From the International Rescue Committee in August 2022 (after the Taliban took over in 2021)
Despite countless hurdles, all-women teams of medical doctors are braving long distances and treacherous terrain to bring health care to the remotest villages in Afghanistan, reaching women who lack access to health services, some for up to 50 years.
Dr. Najia Tareq, a gynecologist with years of experience in public health, felt anxious the day the Taliban entered Kabul a year ago. “The political transition was very difficult for us,” she says. “We were concerned about our futures and thinking, what will happen to us?”
Dr. Najia Tareq runs IRC mobile medical units that provide health care to Afghanistan’s remote areas, which often lack basic infrastructure.
Photo: Oriane Zerah for the IRC
Dr. Najia’s family had encouraged her to become a doctor from a young age. When she began her studies, she soon discovered the dire need for female specialists in Afghanistan.
She remembers better times for women in her country, recalling her student days at Kabul Medical University. “It was a good environment for women and girls back then,” she says. “Everyone could study in Afghanistan or abroad.” (continued)
Picasso’s turbulent etching from the eve of the Spanish Civil War seems a timely image of my own country in this harrowing election season. The monstrous beast towers over his victim—the wounded female matador lying unconscious on the back of her tormented horse. From a high window, two other women, with doves of peace, witness the predator’s violence with both anger and sorrow. The cowardly male fleeing up the ladder takes no side, offers no resistance. Only the brave young girl, with her candle and flowers, stands firm against the Minotaur, whose hand tries to block the light of truth. Her calm and steady presence is unperturbed by the monster’s agressive rage. She knows something he will never understand. Even in the darkest hour, there is a light which refuses to be extinguished.
Here’s to the truth-tellers, activists, organizers, public servants, door-knockers, and phone-bankers whose candles shine so brightly in these challenging days. And for my own candle on Election Eve, let me offer the words of Abraham Lincoln, who summoned our better angels in his 1862 address to a divided nation:
“Can we do better?” The dogmas of the quiet past are inadequate to the stormy present. The occasion is piled high with difficulty, and we must rise with the occasion. As our case is new, so we must think anew and act anew. We must disenthrall ourselves, and then we shall save our country.
Fellow-citizens, we can not escape history. We of this Congress and this Administration will be remembered in spite of ourselves. No personal significance or insignificance can spare one or another of us. The fiery trial through which we pass will light us down in honor or dishonor to the latest generation … We shall nobly save or meanly lose the last best hope of earth.
Frederic Edwin Church, Our Banner in the Sky (1861), painted at the outbreak of the American Civil War.
Massive and sweeping change will come and it will come swiftly. Whether or not it is healing and conclusive depends on us…. The end of our country has loomed many times before. American is not as fragile as it seems
Americans on Medicare will see big, and welcome, changes next year. The program’s prescription drug insurance will be much stronger — and easier to understand — as a result of the Inflation Reduction Act of 2022.
But the changes make it all the more important to review your coverage options during Medicare’s annual enrollment period, which is happening now and runs through Dec. 7.
Prescription drug and Medicare Advantage plans are revising their offerings more than usual for 2025 because of changes required by the Act. The legislation strengthens prescription drug coverage substantially by imposing a hard $2,000 cap on total out-of-pocket spending for drugs covered by your plan.
The law will provide thousands of dollars in relief to beneficiaries who take high-cost drugs for conditions like cancer and multiple sclerosis, and it will give seniors greater predictability in planning their health care spending.
But the plan you’re in for 2024 may not be the best fit next year. Your premium and deductible might actually rise as insurance companies react to the changing rules, and a plan’s list of covered drugs might change.
If you are enrolled in traditional Medicare Part A (which covers hospitalizations) and Part B (outpatient visits) and have a supplemental Medigap policy, there’s no need to review that coverage. But stand-alone Part D prescription plans should be re-evaluated. And if you have chosen Medicare Advantage as an alternative to traditional Medicare, it makes sense to re-evaluate this coverage, too, since many of these plans include drug coverage.
“People need to be on high alert this year for changes to whatever type of private Medicare plan coverage they have,” said Philip Moeller, author of the book, “Get What’s Yours for Medicare.”
