Trump Administration Proposes Allowing Drug Imports for Cheaper Prescriptions

The Trump administration said on Wednesday that it was taking steps to make it easier for less expensive prescription drugs to be imported from other countries, particularly Canada, a move that has long been supported by progressives but has encountered fierce opposition from the pharmaceutical industry.

Under the plan, the administration said it would propose a rule to permit pilot programs developed by states, pharmacies or drug distributors that sought to safely import prescription medications from Canada. The Food and Drug Administration also planned to advise manufacturers for how they could import high-priced drugs like insulin that are sold more cheaply in other countries.

“President Trump has been clear: For too long American patients have been paying exorbitantly high prices for prescription drugs that are made available to other countries at lower prices,” Alex M. Azar II, the secretary of health and human services, said in a statement released Wednesday.

Although the announcement signaled a major policy shift because Democratic and Republican administrations have generally opposed importing drugs from overseas, the proposal was also limited in nature. The proposed rule would not apply to high-priced drugs like insulin or biologic drugs like Humira, because of exceptions included in earlier legislation. And the F.D.A. guidance would only permit importation of drugs, including insulin, if the drug makers agreed to take part in the plan.

Democrats and Republicans in Congress have been debating legislation that would allow importation of drugs to obtain cheaper prices, and other measures to try to rein in costs. But leading members of Congress have said that major proposals won’t be fully prepared before September.

The rising price of prescription drugs has been a popular topic at the Democratic presidential debates, and the timing of the administration’s announcement fell in the middle of the Tuesday-Wednesday schedule of this month’s debates for the Democratic candidates.

On Tuesday night, Senator Bernie Sanders of Vermont, who has long supported the idea, said he traveled to Canada on Sunday with a group of consumers who were buying insulin at what they said was one-tenth the price they usually pay in the United States. Higher prices are being charged by “the crooks who run the pharmaceutical industry in America today,” Mr. Sanders said.

Many other countries are able to negotiate lower prices because their health care systems are run by the government, giving them more leverage. In the United States, private insurers typically negotiate with drug companies on prices. The drug industry has said that the prices overseas are artificially low and that people in those countries often don’t get access to as many new drugs as Americans do.

The new policy is an about-face for Mr. Azar, who like other Republicans has been skeptical about importing drugs from other countries. The idea had also been rejected by previous commissioners of the Food and Drug Administration, including Margaret Hamburg, who raised concerns about importing counterfeit products.

In May 2018, Mr. Azar called the idea a “gimmick” and said: “They are a lovely neighbor to the north, but they’re a small one. Canada simply doesn’t have enough drugs to sell them to us for less money, and drug companies won’t sell Canada or Europe more just to have them imported here.”

But over the past year, the tone has shifted as Republican state leaders have joined Democrats in talking about importing drugs from Canada. The Florida governor, Ron DeSantis, has said he wants to be able to do so, and in May Mr. Trump directed Mr. Azar to help make it happen. Vermont also has a law allowing importation although it has not gotten federal approval.

Canadian officials have warned the United States government that importation programs could jeopardize their own supply of drugs, leading to potential shortages, according to a Reuters report this month. Others have said drug companies could limit their supplies to those countries or raise their prices in response to any new American policy.

Mr. Trump has railed against the idea that many countries pay less for drugs than in the United States, calling it a form of “global freeloading” because many treatments sold overseas were developed by American companies.

In July, Mr. Trump said he was planning an executive order, a “favored-nation clause,” which would allow the United States to pay whatever the lowest price is in other countries. But his comments were vague, and it was unclear whether he was referring to a more limited pilot program being proposed by his administration that would apply only to a small subset of drugs administered by doctors and in clinics. There were also questions about how far any executive order could go without congressional legislation.

Several of Mr. Trump’s other proposals to lower drug prices have faltered recently, including efforts to force drug companies to list their prices on TV ads.

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Ryanair threatens job cuts with 900 workers at risk including pilots

RYANAIR said reports that it was "at risk" of axing 1,500 jobs is false – and that 900 staff members jobs were at risk instead.

This includes pilots and flight attendants who work for the budget airline.

 Up to 900 Ryanair crew could be at risk of losing their job

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Up to 900 Ryanair crew could be at risk of losing their jobCredit: AFP

A leaked internal video, revealed by Bloomberg saw Ryanair CEO Michael O'Leary claim the low-cost carrier had an excess of "500 pilots and 400 flight attendants".

It also claimed that another 600 people would fall into those risk position next year.

He made the comments in an internal video to staff following the release on Monday of financial results for the three months to June 30, saying job cuts would take place at around the end of September and again after Christmas.

However, a spokesperson has claimed that this is not true.

Ryanair customer has showdown with police onboard airline

A Ryanair spokesperson told Sun Online Travel that "900 current staff could be impacted" but that the number of 1,500 jobs at risk was "falsely reported".

