�Թϲ�����

Earlier this summer, Robert Runcie, the superintendent of schools in Broward County, Florida, sent a back-to-school message to the “families and community” of Marjory Stoneman Douglas High School.His missive mentioned nothing about teachers or books or curriculum. Instead it went on for four pages about security measures the school has taken since a gunman committed mass murder there last February, killing 17 and injuring 17 more. (9/12)

Exceptional dangers require exceptional and sometimes unusual responses. This was the spirit animating the volunteers at a phone bank here Tuesday night. ...They were asking citizens to urge their state’s popular Republican senator, Susan Collins, to oppose the confirmation of Judge Brett M. Kavanaugh to the Supreme Court. The organizers were unapologetic. “The idea of Susan Collins attacking an effort by 35,000 small-dollar donors as bribery is politics at its worst,” Marie Follayttar Smith, the Accountable Leadership group’s co-director, said in a statement. “We absolutely have the right to prepare to unseat her given everything Judge Kavanaugh would do on the Supreme Court to make life worse for Maine women.” (E.J. Dionne Jr., 9/12)

(President) Trump’s response to the tragedy in Puerto Rico has been to congratulate himself for his amazingly fantastic relief efforts. On Tuesday, he celebrated his “incredibly successful” response to Maria, which killed about as many Americans as the 9/11 attacks. On Wednesday, he said his team “did an unappreciated great job in Puerto Rico,” again blaming the island territory’s infrastructure and San Juan’s “incompetent” mayor for any troubles. And the Republican majority in Congress has assisted Trump’s fiction by suppressing an investigation. (Dana Millbank, 9/12)

Kaiser Health News: Are We Being Misled About Precision Medicine?

Facing incurable breast cancer at age 55, MaryAnne DiCanto put her faith in “precision medicine” — in which doctors try to match patients with drugs that target the genetic mutations in their tumors. She underwent repeated biopsies to identify therapies that might help. “She believed in it wholeheartedly,” said her husband, Scott Primiano of Amityville, N.Y., a flood-insurance broker. “You live on hope for so long, it’s hard to let go.” (Liz Szabo, 9/13)

As we send our kids back to school, we do our best to prepare them for the new academic year. We buy their school supplies, make their lunches, sort out secure routes to and from campus and attempt to curb bullying. But there is a truly lethal threat that we scarcely discuss: asbestos poisoning. Roughly one-third of American schools contain asbestos, the dangerous mineral once heralded for its fire-resistant properties, but which we now know causes cancer and a host of other diseases, even at very low levels of exposure. (Linda Reinsteins, 9/13)

The 1998 Master Settlement Agreement (MSA) between the tobacco industry and 46 state attorneys general (AGs), five U.S. territories, and Washington, D.C., remains the largest legal settlement ever executed in the United States. The MSA achieved important public health objectives, including substantially reduced smoking rates and lives saved. Given its success, the agreement has enormous promise as a model for similar litigation or settlements that could hold industries accountable when they knowingly deceive and injure consumers with their products. Several of the most serious public health problems in the United States could be targets for AGs, including the opioid epidemic, firearm violence, excessive consumption of fast food and sugar-sweetened beverages, alcohol use, and climate change. Collectively, obesity, the misuse of alcohol and opioids, and firearm violence cause approximately 374,000 deaths each year in the United States. Data on U.S. deaths related to climate change are not systematically collected. (Cheryl Healton, 9/13)

As an infectious diseases specialist, those outpatient evaluation and management encounters are essential to the care I provide, and take about 90 percent of my time. Last month, however, the Centers for Medicare and Medicaid Services released a proposal that would add to the challenges of providing that cognitive (nonprocedural) care, by significantly reducing reimbursement for evaluation and management of complex cases such as the patient I’ve just described. (Daniel McQuillen, 9/12)

The National Academies of Science, Engineering, and Medicine (NASEM) recently released a report on sexual harassment of women working in academic sciences, engineering, and medicine. Its findings are deeply disturbing: sexual harassment is common across scientific fields, has not abated, and remains a particular problem in medicine, where potential sources of harassment include not just colleagues and supervisors, but also patients and their families. To highlight one statistic, as many as 50% of female medical students report experiencing sexual harassment. Imagine a medical-school dean addressing the incoming class with this demoralizing prediction: “Look at the woman to your left and then at the woman to your right. On average, one of them will be sexually harassed during the next 4 years, before she has even begun her career as a physician.” (Esther K. Choo, Jane van Dis, and Dara Kass, 9/13)

From the moment of conception onward, genes control our development and health. But they don’t do it alone. The exposome — all the internal and external chemical exposures we experience during the course our lives — influences, for better or worse, the genes and proteins they code for. A better understanding of the exposome, a concept still in its infancy, will help identify how nongenetic factors influence biological reactions and possibly the development of chronic diseases. There’s a canonical equation in genetics: P = G + E. In English, it means that an individual’s Phenotype (observable health and physical traits) is the sum of his or her Genetics and Environment.I think the E should stand for exposome, a term coined in 2005 by Christopher Wild, now the director of the International Agency for Research on Cancer. (Anthony Macherone, 9/13)

A smart new mental-health survey and intervention program at a number of middle schools in King County promises to help detect and prevent teen substance abuse as well as tease out feelings of anxiety or suicidal thoughts. The program, funded by the voter-approved initiative Best Starts for Kids and the Mental Illness and Drug Dependency Levy, is expected to reach as many as 35,000 students across the county in a dozen school districts over the next three years. It is a demonstration of good teen mental-health services as well as a stark example of how extra tax money can help school districts do more than the basics for their students. (9/12)

Proposition 8, which would limit revenues at nearly 600 outpatient dialysis clinics, is another power play by SEIU-United Healthcare Workers West, which is trying to organize clinic workers and force more hiring. ...While Proposition 8 is backed by labor, Proposition 11 is on the Nov. 6 ballot due to a pro-worker court decision. (9/12)