F.D.A. Approves First Drug to Treat Severe Multiple Sclerosis

The Food and Drug Administration approved on Tuesday the first drug to treat a severe form of multiple sclerosis, offering hope to patients who previously had no other options to combat a relentless disease that leads to paralysis and cognitive decline.

The federal agency also cleared the drug to treat people with the more common, relapsing form of the disease.

“I think that this is a very big deal,” said Dr. Stephen Hauser, the chairman of the neurology department at the University of California, San Francisco, and leader of the steering committee that oversaw the late-stage clinical trials of the drug, ocrelizumab. “The magnitude of the benefits that we’ve seen with ocrelizumab in all forms of M.S. are really quite stunning.”

The drug, which will be sold under the brand name Ocrevus by Genentech, showed the most notable results in patients with relapsing multiple sclerosis, appearing to halt progression of the disease with few serious side effects. In patients with the more severe form, primary progressive multiple sclerosis, the drug only modestly slowed patients’ decline, but medical experts described it as an important first step.

“This sort of opens the door for us,” said Dr. Fred D. Lublin, who was a crucial investigator for the clinical trial and is director of the Corinne Goldsmith Dickinson Center for Multiple Sclerosis at Mount Sinai Hospital in New York. “Once we open that door, then we do better and better and better. It’s a very encouraging result.”

Genentech, which is owned by the Swiss pharmaceutical giant Roche, said Tuesday that it would charge a list price of $65,000 a year, which — though expensive — is 25 percent less than an existing drug, Rebif, that was shown to be clinically inferior to Ocrevus in the two clinical trials that led to Ocrevus’s approval.

Rebif, sold in the United States by the German company EMD Serono, carries a list price of about $86,000. In a statement, Genentech noted that the price of drugs to treat multiple sclerosis had risen sharply in recent years.

“We feel that the industry needs to start to reverse this trend, and believe that pricing Ocrevus 25 percent less than the comparator in our trials is an important first step,” the company said.

Although people with the relapsing form of the disease have more than a dozen treatment options, many of the most effective drugs also come with significant side effects, which means that doctors often wait to prescribe them until a patient’s disease has advanced significantly. Ocrevus is viewed as relatively safe: Side effects included reactions at the injection site (the drug is infused every six months), and more upper respiratory infections and cold sores.

As a result, “it represents a new treatment option that has the potential to be used earlier,” said Dr. Peter Chin, the group medical director of neuroscience at Genentech, who was closely involved in developing the drug.

An estimated 400,000 people have multiple sclerosis in the United States, and about 15 percent have the primary progressive form of the disease.

In the trials that studied the relapsing form of the disease, which involved 1,656 patients, those taking Ocrevus saw a 47 percent reduction in their rate of relapses compared with patients who were taking an existing treatment, Rebif. In the clinical trial for people with primary progressive multiple sclerosis, which involved 732 patients, those on the drug had 24 percent less risk of their disability progressing compared with patients who were taking a placebo.

Ocrevus works by depleting a specific type of a patient’s B cells, which circulate in the blood and are part of the immune system. While they normally help the body fight off infections, they are believed to malfunction and contribute to central nervous system damage in people with multiple sclerosis.

“I think if the safety holds up, it will become the leading M.S. therapy,” said Dr. Steven L. Galetta, the chairman of the department of neurology at NYU Langone Medical Center, who is an expert in multiple sclerosis and who was not involved in the clinical trials. But, Dr. Galetta said, the medical community will be watching to see how the drug performs once it is widely available. The clinical trial showed a slightly heightened rate of tumors in patients with primary progressive multiple sclerosis, which he said needed to be monitored closely. “There can be side effects, but you just didn’t have enough patients initially to confirm that signal,” he said.

Jerrie Gullick, one of the patients who received Ocrevus in the clinical trial, said the drug had significantly slowed the progression of her primary progressive multiple sclerosis since she began taking it about three and a half years ago.

Ms. Gullick, who is 51, had been declining steadily since she learned she had the disease in 2010. At the time she learned she had multiple sclerosis, Ms. Gullick was an active 45-year-old who walked six miles a day between her home in Park Slope and her office in Downtown Brooklyn, where she worked as the chief financial officer of a technology start-up.

But her condition quickly deteriorated, and the drugs she was given appeared to do little to help her. She lost the ability to walk more than two to three blocks at a time, and she had to move out of her third-floor walk-up to an elevator building. Fatigue led her to leave her job, and she began to notice cognitive decline.

Ms. Gullick said that at first she hoped she was on the placebo because while she noticed her disease slowing, her condition did not improve. “From a patient perspective, what you want is to get back what you’ve lost,” Ms. Gullick said. “What this drug seems to do is to stop what was happening.”

Now, she said, she is thankful that Ocrevus appears to have bought her more time. “I was figuring another five years, and I was going to be bed-bound, and one day I realized I might have 20 or 30 more years of this,” she said. “It’s like I was on a bullet train, and I was transferred to a local.”


Missing man found in the stomach of 20-foot-long snake

A man who went missing in Indonesia earlier this week was near his own garden — inside the stomach of a 20-foot long snake.

Photo Gallery: 5 largest types of snakes

The Straits Times —an English-speaking newspaper in Singapore — reports that Akbar Salubiro was last seen on Sunday morning when he went off to harvest palm oil. After he didn’t return home that evening, a search party was formed.


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On Monday, those searching for Akbar found the giant snake lying dead just feet from Akbar’s house. According to the Times, Akbar’s boots were clearly visible in the snake’s stomach. Villagers used a knife to cut open the snake and remove the corpse.

Village secretary Salubiro Junaidi told Tribun Timur, a local media outlet, that cries for help could be heard from the palm grove at about 1 p.m. on Sunday afternoon.

It’s assumed the python choked Akbar to death, and the python then choked while attempting to swallow Akbar. It’s common for pythons to choke on large animals they attempt to eat.

Paralyzed man uses experimental device to regain hand movements

(CNN)A man paralyzed from his shoulders down has regained use of his right hand with the aid of an experimental prosthetic that replaces lost connections between the brain and the muscles.

