Category: 8. Health

President Donald Trump has nicknamed himself “the fertilization president,” but six months after he formally pledged to expand access to in vitro fertilization, the White House has yet to issue a policy to that end.

Since he campaigned on the issue last year, Trump’s push to support IVF has been complicated by backlash from conservatives and anti-abortion groups who see IVF as unethical, as well as members of the “Make America Healthy Again” movement who view the pharmaceutical industry as having undue influence over fertility care.

Many of these groups have instead suggested that Trump redirect his attention to a little-known holistic approach called restorative reproductive medicine. The underlying philosophy is that doctors can identify and treat the root causes of infertility, often with less invasive and more affordable methods than IVF.

But restorative reproductive medicine isn’t formally recognized as a medical specialty in the U.S. and has not been evaluated as extensively as IVF has. Many fertility doctors worry that holistic methods are being presented to patients as a better alternative to IVF, thereby denying patients access to a proven option in fertility care.

“Restorative approaches may work for certain patients, but elevating them as morally superior or universally preferable undermines the individualized, evidence-based care modern reproductive medicine is built on,” said Dr. Brian Levine, the founding partner of CCRM Fertility of New York.

After Trump issued an executive order in February promising to make IVF more affordable and attainable, Republican lawmakers introduced companion bills in the House and Senate that would expand access to restorative reproductive medicine and prohibit discrimination against providers who don’t offer IVF. And in June, Arkansas became the first state to require insurance companies to cover restorative reproductive medicine treatments.

Recent actions out of the Department of Health and Human Services suggest an aligned interest in holistic fertility methods. Calley Means, a special government employee at HHS, told Fox News in April that there was a “mandate from the top” to come up with “a holistic fertility policy.” That same month, HHS laid off the team responsible for tracking IVF success rates as part of the agency’s massive restructuring.

Then in July, HHS posted a grant opportunity for an “infertility training center” that would educate people on a “broad range of holistic infertility treatments.” The proposed center would draw from federal Title X funds, which have historically been used to provide birth control or testing for sexually transmitted diseases.

Andrew Nixon, a spokesperson for HHS, said the agency released a forecast for a future funding opportunity but is not currently soliciting applications for an infertility training center.

“HHS is committed to prioritizing helping couples suffering from infertility,” Nixon said, pointing to Trump’s executive order on IVF.

Some IVF supporters say they sense indecision within the Trump administration over how to proceed with a federal policy, despite the president calling himself the “father of IVF.” (Decades of research laid the foundation for IVF, but the first successful IVF pregnancy took place in England in 1978.)

The White House Domestic Policy Council, which advises the president on domestic issues, presented Trump with policy recommendations for supporting IVF in May. Dr. Kaylen Silverberg, an adviser to that council and a fertility specialist at Texas Fertility Center, said he recommended to White House officials that they declare infertility an essential health benefit under the Affordable Care Act and cover IVF services for military and government employees.

But The Washington Post reported Sunday that the White House does not plan to require health insurers to cover IVF services, a policy Trump previously said he would implement.

Silverberg said White House officials haven’t told him which policies they favor.

“They come at me with very insightful questions, but they don’t give me anything,” he said. “If I say to them, ‘Hey, what are you thinking about such and such?’ The pat answer that I get back is, ‘Well, we’re listening to lots of different sources, and we’re trying to formulate the best solutions that we can.’”

The White House said it has met with stakeholders across the spectrum to solicit their input.

“President Trump pledged to expand IVF access for Americans looking to start families, and the Administration remains committed to delivering on that pledge and exploring all options that address the root causes of infertility,” White House spokesman Kush Desai said.

Restorative reproductive medicine may indeed be one of those options. The International Institute for Restorative Reproductive Medicine, the professional association for doctors who offer this type of fertility care, has spoken with federal officials about its methods, said Dr. Tracey Parnell, the institute’s global director of communications and development.

Parnell, who is Canadian, coined the term “restorative reproductive medicine” in the late 1990s alongside a small group of international physicians. She was surprised earlier this year when her community became part of the national conversation in the U.S., she said.

“We were sort of expecting another decade to be able to get to the stage of more published information and further along the pathway to formal recognition as a specialty,” Parnell said, noting that such recognition in the U.S. requires accreditation by a national board.

One group responsible for increasing the visibility of restorative reproductive medicine is the Heritage Foundation, a conservative think tank whose policy proposals are known to influence the White House’s agenda.

In March, the foundation published a report highlighting what it said are the benefits of restorative reproductive medicine over a fertility industry that “profits from the creation and selection of human life.” The report emboldened groups that are morally or ideologically opposed to IVF, said Levine, of CCRM Fertility.

“Part of the ultra-right-wing personhood movement has taken advantage of this opportunity that IVF is now ubiquitous in all of our conversations, to now jump in and say that they believe that there is a better alternative than IVF itself,” Levine said.

Many members of the “Make America Healthy Again” movement, led by Health Secretary Robert F. Kennedy Jr., also favor holistic methods.

In late June, the Heritage Foundation and the MAHA Institute — a policy center that backs initiatives that align with the MAHA movement — held a roundtable discussion on women’s fertility. Many of the speakers there advocated for restorative reproductive medicine and warned of the risks of hormonal birth control. At least one high-powered federal official, the Food and Drug Administration’s principal deputy commissioner, Sara Brenner, was in attendance and expressed support for the topics discussed.

