Holy hazelnut mocha! California has gone off the deep end

(CNN)Holy hazelnut mocha! California may now be placing a warning label on coffee.

(I’ll pause while you do a “spit take” involving your caramel frappuccino.)
Before I proceed, a disclosure is in order: I’m not neutral when it comes to coffee. In fact, I’m writing this article from my second coffee shop location of the day. That said, I’m quite certain this decision will backfire more loudly than an antique espresso machine with two broken pumps.
    “How did this even happen?” you’re probably asking yourself.
    It started with Proposition 65, “which requires businesses to notify Californians about significant amounts of chemicals in the products that they purchase,” according to the San Diego Union Tribune. It turns out that one of those “Prop 65” chemicals, acrylamide, can be found in coffee.
    According to the National Cancer Institute, “studies in rodent models have found that acrylamide exposure increases the risk for several types of cancer.” And one of the major food sources of acrylamide is coffee.

      Coffee may lower risk of depression

    I’m sorry, it’s apparently true.
    And a Los Angeles superior court judge has decided this is serious enough to warrant a warning label.
    Here are just a few problems with this decision, my comrades-in-cold-brewing.
    First, the benefits that coffee provides far outweigh any small chance that you’ll develop a disease from a trace chemical in your favorite coffee drink. For one thing, according, again, to the National Cancer Institute, while “in the body, acrylamide is converted to a compound called glycidamide, which causes mutations in and damage to DNA … a large number of epidemiologic studies (both case-control and cohort studies) in humans have found no consistent evidence that dietary acrylamide exposure is associated with the risk of any type of cancer.”
    And as an article on the website of Harvard’s T.H. Chan School of Public Health notes (citing Edward Giovannucci, a researcher there), “Two decades of research suggests that coffee may help reduce the risk of illnesses ranging from cancer to heart disease to Alzheimer’s.”

      Tom Hanks gifts White House reporters caffeine

    Wait: Coffee is capable of both preventing cancer and causing cancer? Apparently so. And that’s why the California judge was far too hasty in making the preliminary decision to slap a Prop 65 label on the fuel that keeps America functioning.
    Second, the unintended consequences could be enormous. We already have a crisis of confidence in our governments, institutions, and scientists. Maybe this is my second soy latte talking, but why risk incurring the wrath of the nation to prove a nanoscale point? Why cast the country into even more confusion by overreacting about a beverage consumed by Americans on the order of 2.1 cups per day per person?
    We need to be restoring the public’s trust, building confidence, taking measured steps to real science-based threats, not causing hysteria over an extreme unlikelihood.
    Think about our current political environment: Anti-vaxxers are putting the entire population at risk by refusing to allow their children to receive inoculations that keep them (and, by extension, others) from contracting life-threatening diseases. And consider: Only 27% of US adults agree with the statement “Almost all climate scientists agree that human behavior is mostly responsible for climate change.” (The number of scientists who agree that human behavior is the culprit is 97%, according to NASA.)
    Under these conditions, slapping a warning label on coffee will effectively be a license to partake of any kind of food or beverage — or any type of activity — that the “experts” say we should avoid.

      Turning coffee waste into clean energy

    Why? Because “the experts also tell us not to drink coffee.” Ridiculous, right?
    Oh, and here are some other major sources of acrylamide, according to the cancer institute: French fries, potato chips, crackers, bread, cookies, and breakfast cereals.
    Quick, non-Californians! Before we lose any additional people to the anti-science camp, coffee sellers in other states should respond to California’s action by placing labels on their product announcing the health benefits associated with coffee, such as improved cognitive function and decreased risk of depression.
    Or add a label pointing to the 2017 study connecting coffee consumption to a longer lifespan: “People who consumed a cup of coffee a day were 12% less likely to die during the study period compared to those who didn’t drink coffee. This association was even stronger for those who drank two to three cups a day — 18% reduced chance of death.”
    That study, by the way, was conducted in part by the Keck School of Medicine. At the University of Southern California.

    Read more: https://www.cnn.com/2018/03/30/opinions/california-cancer-coffee-label-wheeler/index.html

    New cancer test isn’t ready for prime time

    (CNN)A simple blood test to detect cancer early. How great is that?

    A widely reported study in the journal Science described a liquid biopsy test — CancerSEEK — which combined measuring eight tumor biomarkers with testing for pieces of DNA with cancer associated mutations in 16 genes.
    It’s not one test; it’s a battery of tests. And while collecting the blood may be simple, the subsequent analysis is extraordinarily complex.
      The task at hand is particularly challenging. We all have pieces of DNA in our blood. Distinguishing the tumor DNA from the background DNA requires finding the mutations specifically associated with cancer.
      Adding to the complexity, healthy individuals can have mutations. To avoid labeling innocuous mutations as cancerous requires a bunch of statistical fine-tuning.
      In other words, there are a lot of steps in a liquid biopsy and much potential for things to go awry.
      To their credit, the CancerSEEK investigators were very forthright that the study conditions were ideal for the test to accurately detect cancer. The liquid biopsy simply had to discriminate between patients with known cancer (the majority of whom had symptoms) and healthy individuals. And the statistical fine-tuning was tailored to the study participants — with the knowledge of who had, and who did not have, cancer.
      Although the test was able to detect most of the late-stage cancers, it detected less than half of the stage 1 cancers.
      But doctors don’t screen to find advanced cancer, we screen to find early cancer. And we don’t screen people with symptoms of cancer, we screen people who don’t have symptoms of cancer.
      There’s no doubt that there would be more detection errors in the less controlled environment of the real world.
      Just how often was made clear in a recent JAMA-Oncology study. Forty patients with metastatic prostate cancer received liquid biopsies to tailor therapy in real time to the genetics of their spreading tumors. That’s the vision for precision medicine.
      But the investigators added a little twist. They wanted to know whether it mattered which lab the liquid biopsies were sent to. So they sent each patient’s blood for two different commercial liquid biopsies: Guardant360 and PlasmaSELECT. Both tests were designed to detect mutations in the same genes.
      Yet in over half of the 40 patients, the tests gave different answers about which mutations were present. Different liquid biopsy tests give different answers in a majority of patients? That’s not precision, that’s awful.
      Sure, the analyses of liquid biopsies will improve. But if this much confusion exists about what mutations are present in the blood of patients with metastatic cancer (who have a lot of tumor DNA), imagine the uncertainty that will exist for asymptomatic individuals not known to have cancer — the very people who would be screened.
      And then there is the question of what to do with a positive result. This is very different than detecting a concerning lung nodule on a screening chest CT scan or a concerning breast mass on a screening mammogram. In these cases, it’s clear what to do to get a definitive answer: surgically biopsy the nodule or the mass. But with a liquid biopsy, the anatomic location of a cancer can be a mystery. It may not even be clear what organ the cancer is in.
      Imagine what this might mean for a patient: A doctor says, “It looks like you have cancer, but we are not sure where.”
      Even if there is certainty that the cancer is in, say, the liver, doctors may not know where in the organ. What to do then? Randomly biopsy different parts of the liver?
      This is doubly concerning when screening average-risk individuals, because most positive results are expected to be false alarms. We typically learn that a screening test is falsely positive because a surgical biopsy is normal. But absent the knowledge of where to biopsy, how can we ever be sure a positive liquid biopsy is wrong?
      Doctors won’t know where to look, but we will keep looking. Liquid biopsies are a recipe for more health anxiety, more procedures, more complications and more overdiagnoses. Not to mention, more out-of-pocket costs for our patients.
      Of course, we should continue to study liquid biopsies. The detection of circulating tumor DNA may ultimately prove useful in selected settings, such as tailoring therapy for aggressive cancers that are rapidly mutating. But the real enthusiasm is for screening average-risk individuals.

