Tag: us senate

U.S. House passes billions in aid for Ukraine and Israel after months of struggle

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The House swiftly approved $95 billion in foreign aid for Ukraine, Israel and other U.S. allies in a rare Saturday session as Democrats and Republicans banded together after months of hard-right resistance over renewed American support for repelling Russia’s invasion.

With an overwhelming vote, the $61 billion in aid for Ukraine passed in a matter of minutes, a strong showing as American lawmakers race to deliver a fresh round of U.S. support to the war-torn ally. Many Democrats cheered on the House floor and waved blue-and-yellow flags of Ukraine.

Aid to Israel and the other allies also won approval by healthy margins, as did a measure to clamp down on the popular platform TikTok, with unique coalitions forming to push the separate bills forward. The whole package will go to the Senate, which could pass it as soon as Tuesday. President Joe Biden has promised to sign it immediately.

“We did our work here, and I think history will judge it well,” said a weary Speaker Mike Johnson, R-La., who risked his own job to marshal the package to passage.

Biden, in a statement, thanked Johnson, Democratic leader Hakeem Jeffries and the bipartisan coalition of lawmakers “who voted to put our national security first.”

“I urge the Senate to quickly send this package to my desk so that I can sign it into law and we can quickly send weapons and equipment to Ukraine to meet their urgent battlefield needs,” the president said.

President Volodymyr Zelenskyy of Ukraine said he was “grateful” to both parties in the House and “personally Speaker Mike Johnson for the decision that keeps history on the right track,” he said on X, formerly Twitter.

“Thank you, America!” he said.

The scene in Congress was a striking display of action after months of dysfunction and stalemate fueled by Republicans, who hold the majority but are deeply split over foreign aid, particularly for Ukraine. Johnson relied on Democrats to ensure the military and humanitarian funding — the first major package for Ukraine since December 2022 — won approval.

The morning opened with a somber and serious debate and an unusual sense of purpose as Republican and Democratic leaders united to urge quick approval, saying that would ensure the United States supported its allies and remained a leader on the world stage. The House’s visitor galleries were crowded with onlookers.

“The eyes of the world are upon us, and history will judge what we do here and now,” said Rep. Michael McCaul, R-Texas, chairman of the House Foreign Affairs Committee

Passage through the House cleared away the biggest hurdle to Biden’s funding request, first made in October as Ukraine’s military supplies began to run low.

The GOP-controlled House struggled for months over what to do, first demanding that any assistance for Ukraine be tied to policy changes at the U.S.-Mexico border, only to immediately reject a bipartisan Senate offer along those very lines.

Reaching an endgame has been an excruciating lift for Johnson that has tested both his resolve and his support among Republicans, with a small but growing number now openly urging his removal from the speaker’s office. Yet congressional leaders cast the votes as a turning point in history — an urgent sacrifice as U.S. allies are beleaguered by wars and threats from continental Europe to the Middle East to the Indo-Pacific.

“Sometimes when you are living history, as we are today, you don’t understand the significance of the actions of the votes that we make on this House floor, of the effect that it will have down the road,” said New York Rep. Gregory Meeks, the top Democrat on the House Foreign Affairs Committee. “This is a historic moment.”

Opponents, particularly the hard-right Republicans from Johnson’s majority, argued that the U.S. should focus on the home front, addressing domestic border security and the nation’s rising debt load, and they warned against spending more money, which largely flows to American defense manufacturers, to produce weaponry used overseas.

Still, Congress has seen a stream of world leaders visit in recent months, from Zelenskyy to Japanese Prime Minister Fumio Kishida, all but pleading with lawmakers to approve the aid. Globally, the delay left many questioning America’s commitment to its allies.

At stake has been one of Biden’s top foreign policy priorities — halting Russian President Vladimir Putin’s advance in Europe. After engaging in quiet talks with Johnson, the president quickly endorsed Johnson’s plan, paving the way for Democrats to give their rare support to clear the procedural hurdles needed for a final vote.

“We have a responsibility, not as Democrats or Republicans, but as Americans to defend democracy wherever it is at risk,” Jeffries said during the debate.

While aid for Ukraine failed to win a majority of Republicans, several dozen progressive Democrats voted against the bill aiding Israel as they demanded an end to the bombardment of Gaza that has killed thousands of civilians. A group of roughly 20 hard-right Republicans voted against every portion of the aid package, including for allies like Israel and Taiwan that have traditionally enjoyed support from the GOP.

