Tag Archives: Drugs

These Antidepressants May Increase the Risk of Birth Defects

Mother Jones

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Babies born to women who took certain antidepressants during pregnancy may have an elevated risk of birth defects, according to a study published Wednesday in the medical journal BMJ.

Over the past few years, researchers have come to conflicting conclusions about the health impacts of taking common antidepressants called selective serotonin reuptake inhibitors, or SSRIs, early in pregnancy. Some studies have found prenatal exposure to SSRIs to be associated with heart and brain defects, autism, and more, while others have found the risk to be minimal or nonexistent.

The BMJ study, led by researchers at the the Centers for Disease Control and Prevention, shed light on the matter by analyzing federal data of 38,000 births between 1997 and 2009. Researchers interviewed the mothers of children with certain birth defects associated with SSRIs, asking if they took certain antidepressants during the first three months of pregnancy or the month prior to it. Unlike many previous studies, which looked at the effects of SSRIs as a group, the researchers looked at the health impacts of five specific drugs. They found that two drugs were associated with birth defects, while three of the drugs were not. Here are the details:

Sertraline (Zoloft): No increased risk of birth defects. (This was the most common of the five drugs, taken by forty percent of the women on antidepressants.)
Paroxetine (Paxil): Babies were between 2 and 3.5 more likely to be born with heart defects, brain defects, holes between heart chambers, and intestinal deformities.
Fluoxetine (Prozac): Babies were two times more likely to experience heart defects and skull and brain shape abnormalities.
Escitalopram (Lexapro): No increased risk of birth defects.
Citalopram (Celexa): No increased risk of birth defects.

Researchers are quick to note that even in the case of paroxetine and fluexetine, the absolute risk of these defects is still very small. If mothers take paroxetine early in pregnancy, for example, the chance of giving birth to a baby with anencephaly, a brain defect, rise from 2 in 10,000 to 7 in 10,000.

Some doctors worry that studies like this dissuade mothers who truly need mental health treatment from seeking it—particularly since the stress associated with depression in the mother can impact the health of the baby. Elizabeth Fitelson, a Columbia University psychiatrist who treats pregnant women with depression, described this tricky balance to the New York Times earlier this year: “For about 10 percent of my patients, I can readily say that they don’t need medication and should go off it,” she said. “I see a lot of high-risk women. Another 20 percent absolutely have to stay on medication—people who have made a suicide attempt every time they’ve been unmedicated. For the remaining 70 percent, it’s a venture into the unknowable.”

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These Antidepressants May Increase the Risk of Birth Defects

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America’s Cops Shoot More People Than Criminals Do in These Countries

Mother Jones

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If the current trend continues, police are on track to fatally shoot nearly 1,000 Americans by the end of the year. If you took that number alone, the United States would still have a higher per capita firearm-related murder rate than most of the world’s developed nations’, according to an analysis by Vocativ.

Vocativ compiled data from the United Nations Office on Drugs and Crime and found that police shootings in the United States outnumber all gun-homicides in France, England, Germany, Chile, Canada, and 25 other developed nations. Here’s how those figures line up, using 2013 data:

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America’s Cops Shoot More People Than Criminals Do in These Countries

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John Oliver: Big Pharma Is Like Your High School Boyfriend, Only Concerned with "Getting Inside You"

Mother Jones

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Following a three-month hiatus, John Oliver has returned with a brilliant takedown against pharmaceutical companies and the billions of dollars executives pump into peddling drugs to doctors around the country.

“Drug companies are a bit like high school boyfriends,” Oliver explained on Last Week Tonight. “They’re much more concerned with getting inside of you than being effective once they’re in there.”

According to one report referenced on Sunday’s show, nine out of ten drug companies allocate significantly more on marketing than actual scientific research–a practice Sen. Elizabeth Warren recently announced she is working to reverse. Much of the money is spent on attractive representatives, many of whom are clueless to the products they’re selling, to push the drugs. Some reps even dangle complimentary meals to persuade doctors into cashing in.