“Everyone needs to be especially vigilant,” he said.
The 2025 changes join other cost-containment provisions of the Inflation Reduction Act that have already been phased in, including a $35 monthly cap on the cost of insulin for diabetes patients and, for low-income seniors, free vaccines and expanded eligibility for financial assistance with Part D costs.
Here’s a look at how private plan offerings will change in 2025, and what to look out for as you shop for coverage. (continued on page 2)
“Fellow-citizens,” Lincoln reminded his colleagues, “we cannot escape history. We…will be remembered in spite of ourselves.”
Commentary by Heather Cox Richardson
I’m home tonight to stay for a bit, after being on the road for thirteen months and traveling through 32 states. I am beyond tired but profoundly grateful for the chance to meet so many wonderful people and for the welcome you have given me to your towns and your homes.
I know people are on edge, and there is maybe one last thing I can offer before this election. Every place I stopped, worried people asked me how I have maintained a sense of hope through the past fraught years. The answer—inevitably for me, I suppose—is in our history.
If you had been alive in 1853, you would have thought the elite enslavers had become America’s rulers. They were only a small minority of the U.S. population, but by controlling the Democratic Party, they had managed to take control of the Senate, the White House, and the Supreme Court. They used that power to stop the northerners who wanted the government to clear the rivers and harbors of snags, for example, or to fund public colleges for ordinary people, from getting any such legislation through Congress. But at least they could not use the government to spread their system of human enslavement across the country, because the much larger population in the North held control of the House of Representatives.
Then in 1854, with the help of Democratic president Franklin Pierce, elite enslavers pushed the Kansas-Nebraska Act through the House. That law overturned the Missouri Compromise that had kept Black enslavement out of the American West since 1820. Because the Constitution guarantees the protection of property—and enslaved Americans were considered property—the expansion of slavery into those territories would mean the new states there would become slave states. Their representatives would work together with those of the southern slave states to outvote the northern free labor advocates in Congress. Together, they would make enslavement national.
America would become a slaveholding nation.
Enslavers were quite clear that this was their goal.
South Carolina senator James Henry Hammond explicitly rejected “as ridiculously absurd, that much lauded but nowhere accredited dogma of Mr. Jefferson, that ‘all men are born equal.’” He explained to his Senate colleagues that the world was made up of two classes of people. The “Mudsills” were dull drudges whose work produced the food and products that made society function. On them rested the superior class of people, who took the capital the mudsills produced and used it to move the economy, and even civilization itself, forward. The world could not survive without the inferior mudsills, but the superior class had the right—and even the duty—to rule over them.
But that’s not how it played out. (continued on Page 2)
A regional public health department in Idaho is no longer providing COVID-19 vaccines to residents in six counties after a narrow decision by its board.
Southwest District Health appears to be the first in the nation to be restricted from giving COVID-19 vaccines. Vaccinations are an essential function of a public health department.
“I’m not aware of anything else like this,” said Adriane Casalotti, chief of government and public affairs for the National Association of County and City Health Officials. She said health departments have stopped offering the vaccine because of cost or low demand, but not based on “a judgment of the medical product itself.”
By McKay Coppins in The Atlantic (thanks to Alice W.)
Everything about the staging of Kamala Harris’s “closing argument” rally Tuesday night on the White House Ellipse seemed designed to frame the upcoming election as a referendum on democracy. Flanked by American flags and surrounded by banners that screamed FREEDOM, the Democratic nominee delivered her speech against the same backdrop that Donald Trump used on January 6 when he addressed the crowd that went on to storm the Capitol.
“So look,” Harris said about halfway through her speech. “In less than 90 days, either Donald Trump or I will be in the Oval Office …”
Scattered shouts of You will! You will! echoed from the audience near the stage. In my conversations with Harris supporters afterward, their confidence seemed authentic. To a person, everyone I talked with believed they were on the verge of victory—that Harris would defeat the “wannabe dictator” once and for all, pull America back from the brink, and save the world’s oldest democracy from descending into facism.
Then I would ask a question they found dispiriting: What if she doesn’t?
