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Column: Mark Berman, pusher of unproven stem cell therapies, dies while awaiting verdict in FDA lawsuit

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Column: Mark Berman, pusher of unproven stem cell therapies, dies while awaiting verdict in FDA lawsuit

For years, California beauty surgeon Mark Berman was a pacesetter of that nook of the healthcare world pushing unproven and unapproved stem cell therapies for a number of medical circumstances.

Berman aired his claims for what he known as “magic cells” in a e-book, video appearances and thru a community of affiliated clinics across the nation. These claims caught the eye of the Meals and Drug Administration, which has been attempting to stamp out clinics claiming that stem cell injections can deal with illnesses and circumstances comparable to Alzheimer’s, Parkinson’s, autism and even— most lately — COVID-19.

I can not condone exploitation of determined people who find themselves led to consider that they are going to be cured and even helped by a clinic or a tablet or any purported remedy that’s not based mostly in science.

— Jeanne Loring, Scripps Analysis Institute

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A 2018 lawsuit the FDA filed towards Berman, his skilled accomplice Elliot Lander and their two stem cell companies is awaiting a verdict from U.S. District Decide Jesus Bernal in Riverside. Whichever approach it goes, Bernal’s ruling would set the stage for the subsequent section of the FDA’s marketing campaign towards stem cell clinics — both endorsing its place that the injection process quantities to administering unlawful medication or erecting an impediment to enforcement of its guidelines.

Berman died April 19, in response to his workplace. His dying hasn’t been publicly introduced. An electronic mail despatched final week to a affected person and signed by an workplace supervisor at Cell Surgical Community, which Berman co-founded with urologist Elliot Lander in 2012, said that he died after being hospitalized in early January.

Lander instructed me by electronic mail, “The household will launch all pertinent info in an obituary which has not been accomplished and revealed but.” Berman’s son, Sean, confirmed that an obit is being written.

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Berman’s dying supplies us with a possibility to evaluation the FDA’s marketing campaign towards clinics purveying bogus stem cell therapies.

The company’s targets are clinics that depend on a way just like the one promoted by Berman and his colleagues at clinics branded because the California Stem Cell Therapy Heart in Rancho Mirage and Beverly Hills and at scores of clinics affiliated with the Cell Surgical Community. The therapy facilities have been co-founded by Berman and Lander in 2010.

The strategy begins with extracting fats from a buyer by way of liposuction. The fats is then refined to isolate what is named the “stromal vascular fraction,” or SVF, which Berman asserted is wealthy in stem cells. The SVF is then reinjected into the client.

Clients of greater than 1,000 clinics across the nation, a few of that are affiliated with the Cell Surgical Community, have been charged as a lot as a number of thousand {dollars} for such procedures, that are seldom, if ever, lined by medical health insurance.

In a 2015 e-book titled “The Stem Cell Revolution,” Berman and Lander asserted that their colleagues within the community have been treating “a variety of circumstances” comparable to Alzheimer’s, autism, cerebral palsy, a number of sclerosis, muscular dystrophy, Parkinson’s, stroke and traumatic mind damage.

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Extra lately, Berman, Lander and different stem cell promoters have been implying that stem cells can be utilized to deal with COVID-19.

The FDA’s place on these claims is crystal clear. The company observes that there isn’t a scientifically validated proof for these therapy claims. The company has warned potential clients to avoid the claims’ promoters.

“Don’t consider the hype,” the company says on its web site. “Some unscrupulous suppliers supply stem cell merchandise which might be each unapproved and unproven,” in addition to “probably harmful.”

The FDA says it has not authorized stem cell therapies for any circumstances aside from uncommon blood system illnesses, for which it has authorized therapies utilizing blood-forming stem cells derived from umbilical wire blood. The company has particularly warned towards claims that stem cells can be utilized to deal with autism, macular degeneration, blindness, power ache, fatigue; neurological problems comparable to a number of sclerosis, Alzheimer’s and Parkinson’s; or cardiovascular or pulmonary illnesses.

The company additionally has warned towards claims, that are additionally unproven, that stem cells can be utilized for “the therapy or prevention of COVID-19, acute respiratory misery syndrome (ARDS), or some other complication associated to COVID-19.”

