Why Competition Hasn’t Brought Down The High Price Of Snakebite Treatment

The antivenin market for treating bites from rattlesnakes and other pit vipers might be considered a case study of why drugs prices are so high. Head-to-head competition between brand-name medicines may not meaningfully reduce prices.

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Dr. Steven Curry, a medical toxicologist and professor at the University of Arizona, has treated snakebites since the 1980s — long enough to remember when the treatment represented its own form of misery.

The first medication Curry used sometimes caused an immune reaction called serum sickness — patients broke out in a severe, itchy rash. Then, about 20 years ago, the snake antivenin CroFab entered the market and dramatically reduced the adverse reactions associated with treatment, he says.

But the drug came with a sky-high price tag. In one case reported by NPR and Kaiser Health News, an Indiana hospital last summer charged nearly $68,000 for four vials of CroFab.

Now, CroFab faces competition from a snake antivenin called Anavip. Curry says the health system he works for in Phoenix — Banner Health — is using the new drug as its first line of treatment. It is switching, he says, because Anavip could reduce readmissions by better controlling bleeding associated with a snakebite and lead to “substantial savings” for the hospital.

But few experts who study drug laws and drug prices expect this competition to reduce the cost for patients. Legal wrangling, the advantageous use of the patent system and the regulatory hurdles in creating cheaper alternative drugs stymie any serious price competition.

Indeed, the antivenin can be considered a case study of why drug prices are so high: Head-to-head competition between brand-name medicines may not meaningfully reduce prices.

“When we allow a system of perverse incentives to flourish, this is the result we get,” says Robin Feldman, a professor at University of California, Hastings College of the Law in San Francisco, who specializes in pharmacy law.

After being approved by the Food and Drug Administration in 2000, CroFab was the only commercially available snake antivenin in the United States.

That gave the drug’s British manufacturer, BTG, “a lot of latitude to determine what price it’s going sell its product at,” says Aaron Kesselheim, a faculty member at Brigham and Women’s Hospital in Boston, who studies pharmaceutical policy.

The Centers for Disease Control and Prevention reports that roughly 8,000 people in the U.S. each year are bitten by venomous snakes, which means there’s not a huge market for antivenin. But victims desperately need the remedy. Snake venom can cause tissue damage, hemorrhaging and respiratory arrest — in other words, a painful death.

Having had the market all to itself for years, CroFab has quadrupled in price since its launch, according to data from the health technology company Connecture. Today, the list price for wholesalers for the medicine is $3,198 a vial and the recommended starting dose for a patient is between four and six vials.

CroFab generated more than $132 million in revenue for its parent company, according to BTG’s 2019 annual report. The antivenin represented 14% of the firm’s total revenue.

Anavip, the competitor drug that was launched in October, is priced at $1,220 per vial for wholesalers, and the recommended initial dose is 10 vials.

That’s a “sustainable price that keeps us in business,” says Jude McNally, president of Rare Disease Therapeutics, a Tennessee-based company that markets Anavip in the U.S. (The drug is made by a Mexican company.) McNally says he has no plans to lower the price.

In practice, the prices for these drugs are closer than they appear.

Doctors need to use a higher starting dose of Anavip than of CroFab. Taking that into account, the difference in wholesale price from Anavip shrinks to about $500.

McNally says RDT “has done what we can to reduce initial and subsequent health care costs” with Anavip. He also noted that the package insert for CroFab recommends that patients receive additional doses on a timed schedule if needed to control the damage from the snakebite, making treatment more expensive.

In general, Kesselheim says, direct competition between two drugs can reduce prices for consumers by 15% to 20%. But “if you’re starting at a very high price,” he says, “it may not be helpful for patients.”

Cheaper, alternative versions of brand-name drugs can drive prices down. But an analysis by Kesselheim and his colleagues, described in the New England Journal of Medicine in 2017, found this tends to happen only after three or more generic drug manufacturers enter the market. At that point, the increased competition can offer generic drugs that are priced at 60% (or less) of the brand name’s initial price per dose.

That didn’t happen with antivenin. Manufacturers face bureaucratic challenges to making a cheaper, copycat drug to compete with CroFab and Anavip. These snake antivenins are biologic drugs — complex medicines made from live cells. Congress created a unique pathway for the FDA to greenlight cheaper equivalents to biologics, called biosimilars, in 2009.

As of July 23, the agency has approved 23 biosimilars. In contrast, European countries enjoy a larger, thriving market of biosimilars that are sold at a fraction of the U.S. cost.

In the U.S., even when the FDA approves another drug, the maker can manipulate the patent process to keep competitors out. A patent allows a drug manufacturer to claim ownership of certain product information and bar others from making, using or selling a drug based on the protected content for 20 years. This gives manufacturers a powerful edge – they can sue potential competitors for patent infringement.

“The most creative activity in the drug company should be in the lab, not in the legal department” says Hastings law professor Feldman, paraphrasing a former FDA commissioner.

