Tom Petri Says President Barack Obama’s debt commission recommended converting Medicare "to a system where Medicare participants are given a voucher to purchase insurance in the private market.

Explanation: Wisconsin GOP Rep. Petri says Obama commission recommended vouchers for Medicare

Deficit, Federal Budget, Medicare, Wisconsin, Tom Petri,

When House Budget Committee Chairman Paul Ryan submitted his 2012 federal budget plan in April 2011, he touted how much more it cut spending, debt and deficits than President Barack Obama’s plan. Some of the loudest objections to the Wisconsin Republican’s proposal, however, decried its transformation of Medicare. MoveOn.org, a left-leaning political advocacy group, went so far as to say Ryan would abolish the 46-year-old program in 10 years. We ruled that claim , partly because current Medicare recipients would continue to receive traditional Medicare even after 10 years. But, as we noted, Ryan’s plan would change Medicare dramatically. Starting in 2022, Medicare would no longer directly help pay for doctor visits, hospital care, other services and prescription drugs. Rather, future Medicare participants would choose a private insurance plan and Medicare -- through what are called premium-support payments or vouchers -- would help pay for the insurance. The Kaiser Family Foundation, a nonpartisan group that studies health care policy, noted that in the days after Ryan’s budget plan was released, three national polls found Americans divided on such a change. Meanwhile, U.S. Rep. Tom Petri, R-Wisconsin, was conducting his annual survey of constituents. In his April 2011 newsletter, the 32-year Fond du Lac congressman posed this question to residents in the 6th District, which is north and west of Milwaukee:  "One of the recommendations put forth by the president’s debt commission was to convert the Medicare system from a government-run insurance program to a system where Medicare participants are given a voucher to purchase insurance in the private market. Would you support such a change?" That left us with this question: Did a commission created by a Democratic president recommend the same sweeping change to Medicare that was part of the House GOP budget? The debt commission mentioned in Petri’s question -- the National Commission on Fiscal Responsibility and Reform-- was formed by an Obama executive order in February 2010. The 18-member panel included Ryan, who was appointed by Republican leaders of the House of Representatives. The commission was charged with making recommendations to balance the federal budget, excluding interest payments on the debt, by 2015. The recommendations came in a report issued in December 2010. This is what Petri’s survey question cited in saying the commission recommended a voucher program for Medicare. The word voucher appears only once in the commission’s 66-page report, as part of Recommendation "3.3.13." The recommendation addressed Federal Employees Health Benefits, the health insurance program for federal employees and retirees. The commission said the insurance should be made into a premium-support or voucher program. Federal retirees could use their voucher to pay part of their Medicare premium. But that is for a limited group, federal employees and retirees. That is not transforming all of Medicare into a voucher program. Had that recommendation been made, it undoubtedly would have stirred the same criticism that the Republican plan has. The commission’s report noted that two commission members -- Ryan and Alice Rivlin, director of the Office of Management and Budget under President Bill Clinton -- had proposed converting Medicare into a voucher system. The commission’s view was that such a system "holds significant promise of controlling costs, but also carries serious potential risks." The commission suggested that, if its recommendation were put in place to make health insurance for federal employees and retirees a premium-support or voucher program, "that experience would be useful in considering a premium-support program for Medicare." So, the president’s commission recommended trying a voucher program with federal employees and retirees and then, based on the results, deciding whether to try it with Medicare. After we contacted Petri’s office on May 6, 2011, spokesman Niel Wright said the wording in the constituent survey question about Medicare was incorrect. He said the question should have stated that the president’s commission "discussed," rather than recommended, making Medicare a voucher program. Also after our call, this note was added to the electronic version of the survey question on Petri’s website:  "CORRECTION: The question above is somewhat misleading. Instead of saying that the recommendation was ‘put forth’ by the president's debt commission, the question should read that this recommendation was ‘discussed’ by the president's debt commission." Wright told us that when Petri’s office distributes results of the survey, a note will be included "indicating that a problem with this question was brought to our attention," as would "additional information clarifying how the question should have been phrased." Wright also said the survey was reviewed by the Commission on Congressional Mailing Standards, also known as the Franking Commission, and that "neither the Republican nor the Democratic staffers at the commission noticed anything objectionable" or partisan. Turning to the Truth-O-Meter, in surveying constituents, GOP Congressman Tom Petri said a commission created by the Democratic president had recommended making Medicare a voucher program. The commission did not make that recommendation and Petri admitted the wording in his survey was wrong. We rate his statement .


Gabapentin is now considered the most dangerous drug in America and will surpass opioids as the largest prescription drug killer.

Explanation: While the increasing prevalence of gabapentin abuse is an important finding and a vital step in understanding the complexities of the opioid epidemic, it is not a finding that should cause legitimate users alarm. To suggest that a drug which millions of people depend on is deadly and should be avoided at all costs, as the viral Facebook post suggested, is wholly irresponsible. Its potential for abuse was underestimated, but nobody is arguing that it is now more likely to cause death through an overdose on its own. As such, we rank this claim as false.

Medical, drug abuse, drug overdose, gabapentin

On 28 June 2017, Kaiser Health News reported on an apparent increase in abuse of gabapentin (brand name Neurontin) in Ohio and across the nation in a story that saw wide syndication in USA Today, STAT News, and many other outlets: Last December, Ohio’s Board of Pharmacy began reporting sales of gabapentin prescriptions in its regular monitoring of controlled substances. The drug, which is not an opioid nor designated a controlled substance by federal authorities, is used to treat nerve pain. But the board found that it was the most prescribed medication on its list that month, surpassing oxycodone by more than 9 million doses. In February, the Ohio Substance Abuse Monitoring Network issued an alert regarding increasing misuse across the state. The claims that gabapentin is “the most dangerous drug in America” gained widespread exposure thanks to a viral 1 January 2018 Facebook post that alleged, without sources, that gabapentin is the “newest” killer prescription. Claims that it is “killing thousands” appear to be based off this earlier reporting. While abuse of the drug “on the street” may be a newer phenomenon, gabapentin has been around since 1993 as a treatment of epilepsy in the United States. In the European Union, the drug is approved to treat neuropathic pain as well. Controversially, the drug has been — and continues to be — used to treat a wide variety of unapproved conditions off-label. The drug is not a narcotic like an opioid, and it has only an indirect effect on the central nervous system, making a direct overdose from the drug alone unlikely. A 62-year-old woman’s suicide, reported in a 2011 case study, claimed to be the first published report of a gabapentin overdose in combination with no other drugs — an outcome that confounded researchers. (There has since been at least one other gabapentin overdose reported in the absence of other drugs). The pharmacological and medical community have long considered the drug safe with few adverse effects. This lack of concern about its adverse effects, more recent research alleges, may have masked the legitimate risk for the drug’s potential for abuse. While a high from abusing the drug alone is reported to be mild, numerous case studies have indicated that opioid addicts find that gabapentin is able to increase the euphoric effects of an opioid high. Larger scale studies of opioid addicted individuals have confirmed this. Increasing awareness of the link between gabapentin and opiod addicts lead the Ohio Substance Abuse Monitoring Network to issue a February 2017 warning, which partially inspired the original June 2017 reporting by Kaiser Health News, and included this first-person account of its use: It’s not a narcotic, but what it does, is, it intensifies your methadone [an opioid]… so if you take your methadone and you go buy 10 [gabapentin pills] and you take all 10, it’s sort of like you tripled your dose. Further confusion over the lethality of gabapentin, based on the comments in the aforementioned viral post, appear to stem from an in-depth analysis of drug overdose deaths in Kentucky in 2016 performed by FiveThirtyEight and published on 17 January 2018. That story (“There Is More Than One Opioid Crisis”) indicated that 32.6 percent of all people who overdosed in Kentucky in 2016 had the presence of gabapentin in their system under autopsy, and that it was the most common drug found in some specific demographics: According to the findings, gabapentin […] was the drug most frequently detected in women who had died from drug overdoses and among victims over the age of 44. Crucially, these data do not indicate that gabapentin caused these deaths, just that its presence was found during autopsy toxicology reports. These data, as well, do not indicate that gabapentin was the only drug found in the system of drug overdose victims. To further illustrate that point, THC, the active component of marijuana which is incapable of causing an overdose on its own, was detected in a quarter of cases, according to the same dataset; it is impossible to credibly argue that marijuana caused a quarter of overdose deaths in Kentucky in 2016. The fact that gabapentin was frequently found in combination with opiates in that report, however, lends further credence to the idea that the drug is being used as a way to enhance the effects of other more deadly drugs.


Disney closes controversial fat-fighting exhibit.

Explanation: Obesity experts on Friday applauded Walt Disney World for shuttering a new attraction that drew fierce criticism for its potential to shame overweight children and misrepresent the causes of the global obesity crisis.

