Tuesday, December 26, 2017

EXCLUSIVE! Blockbuster Data for Lymphoma Patients: An Exhaustive Guide to the Best and Brightest New Treatments

It’s been a very good year for lymphoma patients. At the 59th American Society of Hematology (ASH) Annual Meeting and Exposition in Atlanta earlier this month, an avalanche of mostly positive clinical trial data was presented by pharmaceutical companies for various newly approved treatments for lymphoma, one of the most common cancers in America.
The number of therapies green-lighted this year by the Food and Drug Administration (FDA) for non-Hodgkin’s lymphoma (NHL), specifically, is particularly exciting and encouraging.
But negotiating this whirlwind of new information can be daunting for patients looking for the best treatment options. That’s why I’m here. 
Below, for my fellow lymphoma patients and their loved ones, is a guide in which we take an exclusive, inside look at some of the most significant lymphoma treatments that recently debuted in the market and, hopefully, at your cancer clinic, with the science jargon replaced, whenever possible, with regular English.
For this guide, we talked with patients, physicians and researchers to get the most comprehensive and no-baloney summary for anyone who is about to make a decision about treatment and wants the latest 411 on what works and what doesn’t.
And as if I have to remind anyone, I am not a doctor, I’m just a journalist, patient advocate, and three-time survivor of non-Hodgkin’s lymphoma who’s been writing about this stuff, and living it, since my own diagnosis 21 years ago.
If you have any questions or comments about any of this, please contact me directly at my personal email:  jreno@san.rr.com

So, let’s start with Aliqopa, a treatment from Bayer Healthcare Pharmaceuticals that’s in a class of drugs known as kinase inhibitors. Aliqopa, which works by blocking several enzymes that promote cell growth, was granted accelerated approval by the FDA in September for adults with relapsed follicular non-Hodgkin’s lymphoma (fNHL).

Follicular is the type of lymphoma I’ve been battling for 21 years. Treatment options for fNHL are limited. The approval of Aliqopa provides an evidently effective new choice for patients who’ve received at least two prior treatments known as “systemic therapies.”

That just means drugs that spread throughout the body to treat cancer cells. They include chemotherapy, hormonal therapy, targeted drugs and immunotherapies. 
From what I’ve been told by lymphoma patients who’ve been treated with Aliqopa, the side effects are often substantially more tolerable than chemotherapy, which will come as good news for those of you who, like me, had a rough time with chemo.
When I was originally diagnosed with cancer, I was treated with a chemotherapy regimen called CHOP. It literally almost killed me. It was brutal. Thankfully not every patient has that experience.
What you should know about Aliqopa is that in a clinical trial of 104 patients with fNHL, this treatment gave 59 percent of patients a complete or partial response for a median 12.2 months.
Lymphoma Patient Embracing New Treatment
Thanks to Aliqopa, Brenda Montgomery got her life back. Brenda, 68, a charming, effervescent woman from Carrollton, Kentucky, was diagnosed with follicular NHL nine years ago. Last July, her doctors told her the cancer had returned. Again.

But she had pretty much run out of options. So, she took an educated risk and entered a clinical trial of Aliqopa after asking her doctors about the clinical trial data. “We didn't know what would happen in the trial,” Brenda tells me, “but after three times in and out of remission, I thought, ‘What have I got to lose’?”

Brenda, who was treated with the drug every three weeks for 18 months, is now in complete remission. The trial was a breeze compared to some of her previous treatments. “It was great, though I did have a few side effects, including soreness in my mouth,” she says.

Brenda, who still works as a Mary Kay representative and loves to have fun with friends at the casinos not far from her Kentucky home, says this drug has enabled her to live her life again. “I have new hope now,” she says. “I’m doing the things I love to do and enjoying my life.”


The newest Non-Hodgkin’s lymphoma treatment to enter the marketplace is Gazyva, an engineered monoclonal antibody from Genentech that targets and attaches to the so-called CD20 proteins found on follicular lymphoma cells as well as some healthy blood cells.

Gazyva, too, represents a new and viable option for follicular NHL patients. It was approved by the FDA just last month for people with previously untreated advanced follicular lymphoma (stage II bulky, III or IV) in combination with the chemotherapy drug Bendamustine, followed by Gazyva alone in patients who responded.