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In sensible phrases, nevertheless, the FDA’s marketing campaign has not been going effectively. In 2017, the FDA closed a loophole that allowed the stem cell clinics to proceed pitching unproven, ineffective and probably hazardous stem cell therapies on to customers. The stem cells extracted from fats, the FDA dominated, have been medication underneath the regulation, which means that the clinics would should be licensed and subjected to inspection.

However the company unwisely gave clinics as much as three years to adjust to its new laws. Then it prolonged the deadline by six months due to the pandemic, so its interval of regulatory “forbearance” expired Could 31, 2021.

By then, a torrent of shady operations had poured into the sphere — so many who the duty of defending the general public from them could exceed the FDA’s capabilities. In line with a research by Leigh Turner of UC Irvine, by midyear 2021 there have been 1,480 companies working 2,754 clinics nationwide.

“That hardly looks like progress,” Turner instructed me final 12 months. “The issue the FDA faces is 4 instances bigger than what existed in 2016. The FDA solely has so many staff and so many inspectors. They don’t actually have sufficient inspectors to ship them to 1,480 companies.”

Earlier than his dying at age 69, Berman and his associates reportedly had been learning whether or not stem cells could possibly be used to deal with COVID. In testimony throughout the federal trial, Berman said that Cell Surgical Community was working with a Florida stem cell firm, American Cell Expertise, “to deal with COVID-19 sufferers” in accordance with a therapy protocol the community developed, as an FDA post-trial transient filed in June describe his statements from the witness field.

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Sean Berman, Mark Berman’s son, who says he’s a advisor to ACT, instructed me that so far as he’s conscious, no sufferers have been handled for COVID in response to the protocol the FDA talked about.

Lander appeared to point, nevertheless, {that a} research of some kind had taken place. “No sufferers have been ever charged any charges in our Covid-19 research,” he instructed me by electronic mail.

Particulars about Berman’s dying haven’t been made public.

An individual who answered the telephone at California Stem Cell Therapy Heart instructed me that Berman died of “issues from Covid.”

Lander, nevertheless, instructed me: “Any one who represented themselves to be an agent of California Stem Cell over the telephone was neither educated sufficient, nor licensed, to debate Dr. Berman’s medical historical past.”

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One affected person says Berman’s workers canceled a pre-op process in January, stating that Berman had COVID. The affected person, who doesn’t need to be recognized, says Berman’s workplace stored providing to reschedule the appointment, however finally the process didn’t happen.

The FDA has been taking a look at Berman’s operations at the very least since 2017. In two inspection experiences in July 2017, the company listed quite a few “objectionable circumstances” on the California Stem Cell Therapy Heart services in Rancho Mirage and Beverly Hills that it asserted have been in violation of regulatory requirements .

The experiences criticized sterilization procedures, coaching and record-keeping on the places. At Rancho Mirage, at the very least 4 “severe adversarial occasions” after stem cell procedures had not been investigated by the clinic or reported to the FDA as required, the company mentioned.

They included a affected person’s retinal detachment after the SVF was injected into the affected person’s eyes, hospitalization of one other affected person for “confusion and headache,” and two instances of an infection.

Berman and Lander wrote of their e-book that that they had discovered “extraordinary security and no severe adversarial results associated to SVF deployment.”

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The FDA’s most decided assault on Berman got here within the lawsuit filed in Riverside federal court docket in Could 2018, aimed basically at forcing him and his services to stop treating sufferers with the fats extractions. The lawsuit was largely an identical to 1 the company filed the identical day towards U.S. Stem Cell, a Florida clinic operator, in Miami federal court docket.

Each units of plaintiffs mounted related defenses — mainly that they have been merely treating sufferers with their very own tissues, so their merchandise fell exterior the FDA definition of a drug and thus have been exempt from the company’s jurisdiction. The FDA disagreed. The extracted tissues have been so totally manipulated earlier than reinjection, the company argued, that they have been correctly outlined as a drug and didn’t qualify for the exemption.

The 2 lawsuits have adopted divergent paths. In Miami, District Decide Ursula Ungaro agreed with the FDA in a serious victory for the company’s marketing campaign towards stem cell clinics.

Ungaro held in June 2019 that the SVF was certainly a drug and subsequently used illegally. She additional noticed that U.S. Stem Cell’s procedures “contain the next threat of communicable illness and different security issues and are subsequently topic to FDA regulation.” Her resolution siding with the company by way of abstract judgment — that’s, with out trial — successfully shut down U.S. Stem Cell’s clinic.