At the same time, Donald Trump, the presumptive Republican presidential nominee, has loomed large over the fight, weighing in from afar via social media statements and direct phone calls with lawmakers as he tilts the GOP to a more isolationist stance with his “America First” brand of politics.

Ukraine’s defense once enjoyed robust, bipartisan support in Congress, but as the war enters its third year, a majority of Republicans opposed further aid. Trump ally Rep. Marjorie Taylor Greene, R-Ga., offered an amendment to zero out the money, but it was rejected.

The ultraconservative House Freedom Caucus has derided the legislation as the “America Last” foreign wars package and urged lawmakers to defy Republican leadership and oppose it because the bills did not include border security measures.

Johnson’s hold on the speaker’s gavel has also grown more tenuous in recent days as three Republicans, led by Greene, supported a “motion to vacate” that can lead to a vote on removing the speaker. Egged on by far-right personalities, she is also being joined by a growing number of lawmakers including Reps. Paul Gosar, R-Ariz., and Thomas Massie, R-Ky., who is urging Johnson to voluntarily step aside.

The package included several Republican priorities that Democrats endorsed, or at least are willing to accept. Those include proposals that allow the U.S. to seize frozen Russian central bank assets to rebuild Ukraine; impose sanctions on Iran, Russia, China and criminal organizations that traffic fentanyl; and legislation to require the China-based owner of the popular video app TikTok to sell its stake within a year or face a ban in the United States.

Still, the all-out push to get the bills through Congress is a reflection not only of politics, but realities on the ground in Ukraine. Top lawmakers on national security committees, who are privy to classified briefings, have grown gravely concerned about the tide of the war as Russia pummels Ukrainian forces beset by a shortage of troops and ammunition.

Senate Majority Leader Chuck Schumer announced the Senate would begin procedural votes on the package Tuesday, saying, “Our allies across the world have been waiting for this moment.”

Senate Republican Leader Mitch McConnell, as he prepared to overcome objections from his right flank next week, said, “The task before us is urgent. It is once again the Senate’s turn to make history.”

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Kevin McCarthy becomes the first Speaker ever to be ousted from the job in a U.S. House vote

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Speaker Kevin McCarthy was voted out of the job on October 3 in an extraordinary showdown, a first in U.S. history that was forced by a contingent of hard-right conservatives and threw the House and its Republican leadership into chaos.

Mr. McCarthy’s chief rival, Rep. Matt Gaetz of Florida, forced the vote on the “motion to vacate,” drawing together more than a handful of conservative Republican critics of the speaker and many Democrats who say he is unworthy of leadership.

Next steps are uncertain, but there is no obvious successor to lead the House Republican majority.

Stillness fell as the presiding officer gavelled the vote closed, 216-210, saying the office of the Speaker “is hereby declared vacant.”

Moments later, a top McCarthy ally, Rep. Patrick McHenry, R-N.C., took the gavel and, according to House rules, was named Speaker pro tempore, to serve in the office until a new Speaker is chosen.

The House then briskly recessed so lawmakers could meet and discuss the path forward.

It was a stunning moment for the battle-tested Mr. McCarthy, a punishment fuelled by growing grievances but sparked by his weekend decision to work with Democrats to keep the federal government open rather than risk a shutdown.

An earlier vote was 218-208 against tabling the motion, with 11 Republicans allowing it to advance.

The House then opened a floor debate, unseen in modern times, ahead of the next round of voting.

Mr. McCarthy, of California, insisted he would not cut a deal with Democrats to remain in power — not that he could have relied on their help even if he had asked.

Democratic leader Hakeem Jeffries said in a letter to colleagues that he wants to work with Republicans, but he was unwilling to provide the votes needed to save Mr. McCarthy.

“It is now the responsibility of the GOP members to end the House Republican Civil War,” Mr. Jeffries said, announcing the Democratic leadership would vote for the motion to oust the Speaker.

As the House fell silent, Gaetz, a top ally of Donald Trump, rose to offer his motion. Gaetz is a leader of the hard-right Republicans who fought in January against Mr. McCarthy in his prolonged battle to gain the gavel.

“It’s a sad day,” Republican Rep. Tom Cole of Oklahoma said as debate got underway, urging his colleagues not to plunge the House Republican majority “into chaos.”

