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The Food and Drug Administration said Thursday it wants to sharply reduce the amount of nicotine in cigarettes. The idea is to help wean millions of smokers off their deadly habit and prevent millions more from becoming regular smokers in the first place. "Despite years of aggressive efforts to tackle the leading cause of preventable disease and death in the United States, tobacco use — largely cigarette smoking — still kills more than 480,000 Americans every single year," FDA Commissioner Scott Gottlieb said in a statement. (Stein, 3/15)

Kaiser Health News: FDA Moves To Cut Nicotine In Cigarettes, Helping Smokers Kick Habit

The idea of reducing nicotine to non-addictive or “minimally addictive” levels is the “cornerstone” of a comprehensive tobacco control plan announced in July by FDA Commissioner Scott Gottlieb. “We’re taking a pivotal step today that could ultimately bring us closer to our vision of a world where combustible cigarettes would no longer create or sustain addiction — making it harder for future generations to become addicted in the first place and allowing more currently addicted smokers to quit or switch to potentially less harmful products,” Gottlieb said. (Szabo, 3/15)

Commissioner Scott Gottlieb unveiled an “advance notice of proposed rulemaking,” the earliest step in what promises to be a long, complicated regulatory effort to lower nicotine levels to be minimally addictive or nonaddictive. The notice, to be published Friday in the Federal Register, includes new data published in the New England Journal of Medicine on Thursday based on a possible policy scenario. That FDA-funded analysis found that slashing nicotine levels could push the smoking rate down to 1.4 percent from the current 15 percent of adults. That in turn would result in 8 million fewer tobacco-related deaths through the end of the century — which Gottlieb termed “an undeniable public health benefit.” (McGinley, 3/15)

Currently, there are no limits on nicotine, which occurs naturally in tobacco plants. Under law, the FDA can regulate nicotine although it cannot remove it completely. The FDA's powers to police the tobacco industry are unique worldwide and the attempt to restrict nicotine would represent a first in global efforts to reduce smoking-related deaths. Under one scenario, the FDA estimates the U.S. smoking rate could fall as low as 1.4 percent by 2060, down from the 15 percent of adults who smoke now. (Perrone, 3/15)

Nicotine levels in cigarettes can be reduced in different ways. Manufacturers can adjust the blend of tobacco leaves or use different types of paper or filters. Nicotine can also be stripped from the leaf in the manufacturing process. But products with very low levels of nicotine have never garnered a significant share of the U.S. market. The FDA has said its approach will consider a continuum of risk for nicotine delivery, from combustible products such as cigarettes to replacement therapies like nicotine gums. (Chaudhuri, 3/15)

The FDA action won praise from public health advocates, who lament the loss of 480,000 American lives each year due to smoking. "The benefits the FDA cites for this proposal are extraordinary," said Matthew L. Myers, president of the Campaign for Tobacco-Free Kids. He added that for the proposal to have maximum impact, the FDA should reduce nicotine levels in all combustible tobacco products, not just cigarettes. (Healy, 3/15)

The nicotine rule is one of a number of tobacco-related regulations FDA is working on. The agency will soon seek comment on the role that flavors like menthol play in tobacco use, and to get feedback and data concerning the possible regulation of premium cigars. It’s also working to modernize its approach to the development and regulation of nicotine replacement products like gum and patches. (Karlin-Smith, 3/15)

The Food and Drug Administration (FDA) on Thursday took the first step in creating a new rule to reduce the level of nicotine allowed in cigarettes to nonaddictive levels. In an advanced notice of proposed rulemaking, FDA asked the public to submit comments over the next 90 days on the impact of a product standard for the maximum nicotine level in cigarettes. (Wheeler, 3/15)

The Trump administration is finalizing a long-awaited plan that it says will solve the opioid crisis, but it also calls for law enforcement measures — like the death penalty for some drug dealers — that public health advocates and congressional Republicans warn will detract from efforts to reverse the epidemic. The ambitious plan, which the White House has quietly been circulating among political appointees this month, could be announced as soon as Monday when President Donald Trump visits New Hampshire, a state hard hit by the epidemic. It includes a mix of prevention and treatment measures that advocates have long endorsed, as well as beefed-up enforcement in line with the president’s frequent calls for a harsh crackdown on drug traffickers and dealers. (Diamond, 3/15)

President Donald Trump will be traveling to New Hampshire to unveil more of his plan to combat the nation’s opioid crisis. The White House says the president and First Lady Melania Trump will travel to the Granite State on Monday. Trump had come under fire for being slow to act on the drug crisis but has begun rolling out new plans. He had promised during the campaign to make fighting the epidemic a priority. (3/15)

