Joining today's show are Mike Barnicle, Donny Deutsch, Sam Stein, Mark Halperin, Marc Morial, Kasie Hunt, Chuck Todd, Olivia Stearns, Kate Andersen Brower, Katy Tur, Carole King, Mike Lupica, Sara Eisen and more...NN debate: New York fight night for Clinton and Sanders...
Some would say Donny Deutsch has it all. Money? He sold his ad agency, Deutsch Inc., in 2000, for a reported $250 million. Fame? In 2004, the creative director made the leap to TV, hosting The Big Idea with Donny Deutsch on CNBC, a success-oriented talk show, and he’s been an outspoken fixture on other shows since, popping up everywhere from NBC’s Today to Morning Joe on MSNBC. Women? He’s known a few. There was, however, one thing missing from his own bucket list: a sitcom. But Donny Deutsch also has a motto: “Just fucking go for it.” (Take note, fellas!) So he did, and he now stars in his own eponymous scripted series, Donny! (which airs Tuesdays at 10:30 p.m. EST on USA), on which the real-life Donny Deutsch, 58, is reimagined as a trashy talk-show therapist. He's also returning to the radio booth with Dialing Donny, his noontime SiriusXM show premiering March 2, in which he'll offer his unvarnished perspective on women's issues like relationships, careers, and (naturally) sex.
Here, he helps us separate fact from fiction.
How did Donny! come about?
I had been doing TV for a number of years. I had my show The Big Idea on CNBC, then I was doing the “Today’s Professionals” segment on the Today show, and then I did some Morning Joe stuff. But I was kind of hitting a creative wall. I thought, “How do I break out of this?” I was with my production company, and we were talking about doing a daily talk show with a live audience. At the end of the meeting I said, “I’ve got this crazy idea...”
Is there a show that inspired yours?
Curb Your Enthusiasm was the real inspiration. I feel like an idiot even putting myself in the same sentence as Larry David, but as a genre, I would. Somebody told me it’s like a more current male Sex and the City, which I thought was interesting. It has a very urbane quality to it. But I think it is its own thing.
You play a sort of fictionalized version of yourself on Donny! Have you always been playing some sort of “Donny” character?
As an agency head, I was a guy who ended up being seen in the business as a maverick, so you start playing the maverick. On Morning Joe, I’m the guy who fights with Joe [Scarborough], who flirts with Mika [Brzezinski], who’s a little bit more liberal, who tends to be rogue. It’s not that it’s not me; it’s a presentation of me. It’s exaggerated.
Hillary Clinton and Bernie Sanders squared off Thursday night in the most heated and dramatic Democratic presidential debate of the 2016 cycle. The rivals battled it out at a two-hour prime-time event on CNN that exposed fundamental differences in their candidacies and campaign styles.
Coming just five days ahead of the crucial New York contest Tuesday, the debate featured combative exchanges on issues including gun control, Israel and Wall Street reform. These policy disagreements were fueled by a broader clash: Sanders cast doubt on Clinton's judgment and credibility, while Clinton insisted that the Vermont senator lacked experience and pragmatism.
As the two delivered harsh attacks throughout the night -- on multiple occasions inviting intervention from the moderators -- a rowdy crowd at the Brooklyn Navy Yards stoked the tension, loudly cheering and hissing to take sides.
Thursday's debate and the primary here next week come at a critical juncture in the Democratic contest. Sanders is trying to change the dynamics of a race that has delivered many more delegates to Clinton; the former secretary of state, meanwhile, is on an urgent mission to halt the momentum of her unexpectedly strong challenger.
Sanders came out swinging, accusing his Democratic presidential rival of "lacking the kind of judgment we need to be the kind of president we need." But he found himself on defense for not releasing his taxes and said he would do so on Friday.
Clinton again found herself in the spotlight for her paid speeches to big banks, declining to release the transcripts when pressed by CNN moderators. But she counterpunched by referring to the Vermont senator's trouble explaining some of his core policies in an interview with the New York Daily News.
Attacks on Wall Street
The showdown, held just across the river from Wall Street quickly turned to the issue of the big banks and their perceived excesses.
When asked to name a single policy decision Clinton made as senator that showed she was favoring the banks, Sanders said that when the "greed and recklessness and illegal behavior of Wall Street" led to the financial crisis, he had called on the big banks to be broken up -- while Clinton was "busy giving speeches to Goldman Sachs."
Clinton shot back: "He cannot come up with any example because there is no example ... It's always important -- it may be inconvenient -- but it's always important to get the facts straight."
When Clinton said that she had spoken out against the big banks for the actions, Sanders took a mocking tone.
Clinton waves as she speaks to supporters at the National Building Museum on June 7, 2008, in Washington. After pulling out of the presidential race, Clinton thanked her supporters and urged them to back Barack Obama to be the next president of the United States.
Clinton campaigns in Council Bluffs, Iowa, with her daughter, Chelsea, on January 1, 2008, two days ahead of the January 3 state caucus.
50 photos: Hillary Clinton's career in the spotlight
Clinton campaigns in Council Bluffs, Iowa, with her daughter, Chelsea, on January 1, 2008, two days ahead of the January 3 state caucus.
"Oh my goodness, they must have been really crushed by this," he said, asking whether her statements came before or after "receiving huge sums" from the banks in speaking fees.
Clinton was pressed by co-moderator Dana Bash on why she would not release the transcripts from the speeches she made to Goldman Sachs and put the issue to rest. Clinton answered: "There isn't an issue. When I was in public service serving as the senator from New York, I did stand up to the banks."