“I think they (Disney) likely subscribed to that common misconception that this is something we should just be able to push away from the table and cure,” said Ottawa bariatric surgeon Yoni Freedhoff, whose blog post sparked a public outcry over the attraction at Walt Disney Co’s world-famous Florida theme park. “The truth is, if it was that simple to manage weight, I’m pretty confident we wouldn’t have a problem,” said Freedhoff. Disney last month unofficially opened the interactive exhibit called “Habit Heroes” at Epcot, one of the sites at the park, and introduced a companion online game. In both, svelte heroes, “Callie Stenics” and “Will Power,” combat fat and misshapen villains with names like “Lead Bottom” and “The Snacker.”   “Here, they (children) are in Disney, the happiest place on earth, and basically Disney is being the schoolyard bully that’s been making fun of them for years at home,” Freedhoff said. Freedhoff blogged on February 23 about what he called the “horrifying” exhibit. Disney closed the exhibit two days later following complaints and petition drives by other advocates for the overweight and people with eating disorders. Disney spokeswoman Kathleen Prihoda told Reuters no date has been set for Habit Heroes to reopen. “We’ve closed it for the time being to further improve and refine the experience,” Prihoda said. “We’ve received feedback from a variety of sources and we’re taking it all into consideration at this time.”   The exhibit was sponsored by two independent Blue Cross and Blue Shield organizations. Spokesman John Herbkersman of Blue Cross and Blue Shield of Florida told Reuters that initial reaction from Disney guests was positive. He said the Disney Imagineers created the exhibit, and that he did not know how much input his organization had in crafting its message. The World Health Organization, which calls childhood obesity one of the most serious public health challenges of the 21st century, cites many causes, including a global shift in food processing, food marketing, the fat and sugar content of food, increased urbanization and changes in the way people get around. “Kids have not suddenly suffered an epidemic loss of will power. I think the world in which children are growing up has changed very dramatically,” Freedhoff said. In January researchers with the U.S. Centers for Disease Control and Prevention reported that in 2009 and 2010, about one in three American adults and one in six children and teenagers were obese. Laura Discipio said her organization, the National Association of Anorexia Nervosa and Associated Disorders, was one of several that urged its supporters to put public pressure on Disney to rethink Habit Heroes. “They (Disney officials) said the goal is really to teach people how to be healthy. I said I get that, but you can’t be villainizing children of size,” Discipio said. A petition started by the National Association to Advance Fat Acceptance logged more than 300 signatures before the exhibit was closed, according to spokeswoman Peggy Howell. “The attraction and game feature negative stereotypical characters, traditionally used to torment overweight kids, will potentially reinforce and strengthen a cycle of bullying, depression, disease, eating disorders and even suicidal thoughts,” the petition stated. Howell said members of her board of directors have received personal letters and phone calls from Disney asking for their input. “The problem is quite complicated despite the fact that there is this truism that involves eating fewer calories and/or burning more of them,” Freedhoff said. “That truism is about as useful as buy low/sell high would be to making you a millionaire in the stock market. It’s true. It’s just not helpful.”


Abaloparatide may help prevent fractures in postmenopausal women with osteoporosis

Explanation: This release from The Endocrine Society describes the results of one of a series of randomized, double-blind comparative clinical trials of abaloparatide-SC, an investigational drug designed to increase bone mineral density and prevent bone fractures in postmenopausal women who have osteoporosis and who already had suffered one fracture. The study was presented as a poster presentation at the Society’s recent conference. The release helpfully — and carefully — notes early that the research is “industry sponsored.” The release did a good job discussing the study design and results but didn’t address potential cost and harms. Some health organizations estimate more than 200 million women (and men) worldwide have osteoporosis and that in the United States, 43 million adults are at risk for osteoporosis and that the disease is responsible for about 2 million broken bones each year. Various prescription treatments are on the market designed to increase bone mineral density and either prevent fractures in the first place or reduce the risk of a subsequent one. Exercise, diet and lifestyle also are involved in risk factor prevention and modification, and all of the prescription drugs carry risks for some women of serious side effects, including higher than usual risks for a rare form of bone cancer, kidney stones, weakness, respiratory infections, and dizziness. The costs of some treatments also are high. Thus, any news of additional drug treatments will be of significant interest to millions of women and men.

Association/Society news release,Women's health

The release doesn’t include any discussion of the financial burden of the disease or estimated costs of treating it. This is a big market for drug makers and there are plenty of data available. Forteo, a similar drug to abaloparatide-SC, a human parathyroid hormone, is already on the market. It is reasonable to assume that the cost structure will be similar. GoodRx.com notes that a 28 day supply costs about $2,400. The release would have been much more helpful to the reader if it had included some absolute numbers along with the relative risk reductions. The release notes that of 2,463 osteoporosis patients, ages 49 to 86, the drug increased bone mineral density in the lumbar spine by 9.2%, in the hip 3.4% and in the femoral neck by 2.9% compared to placebo. The release also describes the reduction in vertebral fractures by 86%, and other risk reductions, also in terms of percentages. But what were the actual rates of fractures in each group? That would give readers the best sense of the size of the benefit. A serious omission, the release is essentially silent about potential harms, which, according to other sources, may include “back pain, arthralgia, upper-respiratory-tract infection, hypercalciuria, and dizziness.” A mid-term post-marketing surveillance study of Forteo (teriparatide), a related drug on the market, observed an association but not causation with osteosarcoma (a rare malignant bone cancer) in people taking the drug. Osteosarcoma had been observed in animal trials of the drug that were dependent on dose and treatment duration. The release provides a good overview of the randomized, double-blind trial which lasted 18 months and provides demographics of those enrolled in the study. The release also lets readers know that there is at least one other drug similar to the one being studied that is already FDA approved. It does a quick but effective job of distinguishing what might be better about the new drug. (Increased density in the hip region that is greater than the existing compound.) It would have been helpful to note that the trial was conducted in the US, Brazil and Denmark which carry different levels of risk for fracture in post menopausal women, as pointed out in an International Osteoporosis Foundation report. Statements about the potential value of the drug are reasonable and cautious and there’s no disease mongering here. The release prominently and early notes that the research is “industry sponsored,” and names the company (Radius Health, Inc.). It also notes that the investigator quoted in the release is a consultant to the company. Kudos! Because the study was comparative, the release gives some detail about its head-to-head comparison with a current drug on the market. There is another class of drug treatments, namely bisphosphonates, that could have been mentioned. The release notes that the drug is investigational which signifies it is not yet FDA approved and that the study was a phase 3 study. The release doesn’t make a explicit claim to novelty but it does note the greater hip bone density benefit and reduced fractures with the new drug compared to the existing drug and placebo. We’ll give them the benefit of the doubt as this is a strong indication of new findings. There’s no unjustifiable language in use here.


People vaccinated for seasonal influenza face higher chances of catching SARS-COV-2, which causes COVID-19, or testing positive for the virus when they do not actually have it.

Explanation: A panel for the North Carolina Medical Board in 2008 ruled Buttar should stop treating children or patients with cancer because “his alternative medicine practice is below accepted medical standards in North Carolina.” But the doctor challenged that recommendation, and in 2010 the board and Buttar made a compromise: He could continue offering his treatments so long as his participants signed consent forms “acknowledging this practice is outside the mainstream,” according to the newspaper.