As described in a paper published Tuesday in the journal The Lancet, this technology, called a neuroprosthetic, works by first decoding the patient’s brain signals and then transmitting them to sensors in his arm.
The early stage research has been tested in a lab with just one patient so far, yet someday it may change the lives of many with spinal cord injuries, said lead author Abidemi Bolu Ajiboye, an assistant professor at Case Western Reserve University.
Even though the system would not become immediately available to patients, Ajiboye believes that all the technical hurdles can be overcome within five to 10 years. “We actually have a handle on everything that we need. There are no significant novel discoveries we need to make for the system,” he said.
Ajiboye said that what makes this achievement unique is not the technology, but the patient. Unlike any previous experiments, a man who is nearly completely paralyzed — or tetraplegic — regained his ability to reach and grasp by virtue of a neuroprosthetic.

Cycling accident

Bill Kochevar, a resident of Cleveland, injured his spinal cord in 2006 prior to enrolling in the study.
“It was a bicycling accident,” said Ajiboye, who explained that Kochevar, 53, was doing a 150-mile bicycle ride on a rainy day. “He was following a mail truck and the mail truck stopped and he ended up running into the back of the truck,” said Ajiboye. As a result, Kochevar has paralysis below the shoulders.
“So he can’t walk, he can’t move his arms, he can’t move his hands,” said Ajiboye.
While the American Spinal Injury Association classifies him at the most disabled level of paralysis, Kochevar is capable of both speaking and moving his head. Prior to enrolling in the study, he often used head tracking software technology that relied on him moving his head to move a cursor on a screen. “But he had no ability to do any sort of functional activities,” said Ajiboye.
Kochevar underwent two surgeries fitting him with the neuroprosthetic. The first operation on December 1, 2014, implanted the brain computer interface, or BCI, in the region of Kochevar brain that is responsible for hand movement, called the motor cortex.
The BCI is an electrode array which penetrates the brain between one to one and a half millimeters, said Ajiboye.
Next, Kochevar underwent a second surgery to implant 36 muscle stimulating electrodes into his upper and lower arm. Known as functional electrical stimulation or FES, these electrodes are key to restoring movement in his finger and thumb, wrist, elbow and shoulders.
The Cleveland Functional Electrical Stimulation Center, of which Ajiboye is a part, first developed electrical stimulation technology for reanimating paralyzed function nearly 30 years ago. As Ajiboye explained, the technology is similar to a pacemaker in that it applies electrical stimulation to the muscles in order to stir movement.
After the separate technologies were implanted, the researchers connected Kochevar’s brain-computer interface to the electrical stimulators in his arm. At this point, Kochevar began learning how to use his neuroprosthetic and that process started with a virtual arm.
“We had him watch the virtual arm move, he attempted to move his arm in the same way, and that elicited some patterns of cortical activity — some patterns of electrical neural activity,” said Ajiboye.
This electrical activity was recorded and based on this recording, Ajiboye and his colleagues created a “neural decoder” — an algorithm specific to Kochevar — that could translate the patterns of Kochevar’s recorded brain signals into commands for the electrodes in his arm.
“Then we had him use our algorithm to control the virtual arm on the screen just using his brain signals,” said Ajiboye. “Very early on he could hit the target with 95 to 100% accuracy.” This ‘virtual’ step in the process helped Ajiboye and his colleagues refine the algorithm.
“Then, finally, we basically do the same thing with his actual arm. We manually move his arm, and we have him imagine he’s doing it,” said Ajiboye. Kochevar is then able to move his arm on his own by thinking the command (and so generating once again the same brain pattern when he imagined moving his arm) and this is then actuated through electrical stimulation.
Essentially, the technology circumvents the spinal injury feeding the electrical stimulation of his brain through wires to the electrodes in his arm.
After mastering simple movements, Kochevar was tested on day-to-day tasks, including drinking a cup of coffee and feeding himself. In all of these, Kochevar was successful.
“There were no significant adverse events, the system is safe, so as far as the clinical trial endpoint goes, he has met those,” said Ajiboye.
“Now he has opted voluntarily to continue working as a participant in our study for at least another five years,” said Ajiboye. Kochevar hopes to experience the benefits of the technology for himself while also seeing it advance to the point of becoming available for other people with spinal cord injuries, according to Ajiboye.
CNN attempted to contact Kochevar for comment.

‘Encouraging’ results

A previous unrelated study showed paraplegic people with spinal cord injuries using brain-machine interfaces to gain control of their brain activity and stimulate movement in their legs. A separate study used a brain-spine interface to communicate nerve signals and helped paralyzed monkeys to regain movement.
According to Andrew Schwartz, a professor of neurobiology at the University of Pittsburgh, the new study “shows the potential that [a brain-machine interface] can be used to reanimate a limb.” Schwartz was uninvolved with the current study.
While the “generated movements were somewhat rudimentary” with a rather limited range of action, “the attempt to use multiple degrees of freedom was encouraging,” said Schwartz.
“I liked the idea that movements were decoded first and then transformed to muscle activations,” he added. “For real movements in the real world, this transformation will be very difficult to calculate and that is where real science will be needed.”
In an editorial published alongside the study, Steve I. Perlmutter, an associate professor at University of Washington in Seattle, said the research is “groundbreaking as the first report of a person executing functional, multijoint movements of a paralysed limb with a motor neuroprosthetic. However, this treatment is not nearly ready for use outside the lab.”
Similar to Schwartz, Perlmutter noted that Kochevar’s movements were “rough and slow” and had limited range due to the necessary motorized device.
“Stimulation of nerves or the spinal cord, rather than muscles, and more sophisticated stimulation technology may provide substantial improvements,” wrote Perlmutter.
“The algorithms for this type of brain computer interface are very important, but there are many other factors that are also critical, including the ability to measure brain signals reliably for long periods of time,” Perlmutter said in an email. He added another critical issue is execution of movement.
Hurdles that all motor neuroprostheses must overcome have yet to be addressed, noted Perlmutter, including “development of devices that are small enough, robust enough, and cheap enough to be fully mobile and widely available.”
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Ajiboye acknowledges the need for smaller technologies. Still, he said, his new study differs from previous work done in the field. Although other labs have worked with non-human primates or partially paralyzed participants, his study helped someone who is completely paralyzed.
“This is an exponentially harder problem,” said Ajiboye. “Our study is the first in the world, to my knowledge, to take someone paralyzed and give him the ability to both reach and grasp objects… so that he can regain the ability to perform functional activities of daily living.”
One other way the new study differs from previous research is Ajiboye and his colleagues built their neuroprosthetic from separate technologies, each of which had already been proven viable. This translates to the entire system, when refined, more easily gaining approval and becoming available to patients.
“The goal is to do much more than a cool science experiment,” said Ajiboye.

