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Morning Briefing

Summaries of health policy coverage from major news organizations

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Thursday, Aug 8 2019

吃瓜不打烊 Original Stories 3

  • Federal Experts鈥 Advice On HPV Vaccine Could Leave Adults Confused
  • Price Of Snakebite Drug Is Sky High, But New Competitor Unlikely To Lower Costs
  • Obesity Plagues Hispanics And Blacks In Colorado, Nation鈥檚 鈥楬ealthiest鈥 State

Gun Violence 4

  • Trump Champions Deeper Background Checks For Guns As GOP Rallies Around 'Red Flag' Laws Despite Flaws
  • Tensions Roil Over The Effect Of Ideology and Rhetoric On Mass Shootings, While Trump Visits Dayton, El Paso
  • Routinely Blaming Mass Shootings On Mental Illness Is 'Unfounded And Stigmatizing.' So What Are The Risk Factors To Look For?
  • In Era Of Mass Shootings, Workers Turn To Insect Spray, Homemade Panic Buttons And Hiding Spots As Contingency Plans

Pharmaceuticals 2

  • Medicare To Pay For Cutting-Edge, Expensive CAR-T Treatment That Harnesses Cancer Patients' Own Immune System
  • Novartis CEO Justifies Decision To Delay Telling FDA About Manipulated Data For $2.1M Gene Therapy Drug

Elections 1

  • 'Medicare For All' Could Toss Wrench In Senate Democrats' Plan To Use Midterm Playbook That Secured The House

Health Law 1

  • When It Comes To Patients With Short-Term 'Junk' Plans, Insurers Aren't Spending Much On Medical Care

Government Policy 1

  • Detroit Man Who Was Deported To Iraq Dies After Family Says He Couldn't Access Needed Insulin

Marketplace 2

  • Critics See Juul's Lobbying Blitz As Proof That Its Promises To Fight Youth Vaping Are Empty
  • CVS Posts Second Straight Quarter Of Unexpectedly Strong Financial Results

Opioid Crisis 1

  • Fentanyl Deaths In San Francisco Soar Almost 150% In Largest Uptick The City Has Ever Seen

Veterans' Health Care 1

  • 'Recovery-Based' Caregiver Model Doesn't Account For Veterans With Catastrophic Injuries, Advocate Group Says

Public Health 1

  • 'It Can Get Lonely, Very Lonely': Novel Program Aims To Combat Rural Isolation By Connecting The Generations

State Watch 1

  • State Highlights: Georgia Health Officials Confirm 12 Cases, 1 Death From Legionnaires' Disease; Feds Sign Off On Changes Made To Correct Patient Safety Issues At St. Luke's In Houston

Health Policy Research 1

  • Research Roundup: State Gun Laws; The 'Public Charge' Rule; And Medicare Advantage

Editorials And Opinions 2

  • Perspectives: Senate Needs To Pass Bill Calling For Gun Safety Research; Talk All You Want About Regulations But Remember The Second Amendment
  • Viewpoints: 'Medicare For All' Is Doomed, But Harris Has Other Health Care Ideas That Make Sense; Congress Needs To Protect Safety Of Everyday Drugs

From 吃瓜不打烊 - Latest Stories:

吃瓜不打烊 Original Stories

Federal Experts鈥 Advice On HPV Vaccine Could Leave Adults Confused

A federal advisory panel says people between ages 27 and 45 may benefit from the vaccine to fight the human papillomavirus. But some public health advocates worry that the advice doesn鈥檛 provide doctors and patients clear guidance about who in this large age group are good candidates for the vaccine. ( Michelle Andrews , 8/8 )

Price Of Snakebite Drug Is Sky High, But New Competitor Unlikely To Lower Costs

The drug CroFab, which has been on the market since 2000, now faces competition from a drug called Anavip. But both are expensive. ( Carmen Heredia Rodriguez , 8/8 )

Obesity Plagues Hispanics And Blacks In Colorado, Nation鈥檚 鈥楬ealthiest鈥 State

Obesity prevention does not get much attention in Colorado, often billed as the healthiest state. Yet more than 1 in 4 black or Hispanic residents are obese, as state and federal public health spending fuels other needs. ( Markian Hawryluk , 8/8 )

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Summaries Of The News:

Gun Violence

Trump Champions Deeper Background Checks For Guns As GOP Rallies Around 'Red Flag' Laws Despite Flaws

President Donald Trump raised concerns among his advisers and the NRA when he talked about the current political appetite for extensive background checks on guns, an idea that hasn't been popular among his allies in the past. Meanwhile, Republicans see "red flag" laws as a way to address the public's renewed calls for lawmakers to "do something." But a look at previous shooting incidents show that those "red flags" often go unseen or unheeded even by those trained to spot them.

President Trump has repeatedly told lawmakers and aides in private conversations that he is open to endorsing extensive background checks in the wake of two mass shootings, prompting a warning from the National Rifle Association and concerns among White House aides, according to lawmakers and administration officials.聽Trump, speaking to reporters Wednesday before visiting Dayton, Ohio, and El Paso, where weekend shootings left 31 dead, said there 鈥渨as great appetite for background checks鈥 amid an outcry over government inaction in the face of repeated mass shootings. (Dawsey and Kim, 8/7)

鈥淚'm聽looking to do background checks,鈥 Trump said at the White House as he聽departed聽for Dayton, where he聽met with shooting survivors and first responders.聽鈥淚 think background checks are important.鈥 Trump, who also visited El Paso on聽Wednesday,聽said he senses there is 鈥渁 very strong appetite鈥 for background checks, though many lawmakers have mostly focused publicly on red flag聽laws aimed at聽keeping guns out of the hands of people deemed聽an imminent danger to themselves or others. (Collins, Lalljee, Elbeshbishi and Jackson, 8/7)

Battling dual crises of gun violence and trade, President Donald Trump is twisting the facts in regards to gun control and exaggerating his case for tariffs against China. Speaking Wednesday, Trump defended his past incendiary rhetoric on race in the wake of weekend mass shootings in Texas and Ohio and suggested that legislation addressing background checks was imminent. That鈥檚 not the case. (Yen and Wiseman, 8/7)

Most Republicans would support legislation banning assault-style weapons, a new POLITICO/Morning Consult poll found Wednesday 鈥 a finding that contradicts President Donald Trump's claim earlier the same day that there's "no political appetite" for such restrictions. The poll found that nearly 70 percent of all voters would back such a ban. Support for an assault-weapons ban was higher, at 86 percent, among Democrats, who have been pushing for new restrictions on the firearms in the wake of two mass shootings over the weekend. (Shepard, 8/7)

A cluster of recent mass shootings that killed 36 people in California, Texas and Ohio has sparked renewed calls for the U.S. Congress to pass legislation to prevent gun violence. While Democrats want the Senate to interrupt its five-week summer recess and return to Washington to address the matter immediately, Senate Majority Leader Mitch McConnell, a Republican, has not acted on the request. (8/7)

More than 200 mayors, including two anguished by mass shootings in Texas and Ohio, are urging the Senate to return to the Capitol to act on gun safety legislation amid criticism that Congress is failing to respond to back-to-back shootings that killed 31 people. In a letter Thursday to Senate Majority Leader Mitch McConnell and the Democratic leader, Charles E. Schumer, the mayors wrote, 鈥淥ur nation can no longer wait for our federal government to take the actions necessary to prevent people who should not have access to firearms from being able to purchase them.鈥 (Daly and Mascaro, 8/7)

Gov. Greg Abbott said Wednesday he's not aware of any "red flags" in the suspected El Paso gunman's past and made no mention of taking major gun-control measures in Texas, where three mass shootings since 2017 have killed more than 50 people. Abbott, a Republican, said racism needs to be confronted and a crackdown initiated on internet sites used by violent extremists after the weekend attack that left 22 people dead in the mostly Latino border city. (8/7)

Days after a white gunman murdered 22 people in El Paso in a shooting fueled by racism, Gov. Greg Abbott on Wednesday said that he will hold another series of roundtable discussions to consider legislative proposals to address the tragedy. The roundtables, which may start later this month, are meant to collect ideas to legislatively address the domestic terrorism El Paso experienced as well as ensuring guns do not end up in the hands of 鈥渄eranged killers like the man who committed this heinous crime,鈥 Abbott said. (Ura, 8/7)

