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Sen. Ron Johnson, the author of the federal “right-to-try” law signed by President Trump this week, wants to make one thing clear: His new law is meant to weaken the Food and Drug Administration. “This law intends to diminish the FDA’s power over people’s lives, not increase it,” he wrote in a letter to Commissioner Scott Gottlieb Thursday. (Mershon, 5/31)

The Republican author of the new “right to try” law is calling on the Food and Drug Administration to enforce it as written. In a letter sent Thursday to the FDA, Sen. Ron Johnson (R-Wis.) said the right to try law “intends to diminish the FDA’s power over people’s lives, not increase it.” (Weixel, 5/31)

Physicians are prescribing fewer opioids and tracking prescriptions with greater frequency to address potential misuse, according to the American Medical Association. The numbers arrived in a report that appears to serve as an argument against proposed legislation that would impose federal mandates on clinical practices, such as limiting the number of days worth of an opioid that physicians can prescribe, or requiring physicians to use state prescription drug monitoring programs. (Johnson, 5/31)

The number of opioid prescriptions issued nationwide has dropped by 22 percent between 2013 and 2017, which a doctors group touted as progress in fighting the epidemic of opioid addiction. The report from the American Medical Association (AMA) finds there were 55 million fewer prescriptions over that time period and the number of prescriptions has dropped for five years in a row. (Sullivan, 5/31)

Federal indictments against Insys executives accuse them of using their speaker program to pay kickbacks to doctors for prescribing their powerful opioid spray, Subsys. [Steven] Simon, who was one of the top-paid speakers in the program, is facing three lawsuits related to his Subsys prescribing, and the FBI served a search warrant last year at the pain clinic where he worked. (Marso, 5/31)

Yet another former Insys Therapeutics (INSY) sales rep has pleaded guilty to bribing doctors to write prescriptions for the Subsys opioid painkiller, which contains fentanyl and carries a high risk of dependency. Michelle Breitenbach, 38, who worked in New Jersey for the drug maker, paid kickbacks and bribes to an unspecified number of physicians in the form of speaking fees for purported education events, according to the New Jersey attorney general. She faces up to five years in prison. (Silverman, 5/31)

Around 2015, just before overdoses sweeping the country started making national news, a pharmaceutical sales representative in New Jersey faced a dilemma: She wanted to increase her sales but worried that the opioid painkiller she was selling was addictive and dangerous. The medication was called Subsys, and its key ingredient, fentanyl, is a synthetic opioid 100 times stronger than morphine. When the rep, who requested to go by her initials, M.S., voiced her concerns to her manager, she was told that Subsys patients were “already addicts and their prospects were therefore essentially rock-bottom,” according to a recently unsealed whistleblower lawsuit that M.S. filed after leaving Insys in 2016. To boost her numbers, the manager allegedly advised M.S. to “behave more sexually toward pain-management physicians, to stroke their hands while literally begging for prescriptions,” and to ask for the prescriptions as a “favor.” (Lurie, 5/31)

Utah sued OxyContin maker Purdue Pharma LP after talks sponsored by state attorneys general failed to yield a settlement over the company’s handling of the opioid painkiller. Utah Attorney General Sean Reyes said Thursday that after months of negotiations in the so-called multi-state talks with Purdue about its role in the U.S. opioid epidemic, the negotiations were “no longer effective.” (Feeley, 5/31)

An attorney for Purdue Pharma, the company that makes the prescription opioid painkiller OxyContin, told an Alaska judge Thursday that there is an opioid crisis but the state has no legal basis for trying to pin that crisis on the company. (Bohrer, 5/31)

Philadelphia authorities on Wednesday cleared two tent camps where opioid users congregated, capping a monthlong effort to move people into treatment and shelters. Four tunnels filled with tents and mattresses beneath a freight railway have become highly visible symbols of the city’s drug problem, spilling out into Philadelphia’s Kensington neighborhood. Deeming the tunnels health and safety hazards, the city cleared two of them as part of a pilot project. (Kamp, 5/31)

