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The Senate confirmed Alex M. Azar II on Wednesday to be secretary of health and human services, clearing the way for President Trump’s second health secretary to begin controlling more than a trillion dollars a year in spending on medical insurance coverage for about one-third of all Americans. The vote was 55 to 43. (Pear, 1/24)

A 50-year-old Ivy League-educated lawyer, Azar says he has four main priorities for the Health and Human Services Department: help curb the cost of prescription drugs; make health insurance more affordable and available; continue bipartisan efforts to focus Medicare payments on quality; and confront the opioid addiction epidemic. (1/24)

Republicans praised Mr. Azar as a detail-oriented lawyer familiar with the workings of government and the health industry. Mr. Trump nominated Mr. Azar in November, saying in a tweet that “he will be a star for better health care and lower drug prices!” Democrats, noting that Mr. Azar recently headed an affiliate of Eli Lilly & Co., warned he would do little to bring down drug prices and would undermine the ACA. (Armour, 1/24)

Azar said at a nomination hearing that he would consider implementing some sort of drug negotiation in Medicare Part B, the part of the government health program for the elderly that covers drugs administered by doctors. But he dismissed a similar move for Medicare’s larger prescription-drug benefit, known as Part D, saying private companies already bargain on the government’s behalf. (Tracer and Edney, 1/24)

Azar, 50, will take over as policies in the sprawling department, with its budget of more than $1.1 trillion, are tilting to the right. A new civil rights division has just been created to protect health-care workers who refuse to provide contraception and other services inconsistent with their moral or religious beliefs. For the first time, new rules allow states to impose work requirements as part of their Medicaid programs. Other priorities Azar will oversee include trying to control rampant opioid addiction that is ravaging many U.S. communities. He will be under pressure to find ways to constrain drug prices — a realm in which suspicions of him run high given his years as a top executive of Eli Lilly. In addition, he will be at the vortex of the ongoing political feud over the Affordable Care Act, the 2010 law that has spread insurance to millions of Americans and is a main target of the administration and congressional Republicans. (Goldstein, 1/24)

He'll take over the agency at a time when rising drug prices are a huge political issue. Azar acknowledged as much in his confirmation hearing in early January. He told members of the Senate Finance Committee that dealing with high drug prices would be a priority. But Azar won't have the power to get Congress to change the law to let Medicare negotiate prices directly with manufacturers. He told senators that allowing the insurance companies that contract with Medicare is more effective. "These are incredibly powerful negotiators who get the best rates available," he said. (Kodjak, 1/24)

“I think he’s incredibly competent,” said Democratic Sen. Heidi Heitkamp. “I don’t share a lot of his philosophy, but I think he understands — as someone who has been at the administration — the importance of the rule of law and compliance.” (Cancryn, 1/24)

Azar knows the regulatory process well. Under former President George W. Bush, he served HHS as general counsel from 2001 to 2005. He then became deputy secretary for two years under Secretary Mike Leavitt, who asked Azar to oversee the department’s regulatory process. “He understands the process and he knows the levers and how you make it work and where the potential roadblocks are,” Leavitt told The Hill last year. “I think he would be of particular value given the fact that ... so far a repeal bill has not occurred and they’re going to need to make their imprint on existing laws through replacing the ideology underpinning it.” (Roubein, 1/24)

Former colleagues praise Azar's efficiency and leadership—traits that make Democrats who oppose his policies wary of the direction he is likely to take the department. "This nomination is about more than just the administration's failure on prescription drug prices," Oregon Sen. Ron Wyden, the ranking Democrat on the Finance Committee, said on the Senate floor Tuesday. "It's a referendum on an entire healthcare agenda." (Luthi, 1/24)

Kaiser Health News: Big Pharma Greets Hundreds Of Ex-Federal Workers At The ‘Revolving Door’

Alex Azar’s job hop from drugmaker Eli Lilly to the Trump administration reflects ever-deepening ties between the pharmaceutical industry and the federal government. A Kaiser Health News analysis shows that hundreds of people have glided through the “revolving door” that connects the drug industry to Capitol Hill and to the Department of Health and Human Services. (Lupkin, 1/25)

Concerned about soaring health care costs, Idaho on Wednesday revealed a plan that will allow insurance companies to sell cheap policies that ditch key provisions of the Affordable Care Act. It's believed to be the first state to take formal steps without prior federal approval for creating policies that do not comply with the Obama-era health care law. Health care experts say the move is legally dubious, a concern supported by internal records obtained by The Associated Press. (Boone, 1/24)

The Trump administration is exploring ways to excuse more Americans from the requirement that they prove they’re insured in the remaining months before the Affordable Care Act’s individual mandate is laid to rest. The Centers for Medicare and Medicaid Services is working on guidance expanding the “hardship” exemptions from the 2010 health-care law’s mandate that people purchase health plans, according to two people familiar with the effort. Agency officials haven’t yet finalized the guidance, but aim to increase the number of reasons people could cite as justifications for not showing they’re insured when they file their tax returns. (Winfield Cunningham and Eilperin, 1/24)