Ryanair currently employs approximately 5,000 pilots and 9,000 flight attendants, according to the Bloomberg report.

It isn't the only cuts the airline is making – a number of routes will stop and bases will be closed following the grounding of the Boeing 737 Max jets.

With just 30 of the 58 aircraft ordered being delivered to Ryanair next summer, this mean five million less seats and could result in more expensive fares.

 Ryanair passengers could face strike action later this month

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Ryanair passengers could face strike action later this monthCredit: Getty – Contributor

The affected routes and bases is yet to be confirmed.

Passengers travelling with Ryanair this summer could face disruptions as crew announce their intent to strike.

The airline's cabin crew in Portugal have announced a series of strikes, just after the unions for its UK and Irish pilots said they were voting on industrial action.

Ryanair cabin crew in Portugal are set to strike for five days in August in a dispute over pay and conditions, the SNPVAC union said on Wednesday.

However, the exact dates have not been confirmed yet.

Put your phone on airplane mode during flights or get charged hundreds of pounds

YOU could be faced with a rather steep bill when you return from a holiday if you forget to put your phone on airplane mode during a flight.

Passengers who forget to turn the feature on have found hundreds of pounds added to their monthly phone bill.

 You could face a steep bill if you don't put your phone on plane mode during a flight

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You could face a steep bill if you don't put your phone on plane mode during a flightCredit: Getty – Contributor

According to the Financial Review, one young traveller found himself $300 (£245) out of pocket when he forgot to turn on flight mode during an Aer Lingus flight.

After putting his phone in the overheard compartment, he didn't realise he had not turned off signal and roaming.

It then connected to the plane's in-flight network Aeromobile, which the provider explained was due to the "antennas installed on the plane".

An Aer Lingus spokesperson told Financial Review that crew "advise" passengers to put their phones on airplane mode as it could "connect to the in-flight roaming network and the guest will be billed by their home operator for any usage".

PLANE SILLY Delta flight attendant kicks off EIGHT passengers after one gives ‘attitude’ about putting phone on airplane mode

Aeromobile is used on a number of carriers including Virgin Atlantic, Emirates and Lufthansa.

On their website, Virgin Atlantic warns: "The charges are almost the same as they would be if you were roaming from another country.

"The calls and texts will just be added to your mobile bill after you’ve flown."

Emirates also warns on their website that usage during a flight will be "charged by your service provider in line with international roaming rates".

Five passengers are booted from a Delta Air Lines flight after an argument about a woman's phone being on airplane mode

Other passengers have revealed their own horror stories of being charged during a flight without realising.

Twitter user Dave Moreau wrote: "O2 has charged Mrs M £35 for forgetting to put her phone on Aeroplane mode on an Emirates flight.

"It tried to connect in background to in-plane WiFi (it didn’t) and they charged her the connection fee to Norway (we were at 35,000 feet and about 1000 miles from Norway). Watch out!"

Kevin McKinless added: "Confirmed. Do NOT use #data on an @AerLingus flight. You could be charged up to £6 per MB!"

O2 has charged Mrs M £35 for forgetting to put her phone on Aeroplane mode on an Emirates flight. It tried to connect in background to in-plane WiFi (it didn’t) and they charged her the connection fee to Norway (we were at 35,000 feet and about 1000 miles from Norway). Watch out!

— Dave Moreau (@DaveMoreau) July 28, 2019

Confirmed. Do NOT use #data on an @AerLingus flight. You could be charged up to £6 per MB!!! WTF?! I am not happy @O2 and Aer Lingus. As soon as you turn off Aeroplane Mode, sure you load one web page accidentally and that would cost you £18. Please advise. #roaming pic.twitter.com/fcIekSixd5

— Kevin McKinless (@KevinMcKinless) March 26, 2019

Amazed that a @ThreeUKSupport CS rep just told me I could be charged for data use, whilst I’m using an airplanes wifi!? How is that possible when a phone is in flight mode.

— Hannah (@hannahkaty) February 25, 2019

 

He added: "I am not happy @O2 and Aer Lingus. As soon as you turn off Aeroplane Mode, sure you load one web page accidentally and that would cost you £18."

Hannah said: "Amazed that a @ThreeUKSupport CS rep just told me I could be charged for data use, whilst I’m using an airplanes wifi!? How is that possible when a phone is in flight mode."

Passengers who want to avoid being caught out should turn their flight mode on as soon as they board the plane, and leave it on until they land.

If there is free WiFi on board, this can then be used safety without any additional charges.

Otherwise it is advised to keep flight mode on for the duration of the holiday – with Brits being hit with £50 fees for sending just one photograph abroad.

How to avoid roaming charges abroad

To avoid getting a bill in the hundreds, here's how to keep roaming charges to a minimum:

Turn on airplane mode – airplane mode turns off all wireless connections, including your mobile data. Ensure that data roaming is turned off – some iPhone and Android devices have a specific setting where you can turn off data roaming Ask your mobile network to block data roaming – most networks will allow you to put a block on data roaming. Only use your data when you know you're using free WiFi For those who want to use data roaming, many networks offer some kind of package designed to reduce costs.