Ungaro’s ruling was upheld in June by the U.S. eleventh Circuit Court docket of Appeals in Atlanta.

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In Riverside, nevertheless, Bernal denied the FDA’s movement for abstract judgment. As an alternative, he held a seven-day trial in Could 2021. Submit-trial briefs by either side have been submitted in August, however Bernal has but to problem a verdict. There are not any indications of when he may rule.

Berman’s dying gained’t require Bernal to droop his deliberations, as there are nonetheless three different defendants — Lander, California Stem Cell Therapy Heart and Cell Surgical Community.

The FDA, in its post-trial transient in June, correctly raised the alarm that the defendants may be aiming their pitch at victims of COVID-19, regardless of the dearth of proof that stem cells are efficient in treating the illness. Why ought to that be a shock? The sector of stem cell clinics has been feeding on the desperation of sick folks nearly since its inception.

“Has a physician ever instructed you ‘there’s nothing we will do?’” Berman and Lander wrote of their e-book. “We sincerely hope you gained’t settle for that as the ultimate reply.” The FDA’s response has been, in impact: Beware, as a result of they don’t have the reply both.

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Inside Elon Musk’s Plan for DOGE to Slash Government Costs

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Inside Elon Musk’s Plan for DOGE to Slash Government Costs

An unpaid group of billionaires, tech executives and some disciples of Peter Thiel, a powerful Republican donor, are preparing to take up unofficial positions in the U.S. government in the name of cost-cutting.

As President-elect Donald J. Trump’s so-called Department of Government Efficiency girds for battle against “wasteful” spending, it is preparing to dispatch individuals with ties to its co-leaders, Elon Musk and Vivek Ramaswamy, to agencies across the federal government.

After Inauguration Day, the group of Silicon Valley-inflected, wide-eyed recruits will be deployed to Washington’s alphabet soup of agencies. The goal is for most major agencies to eventually have two DOGE representatives as they seek to cut costs like Mr. Musk did at X, his social media platform.

This story is based on interviews with roughly a dozen people who have insight into DOGE’s operations. They spoke to The Times on the condition of anonymity because they were not authorized to speak publicly.

On the eve of Mr. Trump’s presidency, the structure of DOGE is still amorphous and closely held. People involved in the operation say that secrecy and avoiding leaks is paramount, and much of its communication is conducted on Signal, the encrypted messaging app.

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Mr. Trump has said the effort would drive “drastic change,” and that the entity would provide outside advice on how to cut wasteful spending. DOGE itself will have no power to cut spending — that authority rests with Congress. Instead, it is expected to provide recommendations for programs and other areas to cut.

But parts of the operation are becoming clear: Many of the executives involved are expecting to do six-month voluntary stints inside the federal government before returning to their high-paying jobs. Mr. Musk has said they will not be paid — a nonstarter for some originally interested tech executives — and have been asked by him to work 80-hour weeks. Some, including possibly Mr. Musk, will be so-called special government employees, a specific category of temporary workers who can only work for the federal government for 130 days or less in a 365-day period.

The representatives will largely be stationed inside federal agencies. After some consideration by top officials, DOGE itself is now unlikely to incorporate as an organized outside entity or nonprofit. Instead, it is likely to exist as more of a brand for an interlinked group of aspirational leaders who are on joint group chats and share a loyalty to Mr. Musk or Mr. Ramaswamy.

“The cynics among us will say, ‘Oh, it’s naïve billionaires stepping into the fray.’ But the other side will say this is a service to the nation that we saw more typically around the founding of the nation,” said Trevor Traina, an entrepreneur who worked in the first Trump administration with associates who have considered joining DOGE.

“The friends I know have huge lives,” Mr. Traina said, “and they’re agreeing to work for free for six months, and leave their families and roll up their sleeves in an attempt to really turn things around. You can view it either way.”

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DOGE leaders have told others that the minority of people not detailed to agencies would be housed within the Executive Office of the President at the U.S. Digital Service, which was created in 2014 by former President Barack Obama to “change our government’s approach to technology.”

DOGE is also expected to have an office in the Office of Management and Budget, and officials have also considered forming a think tank outside the government in the future.