Deadly massacres in recent years have exposed the difficulty in identifying and聽acting on warnings signs from troubled people聽鈥 even inside institutions such as the military, which聽screens its personnel continuously.聽After massacres in El Paso, Texas, and Dayton, Ohio, President Donald Trump said the government needs the power to identify potential shooters and take away their firearms if they have threatened harm to themselves or others. But even when warning signs are apparent, they can be overlooked or unheeded. Information reporting systems have聽gaps that can allow would-be shooters to obtain weapons. (Brook and Johnson, 8/7)

Seventeen states and the District of Columbia have enacted laws, primarily since 2012. Maryland鈥檚 law went in effect in 2018, after the shooting at Marjory Stoneman Douglas High School in Parkland, Fla. All the laws allow law enforcement to petition the courts. Many states also allow family members and intimate partners to seek an order. The Maryland law is considered among the strongest because it also allows some health care providers and social workers to petition the court and permits requests any day or time. (Cohn and Rentz, 8/7)

The state lawmakers had been crammed into a conference room for nearly two hours, listening to fellow legislators talk about bulletproof desks, clipboards that double as shields and special phone apps to alert emergency services 鈥 all part of a cottage industry to prepare students for a mass shooting. There was talk of mental-health interventions, video games and social media monitoring during the informational session titled 鈥淎 proactive approach to school safety.鈥 But as the talk neared its end, no one had mentioned the word 鈥済un.鈥 (Wax-Thibodeaux, 8/7)

In the run-up to the 2020 legislative session, the Florida Senate will review acts of mass violence such as the deadly shootings this weekend in El Paso, Texas, and Dayton, Ohio, along with factors such as white nationalism. Senate President Bill Galvano, R-Bradenton, on Monday directed Senate Infrastructure and Security Chairman Tom Lee, R-Thonotosassa, to lead efforts to determine if any further action is needed after laws were enacted in the wake of the Feb. 14, 2018 massacre at Marjory Stoneman Douglas High School in Parkland. (Turner and Ceballos, 8/7)

Tensions Roil Over The Effect Of Ideology and Rhetoric On Mass Shootings, While Trump Visits Dayton, El Paso

After President Donald Trump's rhetoric was criticized, some on the right pointed to the Dayton's shooter left-leaning social media posts in return. But experts say there's no evidence that the Dayton shooter was motivated by ideology, while the El Paso attacker left behind a manifesto. The accusations have thrust the role of ideology, white supremacy and political rhetoric into the national spotlight following the incidents.

U.S. President Donald Trump met victims and first responders from last weekend's deadly shootings in Texas and Ohio on Wednesday, as chanting protesters accused him of inflaming tensions with anti-immigrant and racially charged rhetoric. Trump visited hospitals where victims were treated in El Paso, Texas, on the border with Mexico, and in Dayton, Ohio, after massacres 13 hours apart that shocked the country and reopened a national debate on gun safety. (Mason, 8/8)

On a day when President Trump vowed to tone down his rhetoric and help the country heal following two mass slayings, he did the opposite 鈥 lacing his visits Wednesday to El Paso and Dayton, Ohio, with a flurry of attacks on local leaders and memorializing his trips with grinning thumbs-up photos. A traditional role for presidents has been to offer comfort and solace to all Americans at times of national tragedy, but the day provided a fresh testament to Trump鈥檚 limitations in striking notes of unity and empathy. (Parker, Rucker, Johnson and Sonmez, 8/8)

As he left Washington, Mr. Trump said he 鈥渨ould like to stay out of the political fray,鈥 and the president and first lady Melania Trump met privately with victims, hospital staff and first responders in both cities. But he blasted critics who said his often-combative language on immigration, race and his political opponents has sowed divisions and encouraged violence. Democrats, meanwhile, continued to press the Republican president to throw his support behind gun-control legislation. Departing Washington, Mr. Trump said he is working with members of Congress, and he expressed optimism that progress can be made on the issue of background checks, though he didn鈥檛 offer details. (Leary, Lucey and Maher, 8/8)

But Mr. Trump鈥檚 proved unwilling to completely refrain from his usual combative style. On his way to El Paso from Dayton, he tweeted attacks on the Democratic mayor of Dayton and a Democratic senator who he said had not accurately described the closed-door sessions at a Dayton hospital earlier in the day. And earlier on Wednesday, Mr. Trump held a 20-minute session with reporters in which he unloaded many of his usual grievances, displaying little hesitation to engage in politics on a day of grief for many people around the country. (Shear, 8/7)

Democratic presidential front-runner Joe Biden on Wednesday accused Republican President Donald Trump of fueling the white supremacy beliefs blamed for several U.S. mass shootings, as Trump visited two cities where 31 people were killed in rampages last weekend. "In both clear language and in code, this president has fanned the flames of white supremacy in this nation," Biden, the former vice president, said in a speech in Burlington, Iowa. (Reid and MacLeod, 8/7)

Booker, in contrast, spent much of his time exploring the nation鈥檚 painful racial history in broad terms, depicting Trump as more symptom than cause and refraining from mentioning his name. 鈥淚n both clear language and in code, this president has fanned the flames of white supremacy in this nation,鈥 the former vice president said. 鈥淗is low-energy, vacant-eyed mouthing of the words written for him condemning white supremacists this week fooled no one. The energetic embrace of this president by the darkest hearts, the most hate-filled minds in this country, says it all.鈥 (Wootson and Viser, 8/7)

In their political views, the gunmen who brought carnage to two American cities last weekend could not have been more different. One posted a lengthy screed railing against the 鈥淗ispanic invasion of Texas鈥 and supported President Trump. The other apparently identified as a leftist, taking to Twitter to support Democratic presidential candidate Elizabeth Warren and proclaim, 鈥淜ill every fascist.鈥 As the nation struggles to understand the motives behind the attacks, political ideology has become a focus. (Jarvie, 8/7)

President Donald Trump has often railed about an 鈥渋nvasion of illegals鈥 at the southern border, words echoed in a screed the El Paso shooting suspect apparently posted that called the attack that killed 22 people at a Walmart his response to a 鈥淗ispanic invasion of Texas.鈥 Some extremism experts believe that may not be an accident. They say historical data suggests a link between heated rhetoric from top political leaders and ensuing reports of hate crimes, only adding to the fears of those who could be targeted. (Kunzelman and Galvan, 8/7)

Authorities, however, have said there is no clear motive behind the [Dayton] attack, and writings by Betts did not indicate any racial or political motive, sources have told CNN. Instead, investigators have pointed to an apparent fixation of Betts on violence and killing. In contrast, investigators say Patrick Crusius, the El Paso suspect, left behind a manifesto filled with white supremacist language and racist hatred aimed at immigrants and Latinos. The author says he opposes "race mixing" and encourages immigrants to return to their home countries. (Carvajal, 8/7)

The issue of gun violence has divided Americans along political lines for decades and will continue to do so, but white extremism is jumping to the forefront of the political conversation in a new way: Democrats say it's a crisis that needs to be addressed immediately while President Donald Trump and some pundits appear to believe there is no problem at all. (Wolf, 8/8)

Routinely Blaming Mass Shootings On Mental Illness Is 'Unfounded And Stigmatizing.' So What Are The Risk Factors To Look For?

