It's a sur-fight of hedonistic pleasure. It's whim-based. It doesn't constitute the kind of action that lays the groundwork for functional relationships. It stops you from being desperate enough to go and put yourself on the line in a real relationship. It trains you sexually to respond only to pornography. There's nothing about it that's good. I totally agree with Jordan Peterson here, but I want to add a piece. The Bible says that our fleshly desires are waging war against our soul.  I want to offer you a tool that's going to help you. Click the link in my bio for 30 days free off covenant eyes. It's a program that'll help keep you accountable. Today, take this step of boldness, not just for yourself, but for those around you.


Mental toughness for me is you see only good in everything even if something catastrophic happens you only see the good because there is good in all bad events there is some good if tomorrow a doctor tells you you're gonna die in cancer in six months well you got to tell yourself I'm gonna live at another level in these six months because I know these days are numbered so every day for me is gonna be like a year every second is gonna be like hours for me because I'm gonna appreciate it that much there's got to be something positive in whatever happens one of my favorite new authors that I'm reading into now is Marcus Aurelius and he wrote his journals you know during the war with the Germanic tribes he was writing in his journal and this was just his own personal journal wasn't a book and he was in the situation where he was leading the softer generation of Romans the Romans they haven't gone through war they're just living through the spoils of their fathers who went to war and dominated the world so they weren't ready to go to war and fight these barbarians etc and they were more corrupt and wanted to live the good life etc and he's writing this journal and he's considered one of the great great five emperors he was one of the the best leaders Rome ever had and he was basically saying that he's saying you have to find the good in every single bad situation and this is a guy who is on the brink of being destroyed by the Germans he eventually defeated the Germanic tribes but it was almost lights out for Rome at that time and he was he reading this journal of his and his thoughts and he's like your thoughts are what you soak your mind in the dye you soak your mind in and how you see the world all depends on your thoughts because somebody who sees the positive and everything you can't beat him you have to kill him to beat him because no matter how low you put him down if there's still a spark he still believes you can climb to the top whereas somebody sees the negative and they start to convince themselves they're lost they're easy to beat they're ready beat themselves I really love that description and and that's something that my partners Ron Mike and I talk a lot about is you know when you're in business you learn very quickly that you're operating without a safety net right so it can all go away not only tomorrow could go away today right I could walk off this set only to find out that some catastrophic things happen and now we're out of business I mean and that really forces you to analyze what do I have in my life to fall back on and you talk a lot about what fighters that have nothing to fall back on right I think you quoted Don Shula you know and having a three tier system of God family and football that's correct and and in business I find it the same if you if you don't have something to fall back on you're gonna be in real trouble and the thing that we have of the collectively always focused on is what you just said which is the guy that has a spark of hope no matter how low you take him he believes in his heart that he can rise back up and it's interesting because I've never put that together as being a mental toughness but it's it's a pretty core component certainly I think it's it's an incredibly important core component because once you're depressed inside it becomes a downward spiral of negativity you can never let yourself have negative emotions for a prolonged period of time and actually it's a great thing that Marcus really also says I says whenever you you lose you're off balance emotionally see how fast you can bring yourself back to being positive and make it a game he says you know like just see how fast because for him things bad things were happening every day you know literally every day he was betrayed by his best friend his wife left him you know all these but he'd bring him back himself back to being centered and you know and he's this is key because a person like that will be successful down the line in the long run they're just the worst person to face if that's your enemy he's never no matter what you throw at him he will never go away he'll never quit he in his mind it's gonna work out in the end somehow some way and I look around me all the time and I see people who are down and out and then came back to make it they were down and out they came back to make it like you see that in corporations you see that in individuals see that in fighters you see that in actors you see that all across the board so winners see a bad situation as temporary winners see a bad situation as temporary that's it no matter how down and out you are it's temporary


Great. All right. Well, here we are. Welcome everyone. My name is Emily. I'm the local peace economy coordinator here at Code Pink. Just set up my screen right here. Great. Yes, I'm a local peace economy coordinator here at Code Pink. I've been with Code Pink in this role since May. So coming up on a year, which is kind of crazy to me at least. And as many of you know, Jodi Evans, co-founder of Code Pink is typically here. She couldn't be here tonight. So I'll be meeting the meeting and it'll be a lot of like open conversation too. And time for sharing. So, so welcome. And if you haven't already, as I've said, please continue to put your name where you're living or where you are right now in the chat and any other information you want to share to introduce yourself. And as you always have been here before, you know that we always like to start with, with the piece of culture and also a way to ground us as so much of this work is about the internal, internal divestment and the internal embodied experience that we have of ourselves and each other in relationship as we move to the peace economy. So we'll start with the grounding. Welcome everyone who's coming in. Please feel free to put your name and where you are right now in the chat. And I mentioned that joy will like potentially the grounding today it's coming from reduced to joy, a book of poetry by Mark Meepo. And I reached for this today for the grounding because I personally just woke up feeling just a lot of grief for the world as I know many of us have. I was feeling it really poignantly this morning and throughout the day. And so, yeah, I was wondering what what medicine this book had for us today. I'm going to take a breath. This poem is called On the Ridge by Mark Meepo. We can grow by simply listening the way the tree on that ridge listens its branches to the sky.  We can listen our way out of anger if we let the heart soften the wolf we keep inside. We can last by listening deeply the way roots reach for the next inch of earth, the way an old turtle listens, all he hears into the patterns of his shell. And part of the reason that that poem felt like it resonated for the topic this evening is because today we're going to, it's a day of harvesting and sharing and listening to our lives in order to learn from our own experience. So that's what we'll be doing today, or tonight. We'll be harvesting what we've been learning and sharing with one another so we can all learn from the collective wisdom in the group and we saw such a beautiful example of that two weeks ago when Macy shared their experience with mapping. I don't know if Macy's here. But if you weren't there, I highly recommend looking back at the recording on YouTube, which I can put that link in the chat. Yeah, Macy shared just a lot of beautiful wisdom about how they've been engaged with local peace economies and in their community and the mapping that they've been doing. So today we're really practicing the pivot of rushing to wisdom together pivoting from rushing to figuring it all out and doing and building local peace economies to taking the time to pause and reflect together and to harvest the wisdom of our own lives. And we've been meeting since the beginning of the year so about four months now. Which, again, hard for me to believe. And I know not everyone has been joining these calls the whole time for some of you it might be your first time. And that's great. And because you have an abundance of experience that brought you here regardless and so I hope you'll lean into sharing during our conversation tonight. And in the spirit of sharing. Jodi and I and just participated in buying years, which you some of you may be familiar with it's a conference a climate justice conference that takes took place this year in Berkeley, California. And it's a super rich site of collective learning. And so to begin, I and Tim, who was there with me as a volunteer are going to share our some of our learnings from our time there. And we'll move into a larger sharing so we can learn from each other. So, so first I want to invite Tim, like I said was a volunteer with me at the conference to share a bit about his experience at the conference so it looks like you're unmuted Tim so thank you. If it's helpful for you all you can, if you're not already on speaker view. You can change in the right hand corner to it's as view. If it's helpful for you to just see who's speaking. You can hit speaker instead of gallery or you can if you want to feel like the collective presence of the group, you're welcome to keep it on gallery view as well I typically enjoy that but. Okay, so Tim. Kind of the first questions I have for you are what struck you that you heard at the conference and what did you what did you leave with. Well, first of all, it was very positive. Like you said earlier about feeling sorrow. There was so much negativity in the world right now Gaza and Trump and and climate deniers even and green economy deniers. So what was interesting to me that was so much positive energy about trying to fix climate change and then and include all people in this journey to leave no one behind essentially in the new economy. So that part was very refreshing for me in positive energy, which we need sometimes to build up our strength to go through the day to day struggle that it's like out there sometimes. Absolutely. Yeah, really speaking to like the power of community and enjoy that's felt in. Growing the community. I think they're very pushing that idea that this whole community needs to grow. We all need to help each other achieve happiness. Absolutely. Is there anything you've