Fewer mammograms means more breast cancer deaths

Explanation: This broadcast describes data from two recent government reports showing that fewer women are undergoing mammograms and fewer mammography centers are in business today than a few years ago. It quotes one expert who says this means that more women will therefore die of breast cancer. Few would argue that all women should have access to mammography. However, the broadcast provides no evidence to support the dire conclusion of the expert that more deaths will ensue. It also fails to balance this view with information about the potential harms of mammography. And it neglects to note that the GAO report says that current capacity is “likely adequate.”  What is the quality of evidence on this complex topic? There is no way to tell from the broadcast whether the scientific evidence supports the view that fewer mammograms will categorically result in more cancer deaths, nor any attempt to weigh this against the evidence that mammography may produce harms as well as benefits. Most experts believe that mammography in women aged 50 to 69 saves lives; its benefit in those younger and older is controversial. But like other cancer screens, improved survival among women who undergo mammography may be deceiving. It is possible, for example, that screened patients do not actually live longer than unscreened patients do, but simply appear to live longer because they receive a diagnosis earlier. It is also possible that mammography will actually cause harm. Exposure to radiation during mammography could itself cause breast cancer 10 or 20 years down the road. (Br J Cancer 2005;93:590-6. Lancet 2000;355:1757-70) In addition, mammograms increase the diagnosis of lesions. Left untreated, some of these will become cancers, but many will not. The discovery of a lesion leads not only to fear and anxiety, but also to invasive diagnostic tests and invasive treatments (including mastectomy or lumpectomy) that inflict additional emotional and physical harm. “For every woman who has her life extended by screening,” writes the Cochrane Center’s Peter Gotzsche in Denmark, “there are at least five women who will be diagnosed with, and treated for, cancer unnecessarily.” (Lancet 2005;366;1519-20) One learns nothing about these potential harms in the ABC News broadcast. Because medicine does not yet have perfect estimates of the harms of mammography, some would say there is no simple “right” recommendation for every patient. The only possible blanket recommendation might be for clinicians–and the news media–to explain the potential benefits and harms, and thus help women to evaluate their own individual tolerance for risk and preferences so that they can choose the course of action that best suits them. News organizations that choose to cover medicine should explain the quality of the evidence and the pros and cons surrounding any medical procedure well enough for patients to understand what is known and what remains unknown. Unfortunately, instead of an even-handed analysis, this broadcast promotes fear.

The news story makes no mention of cost. Although the cost of mammography to individuals is generally not great, the financial burden on the health care system is substantial. The story describes the reduction in mammograms and mammography centers in both relative and absolute numbers. But there is no quantification of the estimated benefit of mammography itself. That benefit is just assumed, leading to a concurrent assumption about the impact of fewer mammography centers. There is no mention of harms. This is a major flaw. Although mammograms can identify disease early and reduce deaths, they are also associated with several harms. Mammograms increase the diagnosis of lesions. Left untreated, some of these will become cancers, but many will not. The discovery of lesions leads not only to fear and anxiety, but also to invasive diagnostic tests and invasive treatments (including mastectomy or lumpectomy). Finally, mammography exposes women to radiation that could itself cause breast cancer 10 or 20 years down the road. (Br J Cancer 2005;93:590-6. Lancet 2000;355:1757-70). Because medicine does not yet have perfect estimates of these harms, the decision to have mammography is not always simple. The news broadcast demonstrates no grasp of the evidence around this controversial area of preventive medicine. There is no mention of the quality of evidence to support the fear that fewer mammograms will categorically result in more cancer deaths, nor any attempt to weigh this evidence against the evidence that mammography may produce harms as well as benefits. (See “Harms of Treatment” below) The news story quotes one expert who asserts that less screening will mean more cancer deaths. But when? Today or next year? The GAO report says that current capacity is “likely adequate,” adding that the entry of fewer health care professionals into the field “could result in access problems in the future.” (http://www.gao.gov/new.items/d06724.pdf) The CDC report says “Because mammography screening every 1–2 years can significantly reduce mortality from breast cancer, continued declines in mammography use might result in increased breast cancer mortality rates.” (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5603a1.htm.) The broadcast also ignores evidence that questions the value of mammography in women aged 40-49 and over age 70 who have other medical conditions that might shorten their lives. Finally, the news story overlooks the flip side of screening. Although most agree it saves lives among women aged 50 to 69, mammography also has the potential to cause these women harm. (See “Harms of treatment” below.) Viewers would be better -served by an even-handed explanation of the potential benefits and risks of having a mammogram, so that women could make an informed decision. Instead, the broadcast spreads fear. Two independent sources were quoted. The broadcast cites data from the CDC and the GAO, independent government agencies. The broadcast provides no information about other alternatives to mammography, which for some might include doing nothing. The broadcast explains that the number of mammography centers and mammograms in the U.S has decreased in recent years, and cites reliable sources for this. But it does not report the GAO’s finding that, despite facility closings, “current capacity is adequate.” The news broadcast explains that screening goes back at least to 1987; a viewer who might be unfamiliar with the procedure can accurately glean that it is not new. No obvious use of text from the press release.


Cuban doctors head to Italy to battle coronavirus.

Explanation: Communist-run Cuba said it dispatched a brigade of doctors and nurses to Italy for the first time this weekend to help in the fight against the novel coronavirus at the request of the worst-affected region Lombardy.

The Caribbean island has sent its “armies of white robes” to disaster sites around the world largely in poor countries since its 1959 revolution. Its doctors were in the front lines in the fight against cholera in Haiti and against ebola in West Africa in the 2010s. Yet with the 52-strong brigade, this is the first time Cuba has sent an emergency contingent to Italy, one of the world’s richest countries, demonstrating the reach of its medical diplomacy. This is the sixth medical brigade Cuba has sent in recent days to combat the spread of the new disease abroad. It has sent contingents to socialist allies Venezuela and Nicaragua as well as Jamaica, Suriname and Grenada. “We are all afraid but we have a revolutionary duty to fulfill, so we take out fear and put it to one side,” Leonardo Fernandez, 68, an intensive care specialist, told Reuters late on Saturday shortly before his brigade’s departure. “He who says he is not afraid is a superhero, but we are not superheros, we are revolutionary doctors.”  Fernandez said this would be his eighth international mission, including one in Liberia during the fight against ebola. Italy is the country that has been worst affected by the highly contagious virus that originated in China, with the northern region of Lombardy bearing the brunt of the contagion. Its death toll rose on Saturday by 546 to 3,095, according to its head of welfare, Giulio Gallera, who requested the Cuban doctors. We are going to fulfill an honorable task, based on the principle of solidarity,” said Graciliano Díaz, 64. Cuba built a healthcare system that was the envy of the developing world with economic aid from former ally Soviet Union, though some of those advances have been lost since the communist bloc collapsed. Many Cuban hospitals have fallen into disrepair and Cubans say they have difficulty finding medicine, a situation the government says is largely due to decades-old U.S. sanctions although analysts blame also the inefficient state-run economy. Still, Cuba has one of the highest ratios worldwide of physicians per capita even when excluding those doctors abroad, and its medical brigades for disaster relief continue to earn Havana goodwill worldwide. “In a time of crisis, the Cuban government, the Cuban people ... have risen to the occasion, they have heard our appeal and they have responded,” Jamaican Health Minister Christopher Tufton said on Saturday upon greeting 140 Cuban medical professionals at Kingston international airport. Britain also thanked Cuba last week for allowing a British cruise ship that had been turned away by several Caribbean ports to dock on the island and for enabling the evacuation of the more than 600 passengers onboard. [nL1N2BB1ZQ]  Meanwhile Cuba, which is known for its disaster preparedness, is stepping up measures at home too to stem the coronavirus contagion. Twenty-five cases have been confirmed so far. [nL1N2BD2JM]  President Miguel Diaz-Canel announced late on Friday the country would be closing its borders to foreign non-residents from Tuesday in a major blow to one of the motors of its cash-strapped economy, tourism. Thousands of doctors and medicine students are also going door-to-door monitoring their local communities.


Activities by foreign governments had "absolutely no effect on the outcome of this election.