“The goals of the Make America Health Again movement — to return to holistic, root-cause medical care for men and women — align with the goals and approach of restorative reproductive medicine, even if there are notable differences and distinctions between those two movements,” said Emma Waters, a policy analyst at the Heritage Foundation.

Parnell, of the International Institute for Restorative Reproductive Medicine, said the group’s methods don’t prevent people from pursuing IVF, but rather give them options.

Practitioners of restorative reproductive medicine say their methods are individualized to the patient and don’t rush to diagnose women with infertility if they can’t conceive right away. They often ask patients to carefully track their menstrual cycles, body temperature and changes in cervical mucus to help determine when they’re ovulating. They also look to diagnose and treat medical conditions that may impact fertility, such as polycystic ovary syndrome or endometriosis.

Where necessary, practitioners may suggest changes to patients’ diets, recommend vitamins or supplements or prescribe hormone medications that improve ovulation. In some cases, they may advise surgery to diagnose endometriosis and remove scar tissue that can block an egg’s path to the uterus.

But IVF doctors said the restorative approach can take time, which some patients may not have if they have a diminished number or quality of eggs. Many of the tactics of restorative reproductive medicine, like prescribing hormones or dietary changes, are already used in fertility clinics nationwide, they added.

Silverberg, of Texas Fertility Center, said restorative reproductive medicine is “a made-up term for something that’s been going on for decades.”

“My concern is that the people who focus solely on restorative reproductive health want things to stop right there. They unfortunately advocate ignoring all of the medical advances that have happened in the last 40 years,” Silverberg said, adding that he shared these thoughts with White House officials.

Monica Minjeur, the U.S. director of communications and development for the International Institute for Restorative Reproductive Medicine, said there is data to show that the approach works. In a study of more than 400 women with a history of infertility, most of whom had been unsuccessful with IVF, roughly 32% gave birth after turning to restorative reproductive medicine. The odds of having a child via an additional cycle of IVF were roughly the same, according to the paper, which Parnell co-authored. (The average success rate of a woman’s first IVF cycle is around 30%.)

Despite its conservative fan base, Minjeur said, restorative reproductive medicine is not inherently political or religious, and her organization is cautious about these associations.

“We are a science-based medical organization who is trying to just get the good word out to the people,” she said. “If and where that aligns with government priorities to help people who want to build families, great, we’ll take it.”

A young woman reportedly suffered liver failure after eyebrow threading. Here’s what really happened and how to protect yourself. We all love the post-threading glow, clean brows, sharp lines, instant confidence. But what if your five-minute parlour visit comes with a hidden health risk? That’s exactly what Dr Aditij Dhamija (MBBS) warned about in a recent viral Instagram reel, where he shared a jaw-dropping case: a 28-year-old woman walked into a local salon for eyebrow threading and, days later, ended up battling acute liver failure. The likely culprit? A case of viral hepatitis, possibly transmitted through reused thread.Sounds dramatic but it’s not just internet fear-mongering. This incident has opened up a real conversation: Can you really catch a liver-damaging virus from eyebrow threading? The short answer is, yes, if the parlour doesn’t follow proper hygiene.

Can eyebrow threading give you hepatitis?

Technically, threading, in itself, doesn’t damage your liver. But when parlours reuse the same thread on multiple clients, or skip basic hygiene like sanitising tools and washing hands, things get risky. Even the tiniest cut or abrasion during threading can become an open invitation for blood-borne viruses like hepatitis B or C to enter the body. These viruses don’t always show symptoms right away, they quietly settle in, slowly harming your liver over the years.If left untreated, chronic hepatitis can lead to serious complications like liver inflammation, scarring (cirrhosis), or in rare cases, full-blown liver failure. And the worst part? Many people don’t even realise they’re infected until significant damage has been done.And hepatitis isn’t your average viral fever. These viruses can silently attack your liver for months or even years, sometimes leading to:

In rare instances, the onset can be rapid, like in the case shared by Dr Dhamija.

So how bad is the risk of getting hepatitis via threading?

Let’s be clear: we’re not saying threading is unsafe. But salons that don’t change thread between clients or skip basic hygiene steps? That’s where the danger creeps in. Threading involves minor cuts and micro-tears. If your beautician used the same thread just minutes ago on another client, who may be unknowingly carrying hepatitis, the infection could transfer to you. Even if it’s invisible to the naked eye. And hepatitis viruses are tough cookies. They survive outside the body longer than you’d think.

Parlour hygiene tips to prevent catching hepatitis through threading: More important than you realise

Next time you go for your threading or waxing appointment, keep these in mind:

Threading isn’t dangerous but poor hygiene absolutely is. What Dr Aditij Dhamija’s viral post really highlights is this: we trust parlour visits too easily. We rarely ask how tools are cleaned, or how many clients used that same piece of thread. And that silence can cost you more than a botched brow shape. Your salon routine shouldn’t be a gamble. So next time you’re in the chair, speak up. Your health’s worth more than a perfect arch.Also read| Walking into rooms and forgetting why? The ‘doorway effect’ explains what your brain is really doing

Dr. Nelson, who chairs the Department of Neuroscience at West Virginia University, has spent the past decade uncovering the hidden dangers of artificial light exposure. His research demonstrates that light at night doesn’t just affect sleep quality; it fundamentally alters immune function, triggers neuroinflammation, disrupts metabolism, and influences mood regulation.

