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Health July 15, 2019

Oklahoma Opioid Trial Ends

Monday was the last day in a widely-watched trial about opioid addiction in Oklahoma. The state sued opioid manufacturers, but only Johnson & Johnson fought it in court after others settled.



ARI SHAPIRO, HOST:

Today the state of Oklahoma laid out its closing argument for holding a pharmaceutical company responsible for the national opioid epidemic.

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BRAD BECKWORTH: Because the facts in this case showed the causation is causation. When you oversupply, people die.

SHAPIRO: That’s Brad Beckworth, lawyer with the Oklahoma Attorney General’s Office. On the other side, Johnson & Johnson attorney Larry Ottaway said opioids are already subject to a litany of rules.

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LARRY OTTAWAY: This is not a free market. The supply is regulated by the government.

SHAPIRO: This is the first such trial in the U.S., many are set to follow. Joining us from the courthouse is Jackie Fortier. She’s a reporter for StateImpact Oklahoma, and she’s been covering the case for NPR. Hi there.

JACKIE FORTIER, BYLINE: Hi.

SHAPIRO: You’ve been in court for about seven weeks. You’ve listened to 38 witnesses. What top line have we learned from this trial?

FORTIER: I mean, this trial was really an opportunity to pull back the curtain and show the public how part of the pharmaceutical industry operates. And originally, Attorney General Mike Hunter had sued three drug companies, but two of those settled before the trial. That was Teva and Purdue Pharma, which makes OxyContin. And that left just Johnson & Johnson.

So during the trial, lawyers for the state picked over their business strategy and claimed that the company helped drive a surge in opioid prescribing among doctors, and that led to a pain medication market worth billions.

SHAPIRO: So the central argument by the state is that basically the drug companies created the opioid crisis. Is that what they’re saying?

FORTIER: Yeah. The state says that Purdue Pharma really kickstarted the epidemic with OxyContin in the ’90s. And then Johnson & Johnson decided to compete with its own product. But the state says the company was just too aggressive. It’s falsely claimed that there was a very low addiction risk.

And then Johnson & Johnson purchased prescribing data from pharmacies, and that told them which doctors were prescribing lots of Purdue’s OxyContin. Johnson & Johnson then targeted those specific doctors in Oklahoma to try to get them to switch over to their company’s opioids.

SHAPIRO: So when you say they targeted doctors, they used drug sales representatives who worked for the drug company. Those representatives visit doctors and staff. How important were those people in this trial?

FORTIER: They were very important. Their goal is to market specific drugs to doctors. It’s a common practice. But the state says that Johnson & Johnson took it too far. As evidence, the state wheeled in 34 boxes full of reports that drug reps wrote about their meetings with doctors. And we learned that drug reps encouraged some Oklahoma doctors to continue prescribing opioids even after some of those doctors’ patients died from overdoses. They even kept visiting doctors who’d been disciplined by the state for prescribing too many opioids.

SHAPIRO: And what did Johnson & Johnson say about all of this?

FORTIER: Well, they actually blame Oklahoma. The company says, hey, state regulators are the ones who license the doctors prescribing our products. So that’s your role. You didn’t notify us that those doctors were disciplined. Another really big part of the company’s defense has been to point out that opioids have a legitimate medical purpose. They’re FDA approved. They come with warning labels. But ultimately, it’s up to doctors how they’re prescribed and which patients get that prescription.

SHAPIRO: So for people who are struggling with addiction to these drugs and for their families, what would a decision in this case mean?

FORTIER: Yeah. If Oklahoma wins, it could mean more access to treatments. The state is asking that the company pay more than $17 billion over the next 30 years. If the state loses, it’s still significant. There’s more than 1,600 opioid-related lawsuits. So the outcome of this trial is really going to be closely watched.

SHAPIRO: And when do we expect to know the outcome?

FORTIER: The judge is expected to issue an opinion in August, and it’s up to him to decide if Johnson & Johnson will pay anything, and if so, how much.

SHAPIRO: That’s Jackie Fortier, a reporter with StateImpact Oklahoma. Thanks a lot.

FORTIER: You’re welcome.

Copyright © 2019 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

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Sports July 15, 2019

Crowds Gather Each Week In Wisconsin To Watch Their Teams Play Ball — In Snowshoes

Huge crowds turn up each week to watch a game of baseball on a woodchip field, where the players wear snowshoes.

Mackenzie Martin/WXPR


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Mackenzie Martin/WXPR

Most snowshoes in the United States are probably in storage right now, gathering dust and waiting for temperatures to drop. In the town of Lake Tomahawk in the Northwoods of Wisconsin though, they’re getting a lot of use this summer.

Snowshoe baseball is exactly what it sounds like. It’s a game of baseball played on snowshoes, though it more closely resembles a bizarre game of softball.

Every Monday night in the summer—and on the 4th of July—hundreds of tourists and residents gather to cheer on players who strap on snowshoes and hit a large softball around a field of wood chips. This has been going on since 1961, when then town chairman Ray Sloan came up with the idea to turn the game into a spectator sport capable of entertaining both summer tourists and town residents. An earlier version of the game was played on frozen lakes. Hence, the snowshoes.

Admission is free, but slices of homemade pie cost $2. The pie is a big deal here, too. On any given night you can find 40 different flavors.

Sheila Punches says that “they come for the pie and stay for the game.” She’s been coming to games since the 1970s and she says pie is one way she measures its popularity.