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      One reason is obvious: there is a lot of money to be made. A Goldman Sachs video estimated the potential liquid biopsy market to be $14 billion annually, adding “and we’re just at the beginning.” That kind of money doesn’t come from testing the few patients with aggressive cancer, that comes from screening millions of people.
      And there is a less obvious reason: it is easier for a new test to pass regulatory muster than it is for a new drug. While the FDA has a longstanding mandate to protect us from snake oil treatments, this often doesn’t extend to snake oil testing.
      The enthusiasm for finding things that might benefit people in the future ignores the fact that doing so can cause people to have problems now. In short, a bad test can do as much damage as a bad drug. Worrisome liquid biopsies will start a cascade of subsequent, not-so-simple tests and procedures. People will be hurt in the process.

      Read more: http://www.cnn.com/2018/02/13/opinions/liquid-biopsy-opinion-welch/index.html

      It’s a real shame Trump didn’t eat more fish

      (CNN)Cast your mind back to the 1970s. A young Czech-born model named Ivana joins her husband-to-be at the touristy restaurant called Tavern on the Green on the west side of New York’s Central Park.

      When Ivana’s turn came, she opened her mouth to speak and was interrupted by the paterfamilias. “She’ll have the steak,” said Fred Trump Sr., real estate magnate and father of a future president of the United States.
      “No, I’ll have the fish,” she says.
        “No, she’ll have the steak.”
        In the showdown, Ivana didn’t budge. She got the fish and thus established she was her own person, with her own preferences. Donald Trump, the man who would become first her husband and then POTUS, had the steak. He would order it countless times in the future. And when he wasn’t choking down on sirloin, it would be fried chicken or hamburgers.
        Fast-forward 40-plus years and Ivana is no longer Mrs. Trump, and she’s sharing her dining room story with me to explain how domineering Fred Trump could be and how she won his respect. This conversation, which was part of an interview for the biography I wrote about her ex-husband, also illustrated the President’s approach to diet and fitness.
        As everyone who has paid attention knows, President Trump has never been a health nut. His diet is famously poor and his approach to exercise begins and ends with golf played from a riding cart.
        When I interviewed Trump, we met in his home, which was atop Trump Tower, and then, after the tape recorder was switched off, we went downstairs to his office before saying goodbye. Each time, he walked me through the gym that was on a floor of the building, so he could show off one of the towers amenities. He repeated this tour the way he repeated stories, and each time he would say: “I’m told it’s a good gym. I don’t know. I don’t use it.”
        During the campaign for the White House, candidate Trump showed he had ample energy, criss-crossing the country and giving impassioned speeches. However, he was enabled by a staff of handlers, his private jet and a carefully-planned schedule.
        And though people around him insisted he had a young man’s vigor, so many misrepresentations came out of his mouth — and the mouths of his aides — that no one could know what was true.

          Trump’s heart health in focus after doctor’s briefing

        As with so many things about Trump, Americans were asked to ignore what they saw with their own eyes — a substantially overweight man of 70 dining on fried chicken and burgers — and accept the sales pitch.
        In the meantime, his side did everything they could to suggest that opponent Hillary Clinton was hiding one health problem or another and physically unfit for office. In August, the candidate himself said Clinton lacked the “physical stamina” to serve.
        Looking at the two, no one with eyes to see would imagine Trump was healthier.
        Further dissonance arose when Trump and Clinton issued medical reports. Hers was comparable in detail to those released by Barack Obama and his opponents in 2008 and 2012. Her physician, an internist, noted hypothyroidism but declared her in good condition.
        Trump’s medical report was filed by a gastroenterologist, hardly a general medicine expert, who in Trumpian fashion declared he would be the “healthiest individual ever elected to the presidency,” though he offered little real information.
        This week, the world learned that Trump’s doctor was either more salesman than physician, or he didn’t perform the kind of tests and analysis that would permit his glowing report.
        The White House, to its credit, announced that the President has a form of heart disease, which, barring changes that might occur with diet and exercise, put him at moderate risk of a heart attack in three to five years.
        News of the heart condition comes amid concerns — contradicted by the White House physician — that Trump could suffer from a cognitive problem. (Turns out his intemperate behavior and statements are a matter of character and attitude.)
        I for one always thought the problem with Trump was his heart, not his mind. But I was speaking symbolically, not medically. As we now know, the trouble — if truly cardiac and if his longstanding habits are any indicators to go by — he will struggle to change in ways that could help him.
        I think it is worth noting that the President’s temperament, which is one type of heart problem, and his health concern, which is another, may have the same antecedent.
        Fred Trump was a demanding, impatient man who likely laid the foundation for Donald Trump’s own bullying tendencies. He also set the dietary template, insisting everyone should have the steak.
        Considering the son’s problems today, one can’t help but wish Fred had been a kinder, gentler father who taught his boy it was okay to order the fish.

        Read more: http://www.cnn.com/2018/01/18/opinions/trump-should-have-eaten-more-fish-michael-d-opinion/index.html

        America’s health is declining — and corporations are stoking this crisis

        (CNN)America’s powerful corporations made a killing with the passage of the Republican tax cuts. The tax cuts will hand trillions of dollars to the companies and their moneyed owners following a massive corporate lobbying campaign.

        And make no mistake — America’s health crisis is the result of greedy corporations and their reckless practices.
        The US life expectancy is slipping further and further behind other high-income countries. According to the most recent comparative data of the Organization for Economic Cooperation and Development, US life expectancy in 2015 (at 78.7 years) ranked 27th out of 35 OECD countries, more than five years behind the leader, Japan (83.9 years), and roughly four years behind the next three countries, Spain (83.0), Switzerland (83.0) and Italy (82.6).
          Yet Americans pay on average almost $10,000 per person per year for health care — twice or even three times the cost in Canada and many European countries. So, then, what accounts for America’s shorter life span?
          One problem is the low value for money in America’s healthcare spending. Unlike the highly regulated health systems abroad, America leaves much more of the pricing for drugs, procedures and hospital stays in the hands of the private sector, which exploits its market power by charging outrageous prices and leaving millions of Americans without coverage.
          Another cause of America’s lagging life expectancy is the nation’s rising inequality of income. America’s poor die much younger on average than America’s rich, with a discrepancy of up to 10-15 years on average. The combination of overpriced American health care and poverty is lethal.
          Two corporate-caused US epidemics — obesity and opioid addictions — add to the misery.
          America’s obesity epidemic is shortening the lives of Americans and burdening them with a range of chronic diseases, including coronary heart disease, type-II diabetes, hypertension and certain cancers. Obesity is also a risk factor for the onset of depression, while depression, in turn, contributes to the onset of obesity.
          America’s opioid epidemic is leading to soaring deaths from drug overdoses, and substance abuse more generally is contributing to soaring rates of suicide, addiction and suffering. The CDC calculates that there were 63,600 deaths from drug overdoses in 2016, and more than a tripling in the age-adjusted rate of drug-overdose deaths from 1999 to 2016.

