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2025-01-12
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circus costume ideas NEW HOPE, Pa. (AP) — Dayle Haddon, a Canadian-born actor, activist and trailblazing former “Sports Illustrated” model who pushed back against age discrimination by reentering the industry as a widow, has died in a Pennsylvania home from what authorities believe was carbon monoxide poisoning. Authorities in Bucks County found Haddon, 76, dead in a second-floor bedroom Friday morning after emergency dispatchers were notified about a person unconscious at the Solebury Township home. A 76-year-old man police later identified as Walter J. Blucas of Erie was hospitalized in critical condition. Responders detected a high level of carbon monoxide in the property and township police said Saturday that investigators determined that “a faulty flue and exhaust pipe on a gas heating system caused the carbon monoxide leak.” Two medics were taken to a hospital for carbon monoxide exposure and a police officer was treated at the scene. As a model, Haddon appeared on the covers of Vogue, Cosmopolitan, Elle and Esquire in the 1970s and 1980s, as well as the 1973 Sports Illustrated swimsuit issue. She also appeared in about two dozen films from the 1970s to 1990s, according to IMDb.com, including 1994’s “Bullets Over Broadway,” starring John Cusack. Haddon left modeling after giving birth to her daughter, Ryan, in the mid-1970s, but then had to reenter the workforce after her husband's 1991 death. This time she found the modeling industry far less friendly: “They said to me, ‘At 38, you’re not viable,’” Haddon told The New York Times in 2003. Working a menial job at an advertising agency, Haddon began reaching out to cosmetic companies, telling them there was a growing market to sell beauty products to aging baby boomers. She eventually landed a contract with Clairol, followed by Estée Lauder and then L’Oreal, for which she promoted the company's anti-aging products for more than a decade. She also hosted beauty segments for CBS’s “The Early Show.” "I kept modeling, but in a different way," she told The Times, “I became a spokesperson for my age.” In 2008, Haddon founded WomenOne, an organization aimed at advancing educational opportunities for girls and women in marginalized communities, including Rwanda, Haiti and Jordan.' Haddon was born in Toronto and began modeling as a teenager to pay for ballet classes — she began her career with the Canadian ballet company Les Grands Ballet Canadiens, according to her website . Haddon's daughter, Ryan, said in a social media post that her mother was “everyone’s greatest champion. An inspiration to many.” “A pure heart. A rich inner life. Touching so many lives. A life well lived. Rest in Light, Mom,” she said. The Associated Press

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Insurtech startups that wanted to change the way India buys insurance seem to have fallen back on the tried and tested model. The likes of Policybazaar had built a business around selling insurance virtually, instead of relying on agents to sell insurance policies through doorstep visits. But this same crop of players is now setting up an army of field agents, or point-of-sales personnel, to sell insurance products. Policybazaar has around 250,000 physical agents, and according to the results of its parent PB Fintech , the Gurugram-based insurance aggregator posted nearly Rs 400 crore of revenue from this business in the quarter ended September 30. InsuranceDekho , another major player in this segment has more than 200,000 agents on the ground. The business has grown too, with the company which is set to acquire smaller rival Renewbuy reporting total revenue of Rs 743 crore for the financial year 2024 with a net profit of Rs 85 crore. Mumbai-based Turtlemint claims to have around 400,000 physical agents. Web Development Intermediate Java Mastery: Method, Collections, and Beyond By - Metla Sudha Sekhar, IT Specialist and Developer View Program Marketing Digital marketing - Wordpress Website Development By - Shraddha Somani, Digital Marketing Trainer, Consultant, Strategiest and Subject Matter expert View Program Marketing Modern Marketing Masterclass by Seth Godin By - Seth Godin, Former dot com Business Executive and Best Selling Author View Program Strategy Succession Planning Masterclass By - Nigel Penny, Global Strategy Advisor: NSP Strategy Facilitation Ltd. View Program Web Development Advanced C++ Mastery: OOPs and Template Techniques By - Metla Sudha Sekhar, IT Specialist and Developer View Program Entrepreneurship Crafting a Powerful Startup Value Proposition By - Dr. Anu Khanchandani, Startup Coach with more than 25 years of experience View Program Web Development 12-Factor App Methodology: Principles and Guidelines By - Prince Patni, Software