From Turkey Processing Plant to Top Research Institution

The interview reveals Dr. Nelson’s remarkable journey to academic prominence. After working night shifts at a turkey processing plant during high school and later conducting postmortem examinations at two Cleveland hospitals, he eventually found his way to the University of California, San Diego, through an unexpected job opportunity at the San Diego Zoo.

“My path to academia is typical in the sense that it is not ‘typical,’” Dr. Nelson reflects in the interview. His unique background, including becoming the first person in the United States to simultaneously earn two separate PhDs (in Psychology and Endocrinology from UC Berkeley), shaped his integrative approach to neuroscience research.

Circadian Disruption: A Modern Health Crisis

Dr. Nelson’s laboratory has published groundbreaking findings on how exposure to artificial light at night affects multiple body systems. The research goes beyond simple sleep disturbance to reveal profound effects on physiological processes that evolved over millions of years to function in sync with natural light-dark cycles.

Key areas of impact identified by Dr. Nelson’s research include immune system dysfunction, where light exposure at inappropriate times can suppress typical immune responses or trigger excessive inflammation. The work also demonstrates clear links between circadian disruption and metabolic disorders, potentially contributing to the obesity epidemic. Perhaps most concerningly, the research shows direct effects on mood regulation, with implications for understanding depression and anxiety disorders.

What specific wavelengths of light are most disruptive to circadian rhythms? How quickly can the body recover from chronic light exposure? What is the contribution of time-of-day as a biological variable? These questions drive ongoing investigations in Dr. Nelson’s laboratory.

Translating Discovery to Clinical Practice

Moving beyond foundational research, Dr. Nelson’s team currently conducts clinical trials examining whether blocking disruptive light effects can improve outcomes for intensive care patients. Two major trials focus on stroke recovery and cardiac surgery patients, populations particularly vulnerable to the harsh lighting conditions typical of hospital ICUs.

“Circadian rhythms are a fundamental aspect of biology, and much is known from foundational science about them,” Dr. Nelson explains. “However, little of this foundational science has been translated to clinical medicine.”

The research also extends to healthcare workers themselves. A third clinical trial investigates whether bright blue light visors can help night shift nurses reset their circadian rhythms, potentially improving their sleep quality, cognitive performance, and mood. Could similar interventions help other shift workers across various industries maintain better health despite irregular schedules?

Time as a Biological Variable

One of Dr. Nelson’s most provocative proposals involves recognizing time-of-day as a crucial biological variable in all research. He argues that experimental results can vary dramatically depending on when studies are conducted, yet this information rarely appears in scientific publications.

“The answer to an experimental question may depend in part on the time-of-day when the question is asked,” Dr. Nelson notes. This observation has profound implications for research reproducibility and could explain why some studies fail to replicate previous findings.

Building the Next Generation of Neuroscientists

Throughout his career at Johns Hopkins University, Ohio State University, and now West Virginia University, Dr. Nelson has mentored 25 PhD students and 16 postdoctoral researchers. His leadership philosophy emphasizes creating supportive environments where young scientists can thrive. His mentoring philosophy has been featured in a recent Society for Neuroscience Neuronline podcast.

As current president of the Association of Medical School Neuroscience Department Chairs, Dr. Nelson advocates for resources and policies that support early-career researchers. He particularly values helping faculty members navigate the challenging early stages of their careers through strategic resource allocation and mentorship.

What role might circadian rhythm research play in addressing the mental health crisis among graduate students and postdocs? How can academic institutions better support work-life integration for researchers studying around-the-clock biological processes?

A Vision for Healthier Living

Dr. Nelson’s research carries immediate practical implications for public health. Simple interventions like reducing evening screen time, using warmer light colors after sunset, and maintaining consistent sleep schedules could significantly impact population health. His work suggests that respecting our evolutionary heritage by aligning modern life more closely with natural light patterns could prevent numerous chronic health conditions. He recently published a trade book with Oxford University Press entitled, “Dark Matters,” to help the general public appreciate the importance of good circadian hygiene for health and wellness.

The interview also touches on Dr. Nelson’s personal interests, including travel, biking, and gardening, activities that keep him connected to natural rhythms. His favorite place remains Southern California, where his academic journey began through that serendipitous opportunity at the San Diego Zoo decades ago. Dr. Randy J. Nelson’s Genomic Press interview is part of a larger series called Innovators & Ideas that highlights the people behind today’s most influential scientific breakthroughs. Each interview in the series offers a blend of cutting-edge research and personal reflections, providing readers with a comprehensive view of the scientists shaping the future. By combining a focus on professional achievements with personal insights, this interview style invites a richer narrative that both engages and educates readers. This format provides an ideal starting point for profiles that explore the scientist’s impact on the field, while also touching on broader human themes.

The US Health Secretary’s plan to cut half a billion dollars’ worth of US government funding from mRNA vaccine programmes have been criticised by the scientific community.

