Stroke Risk Drops in Both Black and White Older Adults – Black Patients Have Largest Reductions in Mortality

(HealthNewsDigest.com) –  – Recent reductions in hospitalization and death due to stroke extend to both black and white Medicare beneficiaries, reports a study in the April issue of Medical Care. The journal is published in the Lippincott portfolio by Wolters Kluwer.

The reductions in mortality after initial stroke have been even greater in black Medicare patients, according to the new research by Margaret C. Fang, MD, MPH, of the University of California, San Francisco, and colleagues. Dr. Fang comments,” Despite these promising trends, our study also found that black men and women continue to be at higher risk for stroke than white patients.”

Stroke Risks Decline Over 25 Years – Trends Linked to Improving Risk Factors

Using Medicare data from 1988 to 2013, the researchers analyzed trends in hospitalization and mortality after an initial stroke in black or white men and women aged 65 or older. The study included more than 1 million hospitalizations for ischemic stroke, caused by blockage or narrowing of the brain blood vessels; and nearly 150,000 hospitalizations for hemorrhagic stroke, caused by bleeding into or around the brain.

Over the 25-year study period, hospitalizations for stroke decreased for both black and white patients. Adjusted for age, ischemic stroke risk decreased from 1,185 to 551 per 100,000 Medicare beneficiaries among black men and from 932 to 407 per 100,000 among white men. Risk fell from 1,222 to 641 per 100,000 for black women and from 892 to 466 per 100,000 for white women.

Mortality after ischemic stroke also fell, with greater reductions in black patients. Risk of death within 30 days after ischemic stroke decreased from approximately 16 to 8 percent in black men and from 16 to 12 percent in white men. Ischemic stroke mortality declined from about 14 to 9 percent in black women versus 16 to 15 percent in white women.

The data for hemorrhagic stroke showed a similar pattern: hospitalization rates decreased to a comparable extent in both races, while black patients had a greater reduction in mortality.

Although the study can’t show a causal relationship, the reductions in stroke hospitalization and mortality were accompanied by declines in key risk factors: particularly smoking, blood pressure, and cholesterol levels. The improvements in stroke outcomes occurred despite the worsening US epidemic of diabetes and obesity.

The findings add to previous studies showing that stroke rates and stroke mortality have declined considerably over the past few decades. Along with reductions in the prevalence of stroke risk factors, these gains could potentially reflect improvements in stroke care, including the development of specialized stroke centers.

This study is important because black Americans have been shown consistently to be at higher stroke risk than whites. “Our study of evolving US trends in stroke found that both black and white Medicare enrollees experienced considerable improvements over time with regard to stroke hospitalizations,”  Dr. Fang and coauthors write.

Moreover, reductions in stroke mortality were more pronounced among blacks. Although the exact reasons for these observations could not be definitively established by the study, Dr. Fang states, “Our findings provide hopeful news about how stroke is being prevented and managed in the United States.”

Click here to read “Trends and Racial Differences in First Hospitalization for Stroke and 30-Day Mortality in the US Medicare Population From 1988 to 2013”

DOI: 10.1097/MLR.0000000000001079

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About Medical Care

Rated as one of the top ten journals in health care administration, Medical Care is devoted to all aspects of the administration and delivery of health care. This scholarly journal publishes original, peer-reviewed papers documenting the most current developments in the rapidly changing field of health care. Medical Care provides timely reports on the findings of original investigations into issues related to the research, planning, organization, financing, provision, and evaluation of health services. In addition, numerous special supplementary issues that focus on specialized topics are produced with each volume. Medical Care is the official journal of the Medical Care Section of the American Public Health Association

About Wolters Kluwer

Wolters Kluwer is a global leader in professional information, software solutions, and services for the health, tax & accounting, finance, risk & compliance, and legal sectors. We help our customers make critical decisions every day by providing expert solutions that combine deep domain knowledge with specialized technology and services.

Wolters Kluwer, headquartered in the Netherlands, reported 2017 annual revenues of €4.4 billion. The company serves customers in over 180 countries, maintains operations in over 40 countries, and employs approximately 19,000 people worldwide.

Wolters Kluwer Health is a leading global provider of trusted clinical technology and evidence-based solutions that engage clinicians, patients, researchers and students with advanced clinical decision support, learning and research and clinical intelligence. For more information about our solutions, visit http://healthclarity.wolterskluwer.com and follow us on LinkedIn and Twitter @WKHealth.

Which Colorectal Cancer Screening Do I Need?

(HealthNewsDigest.com) – HERSHEY, Pa. — March is Colorectal Cancer Awareness Month, and the Colorectal Cancer Alliance is urging everyone to talk with their health care providers about screening.

Each year, more than 140,000 people in the U.S. receive a diagnosis of colorectal cancer, and about 50,000 die from the disease. It’s the second-leading cause of cancer death among U.S. men and women combined. Yet it’s highly preventable.

“With colorectal cancer screening, we can detect precancerous lesions and get them removed,” said Dr. Kofi Clarke, chief of the Division of Gastroenterology at Penn State Health Milton S. Hershey Medical Center. “We’ve begun to notice the incidence of colorectal cancer decreasing in the past few years, and we believe that is partly due to screening.”

While all types of colorectal cancer screening are more effective than no screening, the right test for an individual depends on their risk factors.

If a person has no family or personal history of polyps, colon cancer or inflammatory bowel disease (IBD), no history of abdominal radiation as a child or radiation treatment for prostate cancer, they are typically at average risk for colorectal cancer. This category represents the majority of people.

“People at average risk should start getting screened at age 50 with the exception of African-Americans who should start screening at age 45,” Clarke said.

People at average risk have numerous screening options, including:

Colonoscopy: This test allows doctors to view the inside of the colon and remove any polyps or abnormal findings for further testing. It’s the gold standard and is recommended once every 10 years for patients at average risk. If a patient’s doctor finds precancerous polyps, he may ask them to increase the frequency of colonoscopies depending on the size, number and type of polyps found.

Virtual Colonoscopy: People at average risk who decline a colonoscopy can have this less invasive test — a CT scan of the colon — once every five years. “But if the test detects polyps, you will still need a colonoscopy to have them examined,” Clarke said.

Stool DNA Test: This newer option includes tests like Cologuard, which was approved by the U.S. Food and Drug Administration in 2014. In simple terms, it measures stool DNA from a single sample and can be as effective as a colonoscopy for people at average risk. These tests should be done once every three years.

Other fecal tests: A Fecal Immunochemical Test (FIT) checks for blood in samples from a single stool. A High-Sensitivity Guaiac-Based Fecal Occult Blood Test (HSgFOBT) preferably should be done at home. It involves testing for blood from three separate bowel movements. Either test is recommended once a year for people at average risk.

People at high risk for colorectal cancer should have a colonoscopy once every five years and preferably should not use other screening options. “For those with a family history of colorectal cancer, we recommend they start screenings at either age 40 or five years before their family member was diagnosed,” Clarke said. People with IBD should begin screening after eight years with the condition.

People who are uncertain about their risk level should talk with their health care provider.

Learn more:

The Medical Minute is a weekly health news feature produced by Penn State Health. Articles feature the expertise of faculty, physicians and staff, and are designed to offer timely, relevant health information of interest to a broad audience.

Fentanyl-Linked Deaths: The U.S. Opioid Epidemic’s Third Wave

Authorities intercepted a woman using this drug kit in preparation for shooting up a mix of heroin and fentanyl inside a Walmart bathroom last month in Manchester, N.H. Fentanyl offers a particularly potent high but also can shut down breathing in under a minute. Salwan Georges/Washington Post/Getty Images hide caption

toggle caption

Salwan Georges/Washington Post/Getty Images

Authorities intercepted a woman using this drug kit in preparation for shooting up a mix of heroin and fentanyl inside a Walmart bathroom last month in Manchester, N.H. Fentanyl offers a particularly potent high but also can shut down breathing in under a minute.

Salwan Georges/Washington Post/Getty Images

Men are dying after opioid overdoses at nearly three times the rate of women in the United States. Overdose deaths are increasing faster among black and Latino Americans than among whites. And there’s an especially steep rise in the number of young adults ages 25 to 34 whose death certificates include some version of the drug fentanyl.

These findings, published Thursday in a report by the Centers for Disease Control and Prevention, highlight the start of the third wave of the nation’s opioid epidemic. The first was prescription pain medications, such as OxyContin; then heroin, which replaced pills when they became too expensive; and now fentanyl.

Fentanyl is a powerful synthetic opioid that can shut down breathing in less than a minute, and its popularity in the U.S. began to surge at the end of 2013. For each of the next three years, fatal overdoses involving fentanyl doubled, “rising at an exponential rate,” says Merianne Rose Spencer, a statistician at the CDC and one of the study’s authors.

Spencer’s research shows a 113 percent average annual increase from 2013 to 2016 (when adjusted for age). That total was first reported late in 2018, but Spencer looked deeper with this report into the demographic characteristics of those people dying from fentanyl overdoses.

Loading…

Don’t see the graphic above? Click here.

Increased trafficking of the drug and increased use are both fueling the spike in fentanyl deaths. For drug dealers, fentanyl is easier to produce than some other opioids. Unlike the poppies needed for heroin, which can be spoiled by weather or a bad harvest, fentanyl’s ingredients are easily supplied; it’s a synthetic combination of chemicals, often produced in China and packaged in Mexico, according to the U.S. Drug Enforcement Administration. And because fentanyl can be 50 times more powerful than heroin, smaller amounts translate to bigger profits.

Jon DeLena, assistant special agent in charge of the DEA’s New England Field Division, says one kilogram of fentanyl, driven across the southern U.S. border, can be mixed with fillers or other drugs to create six or eight kilograms for sale.

“I mean, imagine that business model,” DeLena says. “If you went to any small-business owner and said, ‘Hey, I have a way to make your product eight times the product that you have now,’ there’s a tremendous windfall in there.”

For drug users, fentanyl is more likely to cause an overdose than heroin because it is so potent and because the high fades more quickly than with heroin. Drug users say they inject more frequently with fentanyl because the high doesn’t last as long — and more frequent injecting adds to their risk of overdose.

Fentanyl is also showing up in some supplies of cocaine and methamphetamines, which means that some people who don’t even know they need to worry about a fentanyl overdose are dying.

There are several ways fentanyl can wind up in a dose of some other drug. The mixing may be intentional, as a person seeks a more intense or different kind of high. It may happen as an accidental contamination, as dealers package their fentanyl and other drugs in the same place.

Or dealers may be adding fentanyl to cocaine and meth on purpose, in an effort to expand their clientele of users hooked on fentanyl.

“That’s something we have to consider,” says David Kelley, referring to the intentional addition of fentanyl to cocaine, heroin or other drugs by dealers. Kelley is deputy director of the New England High Intensity Drug Trafficking Area. “The fact that we’ve had instances where it’s been present with different drugs leads one to believe that could be a possibility.”

The picture gets more complicated, says Kelley, as dealers develop new forms of fentanyl that are even more deadly. The new CDC report shows dozens of varieties of the drug now on the streets.

The highest rates of fentanyl-involved overdose deaths were found in New England, according to the study, followed by states in the Mid-Atlantic and Upper Midwest. But fentanyl deaths had barely increased in the West — including in Hawaii and Alaska — as of the end of 2016.

Researchers have no firm explanations for these geographic differences, but some people watching the trends have theories. One is that it’s easier to mix a few white fentanyl crystals into the powdered form of heroin that is more common in eastern states than into the black tar heroin that is sold more routinely in the West. Another hypothesis holds that drug cartels used New England as a test market for fentanyl because the region has a strong, long-standing market for opioids.

Spencer, the study’s main author, hopes that some of the other characteristics of the wave of fentanyl highlighted in this report will help shape the public response. Why, for example, did the influx of fentanyl increase the overdose death rate among men to nearly three times the rate of overdose deaths among women?

Some research points to one particular factor: Men are more likely to use drugs alone. In the era of fentanyl, that increases a man’s chances of an overdose and death, says Ricky Bluthenthal, a professor of preventive medicine at the University of Southern California’s Keck School of Medicine.

“You have stigma around your drug use, so you hide it,” Bluthenthal says. “You use by yourself in an unsupervised setting. [If] there’s fentanyl in it, then you die.”

Traci Green, deputy director of Boston Medical Center’s Injury Prevention Center, offers some other reasons. Women are more likely to buy and use drugs with a partner, Green says. And women are more likely to call for help — including 911 — and to seek help, including treatment.

“Women go to the doctor more,” she says. “We have health issues that take us to the doctor more. So we have more opportunities to help.”