heard from any of the presenters or someone that you met there that you want to pass along to the group. Yes, I just to give a quick little bit of background of me. And I've been with code pink eight or nine years now and been involved in the local peace economy for a number of years and there was an active person named Kelly Curry was an Oakland a number of years ago. And she was into making smoothies to give to school children and trying to get nutrition into schools and growing local foods and how that is people in the community need fresh grown local foods. And that really got my interest. And I started looking around and studying about urban agriculture and learning about regenerative gardening and growing so I started a little garden plot. And it now has grown to kind of a small little farm. I'm not quite a farm yet, but I like to call myself that. But at the conference, there was a lot of information about what people are doing in agriculture, not just urban but agriculture in general. So how positive and the science behind it like one of the Lectures I listened to was about how fungus and plant roots talked to each other and and chain exchange the nutrients they both needs, which I found very interesting. But part of the growing the community that we were talking about when I attended a couple of the lectures that one of them was in Oakland was one of the largest urban farms. They always talk about a city slicker farms. I think they're called and it was very interesting to listen to who the founder speak about how her experience of trying to get a farm growing. And I think they're managing four farms now around Oakland. So that was very interesting to listen to her. And then I came across another group called the ecology center. I think that's right. And how they are trying to develop a sustainable community for the East Bay and beyond. And one of the things that they were doing was buying food from local farmers so they can give to families in the East Bay. Area. So that was very interesting. And then I was introduced to another group Tomcat farms out in. Pescadero, California, which is right on the coast, who is trying to get small farmers together to grow food for the schools. So this was expanded my. Village or map really of what is going on in the Bay Area as far as local growing food for the local community. So it was all very interesting to me. And grew my knowledge as well of the urban farming community here in California, North California. Yeah, thanks for sharing that. I'm hearing to like really big pieces in what you're sharing of that we've talked about already in the past is inspiration and how we get inspired by stories and also mapping. And something you shared with me when you were just when we were talking one on one about your experience at the conference is you said the map gets bigger all the time. And I just I love that quote. It's just a matter of, you know, paying attention and putting yourself out into the community and I'm wondering if you want to share anything about your process of mapping because I know you engaged a lot with that and in your community and how the conference kind of added to that. Yes, I mean, I, let's just add more to it. I mean, I was aware of the Oakland farm. And I live kind of, I'm in San Jose, which is the south of the Bay, where Oakland's at the top of the bay. So I, they call South Bay. So I'm pretty familiar with what's around San Jose and up the, up the coast, up the bay a little bit. So this expanded North Bay for me and even out to the coast. So, Yeah, it's, what's that old term. About, I can't think now, but it's, it's your contacts develop more and more as you're out there every day. So it. So, yeah, first I thought it was kind of a small community to this urban farming community, but it's getting larger all the time. So that part is exciting really. Great. Yeah. Are there any like new connections you're excited about making as you as you expand your, your knowledge of who's doing what is out there. I'm definitely going to contact the Tomcat farm and see what, what they would like to do. I mean, how the, what they're proceeding because the USDA does have a program trying to buy farm from local farmers to sell the school. So that'd be interesting to see what they're planning on doing, because as farmers, you do have to sell to make money. They can survive. Be a productive farmer. So if we could sell the schools, fresh fruits and vegetables to our local schools, that would be very rewarding. Yeah. Anything else you want to share with the group. Yeah, one. Spiritually, I like to pray to the great mother. Earth and at the, at the final session, they had a native woman, I think she was from the planes. And she was going to offer a prayer for us. And what she said that the simple prayer is Mother Earth is good. And she sang a beautiful song, basically saying that Mother Earth is good. And I found that really uplifting as well. I know that personally, like I said, I prefer the Mother Earth as opposed to male warrior God that currently being worshiped now. But anyway. Yeah, thanks for bringing that in Tim and like the spiritual component or that language doesn't resonate with you. Just that connection to our home, which is the earth that we talked about we talked about. In the first page in the workbook, pretty much that economy means home and how we how we manage our home or how we care for our home, which it collectively is there. So I definitely felt that presence to at the conference of there was a there's a large indigenous presence there and centering the indigenous experience and leadership happening in the climate justice movement, in the that relational aspect that is so necessary that we talk about peace economy being relational instead of transactional and extracted with the earth. So, yeah, thanks for naming that Tim. And thank you for sharing your experience. It was just personally, I just want to share with the group. It was so lovely to get to spend time with Tim and hear more about how he's living. He's a local piece economy in his life and he really is and it's like super inspiring to me. And with that too I just want to, before I share a little bit about my experience as well I just want to say if there's anyone who wants to as messy did and as Tim just did if there's anyone who wants to speak about a certain aspects of local piece economy, like a certain topic in the workbook or something you're learning. So if you have any of these calls and share with the group I would love to love for more of that to happen to again be I know we were learning from each other in the breakout groups but if you're wanting to share in the larger group as well that is very much welcome just send me an email. If you have emails in all of the, the invitation emails that go out and the follow up emails, or you could email piece economy at code pink dot org, and would love to. Yeah, support you in doing that if that's something you'd like. Great. And so yeah I'll share a few learnings as well. And then we'll go into our smaller groups. And the two one little thing if we have time I'd like to hear what people are doing. They know about the urban agriculture in their area. Yeah, why don't we do that now actually before I just stay on topic. Thanks Tim. But yeah that was it that was a question that Tim wanted to bring to the group but what do people know about what's happening in their urban agriculture world in their noble communities. So feel free to raise your hand or come off mute. Francis. Hello everyone Francis she her pronouns on the board of activists San Diego and do a lot of intersectional organizing. And in what I know of is food shed, which is based in city heights, which has a storefront where people can buy fresh fruits and vegetables.  And through them I've heard of and connected to like people doing a lot of like wildflower farming there's like a little shop that opened up. I don't know if you guys know Nate's garden shop, which is a great little cafe as well. The board of that in that same little parking lot is this little flower shop of women run POC women run flower shop and they do local flower farming, and then through food shed. They can connect with a lot of different organizations and active of San Diego is a endorser of the kale festival. So every year in San Diego for this will be this this September 21 Saturday will be the from nine to one will be the seventh one. It's a break in coven with the kale festival brings together a lot of different people who are well it celebrates kale, first off, and the planet and the earth and the life giving food. And it brings together folks like the rare fruit growers. There's the national city feed library. There's, yeah, so things like that. That's what I know. Interesting. Thanks so much Francis there's a lot of things that I want to make sure the ecosystem map. Yeah, if anyone wants to get involved in the kale festival organizing the first meeting is going to be Friday, April 19. I believe I won't be there but it will probably be at the peace center. The church of the brethren and the, he has no the peace resource center has the space next in this whole little complex but the friends meeting center as well. It'll probably be there. But if I'll put my contact in the chat so if anyone wants to get involved in that just let me know. Please do and can you remind us what city are you in? San Diego. Is this a national call. I wasn't sure. Yes. Okay, is anyone here in San Diego by show fans. We're near to San Diego. No. No, I see surely who's up for the Bay area. I know. All right, well good to see you all if you guys know anyone who's in San Diego. We also have. We're going to say public power campaign going on. All right. Okay. Enjoy. What would you like to share about the urban agriculture scene? Well, um, um, I wanted. So I, uh, with our city on spill Alabama does have a botanical gardens. And at the botanical gardens, there's a community garden. And now that's wonderful and good and all that kind of good stuff. I wrote to them. They're also doing a huge project on the other, like on the south side of town. Uh, that's, uh, um, called John Hunt Park. It's got a lot of, uh, like pickleball courts and, and they're doing a lot of planting trees down there and stuff like that. And so I wrote to the city and I said, why don't you put a community garden down there? And they wrote back and said, well, there's already one at the botanical gardens and we don't need. Yeah, you know, but I am happy to report that lately it's been on a lot of my radar that, uh, there, there is a community garden up at Alabama A&M University on the north end of town. That has been getting a lot of support from like the county commission, I think gave them some money. Um, and the city, I think also gave them some money. And so I'm anxious to get up there and check them out. And of course I have a garden in my backyard and the arugula was fabulous this spring. Um, uh, um, I am would love to set up an urban land trust, um, like they have in cooperation Jackson. Do you guys know about cooperation Jackson? No. No, gosh. Well, there, there's a huge website. You can find them everywhere. There's they have two books out about what they're doing and a rewrite and all that kind of stuff. I highly recommend looking into what they're doing and they do a lot of urban gardening and, you know, trying to be self sufficient food wise stuff. I would love to start an urban land trust here.  