
Top RFK Jr. aide attacks US health system while running company that promotes wellness alternatives
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Calley Means has built a following within the 'Make America Healthy Again' movement by railing against the failings of the U.S. health system, often pinning the blame on one issue: corruption.
Means, a top aide to Health Secretary Robert F. Kennedy Jr., was hired as a White House adviser in March. He has used that perch to attack the nation's leading physician groups, federal agencies and government scientists, claiming they only protect their own interests in the nation's $4.9 trillion-a-year industry.
In recent interviews, speeches and podcasts he has called the American Medical Association 'a pharma lobbying group,' labeled the Food and Drug Administration 'a sock puppet of industry,' and said federal health scientists have 'overseen a record of utter failure.'
Means, however, has his own financial stake in the sprawling health system. He's the co-founder of an online platform, Truemed, that offers dietary supplements, herbal remedies and other wellness products. Some of the vendors featured on Truemed's website are supporters of Kennedy's MAHA movement, which downplays the benefits of prescription drugs, vaccines and other rigorously tested medical products.
Kennedy has pledged to run the Department of Health and Human Services with 'radical transparency,' but Means has never had to publicly disclose his own financial details or where exactly they intersect with the policies he's advancing.
'It reeks of hypocrisy,' said Dr. Reshma Ramachandran, a health researcher at Yale University. 'In effect, he is representing another industry that is touting nonregulated products and using his platform within the government to financially benefit himself.'
In a written statement, Means said his government work has not dealt with matters affecting Truemed and has focused on issues like reforming nutrition programs and pressuring companies to phase out food dyes.
'Pursuing these large-scale MAHA goals to make America healthy has been the sole focus in my government work,' Means said.
Truemed helps users take tax-free money out of their health savings accounts, or HSAs, to spend on things that wouldn't normally qualify as medical expenses, such as exercise equipment, meal delivery services and homeopathic remedies — mixtures of plants and minerals based on a centuries-old theory of medicine that's not supported by modern science.
The business model caught the attention of the IRS last year, which issued an alert: 'Beware of companies misrepresenting nutrition, wellness and general health expenses as medical care.'
Truemed co-founder and CEO, Justin Mares, said in a statement the company is 'in full alignment' with IRS guidelines.
'Truemed enables patients to work with providers to use medical funds for root cause interventions like exercise and vitamin D to reverse disease under current law,' Mares said.
The full extent of Means' potential conflicts — including his personal investments— are unclear because of his status as a special government employee.
Unlike presidential appointees and other senior officials, special government employees are temporary staffers who do not have to leave companies or sell investments that could be impacted by their work. Also, their financial disclosure forms are shielded from public release.
'It's a big problem,' says Richard Painter, a former White House ethics lawyer under George W. Bush now at the University of Minnesota. Painter and other experts have raised alarms over a whirlwind of Trump administration actions to dismantle the government's public integrity guardrails.
Still, part-time government employees are subject to the same law that bars all federal staffers from working on issues that could directly benefit their finances. When such cases arise, they must recuse themselves or risk criminal penalties.
Means regularly opines on matters before HHS, including rethinking the use of drugs for depression, weight loss, diabetes and other conditions. Recently he's been promoting a new government report that calls for scaling back prescription medications in favor of exercise, dietary changes and other alternatives.
'If we rely less on our medical system, less on drugs, it necessitates the spiritual, cultural conversation about what we're doing to our children's bodies,' Means said in a recent podcast appearance.
Experts note that government ethics rules are intended to both prevent financial conflict violations, but also the appearance of such conflicts that might undermine public trust in government.
'If I were running the ethics office over at HHS, I sure as heck wouldn't want anybody going around giving interviews and speeches about government matters that could have an effect on their own financial interests,' Painter said.
Means' rapid rise reflects the seeming contradictions within the MAHA movement itself, which urges followers to distrust both big corporations and the government agencies which regulate them.
Means rails against big pharma and food conglomerates, two industries that he says he spent years working for as a consultant in Washington.
Means has no medical training. A graduate of Harvard Business School, he previously ran a bridal gown startup with his wife. On Wednesday, he's scheduled to be the keynote speaker at FDA's annual science forum, according to a copy of the program shared with The Associated Press.
He traces his passion for health care reform to the death of his mother from pancreatic cancer in 2021. Shortly thereafter, Means and his sister, Dr. Casey Means, took psychedelics together and had 'a mind-blowing, life-changing experience,' which led them to co-author a wellness book, launch separate health startups and begin appearing on podcasts.
Casey Means was recently nominated to be surgeon general and has faced scrutiny over her qualifications, including an unfinished medical residency.
Asked about her nomination, President Donald Trump said: 'Bobby thought she was fantastic,' adding that he did not know her.
Meanwhile, her brother has stepped up his rhetoric for the MAHA agenda, recently declaring that Kennedy has 'a spiritual mandate to reform our broken system.'