National, Elections, Homeland Security, Foreign Policy, Donald Trump,

On Jan. 6, President-elect Donald Trump was briefed on the U.S. intelligence community’s probe into allegations of Russian influence in the 2016 presidential election, including possible connections to electronic hacks and public releases of private communications by senior Democrats. A declassified version of the report found that "Russian President Vladimir Putin ordered an influence campaign in 2016 aimed at the U.S. presidential election. Russia’s goals were to undermine public faith in the U.S. democratic process, denigrate (Trump’s opponent, Hillary) Clinton, and harm her electability and potential presidency." Following the intelligence briefing, Trump’s office released a statement. After noting the "constructive meeting" and the "tremendous respect" he had for their work, Trump stated: While Russia, China, other countries, outside groups and people are consistently trying to break through the cyber infrastructure of our governmental institutions, businesses and organizations including the Democrat (sic) National Committee, there was absolutely no effect on the outcome of the election including the fact that there was no tampering whatsoever with voting machines. There were attempts to hack the Republican National Committee, but the RNC had strong hacking defenses and the hackers were unsuccessful. The phrase that caught our eye was, "there was absolutely no effect on the outcome of the election." That's a pretty definitive statement. And Trump echoed this argument in a Jan. 7 tweet: "Intelligence stated very strongly there was absolutely no evidence that hacking affected the election results. Voting machines not touched!" However, the argument that there was no impact of any kind on the election outcome is not backed up by the intelligence community’s report. The report specifically stated it didn’t look at that question. Here’s what the report actually said: We did not make an assessment of the impact that Russian activities had on the outcome of the 2016 election. The U.S. Intelligence Community is charged with monitoring and assessing the intentions, capabilities, and actions of foreign actors; it does not analyze U.S. political processes or U.S. public opinion. So if the Trump campaign is using the intelligence community report to back up its assertion that there was no Russian influence on the outcome, it's doing so without justification. When we contacted the Trump transition media office, we did not receive a response. Here’s our review of the publicly available evidence. Ballot counts The Trump camp has a point on one issue: Despite some concern among security experts going into the election that Russia might hack into state and local vote-counting systems and tamper with the tallies, the intelligence community report found that any such efforts by Russia were not successful in changing any votes. The report says that while "Russian intelligence obtained and maintained access to elements of multiple U.S. state or local electoral boards," the Department of Homeland Security "assesses that the types of systems Russian actors targeted or compromised were not involved in vote tallying." Rep. Adam Schiff, D-Calif., the ranking Democrat on the House Intelligence Committee, conceded this in an interview with the PBS NewsHour on Jan. 6. "It is true there is no evidence that the tampering with voter machines or tampering with voter registrations or any of like that affected the counting of the votes. That's true," Schiff told PBS’ Judy Woodruff. Some observers might be concerned that Russia did manage to breach at least some election authorities’ computer networks, and they might also be concerned that Russia and Putin, according to the report, tried to influence the election, even if it’s less clear whether they succeeded. Still, Trump has a point that Russia didn’t literally change actual votes electronically. Ballot tampering vs. other types of Russian influence Members of the Trump camp have portrayed the report’s clean bill of health on the question of Russian ballot-tampering as proof that Russia had no impact at all on the election. For instance, on the Jan. 8 edition of CNN’s State of the Union, incoming White House counselor Kellyanne Conway told Jake Tapper that "if you read the full report, they make very clear, (Director of National Intelligence James) Clapper in his testimony (to the Senate Armed Services Committee) made very clear on Thursday under oath that that any attempt, any aspiration to influence our elections failed. They were not successful in doing that." On Fox News Sunday, incoming White House chief of staff Reince Priebus echoed Conway’s invocation of Clapper’s testimony, saying Clapper had testified to the Senate panel "that there is no evidence in the report that any of this changed the outcome of the election." Neither assertion is accurate. First, to equate a lack of ballot tampering with a lack of any Russian influence on the election conflates two things that are not the same. Conway and Priebus essentially defined ballot-rigging as the only way an election can be influenced, when in reality the intelligence report primarily addresses other ways Russia tried to influence the election. The Russian effort blended, in the report’s words, "covert intelligence operations — such as cyber activity — with overt efforts by Russian Government agencies, state-funded media, third-party intermediaries, and paid social media users or ‘trolls.’ " And second, Clapper in his testimony never said that "any attempt, any aspiration to influence our elections failed" (as Conway put it) or that "there is no evidence in the report that any of this changed the outcome of the election" (as Priebus put it). Clapper’s most direct remark at the Senate hearing on this issue came in this exchange with the panel’s chairman, Sen. John McCain, R-Ariz.: McCain: "So really, what we're talking about, is if they succeeded in changing the results of an election, of which none of us believe they were, that would have to constitute an attack on the United States of America because of the effects, if they had succeeded, would you agree with that?" Clapper: "First, we cannot say -- they did not change any vote tallies or -- or anything of that sort." McCain: "Yeah, I'm just talking about…" Clapper: "And we have no -- we have no way of gauging the impact that -- certainly the intelligence community can't gauge the impact it had on the choices the electorate made. There's no way for us to gauge that." Subsequently in the hearing, Clapper arguably went even further in a response to questioning by Sen. Angus King, I-Maine. King, referring to his work with Baltic states that have been grappling with Russian influence in elections for several years, said, "The best defense is for our public to know what's going on, so they can take it with a grain of salt. … That's why I think public hearings like this and the public discussion of this issue is so important, because we're not going to be able to prevent this all together. But we need to have our people understand that when they're being manipulated. Would you agree with that conclusion?" Clapper responded, "Absolutely. That's why I feel so strongly about the statement in October," referencing his own statement during the campaign that the Russian government had been engaged in efforts "intended to interfere with the U.S. election process." How credible is the argument that Russia influenced the election in some fashion? Schiff is one of many Democratic officials who personally believe that other types of Russian efforts may have had an impact on an election that ultimately hinged on fewer than 100,000 votes cumulatively in three states -- Michigan, Pennsylvania and Wisconsin. In his PBS interview, Schiff specifically referred to the hacking and release to websites such as WikiLeaks of personal emails written and received by Clinton campaign chairman John Podesta and other top Democrats -- releases that Trump prominently featured during the campaign. "The daily dumping of information that was damaging to Secretary Clinton and helpful to Donald Trump was hugely consequential," Schiff said. But is it possible to move beyond a gut feeling and prove that Russia influenced enough voters to change the election’s outcome? Not really, say political scientists. A campaign as large-scale as a presidential race is buffeted by so many factors that it’s essentially impossible to know for sure that any given factor played a role in determining who won. "The presidential election, with its national constituency, is decided by multiple, interrelated causes, all of which were necessary but not sufficient," said Kyle Saunders, a Colorado State University political scientist. Referring to such factors as the candidates’ personalities and messages as well as the general political environment, Saunders said that "no one determinate cause can be offered as ‘the’ explanation, and doing so is a fool's errand." Saunders agreed that one doesn’t have to believe that hacking did affect the election to say comfortably that Trump is wrong to say it absolutely didn’t affect the election -- there's simply no way of knowing either way with any certainty that something affected the outcome. He added that while a reasonable case can be made that the hacking did help Trump, that's informed speculation -- not certainty -- and said there’s no way to know how big a factor it may have been compared to other factors. "It is difficult to argue that the barrage of damaging information released almost exclusively about Clinton and Democrats did no harm or did not create an atmosphere in which voters questioned her judgment or credibility or dampen support for her candidacy," said Costas Panagopoulos, a Fordham University political scientist. That said, Panagopoulos added, "in truth, there is no way to know with certainty what the causal impact of Russian involvement was on the outcome of the 2016 election." Our ruling After meeting with senior intelligence officials about the details of a soon-to-be-released report on alleged Russian hacking, Trump said that activities by foreign governments had "absolutely no effect on the outcome of this election." Trump can use the intelligence report to bolster this assertion only in one limited way -- that Russia did not succeed in tampering with vote counts (though it appears to have tried). On the broader issue of whether Russia had any impact on the outcome of the election, the report specifically noted that it didn’t address this issue, and Clapper in his Senate testimony didn’t either. Saying there was no Russian ballot-tampering is not the same thing as saying there was no Russian influence on the election. Political scientists say it’s impossible to move beyond informed speculation about whether there was a Russian impact on the election’s outcome -- or, importantly, whether there wasn’t an impact. Trump’s formulation, echoed by later statements by those in his camp, offers a definitive, broad-brush conclusion that isn’t proven by the evidence, and really can’t be. We rate this statement .


Fourteen-year-old, terminally ill cancer patient Maddox Hyde asked that people send him Christmas cards for the holiday.

Explanation: Sadly, the same family member informed us that Maddox died in 2019 and that receiving cards is “heartwarming but painful for the family.” For this reason, we updated the rating to Outdated.