As the death toll from the nation’s opioid crisis swells, California officials have launched an experiment: paying for people to test their drugs for fentanyl. Fentanyl, an opioid that is up to 50 times stronger than heroin, is responsible for a growing number of overdose deaths each year. Typically manufactured as a white powder, it can be mixed into other drugs such as heroin and cocaine without the user knowing, but with extreme consequences. (Karlamangla, 5/30)

Michael Marquesen, executive director of needle exchange Los Angeles Community Health Project, said distributing the strips allows him to warn people about fentanyl and teach them how to use the anti-overdose medication naloxone. The tests have shown that 40 percent of the heroin in Hollywood contains fentanyl, he said. “The overdose rates in Hollywood are through the roof,” Marquesen said. “They keep rising every month.” (6/1)

Arizona State University scientists will work with Tempe to detect opioids and other drugs in city wastewater, an exploration that could serve as an early warning system in the ongoing opioid crisis. The city and the ASU Biodesign Institute each will contribute $35,000 to study wastewater for opioids, cocaine, marijuana and other drugs as part of its efforts to monitor public health. (Brown, 5/31)

The DEA has already considered designating kratom a Schedule 1 drug — the same category occupied by heroin, ecstasy and cocaine — which would effectively ban it. Federal concerns about health risks and potential abuse of the supplement manifested in a public health advisory from the Food and Drug Administration last year that said the FDA was aware of reports of 36 deaths associated with the use of products containing kratom. (Gutierrez, 5/31)

Oncologists sued HHS Thursday over the continued 2% cuts to Medicare Part B drug reimbursements packed in the budget sequester, claiming Congress never gave HHS authority to change the reimbursement formula. In the lawsuit filed in federal district court in Washington, the Community Oncology Alliance argued the sequester accelerated independent cancer treatment centers' closures and consolidations, ultimately driving up the cost of care as patients head to hospitals rather than oncology practices for treatment. The trade group based its case on the claim that Congress never granted the executive branch explicit statutory authority to apply the cuts to Part B drugs. (Luthi, 5/31)

More than 90% of clinicians required to report under MIPS submitted data this year, but thousands of physicians will still face penalties for not complying with the program, according to CMS Administrator Seema Verma. The CMS found that 91% of clinicians eligible to participate in the Merit-based Incentive Payment System submitted data in the program's first year, surpassing the agency's goal of a 90% participation rate, Verma announced in a blog post Thursday. (Dickson, 5/31)

The National Basketball Players Association named Dr. William D. Parham its first director of mental health and wellness on Thursday. In his role, Parham will oversee the development and management of the newly launched NBPA Mental Health and Wellness Program designed to assist all members of the union in addressing any mental heath challenges or issues they face. (5/31)

Studies show that about 5 percent to 10 percent of people are unable to tolerate statins, largely because of muscle aches and related side effects, including potential muscle damage. But many people who have been labeled intolerant to the drugs probably are not, and medical researchers, normally a genteel lot, disagree sharply on the extent to which side effects are a problem. (Klasco, 6/1)

If you go to the hospital for medical treatment and scientists there decide to use your medical information to create a commercial product, are you owed anything as part of the bargain? That's one of the questions that is emerging as researchers and product developers eagerly delve into digital data such as CT scans and electronic medical records, making artificial-intelligence products that are helping doctors to manage information and even to help them diagnose disease. (Harris, 5/31)

It lists studies from research journals, company announcements, and preprints, chosen because they reported a key advance in either the genome-editing technology or the diseases that might be treated with it. It also links to the research papers, though not all are open access (sorry). We’re not including everything, but we hope CRISPR Trackr gives you a sense of how quickly things are moving. We’ll update it as needed. (Begley, 6/1)

Nine months of treatment with an experimental pill from Madrigal Pharmaceuticals resulted in the significant reversal of the fatty liver disease known as NASH, according to updated data from a placebo-controlled clinical trial released Thursday. A significantly greater number of patients taking the Madrigal drug also saw NASH liver symptoms resolve completely. There was a more modest reduction in the most troublesome tissue-scarring process known as fibrosis. The Madrigal drug is called MGL-3196. (Feuerstein, 5/31)