Mr. Musk’s friends have been intimately involved in choosing people who are set to be deployed to various agencies. Those who have conducted interviews for DOGE include the Silicon Valley investors Marc Andreessen, Shaun Maguire, Baris Akis and others who have a personal connection to Mr. Musk. Some who have received the Thiel Fellowship, a prestigious grant funded by Mr. Thiel given to those who promise to skip or drop out of college to become entrepreneurs, are involved with programming and operations for DOGE. Brokering an introduction to Mr. Musk or Mr. Ramaswamy, or their inner circles, has been a key way for leaders to be picked for deployment.

That is how the co-founder of Loom, Vinay Hiremath, said he became involved in DOGE in a rare public statement from someone who worked with the entity. In a post this month on his personal blog, Mr. Hiremath described the work that DOGE employees have been doing before he decided against moving to Washington to join the entity.

“After 8 calls with people who all talked fast and sounded very smart, I was added to a number of Signal groups and immediately put to work,” he wrote. “The next 4 weeks of my life consisted of 100s of calls recruiting the smartest people I’ve ever talked to, working on various projects I’m definitely not able to talk about, and learning how completely dysfunctional the government was. It was a blast.”

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These recruits are assigned to specific agencies where they are thought to have expertise. Some other DOGE enrollees have come to the attention of Mr. Musk and Mr. Ramaswamy through X. In recent weeks, DOGE’s account on X has posted requests to recruit a “very small number” of full-time salaried positions for engineers and back-office functions like human resources.

The DOGE team, including those paid engineers, is largely working out of a glass building in SpaceX’s downtown office located a few blocks from the White House. Some people close to Mr. Ramaswamy and Mr. Musk hope that these DOGE engineers can use artificial intelligence to find cost-cutting opportunities.

The broader effort is being run by two people with starkly different backgrounds: One is Brad Smith, a health care entrepreneur and former top health official in Mr. Trump’s first White House who is close with Jared Kushner, Mr. Trump’s son-in-law. Mr. Smith has effectively been running DOGE during the transition period, with a particular focus on recruiting, especially for the workers who will be embedded at the agencies.

Mr. Smith has been working closely with Steve Davis, a collaborator of Mr. Musk’s for two decades who is widely seen as working as Mr. Musk’s proxy on all things. Mr. Davis has joined Mr. Musk as he calls experts with questions about the federal budget, for instance.

Other people involved include Matt Luby, Mr. Ramaswamy’s chief of staff and childhood friend; Joanna Wischer, a Trump campaign official; and Rachel Riley, a McKinsey partner who works closely with Mr. Smith.

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Mr. Musk’s personal counsel — Chris Gober — and Mr. Ramaswamy’s personal lawyer — Steve Roberts — have been exploring various legal issues regarding the structure of DOGE. James Burnham, a former Justice Department official, is also helping DOGE with legal matters. Bill McGinley, Mr. Trump’s initial pick for White House counsel who was instead named as legal counsel for DOGE, has played a more minimal role.

“DOGE will be a cornerstone of the new administration, helping President Trump deliver his vision of a new golden era,” said James Fishback, the founder of Azoria, an investment firm, and confidant of Mr. Ramaswamy who will be providing outside advice for DOGE.

Despite all this firepower, many budget experts have been deeply skeptical about the effort and its cost-cutting ambitions. Mr. Musk initially said the effort could result in “at least $2 trillion” in cuts from the $6.75 trillion federal budget. But budget experts say that goal would be difficult to achieve without slashing popular programs like Social Security and Medicare, which Mr. Trump has promised not to cut.

Both Mr. Musk and Mr. Ramaswamy have also recast what success might mean. Mr. Ramaswamy emphasized DOGE-led deregulation on X last month, saying that removing regulations could stimulate the economy and that “the success of DOGE can’t be measured through deficit reduction alone.”

And in an interview last week with Mark Penn, the chairman and chief executive of Stagwell, a marketing company, Mr. Musk downplayed the total potential savings.

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“We’ll try for $2 trillion — I think that’s like the best-case outcome,” Mr. Musk said. “You kind of have to have some overage. I think if we try for two trillion, we’ve got a good shot at getting one.”