The move by Robert F Kennedy Jr, a vaccine sceptic, has proven highly controversial, especially as mRNA vaccines are seen as having been highly successful in combating Covid-19.

Ian Jones, a professor of virology at the UK’s University of Reading, said the funding cut was “regrettable” and could be seen as “bonkers”.

“He really ought to be advised by experts in the field,” Prof Jones said of Mr Kennedy. “Rational decision-making should always be based on testable science and not on opinion. It appears the current administration is largely based on opinion, even though that opinion is poorly informed.”

Prof Jones said scientific opinion was “overwhelmingly in favour” of using mRNA vaccines, with large numbers of people having received them without significant problems.

Why has vaccine funding been cut?

Mr Kennedy said the US Department of Health and Human Services had “reviewed the science, listened to the experts” when terminating 22 mRNA vaccine-development programmes.

This decision had been made “because the data show these vaccines fail to protect effectively against upper respiratory infections like Covid and flu”.

“We’re shifting that funding towards safer, broader vaccine platforms that remain effective even as viruses mutate,” Mr Kennedy said.

Some axed projects involve the pharmaceutical companies Pfizer, AstraZeneca and Moderna, while the Global Health Investment Corporation, a partner organisation managing US government health investment funds, has been told to stop mRNA-related investments. Together, all the affected projects are worth nearly $500 million.

From now on, the focus will be on vaccine “platforms with stronger safety records and transparent clinical and manufacturing data practices”. This will mean a pivot towards “whole-virus vaccines and novel platforms”.

What are the international implications?

Prof Jones indicated the US decision could have widespread effects because of “the sentiment it develops”. Other nations may decide to look at mRNA vaccines “more strictly than would otherwise be the case”.

“If there’s a feeling the market is going to be smaller because of this and because of the suspicion it generates, I guess going forward there will be a reduction in the amount of private funding going into mRNA vaccines,” he said.

Paul Hunter, an infectious diseases researcher and professor in medicine at the University of East Anglia, called Mr Kennedy’s decision “retrograde” and warned that as a result “some people would die” who would otherwise have been saved by protection from an mRNA vaccine.

He said the cutting of financial support for mRNA vaccine programmes was not based “on what we know about the science of vaccine development”. Many scientists, he said, “believe mRNA vaccines are the future for all vaccines”.

However, Prof Hunter said mRNA vaccine research would continue outside the US, with “a lot going on in Europe, Japan, India and other countries”.

“It will certainly slow down the research effort and the time we need to get good, quality vaccines to market, but I don’t think it will stop it,” he said.

He suggested some vaccine researchers might leave the US and move to, for example, Europe in the wake of Washington’s move.

What are mRNA vaccines?

It was not until the Covid-19 pandemic that the first mRNA, or messenger RNA vaccines, for use in people were approved.

Covid-19 mRNA vaccines contain the genetic instructions for a person’s own cells to produce a protein found on the surface of the virus. The immune response to these proteins typically offers protection if the vaccinated person is subsequently infected with Covid-19.

Work is continuing to develop mRNA vaccines against many other conditions, including flu.

In a report published last year in Vaccines, researchers said mRNA vaccines “represent a revolutionary approach in influenza prevention”, with the potential to significantly improve global management of the condition. Scientists say that mRNA vaccines are likely to offer protection against a wider range of flu types than existing flu vaccines can.

A study in the International Journal of Infectious Diseases in 2023 said mRNA vaccines could be designed and developed quickly, stimulate a strong immune response and could be manufactured rapidly at relatively low cost.

There are numerous other types of vaccine apart of those based around mRNA. These include those that contain the pathogen – a virus or bacterium – in a form that is no longer harmful, either because it has been weakened or inactivated. Among the other types of vaccine are those made of proteins or sugars from the pathogen.

“Whole virus vaccines generally have been effective in the past, but we saw with Covid they were nowhere near as effective as mRNA vaccines,” said Prof Hunter.

He also said more severe vaccine side effects have typically been seen not with mRNA vaccines, but with bacterial whole cell vaccines, such as a shot against whooping cough.

The Oxford-AstraZeneca Covid-19 vaccine involved another type of technology, a viral vector, which is a modified virus that enters recipients’ cells and contains genetic material that causes them to produce a protein from the Covid-19 virus. This stimulates an immune response that protects against subsequent Covid-19 infection.

While more than three billion doses of this vaccine were used and it is credited with saving millions of lives, it has been withdrawn as Covid-19 mRNA vaccines are seen as being more effective. The Oxford-AstraZeneca vaccine was also associated with rare and potentially fatal blood clots.

Diabetic wounds, particularly foot ulcers, are notorious for their slow and often incomplete healing due to reduced blood flow and endothelial cell dysfunction. One of the major contributors to this issue is thrombospondin-1 (TSP-1), which inhibits the growth of new blood vessels, a process crucial for tissue repair. Despite various existing treatments, the challenge of addressing this barrier to healing remains unmet. With the global rise in diabetes cases, new treatments targeting the underlying causes of delayed wound healing have become a critical area of research. In light of these ongoing challenges, this study explores a new approach to stimulate angiogenesis and speed up the healing process.