While promoting the administration's accomplishments, Means does not shy away from plugging his own brand or those of his business partners.
When asked to offer health advice to listeners of a sports podcast, Outkick The Show, in April, Means said: 'Read our book, 'Good Energy.''
He also recommended blood tests sold by Function Health, which provides subscription-based testing for $500 annually. The company was cofounded by Dr. Mark Hyman, a friend of Kennedy and an investor in Truemed, which also offers Hyman's supplements through its platform. Casey Means is also an investor in Hyman's company.
'If you're sick, most likely you have some kind of nutrient deficiency, some kind of biomarker that you can actually then target with your diet and your supplements,' Calley Means said.
Like dietary supplements, the marketing claims on laboratory tests sold by Hyman are not approved by the FDA. The agency has warned for years about the accuracy of such tests and tried to start regulating them under President Joe Biden.
Experts say MAHA entrepreneurs like Hyman are following a playbook common to the wellness industry: Identify a health concern, market a test to diagnose it and then sell supplements or other remedies to treat it.
'It ends up favoring these products and services that rest on flimsy grounds, at the expense of products that have actually survived a rigorous FDA approval process,' said Dr. Peter Lurie, a former FDA official who is now president of the Center for Science in the Public Interest.
Many of the items sold via Truemed, including sweat tents, cold plunge tanks and light therapy lamps, wouldn't typically qualify as medical expenses under rules for HSAs, tax-free accounts created by Congress to manage medical costs.
The IRS generally states that HSA purchases must help diagnose, cure, treat, mitigate or prevent disease.
Truemed allows users to request a 'letter of medical necessity' from a doctor, stating that the product in question could have medical value for them. Like other telehealth services, there's usually no real-time communication with the patient. The physician reviews a 'simple survey solution,' filled out by the Truemed user, according to the company's website.
Industry representatives say customers should be careful.
'You need to be prepared to defend your spending habits under audit,' said Kevin McKechnie, head of the American Bankers Association's HSA council. 'Companies are popping up suggesting they can help you manage that process and maybe they can — so the debate continues.'
Americans have an estimated $147 billion in HSA accounts, a potential windfall for companies like Truemed that collects fees for transactions made using their platforms.
Means sees an even bigger opportunity — routing federal funds out of government programs and into more HSAs.
'The point of our company is to steer medical dollars into flexible spending,' Means told fitness celebrity Jillian Michaels, on her podcast last year. 'I want to get that $4.5 trillion of Medicare, Medicaid, everything into a flexible account.'
Means' pitch for expanding HSAs echoes two decades of Republican talking points on the accounts, which were created in 2003 to encourage Americans in high-deductible plans to be judicious with their health dollars.
But HSAs have not brought down spending, economists say. They are disproportionately used by the wealthiest Americans, who have more income to fund them and a bigger incentive to lower their tax rate.
Americans who earn more than $1 million annually are the group most likely to make regular HSA contributions, according to an analysis by the nonprofit Center on Budget and Policy Priorities. More than half Americans with HSAs have balances less than $500.
Trump's 'One Big Beautiful Bill' would further expand HSA purchases, making gym memberships and other fitness expenses eligible for tax-free spending. That provision alone is expected to cost the government $10 billion in revenue.
'These are really just tax breaks in the guise of health policy that overwhelmingly benefit people with high incomes,' said Gideon Lukens, a former White House budget official during the Obama and Trump administrations, now with the Center on Budget and Policy Priorities.
Expanding HSA eligibility was listed as a goal for a coalition of MAHA entrepreneurs and Truemed partners, founded by Means, which lobbied Congress last year, according to the group's website.
Means said in a statement that the group focused only on broad topics like 'health care incentives and patient choice — but did not lobby for specific bills.'
In total, the HSA expansions in Trump's bill are projected to cost the federal government $180 billion over the next 10 years. As HSAs expand to include more disparate products and services, Lukens says the U.S. government will have fewer dollars to expand medical coverage through programs like Medicaid.
'We have a limited amount of federal resources and the question is whether we want to spend that on health and wellness products that may or may not be helpful for wealthy people,' Lukens said.
