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This year, a handful of Democratic-led states are gearing up to curb further rate hikes by enacting laws and adopting insurance regulations designed to shore up the traditional insurance industry and restore parts of the ACA, known as Obamacare. At the same time, at least one Republican-leaning state has moved to further unravel the federal health law by encouraging insurance companies to offer cheap policies with fewer benefits. Others are expected to follow. (Vestal, 1/26)

Idaho officials will allow insurers in the state to sell health plans that don’t comply with rules set up under ObamaCare — a move that could test how committed the Trump administration is to enforcing the law. Under the new guidelines, insurers will be allowed to offer “state-based plans” to consumers that won’t be required to meet some of the basic rules of ObamaCare plans, such as the essential health benefits that plans must cover. (Weixel, 1/25)

In a bulletin issued Wednesday, the Idaho Department of Insurance said that it would allow insurers in the state to begin offering “state-based plans” to consumers. These products could leave out some of the benefits mandated by the ACA for individual coverage. Insurers would be able to consider enrollees’ medical history in setting their premiums, a practice known as underwriting, which isn’t authorized under the ACA. The new state-based plans could also include dollar limits on total benefit payouts, which the ACA banned. (Wilde Mathews, 1/25)

Sen. Elizabeth Warren (D-Mass.) on Thursday said it was time to go on “offense” on health care after a year of defending ObamaCare against repeal efforts. In a speech to a conference hosted by Families USA, a leading liberal health-care advocacy group, Warren laid out a range of ways to build on the Affordable Care Act, and attacked health insurance companies for how they treat consumers. (Sullivan, 1/25)

GOP leaders from both chambers of Congress want reinsurance. But they want it in different ways. And with two different Republican measures on the table, each handling the mechanics differently, the big question is: Which one will win out if congressional Republicans go through with their plan to address stabilization in an upcoming spending bill. The GOP-only House iteration sponsored by Rep. Ryan Costello (R-Pa.) allocates $30 billion over three years at the full discretion of the HHS secretary.  It would also consolidate a federal reinsurance program as the House GOP leadership tried to do through their failed attempt to repeal and replace the Affordable Care Act. It also includes retroactive funding of cost-sharing reduction payments for the rest of 2017 and future funding for 2019. (Luthi, 1/25)

A federal advisory committee on Thursday recommended that the Food and Drug Administration reject a bid by Philip Morris International to market a smokeless tobacco stick in the United States as safer than traditional cigarettes. (Kaplan, 1/25)

The penlike device heats Marlboro-branded sticks of tobacco but stops short of burning them. It is already sold in more than 30 countries and Philip Morris aims to make it the first "reduced risk" tobacco product ever sanctioned by the U.S. The votes Thursday by the panel of Food and Drug Administration advisers on the marketing of the iQOS device are nonbinding. The FDA will make a separate decision on whether to allow the product on the market, and — if so — how it could be marketed to consumers. (Perrone, 1/25)

For the user, the IQOS system delivers nicotine like an e-cigarette, but with the taste and buzz of tobacco. A cigarette burns at 600 degrees, but at 350 degrees, the HeatStick tobacco never ignites. The user exhales a largely odorless vapor in which some of the most toxic byproducts of combustion — carbon monoxide, nitrogen oxides, formaldehyde, mercury and ammonia — are reduced by 69% to 99.9% compared to the average cigarette on the market. (Healy, 1/25)

There was some support for the company's claims that "switching completely to iQOS presents less risk of harm than continuing to smoke cigarettes." But the measure failed on a vote of 4-5 against. (Stein, 1/25)

“I don’t see a whole host of studies,” Michael Weitzman, an advisory panel member and professor in the Department of Pediatrics at New York University School of Medicine, said before the vote. “I feel very uncomfortable making the judgment call. What we’ve seen -- it suggests, it implies. I could not say under oath that what we’ve seen demonstrates.” (Edney, 1/25)

