Biden prostate cancer diagnosis: Inside the 82-year-old former president's health history
As president, Biden had regular physical examinations at Walter Reed National Military Medical Center in Bethesda, Maryland, that were conducted by Dr. Kevin O'Connor, a former U.S. Army physician who began treating Biden during his time as vice president in the Obama administration.
Though he was the oldest person to serve as commander-in-chief, O'Connor's reports from those annual exams downplayed his age and invariably pronounced him fit to serve.
One February 2024 memorandum from O'Connor, following Biden's final annual physical as president, described him as 'a healthy, active, robust 81-year-old male, who remains fit to successfully execute the duties of the Presidency, to include those as Chief Executive, Head of State and Commander in Chief.'
Yet subsequent events have called into question whether O'Connor — and other top Biden administration aides — were forthcoming about the then-president's health and fitness.
Four months after his final physical, Biden's performance at a June 2024 debate with Donald Trump was so dismal that he was forced to exit the race just five weeks later. During the 90-minute televised session, he appeared frail and was unable to form coherent sentences at times, leading to questions over whether he was suffering from any sort of degenerative condition.
Last July, then-White House Press Secretary Karine Jean-Pierre denied that he was suffering from Alzheimer's, a form of dementia, or another degenerative illness that would explain his rambling, meandering performance. And no evidence has emerged that Biden has been diagnosed with any condition that would have had such an effect on his mental acuity other than the normal aging process.
Yet this is not the first time he has been diagnosed with a form of cancer.
In March 2023, the White House announced that Biden had undergone a procedure to remove a common type of skin cancer from his chest.
A memorandum from O'Connor released to the press at the time said a biopsy 'confirmed that the small lesion' removed from the then-president 'was basal cell carcinoma'.
'All cancerous tissue was successfully removed. The area around the biopsy site was treated presumptively with electrodessication and curettage at the time of biopsy. No further treatment is required,' O'Connor added.
The former president also battled Covid-19 at two different points during his term, once in 2022 and a second time in July 2024, days before he decided to stand down from his re-election bid after his disastrous debate with Trump.
Before his first bout with Covid, the most serious health problem he had faced since winning the 2020 election had been a broken foot, endured while playing with one of his German Shepherd dogs.
But his health was not always so robust.
Twice in the 1980s, Biden had near-death experiences that required him to undergo brain surgery two times within five months.
He described them in a speech delivered at a Jerusalem hospital during a February 2023 visit to Israel.
'I was making a speech and I had a terrible headache — this was years ago — and I did a very stupid thing: I got on an aircraft and I flew home. It turned out I had two cranial aneurysms, and I got rushed to a hospital in the middle of a snowstorm for a nine-and-a-half-hour operation that saved my life,' he recalled, describing the February 1988 trip to Walter Reed Army Medical Centre, then in Northwest Washington DC.
The plane ride Biden spoke of came after he'd passed out in a hotel following a speech at the University of Rochester.
In his 2007 memoir, Promises to Keep, Biden wrote that he recalled having "lightning flashing inside my head, a powerful electrical surge — and then a rip of pain like I'd never felt before'.
At Walter Reed, he was told he needed surgery, with only a 50-50 chance he'd live through the procedure.
"Maybe I should have been frightened at this point, but I felt calm," he wrote. "In fact, I felt becalmed, like I was floating gently in the wide-open sea. It surprised me, but I had no real fear of dying. I'd long since accepted the fact that life's guarantees don't include a fair shake."
But he did survive, and three months later he underwent a similar procedure to fix another, smaller aneurysm on the opposite side from the first.
According to The Daily Beast, the then-senator made a last-minute request of the surgeon, Dr Neal Kassell, as he was being wheeled in for the procedure.
'He looked me in the eye and said: 'Doc, do a good job, because someday I'm going to be president,'' Dr Kassell said in November 2020, just days after Biden's prediction finally became reality with his victory over Trump.