Indeed, it was lawyers who helped BTG make even more money. When the makers of Anavip first wanted to enter the snake antivenin market in 2013, BTG sued them; the companies settled the case in 2014. In the agreement, Anavip promised to pay BTG royalties on its sales of antivenin until 2028.

BTG intends to maintain its market dominance, says spokesman Chris Sampson, by using strategies that include improving the CroFab formula. He also says the company doesn’t plan to lower the drug’s price.

“If your question is ‘Are we ready for the competition?’ ” Louise Makin, CEO of BTG, told investors in a May 2018 earnings call, “we are ready — we are absolutely ready.”

Kaiser Health News is a nonprofit, editorially independent program of the Kaiser Family Foundation. KHN is not affiliated with Kaiser Permanente.

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After World Cup Win, Other U.S. Women’s Sports Leagues Ask, ‘What About Us?’

Seattle Mayor Jenny Durkan, center, wears a T-shirt honoring Megan Rapinoe, right, of the U.S. women’s World Cup championship soccer team, and Seattle Storm’s Sue Bird, left, as Rapinoe was introduced during the first half of a WNBA basketball game between the Storm and the Dallas Wings on July 12, 2019 in Seattle.

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Fans of the World Cup champion U.S. Women’s National Soccer Team are getting what they want.

More.

The team began a victory tour last weekend. It runs until October.

It’s a heady time for women’s soccer. But other women’s sports want to take advantage of the moment as well. And they’re hoping to overcome cultural obstacles that traditionally have made their sports less relevant.

Powerful potential

Five days after the U.S. won the Women’s World Cup, fans of the WNBA’s Seattle Storm welcomed a surprise visitor to the team’s home arena. Even from the cheap seats, the pink/purple hair gave it away.

“Well look who has graced us with her presence,” Storm play-by-play announcer Dick Fain told a television audience. “Is there a more recognizable face in the world of sports over the last month, than that young lady on the right, Megan Rapinoe?!”

Welcome home, CHAMP! ???@mPinoe #WeRepSeattle pic.twitter.com/P88CvUPiar

— Seattle Storm (@seattlestorm) July 13, 2019

Actually this moment wasn’t a shock. Rapinoe and Storm star Sue Bird are one of Seattle’s “it” couples. Still, Rapinoe’s appearance and standing ovation from an arena full of basketball fans, was a reminder of the powerful crossover potential of the women’s World Cuppers.

“For me it was just simply hopeful,” said Storm CEO and General Manager Alisha Valavanis. “That that awareness would continue to expose the country and the globe to the other sports.”

Like ice hockey, lacrosse, softball, pro soccer … and basketball, the most prominent of this country’s women’s professional sports.

A complex game

It would be wonderful, Valavanis said, if this awareness of the Women’s National Soccer Team and exposure to the others, were like a magic wand. That could wave away the chasm separating women’s and men’s pro sports, on issues of money, visibility and relevance.

But there’s no magic wand.

“This is a complex game,” Valavanis said, adding, “there is no quick fix to….the gap.”

Talking is a start.

Rapinoe and her soccer teammates have done plenty of that, about the gap in pay and inferior working conditions. WNBA players are confronting similar issues. Seattle forward Alysha Clark said they’ve been newly-inspired by the soccer team.

“They’re helping grow the confidence of women athletes,” Clark said, “to speak up for what we feel is right.”

An uncomfortable truth

But if a conversation about women’s sport truly has been sparked by the success and audacity of the U.S. Women’s National Team, ultimately it has to also confront an uncomfortable truth.

“Whatever sport is out there that women are trying to make their way professionally,” said Storm co-owner Ginny Gilder, “the biggest problem is the extent, the depth of what I would call invisible and cultural bias against women professional athletes.”

Gilder has owned the Seattle Storm with two other women since 2008. As an undergraduate rower at Yale in the 1970’s, she took part in a Title IX protest – Title IX is the federal law that, among other things, bans gender discrimination in girl’s and women’s sports. Gilder says the protest radicalized her and made her keenly aware of the bias.

“I think we make an assumption, it’s a very deeply held assumption,” she said, “that men are more important. And you actually start seeing that in sports at a very young age.”

“[Even at] 10 years old, boys are starting to have more fans. By the time you get to high school, this interest in supporting boys’ sports has been well established.”

The choice of what to watch

The traditional argument is that male sports are better. Because the athletes mostly are bigger, stronger, faster. Gilder says it’s what often tips the balance when fans have a choice – between paying money to watch a men’s pro sporting event, or a women’s.

“But who decides that?” Gilder asked. “Who decides that women’s basketball isn’t interesting?”

Ginny Gilder at her home in Seattle. Gilder, who won a silver medal in rowing at the 1984 Olympics, owns the Seattle Storm with two other women.

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Storm CEO Valavanis places some of the blame on mainstream sports media.

