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Public health officials have linked 20 of the laboratory-confirmed cyclosporiasis cases in Georgia ... [+] and Alabama to raw imported broccoli. But the potential sources of the other 190 cases are currently unknown. (Photo: Getty)
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Well, here’s some potentially explosive news—in an explosive diarrhea sort of way. Since April, there’s been 210 reports of cyclosporiasis across 22 states in the U.S. with 30 of these cases resulting in hospitalizations, according to the Centers for Disease Control and Prevention (CDC). And cyclosporiasis commonly results in watery diarrhea. Often very watery diarrhea. Often explosive diarrhea.
Now, explosive diarrhea is not a great symptom to have. Rarely will you say, “Besides the explosive diarrhea that I am having, I’m all set to go to the trampoline park.” Cyclosporiasis can leave you with nausea, a loss of appetite, cramping, bloating, increased gas, and fatigue as well. Such symptoms usually start about one to two weeks after you’ve consumed something contaminated with a parasite that foes by the name Cyclospora cayetanensis.
Cyclosporiasis is not your run-of-the-mill diarrhea for about 24-to-48-hours-and-then-everything-is-cool type of gastroenteritis, either. Symptoms can go on for weeks, months, and even longer than that. Without treatment, symptoms of cyclosporiasis can essentially “cycle,” alternating between getting better and getting worse. Having watery diarrhea over longer periods of time can quickly leave you dehydrated, which can become quite dangerous and even life-threatening, especially if you are already weaker or vulnerable.
The CDC has not identified a specific common cause of all 210 of these cases. Typically, you can get Cyclospora by consuming food or water that has been contaminated with feces, which is a medical term for stool, a deuce, a number two, a backdoor trout, a Lincoln Log, poop there is, or whatever else you want to call it. That’s why the CDC recommends that the “best way to prevent cyclosporiasis” is “avoiding food or water that may have been contaminated with feces.” That is important news if all along you’ve been seeking food or water contaminated with feces.
So, assuming that you don’t regularly tell restaurants and other food providers, “Umm, could you put some feces in that,” what’s the best way to prevent cyclosporiasis these days? After all, since the CDC hasn’t yet identified a clear source, avoiding all food and water is not very feasible, unless you happen to be a cactus. Well, the most common food source of Cyclospora is fresh produce, since such items can be handled by many different people. In fact, public health officials have linked 20 of the laboratory-confirmed cyclosporiasis cases in Georgia and Alabama to raw imported broccoli, although to date they haven’t determined a specific distributor. So one thing to do is be aware of how your produce is being handled and avoid and report places that are not employing basic food safety practices such as frequent and thorough hand washing before handling food.
There is no vaccine against Cyclospora. But there is a treatment. It’s an antibiotic known as trimethoprim/sulfamethoxazole (TMP/SMX), not to be confused with TMZ, which is not a treatment for explosive diarrhea. You may know TMP/SMX by the brand names of Bactrim, Septra, or Cotrim. Unfortunately, if you are allergic to such sulfa drugs, you don’t have any alternative treatment. If you do have a healthy immune system, chances are you will be able to slog through the illness and recover without treatment. But if you do think that you may have cyclosporiasis, contact your doctor as soon as possible. And stop touching other people’s food.
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I am a writer, journalist, professor, systems modeler, computational, AI, and digital health expert, medical doctor, avocado-eater, and entrepreneur, not
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Fauci Stepping Down In December
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I'm not a big fan of scatological humor but I'm even less impressed by journalism that ignores the elephant in the story. Local, state, and national enforcement of food safety regulations is the issue that this story should address, not the consumers' vigilance in monitoring hygiene in the farm to ...
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Why the picture of broccoli?
Wow, just by seeing all the non-funny toilet humor scattered throughout this article already confirmed my guess that it was you (again) who penned this piece! Can you not just create a piece that is meant to inform without the desperate need to be funny? Seriously, have (honest) people around you n...
Hydrogen formed deep underground by natural processes could be a major new source of untapped carbon-free power–and unlike oil or gas, the supply is virtually unlimited.
The push to wean the planet off carbon-free fuels and transition to renewable energy has focused mainly on wind and solar power. But mounting scientific evidence suggests there’s an untapped clean energy source deep underground that could provide vastly more power than we need: hydrogen created by natural geologic processes. And like the oil industry’s early days in the 19th century, it’s spawning a wave of drilling startups vying to be first to find big deposits.
