First Edition: January 16, 2019

Kaiser Health News: GoFundMe CEO: ‘Gigantic Gaps’ In Health System Showing Up In Crowdfunding
Scrolling through the GoFundMe website reveals seemingly an endless number of people who need help or community support. A common theme: the cost of health care. It didn’t start out this way. Back in 2010, when the crowdfunding website began, it suggested fundraisers for “ideas and dreams,” “wedding donations and honeymoon registry” or “special occasions.” A spokeswoman said the bulk of collection efforts from the first year were “related to charities and foundations.” A category for medical needs existed, but it was farther down the list. (Bluth, 1/16)

Kaiser Health News: Patients Turn To GoFundMe When Money And Hope Run Out
Tammy Fox wanted to help after a friend took ill with a rare and difficult-to-diagnose autoimmune disorder that required many trips to the Mayo Clinic. Although Fox couldn’t do anything medically, she knew there was a way to ease some of the burden of medical bills and costs associated with doctor visits. She turned to the website GoFundMe and set up a site for her friend.“You’ve got meals; you’ve got hotel stays,” she said. “And gas. So that all needed to be covered.” (Zdechlik, 1/16)

The Washington Post: FDA Restarts Some Food, Drug Inspections Halted By Shutdown
Hundreds of Food and Drug Administration inspectors and other staff resumed work Tuesday, focusing on facilities that produce higher-risk foods, drugs and devices, according to the agency’s commissioner. Those workers, who had been furloughed because of the government’s partial shutdown, remain unpaid, said FDA Commissioner Scott Gottlieb, who discussed the move in tweets and a subsequent interview. About 150 of the returning workers are in food safety. Most are inspectors but some work in laboratories and other areas, Gottlieb said. As many as 250 more employees will be resuming work inspecting drugs and devices. (McGinley, 1/15)

The Washington Post: U.S. Lettuce Industry, Wary Of E. Coli, Wants FDA Back On The Job
It’s the peak of the leafy greens growing season in Yuma, Ariz., where irrigated valleys are lush and verdant amid cactus-covered mountains. This is America’s Salad Paradise, which produces most of the fall and winter lettuce consumed in the United States. Locals credit excellent soil, preposterously abundant sunshine and a steady supply of labor, thanks to Mexicans with work visas who cross the border checkpoint and ride buses to the fields. (Achenbach, 1/15)

The Washington Post: Tribes Face Food And Medicine Crisis As Shutdown Continues, Lawmakers Are Told
As the partial government shutdown drags on, Native American tribes in urban and rural areas are facing food shortages and a health care crisis because federal funds that stock pantries and provide medicine for diabetes and opioid addiction have been cut off, witnesses told a House committee Tuesday. In addition to the shutdown’s impact on indigenous people, citizen observers at national parks are reporting poaching of wild game such as deer, garbage piled high and trees that have been illegally cut as most park workers remain on furlough, former Interior officials who appeared before the committee said. (Fears, 1/15)

Politico: States Warn Food Stamp Recipients To Budget Early Benefit Payments Due To Shutdown
State agencies are warning food stamp recipients to carefully budget their grocery purchases once they receive their February benefits weeks earlier than normal due to the partial government shutdown. The Department of Agriculture's backup plan for paying out Supplemental Nutrition Assistance Program benefits amid the lapse in funding means it could be 40 days — or longer, in some cases — before additional money is added to recipients' benefit cards. There is also no guarantee about when nearly 39 million low-income Americans will next receive another payment to help them buy groceries. (Bottemiller Evich, 1/15)

The Washington Post: Trump Administration Calling Nearly 50,000 Back To Work, Unpaid, As Shutdown Drags On
The Trump administration on Tuesday said it has called back tens of thousands of federal workers to fulfill key government tasks, including disbursing tax refunds, overseeing flight safety and inspecting the nation’s food and drug supply, as it seeks to blunt the impact of the longest government shutdown in U.S. history. The nearly 50,000 furloughed federal employees are being brought back to work without pay — part of a group of about 800,000 federal workers who are not receiving paychecks during the shutdown, which is affecting dozens of federal agencies large and small. (Werner, 1/15)

The New York Times: Sacklers Directed Efforts To Mislead Public About OxyContin, New Documents Indicate
Members of the Sackler family, which owns the company that makes OxyContin, directed years of efforts to mislead doctors and patients about the dangers of the powerful opioid painkiller, a court filing citing previously undisclosed documents contends. (Meier, 1/15)