I’m not a big fan of chemo drugs, for reasons I listed above. I tend to support newer protocols that move away from chemo. But that is a very personal choice and I respect others who disagree. There are thankfully plenty of cancer patients who’ve tolerated chemotherapy better than I did.

The trial data shows that a Gazyva-based regimen reduces the risk of disease worsening or death by 28 percent compared to a regimen of Rituxan, the blockbuster monoclonal antibody lymphoma drug also from Genentech/Roche.

Gazyva is designed to attack and destroy targeted B-cells both directly and together with the body's immune system. It is definitely another legitimate treatment option. And it’s interesting that it is in some scenarios positioned to replace Rituxan, which has been the most popular treatment for several types of lymphoma for years.

Lymphoma patients should also be aware that there will soon be more than one so-called “biosimilar” drug designed for lymphoma patients interested in taking Rituxan. Biosimilars are drugs that can be very similar to the drug they are designed to resemble, but there is no way to make them identical. A generic drug, on the other hand, is an exact copy of its reference medicine and must have the same chemical makeup.


Then of course there’s Yescarta, an immunotherapy from Gilead/Kite that is in a new class of cancer treatments called CAR-T that is arguably the most discussed cancer treatment in America at present.

Yescarta, which was approved by the FDA in October, is called an immunotherapy because it uses a patient’s own T-cells to attack cancer cells bearing the molecule called CD19 at their surface. CD19 is expressed in most lymphoma and leukemia cells.

A so-called chimeric antigen receptor T cell (CAR-T) therapy, Yescarta was approved for patients with certain types of large B-cell lymphoma who’ve not responded to or relapsed after at least two other kinds of treatment.

CAR-T has been the subject of an enormous amount of national press. I’ve covered the CAR-T sector for such publications as Yahoo Finance and Healthline, in 2016 and again this year.

Yescarta, the second CAR-T therapy approved by the FDA and the first to be green-lighted for certain types of non-Hodgkin’s lymphoma, is showing very impressive and durable complete remission rates for patients who have exhausted their options.

Survival rates for patients whose large b cell lymphoma recurred were 8 to 10 percent. But with CAR-T the survival rates have increased dramatically: 40 to 50 percent of patients experience a complete response, and show no sign of disease for months and potentially years.

More than 15 months after receiving the treatment, 40 percent of the lymphoma patients who were treated with Yescarta in Kite’s ZUMA-1 clinical trial are in complete remission. And these are patients who for the most part simply have nowhere else to turn.

Kite Pharma, the company that developed Yescarta, was recently purchased by Gilead for just under $12 billion in a purchase that generated global bold-type headlines. That buy should give you some idea of how much the industry, and patients, value this new treatment. It appears to be a game-changer, a remarkable new option that only promises to get better, and safer.

I’m eager to see how Yescarta and other CAR-T treatments will do in the coming years and, eventually, as a first-line therapy. It seems inevitable that the FDA will approve CAR-T as well as other immunotherapies as a patient’s first option, not just a last resort.
Meet the Next Patient to Do Yescarta
Despite how well Yescarta works, shockingly only six lymphoma patients have received the treatment since it was approved two months ago.

As Bloomberg reported, the wait times are creating anxiety in some lymphoma patients. But don’t blame the drug company. Doctors blame the delays on Medicare, the two government health programs, and on the insurance companies.

The sixth Yescarta patient was treated last week, and the seventh will be treated this week at Stanford.

I spoke exclusively with the family of Shazhad Bhat, 52, who has diffuse large B cell lymphoma (DLBCL), and will soon become the seventh patient to receive the treatment.

He and his wife Nicole, who live in Las Vegas with their 12-year-old son, are at preparing for the infusion this week. But this probably would not have happened if not for Nicole’s tireless advocacy for her husband, who works at the MGM and has insurance through his culinary union.

Nicole asked to meet the case member of the insurance plan in person to tell her their situation.“I didn’t have to deal with a red tape fight, I just contacted the case manager and said my husband had been fighting this for almost two years, and asked if I could meet her face to face,” she says.

Nicole asked the case manager one simple question. “I said, ‘Are you going to try to save my husband’s life?’ They said yes. We got it approved. I was not taking no for an answer.”

Nicole says it came down to one person being at the right place at the right time making the right decision. But she says it’s unfortunate that patients are forced to deal with so much governmental red tape and so many reluctant insurance companies.