Clinton -- as she has in the past -- asked that there be the "same standard for everybody," saying she would be happy to release the transcripts if other presidential candidates, including Donald Trump, did the same.
She then turned the tables on Sanders and his tax returns, saying: "Set the same standard on tax returns. Everybody does it -- and then we move forward."
Sanders, who has come under pressure to release his tax returns, vowed on the debate stage to release his previous year's return on Friday. Returns from earlier years, he said, would also be released "very shortly."
Firing on gun control
The two also displayed intense friction over gun control.
Throughout the campaign, Clinton has criticized Sanders' record in Congress on gun control -- an attack she once again made forcefully on Thursday night. Clinton accused Sanders of having made a "commitment to the NRA" to oppose a waiting period for background checks on gun purchases -- and slammed the senator for voting against the so-called "Brady Bill" five times.
Sanders was forced to address one particularly difficult issue related to guns.
Recently, the daughter of the Sandy Hook Elementary School principal who was killed at the Newtown massacre asked that the senator apologize to the victims for "putting the gun lobby above our families."
Asked whether he would apologize, Sanders punted. Pressed a second time by Wolf Blitzer, Sanders said he did not believe he owed them an apology but that he would support their right to sue gun makers.
While speaking of the crime bill Clinton's husband Bill ushered in as president, Sanders called a term Hillary Clinton had used in the 1990s -- superpredator -- "a racist term." Clinton has since said it was a word she shouldn't have used.
At the debate, Clinton also said she was sorry for the consequences of the crime bill.
After the debate, Sanders said that in retrospect the bill, which he voted for, led to "awful things."
Differences on Israel
The second hour of the debate exposed a major foreign policy disagreement between Clinton and Sanders on the Israeli-Palestinian conflict.
Sanders recently said that Israel's response in the 2014 Gaza war was "disproportionate." On the debate stage, the senator labeled himself "100% pro-Israel" and said that the point of those controversial comments had been to emphasize that Palestinian people must be treated with respect and dignity.
"That does not make me anti-Israel," Sanders said.
Clinton, who used the discussion to highlight the extensive role she played as secretary of state in negotiating a ceasefire between Israel and Hamas in 2012, said Israel is under "constant threat."
"I don't know how you run a country when you are under constant threat. Terrorist attacks, rockets coming at you -- you have a right to defend yourself," she said.
Sanders responded by accusing Clinton of failing to answer the question of whether Israel's response was disproportionate. "You evaded the issue," he said. In a major speech to AIPAC, Sanders said his rival had "barely mentioned the Palestinians."
"We cannot continue to be one-sided," he said.
Clinton, once again, suggested that Sanders likes to point out problems without having a fully thought-out solution to address them.
"Describing a problem is a lot easier than trying to solve it," she said.
Minimum wage debate
The heated debate also exposed tensions on the issue of income inequality -- specifically, raising the minimum wage.
Asked whether she would sign a bill raising the federal minimum wage to $15, Clinton responded: "Of course I would."
That response drew this skeptical reaction from Sanders: "I am sure a lot of people are very surprised to learn that you support raising the minimum wage to $15 an hour. That's just not accurate."
In one of the most animated exchanges of the evening, the two candidates began to talk over each other, eventually prompting moderator Blitzer to intervene.
"If you're both screaming at each other, the viewers won't be able to hear either of you," Blitzer said.
On environmental issues, their differences highlighted a fundamental contrast between the pair's approaches: Clinton's calls for pragmatism and Sanders' calls for a political revolution.
Clinton lauded the global climate change pact reached in Paris, calling it a "major accomplishment."
The most memorable lines from the Democratic debate in Brooklyn
Democratic debate in Brooklyn: Memorable lines
"Our president led that effort to protect our world and he deserves our appreciation, not our criticism," Clinton said.
But Sanders argued that while the agreement was a "step forward," it wasn't enough.
"Incrementalism and those little steps are not enough," he said, before accusing Clinton of having supported fracking technology -- a drilling technique that has created a major boom in oil and natural gas but raised environmental concerns -- around the world as secretary of state.
Clinton responded that she was "bewildered" by Sanders' remarks.
"It's easy to diagnose the problem. It's harder to do something about the problem."
The dramatic debate concluded with Clinton and Sanders each making the same argument: that they are best positioned to defeat Republican front-runner Donald Trump in the November election.
Sanders said that in virtually all of the general election matchup polls pitting each of the Democrats against Trump, Sanders fared better than Clinton.
His opponent responded with numbers.
"I have gotten more votes than anybody running," she said, "2.3 million more than Sen. Sanders. And it is 1.4 million more than Donald Trump."
The location of the debate, across the East River from Manhattan, made it a home-turf battle for both candidates.
Clinton served as a New York senator for eight years and Brooklyn is the location of her campaign headquarters, while Sanders was born and raised in the borough.
In her opening statement, Clinton began with an oblique attack on the GOP, defending the "New York values" that Republican presidential candidate Ted Cruz, a Texas senator, has used as a pejorative.
Speaking of her days representing the state in the Senate, she said, "We worked hard to really keep New York values at the center of what we are and what we do together."
Polls show Clinton is likely to defeat Sanders in New York, and even as she enjoys a sizable delegate lead, it is critical for Clinton that she win this state.
The Democratic race so far has proven Sanders to be an unexpectedly durable candidate whose popularity among liberals and younger voters has helped to expose the vulnerabilities in Clinton's candidacy.