“View them like oil wildcatters right now,” Doug Wicks, director of the U.S. Energy Department’s Advanced Research Projects Agency-Energy, told Forbes, equating hydrogen hunters to traditional drillers scouting for petroleum in new fields. Globally, he says the amount of geologic hydrogen may be “astronomical” based on how common the geologic conditions needed to generate it appear to be: Iron-rich pockets of water near tectonic rifts, located worldwide.
Potentially, “it's 150 trillion metric tons,” Wicks said. “One billion tons would power the United States for a full year.”
Big energy companies like Shell, BP and Chevron are joining a consortium created by the U.S. Geological Survey and Colorado School of Mines to study geologic hydrogen, but a handful of ambitious startups are already on the hunt. HyTerra and Natural Hydrogen Energy are preparing to drill for it in Nebraska and Kansas, and Gold Hydrogen is searching for it in Australia. French researchers believe it exists in old coal mines in the country’s Alsace-Lorraine region and are seeking it there. In Africa, Montreal-based Hydroma is already tapping a hydrogen well discovered years ago in Mali and is looking for more. (On the hydrogen color spectrum, the geologic variety is also known as gold or white; hydrogen made with renewable power is green. The form produced from natural gas is gray.)
Tracking down potential hydrogen sites requires skills similar to those used in the oil and gas industry, and getting to it thousands of feet underground uses the same drilling rigs. But unlike oil and gas deposits, which are both dirty and finite, natural hydrogen is generated continuously. There are different theories as to how it’s generated, but the main view is that it’s a byproduct of a continuous chemical reaction of water mixing with iron in an oxidation state. It’s an intermediate stage, “not quite full rust, not metal,” according to Wicks.
“Imagine the potential of an underground factory fueled by nature that generates a replenishing supply of clean, dispatchable energy.”
“Imagine the potential of an underground factory fueled by nature, that generates a replenishing supply of clean, dispatchable energy,” said Luke Velterop, COO of Subiaco, Australia-based HyTerra. He believes that geologic hydrogen “resolves the intermittency of renewable power and provides the security and stability needed to displace fossil fuels.”
The universe’s most abundant element has been a compelling but elusive form of clean energy for decades. It’s not quite as unobtainable as nuclear fusion, but it still faces big challenges. It’s currently vital for oil refining, making fertilizer, chemicals and food processing and steel production. Run it through a fuel cell and it creates electricity to power cars and trucks with only water vapor as a byproduct. It can be made cheaply and easily from natural gas but that generates carbon pollution. Making it from water and renewable power solves that problem but creates another: green hydrogen requires more energy to generate than it provides when used. The appeal of geologic hydrogen is that it solves both of these problems.
Hydrogen-Eating Microbes
It’s been commonly thought that because hydrogen is the lightest element on the periodic table, it existed mainly in combination with other elements and not on its own. But reports of naturally occurring hydrogen go back decades. In 1984, hydrogen enthusiast Roger Billings believed he’d found a field of natural hydrogen in Kansas. According to a contemporary UPI report, his company, Missouri-based Billings Energy, wanted to tap its energy potential, which was estimated at the equivalent to 65 million barrels of oil. Billings didn’t reply to an email seeking details on why it failed.
More recently, the existence of natural hydrogen has been a hot topic. At Montana State University, scientists have been monitoring hydrogen belched out of Yellowstone National Park’s boiling cauldrons. Science magazine published a detailed piece in February 2023 on the discovery of a hydrogen well in Mali in 2015, which Hydroma is tapping.
So why has it taken so long to start hunting for natural hydrogen? Aside from not knowing to look for it, geologic hydrogen’s presence is hidden by microbes in the ground that consume it, said Geoff Ellis, a petroleum geochemist with the USGS’s Energy Resources Program. (Hydrogen-eating organisms include caminibacter and aquifex, while hydrogenobacter thermophilus, discovered in Japan, thrives on hydrogen produced by hot springs.)
“It's not that surprising that it's been overlooked because it's a colorless, odorless gas and these microbes eat it really efficiently in the subsurface as it’s leaking out of the ground,” Ellis told Forbes. “There could be really large accumulations in the ground. We just have to figure out where to find them and we can just drill down there and have this great clean energy source.”
But he cautions that while there’s a vast potential volume of geologic hydrogen globally, much of it may be too hard to get to.