            Why are opioids so addictive?

          While the obesity and opioid epidemics are sometimes written off as “bad life choices,” these epidemics are largely the handiworks of an irresponsible corporate sector. As University of California pediatric endocrinologist and neuroscientist Dr. Robert Lustig describes in his remarkable book, The Hacking of the American Mind, America’s soaring obesity reflects a fast-food diet that has been deliberately stuffed with high-fructose corn syrup and various processed meats and grains that cause obesity.
          American are being killed slowly and painfully by their own food industry. Yet instead of taking responsibility for the epidemic and doing something about it, most of the leaders of the food industry actively resist a change of direction and the needed changes in public-health regulation. The beverage industry, for example, is fighting strenuously against public health measures aimed at cutting America’s deadly over-consumption of sugar-packed sodas. Sad to say, things — human health, for one — do not go better with soft drinks.

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          The corporate hidden-hand is also present in the opioid epidemic. A recent expose in the New Yorker and lawsuits filed against Purdue Pharma, the maker of OxyContin, allege that the company pursued a marketing campaign that pushed OxyContin onto doctors. According to the article, Purdue allegedly did not adequately study the risks of OxyContin, paid off doctors to ignore them and pushed aggressive advertising despite growing concerns and evidence of an addiction crisis. While the company rejects this characterization and denies the allegations, drug makers — at the very least — failed to respond adequately to the growing alarm bells as the opioid epidemic soared. (Purdue has since issued a statement saying it is committed to helping in the fight against prescription opioid abuse and to supporting the recommendations of the Food and Drug Administration’s Opioid Action Plan.)
          Corporate power has run amok in American politics. Yet the mortality crisis is even worse. The health of the American people depends on restoring democratic oversight and regulation over powerful food and drug companies blinded by greed and arrogance.

          Read more: http://www.cnn.com/2017/12/27/opinions/life-expectancy-corporations-opinion-sachs/index.html

          When racism cuts, Michelle Obama helps us heal

          (CNN)Three weeks ago, my house was pelted with watermelon rinds. No other garbage. Just watermelons. As soon as I heard the noise, I ran outside. When I saw the mess, I was enraged. I wanted to confront the culprit.

          My anger was caused by something much deeper than watermelons. You see, growing up in the United States, I’ve been culturally conditioned to see the world always through the suffocating prism of race. And it’s not just me. This is a basic instinct for Americans of every race. No matter how much we say “everyone is equal,” our government policies, our history and our daily social interactions betray this lie.
          Without a second thought, I freeze with terror when I see a police officer — in any country — or wake up in a panic when I know that my son is driving home late. It often feels like there’s no escape from this nightmare.

              Michelle Obama called ‘ape in heels’

            So when I saw watermelon slices scattered all over my patio, I took it as a form of racist intimidation. The problem was, I wasn’t in the United States. I was in Costa Rica, where watermelon is just a delicious fruit enjoyed by all. There’s no racial stigma attached, no lingering racist Reconstruction Era cultural stereotypes about lazy blacks and watermelons.
            Calm down and breathe is what I told myself as I cleaned up those watermelon rinds. It’s nothing. But generations of toxic cultural indoctrination do not die easily and even now, weeks later, I’m still trying to get over it and my suspicions about some of my expat neighbors, many of whom like me are from the United States and travel around the world towing their own racial baggage as white Americans.
            This is what racism does to you. It scars you and dehumanizes us all. It makes us mistrust one another. And if you don’t fight it every day, the hate will defeat you.
            And this is exactly why a trailblazing woman like Michelle Obama is so inspiring. As the nation’s first black First Lady, Michelle was the object of equal parts adulation and scorn for eight years. And she still is. Recently, she spoke at a women’s empowerment conference in Colorado. She told the crowd that the racism she faced as First Lady was extremely painful, specifically one incident where a woman called her “an ape in heels.”
            That remark cut as it was intended, she said. But Michelle urges us to acknowledge our pain, work to heal our wounds and hold on to our power at the same time.
            “Women, we endure those cuts in so many ways that we don’t even notice we’re cut,” she said. “We are living with small tiny cuts, and we are bleeding every single day. And we’re still getting up.”
            She knows the path is not easy. The moment the Obamas stepped onto the national stage it was apparent that America just couldn’t resist the ugly racial jabs, whether done in jest or with malice. And it’s not just Twitter-crazed private citizens who’ve attacked.
            Media outlets — liberal and conservative — have helped instigate this hate. Fox News anchors took to calling Michelle, “Obama’s baby mama.” Impossible to imagine Barbara Bush or Melania Trump ever being denigrated in this way.
            And back in 2008, a New Yorker magazine cover depicted Michelle as a machine-gun toting, afro-wearing terrorist standing with Barack dressed in Muslim attire.

              Defining racial moments in Obama’s presidency

            The two were celebrating with a fist-bump standing beside a portrait of Osama bin Laden. As if black folks winning the White House was more horrifying than terrorists taking over our nation. The magazine called it satire, humor meant to make a mockery of all the racist stereotypes aimed at the Obamas. No black people I knew were laughing, though. We weren’t liberal enough to get that joke.
            The First Lady would have to be made of stone not to be hurt by these attacks. But she is not sidetracked. She has used her platform to improve the lives of girls, military families and young people around the world.
            In 2010, she launched Let’s Move!, a project to fight childhood obesity by making school lunch programs healthier, encouraging exercise and promoting community gardening. Her Joining Forces project, launched with Jill Biden, supports veterans and their families with mental health, education and employment services.
            Her Reach Higher Initiative helps students to expand their educational horizons beyond high school. And just two years ago, Michelle and President Obama together started the Let Girls Learn, a federal program that helps educate girls around the globe. (President Trump has already talked of eliminating some of Michelle’s programs.)
            Michelle understands that these days it’s easy for young people, for all of us, to get discouraged by life — especially people who look like her. And that our problems are much larger than name-calling or racist cartoons.
            According to the Washington Post database on police shootings, as of July 2017, 122 black and 90 Hispanics people have been killed by police this year. Yearly totals for 2016 were 233 blacks and 160 Hispanics killed, and, in 2015, 258 blacks and 172 Hispanics.
            Still, like the former First Lady, I believe we have the power change lives. Michelle’s refusal to let her humanity be stripped down by hatred is really the only hope for all of us. Because literally the chronic stress of racism is cutting our lives short.
            For years, psychologists have known the stress of racism — both perceived and real — is the cause of shorter lifespans in communities of color. African Americans, Native Hawaiians and Latin Americans have been impacted greatly by hypertension and diabetes due, in part, to chronic stress resulting from discrimination, according to the American Psychological Association.
            And Psychoneuroendocrinology journal published a 2015 study that showed how merely feeling like we’ve been discriminated against or thinking that we will be in the future is enough to trigger chronic stress ailments including high blood pressure, infant mortality, heart disease and mental disorders.

