�Թϲ�����

While Washington focused on the continuing upheaval in the White House, the Food and Drug Administration last month made a little-heralded announcement that will likely prove to be much more far-reaching. The public-health agency revealed plans to impose a new standard on tobacco products that would “limit the level of nicotine in cigarettes, rendering them minimally addictive or nonaddictive.” If the FDA follows through, millions of Americans would be spared from debilitating disease and premature death. (4/7)

Who knew that in today’s classroom, students in middle school or high school could sneak a hit of nicotine from something that looks like a flash drive, or a pen, or lipstick. They can, and they do. Nearly a quarter of high school seniors say they vape daily, and more than 1 in 10 eighth-graders say they they’ve vaped in the past year, according to the 2017 Monitoring the Future survey conducted by the University of Michigan. “Vaping” is done with electronic cigarettes, or e-cigarettes, that heat nicotine-infused liquid into a vapor, which is then inhaled by the user. There’s no smoke, just flavored vapor that can smell like strawberry, cotton candy or creme brulee. Why so much adult hand-wringing about this adolescent craze? Vaping’s sort of like smoking cigarettes, but without the lung-clogging, cancer-causing tar, right? Not exactly. There’s still a lot we don’t know about the long-term health effects of vaping, one reason why parents and school officials should be more hands-on about reversing vaping’s popularity among teens. (4/9)

The jury is still out on whether e-cigarettes will be a savior to smokers who want to quit, the gateway to addiction for a new generation, or both. But teenagers are not waiting for the answer. E-cigarettes — especially sleek new products that look nothing like traditional smokes, are easily concealed, and produce less noticeable plumes — have taken off in high schools from Maine to California. (4/8)

With the Centers for Disease Control and Prevention demonstrating that vaping products are among the most used quit-smoking tool in the U.S., many in public health recognize the need to have an adult conversation about nicotine and harm reduction. Last year, Food and Drug Administration Commissioner Scott Gottlieb attempted to do so when he announced a comprehensive nicotine and tobacco regulatory strategy. Much of his framework, particularly plans for the FDA to be much more aggressive in regulating combustible cigarettes, was met with cheers from health activist groups. Now, eight months later, these activists have petitioned a federal judge to play regulator and overturn a portion of the strategy that they disagree with — a four-year delay on requiring all vaping products to undergo a retroactive premarket review process. (Gregory Conley, 4/8)

When leading alcoholic beverage makers pay the bulk of $100 million for a study to determine whether a daily drink leads to better health, can the research results believably be free of bias? The National Institutes of Health has seriously damaged its credibility as one of the world’s leading medical research centers by obtaining industry funding for such a study. (4/7)

America has 3 million nurses. That is not enough. The U.S. Bureau of Labor Statistics estimates there will be more than 1 million vacancies for registered nurses by 2024. This is twice as bad as the worst previous nursing shortage. If there is no national and international strategy to build a workforce of nurses, we will witness — very soon — crippled healthcare systems across the world. (Christie and Watson, 4/9)

There is no plot to deny veterans access to government-funded health care as part of a grateful nation’s compensation for their service. There has been no recommendation that VA hospitals be auctioned off to for-profit medical conglomerates. There is no push to transfer the functions of the Veterans Health Administration — the government agency that operates veterans hospitals and outpatient clinics — to the private sector. What there have been are various proposals to give veterans more choices. (Jeff Jacoby, 4/7)

President Trump’s proposal to solve the opioid crisis by executing drug dealers is reminiscent of the failed War on Drugs, and it’s an absurd solution to a public health crisis that ravages families, children and entire communities across the nation. Children are entering foster care because their parents are addicted to opioids, and the epidemic is only getting worse. This crisis demands a response focused on treatment and prevention, so we can keep these families together and protect our most valuable resource: our children. (Sandy Santana, 4/7)

More than 4,000 Ohioans died of drug overdoses in 2016 — that’s 10 people per day — part of the 64,000 Americans who died overdosing on drugs that year. This is a crisis that shows no sign of slowing, as deaths from opioid overdoses increased nearly 28 percent in 2017. Especially concerning are the rates of opioid abuse in minority communities and specifically among African-Americans. As one study showed, a major obstacle is lack of access to necessary treatments. (Deborah King, 4/9)