“Most of this is going to be way too deep or too far offshore, or accumulations that are much too small that they would never be economic,” Ellis said. He estimates globally there could be at least 10 million megatons of hydrogen in the ground, vastly more than the 100 megatons the world now uses for industrial processes. New applications of the element for things like aviation fuel and stationary power generation will raise global demand to at least 500 megatons over the next two decades.
“Most of this is going to be way too deep or too far offshore, or accumulations that are much too small that they would never be economic.”
“So if just 2% or 3% of the 10 million megatons out there can be tapped, that would supply all of the world’s demand of 500 million tons per year for hundreds of years,” he said.
And it’s not just the potential for cheap, clean hydrogen. Importantly, the underground conditions creating hydrogen may also generate highly valuable helium, an industrial gas that’s grown more expensive as traditional supplies tighten, Ellis said.
HyTerra, which has raised $4 million to fund initial drilling efforts and is seeking a few million dollars more, partnered with Natural Hydrogen Energy on a well project in Geneva, Nebraska. This month, the startup said it also has drilling rights to search for hydrogen deposits along Kansas’s Nemaha Ridge. Both sites are located along the 1200-mile Midcontinent Rift System, a tectonic fissure through the middle of North America.
Building A Hydrogen Market
Figuring out where large volumes of geologic hydrogen exist and finding ways to safely extract the gas are challenges yet to be solved. The DOE’s Wicks also wants to create a federal grant program to help company and university researchers develop methods to stimulate the natural underground process that generates hydrogen, potentially using chemical or electrical methods to substantially boost the amount already being created. That could prove to be critical to commercializing geologic hydrogen as it would help companies coax more out of the ground.
“We would be the first governmental program, foreign or domestic, to acknowledge this possibility,” Wicks said.
Confirming that large commercial quantities of natural hydrogen can be pulled from underground sources could take years, but that’s not a dealbreaker. It’s still early days for the use of hydrogen as a fuel beyond its current industrial niche; the market hasn’t formed yet, according to the USGS’s Ellis.
“If I drill the well out in my backyard today and found a bunch of hydrogen, I wouldn't be able to sell it to anybody, probably,” he said. That’s part of the reason why HyTerra and Natural Hydrogen Energy are working together on a drilling project in Nebraska.
“They chose that site because there's a fertilizer plant just down the road,” he said. “They contacted them and said, ‘Would you buy hydrogen from us?’ And the plant said, ‘Sure, we would.’ So they had a market close by.”
If smaller startups show some success, big oil companies, with the ability to invest billions of dollars into geologic hydrogen, may join the race, Ellis said. “They're not looking at drilling wells yet. They're taking a wait-and-see kind of attitude.”
One reason for that may also be a conflict with their core business, said Viacheslav Zgonnik, founder and CEO of Natural Hydrogen Energy.
“It challenges their economic model,” he told Forbes. “The announcement that there is a resource which can be accessed using the same techniques, the same technology, but which is not a fossil fuel and is renewable and clean, that may depreciate their assets, I believe.”
LOS ANGELES, CALIFORNIA - APRIL 17: In this photo illustration, boxes of the diabetes drug Ozempic ... [+] rest on a pharmacy counter. Ozempic was originally approved by the FDA to treat people with Type 2 diabetes. In recent months, there has been a spike in demand for Ozempic (semaglutide), as it's being prescribed off-label as a weight loss therapeutic. This has led to shortages. (Photo illustration by Mario Tama/Getty Images)
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In a recent STAT-Harris poll, nearly 50% of Americans say they’d be willing to spend up to $100 a month for one of the latest wave of obesity drugs, including Ozempic, Wegovy, and Mounjaro.
Some suggest this is a sign of just how much Americans want to get their hands on the new weight-loss drugs. Undoubtedly, the off-label uses of Ozempic and Mounjaro and the on-label use of Wegovy are popular. Repurposed semaglutide, liraglutide and tirzepatide are much more effective than the older generation obesity drugs. Additionally, Eli Lilly’s experimental weight-loss drug retatrutide may eventually set a new bar, as it has helped obese patients in a Phase 2 study lose 24% of their body weight after 12 months of treatment.
But the typical American’s willingness to pay amount for these drugs appears to be quite low in relation to the actual list prices. For the weight loss agents mentioned, list prices range from around $900 to $1,600 per month, which is well above what the vast majority of people are willing to pay, according to the poll. And, most people’s willingness to pay `price' is even below what patient co-insurance generally is if they’re lucky enough to have commercial coverage of one or more of the drugs. Here, co-insurance denotes a percentage of the list price, typically anywhere between 10% and 25%, that an insured patient must pay out-of-pocket for a drug. While 84% of respondents believe their insurance should cover the drugs, thus far only around a third of insurers offer coverage.