“This world has become a conglomerate bureaucracy, I come from hotel hospitality and telecommunications, I was a manager for over 20 years. When I see something wrong I just look for ways to fix it,” she says.

Juno’s CAR-T Treatment

Meantime, another leader in the CAR-T sector is Juno Therapeutics, who also brought impressive CAR-T data to the ASH convention.

Juno is developing a CAR-T-based immunotherapy called liso-cel (formerly known as JCAR017), in partnership with Celgene, for adults with diffuse large B-cell lymphoma (DLBCL), the most common form of NHL.

Juno’s trial showed a 50 percent complete response rate, and also impressed observers with its stellar safety numbers. Some lymphoma patients in CAR-T clinical trials have had to contend with something called cytokine release syndrome (CRS), a serious and even potentially fatal toxicity that can result from T-cell cancer therapies.

Cytokines are various proteins that are secreted by certain cells of the immune system and have an effect on other cells. CRS is associated with elevated circulating levels of several cytokines including interleukin (IL)-6 and interferon γ.

But Juno and other pharmaceutical companies in the CAR-T space are working to mitigate the side effects of treatment. Juno, which suffered a tragic death of two patients in a separate clinical trial, has put a priority on patient safety and it appears to have paid off.
The company saw just one of its 67 patients in the B-cell lymphoma trial suffer from severe CRS, whereas Gilead/Kite’s trial for Yescarta saw 13 percent of its patients suffer from severe CRS.

Juno’s Head Researcher Responds

Dr. Sunil Agarwal, Juno’s president of research development, tells me the company is pleased with the 50 percent complete response rate among patients and the strong safety numbers in its trial.

“The 50 percent complete response rate is very exciting for patients in its own right,” Agarwal says. “We are [also] encouraged by the high durable response rate we have seen: greater than 80 percent between 3 and 6 months and greater than 90 percent beyond 6 months.”

Agarwqal is confident that liso-cel’s efficacy and safety profile have a good chance of being the “best in class” as the booming CAR-T sector moves quickly forward. 
“We are very encouraged by the emerging safety profile for liso-cel, which challenges the conventional thinking that efficacy inevitably comes with toxicity,” he says. “The clinical data for liso-cel show good efficacy with a tolerability profile that could be beneficial for patients and allow for outpatient administration. This would also be beneficial for hospitals and payers.”

Eureka: An Even Newer Idea, But Will It Work?

On that patient safety note, there is an even newer company in the T cell immunotherapy space whose treatment potentially harnesses the body’s T cells to attack lymphoma but removes the risk of cytokine release syndrome.

Eureka Technologies, a small but up-and-coming biotech firm, recently announced the FDA’s allowance of a Phase I clinical trial for ET190L1-ARTEMIS T cells in relapsed and refractory CD19-positive NHL.

Eureka expects to enroll the first patient in this trial in the first quarter of 2018. In pre-clinical studies, Eureka’s T-cell technology matched the cancer killing potency of current CAR-T therapies, but with a dramatic reduction in the levels of inflammatory cytokines released.

In addition, these studies have shown that ET190L1-ARTEMIS T cells are less exhausted and more naive and therefore expected to have improved persistence.
If confirmed in the clinic, this could result in a longer-term therapeutic benefit to patients and of course pose serious competition with the other CAR-T makers.
“We designed our ARTEMIS T cell receptor platform with the goal of improving upon the efficacy and safety of current T cell therapies,” Dr. Cheng Liu, President and Chief Executive Officer of Eureka Therapeutics, says in a statement. 
The principal investigator for the Phase I clinical trial is Dr. David Rizzieri, professor of medicine, a leading blood cancer physicians and researcher at Duke Cancer Institute at Duke University School of Medicine, says in a statement that he is “excited to work with Eureka Therapeutics in bringing this innovative therapeutic approach to the clinic.
Rizzieri says this treatment has the potential to “reduce the serious side effects that I have seen in patients being treated with current approaches.”
The CAR-T Sector Continues to Grow

Johnson & Johnson also just announced it is paying $350 million through its subsidiary, Janssen Biotech Inc., to collaborate on a new CAR-T treatment for myeloma with a little-known Chinese company called Legend Biotech. 

Under the licensing deal announced Thursday, Janssen and Legend will equally split development costs and any future profits of the CAR-T candidate in multiple myeloma — excepting Greater China, where the Legend will take a 70% share.