“What if we started to play more highlights of the women?” Valavanis said. “Would we then have those individuals, watching and saying ‘gosh I need to see the dunk. I’m only interested if they’re as fast and strong as the men.’ Or is that something we perpetuate because it’s exactly what you’re watching every day?”

Certainly the choice isn’t always to watch men.

At a recent WNBA game in Washington, D.C., Washington Mystics fan Teresa Tidwell said she’s had the choice of basketball games. And she prefers the women.

“I think in women’s basketball, particularly in women’s professional basketball, the team play is better,” Tidwell said. “In men’s professional basketball it’s a lot of run and gun. It’s not really very entertaining from my point of view.”

The WNBA hasn’t had enough Teresa Tidwell’s.

In each of its 23 seasons, the league reportedly has never made a profit. Building up attendance is an ongoing problem. Heading into the recent WNBA All-Star break, Seattle ranked fourth out of 12 teams in total attendance. Still the Storm does what it can to bring fans to games. Including a promotion offering free tickets…for donated blood.

Twenty-nine-year-old Jordan Lake and two friends took advantage of the deal at a recent home game. Their first WNBA experience.

“It’s entertaining,” Lake said, watching the Storm play the Las Vegas Aces. “I’ve grown up with sports. I love sports. You’ve got to find something else to watch in the off-season of football, I suppose.”

Not exactly a ringing endorsement. Despite the athleticism on display in a tight, competitive game, Lake said he probably wouldn’t come back if he had to pay for a ticket.

Not betting, but hopeful

In the face of resistance, still, is there the chance to nudge a cultural change more toward women’s sports?

“I absolutely believe that it’s possible, said Storm co-owner Gilder. “At the same time, I’m a business person and I’ve been in this business for 12 years and I’m not betting on it.”

But she’s hardly giving up, either.

“I am a believer in progress,” Gilder said. “And without showing up and agitating in some way, then you’re wishing. That’s your choice. Agitate or wait.”

“Is this a pivotal moment?” she asked. “Has the Women’s World Cup team been able to bring more awareness in a way that individual Americans start looking at themselves, not in a critical way but like….’oh my gosh [women’s professional sports] could be fun to be part of,’ or ‘I want to do this,’ or maybe a little bit of ‘I should do this.'”

“I hope so.”

A new WNBA plan could help fuel Gilder’s hope.

This fall and winter, some of the league’s best players will tour the country as part of the lead-up to next summer’s Olympics in Tokyo. The training and games will also help increase visibility and connect players more with fans.

Seattle guard Sue Bird helped come up with the idea.

Her inspiration, in large part, was the electric experience of the U.S. Women’s National Soccer team.

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Coordinating Care Of Mind And Body Might Help Medicaid Save Money And Lives

John Poynter of Clarksville, Tenn., uses a wall calendar to keep track of all his appointments for both behavioral health and physical ailments. His mental health case manager, Valerie Klein, appears regularly on the calendar — and helps make sure he gets to his diabetes appointments.

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In modern medicine, the mind and body often stay on two separate tracks in terms of treatment and health insurance reimbursement. But it’s hard to maintain physical health while suffering from a psychological disorder.

So some Medicaid programs, which provide health coverage for people who have low incomes, have tried to blend the coordination of care for the physical and mental health of patients, with the hope that it might save the state and federal governments money while also improving the health of patients like John Poynter of Clarksville, Tenn.

Poynter has more health problems than he can even recall. “Memory is one of them,” he says, with a laugh that punctuates the end of nearly every sentence.

He is currently recovering from his second hip replacement, related to his dwarfism. Poynter is able to get around with the help of a walker — it’s covered in keychains from everywhere he’s been. He also has diabetes and is in a constant struggle to moderate his blood sugar.

But most of his challenges, he says, revolve around one destructive behavior — alcoholism.

“I stayed so drunk, I didn’t know what health was,” Poynter says, with his trademark chuckle.

Nevertheless, he used Tennessee’s health system a lot back when he was drinking heavily. Whether it was because of a car wreck or a glucose spike, he was a frequent flyer in hospital emergency rooms, where every bit of health care is more expensive.

The case for coordination of mind-body care

Tennessee’s Medicaid program, known as TennCare, has more than 100,000 patients who are in similar circumstances to Poynter. They’ve had a psychiatric inpatient or stabilization episode, along with an official mental health diagnosis — depression or bipolar disorder, maybe, or, as in Poynter’s case, alcohol addiction. And their mental or behavioral health condition might be manageable with medication and/or counseling, but without that treatment, their psychological condition is holding back their physical health — or vice versa.

“They’re high-use patients. They’re not necessarily high-need patients,” says Roger Kathol, a psychiatrist and internist with Cartesian Solutions in Minneapolis, who consults with hospitals and health plans that are trying to integrate mental and physical care.

As studies have shown, these dual-track patients end up consuming way more care than they would otherwise need.

“So, essentially, they don’t get better either behaviorally or medically,” Kathol says, “because their untreated behavioral health illness continues to prevent them from following through on the medical recommendations.”