Experts say that problems with self esteem and perceived social rejection are common characteristics among people who commit mass shootings, as is having experienced significant trauma over an extended period of time. 鈥淚f you鈥檙e going to do screening, you need to screen for multiple things, and mental health is only one of them,鈥 Dan Flannery, director of the Begun Center for Violence Prevention at Case Western University, told NBC News. 鈥淵ou need to understand what鈥檚 going on in and consider stress points 鈥 what鈥檚 happening at work, in domestic life and their social media activity. If someone belongs to a lot of hate groups on social media, that鈥檚 a red flag.鈥

Having access to a gun is more of a risk factor for violence than being diagnosed with a mental illness, research shows. That stands in stark contrast to a statement President Donald Trump made Monday in addressing the nation after this weekend鈥檚 mass shootings in Dayton, Ohio, and El Paso, Texas. 鈥淢ental illness and hatred pull the trigger, not the gun,鈥 Trump said. (Sullivan, 8/6)

Following a bloody weekend聽in Texas and Ohio where mass shootings聽left 31 people dead and dozens more injured,聽President Donald Trump called for culture change to a stop the glorification of violence in video games and online platforms, an end to bigotry and hatred and reforms to mental health laws.聽But his statements about聽mental health聽-鈥斅爎eferring聽to mass shooters as "mentally ill monsters" and suggesting聽"involuntary confinement" for some people with mental illness聽鈥 were off the mark, said聽Kevin Fischer, the executive director of the Michigan chapter of the National Alliance on Mental Illness. (Shamus, 8/8)

Four mental health experts who spoke with the PBS NewsHour described President Donald Trump鈥檚 conflation on Monday that 鈥渕ental illness and hatred pull the trigger, not the gun鈥 as 鈥渃ompletely false鈥 and 鈥渋rresponsible.鈥 (Akpan, 8/7)

A pair of mass shootings have renewed the spotlight on the nation's high rate of gun deaths. POLITICO's Dan Diamond reviews why health care groups say that gun violence deaths represent a "public health crisis" 鈥 and how GOP congressmen and the current Surgeon General avoid using that term. (8/8)

Gov. Ron DeSantis pointed to 鈥渞ecesses of the internet鈥 where people can share 鈥渧ile鈥 views and a need to look at white nationalism --- along with other causes --- when asked Wednesday about tackling mass violence. But he also said, after a Purple Heart dedication ceremony at Tallahassee National Cemetery, that it鈥檚 not productive to any gun-safety dialogue to focus on partisan politics, as Democrats continued to criticize President Donald Trump after two mass shootings over the weekend. (Turner, 8/7)

And, when following the coverage gets to be too much, mental health experts say step away from social media and news 鈥

Maybe it happened for you after the Parkland or San Bernardino shootings. Or when attacks in France, Brussels, New Zealand and other faraway regions came in such quick succession there wasn't time for mourners of one trauma to disperse before the next took its place. Maybe it was earlier -- after Sandy Hook or maybe even Columbine. Maybe it's happening for you now after the Gilroy, El Paso and Dayton shootings. No matter when it happened, what you felt is how sadness and prayer can harden into palpable exhaustion. (Willingham, 8/7)

In Era Of Mass Shootings, Workers Turn To Insect Spray, Homemade Panic Buttons And Hiding Spots As Contingency Plans

鈥淪adly, we live in a world where you should always suspect the worst," said Maricarmen Molina, a worker who has a mentally mapped exit plan in case an attacker comes into her building. Meanwhile, Amnesty International issues a warning to travelers over gun violence in America and mourners in both cities grieve as the political fireworks play out.

Like a growing number of U.S. workers, Maricarmen Molina has mentally mapped out how she hopes to escape should a gunman ever enter her workplace. The 26-year-old shop steward at a New Jersey apparel warehouse said she plans to sprint to the back of the sprawling building and hide between racks of nearly floor-length dresses, trying not to make a sound. It is a strategy she re-evaluated over the weekend as back-to-back mass shootings unfolded at a Walmart in El Paso, Texas, and outside a bar in Dayton, Ohio. (Cutter, Gee and Simon, 8/8)

Amnesty International has joined a growing list of countries warning travelers about the perils of gun violence in the United States. A travel advisory the organization issued Wednesday 鈥渃alls on people worldwide to exercise caution and have an emergency contingency plan when traveling throughout the USA.鈥 鈥淭his Travel Advisory is being issued in light of ongoing high levels of gun violence in the country,鈥 the warning continues. (Parker, 8/7)

Tearful mourners hugged at a service to remember a student gunned down in Ohio. In Mexico, relatives and friends gathered for the wake of a teacher slain at a store in Texas. With a policy debate raging over what to do after the United States鈥 latest mass shootings 鈥 at a Walmart store in El Paso, Texas, and an entertainment district in Dayton, Ohio 鈥 loved ones of the more than 30 people who were killed are struggling with the aftermath. (Stengle and Sherman, 8/7)

Pharmaceuticals

Medicare To Pay For Cutting-Edge, Expensive CAR-T Treatment That Harnesses Cancer Patients' Own Immune System

CMS Administrator Seema Verma said the decision should clear up "a lot of confusion" about coverage and will help patients get access to the novel therapies. The treatment costs $375,000 or $475,000, depending on whether it is used for advanced lymphoma or pediatric leukemia.

The U.S. Centers for Medicare and Medicaid Services (CMS) on Wednesday said it has finalized a decision to cover expensive cancer cell therapies sold by Gilead Sciences Inc and Novartis AG. CMS, which runs Medicare - the federal government's health plan for Americans 65 and older - said it will cover the U.S. Food and Drug Administration-approved therapies when provided in healthcare facilities that have programs in place to track patient outcomes. (Beasley, 8/8)

Officials said Medicare will cover CAR-T cell therapies for certain types of lymphoma and leukemia , uses that are approved by the Food and Drug Administration. The cost can run to hundreds of thousands of dollars per patient, not counting hospitalization and other expenses. Medicare Administrator Seema Verma said the decision will provide consistent and predictable access nationwide, opening up treatment options for some patients 鈥渨ho had nowhere else to turn.鈥 (Alonso-Zaldivar, 8/7)

In announcing the decision, Seema Verma, administrator of the Centers for Medicare and Medicaid Services, said that until now, Medicare鈥檚 regional administrators had decided whether to cover the treatment, which led to confusion. Verma said the agency, which had scheduled this coverage decision originally for late May, has been struggling to figure out how to cover and pay for the treatment, called CAR T-cell therapy. The treatment costs $375,000 or $475,000, depending on whether it is used for advanced lymphoma or pediatric leukemia. Hospital stays can add hundreds of thousands of dollars to the cost of care. (McGinley, 8/7)

The treatments provide new options for the cancer patients. Yet their use has been limited, in part because hospitals aren鈥檛 always sure they could get reimbursed for both the cost of the drugs and the lengthy hospital stays for side effects and other care that are often required. The problem was that health-insurance payments aren鈥檛 structured for treatments like a CAR-T, which trigger not just the price of the drug itself but related care costs that can reach hundreds of thousands of dollars. Novartis listed Kymriah for $475,000, while Gilead priced Yescarta at $373,000. (Rockoff, 8/7)

CMS hasn鈥檛 yet set a price that it will pay for the treatments, and instead will cover 65% of a hospital鈥檚 costs, Verma said. They can also apply for an additional outlier payment, offered for some new breakthrough therapies that have steep price tags. Between the two payments, some hospitals are getting close to the average sales price of the drug, she said. (Cortez, 8/7)

The agency also abandoned its previous idea of requiring hospitals collect data on how patients fare when they receive these treatments. Wednesday鈥檚 announcement does not, however, ensure that hospitals are breaking even when offering CAR-T treatments. CMS鈥 coverage policy does not change how much CMS reimburses for CAR-T treatments, which currently cost over $300,000. The agency has been 鈥渟truggling鈥 to set those payment rates, and it could be years before that issue is solved, Verma told STAT in an interview earlier this week. (Florko, 8/7)

Meanwhile, in other news 鈥

Congress this year could enact the biggest overhaul of Medicare鈥檚 prescription drug benefit since it was first established in 2003. If successful, seniors 鈥 and taxpayers 鈥 would be more insulated against the cost of the most expensive drugs.聽聽One proposed change is meant to help Medicare control the costs it absorbs so that the program鈥檚 premiums can remain stable despite increasing drug prices. Supporters of the drug program tout聽its low premiums, with the Trump administration and the private insurers who run Part D recently highlighting that average consumer premiums will fall in 2020.聽(Siddons, 8/8)

Novartis CEO Justifies Decision To Delay Telling FDA About Manipulated Data For $2.1M Gene Therapy Drug

Novartis CEO Vas Narasimhan said the company "thoroughly, aggressively" investigated whether the issue would effect patient safety. The FDA, after publicly rebuking the company, came to a similar conclusion that patients aren't at risk because of the lapse in judgment. Other pharmaceutical industry news looks at Gilead's pricey HIV drug, cell therapies, the cost of a snakebite, and more.