Green notes that every interaction with a health care provider is a chance to bring someone into treatment. So this finding should encourage more outreach, she says, and encourage health care providers to find more ways to connect with active drug users.

As to why fentanyl seems to be hitting blacks and Latinos disproportionately as compared with whites, Green mentions the higher incarceration rates for blacks and Latinos. Those who formerly used opioids heavily face a particularly high risk of overdose when they leave jail or prison and inject fentanyl, she notes; they’ve lost their tolerance to high levels of the drugs.

There are also reports that African-Americans and Latinos are less likely to call 911 because they don’t trust first responders, and medication-based treatment may not be as available to racial minorities. Many Latinos say bilingual treatment programs are hard to find.

Spencer says the deaths attributed to fentanyl in her study should be seen as a minimum number — there are likely more that weren’t counted. Coroners in some states don’t test for the drug or don’t have equipment that can detect one of the dozens of new variations of fentanyl that would appear if sophisticated tests were more widely available.

There are signs the fentanyl surge continues. Kelley, with the New England High Intensity Drug Trafficking Area, notes that fentanyl seizures are rising. And in Massachusetts, one of the hardest-hit areas, state data show fentanyl present in more than 89 percent of fatal overdoses through October 2018.

Still, in one glimmer of hope, even as the number of overdoses in Massachusetts continues to rise, associated deaths dropped 4 percent last year. Many public health specialists attribute the decrease in deaths to the spreading availability of naloxone, a drug that can reverse an opioid overdose.

This story is part of NPR’s reporting partnership with WBUR and Kaiser Health News.

Evangelicals and Muslims see similarities in faiths and favor closer ties, survey says

(RNS) — As a growing number of evangelical Christian leaders are working to improve Christian-Muslim relations, a new online study finds that more than 3 in 4 U.S. evangelicals say they never or infrequently interact with Muslims.

The national benchmark survey by the Foundation for Ethnic Understanding — which conducted online interviews with 500 self-identified Muslims and 500 self-identified evangelicals in early January — suggests that an overlap in religious values between the two faith groups is obscured by a lack of understanding.

Rabbi Marc Schneier, who heads the foundation, said he was surprised at the low number of evangelical Christians — 22 percent — who said they interact with Muslims at least somewhat frequently and that they believe the interaction has fostered better understanding between the groups. In contrast, 53 percent of Muslims said the same for evangelicals.

Fentanyl-Linked Deaths: The U.S. Opioid Epidemic’s Third Wave Begins

Authorities intercepted a woman using this drug kit in preparation for shooting up a mix of heroin and fentanyl inside a Walmart bathroom last month in Manchester, N.H. Fentanyl offers a particularly potent high but also can shut down breathing in under a minute. Salwan Georges/Washington Post/Getty Images hide caption

toggle caption

Salwan Georges/Washington Post/Getty Images

Authorities intercepted a woman using this drug kit in preparation for shooting up a mix of heroin and fentanyl inside a Walmart bathroom last month in Manchester, N.H. Fentanyl offers a particularly potent high but also can shut down breathing in under a minute.

Salwan Georges/Washington Post/Getty Images

Men are dying after opioid overdoses at nearly three times the rate of women in the United States. Overdose deaths are increasing faster among black and Latino Americans than among whites. And there’s an especially steep rise in the number of young adults ages 25 to 34 whose death certificates include some version of the drug fentanyl.

These findings, published Thursday in a report by the Centers for Disease Control and Prevention, highlight the start of the third wave of the nation’s opioid epidemic. The first was prescription pain medications, such as OxyContin; then heroin, which replaced pills when they became too expensive; and now fentanyl.

Fentanyl is a powerful synthetic opioid that can shut down breathing in less than a minute, and its popularity in the U.S. began to surge at the end of 2013. For each of the next three years, fatal overdoses involving fentanyl doubled, “rising at an exponential rate,” says Merianne Rose Spencer, a statistician at the CDC and one of the study’s authors.

Spencer’s research shows a 113 percent average annual increase from 2013 to 2016 (when adjusted for age). That total was first reported late in 2018, but Spencer looked deeper with this report into the demographic characteristics of those people dying from fentanyl overdoses.

Loading…

Don’t see the graphic above? Click here.

Increased trafficking of the drug and increased use are both fueling the spike in fentanyl deaths. For drug dealers, fentanyl is easier to produce than some other opioids. Unlike the poppies needed for heroin, which can be spoiled by weather or a bad harvest, fentanyl’s ingredients are easily supplied; it’s a synthetic combination of chemicals, often produced in China and packaged in Mexico, according to the U.S. Drug Enforcement Administration. And because fentanyl can be 50 times more powerful than heroin, smaller amounts translate to bigger profits.

Jon DeLena, assistant special agent in charge of the DEA’s New England Field Division, says one kilogram of fentanyl, driven across the southern U.S. border, can be mixed with fillers or other drugs to create six or eight kilograms for sale.

“I mean, imagine that business model,” DeLena says. “If you went to any small-business owner and said, ‘Hey, I have a way to make your product eight times the product that you have now,’ there’s a tremendous windfall in there.”

For drug users, fentanyl is more likely to cause an overdose than heroin because it is so potent and because the high fades more quickly than with heroin. Drug users say they inject more frequently with fentanyl because the high doesn’t last as long — and more frequent injecting adds to their risk of overdose.

Fentanyl is also showing up in some supplies of cocaine and methamphetamines, which means that some people who don’t even know they need to worry about a fentanyl overdose are dying.

There are several ways fentanyl can wind up in a dose of some other drug. The mixing may be intentional, as a person seeks a more intense or different kind of high. It may happen as an accidental contamination, as dealers package their fentanyl and other drugs in the same place.

Or dealers may be adding fentanyl to cocaine and meth on purpose, in an effort to expand their clientele of users hooked on fentanyl.

“That’s something we have to consider,” says David Kelley, referring to the intentional addition of fentanyl to cocaine, heroin or other drugs by dealers. Kelley is deputy director of the New England High Intensity Drug Trafficking Area. “The fact that we’ve had instances where it’s been present with different drugs leads one to believe that could be a possibility.”

The picture gets more complicated, says Kelley, as dealers develop new forms of fentanyl that are even more deadly. The new CDC report shows dozens of varieties of the drug now on the streets.

The highest rates of fentanyl-involved overdose deaths were found in New England, according to the study, followed by states in the Mid-Atlantic and Upper Midwest. But fentanyl deaths had barely increased in the West — including in Hawaii and Alaska — as of the end of 2016.

Researchers have no firm explanations for these geographic differences, but some people watching the trends have theories. One is that it’s easier to mix a few white fentanyl crystals into the powdered form of heroin that is more common in eastern states than into the black tar heroin that is sold more routinely in the West. Another hypothesis holds that drug cartels used New England as a test market for fentanyl because the region has a strong, long-standing market for opioids.

Spencer, the study’s main author, hopes that some of the other characteristics of the wave of fentanyl highlighted in this report will help shape the public response. Why, for example, did the influx of fentanyl increase the overdose death rate among men to nearly three times the rate of overdose deaths among women?

Some research points to one particular factor: Men are more likely to use drugs alone. In the era of fentanyl, that increases a man’s chances of an overdose and death, says Ricky Bluthenthal, a professor of preventive medicine at the University of Southern California’s Keck School of Medicine.

“You have stigma around your drug use, so you hide it,” Bluthenthal says. “You use by yourself in an unsupervised setting. [If] there’s fentanyl in it, then you die.”

Traci Green, deputy director of Boston Medical Center’s Injury Prevention Center, offers some other reasons. Women are more likely to buy and use drugs with a partner, Green says. And women are more likely to call for help — including 911 — and to seek help, including treatment.

“Women go to the doctor more,” she says. “We have health issues that take us to the doctor more. So we have more opportunities to help.”

Green notes that every interaction with a health care provider is a chance to bring someone into treatment. So this finding should encourage more outreach, she says, and encourage health care providers to find more ways to connect with active drug users.

As to why fentanyl seems to be hitting blacks and Latinos disproportionately as compared with whites, Green mentions the higher incarceration rates for blacks and Latinos. Those who formerly used opioids heavily face a particularly high risk of overdose when they leave jail or prison and inject fentanyl, she notes; they’ve lost their tolerance to high levels of the drugs.

There are also reports that African-Americans and Latinos are less likely to call 911 because they don’t trust first responders, and medication-based treatment may not be as available to racial minorities. Many Latinos say bilingual treatment programs are hard to find.

Spencer says the deaths attributed to fentanyl in her study should be seen as a minimum number — there are likely more that weren’t counted. Coroners in some states don’t test for the drug or don’t have equipment that can detect one of the dozens of new variations of fentanyl that would appear if sophisticated tests were more widely available.

There are signs the fentanyl surge continues. Kelley, with the New England High Intensity Drug Trafficking Area, notes that fentanyl seizures are rising. And in Massachusetts, one of the hardest-hit areas, state data show fentanyl present in more than 89 percent of fatal overdoses through October 2018.

Still, in one glimmer of hope, even as the number of overdoses in Massachusetts continues to rise, associated deaths dropped 4 percent last year. Many public health specialists attribute the decrease in deaths to the spreading availability of naloxone, a drug that can reverse an opioid overdose.

This story is part of NPR’s reporting partnership with WBUR and Kaiser Health News.

What Does the Uptown Innovation Corridor Mean for Avondale Residents?

News10320Uptown Innovation CorridorThe intersection of Reading Road and Martin Luther King, Jr. DriveNick SwartsellThe neighborhood of Avondale has seen a monumental transformation over the past 25 years. What was in 2000 a neighborhood of 16,298 shrank into a neighborhood of 12,466 by 2010, according to the U.S. Census.

The reasons for the population loss in Avondale — the city’s fourth-largest neighborhood — are complex. Some residents moved out to seek better housing or economic opportunities. Some lost their homes as major institutions like Cincinnati Children’s Hospital have expanded.

Now, efforts are well underway to bring new jobs and residents here. But can the long-term residents who have remained in this predominantly African-American community benefit from the coming changes? While the groups in charge of the next major development in the area are making big promises of innovation and opportunity, fears of residential displacement and gentrification are as strong as ever.

Since 2014, when the city began construction of the interchange at Interstate 71 and Martin Luther King Drive, Vice Mayor David Mann, the University of Cincinnati and the Uptown Consortium — an organization comprised of leaders from Cincinnati Children’s Hospital, the Cincinnati Zoo & Botanical Garden, University of Cincinnati, UC Health and TriHealth, Inc. — started vocalizing ideas about an “innovation corridor” located in the area around the interchange, but it was not clear at that time exactly what that would look like.

Avondale’s low-income residents and renters are very concerned about being priced out of the area with so many higher-income residents potentially moving in, says Patricia Milton, president of the Avondale Community Council. For Milton, racial gentrification is not the only issue, but income gentrification as well.

“You’ll have more professional people that will be moving in to the neighborhood who can call Avondale home, and that’s really the thing that we’re trying to figure out now — how that’s going to work without displacing folks that are already a part of the community,” she says.
Plans for Avondale’s resurgence via the Innovation Corridor have come into sharper focus recently.

The latest development along that corridor: the March 12 announcement of the Uptown Gateway, which represents $150 million in private investment in the form of an office complex, hotel and University of Cincinnati’s Digital Futures building.

The idea of an “innovation corridor” is inspired by similar areas such as the Innovation District in Boston or Silicon Valley in San Francisco. These districts, centered near universities, share the goal of attracting cutting-edge companies that intend to take advantage of university resources and recruit students to work on projects, particularly focused around new technology. Cincinnati’s Uptown Innovation Corridor will be made up of “four corners” centered around the intersection of Martin Luther King Drive and Reading Road in Avondale.

UPTOWNWEBA map of proposed Uptown Innovation Corridor developmentsUptown Consortium

Each segment of the new district has been designated to a different development group, each one with a different concept and purpose than the others:

• The northwest corner is exclusively designated for the construction of a $110 million campus for the National Institute for Occupational Safety and Health (NIOSH), to be completed by 2021. The campus will employ 550 people, according to the Centers for Disease Control (CDC). It will consist of three buildings — an office, a lab and a warehouse.

• MLK Investors I, a partnership between Neyer Properties Inc. and Kulkarni Properties, will redevelop the 20 acres in the northeast corner. The project will be developed in three phases and will include office, retail and residential spaces, according to the Uptown Consortium.

• The consortium tasked Queen City Hills, a minority-owned development organization, with redeveloping the southwest corner, the former site of the Dual Manor Health Care Center. The corner will house a 162-room Residence Inn by Marriott hotel, the Business Courier reported in June, along with other mixed-use spaces.