But Gaetz shot back during the debate, “Chaos is Speaker McCarthy.”

Mr. McCarthy’s fate was deeply uncertain as the fiery debate unfolded, with much of the complaints against the Speaker revolving around his truthfulness and his ability to keep the promises he has made since January to win the gavel.

But a long line of Mr. McCarthy supporters, including Rep. Jim Jordan, R-Ohio, a founding leader of the conservative Freedom Caucus, stood up for him: “I think he has kept his word.” And some did so passionately. Rep. Garret Graves, R-La., waved his cellphone, saying it was “disgusting” that hard-right colleagues were fundraising off the move in text messages seeking donations.

At the Capitol, both Republicans and Democrats met privately ahead of the historic afternoon vote.

Behind closed doors, Mr. McCarthy told fellow Republicans: Let’s get on with it.

“If I counted how many times someone wanted to knock me out, I would have been gone a long time ago,” Mr. McCarthy said at the Capitol after the morning meeting.

Mr. McCarthy insisted he had not reached across the aisle to the Democratic leader Jeffries for help with votes to stay in the job, nor had they demanded anything in return.

During the hourlong meeting in the Capitol basement, Mr. McCarthy invoked Republican Speaker Joseph Cannon, who more than 100 years ago confronted his critics head-on by calling their bluff and setting the vote himself on his ouster. Cannon survived that takedown attempt, which was the first time the House had actually voted to consider removing its speaker. A more recent threat, in 2015, didn’t make it to a vote.

Mr. McCarthy received three standing ovations during the private meeting — one when he came to the microphone to speak, again during his remarks and finally when he was done, according a Republican at the meeting who was granted anonymity to discuss it.

At one point, there was a show of hands in support of Mr. McCarthy and it was “overwhelming,” said Rep. Ralph Norman, R-S.C., a member of the House Freedom Caucus.

Gaetz was in attendance, but he did not address the room.

Across the way in the Capitol, Democrats lined up for a long discussion and unified around one common point: Mr. McCarthy cannot be trusted, several lawmakers in the room said.

“I think it’s safe to say there’s not a lot of good will in that room for Kevin McCarthy,” said Rep. Richard Neal, D-Mass.

“At the end of the day, the country needs a speaker that can be relied upon,” said Rep. Adam Schiff, D-Calif. “We don’t trust him. Their members don’t trust him. And you need a certain degree of trust to be the speaker.”

Removing the speaker launches the House Republicans into chaos, as they try to find a new leader. It took Mr. McCarthy himself 15 rounds in January over multiple days of voting before he secured the support from his colleagues to gain the gavel. There is no obvious GOP successor.

Mr. Trump, the former President who is the Republican front-runner in the 2024 race to challenge Mr. Biden, weighed in to complain about the chaos. “Why is it that Republicans are always fighting among themselves,” he asked on social media.

One key Mr. McCarthy ally, Rep. Marjorie Taylor Greene, R-Ga., took to social media urging support for “our speaker” and an end to the chaos that has roiled the Republican majority.

Republicans were upset that Mr. McCarthy relied on Democratic votes on Saturday to approve the temporary measure to keep the government running until Nov. 17. Some would have preferred a government shutdown as they fight for deeper spending cuts.

But Democrats were also upset with Mr. McCarthy for walking away from the debt deal that he made with Mr. Biden earlier this year that already set federal spending levels, as he emboldened his right flank to push for steep spending reductions.

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Huzzay! Debt Ceiling Raised, Catastrophe Averted, Republicans And Joe Manchin :(

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The Senate passed the debt limit bill last night, raising the ceiling on how much the government can borrow to pay for spending it’s already done, and thereby avoiding a default on the federal debt and the attendant economic disaster that would follow. The bill now goes to President Joe Biden, who will sign it today and is scheduled to address the nation this evening at 7 p.m. Eastern. We expect the speech will say something along the lines of, “Now look, for cryin’ out loud, we need to pay our bills, I mean it! None of this was necessary, and that’s why I’m invoking the 14th Amendment, I’m not joking, to make the Supreme Court rule on whether the debt limit law is even constitutional. What a load of malarkey, goodnight.”

Following the Senate vote last night, Biden actually said in a statement, “No one gets everything they want in a negotiation, but make no mistake: This bipartisan agreement is a big win for our economy and the American people,” which was far nicer.