The chief executive of Novartis on Wednesday defended the company鈥檚 decision to delay telling the Food and Drug Administration about manipulated data involving its $2.1 million gene therapy treatment, saying that it 鈥渢horoughly, aggressively鈥 investigated the issue and that patient safety was never threatened. Vas Narasimhan, the chief executive, also indicated in a call with investors that the company was forcing out a small number of scientists who were involved in the manipulated data. (Thomas, 8/7)

Mr. Narasimhan explained that the company waited to tell the regulator because it was completing the investigation and that none of the delays were related to its drug application with the U.S. drug watchdog. 鈥淲e made the decision to progress our quality investigation prior to informing FDA and other regulatory authorities so that we could provide the best information and technical analysis--which we did promptly on completion on June 28,鈥 said Mr. Narasimhan. (Martuscelli, 8/7)

鈥淚 think everyone in our organization can stand proud that we tried to do the right things in this instance,鈥 Narasimhan told financial analysts on a conference call. 鈥淲e understand the agency has a different perspective, which we respect, but we鈥檝e tried to be transparent, thorough, science-based, and, most importantly, patient-oriented to ensure that we never compromised patient safety, efficacy, or product quality during any moment during all of this.鈥 (Garde, 8/7)

The FDA has indicated it might pursue civil or criminal penalties against the company, and that it would have delayed the drug's approval if it knew about the manipulated data. Both the FDA and Novartis said the drug is still safe to use and will continue to be sold. (Hellmann, 8/7)

Three years after Pulitzer Prize-winning writer and oncologist Dr. Siddhartha Mukherjee founded Vor Biopharma, the company finally has its first executive. Robert Ang, formerly the chief business officer for Neon Therapeutics (NTGN), will be Vor鈥檚 first chief executive officer, the company announced Wednesday. Vor is one of several startups developing cell therapies for cancer, though specifics about the company鈥檚 plans had been sparse until recently. In May, the company鈥檚 scientific founders published a preclinical proof-of-concept paper in the Proceedings of the National Academy of Sciences that laid out just what they hope the company will do. (Sheridan, 8/7)

Gilead Sciences Inc hopes to soon introduce a pricey new pill to prevent HIV in people at risk of contracting the infection, but the drugmaker faces opposition from an unusual source: patient advocates. Such groups have traditionally lobbied for insurance coverage of newer HIV drugs regardless of expense. But at least three U.S. organizations now question whether Gilead鈥檚 Descovy would be the best option for most people at risk of exposure. (Beasley, 8/7)

Kaiser Health News: Price Of Snakebite Drug Is Sky High, But New Competitor Unlikely To Lower Costs

Dr. Steven Curry has treated patients with snakebites since the 1980s 鈥 long enough to remember when the treatment represented its own form of misery. The first medication he used sometimes caused an immune reaction called 鈥渟erum sickness鈥 鈥 patients broke out in a severe, itchy rash. About 20 years ago, the drug CroFab entered the market and dramatically reduced the adverse reactions associated with treatment, said Curry, who works at a Phoenix hospital. He is a medical toxicologist, a specialist in treating patients harmed by poison or venom. (Heredia Rodriguez, 8/8)

All three efforts were part of a massive drug company push to boost the sale of expensive, immune-suppressing drugs to treat autoimmune conditions such as psoriasis and rheumatoid arthritis. The drugs, many of which are biological medicines, called biologics, were introduced two decades ago and have hit $45 billion in sales, despite escalating prices and mounting reports of serious side effects. (Fauber, 8/7)

Elections

'Medicare For All' Could Toss Wrench In Senate Democrats' Plan To Use Midterm Playbook That Secured The House

Senate Democratic candidates want to replicate the success of the midterm elections, where House candidates used protecting the health law as a winning topic. But the push toward a more progressive plan like "Medicare for All" could undermine that strategy. Meanwhile, opponents of a Medicare buy-in option say such a plan would hurt rural hospitals.

The divide over health care among Democratic presidential candidates is raising fears the party might turn an issue that was a key winner in the House midterms into a liability in next year's Senate races. Democratic Senate candidates have been planning to borrow heavily from the playbook used by House Democrats in 2018, when the party won back the chamber in large part because of a pledge to protect ObamaCare against Republican attempts to kill the 2010 law. (Hellmann, 8/8)

Opponents of the public option have funded an analysis that warns more rural hospitals may close if Americans leave commercial plans for Medicare. With the focus on rural hospitals, the Partnership for America's Health Care Future brings a sensitive issue for politicians into its fight against a Medicare buy-in. The policy has gone mainstream among Democratic presidential candidates and many Democratic lawmakers. (Luthi, 8/7)

Previous KHN coverage: Doctors Argue Plans To Remedy Surprise Medical Bills Will 鈥楽hred鈥 The Safety Net

And in other news 鈥

Nearly every Democratic candidate for the White House, from the most progressive to the most conservative, are calling for changes to the nation鈥檚 health care system that would adversely impact Connecticut鈥檚 health insurers 鈥 and that industry is hitting back. Joining forces with their longtime foe, the pharmaceutical industry, and with some of the biggest names in the health care industry, including the American Medical Association and the Federation of American Hospitals, the nation鈥檚 health insurers have joined a coalition that is fighting Medicare-for-all proposals and other Democratic plans to alter the nation鈥檚 health care. (Radelat, 8/7)

More than half of New Hampshire Democratic primary voters say it is very important that their party nominate a candidate who supports Medicare for All, according to a new Suffolk University/Boston Globe poll released Tuesday. Fifty-six percent of respondents said Democrats should nominate someone who supports Medicare for All, and 60 percent said they personally supported the policy (compared with to 22 percent who said they were opposed to the idea). (Prignano, 8/6)

Health Law

When It Comes To Patients With Short-Term 'Junk' Plans, Insurers Aren't Spending Much On Medical Care

The "loss ratios" can be as low as 9 cents for medical care for every dollar in premiums. "Compared to comprehensive plans that have to comply with the ACA's rules, short-term plans' coverage limitations often result in carriers paying out far fewer claims, or paying pennies on the dollar," said Rachel Schwab, a research associate at Georgetown University's Center on Health Insurance Reforms.

For every dollar in premiums that UnitedHealthcare collected from people enrolled in short-term health plans last year, it spent less than 40 cents on patients' medical claims. Short-term plans sold by Cambia Health Solutions, which operates Blue Cross and Blue Shield plans in four states, spent even less on medical care, paying out just 9 cents for every dollar in premiums. These low "loss ratios"鈥攚hich show the percentage of premiums spent on medical claims and were published last week in the National Association of Insurance Commissioners' 2018 Accident and Health Policy Report鈥攁re a stark reminder that short-term plans benefit insurance companies more than the patients who purchase them. (Livingston, 8/6)

Government Policy

Detroit Man Who Was Deported To Iraq Dies After Family Says He Couldn't Access Needed Insulin

Jimmy Aldaoud spent most of his life in the United States but was deported as part of increased immigration enforcement efforts. In Iraq, he was unable to get the insulin needed to treat his diabetes, his family says. "Jimmy Aldaoud ... should have never been sent to Iraq," Rep. Andy Levin (D-Mich.) said. "My Republican colleagues and I have repeatedly called on the executive branch to cease deportation of such vulnerable people. Now, someone has died." Meanwhile, nearly 700 immigrants were arrested Wednesday in a raid that left children coming back from school to empty homes.