In a new study (DOI: 10.1093/burnst/tkaf036) published in Burns & Trauma, a team of researchers from leading Chinese institutions has unveiled a novel therapeutic solution for diabetic wound healing. The study introduces an innovative wound dressing that combines miR-221OE-sEVs—engineered extracellular vesicles that target and reduce TSP-1 levels—with a GelMA hydrogel to create a sustained-release system. This cutting-edge approach has shown to significantly enhance wound healing and blood vessel formation in diabetic mice, offering hope for more effective treatments in the future.

In their study, the researchers discovered that high glucose conditions commonly found in diabetic wounds lead to increased levels of TSP-1 in endothelial cells, impairing their ability to proliferate and migrate—key processes for angiogenesis. By utilizing miR-221-3p, a microRNA that targets and downregulates TSP-1 expression, they restored endothelial cell function. The engineered miR-221OE-sEVs were encapsulated within a GelMA hydrogel, ensuring a controlled release at the wound site, mimicking the extracellular matrix. In animal trials, this composite dressing dramatically accelerated wound healing, with a notable increase in vascularization and a 90% wound closure rate within just 12 days, compared to slower healing in control groups.

Dr. Chuan’an Shen, a key researcher in the study, shared his excitement about the potential impact of this innovation: “Our results demonstrate the power of combining advanced tissue engineering with molecular biology. By targeting TSP-1 with miR-221OE-sEVs encapsulated in GelMA, we’ve not only improved endothelial cell function but also ensured a sustained and localized therapeutic effect. This breakthrough could revolutionize how we approach diabetic wound care, with the potential to improve patients’ quality of life significantly.“

The success of this engineered hydrogel in diabetic wound healing opens up several exciting possibilities. Beyond diabetic foot ulcers, the technology could be adapted for use in treating other chronic wounds, such as those caused by vascular diseases, or even in regenerating tissues like bone and cartilage. As further research and clinical trials progress, the promise of combining miRNA-based therapies with biocompatible hydrogels could become a cornerstone in regenerative medicine, offering patients more efficient and lasting wound healing solutions.

Talking therapy offered by the NHS for people with depression or anxiety appears to be less effective for people aged 16-24 than those aged 25-65, according to a new study led by UCL researchers.

While talking (psychological) therapy services are helpful for young people, the authors of the new Lancet Psychiatry paper say that more work is needed to tailor mental health services to young people to ensure they are as effective as possible.

Talking therapy is an effective treatment for depression and anxiety disorders, and particularly tends to be preferred to pharmacological treatment by younger adults. Our analysis shows that talking therapies offered by the NHS are effective for younger adults, but as they are more effective for working-age adults, we believe there is work to be done to improve services for young adults.

Rates of depression and anxiety in young adults are rising, so there is an urgent need to ensure we are offering them the best possible mental health care.”

Dr. Rob Saunders, Lead author, UCL Psychology & Language Sciences

The study used data from 1.5 million people who had attended NHS Talking Therapies for anxiety and depression services in England in 2015-2019, including over 300,000 people aged 16-24. Talking therapies offered by the NHS can include cognitive behavioral therapy (CBT), guided self-help, counselling or interpersonal therapy.

The researchers looked at differences in symptom severity changes following a course of talking therapy, using two commonly used measures (Patient Health Questionnaire 9-item (PHQ-9) and the Generalised Anxiety Disorder Scale 7-item (GAD-7) scales), finding that improvements in symptoms were smaller for young adults than those aged 25-65.

People aged 16-24 years were around 25% less likely to meet the threshold for reliable recovery after having talking therapy, and 17% less likely to meet criteria for reliable improvement than those aged 25-65.

The research team estimated that if talking therapies were as effective for young adults as those over 25, over 20,000 more younger adults would have reliably recovered from their psychological disorder in England across the study period – approximately 5,000 young people each year.

Senior author Professor Argyris Stringaris (UCL Psychiatry) said: “Young people may find it harder to navigate services which have been set up for adults, and are more likely to miss sessions or stop attending altogether. Additionally, the late teens and early 20s are a point of transition for many people, which can involve plenty of stressful life events and changes that may make it more difficult to consistently attend. Working together with young people should help optimise the content of treatment and the ways in which it is delivered.

“Finally, young people may suffer from depression and anxiety problems that may differ somehow in their causes from those affecting adults; early onset depression could have different causes and may require different approaches to treatment. This is an area that requires a lot of new basic and clinical research.”

Carbis Bay Hotel Ltd & Anor v American
International Group Ltd [2025] EWHC 1041
(Comm)

This matter concerned the interpretation of policy wording in an
insurance contract – in particular, whether COVID-19 fell
within the scope of an infectious diseases extension
(‘the ID Extension’) to the Business
Interruption section (‘the BI Cover’)
to a ‘Commercial Combined’ insurance policy
(‘the Policy’).

The claim was brought by way of Part 8 against the Defendant
(‘AIG’), both in its own right and as
representative of Covea Insurance (together ‘the
Insurers’), who underwrote the relevant risk.
Pursuant to the Policy, the Claimants made their claim to recover
business interruption losses associated with the COVID-19 lockdown,
which led to a loss of custom due to hotel and other hospitality
premises being closed.

After a thorough analysis of the parties’ arguments, HHJ
Russen KC decided that COVID-19 did not fall within the ID
Extension to the BI Cover, and accordingly agreed with the position
advanced on behalf of the Insurers.