The cigarette has triggered debate and worries among health experts about whether IQOS will help or hurt public health in this country. Health advocates worry that such products could be used to attract new smokers and lure people away from quitting altogether. IQOS represents a significant investment by Philip Morris as smoking in the United States drops to all-time lows. The company spent $3 billion to develop IQOS and other smokeless tobacco products and has begun selling them in other countries. The company’s stock was down 2.8 percent Thursday afternoon after tumbling by as much as 6 percent during the advisory panel’s meeting. (Wan, 1/25)

The advisory panel members said unanimously they didn’t believe Philip Morris had shown consumers would understand the risks of using IQOS from its labeling and advertising. A majority of panelists also said the likelihood was low U.S. smokers would switch completely to IQOS. A Philip Morris spokesman said, “We are confident in our ability to address the valid questions raised by the Committee with the FDA as the review process for our application continues.” (McKay and Chaudhuri, 1/25)

Seventeen public health schools in the U.S. and Canada pledged Thursday to refuse research money from a new anti-smoking group funded by the tobacco industry. The Foundation for a Smoke-Free World was created in September with nearly $1 billion from the Philip Morris tobacco company, saying it aims to end smoking worldwide and support research to meet that goal. But deans of public health schools at Harvard, Johns Hopkins and other universities said the group is too closely tied to an industry that sells deadly products to millions. (Binkley, 1/25)

Democrats are focusing on health care as the dominant policy issue in the 2018 midterm elections, but a new poll finds that voters in battleground states have greater concerns. Health care is the top issue for voters nationwide but ranks fourth in importance in states with competitive House, Senate and governor races, according to a Kaiser Family Foundation poll released Friday. In those states, voters say jobs and the economy, the situation in North Korea and immigration are more important for congressional candidates to talk about during the campaign. (McIntire, 1/26)

Kaiser Health News: In Battleground Races, Health Care Lags As Hot-Button Issue, Poll Finds

As the midterm elections approach, health care ranks as the top issue, mentioned more frequently among voters nationwide than among those living in areas with competitive races, a new poll finds. In areas with competitive congressional or gubernatorial races, the economy and jobs ranked as the top issue for candidates to discuss, with 34 percent of registered voters listing it as No. 1, according to the poll from the Kaiser Family Foundation. (Rau, 1/26)

Polling conducted by Democratic operatives in 18 GOP-held congressional districts suggests voting to repeal Obamacare or the recently passed tax reform law will damage Republican incumbents' chances at reelection. ...While polling has shown both Obamacare repeal and the tax law to be unpopular, the operatives believe this is the first public experiment to show how attacking members for their support of either piece of legislation could damage GOP chances to hold the House in 2018. (Robillard, 1/25)

The Veterans Affairs administration failed to seriously investigate multiple complaints of poor patient care at the Manchester VA Medical Center in New Hampshire until media reports last year made the issues public, according to a sharply critical letter a whistle-blower agency sent to President Trump. Doctors at New Hampshire’s only hospital for veterans had long complained that an extraordinary number of veterans being treated in Manchester were suffering from a rare spinal condition that can lead to paralysis if not treated. They said it was a sign hospital officials were not paying attention to patients’ declining conditions until it was too late. (Estes, 1/25)

The independent federal agency noted that the VA knew about shortcomings in January 2017 but acted only after the media reported about fly-infested operating rooms and spine patients facing “Third World” problems. The Special Counsel also said the VA’s Office of Medical Inspector (OMI) did not go far enough in reviewing patient charts and investigating complaints raised by whistleblower doctors. “Basically, what it is is a cover-up. That’s what the OMI has done,” said Andrea Amodeo-Vickery, who represents the whistleblower doctors. (Hayward, 1/25)

In response to the Globe report, Secretary of Veterans Affairs David Shulkin immediately removed three top officials and ordered an investigation. Shulkin visited the hospital in August, and said a task force would explore bringing a full-service veterans hospital to New Hampshire, teaming up with other hospitals in the state or forming a public-private partnership to improve care. "The VA did not initiate substantive changes to resolve identified issues until over seven months had elapsed, and only did so after widespread public attention focused on these matters," Special Counsel Henry J. Kerner wrote to President Donald Trump. "It is critical that whistleblowers be able to have confidence that the VA will address public health and safety issues immediately, regardless of what news coverage an issue receives." (Casey, 1/25)