It remains to be seen if Johnson & Johnson will pursue any CAR-T treatments for lymphoma, in China or elsewhere. But it certainly seems possible, given the fact that its subsidiary, Jannsen, is already bringing a lymphoma treatment to China.

As I reported in Healthline, Janssen and Pharmacyclic, an AbbVie company, are brining ibrutinib, which treats several types of lymphoma and leukemia, to China.

Ibrutinib is an oral therapy that inhibits the function of Bruton’s tyrosine kinase (BTK), a target for therapy of B cell diseases that includes several types of lymphoma as well as chronic lymphocytic leukemia.
Cancer Genetics

Another company that lymphoma patients may not know about yet, but which is doing some of the most advanced and significant work in the entire cancer field, is Cancer Genetics (CGI).

The company, whose latest data presented at the ASH convention generated widespread interest, is at the forefront of precision medicine, which is the effort to increase the efficacy of a treatment and speed up the process of finding the right treatment or treatments for patients.

CGI provides molecular and biomarker tests that enable physicians to personalize patient management. The company’s technology enables pharmaceutical companies involved in clinical trials to reduce adverse drug reactions in patients with lymphoma, and other cancers, by providing information regarding genomic factors influencing patient responses to treatments.

In an exclusive interview, Dr. Rita Shaknovich, CGI‘s new chief medical officer and group medical director, said the company is looking at the genetics of cancer, and adapting its findings to choose the best possible treatment options for the patient.

Shaknovich’s esteemed research, which has been funded by such agencies as National Institute of Health (NIH), Leukemia and Lymphoma Society (LLS) and Lymphoma Research Foundation (LRF), has focused largely on lymphoma and its genetic mechanisms.

Her work for the last decade-plus has identified some of the genetics involved in the conversion of a tissue with a normal growth patter into a malignant tumor.

“Technology has improved. We know there are dominant mutations in certain types of disease, and we are gaining a better understanding of the genomic events that lead to transformation of normal cells into lymphoma,” she says. “A large number of cases have been sequenced; we know there are certain genomic abnormalities.”

Shaknovic says CGI tries to assess biomarker expression in B cell lymphoma, and that data hopefully will enable the design of clinical trials using inhibitor treatments.  

“The good news is there are companies focusing on creating drugs that target those abnormalities. This is what precision medicine is all about,” she says.

At ASH this month, CGI announced the results of a study demonstrating the potential value of its precision medicine technology in better understanding diffuse large B cell lymphoma (DLBCL).

In a statement, Panna Sharma, president and CEO of CGI, says
the study demonstrates that choice and integration of diagnostic modalities can provide “key additional information to assist oncologists to more accurately select therapeutic options for their patients.”

While not a household name, yet, CGI appears well-positioned, with much study of NHL already in the books, to have a profound effect on lymphoma patient management treatments.

It’s pretty evident to me that CGI’s technology will save lymphoma patients’ lives in the very near future, if it hasn’t already. 

Sunday, November 19, 2017

San Diego State's Rashaad Penny: The Best College Football Player In America In 2017

A few weeks ago, I wrote here that any sportswriter or other member of the Heisman Trophy voting committee that doesn’t select San Diego State University running back Rashaad Penny as a finalist for the prestigious award for college football's best player should have his or her voting priveledges taken away. 

But after watching last night's game, in which Penny finished with an astounding 429 all-purpose yards, allow me to amend that declaration a bit: Those of you who don't vote for Penny as a Heisman finalist should never be allowed to write about college football again!

Penny is easily one of the best three college football players in the nation in 2017. He deserves to be a Heisman finalist. If you've watched him play this year, you surely agree. It's indisputable at this point. 

San Diego State beat Nevada last night 42-23 in a game that will only confirm and expand the Aztecs’ postseason options. This will mark the eighth bowl game in the last eight years for San Diego State football. But the bigger story last night was the historic performance from Penny, who leads the nation in rushing and all-purpose yards. 

It was a game for the ages for Penny, who ran for 222 yards to bring his total to 1,824, putting him atop the nation's running backs. Stanford’s Bryce Love, a surefire Heisman finalist who Penny outplayed in San Diego State's win over #19 Stanford in September, is in second place with 1,723 yards.