The incident command system kicked in at Brigham and Women’s Hospital about a week ago. A large team of doctors, pharmacists, and nurses began assembling every morning to confront an emerging crisis with the potential to severely undermine care for patients. The challenge was different than it was during the Boston Marathon bombing, another event that triggered the command response. This one wasn’t rushing toward caregivers as fast. But it was similarly daunting and logistically demanding: Amid a nationwide crisis caused by too-easy access to medical painkillers, hospitals are now struggling to find enough of that same class of drugs to keep their patients’ pain controlled. (Ross, 3/15)

The city of Alexandria, Va., is suing sellers of prescription painkillers, saying drug addiction has killed scores of residents and overwhelmed city services. Alexandria is asking $100 million from the companies, which include manufacturers, distributors and pharmaceutical providers. The city joins dozens of state, county and city governments across the country that have taken opioid providers to court to argue that the companies that profited so much from the drugs should help pay for their destructive effects. Montgomery and Prince George’s counties in Maryland are among those who have sued opioid manufacturers and distributors. (Weiner and Stein, 3/15)

A woman addicted to opioids walks into an emergency room, complaining of severe dental pain, leaves with a prescription for opioids and repeats the visit one week later, at another ER. A man complaining of chest pain is rushed to a hospital, gets a full battery of tests, is discharged and repeats the same round of tests in a different ER the following day. ... Now [the Massachusetts College of Emergency Physicians], in collaboration with the Massachusetts Hospital Association (MHA), has launched a pilot program that will alert hospitals across the state to patients who are in and out of emergency rooms on a regular basis. (Bebinger, 3/15)

Health insurers and the Trump administration face a court decision shortly that will determine whether the government must pay insurers billions of dollars despite Republican efforts to block payments they view as an industry bailout. Insurers have filed roughly two-dozen lawsuits claiming the federal government reneged on promises it made to pay them under the Affordable Care Act. A decision could come at any time on pivotal litigation before a three-judge panel at the U.S. Court of Appeals for the Federal Circuit. (Armour, 3/15)

Idaho officials met with Trump administration officials and Sen. Jim Risch (R-Idaho) on Wednesday to try to find a path forward on the state’s controversial plan to skirt ObamaCare rules. Idaho insurance commissioner Dean Cameron told The Hill that he met with administration officials in Washington on Wednesday to discuss possible changes to the state’s plan. (Sullivan, 3/15)

Lt. Gov. Brad Little on Thursday said he has a better understanding of the federal government's position after being told the state's move to let companies offer health insurance plans that don't meet Affordable Care Act standards is illegal. ... "After these discussions, I believe they understand where we are coming from better, and we understand their position better," Little said in a prepared statement. "Moving forward, I am very optimistic that we can work together with the Trump Administration to implement an Idaho-based solution for health care that works for Idahoans and fulfills the goals of Idaho's executive order." (Kruesi, 3/15)

House Minority Leader Nancy Pelosi Thursday expressed doubt that an Obamacare stabilization package would be part of this month’s $1.3 trillion omnibus spending bill because of a lingering dispute over abortion policy. “One of the regrets we have about the negotiation is that we thought there’d be a chance to have a health piece, like 'reinsurance,' to kind of help,” Pelosi told reporters in a brief interview Thursday. “But everything about health care, [Republicans] want to put Hyde on,” she said, referring to the prohibition on the federal funding of abortion known as the Hyde amendment that's a regular feature of annual spending bills. (Ferris and Haberkorn, 3/15)

House Labor-HHS appropriations subcommittee chairman Tom Cole said the omnibus spending bill should not include funding to stabilize Obamacare insurance markets because it would cost too many Republican votes. He added that legislative text of the entire bill is unlikely before Monday evening. “I would prefer not to do [Obamacare stabilization] unless it is coupled with some reform,” Cole said Thursday. “You risk a lot of Republican votes with that and I think we need a very healthy majority of the majority. The interest in that seems to be more on the other side of the rotunda than on our side.” (Haberkorn, 3/15)

Informed Choices is what its president describes as a "life-affirming" pregnancy center on the edge of downtown Gilroy in northern California. Even as it advertises "free pregnancy services" and promises in signs on its door and inside to discuss all options with pregnant women, Informed Choices exists to steer women away from abortion. The state of California, prompted by abortion rights groups, worried that vulnerable, uninsured women were going to Informed Choices and other anti-abortion crisis pregnancy centers expecting they would get comprehensive care. (Sherman, 3/16)

Accounts from two women who visited crisis pregnancy centers, with differing views of the experience. (3/16)