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Times
an hour ago
- Times
‘I was the Trump team': how the Podcast Election was won
The president's social media strategist has had a busy morning stirring up online outrage. In the past few hours Alex Bruesewitz has condemned Democrats as a 'pathetic group of people', denounced critics of Jair Bolsonaro, the former president of Brazil, as 'far-left maniacs' and shared a post of the 'horrible' liberal podcast host Alex Cooper being booed at a baseball game. Bruesewitz, 28, has been starting arguments like this professionally for a decade but now, sipping a glass of water at the Waldorf Astoria in Washington, in a well-fitted navy blue suit, he is relaxed and even polite. He co-founded X Strategies, a company that counsels conservatives on how to win social media wars, when he was 19. Last year he was the architect of the podcast game plan credited with helping Donald Trump to win back the White House. Today he is at the heart of the administration's ultra-combative communications operation, working as a hired gun because he is planning to get married and thinks that it is 'a little bit difficult' to afford a wedding on a government salary. Often the best ideas are not his, he says. Take some of the viral memes — of Trump dressed as the Pope, or Gaza rendered as a holiday resort (Gaza-Lago), or the AI-generated cartoon of a crying migrant — that have driven huge clicks and controversy, amplified by the president's social platforms. Bruesewitz says they are generated by Trump 's fans, whom he calls 'really talented people'. 'These guys make some of the best memes, and they're bus drivers in small towns across the country,' he says. 'And they get off of work and they go home and they open their computer, they tell their wife they love them and they log on to X for the next five hours of their life. And they're making hilarious memes of the president or videos of the president.' But it was podcasts, not memes, that really sealed his reputation. During the 2024 campaign, which became known as the 'podcast election' because of the extent to which the format often seemed to usurp traditional media, Trump appeared on 20 episodes. Most were hosted by young men and popular with young men. These appearances reached 23.5 million Americans in an average week, compared with 6.4 million for his Democratic opponent, Kamala Harris. Subsequently 56 per cent of men aged 18 to 29 backed Trump in 2024, up from 41 per cent in 2020. Trump's podcast circuit has been depicted as a long pitch to the 'right-wing manosphere'. Bruesewitz thinks this is unfair. 'None of the podcasters we sat down with during that period were Trump lovers,' he says. Instead, he calls them 'equal-opportunity critics' — hosts who have been critical of Trump on certain issues, and critical of Democrats on others. He also notes that Trump saw a bounce among young women, up from 33 per cent in 2020 to 40 per cent in 2024. Podcasts worked for the candidate because they suited his unique political skills, he says. 'The greatness about President Trump is that he knows all the issues, and he also has charisma that is unrivalled in the political space,' Bruesewitz says. In general, little to no preparation was needed. 'I think over-prepping your candidates is what kind of trips you up.' Underpreparing has its pitfalls too. Rapid rise In the last few days of the election The Atlantic described Bruesewitz as a 'terminally online troll and perpetual devil on the campaign's shoulder' who had urged JD Vance to amplify the lie that illegal Haitian immigrants were stealing and eating pets. The magazine also reported that it was Bruesewitz who had personally advocated for the comedian Tony Hinchcliffe to appear at a Trump rally days before the election, at which he then called Puerto Rico a 'floating island of garbage' (Bruesewitz says both claims are untrue.) But Trump's subsequent victory cast him in a much more favourable light and Axios hailed him as 'one of the most influential political strategists in the US'. In February the Trump family appointed him senior adviser to the political action committee Never Surrender, entrusting him with running two of the president's social media accounts. His team of five, based in Florida, manage the @TrumpWarRoom and @TeamTrump handles, which are followed by millions (although the president still posts his own messages on Truth Social). Bruesewitz has also found time to meet some British conservatives. He met Kemi Badenoch, the leader of the Conservative Party, in London. 'I think she's a good person,' he says, adding that she's got the issues right but is in a tough position. 'The party that she leads now was led by imbeciles before.' On the Reform leader Nigel Farage, he says: 'He's probably the best in the UK and my advice to him has been to make sure you use your momentum and your platform to build up the voices of the next generation because he's not going to be hot for ever.' It all started with a tweet Bruesewitz's career started in April 2015 when he was 18 years old. He was sitting at his high school desk in the Wisconsin town of Ripon (population 7,900), 'and I posted a picture of the Trump Hotel in Chicago,' he says. 