By GEOFF MULVIHILL, Associated Press

NEW YORK (AP) — Lawyers representing OxyContin maker Purdue Pharma, branches of the Sackler family that own it, cities, states, counties, Native American tribes, people with addiction and others across the U.S. delivered a nearly unanimous message for a bankruptcy court judge Friday: Approve a plan to settle thousands of opioid-related lawsuits against the company.

If U.S. Bankruptcy Judge Sean Lane abides, it will close a long chapter — and maybe the entire book — on a legal odyssey over efforts to hold the company to account for its role in an opioid crisis connected to 900,000 deaths in the U.S. since 1999, including deaths from heroin and illicit fentanyl.

Friday’s closing arguments were wrapping up a three-day hearing over the bankruptcy plan for the company, which filed for protection six years ago as it faced lawsuits with claims that grew to trillions of dollars.

The opposition is much quieter this time around

The saga has been emotional and full of contentious arguments between the many groups that took Purdue to court, often exposing a possible mismatch between the quest for justice and the practical role of bankruptcy court.

The U.S. Supreme Court rejected a previous deal because it said it was improper for Sackler family members to receive immunity from lawsuits over opioids. In the new arrangement, entities who don’t opt into the settlement can sue them. Family members are collectively worth billions, but much of their assets are held in trusts in offshore accounts that would be hard to access through lawsuits.

This time, the government groups involved have reached an even fuller consensus and there’s been mostly subdued opposition from individuals. Out of more than 54,000 personal injury victims who voted on whether the plan should be accepted. just 218 said no. A larger number of people who are part of that group didn’t vote.

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A handful of objectors spoke Thursday at the hearing, sometimes interrupting the judge. Some said that only the victims, not the states and other government entities, should receive the funds in the settlement. Others wanted the judge to find the members of the Sackler family criminally liable — something Lane said is beyond the scope of the bankruptcy court, but that the settlement doesn’t bar prosecutors from pursuing.

A Florida woman whose husband struggled with addiction after being given OxyContin following an accident told the court that the deal isn’t enough.

“The natural laws of karma suggest the Sacklers and Purdue Pharma should pay for what they have done,” Pamela Bartz Halaschak said via video.

Deal would be among the biggest opioid settlements

A flood of lawsuits filed by government entities against Purdue and other drugmakers, drug wholesalers and pharmacy chains began about a decade ago.

Most of the major ones have already settled for a total of about $50 billion, with most of the money going to fight the opioid crisis. There’s no mechanism for tracking where it all goes or overarching requirement to evaluate whether the spending is effective. Those hit the hardest generally haven’t had a say.

The Purdue deal would rank among the largest of them. Members of the Sackler family would be required to pay up to $7 billion and give up ownership of the company. None have been on its board or received payments since 2018. Unlike a similar hearing four years ago, none were called to testify in this week’s hearing.

The company would get a name change and new overseers who would dedicate future profits to battling the opioid crisis.

There are also some non-financial provisions. Certain members of the Sackler family would be required to give up involvement in companies that sell opioids in other countries.

Family members would also be barred from having their names added to institutions in exchange for charitable contributions. The name has already been removed from museums and universities.

And company documents, including many that would normally be subject to lawyer-client privilege, are to be made public.

Some people hurt by Purdue’s opioids would receive some money

Unlike the other major opioid settlements, individuals harmed by Purdue’s products would be in line for some money as part of the settlement. About $850 million would be set aside for them, with more than $100 million of that amount carved out to help children born dealing with opioid withdrawal.

About 139,000 people have active claims for the money. Many of them, however, have not shown proof that they were prescribed Purdue’s opioids and will receive nothing. Lawyers expect that those who had prescriptions for at least six months would receive about $16,000 each and those who had them more briefly would get around $8,000, before legal fees that would reduce what people actually receive.

One woman who had a family member suffer from opioid addiction told the court by video Thursday that the settlement doesn’t help people with substance use disorder.

“Tell me how you guys can sleep at night knowing people are going to get so little money they can’t do anything with it,” asked Laureen Ferrante of Staten Island, New York.

Most of the money is to go to state and local governments to be used in their efforts to mitigate damage of the opioid epidemic. Overdose death numbers have been dropping in the past few years, a decline experts believe is partly due to the impact of settlement dollars.