Okay. And, um, I don't know. I'm trying to find lawyers and stuff to, to figure out how to do this. If it's, if it just starts with my house, I'm fine with that. You know, we'll see, we'll see what happens. But there's my, my thinking about urban gardening type of stuff. There's a lot of help from the cities that local governments are really looking to expand urban agriculture in communities. Yeah, to help. They're really putting the state. Did you catch the part of my story where, where I said, when we need another community garden, they went, oh, we've got one. We don't need it. Yes. But it's there. I mean, I would look at your city, your state, your county, because the USDA and part of the green economy is really pushing, you know, the Biden bill is really pushing trying to get urban farming going. Going across the United States. So I reached out to look there. County and, and, and see, I'm sure there's some program there in your state. I'm sure the state at the state level, there's something for sure. Federal level as well. Okay. I'll also put a resource in the chat. It's called the sustainable economies law center. I'm not sure if they have like what you're looking for, but they I see them around a lot in the global peace economy solidarity economy work so I'll put them in the chat. I'm surely would you like to share and then we'll move on. Yeah, okay. This was probably pre COVID but I recollect and I just, you know, while people were chatting I went online to see if I could find it. But here in Oakland, there was some, you know, some group. Perhaps they were young people out in East Oakland. And what they were doing and they might have also been in LA. They were letting people in their front yard, take out their lawns and turn the lawns into a garden.  I mean, there was no restrictions but the idea was that, you know, the water waste for the lawn could actually grow many edibles. And, you know, people, I think we're getting very excited about it but I don't know what happened as I say I think it was before COVID so it might have not continued. Francis, do you want to share. I can give you an update on the project that he was talking about. Yeah. It was, I believe that project has survived that project did get media. And it was, I believe, when I connected with them they had a booth at the Los Angeles. This is Los Angeles we're talking about. Correct. Was that where was she talking about it at. Sorry. Alabama. Alabama. Okay. That was joy. Okay, well, yeah, if she's talking about the one, well there was one in Los Angeles that I'd seen that they have a booth at the Los at the Hollywood farmers market. And they have like the articles have been written about them there. And it's been from when I connected them which was definitely mid pen mid to late pandemic. It seemed to be a really thriving program. And, and I'll just throw in in San Diego I'm not sure if the other places that are doing it, but something awesome I've seen here is nonprofit that gets volunteers to go pick fruits from people's trees. And meanwhile, like completely cleaning up their yard and garden to make it look beautiful. For free. And then they get that fruit over to food pantries to be distributed into that system. And so it's a really great sort of circle of support. Because the homeowners love that their lawns are getting cleaned for free, and that it's going to give you some that fruit's not going to waste because down here in San Diego we have a ton of others also Southern California there's so much fruit going to waste just on everyone's in everyone's yards. Yeah, I agree that up in the same thing. Yeah, sounds like there's lots of lots of cool products going on and thanks for surfacing that that Tim. Just to keep us kind of in the flow of time make sure we have enough time for breakout rooms and everything will move on. I'm going to share a little bit about my learnings that I want to pass along to the group from vineyards and then we'll do breakout rooms and large group share. So, I want to share two learnings from two women. In particular that I heard speak up by nears. The first is collect peace on battle and collect is the co founder and vision initiative partner at tackroot earth. You may be familiar with them. They are on the ecosystem. They're on our website, and their mission is to build power and cultivate solutions among frontline communities advancing climate justice and democracy, and their work is rooted in black liberation. And I wish I could share her whole talk with you and I believe that by nears will edit all of those talks and share them publicly so I'll keep an eye out for that and if that even when that does happen I'll share it out in one of our emails. But yeah, it was just, it was, it had me in tears. But what struck me, one of the things that struck me about her talk among many was the way she spoke to the need to transform ourselves as we work for change and for transformation. And that's a theme that we've talked about, obviously, and she called us to really look in the mirror, and as we try to bring people into the movement for climate justice to really ask ourselves who are we asking them to join with. And to me her words really reminded me of the pivots that we've been talking about and working with and underline the importance of shifting our ways of being and relating as we cultivate local peace economies, because the war economy lives in us. And if we don't do the work of pivoting away from war economy habits will continue to recreate it, even if our intentions are otherwise. And it can be really seductive and exciting to focus so much on the external labor that's needed to grow local peace economies and that excitement is like so beautiful I mean I'm feeling so excited just like hearing about all these projects on the call. And excitement comes from oftentimes like a feeling of authentic connection and authentic community that we're starved of in the war economy, and amidst that. We can't forget to do the internal divestment or the pivoting needed to be able to bring about something different in the world and that's something I really heard in her talk and just wanted to pass that through. Another thing I heard from her is the need to visualize all different types of labor as we shift away from the war economy. And I just wanted to share this quote from her talk. She said, let's reimagine labor. Let's visualize what labor really is. Let's talk about what kind of labor it takes to make sure a baby is raised correctly, or that communities are hugged. There is labor happening all the time. Let's redefine this. This speaks directly to what we're doing when we're cultivating the local peace economies because we're told this lie that the economy is the stock market, that it's the banks, that it's the labor that we're paid for. But it's really this wide web of relationships that we're part of that help us be well and get our needs met collectively. So much inspiration. I'll put her the website for Taproot Earth in the chat momentarily. But first I want to share one more learning from a woman at the conference named Pat McCabe and I'm just going to read a little bit from her bio on her website. She is named as a DNA or Navajo mother, grandmother, activist, artist, writer, ceremonial leader and intentional speaker. She has a voice for global peace and her paintings are created as tools for individual earth and global healing. She has been a part of the indigenous sciences of thriving life to reframe questions about sustainability and balance, and she is devoted to supporting the next generations women's nation and men's nation and being functional members of the group of life and upholding the honor of being human. And what I want to share is a quote that I heard from her that I keep thinking about and coming back to you. I believe that she's come to understand that it's her responsibility to ask, are we placing life at the center. And if not, we must begin again. I'm going to say that one more time just to let it land. Are we placing life at the center. If not, we must begin again. And I believe that question if I'm remembering the context you provided correctly came to her through ceremony and through her own spiritual work and journey so I don't want to claim that question for myself or for any of us here. And I also wanted to bring it to the group because it felt so centering to me. And like it can really ground and cut through so many of the distractions at the war economy. The war economy offers us as we call us even as we do the work to cultivate local piece economies because of the ways that the war economy lives in us and pits us against each other through these addictions or habits that we talked about in the pivot so just wanted to offer that wisdom from Pat McCabe to the group as well. And I think it's time for breakout rooms. When we're in one in the breakout rooms I'll put those two websites in the chat Pat McCabe's website and taproot earth. But I'll get us the breakout rooms and the question for the breakout room. Again, I'll put this in the chat and broadcast it as well. So with sharing and harvesting collective learning. What are you learning along your local piece economy journey, what has surprised you, what has been challenging and what has been joyful. So I will see how many people do we have here one, two, three, four, five, six, seven, eight. Okay, I will do five groups. So probably with two or three people. And please keep your, keep your time just to make sure that everyone has time to speak and feel free to introduce yourself again and share where you are. And we'll have 15 minutes. And I'll call you back. Welcome back everyone. Just a reminder to please meet yourself you're probably off coming back from that. So we'll have a breakout room just to reduce background noise. And yeah, we're going to open up for large group shares before I do just because I know, you know, as we get talking and then it gets to the hour and some people might have to leave right at the hour. I just want to share a couple links. So everyone has the opportunity to see it. I don't know if you all know, but code pink has a radio show and we just did a radio show episode about the local peace economy. And we sounds like looks like some of you have heard it and there are some little snippets of more interviews from Bioneers as well as I interviewed Jodi about local peace economy so I'm going to put that link in the chat for the radio show. The one right there is episode 242. Hope