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An economic evaluation of eptinezumab for the preventive treatment of migraine in the UK, with consideration for natural history and work productivity | The Journal of Headache and Pain | Full Text

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Page 2

Results over 12 weeks of treatment, with standard error (SE)

TF3+ EM,

 ≥ 50% reduction in MMDs

TF3+ CM,

 ≥ 30% reduction in MMDs

TF3+ CM,

 ≥ 50% reduction in MMDs (scenario)

Responder rate, BSC, %

9.6 (2.0)

23.2 (4.6)

8.9 (1.8a)

Responder rate, eptinezumab 100mg, %

40.0 (8.0)

63.4 (12.9)

30.4 (6.1a)

Change from baseline in MMDs, BSC responders

-5.82 (1.50)

-8.80 (1.99)

-10.45 (1.41)

Change from baseline in MMDs, eptinezumab 100 mg responders

-6.82 (0.92)

-9.93 (1.41)

-12.68 (1.40)

Change from baseline in MMDs, BSC non-responders

-1.31 (0.84)

-0.85 (1.42)

-1.94 (0.96)

Change from baseline in MMDs, eptinezumab 100 mg non-responders

-1.39 (1.18)

-1.71 (2.28)

-4.52 (1.17)

  1. Key BSC, best supportive care, CM chronic migraine, EM episodic migraine, MMDs monthly migraine days, SE standard error, TF3+ have tried three or more other preventive treatments that failed
  2. aSE = 20% of mean estimate
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Philippine students are told to stay home as Southeast Asia copes with a sweltering heat wave | PBS NewsHour

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MANILA (AP) — Southeast Asia was coping with a weekslong heat wave on Monday as record-high temperatures led to school closings in several countries and urgent health warnings throughout the region.

Millions of students in all public schools across the Philippines were ordered to stay home Monday after authorities canceled in-person classes for two days. The main advice for everyone, everywhere has been to avoid outdoor activities and drink plenty of water, but the young and the elderly were told to be especially careful.

Cambodia this year is facing the highest temperatures in 170 years, Chan Yutha, a spokesperson for the Ministry of Water Resources and Meteorology, told The Associated Press on Monday. His agency has forecast that temperatures in most parts of the country could reach up to 43 degrees Celsius (109 degrees Fahrenheit) this week.

Myanmar’s meteorological department said Monday that seven townships in the central Magway, Mandalay, Sagaing and Bago regions experienced record-high temperatures. Several towns in Myanmar last week were on lists of the hottest spots worldwide.

Chauk township in Magway, historically the country’s hottest region, saw Myanmar’s highest temperature at 48.2 degrees Celsius (118.8 degrees Fahrenheit), breaking the previous record of 47.4 degrees Celsius (117.3 degrees Fahrenheit) set in 1968.

WATCH: A Brief But Spectacular take on giving climate activism a shot

The Philippines is among the nations worst affected by the sweltering weather in Southeast Asia, where the intense tropical summer heat worsened by humidity forced class cancellations in recent weeks and sparked fears of water shortages, power outages and damage to agricultural crops.

The Department of Education ordered students in more than 47,000 public schools to switch to home-based and online learning due to health risks from record-high temperatures and a three-day strike starting Monday by drivers who oppose a government program they fear would remove dilapidated passenger jeepneys from streets.

Large crowds have sought relief in air-conditioned shopping malls in Metropolitan Manila, the congested capital region of more than 14 million people where the temperature soared to 38.8 degrees Celsius (101.84 Fahrenheit) Saturday, surpassing the record set decades ago, according to weather officials.

In Thailand, temperatures have topped 44 C (111 F) in some areas in the northern parts of the country, while the capital Bangkok and metropolitan areas have seen temperatures go above 40 C (104 F). The forecast from the Meteorological Department said this year’s summer, which usually lasts from late February to late May, is expected to be 1-2 degrees hotter than last year, and rainfall will be lower than average.

Thailand’s Department of Disease Control said last week that at least 30 people have died from heatstroke so far this year, compared to 37 for all of last year.