For example, a patient’s high blood pressure will never be controlled if an active addiction keeps them from taking the necessary medication.

But coordinating mental and physical health care presents business challenges — because, usually, two different entities pay the bills, even within Medicaid programs. That’s why TennCare started offering incentives to reward teamwork.

Health Link

TennCare’s interdisciplinary program, known as Tennessee Health Link, was launched in December 2016. The first year, the agency paid out nearly $7 million in bonuses to mental health providers who guided patients in care related to their physical health.

TennCare has a five-star metric to gauge a care coordinator’s performance, measuring each patient’s inpatient hospital and psychiatric admissions as well as visits to emergency rooms. Providers are eligible for up to 25% of what’s calculated as the savings to the Medicaid program.

Studies show this sort of coordination and teamwork could end up saving TennCare hundreds of dollars per year, per patient. And a 2018 study from consulting firm Milliman finds most of the savings are on the medical side — not from trimming mental health treatment.

Savings from care coordination have been elusive at times for many efforts with varying patient populations around the U.S. A TennCare spokesperson says it’s too early to say whether its program is either improving health or saving money. But already, TennCare is seeing these patients visit the ER less often, which is a start.

While there’s a strong financial case for coordination, it could also save lives. Studies show patients who have both a chronic physical condition and a mental illness tend to die young.

“They’re not dying from behavioral health problems,” points out Mandi Ryan, director of health care innovation at Centerstone, a multistate mental health provider. “They’re dying from a lack of preventive care on the medical side.”

“So that’s where we really started to focus on how can we look at this whole person,” Ryan says.

But refocusing, she says, has required changing the way physicians practice medicine, and changing what’s expected of case managers, turning them into wellness coaches.

“We don’t really get taught about hypertension and hyperlipidemia,” says Valerie Klein, a care coordinator who studied psychology in school and is now an integrated care manager at Centerstone’s office in Clarksville, Tenn.

“But when we look at the big picture,” Klein says, “we realize that if we’re helping them improve their physical health, even if it’s just making sure they got to their appointments, then we’re helping them improve their emotional health as well.”

Klein now helps keep Poynter on track with his treatment. Her name appears regularly on a wall calendar where he writes down his appointments.

Poynter calls Klein his “backbone.” She helped schedule his recent hip surgery and knows the list of medications he takes better than he does.

Klein acknowledges it’s a concept that now seems like an obvious improvement over the way behavioral health patients have been handled in the past. “I don’t know why we didn’t ever realize that looking at the whole person made a difference,” she says.

This story is part of NPR’s reporting partnership with Nashville Public Radio and Kaiser Health News.

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The Thistle & Shamrock: From The Archives, Part 1

Cathie Ryan is one of the artists featured on this week’s episode of The Thistle & Shamrock.

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It’s a bit like browsing through a photo album where the memories are captured in sounds, not images. Join Fiona Ritchie as she delves into her archives to re-visit highlights from the past decade of radio shows featuring artists John Doyle, Peggy Seeger and Cathie Ryan.

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Women’s World Cup Bump — Short-Lived Or Longer?

Before the Dash and Sky Blue FC match, a ceremony honors Dash members who played during the World Cup.

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It’s been a month since the U.S. Women’s National Soccer Team won a second straight World Cup, and gained rock star popularity in the process.

Since the win, the goal has been to capitalize on that success.

U.S. Soccer Federation president Carlos Cordeiro has been at odds with the women’s team on issues of pay and working conditions. Still, Cordeiro understands the importance of maintaining USWNT momentum.

“If you love these players of the World Cup,” he said at a victory celebration in New York City, “then come out and cheer on your local teams, NWSL teams, this year.”

The NWSL is the women’s pro soccer league in the U.S. Now in its seventh year, it helped develop the World Cup heroes – all 23 who went to France, play in the league. But it’s still somewhat unknown.

Carli Lloyd, a veteran of the U.S. National Team and current member of Sky Blue FC, is interviewed by the press after the team’s loss to the Dash.

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“There are a lot of people out there that don’t even know there’s a league that exists,” said Carli Lloyd, “That’s a problem.” The U.S. National Team veteran and current member of the NWSL’s Sky Blue FC echoes Cordeiro’s call to action.

“It’s about awareness,” Lloyd said.

World Cup Bump

In the National Women’s Soccer League, World Cup bump is a relative term.

In soccer hotbed Portland, Ore., the NWSL’s Thorns drew a whopping post-World Cup crowd of more than 22-thousand. Orlando had its biggest attendance in two years. Even in Houston, where major pro teams like the Rockets, Astros and Texans dominate the sports landscape, the NWSL’s Dash had a season-high turnout at its first home game after the World Cup.

“We drew just under [5,500],” said Zac Emmons, the Dash’s senior director of Communications. “For Dash games we sell the lower bowl of [BBVA Stadium]. We had the entire lower bowl sold out. [We] actually had to open some upper level sections to accommodate the crowd.”