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            I need look no further than my own family over the past three generations. Black women and men stood strong because they were never allowed to be weak. I’ve watched my relatives sacrifice their mental and physical health, internalizing their pain day after day. Those sacrifices cannot be in vain. But it’s time we found a better way to manage our pain. We can practice self-care and still fight passionately for the full equality that has forever evaded us.
            Michelle’s ability to continuously rise above hate, to speak with love and compassion for all people is her true power — it is not her Harvard degree, her title or her husband. She has found a way to acknowledge her pain without sacrificing her dignity or robbing others of their own.
            She inspires me to join her on this journey.

            Read more: http://www.cnn.com/2017/07/30/opinions/michelle-obama-overcoming-racism-opinion-jones/index.html

            Why the Cruz amendment is smart policy

            (CNN)Republicans are finally getting smart on Obamacare. It took one of the savviest Republican senators — Ted Cruz of Texas, with an assist from Mike Lee of Utah — to get the GOP to figure out how to replace Obamacare, reduce premiums, and save money for the government. And all without alienating millions of voters. But he’s pulled the Republicans’ fannies out of the fire by having flipped a political losing strategy into a big-time winner.

            The Cruz amendment — which has been inserted into the GOP Senate health plan — is smart, because it doesn’t take anything away from anyone. If you want Obamacare — you can have it. You can have the coverage for the 10 “essential benefits,” you can have the subsidies and the exchanges that were supposed to save $2,500 per family. It’s still there for you.
            The Cruz amendment creates what is called a “Consumer Freedom Option.” This essentially allows an “off-ramp” from Obamacare for the tens of millions of Americans who don’t want it. The “Consumer Freedom Option” allows insurers who offer Obamacare-compliant plans to offer a range of much less costly plans. In other words, it empowers people and families to pick and choose what they want in their own insurance package. Some families want and can afford blanket coverage that insures them for everything from cancer to contraceptives to drug addiction to dental care to the sniffles. If you want to pay for that coverage, go for it.
              What about families or individuals with lower incomes or healthy life styles that want the other extreme? They want slimmed-down coverage that protects them from major medical expenses — a bad injury like breaking a leg, or a serious disease with costly ongoing treatments. These families may voluntarily choose to pay for more routine medical expenses, like a checkup or a visit to the dentist’s office, out of pocket. One benefit is that since more people will pay directly for medical services, they are likely to shop around for the best price, and this competition will lower prices for everyone.

                If Sen GOP gets 1 more ‘no’ new health plan dies

              In other words, the Cruz amendment is pro-choice — which I thought was one of the anthems of liberalism. Cruz told me that he believes that based on the preliminary numbers that this approach could save tens of millions of Americans as much as 30% on their health costs. That’s thousands of dollars of savings per family.
              My advice for the Republicans is to start running national TV and radio ads right now with a Geico-type message. A mother is smiling as she pays the bills at the kitchen table and declares: “Hey, I just saved $5,000 on my health care thanks to Senator Cruz.”
              To the left, the Cruz plan is like a cross in front of a vampire. They complain that this will destabilize the market “and [turn] the marketplaces into high-risk pools,” as Larry Levitt, senior vice president at the Kaiser Family Foundation, has put it. Insurance companies are claiming that the sick and those with pre-existing conditions will have to pay more.
              That’s partly true, but it’s not the whole story. Cruz provides billions of dollars of subsidies for people who have pre-existing conditions and high medical costs. This number is much smaller than the media is saying. Cruz believes the number of people without private insurance (mostly through their employers), who don’t have adequate coverage for preexisting conditions is about 1.5 million people. Why contaminate a functioning insurance market for 300 million people, to give coverage to 1.5 million?
              The Cruz plan provides protection for those 1.5 million people in exchange for giving tens of millions of Americans the freedom to choose the affordable health plan of their choice. This is America. The government should never force people to buy insurance they don’t want or can’t afford. Cruz says that the vast majority of the people in Texas who have had to pay the Obamacare penalties for not buying a plan have incomes of less than $50,000 — they are the victims of the “Affordable Care Act.”
              The left prefers a system where people who want Cadillac coverage for contraceptives, dental care, substance abuse problems, etc., should be subsidized through higher premiums paid for by people who don’t want that coverage. How is that fair?
              Another virtue of the Cruz plan is that if people can save money on their medical insurance by living healthier lifestyles — by exercising, stopping smoking or doing drugs, getting enough sleep, taking vitamins, watching their weight, having the right diet with less sugar — they will be rewarded with plans that offer lower premiums. This will incentivize wellness behavior, which will dramatically lower health care costs over time. The major expenses in health care are associated with diseases like diabetes, heart disease, stroke, and cancer, which are all in part a result of bad lifestyle decisions — especially obesity. So the Freedom Accounts are tied to a concept liberals have come to hate — individual responsibility.

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              And now for the real genius of the Cruz plan. If his amendment stands, the left’s grand vision of a single-payer government-run health insurance dystopia will go up in smoke for good. The left wants everyone in the same insurance boat. No choice. No competition in plans. But once people are given the right to choose the health plan that is affordable to them and tailored to their individual needs, they will resist single-payer, one-size-fits-all insurance. It doesn’t take a village to buy a health plan.
              If the GOP is smart enough to rally behind the Cruz amendment, and health costs and premiums start falling almost immediately, we will start to have what Obamacare never delivered: affordable care. And by the way, Trump will get reelected in a landslide and so will congressional Republicans.

              Read more: http://www.cnn.com/2017/07/15/opinions/cruz-amendment-smart-policy-moore/index.html

              GOP’s message to Americans: You’re on your own

              (CNN)Beware the Ides of September, which could find everything from your cancer surgery to HIV treatment for Africans sliced to smithereens. As Republicans cheered passage of their Obamacare repeal in the House on Thursday, the Democrats chided them that America will vote the GOP out of power in 2018, singing, “Sha-na-na-na! Na-na-na! Hey! Hey! Goodbye!”

              The battle lines are clearly drawn. There will be skirmishes in coming weeks and open warfare in Washington this fall.
              Bad as the GOP’s latest iteration is, the Republican health bill will not become the law of the land. But before you heave a sigh of relief know this: It is an awful harbinger of what is to come, demonstrating that the party in control of all three branches of the American government is more than willing to chuck you, and the whole world, on the pyre of failed personal responsibility before it will consider paying to keep you alive and well.
                The “blame the victim” mantra of the 1980s that saw employers firing elders, smokers and obese employees in order to maintain low, pooled insurance costs is back in vogue, now a philosophy of governance applied to everything from cancer prevention to foreign policy.
                By a narrow 217-213 vote, the House of Representatives voted to repeal Obamacare, replacing it with a new 2.0 version of the Republican’s American Health Care Act, or AHCA, that appeased both the party’s hard right Freedom Caucus and some of its moderates’ concerns. The bill passed without any Democratic votes, and 20 moderate Republicans sided with the opposition.
                On the other side of Capitol Hill, the Senate approved a $1.1 trillion Omnibus Spending Bill that will keep government lights on until the end of the fiscal year, September 30. It passed with bipartisan support, though 18 of the GOP’s fiscal conservatives voted against it, largely opposing what they consider overspending.

                The worst is yet to come

                While President Trump is frustrated by the slow pace of what he thinks are watered-down actions on the Hill, both the Omnibus Budget and AHCA 2.0 are mere preludes to much tougher times to come.
                On the health care side, the House AHCA 2.0 has about a zero probability of passing the Senate in its current form, prompting the Washington Post to say, “Republicans’ health-care bill isn’t really a health-care bill. It’s a political prop.”
                The real action will come with fights over the FY2018 budget, draft elements of which have been leaked, indicating substantial backing for Trump’s “skinny budget,” a slim presidential statement of spending priorities meant to guide GOP action on the Hill.