A large-scale clinical trial launched by the National Institutes of Health in May could pave the way for more HIV-positive patients with kidney disease to receive life-saving transplants. The trial, called the HOPE in Action Multicenter Kidney Study, will assess the risks of transplanting kidneys from HIV-positive donors into patients living with the virus, says Dr. Christine Durand, assistant professor of medicine at Johns Hopkins University and a principal investigator of the study. (Forman, 6/1)

Army Sgt. Nick Harrison learned he was infected with H.I.V. six years ago, but the once fatal diagnosis has barely changed his routine at work or at home because he keeps the virus in check with a once-a-day pill. The only thing H.I.V. crippled was his military career. The military bars anyone with the virus that causes AIDS from joining. Policies crafted in the 1980s allow troops who contract the disease while in the military to stay as long as they remain otherwise healthy, but bars them from deploying in nearly all cases. (Philipps, 5/31)

To help consumers read nutritional information more easily, there is now bigger type for printed information such as “calories,” “servings per container” and “serving size,” as well as for the listings of the amounts of vitamin D, calcium, iron and potassium. Also, the labels now include the amount of “added sugars” (in grams), while they no longer list the “calories from fat.” (Webb, 6/1)

More than seven weeks after the start of a massive E. coli illness outbreak from romaine lettuce that sickened 172 people and caused romaine sales to plummet 45 percent, the Food and Drug Administration says it has no idea who or what caused the contamination. Agency investigators have not managed to trace the affected lettuce back to one farm, processor or distributor, FDA Commissioner Scott Gottlieb said in an update Thursday. And with the affected lettuce now off shelves and the growing season over, there’s a chance the FDA may never crack the case. (Dewey, 5/31)

Blue Cross and Blue Shield of Texas has agreed to a 60-day delay of a contentious program to step up scrutiny of out-of-network emergency room claims and deny those determined after-the-fact not to be true emergencies. The program could potentially affect about a half million Texans who have Blue Cross and Blue Shield health maintenance organization, or HMO, plans. It was set to roll out June 4. (Deam, 5/31)

The plan outraged consumer groups, medical professional organizations and others who worried that such a process would force consumers to self-diagnose, when the average person does not have the medical expertise needed to do so. (Rice, 5/31)

A small group of Nashville General Hospital leaders made a surprise move Thursday night, offering the CEO of the cash-strapped safety-net hospital a new three-year contract and saying details of the contract will be ironed out later. ... Thursday’s decision was pushed through by four members of the Hospital Authority Board, which oversees Nashville General. The four strongly supported [CEO Joseph] Webb and said he had waited too long for job security. (Kelman, 5/31)

A Des Moines hospital is offering an alternative for Iowans who have had to wait weeks or even months for initial appointments for depression, anxiety or other common mental health issues. Broadlawns Medical Center will open its new “psychiatric urgent care” clinic Monday. Leaders of Polk County's public hospital say the clinic, which will accept walk-in patients, will help address the area’s shortage of services for people with mental health issues. (Leys, 5/31)

Gov. Mark Dayton this week signed legislation that grants Regions Hospital in St. Paul licenses for 55 new hospital beds. The new law specifies that 15 beds are to be used for inpatient mental health, and 40 beds for other services. In addition, five unlicensed beds for mental health patients with short-term needs are to be added at Regions. (Snowbeck, 5/31)

A woman found dead in a stairway on the grounds of Zuckerberg San Francisco General Hospital was identified by officials as a resident of a nearby care home who had been missing for 10 days. The death of Ruby Anderson — who was discovered in a stairwell of the power plant building Wednesday afternoon — prompted swift changes on the sprawling campus as officials acknowledged gaps in security protocols. (Tchekmedyian, 5/31)

[W]ith the heat index in Dallas forecast to reach 108 by Saturday, local health care providers and emergency management teams are prepping for a potential spike in heat-related medical issues. (Rice, 5/31)

The Department of Health and Human Services is investigating requirements by California and Hawaii that anti-abortion “crisis pregnancy centers” tell women about state-subsidized family-planning services including abortion, according to people familiar with the matter. The HHS Office for Civil Rights has sent letters to the two states saying it has legal authority to investigate these requirements and is doing so, according to the people. The move is part of a new approach under the Trump administration to use civil rights law to roll back Obama-era health-care rules. (Armour, 5/31)