A Springfield veteran with Lou Gehrig's disease who needs around-the-clock care is suing the U.S. Department of Veterans Affairs over a plan to force him to move to a nursing home out of state. The lawsuit, filed in U.S. District Court in Eugene, says Michael Williamson has received in-home care for nearly 17 years through a company that contracts with VA's medical facility in Roseburg, the Roseburg VA Health Care System. (Terry, 1/25)

This year's flu season is already the most widespread on record since health officials began keeping track 13 years ago, and has already caused the deaths of more children than what normally would be expected at this time of the year, federal health officials have said. During the second week of January, more people sought care for flulike illnesses than at any comparable period in nearly a decade, the Centers for Disease Control and Prevention's most recent weekly report shows. (Sun, 1/25)

The CDC has reported "widespread" flu activity in the entire continental U.S. this year, and added that there are more serious cases of flu than usual due to H3N2, this year's main flu strain. (Kennedy, 1/25)

Like many flu-related illnesses, Dylan Winnik's started with a cold — and escalated rapidly. He had it for a couple of days. By Monday, he was feverish. By Tuesday, his temperature had gone back to normal, but he died that day. The 12-year-old Florida boy became the latest casualty of an intense flu season that has so far resulted in thousands of hospitalizations and deaths of 2½ dozen children nationwide. (Phillips, 1/25)

Thirteen people already have died from influenza-related illness in New Hampshire, and there are still many weeks to go in the flu season, according to the Department of Health and Human Services. New Hampshire is one of 49 states reporting “widespread” flu activity; only Hawaii and Washington, D.C. have been spared, according to the Centers for Disease Control and Prevention. This year’s flu season is already the most widespread on record since federal health officials began keeping track 13 years ago. (1/25)

To address the deadly opioid crisis wracking Philadelphia, city leaders are backing a novel step to open a safe haven where addicts can use their drugs. The idea of permitting the open use of illicit opioids is controversial and largely untested in the U.S., but proponents argue that bringing opioid use out from the shadows would save lives. Opponents, including law-enforcement agencies and some public officials, say it would essentially sanctify an illegal activity and enable addicts. (Kamp, 1/25)

Kaiser Health News: What’s Next For ‘Safe Injection’ Sites In Philadelphia?

“There are many people who are hesitant to go into treatment, despite their addiction, and we don’t want them to die,” said Dr. Thomas Farley, Philadelphia’s health commissioner and co-chair of the city’s opioid task force. Supervised safe-injection sites, he said, save lives by preventing overdose deaths and connecting people with treatment. (Gordon, 1/26)

Senators on Thursday called for tougher screening of international mail shipments to prevent overseas drug manufacturers from sending deadly narcotics to the United States. At a hearing Thursday, the Senate Homeland Security and Governmental Affairs Permanent Subcommittee on Investigations discussed the results of a report released a day earlier that showed how easy it is to purchase the powerful opioid fentanyl online. Fentanyl and similar substances have been a major contributor to the rising number of drug overdose deaths in recent years. Since small amounts can be diluted into larger quantities or mixed with other drugs, there is a large profit margin. (Siddons, 1/25)

Back in December, in front of a sold-out audience at the Forum awaiting Grammy front-runner Jay-Z, opening act and rapper Vic Mensa vaulted onstage. Dressed in punky red leather, he was boisterous and triumphant, the show a crowning achievement in his career.But underneath the bravado were lacerating lyrics about depression and drug addiction."In the cyclone of my own addiction," he rapped on his song "Wings." (Brown, 1/25)