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They lost their home insurance policies. Then came the fires

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They lost their home insurance policies. Then came the fires

Last year, Francis Bischetti said he learned that the annual cost of the homeowners policy he buys from Farmers Insurance for his Pacific Palisades home was going to soar from $4,500 to $18,000 — an amount he could not possibly afford.

Neither could he get onto California FAIR Plan, which provides fewer benefits, because he said he would have to cut down 10 trees around his roof line to lower the fire risk — something else the 55-year-old personal assistant found too costly to manage.

So he decided he would do what’s called “going bare” — not buying any coverage on his home in the community’s El Medio neighborhood. He figured if he watered his property year round, that might be protection enough given its location south of Sunset Boulevard.

It wasn’t. The home he lived in for nearly all his life burned down Tuesday along with more than 10,000 other homes and structures damaged or destroyed in the worst fire event in the history of Los Angeles. Sixteen deaths have been confirmed countywide.

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“It was surrealistic,” he said. “I’ve grown up and lived here off and on for 50 years. I’ve never in my entire time here experienced this.”

Farmers Insurance declined to comment, saying it does not discuss individual policyholders.

‘A train wreck coming down the track’

Bischetti was far from the only homeowner living in Pacific Palisades, Altadena or other fire-prone hillside neighborhoods who struggled to maintain their insurance amid sharply rising costs and the decision by many insurers to reduce their exposure to catastrophic wildfire claims by not renewing the policies of even longtime customers. Many fire victims reported that insurers had dropped their policies last year.

The fires — expected to be among the costliest natural disasters in U.S. history — have deepened a crisis in the state’s home insurance market that was already reeling before the devastation came.

The state’s largest home insurer, State Farm General, announced in March it would not renew 30,000 homeowner and condominium policies — including 1,626 in Pacific Palisades — when they expired.

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Chubb and its subsidiaries stopped writing new policies for high-value homes with higher wildfire risk. Allstate has stopped writing new policies, and Tokio Marine America Insurance Co. and Trans Pacific Insurance Co. pulled out of the state, though Mercury Insurance offered to take their customers.

Liberty Mutual was sued last month by a homeowner who accused the insurer of dropping her over a bogus claim that her roof had mold damage.

“Driven by a desire to maximize profits, property casualty insurance companies … have engaged in a troubling trend of dropping California homeowners’ insurance policies like flies,” said the complaint, filed in San Diego County Superior Court. A spokesperson for Liberty Mutual declined to comment on the litigation.

The inability to get coverage is reflected in the number of policies picked up by California FAIR Plan, which as of September had about 452,000 policies, up from a little over 203,000 four years ago. FAIR Plan’s website says its claims exposure is nearly $6 billion in Pacific Palisades alone.

“The situation has been a train wreck coming down the track for a while,” said Rick Dinger, president of Crescenta Valley Insurance, an independent brokerage in Glendale.

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Not enough insurance money to rebuild

Peggy Holter spent decades as a television journalist, a peripatetic career that took her all over the world, but there was one place she called home and always returned to: the Pacific Palisades condo she moved into on Jan. 1, 1978. That all changed after Tuesday’s firestorm, when her condo burned to the ground along with the rest of the 36 units in the Palisades Drive complex.

Holter, 83, who only retired last year, is now facing uncertainty after she said State Farm didn’t renew her individual condo insurance, citing the condition of her roof.

But with the loss of her documents she isn’t sure if and when the policy lapsed — and she hadn’t yet secured a new carrier. The insurance typically covers personal belongings and a unit’s interior and provides benefits such as living expenses if a condo becomes unusable.

“I’m not a big keeper of things, but what I did have was a whole wall of pictures and albums of all the places I had been, family photos. I had a picture of my mother on a camel when she was 52 in front of the Sphinx,” Holter recalled. “The only thing I am concerned about is the future, because that is what you have to do.”

Her biggest question is whether she can rebuild. The homeowners association had a master policy from FAIR Plan, which totaled only $20 million. That would pay out only about $550,000 per unit if the complex were not rebuilt — far below the $1 million-plus the condos commanded in recent sales. The land could be sold off to a developer.

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Holter, who is now living with her son in the Hollywood Hills, had paid off her condo.

She went back to the complex after the fires died down to get a closer look at the damage. There was nothing left of her unit, but the complex’s koi pond survived, along with the fish.