Oklahoma Man Uses AR-15 to Kill Three Teen Home Intruders

A 23-year-old Oklahoma man used a semi-automatic AR-15 rifle to shoot and kill three masked teenage intruders dressed in black who broke into his home Monday afternoon — an act authorities are investigating as self-defense.

Zach Peters, the homeowner’s son, fatally shot an 18-year-old man and two boys ranging between 16 and 17 around 12:30 p.m. The trio allegedly forced their way into the residence through a back door and were killed after exchanging words with Peters, who fired multiple shots.

Police said the alleged getaway driver, 21-year-old Elizabeth Rodriguez, surrendered to the Broken Arrow Police Department Monday evening and is facing charges on three counts of first-degree murder and three counts of burglary.

Her first court appearance, set for Tuesday, has been pushed to April 5 and she was ordered to be held on no bond.

Image: Elizabeth Rodriguez
Police say Elizabeth Rodriguez drove the getaway car in a home invasion in Broken Arrow, Oklahoma. Wagoner County Sheriff’s Office

“Upon making entry to the home, one of the residents fired a rifle striking all three of the suspects,” the Wagoner County Sheriff’s Office said in a statement.

Wagoner County Deputy Sheriff Nick Mahoney said that Rodriguez is being charged with the murders because she was in “commission of felony” when she allegedly dropped them off at the residence, meaning she had an intent to burglarize the home. He said the crime was random and there was no connection between the suspects and Peters.

Police said all of the unidentified suspects were wearing black clothes, masks and gloves. One was armed with a knife and another with brass knuckles. Two of the intruders died in the kitchen, while the other reached the driveway, “before succumbing to his injuries,” according to the statement.

After the shooting, police said the son and homeowner made statements at the sheriff’s office.

Although authorities are approaching the shooting as self-defense, Mahoney said the investigation is open and the district attorney will ultimately decide whether charges are filed.

Image: Police investigate the scene of a failed robbery in Broken Arrow, Okla.
Police investigate the scene of a failed robbery that led to the death of the three robbers in Broken Arrow, Okla., on March 27. Ian Maule / AP

Similar to 22 other states, Oklahoma has passed stand-your-ground legislation which justifies a person using deadly force in order to protect themselves under certain circumstances.

Oklahoma’s law states that a person who is attacked in their home “has the right to stand his or her ground and meet force with force, including deadly force, if he or she reasonably believes it is necessary to do so to prevent death or great bodily harm to himself or herself or another or to prevent the commission of a forcible felony.”

“They are looking at it as self-defense but they are also looking at any other possible way that it could be looked at,” Mahoney said.

During a press conference, First Assistant District Attorney Jack Thorp called the case “complex” and said a Medical Examiner is working to identify the bodies of the three teens. Charges will likely be filed against Rodriguez next week.

A probable cause affidavit was presented to the court, allowing Rodriguez to be held without charges past 48 hours, officials said. Thorp told NBC News that Rodriguez does not yet have a lawyer.

“This is a triple homicide. We want to make sure we cross all our t’s and dot our i’s. We need the maximum amount of information before filing charges… Hopefully, as we go forward, we’ll see whether the facts meet the law,” Thorp said during the press conference.

The AR-15 was the weapon used in mass shootings such as Newtown, the Aurora movie theater in Colorado and San Bernardino.

Bloodshed like this is rare in the area, Mahoney told NBC-affiliate KJRH. Broken Arrow, with a population of 103,500 people, is the largest suburb of Tulsa and is located about 15 miles east of the city.

“This isn’t something that happens frequently here,” Mahoney told NBC-affiliate KJRH. “We don’t generally have triple shootings inside Wagoner County. It’s a very nice neighborhood…the neighbors have all been concerned…it’s not something that happens.”

Democrats, once threatened by Trump, see little reason to worry

President Trump meets with Democratic senators tonight, but he has already put them on notice. On Friday, he announced that the American Health Care Act had been pulled by warning that the health-care system would “explode,” and that voters would blame Democrats.

“I think the losers are Nancy Pelosi and Chuck Schumer, because now they own Obamacare,” the president said.

Corey Lewandowski, the president’s former campaign manager, told the weekend hosts of “Fox and Friends” that 10 Senate Democrats up for reelection in November 2018 are from states carried by Trump.

“You know what that means: They’re going to negotiate with the president,” Lewandowski said.

But with a few exceptions, Democrats are feeling no public pressure to work with Trump — and not expecting blame if the health-care system bristles under the new administration. Before the failure of the American Health Care Act, the president’s approval rating was underwater in most of the country. Afterward, Democrats are speaking more confidently about resisting the president and being rewarded at the polls.

“If people have a sense that he’s not just rooting for failure but creating it, that’s not a good position to be in,” said Sen. Robert P. Casey Jr. (D-Pa.), a member of the Health, Education, Labor and Pensions Committee, and one of the 10 Democrats up for reelection next year in a state that voted for Trump. “It’ll be clear to people who did the damage.”

In conversations Tuesday, a dozen Democrats from Trump-voting states and districts generally dismissed the political threats from the White House — which, confusingly, have alternated with rhetoric about the president reaching across the aisle to cut deals. Badgered in hallways about what sort of negotiations they could have with Trump, most suggested long-standing Democratic policies.