Scientists have said the number of heat-related deaths around the world has been rising significantly in recent years along with temperatures, but the trend in Asia this year so far is unclear, partly because of the question of how to classify deaths that appear to be heat related.

At least 34 people have fallen ill due to the extreme heat in the Philippines so far this year, including six who died. The Department of Health said it was verifying what exactly caused the deaths.

Media in Bangladesh reported that in a five-day period earlier this month, at least 20 people died from heatstroke.

In Cambodia, however, officials indicated there were few if any heat-related fatalities. The Khmer Times, an online news platform, quoted the head of the Health Department of Phnom Penh, the capital, saying there had been no heat-related deaths or collapses.

Associated Press writers Sopheng Cheang in Phnom Penh, Cambodia and Jintamas Saksornchai in Bangkok contributed to this report.

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anarchopuppy:weirdlylyricalnotes:shouldabeentwins:valoricky:memewhore:This is a ...

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anarchopuppy:

weirdlylyricalnotes:

shouldabeentwins:

valoricky:

memewhore:

This is a stupid conversation! and I’m not going to continue it!


literally so fucking correct

What I’m really proud of is the fact that he made SURE the audience understood why the caller was being an idiot. He made a PERFECT comparison, gave the caller an honest chance to re-evaluate and change his mind. His point landed, everyone knew it, even the caller (note his pause and almost hesitancy after being asked).

But when the caller decided to bulldoze on anyway, because god forbid actually listen to the other person in the conversation, the expert cut him off and refused his time. And good for him.

[VD: A tweet by @ g33kgurli, tweeted at 9:47 PM on Dec 17, 2021. It reads, “Perhaps the best clap back to antivaxxers and antimaskers.” Attached is a video from The Thom Hartmann Program, where Hartmann is talking with a caller. The conversation goes as follows:

Caller: Hey Thom. Uh, I was listening to you for the last hour so, um, I heard survival of the fittest. Um, you know some of us choose not to vaccinate and uh–

Hartmann: You’re nuts, Nicholas.

Caller: –because we work very hard about staying fit, eating healthy, and our natural immune system.

Hartmann: So Nicholas if you’re so healthy, would you have unprotected sex with somebody who has syphilis or gonorrhea?

Caller: You’re missing the point.

Hartmann: No, I’m not missing the point. They’re contagious diseases. Would you have unprotected sex with somebody who has syphilis and gonorrhea and not worry about it because you’re so healthy?

Caller: [pause] No, I wouldn’t do that.

Hartmann: Okay, then why would you expose yourself to covid without having some protection?

Caller: Because the protection is my natural immunity.

Hartmann: No, it’s not. Tell that–

Caller: Yes, yes, my natural immune system–

Hartmann: Tell that to eight hundred thousand dead Americans. Nicholas, this is- this is a stupid conversation and I’m not going to continue it.

/end VD]

Everyone who’s ever died of a disease had an immune system

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sarcozona
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Nadezh
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I cant believe this tweet is how I find out

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would-you-punt-them:

loredwy:

I cant believe this tweet is how I find out

now all the things you guys have told me about american high schools are starting to make sense

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sarcozona
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The only thing university administrators had to do was NOTHING.

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I am not on campus this semester. I’m on sabbatical, sitting in coffeehouses, writing blog posts and a book.

But if I were on campus this semester, yesterday I would have seen the quad across the street filled with tents yesterday. And then I would have seen the police arrive, to break up the encampment. Not the campus cops either — the real ones.

Those are my students occupying the tents. I don’t mean that figuratively. Among the students who organized the protest action on campus yesterday are almost certainly people who have taken my strategic political communication class. They’ve shown up to my office hours. They did the reading. (FWIW, several of them are jewish.)

One book that I have my students read every semester is E.E. Schattschneider’s 1960 classic, The Semi-Sovereign People. The book is a tight 180 pages. It weighs only 7.1 ounces. I mention its weight because, if I were on any college campus right now, I would be mighty tempted to smack a few administrators in the face with it. Doing so would leave an impression without leaving a mark.

