dr. Arnaud Fontanet, epidemiologist and member of the Scientific Council, estimates that 12 percent of French people have caught COVID-19 to date but that “the virus will only stop circulating epidemically” when at least half of the population have been immunized.

“My worry is not so much about the first few weeks,” he added. “My concern is that we are facing a worldwide demand for these vaccines. In three months, will we have sufficient doses for Europe and the rest of the world.”

On Monday the French government will launch a citizens’ committee formed of 35 randomly-selected, non-expert French people to help decide the country’s vaccine strategy. Made up of representatives of different demographics such as age, gender, region, level of qualification and socio-professional category, the committee is intended to "nourish the executive and legislative power" of the vaccination campaign and “to take into account their responses” .

In the middle of an unprecedented health crisis, however, the creation of a non-expert group to advise on policy has led to puzzlement.

“The French are vaccine sceptics despite our great elders like Pasteur,” said Emmanuel Andrès, head of the internal medicine department of Strasbourg’s University Hospitals and president of the medical commission establishment. “Personally, I don't really see how a citizens' committee could be useful in defining French vaccination policy.”

Mixed messages from the government over the plans haven’t helped matters. On Sunday the minister of transport, Jean-Baptiste Djebbari, told BFM-TV that the goal was to “vaccinate 26 million people by the summer”, contradicting the target of 15 million set out by Prime Minister Jean Castex before parliament in December. Gabriel Attal, the government spokesperson, was then forced to clarify that the “priority objective” is 15 million by the summer.

In comments leaked to the Journal du Dimanche on Sunday, Macron complained that the government’s vax program has all the urgency of a “family stroll” and that “the government has failed to grasp the seriousness of the moment”. The report cited a senior minister source claiming that health authorities incapable of organizing mass vaccination were “presenting a constraint as a strategy”.

Macron has also come under withering criticism in the national media for this latest misstep. “While America, Israel, Great Britain, Germany gallop, France advances at the speed of the snail. Champion in restrictions, gold medal in certificates, she is last in solutions,” read an editorial in Le Figaro, a daily newspaper.

The French government has received 560,000 doses of the Pfizer vaccine and from Wednesday, it expects to receive another 500,000. But the first two deliveries of vaccines at the end of December 2020—first 60,000, then 500,000 doses—were only sent to 40 hospitals, out of the hundred reference centers selected by the state.

On top of the slow vaccine rollout, Macron is under pressure for failures in public education that put anti-vaxxer sentiment at nearly 60 percent and the fact that the French Sanofi vaccine will be delayed until the end of 2021 while Germany’s Pfizer-BioNTech Vaccine and the U.K.’s Oxford-AstraZeneca vaccine have already been deployed.

An Odoxa poll for Le Figaro, which was published on Sunday but carried out on Dec. 22 and 23, found that the majority of the population is still reluctant to be vaccinated, with a refusal rate of 58 per cent. That's an increase of 8 points compared to the previous month, when the first vaccines were given the green light.

But in France, the arrival of the British variant of SARS-CoV-2, suspected of being more contagious, has raised concerns. The director general of health, Jérôme Salomon, said that “the trend is already worrying.” Even though the impact of the festive period is not yet known, he said: “We have had a gradual increase since the beginning of December”.

Currently, 24,780 patients are hospitalized in France because of COVID-19, including 2,665 in intensive care, according to data from Public Health France. A total of 65,037 people have died since the beginning of the pandemic.