Developer (BI, Data Science) View Program Web Development A Comprehensive ASP.NET Core MVC 6 Project Guide for 2024 By - Metla Sudha Sekhar, IT Specialist and Developer View Program Office Productivity Mastering Microsoft Office: Word, Excel, PowerPoint, and 365 By - Metla Sudha Sekhar, IT Specialist and Developer View Program Web Development Java 21 Essentials for Beginners: Build Strong Programming Foundations By - Metla Sudha Sekhar, IT Specialist and Developer View Program Office Productivity Excel Essentials to Expert: Your Complete Guide By - Study At Home, Quality Education Anytime, Anywhere View Program Design Microsoft Designer Guide: The Ultimate AI Design Tool By - Prince Patni, Software Developer (BI, Data Science) View Program Artificial Intelligence(AI) Basics of Generative AI: Unveiling Tomorrow's Innovations By - Metla Sudha Sekhar, IT Specialist and Developer View Program Finance A2Z Of Money By - elearnmarkets, Financial Education by StockEdge View Program Entrepreneurship From Idea to Product: A Startup Development Guide By - Dr. Anu Khanchandani, Startup Coach with more than 25 years of experience View Program Artificial Intelligence(AI) AI and Analytics based Business Strategy By - Tanusree De, Managing Director- Accenture Technology Lead, Trustworthy AI Center of Excellence: ATCI View Program Finance Crypto & NFT Mastery: From Basics to Advanced By - CA Raj K Agrawal, Chartered Accountant View Program Entrepreneurship Startup Fundraising: Essential Tactics for Securing Capital By - Dr. Anu Khanchandani, Startup Coach with more than 25 years of experience View Program Artificial Intelligence(AI) Generative AI for Dynamic Java Web Applications with ChatGPT By - Metla Sudha Sekhar, IT Specialist and Developer View Program Entrepreneurship Building Your Winning Startup Team: Key Strategies for Success By - Dr. Anu Khanchandani, Startup Coach with more than 25 years of experience View Program Artificial Intelligence(AI) Collaborative AI Foundations: Working Smarter with Machines By - Prince Patni, Software Developer (BI, Data Science) View Program Artificial Intelligence(AI) AI-Powered Python Mastery with Tabnine: Boost Your Coding Skills By - Metla Sudha Sekhar, IT Specialist and Developer View Program Data Analysis Animated Visualizations with Flourish Studio: Beginner to Pro By - Prince Patni, Software Developer (BI, Data Science) View Program Finance Financial Literacy i.e Lets Crack the Billionaire Code By - CA Rahul Gupta, CA with 10+ years of experience and Accounting Educator View Program Web Development Maximizing Developer Productivity: The Pomodoro Technique in Practice By - Prince Patni, Software Developer (BI, Data Science) View Program The strong uptick in agent count for intermediaries shows up in the industry figures as well, where insurance companies have not grown their agent base at that pace. Data from the Insurance and Regulatory Development Authority of India ( IRDAI ) show that between financial years 2023 and 2022, intermediaries increased their agent count by 300,000 to more than a million. Insurance companies had 700,000 agents in the same time frame. The regulator has yet to release the figures for FY24. Discover the stories of your interest Blockchain 5 Stories Cyber-safety 7 Stories Fintech 9 Stories E-comm 9 Stories ML 8 Stories Edtech 6 Stories Intermediaries say working with them allows agents to provide more options to their customers. “The agent wants the choice or options from multiple insurance companies to offer to their clients and we as a broking platform have aggregated insurers and their products. We have also built technology which has made it easier for our agents to manage these policies and to service their clients,” said Turtlemint cofounder Anand Prabhudesai. ETtech The challenging part While the insurtech industry has been growing at a fast speed, there are challenges of sustainability around this growth rate. Industry insiders pointed out that the physical distribution business is primarily a volume-led business with margins being squeezed due to aggressive competition. PB Fintech group chief executive officer Yashish Dahiya, while addressing the company’s September quarter analyst call, spoke about business sustainability. “A confident market leader who's a marathon runner has to be countercyclical. He does not start sprinting just because some kids are sprinting for 5 kms; he waits (for) them to tire out. When they tire out, he tells them that you're tired, and I'm going fast now,” he said. For a business which is generating almost 40% of the revenue for a group like PB Fintech, why is the insurance veteran taking a contrarian stance — that he doesn’t want to grow very fast by burning cash. “Growth of agents in this sector is being achieved through offers of lucrative commissions mostly; add to that a technology