Since the early weeks of the U.S. COVID-19 coronavirus disease outbreak in March 2020, social media users began spreading claims that people who had gotten vaccinated to increase their immunity against seasonal influenza were at a higher risk of catching or testing positive for SARS-CoV-2, the virus that causes COVID-19. The assertions took a variety of forms and resurged with new viral postings over weeks. In March and early April, many cited misinterpretations of a 2020 study by an epidemiologist with the U.S. Department of Defense (DOD) that examined how the 2017-2018 flu season affected personnel. “You can get coronavirus from the flu shot,” one person wrote to Snopes, referencing the DOD study (which we unpack below). Then, in late April and May, the claims shifted to focus on remarks by anti-vaccine advocate and conspiracy theorist, Dr. Rashid Buttar, who said in a video interview posted on Facebook on April 19: All the way back to 1984 all the way up to now, 2018, there are multiple studies that show that if you’ve had the flu shot… false positives on COVID-19 testing. After that posting, numerous Facebook accounts circulated the below-displayed meme:  For the purpose of this investigation, we will first dissect what appear to be the main sources of the claim regarding flu shots — the DOD study that examined the health of military personnel (which is available via a five-page PDF) and Buttar, and then provide scientific and medical research that prove their invalidity. Greg Wolff, an epidemiologist with the U.S. Armed Forces Health Surveillance Branch, conducted the study, examining whether the flu vaccine between October 2017 and September 2018 increased his colleagues’ risk for non-flu respiratory viruses, such as coronavirus, adenovirus or human bocavirus, via a phenomenon known as virus interference. Of the roughly 9,500 DOD employees he considered for the research — most of whom were male active duty service members between 18 and 35 years old — more than two-thirds had gotten flu shots that season; however, that group did not show significant odds of catching other respiratory illnesses compared to those who were not vaccinated, according to Wolff’s findings. The study states: The overall results of the study showed little to no evidence supporting the association of virus interference and influenza vaccination. Individual respiratory virus results were mixed, and some rebutted virus interference. Additionally those receiving the influenza vaccine were more likely to have no pathogen detected and reduced risk of influenza when compared to unvaccinated individuals. In other words, the flu shot did not change the likelihood of test subjects overall catching other respiratory illnesses; however, each non-flu respiratory virus, such as coronavirus, showed varied results for how they impacted vaccinated DOD employees. At the same time, the vaccine protected personnel against influenza, the study found. The idea of non-flu respiratory viruses showing individually different results on the test population is where anti-vaxxers focused their messaging. On April 16, 2020, more than three months after Wolff published the study, an anti-vaccine nonprofit called the Children’s Health Defense highlighted the DOD research on its website, with the headline, “Pentagon Study: Flu Shot Raises Risk of Coronavirus by 36% (and Other Supporting Studies).” Authored by the organization’s founder, Robert F. Kennedy Jr., a high-profile leader of the U.S. modern anti-vaxx movement, the web page focused on one aspect of Wolff’s multi-pronged study of DOD personnel: 507 test subjects who did not have the flu and were vaccinated to increase their immunity against it tested positive for “coronavirus,” while only 170 test subjects who did not have an influenza vaccine tested positive for “coronavirus.” The study included the following table:  Wolff summarized that finding like this: Examining non-influenza viruses specifically, the odds of both coronavirus and human metapneumovirus (which causes upper and lower respiratory disease with cold-like symptoms) in vaccinated individuals were significantly higher when compared to unvaccinated individuals. But nowhere did the epidemiologist describe the type of coronavirus(es) for which his subjects tested positive, and the Children’s Health Defense and other anti-vaxxers failed to make that distinction in their postings. In science, the word “coronavirus” refers to a family of hundreds of viruses, not just one type of sickness. (Politicians and journalists frequently — and misleadingly — used the term in the early days of the COVID-19 pandemic, when the novel coronavirus was first reported in humans in Wuhan, China, in late 2019.) Per the Centers for Disease Control and Prevention (CDC), seven types of coronaviruses cause illness in humans, some of which are fairly common and cause seasonal cold-like symptoms while others cause more severe and sometimes fatal infections, including the Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS). The type of coronavirus that causes the COVID-19 disease is called SARS-CoV-2, and it was yet to be discovered at the time of Wolff’s study in 2017 and 2018. That means no one in the experiment was confirmed to have the virus that causes COVID-19, and Wolff did not once refer to the novel coronavirus in his research. Additionally, considering the size and makeup of Wolff’s testing sample — as well as the overall findings of the study (mentioned above) and the fact that coronaviruses and influenza viruses vary by season and impact age groups differently — any assertion that the research definitely proves a connection between influenza vaccines and coronaviruses, including COVID-19, is misleading. According to the CDC, everyone 6 months and older should get an influenza vaccine each year to increase their chances of fighting the flu — even in the era of COVID-19 — though the effectiveness of the shot may vary person-to-person, year-to-year. The CDC states: Any flu infection can carry a risk of serious complications, hospitalization or death, even among otherwise healthy children and adults. Therefore, getting vaccinated is a safer choice than risking illness to obtain immune protection. In terms of whether the shot makes people more susceptible to other respiratory viruses, which in 2020 could include COVID-19, no strong scientific or medical evidence shows that flu shots increase people’s risk of catching other viruses as of this writing. One 2012 study in the peer-reviewed medical journal Clinical Infectious Diseases, which considered a test sample of 115 children and teens, suggested the flu vaccine might increase people’s odds of catching non-flu viruses. But a study one year later in the same peer-reviewed journal came to the opposite conclusion. The CDC said: Many experts looked into this issue further and conducted additional studies to see if the findings (in the 2012 study of children and teens) could be replicated. No other studies have found this effect. … It’s not clear why this finding was detected in the one study, but the preponderance of evidence suggests that this is not a common or regular occurrence and that influenza vaccination does not, in fact, make people more susceptible to other respiratory infections. Buttar, a licensed doctor of osteopathic medicine in North Carolina, is another leading source of the viral COVID-19-era claim that flu shots worsen your chances of catching the novel virus. In at least one spring 2020 video appearance (mentioned above), he claimed: “Studies clearly show that if you’ve had a flu shot, you’re going to test positive for COVID-19,” suggesting that the influenza vaccination contains antibodies that would make a person show a false positive on a COVID-19 test. Buttar first gained public recognition via his hometown newspaper, the Charlotte Observer, in the late 1990s, advertising “advanced concepts in alternative and preventative medicine.” A few years later, he and another doctor gained news coverage for enrolling patients with heart disease in a controversial study that tested chelation therapy, a treatment to remove metals from patients’ bloodstream and commonly used to treat people with heavy metal poisoning. But in the late 2000s, Buttar’s unconventional practices drew criticism. In 2007, the North Carolina Medical Board accused Buttar of “unprofessional conduct for departing from prevailing medical practice by treating patients with experimental, ineffective therapies and charging ‘exorbitant’ fees’ for unproven therapies that didn’t work,” the Charlotte Observer reported. A local TV station reported: Buttar has spent years selling skin drops at $150 a bottle as a treatment for diseases ranging from autism to cancer.


In the social media wars over gun control, a new social-media meme makes the case that gun violence is wildly exaggerated by the media. "Gun homicide is down 49 percent in the past 12 years. Only 12 percent of Americans know that. Tell us again how unbiased our media is," the Facebook post said. A reader sent us the posting and asked us to fact-check it. We’ll focus our attention on the claim about gun homicides, but we’ll also touch on the media question later on. Trends in gun homicide We began by looking at year-by-year statistics on gun homicides compiled by the Centers for Disease Control and Prevention. Since the meme’s language was clear about focusing on "homicides," we didn’t include statistics for suicides, gun shootings with undetermined causes, or "legal interventions," such as justified shootings by police. The most recent data is for 2010, so we went as far back as 1998 to define the 12-year period. This table summarizes what we found:  Year Gun homicides Gun homicides per 100,000 people 1998 11,798 4.28 1999 10,828 3.88 2000 10,801 3.84 2001 11,348 3.98 2002 11,829 4.11 2003 11,920 4.11 2004 11,624 3.97 2005 12,352 4.18 2006 12,791 4.29 2007 12,632 4.19 2008 12,179 4.01 2009 11,493 3.75 2010 11,078 3.59  This disproves the clear wording of the meme. Over the past 12 years, the number of gun homicides is down 6 percent, and the rate of gun homicides is down 16 percent. Both are well below the 49 percent claimed in the post. However, we also found that the statistic did come from somewhere. The 49 percent decline emerged from 2013 report by the Pew Research Center. It found that gun homicides (or more specifically, the rate of gun homicides per 100,000 residents) had declined by 49 percent between their peak in 1993 and 2010, a period of 17 years. We double-checked Pew’s calculations of the CDC figures and found that they were correct. Between 1993 and 2010, the gun homicide rate fell from 7.02 per 100,000 to 3.59 per 100,000, or a decline of precisely 49 percent. Here’s the rundown of those earlier years:  Year Gun homicides Gun homicides per 100,000 people 1992 17,488 6.82 1993 18,253 7.02 1994 17,527 6.66 1995 15,551 5.84 1996 14,037 5.21 1997 13,252 4.86  It’s possible to chalk this mistake up to a simple typo -- after all, if the claim had said 17 years rather than 12, it would have been correct. However, the time frame raises important issues. For one thing, the CDC data show that the big decline in gun homicides came between 1993 and 2000, which happens to coincide with the years Bill Clinton was president. While Clinton and his policies are hardly the only reason for this decline, his signing of tighter gun-control legislation makes him unpopular among the kinds of gun supporters who might have created this meme. By contrast, by framing the decline as happening over the past 12 years, the meme implies that George W. Bush -- a president much more friendly to gun-rights supporters -- can take some credit for the decline. More importantly, by making this mistake, the meme misunderstands the overall trend lines of gun homicides. Gun homicides didn’t decline 49 percent over the last 12 years -- rather, they declined precipitously over six years in the 1990s, then have remained basically stagnant for the past decade or so. Why is this important? Because the decline, to a large degree, has to do with a specific reason -- the end of the crack epidemic. The decline in gun homicides in the 1990s "was largely a reversal of an upward trend that occurred in the mid-to-late 1980s," said James Alan Fox, a criminologist at Northeastern University. "There would not have been much of a downturn were it not for the surge. This up-and-down change was primarily in cities and among offenders under age 25, and indeed have much to do with crack markets and gang activity." In fact, the Pew study made the same point, noting that "by the early 1990s, crack markets withered in part because of lessened demand, and the vibrant national economy made it easier for even low-skilled young people to find jobs rather than get involved in crime. At the same time, a rising number of people ages 30 and older were incarcerated, due in part to stricter laws, which helped restrain violence among this age group." Fox said another reason for the decline in gun homicides overall was a specific decline in cases that involved intimate partners. After 1993, when the pro-gun-control Brady Law was passed, "there was a decline in gun homicides by women against their partners, but no decline in non-gun killings," he said. Media bias? The meme also takes a shot at the media for burying this large decline. But that’s not deserved. Just the first two pages of Google search results show articles about the Pew study appearing in the following outlets: • Associated Press • Washington Post • CNN • NPR • NBC News • Yahoo News Oh, and PolitiFact. As for the claim that "only 12 percent of Americans know that," the meme got the percentage right, though of course it got the substance of what that 12 percent knew wrong. "Despite national attention to the issue of firearm violence, most Americans are unaware that gun crime is lower today than it was two decades ago," the report said. "According to a new Pew Research Center survey, today 56 percent of Americans believe gun crime is higher than 20 years ago and only 12 percent think it is lower." Our ruling The social media meme said that "gun homicide is down 49 percent in the past 12 years." The gun homicide rate is actually down by 49 percent over the past 17 years, but this seemingly minor mistake betrays a significant misunderstanding of how rates have fluctuated over the past two decades. During the past dozen years, gun homicide rates have been largely static; their big decline mostly came in the years before the meme even started counting. The meme is not just incorrect; it’s a distraction from what actually happened. We rate the claim .


Viral image Says two patients at Valley Regional Medical Center in Brownsville, Texas, “are being looked at” for possible coronavirus infections.

Explanation: Health officials say there are no coronavirus patients in the Rio Grande Valley. Texas is not among the states where the CDC is reporting coronavirus cases.