“There was a time when 30 pies was enough,” she says. “Then it was 40, 50, 60, 70 … 100 pies is not too many pies to have. I think somebody said they had 160 pies last week for the 4th of July.”

Pie flavors range from the traditional — Raspberry Rhubarb or Apple — to the more unique: Banana Split, Margarita, and even Sawdust, featuring graham crackers and coconut flakes.

The game starts with a rendition of the national anthem by the local barbershop chorus. Then local commentators Adam Lau and Jimmy Soyck lead the way.

In a recent game, someone takes a swing, misses the ball, and switches bats.

“Oh, it’s the bat,” says Soyck into his microphone.

“It’s always the bat’s fault,” agrees Lau.

Then when the player does hit the ball, he trips right after leaving home plate. The crowd audibly cheers, then sighs.

This hilarious scene is all too common, especially for newer players. Soyck says you can’t run in snowshoes. It’s all in the shuffle.

“You gotta shuffle your feet. You can’t pick them up,” he says. “If you pick them up, you’re going over. No ifs, ands, or buts about it.”

The game carries on this way until about the 7th inning, when one lucky batter gets a disguised cantaloupe thrown to him instead of a ball. When the batter makes contact, he immediately scatters the baseball field with pieces of melon.

“When that thing hits, it splatters everywhere,” says Jeff Smith, who coaches the Snow Hawks, the home team. “It’s painted to look pretty much like those balls out there, and the batter isn’t supposed to know until he hits it.”

It’s easy to laugh at the idea of people playing softball on snowshoes in the middle of the summer, but fan Phil Hejtmanek says there are a lot of talented players here.

“The funny thing is these guys are really good,” he says. “You figure ‘oh, the outfielders aren’t going to be able to make any plays,’ but just you wait.”

When you drive into the town of just more than 1,000 residents, a sign reads: “Welcome to Lake Tomahawk: Home of Snowshoe Baseball.” The game is a part of this town’s history, with generations of families coming together each summer to watch the games.

Mackenzie Martin/WXPR


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Mackenzie Martin/WXPR

Coach Jeff Smith says that it takes a lot of work from local volunteers to make each game run smoothly, but that he doesn’t expect the game to ever fade out.

“There’s too much passion amongst the townspeople around Snowshoe Baseball,” he says. “People get pretty serious about their home team winning and playing and they just want to be a part of it.”

Ultimately, this game is a part of this town’s fabric. Residents like Macey Macintyre grew up watching it.

“The whole town comes together just to watch this and you know it’s the whole town because you see everyone week in and week out,” she says. “It makes our town unique and it makes me just love my town and the people in it a lot more.”

So if you’re in Wisconsin’s Northwoods on a Monday night this summer and looking for some entertainment and good company, snowshoe baseball will be happening in Lake Tomahawk. The season ends in late August.

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Sports July 14, 2019

Novak Djokovic Defeats Roger Federer in Record-Breaking Wimbledon Match

Novak Djokovic celebrates after defeating Roger Federer in the men’s singles final match of the Wimbledon Tennis Championships in London.

Tim Ireland/AP


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Tim Ireland/AP

In a stunning nearly five-hour match that broke records and tested new rules, Novak Djokovic defeated Roger Federer in the Wimbledon men’s championship on Sunday, defending his 2018 title.

Clocking in at four hours and 57 minutes, the match was the longest men’s singles final in Wimbledon history, and had it not been for a new rule that requires a tie-breaker if both players score 12-12 in the final set, it could have gone even longer.

Djokovic won the first set, a bad sign for Federer, as his opponent is 63-1 in majors when taking the first set.

The pair went back and forth, Djokovic taking the first set, Federer the second, Djokovic the third, and Federer the fourth. After the 12-12 fifth set, Djokovic took the unprecedented tie-breaker 7-3.

The 32-year-old Serbian won back-to-back titles in 2014 and 2015. Now, he’s repeated the achievement, defending his 2018 title to win his fifth Wimbledon championship. Federer, his Swiss opponent, boasts eight Wimbledon championships and would have been the oldest player to take a Grand Slam title had he not been defeated.

Djokovic commended his opponent, saying “I think that if this is not the most exciting final then it’s definitely in the top two or three of my career against one of the greatest players of all time, Roger, who I respect.”

Federer holds the record for most Wimbledon finals appearances, at 12.

“You take it on your chin, you move on,” Federer told the Telegraph. “You try to forget, try to take the good things out of this match. There’s just tons of it. Similar to ’08 maybe, I will look back at it and think, ‘Well, it’s not that bad after all.'”

Since his first Wimbledon victory against Rafael Nadal in 2011, Djokovic has established a signature tradition of eating grass from the court after each win. This year, he didn’t disappoint, crouching to pluck a bit of the turf into his mouth and grinning at the crowd as he savored his title.

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Business July 14, 2019

In Boston, Web App Matches Budget Renters With Senior Homeowners

In Boston, a web app called “Nesterly” matches would-be renters with people who have a room to spare and could use a little help around the house.



MICHEL MARTIN, HOST:

Cities across the country are struggling with a shortage of housing, but there are millions of spare bedrooms. Now, as Stephanie Leydon from member station WGBH tells us, Boston has become a launching pad for a tech platform that connects people looking for affordable rent with homeowners who have a room to spare.

STEPHANIE LEYDON, BYLINE: Before she started a graduate program in public health, Abby Herbst got a crash course in math. There are too few apartments for too many people in Boston.