Rihanna Just Dictated What Colour Lipstick You Should Wear According To Your Star Sign

Rihanna

Getty Images

Whether it’s Mercury in retrograde messing with our mood, basing our Tinder activity on whether our future SO is zodiac compatible, or obsessively reading our daily/monthly/yearly (delete as appropriate ) horoscope, it’s safe to say that our reliance on star signs is pretty committed.

So when queen of creating a #mood and make-up mogul, Rihanna, took to Fenty Beauty to dictate the exact shade of lipstick we should wear depending on our star sign, it’s safe to say we lost it. Like, a lot.

Forever our make-up mission, finding the colour of lipstick that perfectly suits, not only your skin tone, but your complex personality traits as well, is something we’ve been working on for years.

Does a blue-toned red express how loyal I am to my friends and complement my fair skin?

Will a moody purple lipstick pop against my olive skin and say ‘I’m committed to saving £300 a month so I can buy that Dior canvas bag’?

These are the questions.

Thankfully RiRi has done the hard work for us and revealed the ideal shade of Fenty Beauty Mattemoiselle lipstick for every fabulous star sign out there.

For the ‘Loyal Cancer Who Has Hella Moods’, the entrepreneur prescribes a sophisticated oxblood shade called ‘PMS’, whilst the ‘Creative Pisces That Can Be Sweet As Candy Or Lethal Like Venom’ was allocated a bold bubblegum pink colour.

Suitably, Aquarius was given the sea blue ‘Clapback’ shade, Leo – a fiery burnt orange called ‘Saw-C’, and Scorpio the ‘Violet Fury’ lipstick in a statement purple colour.

Scroll through to find your own personal lipstick that matches your unique star sign and serve up some zodiac realness.

Carnival Cruise ship spews black smoke despite pollution fines

A CARNIVAL Cruise ship has been spotted spewing clouds of black smoke from its funnel while docked in the Bahamas.

The two-minute video comes just one month after Carnival was fined millions of pounds for air and water pollution.

 A Carnival cruise ship was caught emitting black smoke while docked

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A Carnival cruise ship was caught emitting black smoke while docked

The video, taken on July 28, was filmed via a webcam near the port of Nassau in the Bahamas.

The caption says: "#CarnivalVictory 'no smoke without …?' Hard to imagine anything good happening here. "

At first the smoke appears to be coming from the Royal Caribbean ship, but on closer inspection it is the Carnival Victory cruise liner hidden behind which is emitting the black clouds.

It’s unclear what is causing the smoke, as the ship appears to be docked.

 The Carnival Victory was docked in the Bahamas

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The Carnival Victory was docked in the Bahamas

 The dark smoke was filmed for two minutes while it was in Nassau

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The dark smoke was filmed for two minutes while it was in Nassau

Social media users were conflicted over what it meant.

One person said: "Someone added: "Love cruising, but scenes like this make me really feel guilty."

Another person remarked: "These kinds of things happening are going to eradicate the cruise industry. "

However, an 'expert' seemed to explain they thought was happening : "Coming from a mechanic's point of view, it looks like they may have had some engine issues they were dealing with and it is burning way to much fuel. Which is why the smoke is so black, just like diesel trucks when you see them "rolling coal" as it is called."

According to boat website Boats.com, black smoke is caused by "excess, unburned or partially combusted fuel, or conversely by inadequate air supply to your engine."

BUMMER HOLIDAY Dispatches investigation shows how your cruise holiday could leave you breathing in dirty air more polluted than the air in central London

The worrying black smoke comes just one month after Carnival Cruises agreed to pay $20 million (£15.7 million) in fines after admitting to polluting the oceans after a settlement with US federal prosecutors.

Carnival Corp, who own Carnival Cruises, agreed to pay the settlement after pleading guilty to continuing to pollute the sea despite a previous criminal conviction aimed to prevent it.

The court case follows the report that the cruise liner dumped over 500,000 gallons of sewage into the oceans since their probation.

Senior US District Judge Patricia Seitz approved the settlement agreement after Carnival CEO Arnold Donald stood up in open court and admitted the company’s responsibility for probation violations stemming from the previous environmental case.

Passengers left terrified after luxury Viking Cruises ship crashes into an oil tanker in Holland

In a courtroom including other Carnival executives including company chairman and Miami Heat owner Micky Arison, Arnold repeated six times: "The company pleads guilty."

He added: "We acknowledge the shortcomings. I am here today to formulate a plan to fix them.

Carnival admitted violating terms of probation from a 2016 criminal conviction for discharging oily waste from its Princess Cruise Lines ships and covering it up.