Schattschneider tells us that contentious politics can be best understand through a lens of conflict expansion. Those in power will (and, strategically, should) try to maintain and contain the scope of a conflict. Those arrayed against them will (and should) attempt to expand the scope of the conflict. If you want to understand an episode of contentious politics, don’t evaluate the substance of the arguments as though you are judging an intercollegiate debate. Instead, watch the crowd.

I don’t personally know Columbia University’s President, Minouche Shafik. But I am pretty confident that, unlike my students, she has not read her Schattschneider.

If you had asked me on April 17th what I thought of the Columbia University encampment, I would’ve shrugged my shoulders before apologetically explaining why it didn’t seem like an especially powerful tactic. Around 100 Columbia University students had set up a tent city on the campus quad. They were standing in solidarity with the residents of Gaza, while making demands of the campus administration.

This is a radical tactic, but it is not a novel tactic. It breaks campus rules while demonstrating commitment and solidarity among the participants. But it is also a radical tactic that is relatively easy to defuse or ignore. There is less than month until finals and the end of the semester. The students aren’t preventing the university from operating. They are making some noise and making a scene. Once the semester ends, the campus shuts down, as does the encampment.

The way that administrators normally respond to a tactic like this is to just wait it out. Have campus security keep an eye on them to make sure things don’t get out of hand. Make vague statements to the campus paper. Schedule some meetings. Maybe declare that you’ll form a committee to look into things further.

Traditionally, the weakness of this tactic is that it does little to expand the conflict. Students are outraged. They have demands. But they don’t have numbers or time on their side. Even when the majority of their peers agree with them, so long as the administration slow-walks the response, it will remain a conflict between the most-committed student activists and a slow-moving bureaucracy.

All the administration has to do is nothing. University administrators are great at doing nothing.

But that’s not how it looked to President Shafik. Because she wasn’t responding to the students.

She was responding to the former Presidents of Harvard and Penn.

Here’s the basic timeline of events.

  • Five months ago, the Presidents of Harvard, Penn, and MIT testified before a House committee. This was a trap. It was not subtle. Everyone knew it was a trap.

  • Instead of prepping for the testimony by talking to a comms professional, they prepped by talking to a lawyer. (Don’t do that. Don’t treat televised spectacle like a deposition. It will go badly for you in all the very predictable ways.)

  • Having screwed that up, outraged conservative alumni were able to force Penn’s President to resign. That was a win for them. They tried to force Harvard’s President to resign. That didn’t work, so they ginned up some more faux scandals until they got their way. Double-win.

  • Fast-forward to this month. Columbia’s President is asked to testify before the House committee as well.

  • She decides to do the opposite of those other Ivy League Presidents. That, apparently, is her entire comms strategy. Just agree with everything the hostile Republicans say, and hope they applaud you at the end.

  • But they aren’t asking these questions in good faith. They are strategic actors, pursuing another win. (Again, this isn’t exactly subtle.)

  • Having given them every answer they asked for, she then went back to campus and clamped down on the protest, in order to prove that she really totally meant it, guuuuuuys.

  • They’re calling for her resignation anyway, and turning Columbia into a prop. Of course they are. That’s what they were planning to do anyway. You only win against these Congressional Republicans by refusing to play their game.

  • But in the meantime, she called in the NYPD to clear the encampment. And she tried to shut down the campus radio station. And she barred journalists (IN NEW YORK!) from covering the Columbia protests (DESPITE COLUMBIA JOURNALISM SCHOOL BEING THE PLACE THAT AWARDS THE PULITZERS).

  • And, oh yeah, now that the conflict has expanded, a bunch of protestors unaffiliated with the university, some of whom are rabid antisemites, are showing up and shouting things at students in front of cameras as well. Not great, because this part can potentially escalate in directions that pose an actual safety risk to students. (Unlike the encampment, which wasn’t a risk to anyone. And which you could’ve just ignored if you weren’t shadowboxing the phantom figures of other universities’ former presidents.)

  • So now you’ve launched the biggest crackdown on campus speech since the 1960s. The conflict has now expanded. Every college campus is now going to feature an encampment. And that encampment is both a show of solidarity with people in Gaza and a show of solidarity with students at Columbia. (And Emory. And UT Austin. And probably a dozen other places.)