In November 2018, Reynoldsville, Pennsylvania, middle-schooler Maddox Hyde, who had been coping with cancer for eight years, learned from doctors he had only weeks or months to live. A report in the Centre Daily Times said Maddox was diagnosed with neuroblastoma, a type of tumor that starts in the central nervous system and spreads. The tumor doctors found on the back of his head was only the latest development in a saga that began in 2010, when he was in first grade. According to his mother, Kristi Potter, the first mass they found was on Maddox’s right adrenal gland. Eighteen months after that went into remission, another was found on his right hip. Unfortunately, it was not to be the last: Potter said her son went into remission again on March 29, 2016, but that good news only lasted three days. He was paralyzed and diagnosed with Guillain-Barre syndrome and was in a pediatric intensive care unit on a ventilator for two weeks. He spent two months in the hospital’s rehab center, where he re-learned to walk, eat and write. With the exception of lingering weakness in his left foot, all of his abilities and feeling returned. That milieu lasted for 10 months before doctors found a small tumor on his spine. His treatments were working and the tumor was shrinking, but then it “exploded” after six weeks and grew drastically. Instead of subjecting him to further treatment, Maddox’s family decided to bring him home to live out the time he has left in more comfort. Local television station WJAC reported on 25 November that the community had rallied behind Maddox and his family, holding fundraisers to help pay their medical bills, throwing a surprise Christmas party in Maddox’s honor, and showering him with Christmas cards: “It’s just amazing. I could not ask for a better community to live in,” Potter said. Most recently, his mother says it’s been a trend of Christmas cards: hundreds and hundreds of cards from people everywhere. “It is really cool to see how many people are sending them,” Maddox said. He says the cards feature pictures, stories and long messages. One retired officer gave him his prized possession, his patch he wore for over 20 years. Another card came with a bottle of sand from the beach. Each one of the hundreds of cards had something special. So many people sent cards that he got the same ones more than once. Maddox’s friends and family launched a social-media campaign soliciting cards from everywhere:  A young boy from my hometown has recently been told he has only weeks to live after battling cancer for about 8 years. His only wish is to receive Christmas cards from all over the world so please help show Maddox some love and let’s overwhelm him with wishes. #maddoxstrong 🙏🏼🙏🏼 pic.twitter.com/i66soZ5L9X — Paul Butler (@_Paul_Butler_) November 27, 2018  Maddox hoped to receive cards from people everywhere in the world. According to a family member, the response was “overwhelming.”


Officials say 2 meningitis deaths in Ohio county unrelated.

Explanation: Health officials in a rural northeast Ohio county say they have no explanation for a second bacterial meningitis death less than two weeks after a 14-year-old boy was fatally infected.

Health, Ohio, New Philadelphia, Meningitis

The New Philadelphia Times Reporter reports Tuscarawas County Health Commissioner Katie Steward says the deaths are unrelated and calls the situation “unusual, bizarre and unexplainable.” The health department hasn’t released the name or age of the second victim, who died Monday. High school freshman Ryan Freeland, of Port Washington, died at a hospital Dec. 15 after getting sick the previous day. Indian Valley High School in Gnadenhutten closed Dec. 18 so it could be cleaned. There were 134 cases of bacterial meningitis in Ohio last year, seven of which were fatal. ___ Information from: The Times Reporter, http://www.timesreporter.com


Getting relief from sexual dysfunction and incontinence caused by menopause

Explanation: This news release summarizes an observational study on the benefits of CO2 ablative laser treatments for reducing menopausal symptoms like vaginal dryness/itching/burning, painful intercourse, frequent urinating, or incontinence in 94 post-menopausal women. While the release makes the claim that the study “demonstrated that this type of laser surgery was particularly effective in reducing the intensity of dyspareunia (painful sex) and dryness,” it was an observational study which cannot show cause-and-effect. The release notes that this intervention is a subject of debate among experts, and that more studies are needed to confirm the long term efficacy and safety of this approach. It falls short in several areas: it neglects to mention that the FDA warns against using lasers for menopause symptoms, excludes any data from the study, and omits disclosure of significant financial conflicts of interest among study authors and the organization that distributed the release, the North American Menopause Society. It’s estimated that around half of post-menopausal women have at least one of the aforementioned constellation of symptoms that some doctors label “genitourinary symptoms of menopause,” or GSM, and others see as normal (but problematic) symptoms of a low estrogen state. Some women respond well to symptomatic treatment, others may choose hormone replacement, and some struggle to find relief. It’s important to point out that many women seek no treatment at all. For women interested in treatment, finding reliable information can be problematic. Thorough and thoughtful news releases and news coverage should, at the very least, provide:  good data balancing the benefits and potential harms, give a sense of safety and efficacy in comparison to other existing treatments, seek out independent experts not involved in the highlighted study, as well as fully disclose if that study could be biased by conflicts of interest.

menopausal symptoms,North American Menopause Society,vaginal laser surgery

The cost of CO2 laser therapy is not mentioned. Much of the CO2 laser treatment in the US is applied to skin — often for wrinkles, scars, discolorations, or people who want to look younger. According to WebMD such “laser skin resurfacing” cost an average of $2,330 in 2016. However, it’s unclear if vaginal laser therapy would be comparable in terms of duration, equipment involved, or cost. The release does not offer data to support this statement: This type of laser surgery was particularly effective in reducing the intensity of dyspareunia (painful sex) and dryness. It further demonstrated that four or five laser therapies may be superior in lowering GSM symptoms compared with three in both short- and long-term follow-up. Readers might correctly guess the improvements reported come from patient questionnaires, but would have no sense of the scale or significance of these benefits. Without supporting evidence they’d also be left wondering which GSM symptoms improved, by how much, and for how long. It also appears that the results after three treatments is very similar to four or five treatments without any evaluation of the side effects. Most importantly, since the study was not controlled and subjects were not randomized, there are multiple confounding factors that could have been responsible for the beneficial results. Not mentioned and extremely relevant based on this June, 2018 publication by the FDA: FDA warns against use of Energy-based devices to perform vaginal ‘rejuvenation or vaginal cosmetic procedures This includes “procedures intended to treat vaginal conditions and symptoms related to menopause, urinary incontinence, or sexual function” Side effects listed include: “vaginal burns, scarring, pain during sexual intercourse, and recurring/chronic pain.” The release does well to point out this is a “small, retrospective, non-sham-controlled study” and that “there is ongoing debate regarding the safety and effectiveness of vaginal laser surgery.” Several key limitations of the study were excluded. The release claims that the study “demonstrated that this type of laser surgery was particularly effective in reducing the intensity of dyspareunia (painful sex) and dryness.”  It should have more directly stated that as an observational study, it cannot show cause-and-effect. In addition, the study could not exclude the possibility that some of the positive outcomes reported by the subjects were due to a placebo effect. The release tells us that “painful sex, dryness, itching/burning, urinary frequency, and incontinence” are symptoms and signs associated with menopause. We’re also told that “collectively” these represent genitourinary syndrome of menopause (GSM) which the gynecologic literature variably describes as either a “condition” or a “constellation of symptoms” associated with low estrogen levels in women. (See this helpful essay from Harvard Women’s Health Watch.) Some readers might be left wondering: “So is GSM a disease? Do I need to have all the symptoms to qualify? Aren’t many of these symptoms part of ‘normal’ menopause? Or, is having such symptoms abnormal and should therefore be treated?” We wish the news release had made it clear that these symptoms can represent normal aspects of aging that many women choose to manage with non-pharmacologic and non-surgical approaches. We’ll give this the benefit of the doubt and rate this satisfactory since it’s debatable whether or not this news release disease mongers. Funding for the study is not included. Also relevant for readers, but not mentioned, is that two of the authors have financial ties to the company that produces the laser tested in this study. Both authors have been expert witnesses for the laser company, suggesting a higher degree of approval of the therapy and potential for bias in the way the study is done. Equally relevant is that the National Menopause Society (NAMS)  — which authored the news release — receives corporate support from about a dozen biotechnology companies, many that sell treatments targeted at GSM. Also, about three-fourths of the NAMS board have disclosed relationships with industry. The news release names some of the many treatments available for managing menopause symptoms through this quote from the executive director of NAMS: Until more data are available, all treatment options, including lubricants, vaginal moisturizers, and FDA-approved vaginal and systemic hormone therapies, should be discussed with women who suffer from GSM to determine the best treatment option for them. It’s mentioned that vaginal laser surgery represents “one of the newer and more hotly contested approaches” to menopause symptoms. So we’ll give this a satisfactory mark, but it would have helped readers to give them a ballpark sense of how widely the surgery is being used in North America. The news release doesn’t say what’s new about the study. Lasers have been used for vaginal atrophy for at least 5 years. It’s not clear from the release how long CO2 lasers have been used for genitourinary symptoms. The release is unjustified in claiming that this observational study demonstrates effectiveness. It made the claim in the following paragraph: The results of this small, retrospective, non-sham-controlled study demonstrated that this type of laser surgery was particularly effective in reducing the intensity of dyspareunia (painful sex) and dryness. It further demonstrated that four or five laser therapies may be superior in lowering the intensity of GSM symptoms compared with three laser therapies in both short- and long-term follow-up. The last paragraph of the release somewhat moderates the hearty endorsement of the therapy.