Stephanie Ho and her staff scrambled to call patients, canceling appointments for the women who had sought the two-pill medical abortions that the Fayetteville Health Center offered. It was moments after the U.S. Supreme Court declined Tuesday to hear a case challenging an Arkansas law that effectively prohibits medical abortions in the state, and Ho’s practice needed to ensure the women knew that option was no longer available to them. Women in Arkansas who had sought to take what is commonly known as “the abortion pill” now would have to travel to the only abortion clinic in Arkansas that offers surgical abortions, in Little Rock. (Wax-Thibodeaux, 5/31)

Student activists at the University of Minnesota are trying to reinstate a medical school fellowship in reproductive health that the school has delayed following opposition from anti-abortion groups. University officials announced this month that the fellowship would be delayed for a year as they examine the value of the training. The program was scheduled to begin this fall. (5/31)

Worried that Michigan voters might legalize recreational marijuana this fall, some Republican lawmakers think they have a way to apply the brakes: pass it themselves first to make it easier to change later. To be clear, passage in the Legislature is a longshot. Republican House Speaker Tom Leonard said it would take a “marijuana miracle” for the House to vote on it by a Tuesday deadline. Republicans, who control both chambers, are divided on the issue and Democratic leaders want voters to decide. (Eggert, 6/1)

U.S. Sen. Bill Nelson said Thursday that Florida doctors should be allowed to prescribe smokable medical marijuana to their patients. ...Last week, a Leon County circuit court judge ruled that the state's ban on smoking medical marijuana is unconstitutional, calling it a "conflicting, overreaching" statute. (Contorno, 5/31)

An estimated 360,000 Californians are served by water systems with unsafe drinking water, according to a McClatchy analysis of data compiled by the State Water Resources Control Board. In many communities, people drink, shower, cook and wash dishes with water containing excessive amounts of pollutants, including arsenic, nitrates and uranium. (Kasler, Reese and Sabalow, 6/1)

The National Guard will hand out free water to residents who can’t drink tap water contaminated by an algae bloom in the Salem, Oregon, area, and state law enforcement authorities are looking into claims of price gouging after officials extended an emergency drinking water advisory. Gov. Kate Brown’s office said Thursday the water will be distributed to people at 10 locations in the state’s capital and Stayton because of toxins created by a bloom at Detroit Lake, a municipal reservoir. (James, 6/1)

The draft report by the state Department of Health Services looked at 108 lead-poisoning cases reported to the city's troubled Childhood Lead Poisoning Prevention Program between 2012 and 2017. It found more than 90% of the cases were closed before the amount of lead in kids' blood had dropped to levels deemed safe by the state. (Bice and Spicuzza, 5/31)

Once deemed a national model, the City of Milwaukee's program to prevent childhood lead poisoning has come under fire in the past six months. What is not clear is just how extensive the problems are in the program overseen by the city Health Department, even after the resignation of former Health Commissioner Bevan Baker earlier this year. (Spicuzza and Bice, 5/31)

After three years of precipitous increases, homelessness dipped slightly this year, the Los Angeles Homeless Services Authority reported Thursday, providing a hopeful sign that new money flowing into housing and services is having an effect. But in releasing results of the 2018 count, officials also warned that the number of people falling into homelessness for the first time increased, holding back the potential gains. And the report noted that three out of four homeless people in the county live on the street, a figure unchanged from last year. (Smith, Holland and Smith, 5/31)

The East Baton Rouge Parish Prison, a squat brick building with low-slung ceilings and walls sometimes smeared with feces, is the face of a paradigm shift: penitentiaries as mental health care providers. Across the United States thousands of jails are sheltering a wave of inmates accused of crimes and serving time while suffering from illnesses ranging from depression to schizophrenia. (Fares and Levinson, 5/31)

Gov. Jeff Colyer is scheduled to sign an executive order on Friday night that will lead to the development of a state dementia plan. Kansas is the only state without a plan. Advocates have been in contact with Colyer since July about forming a task force and putting a plan together. (Eckels, 5/31)