Health and Human Services (HHS) Secretary Alex Azar indicated Thursday he would not fire Scott Lloyd, the HHS official who has tried to block unaccompanied immigrant minors in U.S. custody from getting abortions. Asked by Rep. Rosa DeLauro (D-Conn.) when Azar would fire Lloyd, Azar replied: “This is simply not an issue of Mr. Lloyd. This is the statutory obligation of the director of the Office of Refugee Resettlement (ORR) to coordinate and improve the care of placement of these minors, including providing for serious medical services to them.” (Hellmann, 3/15)

An Iowa House committee Thursday advanced what could become the strictest abortion law in the nation ahead of a legislative deadline. It would ban abortions after a fetal heartbeat is detected, which can be as early as six weeks into a pregnancy. That provision is attached to a bill that puts limits on the donation and use of fetal tissue. Democratic lawmakers accused Republicans of being willing to risk women’s lives to make an ideological point. (Sostaric, 3/16)

Ohio Attorney General Mike DeWine said Thursday his office will appeal a federal judge's order blocking the state's Down syndrome abortion ban from taking effect. On Wednesday, U.S. District Court Judge Timothy Black issued a preliminary injunction putting House Bill 214 on hold while abortion providers challenged the law's constitutionality. The law bans abortions after a prenatal test shows the fetus has or is likely to have Down syndrome. (Borchardt, 3/15)

Facing reports that he might soon be fired by the White House, Veterans Affairs Secretary David Shulkin told a House subcommittee Thursday that he was fighting “politics and distractions to focus on vets.” Shulkin began the session with praise of President Trump’s proposed $200 billion budget for the agency, calling it “very strong.” But he was quickly asked about his own situation. “Let’s discuss the proverbial elephant in the room — some reports even mentioned you have an armed guard stationed outside your office?” Rep. Charlie Dent (R-Pa.) asked during the hearing before the House Appropriations subcommittee. “Is all of this squabbling affecting your mission to serve veterans?” (Wax-Thibodeaux, 3/15)

A combat veteran killed himself after fatally shooting three mental health workers last week at a California veterans home, authorities said Thursday. The Napa County Sheriff’s Office said Albert Wong, 36, shot the three workers in the head with a rifle at the California Veterans Home in Yountville. The sheriff didn’t release the type of rifle used. The sheriff also serves as the county’s coroner. (3/15)

Many of them had already endured their share of heartache. Some had been trying for years to get pregnant, suffering through multiple miscarriages. Others had undergone cancer treatments that destroyed their fertility. Now, hundreds of these women and couples have learned that the eggs and embryos they froze for eventual use in starting or expanding a family may have been destroyed by storage tank failures March 4 at two fertility clinics in suburban Cleveland and San Francisco. (Seewer, 3/15)

A second lawsuit has been filed against a San Francisco fertility center by a Sacramento couple that says their frozen embryos were destroyed by a rare tank malfunction, dashing their hopes of starting a family. Megan and Jonathan Bauer’s lawsuit says they were planning to transfer one of their eight embryos stored at Pacific Fertility Center next month — and were shocked to be told that something went wrong. (Krieger, 3/15)

Long after the sirens, vigils and cable news debates, the question remains. It nags at survivors and their families. It haunts investigators as they comb through the gunman’s belongings, text messages and the scattered pieces of his life. Even as our attention as a society fades, the mystery of motive lingers like an open, forgotten wound until the next shooting, the next cycle of grief, outrage and desperate search for answers. (Wan and Berman, 3/15)

States across the country are responding to high-profile school shootings and rising teen suicide rates by creating tip lines modeled on Colorado’s. The programs aim to prevent young people from behaving dangerously, whether that means bullying, using drugs or killing someone. [Colorado Attorney General Cynthia Coffman] said that Safe2Tell has saved lives in Colorado, and that such a system could have prevented the Parkland shooting. Nikolas Cruz, the expelled student who has admitted to shooting his former classmates at Marjory Stoneman Douglas High School, had a long record of disturbing behavior but it didn’t provoke a sufficient response from local authorities. A tipster’s warning to an FBI hotline was never communicated to local law enforcement. (Quinton, 3/16)

Almost immediately after the shooting at Marjory Stoneman Douglas High School, Melissa Kornhaus, a licensed mental health counselor with a specialty in trauma therapy, was looking for a way to help. So Kornhaus, who’s based in Broward County, quickly organized Professionals United for Parkland—an all-volunteer group of more than 250 licensed mental health workers providing pro-bono therapy. Her group established a referral hotline, (443) 390-8343, for anyone in South Florida affected by the shooting. (Mack, 3/15)

A lawsuit in Connecticut against a leading maker of AR-15 rifles is awaiting a pivotal court ruling over whether the gun industry can be held legally responsible for mass shootings. The Connecticut Supreme Court is deciding whether to throw out a wrongful-death lawsuit brought by families of victims killed at Sandy Hook Elementary School against the manufacturer of the semiautomatic gun Adam Lanza used in the 2012 rampage. (Gershman, 3/16)