It’s a question that’s been on my mind for months. We are in a strange and precarious political moment as a country: With four days left in one of the closest presidential races in history, supporters of both campaigns seem convinced that they are going to win—and that if they don’t, the consequences for America will be existential. (continued on Page 2)
Ed note: In these dark days of winter with the very short days, sleep disruption and seasonal affective disorders are fairly common. So I break out my happy light and have it on the breakfast table for 30 minutes. Placebo or not, it seems to help. Below is a portion of the article from an extensive review by the Wirecutter researchers at the NYT.
Today, “bright light therapy is recommended as the first-line option” for the treatment of SAD, according to a 2003 review (PDF) in the journal Dialogues in Clinical Neuroscience. Far from being a fringe or “alternative” purported remedy for SAD, light therapy has been clinically shown in many studies to work to alleviate symptoms.
How we picked and tested
Photo: Rozette Rago
When you’re shopping for a SAD lamp, to ensure that you receive the full therapeutic benefits of the light, there are a few important factors to consider, namely how much light it delivers and how close to the lamp you need to sit for the treatment to be effective.
First, know that the FDA does not test, approve, or regulate light-box devices. As such, you should not use one without a physician’s guidance. We based our picks on research, customer feedback, and product specifications—including optimal sitting distances—provided by manufacturers, as well as conversations with experts who study and prescribe these units.
A light box should deliver between 2,500 and 10,000 lux. A lux is a unit that measures 1 lumen per square meter. The more lux a light delivers, the less time you need to spend positioned in front of it. For most 10,000-lux lights, 30 uninterrupted minutes per day, preferably in the morning, should suffice. “If you’re going to sleep too early and want to stay awake longer, a little bit of light therapy in the afternoon can help mitigate that,” said Teodore Postolache, PhD, a professor of psychiatry at the University of Maryland School of Medicine.
We also looked at how close to each box you need to sit to score the maximum results. Light intensity is subject to the inverse square law, which says that the intensity of light falls off by the square of the distance that you move away from it. For instance, if you are 2 feet away from a light source, you see a fourfold decrease in intensity. The farther away a person is able to sit from a lamp and still receive 10,000 lux for maximum efficacy, the more flexibility they have in terms of what they can be doing and how they can be sitting during treatment. “I insist, absolutely, that any reputable, reliable manufacturer has to tell the consumer what the distance it should be from the eyes to achieve 10,000 lux,” Lewy said. “If a light box doesn’t have that information, I wouldn’t use it.”
The FDA does not test, approve, or regulate light-box devices.
The larger the surface of the light box, the better. In Winter Blues, Rosenthal notes that the lights “used in almost all research studies … have an illuminated surface that is at least about one foot square.” For that reason, and the fact that smaller therapeutic lamps have not undergone the same kind of rigorous study that their bigger cousins have received, we strongly recommend light boxes with the largest surfaces. (We do recommend a smaller lamp, the HappyLight Luxe, which we think is a serviceable option if you don’t have the space or budget for one of our larger picks. However, our top pick has a longer track record of efficacy in home and academic use, and in a side-by-side comparison that we performed with a commercial luxmeter, the HappyLight Luxe’s light output did not seem as strong.)
We avoided any lamps that did not have a plastic filter to remove most if not all ultraviolet waves (which are potentially harmful to the eye), and we avoided those with incandescent bulbs, which can build up a lot of heat, as well as models that used blue LEDs, as there’s still some controversy over whether blue light, which is different from blue-enriched white light (PDF), is harmful to the eyes. (continued on page 2)
Cognitive behavioral therapy for insomnia is considered the most effective treatment for people who continually struggle to fall or stay asleep.
By Christina Caron in the NYT
About one in four adults in the United States develops symptoms of insomnia each year. In most cases, these are short-lived, caused by things like stress or illness. But one in 10 adults is estimated to have chronic insomnia, which means difficulty falling or staying asleep at least three times a week for three months or longer.
Sleep deprivation doesn’t just create physical health problems, it can also harm our minds. A recent poll from the National Sleep Foundation, for example, found a link between poor sleep health and depressive symptoms. In addition, studies have shown that a lack of sleep can lead otherwise healthy people to experience anxiety and distress. Fortunately, there is a well-studied and proven treatment for insomnia that generally works in eight sessions or less: cognitive behavioral therapy for insomnia, or C.B.T.-I.