Texas, Facebook Fact-checks, Coronavirus, Viral image,

Has there been an outbreak of misinformation about the coronavirus in your town? We’ve already debunked claims of cases in Gainesville, Fla., and Mississippi, among others. Now, a March 2 Facebook post claims that "Coronavirus may be in Brownsville, Texas." "Two patients in Valley Regional Medical Center are being looked at for the possible virus that has been spreading throughout the globe," it continues. This post was flagged as part of Facebook’s efforts to combat  news and misinformation on its News Feed. (Read more about our partnership with Facebook.) The post appears to be a screenshot of another post published by the account Brownsville Online, which describes itself as a digital community featuring news about Brownsville. But we didn’t see any posts there claiming two possible coronavirus cases at Valley Regional Medical Center. A spokesperson for the hospital did not immediately return PolitiFact’s call about the Facebook post. But health officials in the area have said and continue to say that there are no cases of coronavirus in the Rio Grande Valley. Hidalgo County, which is adjacent to Brownsville’s Cameron County, has specifically called out social media posts for spreading bad intel. "Misinformation on social media," the county’s health and human services department tweeted on March 2. "THERE IS NO #CoV19 in the RGV." As of March 3, Texas was not one of 12 states reporting cases of COVID-19, the disease caused by the novel coronavirus, to the Centers for Disease Control and Prevention. KRGV, a local news station in the Rio Grande Valley, reported on March 2 that Cameron County health officials also confirmed that there were no cases of the virus there. The station quotes a statement from the Valley Regional Medical Center saying it doesn’t "have any patients that have tested positive for COVID-19." We rate this Facebook post .


EPA to issue permits for Los Alamos storm water runoff.

Explanation: New Mexico officials are planning another public meeting focused on the state’s oversight and scientific monitoring of environmental impacts at Los Alamos National Laboratory.

The Environment Department has scheduled the next meeting for Jan. 9 at the University of New Mexico campus in Los Alamos. The focus will be a 2016 agreement the state signed with the U.S. Energy Department regarding the cleanup of contamination and other responsibilities of the lab. “The Los Alamos community asked for this discussion on the Los Alamos National Laboratory Consent Order and we listened,” Environment Secretary James Kenney said in a statement Tuesday. “Collaborating with stakeholders is essential to protecting public health and the environment.”   The order spells out milestones the lab needs to meet with its cleanup campaigns and establishes corrective actions for the release of hazardous wastes or groundwater contamination. Watchdogs have been critical of the pace of cleanup projects at the northern New Mexico lab. Earlier this year, environmental groups filed a federal lawsuit over water pollution downstream from the lab. The groups asked the U.S. Environmental Protection Agency to issue a permit that would specifically regulate urban stormwater runoff from developed areas at the lab, the town of Los Alamos and the nearby community of White Rock. According to the lawsuit and data from the state Environment Department, excess levels of mercury, silver, copper, zinc, nickel, polychlorinated biphenyls and gross alpha radiation are entering local waterways through runoff. The EPA just weeks ago issued a final determination that stormwater discharges from the lab and Los Alamos County are contributing to violations of water quality standards and that discharges must be controlled and regulated under an EPA-issued permit. Rachel Conn, projects director with Amigos Bravos, said regulating and controlling discharges will protect drinking water sources for both Santa Fe and Albuquerque because some of the canyons that feed into the Rio Grande run through lab property. Andrew Hawley, an attorney with the Western Environmental Law Center, said her group hopes the EPA moves quickly to issue permits that include all of the legally required limits to protect people and wildlife in Los Alamos and downstream.


Scientists find nutty risk reducer: Eat more nuts

Explanation: Although the story did a good job explaining the diet, the story did not differentiate between an impact on risk factors and an impact on cardiovascular disease itself. The story also never even mentioned significant questions and uncertainties that exist about the “metabolic syndrome.”  Reporting – rather than just reflecting what appeared in a journal article – would have uncovered questions about the definition of, existence of, and utility of a metabolic syndrome.

There was no discussion of how the various diets compare in cost. Diets can vary substantially in costs, and healthier diets tend to cost more than less healthy diets. The potiential impact of dietary changes on diet costs should have been mentioned. The story fell into a trap that was partially set by the parameters of the study on which it reported. While it is clear that risk factors are improved, it is not clear what the magnitude of the benefit is. The story should have mentioned this issue outright: that the nuts diet may help lower risk factors, but it is unclear from this study how much a person’s risk of cardiovascular disease is reduced by adopting this approach. The story mentioned that the dietary intervention did not have any impact in terms of weight loss or improving blood sugar levels. The story did not provide the evidence from the results section of the study clearly. The study clearly shows that the Med nuts diet was successful in reducing the metabolic syndrome; however, the Med olive oil diet was NOT. This is not clearly presented in the story, indeed the story suggests (2nd paragraph) that the Med olive oil study was successful. The story began with an accurate summary of the benefits that might be obtained, i.e. reducing risk factors rather than reducing disease related outcomes. Later, there was some warning about the number of people estimated to have ‘Metabolic Syndrome’ which does sound a bit like disease mongering, though the story did not describe much about what, if any, the ramifications were to having ‘metabolic syndrome’. A scientist who was not involved in this particular study and the study lead author were interviewed for this story. The story would have been improved by obtaining insight from someone outside the field of nutritional epidemiology to comment about what utility the results of the study might have for people. The story did a good job describing the details of the diet involved in the study reported on. It failed to mention that there are other interventions (dietary, exercise, medication) that have been demonstrated to be effective for making changing in those parameters which are said to define the metabolic syndrome. The story could have mentioned other ways to reduce cardiovascular risk. The story described the essence of the Mediterranean diet as well as the amount of added nuts used in the study reported on. The story didn’t say anything about whether it was a novel research question to look at the mixture of nuts and the Mediterranean diet. It does not appear that the story relied solely or largely on a news release.


Cancer drug 49 times more potent than Cisplatin

Explanation: This University of Warwick release promises much more than it should, considering the research was conducted not on humans or even mice but on cell lines in labs. The release headline claims that a new compound called FY26 is “49 times more potent” than an existing chemotherapy, and a subhead says, “Effectiveness shown in tests on ovarian and bowel cancer.” But it’s a bit misleading to claim increased potency for a drug that’s never even been tested in humans, because the compound may not work the same way in humans as it does in a petri dish. The drug certainly faces a very long and uncertain road before it might be approved for use in actual cancer patients — something the release never warned readers about. This is interesting research that’s worth writing about, but the release desperately needed a statement cluing readers in to the very preliminary nature of the study. Millions of people with cancer are hoping for new therapies, and this release could set them up for false hope. The release promises that FY26 could be “cheaper to produce, less harmful to healthy cells than existing treatments and has been shown to be active against cancer cells which have become resistant to platinum-based drugs.” The release does not say that results from lab work will need to be tested for years before the therapy is proven safe and effective.

The release speculates that FY26 could be cheaper to produce than platinum-based chemotherapy drugs. That may well be true, but the release didn’t provide any evidence or reasoning as to why this would be the case. Nor does it explain that cheaper “production” might not mean cheaper pricing for patients. We know that platinum is expensive, but then again new drugs are typically far more expensive than existing generic treatments. We’d need more than a general claim that the drug “could be cheaper” to award a Satisfactory rating here. The release claims that FY26 is “49 times more potent than Cisplatin” — a statement that strikes us as hyperbolic. There’s no explanation at all of how the researchers measured the “potency” of the drug, and we’re left wondering how they concluded that it was exactly “49 times” more potent. Rather than focus on this promotional-sounding claim, we’d have preferred some description of what the researchers actually did in the experiment and what their results showed. The story promises so much of this compound, including that it could be less harmful to healthy cells than existing treatments. But it’s hard to know what side effects might exist because the drug has apparently never been tested in animals or humans. The release does mention the many side effects associated with existing chemotherapies, but we wish there had been a caution: “There may be side effects with FY26 that remain to be discovered.” The release speculates that this research “could also lead to substantial improvements in cancer survival rates.” But the compound has only been administered to cell lines, not to any human subjects. The release does eventually get around to mentioning the fact that these were cell lines, but we would have welcomed a disclaimer – high up in the release – cautioning that any excitement surrounding this drug should be tempered by experience with past failures. Years of clinical research and many obstacles must be cleared before this is a practical alternative for patients. There was no disease mongering. The funding sources were carefully noted in the release. One researcher does talk about a comparison with existing treatments and why new therapies are needed. “Existing platinum-based cancer treatments often become less effective after the first course, as cancer cells learn how they are being attacked, but our new osmium compound with its different mechanism of action, remains active against cancer cells that have become resistant to drugs such as Cisplatin”. It is clear that the compounds are not available to human patients yet. The novelty of this compound and potential advantages over existing treatments are clear from the story. The release also notes that NIH is conducting similar studies. The claim of increased potency, based on cell line research and with no qualifications, is not justifiable. The release also states, “Effectiveness shown in tests on ovarian and bowel cancer.” We think people reading will think the research showed the compound killed ovarian and bowel cancer IN PATIENTS not just in a petri dish.


Experts Issue New Guidelines on Breast Cancer Drugs

Explanation: The American Society of Clinical Oncologists (ASCO) has released updated guidelines on adjuvant endocrine therapy in breast cancer. The story met many of our criteria, but missed the mark by insinuating that all postmenopausal women with hormone receptor-postiive breast cancer should use aromatase inhibitors: "The committee preparing the guidelines recommended, therefore, that all postmenopausal women with this type of breast cancer use aromatase inhibitors either before or after tamoxifen."

The story specifically points out that generic tamoxifen costs $21.90 a month and the aromatase inhibitor, Arimidex®, costs $379.80 a month. The story was also quick to note that a generic form of Arimidex® is now available and costs much less. Going one step further, the story included a discussion of how the cost of treatment can factor into the decision-making process. It’s clear from the story that tamoxifen is not new and that aromatase inhibitors “are a more recent entry into the field.” The story also states that aromatase inhibitors have been a standard part of care before the guidelines were released.


Ireland has mostly contained coronavirus outbreak: health chief.