“If Charlie Manson brought me a free lunch everyday, I’d at least listen to his sales pitch on forehead swastikas.”

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John Oliver: Big Pharma Is Like Your High School Boyfriend, Only Concerned with "Getting Inside You"

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Obamacare Isn’t Perfect, But That’s No Reason to Give Up On It

Mother Jones

A few days ago I noted that health insurance companies were starting to price certain drugs at higher rates. Not just certain brands of drugs, but entire classes of drugs. This is being done in an apparent attempt to discourage patients with certain conditions from applying for insurance. Better to have some other insurance company pick up the cost of their expensive illness.

The reason this is happening is that Obamacare prohibits insurance companies from turning away customers with pre-existing conditions. So instead they need to find cleverer ways of making sure they’re someone else’s problem. David Henderson comments:

I predict that none of this will cause Kevin Drum to reconsider his pre-existing view that pricing for pre-existing conditions should be illegal.

Quite right. When it comes to Obamacare, there are two kinds of people. Henderson is the first kind. Whenever they hear about a problem, their invariable response is that this proves Obamacare is a hopeless mess and needs to be abandoned.

I’m the second kind. When I hear about a problem, my response is that we need to try to fix it. This is because I believe everyone should have access to decent health care at a reasonable price, and one way or another, we need to figure out how to provide it. We don’t give up just because it’s hard.

For what it’s worth, this particular problem is not something that’s taken any of us by surprise. Capitalism has a well-known capacity for motivating people to find clever ways to make money, and Obamacare supporters were all keenly aware that insurance companies would try to game the rules to maximize their profits. It was one of those things that required constant vigilance. Unfortunately, that never happened because it turned out that Republicans in Congress are so uncompromisingly opposed to Obamacare that they’ve prevented problems of any kind from being addressed, apparently in the hope that someday these problems will grow serious enough that the public will turn against the whole thing.

I guess you can decide for yourself if you consider that a praiseworthy response to a law you don’t like. I consider it loathsome myself. As for my pre-existing view about pre-existing conditions, that’s easily explained. I supported Obamacare as a good first step, but if I had my way the whole edifice would get torn down and replaced with a sensible national health care plan of the kind used by virtually every other civilized country on the planet. This is because health care of the kind that civilized people desire simply isn’t a good that can be efficiently provided by the free market, for reasons that are fairly obvious to anyone familiar with the literature. Nor is this just an academic point. Half a century of experience shows us that national health care works better on nearly every measure than our Rube Goldberg system. It’s not perfect, because nothing ever is. But it would be a big step forward.

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Obamacare Isn’t Perfect, But That’s No Reason to Give Up On It

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How to Discriminate Against Pre-Existing Conditions in Two Easy Tiers

Mother Jones

Via ProPublica, here’s an editorial published yesterday in the American Journal of Managed Care:

For many years, most insurers had formularies that consisted of only 3 tiers: Tier 1 was for generic drugs (lowest co-pay), Tier 2 was for branded drugs that were designated “preferred” (higher co- pay), and Tier 3 was for “nonpreferred” branded drugs (highest co-pay)….Now, however, a number of insurers have split their all-generics tier into a bottom tier consisting of “preferred” generics, and a second tier consisting of “non-preferred” generics.

Hmmm. What’s going on here? In some cases, this new non-preferred tier is reserved for higher-priced medicines. That’s pretty easy to understand: insurers are trying to motivate their patients to choose cheaper drugs when they’re available. That’s the same reason copays are lower for generics compared to brand name drugs.

But it turns out that sometimes all the generic drugs for a particular disease are non-preferred and therefore have high copays. What are insurance companies trying to motivate in these cases? Charles Ornstein takes a guess:

The editorial comes several months after two advocacy groups filed a complaint with the Office of Civil Rights of the United States Department of Health and Human Services claiming that several Florida health plans sold in the Affordable Care Act marketplace discriminated against H.I.V. patients by charging them more for drugs.