Kaiser Health News: Listen: As Puerto Rico Struggles To Rebuild Health System, Changes In Medicaid Loom

KHN reporter Carmen Heredia Rodriguez joins in a discussion on WNYC’s “The Takeaway” about health care issues following widespread destruction by Hurricane Maria on the island. (5/31)

Louisiana 911 operators will now be trained on how to provide over the phone instructions on how to perform CPR. The legislation which was signed Thursday (May 31) by Gov. John Bel Edwards was supported by the American Heart Association as a way to help the dispatcher and caller work as a team and improve the chance of survival for the victim until rescuers arrive. (Clark, 5/31)

The University of Southern California’s board of trustees has elected mall magnate Rick Caruso to be the new chair of the board, giving fresh leadership as the university navigates a widening scandal involving a longtime campus gynecologist. The move marks the latest effort by USC to address the case, which has sparked a criminal investigation by the Los Angeles Police Department and dozens of civil lawsuits. More than 400 people have contacted a hotline that the university established for patients to make reports about their experience with Dr. George Tyndall. (Hamilton, Ryan and Curwen, 5/31)

A UCLA cardiologist has been temporarily stripped of his medical license after state regulators described him as a “sexual predator” who assaulted three female colleagues when he was working and training at L.A. County-USC Medical Center. (Parvini and Hamilton, 5/31)

Are medical and adult-use marijuana laws passed after 2010 associated with lower rates of opioid prescribing for Medicaid enrollees? ...State implementation of medical marijuana laws was associated with a 5.88% lower rate of opioid prescribing. (Wen and Hockenberry, 5/1)

This report assesses the size and composition of Medicaid enrollees in Arkansas who could be affected by the program’s new work and community engagement requirements. ...Given the exemptions Arkansas plans to implement, we find that in 2018, 86 percent of nonelderly, nondisabled adult Medicaid enrollees would likely be exempt from work requirements, a share that includes adults ages 19 to 29. (Gangopadhyaya, Kenney, Burton et. al., 5/24)

The Orphan Drug Act’s market exclusivity incentive has played an increasingly smaller role in protecting rare disease drugs from competition, while rare disease drugs have substantially increased as a fraction of all new drug approvals. (Sarpatwari, Beall, Aburrob et. al., 5/7)

Black infants born preterm face high rates of recurrent wheezing throughout infancy. Vitamin D supplementation has the potential to positively or negatively affect wheezing through modulation of the pulmonary and immune systems. ...Among black infants born preterm, sustained supplementation with vitamin D, compared with diet-limited supplementation, resulted in a reduced risk of recurrent wheezing by 12 months’ adjusted age. (Hibbs, Ross, Kerns et. al., 5/22)

E-cigarette use predicts subsequent marijuana use among youth, with a stronger associations among young adolescents. Reducing youth access to e-cigarettes may decrease downstream marijuana use. (Dai, Catley, Richter et. al., 5/1)

Anyway, the will of the people on health care is clear: Whatever qualms voters may have had about Obamacare, a strong majority want to keep and expand the gains in coverage that America has achieved since the law went into effect. In other news, there are multiple reports that Republicans in Congress may make another attempt at repealing the A.C.A. this summer. Even if they don’t succeed, you can be sure that they will next year — if they manage to hold on to the House in the midterm elections. (Paul Krugman, 5/31)

Medicaid expansion is still going strong. And Virginia may have just given us a preview of another wave. The Virginia Legislature on Wednesday, despite very narrow Republican majorities in both chambers, voted for the piece of Obamacare that the Supreme Court had made optional for the states. After Virginia, there are only 17 holdouts — including Texas and Florida. What’s really important is that no state has gone in reverse, even those states that switched from Democratic to Republican governments after implementing expanded Medicaid. I’m going to take a short victory lap on my prediction from five years ago. (Jonathan Bernstein, 5/31)