At first, the pills helped her feel so much better. Jessica Falstein, an artist living in the East Village in Manhattan, learned she had an anxiety disorder in 1992. It led to panic attacks, a racing pulse, sleeplessness. “Whenever there was too much stress, the anxiety would become almost intolerable, like acid in the veins,” she recalled. When a psychopharmacologist prescribed the drug Klonopin, everything brightened. “It just leveled me out,” Ms. Falstein said. “I had more energy. And it helped me sleep, which I was desperate for.” (Span, 3/16)

The Food and Drug Administration is keeping tight watch on “direct-to-consumer” genetic tests but has been taking a hands-off approach with similar tests that have a crucial distinction: a physician’s sign-off. A physician order appears to be a key regulatory difference between companies like 23andMe, whose tests FDA has said must seek official approval, and companies like Color Genomics, Helix, and Veritas, who are offering some similar tests but don’t need the agency’s permission. (Swetlitz, 3/16)

Gregor Mendel discovered fundamental rules of genetics by raising pea plants. He realized that hidden factors — we now know them to be genes — were passed down from parents to offspring. It wasn’t until the early 1900s, long after Mendel’s death, that doctors discovered that humans weren’t so very different. Some diseases, it turns out, are inherited — they’re Mendelian. Today, scientists have identified over 7,000 Mendelian diseases, and many are discovered with screenings of children and adults. But a new study suggests that many disorders go undetected. (Zimmer, 3/15)

Genetic mutations are the driving force of evolution, and now scientists have managed to study the effect of mutations in exquisite detail by watching what happens as they pop up in single cells. Only about one percent of mutations were bad enough to kill off the cell, according to a report published Thursday in Science. Most of the time, these small changes in its DNA appeared to have no effect at all. (Greenfieldboyce, 3/15)

Humans weren't just making babies with Neanderthals back in the day. A new study that compares the genomes of different groups of modern humans has found that our ancestors interbred with another close relative, the Denisovans, more than once. The findings, published in the journal Cell, demonstrate a special method that scientists can use to find these hidden fragments of DNA from our long-gone cousins — and shed fresh light on the complexities of human evolution. (Khan, 3/15)

When it comes to our weight, is there a “sweet spot” for heart health? A large prospective study in the European Heart Journal collected data on almost 300,000 healthy men and women ages 40 to 69 and followed them for an average of five years. Researchers measured obesity in five ways: body mass index, waist circumference, waist-to-hip ratio, waist-to-height ratio and percentage body fat mass. (Bakalar, 3/15)

As Alex Rivero biked around town raising money for the Newton North High School football team last fall, the 17-year-old started getting pretty good at guessing which houses were worth the door knock. He'd look for lights on and listen for kids' voices. When he found a house that looked promising, he would stop. At one place, Dr. Lee Goldstein opened the door. Goldstein cares a great deal about high school football. It's what he was thinking about when the doorbell rang. (Leydon, 3/15)

Stimulant drugs like Adderall and Ritalin are commonly prescribed to kids with what's known as ADHD, or attention deficit hyperactivity disorder. But recently, adults became the biggest users of these drugs. That's partially because more adults are being diagnosed with ADHD for the first time. But the new Netflix documentary Take Your Pills focuses on the use of these drugs to boost cognitive performance in college classrooms and the workplace. (McCammon, 3/15)

When most senior citizens think about their overall health, the first things that come to mind are eating well and exercising. However, one of the most important parts of seniors' overall health that is easy to overlook is good dental care. Good dental care is more important in later years due to problems that can occur during aging. ... One problem many senior citizens face when it comes to dental care is the lack of insurance coverage, or the limited coverage by Medicare. However, there are many low-cost insurance dental policies just for senior citizens. (Maitland, 3/15)

Supplementing breast-feeding with formula may be good for some babies in the early days of life. Exclusive breast-feeding is widely recommended by experts, and rates of breast-feeding have risen. But so have rates of readmission for dehydration and jaundice attributable to inadequate nutrition. (Bakalar, 3/15)

Visitors to airports in Detroit; Newark, N.J.; and Memphis may have been exposed to measles after cases were confirmed in two international travelers, health officials in two states said Tuesday. But people who received the measles, mumps and rubella vaccine twice as children are considered protected for life, federal Centers for Disease Control and Prevention officials said. Others who have not been vaccinated or had only one shot could come down with the disease, which can be life threatening. (3/15)

Anyone in those airport locations in that time frame who experiences high fever, red eyes, coughing, a runny nose or light sensitivity followed by a bumpy rash should contact their primary-care doctor, the agency said. Symptoms manifest 10 to 12 days after infection but could be spread to other people before that. (Horton, 3/14)