Jimmy Aldaoud crouched on a sidewalk, miserable, hungry and short on insulin. The 41-year-old with diabetes and severe mental illness had spent nearly his whole life in Detroit until just over two months ago, when Immigration and Customs Enforcement deported him to Iraq 鈥 a country he鈥檇 never set foot in. 鈥淚 don鈥檛 understand the language,鈥 Aldaoud said in an undated video shared to Facebook on Wednesday night. 鈥淚鈥檓 sleeping in the street. I鈥檓 diabetic. I take insulin shots. I鈥檝e been throwing up, throwing up, sleeping in the street, trying to find something to eat. I鈥檝e got nothing over here." (Elfrink, 8/8)

Edward Bajoka, an immigration attorney who described himself as close to Aldaoud鈥檚 family, wrote on Facebook that the death appeared to be linked to the man鈥檚 inability to obtain insulin in Baghdad to treat his diabetes. Aldaoud was an Iraqi national, but he was born in Greece and came to the U.S. as a young child, his family friend said. He had never lived in Iraq and did not speak Arabic, according to Bajoka. (Hesson and Toosi, 8/7)

Representative Andy Levin responded to Aldaoud鈥檚 death on Twitter, saying that deporting the U.S. resident to a place where he ultimately lacked access to medical care 鈥減ut his life in extreme danger.鈥 (Gunia, 8/8)

It was the first day of school in Morton, Mississippi, Wednesday, and many undocumented parents and their children went together to the first morning drop off, said Elizabeth Iraheta. By the end of the day, some of those children were all alone, she said. US immigration authorities arrested about 680 undocumented immigrants at seven sites in six different cities in Mississippi on Wednesday. The raids are "believed to be the largest single-state immigration enforcement operation in our nation's history," said US Attorney for the Southern District of Mississippi Mike Hurst. (Holcombe and Shoichet, 8/8)

Elizabeth Iraheta was passing the Koch Foods processing plant in Morton, Miss., on Wednesday when she saw immigration officials swarming outside and a helicopter overhead. Big silver buses lined the driveway and agents blocked the entrance gates. U.S. Immigration and Customs Enforcement officers were sweeping through the workplace and rounding up all undocumented immigrants. By the day鈥檚 end, nearly 700 people would be arrested. Angie鈥檚 mother was one of them. (Fritz and Velarde, 8/8)

Marketplace

Critics See Juul's Lobbying Blitz As Proof That Its Promises To Fight Youth Vaping Are Empty

鈥淛uul鈥檚 increased spending on lobbying and political donations is the latest example that the company says one thing and does another," said Vince Willmore, vice president of communications at the Campaign for Tobacco-Free Kids. The company, under fire from regulators and lawmakers, has been ramping up spending in Washington. In other news, the FDA is investigating seizures possibly linked to e-cigarettes and a study finds that quitting smoking can help even late in a pregnancy.

Juul聽Labs is spending big on campaign donations and a massive lobbying blitz as the e-cigarette maker faces growing threats from lawmakers and regulators, and with few allies in Washington. The company spent $1.95 million on lobbying in the first two quarters of 2019, surpassing its 2018 total of $1.64 million. And Juul's PAC has given nearly $100,000 to lawmakers this year, a pace that will blow past the $225,000 the company spent in the entire 2018 cycle.聽 (Gangitano, 8/7)

The US Food and Drug Administration has received 127 reports of seizures or other neurological symptoms possibly related to e-cigarettes, the agency announced Wednesday. Investigators have yet to determine, however, whether vaping was directly linked to the cases. (Azad, 8/7)

The link between smoking and low birth weight babies has been well-established. But the study published in the Maternal and Child Health Journal is one of the first clear indications that quitting smoking during pregnancy can have health benefits for a developing fetus throughout the third trimester, said Pam Xaverius, an assistant professor of epidemiology at SLU. (Fentem, 8/7)

CVS Posts Second Straight Quarter Of Unexpectedly Strong Financial Results

The results could help the company sell skeptical investors on its acquisition of Aetna, as the health insurer drove much of the gains.

CVS Health Corp raised its full-year profit forecast and reported higher-than-expected second-quarter results on Wednesday, as increased U.S. prescription drug prices fueled rebates to its pharmacy benefits business. CVS shares were up 6.6% at $57.65, while the broader market was down about 0.5%. (Mishra and Mathias, 8/7)

The tone Wednesday was a change from early this year, when CVS gave a downbeat earnings projection for 2019 that pushed its shares down sharply and led investors to press for more detail about the company鈥檚 growth plans. CVS and rival Walgreens Boots Alliance Inc. are under pressure to find new ways to counter slowing revenue from prescription drugs, which drive the bulk of the pharmacy chains鈥 sales. They also face government scrutiny of the traditional pharmacy-benefits business model, and particularly of rebates paid by drugmakers. (Terlep and Maidenberg, 8/7)

CVS Health swung back to a profit in the second quarter, thanks to an influx of health insurance revenue, and the company raised its 2019 forecast beyond Wall Street expectations. Shares of the drugstore chain and pharmacy benefit manager outpaced the broader market in Wednesday trading after the company detailed its better-than-expected quarterly performance. (Murphy, 8/7)

Opioid Crisis

Fentanyl Deaths In San Francisco Soar Almost 150% In Largest Uptick The City Has Ever Seen

Health experts say fentanyl wasn't available in California to the degree it was in the eastern U.S. until several years ago. The epidemic has unfolded in three waves, says UCSF professor Daniel Ciccarone. "Wave one: pills. Wave two: heroin. Wave three: fentanyl.'' News on the opioid epidemic looks at naloxone's impact on lowering death rates in Massachusetts and investors' worries over lawsuits, as well.

Deaths from the powerful synthetic opioid fentanyl skyrocketed in San Francisco in 2018, increasing by 147% since the previous year. That's according to the San Francisco Department of Public Health, which released data this week showing that 89 people died from accidental overdoses of fentanyl last year, compared to 36 fentanyl-related deaths in 2017. (Klivans, 8/7)

Massachusetts has among the highest rates of dispensing naloxone, the drug that can reverse an opioid overdose, according to new federal data. Among counties nationwide, Franklin County in western Massachusetts last year had the fourth-highest rate of prescriptions for naloxone 鈥 commonly sold under the brand name Narcan 鈥 with more than 2,200 prescriptions filled for every 100,000 residents. (Bebinger and Jarmanning, 8/7)

Even solid corporate earnings can鈥檛 reverse investor angst over drug companies facing opioid litigation risk. Generics manufacturer Teva Pharmaceutical Industries TEVA 3.26% was the latest to experience that. Sales of $4.3 billion and adjusted earnings of 60 cents a share both topped analysts鈥 expectations. Teva also reaffirmed its full-year guidance. That wasn鈥檛 nearly enough to reassure investors. Teva shares fell once again in morning trading and have lost more than half of their value since May. (Grant, 8/7)

Veterans' Health Care

'Recovery-Based' Caregiver Model Doesn't Account For Veterans With Catastrophic Injuries, Advocate Group Says

Advocates call for changes to the support program that eliminated caregiver funds, usually for a family member, for some vets with multiple permanent injuries because they "didn't make significant progress.'' Other veterans health care news comes from Arizona.

The VA program provides support and a stipend to caregivers for post-Sept. 11 veterans, usually a wife or parent. ... Almost from the start, that meant problems with uneven standards and implementation around the United States. NPR has reported on hundreds of caregivers being arbitrarily cut from the program; so has the Government Accountability Office and the VA's inspector general. (Lawrence, 8/8)

The U.S. Court of Appeals in Washington, D.C., ruled that Lance Robinson, former associate director for the Phoenix VA Health Care System, was properly terminated based on charges of negligence and failure to provide accurate information. The circuit court concluded that the Merit System Protection Board properly sustained Robinson's removal by VA administrators two years ago. (Wagner, 8/7)

Public Health

'It Can Get Lonely, Very Lonely': Novel Program Aims To Combat Rural Isolation By Connecting The Generations

Loneliness can lead to all kinds of negative health effects, and it can be especially bad in rural areas. A new program looks at bringing together children and older seniors to give each other support. In other public health news: climate change, baseball players and longevity, airports and autism, racial tensions, fewer babies, and more.