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Yahoo
30 minutes ago
- Yahoo
Trump tariffs live updates: Trump says he will set unilateral tariff rates within weeks
President Donald Trump told reporters on Wednesday that he would send letters to trading partners in the next week or two setting unilateral tariff rates. 'At a certain point, we're just going to send letters out. And I think you understand that, saying this is the deal, you can take it or leave it,' the president said at the Kennedy Center in Washington. Soon after introducing steep new tariffs that roiled markets, Trump instituted a pause on his most punishing duties that expires July 9. His latest comment, however, only muddies the waters about what could happen next as the deadline approaches. Earlier on Wednesday, Treasury Secretary Scott Bessent told Congress that it is "highly likely" that the tariff pause would be extended for countries that are negotiating with the administration "in good faith." "There are 18 important trading partners — we are working toward deals on those — and it is highly likely that those countries that are ... negotiating in good faith, we will roll the date forward," Bessent said during testimony before the House Ways and Means Committee. On Tuesday, the US and China agreed to a framework and implementation plan to ease tariff and trade tensions. Trump signaled his approval, saying the deal was "done" pending sign-off from him and Chinese President Xi Jinping. Trump and other US officials indicated the deal should resolve issues between the two countries on rare earths and magnets, though reports later indicated China would only loosen restrictions on rare earth mineral exports for a six-month period. Trump also said the US will allow Chinese students in US colleges, a sticking point that had emerged in the weeks following the countries' mid-May deal in Geneva. Trump said the US would impose a total of 55% tariffs on Chinese goods. Yahoo Finance's Ben Werschkul reports, citing a White House official, that Trump arrived at that figure by adding together an array of preexisting duties and not any new tariffs. Meanwhile, though Trump's most sweeping tariffs continue to face legal uncertainty, on Tuesday, the president received a favorable update. A federal appeals court held a decision saying his tariffs can temporarily stay in effect. The US Court of International Trade had blocked their implementation last month, deeming the method used to enact them "unlawful." Read more: What Trump's tariffs mean for the economy and your wallet Here are the latest updates as the policy reverberates around the world. Treasury Secretary Scott Bessent told House lawmakers on Wednesday that the Trump administration may extend the 90-day tariff pause on some countries in order to continue trade negotiations. When asked if Americans should prepare for another "Liberation Day" on July 9, when the tariff pause ends for most countries, Bessent said that the administration may choose to move the deadline on 18 of the most important trading partners, so long as they make an effort to come to the negotiating table. "We are working toward deals on those, and it is highly likely that [for] those countries — or trading blocs, in the case of the EU — who are negotiating in good faith, we will roll the day forward to continue good faith negotiations," Bessent said (see video below). "If someone is not negotiating, then we will not." A recent report on the drastic decline of US ocean imports serves as an example of how President Trump's increased tariffs on China affected supply chains and several industries as ttalks continue. Reuters reports: Read more here. The Treasury Department says that the US government is successfully using tariffs to decrease the budget deficit by more than $30 billion, largely due to increased customs receipts. Reuters reports: Read more here. China will ease curbs on exports of rare earth minerals for six months as part of a new trade understanding with the US, according to The Wall Street Journal. The move could add more uncertainty for American manufacturers, particularly the auto industry, which has been pushing for easier access. The Journal notes that the move gives China leverage down the line if tensions ratchet back up. From the report: In celebrating the agreement early Wednesday, President Trump noted "any necessary rare earths will be supplied, up front, by China." He did not mention any time limit on loosening those restrictions. Treasury Secretary Scott Bessent, in testimony before Congress on Wednesday, painted Wednesday's agreement as an incremental step on the longer road to a more comprehensive trade deal. "A trade deal today or last night was for a specific goal, and it will be a much longer process," he told a House committee. When asked if current US tariff levels on Chinese imports would not change again, Commerce Secretary Howard Lutnick told CNBC, "You can definitely say that." "We're in a great place with China," Lutnick said Wednesday. While the US-China truce framework is awaiting final word from US President Trump and Chinese President Xi Jinping, Lutnick added, "Both sides are really positive." The agreement is largely viewed as reestablishing the "handshake" that US and Chinese officials reached in Geneva last month, as details on a larger trade pact remain scant. Trump posted on social media this morning that the US has imposed 55% tariffs on China, a number that does not include any new tariffs but instead comprises some preexisting tariffs, Trump's fentanyl tariffs, and 10% "Liberation Day" tariffs. Lutnick touted that, as a result of the two-day talks, the US will gain access to rare earths and magnets, while the Chinese delegation sought to remove the US's export controls. He added that the trade deficit remains an ongoing issue, stating, "We're going to examine how China can do more business with us." May's Consumer Price Index (CPI) report showed inflation pressures eased on a monthly basis despite investor concerns that President