The Affordable Care Act -- Obamacare to some -- is a perennial target of Republicans. But at the GOP presidential debate in Milwaukee, Carly Fiorina made a particularly strong statement about the law’s ineffectiveness. "Look, I'm a cancer survivor, okay?" Fiorina told moderator Maria Bartiromo of Fox Business Network. "I understand that you cannot have someone who's battled cancer just become known as a pre-existing condition. I understand that you cannot allow families to go bankrupt if they truly need help. But, I also understand that Obamacare isn't helping anyone." Fiorina’s staff did not respond to an inquiry, but during the debate, she listed a number of problems she has with the law. "It is crony capitalism at its worst," she said. "Who helped write this bill? Drug companies, insurance companies, pharmaceutical companies. … Health insurance has always been a cozy, little game between regulators and health insurance companies." Fiorina also said that "Obamacare is crushing small businesses, it is not helping the families it was intended to help. So, let us allow states to manage high risk pools. Let us try the one thing in health insurance we've never tried, the free market. Let us ensure that as patients, and customers, that we have information to shop wisely for our health care." Reasonable arguments can be made against the law and its many provisions. But is no one at all getting any actual help from the law? We decided to take a closer look. Here are some of the provisions of the law and estimates of how many people have benefited from each. The estimates are from Charles Gaba, who has spent several years crunching the numbers for usage of the law at the blog ACAsignups.net. Gaba’s estimates are current through November 2015 unless noted: • Americans currently enrolled in policies bought on the ACA’s online exchange: 9.5 million, of which roughly 8 million are receiving subsidies under the law. Another 2.5 million were enrolled in such policies during 2015 but have since dropped their coverage. • Net number of Americans added to Medicaid due to the law: 15 million. This includes 10 million added through direct expansion of Medicaid under the law, 4 million new but previously eligible beneficiaries who signed up for Medicaid after the ACA passed, and about 1 million transferred to Medicaid from existing, state-based programs. • Number of young adults age 19 to 26 who have been able to stay on their parents’ insurance due to the law: Possibly 1 million to 3 million, but the numbers change so often it’s hard to get a solid number. Of the 25 million-plus total from these three categories, Gaba estimates, roughly 17 million are newly insured specifically because of the law -- approximately 5 million through the exchanges, 11 million through Medicaid, and 1 million assorted others. Here are a couple of more ways people are benefitting: • Americans no longer at risk for coverage denial due to pre-existing conditions: As PolitiFact has previously reported, between 19 percent and 50 percent of Americans fall into this category, or between 60 million and 160 million people. • Americans no longer at risk of being kicked off policies for developing expensive medical conditions: Smaller than the previous categories, but unknown. There is some overlap between these categories. But whatever the number is, it’s in the tens of millions -- and most of those people, Gaba said, "would disagree that it's ‘not helping anyone.’ " Jonathan Oberlander, a professor in the Department of Health Policy and Management at the University of North Carolina-Chapel Hill, added two additional categories of Americans who have benefited from the ACA: • Medicare Part D beneficiaries, who are getting better prescription drug coverage: 39 million Medicare beneficiaries are enrolled in the program. These and other Medicare beneficiaries are also getting such new benefits as free preventive screenings and an annual wellness checkup. • Americans with private insurance who now have access to preventive services at no charge: Unknown, but likely in the millions. Another way to look at it holistically is to gauge the net impact on national uninsurance rates. They have fallen sharply since the law has been put into practice, as this chart from the Kaiser Family Foundation illustrates:  "The statement is utter nonsense. Put simply, it is a wild exaggeration that amounts to a lie," Oberlander said. "You can certainly debate the overall impact and desirability of Obamacare. But to say it isn’t helping anyone is to ignore both reality and overwhelming evidence to the contrary." Policy experts who have mixed feelings about the law or oppose it outright say that some of these benefits have come at too high a cost, or have left more people significantly hurt than significantly helped. For instance, Gail Wilensky, who ran Medicare and Medicaid under President George H.W. Bush and who has provided unofficial advice to Jeb Bush’s 2016 presidential campaign, said the law has squeezed out many of the more limited-benefit and catastrophic-coverage plans that beneficiaries may have liked, forcing them to pay for more expensive policies. "This has been a problem for people above 300 percent of the poverty line who get small subsidies, and it’s been a real problem for people above 400 percent of the poverty line who get no subsidy," Wilensky said. Michael Tanner, a scholar at the Cato Institute, said there have been both winners and losers, and that he expects that "the losers far outnumber the winners." That said, both Wilensky and Tanner agreed that Fiorina went too far in saying that "Obamacare isn't helping anyone." "People on expanded Medicaid or who were previously uninsured and substantially subsidized in the exchange are better off than they were," Wilensky said, even if "they may or may not be as well off as they could be." Tanner added that, despite his qualms with the law, "you can’t truthfully say that no one has benefited. Even if you believe that the previously uninsured are paying too much for crummy policies under the ACA, as I do, I don’t think you can say that none of them have benefited at all. That’s a pretty low bar, of course. If you flew across the country dumping money from an airplane, some people would benefit." Our ruling Fiorina said that "Obamacare isn't helping anyone." Even taking the low end of estimates, tens of millions of Americans have benefited from the ACA, in big ways (such as securing insurance for the first time) or smaller ways (paying less for drugs under Medicare Part D). One does not have to buy into every aspect of the law or feel comfortable with its overall price tag to acknowledge that lots of people have benefited from it. We rate Fiorina’s statement .


A secret tape recorded aboard the doomed space shuttle Challenger captured the final panic-stricken moments of the crew.

Explanation: Reports of a secret tape recorded aboard the doomed space shuttle Challenger that captured the final panic-stricken moments of the crew raised suspicions of a cover-up.