The Wall Street Journal: Purdue Pharma Family Had Heavy Hand In Opioid Marketing, Complaint Says
The complaint, using information culled from company emails, presentations and handwritten notes, suggests Richard Sackler and other Sackler family members at times influenced the marketing of the company’s opioids, including its signature drug OxyContin. Those actions include Sackler family members poring over detailed sales reports, pressing its sales force to improve numbers and even attending sales pitches themselves, according to the complaint. Company staff informed the Sacklers about opioid-related deaths and other addiction issues, the complaint says, as well as doctors prescribing pills inappropriately. (Randazzo and Hopkins, 1/15)

The Associated Press: Filing: OxyContin Maker Forecast 'Blizzard Of Prescriptions'
The details were made public in a case brought by Massachusetts Attorney General Maura Healey that accuses Purdue Pharma, its executives and members of the Sackler family of deceiving patients and doctors about the risks of opioids and pushing prescribers to keep patients on the drug longer. The documents provide information about former Purdue Pharma President Richard Sackler's role in overseeing sales of OxyContin that hasn't been public before. The drug and the closely held Connecticut company that sells it are at the center of a lawsuit in Massachusetts and hundreds of others across the country in which government entities are trying to find the drug industry responsible for an opioid crisis that killed 72,000 Americans in 2017. The Massachusetts litigation is separate from some 1,500 federal lawsuits filed by governments being overseen by a judge in Cleveland. (Richer and Mulvihill, 1/15)

The Associated Press: Kentucky Residents Again Seek To Block New Medicaid Rules
Sixteen Kentucky residents have again asked a federal judge to block new eligibility requirements for Medicaid, but the partial federal government shutdown could delay a decision until after the new rules take effect. Republican Gov. Matt Bevin is trying to change Kentucky's Medicaid rules so some people would have to pay premiums and either get a job, go to school or do volunteer work to keep their health coverage. President Donald Trump's administration gave him permission last year to do it, but a federal judge blocked the rules in June before they could take effect. (Beam, 1/15)

The Hill: Trump Administration Sued Over New Kentucky Medicaid Work Requirements
The lawsuit comes after a federal judge in June blocked Kentucky’s efforts to impose work requirements and premiums on beneficiaries days before the waiver was set to go into effect. “The Secretary is working to effectively rewrite the Medicaid statute, ignoring congressional restrictions, overturning a half century of administrative practice, and threatening irreparable harm to the health and welfare of the poorest and most vulnerable in our country,” the complaint says. A federal judge ruled in June 2018 that Kentucky’s effort to add work requirements to the state’s Medicaid program was “arbitrary and capricious.” (Weixel, 1/15)

The Wall Street Journal: Lawsuits Challenge Rules Limiting Who Can Perform Abortions
Abortion-rights activists concerned about the shrinking number of abortion providers are mounting court challenges to longstanding state laws that forbid anybody but doctors to perform the procedure. Lawsuits pending in at least nine states are seeking to strike down statutes that make it a crime for clinicians such as highly trained nurses and midwives to provide early-term abortions. Taken together, the cases represent the strongest push by abortion-rights groups to build upon a recent Supreme Court decision that put more of a burden on states to justify the medical benefit of abortion regulations limiting women’s access. (Gershman, 1/15)

The Hill: Democrats Vow To Lift Ban On Federal Funds For Abortions
House Democrats on Tuesday vowed to repeal a ban on the use of federal funds for abortions. While a repeal of the long-standing ban is unlikely with Republican control of the Senate, the move indicates the direction Democrats want to go should they gain control of the upper chamber in 2020.  (Hellmann, 1/15)

The Associated Press: No-Cost Birth Control, Now The Norm, Faces Court Challenges
Millions of American women are receiving birth control at no cost to them through workplace health plans, the result of the Obama-era Affordable Care Act, which expanded access to contraception. The Trump administration sought to allow more employers to opt out because of religious or moral objections. But its plans were put on hold by two federal judges, one in Pennsylvania and the other in California, in cases that could eventually reach the Supreme Court. (1/15)