stack which can help them manage sales and on-time pay-outs of commissions,” said an insurtech founder on the condition of anonymity. While competition among well-funded players means higher pay-outs to business partners and perhaps better deals for the consumers, there are questions about whether it is helping insurance penetration in the country or are brokers eating into the agent network of insurers with promises of lofty pay-outs? Industry insiders pointed out that the average commission paid to the field agent has gone up significantly and it could eventually hurt insurance companies. Motor commissions which should have been around 15% have shot up to around 30% and life and health commissions can go as high as 45%, they said. Also, insurance brokers are paying higher commissions to the agent by dipping into their own share of the revenue in some cases, which raises questions of sustainability in the long run, the insurtech founder cited earlier said. "The strategy for us is to go deep into the country where you can make more money per insurance sale, beyond tier one two cities, we are getting around 80% of our business from tier two cities and beyond and around 60% from tier three and beyond," said Ankit Agrawal, chief executive officer, InsuranceDekho. Regulatory scrutiny The question around brokers’ commissions and the aggression in this agent-driven market did attract regulatory attention. This question was raised last year in the Regulations Review Committee of the IRDAI, which suggested that agents be allowed to work only with insurers and intermediaries be allowed to sell insurance only through their on-roll employees. The Insurance Brokers Association had defended the role played by brokers in taking insurance to the masses. According to it, by offering choices from multiple insurance companies, they were actually helping customers get better products with a higher degree of clarity on the products. The committee’s proposal, though debated last year, seems to have been put on the backburner as of now. So the question that remains is the financial viability of these businesses. “We have stayed away from higher pay-outs to agents, we want them to work with us for our technology stack and timely pay-outs, we want to be seen as a reliable partner,” Prabhudesai of Turtlemint commented. Even PB Fintech’s Dahiya at the September analyst call pointed out that this business would never make a lot of money for his company in terms of margin percentage, but at scale it would have a significant contribution to the overall business. The wild card in all of this is Bima Sugam , the IRDAI’s attempt to create a digital public infrastructure which can connect all insurance companies through a common technology platform. If turned into a reality and at scale, it could play a significant role in stabilising prices and competition in the insurance distribution market. “As of now we are yet to see any significant achievement on that front. While insurance companies will love to have a regulator-managed online platform, the amount of capital required and the efforts needed will be huge and it will be a test for the sector to come together to build it,” said one of the founders. The Business Standard newspaper wrote on November 24 that the capital requirement for this platform has shot up to Rs 500 crore, significantly higher than previously anticipated. So whether it is an IRDAI order to restrict brokers from appointing agents, or an industry initiative to democratise technology or high burn which results in ultimate slowdown in growth, the fast growing insurance distribution industry needs to grapple with many challenges. In the meantime, every player is looking to build its own business moats, either through a war chest of venture dollars or through a network of possibly loyal agents.None

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Insurtech startups that wanted to change the way India buys insurance seem to have fallen back on the tried and tested model. The likes of Policybazaar had built a business around selling insurance virtually, instead of relying on agents to sell insurance policies through doorstep visits. But this same crop of players is now setting up an army of field agents, or point-of-sales personnel, to sell insurance products. Policybazaar has around 250,000 physical agents, and according to the results of its parent PB Fintech , the Gurugram-based insurance aggregator posted nearly Rs 400 crore of revenue from this business in the quarter ended September 30. InsuranceDekho , another major player in this segment has more than 200,000 agents on the ground. The business has grown too, with the company which is set to acquire smaller rival Renewbuy reporting total revenue of Rs 743 crore for the financial year 2024 with a net profit of Rs 85 crore. Mumbai-based