'And I said, 'the sign on Trump Chicago would look just as good on the White House'. And the president, then businessman Donald Trump, retweeted me.' Two months later, Trump announced his candidacy. 'And when he announced that he was running, I was sold already. I wanted to be like Donald Trump.' After high school, Bruesewitz skipped college and tried his hand at real estate, having admired the empire Trump had built. 'I didn't do so well in that,' he concedes. Trump's election in 2016 inspired Bruesewitz and his business partner Derek Utley to form X Strategies a year later. Their early clients included FreedomProject Academy, a Christian conservative homeschooling academy in central Wisconsin, and a father who lost his daughter in the Parkland school shooting in 2018. Utley and Bruesewitz represented the latter pro bono as he argued for more school security rather than fewer guns. Then came the 2020 election and Trump's claims of election fraud. Bruesewitz leapt to his defence on social media and made a speech in Washington's Freedom Plaza. When the BBC invited Bruesewitz on air, he argued with the presenter. 'Thank you for having me on,' he said, 'and I just want to make one thing very clear … your country's opinion stopped mattering in our country in 1776.' His sparring eventually got Donald Trump Jr's attention. 'He liked my tenacity online,' Bruesewitz says. 'He found me to be quite entertaining.' The two became friends and Don Jr introduced Bruesewitz to his father. 'I got to spend quality time with the president for the first time at a live golf tournament at his club in New Jersey,' he tells me. 'I ended up spending four and a half hours with the president that day.' They spoke about 'all things' — not just politics. 'And we've had a great relationship ever since.' After that, Bruesewitz poured his energy into attacking Republicans who had backed Trump's impeachment — not as an official Trump appointee but out of 'sheer patriotism and love of nation'. Eight out of ten of those Republicans either declined to stand in 2022 or lost their primary. 'We travelled [around] their campaign districts,' Bruesewitz says. 'I personally picked fights with Liz Cheney and Adam Kinzinger,' he says of the two anti-Trump Republican members of Congress, 'which was also great entertainment. I found great joy in that'. In November 2022, the Trump family finally hired Bruesewitz. His mission? To help beat Ron DeSantis, governor of Florida, to the Republican presidential nomination. That worked — and then came the general election. The podcast plan It was Trump's youngest son Barron, not Bruesewitz, who set up the first big podcast interview — with the 24-year-old online streamer and influencer Adin Ross — which proved the power of the format before the election. Bruesewitz calculated that clips from Trump's appearance were seen by 113 million people in the first 24 hours. When Bruesewitz presented the numbers to Trump, 'he flipped through it, and he was like, 'these numbers are massive''. Trump also thanked his 19-year-old son in a Truth Social post. 'And then about four or five days passed, and he kept texting me or calling me about how great that interview was.' Not long afterwards, Bruesewitz was called into the office of Susie Wiles, who helped manage Trump's election campaign and is now White House chief of staff. 'She's like, 'Alex, we've got to get him to do more of these.'' After that, they went all in. 'We lined them up, one major podcast a week, up until we did Rogan, which was like a week before the election,' Bruesewitz says. The appearance on The Joe Rogan Experience, the most popular podcast in the US, garnered more than 44 million views on YouTube by election day, allowing Trump to reach young, predominantly male voters, opining on topics such as martial arts, the possibility of life on Mars, and his admiration for William McKinley, the president who was assassinated in 1901. When I ask how Bruesewitz decided which podcasts Trump should do, he shrugs. 'I mean, I just went through something called Spotify and Spotify rankings. And I think we did eight of the ten podcasts on Spotify that were popular.' There was one conspicuous exception, however. Trump avoided Alex Cooper's Call Her Daddy, one of the most popular podcasts among young American women. Cooper, the 30-year-old host of the show, is beloved by her 'Daddy Gang' — some 70 per cent of whom are female, with 76 per cent under 35. In October Kamala Harris appeared on the podcast, discussing women's rights and abortion. Cooper later said her team had a Zoom call with Trump's team about the possibility of him appearing. Bruesewitz says that's not true. 'I was President Trump's team,' Bruesewitz says. 'I never had a conversation with Alex Cooper about going on the podcast. Her team reached out to me. We never responded. I would never put the president on Call Her Daddy.' Why not? 'Because one, she's terrible, she's terrible at what she does. I think personally. I think she's been a detriment to society with the content that she talks about.' And she's 'regressive', he says, 'when it comes to starting families and having happy, healthy relationships'. A source close to the Call Her Daddy team confirmed that a call about the president coming on the show occurred before the election in November 2024 with members of his campaign team, including discussing a suggestion by his staff that they film the episode at Mar-a-Lago. Unexpected love story Instead, looking for a female-friendly podcast to counter Harris's appearance on Call Her Daddy, he landed on a show called Girls Gone Bible. 