In a rare moment of bipartisanship, the Arizona Legislature voted unanimously Thursday night to approve a sweeping plan to combat the state's opioid epidemic that has claimed more than 800 lives since June. Lawmakers approved the Arizona Opioid Epidemic Act, legislation that would limit initial pain-pill fills to five days for “opioid naive” patients, and impose a maximum dosage limit for many others seeking new prescriptions. (Nicla and Gardiner, 1/25)

If you keep swatting at a mosquito, will it leave you alone?Some scientists think so. But it depends. Some blood meals are worth a mosquito risking its life. But if there’s a more attractive or accepting alternative to feed from, a mosquito may move on to that someone or something instead. That’s because if you keep trying and missing, the mosquito may learn to associate your swatting vibrations with your scent, a study published Thursday in Current Biology suggests. And it just may remember: This is not a person who will tolerate me. (Klein, 1/25)

"Some people are super-attractors for mosquitoes," Riffell says, "while other people aren't attractive at all, and the mosquitoes will avoid them. "Now Riffell says he has come up with a way to teach mosquitoes to hate your smell so they leave you alone. "Swat them!" he exclaims. Just wave your hands and arms all around the buggers. You don't even need to touch them. (Doucleff, 1/25)

The mosquito-born Zika virus may be responsible for an increase in birth defects in U.S. states and territories even in women who had no lab evidence of Zika exposure during pregnancy, U.S. health officials said on Thursday. Areas in which the mosquito-borne virus has been circulating, including Puerto Rico, southern Florida and part of south Texas, saw a 21 percent rise in birth defects strongly linked with Zika in the last half of 2016 compared with the first half of that year, the U.S. Centers for Disease Control and Prevention said in its weekly report on death and disease. (Steenhuysen, 1/25)

The incidence rate of birth defects "strongly linked" to Zika infection in areas with local transmission of the virus—which include South Florida, parts of south Texas and Puerto Rico—rose by 21% in the latter half of 2016 compared to the first half of that year. Birth defects considered "strongly linked" to Zika infection include such conditions as brain abnormalities, microcephaly, eye abnormalities and central nervous system dysfunction (Johnson, 1/25)

At this point in the resolution-heavy month, many of us may be trying to shed pounds, either the ones we added during the holidays or the ones we’ve accumulated stealthily with time. But by the end of the year, most of us won’t have succeeded — and there’s not much established science to tell us why. An ambitious new study published this month in Cell Systems, however, promises to shed some new light, enumerating for the first time the thousands of changes in genes and various biological systems that may occur after even a small amount of weight gain, and which may — or may not — be reversed if the weight is then dropped. (Reynolds, 1/25)

The dream of using brain organoids to repair actual human brains has taken a baby step closer to reality: Researchers at the University of Pennsylvania have coaxed their tiny, three-dimensional organoids to produce functional neurons with long axons and dendrites — the gray and white matter, respectively — plucked them out, and grew them into fat bundles that might be transplanted into a broken brain. The scientists, led by neurosurgeon Isaac Chen, have not taken that final step, according to the draft of their study posted on Thursday to bioRxiv, which publishes papers before they have been peer-reviewed, let alone appeared in a scientific journal. (Begley, 1/25)

Your body is hot. Depending on the time of day, and where the thermometer is placed, it runs somewhere between 35 to 38 degrees Celsius, or 95 to 100 degrees Fahrenheit. Little organs called mitochondria, slotted into your cells like batteries in a TV clicker, produce most of this body heat. Mitochondria are the powerhouses of the cell, as biologist Philip Siekevitz called them in 1957. They use oxygen and nutrients to create energy and heat. (Guarino, 1/25)

Kaiser Health News: As Doctors Drop Opposition, Aid-In-Dying Advocates Target Next Battleground States

When the end draws near, Dr. Roger Kligler, a retired physician with incurable, metastatic prostate cancer, wants the option to use a lethal prescription to die peacefully in his sleep. As he fights for the legal right to do that, an influential doctors group in Massachusetts has agreed to stop trying to block the way. Kligler, who lives in Falmouth, Mass., serves as one of the public faces for the national movement supporting medical aid in dying, which allows terminally ill people who are expected to die within six months to request a doctor’s prescription for medication to end their lives. (Bailey, 1/26)