By KATIE WORKMAN, Associated Press

If you want a salad that shouts “holiday,” then you have landed in a very good spot.

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First of all, anytime you want to make a salad feel very festive and holiday-ish, you can’t go wrong with pomegranate seeds. That’s just a fact. Bright ruby little arils, kind of glowing and translucent, with their sweet-tart flavor instantly make a salad feel like a holiday salad. You can remove them from a whole pomegranate, or purchase them in little containers, and save yourself the hassle of dismantling a full pomegranate.

Then we get to the pears, which have a lovely holiday vibe. Fruit in salad; it always feels special. And sophisticated.

And cheese! In this salad, we welcome shavings of Parmesan, one of the finest cheeses in the world, with it nutty taste and firm texture.

But finally — what makes this salad so special — is puff pastry croutons. I cannot stand packaged croutons. I feel sad when I see them, like they have downgraded my salad, and I will pick them out as quickly as possible. But I love fresh croutons. And I love puff pastry. And boy, do I love this combo.

Many of us think of puff pastry when it comes to desserts, but sometimes forget about how many ways it can be used in savory dishes. You will be amazed at how easy these croutons are to make. You simply cut out the shapes you want your croutons to be with mini cookie cutters (available online and wherever baking tools are sold). Or, just slice the puff pastry into squares or diamond shapes. Remove any excess dough, if needed, give the tops a quick brush with mayonnaise, and a sprinkle of finely grated Parmesan and salt, bake briefly and you have these adorable little croutons.

I had these tiny little leaf cookie cutters which were just perfect for an autumnal salad (Thanksgiving, I’m all over you). But I also cut them into diamonds and played with some other shapes. They worked every which way. They worked when I left the pastry dough in place around the cut outs, and they worked when I peeled up the excess puff pastry and left the cut out silhouetted on the parchment paper. The mayonnaise is like a cross between brushing them with egg and melted butter, both classic options for making pastry glossy and nicely browned. And the sprinkle of grated Parmesan and salt gives them a great punch of flavor.

They also keep in a sealed container for a few days, so you can make them ahead, or just store your leftovers for some very stylish snacking.

Note: Shaved Parmesan is simply Parmesan that has been very thinly sliced, or shaved, into smallish bite-sized pieces. You can actually buy it that way in many upscale supermarkets, in those little tubs. You can also grab a chunk of Parmesan and a vegetable peeler and shave off strips of the Parmesan (make sure you don’t get any of the rind). Very easy to do. Allow the Parmesan to sit at room temperature for at least 20 minutes before doing this, so the shavings will come off smoothly and not get crumbly (and if they get crumbly, toss those crumbles right into the salad).

Thanksgiving Holiday Salad

Serves: 6

Parmesan Puff Pastry Croutons

1 package puff pastry dough, defrosted and chilled
About 4 tablespoons mayonnaise, or more as needed
About 3 tablespoons finely grated Parmesan cheese, or more as needed
Kosher salt to taste

Vinaigrette

1 large shallot, minced
2 tablespoons white wine vinegar
1 tablespoon lemon juice
3 tablespoons olive oil
2 teaspoons honey
Kosher or coarse salt and freshly ground pepper to taste

Salad

4 cups baby arugula
4 cups thinly sliced romaine
2 pears, halved, cored, and thinly sliced
1/2 cup shaved Parmesan (see Note above)
1 cup pomegranate seeds, divided

Directions

Make the Puff Pastry Croutons: Unfold or unroll the puff pastry directly onto a baking sheet lined with parchment paper. Either cut the pastry into squares or diamond shapes, or any other shape you like, or use cookie cutters to cut the pastry into the desired shapes. You can pull up the dough around the shapes, and toss it, and then you will have croutons that are lightly browned on the sides as well as the top, or you can leave the whole sheet of pastry in place, and pop out the croutons once the whole thing has baked. If you have cut the pastry into diamonds, just leave everything in place.

Brush the tops of the pastry shapes with a very light wash of mayonnaise. Lightly sprinkle on some Parmesan, and then some salt.