'It's the No 2 religious podcast on Spotify,' he says. 'Massive following. They do these in-person shows where they get 1,000 young girls at each tour stop. They talk about Jesus and they pray over them. And it's actually really beautiful.' Bruesewitz organised a meeting between Trump and the hosts of Girls Gone Bible in Las Vegas. The night before, one of the hosts brought a glamorous friend to dinner. It was Carolina Urrea, the former Miss Nevada. 'Carolina walked in. I'm like, wow, who's that girl?' The following day, Carolina took a picture with Trump, who gave Bruesewitz a 'thumbs up'. The pair got engaged eight months later. Bruesewitz says his fiancée has 'strengthened my relationship with the Lord'. ALEX BRUESEWITZ/INSTAGRAM He sees his experience as part of a larger shift toward Christianity in America in recent years. 'Another trend is moving away from the girl boss attitude to the trad wife,' he says. 'I don't know if it was Covid that kind of made that switch where people were spending more time at home and they were, you know, learning to cook more and doing more things. But that trad culture started taking off big time.' • My day with the trad wife queen and what it taught me While podcasts helped Trump to reclaim the White House, the president has rarely appeared on them in his second term. Though he showed up last month on the New York Post's Pod Force One, Trump is spending most of his time these days on Truth Social and his old favourite: TV news. Bruesewitz, who describes Trump as 'a good friend of mine' thinks this could change. 'I think he'll eventually do some. You know, he's been very busy running the free world.' As for his own future, he says that Trump would have endorsed him to run for office if he had wanted to, but he didn't. 'I think Congress would be a little too boring for me.'
BBC News
an hour ago
- BBC News
Our body is a mosaic of fungi. Some scientists think they could be influencing our brain
The fungi within our bodies may have a much greater effect on our health than we've long given them credit for. Amongst the millions of tiny life forms living on and inside our bodies are countless species of fungi. Our skin is a mosaic of them, membranes inside the nose and vagina are full of them, and fungi even live alongside the bacteria inside our guts. While we might acquire some fungi from our mothers at birth, new fungi are also constantly entering our bodies; we ingest yeasts every time we drink beer or eat bread, and we inhale floating fungal spores with every breath. Many of these fungi are quickly killed off by our immune systems, but others are transient passengers or lifelong acquaintances. Lately, scientists have been exploring how our fungal inhabitants could even influence our brains, minds and behaviour. Doctors have long known that fungi can cause dangerous brain infections. But researchers are now also finding curious – albeit sometimes controversial – hints that these microbes might have other neurological effects on humans. The idea might evoke images of the human-zombifying fungus from HBO's apocalyptic series The Last of Us. But while scientists agree that the idea of fungi taking complete control over our bodies is implausible, they're earnestly investigating whether some fungi inside us could contribute to brain-damaging diseases, or if gut-dwelling fungi could influence our behaviour and mental health. Much more research is needed, experts say. But these possibilities are important to study – both to understand the deep and complex relationships with the microbes within us and to explore new ways of boosting our health. In general, humans are pretty good at resisting fungi (our warm body temperature tends to make it hard for them to take hold). And many of the fungi that do might actually be good for us, possibly supporting our immune systems or helping wounds to heal, says microbiologist Matthew Olm of the University of Colorado Boulder, US. "I would say fungi are definitely a critical part of being a healthy human," he says. But many other fungi can cause infections, from athlete's foot to thrush. This happens when we encounter new, harmful fungi in our environment or when fungi that naturally coexist with us are under certain conditions triggered to explode in abundance, says Rebecca Drummond, a fungal immunologist at the University of Birmingham, UK. It's rare for fungi to reach the brain, thanks to protective barriers in the lungs and intestines, along with the brain's own defensive wall, the blood-brain barrier, and immune cells that are primed to destroy any fungi that slip through. But fungal brain infections do happen, and the number of cases has increased in recent decades. This is due to a growing number of people with weakened immune systems, Drummond says, partly because of the global spread of the immune-crippling virus HIV, especially in parts of Africa but also due to rising use of immune-suppressing medications in cancer patients and organ transplant recipients. "The