WASHINGTON: A mass shooting involving several assailants has left at least four people dead and dozens wounded in the US state of Alabama, police said on Saturday (Sep 21).

“We believe that multiple shooters fired multiple shots on a group of people” in the Five Points South district of Birmingham just after 11pm, police officer Truman Fitzgerald told local media.

Officers found two adult males and one adult female who was unresponsive on the sidewalk suffering from a gunshot wound, Fitzgerald said. All three were pronounced dead at the scene.

A fourth victim died at a local hospital, he added.

Dozens of people were wounded in the shooting with at least four sustaining life-threatening injuries, Fitzgerald said.

The others had “various injuries”, he added.

Police have not got anyone in custody over the shooting, Fitzman said, urging the public to provide any information that could help the investigation.

Several agencies are involved in the investigation, including the Federal Bureau of Investigation and the Bureau of Alcohol, Tobacco, Firearms and Explosives.

Fire rescue services were on the scene Saturday night and had cordoned off the area.

This year, there have been at least 403 mass shootings – defined as a shooting involving at least four victims, dead or wounded – across the United States, according to the Gun Violence Archive.

At least 12,416 people have been killed in firearms violence this year in the United States, according to the GVA.

Men have been steadily dropping out of the workforce — especially men ages 25 to 54, who are considered to be in their prime working years. About 10.5% of men in their prime working years, or roughly 6.8 million men nationwide, are neither working nor looking for employment, compared with just 2.5% in 1954. So what exactly is driving men out of the workforce?

The China-U.S. tensions over Taiwan are not new, but recent events have cast a harsher light on the fragility of the situation. Despite attempts at dialogue, like National Security Adviser Jake Sullivan’s visit to Beijing in late August, the Chinese government’s reaction to U.S. arms sales to Taiwan has been swift and severe. 

On September 18, China’s Ministry of Foreign Affairs imposed sanctions on nine U.S. defense companies over a $228 million arms sale, announced by the U.S. State Department on September 16, that involved the return, repair, and reshipment of spare parts for Taiwan. The announcement came just before a U.S. Navy P-8A Poseidon transited the Taiwan Strait on September 17. 

In response, China’s Ministry of Defense doubled down on September 20, warning both Taiwan and the United States that U.S.-made weapons would not safeguard Taiwan’s Democratic Progressive Party (DPP), but would instead directly lead to “self-destruction” – a stark reminder of the increasing hostility and rhetoric surrounding Taiwan’s defense.

The September 16 announcement marks the 16th arms sale to Taiwan under the Biden administration, yet doubts continue to mount over the United States’ true commitment to Taiwan’s security. The Biden administration’s sales have primarily consisted of munitions and sustainment packages delivered in small tranches, failing to address Taiwan’s need for a comprehensive modernization of its military, especially in comparison to China’s rapid space of military modernization.

According to Rupert Hammond-Chambers, the president of the US-Taiwan Business Council, the Biden administration appears to be avoiding more substantial military commitments to Taiwan, reminiscent of pre-Trump era policies that capped the value of arms sales to avoid provoking Beijing. In a press release, Hammond-Chambers warned that “U.S. support for Taiwan’s material force modernization has been waning since 2021. It now sits at its lowest point since 2001, bar the Obama Administration’s 4+ year arms sales freeze from 2011-2015, and it is continuing to fall.”

Recent arms deliveries have also been fraught with problems. A $345 million arms package delivered between November 2023 and March 2024 included unserviceable and expired equipment, some of which was found to be mildewed and water-damaged, according to a report published on September 11 by the Inspector General Office of the U.S. Department of Defense. These revelations undermine the credibility of U.S. commitments to Taiwan and raise serious questions about the effectiveness of these sales in enhancing Taiwan’s defense capabilities.

More advanced and lethal systems, such as F-16Vs, have faced significant delays, adding to a backlog of $20 billion in undelivered military hardware. U.S. officials have attributed these delays to the urgent demands of the war in Ukraine, suggesting that Washington’s priorities lie elsewhere, particularly in Europe, rather than in the Indo-Pacific region. This prioritization was further underscored by the urgent redeployment of the USS Lincoln from the West Pacific to the Arabian Sea in early August, leaving a significant gap in aircraft carrier presence in the region that remains unfilled.

The restrained and fragmented nature of U.S. arms supplies to Taiwan sends mixed signals at a time when Beijing’s military posture is increasingly aggressive. China’s Ministry of Defense has pledged that the People’s Liberation Army (PLA) will continue to intensify its military training and preparations, and will take decisive measures to thwart any attempts at “Taiwan independence” or external interference. China’s actions are not merely rhetorical; they underscore a clear strategy to pressure Taiwan and the United States by both escalating military readiness and undermining the credibility of U.S. security guarantees to Taiwan.

Meanwhile, China appears to be taking calculated steps to marginalize the Taiwan issue in its broader strategic relationship with the U.S., particularly during the sensitive U.S. presidential election cycle. With polls showing a close race between Donald Trump and Kamala Harris, Beijing has publicly maintained a non-interventionist stance, framing the U.S. election as a domestic affair. However, behind the scenes, China is hedging its bets, preparing to navigate both potential outcomes. In the event of a Trump victory, Beijing appears ready to endure economic sacrifices in exchange for strategic leverage, anticipating a transactional approach from a second Trump administration regarding Taiwan. 