A. The Key Question

The central question the Court was invited to determine was as
follows:

On true construction of the Policy, is the word
“Disease” appearing in the phrase
“any human infectious or human contagious Disease
(excluding Acquired Immune Deficiency Syndrome [AIDS] or an AIDS
related condition)” in the Infectious Diseases
extension to the Business Interruption section of the Policy to be
understood:

(a) As limited to the specific diseases listed in the definition
of ‘Disease’ in the business interruption
section (which does not include COVID-19); or

(b) As not so limited but including any kind of human infectious
or human contagious disease (including COVID-19).

The Claimants contended for meaning (b); and the Insurers for
meaning (a).

B. The Factual Background

The Claimants owned and operated businesses in the Carbis Bay
area of Cornwall, including restaurants, bars and hotels. Each of
those business were affected by COVID-19 events, including:

1. On 20 March 2020, the Government advising public houses,
   restaurants and bars to close on the following day;




2. On 21 March 2020, the passing of the Health Protection
   (Coronavirus, Business Closure) Regulations 2020 – which
   required the closure of such premises;




3. On 23 March 2020, the Government announcing an intention to
   prevent (inter alia) weddings from taking place;




4. On 24 March 2020, the Government issuing guidance to businesses
   offering holiday accommodation to close for commercial purposes;
   and




5. On 26 March 2020, the passing of the Health Protection
   (Coronavirus, Business Closure) Regulations 2020 – which
   updated the earlier regulations and required the closure of holiday
   accommodation.

The Claimants were therefore prevented from operating their
businesses between 26 March 2020 (at the latest) and 6 July 2020.
Even after reopening, earnings and profitability were reduced
pursuant to social distancing regulations and measures. The
Claimants’ insurance broker submitted a claim on the policy
in respect of the losses suffered by the businesses. The policy
administrators, acting as the Insurers’ agents, notified the
broker that the Insurers had declined the claim.

C. The Policy

The Policy incepted on 2 August 2019 and was for the period of
one year, such that the BI Cover expired on 1 August 2020. An
appendix to the BI Cover section confirmed the limit of the
indemnity in respect of business interruption through infectious
diseases was £100,000. That risk was addressed in the ID
Extension, which provided:

Aside from the heading “Infectious Diseases”, the
relevant wording was that found in paragraph (1) of the ID
Extension. Nothing was said in the Policy about the significance of
headings as an aid to interpretation – and, importantly,
“Infectious Diseases” was not a defined
term. The Appendix simply confirmed that the ID Extension had a
limit of cover of £100,000, and therefore that the other
causes set out in paragraph (2) and (4) were deemed to be within
it.

The ‘About Your Policy’  section of
the Policy stated:

For the ID Extension, the term
‘Disease’ (by the definition section of
the Policy which was specific to BI Cover) was defined as
follows:

That was a list of 33 diseases, and was a closed list (the
language was ‘means’ and not
‘includes’); it therefore encompassed
only those diseases listed, and not COVID-19.

D. The Correct Approach to the Interpretation of the
Policy

HHJ Russen KC’s analysis of the Policy commenced with an
overview of relevant legal principles.

His Lordship noted that in Financial Conduct
Authority v Arch Insurance (UK) Ltd [2021] UKSC
1; [2021] AC 649, Lords Hamblen and Leggatt said at [47] that the
core principle in construing the meaning of an insurance policy is
that, like any other contract, it must be interpreted objectively
by asking what a reasonable person, with all the background
knowledge which would reasonably have been available to the parties
when they entered into the contract, would have understood the
language of the contract to mean.

That is the approach that has been restated by the highest
authority over the last 10 or so years – in particular since
the leading authority of Arnold v
Britton [2015] UKSC 36; [2015] AC 1619 at [14]
– [22]. Of Lord Neuberger’s propositions, the following
were particularly relevant:

1. The court is concerned to identify the intention of the parties
   by reference to “what a reasonable person having all the
   background knowledge which would have been available to the parties
   would have understood them to be using the language in the contract
   to mean” (i.e. the basic task identified again
   in FCA v Arch);




2. In discerning that intention, the court focuses upon the
   objective meaning of the relevant words, in their documentary,
   factual and commercial context. That meaning is assessed in the
   light of (i) their natural and ordinary meaning; (ii) any other
   relevant provisions of the contract, (iii) the overall purpose of
   the contract; (iv) the facts and circumstances known or assumed by
   the parties at the time it was made; and (v) commercial common
   sense. Commercial common sense cannot be invoked retrospectively.
   The party’s subjective intentions are of course to be
   disregarded in this process of interpretation;




3. It is points (i) and (v), in particular, which require the
   court to look at what the language of the ID Extension would have
   conveyed to the mind of the ordinary conscientious policyholder.
   The clearer the natural ordinary meaning of the words, the more
   difficult it will be to justify a conclusion that the policyholder
   would have understood them to have had a different meaning. The
   court should not embark ‘on an exercise of searching for,
   let alone constructing, drafting infelicities in order to
   facilitate a departure from the natural meaning.‘

HHJ Russen KC stated that the process of interpretation was not
to be influenced by the ‘wisdom’ of hindsight; the
purpose of interpretation is to identify what the parties have
agreed, not what the Court thinks that they should have agreed.
This was particularly important where an insurance risk of a type
expressly contemplated (business closure through infectious
disease) manifests itself in a form of disease that was not known
about at the date of the policy’s inception, and only became
a notifiable disease after that date.