Specifically, the complaint contended that the plans placed all of their H.I.V. medications, including generics, in their highest of five cost tiers, meaning that patients had to pay 40 percent of the cost after paying a deductible. The complaint is pending.

“It seems that the plans are trying to find this wiggle room to design their benefits to prevent people who have high health needs from enrolling,” said Wayne Turner, a staff lawyer at the National Health Law Program, which filed the complaint alongside the AIDS Institute of Tampa, Fla.

If all your HIV drugs are expensive, then people with HIV will look for another plan. Technically, you’re not discriminating against anyone with a pre-existing condition, but you’re sure giving them a reason to shop around someplace else, aren’t you?

At the moment, this practice appears to be confined to just a few insurers and a few classes of drugs. But if it catches on, it will prompt everyone to follow suit. After all, you can hardly afford to be the insurance company of choice for chronically sick people, can you? This is worth keeping an eye on.

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How to Discriminate Against Pre-Existing Conditions in Two Easy Tiers

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What Do We Know So Far From Mike Brown’s Autopsies?

Mother Jones

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Normally, it takes weeks to get the results of an autopsy. But today, St. Louis County medical examiner Mary Case announced that Michael Brown, the unarmed teenager who was killed by a policeman last weekend in Ferguson, Missouri, was shot in the head and chest multiple times. Here’s the information we know about Michael Brown’s death, and a little background on why autopsies usually take so much longer.

What have the autopsies found so far?

Three separate autopsies are in various stages of completion. The St. Louis County medical examiner’s office announced on Monday that Brown was killed by multiple bullets to the chest and head. The office has not yet released information about the number or location of the bullets or their toxicology report. According to a confidential source reporting to the Washington Post, Brown’s toxicology test found that he tested positive for marijuana.

The preliminary results of an independent autopsy arranged by the Brown family and performed on Sunday by former New York City medical examiner Michael Baden found that Brown was shot six times: four times in his right arm, and twice in the head. One of the bullets entered the top of Brown’s skull, indicating that his head was tilted forward when the bullet struck him and caused a fatal injury. According to Benjamin Crump, the attorney representing the Browns, the family wanted “an autopsy done by somebody who is objective and who does not have a relationship with the Ferguson police.”

Attorney General announced on Sunday that the Justice Department would conduct a third autopsy, because of “the extraordinary circumstances involved in this case and at the request of the Brown family.” A department representative said the autopsy would take place “as soon as possible.”

Why does it usually take so long to get autopsy results?

An autopsy itself usually doesn’t take too long, but often, medical examiners will wait to release the results until toxicology tests, which analyze the presence of drugs, are also complete. Toxicology tests usually take several weeks, in part due to the chemistry involved and in part because there’s often a backlog of tests. Coupling the release of the toxicology and autopsy results is standard practice because it gives a more complete picture of what may have happened during the shooting, says Judy Melinek, a forensic pathologist and the author of Working Stiff: The Making of a Medical Examiner. Determining whether or not a person was under the influence of drugs “may help interpret a person’s behavior and reaction time,” she says.

What do toxicology tests entail?

A basic screening often involves using immunoassays to test blood and urine (from inside the body) for drugs, including alcohol, marijuana, and opiates. If a test comes back positive, then a lab will run more complex tests, like mass spectrometry, to determine the exact concentration of the drug. Melinek says that “negative results come back faster,” and “the more drugs found in a person’s system, the longer it takes because each has to be verified and quantitated.” If Brown only tested positive for marijuana, the tests would only take a few days.

Was Brown’s case slowed down by an autopsy backlog?

Autopsy backlogs do exist—last year in Massachusetts, for example, there were nearly 1,000 unfinished death certificates due to lack of qualified pathologists and state funding for toxicology testing. According to Suzanne Picayune, a representative of the St. Louis County medical examiner’s office, Brown’s case was expedited through the system, as often happens for cases involving officers.

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What Do We Know So Far From Mike Brown’s Autopsies?