ABBY HERBST: I called, actually, a real estate agent, and they, like, wouldn’t take me as a client basically because I didn’t have the budget for a regular place. And then I was looking farther and farther outside of the city.

LEYDON: But she found a place just a 20-minute walk from campus in a brownstone, complete with a furnished bedroom, fully equipped kitchen – and the homeowner.

HERBST: You want to do a salad?

BRENDA ATCHISON: Yes, I do.

LEYDON: Sixty-seven-year-old Brenda Atchison.

ATCHISON: We fell in together very well, very smoothly.

LEYDON: They met online through a home-sharing website called Nesterly, designed to connect two generations with compatible needs – older people who want to stay in their homes but struggle to keep up with the cost and maintenance…

ATCHISON: Twelve-foot ceilings – it’s a little hard to heat in the wintertime. So little extra doesn’t hurt.

LEYDON: …And younger people who need affordable rent. Herbst pays $650 a month, less than half the cost of a studio. And she does some basic chores.

HERBST: Like, I take out the trash, the snow shoveling.

LEYDON: Noelle Marcus launched Nesterly a few years ago when she was in graduate school at MIT, paying Boston rents. She’s now based in New York City, where we met.

NOELLE MARCUS: I think the average one bedroom in New York is over $3,000.

LEYDON: Maybe worse than Boston.

MARCUS: Worse than Boston.

LEYDON: And it’s not just Boston and New York. Marcus says cities across the country and the world are facing an affordability crisis, fueled by the same trends – a limited housing supply and aging homeowners who aren’t ready to move.

MARCUS: We have had over 6,000 people reach out to us from 280 different cities around the world and tell us that they want us to expand to their city.

LEYDON: She wants Nesterly to go global, like Uber and Airbnb. But for now, it’s available only in Boston and nearby communities, where so far, dozens of people have connected for home shares. Of course people have always rented out extra rooms, so why a service like this one?

MARCUS: So according to AARP, 40% of over-45-year-olds say they’re interested in renting out a room in their home, but today, only 2% are doing it. And we think that’s because the right product and the right service did not exist.

LEYDON: Nesterly offers background checks, a payment system and ongoing support. A one-time housing aide to two New York mayors, she sees the platform as a way to ease the housing shortage and a problem that, as Abby Herbst discovered, plagues young and old alike – loneliness.

HERBST: Like, I had never eaten meals alone in high school before. If I feel, like, a little bit lonely or like I want to talk to somebody, I just come downstairs and sit in the kitchen.

LEYDON: Where both she and Brenda Atchison find perspective they couldn’t get from a peer.

ATCHISON: You just never know. You just never know what you’re going to talk about.

LEYDON: That older and younger people enrich one another’s lives isn’t a surprise to Noelle Marcus. She moved from Boston to New York mainly to be close to her grandmother. She calls her one of her best friends. For NPR News, I’m Stephanie Leydon in Boston.

Copyright © 2019 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

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Business July 13, 2019

A Bug’s Life: Remembering The Classic Volkswagen Beetle

Jessica Bray and her husband, Anthony Bray, pose with their 1970 Volkswagen Beetle. Anthony converted his Beetle to an electric car. “As a special touch, we added bubble machines to the back to blow bubbles at car shows and as we drive,” Jessica said.

Courtesy of Jessica Bray


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Courtesy of Jessica Bray

At one time, the Volkswagen Beetle was so ubiquitous that its sighting is often punctuated by a swift punch in the arm and a shout of “Punch Buggy!” (Or “Slug Bug!” depending on your regional take on the road trip game).

But this week, the Beetle set off down the road to extinction. On Wednesday, Volkswagen ended production of the Beetle, saying it wants to set its sights on manufacturing electric vehicles.

Over the decades, Volkswagen managed to revamp the beloved car’s image by distancing itself from an uncomfortable history.

The original Beetle was formulated by Adolph Hitler, who wanted a “people’s car,” or “volkswagen.” But the car wasn’t actually produced for civilians until the late 1940s, when the victorious Allies wanted to refuel Germany’s economy.

Many rebranding campaigns later, a hipster favorite was born.

For many Beetle owners, bidding adieu to the automotive icon summons nostalgia.

NPR asked its audience to share their favorite Volkswagen Beetle memories. More than 900 of you wrote in. We’ve excerpted just a handful of your stories — both fond and unpleasant — below.

Hippie’s best friend

Kristine Smith’s parents gifted her a 2005 robin egg blue convertible Beetle for her 16th birthday.

Although the car better withstood her college move to Los Angeles than her Chicago winter back home, the car accessorized her patched-up denim and her long and flowy tie-dye skirts that she procured from eBay.

“I was obsessed with all things hippie/bohemian in high school, and my Beetle was core to my identity,” she said in an interview with NPR’s Michel Martin.

Kristine Smith, pictured in 2005, when she first got her robin egg blue convertible Beetle for her 16th birthday.

Courtesy of Kristine Smith


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Courtesy of Kristine Smith

Regrettably, she said, she sold it in 2013 to use the money for graduate school in Washington, D.C.

“The car definitely feels like a pet I once had than a piece of machinery,” she said.

But, as a souvenir for her first and only car, Smith did hold onto the fake flowers she kept in the vase next to the steering wheel.

Burned into memory

A hot summer day in Oklahoma was too much for Robert Rillo’s family Beetle.