State Farm has declined to comment on its non-renewals, saying in a recent statement: “Our number one priority right now is the safety of our customers, agents and employees impacted by the fires and assisting our customers in the midst of this tragedy.”

‘We don’t cover anything in California’

Matt Knight considers himself fortunate: He and his family could have lost it all in the Eaton fire, just like Bischetti and Holter in the Palisades fire.

The trouble started last year he said when he received a notice from Safeco Insurance that the policy on his Sonoma Drive home in Altadena, where he lives with his wife and three children, would not be renewed due to a tree overhanging his garage.

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The 45-year-old Covina elementary school teacher said he dutifully trimmed the tree only to be told the ivy growing on the garage also was a problem. After removing that, he said he was told he had to fix his damaged stucco, which forced him to paint his house and in the process replace his old roof. Yet he said he still couldn’t get insurance after spending $30,000 on the repairs.

A spokesperson for Safeco, a subsidiary of Liberty Mutual, said the carrier does not comment on individual policyholders.

“So we went looking company after company after company, and some of them would say, ‘No, we don’t cover anything in California.’ Some said, ‘We’re not doing any new policies.’ Some said, ‘No, we don’t do 91001 because it’s in a fire zone, and we were were like, ‘That’s crazy.’”

Just a day before his policy was set to expire last summer, Knight said he finally managed to secure similar coverage with Aegis Insurance. But in the haste to get the policy in force, the home he has lived in for 16 years was left wildly under-insured for less than $300,000. The home is valued at $1.13 million on Zillow.

The ferocious winds that fanned the Eaton fire started a power outage Tuesday evening, so Knight decided to drive his children over to his parents’ home on the other side of Altadena where they could do their homework. From there, he saw the fire start on a street hugging the mountains near what appeared to be a power line.

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“Within minutes it was taken up the hillside. It was unbelievable,” he said.

His parents’ home on Roosevelt Avenue escaped the devastation, and throughout the night he drove over to check on his home. By 6 a.m., he had joined a brigade of homeowners to fight the encroaching flames on Sonoma Drive. “The whole neighborhood was there grabbing hoses and fighting fires,” he said.

In the late afternoon, he said, the water ran out for the homeowners and firefighters alike, forcing him and his neighbors to pack up and go. He was sure he would lose his home, but the winds died down.

“I think that was the ultimate good fortune,” he said, though some other neighbors were not so lucky.

Bischetti was not so lucky either.

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On Tuesday, when the fires started in the hills and all of his Palisades neighbors started to pack their cars, Bischetti stayed behind to keep hosing down his property, including his lawn, roof, rafters and walls.

“I thought everything would be relatively safe,” he said. “I was sticking around trying to protect the house with water.”

He gradually started packing his car with a change of clothes, one of his guitars, tax papers, property deeds and hard drives from his computer. He left his computer itself back in the house, along with his amps, music equipment and tools.

His entire street was a ghost town by 5 p.m. By then, Bischetti had already watered down his property multiple times. It was dusty and smoky, and a voice in his head told him it was time to go. “I’m going to come back for this tomorrow,” he recalled thinking. “I don’t want to weigh down my car.”

It didn’t work out that way.

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Bischetti drove near Palisades High School and saw a house on the corner of the street start to burn down. He then tried going on El Medio Avenue and drove into black smoke, with flames on both sides of his car. He started panicking and realized he couldn’t get through.

After making it to his sister’s home in Mar Vista, he found out from a neighbor that all of the homes on his block had been leveled.

Bischetti said his siblings lost family mementos and photos and he lost thousands of dollars’ worth of tools and musical instruments. They also had spent nearly $4,000 fixing up the home in order to rent out some of the rooms.

Bischetti and his family have signed up for Federal Emergency Management Agency disaster relief funds and are trying to get help with cleaning up the property, which he said could cost at least $10,000.

“I was getting ready for this,” he said of his one-man firefighting efforts. “That was the last hurrah.”

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4 Takeaways From the Arguments Before the Supreme Court in the TikTok Case

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4 Takeaways From the Arguments Before the Supreme Court in the TikTok Case

The Supreme Court on Friday grappled over a law that could determine the fate of TikTok, an enormously popular social media platform that has about 170 million users.