They help some of the most vulnerable people in Sonoma County, those grappling with severe mental illnesses who can’t afford to pay for help. Now, their funding is in jeopardy at a terrible time. Sonoma County officials are considering millions of dollars in emergency budget cuts to more than 40 nonprofit groups that provide counseling, suicide prevention, supportive housing and addiction intervention — even as the region faces a mental health crisis after October’s Wine Country firestorm. (Johnson, 3/15)

Minnesota Republicans introduced legislation on Thursday intended to repair the state’s broken system for investigating allegations of elder abuse, while lashing out at the Dayton administration for failing to act sooner as thousands of maltreatment allegations went uninvestigated. The legislation would streamline the state’s abuse reporting process, create new civil penalties for facilities that mislead consumers, and lift the layers of secrecy that often surround state investigations of maltreatment in senior homes. The bill would also enshrine in state law the rights of Minnesota families to use cameras in the rooms of their loved ones — further empowering consumers and potentially ending years of confusion over the use of electronic surveillance in senior homes. (Serres, 3/15)

The Florida Department of Health this week asked a circuit judge to dismiss a public-records lawsuit filed by a Broward County nursing home where residents died after Hurricane Irma. The Rehabilitation Center at Hollywood Hills filed the case last month in Leon County circuit court, alleging that the department had improperly refused to provide copies of death certificates for people across the state from Sept. 9 through Sept. 16 --- a week-long period that included Hurricane Irma and its immediate aftermath. (3/15)

A hotly disputed bill to ease restrictions on Cancer Treatment Centers of America’s facility in Newnan was defeated in a House committee vote Thursday. The Health and Human Services Committee voted 13-8 against Senate Bill 31, which would have relaxed the state’s limits on bed capacity and the percentage of Georgia patients served by the CTCA hospital. The committee’s brief discussion before the vote was much milder in tone than Wednesday’s emotionally charged hearing, which featured a testy exchange between the panel’s chair, Rep. Sharon Cooper (R-Marietta), and a Georgia Hospital Association official. (Miller, 3/15)

A bill approved by the Florida Legislature would end HCA’s bid to open a trauma center at Northside Hospital in St. Petersburg. Under the legislation, HCA will receive trauma center designations for two hospitals in Miami-Dade County and one in Clay County. But the bill blocked Northside's proposal, which was fighting its way through the court system after HCA applied last year. (Ochoa, 3/15)

The video showed 13-year-old Marquel Brumley bundled up in a hooded coat, sluggish and slumped in his seat. He was holding somebody's hand, then loosened his grip and let go. “Get well brother,” read a caption on the video, which his sister posted on Facebook last week. (Bever, 3/15)

Amid the monitor alarms and life-and-death conversations on the intensive care unit, Tucker, a very mellow Labrador retriever, rolled onto his back at the nurses’ station. Delighted staff surrounded the dog, cooing and scratching his stomach until he was whisked off for his most important job: Comforting patients like James Cawley. (Kowalczyk, 3/15)

Citrus Heights resident Curtis Fry wants answers. After eight months of waiting, he doesn’t understand why Cal/OSHA can’t provide them. Fry’s 22-year-old son, Spencer Fry, contracted the deadly hantavirus in July 2017 while working at Bodie State Historic Park and living in state-provided housing. An avid runner and hiker, Spencer suffered permanent hearing loss in his left ear and partial leg paralysis as a result. Fry said he wants state investigators to report how he was exposed and hold State Parks accountable, but he fears investigators will water down criticism because Spencer submitted a form saying he intended to sue. (Anderson, 3/16)

Florida’s smoking rates may have dropped, but the need continues for an anti-smoking campaign --- making ill-advised a proposed constitutional amendment that would divert money from advertising to cancer research, a group of health advocates warned Wednesday. The American Cancer Society's Cancer Action Network, the American Heart Association and The American Lung Association have come together under the “Protect Tobacco Free Florida” moniker to try to beat back a proposal being considered by the state Constitution Revision Commission. (3/15)

Wellington Management has sold the entirety of its stake in Community Health Systems. The Boston-based mutual fund owned a 7.12% stake in the Franklin, Tenn.-based hospital chain—nearly 19 million shares—at the end of 2017. As of Thursday, the fund's ownership stake was 0%, according to a U.S. Securities and Exchange Commission filing. The development follows news that CHS has hired a team of financial advisers to help the chain restructure $4.8 billion in long-term debt maturing in 2019 and 2020. The chain's stock price dropped 11% over a two-day period after reports of the hire surfaced. CHS' total long-term debt stands at nearly $14 billion.  (Bannow, 3/15)