Carnival paid a $40 million (£31.4 million) fine and was put on five years’ probation in that case, which affected all nine of its cruise brands that boast more than 100 ships.

BA LOSES appeal to stop August pilot strike affecting thousands of passengers

BRITISH Airways have lost their appeal to stop pilots going on strike next month.

The potential strike could result in chaos across the country if it goes ahead as planned with up to 4,000 pilots walking out.

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Credit: Alamy

However, the pilot union is yet to announce the dates of the strike action as they continue to negotiate for the rest of the week.

By law, at least two weeks notice has to be given – meaning a potential strike mid-August.

An overwhelming number of pilots voted for the strike action last week according to British Airline Pilots' Association (BALPA).

British Airways went to court last week to seek an injunction to stop the strike over a technicality, which meant the ballot (the vote) would be invalid.

But the judge presiding over the case said the pilots union had issued its ballot correctly and therefore the ballot result could stand according to BALPA.

Today, it was announced that their appeal following this injunction request was also rejected.

BALPA General Secretary, Brian Strutton, said: "The Court of Appeal has today rightly dismissed BA’s attempt to injunct this industrial action on a technicality.

Will I get my money back if my flight is cancelled or delayed?

If your flight is cancelled, you have the legal right to either a full refund within seven days or a replacement flight to your destination.

This applies for whatever reason your flight was cancelled or how long before you were told it would no longer be be flying.

If your flight is delayed by three hours or more and you were flying to or from a European airport, or with an EU-based airline such as Ryanair or British Airways.

Then you can claim compensation up to €250 (£229) for short-haul flights and €400 (£367) for mid-haul flights and €600 (£530) for long-haul flights.

But the airline might not payout if it's out of their control, for example, due to bad weather or strikes.

"BA’s attempt to defeat the democratic view of their pilots in court, rather than deal with us across the negotiating table, has sadly wasted huge amounts of time and money that could have been put into finding a peaceful resolution.

"Now the window for negotiation and compromise is closing fast.

"BA need to wake up to reality. Our ballot returned 93 per cent in favour of strike action. There is a serious issue here and BA has so far refused to help us tackle it.

"On BA’s own figures submitted to the court, even a single day of strike action will cost far more than we believe it would take to settle this dispute."

Travel chaos at Heathrow Airport sees a queue of 'up to 1000 people' trying to get a taxi

The union balloted its affected members last month after discussions over pay stalled.

Approximately  90 per cent of those affected turned out to vote, with 93 per cent voting in favour of the strike.

According to Glassdoor, the average BA pilot takes home a base pay of £79,695pa with possibility of additional pay, which could include things such as bonuses, totalling up to £69,444pa on average – adding up to £150,000 overall.

However, a senior airline staff member told The Sun that the strike was because their "secret bonus scheme" was being shared throughout the airline.

For nine years, the bonus was originally just part of the pilots pay benefits, but will now be given to all airline staff.

STRUCK OUT Gatwick, Heathrow and Stansted Airport strikes that could cause travel chaos for Brits this summer

A spokesperson for BA explained in a statement following the blocked appeal: "We are disappointed that the pilots' union, BALPA, has chosen to threaten the holidays of thousands of our customers this summer with unprecedented strike action.

"We are very sorry for the disruption BALPA's strike action will cause our customers.

"While no strike dates have yet been issued by BALPA, and they are required to give us 14 days' notice of any intention to call strike action, we ask our customers to review their contact details by visiting ba.com, or by contacting their travel agent.

"We continue to pursue every avenue to find a solution to avoid industrial action and protect our customers' travel plans.

"Our proposed pay deal of 11.5 per cent over three years is fair, and by contrast to BALPA, has been accepted by the members of the Unite and GMB trade unions, which represent nearly 90 per cent of all British Airways colleagues."

The Sun Says

BRITISH Airways pilots enjoy well-rewarded jobs at one of the best-paying airlines.

But a three-year rise at nearly twice the inflation rate isn’t enough for them. They will strike next month, destroying the holidays of families far less well-off.

What a sickening mix of arrogance, obstinacy and greed.

Trump Administration Proposes Allowing Drug Imports for Cheaper Prescriptions

The Trump administration said on Wednesday that it was taking steps to make it easier for less expensive prescription drugs to be imported from other countries, particularly Canada, a move that has long been supported by progressives but has encountered fierce opposition from the pharmaceutical industry.

Under the plan, the administration said it would propose a rule to permit pilot programs developed by states, pharmacies or drug distributors that sought to safely import prescription medications from Canada. The Food and Drug Administration also planned to advise manufacturers for how they could import high-priced drugs like insulin that are sold more cheaply in other countries.

“President Trump has been clear: For too long American patients have been paying exorbitantly high prices for prescription drugs that are made available to other countries at lower prices,” Alex M. Azar II, the secretary of health and human services, said in a statement released Wednesday.