Priscilla Bogema lives in a rural town called McGregor, Minn., in a part of the state that has more trees and lakes than people. She came here about 20 years ago seeking solitude during a major crisis in her life. She had just gotten divorced and was dealing with some health problems. "So I came to a place where nobody could see me," she says. Now, Bogema is in her 60s, frail and mostly confined to her house. Her arthritis and other health problems have limited her mobility. She struggles with the upkeep of her home and yard. She drives into town once a week for groceries and a movie with other seniors. But she doesn't have close friends she sees regularly and her children and grandchildren only visit once every few months. (Chatterjee, 8/7)

The world鈥檚 land and water resources are being exploited at 鈥渦nprecedented rates,鈥 a new United Nations report warns, which combined with climate change is putting dire pressure on the ability of humanity to feed itself. The report, prepared by more than 100 experts from 52 countries and released in summary form in Geneva on Thursday, found that the window to address the threat is closing rapidly. A half-billion people already live in places turning into desert, and soil is being lost between 10 and 100 times faster than it is forming, according to the report. (Flavelle, 8/8)

Major League Baseball has its problems. Attendance has slipped, fans complain the pace of play has slowed, players are convinced the baseballs are juiced and even the people running it admit its fusty rules could use an upgrade. Yet its players might take comfort in one promising bit of news: they appear to have longer life spans than other Americans. That鈥檚 the tantalizing possibility raised by a study published by Harvard researchers in the medical journal JAMA Internal Medicine. (Bakalar, 8/7)

Pittsburgh International Airport recently opened a suite of "sensory rooms" inside its airside terminal to help travelers on the autism spectrum decompress from the stress of flying. It's one of a handful of airports internationally that's made changes to be more accommodating to people with special needs. The 1,500-square-foot space in Pittsburgh is quiet, muting the hustle and bustle from the terminal. Designed with input from people who have autism, it features soft furniture and whimsical lighting features, including colorful bubble towers, and multiple soundproof rooms. (Davis, 8/8)

Michael Brown's death at the hands of a white Missouri police officer stands as a seismic moment in American race relations. The fledgling Black Lives Matter movement found its voice, police departments fell under intense scrutiny, progressive prosecutors were elected and court policies revised. Yet five years after the black 18-year-old was fatally shot by Ferguson police officer Darren Wilson on a steamy August day, racial tension remains palpable and may be even more intense. (Salter, 8/8)

Agatha Wallen鈥檚 son, Mason, has autism, and when he was 7, she heard about an initiative in San Diego aimed at children with special needs. It involved an unlikely tool: a surf board. She wasn鈥檛 sure how it would work for her son, who struggled with behavioral and sensory issues. 鈥淓ven getting the wet suit on was difficult for him because it was a brand-new sensory sensation,鈥 she recalled. (Amitha Kalaichandran, 8/8)

The confusion over the rules of romance in the digital age shared by Koch and so many others might explain why millions of Americans are having less sex than previous generations did at the same age. Add in a focus on building a career before having a family, and it all may be contributing to a national birthrate that keeps falling. (Sanders, 8/7)

An experiment conducted in German train stations involving paper cups and escaping oranges has found that people are less likely to help a woman if she appears to be Muslim 鈥 but they鈥檙e more likely to help that same woman if she somehow proves that she shares their social values. The findings, described in the Proceedings of the National Academy of Sciences, reveal that discrimination is a somewhat fluid phenomenon that can be mitigated 鈥 within certain limits. (Khan, 8/7)

Kaiser Health News: Federal Experts鈥 Advice On HPV Vaccine Could Leave Adults Confused

Vaccination decisions are usually pretty straightforward. People either meet the criteria for the vaccine based on their age or other factors or they don鈥檛. But when a federal panel recently recommended an update to the human papillomavirus (HPV) vaccine guidelines, it left a lot of uncertainty. The panel recommended that men and women between ages 27 and 45 decide 鈥 in discussion with their health care providers 鈥 whether the HPV vaccine makes sense for them. (Andrews, 8/8)

The fight to stop children鈥檚 deaths in hot cars has gained an unusual ally: PETA and other animal-protection groups. These organizations have formed a surprising partnership with child-safety advocates to support a federal bill that would require car makers to install technology that senses the presence of a child or an animal. Broadening the campaign to include pet owners also aims to overcome a central challenge to solving hot-car deaths: Most people don鈥檛 believe it would ever happen to them. (Byron, 8/7)

Pregnancy started out rough for Leslie Siu. Morning sickness and migraines had her reeling and barely able to function at a demanding New York marketing job, so like rising numbers of U.S. mothers-to-be, she turned to marijuana. "l was finally able to get out from under my work desk," said Siu, who later started her own pot company and says her daughter, now 4, is thriving. (Tanner, 8/7)

During an extended period of travel last year, my husband and I lent our house in the Ozarks to an older couple who were having work done on their own house. We returned after a month away to a spotless house and two hostess gifts. But there was also a distinctive smell in the air: slightly stale and sweet, like the musty first whiff of strawberries in a cardboard box. (Bauer, 8/8)

State Watch

State Highlights: Georgia Health Officials Confirm 12 Cases, 1 Death From Legionnaires' Disease; Feds Sign Off On Changes Made To Correct Patient Safety Issues At St. Luke's In Houston

Media outlets report on news from Georgia, Texas, New Hampshire, Massachusetts, Minnesota, Florida, Connecticut, Missouri, Ohio, California, Colorado, North Carolina and Pennsylvania.

One of a dozen people who contracted Legionnaires鈥 disease after staying at or visiting a hotel in Atlanta, Ga., has died, officials said this week. The woman, Cameo Garrett, died on July 9 from coronary artery disease, a condition that worsened after she contracted Legionnaires鈥 disease, Patrick L. Bailey, the director of the DeKalb County Medical Examiner鈥檚 Office, said Wednesday. (Brown, 8/7)

The federal government has relinquished the greater oversight it assumed over Baylor St. Luke鈥檚 Medical Center earlier this year after a patient death, a significant step forward in the historic Houston hospital鈥檚 hoped-for road to recovery. Centers for Medicare and Medicaid Services officials notified St. Luke鈥檚 late last month that it is again in compliance with the agency鈥檚 conditions of participation and its supervision has been transferred back to its accrediting body, said Doug Lawson, CEO of the medical center. (Ackerman, 8/7)

A poll released Wednesday shows that Seacoast residents support the proposed merger between Dover鈥檚 Wentworth-Douglass Hospital, Exeter Health Resources and Massachusetts General Hospital in Boston. WDH was acquired by Mass General through a separate transaction that started three years ago, and Exeter Health Resources has been working with Mass General鈥檚 oncology program for 10 years. Officials at the three hospitals announced in May 2018 they had signed a letter of intent to form a new regional nonprofit corporation. That corporation would be the subsidiary of Mass General and would serve as the parent to WDH and Exeter Health Resources. (Haas, 8/7)

An outbreak of hepatitis A has been identified in Minnesota, prompting state health officials to appeal for broader vaccination efforts in high-risk areas such as homeless shelters and jails. While Minnesota has been insulated somewhat from a national hepatitis A outbreak 鈥 which has sickened more than 23,000 individuals and caused 233 deaths since 2016 鈥 state officials said Wednesday that a recent uptick in cases is cause for concern. None of the Minnesotans has died, but 23 infections have been identified and 13 patients required hospital care for a virus that can cause severe liver damage. (Olson, 8/8)

A high-ranking legislative staff member has warned that a proposed constitutional amendment to expand Medicaid could forever lock Florida into the safety-net health care program, taking away the Legislature鈥檚 option to walk away from it. The warning was circulated internally among the top staff of House Speaker Jose Oliva and turned over to state economists weighing the costs of the proposed amendment, which would expand Medicaid eligibility to uninsured childless adults. (Sexton, 8/7)

Connecticut health officials who gathered in Bridgeport Wednesday to declare their support for vaccines said they are increasingly concerned about the state鈥檚 religious exemption, with some calling for lawmakers to erase the provision next year. ...While the Connecticut State Medical Society has not taken a formal position on whether lawmakers should repeal the religious exemption, its president called for more public education on the benefits of immunization. (Carlesso, 8/7)

Kansas City's Truman Medical Centers was hit with a ransomware attack on Tuesday morning that locked the hospital out of parts of its computer system. The attackers demanded money to unlock the data, and the safety net hospital agreed to pay a small amount, Truman said in a statement Wednesday. ...The hospital said that patients鈥 personal health and financial information is kept on another system and was not affected by the attack. (Margolies, 8/7)

Seven individuals have been indicted in an alleged abuse scheme victimizing disabled adults in DeKalb County, state Attorney General Chris Carr announced Wednesday. Three of those indicted operated homes for people with mental and physical disabilities, the attorney general said in a press release. (Miller, 8/7)