“I’d like to see the public option back on the table,” said Sen. Tammy Baldwin (D-Wis.).

“I’m grateful that their ineptness and incompetence and demagoguery ensured that 900,000 Ohioans still have insurance, 1 million Ohioans still have the expansion of Medicaid, and every Ohioan still has those protections,” said Sen. Sherrod Brown (D-Ohio), another “Trump state” Democrat.

Some of the Democrats’ attitude comes from the Republicans’ off-message response to the AHCA failure. In several Trump-won states, such as Kansas, Republicans were restarting debates about whether to accept expanded Medicaid funding. In Congress, several Republicans were talking about ending a lawsuit against the American Care Act. As first reported by The Washington Post, House Speaker Paul D. Ryan (R-Wis.) told donors that he would revisit the repeal effort; on Tuesday, Senate Majority Leader Mitch McConnell (R-Ky.) said it was over.

“Our Democratic friends now have the law that they wrote in place and we’ll see how that works out,” he said at a news conference.

On Tuesday, House Democrats shared a polling memo with reporters that revealed just how toxic the AHCA had been over its short existence. With theatrical surprise, Rep. Joseph Crowley (D-N.Y.), who chairs the Democratic conference, noted that the Greenberg Quinlan Rosner survey found 54 percent of voters “in congressional battleground districts” opposed to the bill, and 51 percent disapproving of Trump. Tabling the bill, Crowley said, would not save the Republicans who Democrats wanted to hold accountable.

“It’s the letters that they signed, the statements that they made, and the rule they voted for to bring the bill to the House floor,” he said, pointing out online advertisements that ran against members of a key committee after it moved the AHCA.

The poll’s findings about the president underlined the other major reason for optimism. Since taking office, the president has struggled to reach even 50 percent approval ratings. During the fight over the AHCA, his approval rating in the Gallup poll tumbled to 36 percent — lower, the pollster pointed out, than it ever sank for former president Barack Obama.

As Democrats discovered in 2016, when Trump lost the popular vote but won the White House, the president’s supporters are clustered in states and districts that are more electorally valuable. But in 2002, the last time that a party failed to gain seats in a midterm election, the president was widely popular. The final Gallup poll taken before the 2002 midterm elections found President George W. Bush enjoying a 63 percent approval rating, which helped the party win Senate races in Georgia, Minnesota and Missouri, while gaining eight seats in the House. (The elections also came after a 2001 round of gerrymanders that helped Republicans gain Southern and Midwestern seats.)

Trump has never come close to that level of support, even in the 10 states seen as most winnable for Republicans in 2018. In the five states lost by Mitt Romney but won by Trump — Florida, Michigan, Ohio, Pennsylvania and Wisconsin — Trump’s average favorable rating on Election Day was 40 percent. In Florida, Michigan and Wisconsin, his favorable rating was actually lower than Hillary Clinton’s.

Since then, Trump has seen his numbers sink even further. This week, New York’s Siena poll found the president at just 34 percent approval in his native New York. That had a lot to do with his toxic ratings in New York City. But when the poll was broken into regions, the president was unpopular everywhere. In Upstate New York, where he lost to Hillary Clinton by just five points, Trump’s approval rating was just 39 percent. In the suburbs of New York, where the president actually won, the approval rating was down to 44 percent.

“The intensity between the parties really flipped overnight after Nov. 8,” said Ron Kind (D-Wis.), one of 13 House Democrats who represent a district won by Trump. “There’s a lot of scratching of heads by his supporters. He hasn’t really done a lot to improve people’s lives. I’m not sure how much time they’re going to give him.”

Scotland Votes to Demand a Post-‘Brexit’ Independence Referendum

LONDON — Only hours before Britain is to embark on its momentous journey out of the European Union, Scotland’s Parliament on Tuesday underscored one of the risks along that path by voting to demand a new referendum on Scottish independence.

By a vote of 69 to 59, members of the Scottish Parliament in Edinburgh approved plans to request a referendum on independence that could take place just before Britain completes its withdrawal from the European Union, a process known as Brexit.

That timing has already been rejected by Prime Minister Theresa May of Britain, who must agree to any legally binding referendum on Scotland’s future.

Nevertheless, the Scottish Parliament’s vote sets the stage for a constitutional tussle between London and Edinburgh, and it illustrates the far-reaching, and destabilizing, consequences of Britain’s divisive decision in June to withdraw from the European Union. In that referendum, 52 percent of voters chose to leave the European Union.

But Scotland voted, 62 percent to 38 percent, to remain in the bloc, illustrating a divergence between Scottish and English politics that poses an existential risk to Britain. In Northern Ireland, too, a majority voted to remain in the European Union, amid fears that a withdrawal could weaken the peace process there.

The Scottish vote came on the eve of a historic day for a British government intent on disentangling itself from more than four decades of European integration.

On Wednesday, Mrs. May is expected to send formal notification of Britain’s desire to leave the bloc by invoking Article 50 of its governing treaty.

Late Tuesday, Mrs. May’s office issued a photograph of the prime minister signing the letter; its delivery will start the clock on a negotiation scheduled to last two years. During that time, Mrs. May aims to agree to divorce terms and to negotiate a new economic relationship with the countries that remain in the European Union.

In a speech that she is expected to deliver on Wednesday, she will argue that as Britons “face the opportunities ahead of us on this momentous journey, our shared values, interests and ambitions can — and must — bring us together,” according to excerpts issued by her office.

Mrs. May will also promise that, in negotiations, she will “represent every person in the whole United Kingdom,” including citizens of countries in the European Union who have made Britain their home.

As she embarks on the talks to leave the bloc, Mrs. May knows that one of her many challenges is to secure a deal that helps avert a breakup of Britain.

But because of her control over the timing, a referendum on Scottish independence is unlikely to happen anytime soon.

The vote on Tuesday empowers Scotland’s pro-independence first minister, Nicola Sturgeon, to formally request a referendum, but she already knows Mrs. May’s answer: not now.

The British government plans to withhold agreement at least until it has secured its departure from the bloc, scheduled for the first half of 2019.