When he was 13, he and his 23-year-old sister were stuck in traffic on the way to a Huey Lewis and the News concert.

Rillo remembered that his sister’s friend sitting in the back seat said, “It’s getting hot in here.”

“It was a hot summer day so we didn’t think too much about it, until he says again, ‘It’s getting real hot!’ Suddenly he jumped up and the back seat was on fire.”

The battery, located under the backseat, was heating up — catching the seat on fire. Damage control ensued.

“We yanked the seat out of the car and put it out and went in to the concert.”

Alas, they missed the show’s opening act: Stevie Ray Vaughan — who’s famous, as it happens, for his album Couldn’t Stand the Weather.

Love Bug

Paul Weidenbach of Topeka, Kan., said he vowed to the previous owner of his first car that he would keep “Gladys” as its name.

The third-hand 1973 Super Beetle, with a Starsky and Hutch stripe trimming its top and sides, witnessed Weidenbach’s first love.

Paul Weidenbach in 1984, with his first car, a black-and-yellow Beetle named Gladys.

Courtesy of Paul Weidenbach


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Courtesy of Paul Weidenbach

“My high school sweetheart, Vicky, and I made the rounds with Gladys’ help, including a drive-in movie where we made Vicky’s 6-year-old brother, Matt, sit on the roof during Jungle Book at the Chief Drive-In in Topeka,” he said. “In full disclosure, we only talked and held hands.”

He hadn’t spoken to Vicky since 1991, but last year, he said, she died unexpectedly. When he went to her funeral, the memory returned in full force. “Of course, that night at the Chief Drive-In with Matt on the roof played over and over again in my mind,” he recalled.

As for Gladys, Weidenbach said, her motor has reincarnated as a rare 1950’s VW truck.

“We were ahead of our time!”

You could say Jessica Bray’s husband crept into her life. Bray met him five years ago when she was serving as chair of a local car show in Kentucky.

“As cars were lining up to park, here comes a guy driving a silent VW Beetle,” she said.

After striking up a conversation with him, she learned that he’d converted his ’70 Beetle to an electric vehicle by switching out the motor for a forklift motor and adding batteries, she said. They went out to dinner together that night.

“Six months later, he asked me to be his wife,” she said.

Now Volkswagen says it’s dumping the classic model to pour money into electric car ventures.

“We were ahead of our time!” she said.

Paint it black

In high school, “cool” came before comfort for Damian Rodriguez.

When his mother gave him her baby blue ’73 Bug in 1991, he painted it black to make it “less ‘mom-like.’ “

In sweltering Austin, his parents thought the idea was crazy. The car didn’t even have AC. “I sweated so much in that car, but I loved it and have many great memories of it,” Damian said.

But when a milkman totaled the Bug while delivering to the grocery store where he worked, he said, “I was literally crushed.”

So when he recently came across a die-cast, black ’70s VW Bug toy car, he gave it to his 2-year-old.

Damian Rodriquez gave his son, Diego, a toy replica of his black ’70s-era Bug.

Courtesy of Damian Rodriguez


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Courtesy of Damian Rodriguez

But as it happens — like father, like son.

He dropped it, cracking the back brake light, Rodriguez said, “ironically making it more like my Bug was.”

NPR’s Eliza Dennis and Natalie Winston produced and edited this story for broadcast.

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Sports July 13, 2019

Simona Halep Defeats Serena Williams To Win Her First Wimbledon Title

Serena Williams is dejected after losing a point during the women’s singles final match against Romania’s Simona Halep at Wimbledon on July 13, 2019.

Kirsty Wigglesworth/AP


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Kirsty Wigglesworth/AP

Serena Williams went into the Wimbledon finals on Saturday hoping to secure her 24th Grand Slam singles title — an accomplishment that would have equaled the record set by Margaret Court in the 1970s.

But after losses in two sets — 6-2, 6-2 — she fell to 27 year old Simona Halep, who with the victory became the first Romanian player to win a singles title at Wimbledon.

The win marked Halep’s second major singles title — she previously won the the French Open in 2018.

From the beginning, Halep dominated the match against Williams, controlling the court with her speed, coverage and aggressive ground strokes. When Williams failed to return the final rally that clinched the match, Halep sank to her knees and raised her racket high above her head, closing her eyes and grinning in triumph.

After the match ended, Halep was asked if she’d ever played better.

“Never,” she said. “It was the best match.”

But Halep had kind words for Williams as well.

“Serena has inspired us, so thank you for that,” she said.

Saturday’s match was Williams’ 11th Wimbledon singles final. She’s won the tournament seven times already, most recently in 2016 against Angelique Kerber.

The match was also the third Grand Slam loss in a row for Williams, who hasn’t won a Grand Slam title since the Australian Open in 2017, which she played while pregnant. She lost to Kerber in last year’s Wimbledon final and to Naomi Osaka at the U.S. Open in September.

At 37, Williams is the oldest Grand Slam women’s singles finalist to compete since the start of the Open Era in 1968. But she has struggled to attain her 24th Grand Slam singles title since the birth of her daughter, Olympia, in 2017.

Her daughter’s birth “would have been a perfect moment to walk away, but I wanted more,” she said in an interview last year.

After the match, Williams said playing against Halep made her feel like a “deer in the headlights.”

“When a player plays like that, you just have to take your hat off,” she said.

But Williams said this is far from her last tournament. “I’ve just got to keep fighting, keep trying,” she said. “I love playing the sport.”

