A digest of events, trends, issues, ideas and journalism from and about rural America, by the Institute for Rural Journalism, based at the University of Kentucky.
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H5N1 can be more deadly for younger cows. (Adobe Stock photo)
After the H5N1 bird flu virus was detected in California in August, the virus spread aggressively and has infected at least 124 dairy herds and 13 dairy workers, reports Susanne Rust of the Los Angeles Times. "And according to dairy experts, the spread of the virus has yet to abate." The virus has killed dairy cattle at an "unexpected rate," which has left some dairies with roadside piles of dead cows awaiting rendering service pickup.
While roadside patches of dead cows are grisly, John Korslund, a retired Department of Agriculture veterinarian epidemiologist, said "there was probably very little risk to public health in having the animals piled up," because the virus doesn't last long in a carcass.
Anja Raudabaugh, chief executive of Western United Dairies, "said although the dairy farmers she represents had been reading about the virus for months before it hit, no one was prepared for the devastation and unevenness with which the virus has struck California’s dairy herds," Rust reports. "She said on some farms, the cows seem virtually unaffected, despite being infected. While on others, the animals are dying in droves."
The virus' biggest toll has been on younger dairy cows, but farmers are doing what they can to keep them alive. Raudabaugh told Rust, “given the extreme rearing and raising and just expenses that go into raising these animals, there’s hope that on the other side of the virus, they will come back into production that’s sustainable for the farmer. So it’s definitely a last resort if they are culling them.”
Dairy farmers are concerned that even if a cows survive the virus, their milk production could indefinitely decrease. Rust reports, "The Department of Agriculture has a program to pay back farmers for production loss due to the virus. The program covers the three weeks of production lost by a cow when it is removed from the milking herd to recover, as well as the seven days afterward when production is still low." There is no protection for permanent production loss.
Adams Family Pharmacy often loses money filling prescriptions. (Photo by A. Miller, KFF Health News)
Even as independent pharmacists face low or no profits from medication sales, pharmacy middlemen reimbursements favor large drugstore chains. The Federal Trade Commission and several lawmakers are starting to take aim at prescription benefit managers' power and repayment practices.
"On Sept. 20, the FTC sued three of the largest PBMs. . .The lawsuit followed a scathing FTC report that said the 'dominant PBMs can often exercise significant control over which drugs are available, at what price, and which pharmacies patients can use to access their prescribed medications,'" reports Andy Miller of KFF Health News.
How PBMs dominate reimbursement in Georgia is a drastic example of smaller pharmacies being shorted. The American Pharmacy Cooperative, which represents independent pharmacies, "reviewed the price differential paid to a north Georgia pharmacy and nearby chain stores," Miller explains. "The analysis showed chains were paid well beyond the family business. For example, the chains received an average of nearly $54 for the antidepressant bupropion, while Bell’s Family Pharmacy in Tate, Georgia, got $5.54. . . . For a drug used to treat blood pressure, amlodipine, chain pharmacies received an average of $23.55, while Bell’s got $1.51. . . Bell’s Family Pharmacy closed earlier this year."
Nikki Bryant is a pharmacist and co-owner of Adams Family Pharmacy in rural Cuthbert, Georgia, who has worked to find creative ways to bolster the business' income because the pharmacy loses money. "Bryant and other independent pharmacists say they lose money filling certain prescriptions while reimbursements favor chain pharmacies like CVS that have corporate ties to pharmacy benefit managers," Miller adds. "Bryant said she can make more profit on cake and coffee than with many medications."
Some lawmakers are scrutinizing PBMs. "Members of both parties in Congress have tackled PBM reform," Miller reports. "House
members recently introduced another proposal, known as the Pharmacists
Fight Back Act, which supporters say would add transparency, limit costs
for patients, ensure they get the benefit of drugmaker discounts, and
protect their pharmacy choices."
Years of underpayments by PBMs to smaller pharmacies have disproportionately harmed rural communities by "accelerating closures of mom-and-pop pharmacies across the country, said the National Community Pharmacists Association," Miller reports. "The U.S. loses almost one such pharmacy a day, said Anne Cassity, a senior vice president of the association."