you all enjoy it if you take a listen. There's so many incredible people at Bioneers so you'll get to hear from a few more people. There's a panel tomorrow that Jodi is going to be on with the peace economy project about transitioning to the peace economy. So if you want to register for that that's tomorrow morning and an email one out tonight as well with that invitation link if you don't get it in the chat. So we're going to have our local peace economy group which I'm guessing many most if not all of you are on since you're here and then the last link I'll share really fast is just the link to register for our next call in two weeks. And with that. Yeah what's alive for you what are you learning what did you hear from other people that you want to share what's what struck you about your conversation. Feel free to raise your hand or come off mute. I think one is still here. About things to do with gardens since we were talking about community gardens and and hearing about what other the other two people who were there what they're doing and what's is very nice to chat with each of them and to share ideas together. Very good. What's what's one idea that you shared or that you were shared with you that that's that you're holding on to So I was talking about we we used to have a small pot of land here at an apartment complex where where I live and there were a number of people who wanted to have gardens on that lot of land and the management said okay you know you're just going to have to take care of them yourselves. Get the water and whatever else you're going to do in there so so that was very nice. Yeah, that was a nice experience. Did you get to know people out there and you get to eat some nice fresh food too. Thanks Marjorie. Just want to say that I just put a link in the chat. I encourage everyone to check it out. Actually, San Diego has a monthly community meeting. Often it's hybrid now. And last month we had all the local groups that are organizing for south of ceasefire and Palestinian liberation. We had them reporting on what the different groups are doing and Jodi Evans was able to join us. And she her words of course once again were incredibly powerful and moving and I highly recommend watching it. Even if you just watch the part where she's at it's it's really powerful. The whole thing is great but just want to recommend checking that one out. Thanks for sharing princess. I'm just going to save that link for myself and save the chat. Anyone else want to share I'm also curious if what are people learning about their own process with the pivots. If that's alive for anyone right now. Is there a pivot that you're working with that you're learning about where your resistance is or where it's alive in your life. Princess I'm not sure if your hand is still raised for this question or not. So if it is feel free to come off mute again but or as far as you want to share as you're muted. Thank you for asking that. No, I had a very good experience with excellent people but I can't express myself very well but thank you. I'm being recorded. I don't like that. So I'll speak. I had a I thought the mapping was very interesting. I did a map which was a series of you can see it here series of circles because for me peace is very central to my workers and artists and an activist and I was telling Marjorie and the gentlemen from West Africa who was in our little group that I am about to do on Earth Day which is on April 22nd to do a ritual performance on the Pradzab center where I live where I'm going to be it's a peace courtiers of the world which I have done before for Iraq or Ukraine last year and but this year I'm combining because my work is all about peace whether I do an environmental work or more politically oriented work. So I feel that there is no flourishing of our Earth without none with that with violence. So we need to stop the war so that so I'm able to combine the two but I love this this drawing because you know I said well yeah peace is really central all my work in my community in the Earth and in the world so that was very helpful. Yeah that's what I have to share. Thanks Dominique thanks for sharing your map yeah for those of you here with us two weeks ago we talked about mapping so if anyone wants to share their map now or later on even if it's under a call if you want to email it to peace economy at coping.org we'd love to see it. I think we might have time for one more share if anyone wants to share and also I'm not sure your name but I see iPhone is putting lots in the chat so thank you for that. Francis has her hand up. Yes Francis did you want to share again or is that hand from sorry that was from previous. iPhone man my name is Jello. I have posted some ideas I don't know is a stand for you. Yes there's a lot there so I highly encourage people to take a look at that and save the chat and I'll save it as well. Anyone else last words. Joy. Okay I'm going to hog the mic again for a second. I'm just I want to admit that. You know I show up here because this is good community and I need to hear people you know like minded people. But boy I just work a lot and I have had I'm working on my workbook but I'm only a few pages into it I haven't even gotten to the pivots. But in our small group today I said you can tell me what I would like to see is a pivot and maybe it's already in the list I know I read them before but I can't remember what they are okay. From what I see as this energy density sort of economy or activity to a more hands-on human powered interactive closer to home type thing and by energy density I mean you know like production and stuff that requires vast amounts of fossil fuels and to ship and to grow large scale and all of that kind of stuff. So there's a thought about pivots okay. Thank you Joy I appreciate that and yeah that list can always grow and evolve and as we continue to learn so yeah I'll pass that on to Jodi as well. I would like to speak to that point. That's why growing local food is important instead of growing huge fields then ship putting them on trucks then shipping them halfway across the country. That's why the local peace economy or growing local food is important. Absolutely. I love local food tonight I loved it. Well I know that we're at the top of the hour and so some of you may need to go but I just want to thank you all for the rich conversation I hope it was rich and juicy in your breakout rooms and yeah I hope that you come back in two weeks or join the panel tomorrow and listen to the radio show if you need anything from us you can email I'll put it in the chat real fast. Peace economy at code pink.org and yeah I just really appreciated hearing from so many of you tonight and again if there's anything you would like to speak to in the group during one of the meetings during a large group share like Tim did like Macy did two weeks ago please let us know would love would love to have you share and bring more of your voices in more consistently and Frances I see your hand but I'll just kind of formally close it here so people feel like they can go and we'll see you in two weeks hopefully have a great two weeks.


You can come in here. You can come here. But it's quick, quick. This is for the white paper. Whoa! Oh. All right. Yeah! Hey Ma. What's up? Let's slide. All right. All right.  You smoke. I drink. You too. All right. Cause we gon' take a ride tonight. So Ma. What's that? Let's slide. All right.  All right, guys. Stop number one of the tour. We're here at Barley's Zoo. Let's go check it out. All right. What do I look? Pretty good. That's good lighting right there. Great lighting. All right. Are you in the middle or like on the side? Depending on where we are.  All right. We've got our tickets. If you're wondering, it's 37 Australian dollars to get in. And have a look at the map. It looks pretty sick. So we're just going to go in a little expedition around this place and go check out some wildlife. I can't wait. Stop number one. What's the date for? Perfect day. Hello. They look like statues. I don't even bother trying to sweat off me anymore. It just comes out in buckets. Going on a safari. It's a safari day. Where am I sitting? Where am I? I'm like what happened there? Like it. Casey. I'm next to you. Where are we? We're in paradise. That's where we are. I don't know. After, definitely. See you in five minutes. Or 20. Watermelon last block. I know. They look good. Watermelon. I just want mango and the rest is just a safari. What does that taste like? The sweet mix of sour and sweet. I don't know. Are you getting mine? I can. That one's mine. Thank you. Had to be done, didn't it? Yum. That's really good. Was it like lemon? Yeah. It's sour. Like a sweet pineapple. That's just what I needed. Refreshing on the taste buds. Looks wise, doesn't he? Yeah. Come on. Come on. Come on. Come on. Let's sit in the car. Let's discuss something. Either we lovin' or see you tomorrow. Now we're speeding up the west side. And creeping up the left side. I'm ready to do it. Ready to ball. Ready for dome. Fifty-fifty exit. Damn, we already home. Now let's get it on. What's that? Let's slide. All right. Let's go. Let's go. Yes. Look at the eyes. On this light one. Hey. Hello. I've been here too long. Did anybody want to see the camera? No. Thank you. I think I'm... I want you to stay alive. I really want you to stay alive. I really want you to stay alive. I really want you to stay alive. I really want you to stay alive. I really want you to stay alive. I really want you to be alive. I really want you to stay alive. I really want you to stay alive. A little bit more, little bit more. What a beast. Woah!


Russian's retreat in Kursan, they mine the critical infrastructure. The Russian occupying forces are planting explosives near stationary gas control points, electrical substations and critical infrastructure in the temporarily occupied part of Kursan Oblast informs the defence intelligence of Ukraine. The report noted that these actions indicate Russian forces' likely intention to destroy critical infrastructure when they are forced to retreat. It is worth noting that a year ago, Russian forces during their retreat from Kursan attempted to maximise damage to power lines, other elements of transportation and critical infrastructure in the region. Earlier, ISW analysts reported that Ukrainian forces had made some progress and pushed the occupiers to the left bank of the Nipro River in the Kursan region. It was mentioned that the armed forces of Ukraine had landed on the left bank of the Kursan region. In commenting on the situation on the left bank, Natalia Humenyuk, the head of the United Coordinating Press Centre of Security and Defence Forces of the South of Ukraine, stated that there were positive results in counter-battery warfare and other methods. The military expert Vladislav Zelensnov, in a conversation with RBC Ukraine, identified three bridgeheads for the armed forces of Ukraine on the left bank of the Kursan region.