Explanation: Ireland has contained and effectively suppressed the first wave of the coronavirus outbreak in the population at large but not in nursing homes where its spread remains a concern, the country’s chief medical officer said on Thursday.

The assessment raised hopes that stay-at-home restrictions can be gradually eased from May 5. Acting Prime Minister Leo Varadkar said earlier on Thursday that he hoped to set out a roadmap on how they could be eased before the May 5 expiry. Ireland reported 724 new cases to bring its total to 13,271 with 486 deaths, but officials said the growth rate in new cases has been close to zero since April 3 and the closely watched reproductive rate, or the number of people who become infected from each positive case, fell to between 0.7 and 1. “The data clearly shows that there are two very different experiences of COVID-19,” Tony Holohan said in a statement, referring the continued spread of the disease in care settings versus the containment elsewhere. “In order to protect the vulnerable the first task was to suppress the virus in the population at large. We are increasingly confident that we are achieving this. All of our efforts now need to be on extinguishing COVID-19 in our community residential settings, including nursing homes.”   Nursing homes account for 253 of the 486 coronavirus-related deaths, with 49 more fatalities associated with other care homes or community facilities. There are clusters of two or more cases in 163 of the country’s 550 retirement homes. Eight people or almost a third of residents at one old age psychiatric home who had tested positive for COVID-19, the disease caused by the virus, died over the Easter holiday weekend, Ireland’s Health Service Executive said on Wednesday. Varadkar told parliament that new measures to help protect nursing home residents were not being implemented fast enough, as his acting government faced criticism by opposition politicians for the speed of its response. The government promised nursing homes additional funds, more staff, priority testing and the redeployment of senior medics to improve infectious disease control on April 4 after the number of clusters began to rise rapidly. Fianna Fail leader Micheal Martin, who is in negotiations to form a new government with Varadkar, said nursing homes had been “left behind significantly.”  Health officials across the world have warned that the elderly are especially vulnerable in the pandemic. The median age of deaths in Ireland is 82, compared to a median age of 48 of all those infected, according to health department data. Varadkar also said any roll back of restrictions would be done over a number of months, a message emphasised later by his health officials. “Whatever happens after May 5 has to be approached exceptionally carefully. We can manage a modest rise in cases, if it’s done slightly wrong, but we can’t manage a huge rise in cases,” Irish Epidemiological Modelling Advisory Group chair, Professor Philip Nolan, told a news conference.


Nicotine patches, gum don’t prevent relapse, study finds

Explanation: It fell short by failing to tap any independent sources for commentary and perspective on the findings, by failing to compare the nicotine products to any alternatives for smoking cessation and by relying too heavily on a drugmaker’s press release. Smoking continues to be a hugely destructive force in public health, even after decades of anti-smoking campaigns and mountains of studies documenting the damage. With dwindling resources for public health efforts, any study that can help policymakers better focus their resources could be a boon in the short and long term.

The story addresses the broad scope of costs: “American smokers spend more than $1.5 billion on nicotine gum, patches and related products each year, according to the study. Much of that comes from public health programs, which are facing further rounds of budget cuts.” We would have liked to see actual costs for some of these products and a comparison to cigarettes. People might be more likely to continue buying nicotine products if they are cheaper than the cigarettes themselves. This story and the New York Times story both failed to mention the actual number of people in the study who used nicotine products. Instead, it talked about the overall number of study participants and then provided percentages for the people who relapsed, perhaps leaving readers confused about whether and to what extent nicotine products made a difference in smoking cessation. It says, “The new study examined former smokers three times over a five-year period. At the midpoint of the study, 30.6% of recent quitters had gone back to smoking. By the end, 31.3% had relapsed.” It isn’t clear whether we are talking about the same 30% in each period or a total of roughly 60%. No mention of the potential harms from taking nicotine, as opposed to quitting without drug therapy. There’s also the question of whether people are doing themselves more harm by continuing to smoke because they failed to quit with the help of a nicotine replacement product. If they had been able to more effectively quit earlier, would they live longer? The story, like the others we reviewed, provides the basic outlines of the study design. It does not do a very good job pointing out any potential limitations with the research. It relies on one of the biggest makers of nicotine products — GlaxoSmithKline — as the sole voice criticizing the study. Unlike the New York Times story, this one did not place the study into context. The story notes:   “The findings run counter to the results of several randomized clinical trials conducted before the Food and Drug Administration gave the thumbs-up to these nicotine replacement products in the 1990s. In those trials, volunteers using such products were up to three times more likely to kick the smoking habit.” The NYT did a better job by adding a proviso:  “In medical studies the products have proved effective, making it easier for people to quit, at least in the short term.” But it’s also important to note:  the FDA approved nicotine replacement therapy for smoking cessation and only looked at short term outcomes (6 months to a year). Recidivism is a critical issue for any addiction including smoking. So it isn’t entirely accurate to report that “the findings run counter to the results of trials conducted before the FDA gave the thumbs up.” No disease mongering. This story quoted no independent experts. The only comments it used that were not from the lead researcher were from GlaxoSmithKline. “But GlaxoSmithKline Consumer Healthcare, which makes Nicorette, Nicoderm, Commit lozenges and other smoking cessation products, said that would be premature. The company noted that most of the adults in the study who used nicotine replacement products didn’t use them for the recommended eight weeks. Had those people followed directions, they might have had more success.” This idea appears to have been refuted in the study itself, which showed that the duration that people took the products did not seem to make a difference. A better criticism might have been that it is difficult to tell how these people truly complied with the product because they were not being actively monitored in a clinical trial but were only responding to survey questions. There is no comparison to alternatives in this story. The story basically used sales information to indicate availability. We did appreciate that this story mentioned a wide variety of nicotine products, including nasal sprays. There were no claims of novelty in the story. The story did not rely on this press release from Harvard, but it did rely on this press release from GlaxoSmithKline, one of the big makers of nicotine replacement products. The dependence on the company’s release for the sole outside perspective on the study casts a cloud over a story that already leaves too many questions unanswered. Fully 25% of the words in the story were turned over to the Glaxo response.


New heart attack test could identify two-thirds of patients at very low risk of heart attack in the emergency department

Explanation: This news release describes the results of a study designed to significantly advance the search for a rapid blood test that can rule out evidence of heart muscle damage in people who come to emergency rooms with chest pain and other symptoms of heart attack. The study, reported in the journal The Lancet, specifically offers compelling evidence that a version of a commonly used blood test may indeed further that quest. For the study, investigators used a highly sensitive version of an existing blood test that detects the protein troponin on more than 6,300 consecutive people presenting to hospital emergency rooms (mostly in Scotland) with suspected acute coronary syndrome. The researchers were able to determine the probability that patients were NOT at risk of heart attack or death from heart attack after 30 days for a range of troponin levels. The release does a generally adequate job of describing how the high-sensitivity test appears to identify very low levels of troponin, in contrast to current troponin tests, thus making it theoretically possible to accurately, relatively quickly, and safely rule out a heart attack in more than 60 percent of such people, at least over the short term. It covers the fact that conventional troponin testing detects only higher levels of the protein, and must be done on serial blood samples over a longer period of time. And the news release puts appropriate emphasis on the potential the new test has for decreasing unnecessary hospitalizations and reducing health care costs. All that said, the release could have done a much better job of making clear earlier in the text that substantially more research will be needed to determine the clinical effectiveness and safety of relying heavily on high-sensitivity troponin testing. Although the release uses qualifiers such as “may have been eligible for early safe discharge,” we think more needed to be said about potential risks, about the potential costs of the more sensitive test; and most of all about the limitations of the study and over-reliance on any single test when people experience heart attack symptoms. Patients arriving at emergency facilities with chest pain is a common and costly situation that is associated with potentially devastating consequences when the evaluation isn’t done in a thorough fashion. The current evaluation of chest pain involves a history focused on the patient’s reported symptoms and past history of heart disease and risk factors as well as tests performed. These include an electrical test of the heart (EKG or electrocardiogram) and blood tests looking for damage to heart muscle. This evaluation has been standard for decades, but better blood tests over time have allowed emergency providers to more accurately and quickly identify patients who may be having a heart attack. At the same time, the use of these newer tests has permitted providers to more quickly identify those who are not having a heart attack, allowing for earlier discharge from the emergency facility or hospital. The study reported in this news release seeks to define the threshold below which a new, more sensitive test identifies people who are at low risk for heart attack or heart related death over the next 30 days. If confirmed, this will be a positive step forward in effectively and efficiently evaluating patients with chest pain in emergency facilities. However, the main limitation of this study is that it is using information previously collected to predict what would have happened if this new test and threshold was used. Only with prospective use and evaluation can we actually determine if this new test and threshold, when applied as part of routine care, leads to improved care and more efficient use of emergency and hospital resources.