His Lordship referred to the approach set out
in FCA v Arch, namely that
discerning what a reasonable and informed person would understand
the policy to mean is one that involves reading it as an ordinary
policyholder would, rather than a ‘pedantic lawyer who
will subject the entire policy wording to a minute textual
analysis’. The policyholder, ‘…on
entering into the contract, is taken to have read through the
policy conscientiously in order to understand what cover they were
getting.’

Indeed for parties with the benefit of insurance brokers, the
interpretation of an insurance policy can also involve attributing
the policyholder with the understanding of his broker – the
reasonable person being someone ‘who has been able to
consult with well-informed
brokers’: Stonegate Pub Company Ltd v
MS Amlin Corporate Member Ltd [2022] EWHC 2548
(Comm); [2023] Lloyd’s Rep. IR 672 at [54].

The Court also had regard, inter alia,
to Lewison, The Interpretation of
Contracts  (8^th ed.) at
§5.108 in relation to the use of headings as an interpretative
tool: ‘A heading to a clause may be taken into account in
construing the clause, but it cannot override clear words in a
clause or create an ambiguity where, but for the heading, none
would otherwise exist. Where the contract so provides, headings
should be taken into account.’

E. The Court’s Analysis and Decision

The Court preferred the interpretation of the ID Extension
offered by the Insurers for the following reasons:

1. If the Claimants were right (‘any’ kind of human
   infectious disease was covered), then the closed-list basis of
   infectious disease cover (i.e. that found in the definitions
   section of the BI Cover) would be transformed into an entirely open
   one. This would be a significantly different underwriting
   proposition than the one to which the Insurers apparently
   agreed;




2. The Claimants’ construction strained against commercial
   common sense, that being one of the key considerations by which the
   Court tests the objective interpretation of the contractual
   position under scrutiny. Further, as regards the facts and
   circumstances known by the parties at the time the Policy was
   incepted, the parties would not in August 2019 have been alive to
   the potential need to include COVID-19 specifically as a potential
   risk;




3. In considering the language of the ID Extension within the
   Policy, pursuant to the principles in Arnold v
   Britton at [17], the meaning of the contractual
   provision is most obviously to be gleaned from the language of the
   provision, which, if sufficiently clear, may be found by the Court
   to dispose of the argument over its interpretation. The Court found
   that it was sufficiently clear;




4. By the language of the ID Extension, the parties appeared to
   have agreed upon the inclusion of a defined term which exhaustively
   defined the diseases covering it. A compelling reason or reasons
   would need to emerge from the exercise of contractual
   interpretation to justify the material change of the underwriting
   risk contended for by the Claimants, who had been unable to
   identify an incoherency in the ID Extension’s language to
   displace the ordinary and natural meaning to be attributed to its
   inclusion of the definitional term
   ‘Disease’;




5. No legal pedantry was involved in encountering a capitalised
   and defined term (‘Disease’) and having to
   turn back a few pages to see what it means;




6. The Claimants had argued that the wording of the ID Extension
   was incoherent: the definition of the word
   ‘Disease’  did not refer to AIDS, but the
   exclusion referred to AIDS and AIDS-related illnesses. If the
   definition of ‘Disease’ was exhaustive,
   there would be no need to have excluded AIDS or AIDS-related
   conditions from cover under the ID Extension. However, the Court
   held that the Claimants’ argument that the use of the words
   ‘AIDS or’ in ID Extension was significant
   enough to compel a departure from what would otherwise be the
   ordinary and natural meaning of the provision was, as the Insurers
   had described it, a ‘contrived
   inconsistency’;




7. The drafting of the exception was ‘not the most
   felicitous’ but did not operate to make the key
   definitional term redundant, containing as it did no fewer than 33
   carefully chosen words;




8. The consequence of the Claimants’ argument was that the
   language of an exception to insurance
   cover would prevail in determining the scope of that cover. This
   was probably the kind of interpretation that should be categorised
   as pedantry. It was not how a reasonable policyholder, assisted by
   a broker, would understand the impact of the carve-out;




9. HHJ Russen KC therefore concluded that the ordinary and natural
   meaning of the language of the ID Extension is that it did not
   extend to cover in respect of COVID-19.

F. An Answer to the Question

The Court therefore answered the question raised by the Part 8
claim as follows:

This case serves as a useful reminder that the starting point is
that a policy of insurance is a contract like any other. Questions
of interpretation must be approached objectively, by asking what a
reasonable person with the relevant knowledge at the time of entry
into the contract would have understood its language to mean.
However, the policyholder who has the advantage of a broker can be
attributed with the understanding of a well-informed broker.

The Court will, however, resist arguments which seek to subject
the entire policy wording to a minute textual analysis – that
being the realm of the pedantic lawyer rather than the
conscientious policyholder. The consideration of a fundamental
definition is unlikely to be legal pedantry, but instead consistent
with the conduct of the reasonable policyholder. Lawyers should
therefore be careful to avoid conjuring clever argument which
strains against the ordinary and natural meaning of the language
used in an agreement or policy of insurance – particularly
where the Policy contains an exhaustive definition.