What's up everyone it's your girl Kenty here from Layton sports cards, and I'm ripping 2021 panini select football hobby three box break number 18 Random teams here's a look at the random results You can always find these at Layton sports cards calm underneath the results tab link is also in chat for you Alright best of luck everyone Let's see some big hits. So that has been super hot for us since release Let's see what we can hit you And let's get these football breaks filled up and then our NT basketball as well Still 11 to go. There is the link for you. That one is breaking soon. So let's get it filled up Sri Lantz rookie. We've got out of 99. We've got Brandon cooks to 99 Brandon cooks to 99 Brandon cooks to 99 silver Rondell Moore rookie and a Tommy tremble rookie To to got Derek Henry phenomenon Silver rookie club level Brevin Jordan Texans and LT So up check Longwood Evo got Jared Dokes on the tri-color club level for the Dolphins that is out of 149 Dolphins auto up next out of 299 silver Micasecchi and Levi on was a Rique and we got Sam Ellinger on the maroon to 99 for the Colts Silver rookie club level Kaderious Tony and Ricky Williams monocling Brown to out of 49. We've got purple RPA. Naomi Brown Washington and a in book rookie Stokes Zach Wilson club level rookie selections Elijah Moore Silver DK Metcalf and a Jalen waddle rookie base Did you believe that I have some of my house right now for us because I do Kyle pitch rookie Calvin Ridley. We have a tree Lance on the concourse tri-color nice one there Niners 234 of 249 There you go, Sam Fran Sam a with the Niners. There you go Yeah, Chuba Hubbard on the club Silver Panthers to fun digs. We're gonna make that land for you Hey, I special junior stafford since stations rookie trail ants silver a mon Rossine Brown concourse Lions and a Ian book Always do this. I look down for a couple breaks and look up and it's a new game. I don't know We got Scridge on the premier level tri-color to 199 Seahawks silver feel a fill level Mike Stratchin Kellan Monds Rhonda more rookie silver selection Zach Wilson Carson Wentz silver and Devonte Parker That is You are very correct. We've got Jalen waddle orange concourse 32 of 49 Nice one there. There is like a print. You can see it right over the card. Oh Oh Dolphins we will send a box with this one for you Mark G but that is a very nice waddle. We'll mag that for you. Yeah, we will send a box Silver Kylan Hill rookie and Travis Kelsey last pack box one Romo, we've got sensation silver Darren Waller Raiders silver Diamond Brown on the premier level and Ramond Ray Stevenson at Patriots Now the aces Devonte Smith Sam Darnold Alvin Camaro, we've got out of 75 white RPA here for the Rams Jacob Harris And Frank Darby rookie Jacob Harris out of 99. We've got lightning silver patch Tim Brown Raiders Silver Tyson Williams rookie. I'm Ari Cooper. I've had the entire chip Peterson Granson Mag Jones phenomenons rookie silver Trudavius white club level in a Josh Allen field level can't be a chips away Apologist without having everything in the Aguilore eclair our selections Trey Lance.  Let me get you a better Little crumbled on that one nice Mills We will mag this one for you a nice color match to but that Texans and Silver Corey Davis field level JC Jackson Davis Mills base Got Jake funk Why it's big Ben on the premiere level to 35 Steelers 29 at 35 there Nice big Ben silver field level Anthony Schwartz and not sure Davidson Najee Harris rookie Sensation CMC silver David Johnson and a Jalen waddle rookie field level Niko Collins on the red to 99 for the Texans Silver club level rookie Kellen Mons Kenneth gain. Well, it's like a mosquito in here I think there's like a single mosquito that keeps flying around my legs Kipson a gelari silver selections Jamar Chase Javante Williams silver concourse Broncos gates Kadiria's Tony rookie Javante Williams rookie club level base. We've got Kyle pets nice tricolor there for the Falcons That is 178 of 199 Silver Justin Herbert's and she's young. Do you hear about the guy? Made a bet on draft Kings Chupa Hubbard rookie Tannen Hill silver sensations Patrick Mahomes Silver club level Jalen waddle and a a wosokor moa He made a bet and like I think like a like for golf or something But then someone at or a sport someone got sick So they obviously couldn't do the parlay so they refunded him and he waited last minute to use his The refund money now before it expired maroon lambjack to 99 for the Ravens We've got to 75 maroon auto of Austin Hooper for the Browns So he bets a parlay and Alan Robinson the second on NASCAR and It was like some of these four no names to finish top 10 And he won I think like It was something crazy he hit for that and then he hit for like another 80k or 80 or 90k in a different parlay For golfers like the bottom a bottom golfer to win the tournament Yeah $13 bet On that refund a Monro St. Brown rookie Lions We've got light blue to 99 premiere level rookie Jamie and Davis Washington 53 and 99 silver Joe Burrowfield level Anthony Schwartz Why can't I get that lucky? Sanders we've got to 99 silver rookie patch here Ramon Dre Stevenson Patriots Silver Paul Amalu and Ty Johnson Micah Parsons rookie Trevor Lawrence rookie Phenomenons Jalen waddle silver Tyron Matthew club level in a chupa-hubbered field level Get everyone to football breaks and a basketball break We got we had to move still with spots remaining nice one here jets premiere level try color 76 of 199 Zach Wilson here you go jets James a with the jets congrats on that one will mag that for you silver Derek Gore and a Mack Jones premier level rookie base Ellinger Elijah Moore Devontae Adams out of 199 we got silver RPA for the Broncos Javante Williams Thanks when they're Denver Tyrese Williams Got another Javante rookie base David Johnson blue Najee Harris premier level Steelers that one is 39 to 149 Thanks for subscribing Leo. We got Packers 39 of 49 light blue auto of Lynn Dickey Lynn Dickey So the next break we're trying to fill is a mixer two boxes of prison football two boxes of NT football tiered random rookie of Rondell Moore rookie selections teal off Got Devontae Adams silver semi-fajoco and that breaks here in just a few breaks and after that we've got a Full case tiered random teams flawless. We've got blue field level Rondell Moore 30 of 49 There you go Zona nice hit there Silver Diami Brown field level rookie at Reed and then to end the night We had to push back our NT four box full case break tiered random teams for some NT basketball Let's get that one filled up as well Zach Wilson Ricky. There was seven laps I believe last time we checked on that one sensations Travis Kelsey Silver Sam Ellinger and Cadarius Tony rookie field level scratch Micah Parsons on the Concourse Ricky try level Try color Concourse level try color 201 and 249 Silver club level rookie Ramon Dre Stevenson and Demetric Felton rookie trace sermon We've got silver sensations of Aaron Rodgers Silver club level rookie Trama kitty Chargers Joe makes it last pack and then we'll do a quick recap Derek Gore Paula Mollew silver rookie selections Cadarius Tony Silver Elijah Moore and a Rashad Bateman for our recap We had the Ramon Dre Stevenson Silver Patch Patriots Tim Brown the Raiders Brandon Cooks to 99 Lynn Dickie Packers Javante Williams Broncos. We had Austin Hopper Or Hooper Browns Jacob Harris RPA Rams. Diami Brown Washington Micah Secky silver Dolphins our magged cards. We had the try color Premier level Zach Wilson for the Jets 76 of 199 Jalen Waddle again, it did have a damage across the target of seeing the mag across the card there We will send a box with you Miami That was 32 out of 49 Shray Lance on the concourse try color try Color yes 30 to 34 of 249 Niners and then the beautiful red mojo Davis Mills 28 of 49 on the club level that'll do for the first three boxer there. We've got another one coming right up. Thank you everybody


The Covid-2 wave has been coming under control in Tamil Nadu over the past weeks. At this juncture, on June 14, 2021, postgraduate medical students working in government hospitals across Tamil Nadu staged a demonstration, wearing black badges and demanding hikes on their cycles. All over the country, ambivious students, i.e. undergraduate medical students, are attending compulsory work aid re-residential internship, or CRRI, and the postgraduate students, MD, MS, MCH, and DM students practicing in government hospitals is made a compulsory part of their curriculum. With the added practice of these health workers, Covid patients are being treated. To understand more about why medical students have raised the demand for adequate compensation for their work at present, NewsClip reached out to representatives of Tamil Nadu Resident Doctors Association. So basically, what we had seen is that doctors have been working hard. They have been overworked during these past few months, not only these past few months, but what has been happening is that there has been a disparity between the work and the pay that has been given for the said work. The previous hike by the government was done in the year 2018, and currently the PG's in Tamil Nadu, the first year PG's, we are receiving an amount of rupees 37,000 per month. And for the super speciality PG's, that is DM and MCH PG's, they are receiving an amount of rupees 42,000 per month, first years. So this amount has been statistically covered. We have checked and analyzed with all the other states, and we have found that it is the least in our country. This is considering all the state governments and not the central institutes. The central institutes, for example, AIMS, Jipmar, PGA Chandigar have an amount which is almost three times the set amount that has been given to us. What we have proceeded was a step-by-step approach to the state government. Sending out formal letters to the Honorable Health Secretary, Honorable Health Minister, Honorable Finance Minister, and also our Honorable Chief Minister. We have also approached the Directorate of Medical Education for the same. However, there has been no official written statement released. There have been a series of tweets released by the official TNRDA page and TNMSA regarding the same issue on Twitter with over 900 retweets, but we haven't received any official word in writing. Therefore, it was decided to conduct a black badge demonstration two days ago. The point to be noted is that all services were continued despite the black badge demonstration. There was no service from the doctor's side which was interrupted. All elective services, all emergency services and all COVID duties were continuing as planned. And this has been going on for the past two months with no interruption. Whatever representation we have done to the government has been through a formal manner and through a very step-by-step approach. The least that we had expected from the government was a public release, a formal release or a formal order to be given by the government, if not in the newspapers, at least in the social media. And