Conor Lamb’s stunning victory in last month’s special election for Pennsylvania’s 18th Congressional District makes clear that health care is a winner for Democrats in 2018. More than half of all voters ranked it as a top issue, according to exit polls, and Lamb won the votes of 64 percent of those who named it their No. 1 priority. Republicans’ attempt last year to repeal the Affordable Care Act and send 32 million Americans into the ranks of the uninsured remains an albatross. Voters in the 18th District, where Donald Trump won by 20 percent, disapproved of the ACA repeal by 53 percent to 39 percent. (Henry Waxman, 4/8)

I hope what has been proposed in Virginia is a stepping stone to better, more comprehensive health-care system reforms that deliver on the twin goals of lowering costs and improving patient outcomes. Just as Virginia led the way on welfare reform, we can also lead the way on health-care reform by setting an example that all people who use health-care services should have skin in the game so they help pay for their own care if they get sick or hurt. (Jeff McWaters, 4/7)

For more than five years, the Virginia General Assembly has engaged in heated discussions about whether to accept federal funding through the Affordable Care Act (ACA) to expand access to health coverage for hundreds of thousands of Virginians who need it. However, as we examine this issue through the lens of the potential impact on our health care system and the families it serves, we should also consider the responsibility public officials have to look at the numbers and make the right decisions for taxpayers, regardless of the politics. (Aubrey Layne, 4/8)

What does it mean to be transgender? A Pentagon report released last month, recommending that most transgender Americans be disqualified from military service or forced to serve in their birth gender without full health care, has renewed debate over this question. Is a person less fit to serve if he or she has a medical diagnosis of gender dysphoria — significant distress over an incongruity between one’s birth sex and gender identity? Does welcoming such people threaten the cohesion of an organization like the military? (Nathaniel Frank, 4/9)

Pediatricians play a leading role in lowering the risk of gun injury and death for children. An appeals court ruling in 2017 solidified our right to ask patients if there are guns in the home and encourage parents to remove guns from the home or at least store firearms safely by locking them in a safe with the ammunition locked separately. (Robert Wiskind, 4/7)

Medical school didn’t offer any training on mediation, though I did learn early on about the concept of informed consent — how important it is for patients to understand the tests and procedures being performed, and to have a chance to have their questions answered. But in the pediatric arena, the process of informing is muddy. The law requires that only one parent consent to a test or procedure on a minor. When doctors obtain consent, they almost always obtain a single parent’s consent, and assume that his or her partner agrees. (Christopher Hartnick, 4/6)

Accidents are the No. 1 killer of American children, and car accidents are the most common kind of lethal accidents. It makes sense that health officials focus on making car accidents less common and less dangerous. Unfortunately, as with many other areas, regulations often don’t fully line up with research. In 2011, the American Academy of Pediatrics (A.A.P.) released a policy statement on car safety that recommended that children ride in rear-facing car seats until at least age 2. Before that, the recommendation was until 1. This change caused something of an internet firestorm. (Aaron E. Carroll, 4/9)

Senate Bill 1336 – which is set for a hearing Wednesday before the state Senate health and judiciary committees – would shed some light by allowing the California Department of Public Health to disclose basic information while completely respecting patient privacy and confidentiality. This reasonable, non-intrusive approach should receive bipartisan support, regardless of one’s views on assisted suicide. (Nicole Shirilla and David Major, 4/6)

In Cleveland, where I live, more than one in three households rely on SNAP. But food insecurity isn't just a big city problem: In Lakewood, for example, more than 3,300 households rely on SNAP, and even in mostly affluent Shaker Heights, nearly 1,000 households receive SNAP benefits.Here is why preserving SNAP for these families and individuals is essential. Without SNAP, our neighbors who are food insecure may be forced to choose between groceries and medicine, or groceries and utilities. Furthermore, research shows that kids who are hungry perform worse in school and are more likely to repeat a grade. People of all ages who are hungry are more likely to have adverse health outcomes as a result. For people who are food insecure and unemployed, being hungry is one in a long list of barriers to finding employment. (Kate Warren, 4/8)