The Hill: Dem Chairman Cummings Meets With Trump Health Chief To Discuss Drug Prices 
House Oversight Committee Chairman Elijah Cummings (D-Md.) met with Secretary of Health and Human Services Alex Azar on Tuesday to discuss bipartisan ways to work together to lower drug prices. “He pledged that he wants to work with me,” Cummings told reporters after the meeting. “We have similar goals but the main goal is bringing down the price of drugs. We agreed that we would do everything we could to work together.” (Sullivan, 1/15)

The Hill: House Dems Fire First Salvo In Drug Pricing Fight 
House Democrats this week fired a shot across the bow of the nation’s pharmaceutical companies as they begin a long-anticipated effort to cut down on high drug prices. The House Oversight and Reform Committee launched a sweeping investigation into how the industry sets its prices, in what is being seen as one of the broadest drug pricing investigations in decades. (Weixel, 1/16)

The Washington Post Fact Checker: Can Trump Claim Credit For $26 Billion In Savings On Prescription Drugs?
Trump wrote: “During the first 19 months of my Administration, Americans saved $26 Billion on prescription drugs.” He pulled this number from a report issued in October by his Council of Economic Advisers (CEA), which found that “relative annual price growth for prescription drugs has slowed since January 2017.” That means prices are still going up but at a lower rate than before. The report includes a chart with a trend line of expected prices, based on the second half of President Barack Obama’s term. That happened to be a period with sharp spikes in prescription drug prices, especially because of new drugs to deal with hepatitis C. (Kessler, 1/16)

Modern Healthcare: Fragile Pharmaceutical Supply Chain Increases Costs, Compromises Care 
The increasing frequency of drug shortages has injected some complexity into how Ochsner Health Systems manages supply scarcities. It has pharmacy experts across the system that are constantly calling wholesalers and suppliers to get a hint of what drug may soon be in short supply. Ochsner has a phone call twice a week with its pharmacy, supply chain, chief nursing and chief operating officers to identify the next problem, said Dr. Robert Hart, executive vice president and chief medical officer for Ochsner Health System. (Kacik, 1/15)

Stat: Shifting Part B Drugs To Part D Would Hurt Most Beneficiaries, Analysis Says
One of the many proposals the Trump administration is kicking around in order to lower drug costs would shift coverage of some medicines from Medicare Part B to Part D, which is administered by private managed care plans. A new analysis, however, cautions that while government spending might be reduced, the proposal may also increase out-of-pocket costs for some beneficiaries. (Silverman, 1/15)

Stat: Allergan And A Mohawk Tribe Ask The Supreme Court To Review Patent Deal 
After being rebuffed by a federal appeals court last summer, Allergan (AGN) and the St. Regis Mohawk Tribe have asked the U.S. Supreme Court to decide a vexing question that was at the heart of a controversial maneuver to protect a best-selling eye medicine. Their petition has its roots in events that began in the fall of 2017, when the drug maker transferred six patents to its Restasis treatment, which was on track to generate $1.4 billion in sales, to the Mohawk tribe in hopes of thwarting generic competition. At the time, Allergan was facing a conventional patent challenge from several erstwhile generic rivals in a federal court. (Silverman, 1/15)

Reuters: Drug Companies Greet 2019 With U.S. Price Hikes
Drugmakers kicked off 2019 with price increases in the United States on more than 250 prescription drugs, including the world's top-selling medicine, Humira, although the pace of price hikes was slower than last year. The industry has been under pressure by the U.S. President Donald Trump to hold their prices level as his administration works on plans aimed at lowering the costs of medications for consumers in the world's most expensive pharmaceutical market. (1/15)

NPR: Veterans Claiming Illness From Burn Pits Lose Court Fight
A decade-long fight ended at the Supreme Court this week, when justices refused to hear an appeal by veterans of Iraq and Afghanistan who say that toxic smoke from burn pits made them sick. Hundreds of those veterans had sued the military contracting giant KBR, Inc., but lost first in U.S. district court and then again last year in the U.S. Court of Appeals for the 4th Circuit. The 4th Circuit said KBR was under U.S. military direction when it burned tires and medical waste next to soldiers' barracks, and can't be held liable. (Lawrence, 1/16)