In addition to running for 222 yards last night, Penny also returned a punt 70 yards for a touchdown (it was the first punt return of his college career). Not long after that, Penny returned a kickoff 100 yards for another touchdown. The kickoff return for a TD is the seventh of his career, tying the college record. He had four touchdowns total. 

Nevada played well and was shooting for the upset, but Penny sealed the game for San Diego State. His 429 all-purpose yards broke the school record of 422 set 26 years ago by Marshall Faulk during his monster 386-yard rushing game against Pacific. 

I was at that game back in 1991. It was the greatest performance by a running back I'd ever seen in college football. Until last night.

Sports Illustrated college football writer Bruce Feldman wrote yesterday that the top five Heisman candidates in his book are Oklahoma quarterback Baker Mayfield, and four running backs: Stanford's Bryce Love, Penn State's Saquon Barkley, Wisconsin's Jonathan Taylor, and Auburn's Kerryon Johnson. 

Now Bruce, before you crack your knuckles and start typing me defensive reasons why I'm wrong and why Penny doesn't deserve to be a Heisman finalist, save it. The only argument you can really come back with when a player who isn't in a Power Five conference has these kind of historic numbers is that he hasn't done this against any legit competition.

But Penny demonstrably outplayed Bryce, who is your #2 candidate on the Heisman list, when San Diego State beat Stanford. Penny finished that game with 206 total yards on offense vs. Love’s 187 yards. Both are great athletes. Penny's just a little better.

Penny also had a remarkable game against Arizona State, another Power Five team that beat #5 Washington and #24 Oregon and is headed for a bowl game this year. Against the Sun Devils, in Tempe, Penny had 353 all-purpose yards, including 216 rushing on just 18 carries, 38 yards receiving and 99 yards on special teams.

The opponent does not matter. Penny dominates all comers. There is simply no sound argument left for Bruce or anyone else to justify leaving him on the outside looking in to the Heisman ceremony in New York City next month. 

Don't let this happen yet again, Heisman voters. You slighted Faulk, the college and NFL hall-of-famer who was easily the best football player in the nation when you gave the trophy instead to Gino Torreta, who quarterbacked a great Miami team but was in no way, shape or form a better football player than Faulk was that year or any year. 

You did it again last year to Donnell Pumphrey, the unstoppable and unbelievable San Diego State mighty might who broke the all-time college football rushing record last season and ran for more than 2,000 yards. He deserved to be a Heisman finalist, too.

But this time y'all are out of even bad excuses. Those of you who didn't vote for Pumphrey embarrassed yourselves, but if you make the even bigger blunder and leave Penny out, you will leave your credibility left hanging by a thread from your wrinkled Dockers.

If I sound pissed... bingo! Enough is enough is enough. I have great respect for sportswriters, generally, and often defend them when I'm in the company of those who have no clue how tough the gig really is. But when it comes to the Heisman vote, sportswriters, and especially ESPN analysts, have been displaying a regrettable amount of ignorance and bias for far too long.

Notice I’m not even saying Penny deserves to win the dang thing. He does, of course. I called him the best player in college football above because he is the best player in college football. But all I am saying here is that he deserves to be part of this ceremony. The Heisman finalists are supposed to include the best individual football players in the country. Penny is one of those. 

Some years, Heisman voters make a reasonable argument when Division One players have amazing stats but haven't played against strong competition. But I will say it one more time: two of Penny’s finest games this season were against Power Five teams. He's great no matter who he is playing.
Heisman voters, please stop shaming the award with your myopic, clueless votes. 

Friday, November 17, 2017

Man in the Wilderness: Congressman Walter Jones, the Only House Republican in Deep-Red State to Vote Against House Tax Plan