The New York race comes after a string of victories for Sanders, including Wyoming, Wisconsin, Idaho and Utah. If Sanders were to eke out a win in New York, it would deal a serious blow to Clinton and strengthen the narrative that it is taking Clinton much longer than initially expected to clinch her party's nomination.
The Post endorses Donald Trump. Donald Trump is a rookie candidate — a potential superstar of vast promise, but making rookie mistakes. The nominee Republicans need for the fall campaign is often hard to make out amid his improvisations and too-harsh replies to his critics.
New Yorkers vote Tuesday. What to do?
Here’s how we see it.
Should he win the nomination, we expect Trump to pivot — not just on the issues, but in his manner. The post-pivot Trump needs to be more presidential: better informed on policy, more self-disciplined and less thin-skinned.
Yet the promise is clearly there in the rookie who is, after all, leading the field as the finals near.
Trump has electrified the public, drawing millions of new voters to the polls and inspiring people who’d given up on ever again having a candidate who’d fight for them.
That’s the work of the Donald Trump we know — a New Yorker, born and bred.
Trump is now an imperfect messenger carrying a vital message. But he reflects the best of ‘New York values’ — and offers the best hope for all Americans who rightly feel betrayed by the political class.
A plain-talking entrepreneur with outer-borough, common-sense sensibilities.
Trump is a do-er. As a businessman, he’s created jobs for thousands. And he’s proven how a private-sector, can-do approach can rip through government red tape and get things done.
These last 10 months, he’s ripped through a different morass — the nation’s stale, insider-driven politics.
And he’s done it by appealing to the public’s anger at a government that’s eternally gridlocked when it comes to serving the people — but always able to deliver for the connected.
He’s slammed the system for being rigged — and he’s right.
To those fed up with the rule of lobbyists and an insular political class, to those who’ve seen their government ignore their needs — seen it continually degrade the quality not just of their economic lives, but of their plaace in society — Trump offers hope.
But then there are those rookie mistakes.
Start with policies that seem made on the fly.
No, pulling US troops out of Japan and South Korea — and pushing both countries to go nuclear to defend themselves — is not remotely a good idea. American commitments may need rethinking — but careful rethinking.
Yes, controlling the border is one of Washington’s fundamental duties — but “Build the Wall” is far too simplistic a policy for a nation of immigrants.
By all means, get the best trade deals for America — but remember that trade means cheaper goods for the less well-off, and challenge US industries to improve.
Trump’s language, too, has too often been amateurish, divisive — and downright coarse.
But what else to expect from someone who’s never been a professional politician and reflects common-man passions?
Indeed, his political incorrectness is one of his great attractions — it proves he’s not one of “them.” He’s challenging the victim culture that has turned into a victimizing culture.
In the general election, we’d expect Trump to stay true to his voters — while reaching out to those he hasn’t won yet.
Trump is now an imperfect messenger carrying a vital message. But he reflects the best of “New York values” — and offers the best hope for all Americans who rightly feel betrayed by the political class.
He has the potential — the skills, the know-how, the values — to live up to his campaign slogan: to make America great again.
For those reasons, The Post today endorses Donald Trump in the GOP primary.
Zika Virus and Birth Defects — Reviewing the Evidence for Causality
The Zika virus has spread rapidly in the Americas since its first identification in Brazil in early 2015. Prenatal Zika virus infection has been linked to adverse pregnancy and birth outcomes, most notably microcephaly and other serious brain anomalies. To determine whether Zika virus infection during pregnancy causes these adverse outcomes, we evaluated available data using criteria that have been proposed for the assessment of potential teratogens. On the basis of this review, we conclude that a causal relationship exists between prenatal Zika virus infection and microcephaly and other serious brain anomalies. Evidence that was used to support this causal relationship included Zika virus infection at times during prenatal development that were consistent with the defects observed; a specific, rare phenotype involving microcephaly and associated brain anomalies in fetuses or infants with presumed or confirmed congenital Zika virus infection; and data that strongly support biologic plausibility, including the identification of Zika virus in the brain tissue of affected fetuses and infants. Given the recognition of this causal relationship, we need to intensify our efforts toward the prevention of adverse outcomes caused by congenital Zika virus infection. However, many questions that are critical to our prevention efforts remain, including the spectrum of defects caused by prenatal Zika virus infection, the degree of relative and absolute risks of adverse outcomes among fetuses whose mothers were infected at different times during pregnancy, and factors that might affect a woman’s risk of adverse pregnancy or birth outcomes. Addressing these questions will improve our ability to reduce the burden of the effects of Zika virus infection during pregnancy.