A sewage sludge treatment tank in Scottdale, Penn. (USDA photo, Lance Cheung via Flickr CC)
It may not sound pretty, but looking into sewage sludge disposal practices can be a story that helps your community's health. "There was a time when the Environmental Protection Agency renamed toxic sludge as 'biosolids,' and journalists went along with it," reports Joseph A. Davis of the Society of Environmental Journalists. "As we are becoming aware of more and more toxic chemicals, it is hardly a surprise that we are finding them in sewage sludge. The surprise is that some farmers are spreading them on their fields."
The multiple contaminants within sewage sludge are a health threat to humans and the environment because PFAS or "forever chemicals" can be present in sludge; however, sludge pollutants can also include "heavy metals like lead, other toxic organics like dioxins, PCBs, pharmaceuticals whose names you can’t even pronounce," Davis explains. "The problem gets much harder when you realize there are thousands of individual PFAS chemicals. Not to mention all the other chemical families."
The problems with sludge, even when treated, or labeled "biosolids" remain extensive. EPA rules may not be enough to keep people and nature safe because current rules "allow — some say encourage — sterilized, dried sludge to be spread on fields, golf courses, etc," Davis writes. "The big question is whether harmful chemicals are getting into people’s food and water."
Davis offers the following story ideas:
Where does your sewage go when you flush the toilet? Talk to your local sewage treatment agencies and ask them what they do with their sewage sludge.
Ask who takes the bulk of processed sludge from your local agencies? There may be companies who distribute it in large quantities to farmers, golf courses, etc., who apply it to land. Talk to them. Talk to their customers.
The EPA has to review its 'biosolids' rules every two years to see whether they should be updated as new contaminants come to light. What do local sewage officials and environmental advocates think about the EPA’s performance?
Some disposal of sewage sludge on land requires a National Pollutant Discharge Elimination System (water pollution) permit. Check the permit database for permittees. Check the EPA’s ECHO enforcement database for violators. Talk to permittees and permitting agencies.
Does your local sludge go into the retail market? What companies and brands sell it? Ask for their test results on chemical contamination. Figure out what they didn’t test for.
Talk to groundskeepers or managers at local golf courses. Do they use sludge products on their courses? What can you learn about the run-off situation?
Go to meetings of local garden clubs and community gardens. Or visit on-site. Ask members what they do, especially with vegetable gardens.
Pivot Bio's microbes help nourish corn seeds in the ground and reduce their need for chemical fertilizers. The process has a lot of unanswered questions. (Privot Bio graphic)
In a novel approach to stemming agriculture's contribution to climate change, researchers are altering bacterial DNA, so that corn seeds require less chemical fertilizer to thrive, reports Eric Lipton of The New York Times. "Globally, the manufacture, transportation, and use of chemical fertilizer is responsible for pollution with the equivalent planet-warming power of about 1 billion metric tons of carbon dioxide each year. That’s more than the combined releases from all the coal-burning power plants in the U.S."
Research on genetically modified bacteria that is sprayed on corn seeds and then planted in the U.S. corn belt is ongoing. If successful, it could revolutionize how plantings are nourished throughout their growth cycle while helping reduce carbon emissions. Lipton writes, "Just five years after they were introduced, the seeds are being used on 5% of American corn crops."
The sprayed seeds are produced by Pivot Bio, a California-based company, which "estimates that last year, its treated seeds prevented the release of an estimated 706,000 metric tons of carbon dioxide equivalent — comparable to the greenhouse gasses from burning 1.5 million barrels of oil," Lipton reports. "But it’s also producing intense pushback."
The alteration of bacteria and its application to corn seeds has some organic farming groups up in arms and "manufacturers of chemical fertilizer are also raising doubts about the new industry player," Lipton adds. "Pivot’s own advisers concede there are unanswered questions." David Kanter, a Pivot adviser who teaches environmental studies at New York University, told Lipton, "We have rarely created a solution to an environmental problem that doesn’t create other unforeseen consequences down the line."
Meanwhile, other companies are creating their own hubs of fertilizer-replacement research. "The goal is to supplant as much as half the fertilizer used today," Lipton reports. "Companies, including Ginkgo Bioworks and BioConsortia, are developing their own versions. Academics at M.I.T. and other universities are trying to make further advances. . . . At this point, scientists don’t believe they can completely eliminate the need for chemical fertilizer."
