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It has been my greatest professional honor to serve our country’s more than 20 million veterans. Almost three years ago, I left my private sector job running hospitals and came to Washington to repay my gratitude to the men and women who put their lives on the line for our country. I believe strongly in the mission of the Department of Veterans Affairs, and nothing about my political experience in Washington could ever change that. I also believe that maintaining a strong V.A. is an essential piece of the puzzle that is the United States’ national security system: We can only expect our sons and daughters to risk their lives and fight for our freedom if we can keep our promise to care for them when they return home broken, injured or traumatized. (David J. Shulkin, 3/28)

In 2017, the Centers for Disease Control and Prevention (CDC) warned that life expectancy in the United States dropped for the second year in a row — and drug overdoses are the single biggest reason why. As states and communities on the front lines struggle to respond to the opioid crisis, Washington has only nibbled around the edges. Politicians and policymakers make vague promises, treating the crisis as if it is a novel, intractable problem. It is neither. America has addressed this kind of public health emergency before, and we call on Congress to do so now. (Elizabeth Warren and Elijah Cummings, 3/28)

How certain Sen. Susan Collins seemed that day back in December. How confident that her political leverage, deftly applied to her fellow Republicans’ teetering tax-reform bill, ultimately would save countless Americans from losing access to health care. Looking back, how colossally wrong she turned out to be. ...In short, with the issuance of new annual premiums looming in October, the ACA is about to go over a cliff. And as it goes, speaking of consequences, so will go millions of Americans whose health care hangs in the balance. (Bill Nemitz, 3/29)

President Trump announced a ban on transgender people in the military with a series of tweets last year that surprised many, including senior military leaders. There had been no study, no analysis, no consultation. That arbitrariness was one reason four federal judges have temporarily blocked the policy from going into effect. So when the latest iteration of the ban was rolled out last week, the White House made a point of stressing that it was accompanied by a 44-page Defense Department report and had the backing of Defense Secretary Jim Mattis. (3/28)

It often seems that there is no end to President Trump’s cruel determination to transform America into a country that divides and dehumanizes its people. After his denigration of Muslims, refugees and undocumented immigrants, the latest example of this disgraceful proclivity is a presidential policy banning most transgender people from serving in the military — the second attempt to do so in less than a year. It puts thousands of servicemen and servicewomen at risk of losing their careers and means countless others may never get a chance to put on the uniform. (3/28)

On Sunday, former Pennsylvania GOP Senator Rick Santorum suggested during CNN’s State of the Union that students protesting gun violence should not petition the government for change but should instead take CPR classes. ...Usually just ancillary to the discussion on gun violence, doctors, nurses, and emergency medical technicians this time took center stage in their condemnation of Santorum’s infuriating and misleading statement. They sparked a national conversation about the actual lifesaving measures for gunshot victims as well as their own personal experiences treating patients. (Eugene Gu, 3/28)

In the wake of the inspiring but incredibly upsetting #MeToo movement, I find myself concerned not only for the women who have already experienced sexual harassment, and certainly there are many, but also for those yet to come. Some will unfortunately experience the same pain, fear, humiliation, and stigma of sexual harassment as the stories being brought to light by the brave women who have been reporting their experiences today. In addition, I worry about the potential for gender-based neglect, an unintended backlash in response to this bright light. (Julie Story Byerley, 3/27)

SB 562 is little more than a campaign bumper sticker – unachievable, woefully deficient in policy and fiscally irresponsible. Achieving the laudable goal of universal access will take significant and long-term changes. (Theodore Mazer, 3/28)

Under House Bill 314 (HB 314), which passed the Senate for the second time on March 23 – an earlier version passed unanimously in February – insurance plans would be required to pay for these unexpected out-of-network care situations through direct and fair payments to doctors. This solution will put an end to surprise bills for patients for emergency care while also increasing transparency and establishing a dispute resolution process for other unexpected bills. (Brent Cannon and John Palmer, 3/28)

