First Edition: September 19, 2018
Today's early morning highlights from the major news organizations.
Kaiser Health News:
Senators Unveil Legislation To Protect Patients Against Surprise Medical Bills
“Our proposal protects patients in those emergency situations where current law does not, so that they don’t receive a surprise bill that is basically uncapped by anything but a sense of shame,” Sen. Bill Cassidy (R-La.) said in his announcement about the legislation. Kevin Lucia, a senior research professor at Georgetown University’s Center on Health Insurance Reforms who had not yet read the draft legislation, said the measure was aimed at a big problem. “Balance billing is ripe for a federal solution,” he said. States regulate only some health plans and that “leaves open a vast number of people that aren’t covered by those laws.” (Bluth, 9/19)
The Hill:
Bipartisan Senators Unveil Proposal To Crack Down On Surprise Medical Bills
A bipartisan group of senators is unveiling a draft measure to crack down on surprise medical bills, which they say have plagued patients with massive unexpected charges for care. The measure would prevent a health care provider that is outside of a patient’s insurance network from charging additional costs for emergency services to patients beyond the amount usually allowed under their insurance plan. (Sullivan, 9/18)
The Wall Street Journal:
Behind Your Rising Health-Care Bills: Secret Hospital Deals That Squelch Competition
Last year, Cigna Corp. and the New York hospital system Northwell Health discussed developing an insurance plan that would offer low-cost coverage by excluding some other health-care providers, according to people with knowledge of the matter. It never happened. The problem was a separate contract between Cigna and NewYork-Presbyterian, the powerful hospital operator that is a Northwell rival. Cigna couldn’t find a way to work around restrictive language that blocked it from selling any plans that didn’t include NewYork-Presbyterian, according to the people. (Wilde Mathews, 9/18)
The Associated Press:
Senate Backs Bill To Avert Shutdown, Boost Military Spending
The Senate on Tuesday approved a wide-ranging, $854 billion bill that funds the military and a host of civilian agencies for the next year and provides a short-term fix to keep the government open through early December. The measure includes $675 billion for the Defense Department and boosts military pay by 2.6 percent, the largest pay raise in nine years. The bill also approves spending for Health and Human Services, Education, Labor and other agencies, including a 5 percent boost for the National Institutes of Health. (Daly, 9/18)
The Washington Post:
Senate Passes Defense And Health Spending Bill, Tries To Delay Border-Wall Fight To After Midterms
Funding for the Labor, Education and Health and Human Services departments would total $178 billion, a $1 billion increase from 2018 and almost $11 billion more than Trump requested in his budget proposal for 2019. The Trump administration has objected to the increases in domestic budgets Congress is approving, but that is the price Democrats exacted for agreeing to big military spending increases sought by Republicans and Trump. Although Congress again finds itself nearing the end of the fiscal year without completing action on the 12 must-pass spending bills that fund all government agencies, the situation still represents a major improvement over recent years of budget dysfunction. (Werner, 9/18)
The Wall Street Journal:
Senate Passes Broad Spending Bill
To combat the opioid epidemic, the bill appropriates $3.8 billion, an increase of $2.7 billion over 2017. Of that, $1.5 billion will go to states for grants. The Senate on Monday passed broad, bipartisan legislation aimed at combating the opioid epidemic through new research, treatment and help for families affected by addiction. (Andrews, 9/18)
The New York Times:
Christine Blasey Ford Wants F.B.I. To Investigate Kavanaugh Before She Testifies
The woman who has accused President Trump’s Supreme Court nominee of sexual assault all but ruled out appearing at an extraordinary Senate hearing scheduled for next week to hear her allegations, insisting on Tuesday that the F.B.I. investigate first. Speaking through lawyers, Christine Blasey Ford said she would cooperate with the Senate Judiciary Committee and left open the possibility of testifying later about her allegations against Judge Brett M. Kavanaugh. But echoing Senate Democrats, she said an investigation should be “the first step” before she is put “on national television to relive this traumatic and harrowing incident.” (Baker, Stolberg and Fandos, 9/18)
The Washington Post:
Woman Who Accused Brett Kavanaugh Of Sexual Assault Wants FBI To Investigate Incident Before She Testifies To Senate