[T]here’s nothing like the Barbary Coast lounge almost anywhere in the United States, a conundrum confronting many marijuana enthusiasts who find it increasingly easy to buy pot but harder to find legal places to smoke it. Only California permits marijuana smoking at marijuana retailers with specially designed lounges. But it also allows cities to ban those kids of shops. (Elias, 3/15)

This research adds to the growing evidence that connects specific kinds of household debt and financial exclusion to poor health. Effectively addressing the health consequences of fringe borrowing and being unbanked will likely require expanding social welfare programs and labor protections. Future research should explore in more depth how the two-tier US financial system—one for the wealthy and one for the poor—affects health and worsens health inequities. (Eisenberg-Guyot, Firth, Klawitter and Hajat, 3/1)

For interventions to be effective in this marginalized population, challenges in engaging survivors in long-term therapeutic primary and mental health care must be better understood and overcome. This article uses the socioecological model of public health to identify barriers to engagement; offers evidence- and practice-based recommendations for overcoming these barriers; and proposes an interdisciplinary call to action for developing more flexible, adaptable models of care.(Judge et al., 3/13)

The expansion of short-term limited-duration policies implied in the current administration’s proposed rule has significant implications, particularly for insurance coverage and premiums in the remaining ACA-compliant insurance market. We estimate that ACA-compliant private nongroup coverage would fall by 2.2 million people in 2019 from the expansion of STLD policies alone, exacerbating the nongroup market decline of 5.5 million people already anticipated in 2019 because of the elimination of the individual-mandate penalties and other policy changes made since early 2017. (Blumberg, Buettgens and Wang, 3/14)

While there might be value in risk-mitigation programs such as reinsurance or high-risk pools, such programs are best applied in the context of larger efforts to stabilize the market by repealing and replacing the Obamacare provisions responsible for destabilization. ... Some might argue that funding the cost-sharing reductions could help to offset increasing costs in premiums subsidies but like funding for reinsurance, such efforts are not a response to the underlying problems of the law that fuel these increased costs: They are merely a patch that masks the real problems. (Owcharenko Schaefer, 3/7)

A physician goes through a decade of training and multiple background checks before being allowed to prescribe a controlled substance that could be deadly. But in many states, firearms can be purchased in days. A physician prescribes proven and tested treatments, but the same standard is not expected of our lawmakers. Too many ignore the evidence in front of them—refusing to acknowledge that the states with the most gun laws also have the fewest gun deaths. (Gregory Siegel, 3/15)

When Dr. Jeffrey Claridge opens the body of a victim felled by a high-powered rifle, the damage he finds is invariably catastrophic. "It's like a small grenade went off inside," he explained. "Organs are literally pulverized." Few people on the planet speak with more authority on this than Claridge.  A trauma surgeon since 2003, since 2009 he has been medical director of MetroHealth's division of trauma, critical care and burns - at one of the nation's elite, Level 1 trauma centers. And Claridge, like anyone with a modicum of common sense, believes there is no justifiable reason to make these assault-style weapons available to the public. (Brent Larkin, 3/15)

Principal Matt Creasman handled it perfectly. Faced with 200 Northeast Magnet High students leaving classes Wednesday to protest school violence, Creasman’s response to the disruption had three components. Allow students to protest, standing up for their beliefs and honoring students killed across the country. There has to be a penalty for leaving school. "One of the central elements to civil disobedience is understanding that with the act, comes a consequence,” he wrote in a letter to parents. The penalty is perfect: lunch detention, where Creasman will facilitate a discussion about school safety and get students’ input. So Northeast students were allowed to peacefully protest, and their penalty is a chance to voice opinions on their own school’s safety. (Kirk Seminoff, 3/15)

“We have to talk about mental illness.” Since I’m a therapist, hearing politicians say this should excite me, because it will help expand mental health treatment for all who need it. Right? Wrong. ...Let’s talk instead about the psychological concept of toxic masculinity. Let’s talk about our pushing boys into dominance, suppressing emotions, devaluing women and obsessive self-reliance, often interlinked with violence. (Justin Perry, 3/15)

There is a toxin in Philadelphia that our children and families are being exposed to near constantly: trauma. Trauma lingers and isn’t just limited to a single incident, like a gunshot. Trauma manifests in hunger, housing instability, or living without utilities. It can include exposure to abuse, neglect, gun violence, police brutality, imprisonment, and domestic violence. And trauma can pass through generations as the result of historical violence, slavery, redlining, and mass incarceration. Very much like a toxin, the longer it goes unnoticed and untreated, the worse things can get. (Mariana Chilton, 3/15)

Following reports that Nikolas Cruz, the Parkland school shooter, played violent video games between eight and 15 hours a day, the spokesman for the Entertainment Software Association has claimed that “numerous authorities and reputable scientific studies have found no connection between games and real-life violence. This is a cynical claim and blatantly untrue. (Patricia Marks Greenfield, 3/15)) 