On Tuesday, David Mundell, the British government’s Scottish secretary, seemed to push the timetable further by saying that government “won’t be entering into any negotiations at all until the Brexit process is complete.” That hints at a date beyond the British withdrawal and after any further transitional period, perhaps several years later.

Nevertheless, Britain’s vote has given Ms. Sturgeon’s governing Scottish National Party a reason to demand another independence referendum, less than three years after it lost the last one in 2014.

At that time, Scots were told that if they voted to leave Britain, they would lose their place in the European Union. They may now lose it anyway. Ms. Sturgeon argued that Scots should have the right to choose between Brexit “or becoming an independent country, able to chart our own course and create a true partnership of equals across these islands.”

Ms. Sturgeon argues that the shape of any Brexit deal should be known by autumn 2018. Scots should then have the opportunity to try, through independence, to stay in the European Union, or at least in its single market and customs union, she has said.

But with London intent on blocking a referendum anytime soon, Ms. Sturgeon’s best hope may be for Mrs. May’s stalling tactics to backfire — annoying Scots enough to persuade a majority to support independence if they finally have the chance to vote.

U.S. ‘Probably Had a Role’ in Mosul Deaths, Commander Says

WASHINGTON — The senior United States commander in Iraq said on Tuesday that an American airstrike most likely led to the collapse of a building in Mosul that killed scores of civilians this month.

But the commander, Lt. Gen. Stephen J. Townsend, indicated that an investigation would also examine whether the attack might have set off a larger blast from explosives set by militants inside the building or nearby.

It was the fullest acceptance of responsibility by an American commander since the March 17 airstrike.

“My initial assessment is that we probably had a role in these casualties,” said General Townsend, who commands the American-led task force that is fighting the Islamic State in Iraq and Syria. But he asserted that “the munition that we used should not have collapsed an entire building.”

“That is something we have got to figure out,” he added.

With an increase in reports of civilian casualties from the American bombing of Islamic State targets in Iraq and Syria, some human rights groups have questioned whether the rules of engagement have been loosened since President Trump took office.

Pentagon officials said this week that the rules had not changed. But General Townsend said on Tuesday that he had won approval for “minor adjustments” to rules for the use of combat power, although he insisted they were not a factor in the Mosul attack.

General Townsend acknowledged, however, that steps had been taken to speed up the process of providing air power to support Iraqi troops and their American Special Operations advisers at the leading edge of the offensive to recapture Mosul from the Islamic State. The goal, he said, was to “decentralize” decision-making.

General Townsend did not describe the changes in detail, but he cast them as a return to the military’s standard offensive doctrine, in contrast to the “very centralized” approach he said was initially put in place after President Barack Obama sent American forces back to Iraq to combat the Islamic State, also known as ISIS or ISIL.

Maj. Gen. Maan al-Saadi, an Iraqi special forces commander, has said that his men called in a coalition airstrike to take out snipers on the roofs of three houses in a Mosul neighborhood called Mosul Jidideh. The Iraqi forces, General Saadi said, were unaware that at least some of the houses were filled with civilians.

General Townsend said he did not have information on the Iraqi commander’s specific role, but explained that the United States had been training Iraqi military officers how to call in airstrikes that are carried out by Iraqi aircraft.

Any American airstrike requested by the Iraqis, General Townsend said, would need to be approved by American officers.

“If he said his guy was calling for fire, he could have been,” he said. “Now how that works is that they don’t call directly to a U.S. fighter overhead and suddenly a U.S. fighter is rolling in on their grid coordinates.”

Iraqi forces have been eager for the help of American air power as they take on the toughest phase of the more than five-month battle to retake Mosul. American officials have said that 500 Iraqi troops were killed and about 3,000 wounded in taking the eastern half of the city.

General Townsend said the battle for the western half of the city was even more difficult because of what he called its “claustrophobically close terrain” of narrow streets and buildings. He repeated several times that the house-to-house fighting was the most intense urban combat since World War II.

Adding to the challenge is a factor he did not mention: the decision by Iraq’s governments to urge Mosul’s residents to shelter in place instead of trying to flee. When American troops retook Falluja in 2004, the fierce urban fighting took place in a city that had already been abandoned by most civilians.

Though the Iraqis are doing the main fighting on the ground in Mosul, American and coalition forces have been playing an essential role.

United States Army Paladin howitzers have been firing rounds into Mosul from their positions outside the city. Task Force Thor, which is based at Qayyarah West Airfield 40 miles south of Mosul, has been firing Himars satellite-guided rockets into the city. American Apache attack helicopters have added to the firepower.

This year, the United States increased the number of soldiers who have been advising Iraqi troops as they have pushed into the city. While the mission of the advisers is not to directly engage in combat, many are in harm’s way as they advise Iraqi units carrying out the fight.

On Monday, American military officials said that two infantry companies from the 82nd Airborne Division were being sent to help protect those United States advisers and that a “route clearance” platoon was also being deployed to clear away roadside bombs. Together, the deployment adds about 240 troops to the mission.

The troop cap that the Obama administration established for the operation in Iraq — what the Pentagon calls the “force manning level”— is 5,260.

But that formal limit, which the Trump administration is likely to eliminate, does not count temporary deployments. The actual number of troops in Iraq is certainly higher.

With more American forces in Iraq, and more United States advisers near the front lines, the need for timely airstrikes is much greater.

Brig. Gen. Matthew C. Isler, an Air Force officer who serves as deputy to General Townsend, is in charge of the investigation into the Mosul airstrike. A team of American experts has visited the site to collect evidence to determine what caused the significant loss of civilian life.

American officials said they were investigating a number of possibilities, including whether the militants herded the civilians into the building to use as human shields; whether the building was rigged with explosives; or whether a nearby car bomb exploded.

“My initial impression is the enemy had a hand in this, and there’s also a fair chance that our strike had some role in it,” General Townsend said in a briefing broadcast to the Pentagon from Iraq. “I think it’s probably going to play out to be some sort of combination. But you know what, I can’t really say for sure, and we’ve just got to let the investigation play out.”