                The battle is just getting started

                Repeal is an opportunity for Democrats

                Obama’s legacy is in jeopardy

                Obamacare repeal is a tax break for wealthy

                Costello: Health care plan is a betrayal

                Obamacare vote is the diagnosis

                The take-home messages are clear, even though the ultimate details of a Senate version of AHCA 2.0 and the FY2018 budget remain obscure. The winners are America’s wealthiest class, the Department of Defense, military contractors, health insurance companies and America’s closest military allies. The losers? Well, just about everybody else.
                If the Republican Party hopes to claim victories in the 2018 midterm elections, Sean Spicer and his fellow Washington spin doctors are going to have to manage astounding feats of messaging, aimed at convincing average American voters that paying larger fees for their health care out-of-pocket, seeing the cost of medicines skyrocket and having highly humane health programs overseas disappear are all good things for the middle class.
                Though the Congressional Budget Office hasn’t had a chance to weigh in on AHCA 2.0, none of the revisions appear to alter factors that prompted the CBO to predict that the original GOP plan would, by 2026, leave 24 million people uninsured — more than were in that sorry state when Obamacare was conceived in 2009. The effect would be so profound, CBO said, that 14 million Americans will lose coverage before December 2018.
                Close examination of the House’s new AHCA 2.0 reveals that compromise between the party’s factions was reached not by addressing the underlying problems seen by the CBO, but by booting nearly all of the other tough decisions down to the states.

                What is ‘access’?

                Basically AHCA 2.0 claims to guarantee coverage for people with pre-existing conditions and keep Americans that are now receiving Obamacare coverage on some form of health access. But the devil is in the details behind the words “guarantee” and “access,” both of which are left to the states to define.
                The House advocates creation of special insurance pools filled with the very sick, offering no good reason why any profit-oriented company would want to dive into those pools. Overall, AHCA 2.0 cuts federal support of Medicaid by $839 billion over 10 years, but creates an $8 billion fund over five years to help support those special pools of the very-sick.
                A new Washington Post-ABC News poll finds that 70% of Americans want the federal government to mandate that insurance companies provide coverage for people with pre-existing conditions, such as diabetes, schizophrenia or cancer. And the same percent want a minimum package of basic care available at genuinely affordable prices to every American.

                  13 men, no women, tackle health care in Senate

                But nothing is guaranteed by AHCA 2.0, except a hope and prayer that state legislatures and governors will vote through expensive packages of health insurance that incentivize private insurance companies to carry millions of people, including those with costly chronic care needs, based on expansion of states’ Medicaid programs.
                Some states like California already make Medicaid cover more people, for more health problems, than even Obamacare mandated. But most states fall well below Obamacare mandates and will use whatever version of AHCA 2.0 is ultimately enacted into law to further shrink their spending and patient access.
                In a federal appeals court case regarding abortion clinics in Alabama, the state defines “access” as something to be denied, meaning women should be denied all access to abortion services in that state. Several states currently have laws or pending court cases that similarly draw on the language of “access” as a matter of legally mandated denial of services.
                In an emotional appeal on his late-night TV show comedian/host Jimmy Kimmel told his audience that his newborn son was born with a condition requiring neonatal open heart surgery — which he, a wealthy celebrity, could afford.
                But, Kimmel noted, access to health shouldn’t be about personal wealth, adding, “Before 2014, if you were born with congenital heart disease like my son was, there was a good chance you’d never be able to get health insurance because you had a pre-existing condition… And if your parents didn’t have medical insurance, you might not live long enough to even get denied because of a pre-existing condition.”

                Wealth determines access

                But under the AHCA, personal wealth is precisely the prime determinant of health care. As Republican Bill Schuster told his Pennsylvania constituents, “It gets rid of Obamacare’s taxes and mandates, and returns the power of regulating health insurance back to the states.”
                Your access, Schuster continued, is affordable because you can write some of it off in your taxes, pay for some of the rest with your health savings account (which you paid for) and get cheaper care because the state will no longer be covering such things as abortions.
                Hogwash. A single mother of two children who earns $40,000 a year as a domestic worker has no taxable income after paying for transportation, housing, food, school fees, child care and her children’s clothing, so writing off health care costs via her annual IRA filing is a nonstarter.
                Kicking the pre-existing conditions can down the road to the states could lead to denial of health insurance services to 129 million Americans, according to a 2011 Department of Health and Human Services study, and return the nation to the bad old 1980s days of “personal responsibility for health.”
                As Alabama Rep. Mo Brooks told CNN, people with costly conditions should be required to contribute more to their states’ insurance pools so that they aren’t a financial burden “to those people who lead good lives, they’re healthy, they’ve done the things to keep their bodies healthy.”

                Pay attention, America

                The blame game allows Republicans to feel fine about eliminating federal disease prevention programs, putting the onus on individuals and slashing the $1 billion Prevention and Public Health Fund that was created under Obamacare in the Centers for Disease Control and Prevention. The CDC uses those funds to support everything from diabetes diagnoses and care programs to elimination of lead poisoning.
                One-third of the funds ($324 million) were for vaccines and child immunization programs. Another $12 million targeted adolescent suicide efforts and $160 million subsidized epidemic surveillance and the safety of drinking water and food from bacterial contamination.
                All of these programs will disappear — 12% of the CDC’s total budget — if the Senate maintains the thrust of AHCA 2.0, going along with the House majority’s view that government shouldn’t “meddle” in personal decisions such as whether or not to smoke cigarettes or cook your skin in a tanning salon.

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                The House and Senate will battle such sentiments when they finally tackle the FY18 budget in September. Leaked elements of the budget reveal a similar “personal responsibility” perspective guiding slashing of federal support for malaria prevention in Ghana, HIV treatment in Malawi, women’s health programs in Guatemala, democracy-building in Asia and school lunch programs in Harlem.
                If your child is hungry in school, bit by malaria-carrying mosquitoes in bed at night or lacks treatment for the HIV he was born infected with it’s your fault and your responsibility, not a problem for US taxpayers.
                Pay attention, America. You may wake up in a year to discover that your cancer care will bankrupt your family, and your now-impoverished children will get no meals at school. Your town’s hospital may get hit by a tornado and discover the CDC’s stockpiles of drugs and medical equipment for catastrophes and outbreaks has disappeared. You may take a holiday overseas and find fear and loathing directed at you from people angry that services once provided by the US Agency for International Development or other foreign aid agencies no longer exist.
                And if you’re a member of Congress who voted for such changes in the FY18 budget, you may suddenly find your voting constituency backing a different horse — or even a donkey.

                Read more: http://www.cnn.com/2017/05/08/opinions/health-care-worst-to-come-opinion-garrett/index.html

                Jimmy Kimmel is right on health care

                (CNN)A late-night comedian isn’t supposed to make you cry. But on Monday night, Jimmy Kimmel caused many — including me — to shed a tear while watching his emotional plea for compassionate health care coverage for children. While fighting tears himself, Kimmel remarked, “No parent should ever have to decide if they can afford to save their child’s life. It just shouldn’t happen. Not here.”