more of these immune-modulating drugs we use, we'll see more of these fungal infections," Drummond says. Fungi that infect the brain sometimes originate in the lungs, including Aspergillus or Cryptococcus, which we inhale as airborne spores that can germinate, grow and spread if left unchecked, Drummond says. Less often, common gut residents such as Candida albicans grow out of control and, once in the brain, branches out and produces nerve-killing toxins, Drummond adds. Cryptococcus, meanwhile, can grow into tumour-like masses. "Obviously, that causes huge amounts of damage," she says. Fungal brain infections are often fatal, with Aspergillus reaching mortality rates of above 90%. They can be tricky to treat, says Drummond: there aren't many antifungal medications, and not all drugs get across the blood-brain barrier to kill off brain-dwelling fungi. Some fungi have also already developed resistance to these drugs. People who survive fungal infections of the brain are often left with long-term brain damage. Aids patients who have survived cryptococcal meningitis, which arises from a brain infection by Cryptococcus x, suffer vision impairments, memory loss and dizziness, says Drummond. Scientists have long known of the dangers of fungal brain infections. But in recent years, some have been exploring the possibility that fungi are getting into the brain much more frequently than previously believed, and may even be contributing to the loss of nerve cells that occurs in conditions like Alzheimer's disease. To Richard Lathe, a molecular biologist at the University of Edinburgh, UK, some of the most interesting evidence for this theory comes from a handful of cases where fungal and other microbial brain infections were coincidentally discovered in people initially diagnosed with Alzheimer's disease. In several cases where doctors prescribed infection-fighting medication, "the symptoms of dementia remitted", Lathe says. "Quite remarkably, some of them went back to work". Lathe believes that microbes slip across the blood-brain barrier quite frequently but are usually suppressed or killed in people with healthy immune systems. Because our immune systems weaken with age, that could allow microbes to accumulate in the brain, perhaps triggering nerve-killing inflammation. "It's only when the immune system declines that you see damage," he says. Scientists have long linked Alzheimer's to a build-up of certain proteins in the brain, but there's now a growing debate over whether the presence of those proteins is the cause or merely a symptom of the disease. Lathe argues these proteins are actually produced as a defence mechanism against microbial intrusion, based on research suggesting the proteins have infection-fighting properties. Further evidence that brain-intruding microbes could be causing Alzheimer's comes from experiments in mice, where scientists have witnessed the fungus Candida albicans entering the brain after the rodents' immune systems were compromised. And in one pre-print study – which hasn't yet been peer-reviewed by other scientists – Lathe and his colleagues examined brain slices from deceased healthy people and Alzheimer's patients. They found large quantities of bacteria, viruses and fungi in both groups – but more in the brains from patients who had Alzheimer's. If microbes are indeed a factor in Alzheimer's, we may be able to mitigate or even prevent the disease by strengthening people's immune defences, for instance with vaccines that have been shown to boost general immunity. But this theory is young, Lathe says. "It's a new idea." And a debated one, too. Olm and others argue it's hard to rule out that the microbial genetic material may have appeared because of contamination, as fragments of microbes tend to be ubiquitous. Lathe finds that unlikely, though, pointing to reports that microbe fragments in brain tissue are just as abundant inside the samples as they are on the surface, whereas contamination from the air would mostly settle on the brain surface. Still, Olm says that finding more microbe fragments in Alzheimer's brains isn't proof that those microbes cause the disease. For instance, those people's brains might simply have had a weaker blood-brain barrier or some other issue, meaning more microbes entered their brains over time before being killed off by their immune systems. However, new evidence that microbes can invade the brains of animals like fish strengthens the notion that this could be happening in mammals – and perhaps even humans, Olm says. In a 2024 study, scientists labelled bacteria with tiny, fluorescent green molecules and added them to tanks housing salmon and trout. "After a week, you see these microbes making their way into the fish brain, lighting the fish brain up green," Olm says, and curiously, "[the microbes] seemingly live there without huge consequences for these fish over their lifetime." In any case, the notion of fungi and other microbes getting into the brain in old age – either due to a weakening brain immune system or a worn-out blood brain barrier – is more plausible. "I think we've now reached that threshold where there's enough smoke around this hypothesis… it's worth spending money on figuring out if that is happening," Olm says. More like