Care New England Health System of Providence and Partners HealthCare of Boston said Thursday that they are moving forward with plans to merge. The boards of directors from both health systems have not yet signed a definitive agreement — a formal step that would outline details of the proposed deal — but confirmed they are working toward that goal. (Conti, 1/25)

The definitive agreement caps a 10-month due diligence process since Boston-based Partners and Providence, R.I.-based Care New England signed a letter of intent to combine. The organizations released a statement that the process produced a plan for Care New England to "regain solid financial footing." The providers will move forward with the customary regulatory approvals once they finalize a definitive agreement. Meanwhile, Partners and Care New England maintain exclusive negotiating privileges. (Kacik, 1/25)

More than a month after New York City began offering free lead testing to nearly 3,000 children living in public housing apartments in the wake of a lead-paint scare, only 73 children have been tested under the initiative, city officials said. Mayor Bill de Blasio’s administration offered the testing after a Department of Investigation probe last year found the city’s housing authority had failed to conduct lead inspections for four years, violating city law and federal rules. The mayor and New York City Housing Authority Chairwoman Shola Olatoye have said the lapses were unacceptable and that the city is working to ensure residents are safe and failures in compliance never happen again. (Gay, 1/25)

A stream of documented complaints from three separate states flows back to one nursing home operator: Preferred Care of Plano, which filed for bankruptcy in November. As a reason for its financial troubles, the company has cited more than 160 “predatory” lawsuits. When contacted by The Dallas Morning News, Preferred Care’s bankruptcy lawyer, Stephen McCartin, reiterated that point.“It is in the best interest of citizens to have tort reform. That clearly reduces contingency-fee, ambulance-chasing lawsuits. It absolutely does have an effect,” he said Wednesday. From 2014 to 2016, the amount Preferred Care paid in legal fees jumped fivefold to $10 million, which limits its ability to spend  money on patient care, its attorneys told a bankruptcy judge in December. (Rice and Hacker, 1/25)

The Group Insurance Commission said it will reconsider its vote to eliminate popular health plans for hundreds of thousands of state employees and their families at a meeting on Feb. 1. Ashley Maagero Lee, the commission’s chief of staff, said in a prepared statement that the decision to reconsider was “a result of candid feedback from members and stakeholders.” The commission’s goal was to allow people to keep their current health care providers while controlling their premium and out-of-pocket costs, Lee said. (Dayal McCluskey, 1/25)

The Group Insurance Commission, relenting to days of withering criticism over its decision to limit health plan offerings to nearly 450,000 state employees and retirees, plans to reconsider that vote when it meets next week. The move came after Attorney General Maura Healey announced Thursday morning that her office had opened an investigation into whether the GIC properly gave notice of last week's meeting. (Murphy, 1/25)

A whistleblower suit unsealed Thursday in federal court alleges Wichita-based Via Christi Health engaged in an illegal scheme to maximize Medicare reimbursements. The lawsuit was filed in November 2016 but only unsealed after the government declined to intervene. It was brought by Mazen Shaheen, a cardiologist who formerly practiced in the Wichita area. (Margolies, 1/26)

The Florida Department of Children and Families estimates that there nearly 800,000 adults with serious mental illness in the state. The Miami-Dade court system has estimated that an estimated 9.1 percent of the county’s has experienced a serious mental illness, with few getting long-lasting help through the public health system. (Ovalle, 1/26)

Changes continue at the top of HealthPartners, with the health system and insurance company this week announcing the hiring of a new chief financial officer. Todd Hofheins, 53, most recently was CFO at Providence Health & Services, a health system in the Pacific Northwest that in 2016 merged with a California-based group to create one of the largest nonprofit health systems in the country. (Snowbeck, 1/25)