cardiovascular disease,Journal news release

The release makes repeated reference to claims by the study’s authors of substantial savings to the health care system, but no quantitative data are included. More significantly, there is no information presented about the cost of the high-sensitivity test or comparison to current per-patient cost for evaluating acute coronary syndrome in the British health care system. At a minimum, one would want to know the cost of this new test compared to standard troponin tests. Further work would be needed to assess the relative downstream costs associated with this new test. This is a mixed bag. On the one hand, the news release refers to the high negative predictive value of the test (99.6%), which suggests that the test is very good at finding those who aren’t at risk of a heart attack or death over the next 30 days. But it also relies on relative risk comparisons, and does not offer data in absolute terms about risks of heart attack or cardiac death in those with various ranges of troponin levels. It refers to patients “at very low risk” of a heart attack in the next 30 days, but never tells readers what that means (1%? 5%? 15% chance of a heart attack?). Despite these shortcomings, we think the reader will come away with a decent understanding of the potential benefits of the more sensitive test, and so we’ll award a Satisfactory rating here. The potential harms of this test — discharging a patient who may be having a heart attack and be at risk of dying — can only be adequately assessed in prospective evaluations using this new test as part of routine care. The release doesn’t adequately address this or describe what might happen if the test is wrong. We also think that the release could have done a better job of explaining that this new test is only one part of the assessment of patients presenting with chest pain. Other factors that are likely to be important that could have been mentioned from the paper include changes in the EKG (electrical test of the heart) that is also part of standard care. In addition, the duration of symptoms is also important. For patients who have had pain for less than 2 hours, the test may not be as effective. The release would have been stronger had it offered more information about the design of the study and its limitations. We’d emphasize, as noted above, that the main limitation of this study is that it is using information previously collected to predict what would have happened if this new test and threshold were used. Only with prospective use and evaluation can we actually determine if this new test and threshold, when applied as part of routine care, leads to improved care and more efficient use of emergency and hospital resources. We acknowledge that the release hints at this limitation when it quotes from an accompanying editorial — “The ultimate validation for the safety and efficacy of discharging patients with cardiac troponin concentrations less than 5 ng/L will be the report of clinical outcomes after this threshold is implemented in routine clinical practice…” — but we think the release should have been more explicit about this aspect of the study, as the researchers were in the study itself. In the paper they caution much more directly, “Although we determined the number of patients who could be safely discharged, whether clinicians can effectively implement this threshold in clinical practice and whether this will substantially improve rates of discharge, is unknown.” Anyone who has dialed 911 (or its British equivalent, 999) or worried at home about the meaning of chest pain will understand the need for a rapid, reliable way to rule out an emergent heart attack. No disease mongering here; the accurate diagnosis of heart attack is a serious issue. The release duly notes funders. The release does a pretty good job of comparing current troponin tests with more sensitive one used for the current study. The release never explicitly states whether this is now being used, either at the study sites involved or elsewhere. The news hook for this release is pretty well established. Readers might interpret one of the quotes in this release as suggesting that the study is absolutely conclusive in terms of safety and efficacy. “These patients are therefore potentially suitable for immediate and safe discharge from the emergency department. These findings could dramatically reduce unnecessary hospital admissions and provide substantial cost savings for healthcare providers.” But since the language used elsewhere is more measured, we’ll let this one go with a warning.


Novartis Drug Curbs Repeat Hip Fractures

Explanation: This was an interesting story about treatment for an undertreated population of individuals. It defined the population (mostly women with an average age of 74 who had had a hip fracture – but it could have mentioned that 90% were white) and defined that the endpoint was a reduction in the number who died during the study period and that those in the treated group had a lower risk of dying as well as a smaller overall risk of subsequent bone fracture. In only 482 words, the story addressed most of our criteria, failing only to discuss costs and to quantify harms.

There was no information about the cost to the consumer for this product. The story did, however, provide an estimate about projected annual sales. The story reported on the composite endpoint of any fracture where those treated were seen to have a statistically significant fewer number that those in the placebo group. The story did not, however, point out that while the number of hip fractures in the treated group was less than in the placebo group, this difference was not statistically significant. The story did a good job of providing real numbers for the difference in the number of deaths observed in the two groups. The story failed to point out that in terms of serious side effects (renal, cardiovascular, or cerebrovascular events), or of people discontinuing treatment because of side effects – there was no difference between those being treated or those who received the placebo. The story neglected to discuss the side effects commonly seen in the study participants given the treatment; there was a higher incidence of fever and musculoskeletal pain in those infused with the drug. The evidence provided in the story derives from the research study and accompanying editorial published in the New England Journal of Medicine. The story provided this reference for readers who might be interested in tracking down more information about the study reported on. The story provided a clear explanation about the nature of the people in the study it reported on – elderly patients who had already fractured their hip. Although not including an age range for defining the term ‘elderly’ it did mention the average age of the study participants. The story did not engage in overt disease mongering. Although the story contained information and quotes from the editorial accompanying the published research study, it did not appear to tap into the knowledge base of others in the field to assess the importance of the study results. The story did note that those working on the study had ties to the manufactorer of the drug reported on. The story mentioned that the study demonstrated that there could be benefit from the treatment of elderly hip-fracture patients with this drug or another bisphosphonate. The story stated that the company that produces the drug is planning on seeking FDA approval for a new indication. It also reported that the drug is currently available and used for the treatment of Paget’s disease and for treating osteoporosis in wpmen after menopause. It is noteworthy that this story accurately reported on both of these aspects about availability. The story was clear that this was a new use (treatment of osteoporosis in elderly individuals who have already sustained a hip fracture) for a treatment that has FDA approval for a slightly different application. Does not appear to rely on a press release.


In Providence, R.I., it's illegal to sell toothpaste and a toothbrush to the same customer on a Sunday.

Explanation: BuzzFeed ‘awesome fact’ about toothbrush and toothpaste sales in R.I. turns out to be awesomely wrong

Rhode Island, Legal Issues, Pop Culture, BuzzFeed,

Hey fans of Rhode Island trivia! Did you know that in the capital city of Providence "it's illegal to sell toothpaste and a toothbrush to the same customer on a Sunday"? Neither did we. But that's what we were told in a July 14 feature titled "11 Awesome Facts You Never Knew About Rhode Island," listed on the popular news and entertainment website BuzzFeed. Here at PolitiFact, we had two questions. First: Is that really true? Second: Who thinks the inability to buy a toothbrush and toothpaste together on a Sunday is awesome? For the uninitiated, BuzzFeed,  which regards itself as a legitimate news website, is always trying to take a hot topic and make it hotter. BuzzFeed loves lists. Its July 19, 2013 home page featured "The 33 Fluffiest Animals On The Planet," "38 Things Catholic Girls Love" (#7 is "Pancakes." No explanation is offered), and "14 Not-At-All Gratuitous Breast Ads (Note to BuzzFeed: They ARE gratuitous)." We had our doubts about some of the other items on the Rhode Island list. (For example, we couldn't find any reference in state law to BuzzFeed's contention that "It is illegal to throw pickle juice on a trolley in Rhode Island.") We decided to focus on the toothbrush claim because we don't want Providence residents to be at a disadvantage when it comes to dental hygiene. We emailed BuzzFeed and asked for its source. We also checked Rhode Island law to see if there was a toothpaste-toothbrush statute that applied to Providence (or any community). We came up with nothing. We also checked the online version of Providence's city ordinances. We found nada. Then we called Providence City Hall and spoke to Deputy City Clerk Lori Hagen, who indulged us and did her own check. She found zip. The ordinances don't contain any derivative of the word "tooth." If it existed, "it would be in the code of ordinances," Hagen said, adding that she's never heard of any such restriction. She's worked for the city for 24 years. We thought it might be an old ordinance, repealed long ago. City Archivist Paul Campbell came up with bupkis. When we heard back from BuzzFeed, spokeswoman Augusta Mellon said in an email that a Google search for "sell toothbrush toothpaste sunday rhode island" produced over 8 million hits. (We checked that claim as well. Actual number of hits: about 650, and some of those didn't even refer to the "law.") Mellon said, "There's multiple accredited sources that have written about it, including the Brown Daily Herald and the Telegraph" in Australia. The unnamed blogger for the Herald, Brown University's student newspaper, reported buying both items at a local CVS, insisted that the prohibition was real, and treated the purchase like an act of civil disobedience. The blogger's source turned out to be a list at DumbLaws.com, which cites no actual law, past or present. At least the Telegraph story begins: "Here is a list of the world's most ridiculous laws or urban myths - we’re not quite sure." BuzzFeed's Mellon ended her email by saying, "It seems like it's a commonly referenced piece of information." She should have added, "Which nobody ever checks." So oral hygiene fans can breathe a minty-fresh sigh of relief. A toothbrush and toothpaste can legally be purchased together any Sunday in Providence. Maybe someday this PolitiFact item will be part of a BuzzFeed list titled "217 Examples of How BuzzFeed Didn't Check Its Facts." It'll be a hot one because we give the website a ! (If you have a claim you’d like PolitiFact Rhode Island to check, e-mail us at [email protected] And follow us on Twitter: @politifactri.)