Fox News: Supreme Court Upholds Appellate Decision On Burn Pit Lawsuits
The lawsuits charged that military contractor Kellogg, Brown, and Root (KBR) dumped tires, batteries, medical waste, and other materials into open burn pits. The suits claimed the resulting smoke caused neurological problems, cancers, and other health issues in more than 800 service members. The complaints said at least 12 service members died. The original appeals court decision in December 2018 stated that KBR, which was formerly owned by Halliburton Corp., was under military control and had little discretion in deciding how to manage the waste on numerous military bases. KBR's attorney said the decision to use burn pits "was made by the military." (Chiaramonte, 1/15)

Modern Healthcare: New VA Community Care Program Regs Stall At OMB Over Cost
The Veterans Affairs Department's newly expanded and consolidated private healthcare network for veterans could cost billions more than Congress projected when it passed the VA Mission Act. This potentially major extra cost of $5 billion to $8 billion comes with the not-yet-finalized and not-yet-public draft regulations that will likely shape the VA's community health program into a model similar to TriCare Prime, according to sources familiar to talks. TriCare Prime is the managed-care HMO plan for active service military that pays drastically low rates for treatment in private clinics and hospitals but also offers care in military health facilities. (Luthi, 1/15)

The Associated Press: Senators Ask FDA To Update Rules On Certain Pot Products
Oregon's two senators on Tuesday urged the head of the U.S. Food and Drug Administration to update federal regulations to permit interstate commerce of food products containing a key non-psychoactive ingredient of cannabis. The appeal by Sens. Ron Wyden and Jeff Merkley came after Congress legalized the production and sale of industrial hemp and hemp derivatives, including cannabidiols, known as CBD. Wyden and Merkley had been behind a hemp provision that Congress passed and was included in the 2018 Farm Bill. (1/15)

Reuters: Walmart Opts To Leave CVS Partnerships Over Pricing Dispute
CVS Health Corp said on Tuesday Walmart Inc is leaving its network for commercial and Medicaid prescription drug plans after the two companies failed to agree on pricing. CVS said the dispute would not impact Walmart's presence in its Medicare Part D pharmacy network, which according to Cowen & Co analyst Charles Rhyee was a bright spot as it represented a larger chunk of CVS' scripts. (Banerjee and Joseph, 1/15)

The Washington Post: Walmart Drops CVS Pharmacy Coverage In Price Dispute
Walmart confirmed its exit from the CVS Health pharmacy insurance program, called CVS Caremark, after CVS refused the retail giant’s demand for larger reimbursements for the prescription drugs it dispenses. The move affects Walmart customers with CVS Caremark pharmacy coverage through employer-sponsored insurance and state Medicaid managed-care plans. It does not affect Medicare beneficiaries. It also does not affect pharmacies at Sam’s Club stores. (Rowland, 1/15)

The Wall Street Journal: Walmart Could Leave CVS Caremark Pharmacy Networks Amid Dispute
Negotiations over rates reached a boiling point last week when Walmart sent a contract termination letter to CVS, according to people familiar with the situation. Walmart continued to negotiate with CVS as recently as last Friday, said one of these people. Walmart aims to continue discussions with CVS Caremark and is “trying to find a solution that benefits all parties,” said a spokeswoman for the retailer. “We are committed to providing value to our customers across our business, including our pharmacy, but we don’t want to give that value to the middleman. ... Walmart is standing up to CVS’s behaviors that are putting pressure on pharmacies and disrupting patient care.” (Wilde Mathews and Nassauer, 1/15)

Stat: Microsoft And Walgreens Pair Up To Deliver Digital Health Care 
The impact of the seven-year partnership, announced Tuesday, remains to be seen, but it represents another attempt by a large provider of health care services to increase the use of technology to deliver medicines and medical advice. The world’s largest technology companies, including Apple, Amazon, and Google, are making aggressive forays into health care, both through partnerships with providers and the development of their own health care businesses. (Ross, 1/15)

Reuters: UnitedHealth Profit Beats Expectations, Shares Rise
UnitedHealth Group Inc, the largest U.S. health insurer, beat Wall Street estimates for fourth-quarter profit on Tuesday, driven largely by growth in its Optum services business, including its pharmacy benefits unit. UnitedHealth maintained its previous profit forecast for 2019 adjusted earnings of $14.40 to $14.70 per share, and said higher than expected medical costs in the fourth quarter were limited to states for which it manages their Medicaid benefits, the government program for low income Americans. (Mathias and Humer, 1/15)