“A full investigation by law enforcement officials will ensure that the crucial facts and witnesses in this matter are assessed in a non-partisan manner, and that the committee is fully informed before conducting any hearing or making any decisions,” lawyers for the woman, Christine Blasey Ford, said in a letter to the panel late Tuesday. (Kim, Costa and Wagner, 9/18)
The Wall Street Journal:
Kavanaugh Accuser Wants ‘Full Investigation’ Before Any Senate Hearing
Mr. Grassley indicated the committee wasn’t willing to wait for a full FBI investigation of Dr. Ford’s allegations. “Dr. Ford’s testimony would reflect her personal knowledge and memory of events. Nothing the FBI or any other investigator does would have any bearing on what Dr. Ford tells the committee, so there is no reason for any further delay,” Mr. Grassley said in a statement Tuesday night. (Peterson, Andrews and Nicholas, 9/18)
Los Angeles Times:
California Professor Wants FBI Inquiry Before Testifying About Sexual Assault Allegation Against Kavanaugh
Sen. Bob Corker (R-Tenn.) tweeted: “Republicans extended a hand in good faith. If we don’t hear from both sides on Monday, let’s vote.” But Democrats backed Ford’s call for an FBI investigation and hinted they may not attend the hearing if she does not testify. “We should honor Dr. Blasey Ford’s wishes and delay this hearing,” Sen. Dianne Feinstein (D-Calif.) said in a statement. “A proper investigation must be completed, witnesses interviewed, evidence reviewed and all sides spoken to. Only then should the chairman set a hearing date.” (Haberkorn, 9/18)
Bloomberg:
Swine Waste Swirls Into Carolina Floods, Threatening Humans
Hurricane-wracked North Carolina faced a health and environmental crisis after at least 17 hog-waste lagoons were compromised and sewage plants across the state flooded, releasing millions of gallons of partially treated human discharge. On an aerial tour Monday of a swath of swine country -- the dozen top hog-producing counties cover an area the size of New Jersey -- many lagoons appeared intact. Roughly the size of a soccer field, they are blue-green or red, thanks to bacteria that break down the feces and urine. Several, though, were swamped with water from the torrential rains and creeks that had burst from their banks. (Niquette, Natter and Vasquez, 9/18)
The New York Times:
Lagoons Of Pig Waste Are Overflowing After Florence. Yes, That’s As Nasty As It Sounds.
When a pig in a large-scale farm urinates or defecates, the waste falls through slatted floors into holding troughs below. Those troughs are periodically flushed into an earthen hole in the ground called a lagoon in a mixture of water, pig excrement and anaerobic bacteria. The bacteria digest the slurry and also give lagoons their bubble gum-pink coloration. North Carolina has 9.7 million pigs that produce 10 billion gallons of manure, mostly on large-scale farms, primarily in low-lying Sampson and Dupin counties. Both counties were affected by Florence. (Pierre-Louis, 9/19)
Los Angeles Times:
Environmentalists Worry That Florence Will Leave Behind A Toxic Mess In North Carolina
These fears have existed for years in a low-lying state with a network of rivers that can disperse pollutants for miles. Now climate change is increasing concerns that storms like Florence will strike more often, altering the calculus for where industries will be safe from flooding. "This is a time to recognize that there's a new normal in environmental protection right now,” said Thomas A. Burke, an associate dean at the Johns Hopkins Bloomberg School of Public Health. (Megerian, 9/18)
The Associated Press:
Florence's Water, Not Winds, Will Be The Long-Term Problem
Like Hurricanes Harvey and Katrina before it, most of Hurricane Florence's damage will not be from the wind but the water. Yes, some people died when they were crushed by trees felled by Florence's winds as it swept across the Carolinas and some homes were destroyed. But most of Florence's victims died in the massive floods that will cause wide and long-term damage to houses, businesses, roads and other infrastructure and produce a spike in water-borne illness. (9/18)
Los Angeles Times:
Analysis: Most Of Florence's Victims Have Died In Vehicles, On The Road During The Storm
Hurricanes can bring all sorts of trouble — winds, rains, floods. And early fatality data from Florence’s assault on the Carolinas suggest that being in your car, on the road, after the storm hits land has been especially deadly. An analysis by the Los Angeles Times of 35 deaths officials have linked to the storm so far showed that more than half — 20 victims — died when they were apparently trapped in their cars by flooding or were involved in auto crashes during inclement weather. (Pearce and Etehad, 9/18)