Fans watch the match from the lower-level of a nearly empty stadium in Houston.

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At the second post-World Cup game, the energy was there, but the paying customers – not so much.

This time, 3,500 people showed up on a hot, sticky Sunday night. Including some who still wanted to make a statement.

“I read a call to action, and that’s what I’m doing,” said Houston resident Marco Gomez, “I’m doing it. I’m acting.”

Marco Gomez, 30, watches the match. He says a call to support women’s soccer on Instagram is what got him coming to this game.

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Gomez, a 30-year-old hospital technician in Sugarland, Texas, explained what brought him to his first-ever Dash game.

“I was on Instagram,” he said, “and I read that the U.S. World Cup team was fighting for equal pay. One of the comments was a question addressed to Alex Morgan – it was like ‘hey Alex, what can we do to help out? What’s the most effective way?'”

“And the reply was, go support women’s soccer at all levels. That makes sense. So that’s what I’m doing.”

Gomez, wearing a backwards baseball cap and sipping a beer, sat and watched by himself. A few sections over, 9-year-old Remy Haguewood sat surrounded by family members. She’s been to lots of Dash games, but was as excited as ever, decked out in a white U.S. Soccer jersey and Houston Dash scarf.

Ava Martin (left), 9, and her friend Remy Haguewood (right), 9, pose for a portrait during the match.

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“I love soccer and I love the drums,” she bubbled, “they play the drums also [the Dash supporter group Bayou City Republic]. So it’s just awesome to be here.”

And, said her mom Lacy Haguewood, it’s also necessary.

“It’s very important to stay dedicated,” Lacy said, “to stay strong for these women. They go to work every day. Carli Lloyd just played for the World Cup and now she’s here [Lloyd’s Sky Blue team was playing the Dash]. Everyone knows who she is. You just have to stay the course and do what we do and that’s show up every day.”

Goal so good we have to take a look from every angle ?#DashOn pic.twitter.com/a4IfsCY7PD

— Houston Dash (@HoustonDash) July 30, 2019

Not Enough

On this night, the dedication of fans like the Haguewoods’ was rewarded midway through the first half.

That’s when Dash forward Rachel Daly blasted a shot from close range into the upper left corner of the Sky Blue goal. It was the only score in a one-nil Houston win over Sky Blue. Despite her starring role, though, Daly was not to be trifled with.

In the autograph line afterwards, where NWSL players work tirelessly to connect with fans, Daly reminded autograph-hungry little girls that manners matter.

Left: Girls hold small soccer balls to get them signed by players after the game; Right: Layla Reese, 8, has a Houston Dash logo painted on her cheek.

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“If you say please,” Daly said to a group of kids, who hadn’t said the magic word. “I know your mom told you to say that.”

One pre-teen fan responded quickly.

“Will you please sign my card?” the girl asked. “‘Cause you said please, I will,” Daly replied.

After she made her way through the line, I asked Daly if she thought the NWSL was getting the World Cup bounce people said it should.

Again, no nonsense.

“No, I actually don’t,” she said. “I think some places are, others aren’t. Y’know I don’t think there were enough people out there for us tonight.”

Promoting Others

Daly was on England’s Women’s World Cup team, which lost to the U.S. in the tournament’s semi-finals. She wondered if Houston lagged in the stands because no U.S. National Team members play for the Dash.

Team spokesman Zac Emmons says Houston has had USWNT members, but because of trades, doesn’t now. He’s not certain that has an impact on attendance. Emmons does say it’s natural you’ll see a bigger bump that first game back [after the World Cup].

“It’s a challenge for us to keep those people coming back,” he said, “to continue engaging with them on a week in, week out basis.”

Fans react to a play on the field.

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This kind of regression toward the mean is natural as the World Cup glow fades. All the more reason, said women’s soccer writer RJ Allen, for the NWSL to promote others.

“Building up players that are sort of stalwarts for the league itself,” said Allen, “highlighting those players and showing off more than just the Alex Morgan’s or Tobin Heath’s or Alyssa Naeher’s is a key. [The league] has to build up a recognizable base of players that have nothing to do with U.S. Women’s National Team.”

That should be easier thanks to a new ESPN TV deal, essentially broadcasting a national game-of-the-week. The league also secured a major sponsorship with Budweiser.

Allen, the editor-in-chief of Backlinesoccer.com, said those deals help; but more has to happen.

“I think a TV deal,” she said, “a true legitimate every-game-is-somewhere-on-television [deal], I think that is a giant thing the league is lacking.”

And while the U.S. National Team members battle for equal pay with U.S. Soccer (which pays their salaries), the NWSL, Allen said, would do well to pay its non-USWNT players more.

“You’re having players come out of college at 21, 22,” she said, “with degrees from Stanford and University of North Carolina and Duke and a lot of really good colleges, and you’re paying them $17,000 minimum salary, and they have job offers on the table for two or three or four times that.”