• The aforementioned southeast corner, called “Uptown Gateway,” will be developed by Terrex Development and Construction and Messer Construction Company. The $150 million development will include three office buildings encompassing 450,000 square feet and a 158-room hotel and is expected to be completed by 2021. The development will also include an underground parking garage with 1,800 spaces. The UC Digital Futures building will be housed in this corner, a space similar to the existing 1819 Innovation Hub that the university promises will provide more space — 180,000 square feet, to be exact — for digital research.

The new corridor will offer approximately 7,000 jobs in the area, according to the Uptown Consortium. The answer of whether Uptown’s residents will be eligible for these positions is still unclear — most of the mixed-use spaces in the corridor don’t have tenants planned out quite yet. What is clear, however, is that a large portion of the corridor’s permanent jobs won’t have anything to do with new technology or the digital future as the district’s marketing may imply — there are lots of opportunities for retail, food and office jobs. There are also a multitude of opportunities for contracted employees such as construction and landscaping.

Beth Robinson, president and CEO of the Uptown Consortium, says that there is more work to be done in terms of determining what kind of jobs will be available for residents, communicating those opportunities and preparing neighborhood residents for them. The consortium has hired WEB Ventures, a consulting firm that works to create and execute economic inclusion, workforce inclusion and wealth building, to ensure that minority and local residents are included in the project. The firm also worked on projects such as the MLK Interchange and recent projects including the Avondale Town Center and the UC Gardner Neuroscience Institute. WEB was able to recruit from the neighborhoods of Uptown 13 residents to work on the Avondale Town Center and about 15 to work on the UC project.

WEB Ventures is constantly meeting with residents at community events about how job opportunities will work, says Bill Witten, managing partner of the Witten Consulting Group and a WEB Ventures partner. The firm has even put computers and printers in the Avondale Business Center to help residents find and pursue these positions.

Witten admits that construction jobs aren’t for everyone and is working to educate locals on what these jobs entail. He says that about 70 local applicants have already interviewed for construction positions in the corridor.

Even though the job site may be right in the backyard of these residents, employers may send their workers all across the region to job sites. Construction workers may stick in one job site for three or four weeks and be moved to another site miles away for another three or four weeks. Many residents don’t have their own cars and oftentimes, construction sites will be far off Metro bus lines.

“It is in Avondale, and we’ve been able to find Avondale residents that can walk to the (Avondale Town Center) as an example and work there for three or four weeks, but when the employer says, ‘Monday of next week we’re no longer here, we need you in West Chester,’ that becomes a real hard problem for them in doing that because what they have is a lack of transportation,” Witten says.

Robinson says that WEB Ventures got her organization to think more long-term about job opportunities, as before she and her team were thinking more about contracted workers, not about the more permanent opportunities.

“They got us to think about the jobs even beyond construction,” Robinson says. “Those are the kind of things they like to call the ‘annuity jobs,’ and those are like the landscaping, the supply companies, that sometimes you don’t think of, but those go on and on regardless of what’s being built — it’s really servicing the buildings and the tenants.”

Regardless of the jobs current residents are able to obtain in the district, companies are moving in and bringing with them executives, researchers and other employees who substantially exceed the area’s median household income of $18,120 (according to the 2010 census).

Robinson expects that the Innovation Corridor will help the population go up again for the first time in decades and create a more vibrant community.

“It will most definitely bring in new people to live and to work,” she says. “I think that’s a good thing because that increases the economic activity in the neighborhood, which will bring in some offerings that the community doesn’t have now. And really specifically, I’m talking about restaurants and coffee places — things that really there aren’t much of in Avondale.”

Uptown Innovation Corridor Arial View March2017A rendering of future development in the Uptown Innovation CorridorUptown Consortium

Avondale also lacks green space and places for people to walk around and be immersed in their community. The Innovation Corridor incorporated these elements into the design of the area and created an “open campus.” In initial designs of the area, there was a giant above-ground parking garage in the Terrex corner, something residents were not happy about. Neighborhood residents asked specifically for underground parking and Terrex incorporated that request into the final design.

Robinson admits that more effort is necessary to ensure that the community is aware of the consortium’s plan. She says she is amazed that some people will hear her speak at meetings and still don’t know exactly what is happening in the area.

Through these developments, which have accelerated far more quickly than anticipated due to monumental levels of state support for the interchange, Milton of the Avondale Community Council wants residents to know that there is still a lot of low-income housing in Avondale and lots of empty land.

She says the goal is to bring in these new high price points while protecting the people already in the neighborhood.

“We’re starting those conversations, and I don’t know exactly how that will be done,” Milton says. “I know that we’re probably two or three years behind the conversation, but at least we are having the conversation and we’re trying to plan for it.

Beto enters the fray

In this March 14, 2019, photo, former Texas congressman Beto O'Rourke speaks to reporters after a meet and greet at the Beancounter Coffeehouse & Drinkery in Burlington, Iowa. The contours of the Democratic presidential primary came into clearer focus this week with O’Rourke’s entry into the race. (AP Photo/Charlie Neibergall)

In this March 14, 2019, photo, former Texas congressman Beto O’Rourke speaks to reporters after a meet and greet at the Beancounter Coffeehouse & Drinkery in Burlington, Iowa. The contours of the Democratic presidential primary came into clearer focus this week with O’Rourke’s entry into the race. (AP Photo/Charlie Neibergall)

Former Vice President Joe Biden takes a photograph with members of the audience after speaking to the International Association of Firefighters at the Hyatt Regency on Capitol Hill in Washington, Tuesday, March 12, 2019, amid growing expectations he’ll soon announce he’s running for president. (AP Photo/Andrew Harnik)

Former Texas congressman Beto O’Rourke autographs a photo after speaking at the International Brotherhood of Electrical Workers Local 13 hall, Thursday, March 14, 2019, in Burlington, Iowa. O’Rourke announced Thursday that he’ll seek the 2020 Democratic presidential nomination. (AP Photo/Charlie Neibergall)

Democratic 2020 field taking shape with Beto O’Rourke entry

By JULIE PACE

AP Washington Bureau Chief

Friday, March 15

WASHINGTON (AP) — The contours of the Democratic presidential primary came into clearer focus this week with Texan Beto O’Rourke’s entry into the race — one of the final puzzle pieces in a contest that will be shaped by questions about race and gender, political ideology and generational change.

The sprawling Democratic field features candidates ranging from 37 to 77 years old; liberals and moderates; senators, governors and mayors; and an unprecedented number of women and minorities. Former Vice President Joe Biden is the only major contender still on the sidelines and has suggested he could remain there for several more weeks.

The field has been awaiting O’Rourke’s decision for months. He narrowly lost the Senate race in conservative Texas in November but became a political celebrity in the process, demonstrating an easy connection with voters and an eye-popping ability to raise money from small donors.

But the anticipation over O’Rourke, who served three terms in Congress, has rankled some in the party, who contend a woman or a minority would not be seen as a viable presidential candidate on the heels of a defeat.

“I wouldn’t be surprised if there was an assumption of competence, an assumption of quality and a desire for him to run again, as a man,” said MJ Hegar, who lost a close congressional race in Texas in the fall. “A question for me, as a woman, is ‘Why did you lose?”

O’Rourke enters a race with no clear front-runner. Biden and Vermont Sen. Bernie Sanders have topped early polling, reflecting the reservoir of goodwill each has with a sizable share of the primary electorate but hardly guaranteeing either an easy path to the nomination.

With the first primary contest still 11 months away, huge uncertainties hang over the field. Among them: Which candidates can raise enough money to sustain a long and grueling campaign?

Sanders set the pace for grassroots donations, pulling in $6 million during his first day as a candidate, according to his campaign. In the final weeks of the first fundraising quarter of the year, many wealthy donors are waiting to make commitments.

“You really have to have a plan to stay alive,” said Joel Benenson, a Democratic pollster who worked for Barack Obama’s and Hillary Clinton’s presidential campaigns. “This is not just about having one demographic group. You’re going to have to have broad reach to stay alive.”

The debates, which begin in June, also loom as the first real test of how the candidates will draw contrasts with one another. Thus far, the Democrats have refrained from challenging one another in public, arguing that party unity will be crucial in the general election campaign against President Donald Trump.

“If you don’t end up being the nominee, let’s have none of this lingering acrimony after the nominee has been selected,” New Jersey Sen. Cory Booker said Thursday. “Everybody needs to unify around the candidate because that’s where the strength of the Democratic Party is.”

It was notable that O’Rourke’s entry into the race was accompanied by a notable uptick in the kind of political shadowboxing the candidates have largely avoided, showing he has the attention of his competitors.

Just after O’Rourke announced his campaign Thursday morning, another Texan running for president, Julian Castro, released a list of endorsements from Democrats in the state. California Sen. Kamala Harris announced she plans to headline a rally in Texas later this month. And she sent a fundraising appeal that singled out O’Rourke by name and pointedly mentioned the “record number of women and people of color” running for the Democratic nomination.

O’Rourke, 46, said he knows that being a white man in a party eager to promote women and minorities may be a challenge.

“I totally understand people who will make a decision based on the fact that almost every single one of our presidents has been a white man, and they want something different for this country,” O’Rourke said in a Vanity Fair cover story published on the eve of his campaign announcement. “And I think that’s a very legitimate basis upon which to make a decision. Especially in the fact that there are some really great candidates out there right now.”

O’Rourke opened his campaign in Iowa. Several of his first stops were in counties that voted for Obama, but flipped to Trump in the 2016 election. He had four events scheduled for Friday.

Some Democrats welcomed O’Rourke’s entry into the race. He received a handful of endorsements from congressional colleagues, who praised his unifying message.

Jennifer Palmieri, a former adviser to Obama and Clinton, said the Texan’s raw talent would help raise the bar for the rest of the field.

“Good candidates make each other better, and it raises the level of competition,” Palmieri said.

With O’Rourke officially in the race, Biden is the only major player left to declare. A few long-shot candidates, most notably Montana Gov. Steve Bullock, may also still get in before the field is set.

Biden’s team has yet to formally hire any staff. But his advisers have been signaling to Democratic operatives in Iowa and New Hampshire that the former vice president is ready to make the leap, likely in early April. He’ll deliver a speech on Saturday before a friendly audience of Delaware Democrats.

“He wants to do it,” said Rep. Cedric Richmond of Louisiana, who is a former chairman of the Congressional Black Caucus and a Biden supporter. “He just wants to cross every ‘t’ and dot every ‘i.”

Stacey Abrams, the popular Democrat who narrowly lost the Georgia governor’s race in November, has also stoked speculation about a 2020 White House run. However, people close to Abrams say she is more likely to pursue a Senate campaign.

Abrams and Biden met privately Thursday in Washington.

Trump is closely monitoring the Democratic primary, including O’Rourke’s announcement. He jabbed at O’Rourke’s animated speaking style, saying, “He’s got a lot of hand movement. Is he crazy or is that just how he acts?” and predicted victory over the eventual Democratic nominee.

“Whoever it is, I’ll take him or her on,” Trump told reporters in the Oval Office.

Associated Press writers Will Weissert in Austin, Texas, Thomas Beaumont in Des Moines, Iowa, and Juana Summers and Elana Schor in Washington contributed to this report.

Follow Julie Pace at http://twitter.com/jpaceDC

O’Rourke begins 2020 bid with big crowds, centrist message

By WILL WEISSERT and ALEXANDRA JAFFE

Associated Press

Friday, March 15

BURLINGTON, Iowa (AP) — Democrat Beto O’Rourke jumped into the 2020 presidential race Thursday, shaking up the already packed field and pledging to win over voters from across the political spectrum as he tries to translate his sudden celebrity into a formidable White House bid.

The former Texas congressman began his campaign by taking his first ever trip to Iowa, the state that kicks off the presidential primary voting. In tiny Burlington, in southeast Iowa, he scaled a counter to be heard during an afternoon stop at a coffee shop.

“Let us not allow our differences to define us as at this moment,” O’Rourke told a whooping crowd, his heels perched at the countertop’s edge. “History calls for us to come together.”

Earlier in the day, O’Rourke popped into a coffee shop in Keokuk while many cable networks aired live coverage. He took questions about his support of federal legalization of marijuana as well as the possibility of a universal basic income, all while characteristically waving his arms and gesticulating fervently.

“I could care less about your party persuasion,” O’Rourke said.

It was the kind of high-energy, off-the-cuff style that made him a sensation in Texas and a monster fundraiser nationwide, but O’Rourke also was clear that he doesn’t believe in strict immigration rules — drawing a distinction that could allow him to clash openly with President Donald Trump on the issue.

Trump took more note of O’Rourke’s gyrations than his policy plans.

“Well, I think he’s got a lot of hand movement,” Trump told reporters in the Oval Office. “Is he crazy or is that just how he acts?”