The Associated Press:
Hurricane Rating System Fails To Account For Deadly Rain
When meteorologists downgraded Hurricane Florence from a powerful Category 4 storm to a Category 2 and then a Category 1, Wayne Mills figured he could stick it out. He regrets it. The Neuse River, normally 150 feet away, lapped near his door in New Bern, North Carolina, on Sunday even as the storm had "weakened" further. (Borenstein and Breed, 9/18)
CNN:
This Is Puerto Rico's 'Maria Generation'
Her son cried out for help via text message on the morning of October 17, a month after Hurricane Maria wrecked this Caribbean island. "Where are you??" the 18-year-old wrote at 11:32 a.m. "Mami call me it's important." Cellular networks in Puerto Rico were still damaged after the Category 4 hurricane, and the messages from her son didn't go through, the boy's mother said. When his frantic words finally appeared on her phone, she panicked. (Sutter, 9/17)
The Associated Press:
A Year After Maria, Puerto Rican Kidney Patients Fear Death
As weeks turned into months, the seats of the small plane began to empty out. In the beginning, 15 passengers flew from Vieques to the Puerto Rican mainland — refugees from Hurricane Maria. The storm had ruined the only dialysis center on this tiny island, their home; without treatment, the kidney patients would die. (Coto, 9/19)
Politico:
Trump Rails On Top Florida Ally Over Hurricane Maria Flap
President Donald Trump is privately lashing out at one of his top allies, Ron DeSantis, angrily accusing the Florida Republican gubernatorial nominee of publicly betraying him. The president has told close associates in recent days that he views DeSantis — who won his Aug. 28 GOP primary thanks to Trump’s strong support — as profoundly disloyal for distancing himself from the president’s assertion that the Hurricane Maria death toll was inflated by Democrats for political purposes. (Isenstadt and Caputo, 9/18)
The New York Times:
U.S. Loses Track Of Another 1,500 Migrant Children, Investigators Find
The Trump administration is unable to account for the whereabouts of nearly 1,500 migrant children who illegally entered the United States alone this year and were placed with sponsors after leaving federal shelters, according to congressional findings released on Tuesday. The revelation echoes an admission in April by the Department of Health and Human Services that the government had similarly lost track of an additional 1,475 migrant children it had moved out of shelters last year. (Nixon, 9/18)
The Associated Press:
White House Sets 'New Direction' In Biodefense Strategy
The Trump administration on Tuesday released a new biodefense strategy that it said takes a more comprehensive approach to preparing the nation for deliberate biological attacks and natural outbreaks of infectious disease. The goal of the strategy, which was required by Congress, is to more effectively prevent, prepare for and respond to biological threats, which the document said are "among the most serious threats" facing the U.S. and the world. (Burns, 9/18)
The Hill:
Trump Directs Government To Step Up Defenses Against Bioterrorism
“My Administration is focused on strengthening our Nation’s defenses against the full range of threats to our health and security, including those of a biological nature,” Trump said in a statement. “With these actions today, I am reaffirming my unwavering commitment to protecting the American people, the American homeland, and the American way of life.” (Sullivan, 9/18)
Politico:
Trump Puts HHS In Charge Of Defense Against Biological Threats
The committee includes officials from the Pentagon, Agriculture and Homeland Security departments and will review capabilities across the intelligence community and 15 executive branch agencies. It will assess the agencies' ability to respond to both man-made and naturally occurring biological threats, HHS Secretary Alex Azar said during a press briefing. That survey will influence spending priorities in fiscal 2020, with the biggest effects likely to be seen in 2021, he said. (Owermohle, 9/18)
Politico:
Obamacare Lawsuit Boosts Democrats In State AG Races
Democrats believe they have their best chance in years to flip crucial state attorney general seats by trumpeting the same message that drew furious protesters to town halls and to the polls last year: Republicans are trying to take away your health care. These down-ballot races usually fly under the radar, but they are front and center in 2018 as many Democratic officeholders have turned the positions into the cornerstone of resistance to President Donald Trump, challenging dozens of his policies in court, from the separation of immigrant families at the border, to the ban on travel from several Muslim countries, to the crackdown on marijuana sales in states that legalized the drug. (Ollstein, 9/18)