POTENTIAL RELATIONSHIP BETWEEN ZIKA VIRUS INFECTION AND BIRTH DEFECTS
Since the identification of the Zika virus in Brazil in early 2015, the virus has spread rapidly throughout the Americas (www.cdc.gov/zika/geo/active-countries.html). An increase in the number of infants with microcephaly in Brazil was first noted in September 2015, after the recognition of Zika virus transmission in the country earlier in the year1; this was followed by the recognition of a similar increase in French Polynesia after an outbreak there in 2013 and 2014.2 Despite accumulating evidence that supports the link between Zika virus infection and microcephaly, most experts have taken care not to state that Zika virus infection is causally related to these adverse outcomes.3 This cautious approach toward ascribing Zika virus as a cause of birth defects is not surprising, given that the last time an infectious pathogen (rubella virus) caused an epidemic of congenital defects was more than 50 years ago, no flavivirus has ever been shown definitively to cause birth defects in humans,4 and no reports of adverse pregnancy or birth outcomes were noted during previous outbreaks of Zika virus disease in the Pacific Islands.5,6
On the basis of the available evidence, the public health response to the outbreak of Zika virus disease has moved forward, with the distribution of health messages about the importance of mosquito-bite prevention, recommendations by public health authorities in some of the most severely affected countries to delay pregnancy, and advisories that pregnant women avoid travel to areas with active Zika virus transmission.7 However, communications regarding Zika virus have been challenging: a recent survey showed low levels of knowledge and concern about Zika virus in the United States.8 The recognition of Zika virus as a cause of microcephaly and other serious brain anomalies would allow for more direct communication, which might lead to improved understanding of and adherence to public health recommendations. Therefore, a review of the evidence linking Zika virus infection and adverse pregnancy and birth outcomes is needed.
As is typically the case in epidemiology and medicine, no “smoking gun” (a single definitive piece of evidence that confirms Zika virus as a cause of congenital defects) should have been anticipated. Instead, the determination of a causal relationship would be expected to emerge from various lines of evidence, each of which suggests, but does not on its own prove, that prenatal Zika virus infection can cause adverse outcomes. Two approaches have been used to identify potential teratogens (exposures to a mother during pregnancy that have a harmful effect on her embryo or fetus)9: first, the identification of a combination of a rare exposure and a rare defect (sometimes referred to as the astute clinician approach),10 and second, the use of epidemiologic data to confirm an association. Many teratogens were first identified by means of the rare exposure–rare defect approach, including rubella virus, which was identified after an ophthalmologist noted a characteristic form of cataracts in infants whose mothers had rubella during pregnancy,11 and heavy alcohol use, which was identified as a teratogen after the recognition of a characteristic pattern of malformations that became known as the fetal alcohol syndrome.12 In contrast, some teratogens have been identified on the basis of epidemiologic studies (e.g., valproic acid was identified as a teratogen after a case–control study showed an odds ratio of 20 for the association of spina bifida with use of this drug during the first trimester of pregnancy).13
SHEPARD’S CRITERIA
In 1994, Thomas Shepard, a pioneer in the field of teratology, proposed a set of seven criteria for “proof” of human teratogenicity (Table 1TABLE 1
Shepard’s Criteria for Proof of Teratogenicity in Humans as Applied to the Relationship between Zika Virus Infection and Microcephaly and Other Brain Anomalies.
) that incorporated both approaches.9 These criteria were an amalgamation of criteria developed by other teratologists and guided by methods that were used to identify previous teratogens. These criteria have been used to guide discussions about causation in teratology-related litigation30 and to assess other potential teratogens.10 We used Shepard’s criteria9 as a framework to evaluate whether the currently available evidence supports the hypothesis that prenatal Zika virus infection is a cause of microcephaly and other brain anomalies (Table 1).
According to these criteria, causality is established when either criteria 1, 3, and 4 (rare exposure–rare defect approach) or criteria 1, 2, and 3 (epidemiologic approach) are fulfilled. The first criterion states that a proven exposure to an agent must occur at a critical time during prenatal development. The severe microcephaly and other brain anomalies that have been observed in many infants are consistent with an infection occurring in the first or early second trimester of pregnancy. Several case reports and studies have shown that women who had fetuses or infants with congenital brain anomalies that were believed, on the basis of the mother’s symptoms or laboratory confirmation, to be due to Zika virus infection were infected in the first or early second trimester of pregnancy, as determined either according to the timing of the symptoms or according to the timing of travel to an area where Zika virus is endemic.14-20 An analysis of the timing of laboratory-confirmed Zika virus transmission in certain states in Brazil and of the increase in the cases of microcephaly identified the first trimester as the critical time period for infection.1 Zika virus infections that occur later in pregnancy have been associated with poor intrauterine growth, fetal death, or in some pregnancies, defects on prenatal imaging that have not yet been confirmed postnatally because the pregnancies are ongoing.14 We conclude that Shepard’s first criterion has been met.
Shepard’s second criterion requires that two epidemiologic studies of high quality support the association. Although ecologic data do not necessarily qualify as an epidemiologic study, data from Brazil regarding the temporal and geographic association between Zika virus infection and the later appearance of infants with congenital microcephaly are compelling.1,31,32 Two epidemiologic studies also provide support.2,14 In a study conducted during the outbreak in Brazil, 88 pregnant women who had had an onset of rash in the previous 5 days were tested for Zika virus RNA. Among the 72 women who had positive tests, 42 underwent prenatal ultrasonography, and fetal abnormalities were observed in 12 (29%); none of the 16 women with negative tests had fetal abnormalities. The abnormalities that were observed on ultrasonography varied widely, and some findings lacked postnatal confirmation because the pregnancies were ongoing.14
A retrospective analysis after the 2013–2014 outbreak of Zika virus disease in French Polynesia identified eight cases of microcephaly; the authors used serologic and statistical data and mathematical modeling to estimate that 1% of the fetuses and neonates who were born to mothers who had been infected with Zika virus in the first trimester had microcephaly2 — a prevalence that was approximately 50 times as high as the estimated baseline prevalence. However, this estimate was based on small numbers, confidence intervals were wide, and the risk of other adverse outcomes (e.g., other brain anomalies) was not assessed.2 Although these studies provide important evidence in support of a causal relationship between Zika virus and microcephaly and other brain anomalies, both have limitations as noted by their authors, such as a lack of control for confounding factors and relatively small numbers of cases, and therefore they do not meet the stringent criteria set by Shepard. Thus, we conclude that Shepard’s second criterion has not yet been satisfied.