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The People Giving Lethal Injections: Untrained, Incompetent, or Just "Complete Idiots"

Mother Jones

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Last week’s botched execution of Clayton Lockett in Oklahoma has heightened the debate over lethal injection. The United States has encountered a shortage of the drugs historically used in capital punishment as pharmaceutical companies have largely refused to make them, export them, or sell them to prisons for use in executions. Death row inmates have filed dozens of challenges to the lethal injection protocols that states have sought to keep secret. Meanwhile, states are trying ever more desperate measures to procure the old drugs or cook up new cocktails to try on inmates.

But as Lockett’s torturous execution showed, the drugs are only part of the problem. In his case, prison staff apparently failed to properly insert the IV into his femoral artery—a procedure that requires professional medical skills—and the drugs were injected into soft tissue rather than the bloodstream, leaving him writhing in pain and forcing officials to halt the execution. (He ended up dying of a heart attack, anyway.)

Historically, lethal injection has been plagued with problems just like those that occurred in Lockett’s case, and they are due in large part to the incompetence of the people charged with administering the deadly drugs. Physicians have mostly left the field of capital punishment; the American Medical Association and other professional groups consider it highly unethical for doctors to assist with executions. As a result, the people willing to do the dirty work aren’t always at the top of their fields, or even specifically trained in the jobs they’re supposed to do. As Dr. Jay Chapman, the Oklahoma coroner who essentially created the modern lethal injection protocol, observed in the New York Times in 2007, “It never occurred to me when we set this up that we’d have complete idiots administering the drugs.”

States typically have had few requirements for those serving on an execution team. At one point, in Florida, the only criteria was that a potential executioner be at least 18 years old. Wardens, prison guards, phlebotomists, paramedics, and nurses are sometimes in the mix. After botched executions, judges have occasionally ordered states to have a board-certified anesthesiologist involved—a requirement that tends to prompt a moratorium because few of those doctors will participate. The actual makeup of execution teams is often a state secret that officials work hard to conceal. Not surprisingly, although things often go wrong, individuals are rarely held accountable. One the rare occasions when details about execution teams are released, they only seem to confirm Chapman’s observation. Here are a few examples of what’s known about people who’ve been involved in administering lethal injections over the years.

By far the most notorious individual in the history of lethal injection, Dr. Alan Doerhoff was the dyslexic surgeon who oversaw 54 executions in Missouri, where he alone was in charge of deciding how to kill people. Doerhoff was the subject of more than 20 malpractice lawsuits during his career, and he was disciplined by the state medical board for concealing lawsuits from a hospital where he worked. Two Missouri hospitals banned him from practicing in their facilities.

The state worked for years to keep Doerhoff’s identity secret. But in a legal challenge by a Missouri death row inmate, he was forced to testify and eventually was unmasked. In his testimony he admitted that his disability made it hard for him to properly combine the death drugs, which he sometimes mixed up, and that, on his own, he’d started “improvising” and reducing the amount of anesthesia given to condemned prisoners by half. Unbelievably, the federal government actually used Doerhoff to create the protocols for federal executions and to oversee them. (He reportedly oversaw the execution of Oklahoma bomber Timothy McVeigh.)

See page five of this report for a graphic illustration of Doerhoff’s handiwork on Missouri inmate Timothy Johnson—the botched IV insertion into the femoral artery is the same sort of problem that apparently occurred in the Lockett execution. Doerhoff had defended groin insertions as having “all benefit…There’s no way it can fail. And no risk to the inmate.”

A federal judge eventually banned Doerhoff from participating in executions in Missouri, which responded by making it a crime to reveal the identity of a current or former member of the state’s execution team. Doerhoff’s public exposure and track record apparently didn’t prevent Arizona from hiring him to oversee an execution there in 2007.

In 2006, testimony in another federal challenge to lethal injection revealed that the execution team leader at California’s San Quentin State Prison had been disciplined for smuggling illegal drugs into the facility before he was put on the team. Another team leader had been diagnosed with and was disabled by post-traumatic stress disorder, a problem hugely amplified by participating in executions.