Health Care, Public Health, State Budget, Terrorism, Wisconsin, Scott Walker,

On Dec. 3, 2015, Gov. Scott Walker was asked by a Wisconsin reporter for his reaction to the gunslaying of 14 people in San Bernardino, Calif. the previous day. That was before authorities had determined that the husband-and-wife shooters had discussed jihad and martyrdom. Walker responded by talking about mental illness. "We don’t know enough about this instance. But for others like that, what we’ve found is one of the common denominators in many of these cases are people who’ve slipped through the cracks when it comes to chronic mental illness," the governor said. "That’s why I’m proud that here in Wisconsin, we’ve put in previous budgets more money into mental health services than any governor has in the last 25 years." Two longtime mental health advocates told us that Walker’s funding boost was exceptional. "We were hard pressed to think of anything quite as significant," said Shel Gross, senior policy associate at Mental Health America of Wisconsin. So let’s see whether Walker put into the state budget more money for mental health than any governor in the last quarter-century. Walker’s evidence Walker announced in February 2013, in the wake of mass shootings in Newtown, Conn., and at a Sikh temple and a spa in suburban Milwaukee, that he would raise spending on mental health services by $29 million in his 2013-’15 state budget. The six initiatives included $12.6 million to open two units at the Mendota Mental Health Institute, a state-run psychiatric hospital in Madison for patients who have been committed, and $10.2 million for expanding community-based care programs for people with severe mental illness. When Walker made his formal budget presentation later that month, he said only half of all Wisconsin adults with "serious psychological distress received mental health treatment or medication". We noted that the Wisconsin chapter of National Alliance on Mental Illness had praised the spending boost, but criticized Walker for rejecting a proposal under President Barack Obama’s Affordable Care Act to expand Medicaid, saying his decision "reflects a shallow understanding" of "crucial means to affordable mental health care for Wisconsin residents." Mental health benefits in private-sector insurance plans are generally less comprehensive than those provided by Medicaid. But that is separate from the amount of state funds Walker put into the state budget. To back the governor’s claim, a spokeswoman provided us a February 2013 email from Walker’s Department of Administration that said there had not been a mental health funding boost in "general purpose revenue" since the creation of what was known as the "community aids" program in the mid-1970s. Walker’s office also had his Department of Health Services provide us more detail in restating that his investment was the largest since the ‘70s. Separately, the nonpartisan Legislative Fiscal Bureau confirmed to us that the $29  million increase in state funding budgeted for mental health services in the 2013-15 state budget was the largest increase in at least 25 years, and that no other increases during that time were nearly as much. A final note: Charlie Morgan, a program supervisor for the fiscal bureau, told us that the total amount the state budgets for mental health services "is not easily answered." That’s because funding for those services is provided through many programs, including: inpatient services provided by the state's mental health hospitals, community-based mental health services that are budgeted as distinct programs; and funding the state provides to counties, including for programs that provide mental health as well as substance abuse services. But it’s clear the additional $29 million added by Walker is the largest such increase in at least 25 years, he said. Our rating Walker said: "Here in Wisconsin, we've put in previous budgets more money into mental health services than any governor has in the last 25 years." It’s worth noting that Walker refused a federal expansion of Medicaid that would have provided more mental health services to Wisconsinites. But on putting state money into the state budget for mental health, he is correct. We rate the statement .


Sen. Elizabeth Warren "doesn’t have any Indian blood.

Explanation: An in-depth look at the science behind the test and what the results do — and don’t — show.

Two weeks ago, Sen. Elizabeth Warren released the results of a genetic test showing she has a small but detectable amount of Native American DNA. The report concluded there is “strong evidence” she had a Native American ancestor approximately six to 10 generations ago. But many have misconstrued the results — including President Donald Trump, who wrongly claimed Warren “doesn’t have any Indian blood.”Warren’s release, which was widely interpreted as a sign that she intends to run for president in 2020, comes after years of controversy over her heritage. Warren has previously said she was part Cherokee and Delaware Indian, based on stories she heard growing up. Her ancestry first became a political issue in 2012, when she ran for Senate in Massachusetts. Critics questioned whether she received any advantages from claiming Native American ancestry — an idea we’ve addressed before (there’s no evidence she benefited). Subsequently, Trump took to calling her “Pocahontas,” and during a rally this past July, challenged her to take a DNA test, saying he would donate $1 million to charity “if you take the test and it shows you’re an Indian.”The new findings support Warren’s claim that she has at least one Native American ancestor, although they cannot reveal whether that individual was a member of any specific tribe. The results were not peer-reviewed, as they would be in a formal scientific publication, but four anthropological geneticists told us the methodologies were valid and the conclusions reasonable.Trump, however, interpreted the findings differently. Over a series of tweets, he called the test “bogus” and said the results showed Warren might have less Native American DNA than the “average American.” Now that her claims of being of Indian heritage have turned out to be a scam and a lie, Elizabeth Warren should apologize for perpetrating this fraud against the American Public. Harvard called her “a person of color” (amazing con), and would not have taken her otherwise!— Donald J. Trump (@realDonaldTrump) October 16, 2018Pocahontas (the bad version), sometimes referred to as Elizabeth Warren, is getting slammed. She took a bogus DNA test and it showed that she may be 1/1024, far less than the average American. Now Cherokee Nation denies her, “DNA test is useless.” Even they don’t want her. Phony!— Donald J. Trump (@realDonaldTrump) October 16, 2018In campaign rallies in Montana, Arizona, Texas and, most recently, Illinois, the president has claimed to be more Native American than Warren.Trump in Murphysboro, Illinois, on Oct. 27: But how do you lose a debate where you say as an example — no, we can’t use Pocahontas anymore. She’s got no Indian blood. We can’t use the name. He says call her Pocahontas. I can’t do it. She doesn’t have any Indian blood. I have more than she does, and I have none. Right? I have none, but it’s more than her. On each of these points, Trump is wrong or comes to an unsubstantiated conclusion:Before explaining more of the science, it’s important to say, as others have done elsewhere, that DNA tests like the one Warren took have no bearing on Native American identity or tribal membership. As a result, even if Warren’s test showed she had a substantial amount of Native American DNA, that would not make her “Native American.” Native identity is socially and culturally determined, and cannot be reduced to a DNA ancestry test. While lineage often matters to tribal membership, it is not established by modern genetic tests that assess overall ancestry. Some, but not all tribes, for example, use a system called “blood quantum,” which requires members to meet certain cutoffs, such as one-quarter or one-half, to officially join as citizens. (This system, it should be noted, began as a forced policy under the federal government, and is therefore viewed as problematic by many.) Other tribes, including the Cherokee Nation, don’t have specific blood quantum requirements, but require proof of descent from an enrolled member in the historical record.For tribes using blood quantum, these fractions do not correspond to an exact percentage of Native American DNA a person might have — thanks to a quirk of biology that we’ll explain later, it’s more variable than that. Instead, they use an approximate value, such as whether an individual has one fully Native parent or grandparent. Tribes might use basic DNA tests, such as paternity tests, in an effort to establish links to certain individuals, but none accepts results from the type of test Warren took.Warren has stated that she understands the difference “between citizenship and ancestry,” and that she is not claiming anything other than ancestry. But many people in indigenous communities, including the Cherokee Nation, found Warren’s decision to release her DNA results offensive. We won’t be wading into that debate any further. Instead, we’ll stick to addressing the scientific claims surrounding Warren’s test.We don’t know all the details about how the test was done because the Stanford geneticist, Carlos Bustamante, did not respond to repeated requests for an interview. But based on the released report, the general methods are similar to what would happen if you sent your DNA to a company like 23andMe or Ancestry.com.The technique is a form of genotyping that uses something called a DNA microarray, or what is more popularly known as a DNA chip. The chips are essentially glass microscope slides covered with tiny dots of DNA, and they can reveal a person’s DNA sequence at hundreds of thousands of spots across their genome. These spots, many of which are single nucleotide polymorphisms, or SNPs, are useful to check because scientists already know something about them. For one, they’re known to be variable across different populations and between individuals. This is important, since humans share the vast majority of their DNA with each other. Second, the SNPs are usually selected because they tend to associate with certain health conditions, physical features or ancestries. In this way, someone can get a lot of information about their genome without having to sequence it. Sequencing is a different method that reads out the entire string of DNA letters, or bases — all of the A, T, C and Gs — in a given piece of DNA. It is much more expensive than chip-based genotyping, especially when applied to the 3 billion bases of a person’s genome (or 6 billion, if covering both sets of chromosomes).Ancestry information ultimately comes from comparisons of a person’s tested genetic variants to those of other individuals. In Warren’s case, scientists compared 660,173 spots of genetic variation to those of 148 people who had had their entire genomes sequenced as part of the 1000 Genomes Project. The 1000 Genomes Project was a collaborative effort by scientists across the globe to better understand human genetic variation, and involved sequencing more than 2,500 genomes from 26 different populations. These genomes are handy as references genomes, which is how they were used here. Warren’s comparison group was equally split between Europeans, Africans, East Asians and those with Native American ancestry. The analyst made the comparisons using a computer program called RFMix, which Bustamante’s group developed and previously established as a reliable tool.To confirm evidence of Warren’s Native American ancestry, researchers also compared Warren’s DNA data to two other sets of reference populations from the 1000 Genomes Project: 99 people from Utah with European ancestry, and 86 people from Great Britain, also with European ancestry.According to the report, Warren’s test results show that she is of “primarily European descent,” but also that she has at least five genetic segments that are “Native American in origin at high confidence.” One of these segments is larger than the others, spanning about 4.7 million bases, and further analysis indicates this DNA chunk has a genetic signature one would expect from a person having European and Native American heritage. The total length of all of Warren’s Native American-assigned segments is about 12.3 million bases, which the report states is about 12.4 times greater than the average in the Great Britain reference population, and 10.5 times greater than the average in the Utah population. Bustamante concludes there is “strong evidence” for a Native American ancestor roughly six to 10 generations ago.All of the anthropological geneticists we consulted felt the test was performed as well as it could have been, given the available data.“Carlos Bustamante is a very respected researcher,” said Jeffrey Long of the University of New Mexico in a phone interview. “What I’ve seen makes sense to me.” (Bustamante is also an adviser to both 23andMe and Ancestry.com. )Long added that while Warren doesn’t appear to have a lot of DNA from a Native American ancestor, it’s “probably proof” there was one, and that the six to 10 generations figure was “appropriately cautious.”“The methods that they used are among the best that are out there today,” said Deborah Bolnick of the University of Connecticut in a phone interview.She said the test still had limitations, largely because of the lack of available Native American data sets, but that the limitations “don’t influence the idea that she had an indigenous ancestor.”For example, in the analysis, the Native American samples came from people from Mexico, Peru and Colombia. Ideally, Warren’s DNA would be compared to that from Native Americans living in the United States — but that data isn’t publicly available. These other samples can still be used, however, because there is enough shared ancestry. Many people living in North and South America today, Bolnick explained, still retain genetic variants that emerged in more ancestral populations, and therefore these people can serve as legitimate comparisons to determine whether an individual descended from the first people of the Americas.While the results are clear on the basic findings, things get murkier when people attempt to extrapolate beyond them.“It’s hard to say more than, ‘Yes, it’s clear she has Native American ancestry,’” said Long.Shortly after Warren’s release, critics began to question whether she has more Native ancestry than other white Americans. Using the six to 10 generations figure, a Republican spokesman and an op-ed writer converted this to fractional ancestry (1/64 to 1/1024), which they then compared to a number appearing in a 2014 study published in the American Journal of Human Genetics. The paper, which was written by 23andMe researchers and colleagues, analyzed the genetic ancestry of more than 160,000 23andMe customers who self-identified as either African American, Latino or European American. For European Americans, the genome-wide “mean estimate” of Native American ancestry was 0.18 percent (given in table 1). Because this percentage is higher than the equivalent percentage for the 10 generations fraction (0.098 percent), these critics concluded Warren might have less Native American ancestry than the “average” white American.Trump appears to have picked up this line of thinking, saying in an Oct. 16 tweet that the test showed that Warren “may be 1/1024, far less than the average American,” and in his Oct. 18 speech in Montana that “the one good thing about her test is that there was so little she had less than the average American.”This is problematic for several reasons, the first being that the Bustamante report never specifies a fraction or percentage, so these estimates are derived from a back calculation from the six to 10 generation estimate. As others have written, this incorrectly assumes equal inheritance through time from all of your ancestors — something that simply doesn’t happen. Biology is more random, and because of the way DNA is passed down, these fractions may not represent the true amount of DNA a person retains from each ancestor.In fact, there is a surprisingly high chance that a person will receive no DNA from a relatively recent ancestor. Graham Coop, an evolutionary and populations geneticist at the University of California, Davis, for example, has estimated there’s about a 13 percent chance a person will not get any genetic material from an ancestor from eight generations ago. At 10 generations, this jumps to about a 50 percent chance. This reveals a fundamental discrepancy between ancestry and genetics, since a person’s ancestry can still be true, and yet they might not have any trace of it in their bodies. Even if we had a more precise estimate of the amount of Native American DNA Warren carries, it still would be inappropriate to use the 23andMe study to come to definitive conclusions about how Warren stacks up.That’s because, Bolnick explained, the 23andMe percentages were calculated using different genetic data and different statistical tools. “They’re not comparable,” she said.Furthermore, because the 23andMe data come from customers, the information is not necessarily representative of all of white America, as this population had the interest in and the means to pay for a genetic test. While this may be the best estimate we have, it’s still not a random sample.“I don’t think it’s way off, but we’re talking about really small numbers here,” cautioned Long.Others have pointed to the Utah reference population — which had on average just a tenth of Native American DNA as Warren’s sample — as a more relevant comparison. But Bolnick and Long don’t think this population is representative of the entire U.S., either.Several of the anthropological geneticists we spoke to also found the entire concept of an “average” Native American ancestry in white Americans questionable, as this ancestry fluctuates a great deal based on geography and past events.In the end, with respect to the “average” claim, Bolnick said, “I don’t think we have enough data to answer whether she does or does not have more.”The most that can be concluded, then, is that Warren’s test results are consistent with someone who has a small amount of Native American ancestry.