“So keeping that talent in the league, growing that talent, having players earn 30,000 minimum, something like that would definitely help the league because it would keep that talent.”

A New Rallying Cry

Houston Dash team member and member of England’s World Cup team Rachel Daly takes a selfie with fans after the game.

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Despite the changes for which Allen and others advocate, there’s general consensus the NWSL is the most competitive women’s pro soccer league in the world. It’s where the best soccer players go to hone their games.

And Allen said the public needs to know that.

“The reason the U.S. won the second [straight] World Cup is directly because of the NWSL,” she said. “Because of players like Sam Mewis and Lindsey Horan playing in the NWSL and getting better because of this league. And without it, it becomes a lot less certain the U.S. is going to keep [its] dominance in the world.”

Meaning, the rallying cry, “If you love the World Cup winners, please support the NWSL,” should perhaps be a bit more hard-edged.

“If you love the World Cup winners, you better support the NWSL.”

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This Time, Franky Zapata Makes It Across The English Channel On A Hoverboard

French inventor Franky Zapata has successfully flown over the English Channel on a personal flying machine.

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French inventor Franky Zapata made history as the first person to cross the English Channel by hoverboard, taking off Sunday from Sangatte on France’s northern coast and touching down near Dover, England.

The elite jet skier’s daring display over the 22-mile channel between France and the U.K. took just over 20 minutes. It seems nobody else has ever tried to cross the body of water by hoverboard, which in Zapata’s case was powered by a backpack full of fuel.

“I’m feeling happy. … It’s just an amazing moment in my life,” Zapata told reporters after landing, according to The Associated Press.

The board moved quickly — almost immediately after takeoff, Zapata rose high in the sky and blasted forward, standing up on his invention as he faded off into the distance above the water. The crowd clapped as they saw him off from the beach.

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The wind above the channel posed challenges, he said, because gusts required him to constantly adjust his body’s position.

“Your body resists the wind, and because the board is attached to my feet, all my body has to resist to the wind,” Zapata told reporters in England. “I tried to enjoy it and not think about the pain.”

The accomplishment probably felt especially sweet because a previous attempt last month ended dramatically. Zapata attempted to land on a platform on a boat to refuel in the middle of that journey but ended up plunging into the water.

This time, Reuters reported, he used a larger boat and a larger platform.

This type of hoverboard isn’t Zapata’s first invention. One of them, called a Flyboard, enables users to fly out of the water and up into the air, shooting out jets of water and even doing flips.

Zapata celebrates on Sunday after crossing the English Channel on a jet-powered hoverboard.

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Heat Check

Heat Check is the playlist for slow-burners, oddly satisfying cross-genre concoctions and the discoveries you almost want to keep for yourself.

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Stream: Spotify, Apple Music.

As the most-consumed genres, the tendrils of rap and R&B have found their way into all popular music today. The current landscape of music is a garden of trap, soul, jazz, funk and global amalgamations. With such a beautiful, organic takeover, more artists than ever are throwing out the rules and creating music that thrives off being outliers. And because of that, there’s always something new blooming that has the potential to catch on like wildfire in the future.

So what makes a song worthy of Heat Check? It’s a slow-burner by a newcomer you’ve never heard of. It’s a track bubbling just under the Billboard Hot 100 and that your friends will claim to have discovered three months before you and put on your radar (Sure.) It’s a new collab you never saw coming — unless, of course, you’ve been paying attention to the artists’ every move on Insta. It’s an oddly satisfying cross-genre concoction. It’s a discovery you almost want to keep to yourself. It’s just something I was feeling at the time.

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Pain Rescue Team Helps Seriously Ill Kids Cope In Terrible Times

Robyn Adcock (left), a University of California, San Francisco pain relief specialist, gently guides Jessica Greenfield to acupressure points on her son’s foot and leg that have helped relieve his chronic pain.

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The Benioff Children’s Hospital at the University of California, San Francisco is a sleek new building with state-of-the-art facilities — a place where the sickest children go for leading-edge treatments.

Which is why it might be surprising to find Robyn Adcock, who practices acupuncture and acupressure walking the halls.

Though Adcock practices ancient arts of traditional Chinese medicine, she is an integral part of the hospital’s integrative pediatric pain and palliative care — or IP3 — team. It’s sort of an emergency response team for pain that combines traditional pharmaceutical pain care with other techniques to ease the suffering of the sick children who populate the rooms here.

The interdisciplinary team includes anesthesiologists and nurses, as you might expect. There’s also a clinical psychologist, a massage therapist and someone who practices hypnosis — as well as Adcock, who treats patients with both acupuncture and acupressure.

“We see cases in the hospital that are end-of-life or very chronic serious illness, or extreme pain cases — where their primary team maybe wants more support and managing the pain piece,” Adcock says.

Adcock (right) softly touches 11-year-old Miller, as she explains her pain relief plan to his parents. Miller has been heavily sedated because his rare neurological disorder periodicially forces all his muscles to clench at once — a painful, and life-threatening condition.