Horse-drawn buggy in rural Holmes County (Wikipedia photo)
Hard work, generosity and 'extreme networking,' are a few of the reasons the Amish community in Holmes County, Ohio, is thriving. The group's unique ways of supporting new businesses can serve as a model for other places looking to bolster economic mobility, reports Scott Calvert of The Wall Street Journal. "Between 2005 and 2019, average household income in Holmes County rose 24% for 27-year-olds raised in lower-income homes."
By some measures, Holmes should be struggling, but instead, it's becoming an economic hub. "Economists and local business leaders believe much of the progress stems from entrepreneurial growth fueled by cooperation and innovation, all buttressed by tight family and community ties," Calvert explains. "Mark Partridge, an Ohio State University economist who has studied Holmes County, points to an 'extreme networking effect,' where companies — and cousins — routinely help each other out."
Location of Holmes County in Ohio (Wikipedia photo)
Experts point out that being Amish isn't necessary to replicate what's going on in Holmes County. Partridge told Calvert, "You can have a tight social network with effective social organizations, chambers of commerce, business organizations, and other kind of nonprofits.” Calvert reports, "While rural areas are often hampered by young talent moving away for better job opportunities, many Holmes County natives remain, held in part by the Amish tradition of staying near one’s community."
Sharing -- even with business competitors -- is a key ingredient in this community's success. Calvert writes, "Steve Miller, 31, started Grand Design Roofing in his 20s with a partner. Their Covid-era boom is over, he said, but business is still robust enough to sometimes overextend him and his six workers." Miller told Calvert, "If we’ve got plenty of jobs, I just go to my competitor and I give him a couple jobs. . . . I’m here so my employees can make a good, honest living. . . . I’m not here to collect all the wealth I can absolutely collect.”
PBMs increase profits when independent pharmacies go out of business. (Adobe Stock photo)
The loss of independent pharmacies across the country has been a concern for rural residents, but who are the fabled PBMs, or pharmacy benefit managers, how do they operate and what do they gain when they force smaller pharmacies to close, ask Reed Abelson and Rebecca Robbins of The New York Times. "A New York Times investigation found PBMs, which employers and government programs hire to oversee prescription drug benefits, have been systematically underpaying small pharmacies, helping to drive hundreds out of business."
PBMs garner the power to underpay smaller pharmacies from "two main sources. First, the three biggest players — CVS Caremark, Express Scripts and Optum Rx — collectively process roughly 80 percent of prescriptions in the United States," Abelson and Robbins explain. "Second, they determine how much drugstores are reimbursed for medications that they provide to patients. . . . When local drugstores fold, the benefit managers often scoop up their customers, according to dozens of patients and pharmacists."
The process of how pharmacists purchase medicines, sell them to patients and receive reimbursements is undermined by PBMs who seek to add to their profits by undercutting smaller drugstores' drug reimbursements. The Times reports, "To take just one example: For a month’s supply of the blood thinner Eliquis, several pharmacists in different states said, the big three PBMs routinely paid them as much as $100 less than what it cost the pharmacies to buy the medication from a wholesaler.
"By contrast, the PBMs sometimes pay their own pharmacies more than what they pay local drugstores for the same medications. Independent pharmacies are powerless to fight back. As the unprofitable transactions pile up, some are unable to stay afloat. . . . [The closures] have disproportionately affected rural and low-income communities,
creating so-called pharmacy deserts that make it harder for residents to
get prescriptions and medical advice."
There is an inherent tension between PBMs and any pharmacy seeking drug reimbursements. The PBMs' purpose is to cut costs, which is accomplished by paying pharmacies less. Those savings can, "in turn, lower insurance premiums for workers and people covered by government programs like Medicare," Abelson and Robbins write. "But that apparent frugality often benefits the PBMs in ways that have nothing to do with their clients’ interests. . . .At the same time that PBMs are reimbursing pharmacies at rates below their costs, the benefit managers are often charging employers much higher prices and pocketing the difference, according to insurance paperwork reviewed by The Times."