Big Pharma has had many grand successes—from correcting erectile dysfunction to masking bald spots on the president’s head. But its TV commercials are starting to make me sick. Across the dial, but especially on cable news, it’s hard to avoid drug ads in which the dominant theme seems to be a risk of sudden death. Worse, if the prescription doesn’t kill you, there’s a chance you’ll simply kill yourself. (Peter Funt, 3/28)

On January 12, 2017, the Centers for Medicare & Medicaid Services (CMS) and the Commonwealth of Pennsylvania announced the launch of the Pennsylvania Rural Health Model. The program provides rural hospitals an opportunity to transition from a fee-for-service reimbursement system based on volume to a multipayer global budget payment method that is intended to improve population health outcomes and quality of care while lowering costs. While rural hospitals provide essential health care services for 57 million people across the country, the ability to achieve financial stability is difficult for some hospitals. ...Over the past 7 years, 83 of 2244 rural hospitals in the United States have closed. One analysis suggests that without intervention, an estimated 673 rural hospitals in the United States may also close over the next 5 years. (Karen M. Murphy, Lauren S. Hughes and Patrick Conway, 3/27)

Although it is difficult to imagine a health care service that is more valuable to society than childbirth, US hospitals often lose money when they provide local childbirth services for healthy mothers. This discrepancy is a major flaw in the design of the maternal health system that may be the basis for lagging birth outcomes in the United States compared with other high-income nations. (Neel T. Shah, 3/27)

Zika remains a health threat in the United States, and public health systems are essential to monitoring the full effect of congenital Zika virus infection on infants and children. Because some healthy infants born following pregnancies complicated by Zika may have developmental problems that become evident later, developmental milestones should be closely monitored throughout the child’s first years of life. (Brenda Fitzgerald, Coleen Boyle and Margaret A. Honein, 3/27)

It’s possible that Bill Harris could have saved Tom Petty’s life, and Prince’s too. But they didn’t ask him. Wait a minute. . . . What does a retired Harvard Medical School professor have to do with the titans of rock and roll? Let me explain. Tom Petty died of an accidental drug overdose last year. An autopsy found three kinds of fentanyl and oxycodone in his system, all of them powerful and addictive painkillers. His wife and daughter revealed that Petty had been performing tour dates — 53 of them — with a fractured hip. “Despite this painful injury he insisted on keeping his commitment to his fans and, as he did, it worsened to a more serious injury,” Dana Petty and Adria Petty said in a statement. “On the day he died he was informed his hip had graduated to a full-on break, and it is our feeling that the pain was simply unbearable and was the cause for his over use of medication.” (Alex Beam, 3/28)

Sugar hasn’t just played its part in Britain’s reputation for tea, cakes and bad teeth; it’s also a major contributor to the country’s obesity and diabetes crisis. ...It’s an issue you might think would weigh on the mind of Prime Minister Theresa May, herself a diabetic, though not a known sugar addict. In fact, May has been, at best, a part-time flagbearer for sugar intake reduction, having scrapped such a tax as one of her first moves in 2016, a cave-in to heavy industry pressure. That will hopefully change this April, when a tax on sugary products — announced last year by Chancellor Philip Hammond as the Soft Drinks Industry Levy — comes into effect.( Richard Martyn-Hemphil, 3/29)

Infectious disease is distinguished from most other fields of medicine by constant and rapid change. As microorganisms emerge, new treatment and prevention strategies also evolve. Although much progress has been made, infections remain a major and often preventable cause of death worldwide. In this issue of JAMA, el Bcheraoui and colleagues report mortality trends for major infectious diseases in the United States, both nationally and at the county level, using data from the National Center for Health Statistics. In one of the first studies of its kind, the authors used deidentified death records to examine mortality trends for the most common causes of infectious diseases mortality, including lower respiratory infection, diarrheal disease, HIV/AIDS, hepatitis (excluding chronic hepatitis B and C), meningitis, and tuberculosis. (Emily K. Shuman and Preeti N. Malani, 3/27)