Bake for 12 to 16 minutes (it depends on size of the pastry shapes, and whether or not you removed the extra pastry from around the cut out shapes.) When the dough is puffed up and a rich golden brown on top, it is done. Place the baking sheet on a wire rack and allow the croutons to cool. If you need to pop the shapes out from the rest of the dough do that once the dough has cooled somewhat.

While the croutons are baking, make the vinaigrette. In a small container, combine the shallots, white wine vinegar, lemon juice, olive oil, honey, and salt and pepper. Shake to blend.

Place the arugula and romaine in a large serving bowl. Add the pears, Parmesan, and half of the pomegranate seeds to the bowl. Pour the dressing on the salad, and toss to combine. Scatter the remaining pomegranate seeds over the top, distribute the puff pastry croutons over the salad, and serve. You may also choose to serve the salads on individual plates, and then top with the remaining pomegranate seeds, and the croutons.

Katie Workman writes regularly about food for The Associated Press. She has written two cookbooks focused on family-friendly cooking, “Dinner Solved!” and “The Mom 100 Cookbook.” She blogs at https://themom100.com/. She can be reached at Katie@themom100.com.

For more AP food stories, go to https://apnews.com/hub/recipes

By LAURAN NEERGAARD, Associated Press Medical Writer

Scientists are trying a revolutionary new approach to treat rheumatoid arthritis, multiple sclerosis, lupus and other devastating autoimmune diseases – by reprogramming patients’ out-of-whack immune systems.

When your body’s immune cells attack you instead of protecting you, today’s treatments tamp down the friendly fire but they don’t fix what’s causing it. Patients face a lifetime of pricey pills, shots or infusions with some serious side effects — and too often the drugs aren’t enough to keep their disease in check.

“We’re entering a new era,” said Dr. Maximilian Konig, a rheumatologist at Johns Hopkins University who’s studying some of the possible new treatments. They offer “the chance to control disease in a way we’ve never seen before.”

Dr. Maximilian Konig, a rheumatologist at Johns Hopkins University, sits for a portrait in the lab where he’s studying some possible new treatments for autoimmune diseases, Tuesday, May 13, 2025, in Baltimore, Md. (AP Photo/David Goldman)

How? Researchers are altering dysfunctional immune systems, not just suppressing them, in a variety of ways that aim to be more potent and more precise than current therapies.

They’re highly experimental and, because of potential side effects, so far largely restricted to patients who’ve exhausted today’s treatments. But people entering early-stage studies are grasping for hope.

“What the heck is wrong with my body?” Mileydy Gonzalez, 35, of New York remembers crying, frustrated that nothing was helping her daily lupus pain.

Diagnosed at 24, her disease was worsening, attacking her lungs and kidneys. Gonzalez had trouble breathing, needed help to stand and walk and couldn’t pick up her 3-year-old son when last July, her doctor at NYU Langone Health suggested the hospital’s study using a treatment adapted from cancer.

Gonzalez had never heard of that CAR-T therapy but decided, “I’m going to trust you.” Over several months, she slowly regained energy and strength.

“I can actually run, I can chase my kid,” said Gonzalez, who now is pain- and pill-free. “I had forgotten what it was to be me.”

“Living drugs” reset rogue immune systems

CAR-T was developed to wipe out hard-to-treat blood cancers. But the cells that go bad in leukemias and lymphomas – immune cells called B cells — go awry in a different way in many autoimmune diseases.

Some U.S. studies in mice suggested CAR-T therapy might help those diseases. Then in Germany, Dr. Georg Schett at the University of Erlangen-Nuremberg tried it with a severely ill young woman who had failed other lupus treatment. After one infusion, she’s been in remission — with no other medicine — since March 2021.

Dr. Justin Kwong, a research fellow who coaxes human stem cells to grow into a kind of immune cell involved in autoimmune diseases, works in a lab at the National Institutes of Health, Tuesday, Jan 21, 2025, in Bethesda, Md. (AP Photo/David Goldman)

Last month, Schett told a meeting of the American College of Rheumatology how his team gradually treated a few dozen more patients, with additional diseases such as myositis and scleroderma — and few relapses so far.

Those early results were “shocking,” Hopkins’ Konig recalled.

They led to an explosion of clinical trials testing CAR-T therapy in the U.S. and abroad for a growing list of autoimmune diseases.

