https://www.youtube.com/watch?v=tsojZ8dXhvQ&feature
Wednesday, August 12, 2020
SCOOP: Hospitals Bankroll The Democrat Who Lets Them Send Patients Surprise Bills
The American Hospital Association is boosting its "friend in Washington" Rep. Richie Neal — as he blocks surprise billing reform.
Donald Shaw
Aug 12
Editor’s note: TMI is co-publishing this report by Donald Shaw of Sludge, a nonprofit campaign finance reporting outlet. Sludge is one of the most important journalism outlets focusing on corruption and money in politics. Check out Sludge’s website at www.readsludge.com and consider supporting their crucial work.
One of the most powerful health care industry lobbying groups has poured hundreds of thousands of dollars into the campaign to reelect Democratic Rep. Richard Neal as he blocks legislation to crack down on “surprise medical bills” and thwarts the push for Medicare for All.
The American Hospital Association’s (AHA) political action committee has spent more than $200,000 on digital ads to boost Neal’s reelection campaign as he faces a spirited primary challenge, according to campaign finance records.
AHA is one of the most powerful forces in Washington D.C. working to keep health care costs outrageously high. The trade group, which represents more than 5,000 hospitals and brings in more than $130 million annually, has lobbied against reforms to end surprise medical billing, against plans requiring hospitals to make their prices public, and against the single-payer Medicare for All proposal to eliminate for-profit health insurance.
AHA’s political action committee, AHAPAC, spends millions each election cycle to support federal candidates, but this cycle it has shelled out far more to support Neal than it has spent in any other race. The $200,000 worth of pro-Neal ads the group has sponsored are the only independent expenditures AHAPAC has made in the 2019-20 election cycle.
Huge Money Boosts An Embattled Committee Chairman
As chair of the Ways and Means Committee, Neal controls all legislation that has a tax component, including most major health care bills. Neal has used his chairmanship in the current congressional session to block a deal to end surprise medical bills at the end of 2019 and to prevent his committee from debating a public health care option or so much as utter the words “Medicare for All.”
AHA’s first round of spending for Neal, totaling $69,000, came shortly after the congressman effectively blew up a measure opposed by AHA that would have eliminated surprise medical bills -- a euphemism for the costly charges that occur when patients visit a hospital within their insurance network but are unknowingly treated by a provider who is not part of their network. The proposal in Congress would have capped out-of-network charges at a benchmark rate based on the cost of equivalent in-network care.
Democrats and Republicans in both chambers of Congress had coalesced around the legislation, and it was set to pass as part of a year-end appropriations bill in December. Neal announced at the last minute that he was working on a counterproposal, fracturing the deal and causing it to be left out of the final package.
AHA bought the pro-Neal ads on Jan. 27, according to FEC records. On Feb. 7, Neal announced the details of his own surprise billing proposal, written with Ways and Means Ranking Member Rep. Kevin Brady (R-Texas). Their plan swapped out the cost control measure in the original bill with voluntary negotiations backed up by arbitration, and closely mirrored what AHA wanted. AHA issued a letter on Feb. 10 saying it supported the bill.
The AHA ads, which were targeted to internet users in Western Massachusetts, said that Neal is “protecting health care” for his constituents, according to Google’s political ad archive.
Hospitals Banking on Surprise Billing
Some hospitals have profit-sharing agreements with the physician staffing firms they contract with, allowing them to retain a portion of what the firms earn by springing surprise bills on out-of-network patients. One AHA member, hospital giant HCA Healthcare, launched a joint venture in 2012 with Envision Healthcare, a physician staffing company owned by private equity firm KKR that has been a top source of surprise medical bills.
Last year, Envision and TeamHealth, a hospital staffing company owned by private equity titan Blackstone Group, joined forces to bankroll a $54 million dark money advertising campaign against surprise billing reform. Blackstone has been Neal’s top source of cash ($48,600) this election cycle, according to the Center for Responsive Politics.
AHA’s second expenditure for Neal, also for internet ads, was made on August 5 and totaled $133,000, according to FEC records, as all signs suggested he was in a close primary race against his progressive challenger, Holyoke Mayor Alex Morse.
Internal polling from the Morse campaign, reported by HuffPost this week, found him gaining ground against Neal, with the incumbent’s support below 50 percent. (The polling was conducted before the College Democrats of Massachusetts publicly accused Morse, 31, of having sexual relationships with college students.)
Morse’s fundraising this cycle has been strong and he’s been endorsed by many of the grassroots groups that supported the campaigns of insurgent progressives like Jamaal Bowman and Rep. Alexandria Ocasio-Cortez (D-N.Y.).