Democrats and activists fought off Obamacare repeal last year by stoking public outrage and stirring protests. Now they want to make the health law the defining issue in 2018 races at the congressional, state and local levels. The grassroots groups at the forefront of the Obamacare fight are expanding their focus to rally opposition to virtually all Republican efforts to alter the health care system, hoping to capitalize on the backlash to repeal and turn it into a wave of victories come November. (Cancryn, 1/24)

Sen. Ted Cruz (R-Texas) said Wednesday that he is pushing to revisit the repeal of ObamaCare this year. Cruz told reporters that he thinks GOP leadership is interested "if we can get 50 votes." "We have to bring the conference together to be able to move forward," he added. (Sullivan, 1/24)

Harvard researchers have found that the Affordable Care Act was linked to better access to surgery and higher quality care, the university said. ... The study, which was published Wednesday in JAMA Surgery, looked at five years of data from nearly 300,000 patients in 42 states who were admitted to the hospital for five common surgical conditions, such as appendicitis, diverticulitis, or gallbladder inflammation. (Finucane, 1/24)

Planned Parenthood President Cecile Richards is expected to step down after 12 years at the abortion rights and women’s health-care organization, with an announcement coming as soon as next week. “Cecile plans to discuss 2018 and the next steps for Planned Parenthood’s future at the upcoming board meeting,” the organization said in a statement. (Weigel, 1/24)

Richards navigated the group through the fallout from a series of activist videos in 2015 that purported to show Planned Parenthood officials discussing sales of fetal tissue, which sparked congressional and state probes into the organization. No investigation found any wrongdoing, but the Trump administration recently indicated it may be conducting its own review. Richards, daughter of the late Texas Gov. Ann Richards, has served as president of the Planned Parenthood Federation of America and Planned Parenthood Action Fund, the group's political arm, since 2006. (Rayasam, 1/24)

As president, Richards has played a large role in upping the scale of Planned Parenthood’s fundraising efforts and political lobbying. Her work at the helm of the organization has often led her back to her home state, where she has fought legal battles with anti-abortion Republican state leaders who sought to defund the organization's women's health clinics. In 2011, she visited the Texas Capitol to decry “legislative assaults” against Planned Parenthood. She also came to Texas in 2016 to campaign for Hillary Clinton. (Platoff, 1/24)

In the latest indication of Apple’s growing ambitions in the digital health market, the tech giant on Wednesday unveiled a new feature that would allow users to automatically download and see parts of their medical records on their iPhones. The feature is to become part of Apple’s popular Health app. It will enable users to transfer clinical data — like cholesterol levels and lists of medications prescribed by their doctors — directly from their medical providers to their iPhones, potentially streamlining how Americans gain access to some health information. (Singer, 1/24)

“Our goal is to help consumers live a better day. We’ve worked closely with the health community to create an experience everyone has wanted for years — to view medical records easily and securely right on your iPhone,” said Apple Chief Operating Officer Jeff Williams. “By empowering customers to see their overall health, we hope to help consumers better understand their health and help them lead healthier lives.” (Lee, 1/24)

Researchers in Germany have developed a robot that is about a seventh of an inch long and looks at first like no more than a tiny strip of something rubbery. Then it starts moving. The robot walks, jumps, crawls, rolls and swims. It even climbs out of the pool, moving from a watery environment into a dry one. ... The robot hasn’t been tested in humans yet, but the goal is to improve it for medical use — for instance, delivering drugs to a target within the body. (Gorman, 1/24)

Federal regulators said Wednesday that they are cracking down on marketers and distributors selling a dozen products that “illegally” claimed to treat or cure opioid addiction and withdrawal. In letters sent earlier this month, the Food and Drug Administration and the Federal Trade Commission cited products that target people desperate to find relief from their addictions. They include “Opiate Freedom 5-Pack,” “CalmSupport” and “Soothedrawal.” Most of the 12 items are marketed as dietary supplements, while two are homeopathic remedies, the FDA said. (McGinley, 1/24)

Senators on both sides of the aisle say they expect Congress to provide new funding for the opioid epidemic as part of a spending caps deal, but it’s not clear how much will be appropriated. Most lawmakers aren’t saying how much money they would like to see given for opioid treatment and prevention, although they have a laundry list of areas that money could go toward. But they are confident it will be addressed in the coming weeks as Congress deals with immigration and budget fights. (McIntire, 1/24)

Nearly $800 million worth of fentanyl pills were illegally sold to online customers in the United States over two years by Chinese distributors who took advantage of internet anonymity and an explosive growth in e-commerce, according to a Senate report released on Wednesday. A yearlong Senate investigation found that American buyers of the illegal drugs lived mostly in Ohio, Pennsylvania and Florida. (Nixon, 1/24)

Staff from the nonprofit Iowa Harm Reduction Coalition meet clients wherever they are to provide several services, including on-site blood tests for HIV and hepatitis C. Volunteers from a collective called Prairie Works sometimes join the nonprofit and give out clean needles and syringes to prevent the spread of those diseases. That’s the illegal part. (Sostaric, 1/25)