The bill passed in the Senate on a 63 to 36 vote, enough to avoid a filibuster. Five members of the Democratic caucus — John Fetterman (Pennsylvania), Ed Markey (Massachusetts), Jeff Merkley (Oregon), Elizabeth Warren (Massachusetts), and Bernie Sanders (I-Vermont) voted nay. (They presumably would have voted for it if necessary.) The majority of Republicans, 31 of ’em, also voted against the bill albeit for very different reasons. Only 17 Republican senators voted for the bill. I’ll note that it was a rare thing for me to see both of Idaho’s senators, Mike Crapo and the other one, voting with Elizabeth Warren and Bernie Sanders.

Before the vote, the Senate debated and rejected 11 amendments to the bill, including Virginia Democrat Tim Kaine’s amendment to yeet Joe Manchin’s pet methane pipeline project out of the bill (which Manchin had somehow sneaked into the House version) and into the sun. That was the only amendment offered by a Democrat; the others were Republican attempts to demand deeper cuts to domestic spending programs than in the House bill, to increase military spending even more than the House bill did, to Git Tougher on the border, and the like.

During floor debate, several Republicans fretted that without unlimited Pentagon spending, the Russians, Chinese, or Martians might try something sneaky, or that the US would be unable to support Ukraine’s defense against Russian invasion (as far as we can tell, no Republicans rose to shout, “That’s the point!”). Majority Leader Chuck Schumer (D-New York) said that the defense hawks needn’t worry, and that the debt ceiling bill

does nothing to limit the Senate’s ability to appropriate emergency supplemental funds to ensure our military capabilities are sufficient to deter China, Russia and our other adversaries, and respond to ongoing and growing national security threats, including Russia’s evil ongoing war of aggression against Ukraine.

Schumer added that the bill wouldn’t limit Congress’s ability to pass emergency funding for disaster relief or other needs, either, although he failed to note that Republicans would certainly whine about such expenditures unless their own states were affected.

All told, the Congressional Budget Office estimated the spending caps in the bill would reduce federal spending by $1.5 trillion over the next decade. Reuters rather cheekily adds, “That is below the $3 trillion in deficit reduction, mainly through new taxes, that Biden proposed,” and we say good on you, Reuters.

Also, in a coda that gives us at least a satisfied smirk, Fox News reports that in an interview, Joe Manchin (D?-Methane) complained that Republicans were getting too much credit for his personal boondoggle in the bill, the fast-tracking of the Mountain Valley Pipeline. The debt limit agreement forces an end to all regulatory and court challenges to Manchin’s pet project, which he has pushed since it was proposed in 2014, and by golly, Joe Manchin isn’t about to have any Republicans take the focus away from him and the ginormous favor he’s doing for the fossil-fuel industries (of which he’s not only the president, he’s also a client).

What’s the problem here? They’re afraid of who gets credit for it?” Manchin told Fox News Digital. “You know, what we said before — success has many fathers, but failure is an orphan. Well, I guarantee you, I was an orphan there for a long time because I was the only one on the front taking all the spears and everything, taking point on this.”

“But I’m happy to — everyone is happy — to share the success. I think everybody knows how this happened,” the West Virginia senator added. “I mean, my God, for the whole year I’ve had the living crap beat out of me, back and forth and everything.”

Now there’s a man who loves sharing the spotlight, as long as nobody else is right in the center. Manchin also whined that it really pissed him off something fierce that Republicans might get any credit (which he’s happy to share, but not) since it was his hard work and stubborn assholishness that won over or exhausted the White House in negotiations, and where were Republicans the other times he tried to ram through a bunch of fossil fuel projects, huh?

“It’s bulls— because they knew there was not going to be a problem on the Democratic Senate side or the Democrat president and his staff because they were the ones who supported it and got us 40 votes in the Senate when we voted,” Manchin said.

“It was the Republicans that killed us when we voted last time — only got seven votes. And the Republicans have always supported permitting. The only reason they wouldn’t support that is because of the Republicans being upset about the [Inflation Reduction Act]. That’s it. So it got caught in the politics.”

Still, you have to be impressed by the bipartisan outreach, calling Joe Biden a “Democrat president” just like the Fox News analyst he’s destined to become following his Senate career.