this:• What your snot can reveal about your health• Why the microbes that live on your skin matter• The mystery origins of Candida auris Interestingly, fungi might not need to enter the brain in order to influence it. In a 2022 study, immunologist Iliyan Iliev of Weill Cornell Medicine in the US and colleagues found that adding Candida albicans to the guts of mice made them more resilient to damage of their gut linings caused by bacterial infections or heavy antibiotic use. Strengthening the gut wall may be a defence mechanism by the body to prevent the fungus and other microbes from escaping the gut and infecting other tissues, Iliev says. But the big surprise came when the team observed the rodents' behaviour. Remarkably, fungi-colonised mice were much more likely to sniff, communicate and engage with other mice – meaning that exposure to the fungi appeared to have some sort of behavioural effect too. Based on other experiments, the scientists theorise that certain molecules released by the mice's immune cells enter the bloodstream and somehow stimulate certain nerve cells in the brain that are involved in behaviour. "It was very surprising to us," Iliev recalls. It's a mystery why, at least in mice, this crosstalk between gut fungi and the brain exists. Is it a coincidence that fungus-triggered immune signals affect the brain, or "is that actually deliberately done by the fungus to benefit its survival?" Iliev asks. Perhaps mammalian bodies somehow benefit from changing their behaviour in response to fungi, Iliev speculates. There's no evidence yet that this crosstalk between gut fungi and the brain happens in humans, but the possibility would be worth investigating, Olm says. In recent years, evidence has mounted that gut-dwelling bacteria may be able to send signals to the brain via the immune and nervous systems, or by producing substances associated with the symptoms of depression, anxiety, and relaxation. In principle, Olm says, "there's no reason to think that fungi aren't doing this as well". (Read more about how gut bacteria could be influencing the brain). Some scientists are even investigating whether fungi could be involved in mental disorders. Several studies have found differences in the makeup of gut fungi in people who suffer from depression or bipolar disorder. In women with schizophrenia, those who showed signs of exposure to the gut-dwelling Candida albicans tended to score lower on tests of memory and other cognitive abilities, according to a 2016 study by Johns Hopkins neuroscientist Emily Severance and her colleagues. She is exploring the possibility that Candida overgrowth – caused by stress or antibiotics, for instance – provokes an imbalance of gut microbes, altering the substances they produce in ways that make susceptible people more likely to develop schizophrenia. If true, it could allow doctors to treat schizophrenia symptoms by giving people probiotics that help reverse the overabundance of Candida – which would in any case be helpful, she says. But finding an association doesn't mean that the fungi cause schizophrenia. It could simply be that these patients are somehow more prone to high levels of Candida. So far "we can only come up with associations", says Severance. 'I think that that's typical for a field of study that is very exciting – but still very early on in the timeline.' Which of our fungal inhabitants – if any at all – are really influencing our brains is something scientists hope to learn in the coming years. "[Fungi are] definitely important," Drummond says, "but exactly how they're important, I think, is still being worked out." One thing is already clear: while bacteria have long been in the limelight, it may be time we also pay serious attention to the fungi quietly shaping our health from within. -- For trusted insights into better health and wellbeing rooted in science, sign up to the Health Fix newsletter, while The Essential List delivers a handpicked selection of features and insights. For more science, technology, environment and health stories from the BBC, follow us on Facebook, X and Instagram.
Reuters
an hour ago
- Reuters
Kremlin says Putin is ready to discuss peace in Ukraine but wants to achieve goals
MOSCOW, July 20 (Reuters) - Russian President Vladimir Putin is ready to move toward a peace settlement for Ukraine but Moscow's main objective is to achieve its goals, Kremlin spokesman Dmitry Peskov told state television in a clip published on Sunday. Peskov said that the world was now accustomed to U.S. President Donald Trump's sometimes "harsh" rhetoric but pointed out that Trump had also underscored in comments on Russia that he would continue to search for a peace deal. "President Putin has repeatedly spoken of his desire to bring the Ukrainian settlement to a peaceful conclusion as soon as possible. This is a long process, it requires effort, and it is not easy," Peskov said told state television reporter Pavel Zarubin. "The main thing for us is to achieve our goals. Our goals are clear," Peskov said. On Monday, Trump announced a tougher stance on Russia, pledging a new wave of military aid to Ukraine, including Patriot missile defence systems. He also gave Russia a 50-day deadline to agree to a ceasefire or face additional sanctions.