The Wall Street Journal: UnitedHealth Sales Rise Across Segments
Revenue increased 12% from a year earlier to $58.42 billion. Analysts polled by Refinitiv were expecting sales of $58.01 billion. Revenue at the UnitedHealthcare segment rose 11% to $46.2 billion, while sales at the Optum segment increased 13% to 27.6 billion. The parent of the nation’s largest health insurer said net earnings fell 16% to $3.04 billion, or $3.10 a share. Analysts had expected the company to earn $3.05 a share. (Chin and Mathews, 1/15)

The New York Times: Eliminating Dental Woes Without Worrisome Debt
Zaps of pain, like tiny shocks, bombarded her head. Susann Davis assumed it was a migraine, a seemingly minor annoyance when stacked against the crises she already faced. In 2016, Ms. Davis lost her job in the hospitality industry. Soon after, she was diagnosed with stomach cancer. Then she learned she was being evicted from her apartment. Luckily, Ms. Davis said in a recent interview, while early into unemployment she had consulted a friend, Katherine Earle, a Community Health Advocates counselor. Ms. Earle had helped her sign up for Medicaid. (Otis, 1/15)

The Washington Post: Fentanyl Overdose: Michigan Toddler Died After Ingesting Parents' Drugs
A toddler in Michigan died after ingesting an “extraordinary level” of fentanyl, a synthetic opioid that is far more potent than heroin, authorities say. Ava Floyd, 18 months old, died on Christmas Day. The prosecutor’s office in the Detroit suburb of Macomb County said the child’s parents had been producing and packing fentanyl in their home and she ingested the narcotic. Antonio Floyd, 28, and Shantanice Barksdale, 27, were charged Monday with second-degree murder, manslaughter, second-degree child abuse, and delivering or manufacturing a controlled substance, among other charges. (Phillips, 1/15)

The Washington Post: Maryland Lawmaker Mike McKay Wants To Use A Mobile Phone App To Protect Babies Born To Drug Addicts
Elizabeth Stahlman was on maternity leave in 2016 when she heard about a Pennsylvania infant who died of starvation days after both of the baby’s parents fatally overdosed on opioids. If only someone had checked in, she thought, the child — from a town about an hour from her home in rural Western Maryland — may have lived. What if someone had been monitoring? After she returned to her job as a community development director for the city of Frostburg, Stahlman began working with Del. Michael W. McKay (R-Allegany) on legislation for a mobile app to help social-service officials verify whether parents with a history of drug addiction can safely care for their newborns. (Hernandez, 1/15)

The Wall Street Journal: For Children With Cancer, Hope For New Treatments
The health-care industry is preparing for a new law that researchers say will mean more treatments for pediatric cancers, which are the leading cause of death from disease among children. The legislation, which requires pharmaceuticals companies to test potential cancer drugs on children as well as adults, goes into effect in 2020. Companies already are ramping up and some plan children’s drug trials this year. (Lagnado, 1/15)

Stat: After 37 Years, This Biotech Nears A First Drug Approval In Breast Cancer
Immunomedics (IMMU) was founded in 1982. Thirty-seven years later, the biotech is finally on the cusp of its first marketing approval — possibly ending one of the longest drug-development droughts in the industry’s history. On Friday, the Food and Drug Administration is expected to render an approval decision on sacituzumab govitecan, an antibody drug conjugate developed by Immunomedics to treat women with triple-negative breast cancer. As its name implies, these breast cancer cells do not carry receptors for estrogen, progesterone, or human epidermal growth factor, which are targeted by such drugs as Herceptin or tamoxifen. (Feuerstein, 1/16)

Los Angeles Times: Preventing Breast Cancer Just Got Easier. Will More Women Give These Drugs A Try?
Breast cancer will strike 1 in 8 women in her lifetime. But women who face an increased risk of being that one unlucky patient may improve their chances with three prescription medications, according to a new report. If 1,000 women took one of the three medications for roughly five years, somewhere between seven and 18 breast cancers could be prevented, and possibly more. But each of the drugs — two originally used to treat breast cancer and a third that prevents the bone-thinning disease osteoporosis — comes with the possibility of serious side effects, including blood clots and a higher likelihood of uterine or endometrial cancer. (Healy, 1/15)