The Wall Street Journal:
Opioid Crisis Emerges As A Dominant Campaign Theme
In the past four years, the opioid crisis has grown from an afterthought in political campaigns to an important issue in some of this fall’s biggest midterm races, according to television advertising data from Kantar Media/CMAG. An analysis by The Wall Street Journal found that, so far in 2018, ads containing opioid messaging have aired more than 50,000 times across 25 states. At this point in 2014, there had been only one political TV ad touching on the topic that aired 70 times—in Kentucky’s Senate race. (Chinni, Jamerson and Dougherty, 9/19)
The Hill:
Bipartisan Group Wants To Lift Medicaid Restriction On Substance Abuse Treatment
A bipartisan group of senators want Congress' final opioids package to lift a decades-old restriction on Medicaid funding for substance abuse treatment. Sens. Rob Portman (R-Ohio), Ben Cardin (D-Md.), Dick Durbin (D-Ill.) and Sherrod Brown (D-Ohio) introduced a proposal Tuesday to allow states to use Medicaid money to pay for coverage at addiction treatment facilities for people with diagnosed substance use disorders for up to 90 consecutive days — something prohibited under federal Medicaid law. (Hellman, 9/18)
The Associated Press:
Pain Patients Rally For Easing Opioid Restrictions
Chronic-pain patients in Maryland are asking for help in easing restrictions they face in getting drugs to treat their pain because of the crackdown on opioids. About two dozen people attended a rally in front of the Maryland State House on Tuesday where participants held signs that said: “Don’t Punish Pain,” and “Make Health Care Again.” (9/18)
The Hill:
Beto O'Rourke Calls For Texas To Expand Medicaid
Rep. Beto O'Rourke (D-Texas) on Monday called for the state of Texas to expand Medicaid. "Texas should expand Medicaid today," O'Rourke, who is challenging Sen. Ted Cruz (R-Texas), for a U.S. Senate seat this November, tweeted, linking to an editorial from The Houston Chronicle about the program that helps people with limited resources receive medical care. (Wise, 9/18)
The Hill:
New Ads Pressure Lawmakers Against Easing Costs On Drug Companies
Drug-pricing advocates are launching a six-figure ad campaign to try to stop Congress from rolling back a move targeting drug companies. The ads from Patients for Affordable Drugs Now seek to counteract an aggressive lobbying push by drug companies to undo a change from February that shifted billions of dollars in new costs onto them. (Sullivan, 9/18)
Modern Healthcare:
AHA Launches 340B Hospital Transparency Effort
The American Hospital Association has launched a new effort it hopes will bring more transparency to the 340B drug discount program. Under the so-called 340B stewardship principle initiative, the trade association plans to encourage hospitals to release information on their 340B savings and what they usually do with that money. (Dickson, 9/18)
Stat:
Clovis Oncology Pays $20 Million To Settle Charges Of Misleading Investors
Clovis Oncology (CLVS), its chief executive, and a former chief financial officer will collectively pay more than $20 million to settle civil charges of misleading investors about a lung cancer drug that was being developed. During a four-month period beginning in July 2015, the drug maker and chief executive Patrick Mahaffy made various misleading statements about the effectiveness of its rociletinib drug compared with another treatment. (Silverman, 9/18)
Stat:
Biotech IPOs Are Yet To See Their Shadow, As The Biggest Deal Ever Awaits
Biotech’s run of successful initial public offerings is showing no signs of fatigue. Five companies are queued up to go public before the month is out, and the industry is on an IPO pace not seen since its most recent boom resulted in a painful correction. Forty-three biotech companies have gone public in 2018, raising about $4.2 billion in the process. If all six of September’s planned IPOs succeed, biotech will be on pace for 60 Wall Street debuts on the year, which would be the most since 2015, when there were 68. (Garde, 9/19)
Stat:
In Unlikely Alliance, PhRMA Sides With Landlords In Calif. Referendum On Rent Control
The pharmaceutical industry’s most powerful lobbying group is opening its war chest to try to sway a policy fight with no clear connection to medicine or health care, spending a half-million dollars here to oppose a California ballot measure that would expand rent control protections across the state. (Facher and Robbins, 9/19)
Reuters:
Novo Nordisk Lays Off 400 Staff In Research & Development Unit