Trump's tariffs would accelerate the pace of price increases. The Consumer Price Index (CPI) increased 0.1% on a monthly basis in May and 2.4% on an annual basis, a slight uptick from April's 2.3% gain. Yahoo Finance's Allie Canal reports: Read more here. I would keep an eye on consumer names off the news of a trade deal with China floated by President Trump this morning (see our prior post below). Seeing upticks premarket in heavily China-exposed retailers such as Nike (NKE), Walmart (WMT), Target (TGT), and Abercrombie & Fitch (ANF). The premarket gains here aren't mind-blowing in part because tariffs appear to still be in place. Trump posted on Truth Social: OUR DEAL WITH CHINA IS DONE, SUBJECT TO FINAL APPROVAL WITH PRESIDENT XI AND ME. FULL MAGNETS, AND ANY NECESSARY RARE EARTHS, WILL BE SUPPLIED, UP FRONT, BY CHINA. LIKEWISE, WE WILL PROVIDE TO CHINA WHAT WAS AGREED TO, INCLUDING CHINESE STUDENTS USING OUR COLLEGES AND UNIVERSITIES (WHICH HAS ALWAYS BEEN GOOD WITH ME!). WE ARE GETTING A TOTAL OF 55% TARIFFS, CHINA IS GETTING 10%. RELATIONSHIP IS EXCELLENT! THANK YOU FOR YOUR ATTENTION TO THIS MATTER!" A variety of market observers quickly weighed in hours after Tuesday evening's unveiling to suggest that the deal may not have a lot of meat on the bones — but at least relations are no longer moving in the wrong direction. The talks perhaps underscored how unlikely a comprehensive trade deal is anytime soon, noted AGF Investments Greg Valliere, "but at least relations may not worsen as talks continue throughout the summer." Both sides promised additional talks in the weeks or months ahead, but none have yet been scheduled. Veronique de Rugy, a professor at the Mercatus Center at George Mason University, suggested the talks continued to show China's leverage. "China is hurting, yes—but they still hold the upper hand on critical resources, and they know how to use them." Any lessening of tensions — and freer flow — of these mineral resources in China would be a significant boost to the global economy with China holding outsized leverage in both the reserves and processing capacity of these key building blocks for everything from computers to electric vehicle batteries to medical devices. Likewise, the US offering concessions on export controls would be a significant move after years where successive US administrations have wielded these controls — especially around the design and manufacture of semiconductors — by saying they need to be tight on China for national security reasons. Read more here. May's Consumer Price Index (CPI) report will be released on Wednesday and its expected to show that prices rose a bit faster than in April. Yahoo Finance's Allie Canal breaks down what to look out for and how President Trump's tariffs are impacting what consumers are now paying for goods and services. Read more here. Now that the US-China trade truce is back on track, both sides are keen to ensure it stays that way. China's Vice Premier He Lifeng said both sides need to now 'show the spirit of good faith in abiding by their commitments and jointly safeguard the hard-won results of the dialogue.' Bloomberg News reports: Read more here. Reuters reports: Read more here. Despite the US-China trade truce resuming the pain from President Trump's tariffs remains in China, especially among small exporters. Reuters reports: Read more here. Japan warned Wednesday that tariffs threaten its economic growth, the government said in a monthly report. Reuters reports: Read more here. Reuters reports: Read more here. Reuters reports: Read more here. A federal appeals could said on Tuesday that President Trump's sweeping tariffs can continue for now. This is a significant win for Trump, who introduced tariffs back in March and declared "Liberation Day," as he saw them as a way to free the US from what he called unfair trade practices. Bloomberg News reports: Read more here. Early summer sales for Inditex, the owner of fashion retailer Zara, came in weaker, as the company missed expectations for first quarter sales on Wednesday. President Trump's tariffs have impacted consumer demand in the US and other major markets. Reuters reports: Read more here. After weeks of back and forth, the US and China have agreed on a framework to implement the Geneva consensus that helped ease tariffs. The breakthrough came after two days of talks in London, including a marathon session on Tuesday. US Commerce Secretary Howard Lutnick said both sides had to "get the negativity out" before making progress. 'Now we can go forward to try to do positive trade, growing trade,' he said. As part of the deal, Beijing has promised to speed up shipments of rare earth metals, a crucial component for global auto and defense industries. Washington will ease export controls. This marks the first sign of movement on key issues. The proposal will now be presented to President Trump and China's Xi. Still, the discussions also did little to resolve a long-standing issue: China's trade surplus with the US. 'Markets will likely welcome the shift from confrontation to coordination,' said Charu Chanana, chief investment strategist at Saxo Markets. 'We're not out of the woods yet — it's up to Trump and Xi to approve and enforce the deal.' The meeting was set up after a phone call between the two leaders, following weeks of each side accusing the other of breaking the Geneva commitments. Both countries had used chips, rare earths, student visas and ethane as bargaining tools. Josef Gregory Mahoney, a professor at East China Normal University, said trust, not money, has been the biggest casualty of the trade war. 'We've heard a lot about frameworks,' he said. 