"Richie Neal profits from special interests because he’s been doing their bidding for decades,” Morse told Sludge and TMI. “His decision to tank legislation that would protect patients from surprise medical billing is just one example of how he’s thrown working families under the bus to protect his corporate donors.”
Neal did not respond to a request for comment on the AHA ads and the surprise medical billing issue.
‘Access to Health Care’
In an August 2019 article, the American Prospect’s executive editor, David Dayen, described how the hospital industry drives up health care costs across the board.
“Hospital administration has swelled, and administrators earn more in America than any other country,” Dayen wrote. “Much of the windfall in health care goes into the waiting arms of middleman executives at large hospital networks. And these networks have consolidated, with 1,667 hospital mergers from 1998 to 2018, over 540 of them just since 2013.”
Neal was a featured speaker at AHA’s 2019 annual membership meeting, held last spring in Washington D.C. Introduced by AHA president and CEO Rick Pollack as their “friend in Washington,” according to audio obtained by TMI and Sludge, Neal went on to recite one of the hospital industry’s main talking points against a single-payer health care system, calling for people to have access to care, rather than guaranteed coverage.
“We should be working together to make sure that we all buy into the idea of universal access to health care. That ought to be the standard that we embrace, to make sure that everyone has the chance to receive the kind of health care we desire for ourselves,” Neal told the AHA summit audience.
Neal then spoke about opposing Republican cuts to the Affordable Care Act, but said nothing about supporting a mainstream Democratic proposal to strengthen the existing law by adding a public option to compete with the private insurance plans on the exchanges. AHA has opposed public option proposals and last year promoted a study suggesting that such a plan could “reduce hospital payments by nearly $800 billion over 10 years.” Private insurers typically pay hospitals about twice as much as Medicare does for the same services.
At least four bills to establish a public option have been proposed in the House this session, and Neal has not co-sponsored any of them. In 2018, Neal told the editorial board of the Daily Hampshire Gazette that he opposed Medicare for All and favored “an approach that is a little more incremental in nature,” and said he would prioritize bringing back the tax penalty for people who do not buy private insurance or otherwise obtain qualifying coverage.
Three of the public option bills introduced this Congress were referred to both Neal’s Ways and Means Committee and the Energy and Commerce Committee, chaired by Rep. Frank Pallone (D-N.J.). The Energy and Commerce’s health subcommittee held hearings on all three, while the Ways and Means health subcommittee did not hear any of them.
Neal, the top House recipient of corporate PAC money in 2019, has received many contributions from the health industry. According to the Center for Responsive Politics, his top donors this cycle include insurance giants Blue Cross Blue Shield ($47,500) and UnitedHealth Group ($21,500), as well as pharmaceutical manufacturers like Eli Lilly ($10,000), Genentech ($10,000) and Regeneron Pharmaceuticals ($10,000).
'AeroNabs' promise powerful, inhalable protection against COVID-19
https://www.sciencedaily.com/releases/2020/08/200811234951.htm
As the world awaits vaccines to bring the COVID-19 pandemic under control, UC San Francisco scientists have devised a novel approach to halting the spread of SARS-CoV-2, the virus that causes the disease.
Led by UCSF graduate student Michael Schoof, a team of researchers engineered a completely synthetic, production-ready molecule that straitjackets the crucial SARS-CoV-2 machinery that allows the virus to infect our cells. As reported in a new paper, now available on the preprint server bioRxiv, experiments using live virus show that the molecule is among the most potent SARS-CoV-2 antivirals yet discovered.
In an aerosol formulation they tested, dubbed "AeroNabs" by the researchers, these molecules could be self-administered with a nasal spray or inhaler. Used once a day, AeroNabs could provide powerful, reliable protection against SARS-CoV-2 until a vaccine becomes available. The research team is in active discussions with commercial partners to ramp up manufacturing and clinical testing of AeroNabs. If these tests are successful, the scientists aim to make AeroNabs widely available as an inexpensive, over-the-counter medication to prevent and treat COVID-19.
"Far more effective than wearable forms of personal protective equipment, we think of AeroNabs as a molecular form of PPE that could serve as an important stopgap until vaccines provide a more permanent solution to COVID-19," said AeroNabs co-inventor Peter Walter, PhD, professor of biochemistry and biophysics at UCSF and a Howard Hughes Medical Institute Investigator. For those who cannot access or don't respond to SARS-CoV-2 vaccines, Walter added, AeroNabs could be a more permanent line of defense against COVID-19.