Congress enacted the law out of concern that the app, whose owner is based in China, is susceptible to the influence of the Chinese government and posed a national risk. The measure would effectively ban TikTok from operating in the United States unless its owner, ByteDance, sells it by Jan. 19.

Here are some key takeaways:

While the justices across the ideological spectrum asked tough questions of both sides, the overall tone and thrust appeared to suggest greater skepticism toward the arguments by lawyers for TikTok and its users that the First Amendment barred Congress from enacting the law.

The questioning opened with two conservative members of the court, Justice Clarence Thomas and Chief Justice John G. Roberts Jr., suggesting that it was not TikTok, an American company, but its Chinese parent company, ByteDance, that was directly affected by the law.

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Another conservative, Justice Brett M. Kavanaugh, focused on the risk that the Chinese government could use information TikTok is gathering on tens of millions of American teenagers and twentysomethings to eventually “develop spies, turn people, blackmail people” when they grow older and go to work for national security agencies or the military.

Justice Elena Kagan, a liberal, asked why TikTok could not just create or buy another algorithm rather than using ByteDance’s.

And another liberal, Justice Ketanji Brown Jackson, said she believed the law was less about speech than about association. She suggested that barring TikTok from associating with a Chinese company was akin to barring Americans from associating with foreign terrorist groups for national security reasons. (The Supreme Court has upheld that as constitutional.)

Still, several justices were skeptical about a major part of the government’s justification for the law: the risk that China might “covertly” make TikTok manipulate the content shown to Americans or collect user data to achieve its geopolitical aims.

Both Justice Kagan and Justice Neil M. Gorsuch, a conservative, stressed that everybody now knows that China is behind TikTok. They appeared interested in whether the government’s interest in preventing “covert” leveraging of the platform by a foreign adversary could be achieved in a less heavy-handed manner, like appending a label warning users of that risk.

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Two lawyers argued that the law violates the First Amendment: Noel Francisco, representing both TikTok and ByteDance, and Jeffrey Fisher, representing TikTok users. Both suggested that concerns about potential manipulation by the Chinese government of the information American users see on the platform were insufficient to justify the law.

Mr. Francisco contended that the government in a free country “has no valid interest in preventing foreign propaganda” and cannot constitutionally try to keep Americans from being “persuaded by Chinese misinformation.” That is targeting the content of speech, which the First Amendment does not permit, he said.

Mr. Fisher asserted that fears that China might use its control over the platform to promote posts sowing doubts about democracy or pushing pro-China and anti-American views were a weaker justification for interfering in free speech than concerns about foreign terrorism.

“The government just doesn’t get to say ‘national security’ and the case is over,” Mr. Fisher said, adding, “It’s not enough to say ‘national security’ — you have to say ‘what is the real harm?’”

The solicitor general, Elizabeth B. Prelogar, argued that Congress had lawful authority to enact the statute and that it did not violate the First Amendment. She said it was important to recognize that the law leaves speech on TikTok unrestricted once the platform is freed from foreign control.

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“All of the same speech that’s happening on TikTok could happen post-divestiture,” she said. “The act doesn’t regulate that at all. So it’s not saying you can’t have pro-China speech, you can’t have anti-American speech. It’s not regulating the algorithm.”

She added: “TikTok, if it were able to do so, could use precisely the same algorithm to display the same content by the same users. All the act is doing is trying to surgically remove the ability of a foreign adversary nation to get our data and to be able to exercise control over the platform.”

President-elect Donald J. Trump has asked the Supreme Court to issue an injunction delaying the law from taking effect until after he assumes office on Jan. 20.

Mr. Trump once shared the view that Chinese control of TikTok was an intolerable national security risk, but reversed course around the time he met with a billionaire Republican donor with a stake in its parent company.

If the court does uphold the law, TikTok would effectively be banned in the United States on Jan. 19, Mr. Francisco said. He reiterated a request that the court temporarily pause the law from taking effect to push back that deadline, saying it would “simply buy everybody a little breathing space.” It might be a “different world” for TikTok after Jan. 20, he added.

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But there was scant focus by the justices on that idea, suggesting that they did not take it seriously. Mr. Trump’s brief requesting that the court punt the issue past the end of President Biden’s term so he could handle it — signed by his pick to be the next solicitor general, D. John Sauer — was long on rhetoric extolling Mr. Trump, but short on substance.

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