Turtlemint claims to have around 400,000 physical agents. Web Development Intermediate Java Mastery: Method, Collections, and Beyond By - Metla Sudha Sekhar, IT Specialist and Developer View Program Marketing Digital marketing - Wordpress Website Development By - Shraddha Somani, Digital Marketing Trainer, Consultant, Strategiest and Subject Matter expert View Program Marketing Modern Marketing Masterclass by Seth Godin By - Seth Godin, Former dot com Business Executive and Best Selling Author View Program Strategy Succession Planning Masterclass By - Nigel Penny, Global Strategy Advisor: NSP Strategy Facilitation Ltd. View Program Web Development Advanced C++ Mastery: OOPs and Template Techniques By - Metla Sudha Sekhar, IT Specialist and Developer View Program Entrepreneurship Crafting a Powerful Startup Value Proposition By - Dr. Anu Khanchandani, Startup Coach with more than 25 years of experience View Program Web Development 12-Factor App Methodology: Principles and Guidelines By - Prince Patni, Software Developer (BI, Data Science) View Program Web Development A Comprehensive ASP.NET Core MVC 6 Project Guide for 2024 By - Metla Sudha Sekhar, IT Specialist and Developer View Program Office Productivity Mastering Microsoft Office: Word, Excel, PowerPoint, and 365 By - Metla Sudha Sekhar, IT Specialist and Developer View Program Web Development Java 21 Essentials for Beginners: Build Strong Programming Foundations By - Metla Sudha Sekhar, IT Specialist and Developer View Program Office Productivity Excel Essentials to Expert: Your Complete Guide By - Study At Home, Quality Education Anytime, Anywhere View Program Design Microsoft Designer Guide: The Ultimate AI Design Tool By - Prince Patni, Software Developer (BI, Data Science) View Program Artificial Intelligence(AI) Basics of Generative AI: Unveiling Tomorrow's Innovations By - Metla Sudha Sekhar, IT Specialist and Developer View Program Finance A2Z Of Money By - elearnmarkets, Financial Education by StockEdge View Program Entrepreneurship From Idea to Product: A Startup Development Guide By - Dr. Anu Khanchandani, Startup Coach with more than 25 years of experience View Program Artificial Intelligence(AI) AI and Analytics based Business Strategy By - Tanusree De, Managing Director- Accenture Technology Lead, Trustworthy AI Center of Excellence: ATCI View Program Finance Crypto & NFT Mastery: From Basics to Advanced By - CA Raj K Agrawal, Chartered Accountant View Program Entrepreneurship Startup Fundraising: Essential Tactics for Securing Capital By - Dr. Anu Khanchandani, Startup Coach with more than 25 years of experience View Program Artificial Intelligence(AI) Generative AI for Dynamic Java Web Applications with ChatGPT By - Metla Sudha Sekhar, IT Specialist and Developer View Program Entrepreneurship Building Your Winning Startup Team: Key Strategies for Success By - Dr. Anu Khanchandani, Startup Coach with more than 25 years of experience View Program Artificial Intelligence(AI) Collaborative AI Foundations: Working Smarter with Machines By - Prince Patni, Software Developer (BI, Data Science) View Program Artificial Intelligence(AI) AI-Powered Python Mastery with Tabnine: Boost Your Coding Skills By - Metla Sudha Sekhar, IT Specialist and Developer View Program Data Analysis Animated Visualizations with Flourish Studio: Beginner to Pro By - Prince Patni, Software Developer (BI, Data Science) View Program Finance Financial Literacy i.e Lets Crack the Billionaire Code By - CA Rahul Gupta, CA with 10+ years of experience and Accounting Educator View Program Web Development Maximizing Developer Productivity: The Pomodoro Technique in Practice By - Prince Patni, Software Developer (BI, Data Science) View Program The strong uptick in agent count for intermediaries shows up in the industry figures as well, where insurance companies have not grown their agent base at that pace. Data from the Insurance and Regulatory Development Authority of India ( IRDAI ) show that between financial years 2023 and 2022, intermediaries increased their agent count by 300,000 to more than a million. Insurance companies had 700,000 agents in the same time frame. The regulator has yet to release the figures for FY24. Discover the stories of your interest Blockchain 5 Stories Cyber-safety 7 Stories Fintech 9 Stories E-comm 9 Stories ML 8 Stories Edtech 6 Stories Intermediaries say working with them allows agents to provide more options to their customers. “The agent wants the choice or options from multiple insurance companies to offer to their clients and we as a broking platform have aggregated insurers and their products. We have also built technology which has made it easier for our agents to manage these policies and to service their clients,” said Turtlemint cofounder Anand Prabhudesai. ETtech The challenging part While the insurtech industry