The tax-reform provision repealing the penalty on those who refuse to participate in ObamaCare has freed millions of Americans to escape a system that exploits them. But while Americans can escape ObamaCare, they still can’t buy insurance in the individual market independent of ObamaCare because private insurers are prohibited from selling it. If this prohibition can be removed through the granting of state waivers by the Department of Health and Human Services, or by the passage of a new federal statute, ObamaCare will collapse into a high-risk insurance pool for the seriously ill rather than become a stepping stone to socialized medicine. (Phil Gramm, 3/15)

To call Veterans Affairs Secretary David Shulkin “embattled” over the last few weeks is an understatement. While the tide of public opinion has ebbed and flowed with respect to Shulkin’s fate for myriad reasons, one thing is certain: What’s good for the Department of Veterans Affairs appears to be the last thing on President Trump’s mind. (Joe Chenelly, 3/15)

Before sentencing notorious pharmaceutical executive Martin Shkreli to seven years in prison, the federal judge presiding over his criminal trial ordered him to turn over "Once Upon a Time in Shaolin," the Wu-Tang Clan album of which only a single copy exists. Shkreli paid $2 million for the album, an extravagance he could afford after making a fortune by jacking up the prices of prescription medications. Seizing the album and other assets worth a total of $7.4 million may seem like karma, but it will do nothing to tame drug costs. Indeed, it is entirely legal to raise generic drug prices (which explains why Shkreli was convicted of securities fraud, not healthcare fraud). The problem is that government has made it far too easy for pharma companies to gain a national monopoly on the supply of drugs that no longer are patent-protected. Rather than make an example of Shkreli, the solution to outrageous drug prices is to embrace globalization. (3/15)

Before the election, Republicans wanted voters to think of (Connor) Lamb as too liberal to support. Afterward, they wanted to buck up Republican morale by saying that he had run to the right. The new spin is not grounded in reality. Lamb is not a conservative, and not a Republican in the wrong party. He ran against most of the Republican economic agenda, including the recently enacted corporate tax cuts and the reforms to Social Security and Medicare that (Paul) Ryan has long advocated. (Lamb objects when Ryan, like much of the press, calls these programs, to which senior citizens are entitled by law, “entitlements.”) He’s for tweaking rather than replacing Obamacare. ...Lamb says he “believes life begins at conception,” but also abortion should be legal even after the 20th week and disavows the label “pro-life.” (Ramesh Ponnuru, 3/15)

Dozens of biotechnology start-ups across the country are investing in the research and development that Big Pharma has stopped funding. Clementia, for instance, is zeroing in on rare bone diseases. Catabasis Pharmaceuticals is focused on amyotrophic lateral sclerosis and other terrible neurological conditions. Quanterix and others are developing blood-based diagnostic tests to help doctors offer more targeted cancer treatments, for example. (3/15)

In a detailed analysis of health care spending in the United States and 10 other high-income, mainly European, countries, the authors found that the United States spends approximately twice as much on medical care and that the “[p]rices of labor and goods, including pharmaceuticals, and administrative costs appeared to be the major drivers of the difference in overall cost.” (Ezekiel J. Emanuel, 3/13)

In short, the claim from many scholars, think tanks, and policy makers is that the US citizen is not getting good care for the money spent on health care. The authors approach this claim with a much more focused analysis than in the past that seeks to identify more tangible root causes and provide insights for strategic and perhaps even tactical policy options for the United States to maximize its health dollar. While (Irene) Papanicolas et al have taken care and scholarship in addressing this complex topic, they have not fully mapped out all the important factors that drive this issue. (Stephen T. Parente, 3/13)

The authors compared spending and various aspects of the US health care system with those in 7 European countries, Canada, Australia, and Japan and report that in 2016, health care spending in the United States accounted for 17.8% of gross domestic product and that annual per capita health care spending in the United States was nearly double that in the other countries ($9403 in the United States vs a range of $3377 to $6808 in the other countries). However, decomposing differences in health care spending into price and quantity is more difficult than it might seem, and there are important challenges in drawing policy inferences from such analyses. (Katherine Baicker and Amitabh Chandra, 3/13)

In 2016, the United States spent nearly twice as much as 10 high-income countries on medical care and performed less well on many population health outcomes. Contrary to some explanations for high spending, social spending and health care utilization in the United States did not differ substantially from other high-income nations. Prices of labor and goods, including pharmaceuticals and devices, and administrative costs appeared to be the main drivers of the differences in spending. ...Efforts targeting utilization alone are unlikely to reduce the growth in health care spending in the United States; a more concerted effort to reduce prices and administrative costs is likely needed. (Irene Papanicolas, Liana R. Woskie, and Ashish K. Jha, 3/13)