                Before that emotional moment, Kimmel had opened his late-night show by explaining that his wife had given birth on April 21 to their son, William “Billy” John Kimmel. The newborn appeared fine at first, but a short time later, Kimmel was told his baby had a life-threatening heart condition that required emergency surgery to repair.
                Kimmel recounted waiting for the doctor to tell him how the surgery went, “It was the longest three hours of my life.” He then shared a photo of his adorable child while explaining that the surgery was a success, though his son will require additional surgery in the future.
                  Kimmel went on from there to make a plea directed at members of Congress, who are considering whether to support the amended Trump-championed health care plan, which as Politifact concluded, would appear to “weaken existing protections for people with pre-existing conditions.”
                  The late-night comedian first offered a little history about America before the Affordable Care Act (ACA). “We were brought up to believe that we live in the greatest country in the world, but until a few years ago, millions and millions of us had no access to health insurance at all.”
                  He added that before the ACA mandated coverage for pre-existing conditions, “if you were born with congenital heart disease like my son was, there was a good chance you would never be able to get health insurance because you had a pre-existing condition.” He added, “(If) you were born with a pre-existing condition and if your parents didn’t have medical insurance, you might not even live long enough to get denied because of a pre-existing condition.”
                  Kimmel is correct. Before the ACA, health insurers could and did deny coverage for children born with heart problems, like his son, because the carriers claimed it was a pre-existing condition.
                  As noted by the Kaiser Family Foundation, coverage was denied by health insurance companies for a range of congenital disorders under the guise of those being pre-existing conditions, despite the fact that the baby literally didn’t exist before being born with the ailment.

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                  Why would we as a nation ever want to go back to that time? A January Pew Poll found that Americans want our government to guarantee more health coverage, not less. That poll found that 60% of Americans say the government should be responsible for “ensuring health care coverage for all Americans.” This includes 52% of Republicans whose families earn $30,000 a year or less.
                  Kimmel concluded by imploring the members of Congress who are considering repealing ACA and replacing it with the less protective plan: “If your baby is going to die and it doesn’t have to, it shouldn’t matter how much money you make.” He added poignantly, “I think that’s something that whether you’re a Republican or a Democrat or something else, we all agree on that, right? … Don’t let partisan squabbles divide us on something every decent person wants.”
                  Kimmel is 100% correct. Now let’s hope that the Republican members of Congress understand that as well.

                  Read more: http://www.cnn.com/2017/05/02/opinions/kimmel-is-right-on-health-care/index.html

                  In Trump’s America, comedians lead the resistance

                  (CNN)In the age of Donald Trump, it’s not the Democrats leading the opposition — it’s the comedians.

                  Sure, Congressional Democrats are voting and speaking out against Trump’s proposals on issues like health care, but few of them can garner national headlines or get a video to go viral.
                  Comedians, on the other hand, are now the ones with a “bully pulpit” to raise issues in ways that dominate our social media feeds and impact the larger political conversation. We saw an example this week with Jimmy Kimmel’s emotional plea to preserve coverage for pre-existing conditions in the Trump-championed health care bill. Kimmel touched a nerve, as the video of his tearful plea was widely shared.
                    While the GOP plan ultimately did pass the House on Thursday in a form that experts agree could weaken coverage for pre-existing conditions, Kimmel’s clip had an impact on the discussion. His late-night plea made more people aware of the issue and in turn placed additional pressure on some politicians.
                    We saw evidence of this from US Senator Bill Cassidy (R-Louisiana), who expressed his reservations to Trump’s health care plan on CNN by directly invoking Kimmel’s heartfelt plea, “Would a child born with congenital heart disease be able to get everything she or he would need in the first year of life? I want it to pass the Jimmy Kimmel test.”
                    Then there’s Stephen Colbert, the late-night leader of the comedic resistance to Trump. Colbert has seen his ratings skyrocket as he has taken on Trump night after night. And his joke this week about Trump and Putin that outraged some on the right — ironically, the anti-politically correct crowd want comedians to be politically correct when mocking Trump — had two positive effects.
                    The joke reminded Americans of the Trump campaign’s possible collusion with Russian intelligence to influence our 2016 presidential election. And it reinforced Colbert’s profile as a fearless comedian who will not hold back when going after a president he feels is failing to lead.
                    Kimmel and Colbert followed other comedians who made headlines last weekend for taking direct aim at the current President. “The Daily Show’s” Hassan Minhaj performed at the White House Correspondents’ Dinner, where he used comedy to remind Americans about Trump’s travel ban on Muslim-majority countries, calling Trump, “the orange man behind the Muslim ban.”
                    And Samantha Bee in her TBS prime-time special used comedy to remind us of Trump’s history of sexism as well as his issues with telling the truth, joking that reporters need to be commended for fact-checking Trump “as if he some day may get embarrassed.”
                    And, of course, “Saturday Night Live” has been nothing short of fantastic in its comedic takedowns of Trump and his administration. Alec Baldwin’s Trump has so unnerved Trump that just a week before being sworn in as the 45th President, he was tweeting about his outrage over Baldwin’s portrayal.
                    “SNL’s” role in the comedy resistance has seen it rewarded with its highest ratings in decades. And with Melissa McCarthy hosting next Saturday, we will likely see her next satiric takedown of White House Press Secretary Sean Spicer.
                    Add to that Seth Meyers, John Oliver and Trevor Noah, who have all contributed mightily to the comedic resistance to Trump. The role these comedians are playing cannot be overstated.
                    Their jokes also play a vital role in not normalizing Trump. Comedy often reminds us that Trump trafficked in bigotry, sexism and xenophobia to win the White House. Democrats are now focused on combating Trump’s policies and don’t spend as much time reminding the public of Trump’s prejudicial currency. But comedians can and do.

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                    Comedians, often called court jesters or fools in literature, have a long history of using humor to speak uncomfortable truths. In Shakespeare’s plays, the fool was able to address social and political realities in ways that the lead characters rarely could — using humor as his shield. And even before Shakespeare, Dutch writer Erasmus wrote that the fool “can speak truth and even open insults and be heard with positive pleasure; indeed, the words which would cost a wise man his life are surprisingly enjoyable when uttered by a clown.”
                    So here’s to the fools! May you fearlessly continue to use your wit and humor to resist Trump. And to Trump supporters offended by their jokes, it’s time you dainty snowflakes put on your “big boy pants” because these comedians are just getting warmed up.

                    Read more: http://www.cnn.com/2017/05/07/opinions/comedians-lead-resistance-opinion-obeidallah/index.html

                    Single, childless and nearing 40, I saw one real option

                    Denver (CNN)It was a year ago when a young woman stopped me in a neighborhood shop. She gazed at my stroller and started crying. She told me how lucky I was to be married with kids.