this has not been done till now. Therefore, our team at TNRDA consisting over 6,000 doctors across Tamil Nadu decided to conduct a black badge demonstration for the same. We are hoping for a favorable response from the government of Tamil Nadu towards our request. So, the thing to be noted is that the previous hike or stipend hike happened in the year 2018 where the salary was actually raised from 28,000 to 35,000 and even that happened unfortunately after a massive protest shook the state. There was no peaceful black badge demonstration or no peaceful protest as such. Almost 5,000 doctors all across the state joined hands and almost 1,000 doctors blocked roads and changed road rockers opposite NMC. So, it was a massive protest and the government literally had to call us and talk and negotiate the demands and they didn't increase the stipend by about 7,000 rupees and made it 35,000 rupees. Then 500 rupees was added every year and now it's 37.5 for the first APGs. So, what has been noted here is the point that even the previous stipend hike happened only because the doctors internally begged for their salaries. So, this is not a good sign of things to be occurring in the country. Number one. And number two, as Ruben particularly elaborated, the past 45 days we have been diplomatically approaching the government. We have been sending almost 100 mails every day from all our accounts. Remember the TNRA consists of all the PDs and the interns in the state and everybody has been sending mails to the government, official mails from their accounts to the health minister, the health secretary, the finance minister, the finance secretary. Whoever think was involved in this issue, who would probably solve this issue for us. We have made sure that everyone has received our mails and we have been documenting everything and not just mails. We have been making formal representations about our demands face to face right from the CEM to the health minister or to the health secretary and the BME. So, we have been hitting at every part of the pyramid right from the beginning and for the past 45 to 50 days the government is also aware of our steps because we keep tweeting about our efforts daily. We keep posting it on social media daily and not just that. We have also been meeting the officials face to face and they have been giving us oral assurances, just blank empty promises and oral assurances that they will meet at the man's and they probably have a solution in hand and they have been keeping us in the dark. But I believe all this is pure epitome because nothing solid has come out of our demands yet and the government though they are giving us oral assurances like nothing in the form of a formal statement or a press release or a government announcement has come forth. So, that is what has been lacking in our from the government side. So, we had to amp up our agitation too. We didn't want to make it as aggressive as enabling states like MP and Telangana went ahead with. We didn't want to disrupt government services at all because doing a massive strike of protest in this situation with the COVID pandemic still not settled would be totally unbecoming of what a good doctor is and that would be catastrophic to both the government and the public in large. So, to make sure that services are disrupted and to make sure that people are not affected but also make sure that the government knew about our grief and they had to listen to our voice. We had no other option but to actually change the black badge demonstration. As Ruben pointed out, no services were stopped and disrupted at all. Everything went as planned and as it was before the Black West demonstration and the doctors who came for the demonstration where all doctors were off-duty or doctors who sacrificed their resting hours for the sake of this cause and we just hope that the government will probably respond to our calls of grief because our state performs wonderfully in the healthcare sector. We have a great healthcare sector thanks to our CM insurance policy. We do so many surgeries, so many cases. The healthcare is one of the big plus points about Tamil Nadu as a state as a high-performing state in India and to be the least paid doctors in the entire nation after this it really hurts a lot because it is totally unfair for in no way are our PG's, the PG's of our state in no way they are working less than the PG's of other states. It is the same amount of hard work that they put and if not more because Tamil Nadu has been getting a lot of cases in both COVID and non-COVID. So in terms of performance, our PG's are in no way inferior to the PG's up north and to be paid literally half of what states like Gujarat and Delhi are being paid it really hurts us a lot and what we are asking for is not unfair. So we have two proper demands. One is a stipend height and one is a yearly percentage increase of a stipend. The yearly percentage increase is definitely paramount to our expectations because if they are going to increase a stipend height by an amount every year it won't solve the problem. If we increase the percentage by yearly it will make sure that 10 years down the line our juniors don't have to hold up placards and beg for their salary because it's going to be increased on a percentage basis with the inflation rate kept in calculation. Such protests, such demonstrations will not be necessary at all. So we really hope that the government listens to our demands and we just want a diplomatic solution for this. These resident doctors are facing many difficulties in the pandemic period. Given that they are on COVID duty they cannot go home to their families and it is the duty of the government to provide them proper accommodation. Doctors say that their accommodations lack basic facilities. Though many other states are giving perks to their PG students apparently this is not the case in Tamil Nadu. Let's learn more about the situation from the students. So a fixed time period was mentioned for which rupees 20,000 and 30,000 based on the cadre would be provided and that is actually under process and only the names and the time period where the post graduates have served has only been noted down so far and that amount has not reached anyone yet. Secondly, there is no extra allowance as such being provided for COVID duty unlike states in for example Karnataka where the interns themselves who earn a stipend of rupees 30,000 are paid a gratuity of another rupees 10,000 for their COVID duty. Our norms specify that we have to work for 8-12 hours per day actually 8 hours which can never happen anytime because if a case is sick and if the case is in my ward I have to do everything in my power to make sure the case becomes stable until then I cannot budge out of that patient's bedside. The intern is allowed to leave soon the assistant professor is allowed to leave soon the chief just has to come and show his face there whereas a PG, a post graduate has to remain with the bedside until the patient dies or until the patient gets stabilized. Number one and number two I really over the past two months we have been really trying our best to meet the government officials and raise the issues and make sure that they listen to our demands this shouldn't be the case I think there should be a proper a grievance system for doctors because we face so much pressure mental and physical pressure people keep forgetting that we are also humans we have a family to run and we have friends and family circles who keep falling ill who keep coming back to us for their opinions and suggestions and also we have to take care of them and we are also humans we also have a married life we have relations to take care of we have so many issues and we fall sick and beyond all that we have to discharge our duties as medical practitioners and in spite of all these thousand and one issues there is a stipend hike issue and this issue really opened me to the fact that if a doctor has to go and request a bed for something nobody is in a position to listen to us so there really has to be a proper a grievance system for us to voice out our grievances we are working for all 365 days the stipend hike giving around 35,000 rupees is only for 290 working days we are supposed to have a every Sunday we are supposed to get a leave and we have vacation holidays also for around 25 days we have to work only for 290 days in a year but we are working 350 days and we are available all 24 hours there is no proper time shift for us we are available for 24 hours and all 365 days but according to the MCA rule what they say is we have to work only for 290 days and in a week for maximum 48 hours and the stipend they are paying is for only that much of work that is 48 hours a week and 290 working days we are almost doing 4 times of work in case if providing us around 40,000 rupees we are doing 4 times of work we deserve around 1,200,000 rupees that's how it is in every other profession if a security guard works for 2 shifts for 2 shifts money only he won't get 1 shift money and work for 2 shifts similarly why not for doctors just because we are students we are exploited, we are made of work almost 4 times and they still pay the same 35,000 rupees to 40,000 rupees how far is it they should consider this ma'am next thing we are working in covid for more than 1 year since the start of the pandemic I am working in covid work now recently because of the recent covid case load we are unable to manage the patients now government has recently passed an order saying that they are recruiting 2,100 MBBS doctors for 50,000 rupees ma'am ma'am I have finished MBBS I have written NEET exam which is one of the most difficult exams more difficult than an IAS exam I have written that exam and I have joined the MD course and I am getting paid around 35,000 to 40,000 rupees and now they are recruiting 2,100 MBBS doctors for 50,000 rupees ma'am so what about me who is working in the same hospital for more than 1 year and getting paid less than that how far is it