'But the fundamental issue remains: Chips versus rare earths. Everything else is a peacock dance.' Bloomberg reports: Read more here. Treasury Secretary Scott Bessent told House lawmakers on Wednesday that the Trump administration may extend the 90-day tariff pause on some countries in order to continue trade negotiations. When asked if Americans should prepare for another "Liberation Day" on July 9, when the tariff pause ends for most countries, Bessent said that the administration may choose to move the deadline on 18 of the most important trading partners, so long as they make an effort to come to the negotiating table. "We are working toward deals on those, and it is highly likely that [for] those countries — or trading blocs, in the case of the EU — who are negotiating in good faith, we will roll the day forward to continue good faith negotiations," Bessent said (see video below). "If someone is not negotiating, then we will not." A recent report on the drastic decline of US ocean imports serves as an example of how President Trump's increased tariffs on China affected supply chains and several industries as ttalks continue. Reuters reports: Read more here. The Treasury Department says that the US government is successfully using tariffs to decrease the budget deficit by more than $30 billion, largely due to increased customs receipts. Reuters reports: Read more here. China will ease curbs on exports of rare earth minerals for six months as part of a new trade understanding with the US, according to The Wall Street Journal. The move could add more uncertainty for American manufacturers, particularly the auto industry, which has been pushing for easier access. The Journal notes that the move gives China leverage down the line if tensions ratchet back up. From the report: In celebrating the agreement early Wednesday, President Trump noted "any necessary rare earths will be supplied, up front, by China." He did not mention any time limit on loosening those restrictions. Treasury Secretary Scott Bessent, in testimony before Congress on Wednesday, painted Wednesday's agreement as an incremental step on the longer road to a more comprehensive trade deal. "A trade deal today or last night was for a specific goal, and it will be a much longer process," he told a House committee. When asked if current US tariff levels on Chinese imports would not change again, Commerce Secretary Howard Lutnick told CNBC, "You can definitely say that." "We're in a great place with China," Lutnick said Wednesday. While the US-China truce framework is awaiting final word from US President Trump and Chinese President Xi Jinping, Lutnick added, "Both sides are really positive." The agreement is largely viewed as reestablishing the "handshake" that US and Chinese officials reached in Geneva last month, as details on a larger trade pact remain scant. Trump posted on social media this morning that the US has imposed 55% tariffs on China, a number that does not include any new tariffs but instead comprises some preexisting tariffs, Trump's fentanyl tariffs, and 10% "Liberation Day" tariffs. Lutnick touted that, as a result of the two-day talks, the US will gain access to rare earths and magnets, while the Chinese delegation sought to remove the US's export controls. He added that the trade deficit remains an ongoing issue, stating, "We're going to examine how China can do more business with us." May's Consumer Price Index (CPI) report showed inflation pressures eased on a monthly basis despite investor concerns that President Trump's tariffs would accelerate the pace of price increases. The Consumer Price Index (CPI) increased 0.1% on a monthly basis in May and 2.4% on an annual basis, a slight uptick from April's 2.3% gain. Yahoo Finance's Allie Canal reports: Read more here. I would keep an eye on consumer names off the news of a trade deal with China floated by President Trump this morning (see our prior post below). Seeing upticks premarket in heavily China-exposed retailers such as Nike (NKE), Walmart (WMT), Target (TGT), and Abercrombie & Fitch (ANF). The premarket gains here aren't mind-blowing in part because tariffs appear to still be in place. Trump posted on Truth Social: OUR DEAL WITH CHINA IS DONE, SUBJECT TO FINAL APPROVAL WITH PRESIDENT XI AND ME. FULL MAGNETS, AND ANY NECESSARY RARE EARTHS, WILL BE SUPPLIED, UP FRONT, BY CHINA. LIKEWISE, WE WILL PROVIDE TO CHINA WHAT WAS AGREED TO, INCLUDING CHINESE STUDENTS USING OUR COLLEGES AND UNIVERSITIES (WHICH HAS ALWAYS BEEN GOOD WITH ME!). WE ARE GETTING A TOTAL OF 55% TARIFFS, CHINA IS GETTING 10%. RELATIONSHIP IS EXCELLENT! THANK YOU FOR YOUR ATTENTION TO THIS MATTER!" A variety of market observers quickly weighed in hours after Tuesday evening's unveiling to suggest that the deal may not have a lot of meat on the bones — but at least relations are no longer moving in the wrong direction. The talks perhaps underscored how unlikely a comprehensive trade deal is anytime soon, noted AGF Investments Greg Valliere, "but at least relations may not worsen as talks continue throughout the summer." Both sides promised additional talks in the weeks or months ahead, but none have yet been scheduled. Veronique de Rugy, a professor at the Mercatus Center at George Mason University, suggested the talks continued to show China's leverage. "China is hurting, yes—but they still hold the upper hand on critical resources, and they know how to use them." Any lessening of tensions — and freer flow — of these mineral resources in China would be a significant boost to the global economy with China holding outsized leverage in both the reserves and processing capacity of these key building blocks for everything from computers to electric vehicle batteries to medical devices. Likewise, the US offering concessions on export controls would be a significant move after years where successive US administrations have wielded these controls — especially around the design and manufacture of semiconductors — by saying they need to be tight on China for national security reasons. Read more here. May's Consumer Price Index (CPI) report will be released on Wednesday and its expected to show that prices rose a bit faster than in April. Yahoo Finance's Allie Canal breaks down what to look out for and how President Trump's tariffs are impacting what consumers are now paying for goods and services. Read more here. Now that the US-China trade