Rep. Walter Jones, lonely voice of reason and decency
Walter Jones must feel like a man in the wilderness. Jones, a North Carolina Republican in the House of Representatives, has a storied history of speaking his mind, regardless of the consequences. But this week, he really went out on a limb. Jones is the only member of his party from a deep-red state to vote against the current House version of the $1.5 trillion tax bill.
It was a brave move. But also a smart one. Why? Because this tax bill will hurt so many of his constituents. When all is said and done, if this absurd tax bill, or its equally preposterous counterpart bill in the Senate, reaches President Trump's desk, many of Jones' supporters will take a major hit. And probably so will you.
Jones, who's been in Congress since 1994, is someone I have long admired. A moderate, he is a truly decent and independent man. You want examples? For more than a decade, he has been quietly writing personal letters of respect and condolence to the families of thousands of men and women who have lost their lives fighting in the nation's post-9/11 wars. He says he does it because he deeply regrets voting in 2002 to authorize the U.S. to invade Iraq.
As I reported in the International Business Times a few years ago, Jones was one of the few voices in Congress who relentlessly demanded that the government release the redacted pages of the Joint Intelligence Committee 9/11 Inquiry report regarding the Saudi Arabian government's alleged involvement in the terrorist attack.
And once again Jones has been a singular voice with this tax "cut," which he voted against in large part because it eliminates the tax deduction for out-of-pocket medical expenses, which, seemingly unbeknownst to his GOP colleagues, is a very scary proposition for millions of suffering Americans. "There are a lot of seniors in my district, and this is life and death for them," Jones said this week.
Middle Class Hit Hard
So, there you go. A rare moment of clarity and decency among House Republicans these days. The so-called tax "cuts" in both the House and the Senate are the biggest scams for wealthy Americans and multi-national corporations Congress has ever attempted to pull on this country. They will greatly harm the economy, and millions of Americans.
The House bill would raise taxes on millions of middle-class families, punish the elderly, eliminate jobs, increase health insurance premiums, encourage American companies to take their jobs to other countries, which of course President Trump has done his entire career, and explode the debt.
In the House bill, people making less than $30,000 a year would actually pay $4 billion more in taxes, while people who make over $200,000 would pay $90 billion less.
And as Jones noted, the bill would kill a deduction that allows millions of American families of disabled children and elderly people to write off large medical expenses. The deduction is currently allowed if medical expenses exceed 10 percent of a taxpayer's adjusted gross income. About 9 million taxpayers reportedly deducted about $87 billion in medical expenses for the 2015 tax year, according to the IRS.
Few Republicans have had the courage to speak out about this ridiculous idea to repeal the medical-expense tax break. Rep. Greg Walden, the Oregon Republican who chairs the Energy and Commerce Committee, told the Chicago Tribune this week that some of his constituents who live in senior care facilities could in fact be harmed if the deduction is taken away.
But when asked what he plans to do about it, his answer was vague and bizarre. "I think it's one we have to continue to massage a bit," he said. "There's a lot of things out there and there's maybe going to be an opportunity to adjust some of them."
Cancer Patients Threatened
Meanwhile, the nonpartisan Congressional Budget Office (CBO) has warned that the House tax cut proposal, which passed narrowly on Thursday (13 Republicans opposed it), would cut $25 billion from Medicare spending next year. The reduction would come in the form of automatic sequester cuts designed to prevent the federal government from running out of money.
Oncologists nationwide are very concerned about this. The Republican's plan to slash Medicare would trigger sequester cuts that would drive more independent cancer clinics out of business and reduce cancer patient access to care.
“Policymakers in Washington should note that blunt budget-cutting gimmicks like the sequester cut backfire. They have terrible unintended consequences and do more harm than good for patients and taxpayers,” the Community Oncology Alliance (COA) said in a statement.
As OncLive reported today, the coalition of independent oncology practices stated that the most recent Medicare sequester cut, five years ago, resulted in the closure of nearly 100 oncology practices—many consisting of multiple clinic locations—and caused another 130 to merge with hospitals in order to survive.
Under the House bill, which was not supported by a single Democrat, corporations can benefit by taking their jobs out of the United States. Companies will have the option of paying the new 20 percent corporate rate the GOP is proposing, or move to a low-tax country and pay just 9 percent to that nation and nothing to the United States. Yes, nothing.
Senate Bill Might Be Even Worse
Not to be outdone, the Senate's version of this so-called tax cut, which will be voted on next week, may be even more harmful to working Americans. In this bill, taxpayers who make between $50,000 and $75,000 would pay $3.9 billion more in taxes per year after the individual cuts expire in 2026, according to the nonpartisan Joint Committee on Taxation (JCT), while wealthy families who benefit more from the corporate tax cuts would continue to get a tax break after the individual cuts expire.
The JCT said the Senate bill will raise taxes on low-income Americans beginning in 2021, and that taxpayers earning less than $40,000 would see their tax bills go up in the second half of the next decade. The CBO also said that the Senate's tax plan could trigger huge cuts to Medicare and other programs in order to meet budget deficit rules.
The Senate bill will repeal the individual mandate in Obamacare, which will increase the number of Americans without health insurance by 13 million, according to the CBO, and raise insurance premiums by about 10 percent for millions of middle-class families and by over $1,000 per year for millions of seniors.
Senate Majority turtle Mitch McConnell admits he added the elimination of the individual mandate to the bill to help pay for permanent corporate tax rate cuts.
Both of these tax bills are frauds. Scams. But don't take my word for it. Read up on them. See for yourself. Walter Jones did. And he should win some sort of medal for it.