A central Ohio family is suing a Cincinnati fertility clinic, hospital and lab, saying that DNA kits purchased as Christmas gifts revealed that a 24-year-old daughter is not biologically related to her father and may have been fathered by a hospital physician. In the lawsuit expected to be filed Wednesday in Hamilton County Common Pleas Court, Jennifer and Joseph Cartellone, of Delaware, and their daughter Rebecca Cartellone, of Dublin, name the Institute for Reproductive Health, the Christ Hospital and Ovation Fertility Cincinnati. (Viviano, 8/7)

A federal judge has allowed a handful of inmates to pursue a class-action lawsuit that could force Connecticut鈥檚 prisons to screen and treat thousands of inmates for the Hepatitis C virus 鈥 a measure that could save lives and cost the state millions of dollars. The suit alleges that the Department of Correction does not adequately care for its prisoners infected with the disease, putting in jeopardy the health of those entrusted to the agency鈥檚 care. (Lyons, 8/7)

In a report released Tuesday, California State Auditor Elaine Howle upbraided the state Department of Health Care Services for its failure to ensure Medi-Cal beneficiaries have adequate access and quality of care in 18 rural counties stretching from Inyo to the south to Tehama and Plumas in the north. Howle looked into the welfare of these Medi-Cal beneficiaries at the behest of the Joint Legislative Audit Committee, which wanted to know whether the patients were receiving care comparable to their peers around the state since being transitioned into managed care plans from fee-for-service plans during the Medi-Cal expansion in 2013. (Anderson, 8/7)

Kaiser Health News: Obesity Plagues Hispanics And Blacks In Colorado, Nation鈥檚 鈥楬ealthiest鈥 State

Colorado stands out on the map of U.S. obesity rates, a cool green rectangle surrounded by more alarming shades of yellow, orange and red. But upon closer inspection, Colorado weighs in as two states: one dangerously heavy and one fit and trim.There are the mostly well-educated, affluent whites, many of whom were drawn to Colorado by high-paying tech jobs and myriad outdoor opportunities. (Hawryluk, 8/8)

The state launched an online tool Wednesday intended to help consumers, businesses and health care providers navigate the state鈥檚 vast system of hospitals and providers. Lieutenant Governor Susan Bysiewicz, who joined employees from the Connecticut Office of Health Strategy at the launch announcement, likened the free tool to Consumer Reports because it will allow users to compare the quality and cost of medical care at 19 of the state鈥檚 health care organizations. (Moore, 8/7)

North Carolina is greying, and with it, more people are predicted to develop Alzheimer鈥檚 disease and other forms of dementia. According to the Alzheimer鈥檚 Association, approximately 170,000 people lived with Alzheimer鈥檚 disease in North Carolina in 2018. This statistic is projected to increase by 23.5 percent in 2025, to a total of 210,000 diagnoses. Despite this expected growth, the proposed state budget 聽has extended a multi-year moratorium on the creation of special care units in nursing and adult care homes, which care for people with Alzheimer鈥檚 disease and other forms of dementia. (Davis, 8/8)

Police conducting a sweep Tuesday in the South End oversaw the destruction of several wheelchairs belonging to homeless people, according to witnesses 鈥 resulting in a flurry of condemnation on Twitter, including strong words from a city councilor. Less than 24 hours later, city officials faced heated criticism for their actions during a South End community meeting Wednesday night regarding drug use and homelessness in the neighborhood. (Freyer and McDonald, 8/7)

Baylor Scott & White beat a False Claims Act whistleblower suit on Monday that claimed the Texas healthcare giant wrongly billed Medicare for more than $61.8 million over seven years. U.S. District Judge David Ezra in Texas dismissed the whistleblower's complaint, which alleged that a Baylor executive created an upcoding scheme to systematically overcharge Medicare. (Luthi, 8/7)

UPMC and other prominent Pittsburgh research organizations announced Wednesday they plan to leverage an Amazon division's machine learning capabilities to accelerate breakthroughs in patient care and product commercialization. Amazon Web Services will share its machine learning鈥攁 type of AI鈥攁nd cloud computing resources with the Pittsburgh Health Data Alliance, a big data consortium formed in 2015 that includes UPMC, the University of Pittsburgh and Carnegie Mellon University. (Bannow, 8/7)

Health Policy Research

Research Roundup: State Gun Laws; The 'Public Charge' Rule; And Medicare Advantage

Each week, KHN compiles a selection of recently released health policy studies and briefs.

Firearms are the second leading cause of pediatric death in the United States. There is significant variation in firearm legislation at the state level. Recently, 3 state laws were associated with a reduction in overall deaths from firearms: universal background checks for firearm purchases, universal background checks for ammunition purchases, and identification requirement for firearms. We sought to determine if stricter firearm legislation at the state level is associated with lower pediatric firearm-related mortality. (Goyal et al, 8/1)

Recent Urban Institute survey data show that heightened immigration-related fears and concerns are shaping immigrant families鈥 daily lives. Many families are changing their daily routines and avoiding safety net programs. This 鈥渃hilling effect鈥 and fear is affecting families with a wide range of immigration and citizenship statuses, including green card holders and US citizens. To complement our national survey findings, we conducted follow-up interviews with 25 adults in immigrant families in March 2019. We spoke with interviewees across the US who had reported avoiding the Supplemental Nutrition Assistance Program (SNAP), Medicaid or the Children鈥檚 Health Insurance Program, and/or housing assistance in 2018 because of immigration concerns. (Bernstein, McTarnaghan and Gonzalez, 8/7)

Medicare-for-All proposals have sparked discussion about the role of private health insurance in the U.S. health care system. Some of the current Medicare-for-All proposals would essentially eliminate private insurance. Others would allow private insurers to administer benefits under the new public program, similar to the role of Medicare Advantage plans today, which serve as a private-plan alternative to traditional Medicare. Another set of proposals would create a new Medicare-like public plan option, but preserve a role for private health insurance, including employer-sponsored coverage and policies sold to individuals and families in the Affordable Care Act (ACA) Marketplaces. (Jacobson, Fehr, Cox and Neuman, 8/5)

Among the 88 physicians in the study (48 women and 40 men), after 6 months of professional coaching, emotional exhaustion decreased by a mean (SD) of 5.2 (8.7) points in the intervention group compared with an increase of 1.5 (7.7) points in the control group by the end of the study (P鈥<鈥.001). Absolute rates of high emotional exhaustion at 5 months decreased by 19.5% in the intervention group and increased by 9.8% in the control group (鈭29.3% [95% CI, 鈭34.0% to 鈭24.6%]) (P鈥<鈥.001). (Dyrbye et al, 8/5)

Osteoarthritis has been linked to an increased risk for cardiovascular disease, and a new study suggests that a large part of the risk comes from the use of nonsteroidal anti-inflammatory medicines, or NSAIDs. Such drugs include ibuprofen (Advil or Motrin) and naproxen (Aleve), as well as a variety of prescription NSAIDs. Researchers used Canadian health databases to match 7,743 osteoarthritis patients with 23,229 healthy controls who rarely or never used NSAIDs. The study is in Arthritis & Rheumatology. (Bakalar, 8/7)

Statins are proven effective in reducing the risk for cardiovascular disease, but some studies suggests that after age 75, the risks outweigh the benefits. Now new research has found that stopping the drugs may be a bad idea. The retrospective study, published in the European Heart Journal, included 120,173 people who turned 75 while taking statins. None had any heart problems. (Bakalar, 8/5)

Editorials And Opinions

Perspectives: Senate Needs To Pass Bill Calling For Gun Safety Research; Talk All You Want About Regulations But Remember The Second Amendment

Editorial writers focus on gun safety issues and other topics stemming from the El Paso and Dayton mass shootings.