Novo Nordisk, the world's top maker of diabetes drugs, said on Tuesday that it will lay off 400 staff in Denmark and China as part of a broader restructuring of its research and development organisation. The firm, which employs more than 42,000 people in 79 countries, has seen growth slow due to pricing pressures in the United States, from where it sources about half its revenue. (Gronholt-Pedersen, 9/18)
Stat:
For CRISPR Patents, The Ugliest Phase May Be Still To Come
Last week, a federal appeals court ruled that foundational CRISPR-Cas9 patents awarded to the Broad Institute described a significantly different invention than does a patent application (in limbo since 2012) from the University of California. As a result, the Broad’s patents do not “interfere” with the one UC applied for. That allowed the Broad to keep its valuable intellectual property and left UC’s CRISPR hanging by a thread. The chances that UC can persuade the full appeals court to re-hear its case for interference, let alone get the Supreme Court to, are next to nil. If not that, what comes next? (Begley, 9/17)
ProPublica/Stat:
Black Patients Are Being Left Out Of Clinical Trials For New Cancer Therapies
It’s a promising new drug for multiple myeloma, one of the most savage blood cancers. Called Ninlaro, it can be taken as a pill, sparing patients painful injections or cumbersome IV treatments. In a video sponsored by the manufacturer, Takeda Pharmaceutical Co., one patient even hailed Ninlaro as “my savior.” The Food and Drug Administration approved it in 2015 after patients in a clinical trial gained an average of six months without their cancer spreading. That trial, though, had a major shortcoming: its racial composition. One out of five people diagnosed with multiple myeloma in the U.S. is black, and African-Americans are more than twice as likely as white Americans to be diagnosed with the cancer. (Chen and Wong, 9/19)
The Wall Street Journal:
To Help Alzheimer’s Patients, A Care Center Re-Creates The 1950s
The two men, high school buddies, sit in a turquoise and white booth at Rosie’s Diner, ribbing each other like they are teenagers at Sweetwater High School where they played baseball together so many years ago. A 1950s-era jukebox spits out tunes like “Peggy Sue” by Buddy Holly. Vinyl records and black-and-white pictures of celebrities like Elvis Presley and Audrey Hepburn line the walls. Now in their 70s, James Mann and Richard Eshbach are actually in Glenner Town Square, a new adult day-care center for dementia patients that is like entering a time warp. The 11 storefronts that surround an indoor park represent the time period from 1953 to 1961, when most of the patients were in the prime of their life. (Reddy, 9/18)
The Associated Press:
DEA Approves Importation Of Marijuana Drug For Tremor Study
In a rare move, the U.S. government has approved the importation of marijuana extracts from Canada for a clinical trial, highlighting a new avenue for American researchers who have long had trouble obtaining the drug for medical studies. The University of California, San Diego’s Center for Medicinal Cannabis Research announced Tuesday the Drug Enforcement Administration has OK’d its plans to import capsules containing two key cannabis compounds — CBD and THC — from British Columbia-based Tilray Inc. to study their effectiveness in treating tremors that afflict millions of people, especially those over 65. (Johnson and Watson, 9/18)
Bloomberg:
Diabetes Alert: 30% Of Americans With Disease Don't Know It
It’s estimated more than 30 percent of American adults with diabetes don’t realize they’re suffering from the potentially deadly disease. Data from the National Health and Nutrition Examination Survey show about one in seven suffered from diabetes between 2013 and 2016, with the prevalence of diagnosed diabetes at 9.7 percent and the prevalence of undiagnosed diabetes at 4.3 percent. (Tanzi, 9/19)
The New York Times:
Why Your DNA Is Still Uncharted Territory
You have a gene called PNMA6F. All people do, but no one knows the purpose of that gene or the protein it makes. And as it turns out, PNMA6F has a lot of company in that regard. In a study published Tuesday in PLOS Biology, researchers at Northwestern University reported that of our 20,000 protein-coding genes, about 5,400 have never been the subject of a single dedicated paper. (Zimmer, 9/18)
The New York Times:
High-Dose Folic Acid Does Not Prevent High Blood Pressure Of Pregnancy
Some experts believe that a high daily dose of folic acid can reduce the risk for pre-eclampsia, the dangerous high blood pressure that can occur during pregnancy. A randomized trial has found that it does not work. Folic acid in small doses is proven to reduce the risk for the serious birth defects of the brain or spinal cord called neural tube defects, so prenatal vitamins contain the nutrient. But some epidemiological evidence has suggested that the more folic acid taken, the lower the risk for pre-eclampsia. (Bakalar, 9/18)