has been growing at a fast speed, there are challenges of sustainability around this growth rate. Industry insiders pointed out that the physical distribution business is primarily a volume-led business with margins being squeezed due to aggressive competition. PB Fintech group chief executive officer Yashish Dahiya, while addressing the company’s September quarter analyst call, spoke about business sustainability. “A confident market leader who's a marathon runner has to be countercyclical. He does not start sprinting just because some kids are sprinting for 5 kms; he waits (for) them to tire out. When they tire out, he tells them that you're tired, and I'm going fast now,” he said. For a business which is generating almost 40% of the revenue for a group like PB Fintech, why is the insurance veteran taking a contrarian stance — that he doesn’t want to grow very fast by burning cash. “Growth of agents in this sector is being achieved through offers of lucrative commissions mostly; add to that a technology stack which can help them manage sales and on-time pay-outs of commissions,” said an insurtech founder on the condition of anonymity. While competition among well-funded players means higher pay-outs to business partners and perhaps better deals for the consumers, there are questions about whether it is helping insurance penetration in the country or are brokers eating into the agent network of insurers with promises of lofty pay-outs? Industry insiders pointed out that the average commission paid to the field agent has gone up significantly and it could eventually hurt insurance companies. Motor commissions which should have been around 15% have shot up to around 30% and life and health commissions can go as high as 45%, they said. Also, insurance brokers are paying higher commissions to the agent by dipping into their own share of the revenue in some cases, which raises questions of sustainability in the long run, the insurtech founder cited earlier said. "The strategy for us is to go deep into the country where you can make more money per insurance sale, beyond tier one two cities, we are getting around 80% of our business from tier two cities and beyond and around 60% from tier three and beyond," said Ankit Agrawal, chief executive officer, InsuranceDekho. Regulatory scrutiny The question around brokers’ commissions and the aggression in this agent-driven market did attract regulatory attention. This question was raised last year in the Regulations Review Committee of the IRDAI, which suggested that agents be allowed to work only with insurers and intermediaries be allowed to sell insurance only through their on-roll employees. The Insurance Brokers Association had defended the role played by brokers in taking insurance to the masses. According to it, by offering choices from multiple insurance companies, they were actually helping customers get better products with a higher degree of clarity on the products. The committee’s proposal, though debated last year, seems to have been put on the backburner as of now. So the question that remains is the financial viability of these businesses. “We have stayed away from higher pay-outs to agents, we want them to work with us for our technology stack and timely pay-outs, we want to be seen as a reliable partner,” Prabhudesai of Turtlemint commented. Even PB Fintech’s Dahiya at the September analyst call pointed out that this business would never make a lot of money for his company in terms of margin percentage, but at scale it would have a significant contribution to the overall business. The wild card in all of this is Bima Sugam , the IRDAI’s attempt to create a digital public infrastructure which can connect all insurance companies through a common technology platform. If turned into a reality and at scale, it could play a significant role in stabilising prices and competition in the insurance distribution market. “As of now we are yet to see any significant achievement on that front. While insurance companies will love to have a regulator-managed online platform, the amount of capital required and the efforts needed will be huge and it will be a test for the sector to come together to build it,” said one of the founders. The Business Standard newspaper wrote on November 24 that the capital requirement for this platform has shot up to Rs 500 crore, significantly higher than previously anticipated. So whether it is an IRDAI order to restrict brokers from appointing agents, or an industry initiative to democratise technology or high burn which results in ultimate slowdown in growth, the fast growing insurance distribution industry needs to grapple with many challenges. In the meantime, every player is looking to build its own business moats, either through a war chest of venture dollars or through a network of possibly loyal agents.