                    My heart dropped. She didn’t know me at all.
                    I am a single mother by choice. Yet I was raised in a Christian, conservative home, where I grew up believing in the traditional family unit. And I was taught that there was an order to achieving it. First, fall in love. Second, marry a man. Third, start a family.
                    Now in my fifth decade, only one has proven true for me — and it isn’t the first.
                    On the day that I turned 30, I journaled that I would think about becoming a mother should I still be single at 38. What that looked like, I didn’t exactly know. It was a promise to myself, maybe to God.
                    At the time, I was in a terrible relationship with a man who told me he wanted to be with me, but he could never love me. It was because of those words that I first clung to the idea of motherhood. Maybe a man could deny me love, but he would never deny me a child.
                    Fast forward to my 38th birthday. I was still single, and the world of dating had changed significantly in the last eight years. Tinder and Bumble, the dominant dating apps, offered countless options for single men and women, but made the experience of dating entirely impersonal.
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                    Dating amounted to small talk with a stranger, who you had briefly interfaced with online because you each thought the other attractive. The small talk was a prelude to hooking up, and there were no expectations even of a text the next day.
                    It was brutal. And after trying my hand at it, I was no closer to finding the love of my life or starting a family.
                    If I needed statistics to back me up, I had them. In 2014, marriage was on the decline, as was the fertility rate in the United States.
                    I had one real option left — and that was to attempt to get pregnant alone.
                    Maybe I didn’t deserve a family, or so many of the subscribers to my conservative Christian values might say. And maybe the men with whom I had been involved didn’t view me as acceptable wife/mother material.
                      But deep down I felt differently and decided to give myself one shot.
                      And so I started the process of in vitro fertilization (IVF). I was mentally prepared for the physical havoc that would ensue, and I had saved every penny for it — to the tune of $30,000.
                      But why didn’t I adopt? After all, even if I were fortunate enough to have a child, the child would be fatherless. And many, myself included, believe this places the child in a precarious situation.
                      That said, at least with IVF my potential child would be biologically related to me, his or her grandparents and cousins. The child might not have a father, but he or she would have a strong bloodline. I hoped this would help ease any future struggle for my child.

                      The IVF experience

                      The very decade I was born into — the glorious 70’s — ushered in the science and technology that might allow me to conceive. Alone.
                      More specifically, 1978 was the year that the first human being was born through the process of embryo creation outside of the womb, then implantation inside of the womb, pregnancy and successful birth. Since that time, IVF has produced approximately 5 million babies, with nearly 1 million of those being born in the United States.
                      The IVF pool is quite minuscule compared to total US births — for example, in 2011, only 0.7% of all US births were attributed to IVF. That said, and barely optimistic, I was committed to the process, or so I thought.
                      And yet there I was at a bar in Los Angeles, a month out from IVF, crying in front of two people I barely knew, but knew well enough to unload to.
                      My life was great on paper. I had done all the right things. I went to Stanford for graduate school. I worked at the White House under Condoleezza Rice. I had the opportunity to travel the world. I had loving parents and two wonderful sisters.
                      And yet I felt unloved — even unlovable. And also greatly conflicted.
                      On the one hand, I was ecstatic — I was weeks away from my shot at becoming a biological mom. I started thinking about this potential path nine years ago and had been setting aside money for five years. I was in love with idea of having a family and giddy at the thought of the unknown.
                        But there was doubt. Goodness, there was doubt. There was that little voice inside my head — the voice of my parents and others — that was very much alive in me. “Why would you purposely bring a child into the world without a father? Are you really that lonely? How would that child feel one day?”
                        Throughout my upbringing, I was told that it’s wrong to play God. And, as recently as the previous Christmas Eve, I was told that bringing a child into the world without a father was selfish.
                        My heart and my brain had to fight back.
                        No, I was not that lonely. No, I was not that selfish. Actually, it was waking up single, every single day of my life — only to be greeted by my career — that felt selfish. And while I could never speak for the feelings that my future child might have, I took solace in the belief that any child would be happy to be alive if he or she were sincerely loved.
                        As I drew nearer to the implantation date, the prospect of creating a tiny human grew more real and began to override any lingering doubt.
                        And so, on August 29, 2014, I asked my doctor to implant two embryos. He wisely asked me to justify two. I was quick to answer. If I were lucky enough to get pregnant with twins — what a gift for them. They may not have a father, but they would always have each other.
                        I knew the statistics and did not expect to get pregnant. Given my age and the means of conception, I was praying for the long shot of one, knowing two would be a miracle.
                        The 2014 Assisted Reproductive Technology National Summary Report, as published by the US Department of Health and Human Services, is a humbling reminder of just how small the odds were during the year that I attempted to conceive. In 2014, a woman of my age, using fresh non-donor eggs with no previous pregnancies, had an 18.8% chance of pregnancy resulting in a live birth. When it came to percentages of cycles resulting in twin lives births, the success rate plummeted to 3.7%.
                        Yes, I had a 3.7% chance of success.

                        Choosing a donor

                        Of course, before the IVF process could begin, I had to choose a donor — and let’s just say I took a less than conventional approach.
                        Given my professional background as a conservative politico, I think people expect me to say that IQ, number of educational degrees and political association were at the top of my donor qualifications list. Not the case.
                        I was looking for someone who I would be attracted to if we were procreating in the traditional way.
                          I know this must sound incredibly superficial. But, let’s be frank, it’s impossible to gauge true intellect or a kind heart by virtue of an online donor search.
                          And so I began my search with a focus on the physical attributes that I have always been attracted to — namely height and athleticism. Six-foot-2 and toned was my baseline.
                          The donor was a collegiate lacrosse athlete. I was able to see three pictures, from tot to teen, of an adorable boy with an incredible smile, unruly hair and a twinkle in his eyes. (This particular bank did not allow adult pictures of the donor for legal reasons. So, at the end of the day, the attraction part of my search was also a gamble.)
                          I finished my search on the scientific side of things. The donor bank I chose provided a full medical history and genetic testing results. Honestly, why wouldn’t you opt for a donor with no heart disease, cancer, mental illness or any other serious genetic conditions in his family history?
                          This is the one distinct advantage of going the donor route as opposed to the good old-fashioned route when conceiving. While I haven’t polled my married or attached friends, I am 99.9% certain that not a single one queried their partner about the specifics of their family’s medical history prior to sleeping with them or accepting a marriage proposal.
                          I was searching for my version of good genes, who also looks good in jeans — at least on paper.

                          The longest days of my life

                          In early September, my blood work came back with hormone levels signaling pregnancy. I was in shock, but I had eight long weeks to go until seeing if there was a heartbeat or two. I started to take a pregnancy test every evening. It was the longest 56 days of my life.
                          D-Day finally arrived. And, there on the sonogram screen right in front of me, was the most beautiful thing: my child’s heartbeat, strong and steady.
                          I had a million immediate questions for the sonographer and started right in. She stopped me, because there was heartbeat number two. Wait, what? I was laughing and crying at the same time. This must be what joy feels like, I thought.
                          The clich that I despise most is: It will happen when you least expect it. Nonsense. I had gone almost 40 years expecting nothing in terms of dating, love and, God forbid, a husband — and I received exactly that in return.
                          But suddenly the least expected had happened. I was pregnant with twins.
                          My journal entry from the evening read as follows:
                          Week 8, Day 1: October 6th D Day
                          Dear God: Thank you.
                          Baby A: your heartbeat was 159 today.
                            Baby B: your heartbeat was 168.
                            I love you A & B. Please keep growing. You’re looking great.
                            Thank you, God. I pray for their development — from their fingers to their toes. From brain to nose. I am so grateful for these precious beings. Prepare me to be the strong parent — fiscally and spiritually — that they will need me to be.
                            Love you.