The New York Times:
Faster. Slower. How We Walk Depends On Who We Walk With, And Where We Live
People move differently when they walk in groups than when they walk alone. And their walking style is especially distinct when they walk with children, according to a fascinating new cross-cultural study of pedestrians in several nations. The study, which also shows that men tend to walk differently with other men than with women and that some cultures may promote walking speed over sociability, underscores that how we move is not dependent solely on physiology or biomechanics. (Reynolds, 9/19)
The New York Times:
Excess Weight Gain Or Loss During Pregnancy Tied To Child’s Heart Health
Gaining either too much or too little weight during pregnancy may be bad for your child’s heart health. Researchers studied 905 mother-child pairs, dividing the mothers into groups that either matched or exceeded the recommended weight gain — 25 to 35 pounds for women with a body mass index between 18.5 and 24.9; 28 to 40 pounds for those with a B.M.I. under 18.5; and 15 to 25 pounds for a woman with a B.M.I. above 25. They then assessed their children’s heart health at age 7. The study is in Diabetologia. (Bakalar, 9/18)
NPR:
With Physician Burnout Increasing, Doctors Ask What Is It, Really?
Today, JAMA publishes two major studies on a hot topic: physician burnout. Burnout is a buzzword that's been in the news, but what is it? How does it affect doctors and their patients? It turns out, nobody really knows. The first study, a systematic review, summarizes the research to date on physician burnout. Study authors found that researchers do not use a consistent definition of burnout, and estimates of how common it is vary widely. The second study followed doctors-in-training over six years and tracked how they felt about their work. They found that women and doctors in certain high-stress specialties were more likely to experience symptoms of burnout, like emotional exhaustion and regret about career choice. (Gordon, 9/18)
The Associated Press:
Judge To Consider Suspending Idaho's Abortion Reporting Law
Lawyers are asking a U.S. judge to issue a preliminary injunction blocking a new Idaho law requiring doctors to report extensive personal information to the state about women who have had abortions. The law, which took effect July 1, requires health care providers to disclose information about patients who had one of several "complications" listed in the law, the Idaho Press reported . A preliminary injunction means the law would not be enforced while the matter is being discussed in court. (9/18)
Reuters:
Bayer's Monsanto Asks U.S. Court To Toss $289 Million Glyphosate Verdict
Bayer AG unit Monsanto on Tuesday asked a California judge to throw out a $289 million jury verdict awarded to a man who alleged the company's glyphosate-based weed-killers, including Roundup, gave him cancer. The company said in motions filed in San Francisco's Superior Court of California that the jury's decision was insufficiently supported by the evidence presented at trial by school groundskeeper Dewayne Johnson. (Bellon, 9/19)
The Wall Street Journal:
Bayer Steps Up Legal Fight Over Weed Killer Blamed For Cancer
The jury in that case ruled unanimously in favor of a former groundskeeper who sought to hold the maker of Roundup liable for his non-Hodgkin lymphoma. The verdict came only two months after the German pharmaceutical and chemical conglomerate sealed its takeover of Monsanto, the U.S. agriculture giant that invented the herbicide. Bayer shares have dropped about 22% since the verdict to five-year lows. (Bunge and Bender, 9/18)
NPR:
Jails Work With Communities To Get Treatment For Mentally Ill Inmates
DeVonte Jones began to show signs of schizophrenia as a teenager. His first public episode was nine years ago at a ball game at Wavering Park, in Quincy, Ill. "He snapped out and just went around and started kicking people," says Jones' mother Linda Colon, who now lives in a Chicago suburb. The police were called. Jones was arrested, charged with aggravated battery and placed in Adams County Jail. Colon says Jones had no recollection of what happened. (Herman, 9/19)
Los Angeles Times:
Surgeon Who Appeared On Reality TV Dating Show Is Accused Of Sexual Assault And Preying On Drugged Women
Dr. Grant William Robicheaux billed himself as an elite orthopedic surgeon catering to Newport Beach’s famous and wealthy. It was a lifestyle he pushed not only in his medical work but on realty TV, where he appeared on a Bravo dating show wearing his hospital scrubs and a wide smile. (Winton, 9/18)