Seventy-three seconds into the 28 January 1986 flight of the space shuttle Challenger the craft broke apart, killing the seven astronauts aboard. Videotapes released by NASA afterwards showed that a few seconds before the disaster, an unusual plume of fire and smoke could be seen spewing from the lower section of the shuttle’s right solid-fuel rocket. It was generally assumed (and NASA did little to disturb this opinion) that all aboard died the moment the external tank blew up. NASA later conceded it was likely that at least three of the crew members aboard remained conscious after the explosion, and perhaps even throughout the few minutes it took forthe crew compartment of the shuttle to fall back to Earth and slam into the Atlantic Ocean. The agency was highly secretive about matters relating to the Challenger tragedy, actively fighting in the courts media requests to be allowed access to photographs of the wreckage, the details of the settlements made with the crews’ families, or the autopsy reports, and this reticence to share information likely convinced some that there was more to the story than was being told. Such an environment breeds its own rumors, and Miami Herald reporter Dennis E. Powell wrote that the crew were likely all alive and conscious until the shuttle’s crew compartment plunged into the Atlantic Ocean: When the shuttle broke apart, the crew compartment did not lose pressure, at least not at once. There was an uncomfortable jolt — “A pretty good kick in the pants” is the way one investigator describes it — but it was not so severe as to cause injury. This probably accounted for the “uh oh” that was the last word heard on the flight deck tape recorder that would be recovered from the ocean floor two months later. As they were feeling the jolt, the four astronauts on the flight deck saw a bright flash and a cloud of steam. The lights went out. The intercom went dead. After a few breaths, the seven astronauts stopped getting oxygen into their helmets. Someone, apparently astronaut Ronald McNair, leaned forward and turned on the personal emergency air pack of shuttle pilot Michael Smith. The PEAP of Commander Francis Scobee was in a place where it was difficult to reach. It was not activated. Even so, if the crew compartment did not rapidly lose air pressure, Scobee would only have had to lift his mask to be able to breathe. Two other PEAPs were turned on. The three others were never found. Though the shuttle had broken to pieces, the crew compartment was intact. It stabilized in a nose-down attitude within 10 to 20 seconds, say the investigators. Even if the compartment was gradually losing pressure, those on the flight deck would certainly have remained conscious long enough to catch a glimpse of the green-brown Atlantic rushing toward them. If it lost its pressurization very slowly or remained intact until it hit the water, they were conscious and cognizant all the way down. In fact, no clear evidence was ever found that the crew cabin depressurized at all. There was certainly no sudden, catastrophic loss of air of the type that would have knocked the astronauts out within seconds. Such an event would have caused the mid-deck floor to buckle upward; that simply didn’t happen. A purported transcript of the Challenger crew’s final horrifying moments  has circulated online for many years, supposedly taken from a “secret tape” leaked from NASA:  A secret NASA tape reveals that the crew of the shuttle Challenger not only survived the explosion that ripped the vessel apart; they screamed, cried, cursed and prayed for three hellish minutes before they slammed into the Atlantic and perished on January 28, 1986. The tape is said to begin with a startled crewman screaming,”What happened? What happened? Oh God – No!” Screams and curses are heard – several crewmen begin to weep – and then others bid their families farewell. Two minutes forty-five seconds later the tape ends. That’s when the shuttles crew compartment, which remained intact after the vessel exploded over the Atlantic, hit the ocean at over 2,000 miles per hour, instantly killing the crew. “Cover up? Of course there was a coverup,” declared Robert Hotz, a member of the Presidential commission that investigated the disaster. “NASA can’t face the fact that they put these astronauts in a situation where they didn’t have adequate equipment to survive. NASA doesn’t give a damn about anything but covering it’s ass,” he said. The official account released by NASA ends with shuttle pilot Michael Smith saying, “Uh-oh!” Some NASA employees have evidently heard more – much more. And they provided the rest of the account based on what they’ve discussed within NASA in the last five years. The astronauts had time and realized something was happening after the shuttle broke up. “All shuttle astronauts carry personal recorders and the tape in question apparently came from Christa’s (McAuliffe), which was recovered after the shuttle disaster,” said Hotz. Jarvis was sitting beside her, and when he figured out what was happening he said, “Give me your hand.” “NASA insists there’s nothing like that on tape but they’re talking about the mission tape, not Christa’s. So they’re not lying, but they’re not telling the truth, either.” A journalist with close ties to NASA was even more emphatic, “There are persistent rumors, dating back to the disaster, that this tape is absolutely bone-chilling.” The following transcript begins two seconds after NASA’s official version ends, with pilot Michael Smith saying, “Uh-oh!” Times from the moment of takeoff are shown in minutes and seconds and are approximate. The sex of the speaker is indicated by M or F. T+1:15   (M)   What happened? What happened? Oh God, no – no! T+1:17   (F)   Oh dear God. T+1:18   (M)   Turn on your air pack! Turn on your air… T+1:20   (M)   Can’t breathe… choking… T+1:21   (M)   Lift up your visor! T+1:22   (M/F)   (Screams.) It’s hot. (Sobs.) I can’t. Don’t tell me… God! Do it…now… T+1:24   (M)   I told them… I told them… Dammit! Resnik don’t… T+1:27   (M)   Take it easy! Move (unintelligible)… T+1:28   (F)   Don’t let me die like this. Not now. Not here… T+1:31   (M)   Your arm… no… I (extended garble, static) T+1:36   (F)   I’m… passing… out… T+1:37   (M)   We’re not dead yet. T+1:40   (M)   If you ever wanted (unintelligible) me a miracle… (unintelligible)… (screams) T+1:41   (M)   She’s… she’s… (garble) … damn! T+1:50   (M)   Can’t breathe… T+1:51   (M/F)   (screams) Jesus Christ! No! T+1:54   (M)   She’s out. T+1:55   (M)   Lucky… (unintelligible). T+1:56   (M)   God. The water… we’re dead! (screams) T+2:00   (F)   Goodbye (sobs)… I love you, I love you… T+2:03   (M)   Loosen up… loosen up… T+2:07   (M)   It’ll just be like a ditch landing… T+2:09   (M)   That’s right, think positive. T+2:11   (M)   Ditch procedure… T+2:14   (M)   No way! T+2:17   (M)   Give me your hand… T+2:19   (M)   You awake in there? I… I… T+2:29   (M)   Our Father… (unintelligible)… T+2:42   (M)   …hallowed be Thy name… (unintelligible). T+2:57   (M)   You…over there? T+2:58   (M)   The Lord is my shepherd, I shall… not want. He maketh me to lie down in green pastures… though I walk through the valley of the shadow of death, I will fear no evil… I will dwell in the house… T+3:15 to end. None. Static, silence. Rest in Peace  However, this “transcript” originated with an article published in a February 1991 issue of Weekly World News, a tabloid famous for creating news stories out of whole cloth. There never was such a transcript, nor was the crew of the Challenger known to have been wearing personal recorders. Moreover, personal recorders would not have picked up the comments of crew members on different decks as the faked transcript would have us believe. Not everyone aboard died the exact second the external tank exploded; that much is known. A complete understanding of exactly what happened in that cabin after the explosion remains elusive because the impact of the crash, plus the six weeks the wreckage and bodies spent in the sea, made it impossible to determine precisely when and how everybody aboard died. (Six weeks in sea water would also have ruined any unshielded audio tapes that miraculously survived the explosion and the crash.)


Israel targets fashion industry over underweight models.

Explanation: Israeli lawmakers want to tighten a ban on the employment of underweight models and on the undeclared digital slimming-down of fashion images, amid concern that the measures are being routinely flouted even as they are adopted abroad.

The fashion industry’s use of wafer-thin models has long been the subject of heated debate worldwide. Critics say the practice promotes an unhealthy body image among women, which can contribute to triggering anorexia and other eating disorders and a preoccupation with unrealistic measures of perfection. Israel in 2012 became the first country to pass a law requiring advertisers explicitly to identify pictures with photoshopped people and prohibiting the use of models below a certain body mass index (BMI), a measure which expresses a ratio of weight to height. Other countries including France, a hub of the fashion industry, have since followed Israel’s lead. But unlike Israel’s so-called ‘anti-photoshop’ law, French legislation that takes effect this month imposes fines and jail sentences on those who fail to comply. “The problem with the Israeli law is that there’s no punishment,” said Israeli photographer Adi Barkan, who was consulted on both the Israeli and French legislation. “So you continue using skinny girls and no one cares,” he said, in comments reinforced by a recent Israeli parliamentary report that revealed the ineffectiveness of the existing law. Israeli lawmaker Nurit Koran,  with the backing of 42 other members of the Knesset, the country’s parliament, has now prepared a draft bill she hopes will rectify the shortcomings. “The fashion industry needs to know (it can no longer ignore the law),” said Koran, who said she took up the cause after watching the daughter of a close friend struggle with anorexia. The 2012 law, which prohibits the hiring of women and men for modeling jobs with a BMI of less than 18.5, says models must obtain a medical certificate confirming a normal BMI. Adverts shown in Israel must also clearly state whether they have used computer-editing techniques to airbrush or slim down models. Under Koran’s proposed changes, state authorities would for the first time be able to fine agencies and others who flout the law and would require a doctor to see an applicant in person, not just “approve” their application over the telephone. Her move coincides with an announcement by major global fashion firms, including Christian Dior and Gucci, that they will stop hiring underweight models for catwalks. Getty Images, a major international photo agency, also recently issued new guidelines barring photos with slimmed-down models, even if labeled. Yael Latzer, an eating disorder expert at Haifa University in northern Israel, said images of skinny and photoshopped models alone do not cause eating disorders. “(But) young (people) always feel that something is wrong with them,” she said, adding that the media was “pulling the trigger” for those already genetically predisposed to eating disorder diseases such as anorexia. Former Israeli supermodel Maayan Keret said she had developed an eating disorder after she “felt a lot of pressure from everyone” to continually lose weight. Now, having overcome the disease, she works to promote positive body images. “The standards (women and girls) see everywhere of beauty are not natural,” Keret told Reuters. “They see those images. And they think that’s the way it should be.”


Doctors, nurses, hospitals, even the pharmaceutical industry, (and) AARP" say that health reform "makes sense to do.

Explanation: Obama says there is widespread support for health care reform

In his recent speech, President Barack Obama said the time is ripe for health care reform because most health care professionals support a new plan. "The default position is inertia," he said during his July 22, 2009, speech on health care when asked why he was so eager to pass health care reform before the end of the summer. "Because doing something always creates some people who are unhappy... And the fact that we have made so much progress where we've got doctors, nurses, hospitals, even the pharmaceutical industry, AARP, saying that this makes sense to do, I think means that the stars are aligned and we need to take advantage of that." Obama was talking about some key industry endorsements he picked up for a health care overhaul. In early May, the hospitals, insurers and the drug industry pledged to save $2 trillion in health care spending over 10 years. That victory was followed by a July 8 announcement that hospitals would contribute $155 billion in Medicare and Medicaid savings to cover health care cost reform. So, at first blush it seems that Obama is right that the stars are aligned for health care reform. However, we found that some storm clouds are overshadowing Obama’s starry sky. First, it's important to note that there’s a big difference between supporting a health care overhaul generally and supporting the legislation being considered by the House and the Senate. Nearly all industry sectors believe our health care system needs an overhaul. But they disagree on what to change. Those divisions are best illustrated by industry support or opposition to the House and Senate health care bills. Among many other things, both bills would create a government-run insurance option and would require that most employers extend some sort of health insurance to their employees. People would be required to have some form of coverage, and insurers would not be able to deny coverage because of a person’s medical history. The House bill would tax the wealthiest people to help pay for the legislation, while the Senate hasn't unveiled how it will pay for the overhaul. The American Medical Association — a coalition of doctors and medical societies — endorsed the House bill, because the "legislation includes a broad range of provisions that are key to effective, comprehensive health system reform." However, several of AMA's members, including the Texas Medical Association, have not endorsed the bill because it includes a government-run health insurance option. Another sticking point is an administration proposal that would create an independent group of medical experts to look for inefficiencies in the Medicare system to save money. The American Hospital Association says the plan will hit rural and teaching hospitals hardest because they get extra Medicare payments to help cover their relatively high cost of doing business. AARP supports the House bill, but believes the Senate bill still needs some work. Specifically, the organization, which represents people over 50, is concerned the bill would prevent some less costly generic drugs from entering the market fast enough. The leading pharmaceutical industry trade group, PhRMA, does not support the House bill, but says the Senate bill "marks an important step toward achieving comprehensive health care reform." And the American Nurses Asssociation supports the House bill, but has no clear position on the Senate bill. Those are a lot of details to keep track of, so we've provided you with a handy guide  here  . But back to Obama's claim. He's correct that most in the health care industry support some sort of reform, but when we're talking about the overhauls that have been put to paper — specifically, the House and Senate bills — there is quite a bit of disagreement among hospitals, nurses, Medicare patients, doctors and the drug industry over which plan is best; industry support isn't as rock-solid as Obama would make it seem. As a result, we give him a .