All you had to do was ignore the fuckin’ encampment for a month. Maybe make a bland statement. Have campus security issue a citation or two. Declare that a committee is going to look into things.

Saul Alinsky writes that “the action is in the reaction.” The campus encampments don’t work if you don’t react to them. And not reacting to student speech on campus is usually one of the things that university administrators do best.

Instead, here we are. Snipers on the roofs of major universities. Encampments springing up everywhere. Actual cops arresting students and faculty. Enough of a spotlight that every university administration is worried that shit might go sideways. Republican politicians gleefully egging it on, crowing about “chaos on campus.” (Because the more this moment resembles 1968 on tv, the better.)

The conflict has expanded. Colleges are passing draconian measures to clamp down on campus protest. Students are responding to those actions, and responding to the police violence. The action is in the OVER-reaction. The semester will end soon, but it now seems more likely that it will form an ellipses instead of an ending.

I’m worried for my students. They are smart and they are brave and they are outraged. They are facing batons and tear gas. This escalation did not have to happen. This escalation will not end well.

I blame Republican legislators. But I also expected them to behave this way. Tom Cotton is exactly how we thought he was. Elise Stefanik’s outrage is scripted, typecast. They have not been subtle about their views or intentions.

I did expect more from University administrators — Shafik especially. All she had to do was act like an average university administrator. Make noncommittal promises, and wait.

Now this is spiraling. And I sit here in this coffeehouse, tapping away at the keyboard. Hoping my students are safe. Hoping I taught them well enough. Wishing that the people who run universities would learn anything at all.

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sarcozona
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hannahdraper
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All the administration has to do is nothing. University administrators are great at doing nothing.
But that’s not how it looked to President Shafik. Because she wasn’t responding to the students.

She was responding to the former Presidents of Harvard and Penn.
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A vegan cheese beat dairy in a big competition. Then the plot curdled. - The Washington Post

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In the wine world, the 1976 Judgment of Paris — a blind taste test in which California chardonnays and Bordeauxs beat out their French counterparts — is remembered as the shocking upending of long-standing order.

A similar moment looked like it was coming to the demimonde of artisanal cheese. On Monday, the winners will be announced of the Good Food awards, a prestigious honor that considers both the quality of the products and the environmental and social consciousness of the companies that produce them.

When the California-based foundation that doles them out announced the finalists in January, among the candidates was a blue cheese from Climax Foods from Berkeley, Calif. The difference between that entrant and its competitors wasn’t a silky mouthfeel or buttery flavor, but rather the fact that the Climax Blue — which is served in restaurants including Michelin-starred Eleven Madison Park in New York — wasn’t made from the milk of cows or goats, but rather a blend of ingredients including pumpkin seeds, lima beans, hemp seeds, coconut fat and cocoa butter.

A plant-based “cheese” held up as an exemplar, in a blind tasting, among true dairy products? Traditional cheesemakers were shocked. As word spread about the interloper, mostly through food writer Janet Fletcher’s Planet Cheese newsletter, the controversy fomented.

The Good Foods Foundation that oversees the awards at first offered a compromise solution: If, in fact, the Climax cheese was a winner, it announced, the foundation would name a co-winner. Then the foundation would reevaluate for next year, perhaps creating a new category or moving them into the broader snacks cohort.

But behind the scenes, things were getting messy.

This week, the foundation quietly removed the Climax Blue from the list of finalists on its website but didn’t make public what had disqualified the cheese. It wasn’t the fact that it is plant-based, since those products are explicitly allowed. But it had never been an issue since a vegan cheese had never impressed the judges enough to be named a finalist.

When asked by The Washington Post about its reasoning, Good Foods Foundation executive director Sarah Weiner at first declined to say, but she said something similar had happened only three times in the awards’ 14-year history. Someone — another entrant, perhaps, or someone else in the community — can alert the foundation that a contestant might not meet the requirements they attested to, which include such things as meeting animal-husbandry guidelines where applicable and offering employees fair wages and diversity training. Weiner also wouldn’t say who tipped off the foundation about Climax.