The passage of the Department of Veteran Affairs (VA) Mission Act of 2018 by both the U.S. House and Senate marks a much-needed shift in the national discourse on health care for veterans. Ever since the scandal involving secret waitlists broke at the Phoenix, Ariz. VA medical center in 2014 — which led to the passage of the first Veterans Access, Choice and Accountability Act of 2014 — the debate on how to improve the delivery of health care to veterans has been colored by partisanship and position entrenchment that would not lead to any legislative wins. But after garnering the support of 38 military and veteran service organizations, the VA mission bill now awaits President Trump’s signature. (Sherman Gillums, Jr., 5/31)

As the public debate over creating harsh work requirements for those receiving SNAP and/or Medicaid heats up, it strikes me that the voices of those who would be most impacted by these policy changes are not being heard. Like mine. (Colten Osborne, 5/31)

A bill passed by the U.S. House of Representatives in February would have a significant adverse effect on the accessibility of public accommodations for people with mobility impairment. (Laura Rothstein, 5/31)

The most iconic image from Donald Trump's helmsmanship of last year's Puerto Rico crisis is the clip of the president in a windbreaker tossing paper towels, free-throw style, to survivors of Hurricane Maria. Other responses were equally disquieting: Trump's assurances that federal emergency managers were doing an "incredible job." His Twitter war with the despairing mayor of storm-ravaged San Juan. And his odd remark that the island's desolation wasn't a "real catastrophe" like Hurricane Katrina, which slammed the Gulf Coast in 2005, because there were only 16 deaths in Puerto Rico. The official tally would eventually rise to 64. But it wasn't until this week, with the release of a Harvard mortality analysis, that Americans could fully gauge how their fellow citizens on Puerto Rico fell victim to the deadliest natural disaster on U.S. soil in a century — an estimated 4,645 deaths, well over twice the number killed by Katrina. (5/31)

Last year’s historic hurricane season was a true test of the nation’s ability to respond to, and recover from, three near-simultaneous catastrophic hurricanes followed by the California wildfires. The impacts of these storms and the wildfires cannot be overstated. About 47 million people were affected by these events, or roughly 15% of the entire U.S. population. FEMA will always work tirelessly to support state, local, tribal and territorial partners to respond to and recover from disasters. FEMA is not a first responder; disasters are state managed, locally executed and federally supported. Our role is to support local governments following a disaster only after their capacity to respond has been exceeded. (Brock Long, 5/31)

The true death toll could exceed 4,600, according to a study published this week in The New England Journal of Medicine that appears to be the most rigorous count yet. Many of the victims likely died from delayed medical care, which is something that a competent government response could have avoided. Puerto Rico’s fatality count is now more than twice as high as the Katrina count that Trump called a “real catastrophe.” It’s easy to overlook Puerto Rico with everything else going on — the latest news about Trump’s apparent efforts to obstruct justice, his continuing criticism of his own attorney general and so on. But I urge you to not forget Puerto Rico. (David Leonhardt, 5/31)

I have written enough books about how media cover politics to know that the story of a racist celebrity losing a TV show, like that of a racist president’s response to the cancellation of the show he once told supporters was “about us,” was going to trump the story about the dramatic loss of life on the island of Puerto Rico. But that does not change the fact that the news of the actual death toll on the islands after they were hit by Hurricane Maria matters more. It matters more than Roseanne Barr’s self-inflicted wounds, and it matters more than Donald Trump’s self-absorbed interpretation of the news. (John Nichols, 5/31)

This is Trump’s Katrina. It is time for the nation to set aside the petty bickering about TV stars and talk show hosts and focus on the tragedy that has so easily been lost in the churn of our tweet-length news cycle. A functioning Congress would leap into action with hearings about what went wrong and what we can learn from Puerto Rico. A country ashamed by its failure to save fellow citizens would push ahead to grant statehood to Puerto Rico so that the island, which is larger than 20 states, would finally have voting members in Congress. Our Gulf Coast leaders, who know well the savagery of Mother Nature, would head a national movement to rebuild and protect our coasts from floods and storms. After all, if 4,600 deaths merit only a shrug, how can Corpus Christi, Galveston or Houston expect a response to a storm like Harvey, which killed 82? (6/1)