The third criterion, careful delineation of clinical cases with the finding of a specific defect or syndrome, appears to be met. Previous teratogens have caused specific birth defects or syndromes rather than a broad range of birth defects.33 Many fetuses and infants with presumed congenital Zika virus infection have had a typical pattern, including severe microcephaly, intracranial calcifications, and other brain anomalies, sometimes accompanied by eye findings, redundant scalp skin, arthrogryposis, and clubfoot15,20-23; such findings have led authors to use the term “congenital Zika syndrome.”22,34,35 On the basis of clinical details from a limited number of cases, some infants with presumed congenital Zika virus infection have had features that were consistent with fetal brain disruption sequence,24 a phenotype involving the brain that is characterized by severe microcephaly, overlapping cranial sutures, prominent occipital bone, redundant scalp skin, and considerable neurologic impairment.20,22 For example, 11 of 35 infants (31%) with microcephaly whose cases were reported to a Brazil Ministry of Health registry had excessive and redundant scalp skin,20 a finding that is not typically seen in other forms of microcephaly.36 These findings suggest an interruption of cerebral growth, but not in that of the scalp skin, after an injury (e.g., viral infection, hyperthermia, or vascular disruption) that occurred after the initial formation of brain structures, followed by partial collapse of the skull. The fetal brain disruption sequence is rare; only 20 cases were identified in a literature review in 2001.24
Shepard’s fourth criterion refers to the association between a rare exposure and a rare defect; we conclude that this criterion also has been met. The concept behind this criterion is that a rare defect occurring after a rare exposure during pregnancy implies causation because of the unlikelihood of the two rare events occurring together.10 Microcephaly is a rare defect that is estimated to occur in 6 infants per 10,000 liveborn infants in the United States.25 Zika virus would not be a rare exposure among women living in Brazil during the Zika virus outbreak. However, reports of adverse birth outcomes among travelers who spent only a limited time period in an area where there is active Zika virus transmission are consistent with Zika virus being a rare exposure.16,18,19
A recent report is illustrative: a pregnant woman traveled for 7 days to Mexico, Guatemala, and Belize during her 11th week of gestation and had a positive test for Zika virus immunoglobulin M (IgM) antibodies 4 weeks later. On fetal ultrasonography and magnetic resonance imaging performed at 19 to 20 weeks of gestation, severe brain anomalies were diagnosed in the fetus, and the pregnancy was terminated at 21 weeks of gestation. Microcephaly was not present at the time of pregnancy termination, but the head circumference had decreased from the 47th percentile at 16 weeks of gestation to the 24th percentile at 20 weeks of gestation (a finding that is consistent with the timing of diminishing head sizes in previous cases),14 which suggests that microcephaly would have developed in the fetus had the pregnancy continued.16 In this woman, Zika virus would be considered a rare exposure, and her fetus had a rare outcome.
The last three criteria are helpful if they are present, but they are not considered to be essential. The fifth criterion, the need for an animal model that shows teratogenicity, has not been met. Although animal models have shown that Zika virus is neurotropic,27,28 no studies that tested for teratogenicity in an animal model have been published, although studies are under way. The sixth criterion, that the association should make biologic sense, is clearly met here. Other viral infections have had similar effects (microcephaly and eye problems).24,26 In addition, pathologic evidence supports this association: Zika virus RNA has been seen in damaged mononuclear cells (presumably glial cells and neurons) in the brains of newborns with microcephaly,17 and the virus appears to be neurotropic.17,19 Live Zika virus has been cultured from the brain of a fetus with severe brain anomalies after maternal infection at 11 weeks of gestation.16 Furthermore, Zika virus efficiently infects neural progenitor cells and produces cell death and abnormal growth, thus providing a possible mechanism for microcephaly.29 The seventh criterion, proof in an experimental system that the agent acts in an unaltered state, is aimed at medications or chemical exposures and does not apply to infectious agents. Thus, given Shepard’s criteria as a framework, criteria 1, 3, and 4 have been satisfied — evidence that is considered sufficient to identify an agent as a teratogen.
OTHER CRITERIA
Other criteria can also be used to assess this relationship. Koch’s postulates, developed in the late 19th century, are often cited as necessary to show causation in infectious disease; however, many authors have noted the need for Koch’s postulates to be updated to accommodate modern technologies.37-39 The Bradford Hill criteria40 provide another framework to assess causation; Frank et al. recently used these criteria to assess the relationship between prenatal Zika virus infection and microcephaly and concluded that additional information was needed to assume that the relationship was causal.41 However, several key pieces of evidence have become available since they performed their analysis, including two epidemiologic studies,2,14 a study of the effects of Zika virus on neural progenitor cells,29 and a case report of a fetus with brain anomalies and decreasing head size from whose brain live Zika virus was isolated.16 On the basis of our update of their analysis, which incorporates newly available evidence (Table 2TABLE 2
Bradford Hill Criteria for Evidence of Causation as Applied to the Relationship between Zika Virus Infection and Microcephaly and Other Brain Anomalies
), nearly all the relevant criteria have been met, with the exception of the presence of experimental evidence. However, Hill emphasizes that meeting all nine criteria is not necessary40; instead, the criteria should serve as a framework to assess when the most likely interpretation of a relationship is causation.