“I think there were a lot more eyes on this particular entrant than there would be on one of the hundreds of other finalists,” she said. “Which made it more likely that someone with expertise would reach out.”

Climax CEO Oliver Zahn accused the foundation of caving to pressure from dairy cheesemakers in revoking the award. And then he spilled the curds: Climax, it turns out, wasn’t just a finalist — it was set to win the award, a fact that all parties are asked to keep confidential until the official ceremony in Portland, Ore., but was revealed in an email the foundation sent to Climax in January. Based on that information, Zahn and several of his colleagues had planned to attend, booking hotel rooms and making travel plans, until, he says, learning from this reporter that his cheese was no longer in the running.

And in the days leading up to the big event, Climax and the Good Food Foundation offered differing versions of the circumstances around the rare award revocation.

Zahn says the foundation made no attempt to reach the company to address potential questions, citing company email records. Weiner says they emailed and called the person who had submitted the application — who they learned no longer works for Climax — and then emailed another employee with no response.

Zahn says he suspects that the person who lodged the complaint is an “informant” from the dairy cheese world who has been particularly outspoken. The substance of the complaint appeared to rest on the ingredient kokum butter — which is derived from the seeds of a kokum tree’s fruit — that Climax used in an earlier version of its cheese. Kokum butter has not been designated as GRAS (generally regarded as safe) by the Food and Drug Administration. Not all ingredients need a GRAS certification: The FDA grandfathers those that have common use in food.

When Climax and the other competitors submitted their products, the Good Food Awards didn’t explicitly require GRAS certification for all ingredients. Since then, though, the foundation added GRAS certification to its rules — a move Zahn says was a belated and clumsy attempt to disqualify him. It isn’t clear when the foundation added the language, but an internet archive search showed that the new wording wasn’t there in January, after the finalists had been announced. Weiner said the awards exist to promote good foods, and that food safety is part of that definition. The addition of the language was “a clarification of our principles and standards ... rather than a new rule,” she said in an email.

Zahn says the kokum butter shouldn’t be an issue anyway: The company has replaced it with cocoa butter, which does have GRAS certification, and that’s the version he says the version he submitted for the awards. (Weiner contends that Climax submitted an ingredient list that included kokum.) Zahn says they could have worked the confusion out if they’d only known about the complaint sooner, but Weiner said the company missed a deadline to respond. “This is something we would have been happy to take a look at if they had gotten back to us in time,” she said in an email.

Another dispute between the two sides? Weiner said the Climax cheese violated a requirement that any product submitted for an award be ready for retail sale, but Zahn insists the cheese is retail-ready.

Weiner called the controversy around Climax and its ultimate disqualification “a big bummer,” but said it showed how much the food community cares about the foundation’s mission. “Our way of making change is to celebrate the good as opposed to call out the bad,” she says. “But other people are good at that.”

Zahn, though, was left frustrated. For his fledgling company, a Good Food Award would have attracted potential buyers for retail stores and impressed would-be investors. Instead, he was soured by the experience — and pretty sure he won’t submit entrants in future years. “Changing the rules six months after submission, and then not even trying to reach the company to try to fix a fixable situation? If that happened in my company, I would step down as CEO,” he says. “Seriously, I would step down because that would be so embarrassing to me that there was no way I could justify continuing to run the company. And I would fire anybody who was involved.”

The to-do wasn’t just a tempest in a cheese pot, the kind of infighting you might find in any industry. Writ large, a plant-based cheese’s ascension to the top of a prestigious heap might be a bellwether moment, an inflection point in the evolution of vegan cheese from rubbery-textured punchline to a product worthy of sitting alongside some of the country’s top cheddars and tommes. And the pushback might offer a preview of the battle that could play out over supermarket shelf space and even the word “cheese” itself.

To Zahn, the method he’s using isn’t all that different from the one used for centuries. When it comes down to it, he notes, plants fuel the animals that produce milk — and so in concocting a milk made out of plants, Zahn says he’s just cutting out the middleman (or middle-bovine). In his analysis of traditional cheesemaking, a cow is essentially a processing machine — and not a very efficient one at that.