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On the day I visit, she’s headed to intensive care unit to see an 11-year-old boy named Miller. He is suffering with a severe neurological disorder called deafness dystonia syndrome, an exceedingly rare genetic condition that impairs his hearing and causes his muscles to contract uncontrollably.

The condition hits children at puberty, and it hit Miller hard earlier this year.

“We started to see some mild cognitive changes in the summer and fall,” says Jessica Greenfield, Miller’s mother. “And then, in January, we started to see significant dystonic movements.”

Today, she says, her son is in a painful and life-threatening state known as status dystonicus — which means all of his muscles are contracting at once.

“So, in the last the last 48 hours we’ve seen a significant ramp up in his symptoms,” Greenfield tells Adcock, as they stand over the bed where Miller lies, heavily sedated.

The medications her child is on are barely keeping his symptoms under control, Greenfield says, and he can’t tolerate any more painkillers. She tells Adcock that the acupressure techniques Adcock taught them a few days earlier have been helpful.

“It’s not that it stops it,” Greenfield says, “but it gives us these periods in there of interruption where we have something to offer him in between all of this medication that he’s getting.”

Adcock says she’s going to try some additional pressure points, and she leans over to greet the boy, who is almost unconscious.

“Hi, Miller,” she whispers. “I’m going to feel your pulses, and then we’re going to do some acupressure again today with you.”

Adcock quietly reaches for Miller’s wrists, then his legs and feet. She works silently for several minutes as Jessica and her husband John Greenfield look on, clutching paper coffee cups, their eyes clouded with sadness and exhaustion.

After working with Miller for about 15 minutes, Adcock beckons Jessica to the bedside to go over the pressure points they’ve already used and to show her some new points that she’s marked with tiny radish seeds.

Miller’s mom, Jessica Greenfield, says she knows the acupressure helps her son cope with his pain, because he requests it, when his medication isn’t enough. “It allows us a means of providing comfort for him,” Greenfield says.

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“So if you feel this side of the tibia … your four fingers will help you” Adcock says, gently guiding Greenfield’s hand. “You’ll feel a soft, deeper spot. And you can let your intuition find it as well.

“If you’re open and listening with your hands, you’ll be able to find the point,” she says quietly. “And you’re on it. Perfect.”

Jessica Greenfield says she knows the treatments help Miller, because he often asks her to touch his pressure points between Adcock’s visits.

Studies estimate that 20 percent of children worldwide have chronic pain. That could range from frequent stomachaches to debilitating pain from cancer.

And the majority of those children will grow into adults who also are in chronic pain, says Christine Chambers, the Canada research chair in children’s pain at the Centre for Pediatric Pain Research at Dalhousie University in Nova Scotia.

So, at a time when addiction to opioid painkillers is a crisis, finding alternative ways to manage pain and provide comfort is crucial, she says. Because not all pain can be taken away.

Chambers says research shows most children, even in hospitals, don’t get adequate pain care. And sometimes, doctors just can’t eliminate the pain.

“Every clinician who works with a child in pain hopes that we will be able to take away all the pain,” Chambers says. “That isn’t always possible.”

So this interdisciplinary approach, she says, helps kids manage their pain, ease it and live with it.

Research backs up many of the techniques, Chambers says, including physical therapy, hypnosis and even distraction.

“There’s a super strong evidence base in favor of distraction,” she says.

That’s where art and music therapy come in, because these can take kids’ minds off their pain.

Unfortunately, Chambers says, this type of pain care is rare, especially for children.

“Most children won’t be able to access these,” Chambers says. “There are specialized centers that offer these interdisciplinary treatment programs but there are not nearly enough of them.”

The team in San Francisco is one of only a handful across the U.S. And that’s particularly unfortunate, she says, because most children who suffer chronic pain will bring that into adulthood.

Tackling pain from many sides is crucial because different techniques target different kinds of pain, says Dr. Stephen Wilson, the Chief Medical Officer at UCSF Benioff who founded the IP3 team a decade ago and who has been building on it ever since.

Chemotherapy, for example, can cause many kinds of pain and discomfort in a child with cancer.

“They’re likely to have pain in their mouth and in their abdomen from the effects of the chemotherapy,” he says. “They’re likely to have pain in their hands and feet because the chemotherapy agents temporarily can affect nerves and give them what we call neuropathic pain.”

And then there’s the fear and sadness, which Wilson calls “existential pain.”

“It’s not the kind of pain that responds to pain medication, but it’s very real,” he says. “They’re suffering for sure.”

Wilson says the team still relies on traditional painkillers, including opioids, to help the children. But, he says, acupuncture may be more effective against nausea than a medication. And a massage therapist can ease muscle aches; a psychologist can help with the existential fear; and art or music therapy can distract children from their pain.

Together these interventions can make the experience of illness less awful.