If you cannot find a provider, C.B.T.-I. instruction is easy to access online. Yet it is rarely the first thing people try, said Aric Prather, a sleep researcher at the University of California, San Francisco, who treats patients with insomnia.
Instead, they often turn to medication. According to a 2020 survey from the Centers for Disease Control, more than 8 percent of adults reported taking sleep medication every day or most days to help them fall or stay asleep.
Studies have found that C.B.T.-I. is as effective as using sleep medications in the short term and more effective in the long term. Clinical trial data suggests that as many as 80 percent of the people who try C.B.T.-I. see improvements in their sleep and most patients find relief in four to eight sessions, even if they have had insomnia for decades, said Philip Gehrman, the director of the Sleep, Neurobiology and Psychopathology lab at the University of Pennsylvania.
Sleep aids can carry risks, especially for older people, who may experience problems like falls, memory issues or confusion as a result of using the medication. C.B.T.-I., on the other hand, is considered safe for adults of any age. It can even be adapted for use in children.
CDC now recommends a second dose of the 2024-2025 COVID-19 vaccine for two groups:
People 65 years and older and
Everyone 6 months and older who are moderately or severely immunocompromised
The second dose of the 2024-2025 COVID-19 vaccine is recommended six months after the first dose. These groups remain at higher risk of severe COVID-19, and these updated recommendations help maximize their protection year-round. Data continue to confirm the importance of vaccination to protect those most at risk for severe outcomes of COVID-19. Also, data on COVID-19 vaccine effectiveness indicate that protection against COVID-19-associated emergency department and urgent care visits and hospitalization likely wanes by four to six months after vaccination. Fortunately, protection from admission to the intensive care unit, a sign of critical illness, lasts longer.
Additionally, data show that SARS-CoV-2, the virus that causes COVID-19, continues to circulate year-round, with peaks typically occurring in the winter and late summer.
CDC previously recommended that people who are moderately or severely immunocompromised may get additional doses of the COVID-19 vaccine, in consultation with a healthcare provider. Historically in years past, uptake of these additional doses for this group was low. ACIP voted to provide a clear recommendation for people who are six months or older and are moderately or severely immunocompromised to receive a second dose of 2024-2025 COVID-19 vaccine 6 months after their first dose.
These updated recommendations also allow for flexibility for additional doses (i.e., three or more) for people who are moderately or severely immunocompromised, in consultation with their healthcare provider (a strategy known as shared clinical decision making). These additional doses can be timed around immunosuppressive treatments, such as chemotherapy, after which some people may be at increased risk of severe COVID-19. These doses can also be timed around activities like travel or other life events, during which people may have increased risk of exposure to the virus that causes COVID-19.
For most residents 18-35, the dream of home ownership is dead, and rising costs of food and transportation hit hard as the state grows more unaffordable.
Brandon Borg, 21, fills his gas tank in Everett, Oct. 24, 2024. Borg must drive long distances for work, and is worried about how the rise in gas prices will affect his ability to save money for his future. (Caroline Walker Evans for Cascade PBS)
Voters of all age groups say the economy is one of their top factors in deciding who to choose for Washington’s next governor. But the issue appears to be top-of-mind for younger voters — specifically the cost of basic necessities.
It makes sense: Young people are new to the workforce and typically make lower wages. They have less money saved, take on more credit-card debt and are more often renters.
“It’s like you scrape by for everything,” said Xihucoatl Alvarado, 24, a Seattle resident who works as a paid canvasser for Greenpeace. “You have to live with at least one roommate to make any ends meet out here.”
People of different ages have varied concepts about what it means to be worried about the economy, said Todd Donovan, a political science professor at Western Washington University.
Older people might associate the economy with questions like “What’s my investment portfolio doing?” Donovan said. Young people, however, tend to be focused on more immediate cost of living concerns like “Where am I going to be living next year?”
“Those are two very different worlds that people are living in,” Donovan said.
Young adults interviewed for this article all gave similar answers when asked about their biggest economic stressors: housing, food and transportation. (continued on page 2)
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