“There’s a lot of energy being used to turn something from one thing to another, and in the case of a cow, 90 percent of the inputs go to just processing,” he says. “There is no factory you could potentially devise that would come with that much processing.”

But traditional cheesemakers see the companies making vegan products as simply operating in another business entirely.

“These are engineered products. And they’re part of a financialized food system that’s fueled by venture capital and disconnected from nature,” says Mateo Kehler, co-owner of the family-run Jasper Hill Farm in Vermont. Kehler’s cheese has previously won Good Food awards, and his bark-wrapped, bloomy-rind Harbison cheese is a finalist this year. “You have these technological products, but they rely on adjacency to the value proposition that we have created — through labor and through creating products that are truly connected to a landscape, to a farming system, and to our collective human history.”

“One could make the argument that this is like a fraudulent cheese,” Kehler said. “As a cheesemaker, it’s a fraud. It looks like a cheese. It might taste like a cheese. But it’s not. It’s not connected to our historical understanding of what cheeses are.”

Kehler appreciates that consumers might want to buy foods that take less of a toll on the environment. But, he says, his farm and ones like it have a much smaller environmental footprint than many of the crops, such as almonds, that are used to create many vegan products. “The people are compelling,” he says of the vegan cheese companies. “The foundational principles and the big ideas are really compelling — like the idea of fully disrupting industrial agriculture. But that’s not what’s happening.”

From a taste perspective, Zahn understands the bad rap that vegan cheese has gotten, or at least what he describes as the “first generation” of the products that rely on artificial flavorings, gums, starches and oils with results that are often bouncy and gummy. But the category is evolving, with companies making high-end products that more closely mimic the real thing, often using culturing and aging processes similar to the traditional methods. Vegan cheese shops have opened from Los Angeles to Atlanta. Big food companies are delving in.

For the Good Food awards, a panel of judges taste entrants without knowing their brands. In the cheese category, judges may learn whether the samples are from cow or goat’s milk — or in the case of Climax, from plants. Weiner indicated that the judges were aware that they were trying a vegan entrant. “Very impressive for being vegan but obviously plant-based,” was one judge’s written comment, she relayed.

“The fact that they selected us to make it this far is exciting, and a testament to the fact that we don’t need cows,” Zahn says.

Janet Fletcher, the newsletter author who has been following the controversy, says it has stoked an unusual level of drama in a typically collegial industry. “For some farmers, it feels almost like an insult to say that their product could be compared to something created in the lab,” she says.

The Good Food awards matter, she says. They might not be something the average consumer is aware of, but retailers often look for the imprimatur when seeking out high-quality, ethically sourced goods.

The incident also brings up the question of semantics. Can you call something “cheese” that has nothing to do with animals? We’ve been here with milk: When alternatives, starting with soy, began making inroads, the dairy industry pushed back. They ultimately lost, with the Food and Drug Administration releasing guidelines allowing plant-based products to be labeled and marketed as milk, but the battle has continued: Last year, the Milk Processor Education Program brought back its iconic milk-mustache motif in a faux advertisement in which actress Aubrey Plaza plays the CEO of a company that makes an unappealing “wood milk,” a clear jab at the alt-milk industry.

Miquela Hanselman, director of regulatory affairs for the National Milk Producers Federation, says vegan products don’t meet the federally prescribed standards of identity for cheese, either. “Our stance is basically the same — if you’re going to use the word cheese on your package, and you’re not going to qualify it with ‘substitute’ or ‘alternative’ that is pretty boldly out there and explain the differences, then it shouldn’t be on the label.”

Marjorie Mulhall, senior director of policy for the Plant Based Food Association, says labeling is just a matter of making things easier for shoppers. “Using cheese terminology helps consumers locate plant-based foods to meet their needs,” she said in an email.

Zahn insists he isn’t hung up on terminology, and would defer to consumers on the matter. And while he says he doesn’t want to offend traditional cheesemakers and instead hopes they can coexist, he challenges his skeptics to have an open mind. “Maybe there is a fear about us infringing or replacing them, but I don’t see it that way — I just want us all to work together towards the better,” he says. “The other thing I would tell them is to taste it themselves. Do they like it?”

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