[CNBC / The Hill / Reuters / Fox News]

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U.S. Congress approves debt-limit suspension, averting default

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The U.S. Senate on June 1 passed bipartisan legislation backed by President Joe Biden that lifts the government’s $31.4 trillion debt ceiling, averting what would have been a first-ever default.

The Senate voted 63-36 to approve the bill that was passed on May 31 by the House of Representatives, as lawmakers raced against the clock following months of partisan bickering between Democrats and Republicans.

The Treasury Department had warned it would be unable to pay all its bills on June 5 if Congress failed to act by then.

Also Read | Explained | What is the stalemate over the U.S. debt ceiling and what happens if the government defaults?

“We are avoiding default tonight,” Senate Majority Leader Chuck Schumer said on June 1 as he steered the legislation through his 100-member chamber.

Mr. Biden praised Congress’ timely action. “This bipartisan agreement is a big win for our economy and the American people,” the Democratic president said in a statement, adding that he will sign it into law as soon as possible. He said he would make an additional statement on Friday.

Before the final vote, senators tore through nearly a dozen amendments – rejecting all of them during a late-night session in anticipation of Monday’s deadline.

Also Read | Explainer | A looming U.S. debt ceiling fight is starting to worry investors

With this legislation, the statutory limit on federal borrowing will be suspended until Jan. 1, 2025. Unlike most other developed countries, the United States limits the amount of debt the government can borrow, regardless of any spending allocated by the legislature.

Schumer and his Republican counterpart Minority Leader Mitch McConnell delivered on their promise to do all they could to speed along the bill negotiated by Biden and Republican House Speaker Kevin McCarthy.

“America can breathe a sigh of relief,” Schumer said in remarks to the Senate.

‘Time is a Luxury’

Republicans had blocked passage of any debt limit increase until they locked in some wide-ranging spending cuts in a move they said would begin addressing a rapidly escalating national debt.

Mr. Biden instead pushed for tax increases on the wealthy and corporations to help address the growing debt. Republicans refused to consider any sort of tax hikes.

Both parties walled off the sprawling Social Security and Medicare retirement and healthcare programs from cuts, and McCarthy refused to consider reducing spending on the military or veterans.

That left a somewhat narrow band of domestic “discretionary” programs to bear the brunt of spending cuts. In the end, Republicans won about $1.5 trillion in reductions over 10 years, which may or may not be fully realized. Their opening bid was for $4.8 trillion in savings over a decade.

Treasury technically hit its limit on borrowing in January. Since then it has been using “extraordinary measures” to patch together the money needed to pay the government’s bills.

Mr. Biden, Treasury Secretary Janet Yellen and congressional leaders all acknowledged that triggering a debt default for lack of funds would have serious ramifications. Those included sending shock waves through global financial markets, possibly triggering job losses and a recession in the United States and raising families’ interest rates on everything from home mortgages to credit card debt.

Schumer drove that point home even as he steered the bill toward final passage.

A default, he said, “would almost certainly cause another recession. It would be a nightmare for our economy and millions of American families. It would take years, years to recover from.”

The Republican-controlled House passed the bill on Wednesday evening in a 314-117 vote. Most of those who voted against the bill were Republicans.

“Time is a luxury the Senate does not have,” Schumer said on Thursday. “Any needless delay or any last-minute holdups would be an unnecessary and even dangerous risk.”

Among the amendments debated were ones to force deeper spending cuts than those contained in the House-passed bill and stopping the speedy final approval of a West Virginia energy pipeline.

Cobbled Over Weeks

Republican Senator Roger Marshall offered an amendment to impose new border controls as high numbers of immigrants arrive at the U.S.-Mexico border. His measure, he said, would “put an end to the culture of lawlessness at our southern border.”

The Senate defeated the amendment, however. Democrats said it would strip away protections for child migrants and rob American farmers of needed workers.

Some Republicans also wanted to beef up defense spending beyond the increased levels contained in the House-passed bill.

In response, Schumer said the spending caps in this legislation would not constrain Congress in approving additional money for emergencies, including helping Ukraine in its battle against Russia.

“This debt ceiling deal does nothing to limit the Senate’s ability to appropriate emergency supplemental funds to ensure our military capabilities are sufficient to deter China, Russia and our other adversaries, and respond to ongoing and growing national security threats, including Russia’s evil ongoing war of aggression against Ukraine,” Schumer said.