On a scale of out-of-pocket amounts from $100 to more than $1,000 a month, as we approach the actual prices of these drugs at the pharmacy counter for those without coverage and even many who are covered, a dwindling number of respondents expressed willingness to shell out more cash. Twenty-five percent said they’d pay $250 a month and 17% responded that they’d be okay with paying $500out-of-pocket on a monthly basis. Only five percent said they’d be willing to spend more than $1,000 a month. Well, if that’s the case, then without coverage—and most insurers in the commercial and public markets don’t cover the products—$1,000 a month or more is what folks will have to pay.
Also, the poll implicitly revealed a falsely optimistic view on the long-term efficacy of these drugs. The 47% of respondents who said they would be willing to spend $100 out-of-pocket would do so until they’d reached a goal. This suggests a misunderstanding about how the drugs work. Studies indicate people must take them chronically to ensure keeping the weight off, which means spending a certain monthly amount indefinitely.
In the commercial market, patient assistance programs offered by drug makers can help defray a portion of eligible patients’ co-insurance or co-payments. But for many patients payer “co-pay maximizers” may de facto nullify the amount they receive. Co-pay maximizers are schemes designed by payers in which a manufacturer's payment assistance does not count toward a patient’s deductible and out-of-pocket maximum.
Moreover, patient assistance programs are prohibited in public programs such as Medicare. Advocacy groups and the pharmaceutical industry are pushing for Congress to pass the Treat and Reduce Obesity Act, which would expand anti-obesity medication coverage for Medicare beneficiaries. However, even if Medicare lifts the prohibition on coverage of obesity drugs, it does not imply that such medication will be automatically covered. In fact, if what we’re observing in the commercial market holds, it’s likely a fairly large percentage of Medicare Part D plans would balk at covering obesity drugs, as it would still be up to individual pharmacy benefit managers and insurers to decide on coverage. Also, payers would in all likelihood impose a variety of conditions of reimbursement, including relatively high patient cost-sharing, extensive use of prior authorization protocols, quantity limits, and step edits.
Medicaid coverage of anti-obesity drugs varies by state, with only a handful of states offering reimbursement. States do have the option to cover weight loss medications, but are not required to do so.
Weight loss drugs still aren’t cost-effective
What isn’t yet in the drugs’ favor with payers is the apparent lack of cost-effectiveness.
On June 6th, for example, the U.K.’s National Institute for Health and Clinical Excellence (NICE) declined to recommend Mounjaro (tirzepatide). The agency says it’s “yet to be established if Mounjaro represents good value for money, alongside diet and exercise, for adults with type 2 diabetes and a high body mass index.”
In the U.S., the health technology assessment body, the Institute for Clinical and Economic Review, did not find semaglutide options—which include both Ozempic and—cost-effective for obesity. Reductions of 30-50% in price for semaglutide treatments would be needed to make them cost-effective.
As part of a clinical- and cost-effectiveness assessment analysts also account for side effect profiles, which can be debilitating for some, as well as the possibility of long-term serious adverse events for a small subset of patients. Possible negative effects of chronic usage are being examined. These are unknown at this time but are being investigated by, among others, the European Medicines Agency.
Then there is the potential for significant financial exposure for payers if they reimburse for a substantial proportion of eligible patients. Consider that more than 40% of adults in the U.S. are obese, which the Centers for Disease Control and Prevention define as a body mass index of 30 or higher.
At the same time, obesity is linked with heart disease, stroke, type 2 diabetes and certain types of cancer. Indeed, the indirect impact of weight loss medicines on cardiovascular outcomes is being studied. The preliminary data suggest positive benefits. If there is more robust evidence that emerges by next year this could alter the cost-effectiveness profile favorably for the the obesity drugs.
While the new classes of obesity drugs are more effective than previous generations, they’re not yet considered cost-effective. As a result, many payers may continue to balk at reimbursing until a firmer cost-effectiveness evidence base is established. Additionally, there appear to be limits to what most Americans are willing to spend out-of-pocket on the new wave of obesity drugs.
I'm an independent healthcare analyst with more than 24 years of experience analyzing healthcare and pharmaceuticals. Specifically, I analyze the value (costs and
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