A Walgreens pharmacy in Murphy, North Carolina, pop. 1,600. (Wikipedia photo)
Over the past decade, rural, independent pharmacies faced shrinking profits and many closed. But now, even big chains are struggling to keep the current drugstore model profitable, reports Nathaniel Meyersohn of CNN News. "CVS is closing 900 stores. Walgreens announced it plans to close 1,200 stores, meaning 1 in 7 will disappear. . . .They are now shutting down because of shifting consumer habits, competition and changes in the pharmacy industry."
Both independent and larger drugstore chains blame some of their financial decline on pharmacy benefit managers, or PBMs, which negotiate rebates from drug manufacturers to insurers. "PBMs have been cutting reimbursement rates to boost their own profits, Elizabeth Anderson, an analyst at Evercore IRI," told CNN. "The pharmacy industry has complained that PBMs have too much control and can squeeze pharmacies. PBMs argue that they help keep drug prices down by negotiating with drug makers."
Walgreens added primary care clinics to try and bolster its bottom line, but the venture was unsuccessful. "Walgreens took a $5.2 billion stake in VillageMD, a primary care network, in 2021. But VillageMD has not been profitable for Walgreens, and Walgreens has tried to cut costs," Meyersohn writes. "The chain has been closing VillageMD locations and said over the summer it will divest from the company."
When the past 20 years of pharmacy availability for Americans is scrutinized, rural residents usually end up with fewer options and a longer drive for medication treatment, but the same can be true for poorer neighborhoods. Meyersohn reports, "Roughly one out of every eight pharmacies closed between 2009 and 2015, which disproportionately affected independent pharmacies and low-income neighborhoods, according to a study published in the Journal of the American Medical Association."
Shield law protections by state (Graph by the Reporters Committee for Freedom of the Press)
The New York Times editorial board offers a compelling piece on the importance of a reporter's shield law and why its protections need to be extended to the federal level. "Safeguarding the anonymity of reporters’ sources is essential . . . . It has been recognized by governments or courts in 49 states and the District of Columbia as a form of protection for journalists and news outlets against unfair or overbearing efforts by the government to ferret out their sources. . . There is nothing of the sort, however, on the federal level, where the need is arguably greatest."
A bipartisan bill representing those federal protections, known as the Protect Reporters From Exploitative State Spying Act, or PRESS Act, has already moved through the House of Representatives and is awaiting release by the Senate Judiciary Committee. The editorial board writes, "It would shield reporters from court-ordered disclosure of their sources of information, except in the rare cases in which disclosure is necessary to prevent an act of terrorism or imminent violence."
Freedom of speech and whistle-blowing protection remain essential parts of a healthy democracy. The editorial board adds, "Leaks and whistle-blowers have often proved essential to the public’s understanding of major events and the workings of government at all levels. There is nothing ideological about their usefulness; they can be just as effective in exposing the unwelcome truth about Democratic administrations as Republican ones. By protecting reporters from having to reveal their sources, the bill would ideally encourage more whistle-blowers to help shine a light on government abuses."
Some members of the House having been "targets of sharp investigative reporting or frequent critics of the news media," the editorial board adds. Still, every member has "supported swift passage of the PRESS bill. . . Nothing in the PRESS Act would prevent the government from prosecuting leakers, and the government has vast powers to monitor its officials without demanding that reporters divulge the information they seek. . . . The PRESS Act is needed now."
Over the past two decades, rural Main Street rehabs have proved challenging to create and sustain, but some entrepreneurs have seen "the blight as an enticement — not a deterrent," reports Lori Ioannou of The Wall Street Journal. "Many Main Streets are riddled with shuttered storefronts and struggling businesses. Here is a look at three entrepreneurs who challenged the odds on Main Street, and how they fared."
Harvey and his "Delta Dirt" family
Harvey Williams Jr. moved his family from the big city of Dallas to rural Helena-West Helena, Ark., where he grew up. Williams was an agricultural engineer, and as he explored business potentials in his hometown "he was inspired to create Delta Dirt Distillery at 430 Cherry St., making sweet-potato vodka from produce harvested on his family’s farm," Ioannou writes. "The distillery opened in April 2021, and locals began spreading the word on social media. . . . The distillery has become a tourist attraction, and many also take a tour of the Williams farm to learn about the history of Black farmers in America."