After weeks of gleefully teasing an announcement, O’Rourke now must prove whether his zeal for personal contact with voters will resonate beyond Texas. He hasn’t demonstrated much skill in domestic or foreign policy, and as a white man, he’s entering a field that has been celebrated for its diverse roster of women and people of color.

Asked in Burlington how he’d contrast himself with other presidential hopefuls, O’Rourke said that he wasn’t sure but that he’d never been afraid to work with congressional Republicans. That may not be enough for Democrats anxious to angrily oppose Trump, however, and some other White House candidates draw shaper contrasts.

“The reason why I think I’m the best candidate for the presidency is very different than his,” New York Sen. Kirsten Gillibrand said of O’Rourke on Thursday. “I think we need a leader who’s going to fight for other people’s kids as hard as you’d fight for your own.”

In an email to supporters, California Sen. Kamala Harris noted that a “record number of women and people of color” are running and added that she was looking forward to “substantive debates” with candidates including O’Rourke. Massachusetts Sen. Elizabeth Warren also sent a fundraising email, saying, “I’m sure you’ve seen” O’Rourke’s launch.

In a recent interview with Vanity Fair, O’Rourke said he was “just born to be in” the presidential race. Asked about that after a Washington conference, New Jersey Sen. Cory Booker noted that he is dedicated to working with “communities that are really being left out and left behind.”

“I’ve got decades of showing people where my heart is, where my dedication is,” Booker said.

Still, he picked up several congressional endorsements on Thursday, as well as the backing of Iowa state Rep. Brian Meyer, who serves as an assistant minority leader in the state House of Representatives.

Until O’Rourke challenged Republican Sen. Ted Cruz last year, he was little known outside his hometown of El Paso, on Texas’ border with Mexico. But the Spanish-speaking, 46-year-old former punk rocker used grassroots organizing and social media savvy to mobilize young voters and minorities and get within 3 percentage points of winning in the nation’s largest red state.

In Burlington, O’Rourke distinguished himself from much of the rest of the field by saying he’d be open to remaking the structure of the Supreme Court so that it reflects modern U.S. diversity, even saying he’d be open to justice term limits.

O’Rourke’s record in Congress has drawn criticism from some for being too moderate, but he also spoke at length on Thursday about combating climate change and supporting the Green New Deal, a sweeping environmental plan backed by liberal Democrats.

Alice Davis, a retired teacher from Burlington, said O’Rourke “seems to be kind of a centrist, which I think we need.”

She said, “He’s not too far left, as some people are, and I think he could appeal to a lot of voters.”

At a house party in Muscatine on Thursday night, O’Rourke spoke about institutionalized racism, the harm done to African-Americans after emancipation and the failures of the Civil Rights movement but did not come down on either side of the reparations debate. He said only that, in speaking to others “who are much smarter on this issue,” he’s been told that the country needs to address its grim history with respect to racism before any repair can take place.

“I want to make sure that we have leadership that reflects that need, that is able to reflect and share the truth and bring a reckoning to this country that is hundreds of years in the making,” O’Rourke said. He offered no further clarification on his stance on monetary or other forms of reparation, which a number of his Democratic opponents have embraced.

O’Rourke started the race in southeast Iowa, where none of the 2020 Democratic presidential hopefuls have gone so far. Bordering the Mississippi River and featuring unemployment rates exceeding the state and national average, the area traditionally leans Democratic but supported Trump in 2016. Voters there helped elect Republican Gov. Kim Reynolds but also supported Democrat Abby Finenauer of Dubuque, who unseated Republican Rep. Rod Blum.

“These communities have slowly been hollowed out by the failure to transition from the extraction economy to a sustainable one,” said former Iowa Gov. Tom Vilsack, who got his political start in the region.

At the house party in Muscatine, O’Rourke stood on a chair to address the dozens of curious Democratic voters who arrived to see him, taking questions from the crowd as he had all day.

Sharee Byrne and Alexis Huscko, both stay-at-home-moms from Muscatine, Iowa, said they had heard about O’Rourke from his Texas Senate run and were excited to see him in person. Both were concerned about rising health care costs and access to affordable education. Byrne said she was still open to choosing a candidate, while Huscko felt strongly in Bernie Sanders’ camp.

But both acknowledged O’Rourke’s charisma and looks were part of his appeal, while Huscko was less than complimentary about Trump.

“I think people are more interested in having a cougar-style, GQ kind of guy, instead of the frumpy cheeto,” Huscko said.

Weissert reported from Austin, Texas. Associated Press writers Thomas Beaumont in Des Moines, Iowa, and Elana Schor in Washington contributed to this report.

O’Rourke returning to Wisconsin for early campaign stops

By SCOTT BAUER

Associated Press

Friday, March 15

MADISON, Wis. (AP) — Beto O’Rourke is returning to Wisconsin this weekend for early campaign stops that speak to the importance of the state in the 2020 presidential race.

O’Rourke is slated to appear Sunday at a coffee shop in Madison, the state’s liberal capital city, before heading to Milwaukee — site of the 2020 Democratic National Convention — for other events. It will be O’Rourke’s second visit to Madison in a month. He met with more than 200 University of Wisconsin students and faculty in February before he officially entered the race on Thursday in neighboring Iowa.

Wisconsin is expected to be one of the most hard-fought states in 2020 because it is one of the few seen as being truly in play. Democrats view it as part of a “blue wall” that they hope to build in the Upper Midwest to deny President Donald Trump a second term.

Trump carried Wisconsin by fewer than 23,000 votes in 2016, becoming the first Republican to carry the state since Ronald Reagan in 1984. Democrat Hillary Clinton was roundly criticized for not returning to the state before Election Day after she lost the Wisconsin primary to Vermont Sen. Bernie Sanders.

But Democrats have been buoyed by recent electoral successes — namely Tony Evers’ defeat of two-term Republican Gov. Scott Walker in 2018 as part of a Democratic sweep of every statewide race.

Adding to the momentum, Democrats on Monday announced that they would hold their national convention in Milwaukee in 2020, choosing it over the much larger cities of Houston and Miami.

O’Rourke, a former Texas congressman, made a point during his first visit in February to emphasize that Wisconsin was “too often overlooked, the conversation does not begin until too late.” He said this feeling was motivating his visits to Wisconsin and several other states, including New Mexico, Oklahoma, Kansas and Colorado.

Minnesota Sen. Amy Klobuchar, another candidate in the large Democratic presidential field, also made an early campaign stop in western Wisconsin last month.

Milwaukee and Madison are Wisconsin’s two largest cities and are the center of Democratic power in the state. In 2016, Clinton carried Milwaukee County with 65 percent of the vote and Dane County, which includes Madison, with 70 percent.

Associated Press writer Will Weissert in Austin, Texas, contributed to this report.

Follow Scott Bauer on Twitter: https://twitter.com/sbauerAP

Beto O’Rourke says nothing in his past will hinder 2020 run

By SCOTT BAUER and WILL WEISSERT

Associated Press

Monday, March 18

MADISON, Wis. (AP) — Democratic presidential candidate Beto O’Rourke told supporters Sunday that he’s never taken LSD and there’s “nothing” he hasn’t already revealed about his past that could come back to hurt his run for office.

The former Texas congressman — who has become known for his propensity for swearing — also promised again to clean up his language, despite breaking such past vows.

O’Rourke grabbed much attention as he wrapped up his first week of campaigning, but his challengers could be found at events from the Upper Midwest to the South. And looming over them all is the shadow of one prominent Democrat not in but not out, former Vice President Joe Biden. He has yet to announce a decision.

Speaking in front of a large map of Russia inside a coffee shop in Wisconsin’s capital, O’Rourke promised to return often, addressing concerns Democrats raised in 2016 after Hillary Clinton never campaigned in the state after her party’s primary and lost the state to Donald Trump by fewer than 23,000 votes.

“This state is fundamental to any prospect we have of electing a Democrat to the presidency in 2020,” O’Rourke said, adding that he was “really glad” Milwaukee was chosen to host the 2020 Democratic national convention. The city, which O’Rourke was visiting later Sunday, beat out Miami and Houston.

O’Rourke, of course, has to secure the Democratic presidential nomination before he can worry about the general election. But then he’s also already said he’d prefer to pick a woman as his running mate, should he make it that far. O’Rourke said Sunday that it was presumptuous to commit to that so early, but that doing so would make a “tremendous amount of sense” given the number of qualified women candidates.

Many remember the Texan for declaring “I’m so (bleeping) proud of you guys” on national television during his concession speech in November, after narrowly losing his Senate race to incumbent Republican Ted Cruz. O’Rourke said Sunday that he’ll not use profanities any more, after being asked by a voter if he was going to “clean up his act,” especially in front of children.

“Point taken, and very strongly made,” O’Rourke said. “We’re going to keep it clean.” He made a similar pledge during his race with Cruz, then didn’t make good.

O’Rourke has previously admitted to a 1998 arrest for drunken driving and said nothing else will come out that could be used against him during the 2020 presidential campaign. Later, he signed the skateboard of a supporter who asked if he had ever taken the drug LSD. The candidate responded that he hadn’t.

About 400 people came to the coffee shop to hear O’Rourke. Half made it inside and half listened from the sidewalk through the opened door. O’Rourke wore a St. Patrick’s Day necklace featuring green cabbage but said he had coffee — not beer — with his breakfast: “Although it can be justified as an O’Rourke on St. Patrick’s Day to do that,” he joked, in a nod to his Irish heritage.

The Republican Party’s official Twitter accounted noted his past arrest, tweeting, “On this St. Paddy’s Day, a special message from noted Irishman Robert Francis O’Rourke” and including an altered photo of the Democrat’s mug shot wearing an oversized, green leprechaun hat over the phrase “Please Drink Responsibly.”

Other highlights of Sunday’s campaigning:

ELIZABETH WARREN

Democratic presidential candidate Elizabeth Warren said during a campaign stop in Tennessee that her proposed tax on “ultra-millionaires” is a key step in reducing corruption and privileges for the rich, while making the economy work better for poorer people.

An energetic Warren spoke a racially-mixed group of about 400 potential voters while standing on a podium in front of the American and Tennessee flags in a large room at Douglass High School in Memphis, Tennessee, on Sunday afternoon. It was her first stop in a three-state tour of the South.

Warren is the first of a crowded field of Democratic presidential candidates to visit the Deep South in the run-up to the 2020 election. She is scheduled to visit the Mississippi cities of Cleveland and Greenville before a CNN town hall in Jackson on Monday. Selma and Birmingham in Alabama are on the agenda Tuesday.

Memphis is a majority black, majority Democrat city that has backed Democrats the past three presidential elections. President Donald Trump won Tennessee.

Warren touted her tax on whose households with a net worth of $50 million or more. Warren said the tax revenue, estimated at $2.75 trillion over a ten-year period. could help in reducing the cost of housing, health care and child care.

“It is an America that is working great for those at the top and not working for anyone else, and that’s why I’m in this fight,” Warren said. She reminded the crowd that she is running a grassroots campaign that does not accept corporate donations.

KIRSTEN GILLIBRAND

Kirsten Gillibrand formally joined the 2020 White House race on Sunday and previewed the hard line she will take against President Donald Trump by announcing a rally outside one of his signature Manhattan properties.

The New York senator had spent more than a month traveling around the country to gauge support for a run. Gillibrand’s announcement that she was joining the dozen-plus Democratic candidates seeking the White House came in a nearly three-minute video released early Sunday, when she says the national anthem poses this question: “Will brave win?”

She said her debut speech as a candidate will come this coming Sunday in front of the Trump International Hotel & Tower in New York.

AMY KLOBUCHAR

Democratic presidential candidate Amy Klobuchar says an exchange with a tearful Vietnam veteran who lost his son to mental illness is “a moment I’m never going to forget, no matter where I go in Iowa.”

The Minnesota senator spoke to voters Sunday at a Davenport, Iowa restaurant. It was the final stop of a two-day swing through the state.

The man, who was sitting toward the front of the room wearing a Vietnam Veterans hat, began crying as Klobuchar spoke about her respect for Sen. John McCain, who died last year. The Republican was a prisoner of war during Vietnam.

Klobuchar approached the man after her speech to take a photo. She stood with a hand on his back for several minutes as he recounted losing his son and told her he fears the U.S. may get into more wars.

Afterward, Klobuchar told reporters the moment “brings up again the importance of mental health centers.” She says mental health care has been one of the biggest concerns she’s heard from voters.

PETE BUTTIGIEG

Democrat Pete Buttigieg says he’s met a fundraising threshold to participate in this summer’s presidential debates.