San Antonio recently took a major step to protect its residents’ health by passing a law that prevents merchants from selling tobacco products to anyone under age 21 within city limits, becoming the first Texas city to do so. Other Texas cities should follow San Antonio’s lead. (Cubbin and Ford, 1/25)

Dozens of parents, and their children, came to the State House Thursday to oppose a bill that would increase oversight for homeschoolers. The bill would require that homeschooled students have their annual assessments reviewed by either state officials or nonpublic school principals. Sponsors of the bill say it’s a way to make sure homeschooled children aren’t being neglected. (Moon, 1/26)

The elimination of cost sharing for screening mammography under the ACA was associated with an increase in rates of use of this service among older women for whom screening is recommended. The effect was attenuated among women living in areas with lower educational attainment and was negligible among Hispanic women. (Funded by the National Institute on Aging.) (Trivedi, Leyva, Lee et. al, 1/18)

Is the protective association between lactation duration and progression to diabetes supported by a biochemical evidence basis? ...This study provides evidence to support the hypothesis that lactation may lower risk of diabetes in women; these findings open new avenues into mechanisms leading to glucose intolerance. (Gunderson, Lewis, Lin et. al., 1/16)

We found that the ACA’s Medicaid expansion was associated with improved hospital financial performance and substantially lower likelihoods of closure, especially in rural markets and counties with large numbers of uninsured adults before Medicaid expansion. Future congressional efforts to reform Medicaid policy should consider the strong relationship between Medicaid coverage levels and the financial viability of hospitals. (Lindrooth, Parraillon, Hardy et. al., 1/18)

Longer times to diagnostic testing after an abnormal screening test can decrease screening effectiveness, but the impact varies substantially by cancer type. Impact: Understanding the impact of time to diagnostic testing on screening effectiveness can help inform quality improvement efforts. (Rutter, Kim, Meester et. al., 1/24)

Over the last few months, Anthem, the nation's biggest health insurer, has informed customers in several states that if they show up at the emergency room with a problem that later is deemed to have not been an emergency, their ER claim won't be paid. The policy has generated protests from numerous physician groups, including ER doctors, as well as pointed questions on Capitol Hill and among state regulators. So Anthem has taken the obvious next step: This year, it's rolling out the policy in three additional states. Prior to Jan. 1, the policy was in effect in Georgia, Missouri and Kentucky. This year, it's adding New Hampshire, Indiana and Ohio. More states may follow. (Michael Hiltzik, 1/24)

Cambridge, Mass. — Amid the budget turbulence in Washington, it’s easy to miss the fact that part of what’s at stake is America’s dominance in science, engineering and innovation. The United States has been the world leader in these categories for so long that we have stopped believing it could be any other way. But other nations, seeing us lose focus, are seizing the chance to rise. (Maria T. Zuber, 1/26)

Proponents neglect the possibility – which based on past experience, is a very likely outcome – that federal negotiations could increase drug prices rather than reduce them. They also neglect the possibility that by insisting on prices that are too low, the government might make certain drugs simply unavailable. (Robert Book, 1/24)

In the long history of successful public health initiatives, such as those leading to the eradication of smallpox, the elimination of polio throughout most of the world, and the marked reduction globally in vaccine-preventable childhood diseases, few programs have matched the impact of one that began in 2003, the President’s Emergency Plan for AIDS Relief, or PEPFAR. This innovative program has had an unprecedented impact on the pandemic of HIV and AIDS. (Anthony S. Fauci and Robert W. Eisinger, 1/25)

Combination antiretroviral therapy (ART) has dramatically improved survival rates among people with HIV and is a mainstay of HIV prevention; evidence shows that durable viral suppression prevents the transmission of infection. In addition, preexposure prophylaxis (PrEP) is an emerging approach to preventing HIV acquisition for certain high-risk groups. Generic ART medications offer the potential for treating and preventing HIV with fewer resources. Generic versions of lamivudine, abacavir, and efavirenz became available in the United States within the past 6 years at prices lower than their brand-name counterparts, a generic version of PrEP (emtricitabine and tenofovir disoproxil fumarate) was approved in 2016, and generic versions of tenofovir disoproxil are expected later in 2018. Yet most of the discussion about the availability of generic HIV drugs focuses on low- and middle-income countries. (Erika G. Martin and Bruce R. Schackman, 1/25)