General Townsend said the results of the investigation would be reported publicly, “unlike our enemy.”

While General Townsend acknowledged an American role in the Mosul strike, he said the allegations that the United States had bombed a school full of refugees in Syria were not credible.

That airstrike, which has garnered considerable attention, occurred during an operation in which American-backed Syrian fighters were trying to seal off the western approaches to Raqqa, the Islamic State’s self-proclaimed capital. But General Townsend said that the evidence he had seen indicated that it was about 30 Islamic State fighters who were killed in that attack.

“I think that was a clean strike,” he said.

He also dismissed reports, publicized by the Islamic State, that an American airstrike had endangered the Tabqa Dam west of Raqqa, saying that the structure was not in imminent danger.

“If something happens to the Tabqa Dam, it will be at the hands of ISIS, not the coalition,” he said.

Still, the reports of desperate civilians in Mosul prompted Zeid Ra’ad al-Hussein, the United Nations high commissioner for human rights, to urge on Tuesday that the American-led coalition reconsider its tactics.

The United Nations has said that at least 61 people were killed in the March 17 strike in Mosul. Amnesty International said as many as 150 might have died.

“The fact that Iraqi authorities repeatedly advised civilians to remain at home, instead of fleeing the area, indicates that coalition forces should have known that these strikes were likely to result in a significant number of civilian casualties,” Donatella Rovera of Amnesty International said in a statement.

Clinton urges women to ‘resist’ Trump agenda

SAN FRANCISCO — Emerging from the political shadows months after a devastating presidential campaign loss to Donald Trump, a fiesty Hillary Clinton — while never directly mentioning the occupant of the White House — urged women to “resist, insist, persist and enlist” in the continuing political struggle on key issues like women’s health care and budget priorities.

“I am thrilled to be out of the woods,’’ Clinton told a sold-out, mostly female audience of 6,000 at the Professional Women’s Business Conference in the Moscone Center on Tuesday, who greeted her arrival with cheers and a standing ovation. “And there’s no place I’d rather be,’’ she added wryly, “… other than the White House.”

Her speech in San Francisco, one of the country’s most liberal bastions, comes amid talk of a “comeback” tour for the 2016 Democratic presidential candidate, who has become increasingly active in expressing her views on Twitter.

The Washington Post reported this week that Clinton’s formal re-emergence into the political realm will include a speech at the Georgetown Institute for Women, Peace and Security on Friday at a ceremony to mark an award that is named in her honor. In addition to getting back on the speaking circuit, Clinton has said she’s also taken on a major writing project — a book of essays and inspirational quotations due out this fall.

In San Francisco, the former secretary of state appeared relaxed, and often resorted to self-depreciating humor to address some of the more painful aspects of her failed campaign — even as she leveled veiled jabs at the Trump administration and its policies, particularly those that affect women. But Clinton, in making several references to her “long walks in the woods” in the past months, appeared to signal she’s rested — and ready to take on new issues and draw contrasts with Trump in the public arena.

“Sure, the last few months are not exactly what I’ve envisioned,’’ she told the audience, “but I do know what I’m fighting for — a fairer, inclusive, big-hearted America.”

Clinton was especially animated when she noted high-profile instances of women’s treatment in the months since Trump has taken office — an administration, she said, which has the lowest levels of women’s hiring in a generation.

“Just look at all that’s happened in the last few days — to women who are simply doing their jobs,’’ she said. Referring to an incident in which White House spokesman Sean Spicer reprimanded African-American journalist April Ryan, she noted that Ryan “was doing her job just this afternoon in the White House press room when she was patronized and cut off just trying to ask a question.”

Clinton also cited Fox News anchor Bill O’Reilly, who on air laughingly dismissed an impassioned House floor speech by Rep. Maxine Waters for wearing “a James Brown wig.” Waters, Clinton said, was “taunted with a racist joke about her hair.”

“Too many women, especially women of color, have had a lifetime of practice taking precisely these kind of indignities in stride,’’ she said. “But why should we have to?”

Clinton also cited recent photos making the rounds on social media showing armies of men standing proudly around the president as he is “making decisions about women’s health.”

“How could they not have invited any women to the table?” she said. “It may not be an oversight at all … but an intentional signal: Don’t worry, the men are in charge of everything.”

Urging women to “resist, insist, persist and enlist” in the political struggle, Clinton said Americans must “resist bias and bullying … hate and fear,” and “insist that we can do better, that is who we are … we are always pushing towards that more perfect union.”

In a pointed reference to Trump’s “American carnage” inauguration speech, she said: “Where some see a dark vision of carnage, I see a light shining on opportunity and creativity.”

“We saw that the day after the Inauguration, when women and men from all walks of life marched … the biggest march in our country’s history,’’ she said. “Afterward, there were plenty of people who wondered whether that level of enthusiasm could be sustained.’’

But Clinton called the run-up to the defeat of the Trump administration’s health care bill last week “the first indication” that the answer is yes.

She said the Republican Congress trying to “jam through a [health care] bill that would have kicked 24 million people off their health insurance,’’ was “met with a wave of resistance.”

And “when this disastrous bill failed, it was a victory for all Americans,’’ she said. Clinton added in warning, “but the other side never quits. Sooner or later they’ll try again.’’

“We will need to fight back” against “bad policies that will hurt our people and take our country in the wrong direction.”

“Obviously the outcome of the election wasn’t one I hoped for,’’ she told the audience. “But I will not stop speaking out” for issues and ideas that will improve the lives of average Americans, she said.

An appearance in California virtually guaranteed a supportive crowd for her re-emergence into the political realm: last November, the Democratic candidate clobbered Trump here by 4.2 million votes in November, or a nearly 2-1 margin.

And San Francisco, an exceedingly friendly turf that the former candidate tapped dozens of times for political fundraising, is also home to Susie Tompkins Buell, one of Clinton’s most longtime and loyal friends, who later shared the stage with her in a conversation at the PBWC event.