truce is back on track, both sides are keen to ensure it stays that way. China's Vice Premier He Lifeng said both sides need to now 'show the spirit of good faith in abiding by their commitments and jointly safeguard the hard-won results of the dialogue.' Bloomberg News reports: Read more here. Reuters reports: Read more here. Despite the US-China trade truce resuming the pain from President Trump's tariffs remains in China, especially among small exporters. Reuters reports: Read more here. Japan warned Wednesday that tariffs threaten its economic growth, the government said in a monthly report. Reuters reports: Read more here. Reuters reports: Read more here. Reuters reports: Read more here. A federal appeals could said on Tuesday that President Trump's sweeping tariffs can continue for now. This is a significant win for Trump, who introduced tariffs back in March and declared "Liberation Day," as he saw them as a way to free the US from what he called unfair trade practices. Bloomberg News reports: Read more here. Early summer sales for Inditex, the owner of fashion retailer Zara, came in weaker, as the company missed expectations for first quarter sales on Wednesday. President Trump's tariffs have impacted consumer demand in the US and other major markets. Reuters reports: Read more here. After weeks of back and forth, the US and China have agreed on a framework to implement the Geneva consensus that helped ease tariffs. The breakthrough came after two days of talks in London, including a marathon session on Tuesday. US Commerce Secretary Howard Lutnick said both sides had to "get the negativity out" before making progress. 'Now we can go forward to try to do positive trade, growing trade,' he said. As part of the deal, Beijing has promised to speed up shipments of rare earth metals, a crucial component for global auto and defense industries. Washington will ease export controls. This marks the first sign of movement on key issues. The proposal will now be presented to President Trump and China's Xi. Still, the discussions also did little to resolve a long-standing issue: China's trade surplus with the US. 'Markets will likely welcome the shift from confrontation to coordination,' said Charu Chanana, chief investment strategist at Saxo Markets. 'We're not out of the woods yet — it's up to Trump and Xi to approve and enforce the deal.' The meeting was set up after a phone call between the two leaders, following weeks of each side accusing the other of breaking the Geneva commitments. Both countries had used chips, rare earths, student visas and ethane as bargaining tools. Josef Gregory Mahoney, a professor at East China Normal University, said trust, not money, has been the biggest casualty of the trade war. 'We've heard a lot about frameworks,' he said. 'But the fundamental issue remains: Chips versus rare earths. Everything else is a peacock dance.' Bloomberg reports: Read more here. Error in retrieving data Sign in to access your portfolio Error in retrieving data Error in retrieving data Error in retrieving data Error in retrieving data


Medscape
30 minutes ago
- Medscape
The Most Vicious Cycle of All: Cardiac PTSD
Just surviving a major cardiac event is an achievement, but of course getting through whatever initial resuscitation and procedures necessary are merely the first steps. As a patient embarks on their rehabilitation journey, one incredibly dangerous setback cardiologists must be on the lookout for is cardiac posttraumatic stress disorder (PTSD). This remarkably common complication — according to a 2004 study published in Critical Care Medicine , as many as 27% of those who survive cardiac events may develop PTSD — can not only cause noncompliance with medication and other ongoing treatment modalities but also put the patient at an increased risk for a second cardiac event. 'In the aftermath of cardiac arrest or a heart attack, one of the most overlooked aspects of recovery is the emotional toll it takes, said Srihari S. Naidu, MD, a professor of medicine at New York Medical College and director of the Cardiac Cath Labs at the Westchester Medical Center Health Network, both in Valhalla, New York. 'The experience can be deeply traumatic, not just for the patient, but for their loved ones as well. Despite this, mental health remains one of the least systematically addressed components of cardiac care.' One problem, Naidu said, is that we 'still, we lack standardized approaches to routinely screen, diagnose, and treat PTSD in this vulnerable population.' Indeed, the American Heart Association identified this as a problem in its 2020 scientific statement, Sudden Cardiac Arrest Survivorship. In this publication, the association said the coordination of multidisciplinary care, to include emotional care, must start as early as within the ICU, but that it needs to continue throughout the recovery period. Srihari S. Naidu, MD 'Without a coordinated plan during hospitalization to assess both short- and long-term recovery needs, we risk missing the broader picture,' said Naidu, who is also the president of the Society for Cardiovascular Angiography and Interventions. 'In my experience, the outpatient clinic visit is often the first, and sometimes the only, opportunity to uncover these issues, which may manifest as anxiety or persistent thoughts about the event, or a variety of unrelated symptoms.' James Jackson, MD, director of Behavioral Health and professor of medicine and psychiatry at Vanderbilt University in Nashville, Tennessee, said the symptoms are all united by one thing: The fact that the patient has the source of their trauma with them at all times. 'If you're carrying your heart around with you and the heart is the source of the trauma, you're constantly reminded, right? And if your cardiac event developed out of the blue, the concern is it could develop out of the blue again, right? So you're carrying this trauma around with you. It's a constant reminder,' he said. 