Both the media and the president considered it Big News when ABC swiftly canceled Rosanne Barr's show hours after she sent an offensive tweet about former Obama White House aide Valerie Jarrett. ... What wasn't Big News? A Harvard study issued the same day estimating that roughly 4,600 Puerto Ricans died as a result of Hurricane Maria — 70 times higher than the official government death toll of 64 people. Researchers believe the number is conservative, and would be higher if they included people who lived alone and died from the storm. (Alicia Shepard, 6/1)

Whether we’re marching with coat-hanger posters or passing laws that outlaw the procedure earlier and earlier, we fight over abortion in the United States as if we know what will happen if it’s banned. But as we inch closer to potentially allowing states to recriminalize the procedure — with laws that ban abortions after six weeks, in the case of Iowa, or in the case of Arkansas, even seek to ban the use of abortion-inducing drugs — we would do well to look past our southern border to consider what happens when abortion actually becomes illegal. It’s not the outcome anyone is looking for. (Michelle Oberman, 5/31)

In defending their pricing practices, pharmaceutical companies consistently point to one argument: High prices are necessary to support innovation, and innovation is the key to scientific breakthroughs that will save future lives. The argument is persuasive. Our nation’s investment in biomedical research and development (R&D)—the basis for innovation—has yielded huge advances that extend life and reduce suffering. But in pointing to R&D as a justification for high and rising drug prices, the pharmaceutical industry is raising a fundamental question: How should we, as a society, decide how much to spend on research and development, and what should we spend it on? (David Blumenthal, 5/31)

Now that President Donald Trump has signed his long-sought “right to try” law, Americans have a dubious new freedom to bypass the drug quality-control system and experiment with medicines of questionable safety that may or may not work.This solves no real problem. The Food and Drug Administration has long granted access to medicines that are only partway through the U.S. approval process for patients in extreme circumstances who might benefit. But a myth had spread throughout the land, promulgated by conservative groups, that dying patients were being refused permission to try experimental drugs. Congress responded with a feel-good law. (5/31)

But when a health insurer merges with a pharmacy benefit manager, who controls whom? If you’re an optimist, you’d say that such a union would allow the insurer to take control over drug purchases. The insurer would want to get the best deal for its subscribers to keep premiums down and attract the greatest market share for their insurance products, so it would buy drugs that are cost-effective and avoid lower-value drugs. The problem with this view is that it neglects the possibility that the pharmacy benefit manager might be the tail that wags the dog. (Barak Richman and Kevin Schulman, 6/1)

The woman at the other end of the line was overcome with remorse about the hospital where her husband had esophageal surgery. Her voice cracked with strain. Might he still be alive, she asked me, if they had chosen a different hospital? As a physician and hospital administrator for over two decades, I heard stories like this more often than should ever be the case. And it boils down to one simple piece of information that too often isn’t available: How many times has the surgeon and hospital performed the type of surgery you need? (Peter Pronovost, 5/31)

Recent demonstrations have illustrated how computers can match or outwit their human physician counterparts in interpreting X-rays, reading pathology specimens, diagnosing heart rhythms, and identifying troublesome moles. Last month the FDA approved the first AI system for diagnosing diabetic retinopathy. These breakthroughs have led to tremendous hope and hype about the potential for AI systems to diagnose alongside doctors–or even instead of them. Before we get ahead of ourselves however, there are a number of legal, ethical, and psychological issues that need to be worked out. (Gurpreet Dhaliwal, 5/31)

“What do you think about physician aid in dying?” Because 18.2% of the U.S. population lives in jurisdictions where physician aid in dying (PAD) is now legal, physicians need to anticipate that patients may inquire about or request it. Two decades ago, when PAD was illegal throughout the United States, 18.3% of physicians reported ever having received a request for assisted suicide; inquiries are likely to be more frequent now. But physicians may feel unprepared, uncertain, and uncomfortable when confronting these conversations, even if they’ve thought through their own position on PAD legalization. (Bernard Lo, 5/31)

One of the most sought-after tickets on Broadway these days is “Angels in America,” a revival of Tony Kushner’s seminal play about the AIDS crisis and its aftermath. While only a few of us will be fortunate enough to see the show in person, everyone can benefit from the following insight: When the play originally debuted in 1991, HIV/AIDS was considered a death sentence and slapped with a stigma that isolated and ostracized those with the disease and their families. The same type of stigma is happening now with substance abuse and the opioid epidemic. (Sandeep Kapoor, 6/1)