The South Bend, Indiana, mayor said says he’s received contributions from 65,000-plus individual donors. That’s key because the Democratic National Committee said last month up to 20 candidates can qualify for debates in June and July by collecting donations from at least 65,000 individuals, with at least 200 unique donors in at least 20 states.

In an email to supporters, Buttigieg said “we weren’t even close” to 65,000 donors when the DNC originally announced the requirement. The 37-year-old veteran says more than 76,000 people have now donated.

He also told “Fox News Sunday” that “all of the signs are pointing in the right direction” to shift from just exploring a 2020 run to becoming an official candidate, as Gillibrand did Sunday.

BILL de BLASIO

New York Mayor Bill de Blasio criticized former President Barack Obama during a small gathering in New Hampshire as he mulls a run for president, saying that Obama’s early days in office were “a lost window.”

Minutes later, in front of a larger audience, de Blasio praised the Affordable Care Act, Obama’s signature legislative achievement, calling it “progress.” Obama pursued the health care legislation during his first two years in office and has been criticized at times for focusing on health care instead of the struggling economy.

A handful of people were present in a second-floor private room of a Concord restaurant when de Blasio compared Obama to President Franklin D. Roosevelt, who took office in 1933 amid the Depression and immediately began a series of actions that came to define the modern presidency’s focus on a 100-day agenda. The mayor said Roosevelt was the only person who “had a greater head of steam and political momentum and capital coming into office.”

“He, to his great credit, did the 100 days and the reckless abandon and understood that you had to achieve for people to build the next stage of capital to use for the next thing,” de Blasio said. “Obama, I think, nobly went at health care, but it played out over such a long time and it got treated politically as such a narrow instead of universal item, tragically, that it was a lost window. And I’m not saying anything I don’t think a lot of people feel.”

CORY BOOKER

Democratic White House hopeful Cory Booker said Sunday night he would reverse President Donald Trump’s ban on transgender individuals serving in the military if elected president.

Speaking to a crowd of more than 300 voters in Davenport, Booker answered a question posed by a woman who identified herself as transgender about what he would do to protect LGBTQ rights as president.

“When I am president of the United States, right away I will end this ridiculous, insulting, un-American ban on transgender Americans serving in the military,” he said to cheers from the crowd.

It was one of a handful of Trump Administration policies the New Jersey senator pledged to undo if elected president, including Trump’s tax cuts and his revocation of protections from deportation for undocumented immigrants brought to the US as children.

Booker also weighed in on marijuana legalization, offering a more comprehensive vision for legalization that would include expunging criminal records and promoting access to the legal marijuana industry for women and people of color.

Weissert reported from Dubuque, Iowa. Associated Press writers Sara Burnett and Alexandra Jaffe in Davenport, Iowa; Hunter Woodall in Concord, New Hampshire; and Adrian Sainz in Memphis, Tennessee, contributed to this report.

In this March 14, 2019, photo, former Texas congressman Beto O’Rourke speaks to reporters after a meet and greet at the Beancounter Coffeehouse & Drinkery in Burlington, Iowa. The contours of the Democratic presidential primary came into clearer focus this week with O’Rourke’s entry into the race. (AP Photo/Charlie Neibergall)

Former Vice President Joe Biden takes a photograph with members of the audience after speaking to the International Association of Firefighters at the Hyatt Regency on Capitol Hill in Washington, Tuesday, March 12, 2019, amid growing expectations he’ll soon announce he’s running for president. (AP Photo/Andrew Harnik)

Former Texas congressman Beto O’Rourke autographs a photo after speaking at the International Brotherhood of Electrical Workers Local 13 hall, Thursday, March 14, 2019, in Burlington, Iowa. O’Rourke announced Thursday that he’ll seek the 2020 Democratic presidential nomination. (AP Photo/Charlie Neibergall)



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UCSF opens “skin of color” dermatology clinic to address…

Black people are far less likely than white people to develop skin cancer, but they also have much lower survival rates. With the deadliest form of skin cancer, nearly 90 percent of white people will live for at least five years after their diagnosis, compared to just 66 percent of African Americans.

There are many reasons for this striking disparity, including systemic racism, lack of access to health care and deeply rooted mistrust in mainstream doctors by the black community. And there’s one deceptively simple explanation: Most dermatologists are white, and white doctors are rarely trained to look at and make diagnoses in dark-colored skin.

Dr. Jenna Lester, who may be the only black dermatologist in San Francisco, is trying to change that. She’s started a “skin of color” clinic at UCSF, focused on addressing the specific needs of patients with darker skin.

The goal to start out is simply to give people of color a comfortable medical home with a doctor who understands their needs both because of her training and her personal background. Eventually, she’d like to expand the clinic to teach other dermatologists to work with people of color and conduct research to improve care.

“When a patient walks into a room and the patient is black, and I’m black, there is a certain relief I see in their face,” Lester said. “Once I’ve established myself and have patients coming to me, we can address gaps in our medical knowledge. Things like research and education, they’ll come a bit later.”

The clinic opened late last year, and so far it’s not limited to a specific location or day or time of the week — patients are referred to Lester, or they track her down by word of mouth, and they make an appointment. She mostly sees patients by referral from within UCSF, but some have come from far reaches of the Bay Area and other parts of the state.

Jenna Lester (right), assistant professor, Department of Dermatology, UCSF Health, talks with patient Elba Clemente-Lambert (left) in an exam room in the Dermatology Clinic China Basin Location about a rash and itchy skin on Friday, March 15, 2019 in San Francisco, Calif. Photo: Lea Suzuki / The Chronicle

Photo: Lea Suzuki / The Chronicle

Jenna Lester (right), assistant professor, Department of Dermatology, UCSF Health, talks with patient Elba Clemente-Lambert (left) in an exam room in the Dermatology Clinic China Basin Location about a rash and itchy skin on Friday, March 15, 2019 in San Francisco, Calif.

Lester said she’s always been interested in addressing health disparities among people of color, and she realized in medical school that dermatology was a field wide open for improving care. Black people already are under-represented in medicine, and even more so in specialty fields like dermatology.

That under-representation feeds the cycle of health disparities that lead to worse outcomes for black people in almost all areas of health, from heart disease and diabetes to most types of cancer. Erasing those disparities is going to require a massive overhaul of the health care system and beyond — from changing how science is taught in high schools to stabilizing medical costs and improving communication between health care providers and communities of color.

A single dermatology clinic isn’t going to solve the broader problems, but it’s an important solution in the interim, said Dr. Bruce Wintroub, chair of dermatology at UCSF.

“People of color have been underrepresentened in medicine, and for that reason populations of people of color have really been under-served,” Wintroub said. “We felt that it was time to offer the beginnings of a solution to this problem.”

Only about 5 percent of all doctors in the United States are black, though black people make up about 13 percent of the total population. And though the total number of black doctors has increased over the past several decades, the percentage hasn’t budged much. Those rates can be even more worrisome when applied to medical specialties like dermatology.

Malcolm Chelliah, a medical student at Stanford who will graduate this year, said he chose to focus on dermatology for many of the same reasons Lester did — because he knew access to care was a problem for many communities of color. When he was growing up in Cleveland, his family and friends were more likely to talk to each other than a doctor when they had a question about a rash or other health problem.

“I’m the first person in my family to go to college, and I recognized by the time I got there that the way health care is practiced in urban areas is very different from more affluent areas,” Chelliah said. “Where you’re from should not dictate the services available to you or the outcomes.”

Dermatologists treat all kinds of disease of the skin, hair and nails, though skin cancer is the most serious. Melanoma — the deadliest type of skin cancer — is more common in people with lighter skin because pigmentation offers some natural protection from ultraviolet rays, which can cause certain skin cells to grow out of control and form tumors. People with darker skin have more pigmentation than those with lighter skin.

Black people are still at risk of developing skin cancer, but often both doctors and patients under-estimate that risk and don’t think to check for early signs of melanoma, leading to later diagnoses and worse outcomes.

Tumors on black skin may be a different color than what white dermatologists are expecting, or they might just look different against a darker backdrop. And black people are more susceptible to tumors on the palms of their hands and the soles of their feet, where they don’t have as much pigmentation.

“In dermatology we have many diagnostic maneuvers, but our primary is visual. It’s looking at the skin and recognizing a pattern,” Lester said. “If we’re not trained to recognize things in skins of color, we may miss diagnoses.”

Skin cancer isn’t the only dermatological issue that might affect people of color in different ways than white people. Everything from eczema to an allergic rash may be harder for doctors to identify if they were only trained to look at lighter skin.

Hair conditions also can look different on people of color, and treatments may vary too. Lester said she may give different advice or recommend different products to patients based on the texture of their hair or whether it’s straight or tightly curled. Chelliah pointed out that a black doctor may think to remind a black patient to remove a weave from her hair before an appointment.

Elba Clemente-Lambert, who is a patient of Jenna Lester (not shown), assistant professor, Department of Dermatology, UCSF Health, stands for a portrait at the Dermatology Clinic China Basin Location on Friday, March 15, 2019 in San Francisco, Calif. Photo: Lea Suzuki / The Chronicle

Photo: Lea Suzuki / The Chronicle

Elba Clemente-Lambert, who is a patient of Jenna Lester (not shown), assistant professor, Department of Dermatology, UCSF Health, stands for a portrait at the Dermatology Clinic China Basin Location on Friday, March 15, 2019 in San Francisco, Calif.

Among Lester’s first patients in the skin-of-color clinic was Elba Clemente-Lambert, who had a scalp condition that was causing her to lose hair. Clemente-Lambert, 77, said she’s comfortable enough seeing doctors who aren’t black — she’s had to be, given how few of them there still are.

Still, after meeting Lester she made sure to schedule her next dermatology appointments with the clinic, in part because she appreciates that a black doctor may have more experience with her specific needs.

“It’s not easy to explain, but just knowing that she was a person of color and so was I, and she may be more aware and more in tune — I could relate to her,” Clemente-Lambert said.

Their first visit, though, ended up being about much more than addressing her health needs.

Clemente-Lambert was a longtime UCSF employee and deeply involved in the university’s black caucus, a group formed in the 1960s to improve representation among the staff and students of the medical school. The day Clemente-Lambert met Lester was almost exactly the day of the 50th anniversary of the founding of the caucus.

“A whole bunch of memories flooded my mind when I saw her. There was a lot of discrimination and racism and prejudices back then. People just wanted to feel valued or respected,” Clemente-Lambert said.

“When Dr. Lester walked into that room, I felt such a connection to her,” she said. “It felt really good. At the end of the session, I asked if I could give her a hug.”

Erin Allday is a San Francisco Chronicle staff writer. Email: eallday@sfchronicle.com

US bars ICC staff

Secretary of State Mike Pompeo speaks during a news conference at the State Department, Friday, March 15, 2019 in Washington. (AP Photo/Carolyn Kaster)

Secretary of State Mike Pompeo speaks during a news conference at the State Department, Friday, March 15, 2019 in Washington. (AP Photo/Carolyn Kaster)

Secretary of State Mike Pompeo speaks during a news conference at the State Department, Friday, March 15, 2019 in Washington. (AP Photo/Carolyn Kaster)

Secretary of State Mike Pompeo speaks during a news conference at the State Department, Friday, March 15, 2019 in Washington. (AP Photo/Carolyn Kaster)

US bars entry of International Criminal Court investigators

By MATTHEW LEE

AP Diplomatic Writer

Friday, March 15

WASHINGTON (AP) — The United States will revoke or deny visas to International Criminal Court personnel who attempt to investigate or prosecute alleged abuses committed by U.S. forces in Afghanistan or elsewhere and may do the same with those who try to take action against Israel, Secretary of State Mike Pompeo said Friday.

Pompeo, making good on a threat delivered last September by national security adviser John Bolton, said the U.S. had already moved against some employees of The Hague-based court, but declined to say how many or what cases they may have been investigating.

“We are determined to protect the American and allied military and civilian personnel from living in fear of unjust prosecution for actions taken to defend our great nation,” Pompeo said.

He said any wrongdoing committed by American personnel would be dealt with in U.S. military and criminal courts.

The visa restrictions would apply to any court employee who takes or has taken action “to request or further such an investigation,” Pompeo said.

“These visa restrictions may also be used to deter ICC efforts to pursue allied personnel, including Israelis, without allies’ consent,” he said.

The ICC prosecutor has a pending request to look into possible war crimes in Afghanistan that may involve Americans. The Palestinians have also asked the court to bring cases against Israel.

Speaking directly to ICC employees, Pompeo said: “If you are responsible for the proposed ICC investigation of U.S. personnel in connection with the situation in Afghanistan, you should not assume that you still have or will get a visa or will be permitted to enter the United States.”