Buell, at the close, declared Clinton officially back in the limelight. “It’s clear you’re out of the woods, for us,’’ she told Clinton. “I always knew you would be. Nobody’s going to take you down.”

The House (White Freemasons and Jews) just voted to wipe away the FCC’s landmark Internet privacy protections



Congress sent proposed legislation to President Trump on Tuesday that wipes away landmark online privacy protections, the first salvo in what is likely to become a significant reworking of the rules governing Internet access in an era of Republican dominance.

In a party-line vote, House Republicans freed Internet service providers such as Verizon, AT&T and Comcast of protections approved just last year that had sought to limit what companies could do with information such as customer browsing habits, app usage history, location data and Social Security numbers. The rules also had required providers to strengthen safeguards for customer data against hackers and thieves.

The Senate has voted to nullify those measures, which were set to take effect at the end of this year. If Trump signs the legislation as expected, providers will be able to monitor their customers’ behavior online and, without their permission, use their personal and financial information to sell highly targeted ads — making them rivals to Google and Facebook in the $83 billion online advertising market.

The providers could also sell their users’ information directly to marketers, financial firms and other companies that mine personal data — all of whom could use the data without consumers’ consent. In addition, the Federal Communications Commission, which initially drafted the protections, would be forbidden from issuing similar rules in the future.

[Republicans voted to roll back landmark FCC privacy rules. Here’s what you need to know.]

Search engines and streaming-video sites already collect usage data on consumers. But consumer activists claim that Internet providers may know much more about a person’s activities because they can see all of the sites a customer visits.

And although consumers can easily abandon sites whose privacy practices they don’t agree with, it is far more difficult to choose a different Internet provider, the activists said. Many Americans have a choice of only one or two broadband companies in their area, according to federal statistics.

Advocates for tough privacy protections online called Tuesday’s vote “a tremendous setback for America.”

“Today’s vote means that Americans will never be safe online from having their most personal details stealthily scrutinized and sold to the highest bidder,” said Jeffrey Chester, executive director of the Center for Digital Democracy.

Supporters of Tuesday’s repeal vote argued that the privacy regulations stifle innovation by forcing Internet providers to abide by unreasonably strict guidelines.

”[Consumer privacy] will be enhanced by removing the uncertainty and confusion these rules will create,” said Rep. Marsha Blackburn (R-Tenn.), who chairs the House subcommittee that oversees the FCC.

Policy analysts said the deregulatory effort may be the first of several that could alter the future of the Internet. Although regulators under President Barack Obama had moved to limit the power of Internet providers — by restricting what they could do with customer information and curbing their ability to block websites or slow down certain types of content — momentum appears to be moving in the opposite direction.

For example, consumer advocates fear that Congress or the FCC’s new Republican chairman, Ajit Pai, may seek to roll back the agency’s rules on net neutrality — the policy that forbids Internet providers from blocking content they don’t like or charging websites a fee to reach consumers over faster Internet speeds. Industry analysts said Tuesday that the FCC is also poised to deregulate the $40-billion-a-year industry for data connections used by hospitals, universities and ATMs.

Tuesday’s vote is a sign that Internet providers will be treated more permissively at a time when conservatives control the executive and legislative branches. That could be a boon for companies such as Verizon and Comcast as they race to become online advertising giants.

Internet providers have historically made their money from selling access to the Web. But now these providers are looking to increase their revenue by tapping the vast troves of data their customers generate as they visit websites, watch videos, read information and download apps.

Industry backers say that allowing providers to use data-driven targeting could benefit consumers by leading to more relevant advertisements and innovative business models. AT&T, for instance, used to offer Internet discounts to consumers in exchange for letting the company monitor their browsing history. With Tuesday’s vote, such programs could see a return, and be marketed as a way to access cheaper Internet — although consumer groups have criticized these plans as a way for providers to charge customers a premium for their privacy.

Tuesday’s vote took aim at FCC rules that were approved in October over strident Republican objections. At the time, the agency’s Democratic leadership argued that consumers deserved the same privacy protections governing legacy telephone service. As more Americans turn to the Internet to find jobs, do homework and seek education, the agency said, consumers needed new protections to keep pace with technology.

But industry advocates said the FCC’s rules defined privacy far too broadly. The industry favors the interpretation of another agency — the Federal Trade Commission — that does not consider browsing history or app usage data to be sensitive and protected.

But the FTC does not have the authority to punish Internet providers that violate its guidelines. That is because of a rule that leaves oversight of those companies to the FCC.

As a result, Tuesday’s vote may release Internet providers from the FCC’s privacy regulation, but the FTC would also be unable to enforce its own guidelines on the industry without new authority from Congress.

“One would hope — because consumers want their privacy protected — that they would be good actors, and they would ask permission and do these nice things,” said Rep. Mike Doyle (D-Pa.) in a House committee hearing Monday. “But there’s no law now that says they have to, and there’s no cop on the beat saying, ‘Hey, we caught you doing something.’ ”

Pai, the FCC chairman, called the legislation “appropriate” and blamed his Democratic predecessor for executive overreach. He also said that responsibility for regulating Internet providers should fall to the FTC.

“Moving forward, I want the American people to know that the FCC will work with the FTC to ensure that consumers’ online privacy is protected though a consistent and comprehensive framework,” Pai said. “The best way to achieve that result would be to return jurisdiction over broadband providers’ privacy practices to the FTC, with its decades of experience and expertise in this area.”

Pai has said that his agency could continue to bring lawsuits against firms that are alleged to have violated consumer privacy, even if the FCC privacy rules were to be repealed.

Trump administration sought to block Sally Yates from testifying to Congress on Russia



The Trump administration sought to block former acting attorney general Sally Yates from testifying in the House investigation of possible links between Russian officials and Donald Trump’s campaign, according to letters provided to The Washington Post. The effort to keep Yates from testifying has further angered Democrats, who have accused Republicans of trying to damage the inquiry.

According to the letters, the Justice Department notified Yates earlier this month that the administration considers her possible testimony — including on the ouster of former national security adviser Michael Flynn for his contacts with the Russian ambassador — to be off-limits in a congressional hearing because the topics are covered by attorney-client privilege or the presidential communication privilege.