After the botched 2005 execution of Stanley Tookie Williams in California—his vein collapsed after several unsuccessful attempts to insert an IV—the nurse responsible for the IV issues said that the execution team responded to the problems by saying “shit does happen.”

In Maryland, during a legal challenge to that state’s lethal-injection protocol, it was revealed that the person responsible for injecting drugs into the condemned man had been fired by a local police department after refusing to cooperate with an internal investigation. He had also been charged with poisoning and killing a bunch of neighborhood dogs. This apparently made him the perfect person to join the Maryland execution team, which also included someone who’d been suspended for spitting in inmates’ food before it was given to them.

Richard Dieter, director of the Death Penalty Information Center, says that in the wake of all the litigation over their lethal-injection protocols, states have attempted to at least provide better training for the people on their execution teams. But given how few people are really interested in becoming professional killers, especially the doctors needed to make sure the process goes smoothly, botched executions are likely to continue, regardless of what sorts of drugs the states come up with.

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The People Giving Lethal Injections: Untrained, Incompetent, or Just "Complete Idiots"

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Zombie Apocalypse Drug Reaches US: This Is Not a Joke (Graphic Image)

Mother Jones

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Krokodil, a highly addictive designer drug that aggressively eats through flesh, has reportedly arrived in the United States. A Phoenix CBS affiliate revealed this week that two cases involving krokodil had been phoned into a local poison control center and quoted one of the center’s medical directors, Dr. Frank LoVecchio, saying he and his colleagues were “extremely frightened.” While the US Drug Enforcement Administration has not yet received a sample of the drug for analysis, and thus cannot confirm it was krokodil, Barbara Carreno of the DEA told Mother Jones that the agency often learns about new synthetic drugs (including the infamous bath salts) through local poison-control centers. “We’ve been scrambling to see what we know about the cases in Arizona,” she added. “This concerns us very much.”

Krokodil, technically known as Desomorphine, has a similar effect to heroin, but is significantly cheaper and easier to make. In the last few years, it’s been wreaking severe havoc on the bodies and lives of Russian youth. The drug earned its nickname—the Russian word for crocodile—because of the ghastly side effects it has on the human body. Wherever the drug is injected, the skin turns green and scaly, showing symptoms of gangrene. In severe cases, the skin rots away completely revealing the bone beneath. Other permanent effects of the drug include speech impediments and erratic movement. Rotting flesh, jerky movements, and speech troubles have prompted media outlets to tag krokodil the “zombie drug.” According to Time, the average user of krokodil only lives two or three years, and “the few who manage to quit usually come away disfigured.” Quitting is its own nasty business. Heroin withdrawal symptoms last about a week; symptoms for krokodil withdrawal can last over a month.

Krokodil use has skyrocketed in poor rural communities in Russia in the last few years, despite the troubling side effects. The Federal Drug Control Service in Russia told Time that in the first three months of 2011, it confiscated 65 million doses of the drug. Desomorphine didn’t originate in Russia; the potent painkiller was patented in the United States in 1934. It only became a recreational drug about 10 years ago, when it surfaced in Siberia. The Independent reported in 2011 that up to 5 percent of Russian drug users have used krokodil—as many as 100,000 people. Zhenya, a former user in Russia, told the Independent that when she used to inject krokodil, she was “dreaming of heroin, of something that feels clean and not like poison. But you can’t afford it, so you keep doing the krokodil. Until you die.”

The main ingredients in krokodil are codeine, iodine, and red phosphorous. The latter is the stuff that’s used to make the striking part on matchboxes. Sometimes paint thinner, gasoline, and hydrochloric acid are thrown into the mix. Like meth, it’s fairly easy to cook up in a home kitchen. You need a stove, a pan, and about 30 minutes. The drug is then injected directly into the vein, producing a high that lasts about an hour and a half. According to the Week, each injection costs about $6 to $8, while heroin is up to $25.

Carreno of the DEA says that krokodil isn’t a controlled substance yet because the agency has to have more evidence that it’s a public health problem. “You don’t want a federal agency going around making things illegal willy-nilly…We’d have to see more than two cases before we control it,” she notes. “But people are mixing codeine and gasoline, and shooting it into their veins. What do they expect?”