How it works: Immune soldiers called T cells are filtered out of a patient’s blood and sent to a lab, where they’re programmed to destroy their B cell relatives. After some chemotherapy to wipe out additional immune cells, millions of copies of those “living drugs” are infused back into the patient.

While autoimmune drugs can target certain B cells, experts say they can’t get rid of those hidden deep in the body. CAR-T therapy targets both the problem B cells and healthy ones that might eventually run amok. Schett theorizes that the deep depletion reboots the immune system so when new B cells eventually form, they’re healthy.

Other ways to reprogram rogue cells

CAR-T is grueling, time consuming and costly, in part because it is customized. A CAR-T cancer treatment can cost $500,000. Now some companies are testing off-the-shelf versions, made in advance using cells from healthy donors.

Another approach uses “peacekeeper” cells at the center of this year’s Nobel Prize. Regulatory T cells are a rare subset of T cells that tamp down inflammation and help hold back other cells that mistakenly attack healthy tissue. Some biotech companies are engineering cells from patients with rheumatoid arthritis and other diseases not to attack, like CAR-T does, but to calm autoimmune reactions.

Scientists also are repurposing another cancer treatment, drugs called T cell engagers, that don’t require custom engineering. These lab-made antibodies act like a matchmaker. They redirect the body’s existing T cells to target antibody-producing B cells, said Erlangen’s Dr. Ricardo Grieshaber-Bouyer, who works with Schett and also studies possible alternatives to CAR-T.

Last month, Grieshaber-Bouyer reported giving a course of one such drug, teclistamab, to 10 patients with a variety of diseases including Sjögren’s, myositis and systemic sclerosis. All but one improved significantly and six went into drug-free remission.

Next-generation precision options

Rather than wiping out swaths of the immune system, Hopkins’ Konig aims to get more precise, targeting “only that very small population of rogue cells that really causes the damage.”

B cells have identifiers, like biological barcodes, showing they can produce faulty antibodies, Konig said. Researchers in his lab are trying to engineer T cell engagers that would only mark “bad” B cells for destruction, leaving healthy ones in place to fight infection.

Nearby in another Hopkins lab, biomedical engineer Jordan Green is crafting a way for the immune system to reprogram itself with the help of instructions delivered by messenger RNA, or mRNA, the genetic code used in COVID-19 vaccines.

Biomedical engineer Jordan Green sits for a photo in his office at Johns Hopkins University, Tuesday, May 13, 2025, in Baltimore, Md., where his team is crafting a way for the immune system to reprogram itself with the help of instructions delivered by messenger RNA, or mRNA, the genetic code used in COVID-19 vaccines. (AP Photo/David Goldman)

In Green’s lab, a computer screen shines with brightly colored dots that resemble a galaxy. It’s a biological map that shows insulin-producing cells in the pancreas of a mouse. Red marks rogue T cells that destroy insulin production. Yellow indicates those peacemaker regulatory T cells — and they’re outnumbered.

Green’s team aims to use that mRNA to instruct certain immune “generals” to curb the bad T cells and send in more peacemakers. They package the mRNA in biodegradable nanoparticles that can be injected like a drug. When the right immune cells get the messages, the hope is they’d “divide, divide, divide and make a whole army of healthy cells that then help treat the disease,” Green said.

The researchers will know it’s working if that galaxy-like map shows less red and more yellow. Studies in people are still a few years away.

Could you predict autoimmune diseases – and delay or prevent them?

A drug for Type 1 diabetes “is forging the path,” said Dr. Kevin Deane at the University of Colorado Anshutz.

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Type 1 diabetes develops gradually, and blood tests can spot people who are brewing it. A course of the drug teplizumab is approved to delay the first symptoms, modulating rogue T cells and prolonging insulin production.

Deane studies rheumatoid arthritis and hopes to find a similar way to block the joint-destroying disease.

About 30% of people with a certain self-reactive antibody in their blood will eventually develop RA. A new study tracked some of those people for seven years, mapping immune changes leading to the disease long before joints become swollen or painful.

Those changes are potential drug targets, Deane said. While researchers hunt possible compounds to test, he’s leading another study called StopRA: National to find and learn from more at-risk people.