The issue of Yates’s testimony adds to the political controversy surrounding the House Intelligence Committee’s investigation of Russian meddling in last year’s election and any possible coordination between Trump associates and Moscow.

David O’Neil, an attorney for Yates, met at the Justice Department to discuss the issue with government officials on Thursday. At the meeting, O’Neil presented a letter in which he said the Justice Department had “advised” him that Yates’s official communications on issues of interest to the House panel are “client confidences” that cannot be disclosed without written consent. O’Neil challenged that interpretation as “overbroad” in the letter.

Spicer says Post report on Yates is ‘false’

White House press secretary Sean Spicer on March 28 disputed a Washington Post report about efforts by the Trump administration to prevent former acting attorney general Sally Yates from testifying before Congress. (Reuters)

The following day, in a letter to O’Neil, the Justice Department responded with another objection: that Yates’s communications with the White House are probably covered by “presidential communications privilege,” and referred him to the White House.

A Justice Department spokeswoman declined to comment.

O’Neil then wrote to White House Counsel Donald McGahn, saying that he believed any privilege had been waived as a result of past White House statements and that Yates planned to testify unless he heard back from McGahn.

But that same day, the hearing, which also would have included former CIA director John Brennan and former director of national intelligence James R. Clapper Jr., was canceled by the House Intelligence Committee’s chairman, Rep. Devin Nunes (R-Calif.), and any White House decision on Yates’s testimony became moot.

In his Tuesday briefing, press secretary Sean Spicer said that the White House did not weigh in on whether Yates could testify. “To suggest in any way, shape or form that we stood in the way of that is 100 percent false,” he said.

Nunes has said he canceled the hearing to first hear from FBI Director James B. Comey in a classified setting. That session was also canceled.

Democrats charge that Nunes has aligned himself too closely with the White House to conduct an independent probe.

“You see the unraveling of this committee happening overnight for no good reason,” said Rep. Jackie Speier (D-Calif.), a committee member. “We have a responsibility to do this investigation.”

O’Neil’s meeting at the Justice Department and the exchange of letters came to light as the House GOP leadership continued to stand by Nunes. House Speaker Paul D. Ryan (R-Wis.) rejected demands that Nunes recuse himself. Nunes said Tuesday that he had no plans to step aside.

Yates was the deputy attorney general in the final years of the Obama administration and served as the acting attorney general in the first days of the Trump administration.

Trump fired Yates in January after she ordered Justice Department lawyers not to defend his first immigration order temporarily banning entry to the United States for citizens of seven Muslim-majority countries and refugees from around the world.

As acting attorney general, Yates played a key part in the investigation surrounding Flynn, who was ousted after revelations that he had discussed sanctions with the Russian ambassador to the United States.

Yates and Brennan had made clear to government officials by Thursday that their testimony to the committee would probably contradict some statements that White House officials had made, according to a person familiar with the matter who spoke on the condition of anonymity.

O’Neil and Ken Wainstein, a lawyer for Brennan, declined to comment.

During his press briefing Tuesday, Spicer said of Yates: “I hope she testifies. I look forward to it.’’

Spicer said the White House did not seek to have the House hearing canceled.

Rep. Adam B. Schiff (Calif.), the ranking Democrat on the Intelligence Committee, said the panel was aware that Yates “sought permission to testify from the White House. Whether the White House’s desire to avoid a public claim of executive privilege to keep her from providing the full truth on what happened contributed to the decision to cancel today’s hearing, we do not know. But we would urge that the open hearing be rescheduled without delay and that Ms. Yates be permitted to testify freely and openly.’’

In January, Yates warned McGahn that statements White House officials, including Vice President Pence, had made about Flynn’s contact with the ambassador were incorrect and could therefore expose the national security adviser to future blackmail by the Russians.

In his March 23 letter — addressed to acting assistant attorney general Samuel Ramer — O’Neil noted that Yates was willing to testify and that she would avoid discussing classified information and details that could compromise investigations. The correspondence was later shared with the House Intelligence Committee.

O’Neil went on to memorialize the government’s position:

“The Department of Justice has advised that it believes there are further constraints on the testimony Ms. Yates may provide at the [House Intelligence Committee] hearing. Generally, we understand that the department takes the position that all information Ms. Yates received or actions she took in her capacity as Deputy Attorney General and acting Attorney General are client confidences that she may not disclose absent written consent of the department,’’ he wrote.

O’Neil continued: “We believe that the department’s position in this regard is overbroad, incorrect, and inconsistent with the department’s historical approach to the congressional testimony of current and former officials.

“In particular, we believe that Ms. Yates should not be obligated to refuse to provide nonclassified facts about the department’s notification to the White House of concerns about the conduct of a senior official. Requiring Ms. Yates to refuse to provide such information is particularly untenable given that multiple senior administration officials have publicly described the same events.’’

The following day, Scott Schools, a senior Justice Department lawyer, replied to O’Neil, writing that Yates’s conversations with the White House “are likely covered by the presidential communications privilege and possibly the deliberative process privilege. The president owns those privileges. Therefore, to the extent Ms. Yates needs consent to disclose the details of those communications to [the intelligence panel], she needs to consult with the White House. She need not obtain separate consent from the department.’’

That letter, in essence, marked Justice Department officials backing away from their earlier strictures, saying that although they thought executive privilege probably applied to Yates’s discussions, that was a conversation she would have to have with lawyers at the White House.

In response, O’Neil sent a letter Friday to McGahn, the White House counsel, saying that any claim of privilege “has been waived as a result of the multiple public comments of current senior White House officials describing the January 2017 communications. Nevertheless, I am advising the White House of Ms. Yates’ intention to provide information.’’

He closed the letter by saying that if he did not hear back from the White House by 10 a.m. Monday, he would assume that it “does not exert executive privilege over these matters with respect to the hearings or other settings.’’

The cancellation of the hearing made O’Neil’s deadline moot, although Spicer said the lack of a response to the lawyer’s letter showed the administration had no problem with Yates testifying.