“A lot of times, just walking in the room, you can sense that the child and their family are doing better with a terrible situation,” Wilson says. “The situation is still terrible, so I don’t want to paint a rosy picture that somehow everything is wonderful, but it makes a huge difference.”

Jessica Greenfield says the acupressure does just that for Miller and the whole family.

“There’s only so much medication he can have, and certainly only so much medication we would give him in a home setting,” she says. “So it allows us a means of providing comfort for him — which is really important for us as parents and for him as a patient.”

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Saturday Sports: Yankees And Red Sox, Concussions In Football

Scott Simon talks with Howard Bryant about the Red Sox and the Yankees battling this weekend, the Astros, and the death of an NFL great that’s renewing concern about concussions.



SCOTT SIMON, HOST:

And now it’s time for sports.

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SIMON: The Bo Sox and the Yankees this weekend – great rivals wherever they sit in the standings – and the loss of a football great brings back concern over concussions. ESPN’s Howard Bryant joins us. Good morning, Howard.

HOWARD BRYANT: Good morning, Scott. How are you?

SIMON: I’m fine. Thanks, my friend.

BRYANT: (Laughter).

SIMON: Yeah – Cubs 6-2 in case you wondered – OK…

BRYANT: (Laughter).

SIMON: …Over Milwaukee yesterday. Yanks won 4-2 last night – doubleheader today. These two great teams are in the same division but, this, year kind of in different leagues, aren’t they?

BRYANT: Yeah. This one’s getting away from the Red Sox pretty quickly. They’re the defending champions. And they lost again last night. They lost their fifth in a row. They haven’t lost five in a row since 2015 July. And so you’re looking at a team right now that is going in the wrong direction, if you want to be a champion or even have a chance to to make the playoffs. You don’t want to get too far ahead of yourself in the first week of August because you’ve got two wildcard spots now. In the old days, they – 13 games out of first place in the lost column, and they would be over. But with two wild card spots, they can still make a run. But as Yogi Berra would say, it’s getting late early around here for the Red Sox.

SIMON: Major League trade deadline was Wednesday. And I want to know, coming up on an election year, why hasn’t the U.S. Congress passed a law to prevent the Houston Astros from acquiring yet another great starting pitcher?

BRYANT: Isn’t that great that we can actually talk about the Houston Astros having an embarrassment of riches considering that they hadn’t been a great team for about 45 years? And all of a sudden, the last few years, they have really done it the right way. They went out a couple of years ago and got Justin Verlander and won the World Series. And now this year, they may go out and get Zack Greinke. And so they’ve got the best pitching staff in baseball right now. They’ve got the best record in the American League. They’re right with the Dodgers with the best record in baseball. We might get a rematch of the 2017 World Series with the Dodgers and the Astros. You’ve got Verlander. You’ve got Gerrit Cole. And now you’ve got Zack Greinke. And there’s not a whole lot of pitching in the game right now anyway, as we know.

SIMON: Yeah.

BRYANT: So to have those three starters go up against anybody…

SIMON: I half-expect them to sign Sandy Koufax.

BRYANT: (Laughter) I bet you Sandy can still throw as well…

SIMON: Yeah.

BRYANT: …Because he always could. And it’s incredible, too, when you watch some of these teams, whether you’re looking at the Dodgers or the Red Sox or even the Yankees, these hundred-million-dollar teams, $200-million teams that didn’t make any moves. And then you see the Astros who just seem to have a way about them when it comes to going to the trade deadline. They went for it. And they’re going for another World Series.

SIMON: And we’ll note, they hit six home runs last night – 10-2 over Seattle. Nick Buoniconti died this week. He was 78, middle linebacker on two Super Bowl Miami Dolphin teams. He became a lawyer when he left football, an activist for medical research after his son Mark suffered a spinal cord injury playing college football. Nick Buoniconti was a smart, honorable good man. And he suffered dementia in recent years and said it was because he’d taken – and he estimated it – 520,000 hits to his head.

BRYANT: Yeah. And as a linebacker, when I heard that number, I was surprised that it was that low. You’re looking at every single play you’re making contact with your head. Every single play in football whether you’re looking at it from the pro level all the way down – this is the conversation, Scott, that we’ve been having for a really long time on this program, that the problem with football is football. And we keep talking about whether it’s possible to make it safer. You think about these end of life – the quality of life that these players have at a very – you know, 78’s a good run, obviously. But it’s not 80s or 90s. And so you’re looking at the price that a lot of the players are paying. I’m actually reading a book right now called “Brain Damage.” And it’s all about the price that parents have paid for the kids that they’ve lost playing football in some of these contact sports. And when you look at it, at some point, you do have to look at a – there’s a lawsuit with Pop Warner coming up next year.

SIMON: Yeah.

BRYANT: And at some point, football is sort of having a conversation about whether or not this sport can last.

SIMON: Howard Bryant, thanks so much – talk to you soon.

BRYANT: Thank you.

(SOUNDBITE OF TANGERINE DREAM’S “STRATOSFEAR”)

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