'The trauma is not parked somewhere in the rear view. The trauma is sort of in the present and even in the future.' Symptom-wise, this trauma manifests itself in a variety of ways and can often go overlooked due to the focus on the physical recovery, Naidu said. 'During follow-up, subtle cues begin to emerge; patients who seem emotionally distant, who have trouble sleeping, or who avoid talking about what happened (can be red flags),' he said. 'PTSD doesn't always present dramatically.' Sometimes, Naidu said, it's the patient who suddenly bursts into tears when recalling the event. Other times, it's the one who avoids follow-ups, skips cardiac rehab, or steers clear of anything that reminds them of the hospital. Early symptoms may include hypervigilance, nightmares, intrusive memories, emotional numbness, and avoidance. The Cycle Folds Onto Itself When you break it down and look at triggering factors, it's not hard to understand how PTSD becomes a self-fulfilling prophecy. 'Often with patients in a cardiac context, they get quite anxious. Their heart starts beating fast, and then they really worry. And so their response to that is, I'm going to withdraw. I'm going to disengage,' Jackson said. While physical activity or exercise often helps reduce stress, patients are often short of breath and are reminded how it felt when they were having the attack. James Jackson, MD 'And so if they start to exercise, it's all well and good,' Jackson said. 'But as soon as they get slightly short of breath, even if they're fine physiologically, as soon as they get short of breath, they're going to shut that down. And this is just one example, but it becomes a very isolating sort of process.' Patients left in this sustained crisis state experience a significantly diminished overall quality of life, and a study led by Antonia Seligowski and published in the March 2024 issue of Brain, Behavior, and Immunity found that PTSD after cardiac arrest significantly increases the risks for both major adverse cardiovascular events and all-cause mortality within just 1 year of discharge. This is supported by the findings of Donald Edmondson, MD, associate professor of behavioral medicine in medicine and psychiatry at Columbia University Irving Medical Center, New York City, both in his 2013 study published in the American Heart Journal and in research he has done since. 'Over the years now, we've studied cardiac patients, both acute coronary syndrome, so myocardial infarction, as well as cardiac arrest and stroke,' Edmondson said. 'What we see is that between 15 and 30% of patients will screen positive for PTSD due to that cardiac event 1 month later. Those who screen positive for PTSD are at least at doubled risk, if not greater, for having another cardiac event or dying within the year after that first cardiac event.' These outcomes highlight how critical it is to address PTSD early and effectively, Naidu said. 'As cardiologists, we often focus on optimizing medications, procedures, and physical rehabilitation, but without integrating behavioral support, we're missing a major part of the healing process,' he said. PTSD and cardiovascular disease have a well-documented relationship: PTSD can worsen cardiovascular risk, and in turn, living with heart disease can amplify psychological stress. Jackson said that there are behavioral health approaches at work in other areas that may be useful for cardiac events that are not sudden onset. 'There's a general sort of a movement afoot called prehab,' Jackson said. 'The general idea about prehab would be, 'Hey, you're going to have this surgery. We think that it's going to knock your brain down. So we're going to try to do some brain training with you before the surgery, and we think that in doing that, we're going to build your reserve up.' Is There a Type? Although a 2022 study led by Sophia Armand and published in the Journal of Cardiovascular Nursing showed that younger age, female sex, and high levels of acute stress at the time of the event to be significant risk factors for developing PTSD after cardiac arrest. There's no one overarching 'profile' in terms of who's likely to develop PTSD after any cardiac event. Naidu has his hunches, though. Donald Edmondson, MD 'I would say that I suspect cardiac arrest is more frequently associated with PTSD than other types of cardiac events. Compared to conditions like myocardial infarction or unstable angina, the psychological impact of cardiac arrest, particularly when complicated by anoxic brain injury, tends to be more profound,' Naidu said, cautioning that individual risk factors should be weighed in every case. 'Anoxic injury significantly increases the risk of depression, anxiety, and PTSD, often for an uncertain duration.' At Columbia, Edmondson said there are two indicators that together predict a high risk for a cardiac patient developing PTSD. 'They tend to pay close attention to their cardiac sensations and catastrophize them,' Edmondson said of the patients who go on to develop PTSD. 'Initially, in the ER [emergency room], they're extremely distressed. Then, post event, they'll say over the past 4 weeks, when I feel my heart beating fast, I worry that I'm having another heart attack. Or if I feel short of breath, I worry that I'm going to die.' 'Having those two predictors together, so initial high distress in the emergency department and this sort of high, what we call interoceptive bias, those two things together place people at high risk for developing PTSD at that 1-month period (after their cardiac event).' Regardless, more research must be done on this extremely risky and highly debilitating mental health issue that's so deeply entwined with its cardiac trigger. 'More focused studies are needed to better understand the timing, risk factors, and mechanisms behind these symptoms, and to develop standardized strategies for early screening, intervention, and long-term psychological support,' said Naidu. 'An urgent need exists to screen for and treat PTSD, not just for mental health but to help prevent repeat hospitalizations and improve long-term cardiovascular outcomes.'