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Health July 13, 2019

Overhauling Kidney Care

This week, President Trump signed an executive order aimed at improving the care of kidney patients. Nephrologist Amaka Eneanya talks with Scott Simon about some of the new initiatives.



SCOTT SIMON, HOST:

Americans with kidney disease got some encouraging news when President Trump signed an executive order aimed at improving their care.

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PRESIDENT DONALD TRUMP: Those who suffer from kidney disease experience a significant toll on their daily lives.

SIMON: The administration wants to improve detection and diagnosis, increase the number of kidney transplants and move patients away from commercial dialysis centers by encouraging more in-home dialysis. Medicare now spends about $114 billion on kidney care every year, about a third of that on people who need regular dialysis or a transplant.

Dr. Amaka Eneanya is a nephrologist with Penn Medicine at the University of Pennsylvania. She treats patients with chronic kidney disease. Thanks very much for being with us.

AMAKA ENEANYA: Thank you for having me on, Scott.

SIMON: The scope of kidney illness in this country is enormous, isn’t it?

ENEANYA: That’s correct. So approximately 37 million adults have chronic kidney disease in United States. And the majority of those adults are unaware of their diagnosis, upwards of 90%.

SIMON: One of the proposals, and certainly one that a lot of people noticed, is encouraging patients to have dialysis at home…

ENEANYA: That’s correct.

SIMON: …Which I gather is common in some countries around the world, but not the United States. Why not so far?

ENEANYA: So there’s a few reasons for that. So one, the training for clinicians who actually do provide care for patients with kidney disease is not very robust for home dialysis. Also, the payment incentives, as they are now, really favor doing dialysis in in-center dialysis facilities. Also, education for patients is still evolving for them to learn about home dialysis.

SIMON: How do you do home dialysis?

ENEANYA: Basically, what your kidneys do is to, on a regular, you know, 24/7 basis, clean the body of fluid and waste. And that’s basically what your urine is. And so when you’re doing home dialysis, you have machines that are actually doing this for you. So you’re connecting to this machine, and it’s removing fluid and waste from the body, just as your kidneys would do.

SIMON: And this works overseas?

ENEANYA: This works incredibly well. Countries – Guatemala, Mexico, Hong Kong have the majority of their patients using some type of home dialysis.

SIMON: I noticed some medical sources this week, in response to the president’s plan, said, look; what we have is working now. Why endanger that?

ENEANYA: The question is who is it working for? If it’s working for the patients and we have a resounding response from them that that’s what the case is, then by all means, we should reconsider and look at things very closely. But that’s not what research has shown, and that’s not what my experience has been, and many others, in terms of caring for these patients. It’s quite a burden to do things the way that they have been doing, which is most of the patients going to dialysis or receiving their dialysis in a facility.

SIMON: The administration wants to double the number of kidneys available for transplant. How do you do that?

ENEANYA: Part of what he was describing was incentivizing donors – paying them for lost wages and child care that they may have to use after doing a surgery. I think a lot of the time, there’s a focus on the recipient because they have this chronic disease, and they’re getting a fresh, new kidney, and great for them. But I recently had an experience where I spoke to a altruistic donor, so a person who just decided to donate a kidney out of the goodness of their heart. And she really remarked, you know, tearfully, how difficult the post-operative period was and how she really wasn’t prepared for how long she would be…

SIMON: Yeah.

ENEANYA: …Out of work and, you know, how difficult that was. And so I think actually educating donors and providing these incentives will really make a difference.

SIMON: Do you think the executive order signed this week is going to – has the hope of improving life for kidney patients in a couple of years?

ENEANYA: Absolutely. This was a phenomenal kind of monumental time for the field of nephrology and for patients with kidney disease. If the goal is to have 80% of patients with end-stage kidney disease to be on a home dialysis modality or to receive a transplant, that’s a really big change. And so we know that quality of life will be – will improve. Patients will have kind of more choices in terms of what is best for them. It’s really an exciting time.

SIMON: Dr. Amaka Eneanya, a nephrologist with Penn Medicine, University of Pennsylvania. Thanks so much for being with us.

ENEANYA: Thank you so much.

(SOUNDBITE OF MUSIC)

Copyright © 2019 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

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Business July 12, 2019

Data Shows U.S. Trade Gap With China Widened During Month Of June

President Trump promoted his trade agenda in Wisconsin on Friday, as new data shows a widening trade deficit with China.



AUDIE CORNISH, HOST:

President Trump’s trade war is having an impact on the nation’s trade deficit, but it’s not the one the president advertised. The U.S. trade gap with China actually widened last month. The trade war depressed both imports and exports, but U.S. exports to China took the bigger hit. The administration is urging Americans to be patient during what could be a drawn-out tariff battle. NPR’s Scott Horsley reports.

SCOTT HORSLEY, BYLINE: President Trump promoted his trade agenda in Wisconsin today while also raising money for his reelection campaign. Speaking at an aerospace company in Milwaukee, Trump said the 25% tariffs he slapped on hundreds of billions of dollars in imports from China are paying off.

(SOUNDBITE OF ARCHIVED RECORDING)

PRESIDENT DONALD TRUMP: A lot of companies are leaving China now because they want to go to a non-tariffed country. And some of those companies are coming here. It’s been incredible. We’re taking in billions and billions of dollars.