On November 1, 2017, the Centers for Medicare and Medicaid Services (CMS) finalized its rule for reducing Medicare Part B payments to hospital outpatient departments for prescription drugs in the 340B Drug Pricing Program. Instead of reimbursing hospitals at the average sales price (ASP) plus 6%, CMS will now reimburse at ASP minus 22.5%, reducing spending by an estimated $1.6 billion in 2018. Though these planned cuts have been lauded by patient advocacy groups and the pharmaceutical industry as a way of limiting abuses of the 340B program and lowering out-of-pocket costs, they have not been well received by hospitals. The controversy surrounding the 340B program is as complicated as the program itself, and the new payment policy is the latest chapter in a drama that has played out over years. (Walid F. Gellad and A. Everette James, 1/25 )

Would you like to live forever? Some billionaires, already invincible in every other way, have decided that they also deserve not to die. Today several biotech companies, fueled by Silicon Valley fortunes, are devoted to “life extension” — or as some put it, to solving “the problem of death. ”It’s a cause championed by the tech billionaire Peter Thiel, the TED Talk darling Aubrey de Gray, Google’s billion-dollar Calico longevity lab and investment by Amazon’s Jeff Bezos. The National Academy of Medicine, an independent group, recently dedicated funding to “end aging forever.” (Dara Horn, 1/25)

In recent weeks, a narrative has gained traction in Washington questioning whether Donald Trump is capable of being the president. ... So this week, I asked CIA Director Mike Pompeo, who personally briefs the president almost every day, to take us inside how Trump receives his most highly classified briefing: the president’s daily brief, or PDB. ... This is a very different picture of Trump’s national security leadership than many in Washington imagine. (Marc A. Thiessen, 1/25)

Burnout rates are now twice as high in medicine as in other fields, even after adjustment for factors such as age, sex, level of education, and hours worked in the past week. In 2014, a national survey found that 54% of U.S. physicians reported at least one symptom of burnout: emotional exhaustion, depersonalization, or a diminished sense of personal accomplishment due to work-related stressors. Those in “front-line” specialties, including general internal medicine, family medicine, emergency medicine, and neurology, are at the highest risk. (Alexi A. Wright and Ingrid T. Katz, 1/25)

There’s no question that when a physician provides medical advice via social media it must be accurate. A nonmedical individual can comment based on blogs and personal experience, while physicians must give opinions based only on evidence. But whether they’re required to do that, or even if it’s a good idea, is an open question. In most social media situations, the two of us and our medical colleagues can be considered “physician civilians” — no doctor-patient relationship exists that creates an obligation for us to provide advice. (Casey Humbyrd and Kavita Shah Arora, 1/25)

Despite considerable scientific evidence demonstrating that later school start times are associated with more sleep among adolescents, as well as improvements in well-being, public safety and academic performance, resistance to changing start times remains high. One of the most oft-repeated arguments against later start times goes something like this: “It’s not about school start times. It’s about bad parenting!”As a parent of a teenager myself, and as a sleep scientist, I absolutely agree that good parenting, is critical for healthy sleep. But when it comes to curbing the epidemic of teen sleep loss, good parenting can do only so much. (Wendy Troxel, 1/26)

Practicing culinary medicine is a low-cost, accessible and culturally adaptable intervention. This entails educating patients about a healthy diet — one rich in vegetables and fruits and low in processed foods and animal products — and how to cook it. (Linda Shiue, 1/25)

After years of Georgia rejecting expansion of Medicaid, there has been increasing political talk about the state pursuing a federal waiver to give health insurance to more people. At the same time, though, requiring that Medicaid beneficiaries work to retain their coverage has picked up momentum nationally, with the Trump administration allowing Kentucky to pursue that switch. (Laura Colbert, 1/25)