"We assembled an incredible group of talented biochemists, cell biologists, virologists and structural biologists to get the project from start to finish in only a few months," said Schoof, a member of the Walter lab and an AeroNabs co-inventor.
Llama-Inspired Design
Though engineered entirely in the lab, AeroNabs were inspired by nanobodies, antibody-like immune proteins that naturally occur in llamas, camels and related animals. Since their discovery in a Belgian lab in the late 1980s, the distinctive properties of nanobodies have intrigued scientists worldwide.
"Though they function much like the antibodies found in the human immune system, nanobodies offer a number of unique advantages for effective therapeutics against SARS-CoV-2," explained co-inventor Aashish Manglik, MD, PhD, an assistant professor of pharmaceutical chemistry who frequently employs nanobodies as a tool in his research on the structure and function of proteins that send and receive signals across the cell's membrane.
For example, nanobodies are an order of magnitude smaller than human antibodies, which makes them easier to manipulate and modify in the lab. Their small size and relatively simple structure also makes them significantly more stable than the antibodies of other mammals. Plus, unlike human antibodies, nanobodies can be easily and inexpensively mass-produced: scientists insert the genes that contain the molecular blueprints to build nanobodies into E. coli or yeast, and transform these microbes into high-output nanobody factories. The same method has been used safely for decades to mass-produce insulin.
But as Manglik noted, "nanobodies were just the starting point for us. Though appealing on their own, we thought we could improve upon them through protein engineering. This eventually led to the development of AeroNabs."
Spike Is the Key to Infection
SARS-CoV-2 relies on its so-called spike proteins to infect cells. These spikes stud the surface of the virus and impart a crown-like appearance when viewed through an electron microscope -- hence the name "coronavirus" for the viral family that includes SARS-CoV-2. Spikes, however, are more than a mere decoration -- they are the essential key that allows the virus to enter our cells.
Like a retractable tool, spikes can switch from a closed, inactive state to an open, active state. When any of a virus particle's approximately 25 spikes become active, that spike's three "receptor-binding domains," or RBDs, become exposed and are primed to attach to ACE2 (pronounced "ace two"), a receptor found on human cells that line the lung and airway.
Through a lock-and-key-like interaction between an ACE2 receptor and a spike RBD, the virus gains entry into the cell, where it then transforms its new host into a coronavirus manufacturer. The researchers believed that if they could find nanobodies that impede spike-ACE2 interactions, they could prevent the virus from infecting cells.
Nanobodies Disable Spikes and Prevent Infection
To find effective candidates, the scientists parsed a recently developed library in Manglik's lab of over 2 billion synthetic nanobodies. After successive rounds of testing, during which they imposed increasingly stringent criteria to eliminate weak or ineffective candidates, the scientists ended up with 21 nanobodies that prevented a modified form of spike from interacting with ACE2.
Further experiments, including the use of cryo-electron microscopy to visualize the nanobody-spike interface, showed that the most potent nanobodies blocked spike-ACE2 interactions by strongly attaching themselves directly to the spike RBDs. These nanobodies function a bit like a sheath that covers the RBD "key" and prevents it from being inserted into an ACE2 "lock."
With these findings in hand, the researchers still needed to demonstrate that these nanobodies could prevent the real virus from infecting cells. Veronica Rezelj, PhD, a virologist in the lab of Marco Vignuzzi, PhD, at Institut Pasteur in Paris, tested the three most promising nanobodies against live SARS-CoV-2, and found the nanobodies to be extraordinarily potent, preventing infection even at extremely low doses.
The most potent of these nanobodies, however, not only acts as a sheath over RBDs, but also like a molecular mousetrap, clamping down on spike in its closed, inactive state, which adds an additional layer of protection against the spike-ACE2 interactions that lead to infection.
From Nanobodies to AeroNabs
The scientists then engineered this double-action nanobody in a number of ways to make it into an even more potent antiviral. In one set of experiments, they mutated every one of the amino-acid building blocks of the nanobody that contacts spike to discover two specific changes that yielded a 500-fold increase in potency.
In a separate set of experiments, they engineered a molecular chain that could link three nanobodies together. As noted, each spike protein has three RBDs, any of which can attach to ACE2 to grant the virus entry into the cell. The linked triple nanobody devised by the researchers ensured that if one nanobody attaches itself to an RBD, the other two would attach to the remaining RBDs. They found that this triple nanobody is 200,000 times more potent than a single nanobody alone.