Thursday, November 16, 2017

President Trump's Asia Sojourn: Welcome To Amateur Hour

President Trump and China President Xi
Upon his return this week from a 12-day tour of Asia, President Trump made an unsurprising number of self-congratulatory declarations about the trip's alleged accomplishments.

“Our great country is respected again in Asia,” he Tweeted. "You will see the fruits of our long but successful trip for many years to come!”

But none of that is true. The journey, which took him to Japan, South Korea, China, Vietnam and the Philippines, yielded no substantive achievements. Zip. Nada. During the trip, which actually set us back on several fronts, Trump gave China a pass on trade, kissed up to a burgeoning dictator in the Philippines, and insulted Japan, our best friend in the region.

What Trump's Asia sojourn did above all was show the world just what an amateur diplomat this President really is. And it didn't give us the first clue what the future holds for the United States and the Pacific Rim. We're no closer to a concrete Asia strategy now than we were before Trump left. We still have no idea, for example, what his plan is with regard to North Korea's development of nuclear weapons. 

And most significantly, every leader he saw on this trip demonstrably had more respect for President Obama than they have for Trump, but they couldn't play Obama as well. Trump is an easy mark.

Trump Is Putty In Xi's Hands

In China, Trump fell hook, line and sinker for President Xi Jinping's Politics 101 strategy to continually flatter the President. That's all it takes for Donald to bite, and speak about you in glowing terms. Just tell him you like his suit. Or his hair. And he's silly putty in your hands.

Politically, Donnie Trump is a freshman, whereas Xi and most of the world leaders Trump encountered on this trip are grad' students. Yes, it's the classic checkers-chess analogy, and I don't need to tell you which one is playing checkers.

After feverishly accusing China of "raping" U.S. workers while on the campaign trail, Trump did a wimpy 180 during this trip and said the trade imbalance between the U.S. and China is "not China's fault." 

He caved, and blamed past U.S. leadership.

I like that we are engaged with China. I have a deep and abiding respect and love for China's people. But Trump is being played by Xi. Trump looked like a fool, much to Xi's obvious delight, and did nothing to challenge the fact that China, not the U.S., is now the number one influential force over the future of the Asian continent.

Trump embarrassingly fawned over Xi, calling him “a very special man” with whom he has “great chemistry.” He even congratulated Xi on the recent Communist Party Congress, which gave Xi sweeping new power as China's leader.

Trump's Asian trade strategy is not a strategy at all. It's a mess. Like virtually everything in this administration. Trump has expressed a desire to make trade deals with each individual Asian state, but there's very little interest in this among any nation in Asia.

Meanwhile, most of the countries Trump visited are involved in healthy new trade deals and/or negotiations with other countries around the planet. Things are moving fast in Asia, and Trump isn't even on the bus, despite having spent 12 days there.

Chummy With One of the World's Worst Leaders

Trump also nauseatingly and irresponsibly made too-nice with one of the world's most despicable and corrupt leaders, Philippine President Rodrigo Duterte, who called President Obama a “son of a whore" and is responsible for a bloody drug war that has led the the deaths of more than 12,000 Filipinos. At least 2,555 of the killings have been reportedly attributed to the Philippine National Police.

Trump never mentioned these glaring human rights abuses during this trip. But he did once again bring up the false claim that Obama “didn’t land” in the Philippines because of his “horrible” relationship with that country.

It was actually Obama who decided to cancel a meeting with Duterte in September 2016 after the two world leaders had a public disagreement over the mass killings in the Philippine drug war.

Trump has a very tenuous relationship with reality and the facts.

“I mean, the Philippines, we just could not have been treated nicer," Trump said, embarrassing himself, again. "And as you know, we were having a lot of problems with the Philippines. The relationship with the past administration was horrible, to use a nice word. I would say ‘horrible’ is putting it mildly. You know what happened. Many of you were there, and you never got to land. The plane came close but it didn’t land."