ASSESSMENT OF CRITERIA
Thus, on the basis of a review of the available evidence, using both criteria that are specific for the evaluation of potential teratogens9 and the Bradford Hill criteria40 as frameworks, we suggest that sufficient evidence has accumulated to infer a causal relationship between prenatal Zika virus infection and microcephaly and other severe brain anomalies. Also supportive of a causal relationship is the absence of an alternative explanation; despite the extensive consideration of possible causes, researchers have been unable to identify alternative hypotheses that could explain the increase in cases of microcephaly that were observed first in Brazil and then retrospectively in French Polynesia, and now in preliminary reports that are being investigated in Colombia.1,2,42
Moving from a hypothesis that Zika virus is linked to certain adverse outcomes to a statement that Zika virus is a cause of certain adverse outcomes allows for direct communications regarding risk, both in clinical care settings and in public health guidance, and an intensified focus on prevention efforts, such as the implementation of vector control, the identification of improved diagnostic methods, and the development of a Zika virus vaccine.44 In addition, after recognizing a causal relationship between Zika virus infection and adverse pregnancy and birth outcomes, we can focus research efforts on other critical issues: First, understanding the full spectrum of defects caused by congenital Zika virus infection; if Zika virus is similar to other teratogens, an expansion of the phenotype would be expected (e.g., with the congenital rubella syndrome, the phenotype was expanded from cataracts to include other findings such as hearing loss, congenital heart defects, and microcephaly).11 Second, quantifying the relative and absolute risks among infants who are born to women who were infected at different times during pregnancy. Third, identifying factors that modify the risk of an adverse pregnancy or birth outcome (e.g., coinfection with another virus, preexisting immune response to another flavivirus, genetic background of the mother or fetus, and severity of infection). Addressing these issues will improve our efforts to minimize the burden of the effects of Zika virus infection during pregnancy.
Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.
This article was published on April 13, 2016, at NEJM.org.
SOURCE INFORMATION
From the Division of Public Health Information Dissemination, Center for Surveillance, Epidemiology, and Laboratory Services (S.A.R.), Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion (D.J.J.), and Division of Congenital and Developmental Disorders, National Center on Birth Defects and Developmental Disabilities (M.A.H.), Centers for Disease Control and Prevention, Atlanta; and the Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, CO (L.R.P.).
Address reprint requests to Dr. Rasmussen at the Centers for Disease Control and Prevention, 1600 Clifton Rd., MS E-33, Atlanta, GA 30329, or at skr9@cdc.gov.
Board recommends parole for Charles Manson follower Leslie Van Houten; victim's daughter vows to oppose.
A California review board recommended parole Thursday for former Charles Manson “family” member Leslie Van Houten, who was convicted along with other members of the cult in the 1969 killings of Leno and Rosemary LaBianca.
Van Houten, 66, had been denied parole 19 times by the state parole board since being convicted of first-degree murder and sentenced to life in prison. After the two commissioners on the panel issued their decision at a hearing at the California Institution for Women in Chino, Van Houten said she felt “numb,” according to her attorney, Richard Pfeiffer.
“The opposition to parole has always been the name Manson,” Pfeiffer said. “A lot of people who oppose parole don’t know anything about Leslie’s conduct. Her role was bad. Everyone’s was. But they don’t know what she’s done since then and all of the good she’s done.”
The ruling will be reviewed by the parole board’s legal team. If upheld, it will be forwarded to Gov. Jerry Brown, who could decide to block Van Houten’s release. A spokesman for the governor said Thursday that it would be premature for his office to comment.
Cory LaBianca, who was 21 when her father, a wealthy grocer, and stepmother were slain in their Los Feliz home, said she was disappointed by the parole board’s decision and planned to lobby the governor to reject Van Houten’s release.
“Maybe Leslie Van Houten has been a model prisoner,” Cory LaBianca said. “But you know what? We still suffer our loss. My father will never be paroled. My stepmother will never get her life back. There’s no way I can agree with the ruling today.”
Los Angeles County Dist. Atty. Jackie Lacey, whose office argued for Van Houten to remain behind bars, also expressed disapproval in a statement: “We disagree with the board's decision and will evaluate how we plan to proceed.
Five people in all, including Van Houten, were convicted of the Tate-LaBianca killings, part of a murderous rampage hatched by Manson in an effort to instigate a race war, according to trial testimony.
The youngest of Manson’s followers, Van Houten has been considered the least blameworthy member of the group and has been portrayed by supporters as a misguided teen under the influence of LSD on the night of the slayings.
A former homecoming queen from Monrovia, Van Houten did not join in the Aug. 9, 1969, murders of Sharon Tate, the pregnant wife of film director Roman Polanski, and four others at the Benedict Canyon home that Tate was renting.
But the following day, Van Houten, then 19, was part of a group that stormed into the LaBiancas’ home. As Charles “Tex” Watson stabbed Leno LaBianca, Van Houten and another woman held down Rosemary LaBianca. After Watson stabbed Rosemary LaBianca with a bayonet, he handed a knife to Van Houten. She testified to stabbing Rosemary in the back at least 14 more times.
The blood of the victims was used to scrawl messages on the walls, as had been done at the Benedict Canyon home.
Van Houten, Manson and three others were convicted and sentenced to death, but after the California Supreme Court struck down the death penalty, their sentences were commuted to life in prison.
An appellate court overturned Van Houten’s conviction in 1976, and a second trial the following year ended in a hung jury. She was convicted in her third trial in 1978 and sentenced to seven years to life in prison.