Account by Apollo 11 astronaut Buzz Aldrin describes his taking Communion on the moon.

Explanation: Apollo 11 astronaut Buzz Aldrin said he wanted to perform "some appropriate symbolic act regarding the universality of seeking" during the moon landing.

History, apollo 11, buzz aldrin, moon landings

One of the smaller details lost amidst the tremendous historic and scientific achievements of the Apollo 11 mission that landed the first two human beings on the moon in July 1969 was that it also marked the first occasion on which a Christian took the sacrament of Communion on an astronomical body other than Earth. This event took place in the interval between the lunar module’s landing on the moon on 20 July 1969 and Neil Armstrong’s taking his first steps on the lunar surface several hours later; during that period, astronaut Buzz Aldrin privately observed Communion using elements he had brought with him to the moon: Example: Communion on the Moon: July 20th, 1969 Forty years ago today two human beings changed history by walking on the surface of the moon. But what happened before Buzz Aldrin (pictured in the LM, left) and Neil Armstrong exited the Lunar Module is perhaps even more amazing, if only because so few people know about it. I’m talking about the fact that Buzz Aldrin took communion on the surface of the moon. Some months after his return, he wrote about it in Guideposts magazine. And a few years ago I had the privilege of meeting him myself. I asked him about it and he confirmed the story to me, and I wrote about in my book Everything You Always Wanted to Know About God (But Were Afraid to Ask). The background to the story is that Aldrin was an elder at his Presbyterian Church in Texas during this period in his life, and knowing that he would soon be doing something unprecedented in human history, he felt he should mark the occasion somehow, and he asked his pastor to help him. And so the pastor consecrated a communion wafer and a small vial of communion wine. And Buzz Aldrin took them with him out of the Earth’s orbit and on to the surface of the moon. He and Armstrong had only been on the lunar surface for a few minutes when Aldrin made the following public statement: “This is the LM pilot. I’d like to take this opportunity to ask every person listening in, whoever and wherever they may be, to pause for a moment and contemplate the events of the past few hours and to give thanks in his or her own way.” He then ended radio communication and there, on the silent surface of the moon, 250,000 miles from home, he read a verse from the Gospel of John, and he took communion. Here is his own account of what happened: In the radio blackout, I opened the little plastic packages which contained the bread and the wine. I poured the wine into the chalice our church had given me. In the one-sixth gravity of the moon, the wine slowly curled and gracefully came up the side of the cup. Then I read the Scripture, “I am the vine, you are the branches. Whosoever abides in me will bring forth much fruit. Apart from me you can do nothing.” I had intended to read my communion passage back to earth, but at the last minute [they] had requested that I not do this. NASA was already embroiled in a legal battle with Madelyn Murray O’Hare [sic], the celebrated opponent of religion, over the Apollo 8 crew reading from Genesis while orbiting the moon at Christmas. I agreed reluctantly. I ate the tiny Host and swallowed the wine. I gave thanks for the intelligence and spirit that had brought two young pilots to the Sea of Tranquility. It was interesting for me to think: the very first liquid ever poured on the moon, and the very first food eaten there, were the communion elements. And of course, it’s interesting to think that some of the first words spoken on the moon were the words of Jesus Christ, who made the Earth and the moon — and Who, in the immortal words of Dante, is Himself the “Love that moves the Sun and other stars.” Aldrin openly described his Communion experience on the moon in print several times, including an August 1969 interview with LIFE magazine, an October 1970 Guideposts article, and his 1973 book Return to Earth. The following account of his motivations and preparation is taken from Aldrin’s 2009 book, Magnificent Desolation: Landing on the moon is not quite the same thing as arriving at Grandmother’s for Thanksgiving. You don’t hop out of the lunar module the moment the engine stops and yell, “We’re here! We’re here!” Getting out of the LM takes a lot of preparation, so we had built in several extra hours to our flight plan. We also figured it was wise to allow more time rather than less for our initial activities after landing, just in case anything had gone wrong during the flight. According to our schedule, we were supposed to eat a meal, rest awhile, and then sleep for seven hours after arriving on the moon. After all, we had already worked a long, full day and we wanted to be fresh for our extra-vehicular activity (EVA). Mission Control had notified the media that they could take a break and catch their breath since there wouldn’t be much happening for several hours as we rested. But it was hard to rest with all that adrenaline pumping through our systems. Nevertheless, in an effort to remain calm and collected, I decided that this would be an excellent time for a ceremony I had planned as an expression of gratitude and hope. Weeks before, as the Apollo mission drew near, I had originally asked Dean Woodruff, pastor at Webster Presbyterian Church, where my family and I attended services when I was home in Houston, to help me come up with something I could do on the moon, some appropriate symbolic act regarding the universality of seeking. I had thought in terms of doing something overtly patriotic, but everything we came up with sounded trite and jingoistic. I settled on a well-known expression of spirituality: celebrating the first Christian Communion on the moon, much as Christopher Columbus and other explorers had done when they first landed in their “new world.” I wanted to do something positive for the world, so the spiritual aspect appealed greatly to me, but NASA was still smarting from a lawsuit filed by atheist Madalyn Murray O’Hair after the Apollo 8 astronauts read from the biblical creation account in Genesis. O’Hair contended this was a violation of the constitutional separation of church and state. Although O’Hair’s views did not represent mainstream America at that time, her lawsuit was a nuisance and a distraction that NASA preferred to live without. I met with Deke Slayton, one of the original “Mercury Seven” astronauts who ran our flight-crew operations, to inform him of my plans and that I intended to tell the world what I was doing. Deke said, “No, that’s not a good idea, Buzz. Go ahead and have communion, but keep your comments more general.” I understood that Deke didn’t want any more trouble. So, during those first hours on the moon, before the planned eating and rest periods, I reached into my personal preference kit and pulled out the communion elements along with a three-by-five card on which I had written the words of Jesus: “I am the vine, you are the branches. Whoever remains in me, and I in him, will bear much fruit; for you can do nothing without me.” I poured a thimbleful of wine from a sealed plastic container into a small chalice, and waited for the wine to settle down as it swirled in the one-sixth Earth gravity of the moon. My comments to the world were inclusive: “I would like to request a few moments of silence … and to invite each person listening in, wherever and whomever they may be, to pause for a moment and contemplate the events of the past few hours, and to give thanks in his or her own way.” I silently read the Bible passage as I partook of the wafer and the wine, and offered a private prayer for the task at hand and the opportunity I had been given. Neil watched respectfully, but made no comment to me at the time. Perhaps, if I had it to do over again, I would not choose to celebrate communion. Although it was a deeply meaningful experience for me, it was a Christian sacrament, and we had come to the moon in the name of all mankind — be they Christians, Jews, Muslims, animists, agnostics, or atheists. But at the time I could think of no better way to acknowledge the enormity of the Apollo 11 experience that by giving thanks to God. It was my hope that people would keep the whole event in their minds and see, beyond minor details and technical achievements, a deeper meaning — a challenge, and the human need to explore whatever is above us, below us, or out there. Some sources asserted that Aldrin’s taking of Communion was kept “secret” from the public by NASA due to an ongoing lawsuit filed by atheist Madalyn Murray O’Hair: The story of the secret communion service only emerged after the mission. Aldrin had originally planned to share the event with the world over the radio. However, at the time Nasa was still reeling from a lawsuit filed by the firebrand atheist Madalyn Murray O’Hair, resulting in the ceremony never being broadcast. After the Apollo 8 crew had read out the Genesis creation account in orbit, O’Hair wanted a ban on Nasa astronauts practising religion on earth, in space or “around and about the moon” while on duty. She believed it violated the constitutional separation between church and state However, it’s not completely true that the public was kept in the dark about the event until many years later. Although Aldrin maintained that NASA asked him not to broadcast his observance of Communion, news accounts released while the Apollo 11 mission was in progress reported that Aldrin was bringing Communion bread with him to the moon and would be joining Earth-bound parishioners in observing Communion from the lunar surface, as noted in this 20 July 1969 Associated Press dispatch: Astronaut Edwin E. Aldrin Jr. went to the moon today with a piece of Communion bread he will use there to symbolize fellowship with his home church on earth. When the Rev. M. Dean Woodruff [minister of the Webster Presbyterian church where Aldrin was an elder] brought out the bread for Communion, a portion of the loaf had been broken away. The minister explained that Aldrin took a portion of the loaf with him on the moon trip and at some time during the afternoon, after the moon landing is made, Aldrin would symbolically join the other parishioners in Communion during one of his rest periods. Buzz Aldrin’s observance of Communion was dramatized in an episode of the 1998 HBO mini-series From the Earth to the Moon:


Quebec appeals court upholds C$15 billion tobacco class action ruling.