The bill was cobbled together over weeks of intensive negotiations between senior aides for Biden and McCarthy.

The main argument was over spending for the next couple of years on discretionary programs such as housing, environmental protections, education and medical research that Republicans wanted to cut deeply.

The nonpartisan Congressional Budget Office estimated the bill would save $1.5 trillion over 10 years. That is below the $3 trillion in deficit reduction, mainly through new taxes, that Biden proposed.

The last time the United States came this close to default was in 2011. That standoff hammered financial markets, led to the first-ever downgrade of the government’s credit rating and pushed up the nation’s borrowing costs.

There was less drama this time as it became clear last week that Biden and McCarthy would find a deal with enough bipartisan support to get through Congress.

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New drug shortages in the US increased nearly 30% in 2022, Senate report finds | CNN

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CNN
 — 

When a pharmaceutical plant in Shanghai that made contrast material for radiological scans shut down last year, half the United States’ supply of the radioactive substance immediately became unavailable. Health care providers had to make difficult choices about who got potentially lifesaving tests.

“I work in the VA system. This impacted veterans literally overnight, where we needed to make decisions about whether we were going to allow some scans to be done to evaluate someone’s cancer or treat someone’s heart disease,” said Dr. Andrew Shuman, a head and neck surgeon who works at the US Department of Veterans Affairs and is an associate professor at University of Michigan Health. “Veterans deserve better and we should not be reliant on a supply chain that’s that tenuous.”

Shuman was one of several experts who testified Wednesday in front of the US Senate’s Homeland Security and Governmental Affairs Committee that shortages like these make the US drug and medical supply far too vulnerable and put national security at risk.

New drug shortages in the US increased nearly 30% between 2021 and 2022, according to a report commissioned by the Senate that was published Wednesday. At the end of 2022, drug shortages experienced a record five-year high of 295 active drug shortages, according to the report. It also found that while the average drug shortage lasts about 1.5 years, more than 15 critical drug products have been in shortage for over a decade.

Many Americans became aware of national shortages during the Covid-19 pandemic. In one of the most notable examples last year, anxious parents reported going from store to store in search of common pain relievers and antibiotics during an especially rough RSV season.

Increased demand can cause shortages, but the way drugs are made and sold for the US market is also a large part of the problem, the experts said Wednesday.

Shortages of common and specialized drugs have been a constant for decades, the report says.

“Since 2007, the FDA identified an average of over 100 separate drug shortages per year. In 2011, the FDA identified a whopping 267 drugs in short supply and despite possessing the most innovative medical industry in the world, the US is unable to maintain a consistent supply of the most crucial medicines,” ranking committee member Sen. Rand Paul, R-Kentucky, said at the hearing.

Under the current regulatory system, the problem won’t probably get better any time soon, the experts said.

“Even drugs needed to treat childhood and adult cancers, including some that have simply no alternative treatment, are regularly in shortage. And while some shortages may only be an inconvenience, others have had devastating impacts on patient care,” said Sen. Gary Peters, D-Michigan, who commissioned the new report.

At its peak last year, there were 295 drugs in shortage, Peters said. In years past, the number has been even higher. The US Food and Drug Administration currently lists 130 drugs in shortage.

Some common medications like Adderall have been on the list for months. Many others like albuterol sulfate, which doctors use to treat breathing problems, are a staple in hospitals.

Albuterol has been in short supply since last summer, according to the American Society of Health-System Pharmacists, and it’s been on the FDA shortage list since October. That particular shortage is expected to get even worse because a major supplier to US hospitals shut down at the beginning of March.

The albuterol shortage shows how consolidation in the market has been a real problem for a number of drugs, experts say. In a consolidated market, labor issues and manufacturing disruptions can make drugs particularly hard to find.

Only one company made certain albuterol products used for continuous nebulizer treatment. The manufacturer that shut down, Akorn Operating Co., filed for Chapter 11 bankruptcy in May 2020.

Lower-priced drugs, generics like albuterol and certain antibiotics like amoxicillin tend to have a higher likelihood of being in shortage, according to an analysis presented at the hearing by US Pharmacopeia, a nonprofit that works to strengthen the global supply chain of medicines and publishes a set of guidelines for medicines. Economics is largely to blame.