HORSLEY: Customs data from the Chinese government confirms Americans bought 8% less stuff from China last month than they did a year ago. But U.S. sales to China plunged more than 30%. Economist Mary Lovely of Syracuse University says U.S. exporters are paying a heavy price for the president’s trade war.

MARY LOVELY: I think whatever jobs are created by President Trump’s war on global supply chains are going to be dwarfed by losses in the U.S. export sectors.

HORSLEY: Trump boasted on Twitter this morning that tariffs are a great negotiating tool and a powerful way to get companies to build products in the United States. Lovely acknowledges some companies are shifting production away from China to avoid Trump’s tariffs, but she says they’re generally not opening factories in the U.S. Instead, they’re building plants in places like Vietnam, South Korea, Singapore and Hong Kong.

LOVELY: We see increasing evidence of the supply chain moving but clearly not to the U.S. And unfortunately, the evidence is mounting that this is not good for the U.S., that we need to take a different approach, work this out. But these guys have dug in.

HORSLEY: Two weeks ago, Trump met with Chinese President Xi Jingping, and the leaders agreed to restart trade talks. But Trump complained on Twitter this week China has not followed through with additional purchases of U.S. farm goods. Hopefully they will start soon, the president said. White House trade adviser Peter Navarro told CNBC this morning the U.S. trade representative, Robert Lighthizer, will soon be traveling to Beijing for talks. Navarro cautioned it could be a lengthy discussion.

(SOUNDBITE OF ARCHIVED RECORDING)

PETER NAVARRO: My advice for investors is to be patient with this process. Don’t believe anything you read in either the Chinese or the U.S. press about these negotiations unless it comes from the mouths of either the president or Ambassador Lighthizer.

HORSLEY: Professor Lovely says patience just means more pain as tariffs mount. The advocacy group Tariffs Hurt the Heartland has been keeping a running tally of tariffs that Americans are paying. Those totaled $5 1/2 billion in May – 2.4 billion of that was on goods from China. Lovely says U.S. producers might absorb the cost of those tariffs for a little while, but eventually, they’ll pass it on in their prices.

LOVELY: I think U.S. producers have been reluctant to do that, especially if they feel that these tariffs are short-lived. But if they believe that these tariffs are here to stay, they’ll be forced to pass those along to consumers.

HORSLEY: China and other countries are fighting back with their own tariffs on U.S. exports. Those tariffs jump to $1.3 billion in May, even as the value of American exports fell. Scott Horsley, NPR News, Washington.

Copyright © 2019 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

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Sports July 12, 2019

Remembering Major League Pitcher Jim Bouton, Author Of ‘Ball Four’

Bouton, who died Wednesday, spoke to Fresh Air in 1986 about his 1970 tell-all memoir, in which he drew on his seven years with the New York Yankees to offer an insider’s guide to baseball.



DAVE DAVIES, HOST:

This is FRESH AIR. I’m Dave Davies, in for Terry Gross. Jim Bouton, the former big-league pitcher better known for his prose than his fastball, died Wednesday at his home in Massachusetts. He was 80.

In 1970, Bouton wrote the book “Ball Four,” a raunchy insider’s look at the game that drew heavily on Bouton’s seven seasons with the New York Yankees. He wrote about players getting drunk, peeping through keyholes at women and popping amphetamines like candy. The book enraged players and some sportswriters and drew a rebuke from commissioner Bowie Kuhn, but it was a bestseller.

After a respectable baseball career, Bouton wrote several other books, did some acting and sportscasting and was a George McGovern delegate to the 1972 Democratic convention. Bouton spoke with Terry in 1986 and began with a story from “Ball Four” about Mickey Mantle.

(SOUNDBITE OF ARCHIVED NPR BROADCAST)

JIM BOUTON: I think the most controversial story in the book was I told about the time Mickey Mantle hit a home run with a hangover. And it wasn’t really even so much as a put-down of Mickey Mantle as it was a story of what a great athlete he was. I told about the time we were in Minnesota. And we’d been out the night before a game, having a few drinks – about 2 o’clock in the morning, I guess it was. I don’t want to say Mickey was drunk, but he spent about a half an hour trying to make a telephone call from a grandfather’s clock.

So he comes into the ballpark the following morning, and he’s hungover. And the manager says, you know, sleep it off. Most managers were players themselves. They understand you come to the ballpark once in a while with a hangover.

So Mick is sleeping in the trainer’s room. We’re playing the Minnesota Twins. We get – stick somebody else in the outfield. And so the game’s going on, and it gets tie score after nine innings. And in about the 12th inning, the manager says, I hate to do it, but I need a pinch hitter in the 13th. Go in and wake up the Mick.

So we go in the trainer’s room, you know, wake up Mickey Mantle, dress him in his uniform, steer him through the tunnel up into the dugout. Thirteenth inning comes around – he put a bat in Mickey’s hands and point him in the direction of home plate. The Mick staggers up to the plate. Fortunately, he’s a switch hitter – doesn’t matter what side he gets on – steps into the batter’s box.

To show you what a great athlete this guy was – and Mickey was the best ballplayer I ever saw – he takes one practice swing and hits the first pitch into the center field bleachers, a tremendous blast 450 feet away. We win the game. The crowd is going nuts, and the players are going crazy in the dugout. We’re laughing and pointing and screaming and slapping each other on the back. And suddenly, it occurs to us he still has to round those bases.

TERRY GROSS: (Laughter).