Despite the important and increasing role of Medicare Advantage plans, there is fairly little insight into the relative value Medicare Advantage provides to beneficiaries or the funder, the US taxpayer. This is attributable mainly to a lack of access to comprehensive claims- or encounter-level data regarding the Medicare Advantage program for researchers, or even more aggregated information that could be made available to the general public. ... in June 2017, the CMS abruptly cancelled the Medicare Advantage data release, citing concerns about data quality, but with very little explanation. This abrupt shift is troubling for a number of reasons. (Niall Brennan, Charles Ornstein and Austin B. Frakt, 3/13)

The vaccine article struck serious chords in the medical community, and doctors took some sharp jabs at the piece. Many physicians chimed in that the medical community couldn’t care less about a non-medical person’s views on one of the most remarkable worldwide public health successes in history. It’s enough of challenge for physicians to explain the safety and effectiveness of vaccines to patients and families, let alone having to answer the claims of movie stars. Others expressed dismay that a mainstream parenting magazine provided yet another stage to some of the most powerful anti-vaccination voices, one of whom has lately played a key role in the anti-vaccination movement. (Nina Shapiro, 3/15)

There is broad agreement that fee-for-service reimbursement does too little to encourage the provision of efficient, high-value care. Consequently, Medicare and other payers are increasingly moving toward alternative payment models (APMs), which disrupt the fee-for-service system by incorporating quality and cost targets into reimbursement. ...In the best-case scenario, clinicians will respond to APMs’ incentives by improving care coordination and integration, which may particularly benefit vulnerable populations with higher-than-average medical and social needs. On the other hand, there may be incentives for clinicians to avoid caring for these groups, who are at risk for high costs or poor outcomes in part because of factors beyond clinicians’ control. Understanding APMs’ potential consequences for vulnerable populations is critical if we wish to maximize benefits and reduce harms. (Karen Joynt Maddox, 3/14)

When I read that the American Academy of Pediatrics has called for universal screening for depression for children 12 and up, it seemed exceedingly welcome and pragmatic news, given the prevalence of teenage depression. After all, 20 percent of teens reportedly encounter depression. Suicide is the second leading cause of death for people ages 10 to 24. Each day, sees an average of over 3,470 attempts by young people in grades nine to 12. I want my pediatrician to assess my children’s overall well-being, thank you. (Sarah Werthan Buttenwieser, 3/15)

In January, the U.S. Department of Health and Human Services (HHS) announced the creation of its Conscience and Religious Freedom Division, explaining that it will allow HHS’s Office of Civil Rights to “more vigorously and effectively enforce existing laws protecting the rights of conscience and religious freedom” and will ensure that “no one is coerced into participating in activities that would violate their consciences, such as abortion, sterilization or assisted suicide.” Responses were as expected: religious conservatives hailed the new division as a needed intervention; public health and clinical leaders and advocates decried it, worrying about its impact on access to care and harm to patients. HHS leaders’ comments to date suggest that they are uninterested in discrimination against health care providers whose consciences compel them to provide care, and uninterested in injuries to patients caused by care refusals. This framing makes conscience yet another issue dividing Americans, largely along partisan lines. Conscience, however, is not inevitably divisive. (Lisa Harris, 3/14)

Gov. Ralph Northam (D) is confident Virginia legislators will give him a budget that includes Medicaid expansion. In his monthly interview on Richmond’s WRVA, Northam said Medicaid expansion was the right thing to do, both from a business and a moral perspective. But he also mentioned the real reason expansion, or something like it, gets done: politics. “What legislators need to realize is that on Nov. 7 Virginia spoke,” Northam said. (Norman Leahy, 3/15)

On Sunday, we learned that Anthem refused to cover the full $32,000 bill for a South County boy airlifted to a St. Louis hospital because the helicopter ambulance was “out of network.” Meanwhile, Anthem reported in late January that its fourth-quarter profits for 2017 had increased by 234 percent to $1.2 billion over the fourth quarter of 2016. Part of that was $1.1 billion in savings from the federal tax reform bill. Anthem paid an effective tax rate of 3.1 percent in 2017. America’s second-largest health insurer, with 39 million members, Anthem is making a lot of money and skating on a fair share of taxes. Premiums are higher and benefits are harder to get. (3/15)

The American population is aging and becoming more diverse. Combating social isolation among older Americans is a public health imperative that will only become more critical in the years ahead. It is undeniable that poverty is a critical factor in social isolation and poor health, and a severe problem for many older Americans, with over 25 million Americans over 60 living in poverty. But according to the National Council on Aging, that should not prevent us from examining community-based options for supporting healthy aging that connect individuals to the resources they need. (Janet Golden, 3/16)