“Manufacturers only receive pennies per dose for some of these drugs,” testified Dr. Vimala Raghavendran, senior director of the pharmaceutical supply chain center at US Pharmacopeia. That means there is little financial incentive for multiple manufacturers to make a generic medicine.

Another problem is with the suppliers of the ingredients that make the drugs. Nearly 80% of the manufacturing facilities that produce these active pharmaceutical ingredients are outside the US, the Senate report says. And there is no one agency that keeps track of all these manufacturers, so it is difficult to get a big picture of where the next problem will come from, Raghavendran said.

“Policymakers are flying blind in our understanding of US reliance on other countries for critical ingredients used in the manufacture of medicines,” she said.

Many ingredient makers are based in China or India. If there are work stoppages there, as during the pandemic, it can affect thousands of products.

Consolidation in ingredient manufacturing was a problem even before the pandemic. In 2018, regulators discovered that material created by a Chinese-based company, Zhejiang Huahai Pharmaceutical Co., that went into certain heart drugs was contaminated with a potential cancer-causing impurity. Thousands of drugs had to be recalled in dozens of countries, causing shortages around the world.

In too many cases, the experts said Wednesday, it is not clear why drugs wind up in such short supply. Part of the problem is a lack of transparency about quality results and inspections information. The cause of a specific shortage may be known to regulators, but the information is rarely publicly available.

“FDA sees really clear quality differences between products and manufacturing sites, but this information is confidential, and it’s not available to people making the purchases. Buyers can’t easily see the reliability of manufacturing operations,” Erin Fox, associate chief pharmacy officer at the University of Utah, said at the hearing.

Fox urged the government to develop a rating system for pharmaceutical manufacturing reliability. The FDA has been working on quality metrics ratings, but it doesn’t intend to make the scores publicly available, she said.

Without knowing whether a company is reliable, a health care system can’t always anticipate that a facility is likely to be shut down and create a shortage. A government rating system could help health systems pick more reliable suppliers, Fox said. Because it is so difficult to anticipate what drugs will be in short supply, most health systems must employ someone full-time to exclusively deal with shortage management.

At Michigan, Shuman said, there are multiple pharmacists whose full-time jobs are to manage drug shortages.

“Not every hospital has that resource. Patients should not have better access to scarce drugs based on the hospital they go to,” he said.

Shortages have a direct negative impact on patients and on their providers. Studies show that people often have worse health outcomes when they can’t be treated with the appropriate medication and even, in some cases, when alternative drugs are used.

“One of the challenges of drug shortages is that it requires hospitals to essentially MacGyver different treatment opportunities and regimens, which is not necessarily evidence for data based,” Shuman said.

People with sepsis, for instance, had a higher mortality rate when there was a shortage of the drug norepinephrine.

With shortages of cancer drugs, Shuman described “a tragedy that’s happening in slow motion.”

He cited etoposide, a medicine used to manage a wide variety of cancers, including those of the prostate, bladder, stomach and lung. It’s a low-cost drug at $50 a vial and has been on the market for more than 40 years.

In 2018, when a manufacturing delay caused a national shortage, some doctors had to make terrible choices.

“Which of our patients with cancer should get it? How can we prioritize between American lives? Should our limited vials go to an older woman who was just diagnosed with lung cancer, a young man who’s already been successfully taking it for testicular cancer, or a baby with neuroblastoma and aggressive cancer for which this drug is recommended but others might substitute?” Shuman said. “As a doctor who’s devoted my life to fighting cancer, it’s hard to express how horrible that is.”

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John Fetterman Hospitalized For Depression, Everybody Awesome About It If You Ignore GOP

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On Wednesday evening, Sen. John Fetterman (D-Pennsylvania) checked in to Washington’s Walter Reed National Military Medical Center to be treated for clinical depression, according to a statement from his office yesterday. Fetterman, the statement said, has long suffered from depression, but the condition has recently become “severe.” The Philadelphia Inquirer reports,

“While John has experienced depression off and on throughout his life, it only became severe in recent weeks,” his chief of staff, Adam Jentleson, said in a statement. “On Monday, John was evaluated by Dr. Brian P. Monahan, the Attending Physician of the United States Congress. Yesterday, Dr. Monahan recommended inpatient care at Walter Reed. John agreed, and he is receiving treatment on a voluntary basis.”

Jentleson added that, “After examining John, the doctors at Walter Reed told us that John is getting the care he needs, and will soon be back to himself.”