Montana lawmakers narrowly voted down a proposal Tuesday that would have banned transgender women from using the women’s bathroom reserved for legislators between the House and Senate chambers. The biennial legislative session starts in January and legislators were meeting to propose changes to the rules that will dictate how they operate over the 90-day term. While the amendment to the joint rules that govern both the House and Senate garnered an 11-7 vote of support from senators on the Joint Rules Committee, it failed among House members 10-12. The proposal needed to pass both chambers separately to advance. Support came only from majority Republicans, while all minority Democrats and a handful of GOP lawmakers opposed the idea. “We don’t need this distraction,” said Republican Rep. David Bedey, of Hamilton, before he voted against the amendment. The proposed change was brought by Rep. Jerry Schillinger, a Republican from Circle. Over the last several legislative sessions, GOP lawmakers have brought a handful of bills that would limit the ability of transgender Montanans to update their driver's licenses, block trans girls from playing on girls’ school sports teams and more. In the 2023 session, operations on the House floor ground to a halt when one of the state's first trans lawmakers, Rep. Zooey Zephyr, D-Missoula, was blocked from speaking when the Republican speaker censured her after comments she made on a bill to ban gender-affirming care for minors. The website PolitiFact notes that at least a dozen states have some sort of laws related to blocking transgender people from using the bathrooms that are in line with their gender identities. Most recently, a federal representative introduced a resolution to ban transgender women from using women's bathrooms in the U.S. Capitol. Bedey said Tuesday he felt a change to the rules was unnecessary. “I do think that taking this particular action is a distraction from us doing our duties. We have a reasonable accommodation that we put in place. This particular action will have the effect of making people famous in the national news and will not contribute to the effective conduct of our business,” Bedey said. Rep. Jed Hinkle, a Republican from Belgrade, said last session there were locks on the bathroom doors between the Senate and House chambers and people could lock the door if they were uncomfortable. But he also said he knew of “multiple women” who did not use the bathroom and instead went to one across the Capitol building. “It may have worked for some females who were comfortable, but there are a number of females in both chambers who are not comfortable,” Hinkle said. Bedey said there was no evidence of people missing votes because they were unable to use the facilities between the House and Senate chambers. The rules package advanced by lawmakers Tuesday will be debated and voted on by the full House and Senate after the session starts Jan. 6. Holly Michels is the head of the Montana State News Bureau. You can reach her at holly.michels@lee.net Get Government & Politics updates in your inbox! Stay up-to-date on the latest in local and national government and political topics with our newsletter. State Bureau Chief {{description}} Email notifications are only sent once a day, and only if there are new matching items.After more than four decades of infusing himself with the blood clotting factor his body can’t make, Chad Stevens decided it was time to try something new. Stevens, 63, suffers from hemophilia B, a bleeding disorder caused by a genetic mutation that affects production of a type of protein known as factor 9. Over the years, bleeds have damaged his joints. His ankles have been fused, his knees and elbows have severe damage. And successfully hitting a vein to infuse himself as he got older wasn’t getting any easier. In mid-October, Stevens traveled from his home town of Newdale, Idaho, to Omaha’s Nebraska Medical Center, where he became the hospital’s first patient to receive the first gene therapy approved for his condition. Called Hemgenix, the therapy doesn’t fix the damaged gene. Instead, a modified virus delivers the working gene to the liver, providing the instructions his body needs to make the factor on its own. The medical center is the first hospital in the region to become an administration site for the therapy, according to drug-maker CSL Behring. Since then, Stevens hasn’t had any bleeds or needed to infuse clotting factor. He said he hopes the therapy will provide enough to take him from severe hemophilia to a milder version that might require infusions only for a severe trauma or surgery. “That’s really promising,” Stevens said. “I hate to get too excited about it, because you never know what’s going to happen. But I’m quite thrilled with it.” So is Dr. Alex Nester, a hematologist with Nebraska Medicine who specializes in benign or non-cancerous blood conditions, including bleeding disorders and sickle cell disease. “It’s incredible,” he said. “It’s (been) a dream in the hemophilia community for 20-plus years.” The treatment, approved by the Food and Drug Administration in 2022, is one of a number of gene therapies that have trickled out in recent years for a variety of genetic conditions. The FDA approved a separate gene therapy for hemophilia A last year. The agency also has approved two gene therapies for sickle cell disease, another inherited blood disorder that causes red blood cells to become misshapen, block blood flow and cause painful episodes. Kim Phelan, CEO of The Coalition for Hemophilia B, said the lasting advantages of the gene therapy include reduced joint damage, fewer hospitalizations and a better quality of life for people with hemophilia. An estimated 7,000 people in the U.S. have hemophilia B, and approximately 17,000 