On all these fronts, there’s a tremendous amount of research left to do — and no guarantees. There are questions about CAR-T’s safety and how long its effects last, but it is furthest along in testing.

Allie Rubin, 60, of Boca Raton, Florida, spent three decades battling lupus, including scary hospitalizations when it attacked her spinal cord. But she qualified for CAR-T when she also developed lymphoma — and while a serious side effect delayed her recovery, next month will mark two years without a sign of either cancer or lupus.

“I just remember I woke up one day and thought, ‘Oh my god, I don’t feel sick anymore,’” she said.

That kind of result has researchers optimistic.

“We’ve never been closer to getting to — and we don’t like to say it — a potential cure,” said Hopkins’ Konig. “I think the next 10 years will dramatically change our field forever.”

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.

By STAN CHOE, Associated Press Business Writer

NEW YORK (AP) — Nvidia, bitcoin and others among Wall Street’s highest flyers are falling more toward Earth on Friday, and the U.S. stock market is heading for a second straight sharp loss.

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The S&P 500 sank 1.2%, coming off one of its worst days since its springtime sell-off and a global wipeout for stocks. Critics had been warning that such drops could be possible because of how high stock prices had shot since April, leaving them looking too expensive. They pointed in particular to stocks swept up in the mania around artificial-intelligence technology.

But even with its recent drops, and the S&P 500 on track for a second straight weekly loss, the index that dictates the movements for many 401(k) accounts is still within 3.3% of its record set late last month.

The Dow Jones Industrial Average dropped 582 points, or 1.2%, and was pulling further from its own all-time high set on Wednesday, while the Nasdaq composite was down 1.5%, as of 9:35 a.m. Eastern time.

AI stocks once again were at the center of the action. Nvidia, which has become the poster child of the AI frenzy, fell 2.2%.

To be sure, it’s still up 36.1% for the year so far. That would count as a stellar year for most any stock, but Nvidia’s price has more than doubled in four of the last five years.

Bitcoin, meanwhile, fell below $96,000 and is back to where it was in May. It had been near $125,000 only in October.

That helped drag down stocks of companies throughout the crypto industry. Strategy, the company that’s built a hoard of bitcoin and used to be known as MicroStrategy, fell 4%. Coinbase Global sank 3.1%, and Robinhood Markets dropped 3.6%.

Outside of tech and crypto, Walmart sank 2.4% after saying its CEO, Doug McMillon, will retire in January in a surprise move. He had helped the nation’s largest retailer embrace technology more.

One way companies can tamp down criticism about too-high stock prices is to deliver solid growth in profits. That’s raising the stakes for Nvidia’s upcoming profit report coming on Wednesday, when it will say how much it earned during the summer.

If it falls short of analysts’ lofty expectations, even more drops could be on the way. That would have a huge effect on the market because Nvidia has grown to become Wall Street’s largest stock by value, briefly topping $5 trillion.

That means Nvidia’s stock movements have a bigger effect on the S&P 500 than any other’s, and it can almost single-handedly steer the index up or down on any given day.

Another way for stock prices broadly to look less expensive is if interest rates fall. That’s because when bonds are paying less in interest, investors are often willing to stomach higher prices for stocks and other kinds of investments.

Treasury yields had been falling for most of this year on expectations that the Federal Reserve would cut its main interest rate several times this year. And the Fed has indeed cut twice already in hopes of shoring up the slowing job market.

But questions are rising now about whether a third cut, which traders had earlier seen as very likely, will actually happen at the Fed’s next meeting in December. The downside of lower interest rates is that they can make inflation worse, and it’s already still above the Fed’s 2% target.

Fed officials have pointed to the U.S. government’s shutdown, which just ended. It delayed the release of many updates on the job market and other signals about the economy. With less information and less certainty about how the economy is doing, some Fed officials have said it may be better to just wait in December to get more clarity.

In the bond market, the yield on the 10-year Treasury ticked down to 4.09% from 4.11% late Thursday.

In stock markets abroad, indexes tumbled across Europe and Asia. South Korea’s Kospi fell 3.8%, and Germany’s DAX lost 1.8% for two of the larger drops.

AP Writer Teresa Cerojano contributed.