Fetterman had also been hospitalized briefly last week after feeling lightheaded; tests determined he had not suffered another stroke, and his office said an EEG showed no signs of seizures, either. He returned to work in the Senate Monday for a vote.

Major depression is one of the most common mental disorders in the US, affecting almost a tenth of all adults, according to the National Institute of Mental Health. It’s a fucking bear to live with, although many of us manage pretty well with antidepressant meds, according to me. Also, a 2021 study found that rates of depression in the US increased during the early months of the pandemic in 2020. And of course, depression is very common among people who’ve survived a stroke.

Frankly, we’re pretty sure everyone in America has been in a state of existential crisis since election night 2016, at least if they’ve been paying attention. Shit has been unrelenting, and that has to go triple for people actually in the middle of things.

Fetterman’s wife, Giselle Barreto Fetterman, wrote on Twitter yesterday,

After what he’s been through in the past year, there’s probably no one who wanted to talk about his own health less than John. I’m so proud of him for asking for help and getting the care he needs. […]

Take care of yourselves. Hold your loved ones close, you are not alone.

The New York Times reports that aides to Sen. Fetterman expect he won’t be hospitalized longer than a few days, although no firm estimate of when he’ll be released home has yet been determined.

Fetterman’s health had been steadily improving since a stroke last summer, but the already stressful work of starting a new job as a senator has been complicated by the continued effects of the stroke, which left him with auditory processing difficulties, as we saw during his campaign debate against Republican snake oil merchant Mehmet Oz in October. Fortunately, there’s a lot of adaptive technology that has been helpful, the Times notes:

The sergeant-at-arms has arranged for live audio-to-text transcription for Mr. Fetterman’s committees and installed a monitor at his desk so he can follow proceedings with closed captioning. His Democratic colleagues in the Senate have been growing accustomed to communicating with him through a tablet that transcribes their words, technology he needs after suffering from auditory processing issues associated with his stroke.

The Times also points out that Fetterman simply never had the usual period of convalescence that would be the norm after a stroke, which

has become a source of pain and frustration for Mr. Fetterman and people close to him, who fear that he may suffer long-term and possibly permanent repercussions. His schedule as a freshman senator has meant that he has continued to push himself in ways that people close to him worry are detrimental.

The Inquirer adds that a “source close to Fetterman” said he had voted and attended hearings Wednesday, but that the stress was showing:

“He was doing everything. He’s been doing everything, he just hasn’t been himself,” the person said, asking for anonymity to disclose personal information. “He decided to get help, and the good news is, he’s getting the help he needs.”

And for Crom’s sake, he deserves that. Doesn’t everyone?

Reactions to Fetterman’s hospitalization have been — at least outside Troll World — overwhelmingly supportive and empathetic. The Washington Post notes that Rep. Ruben Gallego (D-Arizona) tweeted, “There is never any weakness in seeking help.” Gallego has spoken publicly about having experienced PTSD after serving in Iraq, and said the January 6 insurrection had triggered a recurrence. In addition,

Sen. Tina Smith (D-Minn.), who’s spoken publicly about her own battle with depression, also said Fetterman was displaying strength, “not weakness.”

Smith has spoken in Congress about dealing with depression in college, and while raising her children, and told the Post that she’s regularly approached by young people who say that her openness has made them feel able to talk about their own experiences with depression.

We’ve finally reached a point in our crazy society where mental illness can be talked about in the same register we’d discuss a heart attack or other serious physical illness, and that’s a hell of an improvement within my own lifetime. Recall that in 1972, George McGovern suddenly dropped his vice presidential nominee, Sen. Thomas Eagleton (D-Missouri), when news broke that Eagleton had been hospitalized three times for severe depression, and that he’d also had electroconvulsive therapy.

A lot has changed in 50 years.

Here’s wishing all the best to John Fetterman and his family, and we hope — perhaps naively, we’re prone to that — that we’ll take this as a chance to talk about mental illness and how we’re all navigating this strange reality we’ve been in for over half a decade. We’re deliberately staying away from Twitter for a while for that reason.

Be kind to each other. Try to remember we’re all just trying to get through all this, and it isn’t fucking easy.

[Philadelphia Inquirer / NYT / WaPo / Photo: Office of Gov. Tom Wolf, Creative Commons License 2.0]

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