Democrats and Republicans in Congress have been debating legislation that would allow importation of drugs to obtain cheaper prices, and other measures to try to rein in costs. But leading members of Congress have said that major proposals won’t be fully prepared before September.

The rising price of prescription drugs has been a popular topic at the Democratic presidential debates, and the timing of the administration’s announcement fell in the middle of the Tuesday-Wednesday schedule of this month’s debates for the Democratic candidates.

On Tuesday night, Senator Bernie Sanders of Vermont, who has long supported the idea, said he traveled to Canada on Sunday with a group of consumers who were buying insulin at what they said was one-tenth the price they usually pay in the United States. Higher prices are being charged by “the crooks who run the pharmaceutical industry in America today,” Mr. Sanders said.

Many other countries are able to negotiate lower prices because their health care systems are run by the government, giving them more leverage. In the United States, private insurers typically negotiate with drug companies on prices. The drug industry has said that the prices overseas are artificially low and that people in those countries often don’t get access to as many new drugs as Americans do.

The new policy is an about-face for Mr. Azar, who like other Republicans has been skeptical about importing drugs from other countries. The idea had also been rejected by previous commissioners of the Food and Drug Administration, including Margaret Hamburg, who raised concerns about importing counterfeit products.

In May 2018, Mr. Azar called the idea a “gimmick” and said: “They are a lovely neighbor to the north, but they’re a small one. Canada simply doesn’t have enough drugs to sell them to us for less money, and drug companies won’t sell Canada or Europe more just to have them imported here.”

But over the past year, the tone has shifted as Republican state leaders have joined Democrats in talking about importing drugs from Canada. The Florida governor, Ron DeSantis, has said he wants to be able to do so, and in May Mr. Trump directed Mr. Azar to help make it happen. Vermont also has a law allowing importation although it has not gotten federal approval.

Canadian officials have warned the United States government that importation programs could jeopardize their own supply of drugs, leading to potential shortages, according to a Reuters report this month. Others have said drug companies could limit their supplies to those countries or raise their prices in response to any new American policy.

Mr. Trump has railed against the idea that many countries pay less for drugs than in the United States, calling it a form of “global freeloading” because many treatments sold overseas were developed by American companies.

In July, Mr. Trump said he was planning an executive order, a “favored-nation clause,” which would allow the United States to pay whatever the lowest price is in other countries. But his comments were vague, and it was unclear whether he was referring to a more limited pilot program being proposed by his administration that would apply only to a small subset of drugs administered by doctors and in clinics. There were also questions about how far any executive order could go without congressional legislation.

Several of Mr. Trump’s other proposals to lower drug prices have faltered recently, including efforts to force drug companies to list their prices on TV ads.

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U.S. Soccer Says It Pays Women’s Team More Than Men’s Team

U.S. Soccer on Monday released a lengthy fact sheet detailing its financial commitment to the World Cup-winning women’s national team program, stepping squarely into the debate about equal pay only weeks before the federation and the team are scheduled to enter mediation to try to resolve the players’ federal gender discrimination lawsuit.

U.S. Soccer’s president, Carlos Cordeiro, outlined the federation’s position in an open letter to the federation’s members in which he cited figures, produced in a federation analysis of 10 years of financial data, that he said showed the players on the women’s team had actually earned more from U.S. Soccer than their male counterparts over the past decade.

Cordeiro also highlighted tens of millions of dollars of investment by the federation in women’s soccer, noting specifically more than $18 million in direct support for the National Women’s Soccer League, the seven-year-old professional league, and millions more in spending on youth programs.

And the fact sheet… (2/2) pic.twitter.com/XFofHS90f1

— Carlos Cordeiro (@CACSoccer) July 29, 2019

The debate about equal pay and equitable treatment of the women’s team raged long before it won an unprecedented fourth Women’s World Cup championship, beating the Netherlands this month to cap an unbeaten run through the tournament in France. Talk of pay and fairness had hovered over the tournament since its start, in part because 28 members of the American team filed suit against the federation in March, arguing that they were victims of years of “institutionalized gender discrimination” that affected not only their incomes but nearly every feature of their interactions with U.S. Soccer.

The World Cup and its resulting championship glow had been part of an uneasy truce between the team and the federation, one that held as the players were feted by fans and politicians and hailed in media interviews and talk-show appearances. But the issue never lingered far from the stage; the women heard chants of “Equal pay!” even before they received their winner’s medals at the World Cup, and officials like Cordeiro were heckled by the same mantra during the team’s ticker-tape celebrations in New York.

Cordeiro said U.S. Soccer had made “a deliberate decision” not to debate the facts of the lawsuit or the broader equal pay fight while the women’s team was preparing to defend its world championship, but his letter seemed to be an acknowledgment that recent events — including pressure from corporations and at least one U.S. Soccer sponsor, as well as efforts in Congress that could imperil funding to prepare for the 2026 World Cup to be held in North America — had forced the federation to engage.