Conversely, Beijing is also exploring opportunities to proactively build diplomatic consensus with Harris, should she win, possibly through side discussions with President Joe Biden at the upcoming APEC and G-20 summits in South America this November. Given Harris’ inexperience on foreign policy, China will be aiming to influence her potential administration. 

Meanwhile, Beijing is believed to continue strengthening military and political alignment with Russia, thereby complicating U.S. and allied presence in the Western Pacific, and bringing in a Russian factor into potential Taiwan contingency that has been repeatedly mentioned by the United States and Japan in particular. This strategic positioning serves China’s broader goal of diminishing U.S. influence in the region and enhancing its own sphere of control.

The consequences of this restrained U.S. approach are stark. Taiwan finds itself in a security dilemma, relying on a defense partner whose commitment appears inconsistent, while facing a China that is more emboldened than ever. This imbalance heightens the risk of miscalculations and unintended confrontations in the Taiwan Strait, with potential implications that stretch far beyond the immediate region. 

As the United States continues to navigate its broader geopolitical priorities, Taiwan remains caught in a perilous position, where the gaps in its defense capabilities are increasingly visible. The situation illustrates the broader challenges of managing great power competition in a multipolar world where the stakes are high and the margins for error are dangerously thin. The ongoing tensions are not just a test of military resolve but also of strategic stability in the Indo-Pacific, setting the stage for a potentially transformative period in regional security dynamics.

The Federal Trade Commission on Friday sued three large U.S. health companies that negotiate insulin prices, arguing the drug middlemen use practices that boost their profits while “artificially” inflating costs for patients. 

The suit targets the three biggest so-called pharmacy benefit managers, UnitedHealth Group’s Optum Rx, CVS Health’s Caremark and Cigna’s Express Scripts. All are owned by or connected to health insurers and collectively administer about 80% of the nation’s prescriptions, according to the FTC. 

The FTC’s lawsuit also includes each PBM’s affiliated group purchasing organization, which brokers drug purchases for hospitals and other health-care providers. The agency said it could recommend suing drugmakers Eli Lilly, Sanofi and Novo Nordisk in the future as well over their role in driving up list prices for their insulin products.

A UnitedHealth spokesperson said the suit “demonstrates a profound misunderstanding of how drug pricing works, noting that Optum RX has “aggressively and successfully” negotiated with drug manufacturers.

A CVS spokesperson said Caremark is “proud of the work” it has done to make insulin more affordable for Americans, adding that “to suggest anything else, as the FTC did today, is simply wrong.”

And, a spokesperson for Express Scripts said the suit “continues a troubling pattern from the FTC of unsubstantiated and ideologically-driven attacks” on PBMs. It comes three days after Express Scripts sued the FTC, demanding that the agency retract its allegedly “defamatory” July report that claimed that the PBM industry is hiking drug prices.

PBMs sit at the center of the drug supply chain in the U.S. They negotiate rebates with drug manufacturers on behalf of insurers, large employers and federal health plans. They also create lists of medications, or formularies, that are covered by insurance and reimburse pharmacies for prescriptions. The FTC has been investigating PBMs since 2022. 

The agency’s suit argues that the three PBMs have created a “perverse” drug rebate system that prioritizes high rebates from drugmakers, which leads to “artificially inflated insulin list prices.” It also alleges that PBMs favor those high-list-price insulins even when more affordable insulins with lower list prices become available. 

The FTC is filing its complaint through its so-called administrative process, which initiates a proceeding before an administrative judge who would hear the case.

“Millions of Americans with diabetes need insulin to survive, yet for many of these vulnerable patients, their insulin drug costs have skyrocketed over the past decade thanks in part to powerful PBMs and their greed,” Rahul Rao, deputy director of the FTC’s Bureau of Competition, said in a statement. 

“The FTC’s administrative action seeks to put an end to the Big Three PBMs’ exploitative conduct and marks an important step in fixing a broken system—a fix that could ripple beyond the insulin market and restore healthy competition to drive down drug prices for consumers,” Rao continued. 

Roughly eight million Americans with diabetes rely on insulin to survive, and many have been forced to ration the treatment due to high prices, according to the FTC.

President Joe Biden’s signature Inflation Reduction Act has capped insulin prices for Medicare beneficiaries at $35 per month. That policy currently does not extend to patients with private insurance.

The Biden administration and Congress have ramped up pressure on PBMs, seeking to increase transparency into their operations as many Americans struggle to afford prescription drugs. On average, Americans pay two to three times more than patients in other developed nations for prescription drugs, according to a fact sheet from the White House.

The FTC said it remains “deeply troubled” by the role insulin manufacturers play in higher list prices, arguing that they inflate prices in response to PBMs’ demands for higher rebates. Eli Lilly, Sanofi and Novo Nordisk control roughly 90% of the U.S. insulin market.

For example, Eli Lilly’s Humalog insulin had a list price of $274 in 2017, a more than 1,200% increase from its $21 list price in 1999, according to the FTC.

The FTC said all drugmakers should “be on notice that their participation in the type of conduct challenged here raises series concerns.”

An Eli Lilly spokesperson said the FTC’s suit concerns “aspects of the U.S. health care system that we have long been advocating to reform.” They added that the company last year became the first to cap out-of-pocket costs for all of its insulins at $35 per month for people with private insurance. Eli Lilly also cut some insulin list prices by up to 70%.

Sanofi last year announced a similar $35 monthly price cap for its most commonly prescribed insulin. Novo Nordisk last year also said it would slash the list prices of some of its popular insulins by up to 75%.

Sanofi and Novo Nordisk did not immediately respond to requests for comment.

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