That comment suggested that action may have already been taken against the ICC prosecutor who asked last year to formally open an investigation into allegations of war crimes committed by Afghan national security forces, Taliban and Haqqani network militants, as well as U.S. forces and intelligence officials in Afghanistan since May 2003.

The United States has never been a member of the ICC. The Clinton administration in 2000 signed the Rome Statute that created the ICC but had reservations about the scope of the court’s jurisdiction and never submitted it for ratification to the Senate, where there was broad bipartisan opposition to what lawmakers saw as a threat to U.S. sovereignty.

When George W. Bush took office in 2001, his administration promoted and passed the American Service Members Protection Act, which sought to immunize U.S. troops from potential prosecution by the ICC. In 2002, Bolton, then a State Department official, traveled to New York to ceremonially “unsign” the Rome Statute at the United Nations.

In September, Bolton said the ICC was a direct threat to U.S. national security interests and threatened its personnel with both visa revocations and financial sanctions should it try to move against Americans. Pompeo said Friday that more measures may come.

“We are prepared to take additional steps, including economic sanctions, if the ICC does not change its course,” he said, adding: “The first and highest obligation of our government is to protect its citizens and this administration will carry out that duty.”

The ICC did not immediately respond to Pompeo’s announcement, but said last year it was “undeterred” by Bolton’s threat. At the time it noted that it had been established by a treaty supported by 123 countries and said it prosecutes cases only when those countries failed to do so or did not do so “genuinely.” Afghanistan is a signatory.

Supporters of the court, the first global tribunal for war crimes, slammed Pompeo’s announcement.

Human Rights Watch called it “a thuggish attempt to penalize investigators” at the International Criminal Court.

“The Trump administration is trying an end run around accountability,” it said. “Taking action against those who work for the ICC sends a clear message to torturers and murderers alike: Their crimes may continue unchecked.”

Since its creation, the court has filed charges against dozens of suspects including former Libyan dictator Moammar Gadhafi, who was killed by rebels before he could be arrested, and Sudanese President Omar al-Bashir, who is accused of charges including genocide in Darfur. Al-Bashir remains at large, as does Ugandan warlord Joseph Kony, who was among the first rebels charged by the court in 2005. The court has convicted just eight defendants.

The court has been hobbled by refusal of the U.S., Russia, China and other major nations to join. Others have quit, including Burundi and the Philippines.

The Conversation

US military steps up cyberwarfare effort

March 12, 2019

Authors

Benjamin Jensen, Associate Professor of International Relations, Marine Corps University; Scholar-in-Residence, American University School of International Service

Brandon Valeriano, Professor of Armed Politics, Marine Corps University

Disclosure statement

Benjamin Jensen receives funding from the Carnegie Corporation, Office of Naval Research and Koch Foundation. He is affiliated with the Atlantic Council and is an officer in the U.S. Army Reserve. The views expressed are his own. None of these affiliations were used to sponsor the research linked to this article.

Brandon Valeriano receives funding from Carnegie Corporation. He is affiliated with the Atlantic Council. The views expressed are his own. None of these affiliations were used to sponsor the research linked to this article.

Partners: American University School of International Service provides funding as a member of The Conversation US.

The U.S. military has the capability, the willingness and, perhaps for the first time, the official permission to preemptively engage in active cyberwarfare against foreign targets. The first known action happened as the 2018 midterm elections approached: U.S. Cyber Command, the part of the military that oversees cyber operations, waged a covert campaign to deter Russian interference in the democratic process.

It started with texts in October 2018. Russian hackers operating in the Internet Research Agency – the infamous “troll factory” linked to Russian intelligence, Russian private military contractors and Putin-friendly oligarchs – received warnings via pop-ups, texts and emails not to interfere with U.S. interests. Then, during the day of the election, the servers that connected the troll factory to the outside world went down.

As scholars who study technology and international relations, we see that this incident reflects the new strategy for U.S. Cyber Command, called “persistent engagement.” It shifts Cyber Command’s priority from reacting to electronic intrusions into military networks to engaging in active operations that are less intense than armed conflict but still seek to stop enemies from achieving their objectives. In late 2018, the U.S. goal was to take away Russia’s ability to manipulate the midterm election, even if just briefly.

Coercion is difficult

Cyber Command’s operation against the troll factory was part of a sophisticated campaign that targeted individuals – Internet Research Agency workers – and systems – the organization’s internet connection.

In military terms, that effort generated “friction,” or difficulty for opposing forces to perform even mundane tasks. Russian hackers and trolls may wonder how a foreign government got their information, or was able to take their workplace offline. They might be worried about personal vulnerabilities, weaknesses in their own systems or even what else Cyber Command might do if they don’t stop trolling.

Our research has found that covert activities that are not as clear as armed conflict don’t always change a target’s behavior. Successful coercion efforts tend to require clear signals of both capability and resolve – assurance that the defender both can respond effectively and will do so, in order to prevent the attacker from taking a desired action.

Digital operations are often the opposite – concealing that anything has happened, as well as who might have done it.

Even when a defender shows an adversary what it is capable of, there are few guarantees that deterrence will work. It is tough to force a determined aggressor to back down. Most scholarly studies of coercion – whether in the form of cyber action, economic sanctions or limited air strikes – show how hard it is to change an adversary’s behavior.

As we have found, all of these signals, digital and otherwise, are most effective when used by more technologically sophisticated countries, like the U.S., who can combine them with other instruments of national power such as economic sanctions and diplomacy. Actions in the shadows can produce friction, but on their own are unlikely to change an opponent’s behavior.

Through targeted social media posts, Russians have amplified political fault lines in the United States. Social media makes it easy for misinformation to spread, even long after false stories are planted. There will always be “useful idiots” who will circulate disinformation and misinformation.

Entering risky territory

It’s not clear that U.S. military hacking of Russian internet connections will put a damper on Putin’s global information warfare campaign.

It’s also not yet clear whether there will be – or even has already been – any sort of retaliation. There may be a point at which the conflict escalates, threatening the electricity grid, civic groups, private homes or voting systems.

It’s valuable for the U.S. to introduce friction against enemies who seek to harm the American way of life. But it’s equally important to consider the potential for escalation to more widely harmful forms of conflict. This type of cyberoffensive may succeed at pushing back Russian disinformation. Or it may just be the government’s attempt to do something – anything – to convince the public it’s engaging the threat. Quick wins, like shutting down a troll factory for a few days, could produce much bigger longer-term consequences in a connected world.

The Conversation

Sen. Martha McSally, pioneering Air Force pilot, shows how stereotypes victimize sexual assault survivors again

March 12, 2019

Author: Leigh Goodmark, Professor of Law, University of Maryland, Baltimore

Disclosure statement: Leigh Goodmark does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

Martha McSally was the first woman to fly combat missions for the United States Air Force after the prohibition on female combat pilots was lifted in 1991. She later sued the United States Department of Defense, challenging a policy that required servicewomen in Saudi Arabia to wear abaya (full-body coverings) when traveling off-base. In 2014, she was elected to the House of Representatives and is a currently a United States senator from Arizona.

Martha McSally is a powerful woman.

But when a superior Air Force officer raped her, “I was ashamed and confused. I thought I was strong but felt powerless,” McSally said. She blamed herself. And she chose not to report the assault.

The feelings McSally describes are common among victims of sexual violence. McSally is not alone in her decision not to report her victimization. In 2016, only about 23 percent of rapes were reported to law enforcement.

In my 25 years of representing survivors of gender-based violence as an attorney, I have met hundreds of women like McSally. The shame and powerlessness that these women feel are a direct result of antiquated notions about rape and sexual assault that were, until recently, embedded in the legal system.

Those ideas continue to affect how police, prosecutors and judges see victims of violence and how victims see themselves.

Institutional skepticism

Reforming the law was a priority for the anti-rape movement of the 1970s and 80s.

The rape law of the time both implicitly and explicitly challenged the credibility of complainants. Many states gave jurors a cautionary jury instruction derived from 17th-century English jurist Sir Matthew Hale’s observation that rape “is an accusation easily to be made and hard to be proved.”

Prior to the rape law reform of the 1970s and 80s, the law in most states required rapes to be promptly reported. The failure to make a prompt report suggested that the event was fabricated.

Rape law in many jurisdictions precluded prosecution without corroboration of the victim’s testimony; a rape victim, on her own, could not be a credible witness. Many state laws also required that rape victims fight back against their attackers – resisting “to the utmost,” according to the law.

And defendants could introduce evidence about the accuser’s sexual history to undermine the claim that the sex was not consensual.

These laws have, for the most part, been repealed. But the skepticism of rape claims and rape victims underlying these laws continues to shape how the legal system responds to rape and sexual assault.

Victim credibility

Official reports detail just how poorly many police departments and prosecutors understand and deal with rape.

A 2011 United States Department of Justice report describes how police in New Orleans, for example, asked a victim of sexual assault “if she screamed or resisted the perpetrator.” When she said she had not, the detective asked why not, and commented that “the victim ‘seemed very calm and unrattled.’” The implication, of course, is that a true victim would scream and fight; a calm and unrattled victim is not a credible victim.

In a 2016 report, a U.S. Department of Justice investigation of the Baltimore Police Department documents detectives’ skepticism of victims who delayed reporting and detectives’ suggestions that victims had done something to trigger assaults. Police and prosecutors openly ridiculed victims who they did not believe.

In one exchange, a prosecutor wrote, “[T]his case is crazy. … I am not excited about charging it. This victim seems like a conniving little whore. (pardon my language)”; the officer responded, “Lmao! I feel the same.”

In a 2014 report, the Department of Justice described how Missoula, Montana police told a woman that “because ‘no one had a limb cut off and there was no video of the incident,’ prosecutors ‘wouldn’t see [her rape] as anything more than a girl getting drunk at a party.’” Between January 2008 and May 2012, the Missoula County Attorney’s Office filed charges in less than 17 percent of the rape cases referred for prosecution. By contrast, in 2012-2013 about 48 percent of sexual assault related arrests resulted in charges being brought in Arizona.

As recently as September 2018, many observers dismissed Dr. Christine Blasey Ford’s account of being sexually assaulted by Supreme Court Justice Brett Kavanaugh because of her failure to promptly report.

Victim stereotypes

Society generally, and law enforcement specifically, still expects rape victims to look and act a certain way.

They should be demure, virginal and blameless; they should not have had previous sexual contact with their attackers; they should be openly emotional about their experiences; they should report promptly; they should fight to defend their honor.

When rape victims fail to conform to these stereotypes, law enforcement doubts their stories.

Without a “good” victim, law professor Tamara Rice Lave has argued, police are less likely to make arrests, prosecutors are less likely to bring cases to trial, and judges and juries are less likely to convict.

These stereotypes affect how victims respond to rape and sexual assault.

Women see that the system continues to blame them for being raped. Like Sen. McSally, they don’t report because they don’t believe that the system will work for them. When they do report, they often feel, as McSally described, “like the system was raping me all over again.”

Law enforcement reliance on rape stereotypes heightens the shame, powerlessness and revictimization that women who have been raped feel when they do report – and prevents other women from reporting in the first instance.

The Department of Justice reports cited above suggest that changing the law has not changed attitudes toward rape victims. Only by changing the wider culture will we achieve that goal.

At the University of Maryland Carey School of Law, where I teach, we’re trying to make that cultural change through the Erin Levitas Initiative for Sexual Assault Prevention.

As we describe our initiative, “Our goal is to change the way that boys and young men think about women by addressing the attitudes that drive violence.”

The Levitas Initiative will use restorative justice principles, which focus on repairing the harm experienced by victims, to respond to incidents of school-based sexual harassment and educate middle school students on sexual violence.

We hope that restorative dialogue and active accountability will undermine the attitudes and stereotypes that continue to haunt victims of rape – something the law has not been able to achieve.

Takeaways from Beto O’Rourke’s presidential launch

By WILL WEISSERT

Associated Press

Monday, March 18

NORTH LIBERTY, Iowa (AP) — After weeks of hype, former Texas Rep. Beto O’Rourke swung through Iowa for the first time and strode into the presidential race to larger crowds and more media attention than most others in the already crowded 2020 Democratic field.

Until recently, O’Rourke was a little-known El Paso congressman whose views weren’t well known. His campaign rollout filled in some blanks and gave him a chance to try to move past some flubs, such as quips about being a part-time parent. Still, he remains something of a political mystery.

Here’s some of what we learned during his White House rollout:

DONOR DARLING

One of the big questions surrounding O’Rourke’s candidacy is whether he’d be able to recreate the energy that fueled his political stardom during his 2018 challenge to Sen. Ted Cruz.

At least on the fundraising front, the answer is yes.