It was unclear how Cordeiro’s letter would be received by the players themselves. Early indications were that it was not going over well: a statement from a spokeswoman for the women’s team players labeled the conclusions in Cordeiro’s letter “utterly false” and the release of it “a ruse” to change a conversation the federation was losing in the public square.

And even as he heaped praise on the players who have argued publicly and loudly for better treatment — Cordeiro called the World Cup winners “an inspiration to us all and truly some of the greatest athletes that our nation has ever produced” — he also raised familiar arguments about why their pay was different. He said it was difficult to compare the pay of the men’s and women’s national teams because of differing compensation structures; that a vast divide in FIFA prize money for men and women skews any comparison of compensation; and that the women’s team has produced per-game revenues that were, on average over 10 years, half of those generated by the men’s national team.

“Still,” he wrote, “like any organization, U.S. Soccer recognizes that we can continue to improve.” Cordeiro said the federation was “committed to doing right by our players.”

“Together,” he wrote, “I believe we can get this done.”

The reaction to his letter from the players, however, suggested he might have miscalculated.

“This is a sad attempt by U.S.S.F. to quell the overwhelming tide of support the U.S.W.N.T. has received from everyone from fans to sponsors to the United States Congress,” Molly Levinson, a spokeswoman for the players in the gender lawsuit, said in a statement. “The U.S.S.F. has repeatedly admitted that it does not pay the women equally and that it does not believe the women even deserve to be paid equally.”

The players’ spokeswoman contended that the federation included the players’ N.W.S.L. salaries to inflate their national team pay.

“The U.S.S.F. fact sheet is not a ‘clarification,’” Levinson’s statement said acidly. “It is a ruse.”

Change Your Perspective to Change Your Life

Several years ago I found myself lost one night near Big Sur, Calif. Fog encircled me, erasing the full moon that would have helped me find the path to my friend’s house. I stopped and waited, anxiety building, when suddenly I took several steps into a gap in the fog. The moon, uncovered again, revealed the way forward. A few tiny steps and my entire perspective had changed.

I understood the metaphor: Change your perspective to change your life.

I thought about that metaphor, or lesson, recently when I attended a performance of dance, song and spoken word created by patients in Memorial Sloan Kettering Cancer Center’s Visible Ink program, a free one-on-one writing program for the hospital’s patients and caregivers. Since 2008, more than 2,300 patients, and nearly 300 mentors (including myself), have participated in the writing program. For 11 springs, the show’s director, Greg Kachejian, has stitched together a one-night performance, delivered by professional actors.

Midway through the emotional 90-minute show, I sat straight up in my seat when a Broadway actress began a dramatic reading of a poem titled “All I Want, ” written by Sarah Porwoll, 36, who had been given a diagnosis of breast cancer four years earlier, just six days after her boyfriend had proposed. “It was a very intense time,” she explained, “going from sharing the news of being engaged with all my friends and family to then letting everybody know I was about to go through surgery.”

Mrs. Porwoll told me that after her treatment ended, she started to jot down random feelings and thoughts about her illness. A year later she joined Visible Ink, and in tandem with her mentor wrote “All I Want.” “It helped me get my thoughts and feelings out,” she explained. “Maybe if someone else was quietly going through this on their own, it would help them to read this in some way.”

On the darkened stage, the poem was read as the words scrolled by on a scrim.

I’m bored by the repetition of day-to-day life

So I rarely feel like

Each day is a gift

Now

I know

I can’t explain how it feels to believe that

To be normal

Makes me feel like all I want is

The unexpected

Then my world turned upside down

After a pause, the actress read the poem again, this time starting with the last line, reading from the bottom up:

Then my world turned upside down

The unexpected

Makes me feel like all I want is

To be normal

I can’t explain how it feels to believe that

I know

Now

Each day is a gift

So I rarely feel like

I’m bored by the repetition of day-to-day life

The audience gasped as the reading ended, then we applauded loudly. The change in perspective had completely altered the poem’s meaning.

I asked Mrs. Porwoll what the poem meant to her. “It’s about the shift in perspective I’ve had, now that I’ve had even more time between everything that happened, and where I am today,” she told me. “I would catch myself feeling, like, ‘Oh, I’m just riding the subway. I’m going to work. I’m coming home, I’m doing chores.’ That’s what I craved the most when I was going through treatment — to think about the normal things I would think about in a day, to not have the struggles that came along with going through treatment. I find myself needing to remind myself of the joy that can come in the everyday things.”

Mr. Kachejian, the show’s director, told me he included “All I Want” because he was certain it would resonate with the “entire audience — not just those diagnosed with cancer.” When something dramatic happens — whether it’s a cancer diagnosis, a divorce, getting fired or another traumatic event — your world is turned upside down. “You then begin to relish the things that bored you — you long for normalcy, ” he said.