In response to the opioid crisis, the Food and Drug Administration (FDA) has taken action on multiple fronts. We have approved better measures for treating opioid use disorder and preventing deaths from overdose, have launched efforts to inform more appropriate prescribing as a way to limit clinical exposure to opioids, have taken actions to reduce the excess opioids available for abuse, and are working to facilitate development of new therapeutics that can effectively and safely help patients suffering from pain. Going forward, the FDA needs to remain vigilant to recognize shifting trends in the addiction landscape. Taking a systematic approach to monitoring such trends should allow us to intervene promptly and appropriately and protect the public from associated risks.Meanwhile, we must be aware that any decisive actions taken to reduce prescription opioid abuse and stem the tide of overdose and death can have unintended consequences, including prompting people to turn to alternative, potentially dangerous substances. (Douglas C. Throckmorton, Scott Gottlieb and Janet Woodcock, 5/31)

Perched atop a hill overlooking a major thoroughfare, the massive brick tower was a holdout from decades earlier. With green tiles lining the walls, black and white linoleum flooring, and hallways redolent of an antiseptic whose recipe hadn’t changed since the 1950s, the hospital had a distinct postwar feel, and an unchanging culture to go along with it. For surgical trainees like me in the 1990s, the institution’s resistance to change was best embodied by a four-page, single-spaced document affectionately known as “The Hernia List.” (Pauline W. Chen, M.D., 5/31)

Over recent decades, the world has seen incredible progress in reducing child mortality and tackling infectious diseases. Thanks to better vaccines and other interventions, child mortality has decreased by more than 50% since 1990. We are on the verge of eradicating polio. HIV is no longer a certain death sentence. And half the world is now malaria-free. Yet there is one area where the world isn’t making much progress: pandemic preparedness. This failure should concern us all, because history has taught us there will be another deadly global pandemic. We can’t predict when, but given the continual emergence of new pathogens, the increasing risk of a bioterror attack, and the ever-increasing connectedness of our world, there is a significant probability that a large and lethal modern-day pandemic will occur in our lifetime. (Bill Gates, 5/31)

Missouri’s backlog of nearly 5,000 untested rape kits represents the failure of the criminal justice system to take sexual assault seriously. Shame on law enforcement and health care authorities who have not prioritized the testing of rape kits, protected survivors or gotten offenders off the streets. Each kit means there is a woman who has not received the justice she deserves and lives in fear that her attacker is free to strike again. Every woman who suffered sexual assault and went to a hospital or police station to be swabbed, scraped and photographed, expected her kit — with its potential wealth of DNA evidence — would be tested at a laboratory as a first step toward getting her attacker off the streets. It would be a gross understatement to say these women have been let down. (5/31)

Sunny weather? It’s here. Crowded beaches? Check. Now, for what has lately become the third sure sign of New England summer: Killjoy warnings from health officials about the risk of Lyme disease, the tick-borne malady that may cause fatigue, headaches, joint pain, and other ailments. ...Researchers at UMass Medical School in Worcester have identified a human monoclonal antibody that could defend against Lyme disease with just one annual dose. The medicine, called Lyme PrEP, involves injection of a single protective antibody. It blocks the Lyme-causing bacteria in the tick after it bites — before it can get into the bloodstream. ...“There’s definitely a hunger for a medicine that is preventive,” says Dr. Mark Klempner, a professor of medicine at UMass Medical School in Worcester. (6/1)

For the first time in four years, the number of homeless people in Los Angeles County has decreased. It went down by just a modest 3% (and 5% in just the city of L.A.), but that is still a significant reversal of the shocking double-digit increases of recent years.The dip, reported in the official 2018 “homeless count,” was welcome news. The Los Angeles Homeless Services Authority, which administers the count, says that about 16,500 homeless people were housed over the last year, which is the highest number ever. It’s a sign that city and county officials are finally treating homelessness as the crisis it is and directing more time, money and resources into housing, services and outreach. (6/1)