BOUTON: There’s a rule in baseball that you must touch the bases in order. Fortunately, he heads off in the right direction. The minute he hits first base, the entire dugout goes, make a left – goes around, touches second, touches third, comes across, misses home plate – we have to send him back for that – comes over to the dugout.

And, of course, the fans are giving him a standing ovation. And as he’s waving to the crowd, he looks at us in the dugout, and he says, those people don’t know how tough that really was. I went over to his locker afterwards, and I said, how did you do that? You couldn’t even see up there. He said, it was very simple. I hit the middle ball.

GROSS: (Laughter).

BOUTON: So if this destroys America’s illusions about baseball or Mickey Mantle, then I don’t know what you do with all the literature that’s come out since then where each player tries to top the next in terms of what he can tell or how far he can go.

GROSS: Pitching careers are subject to more problems than other careers are, I think, because your arm is so vulnerable. And your career depends on your arm, and it’s what you’re abusing all the time.

BOUTON: Sure. And pitching is not a natural motion. Throwing a ball as hard as you can 120 times every four days is not natural.

GROSS: Did you have to change your pitching style because of injuries you were getting?

BOUTON: Well, I had to change my pitching style when I wasn’t able to throw hard anymore. See, what happened was I threw very hard when I first came up. I was a overhand fastball pitcher. And then when I hurt my arm, I wasn’t able to throw hard for a while. And then when I did, it – the ball didn’t have that zip on it anymore. It didn’t have that snap. Even though the ball was traveling as fast, it wasn’t moving.

So it’s like taking a rubber band and stretching it too far, and then it never gets its elasticity back again. And that’s what happened to my arm. So I had to change from being a fastball pitcher to a knuckleball pitcher.

Fortunately, when I was a kid, I threw a knuckleball, which is not a pitch that requires very much strength. It’s a skill pitch. You push it off with your fingertips. The idea is to get the ball to go through the air without any rotation, and then it jumps around all by itself. And so I became a knuckleball pitcher to compensate for the fact that I couldn’t throw hard anymore.

GROSS: How hard are knuckleballs to hit?

BOUTON: They’re almost impossible to hit when you throw a good one. The difficulty is throwing a good one. When you don’t throw a good one, anybody can hit them. That’s the problem with a knuckleball. Nobody can hit a well-thrown knuckleball, and almost anybody can hit a poorly thrown knuckleball.

GROSS: Say it was a full count, and there were a couple of men on base. What would you throw? Would you throw a knuckleball, knowing that if you made one more – one wrong move, it might be a home run ’cause…

BOUTON: Yes.

GROSS: …It’s easier to hit?

BOUTON: I would throw a knuckleball. I would throw a knuckleball because my feeling is I would rather live and die with my best pitch than take a chance with something that wasn’t my best.

GROSS: Did you have any gestures that you had to do before you threw a pitch and, like, rub your hand on your side three times or (laughter)…

BOUTON: Nothing that was superstitious. Sure, I went through the same sort of little rituals before I threw the ball because it’s important to do that. And athletes need to do that and many performers need to do that because those are the little steps that are really part of the process.

Throwing a ball is not just throwing a ball. Part of it starts when you walk out to the mound – how you walk out to the mound, how you feel about yourself and the fans and the batter and the whole – I mean, all of that – the rosin bag in your hand, how the ball feels. And you want to start playing with that ball in your hand so you get that feeling, and you want to recreate the memory – the muscle memory that brings you back to the last time you were really throwing well. And that whole process starts long before you actually throw the ball.

GROSS: Why do pitchers like to chew when they’re on the mound?

BOUTON: Part of it is because of the nervousness and the tension. And it’s sort of – chewing relieves that. But the spitting part is different, OK? Spitting – and also all this crotch grabbing and spitting back and forth that you see in Major League Baseball – there’s a real reason for that. There’s a behavioral reason for that. And that is that what these are is macho displays, OK? It’s a man-to-man challenge out there, the pitcher versus the batter. And it’s very much like two cats squaring off where they both have to sort of urinate on the shrubbery, saying, OK, this is my yard. I own this space. And the other cat’s saying, yeah, but I own my space, and then they’re fighting.

You see, what the batter is is – he steps into the batter’s box and he spits all over the place. He’s saying he’s – that’s his turf. The pitcher is saying, oh, yeah? Well, (imitating spitting) this is my turf out here, and now we’ll see who’s the best. And so that’s why you have that. It’s that mano-a-mano challenge situation, you know? And that’s what they are. They’re animals marking their territory.

GROSS: Jim Bouton, I want to thank you very much.

BOUTON: Thank you. I’ve enjoyed it.

DAVIES: Jim Bouton spoke with Terry Gross in 1986. Bouton died Wednesday at the age of 80. Coming up, we’ll remember actor Rip Torn, best known for his role as Artie on “The Larry Sanders Show.” This is FRESH AIR.

(SOUNDBITE OF WES MONTGOMERY’S “FOUR ON SIX”)

Copyright © 2019 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

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Health July 12, 2019

A Call For More Research On Cancer’s Environmental Triggers

A stretch of the Mississippi River from New Orleans to Baton Rouge, La., that is crowded with chemical plants has been called “Cancer Alley” because of the health problems there.

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We already know how to stop many cancers before they start, scientists say. But there’s a lot more work to be done.

“Around half of cancers could be prevented,” said Christopher Wild in the opening session of an international scientific meeting on cancer’s environmental causes held in June. Wild is the former director of the World Health Organization’s International Agency for Research on Cancer.