Writing can facilitate that process. “Writing forces people to stop and rethink their lives,” said James Pennebaker, a professor of psychology at the University of Texas at Austin and author of “Open Up By Writing It Down.” “It’s an opportunity to translate our confusing emotions and emotional experiences into words.” After writing it down, he said, “people often have a better understanding of themselves and their situation.”

Patents write for all kinds of reasons, said Judith Kelman, Visible Ink’s founder and executive director: to complete a story or novel, to gain leverage over a terrifying illness, to reconnect with a loved one who has died. For patients at the end of life, Ms. Kelman has witnessed “great peace and healing, from the chance to say and record final thoughts, tell a long-held secret or fulfill the wish of leaving something permanent — in visible ink — as a legacy for loved ones.”

And sometimes writing can be a very effective way to change your perspective and start a new life.

Steven Petrow (@stevenpetrow), a regular contributor to Well, lives in Hillsborough, N.C.

The Boxing Champion Who Battles O.C.D.

Virginia Fuchs announced herself to the boxing world at the 2016 United States Olympic Trials, where she twice upset Marlen Esparza, a world champion. In 2017, Fuchs went 18-0. In 2018, she claimed a bronze medal at the world championships by attacking her flyweight opponents, on average, every four seconds during nine minutes of boxing.

“That’s an engine!” said Billy Walsh, the head coach for the American team. “She’s a supreme athlete. We joke and call her Seabiscuit because she’s like a racehorse.”

Fuchs, known as Ginny, is now the most established fighter from the United States at the Pan American Games this week. The same will most likely be true at the 2020 Tokyo Olympics.

“Pretty much everybody’s looking at me to win gold,” said Fuchs, a 31-year-old Texan.

Boxing, though, is the least of her battles.

About 20 years ago, she learned she had severe obsessive-compulsive disorder. In January, Fuchs had a breakdown that sent her to inpatient treatment for the second time in her life.

She spent a month at an O.C.D. clinic in Houston.

“I was like: I can’t function like this anymore,” she said.

She grew so stuck in her cleaning rituals that she was training daily on three hours of sleep. One night, she said, she couldn’t stop at all and thought: “I’m out of control. I’m scared. I need serious help.”

Elite athletes usually know how to solve their opponents. If they are taller and stronger, be quicker. If they are faster, be smarter. If they are tactically superior, be relentless. But what do you do when the most powerful opponent lies permanently within?

ImageFuchs, right, competing in the AIBA Women’s World Boxing Championships in 2018.

CreditChandan Khanna/Agence France-Presse — Getty Images

By definition, O.C.D. involves unwanted, recurring and distressing thoughts. In response, people often perform repetitive behaviors, or rituals, to alleviate the anxiety caused by the obsessions.

“But the ritual only works very temporarily,” said Dr. Joyce Davidson, a psychiatrist and medical director at the Menninger Clinic in Houston. “The obsessions keep coming back so people get stuck in this vicious circle of obsessions and rituals. In many cases, it really snowballs.”

O.C.D. symptoms go well beyond superstitions or tics.

“People with O.C.D. are really tormented by their symptoms,” Dr. Davidson said. “It’s very disabling.”

O.C.D. takes many forms, and Fuchs’s obsessions and compulsions pertain to contamination and cross-contamination.

“My mind is constantly thinking, ‘What did that touch?’” Fuchs said.

For a boxer, being tormented by the thought of contamination is the ultimate paradox. Fighters are constantly exposed to opponents’ sweat, saliva and blood, and the rot of damp headgear and gloves.

For Fuchs, however, boxing actually provides a respite.

The sport requires such total and immediate focus, she said, that it’s the only setting where she can completely set aside the O.C.D.

“In day-to-day things, I feel like the O.C.D. is more powerful than my regular mind,” she said, even though she knows it can be expensive, wasteful and infuriating to others.

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CreditRachel Woolf for The New York Times

In January, Fuchs was driving to Walmart three times a day to buy cleaning supplies — at $85 a pop. She is still trying to pay off $23,000 that four weeks at the Houston O.C.D. clinic cost her in February.

“She’ll buy flip-flops, wear them for an hour, and throw them away,” said her mother, Peg, a former elementary schoolteacher. Her older sister, Helen, has found full packages of latex gloves and unopened Kleenex boxes in the trash at home.

Kay Koroma, an assistant coach with the United States boxing team, opened the trunk of Fuchs’s car one day and found it filled with supplies that Fuchs said were unusable because they had touched something else.

Before her breakdown, Fuchs’s No. 1 priority was cleaning nonstop. “It made no sense in my clear mind,” she said. “But in my O.C.D. mind, it had to be done or I couldn’t move on with my day.”

Instead of resting in her dorm room between training sessions at the Olympic Training Center in Colorado Springs, Fuchs bleached all the soles of her shoes (high heels, sandals, trainers), tossed them in the washing machine and ran the machine empty between loads to wash the washer.