for senior Americans isn't just a good idea. It's the law. And I note that of the many people that are depicted here, most of them have passed beyond Medicare coverage. So there is a future after Medicare coverage, but I leave that to the reader as an exercise. That's no fair mark. Now we know something. But the question we ask when we think about expanding Medicare is a simple one. Is this reasonable and necessary for the diagnosis of treatment of an illness or injury for Medicare beneficiaries for our covered population? And over the years, through regulation, we've essentially evolved a process, which we call the National Coverage Determination Process, or NCD process, which guides us through a very stepwise procedure to figure out if something is reasonable and necessary. In the instance of genetic variant testing, just like for so many other diagnostic technologies, we primarily look at evidence that the item or service, in this case, testing for genetic variants, improves clinically meaningful and perhaps more recently patient-centered health outcomes for the Medicare population. And in this way, we're actually pretty much on track with some of the other national organizations which have talked about frameworks for evaluating evidence. For example, this one through the ACC, as Dr. Aronson mentioned. We get advice from non-governmental experts about what kind of evidence we should prefer. And essentially, they tell us that we should look for evidence that has higher value as evidence. It wasn't, for example, more value is associated to our minds in prospective trials, to trials which use controls, which use objective comparators and endpoints, which use techniques to reduce bias, such as randomization or masking, and which are well-powered and appropriately statistically analyzed. That's the kind of classic approach that we favor or prefer. But that doesn't mean that that's what kind of data we're going to get or that people will be motivated to provide. In recognizing this, CMS has tried to use a relatively new formulation of the coverage option, coverage with evidence development, in which data collection is a specific condition of coverage. Dr. Corey and Dr. Berg, writing in Health Affairs in 2008, noted that CED has been used by CMS under certain scenarios and, in fact, has received support from some of the other agencies for development, for example, of cancer biomarkers, related diagnostic technology. One of the instances where CMS actually put its money where its mouth was about this was in the instance of Warfarin test, pharmacogenomic testing for Warfarin response. Now, that was only two years ago, and that's the first of the decisions on a national level that CMS has specifically looked at, particular genetic variants, and whether we should cover them. The status, by the way, of this is that two different groups representing multiple clinical centers have agreed to conduct such studies for us. And again, we, excuse me, again, we went ahead and worked with the submitters or the proposers of these studies to make sure that they were going to be focusing them on questions that were of value to us, especially value in ultimately providing coverage on a non-conditional basis for such testing. Whether or not we use CED, and perhaps this could be said to be true in different times for many different new diagnostic technologies, we feel with Dr. Drazen that, in fact, there is a key step that lies between us and at least the regulatory coverage piece of genetic variant testing, and that is knowing on the basis of reliable trial information whether this information really leads to better clinical outcomes. Now, I don't know how that intersects with the concept of actionability, but that's where CMS is now. I should mention one final thing. CED, by the way, is also a CMS coverage policy. CED policy changes may be happening at CMS, and CMS has announced the availability of a public comment period between now and January 6th, in which the members of the public of any type may send CMS their thoughts about how CED could be improved. Now, there are instructions for how to do this on our website, which is shown on the slide. I would like to, by the way, thank the organizers of the conference for allowing such a relatively new and small program like ours to participate. I also would like to thank my colleague, Dr. Sarah Harding, who's sitting in the back, who's much more involved in the reimbursement and of Medicare decision-making than I am. Thank you. Questions? I wonder if you could describe the mechanism by which a coverage with evidence development program comes into being. So, for example, how was this warfarin' trial? Who brought it forward? Who made the decision? How does this happen? Thank you. I think the question is, how do CED decisions evolve? I think there are perhaps two answers to that. The first one is that to distinguish them from other types of coverage, CED decisions are generally four things which are promising, which are basically safe, and in which there is a difficulty in conducting clinical trials. For example, the type of testing that's required to establish different patient groups or as the intervention itself are not easily available, not easily accessible, and so on. So if those conditions are met, CED may be adopted by CMS as a way of providing coverage because we can't make a coverage decision without additional evidence, and CED allows us to financially support studies which will give us better evidence. Does this bubble up from within CMS or do you have a mechanism for people to apply? How does this, what's the mechanism? Of the coverage decisions that we've done in the past, most of them have arisen from external requests, but not all of them. And does that go through the MedCAC? Is that where the level of review takes place? Or who actually does the review when a request like that comes in? Well, the process basically does not necessarily go through the MedCAC. The MedCAC is convened by CMS when there is a question about the kind of evidence that is available that CMS doesn't have the internal expertise to assess or when the question is of such significance that it is felt that a broader degree of input is needed before we can focus on the appropriate evidence on which to make our decisions. So is it true that with the warfarin one, and this is my imperfect recollection, that actually the process that that came about was that the MedCAC considered the question of whether or not that should be a covered benefit and that in the course of the discussion they realized the more evidence was needed and in that case then they made the recommendation that this could be something considered for coverage with evidence development. I do apologize, I can't confirm, I just don't remember. I have a quick question. At our last IOM round table meeting we had a representative from CMS come in and we were talking about genetic testing and one of the comments that he made was that he didn't see that genetic testing was relevant in the Medicare population and I think there's some other people that were at that meeting that it was, he almost kind of wondered why we kept and inviting CMS back. Do you guys am I recollecting that correctly? Yeah. Can you comment on that? Let me comment in two ways. First, although it is primarily a program for those who are 65 and older, it is certainly a program for those who are disabled as well as for those with end stage renal disease. In fact if you look at the statistics about the AIDS distribution in the Medicare population, 80 to 85% and again the figure is in there somewhere are older folks but 10 to 15% are younger folks. So perhaps that would be one concern. The second is that of course people who are older may be more frail medically and let me use the instance of pharmacogenomics may be more susceptible to the effects say of polypharmacy or other types of age related changes which impair their ability either to metabolize or to eliminate drug metabolites and therefore it may in fact be more appropriate to consider genetic testing to prevent harm in our beneficiaries and we do consider prevention of harm to be an important positive benefit to our beneficiaries from such testing. If indeed there's evidence to show that it does. Thank you. Thank you. Yeah, yeah. This is slightly tangential but how does a decision, so from the Medicare population my understanding and certainly with our hospital works is that a Medicare patient has to be seen by an MD medical geneticist cannot be seen and by a licensed genetic counselor for the service to be compensated. How do those decisions get made when they don't seem cost effective for Medicare? Medic, oh sorry, Mark, did you wanna come in? Yeah, I spent years on this. It seems like years, actually it's real years. Genetic counselors are not, we're not represented as billable entities in the original enabling legislation and billable entity decisions have to, cannot be made administratively. So the administration of Medicare CMS cannot add a billable entity. This literally will require an act of Congress for genetic counselors to be added as a billable entity which would allow their services to be reimbursed. So the payers, the Medicare carriers are hamstrung in the sense that they cannot, even though they recognize most of them that in fact genetic counselors would be a much more cost efficient way to manage their benefit, they cannot pay those individuals because they statutorily cannot compensate. So I used to sit in a state Medicare Care Advisory Committee and we always had a mantra that we would recite when these things came up which is yes, it's stupid but it's the government that's consistent. And we would just sort of repeat that over and over again until our blood pressure lowered. So that's the specific entity. The thing that I think is interesting and I wanted you to comment on this because it directly relates is that in the healthcare reform legislation, one of the things that Medicare was now able to do or required to do was to actually pay for preventive medicine benefits which had been statutorily prohibited as long as it's on the United States preventive services task force list. And of course in BRCA testing, the USPSTF has a level B evidence that suggests that BRCA testing can be done if certain criteria are met and that genetic counselors are specifically represented within that. So now you are in quite a dilemma in the sense that you don't have genetic counselors as billable entity yet it is represented in this USPSTF statement which you're required to cover because it's a class B recommendation. How are you dealing with that? Well, in fact, that's a very good question. Thank you, by the way, for answering the initial question. So, Will, one of the concerns that I guess CMS has had for a long time is how do we deal with preventive services in the Medicare law? It's pretty clear that Congress is the only entity that has the authority to extend Medicare coverage to preventive services benefits as we call them. However, as was pointed out in the new legislation, we now have the authority to at least consider those recommendations of the USPSTF which received a grade A or B evidentiary recommendation. And we were also allowed to look for the first time and I'm not sure exactly of the legal ease but essentially at the expenditures that must be made to enable these to happen. Recently, CMS has issued a series of five decisions, supporting preventive services benefits, for example, for counseling, for different types of conditions, for the detection of certain types of diseases. And in fact, there is a lot of interest in other USPSTF recommendations that may possibly come to our attention. Could I ask if my colleague, Sarah Harding, might have any further comments about that issue in terms of any of its aspects? I'm Sarah Harding. I'm not sure that I do. I think to sort of the end of Mark's question, how is CMS dealing with it? Sort of like a dentist might examine a crocodile, just very carefully