This simply did not happen. It's fiction.

Blasting Our Best Friend in Asia

But perhaps the most insulting and inexplicable blunder on this trip didn't happen in China, or the Philippines, but in Japan, which has been our greatest ally in Asia for many years. When speaking with a group of Japanese business execs, Trump stupidly said, “Try building your cars in the United States instead of shipping them over. Is that rude to ask?”

Uh, yeah, it's rude to ask. And it's utterly clueless.

Most Japanese cars that Americans drive are already built here in America. Some of the top Japanese automakers, including Nissan, Toyota and Honda, already build millions of their best-selling vehicles here in the states and have brought hundreds of thousands of jobs and billions of dollars into the US economy. 

Could they build even more cars here? Yes, I suppose. And is there still some trade imbalances between the two countries? Yes. But Japan contributes an enormous amount to the U.S.

Not that this disrespectful remark is at all a surprise. This President puts his foot in his mouth on a daily basis. But he simply should have known better. He claims to be a smart businessman. He isn't. He's bankrupted businesses five times. And making real estate deals isn't the same as making deals with international leaders.

Trump needs to step out of the 1980's and get with the new program. Try reading. It's never too late to educate yourself, Mr. President. The days of hostilities between Japan and the U.S. are long gone. Sure, trade is a legit issue, but Japan is now a solid partner with the United States, and a strong economic friend.

I was personally offended by his comments. I'm a 26-year loyal customer of Nissan. They're the best cars in the world, and the only ones I drive. And I've gotten to know a number of executives at Nissan in the United States.

The relationship between Nissan and the U.S. has been very healthy for both sides for decades. Nissan is an enormous contributor to the US economy and has 22,000 employees across the country.

"Nissan has vehicle assembly plants in Smyrna, Tennessee, which opened in 1983 and is the largest volume plant of any automaker in North America,” Brian Brockman, director of group communications for Nissan Group of North America, told me this week.

Brockman said there are also "Nissan assembly plants in Canton, Mississippi, powertrain assembly plants in Decherd, Tennessee, R&D facilities in Michigan, Arizona and California, a design studio near San Diego, a sales finance corporation near Dallas, and eight regional sales offices" and other training and distribution centers across the country.

But what impresses me most about Nissan is the active role the company plays at the community level in the U.S. Here in San Diego County (California), Nissan is deeply involved in supporting local police, local veterans and our indigenous surf culture.

Mossy Nissan Kearny Mesa, for example, the car dealership where I've bought and serviced my trucks for more than two decades, recently built a fully equipped Titan truck and donated it to the Oceanside Police Department.

At the Supergirl Surf Pro women's surfing competition this summer, Nissan was one of the primary sponsors and was scheduled to give away a new Nissan Rogue to the winner of the competition. But two surfers tied.

"The chances of a tie were like one in a million," Mossy Nissan Kearny Mesa's Executive Manager, Sean Hogan, told me this week.

Nissan executives were faced with a bit of a dilemma. So what did they do? They decided to give both of the winners new cars. "When we made the announcement, the crowd, and both of the winning surfers, went wild," Hogan said with a proud smile.

Sure, it was a smart public relations move. But the point is Nissan makes the effort. That’s just how the company rolls.

Nissan is involved in countless positive programs throughout the U.S., and the Nissan Foundation provides grants annually to organizations that promote cultural awareness and diversity.

Nissan also has a long-standing partnership with Habitat for Humanity that dates back to 2005. The company has contributed $15 million, donated dozens of vehicles to local chapters and logged more than 97,000 employee volunteer hours building 85 homes in communities where Nissan’s American employees live and work.

On a personal note, my cars have been unbelievably reliable. Not a single mechanical issue with any of them, neither my Pathfinder nor either of my Xterras. I've always been treated well by Nissan dealerships.

And of course it's not just Nissan. Toyota’s largest auto manufacturing plant in the world is in Georgetown, Kentucky. The plant employs 8,200 people. In 2016, Honda manufactured nearly 70 percent of U.S.-sold cars in America.

President Trump needs to open a book, a magazine or a newspaper and spend less time watching "Fox and Friends" and Tweeting. He needs to learn how the world really works.

And he really needs to learn how to treat a friend.