Her preshower cleaning routine took at least an hour and required entire tubs of facial wipes. The shower itself ran three to four hours, and she depleted several large bottles of shower gel and at least one full bar of soap.

Teeth cleaning took at least 30 minutes and as many as nine toothbrushes. Her dentist warned her that it could erode her enamel.

“My O.C.D. doesn’t care,” said Fuchs, a graduate of Louisiana State. “I would rather feel the clean feeling and brush the enamel off my teeth.”

“I’ve ruined so many things,” she added. “I even put my hair straightener in the washing machine.” It’s made of metal.

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CreditCharly Diaz Azcue/LatinContent, via Getty Images

Her boxing teammates had clues about her O.C.D. but didn’t immediately realize its severity.

Claressa Shields, the two-time Olympic middleweight champion, noticed that when they did push-ups or crunches in the ring, Fuchs put her hand in her sleeve, not on the canvas.

Fuchs would stand on top of her shoes before stepping on the scale at weigh-ins. She never let her gloves or wraps hit the ground. If her mouthpiece fell on the floor, she would leave it there.

Once, Koroma saw Fuchs with six bottles of Clorox. “How much clothes you got to wash?” he said he told her. “You got a lot of whites?”

Another day at the gym, her teammate Mikaela Mayer put her shoe on Fuchs. “Ginny freaked all the way out,” Shields said. “She ran to a shower and we didn’t hear from Ginny for a couple hours.”

Mayer, a 2016 Olympian and Fuchs’s best friend, noticed something was amiss the first time they shared a hotel room. Fuchs wouldn’t get out of the bathroom.

“Within two hours, there was no toilet paper, all the towels are on the floor and dirty,” Mayer said. “She didn’t even shower and all the soap was gone. I was like, ‘Are you kidding me?’ I started to spy on her. I would watch her do these routines. I would bust in the door and be like, ‘What did I just see?’”

What people don’t know, Mayer said, is that as soon as Fuchs leaves the gym, she remembers exactly where blood spattered, snot flew and precisely where an armpit touched her shoulder.

“She uses her shower time scrubbing those parts of her body and remembering that,” Mayer said.

Unlike other O.C.D. cases, Fuchs’s cleaning rituals aren’t dictated by a fixed number of repetitions. “It’s a feeling,” she said. “I’m always searching for that perfect clean feeling.”

Yet she is not a neat freak.

Far from it, Mayer said, because Fuchs’s idea of clean is completely different. “To her, it’s not visual; it’s all about germs and contamination,” Mayer explained. “So you’ll walk into her room and there are clothes all over the floor, but it’s a ‘clean’ area.”

Mayer and Koroma are really the only ones who see Fuchs struggle up-close, on a daily basis.

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CreditRachel Woolf for The New York Times

When Koroma sees signs, he tries to keep Fuchs close and distract her with a movie, a walk or a video game. Sometimes, she would call crying in the middle of the night. “Usually I could talk her off the ledge,” he said. But the night she broke down in January, he knew it was serious.

He helped Fuchs pack and took her to the airport, and then he had to tell the team.

“Everybody reached out to her, told her: ‘Yo, we got you. Everything’s cool,’” he said.

Upon Fuchs’s return, her room had so many trigger points that she would often spend nights at Mayer’s home nearby, and still does. But Fuchs doesn’t always implement the changes she learned in treatment, like timing her showers and limiting her spending.

“I can cuss her out because we’re best friends,” Mayer said. “But I really worry about her.”

U.S.A. Boxing now has three psychologists working together to help Fuchs. One is at the Olympic Training Center. One travels with the boxing team. And one is an O.C.D. specialist based in Colorado Springs she can see any time.

Every week, Fuchs and the O.C.D. specialist devise a plan, like planning to use only eight sponges per shower instead of 10, or breaking soap in half instead of using an entire bar in every shower. Fuchs reports her progress throughout the week.

“Sometimes I’m able to be strong and do what we planned,” Fuchs said, but on bad days, her old habits return.

Shields, the middleweight champion, remains optimistic that Fuchs will conquer O.C.D. as she has conquered so many of her other opponents.

“Ginny can definitely beat this O.C.D. thing,” Shields said. “She wants to beat it. But just like you won in boxing, you got to get prepared. You got to take steps and make small goals,” she tells Fuchs, reminding her just how strong she is.

In 2016, even though she beat Esparza at the trials, Fuchs didn’t make the Olympic team. Instead she went to Rio de Janeiro as a sparring partner.

“After having all your dreams crushed for another four years, to come support us?” Shields said. “It meant the world to me. Maybe I’ll be that strong one day. Then she went 18-0? Come on! Nobody’s doing that. And she’s facing O.C.D.? That’s amazing.”

For Fuchs, it’s just life.

“There is no cure,” she said. “It’s all about managing it. I’m a little better, but I have a long way to go.”