O’Rourke’s campaign said Monday it drew in $6.1 million in donations during its first day alone, or just more than the $6 million fellow Democratic presidential hopeful Bernie Sanders raised in the opening 24 hours of his campaign. That’s a key indication O’Rourke can revive a deep, nationwide supporter base built heavily on small donors that helped him rake in $80-plus million while nearly upsetting Cruz.

As he did while running for Senate, O’Rourke says he won’t take donations from outside political groups, but he also won’t rule out organizing fundraisers with high-dollar donors, as has another 2020 Democratic White House candidate, Elizabeth Warren. He said he’d support his campaign staff unionizing after Sanders’ became the first presidential campaign to do so.

And O’Rourke has pledged to release his tax personal returns — unlike President Donald Trump — but didn’t say when.

FOREIGN POLICY

O’Rourke’s six years in Congress encompassed little foreign policy experience, and it’s showed at times. He said he supports a two-state solution to the Israel-Palestinian conflict, but when asked if he had an opinion about “Brexit,” he answered simply, “No.” If elected president, O’Rourke says he wouldn’t send U.S. troops to Venezuela. Nor would he deploy them to Syria “without some declaration or authorization for force.”

He’s also denounced China for manipulating international markets but hasn’t said how he’d deal with that other than criticizing Trump’s trade tariffs.

BORDER NATIVE

Policy areas O’Rourke likes discussing are immigration and the U.S.-Mexico border. A fluent Spanish speaker, he hails from El Paso , across the Rio Grande from Ciudad Juarez, Mexico, which he calls the “world’s largest binational community.” O’Rourke says he knows more about the border that has dominated national debate than anyone running for president.

HEALTH CARE

During the Senate race, O’Rourke said he’d support Sanders’ “Medicare for All” plan. Now, O’Rourke says he prefers a proposal by Democratic Reps. Rosa DeLauro of Connecticut and Jan Schakowsky of Illinois known as “Medicare for America.”

O’Rourke says it would allow people who already get health insurance from their employers to continue to do so while helping millions without coverage enroll in Medicare.

When a man in Independence, Iowa, accused O’Rourke of siding with “insurance company greed,” the former congressman responded with one of his common refrains: “If we become too ideological or too prescribed in the solution, we may allow the perfect to become the enemy of the good.”

REPARATIONS

Asked about the U.S. government making financial payments for centuries of stolen labor and oppression of enslaved black Americans, O’Rourke didn’t directly answer. He said only that the nation had to confront the truth about its racist past.

Other 2020 presidential hopefuls, including Harris, Warren and ex-Housing and Urban Development Secretary Julian Castro, have suggested the U.S. government should use tax credits or other subsidies to compensate the descendants of those enslaved.

RUNNING WHILE RUNNING

O’Rourke frequently jogged with supporters while running for Senate and seems poised to get plenty of exercise during the presidential campaign. He participated in a race in North Liberty, Iowa, running 5 kilometers, or about 3.1 miles, in 24 minutes and 29 seconds. He also chatted with fellow racers while doing so, saying talking health care helped speed him up.

O’Rourke acknowledged being in pain toward the end of the race, but he called it a good “pressure check” on his body.

SELF-DRIVING VEHICLE

O’Rourke likes to drive himself to campaign stops, often while livestreaming. He did this constantly as a Senate candidate, saying he can’t stand to sit still.

His presidential campaign used a Dodge Caravan to traverse parts of Iowa, then drive to Wisconsin, Michigan and Ohio with plans to head to Pennsylvania and New Hampshire. But O’Rourke has a tendency to speed — and to sometimes curse at other drivers — which can make for awkward internet moments. He’s promised to clean up his language while running for president.

O’Rourke could have the road to himself a lot. While other candidates, including the senators running for president, have day jobs, the campaign is O’Rourke’s only occupation at the moment.

CONSPICUOUS GYRATIONS

Trump suggested O’Rourke constantly waving his arms might mean the Texan is crazy. Others picked up on how, during the online video announcing his candidacy, O’Rourke bounced so much on the couch where he was seated with his wife that she occasionally pitched forward, appearing to nod in agreement without actually moving her head.

Those who knew O’Rourke before he was elected to Congress in 2012 say he used to be a stiff and little-animated campaigner — a problem he no longer has.

Secretary of State Mike Pompeo speaks during a news conference at the State Department, Friday, March 15, 2019 in Washington. (AP Photo/Carolyn Kaster)

Secretary of State Mike Pompeo speaks during a news conference at the State Department, Friday, March 15, 2019 in Washington. (AP Photo/Carolyn Kaster)

Secretary of State Mike Pompeo speaks during a news conference at the State Department, Friday, March 15, 2019 in Washington. (AP Photo/Carolyn Kaster)



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On the campaign trail

2020 Democratic presidential candidate Sen. Bernie Sanders, left, meets with Sarah Bass of Boone, after a rally, Saturday, March 9, 2019, at the Iowa state fairgrounds in Des Moines, Iowa. (AP Photo/Matthew Putney)

2020 Democratic presidential candidate Sen. Bernie Sanders, left, meets with Sarah Bass of Boone, after a rally, Saturday, March 9, 2019, at the Iowa state fairgrounds in Des Moines, Iowa. (AP Photo/Matthew Putney)

FILE- In this Jan. 16, 2019, file photo Julian Castro, former U.S. Secretary of Housing and Urban Development and candidate for the 2020 Democratic presidential nomination, speaks to the media at Saint Anselm College in Manchester, N.H. Castro isn’t ruling out direct payments to African-Americans for the legacy of slavery, a stand separating him from his 2020 rivals. The former housing secretary says, “If under the Constitution we compensate people because we take their property, why wouldn’t you compensate people who actually were property.’’ (AP Photo/Mary Schwalm, File)

Democratic presidential candidate Sen. Elizabeth Warren, D-Mass., speaks to local residents Friday, March 8, 2019, in the Queens borough of New York. (AP Photo/Frank Franklin II)

Presidential hopeful Castro isn’t ruling out reparations

By PAUL J. WEBER

Associated Press

Monday, March 11

AUSTIN, Texas (AP) — Democratic presidential candidate Julian Castro isn’t ruling out direct payments to African-Americans for the legacy of slavery — a stand separating him from his 2020 rivals.

“If under the Constitution we compensate people because we take their property, why wouldn’t you compensate people who actually were property,” the former Obama-era housing secretary and ex-San Antonio mayor said on Sunday.

Castro was among the last of a pack of 2020 candidates to speak at the South by Southwest Festival in Texas, in what amounted to one of the biggest gatherings of the Democratic field yet.

As Democrats have addressed reparations in the early stages of the race, other candidates are discussing tax credits and other subsidies, rather than direct payments for the labor and legal oppression of slaves and their descendants. Vermont Sen. Bernie Sanders would put resources such as “Medicare for All” and tuition-free college into distressed communities.

Castro tells CNN’s “State of the Union” he doesn’t think that’s the proper argument for reparations if “a big check needs to be written for a whole bunch of other stuff.” Castro stopped short of saying he would push for direct compensation to descendants as president, saying instead that he would appoint a commissioner or task force that would make recommendations.

Sanders was in New Hampshire, while Sens. Elizabeth Warren of Massachusetts was in Dallas, Kamala Harris of California was in Miami and Amy Klobuchar of Minnesota was in Tampa.

Other highlights from Sunday’s campaigning:

BERNIE SANDERS

The Vermont senator emphasized his rise from longshot candidate to major Democratic presidential contender in his first trip to New Hampshire since launching another run for president.

Sanders said his ideas that seemed “radical and extreme” four years ago are now helping define Democrats campaigns across the country.

“Those ideas that we talked about when I came here to New Hampshire four years ago, ideas that seemed so very radical at that time,” Sanders said. “Well, today, virtually all of those ideas are supported by a majority of the American people and they are being supported by Democratic candidates from school board to president of the United States.”

Sanders topped Hillary Clinton by 22 points in the state’s 2016 primary. But he now faces a wider field of rivals who have adopted some of the same views on policy issues he pioneered during his last run for the White House.

“This is where the political revolution took off,” Sanders said. “Thank you, New Hampshire.”

JAY INSLEE

Washington Gov. Jay Inslee laid down a challenge for his 2020 rivals — join him in calling to abolish the Senate filibuster.

Inslee is a newcomer to the Democratic field and is running a campaign that’s almost singularly focused on climate change. But he was similarly adamant about doing away with the Senate filibuster while speaking to a small audience early Sunday morning at SXSW.

He said the six Democratic senators currently running for the White House shouldn’t think twice.

“Maybe they get religion on this and realize that the filibuster is going to stop us from doing anything from health care to climate change,” Inslee said. “As long as Mitch McConnell has the keys to the car, we’re not going to drive it anywhere.”

He was followed on stage by Castro, who also signaled an openness to the Senate doing away with the filibuster, which is a procedural tool that requires a supermajority of at least 60 votes to pass many big items, instead of a simple majority.

JOHN HICKENLOOPER

Former Colorado Gov. John Hickenlooper said he’s not cut out for the Senate — and that he doesn’t see himself switching races if his presidential run fizzles out.

“I don’t see it in my future,” Hickenlooper said.

Democrats have sights on Sen. Cory Gardner’s seat. The Colorado Republican is up for re-election in 2020. Hickenlooper said he’s spoken with Senate Minority Leader Chuck Schumer but says he considers running for president a calling.

Hickenlooper also said decriminalizing prostitution is worth exploring. He brought up the recent Florida crackdown on massage parlor prostitution and investigation into human trafficking, which resulted in New England Patriots owner Robert Kraft being charged with two misdemeanor counts of prostitution. Kraft has pleaded not guilty.

“There are a lot of arguments, and I think they’re worth taking into serious consideration, that legalizing prostitution and regulating where there are norms and protections” to prevent abuse should be looked at, Hickenlooper said.

PETE BUTTIGIEG

Democratic presidential hopeful Pete Buttigieg said Sunday night that he and Vice President Mike Pence have different views of their Christian faith and that he doesn’t understand Pence’s loyalty to President Donald Trump.

The mayor of South Bend, Indiana, said his feeling “is that the Scripture is about protecting the stranger, the prisoner, the poor person, and that idea of welcome. That’s what I get in the Gospel when I’m in church.” He said Pence’s view “has a lot more to do with sexuality, a certain view of rectitude.”

Buttigieg said he is puzzled by Pence’s strong support for the president.

He asked how Pence “could allow himself to become the cheerleader of the porn star presidency?” and adds, “Is it that he stopped believing in Scripture, when he started believing in Donald Trump?”

Buttigieg made the comments at a CNN town hall in Austin, Texas.

Associated Press writer Hunter Woodall in Concord, New Hampshire, contributed to this report.

Follow Paul J. Weber on Twitter: www.twitter.com/pauljweber

Opinion: Will McConnell Buck the American People?

By Robert Weissman

InsideSources.com

Senate Majority Leader Mitch McConnell has built a career on weakening our democracy. Nothing seems to bring out the passion in the famously stoic McConnell more than opposing pro-democracy reforms.

Well, now he has the challenge of a lifetime. The House of Representatives has just passed H.R. 1, the For the People Act, the most sweeping pro-democracy and anti-corruption measure of the last 50 years. McConnell has denounced H.R. 1 and pledged that he will block it from coming to the floor of the Senate.

But if McConnell is so eager to hold a vote on the Green New Deal, a legislative proposal that he strongly opposes, why is he so committed to blocking Senate consideration of H.R. 1? Could it be that he thinks Republicans will have a hard time voting against pro-democracy reforms? Is he worried that voters may hold accountable defenders of the current corrupt political system?

Those would be reasonable fears. But McConnell should be worried also about the impact of preventing a vote on H.R. 1. Voters are desperate for far-reaching campaign finance and ethics reforms — divided only on whether the system should be fundamentally changed or completely rebuilt. Voters are not likely to treat his obstructionism kindly.

They are likely to be especially outraged because H.R. 1 so effectively addresses what so many people are so outraged about and the shameful anti-democratic practices that so tarnish our nation.

Among other measures, H.R. 1 would:

—Replace the current campaign finance system that empowers the super rich and big corporations with one that relies on small donors and public matching funds.

—End secret spending in elections.

—Eliminate partisan gerrymandering.

—Establish automatic voter registration.

—Restore voting rights to felons who have served their time.

—Make Election Day a national holiday.

McConnell calls these democracy expanding measures a “power grab.”

Of course, he’s right to be worried, for it is a reallocation of power away from a narrow grouping of super rich oligarchs and to the people.

That redistribution of power is called “democracy.”