Starting in 1979, Van Houten went before the parole board almost regularly. In 1985, board member Rudolph Castro said her crimes “shocked the conscience” and her “willingness to join a marauding group … whose purpose was to commit crimes” warranted keeping her behind bars.
The Manson murders
Charles Manson and other members of his so-called family were convicted of killing actress Sharon Tate and six other people during a bloody rampage in the Los Angeles area during two August nights in 1969. Prosecutors said Manson and his followers were trying to incite a race war that he believed was prophesized in the Beatles' song "Helter Skelter."
In recent years, Van Houten’s attorneys characterized her as a model inmate, earning bachelor’s and master’s degrees from prison while running self-help groups for incarcerated women.
At a 2002 parole board hearing, Van Houten said she was “deeply ashamed” of what she had done, adding: “I take very seriously not just the murders, but what made me make myself available to someone like Manson.”
According to comments carried by the Associated Press, she told the board Thursday: “I don't let myself off the hook. I don't find parts in any of this that makes me feel the slightest bit good about myself.”
Near the end of the five-hour hearing, Commissioner Ali Zarrinnam told her: “Your behavior in prison speaks for itself. Forty-six years and not a single serious rule violation.”
Manson, 81, and others convicted in the killings remain in prison. Watson and Patricia Krenwinkel have been denied parole several times, and Susan Atkins died in 2009.
Last summer, a review board recommended parole for Manson associate Bruce Davis, who was convicted in the 1969 slayings of Gary Hinman and Donald “Shorty” Shea. He was not involved in the Tate-LaBianca murders.
In January, Brown rejected parole for the 73-year-old, stating that “Davis' own actions demonstrate that he had fully bought into the depraved Manson family beliefs.”
State will not prosecute Donald Trump's campaign manager.
Republican Presidential Candidate Donald Trump speaks at a campaign rally on April 6, 2016 in Bethpage, New York.
Donald Trump's Hollywood star getting mixed reactions
Republican presidential candidate Donald Trump chats with patrons and workers at a George Webb diner following an interview with Fox News on April 5, 2016 in Wauwatosa, Wisconsin.
Who is Corey Lewandowski?
Republican presidential candidate Donald Trump speaks at a news conference before a public signing for his new book "Crippled America: How to Make America Great Again," at the Trump Tower Atrium on November 3, 2015 in New York City.
Donald Trump's Hollywood star getting mixed reactions
Republican presidential candidate Donald Trump chats with patrons and workers at a George Webb diner following an interview with Fox News on April 5, 2016 in Wauwatosa, Wisconsin.
Prosecutor: Not enough evidence to convict Lewandowski.
Corey Lewandowski campaign manager for Republican presidential candidate Donald Trump speaks with the media before former presidential candidate Ben Carson gives his endorsement to Mr. Trump at the Mar-A-Lago Club on March 11, 2016 in Palm Beach, Florida. Presidential candidates continue to campaign before Florida's March 15th primary day. (Photo by Joe Raedle/Getty Images)
Who is Corey Lewandowski?
Lewandowski's lawyer: He was protecting Donald Trump
Republican presidential candidate Donald Trump speaks at a news conference before a public signing for his new book "Crippled America: How to Make America Great Again," at the Trump Tower Atrium on November 3, 2015 in New York City.
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Republican Presidential Candidate Donald Trump speaks at a campaign rally on April 6, 2016 in Bethpage, New York.
Donald Trump looks to dominate in New York
Story highlights
(CNN)Palm Beach County Florida State Attorney David Aronberg will not prosecute Donald Trump's campaign manager, Corey Lewandowski, Aronberg announced Thursday.
"As state attorney I have made the decision that this office will not be filing charges against Corey Lewandowski for battery," Aronberg said at a news conference.
A former reporter for Breitbart, Michelle Fields, sought charges against Lewandowski after an incident in March where she said Lewandowski pulled her away from Trump as she was trying to ask him a question.
Aronberg said police were within their right to charge Lewandowski, but prosecutors are held to a higher standard and thus didn't find enough to bring the case.
He also revealed that Trump personally spoke with prosecutors and the campaign shared a draft of an apology letter with Aronberg's office "earlier this week," though it apparently has not yet been sent.
Lewandowski said Thursday night he was relieved the charges were dropped and he wanted to move on from the incident, which he called a "huge distraction" for the campaign. He said he was "thankful" for Trump's loyalty.
"What we saw was, you know you have an individual that remembers an incident very differently than the way I remember it. I don't remember it at all, candidly, and my entire interaction with her was on that videotape. I've never met her before, I've never spoken with her afterward," Lewandowski told Fox News' Sean Hannity. "So my sum total of that relationship with her was about three seconds long. I know that sounds like a long time, but in a three-second incident that I don't recall because it wasn't very memorable, this has really taken over a big piece of my life. I'm glad it's behind us."
The Trump campaign released a statement Thursday calling the matter closed.
"Corey Lewandowski is gratified by the decision to drop the misdemeanor charge and appreciates the thoughtful consideration and professionalism by the Palm Beach State Attorney and his staff who carefully reviewed this matter, as well as Mr. Trump's loyalty and the support of his colleagues and family during this time," the statement said. "The matter is now concluded."
Aronberg and his deputy who reviewed the case, Adrienne Ellis, said the video clearly shows Fields making contact with Trump's arm as she tries to interview him, him recoiling and shows Lewandowski grab her arm and pull her away.