The content of this article is intended to provide a general
guide to the subject matter. Specialist advice should be sought
about your specific circumstances.

A new report from the Pan American Health Organization (PAHO), titled Major storm on the horizon, warns that between 2020 and 2050, noncommunicable diseases (NCDs) and mental health issues will result in economic losses in South America equivalent to the entire annual GDP of Latin America and the Caribbean. This loss is attributed to healthcare spending and productivity decline.

The report was produced in collaboration with Harvard University’s T.H. Chan School of Public Health in Boston.

This report serves as a wake-up call and a call to action, said Jarbas Barbosa, PAHO’s director and a public health expert, during a press briefing. “The economic impact of NCDs [and mental health problems] is unacceptable because of the harm it causes to families, communities, and society. But we have tools to stop this process, such as health promotion measures and strengthening primary care.”

David Bloom, PhD, the report’s lead author and a professor of economics and demography at Harvard University’s T.H. Chan School of Public Health, stressed that healthy people can work more, be more productive, and maintain their savings. He further stated that the report aims to provide PAHO and South American decision-makers with solid evidence to push for significant and transformative increases in health sector budgets, as well as the rational allocation of these budgets to competing uses.

Analytical Model

Bloom and colleagues developed an analytical model to forecast the macroeconomic effects of NCDs and mental health issues between 2020 and 2050 in 10 South American countries: Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Paraguay, Peru, Uruguay, and Venezuela. They calculated that the total GDP loss from these conditions could reach $7.3 trillion during this period. The report noted that if NCDs and mental health conditions were eliminated, “the annual GDP would be about 4% higher every year for 30 years.”

Brazil, due to its large population, is expected to face the greatest GDP losses during the projected period, with an estimated loss of $3.7 trillion — three times higher than that of Argentina and Colombia. These three countries are also predicted to have the largest losses in disability-adjusted life years. However, when adjusted per 1000 inhabitants, Uruguay, Argentina, and Venezuela top the list. The rise in NCDs and mental health issues in Latin America and the Caribbean is largely attributed to the aging population. “This is an issue that will become increasingly relevant over time, as the region has the fastest demographic transition in the world,” said Barbosa. Additionally, the growing burden reflects greater exposure to preventable risk factors such as tobacco use, unhealthy diets, physical inactivity, alcohol consumption, and air pollution.

In six of the 10 countries studied (Argentina, Bolivia, Chile, Ecuador, Peru, and Uruguay), cancer is expected to be the leading cause of GDP loss between 2020 and 2050. In Brazil, cardiovascular diseases will have the most significant impact, while in Colombia and Venezuela, diabetes and kidney diseases will be the biggest challenges. In Paraguay, mental health disorders are projected to be a major burden.

Investment in Interventions

The report stresses that several interventions can help reduce the risk factors and social determinants of NCDs and mental health issues. These include cost-effective strategies advocated by the World Health Organization, such as taxes on tobacco products, alcohol, and sugary drinks; front-of-package food labeling; vaccination against HPV; cervical cancer screening; public awareness campaigns to reduce physical inactivity; and pharmacological treatments for individuals who have experienced myocardial infarction or stroke.

“For every dollar invested in these interventions, the return on investment is estimated at between two and three dollars,” said Silvana Luciani, a master’s degree holder in community health and head of PAHO’s NCD Unit, during the press briefing.

Other recommended strategies include investing in technology, from portable devices for monitoring blood glucose or blood pressure to artificial intelligence tools that enhance diagnostic accuracy. Additionally, strengthening healthcare systems, with a focus on equity and quality in primary care, is critical for timely diagnosis and treatment.

“The goal is to make better use of available resources to identify individuals with diabetes, hypertension, or cancer at an early stage, where better treatment options and potential cures or maintenance therapies can be offered,” said Barbosa. “With a relatively low investment in primary care, we can prevent people in vulnerable situations from being unaware of their condition until they experience severe health problems, such as heart attacks or strokes.”

Link Between Mental and Physical Health

Another key recommendation from the report is integrating mental health with chronic disease management to reduce the health and economic impact of the growing burden.

“When a person consults for diabetes, we must also assess their emotional state. For depression, it is necessary to monitor blood pressure and blood glucose. This integration saves lives and significantly reduces costs. Every dollar invested in treating depression and anxiety generates at least four dollars in economic benefits. The question is not whether countries can afford to invest in mental health, but whether they can afford not to,” said Matías Irarrázaval, PAHO’s regional mental health and substance use advisor and associate professor of psychopathology and mental health at the University of Chile, Santiago, Chile.

Santiago Levín, professor at the National University Arturo Jauretche in Florencio Varela, Argentina, and president of the Latin American Association of Psychiatrists, agreed. “It’s no longer acceptable to separate mental and physical health as if they were different substances. There is only one health,” he said.

Levín praised the economic analysis presented in the report, which he said was designed to capture the attention of policymakers. He also emphasized that investing in health is not just a cost-saving strategy but also part of promoting the common good. “Public health is the health arm of social equity, and social equity is the ultimate goal of politics,” he concluded.

Levín disclosed having no relevant financial conflicts of interest. 

This story was translated from Medscape’s Spanish edition.