                            The Friday of truth

                            On a Friday morning roughly 30 weeks after implantation, something seemed wrong. I had such severe leg cramps that I was crawling around the apartment on my hands and knees. I called an Uber at 8:30 am. Never having taken any birthing classes, I had no idea what the onset of labor looked like.
                            By the time I got to the hospital the pain was so intense that I could barely make it to the door. The Uber driver offered to help me up. I was immediately checked in and within minutes was told that I was 7 cm dilated and would be headed into an emergency C-section.
                            My heart stopped. I was petrified that those little heartbeats were going to stop and that my sons — my sons — were not going to make it. I was alone in the pre-delivery room just long enough to run through every awful scenario in my head.
                            And then it was time. Seventy minutes after arrival, I was wheeled into a room with a team of 16 doctors and nurses waiting for me. The sight of this army, the two waiting incubators and all the other metal contraptions made me well up. I had no idea what was going to happen next, but I had never expected it to happen quite like this — not this early, not with these many medical professionals and not entirely on my own.
                            Doctors and nurses were working quickly all around me. Epidural, check. Babies’ heart rates, check. Slicing me open, check. Ripping two crimson-colored sons out of me at 10:40 am and 10:43 am, check and check.
                            I saw Eli and Abel for a nanosecond before the nurses cut the cords and rushed them to their incubator stations to begin inserting the breathing tubes. They were 10 weeks premature and neither could suck, swallow or breathe on their own.
                            The two teams whisked my babies to the Level 4 NICU (neonatal intensive care unit) without me getting to touch their skin or ask if their vital signs were stable. I did hear them cry, which was a relief. I just wish my sisters had been there to take a picture and help recount what happened. I can’t ever get that moment back.
                            Little did I know when I moved to Denver that I would be delivering twins two years later at Denver’s premier NICU hospital — The Rocky Mountain Hospital for Children at Presbyterian St. Luke’s
                            I was not able to see my sons until nine very long hours after delivery. I walked into a room with two incubators housing my baby boys, who looked more like starved squirrels than the roly-poly infants that I had envisioned. All wired up, with IVs jutting out of the top of their skulls, they were absolutely perfect. Complete miracles from inception to emergency birth.
                            And, of course, they chose Friday the 13th of March to scare the living hell out of me and fight their way onto this Earth.

                            The next 60 days

                            Two weeks after I was released from the hospital, I found myself sleeping in my Denver home of almost two years, as my boys lived and slept inside NICU — for 60 days straight.
                            And though I could easily have felt alone — so removed from my two miracles — I didn’t.
                            Friends and family from across the country constantly checked in on me, calling, texting, writing me words of encouragement.
                            And even once Eli and Abel were out of NICU, loving and supporting friends — and sometimes even strangers –continued to shower us with kindness and affection.
                            Initially, the NICU team was our rock. These complete strangers became the most significant and consequential people in the lives of my sons during their first two months. I will never be able to appropriately express my gratitude to the nurses and doctors who safeguarded their lives. Several are friends to this day.
                            Then my personal trainer and his wife, the first people to visit me in the hospital, became the most trusted and consistent presence in our lives. From celebrating our birthdays, to helping with our apartment move, to Fourth of July and Super Bowl celebrations, to just being those adult ears that I need — Adam and Teri have been there for all of it.
                            The mother of twin boys, who lived steps away from me, became my sanity check. We were pregnant at the same time and delivered within weeks of each other. We met by fluke, thanks to a double stroller sighting in the alley.
                            And the parents of my first employee proved invaluable, babysitting the boys on weekends so I could nap.
                            I can’t forget the British transplant, who regularly delivered homemade quiche on weeknights just because.
                            More recently, though, the manager at the Palm (steakhouse) took care of my family. It was Thanksgiving night, and I took the twins for our first holiday fte as a family of three. In one of the most random acts of kindness, the manager worked her way to our table, poured me a glass of wine, helped feed the boys, shared a bit of her life story with me and then bought our meal. She did not know me.
                            Most importantly, since the birth of Eli and Abel, my parents have fallen so completely in love with their grandsons that it’s hard to fully put into words the intensity of their connection. What was at first an idea hard for my traditional parents to grasp, is now two, tiny human beings, who have my parents tightly wrapped around their little fingers. Though thousands of miles away, my parents — and my sisters — express their love and support constantly and in innumerable ways.
                            There are incredible people in this world. My sons’ existences have made that real to me.

                            The lessons learned

                            Eli and Abel have proven to be the embodiment of that saying you always hear — the hardest, yet best thing I’ve ever done.
                            My sons are my family and my future. They represent everything good, hopeful and hilarious about life. They smile and cheer when I walk into their room. They blow kisses and sneak hugs. They belly laugh when we dance. They cuddle up at night and put their heads in the crook of my neck.
                            They also scream, bite and bang their heads on the floor when they’re upset. They chuck their food when they don’t like it. They act like the world is coming to an end at bath time. And they are a constant financial stress. Being a single parent is hard as hell.
                            But from my two little men, I quickly internalized that love is a verb. Love is an action and something you work at every single day. You wake up every morning with a mandate and desire to be a better parent to your children than you were the day before.
                            Speaking of love, friends like to tell me that there is a man out there — some wonderful man who will sweep me off my feet and be an excellent father. To that I say, please stop. Do I want to date? Of course. But I can honestly write that I have no expectations for love, and I certainly do not believe that there is a father out there for my sons. I am not waiting and hoping, because I have lost that hope.
                            Why have I lost that hope? Truth be told, I have been vulnerable with a few men pre- and post-pregnancy. But rejection upon rejection by man after man will do it to you. Even when you are that aloof gal, who doesn’t ask questions or have expectations of something real or long-term, it still ends. I guess you just lose your luster after awhile. It’s my reality, and it never changes.
                            And while we are on the topic of relationships, I would note that I will forever be perplexed by the rate of unsolicited and unexpected congratulatory communications from ex-boyfriends after years of no contact. These were the men who rejected me. These were the men who left after months or years of pretending and/or cheating.
                            After the birth of my sons, these same men suddenly thought they had a green card to strike up conversation and ask for pictures of the twins. One suggested grabbing dinner in DC. One kindly offered to come to Colorado to help run errands, cook dinner or do whatever I needed.
                            The attention was hard to digest. I once cried over these men. Perhaps this was a way of absolving their guilt for being dishonest or wasting my time? Perhaps they were sincerely happy for me, which would suggest that they did respect me after all? Perhaps they were feeling slighted or envious that I went it alone, without them? I’ll never know.
                            And, most importantly, I finally no longer care.
                            Though I may never have a significant other, I do have my sons, who’ve taken me from unloved to loved and from unlovable to lovable. They’ve done this all on their own. They are my miracles, which I almost didn’t allow to happen because of heartbreak, self-doubt and maybe even self-loathing.
                            Prior to Eli and Abel, I wasted at least half of my adult life obsessing about things I had lost — men who broke my heart, clients who weren’t a good fit, friendships that had faded.
                            My sons taught me to focus on the miracles that are right in front of my eyes every single day, beginning with my 3.7%.
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                            Correction: This piece initially stated Lenti is in her fourth decade and has been amended to reflect that she is in her fifth decade.

                            Read more: http://www.cnn.com/2017/04/25/opinions/ivf-3-7-percent-opinion-lenti/index.html