McConnell is not alone in attacking H.R. 1. The Koch Brothers’ main organization, Americans for Prosperity, says that “the free speech regulations in H.R.1 would make it more difficult than ever for people to make their voices heard and hold their elected leaders accountable.”

They also are right to be worried. Those supposed “free speech regulations” are disclosure requirements that would end political Dark Money — a move that would absolutely reduce the undue political influence of super rich and corporate donors who are able to hide their efforts to buy elections.

Big Business in general is upset. The U.S. Chamber of Commerce, the trade association for large corporations, leads a large grouping of trade associations in denouncing H.R. 1 for “pushing certain voices, representing large segments of the electorate and our economy, out of the political process altogether.”

Actually, H.R. 1 is amplifying the voices of the electorate. Although the point seems to evade the trade associations, Big Business is not part of “the electorate.” That said, H.R. 1 doesn’t limit corporations’ ability to spend on elections — that will require a constitutional amendment to overturn Citizens United — though it does end their ability to finance electioneering secretly.

McConnell and the power elite are right to be frightened. H.R. 1 would upset the normal way of doing business in Washington. It would break Corporate America’s stranglehold over our government and curtail the shameful vote-suppressing activity increasing across the nation.

But they are clinging to a backward-looking strategy that is doomed to fail. In a nation marked by the most severe wealth and income inequality of the last 100 years, amid intense outrage across the political spectrum against a rigged system that works for corporations and the super rich at the expense of the rest of us, the American people will not tolerate McConnell’s obstructionism. Democracy reform is coming to the United States, whether McConnell and his corporate allies like it or not.

ABOUT THE WRITER

Robert Weissman is the president of Public Citizen, a nonprofit consumer advocacy organization that champions the public interest in the halls of power. He wrote this for InsideSources.com.

Opinion: O, Canada — the ‘Crisis’ of American Health Care Costs

By Robert Graboyes

InsideSources.com

America spends more than any other country on health care — in the aggregate, per capita, or as a percentage of Gross Domestic Product. This, fretters fret, constitutes a crisis; they ask why we can’t be more like Canada, or France, Sweden, or the United Kingdom.

Numbers suggests why we can’t be. And shouldn’t be.

For an American, Canada’s health care system has shortcomings (longer wait-times, for example). America’s health statistics fall a bit short of Canada’s in some respects (shorter lifespan, higher infant mortality), but those differences largely reflect factors outside of health care — personal behavior, physical environment, genetics and so forth. All in all, Canadian and American health care are quite similar, with both countries enjoying some of the best care on the planet.

America, like Canada, could provide much better care for what we spend. But do our high costs constitute a crisis?

According to the Fraser Institute, 2013 per capita health care expenditures were $9,086 in the United States and $4,569 in Canada — 17 percent of GDP in America versus 11 percent in Canada.

But Fraser’s point was why these numbers don’t constitute a crisis for America. America’s 2013 per capita GDP was $53,135; Canada’s was $42,701. In income terms, Canadians are 20 percent poorer than Americans.

That average American who spends $9,086 on health care still has $44,049 left over for food, shelter, clothing, roads, military, entertainment, etc. The Canadian spending $4,569 on health care only has $38,132 remaining for other things.

But why can’t we get our health care spending down to Canada’s level and have an extra $4,517 to spend on other things?

Consider some real-world numbers for a treatment we’ll call Procedure A. On average, Procedure A cost $5,510 in America in 2018 and only $5,070 in Canada (and even better, only $4,740 in the Euro Area). Should America hire Canadians or Europeans to teach us how to do Procedure A more efficiently?

Let’s examine cost variations within the United States for a different treatment for the same condition. In 2013, Procedure B cost $4,490 in Boston and only $2,590 — 42 percent less — in Nashville. Perhaps Bostonians should travel to Nashville to learn the secrets of Nashville’s efficiency?

Maybe not. Procedures A and B are both treatments for the same condition — hunger. Procedure A is the purchase of 1,000 Big Mac hamburgers from McDonald’s. Procedure B is the purchase of 1,000 McDonald’s Quarter Pounders.

Few companies on earth have tighter quality control or more regimented procedures than McDonald’s. Canadians make a Big Mac exactly as Americans do. A Quarter Pounder requires the same routines on the same ingredients to produce a Quarter Pounder. Canadians have little useful advice to offer the Americans, and Bostonians need not visit Nashville unless they’re hungry for country music or hot chicken. Burgers cost different amounts in different places because cost conditions differ. Unless McDonald’s is willing to offer inferior food and service in America, American burgers will continue costing more than Canadian burgers. The same for Boston and Nashville.

Similarly, health care costs more in America than in Canada because cost conditions differ. Consider physician salaries. 2008 data showed primary care physicians (family doctors, internists, obstetrician/gynecologists, and so forth) earning $186,582 in America — 50 percent more than Canada’s $125,000 average. Numerous factors underlie this difference, but an important one is the difference in opportunities in the two countries. Canadian doctors accept $125,000 per year because alternative opportunities for highly intelligent, highly motivated individuals are more limited in Canada than in America. Offer physicians $125,000 in the United States, and would-be medical students may choose careers in law, finance or information technology instead.

The differences become even more acute for specialty physicians. The same study showed orthopedic surgeons earning $442,450 in America — 113 percent more than their Canadian colleagues, who earned only $208,000.

There are many things wrong with America’s health care sector and many ways Americans could get more care and better health for the dollars they spend. But asking “Why can’t we be more like Canada?” leads nowhere useful and distracts us from practical, productive innovations such as telemedicine or enabling nurses, intelligent machines, and patients to do what currently requires high-priced physician labor.

ABOUT THE WRITER

Robert Graboyes is a senior research fellow with the Mercatus Center at George Mason University, where he focuses on technological innovation in health care. He is the author of “Fortress and Frontier in American Health Care” and has taught health economics at five universities. He wrote this for InsideSources.com.

The Conversation

What will happen to Michael Jackson’s legacy? A famed writer’s fall could offer clues

March 14, 2019

Author: Rachel Hope Cleves, Professor of History, University of Victoria

Disclosure statement: Rachel Hope Cleves receives funding from the Social Science and Humanities Research Council of Canada.

There’s no question that Michael Jackson changed music history. But how will history remember Michael Jackson?

Since HBO released the new documentary film “Leaving Neverland,” which detailed allegations by two adults who say that they were molested by Jackson as children, the musician’s legacy – already complicated – is up in the air.

Jackson is not the first notable artist to be accused of sexually abusing children. Some, like Roman Polanski and Woody Allen, are still living and producing art that provokes discussion.

But there are other alleged child abusers who have died and whose works, once considered great, have faded into obscurity, in no small part because it is almost impossible to memorialize them without creating the impression of condoning their behavior.

The writer Norman Douglas is a prime example. The subject of a biography I’m working on, Douglas had a reputation for molesting children. After his death, he became an off-limits topic for biographers, and while he had his defenders, he ultimately couldn’t escape historical erasure.

Rumors do little to dim a budding star

During the first half of the 20th century, Norman Douglas was a literary star. Friends with Joseph Conrad, D.H. Lawrence and Aldous Huxley, he was best known for his bestselling 1917 novel “South Wind.”

Virginia Woolf sang its praises in the Times Literary Supplement. Graham Greene recalled how his generation “was brought up on South Wind.” When the hero of Evelyn Waugh’s “Brideshead Revisited” arrives at Oxford after World War I, he brings with him only two novels, “South Wind” and Compton Mackenzie’s “Sinister Street.”

But today Douglas is entirely forgotten.

The reasons why artists’ works go forgotten vary. In Douglas’ case, it’s fair to say that his erudite writing style went out of fashion.

But there’s more to the story. During his lifetime, Douglas was notorious for his relationships with children. In 1912, he lived with a 14-year-old boy in London while he was working at The English Review. Four years later, he was arrested in London for acts of gross indecency with a 16-year-old. After his release on bail, Douglas fled to Italy, where laws regulating sex between men and boys were more lax. He settled in Florence, where his celebrity only grew.

Visitors to the city, like Huxley and Lawrence, would seek him out in the city’s cafés. The radical journalist and heiress Nancy Cunard, who met Douglas in Florence in 1923 and became a close friend, recalled the “aureole of legend” that surrounded him.

Douglas was always attended to by Italian boys who worked for him as messengers or cooks, and endless rumors circulated about Douglas’ relationships with these boys. A diary entry written by a friend of Douglas’ described how Douglas performed fellatio on a boy named Marcello. Brothers Sacheverell and Osbert Sitwell warned Cunard that Douglas was dangerous. D.H. Lawrence’s widow, Frieda, told her friend Dudley Nichols that Douglas was “the only wicked man I have known, in a medieval sense.”

Scrutiny grows

Britain’s strict libel laws, the norms of politeness and the power of Douglas’ celebrity seemed to prevent people from writing publicly about his sexual relationships with boys while he was alive.

But you can’t libel the dead.

When Douglas died in 1952, debate about his memory erupted in the press. The first signs of the battle to come appeared in the obituaries. British diplomat Harold Nicolson noted Douglas’ shocking “indulgences” in a death notice for The Spectator.

Nicolson’s article prompted 50 or 60 letters of protest from Douglas’ friends, but there was no holding back the tide. In 1954, Douglas’ former friend Richard Aldington published a book of vicious recollections about the writer titled “Pinorman,” a portmanteau of Norman and his friend Pino Orioli. Aldington didn’t mince words. He called Douglas a pederast whose path in life was “strewn with broken boys and empty bottles.”

Douglas’ friends were outraged. Cunard wrote to Aldington’s publisher accusing him of libel and threatening to wage a “collective protest.” She rallied Douglas’ friends to lambaste the book in reviews. Her own review for the periodical Time and Tide was titled “Bonbons of Gall.” Graham Greene wrote to a friend that he intended to “kill” Aldington’s book, and he penned a review for The London Magazine that was so incendiary it could not be published for fear of libel charges from Aldington, who was very much alive.

Greene maliciously sent Aldington the review and asked for permission to publish it. Naturally, Aldington refused and reached out to friends for help putting together a pamphlet attacking Douglas’ defenders. Frieda Lawrence contributed a story about how Douglas once casually offered her a boy of 14, saying that he preferred them younger. But the pamphlet was so intemperate that a lawyer said it would run afoul of the libel laws and could not be published.

The danger of choosing to forget?

Aldington was forced to retreat. With “Pinorman” disparaged by its reviewers, Aldington was discredited. It seemed that Douglas’ friends had won the battle.

But Aldington won the war. The truth was out there, and Douglas’ reputation was permanently injured.

In the decades that followed many would-be biographers tried their hand at writing Douglas’ story; time and again they failed. Douglas simply could not be remembered as a great writer in the face of the allegations against him. Only one comprehensive biography, titled “Norman Douglas,” has ever been published about him. It came out in 1976, during a rare moment of sexual openness; even so, the publisher almost nixed the manuscript after 10 years of work by its author, Mark Holloway.

Today Douglas is a forgotten writer. When the truth about his sexual relations with children was fully exposed after his death he became an impossible figure to memorialize.

Over time, it’s likely that Michael Jackson’s memory will be similarly eroded. The television show “The Simpsons” has already pulled its 1991 episode featuring Jackson. His name will likely be taken down from public monuments. People will be hesitant to produce new versions of his music. His influence will live on, but it will be difficult to commemorate his work.

Perhaps that is for the best. But maybe it isn’t.

Reluctance to preserve the memory of the extensive history of sex between adults and children leaves society ill-equipped to recognize and handle child sexual abuse today. A culture that is caught up in narratives that identify pedophiles as monsters has a hard time recognizing when beloved figures, like Michael Jackson, are molesting children right before its eyes.

There is need for history to remember abusers and to remember them in all their complexity. If Jackson’s memory is preserved, maybe it will be easier to see the present more clearly.

2020 Democratic presidential candidate Sen. Bernie Sanders, left, meets with Sarah Bass of Boone, after a rally, Saturday, March 9, 2019, at the Iowa state fairgrounds in Des Moines, Iowa. (AP Photo/Matthew Putney)

FILE- In this Jan. 16, 2019, file photo Julian Castro, former U.S. Secretary of Housing and Urban Development and candidate for the 2020 Democratic presidential nomination, speaks to the media at Saint Anselm College in Manchester, N.H. Castro isn’t ruling out direct payments to African-Americans for the legacy of slavery, a stand separating him from his 2020 rivals. The former housing secretary says, “If under the Constitution we compensate people because we take their property, why wouldn’t you compensate people who actually were property.’’ (AP Photo/Mary Schwalm, File)

Democratic presidential candidate Sen. Elizabeth Warren, D-Mass., speaks to local residents Friday, March 8, 2019, in the Queens borough of New York. (AP Photo/Frank Franklin II)



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