After reviewing the evidence in the case, the state attorney said he doesn't feel there is enough evidence to pursue criminal charges. He explained that while police are required to meet a "probable cause" threshold to make an arrest, prosecutors must believe they have a chance to prove beyond a reasonable doubt the battery occurred and get a conviction.
"They acted well within their authority to investigate and make an independent charging decision. We agree that probable cause exists for the Jupiter Police Department to charge Mr. Lewandwoski in this case," Aronberg said. "Our standard is higher than probable cause. ... Although the facts support the allegation that Mr. Lewandowski did grab Ms. Fields' arm against her will, Mr. Lewandowski has a reasonable hypothesis of innocence"
The news is a sigh of relief for both Lewandowski and the Trump campaign, which risked facing a major legal distraction during the heat of the competitive presidential campaign.
"I think it's justifiable what he did," Lewandowski's attorney Brad Cohen told CNN's Brooke Baldwin. Aronberg said Lewandwoski may have been protecting Trump.
The incident at Trump's Mar-a-Lago estate on March 8, the night of the Michigan presidential primary, led to a weeks-long dispute between the Trump campaign, some media outlets and Fields, as to what actually happened.
Who is Corey Lewandowski?
Politico first reported that Lewandowski would not be charged.
Fields may still seek defamation charges against Lewandowski based on his efforts to dismiss her claims and cast doubt on her integrity, according to one source.
Cohen suggested on CNN that she may not want to: "I don't find it to be that good of an idea to file a defamation suit in this case because it just opens doors to your past and other things," he said.
In response to the reports the charges would be dropped, Fields tweeted: "Prosecutor's office told me they would inform me of decision tomorrow. If reports true, guess they decided to leak to reporters first. Ugly."
Earlier this week, the state attorney's office tried to broker a deal in which Lewandowski would agree to publicly apologize to Fields instead of facing prosecution, one source with knowledge of the situation said. While Fields agreed to the offer, it's not yet clear that Lewandowski did.
Aronberg confirmed that the office would have appreciated an apology and that the draft of a "short" apology letter was shared with them, but said it did not factor into their decision making.
"The apology, in a case like this, obviously would be encouraged," Aronberg said. "We always appreciate when people take responsibility for their actions."
"Would he apologize for having any contact with her? Certainly he could but I don't know," Cohen said.
Fields added: "For those asking, office of prosecutor asked 2 weeks ago if I'd be ok with an apology from Corey. I said ya but haven't heard back about it."
Aronberg also denied that any political calculations went into his decision. He is a registered Democrat and has supported Hillary Clinton, but he also noted that he shared a bathroom at law school with Texas Sen. Ted Cruz, Trump's Republican opponent, and knew former candidate Sen. Marco Rubio in Florida.
"My political affiliation and my political leanings are very public, but they don't come inside this office," Aronberg said. "The sole bearing on our decision was the facts of this case and the law"
Trump has stood by his aide, initially saying he thought the allegations were made up, but multiple videos of the encounter appeared to show Lewandowski pulling Fields' arm.
"I would have loved to have fired him," Trump told CNN's Anderson Cooper during a town hall event in March. "It would have been much easier than talking to you about this all night long ... I don't want to ruin (Lewandowski's) life."
Trump attributed Lewandowski's actions to security concerns.
"She had a pen in her hand, which Secret Service is not liking because they don't know what it is, whether it's a little bomb," he said.
Trump also forcefully rejected calls from his rivals to suspend or fire Lewandowski, saying Wednesday on ABC's "Good Morning America," that "The other candidates, they said, 'Oh, I should fire him.' That's because they're weak, ineffective people. They want to be politically correct. I don't want to be politically correct. I want to be correct."
Fields, who was a reporter for Breitbart at the time, resigned from the conservative news outlet one week later, along with other staffers. CNN's Dylan Byers, Tal Kopan, Tom LoBianco, Josh Gaynor and Julia Manchester contributed to this report.
Here BTW, is the Donald Trump op-ed they are discussing onthe show now: Let Me Ask America a Question. How has the ‘system’ been working out for you and your family? No wonder voters demand change.
Clinton apologizes for 'unfortunate impact' of 1994 crime bill. Democratic presidential front-runner Hillary Clinton said Thursday that she was sorry for what she described as the unintended consequences of a landmark 1994 crime bill signed into law by her husband, former President Bill Clinton.
Clinton's past support for the law has come under fire from some African-Americans, who say that it has contributed to mass incarceration of young blacks.
When asked if she believed the bill was a mistake during the Democratic debate in Brooklyn, N.Y., Clinton said the law "had some positive aspects", like an effort to prevent violence against women.
When pressed on her support for the law, Clinton said she was "sorry for the consequences that were unintended and that have had a very unfortunate impact on people's lives." She also noted that her husband had apologized for the law and that her opponent, Sen. Bernie Sanders, I-Vt., had voted for the bill.
For his part, Sanders stood by his criticism of Bill Clinton for defending Hillary Clinton's use of the term "super predators" in 1996 to describe some criminals.
"It was a racist term, and everybody knew it was a racist term," Sanders said.
The self-described democratic socialist, who was a congressman at the time the bill was passed, agreed the law was a mixed bag. He then called for a rethink of what he described as "a broken criminal justice system ... from the bottom on up." The Associated Press contributed to this report.
Wall Street puts big money behind candidates. The question of Wall Street's influence on political candidates has been front and center in the 2016 race. MSNBC's Olivia Sterns joins Kate Snow to discuss.
Regardless of it all happening during this long week, please stay in touch.