And when they drew on the results of both modifications, linking three of the powerful mutated nanobodies together, the results were "off the charts," said Walter. "It was so effective that it exceeded our ability to measure its potency."
Would Be Easy to Administer as an Aerosol
This ultrapotent three-part nanobody construct formed the foundation for AeroNabs.
In a final set of experiments, the researchers put the three-part nanobodies through a series of stress tests, subjecting them to high temperatures, turning them into a shelf-stable powder, and making an aerosol. Each of these processes is highly damaging to most proteins, but the scientists confirmed that, thanks to the inherent stability of nanobodies, there was no loss of antiviral potency in the aerosolized form, suggesting that AeroNabs are a potent SARS-CoV-2 antiviral that could be practical to administer via a shelf-stable inhaler or nasal spray.
"We're not alone in thinking that AeroNabs are a remarkable technology," said Manglik. "Our team is in ongoing discussions with potential commercial partners who are interested in manufacturing and distributing AeroNabs, and we hope to commence human trials soon. If AeroNabs prove as effective as we anticipate, they may help reshape the course of the pandemic worldwide."
Authors: Additional authors include Bryan Faust, Reuben A. Saunders, Smriti Sangwan, Nick Hoppe, Morgane Boone, Christian Bache Billesbølle, Marcell Zimanyi, Ishan Deshpande, Jiahao Liang, Aditya A. Anand, Niv Dobzinski, Beth Shoshana Zha, Benjamin Barsi-Rhyne, Vladislav Belyy, Silke Nock and Yuwei Liu of UCSF; Camille R. Simoneau, Kristoffer Leon, Nevan J. Krogan, Danielle L. Swaney and Melanie Ott of the UCSF Quantitative Biosciences Institute (QBI) and the J. David Gladstone Institutes; Andrew W. Barile-Hill of Cytiva Life Sciences; Sayan Gupta and Corie Y. Ralston of Lawrence Berkeley National Laboratory; Kris M White and Adolfo García-Sastre of the Icahn School of Medicine at Mount Sinai; and the QBI Coronavirus Research Group Structural Biology Consortium. Schoof, Faust, Saunders, Sangwan and Rezelj are co-first authors of the manuscript.
Funding: This work was supported by the UCSF COVID-19 Response Fund, a grant from Allen & Company, and supporters of the UCSF Program for Breakthrough Biomedical Research (PBBR), which was established with support from the Sandler Foundation. Other support included National Institutes of Health (NIH) grants DP5OD023048, S10OD020054, S10OD021741, 1R01GM126218; Laboratoire d'Excellence grant ANR-10-LABX-62-IBEID; the URGENCE COVID-19 Institut Pasteur fundraising campaign; the Office of Science and Office of Biological and Environmental Research of the U.S. Department of Energy under contract DE-AC02-05CH11231; a Helen Hay Whitney postdoctoral fellowship; the Alfred Benzon Foundation; a gift from the Roddenberry Foundation; the Howard Hughes Medical Institute; the Pew Charitable Trusts; the Esther A. & Joseph Klingenstein Fund; and the Searle Scholars Program.
Disclosures: Schoof, Faust, Saunders, Hoppe, Walter and Manglik are inventors on a provisional patent describing the anti-Spike nanobodies described in the manuscript.
Story Source:
Materials provided by University of California, San Francisco. Original written by Jason Alvarez. Note: Content may be edited for style and length.
Related Multimedia:
YouTube video: Can this molecule provide protection from COVID-19?
Journal Reference:
Michael Schoof, Bryan Faust, Reuben A Saunders, Smriti Sangwan, Veronica V Rezelj, Nick Hoppe, Morgane Boone, Christian Billesboelle, Marcell Zimanyi, Ishan Deshpande, Jiahao Liang, Aditya A Anand, Niv Dobzinski, Beth Shoshana Zha, Benjamin Barsi-Rhyne, Vladislav Bleyy, Andrew W Barile-Hill, Sayan Gupta, Camille R. Simoneau, Kristoffer Leon, Kris M. White, Silke Nock, Yuwei Liu, Nevan J. Krogan, Corie Y Ralston, Danielle L Swaney, Adolfo Garcia-Sastre, Melanie Ott, Marco Vignuzzi, Quantitative Biosciences Institute (QBI) Coronavirus Research Group Structural Biology Consortium, Peter Walter, Aashish Manglik. An ultra-high affinity synthetic nanobody blocks SARS-CoV-2 infection by locking Spike into an inactive conformation. bioRxiv, August 10, 2020; DOI: 10.1101/2020.08.08.238469
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