Insurance companies "have made a fortune with Obamacare.

As two dozen senators attempt to carve out a short-term compromise on the Affordable Care Act, President Donald Trump is sending mixed signals. At the heart of the deal are payments to insurance companies that sell certain policies on the Obamacare exchanges. In tweets and remarks, Trump both praised the compromise effort championed by Sen. Lamar Alexander, R-Tenn., and flagged his displeasure. "I am supportive of Lamar as a person & also of the process, but I can never support bailing out ins co's who have made a fortune w/ O'Care," Trump tweeted Oct. 18. I am supportive of Lamar as a person & also of the process, but I can never support bailing out ins co's who have made a fortune w/ O'Care. The bailout, as Trump calls it, is no bailout; the money actually ends up with doctors, hospitals and other health care providers. But here we zero in on Trump’s statement that insurers "have made a fortune with Obamacare." There’s no question that the companies’ profits have been enormous. The question is, was Obamacare the cash cow? Based on the filings of the companies, and the analysis of people on Wall Street, at universities and a respected neutral health policy group, the answer is, no. The White House press office pointed to a news article that reported booming profits for the top five for-profit insurance companies, Aetna, Anthem, Cigna, Humana and UnitedHealth Group. Collectively, they had $4.5 billion in net earnings in the first three months of 2017. That cash was"the biggest first-quarter haul for the group since the Affordable Care Act exchanges went live in 2014," the article said. But the article doesn’t actually tie those profits to Obamacare. The fact is, Obamacare does not just include the exchanges where people buy private insurance. The exchanges themselves are a small slice of the overall insurance business. Despite the enormous attention paid to the exchanges, they make up less than 4 percent of the insurance market for people under 65. And contrary to Trump’s assertion, they have dragged profits down, not boosted them up, experts say. Returns from the exchanges have been so bad, three out of five of the companies listed in the article have fled. Aetna reported that it lost $650 million in 2016 and 2017 from the policies it sold in the individual market. For 2018, Aetna pulled out of every state exchange. UnitedHealth Group has also left the exchanges. It put its combined losses at over $1 billion in 2015 and 2016. Humana, which had sold in 11 states, got out too. Cigna trimmed its participation from seven states to six. Cigna CEO David Cordani told CNBC in August that the market is "challenging," and that "we are losing money, but we are losing a little less than we expected." For 2018, Anthem also remains, but withdrew from Ohio, Indiana and Wisconsin, and trimmed back the number of counties it serves in Kentucky, Georgia and California. It was going to leave Virginia completely, but then struck a deal with the state to sell in counties that would otherwise have no carrier. Moody’s Investor Service ranked it as a positive development for companies that exited the exchanges, saying it "lowered exposure to this challenging business." The overall individual market, which includes plans sold on and off the exchanges, brought an estimated $4.7 billion in underwriting losses in 2016, according to the consulting group Oliver Wyman. The news has not been all bad for the companies. Premium hikes in 2016 and 2017 began to balance things out. The Kaiser Family Foundation, a neutral source of health sector statistics, found that insurers who stayed in the exchanges had figured out how to come out ahead, but it took a couple of years for them to get there. So Trump missed the target completely when he linked the exchanges and the multi-billion dollar profits of five big insurance companies. But Obamacare is much more than the exchanges and parts of the program have both helped and hindered company profits. On the negative side of the ledger, the Affordable Care Act imposed limits on the spread between premiums collected and medical services paid out. For individual and small group plans, companies must spend at least 80 percent of premiums on providing care. For the large-group plans, the percent is 85 percent. "This provision has likely had a modest downward effect on profits," said Larry Levitt with the Kaiser Family Foundation. In 2015, companies that fell below those minimums rebated about $400 million to customers, government numbers show. A tax on insurance companies helps finance Obamacare. Congress lifted it for 2017, but it is slated to return in 2018 with an estimated value of nearly $13 billion. Sheryl R. Skolnick, director of U.S. equity research at Mizuho Securities, tracks UnitedHealth Group specifically. "That health insurance industry fee in 2018 is projected to cost the company $.75 a share on just about 1 billion shares," Skolnik said. On the positive side of the ledger, the one clear bright spot for insurers in Obamacare was the expansion of Medicaid. In the 32 states that extended the program to adults making as much as 138 percent of federal poverty, coverage is mainly handled through private insurers. "Mostly as a result of expansion programs under the ACA, health plans and service providers experienced strong Medicaid growth over the early years of ACA," according to a report from Mark Farrah and Associates. Health care analysts at Milliman, an actuarial consulting firm, estimated that insurers had underwriting gains of $1.5 billion in 2016. That was a year when exchange losses topped $4 billion. A study in Michigan found that operating margins for the companies that managed Medicaid in that state improved four-fold between 2013 and 2015. How does this all add up for each of the five big insurance companies? Precision is difficult, but between the losses tied to the exchanges, regulations and taxes on one hand, and profits on Medicaid on the other, Skolnik said it’s a wash. "I think it's fair to say that the health insurance industry has probably lost close to as much as they've gotten under the ACA," Skolnik said. Which raises the question, where did those hefty profits come from? The bulk of the business lies in employer-based coverage, which makes sense since that accounts for nearly 60 percent of the under-65 insurance market. Over the years, companies have benefited by shifting more of the costs onto customers through higher deductibles and other out-of-pocket expenses. And mergers in the industry have also helped. "Consolidation among insurers has led to higher margins," said economist Amanda Starc at Northwestern University’s Kellogg School of Management. Medicare Advantage, a quasi-private version of traditional Medicare, has also been a key profit center for insurers. Under the program, the government contracts with insurance companies to deliver health care to seniors. The rising number of retirements among baby boomers has fueled that market. Enrollments are up, and the insurance companies have worked hard to keep their costs down. "They are very aggressive there which gives them the clout to get better provider contracts," said J.B. Silvers, a professor of health finance at Case Western Reserve University. Trump said insurance companies have made a fortune with Obamacare. The White House cited the companies’ surging profits as proof. But just because insurers made billions since the time when the Affordable Care Act took effect, doesn’t mean that the ACA delivered those profits. Most of the companies had steep losses on the Obamacare exchanges and got out. Every report we saw and every expert we reached said insurers made their huge profits elsewhere, largely through their work in the large group or employer-based market or through the Medicare Advantage program. The expansion of Medicaid, another part of Obamacare also helped, but to a smaller degree. The fortune that Trump cited didn’t come from Obamacare. We rate this claim .