and perhaps a little too slowly in my own personal opinion that's off of CMS. But I think that the issues that CMS tends to face are balancing between wanting to keep up with the pace of the technology and what's being developed and needing to reconcile with what the law tells us we have to do. And both are extremely complicated areas that aren't always understood very well from one side to another, so it's not easy. If I may just break in, thank you, Sarah, to mention that in addition to the coverage issues which I've tried to talk about briefly here, there are an awful lot of other issues that are required by Medicare's enabling statutes, as Sarah mentioned, to allow either an institution to participate in Medicare, to determine whether a service is covered under what's considered a benefit category within the Medicare program, which is set up as a series of defined benefits. Again, there's more to it than I've had at time or actually the knowledge to discuss properly. I do hope that anyone who's interested would go to our website and please read the entire website. We'd be so delighted to think that someone did. I have the two Howard's that want to talk about. As moderator, I have prerogative and I just feel compelled to add on to Mark's comment about genetic counselors and coverage and the National Society of Genetic Counselors has drafted a bill and looking for sponsors to introduce it to add language to the Social Security Act to have genetic counselors as independent providers. And some states where licensure has been passed and I think there's about 13 or 15 states that that's happened have been successful in negotiating with third-party payers within that state for coverage as well. So there is some movement, but as you know, trying to get a bill passed is extremely difficult. So, all right, Howard. So I'm, I think, going to state the obvious, but Ned stated clearly yesterday that EGAP and USPSTF are not secret government death panels. They are independent organizations. A true statement. The problem is that CMS often refers to such bodies to establish policies. And further, unfortunately, CMS is often looked to as a leader, so other payers and decision-makers will. Not always, but sometimes follow CMS. So regrettably sometimes and happily other times, EGAP, USPSTF and similar actually do wind up setting government policy and therefore care needs to be taken. Howard. I think some of the frustration you hear at these sorts of meetings, and I know you have to go to all these and I feel sorry for you, but the, unlike the FDA or some of the other regulatory bodies or payers, there isn't a clear point of engagement with CMS. And if we're lucky enough to spot you where Louie Jacques in the bar, then we can get some work done. But otherwise, it's really one of the, it's like, you know, Noah's Ark. You can only be enter from the top and have to be let into it. You know, there is no door. And so there, one thing you could do is have, in some way, a way for the genetics community, including the pharmacogenetics community, to be able to engage with you. So at least we can vent if not actually help you make progress. Well, I thank you if I could just make the comment that in the United Kingdom, the National Health Service has the great advantage that they have the interest and the attention, apparently, of the House of Lords. Now, we don't have a House of Lords in the United States that I'm aware of. So we are unfortunately bereft of that opportunity. I am sorry. Would anyone of our colleagues like to talk about the positive impact of the House of Lords on public policy, let's say, in a more general sense? Yes. Sorry. Oh, yeah, none. So I was deciding whether to say anything, but she challenged me. So one of the things that from a policy standpoint, people need to recognize is that coverage decisions aren't based on evidence only. And I think the sooner we can actually accept that and figure out how to allow impact by all the other stuff, politics, special interests, and advocacy, we're in trouble. And so my worry about the task force, and it's no longer my circus or my monkey, so I don't have to worry too much, but that this automatic tie to coverage will start to bring influences into the discussion that have nothing to do with evidence. And at least in my pure vision, the way I would do it, were I a Lord, would be to have evidence be the starting point and then have something sit in between, say the task force or the evidence-based recommendation and the coverage decision, a place where you could bring in the politics, the advocacy and the special interests to kind of fight it out and make decisions like happen in every state legislature every year that are based partially on evidence, or at least hopefully partially on evidence, partially on ideology and politics, partially on the economics. So the more that we can recognize that the evidence is just a building block and that rarely do we make really important decisions based on evidence alone, I'm sorry, I just, I've recognized that, we have to have some intervening body and the mistake, sorry, in my opinion, of the way they put the ACA together was this direct link, which I would never have done. So the challenge was not so much to you. No, I know. As much as it was to CMS. Right. And that is that the task forces that evaluate the evidence and make policies, as has been so eloquently stated, can't possibly cover the entire universe of important questions to answer. Yeah, that's true. So my real concern isn't that a task force will make a wrong recommendation, but rather that silence from a task force can be tacitly taken by CMS as there isn't enough evidence here to act. And I think that's a concern that lack of any statement from a governing body or lack of any statement from an evidence evaluation task force doesn't necessarily mean that it isn't worth doing. Actually, I think Sarah, you were next, right? And then Mark. Yeah, I just wanted to point out and just put on everybody's radar if it's not sort of the living schedule for CMS in terms of, I don't wanna say evaluating, but making decisions about tests, specifically those that end up on the clinical lab fee schedule. There's an ongoing rhythm to the year that every July there is a public meeting where those decisions are openly discussed and everybody is invited to CMS. And that really is the point at which we are able to hear most openly from the public as to why certain tests should be covered, what they may want to charge or what they ought to be reimbursed for. In and of itself, it's a bit of a limited engagement opportunity simply because now we see so many more genetic tests coming down the pipeline than a typical year has seen for clinically related tests. But that is kind of the rhythm and that's the opportunity that CMS at least keeps open. So I would encourage you if you do want to speak out specifically about certain tests that that's definitely an opportunity that is always going to happen every July. And if I could piggyback very quickly on to that. I didn't answer one of the questions specifically and I should have and I'm sorry. There is a mechanism for any individual to submit a national coverage determination request to CMS directly. That information is available through our website. Now we tend to get such requests from professional organizations, professional societies and so on. But anyone can do that. I should mention by the way that that opportunity is only for today and every other day from now on. Thank you. Mark. Yeah, so this, Jeff, this is also directed to you. One other opportunity, just a comment and then I have a question. Another opportunity, although there are now some barriers to this are each state has a career advisor committee and carriers for states have the opportunity at least to a limited degree to make local coverage decisions as long as you're not in conflict with the statute. And so there have been some successful opportunities to create local coverage decisions that in some cases have gone up and become national decisions. Although there used to be a mechanism by which at the annual carrier meeting local coverage decisions could sort of be debated at that level and then potentially moved up. And to my knowledge that has sort of been, that methodology has been eliminated to kind of do that. But that's another way to advocate within the CMS system. What I wanted to talk about was to move away from the policy issues to something else that CMS is heavily involved in that we've referenced several times in the meeting, which is CLIA. And the specific response that I'd like to hear from you, Jeff, is that as we talk about a resource such as this, could you comment on the usefulness or what parts of this might be useful for CLIA as it supervises clinical laboratory services? Thank you, Mark. That's actually much more of a broad question than I can answer for at least two reasons. One is that my own familiarity with CLIA is limited. My work is in the coverage side of the house. As many of you may know, CLIA is an organization enabled by legislation some years ago requiring at least registration of any laboratory in the United States performing tests on human specimen material, which would be used for their diagnosis and care. If I could ask my colleague if she has anything perhaps to add to that. And again, I apologize. I didn't perhaps emphasize this. There is another part of our website which deals much more explicitly with CLIA in all of its thousands of permutations and variations. And I think that might be the best way to answer your question. I'm sorry, I can't give a better one. So we'll let Sarah answer this and then we'll let you sit down, Jeff. Yeah. Grazie. I also am not directly involved with CLIA, so I can't speak for them. But I think generally the kind of information, the kind of things that a group like this could offer to CMS, to CLIA would, and it goes back to a point that was made earlier this morning, is just simply being offering an honest broker and also timely source of information. I think for obvious reasons, CMS does hear from a lot of groups and from a lot of people who are interested in seeing what happens with genetic tests and with pharmacogenomic tests and whatnot. And it's often difficult to sift through what might be considered hype as opposed to the actual availability or the actual reflection of where the technology is. And so I think that it sort of goes both ways and I agree that the mechanism isn't always apparent, but we need to hear from you and groups like this just as much as I think you want to talk to us. And so even hearing back and forth about how that can best happen would be great and would be a step in the right direction. So, and that's one reason that even though we may stand up a lot, Jeff and I keep coming to meetings like this. So that's, it's because it's important. So I would just encourage you to not give up on your frustrations and let us know what more we can do. Thank you. So if I can just extract.