Medscape
32 minutes ago
- Medscape
Visa Hacks: Network That's Fuelling Germany's Care Boom
According to the Bertelsmann Foundation, the German care system is under mounting pressure; demand is set to rise by 50% by 2030, while the workforce is shrinking. If the current trends continue, Germany could face a shortfall in nearly 500,000 full-time caregivers. This gap is a major opportunity for qualified foreign nursing staff. Thorough preparation can ensure stable employment and long-term careers. The following five tips show what is important when entering the German healthcare system, from the recognition of professional qualifications to successful integration into everyday working life. 1. Secure Recognition Anyone wishing to work in Germany as a nursing professional must have their foreign qualifications officially recognised. The federal state authorities are responsible for recognition; this is an example of the process for Bavaria. This process is required by law and ensures that professional knowledge and skills are comparable to the German training standards. Each federal state assesses the equivalence of your training, practical experience, and knowledge of law and professional ethics. Non-EU nationals fall under the Professional Qualifications Assessment Act. If gaps are identified, you can either complete an adaptation course — combining theoretical instruction with practical training — or pass a proficiency test comprising written, oral, and practical exams to demonstrate the necessary professional competence at the required level. Many educational providers such as maxQ, FIA Academy, apm Weiterbildung GmbH, and RENAFAN Academy for Nursing Professions offer targeted preparation courses for the knowledge test — valuable support on the path to successful recognition. Costs range from €500-€2 500, often subsidised by employers or supported by grants from the Federal Ministry of Labour and Social Affairs or initiatives like 'Triple Win.' 2. Language Skills Professional qualifications are insufficient; applicants must also have sufficient German language skills. Language plays a central role in everyday professional life, whether in conversations with patients, documenting care services, or in collaboration with colleagues from different professional groups. Recognition typically requires a B2 level under the Common European Framework of Reference for Languages (CEFR), demonstrating advanced proficiency and the ability to hold technically demanding conversations. Start learning German as early as possible — ideally in your home country — to accelerate integration and reduce delays. 3. Visa and Residence Permit Non-EU care workers must secure work visas and employment permits before arrival. The prerequisite is usually a concrete job offer from a hospital, care home, or outpatient service and proof that the recognition process has begun or been completed. The further this process is advanced, the greater the chances of faster processing of the visa application. In many cases, the visa can also be applied with the aim of obtaining professional recognition in Germany, for example, through an adaptation course or a knowledge test. Admission to the labour market is also required. The Federal Employment Agency issues permit and verify that all conditions are met. This distinguishes between general visas for qualified professionals and special regulations for individual regions of origin. Under the Western Balkans regulation (§ 26 (2) Employment Ordinance), nationals of Albania, Bosnia and Herzegovina, Kosovo, Montenegro, North Macedonia, and Serbia may start work before formal recognition, provided they have an approved job offer and the Federal Employment Agency approves it. High demand can lead to long waits for embassy appointments. 4. Recruitment Agencies Many candidates use placement agencies for support with applications, employer selection, organising immigration, and accommodation. However, not all agencies run reliably. While reputable agencies charge reasonable fees and provide clear, written contracts in your language or English, others may place excessive costs, place workers in exploitative conditions, or withhold passports. Insist on contracts detailing salary, hours, leave, notice periods, duties, and training are clearly defined. Avoid vague fees, long commitment periods, or repayment clauses. Reputable employers pay at least the public sector tariff and often provide mentoring, housing assistance, in-house training, and clear career progression structures. It is also a good sign that employers themselves or through cooperation programs, such as those of the Federal Employment Agency and the German Society for International Cooperation, provide transparent information about the procedure and do not demand any financial advance payments. 5. Embrace Integration A job alone is not enough; true integration comes through social participation. Look for welcome guides, tandem partnerships, and intercultural training to build community ties. Recognition and proficiency test preparation courses offer networking opportunities. Engaging with colleagues, professional associations, or regional nursing chambers will help you settle both professionally and personally. EU professionals Nursing professionals from EU member states benefit from simplified procedures in Germany. Their professional qualifications are recognised automatically, eliminating the need for a complex recognition process. This significantly accelerates entry into the German labour market for many nurses. Although an elaborate recognition procedure is usually unnecessary, applicants must demonstrate German skills at the B2 level (CEFR) to work in Germany. Conclusion Pursuing a nursing career in Germany is achievable but requires patience, preparation, and support. Early research, reputable resources, commitment to verbal language, and cultural integration will greatly enhance your prospects.