“Cancer biology and treatment is where most of the money goes,” he said, but prevention warrants greater attention. “I’m not saying that we shouldn’t work to improve treatment, but we haven’t balanced it properly.”

Perhaps no question about cancer is more contentious than its causes. People wonder, and scientists debate, if most malignancies stem from random DNA mutations and other chance events or from exposure to carcinogens, or from behaviors that might be avoided.

At the conference in Charlotte, N.C., scientists pressed for a reassessment of the role of environmental exposures by applying modern molecular techniques to toxicology. They called for more aggressive collection of examples of human pathology and environmental samples, including water and air, so that cellular responses to chemicals can be elucidated.

The hope is that by identifying specific traces of exposures in human cancer specimens, scientists can identify environmental causes of disease that might be prevented.

“Over 80,000 chemicals are used in the United States, but only a few have been tested for carcinogenic activity,” said Margaret Kripke, an immunologist and professor emeritus at MD Anderson Cancer Center, in an interview at the meeting.

“This has been a very neglected area of cancer research for the last several decades,” said Kripke, the driving force behind the conference, which was put on by the American Association for Cancer Research. “Environmental toxicology was very popular in the 1950s and 1960s,” she said, but genetics then began to overshadow studies of cancer’s environmental causes. “Toxicology fell by the wayside.”

While the incidence of tobacco-linked cancers has been falling, malignancies not associated with smoking are rising, Kripke said. Recent evidence suggests an escalating rate of lung cancer in nonsmokers. That trend implicates other environmental factors.

Around the globe, cancer’s overall incidence is climbing. This year, 18 million people will be diagnosed with some form of cancer and over 9 million will die from it.

Infections — many preventable, such as by human papillomavirus —account for 15% of new cases.

Another rising cause is obesity, along with urbanization. People generally get less physical activity and eat differently in cities, and pollution is heavier there, too. “As people move into cities, that will drive up cancer rates,” Wild said.

One of the biggest obstacles to preventing cancer is that many people just don’t think it’s feasible. Progress “requires long-term vision and commitment,” Wild said. “Funding is limited, and there’s little private sector investment.”

A change in the way benefits of cancer prevention are framed could help. “When I was at the IARC, one thing that struck me was the power of economic arguments over health arguments for preventing cancer,” Wild said.

Cancer treatment costs can be prohibitive. But productivity lost from premature deaths in Brazil, Russia, India, China and South Africa alone runs $46.3 Abillion annually, he said. “Developing countries are not prepared to deal with the rising cancer burden.”

The precise proportion of cancers arising from environmental and occupational exposure to carcinogens is uncertain. In 2009, a report by the President’s Cancer Panel called prior approximations of around 6% “woefully out of date” and low. A 2015 paper by over a hundred concerned scientists cited “credible” estimates of 7% to 19%.

Scientist at the Charlotte meeting emphasized the complexity of cancer’s causes and the need for toxicologists to update methods to reflect that complexity, such as by studying interactions of environmental and genetic risks, and by examining cells after a mix of exposures. “Most toxic exposures do not occur singly,” said Rick Woychik, deputy director of the National Institute of Environmental Health Sciences.

Until recently, many toxicology tests were performed in rodents, because it would be unethical to deliberately evaluate possible carcinogens in people. But these animal experiments are labor-intensive and slow, he said.

New alternatives are now being tried. “We learned from pharma that with robotics and high-throughput technology you can interrogate a lot of biology quickly and at lower costs,” he said.

Epidemiological research of human exposures has been stymied by the difficulty of proving cause-and-effect — that a particular substance actually causes cancer — and by shortcomings of survey data from questionnaires.

At the conference, scientists offered glimpses of new technology that is helping fill informational gaps.

Bogdan Fedeles of MIT explained how DNA serves as a lifelong “recording device.” He and others use duplex sequencing to examine human samples for genetic “fingerprints of exposure.”

Allan Balmain, a geneticist at University of California, San Francisco, spoke about mutational signatures in malignancies. In liver cancer, for instance, these signatures can offer causal clues—such as smoking, alcohol or aflatoxin, a product of mold that grows on some foods.

Many chemicals that cause or stimulate cancer growth are produced inside our bodies. “It’s not all about the environment,” Balmain said.

Others highlighted a conceptual shift in how scientists define carcinogens. Key characteristics may include a substance’s capacity to stimulate growth of malignant cells, or to induce inflammation—without necessarily causing DNA damage, long seen as the necessary .

“The answer to ‘What is a carcinogen?’ is changing” said Ruthann Rudel, a toxicologist at the Silent Spring Institute who has published extensively on breast carcinogens. She detailed new techniques to screen breast cancer cells for changes in response to specific chemical exposures.

The public health stakes for the field are high.

Professor Polly Hoppin, of the University of Massachusetts, Lowell, discussed cancer-causing industrial contamination of drinking water at Camp Lejune, N.C., air pollution in St. John the Baptist Parish, La., and potential exposures to carcinogens from fracking and planned plastics production in Pennsylvania.

Hoppin reflected on the U.S. experience with tobacco cessation. Scientists knew that smoking causes cancer by the 1950s, she said. Implementing that knowledge required policy and incentives — like high cigarette taxes and public smoking bans — and took decades.

“The science wasn’t enough,” Hoppin said. “How many lives could have been saved if we’d acted sooner?”

Elaine Schattner is a physician in New York writing a book on cancer attitudes that will be published by Columbia University Press.

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