CNN: Killings Of Transgender People In The US Saw Another High Year
For decades, every year she's been active in the transgender community, Isa Noyola has attended a funeral for a friend. As deputy director at the Transgender Law Center based in Oakland, California, she has met many community members who have the same experience. "Death, profound loss, the violence that surrounds us, it's constant. It's a significant part of my transgender experience." (Christensen, 1/16)

The New York Times: Finding Open-Minded Health Care Abroad
Lola Méndez is no stranger to new experiences. Ms. Méndez. 29, an American freelance travel writer, has explored 56 countries, documenting her adventures on her blog. She has visited ancient tombs in Vietnam and trekked across mountains in Chiang Mai, Thailand. While working as an English teacher in Spain in 2015, she had to embark on a new kind of undertaking: going to the gynecologist in a foreign country. Many women don’t look forward to their yearly exam, and language barriers made an awkward situation all the more unnerving for Ms. Méndez. But her appointment soon went from uncomfortable to degrading. (McHugh, 1/16)

The New York Times: How Exercise May Help Keep Our Memory Sharp
A hormone that is released during exercise may improve brain health and lessen the damage and memory loss that occur during dementia, a new study finds. The study, which was published this month in Nature Medicine, involved mice, but its findings could help to explain how, at a molecular level, exercise protects our brains and possibly preserves memory and thinking skills, even in people whose pasts are fading. (Reynolds, 1/16)

The New York Times: Opposed To G.M.O.S? How Much Do You Know About Them?
Most scientists agree that genetically modified organisms, or G.M.O.s, are safe to eat. But a new study suggests that the people who are most extremely opposed to them know the least about them. Researchers surveyed 501 randomly selected adults, testing their knowledge of G.M.O.s with a series of true/false questions — for example, the cloning of living things produces genetically identical copies (true), or it is not possible to transfer animal genes into plants (false). (Bakalar, 1/15)

The Associated Press: Hospital Replaces Leadership After Blood Transfusion Mistake
A Houston hospital has removed its president and several other leaders following an unusually high number of patient deaths, a loss of some federal funding and a recent case in which a patient died after receiving a transfusion of the wrong blood type. Baylor St. Luke's Medical Center announced the decision to replace its president, Gay Nord, its chief nursing officer and a top physician on Monday, the Houston Chronicle reported. The departures come after investigative reports by the newspaper and ProPublica last year revealed a high rate of patient deaths within the hospital's renowned heart transplant program, as well as major complications after heart bypass surgery and repeated complaints about inadequate nursing. (1/15)

The Associated Press: New Maryland Gun Law Used In 5 Cases Involving Schools
A new Maryland law that allows courts to temporarily restrict firearms access for people at risk to themselves or others resulted in more than 300 protective orders, five of which were related to schools, the sheriff of the state's most populous county told lawmakers Tuesday. Montgomery County Sheriff Darren Popkin told a panel of state lawmakers that 302 orders were sought under the state's "red flag" law in the first three months since the law took effect Oct. 1. He said five of them related to schools, and four of those five "were significant threats." (1/15)

The Washington Post: How Well Is Maryland's Red-Flag Gun Law Working?
Montgomery County Sheriff Darren M. Popkin (D), who has helped train police officers across the state about the “red-flag” law, said he could not provide details about the gun seizures — including those that could have led to school shootings — because of a confidentiality rule. But, Popkin told the House Judiciary Committee, “these orders . . . are saving lives.” Maryland is one of at least nine states, including California, Connecticut and Delaware, that allow a relative, spouse, legal guardian or roommate to seek a court order to keep a person from possessing a gun. (Wiggins, 1/15)

The Associated Press: Hospital: Doc Gave Near-Death Patients Excessive Pain Meds
An intensive care doctor ordered "significantly excessive and potentially fatal" doses of pain medicine for at least 27 near-death patients in the past few years after families asked that lifesaving measures be stopped, an Ohio hospital system announced after being sued by a family alleging an improper dose of fentanyl actively hastened the death of one of those patients. (1/15)

The Associated Press: OKC School District Approves The Use Of Medical Marijuana
Students in the Oklahoma City school district with medical conditions that require cannabis are now permitted to use the drug at school. The Oklahoma City Public Schools board voted to approve the policy Monday night, The Oklahoman reported. The district will provide a place for a guardian to administer medical marijuana to students at school. (1/15)