Explanation: The Court of Appeal of Quebec upheld on Friday the bulk of a 2015 decision that awarded around C$15 billion ($11.29 billion)to smokers in the Canadian province, dealing a blow to Big Tobacco.

The judgment involves class action suits that were consolidated against the Canadian subsidiaries of British American Tobacco, Philip Morris International and Japan Tobacco International, known respectively as Imperial Tobacco Canada Ltd, Rothmans, Benson & Hedges Inc (RBH) and JTI-Macdonald Corp. The companies were appealing a 2015 Quebec Superior Court ruling to award damages to some 100,000 Quebec smokers and ex-smokers who alleged the companies knew since the 1950s that their product was causing cancer and other illnesses and failed to warn consumers adequately. The province’s Council on Tobacco and Health, a non-profit smoking-prevention group that was also a plaintiff in the suits, said the “historic judgment” would cost the companies almost C$17 billion ($12.79 billion), reflecting additional interest since 2015. RBH said in a statement that it will try to appeal the decision to the Supreme Court of Canada. JTI-Macdonald said it would consider that option. While big tobacco companies in the United States have faced lawsuits for decades, the Quebec class action marked the first time tobacco companies went to trial in a civil suit in Canada. “This is a huge defeat for the tobacco industry,” said Rob Cunningham, senior policy analyst from the Canadian Cancer Society. “The Court of Appeal did reverse the Superior Court on some relatively minor points, but that does not materially change the overall result.”  The judgment comes as Big Tobacco firms are pouring billions into vaping devices that deliver nicotine through vapor they say is less harmful than smoke, and as smoking rates fall in many countries. The two Quebec suits, called the Letourneau and Blais cases, were filed in 1998 and certified as class actions in 2005. They were consolidated into one before the 2012 start of trial proceedings, which ended in 2014. JTI-Macdonald said in a statement it “fundamentally disagrees” with the court’s judgment and that Canadians “have had a very high awareness of the health risks of smoking.”   A spokesman for Imperial Tobacco Canada told reporters at the Montreal courthouse the company was “disappointed” with the decision. British American Tobacco Finance Director Ben Stevens told analysts on Thursday that the Canadian cases would likely take years to play out in the courts. British American Tobacco said in a statement late on Friday: “Imperial Tobacco Canada Ltd. needs to review the court’s decision in more detail and will decide on next steps over the coming days and weeks.”


Hunt on for 'patient zero' who spread coronavirus globally from Singapore.

Explanation: As lion dancers snaked between conference room tables laden with plastic bottles, pens, notebooks and laptops, some staff from British gas analytics firm Servomex snapped photos of the performance meant to bring good luck and fortune.

But the January sales meeting in a luxury Singapore hotel was far from auspicious. Someone seated in the room, or in the vicinity of the hotel that is renowned for its central location and a racy nightclub in the basement, was about to take coronavirus global. Three weeks later, global health authorities are still scrambling to work out who carried the disease into the mundane meeting of a firm selling gas meters, which then spread to five countries from South Korea to Spain, infecting over a dozen people. Experts say finding this so-called “patient zero” is critical for tracing all those potentially exposed to infection and containing the outbreak, but as time passes, the harder it becomes. “We do feel uncomfortable obviously when we diagnose a patient with the illness and we can’t work out where it came from...the containment activities are less effective,” said Dale Fisher, chair of the Global Outbreak Alert and Response Network coordinated by the World Health Organisation. Authorities initially hinted at Chinese delegates, which included someone from Wuhan - the Chinese city at the epicentre of the virus that has killed over 1,350 people. But a Servomex spokesperson told Reuters its Chinese delegates had not tested positive. Fisher and other experts have compared the Singapore meeting to another so-called “super-spreading” incident at a Hong Kong hotel in 2003 where a sick Chinese doctor spread Severe Acute Respiratory Syndrome around the world. The WHO has opened an investigation into the Singapore incident, but said its “way too early” to tell if it is a super-spreading event. It was more than a week after the meeting - which according to a company e-mail included Servomex’s leadership team and global sales staff - that the first case surfaced in Malaysia. The incubation period for the disease is up to 14 days and people may be able to infect others before symptoms appear. The firm said it immediately adopted “extensive measures” to contain the virus and protect employees and the wider community. Those included self-isolation for all 109 attendees, of whom 94 were from overseas and had left Singapore. But the virus kept spreading. Two South Korean delegates fell sick after sharing a buffet meal with the Malaysian, who also passed the infection to his sister and mother-in-law. Three of the firm’s Singapore attendees also tested positive. Then cases started appearing in Europe. An infected British delegate had headed from the conference to a French ski resort, where another five people fell ill. Another linked case then emerged in Spain, and when the Briton returned to his home town in the south of England the virus spread further. “It feels really scary that one minute it’s a story in China... and then the next minute it is literally on our doorstep,” said Natalie Brown, whose children went to the same school as the British carrier. The school said in a letter that two people at the school had been isolated. “It’s scary and sobering how quickly it seems to have spread,” said Brown. Back in Singapore, authorities were battling to keep track of new cases of local transmissions, many unlinked to previous cases. Management at the hotel - the Grand Hyatt Singapore - said they had cleaned extensively and were monitoring staff and guests for infection but did not know “how, where or when” conference attendees were infected. The lion dancers, who posted photos of the event on Facebook, said they were virus free. “Everyone assumes it was a delegate but it could have been a cleaner, it could have been a waiter,” said Paul Tambyah, an infectious diseases expert at National University Singapore. He added it was “very important” to find “patient zero” to establish other possible “chains of transmission”. But time may be running out. Singapore health ministry’s Kenneth Mak said the government will continue to try and identify the initial carrier until the  outbreak ends, but as days pass it will get harder. “We might never be able to tell who that first patient is,” Mak said. Meanwhile, the fallout from the conference continues to sow trepidation weeks after the event and thousands of miles away. Reuters visited Servomex’s offices in the suburbs of South Korea’s capital, Seoul. It was closed and dark inside, and a building guard told Reuters employees were working from home. A notice posted by building management stated a coronavirus patient had entered the complex, while several young women could be overheard in a nearby elevator discussing whether it had been used by the infected person. “Do you think the patient would have gotten on this elevator or the other one?” one said.


Getting a coronavirus test in Wuhan: fast, cheap and easy.

Explanation: Coronavirus tests can be difficult to come by in many countries including in hard-hit parts of the United States and Britain, but in Wuhan, the Chinese epicentre of the pandemic, they are fast, cheap and easy to get.

My colleagues and I had just arrived in the central city where the novel coronavirus emerged in humans late last year, and as a foreigner I was told that I was required to take a nucleic test to prove that I was free of the potentially deadly flu-like virus. A government official escorted me to the test site, a table outside the entrance of a shuttered hotel. A single medical worker sat there, dressed in a zipped-up hazmat suit and goggles. She asked for my personal details and told me to sit. She then stuck a swab down my throat, nearly triggering a gag, and then it was over. “You’ll get your results in about one and a half days,” the official said. The test, while not pleasant, took less than three seconds. Wuhan is testing liberally as it tries to get back up and running after lifting a 76-day lockdown last week. The term “nucleic acid test” has become a familiar one in the city of 11 million people, where many companies are asking workers to present test results before they can return to work, although it is not mandatory. At one Wuhan hospital, people only need to spit into a test tube. That test costs 260 yuan ($37) and results are available by mobile app. Since Feb. 21, 930,315 tests have been carried out in Wuhan, according to government data. “Testing is a good thing,” said Zhao Yan, a emergency medicine doctor and vice president of Wuhan’s Zhongnan Hospital told reporters on a government-organised trip last week. “If you’re an enterprise with 500 employees and you want to start working again, you test everybody.”  Across China, officials are simplifying and speeding up the process to obtain a nucleic acid test, even though questions persist about its accuracy. Some Chinese doctors have pushed to raise requirements for discharging hospitalised patients from two negative nucleic acid tests to three. Cities including Beijing have required some arriving travelers to present test results when entering. China has not yet indicated it will require testing for large swathes of the population. The official sent my test result to me by text message. It was negative.