In the wake of yet another spate of mass shootings, America is confronted with many questions. Among them: Will waiting periods on gun purchases help curb gun violence or reduce the number of gun-related deaths and injuries? What about gun buybacks? Or age restrictions? Public health experts know that far more people die of gunshot wounds than of cholera or diphtheria or polio 鈥斅燽ut they know far less about how to prevent gun violence than they do those other causes of death. Because when it comes to guns, research is still maddeningly limited. (8/7)

Last weekend's mass murders in El Paso, Texas, and Dayton, Ohio, have produced a flood of words about everything from gun control to mental illness to white nationalism. Most of those words have addressed the right to keep and bear arms as if it were a gift from the government. It isn't. The Supreme Court has twice ruled in the past 11 years that the right to keep and bear arms is an individual pre-political liberty. That is the highest category of liberty recognized in the law. It is akin to the freedoms of thought, speech and personality. (Judge Andrew Napolitano, 8/8)

As he headed off Wednesday morning to Dayton and El Paso to console the most recent American communities ravaged by mass shootings, President Trump paused on the White House lawn to talk with reporters. He told them that while there might be political support for federal legislation mandating more stringent background checks for gun buyers, he did not believe there was 鈥渁ppetite鈥 in Congress for a ban on civilian possession of high-capacity magazines and combat-style weapons. 鈥淪o far,鈥 he said, 鈥淚 have not seen that.鈥 May we suggest that he ask the American people 鈥 nearly two-thirds of whom support such a ban 鈥 instead of Congress, which remains under the thumb of the National Rifle Assn.? (8/8)

As it often does after a mass shooting, the Onion posted on Sunday a new version of one of its most enduring stories, 鈥溾楴o Way to Prevent This,鈥 Says Only Nation Where This Regularly Happens.鈥 Then Monday morning, President Trump came before the cameras and read a speech saturated with precisely what the Onion was satirizing: the ignoramus鈥 version of American exceptionalism. It treats the United States as not just the greatest country on Earth but in many ways the only country on Earth, such that nothing that happens anywhere else could possibly tell us anything about ourselves or what kind of choices we might make in the future. (Paul Waldman, 8/5)

The senseless shootings in El聽Paso and Dayton, Ohio, should lead every American to contemplate what to do about guns. Policymakers have largely been paralyzed, partly because the public debate has been dominated by extremes. The loudest voices on the political left seek to take away as many firearms as it can, of all kinds, and to overturn Supreme Court decisions recognizing the Second Amendment right of individuals to keep and bear arms. The loudest voices on the political right, for their part, oppose virtually all gun regulation, both on policy and constitutional grounds, fearing that a slippery slope will lead to the abolition of firearms. (George T. Conway and Neal Katyal, 8/5)

Perhaps the gravest danger in the aftermath of the mass shootings in El Paso and Dayton is that these atrocities, far from bringing the country together, will divide it even more bitterly than before. The early signs are hardly encouraging. Don鈥檛 dismiss calling for unity at such times as a worthless clich茅. If all its people cannot join in mourning the victims of such heinous attacks, and in resolving to guard against future barbarities, the U.S. risks being broken beyond repair. (8/7)

鈥淢ental illness and hatred pull the trigger, not the gun,鈥 President Trump announced when he condemned shootings in El Paso and Dayton, Ohio, which together left at least 31 people dead and dozens wounded. Mr. President, what you said about hatred rings true. But you are wrong in blaming mental illness. As the father of an adult son with a mental illness and one of 14 nongovernment experts appointed by your administration to a panel that advises Congress about serious mental illnesses, I鈥檇 like to recount some well-established facts. (Pete Earley, 8/7)

With two more mass shootings in the U.S. this past weekend, one in El Paso, and the other in Dayton, it鈥檚 hard not to feel horrified, depressed and even fearful. While research indicates that those who directly experience or witness mass violence have the most intense mental health reactions, even those outside the firing range can be impacted.聽(Joan Cook, 8/7)

Just how much responsibility does President Trump bear for violence motivated by racism? This week on 鈥淭he Argument,鈥 the columnists discuss the recent shootings in El Paso, Tex., and Dayton, Ohio. Michelle Goldberg sees a direct connection between the president鈥檚 dehumanizing statements about immigrants and the El Paso shooter鈥檚 self-described motivations. Ross Douthat thinks Trump has embodied and abetted a kind of spiritual emptiness that fuels mass killings. And David Leonhardt is torn about whether the politics of gun control are hopelessly mired or simply moving too slowly in response to these tragically regular shootings. (Ross Douthat, Michelle Goldberg and David Leonhardt, 8/8)

I could sure use some help understanding 鈥渁ctive shooters.鈥 Does anybody know why they kill? I鈥檝e watched several active-shooter emergency preparation videos 鈥 called Run, Hide and Fight 鈥 sponsored by the Department of Homeland Security. They depict horrifying reenactments of such attacks at the workplace. You can feel a chill just watching how methodically they go about the homicidal work. But there鈥檚 virtually nothing about their motives. (Courtland Milloy, 8/6)

Viewpoints: 'Medicare For All' Is Doomed, But Harris Has Other Health Care Ideas That Make Sense; Congress Needs To Protect Safety Of Everyday Drugs

Opinion writers weigh in on these health topics and others.

As Democratic presidential candidates veer left to satisfy the party鈥檚 radical base, it鈥檚 easy to dismiss their ideas as 鈥渁 fantasy world,鈥 to quote Joe Biden. Even so, they occasionally have an idea worth considering. Consider Sen. Kamala Harris鈥檚 health-care plan. She starts where Bernie Sanders does, with the goal of ending both employer-based insurance and private coverage in the ObamaCare exchanges. And she corrals everyone into Medicare. So far, so radical. But unlike Mr. Sanders, she retains the Medicare Advantage program, under which more than a third of seniors enroll in private insurance. That鈥檚 a big difference. (John C. Goodman, 8/7)

America is getting older. More than 10,000 Americans turn 65 every day. This demographic shift highlights the need for affordable medicines that will help older Americans stay healthy, active, and productive lives. Biologics, new treatments made from living organisms, offer relief to seniors with chronic conditions such as arthritis. Officials from the Centers for Disease Control and Prevention (CDC) estimate the number of adults in the U.S. living with arthritis to be about 54 million. The number may be even larger, with younger patients 聽not seeking treatment. (Richard Fiesta, 8/5)

Presidential hopefuls in the United States don鈥檛 typically campaign abroad. Sen. Bernie Sanders (I-Vt.), however, made an exception recently when he traveled across the Michigan-Ontario border on a chartered bus with diabetes patients who were headed to Windsor to purchase affordable insulin in Canada. Sanders鈥檚 foreign visit directed a message home: Prescription drug prices in America are too high and must come down. (David Moscrop, 8/7)

As a physician who is concerned about public health, I am glad that President Trump has been shining a spotlight on homelessness and associated squalor in many of our major cities. One associated public health concern is Hepatitis A, a virus that spreads through contaminated food and water. (Marc Siegel, 8/7)

Theodora Ross, a cancer geneticist at the University of Texas Southwestern Medical Center, says that to Silicon Valley types, she is like a taxi driver competing against the more convenient, Uber-like direct-to-consumer companies such as 23andMe. 鈥淭hey think we don鈥檛 need to exist,鈥 she said. The techy approach invites consumers to swab a cheek and mail in the sample, and promises to reveal a broad swath of genetic information. But unbeknownst to many seekers, direct-to-consumer services don鈥檛 deliver what a cancer geneticist like Ross does. Some people, after submitting DNA to such companies, end up in her office, panicked over what turn out to be a false results. (Faye Flam, 8/7)

If you could save 730 Texans' lives each year, would you? If you could, but didn't, are you a murderer? You decide. Here are the pertinent facts: Texas is the nation's most medically uninsured state, with 4.5 million uninsured, 623,000 of them children. The Affordable Care Act provided a Medicaid expansion designed to cover the working poor whose incomes were too big to qualify for Medicaid, but way too small to afford health insurance. Texas alone would have received $10 billion a year. In 2012, Texas and other Republican-run states went all the way to the Supreme Court to win the right to refuse this money. Texas' attorney general at the time, current Gov. Greg Abbott, took the lead for the plaintiff states, with the full support of then-Gov. Rick Perry. (8/7)

Rising homelessness in California has spurred a rodent boom and resurgence of medieval disease. So naturally Democrats in the state Legislature want to ban rat poison. ...Low-income folks who live near homeless populations as usual will suffer the greatest harm from the rat-poison ban. If only there were an antidote to California鈥檚 toxic progressive politics.(8/7)

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