have hemophilia A, which involves a different blood clotting factor. “After more than 25 years of anticipation and hope, individuals with hemophilia now have access to a groundbreaking therapy that offers the potential for greater independence and a more normalized life,” she said. Gene therapy at Nebraska Medicine At Nebraska Medicine, the addition of the gene therapy builds on the work of the team involved in bone marrow transplants and cellular therapies, including CAR-T, or chimeric antigen receptor T-cell therapy. That treatment involves removing patients’ immune cells from their bodies and genetically engineering them to recognize and attack their cancer. Dr. Matthew Lunning, medical director of gene and cellular therapy at Nebraska Medicine, said earlier this fall that the team has used CAR-T to treat hundreds of lymphoma and leukemia patients since the late 2010s. Earlier this year, he and his team used CAR-T for the first time to treat an Omaha woman with lupus, an autoimmune disease, as part of a multi-site clinical trial. He credited Nebraska Medicine’s leaders for making the investment required to offer such ground-breaking therapies. Still, gene therapies, according to news reports, have been somewhat slow to catch on. In the case of hemophilia, Nester said he suspects that may be a result of the complex modern history of the condition. By the 1980s, he said, hemophilia patients who suffered trauma were given a concentrated form of the missing proteins when they needed help getting their blood to clot. But many contracted infections such as HIV and hepatitis C from contaminated blood products, which killed thousands of those with severe disease. Later, the products were purified but still were reserved for cases of active bleeding. As a result, older patients like Stevens suffered significant joint damage. In the 1990s, researchers began producing a recombinant version of the missing proteins in hamster cells, similar to the way insulin is made. Children diagnosed with hemophilia could dose themselves with clotting factors to prevent bleeds, he said. That resulted in a generation with no bleeding episodes for years at a time and without the joint damage suffered by older patients. “You don’t need a lot of these factors to live a pretty normal life,” said Nester, also an assistant professor of medicine in UNMC’s oncology and hematology division. That also means younger patients may have less interest for now in a more permanent solution, he said. Some also may be holding off for newer versions of the gene therapy that are in the pipeline. Stevens said his parents, on the other hand, were told he probably wouldn’t survive his teens. Between his mother and her three sisters, three had children with hemophilia, a total of seven. He was the youngest. He is now the sole survivor. Several died from bleeds and a couple died of complications of AIDs due to the contaminated clotting factor relied on at the time. “It took a big toll on the hemophilia community,” he said. “It just decimated it, really. So us older ones are pretty lucky to have survived all of that.” Issues with earlier blood products, however, also have made older patients skeptical about new treatments. “We like to wait and see how the products are doing out there before you jump on it,” he said. Cost of treatment can run into the millions Patients also have to weigh the cost. The price for the one-time treatment reportedly was set at $3.5 million. A spokesperson for CSL Behring said the company has seen an acceleration in the number of people being infused with the therapy since its approval, which the company attributes to its outreach to patients and work with insurers. Some 90% now cover the therapy, and the company also offers a program to help patients with copays. She declined to say, however, how many patients have received the therapy. But Nester said clotting factors also are costly. Depending on the patient, the source of their factor and their insurance, it may run a half a million dollars a year “to keep nothing from happening,” he said. Meanwhile, he said, researchers have seen that the majority of patients who have received the gene therapy are making 10% or more of the normal levels of the missing clotting factor even five years after being treated. That means their bodies are producing at least the preventative dose. “Patients still may have a bleeding episode after twisting their ankle or maybe needing a dose before surgery,” Nester said, “but, generally speaking, spontaneous bleeds or bleeds associated with minor trauma are gone.” Not every hemophilia patient will qualify for the treatment, however, he said. Patients can’t have antibodies to either the virus or the factor they’re missing. Stevens said his infusions probably cost closer to three-quarters of a million dollars a year. So far, the cost of his gene therapy has been covered. Previously employed in banking in Boise, he retired and applied for Social Security disability benefits on the advice of his doctor after his pain and mobility issues had made it nearly impossible for him to get out of his chair at work. He moved back to Newdale, population 325, in eastern Idaho. But he didn’t like being on disability, because he wasn’t giving back. He was elected to the City Council and appointed mayor, a post he continues to hold. “It was just a pleasure to be contributing again,” Stevens said. Since receiving the therapy, he said, he seems to be moving a little better, and his knee isn’t bothering him as much. Since the damage was done at an earlier age, he doesn’t think the therapy will do much to repair it. “But if we can keep it from getting any worse,” Stevens said, “that’s the goal.” Get local news delivered to your inbox!

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