While on vacation, Jennifer Jones and her husband Brian fell in love with Big Stone Gap, a former coal town of about 5,300 people "nestled in the Appalachian Mountains," Ioannou reports. The couple closed their California business and moved to the western Virginia town. "In April 2022, they bought a struggling vegan pizzeria and its building on 215 Wood Avenue East. At the time, Wood Ave. East was a shadow of its former glory, lined with failed and struggling businesses."
The Jones family helped revive Big Stone Gap's Main Street businesses.
The Jones' efforts were rewarded by an outpouring of community support. "The town manager and other local small-business owners and residents pitched in to help get the business up and running," Ioannou writes. "For their part, the Joneses have supported community events and hosted local festivals that have helped market the business. That pay-it-forward mentality among civic leaders and small-business owners has ignited a small-business revival in Big Stone Gap."
Not every Main Street venture is a success. For Bill Waterhouse and his partner, Sonja Olbert, being able to pursue their passions and help their small community meant adapting. Read their story here.
Rossif Sutherland and Kristin Kreuk star in the new Global/FOX
series 'Murder in a Small Town.' (Global TVvia IMDb photo/The Daily
Yonder)
There's nothing quite like small-town murder tales to get people glued to their television screens week after week. "The latest TV series on FOX puts its own spin on a genre that has stood the test of time," reports Keith Roysdon of The Daily Yonder. "We haven’t yet reached the point where it’s become obvious that something is very, very wrong in the town of Gibsons . . . . 'Murder in a Small Town' is good, dependable murder-of-the-week television, probably not dissimilar to how 'Murder, She Wrote' was perceived for most of its run."
In Lancaster County, Penn., Democrats see an opportunity even though the county typically votes Republican, "the demographics are shifting here and throughout the state," report Campbell Robertson and Robert Gebeloff of The New York Times. "Pennsylvania is arguably the most pivotal state in the election, carrying 19 electoral votes, the most of the so-called swing states. After voting for the Democrat in every presidential election going back to 1992, the state went for Donald J. Trump in 2016 by less than a percentage point. Joe Biden won in 2020, by a little over a percentage point."
Jim
and Sharon Erwin enjoy the natural beauty of Gunnison, Colo.(Photo by Jim Erwin via WSJ)
As baby boomers head into retirement, some choose to resettle in rural places for reasons that range from cutting costs to living closer to natural attractions. "The move to remote mountain and lake areas is helping reverse a long decline in the rural population. From April 2020 to July 2023, the rural counties retirees flocked to grew 4% versus less than 1% for rural America as a whole," report Anne Tergesen and Veronica Dagher of The Wall Street Journal.
If slower is cheaper, is that OK? That depends. "The U.S. Postal Service is moving forward with a plan to slow down delivery for a relatively small portion of mail, telling its regulator the changes would save nearly $4 billion annually and better reflect the evolving nature of mail usage," reports Eric Katz of Route Fifty. Advocates for rural residents say the change will disproportionately affect mail delivery and pickup in more remote areas. Liz Carey of The Daily Yonderreports, "The plan would eliminate evening mail pickup in rural and remote areas, which could affect delivery times for areas that are more than 50 miles from a large USPS regional processing facility."
Apple's AirPods Pro 2 with hearing aid feature (Apple photo via Wired)
Over-the-counter hearing aids seemed like a "cheaper and more accessible [solution] for people with mild to moderate hearing loss. Instead, people are returning them at high rates," reports Julie Jargon of The Wall Street Journal. "Doctors lauded the move as a solution for over 20 million American adults who have hearing loss that isn’t severe enough to warrant expensive prescription devices. In reality, many go for $1,500 to $2,000 . . . . The struggles come as Apple prepares to release a potential game-changer — a software update that will turn its popular, $249 AirPods Pro 2 into hearing aids."
This year's spooky season will be topped off by rarely-seen cosmic visitors. "In the days leading up to Halloween, Tsuchinshan-ATLAS, also known as Comet C/2023 A3, will be at its brightest, and likely visible to the naked eye. . . just look to the western sky shortly after sunset. As the days pass, the comet will get fainter and move to a higher part of the sky," reports James Wray for The Conversation. "The second comet, C/2024 S1 (ATLAS), should be visible around the end of October. The comet will pass closest to Earth on Oct. 24 – look low in the eastern sky just before sunrise. Then, after swinging around the Sun, the comet may reappear in the western night sky right around Halloween."