In the mean time, if you want to feel disgusted and never eat lunch again, look at the graphic picture below of a krokodil user. For more gruesome images, go here.

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Zombie Apocalypse Drug Reaches US: This Is Not a Joke (Graphic Image)

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80% of Antibiotics in the U.S. Go to Factory Farms

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80% of Antibiotics in the U.S. Go to Factory Farms

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Keystone XL oil would be processed in sick East Texas community

Keystone XL oil would be processed in sick East Texas community

Tar Sands Blockade

Children play at a park in front of a Valero refinery in Houston, Texas.

For many, the battle over the Keystone XL pipeline is about national energy strategy and global climate change.

For residents of the Manchester neighborhood in Houston, it’s also about what will be processed and spewed into the air in their backyards.

Activist Doug Fahlbusch recently brought some attention to the community when he held up a sign at a Valero-sponsored golf tournament that said, “TAR SANDS SPILL. ANSWER MANCHESTER.” That protest got him carried away from the links by security guards and arrested.

What did Fahlbusch mean? Why are he and his colleagues at Tar Sands Blockade so concerned about Manchester?

Yes! magazine reporter Kristin Moe took a trip to the embattled neighborhood, where a refinery owned by Valero Energy Corp. could end up processing most of the tar-sands oil that flows south through the proposed Keystone XL pipeline. Here is a little of what Moe found in “Houston’s most polluted neighborhood”:

Yudith Nieto, 24, has lived in Manchester since her family came from Mexico when she was a small child. While it’s OK to visit the playground, she says, it’s not OK to bring her camera. On several occasions, security guards from the Valero refinery next door have appeared and asked her to leave, claiming that taking pictures in the park was “illegal.” They’ve even brought in Houston police as reinforcements. Valero, one of the major oil companies operating in this industrial part of Houston, keeps its security busy: Nieto says that they have harassed documentary filmmakers and journalists. And when college students participating in an “alternative spring break” program came to the park to talk to her about the neighborhood’s problems, a guard drove up in an unmarked vehicle and took video of the meeting on his cellphone. “I’m not afraid of the attention I’m getting from these people,” Nieto says, “because we want people to know that we’re aware.”

Manchester, one of Houston’s oldest neighborhoods, is surrounded by industry on all sides: a Rhodia chemical plant; a car crushing facility; a water treatment plant; a train yard for hazardous cargo; a Goodyear synthetic rubber plant; oil refineries belonging to Lyondell Basell, Valero, and Texas Petro-Chemicals; as well as one of the busiest highways in the city. Industrial development continues uninterrupted down the Houston Ship Channel for another 50 miles south to the Gulf of Mexico. The refineries around Houston have been called the “keystone to Keystone” because they’re expected to process 90 percent of tar sands crude from Alberta [PDF] if the controversial Keystone XL pipeline is completed.

It’s one of the most polluted neighborhoods in the U.S., one where smokestacks grace every backyard view. But it’s taking on a new significance as the terminus of Keystone because the pipeline is at the center of the highest-stakes environmental battle in recent years. As international pressure builds, residents are beginning to organize, educate themselves, and speak out for the health of their families. …

Manchester is in some ways typical of low-income urban neighborhoods: it’s almost entirely Latino and African American, with a large number of undocumented immigrants. A full third of residents live below the poverty line. Drugs, unemployment, and gangs are a problem. And there’s a strange smell in the air: sometimes sweet, sometimes sulfurous, often reeking of diesel. The most striking thing is that people here always seem to be sick. They have chronic headaches, nosebleeds, sore throats, and red sores on their skin that take months to heal.

Manchester is where the tar-sands rubber will hit the ground. Or where the bitumen will hit the air, if you will. To learn more about the community’s battles against Valero and Keystone XL, read the full article in Yes!

John Upton is a science aficionado and green news junkie who

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Keystone XL oil would be processed in sick East Texas community

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