Explanation: This story reports on a potentially important development in the prevention of breast cancer among high risk, postmenopausal women. The story is clear that this is an existing drug for osteoporosis that has not been approved by the FDA for use in breast cancer prevention. The story also does not make claims about when it may be approved for that purpose. There is no obvious disease mongering; the story accurately represents the prevalence and seriousness of breast cancer  Although there is mention of a clinical trial, the story does not describe the study design. Also not mentioned was the fact that the results have not yet been published or peer reviewed, so interpretation of the clinical significance of these results are difficult at this time. Benefits of treatment are quantified in relative terms only. The viewer is told that raloxifene and tamoxifen both reduce the incidence of breast cancer by about 50%, however there is no context provided for these numbers. Most viewers would want to know “50% of what?” They want the absolute risk reduction. Viewers should have been told that even though the women in the study were high risk, the incidence of breast cancer over 5 years was still very low. The story also does not mention that raloxifene does not reduce the incidence of ductal carcinoma in situ (DCIS, which tamoxifen does), so it is not clear that when the story says the benefits are equivalent between the two drugs, if it will hold true if they include all breast cancer events (including DCIS, which is found quite commonly these days). The story also omits an important fact: the decrease in incidence of uterine cancer and clots in the raloxifene group was not statistically different from the tamoxifen group. Although uterine cancer and blood clots are mentioned as harms of treatment, there is no mention of how often they occur. Other harms such as cataracts and stroke are not mentioned. No costs are mentioned. According to the website for the STAR trial, the cost of Raloxifene is about $75 per month, while Tamoxifen costs about $100 per month. Because these drugs have to be taken for long periods of time, cost is an important issue.

No costs are mentioned. According to the website for the STAR trial, the cost of raloxifene is about $75 per month, while tamoxifen costs about $100 per month. Because these drugs have to be taken for long periods of time, cost is an issue. Benefits are quantified in relative terms only. The reader is told that raloxifene and tamoxifen both reduce the incidence of breast cancer by 50%, however there is no context provided for these numbers. Viewers would want to know 50% of what? They would want to know the absolute risk reduction. Viewers should have been told that even though the women in the study were high risk, the incidence of breast cancer over 5 years was still very low. The story also does not mention that raloxifene does not reduce the incidence of ductal carcinoma in situ (DCIS, which tamoxifen does), so it is not clear that when the story says the benefits are equivalent between the two drugs, if it will hold true if they include all breast cancer events (including DCIS, which is being found much more commonly now).The story also omits an important fact: the decrease in incidence of uterine cancer and clots associated with raloxifene was not statistically significant. Although uterine cancer and blood clots are mentioned as harms of treatment, there is no mention of how often they occur. Other harms such as cataracts and stroke are not mentioned. Although there is mention of a clinical trial, the story does not describe the study design. Also not mentioned was the fact that this study has not yet been published or peer reviewed. No obvious disease mongering. The story accurately represents the prevalence and seriousness of breast cancer. Only one source, a physician at the National Cancer Institute, is quoted. In a story of this potential magnitude, other sources and perspectives are needed. It doesn’t add that much time to a story, even in broadcast. Tamoxifen is mentioned as the alternative to raloxifene. The story is clear that this is an existing drug for osteoporosis that has not been approved by the FDA for use in breast cancer prevention. The story does not make claims about when it may be approved for that purpose. The story is clear that raloxifene is an existing drug that is currently used to treat osteoporosis. We can’t be sure if the story relied solely or largely on a news release.


Samoa faces coronavirus threat after recovering from deadly measles outbreak.

Explanation: Just a few months ago, the Pacific island nation of Samoa was in the grip of a deadly measles epidemic.

Now, medical staff are being redeployed, and facilities refitted, to combat the threat of coronavirus on an already stressed population. While the isolated nation, located more than 1000 kilometers (621 miles) north-east of Fiji, has not recorded any COVID-19 cases, some of its residents are worried it is ill-equipped to combat the epidemic. “When it comes, we don’t have the resources to prevent and cure, that’s why it’s a big concern to me,” musician Sio Silva told Reuters in the Samoan capital of Apia on Monday. “We don’t know if it’s inside our island already but don’t have the resources to test it.”    The Pacific region has recorded six cases of COVID-19 - three in French Polynesia and three in Guam - although most island nations cannot screen for the virus onshore which is potentially masking its spread. The Samoan government said in its most recent health update on March 14 that there were no suspected or confirmed cases of coronavirus. Pacific countries have been tightening their border controls to prevent the coronavirus from gaining a foothold in isolated islands with limited health resources. All incoming air travel to the United States-backed Marshall Islands have been banned. Travelers going to Samoa, a twin-island nation of approximately 200,000 people, must obtain a medical clearance report before boarding their flight, and passengers are screened on arrival. White medical tents located near the main airport that were recently used to isolate measles patients will now be used to quarantine suspected coronavirus sufferers, the government said. Last year’s measles outbreak killed 83 Samoans, mainly young children, in a health emergency that was only brought under control less than three months ago after a mass vaccination drive. “We have to be prepared, anytime that the coronavirus might come and infect us, we have to get ready for that,” Naomi Iona, a radio announcer, told Reuters in Apia.


Explanation: Barack Obama said he lowered taxes over the past two years

In an interview on Super Bowl Sunday, Fox News host Bill O'Reilly asked President Barack Obama to react to a Wall Street Journal editorial that accused Obama of being "a determined man of the left whose goal is to redistribute much larger levels of income across society." "Do you deny that you are a man who wants to redistribute wealth?" O'Reilly asked. Obama first noted the robust conservatism of the Wall Street Journal's editorial page, then denied the charge "absolutely." "I didn't raise taxes once. I lowered taxes over the last two years," Obama said. We wanted to fact-check that statement, and we'll begin by saying Obama boils down an awful lot of complexity about federal tax policy into a short sound bite. Looking at the whole statement, he's both right and wrong. For clarity's sake, we're going to take Obama's statement in two parts. Here, we'll look at his statement, "I lowered taxes over the last two years." In a separate report, we checked the statement, "I didn't raise taxes once" and rated it False. Obama has raised taxes on cigarettes and indoor tanning, and the health care law includes a tax penalty on the uninsured. The health care law also includes new taxes on the wealthy, increasing the rates they pay on Medicare hospital taxes starting in 2013. For this one, we'll begin by noting that Obama has not raised income tax rates. Obama and Senate Republicans compromised on tax legislation at the end of 2010, leaving in place the same income tax rates for all tax brackets. (The extensions were necessary because the tax cuts passed under President George W. Bush would otherwise have increased last month.) It's also true that Obama has successfully supported tax reductions for workers who make less than $200,000 a year or couples who make less than $250,000. Obama kicked off his tax cuts for workers with the economic stimulus, formally known as the American Recovery and Reinvestment Act. He asked for tax cuts of $500 per worker per year; Congress agreed to $400. The tax cuts -- called Making Work Pay -- were implemented in early 2009 and people saw small increases in their paychecks. The Obama administration liked giving people the money in their paychecks every week or two -- as opposed to mailing one big check -- because administration economists thought people would be more likely to spend the money and stimulate the economy. But the increases were small enough that a lot of people didn't notice them. A New York Times/CBS News Poll in September showed that fewer than one in 10 people knew that the Obama administration had lowered taxes for American workers. Those tax cuts expired at the end of 2010. But as part of last fall's tax compromise with Republicans, Obama won a different type of tax cut for workers: a 2 percent reduction in payroll taxes that go to Social Security. Keep in mind that normally workers pay 6.2 percent in payroll taxes on up to $106,800 of their earnings. (Employers pay another 6.2 percent, while the self-employed are generally on the hook for the full 12.4 percent.) The new tax cut means workers will pay only 4.2 percent of their earnings. So that lowered taxes for workers. Generally speaking, people who make more than $20,000 will get an even bigger tax cut than they did under Making Work Pay. (Workers who makes less than $20,000 will likely be worse off, but they'll still be paying lower taxes than in 2008.) The tax compromise was a complicated piece of legislation, and not everybody ended up better off. Nevertheless, about 80 percent of tax payers end up with a tax cut under the deal, according to an analysis by the nonpartisan Tax Policy Center. And the broad-based tax cuts on income are significantly larger than the new excise taxes, said Roberton Williams of the Tax Policy Center. So yes, a majority of Americans have seen reduced taxes under President Obama. But he's also taken steps to increase a few taxes like cigarettes and tanning over the past two years. Overall, we find his statement .