Many more stroke victims than previously thought can be saved from disability or death if doctors remove blood clots that are choking off circulation to the brain, a new study has shown. “These striking results will have an immediate impact and save people from lifelong disability or death,” Dr. Walter J. Koroshetz, director of the National Institute of Neurological Disorders and Stroke, said in a statement. “I really cannot overstate the size of this effect.” (Grady, 1/24)

The research is upending doctors’ long-held belief that they have just six hours to save threatened brain tissue from lack of blood flow when a major vessel to the brain is blocked. The new findings suggest they may have as long as 16 hours in many cases; a study published three weeks ago with a different group of stroke victims put the outer limit at 24 hours for some. Both studies showed such dramatic results that they were cut short to speed up reporting of the information to physicians. (Bernstein, 1/24)

Blood clot removal, called thrombectomy, is done by running a catheter from a patient’s groin into the brain and deploying a device that can trap and pull out the clot. It became more common after 2015 research showed it was beneficial for patients up to six hours after they were last known to be well, said Dr. Shahid Nimjee, a Wexner neurological surgeon who performed the surgery on some of the study’s patients. (Viviano, 1/24)

The flu doesn't just make you feel lousy. A study published Wednesday finds it can increase your risk of having a heart attack, too. "We found that you're six times more likely to have a heart attack during the week after being diagnosed with influenza, compared to the year before or after the infection," says study author Dr. Jeff Kwong, an epidemiologist and family physician with the Institute for Clinical Evaluative Sciences and Public Health Ontario in Canada. (Aubrey, 1/24)

The notion that a bout of flu increases the risk of other illnesses, including heart attack, is not new. But lead author Dr. Jeffrey Kwong said this study, published Wednesday in the New England Journal of Medicine, is the first to positively link heart attacks to laboratory-confirmed cases of flu. Most influenza cases are never diagnosed by a medical professional; people with a mild infection often just tough it out at home. And even those sick enough to drag themselves to a doctor may be diagnosed based on their symptoms alone. (Branswell, 1/24)

With a few months left in a flu season that arrived early and hit hard in Chicago and across the country, public health officials continue to urge people to get the vaccination against influenza, which has been deadly, landed people in emergency rooms, and kept employees out of work and students out of school. A flu outbreak led the Illinois Mathematics and Science Academy in Aurora to close its campus from Monday through Sunday, with classes scheduled to resume Jan. 29. Students live on campus but had to go home because of the outbreak. (Vivanco-Prengaman, 1/24)

We know that the flu outbreak around Kansas City is bad, and it's keeping doctors, emergency rooms and walk-in clinics hopping. But local firefighters and paramedics are also carrying more of the load. “I could say it’s probably increasing our call volume by 25 to 30 calls a day,” says Kansas City Fire Department Deputy Chief Tom Collins. (Zeff, 1/24)

Tandy Harmon was vibrant, cheerful and healthy. At 36, the Gresham mom was rarely sick.  But 10 days ago, she started feeling ill. It was a Sunday. The next day, she stayed home from her job as a bartender at Bradford's Sports Lounge in Southeast Portland. She figured it was the flu, said her boyfriend, Steven Lundin. By that Wednesday, she ended up in intensive care at Legacy Emanuel Medical Center in North Portland, diagnosed with the flu, pneumonia and a staph infection, Lundin said. Two days later, the single mother of two, died, leaving family and friends reeling. (Terry, 1/24)

For the first time, researchers have used the cloning technique that produced Dolly the sheep to create healthy monkeys, bringing science an important step closer to being able to do the same with humans. Since Dolly's birth in 1996, scientists have cloned nearly two dozen kinds of mammals, including dogs, cats, pigs, cows and polo ponies, and have also created human embryos with this method. But until now, they have been unable to make babies this way in primates, the category that includes monkeys, apes and people. (Ritter, 1/24)

“Monkeys are nonhuman primates that are evolutionarily close to humans,” said Muming Poo, a neuroscientist and member of the cloning team. He also said: “There is no intention for us to apply this method to humans.” The achievement suggests it is now possible to create research populations of identical, customized monkeys, which Poo and his colleagues said would decrease the number of primates used in laboratory experiments. (Guarino, 1/24)

The researchers hope to use the advance to create genetically identical monkeys for medical research. They describe their work in the journal Cell. "We're excited — extremely excited," Mu-ming Poo of the Chinese Academy of Sciences said. "This is really, I think, a breakthrough for biomedicine. "He sees a need to have "genetically identical monkeys for studying many human diseases, especially brain diseases" such as Alzheimer's, Huntington's and Parkinson's. (Stein, 1/24)

Scientists in China reported on Wednesday in Cell that they had cloned two healthy long-tailed macaque monkeys from the cells of another macaque, using the Dolly technique. The two clones, born 51 and 49 days ago, were created from a fetus’s cells; so far, the scientists have not been able to make the tricky procedure work when they used cells from adult macaques. That would seem to postpone the dystopian day when cloning children and grown-ups becomes as mainstream as IVF. But because “the technical barrier [to cloning primates] is now broken,” co-author Mu-ming Poo of the Institute of Neuroscience in Shanghai told reporters, the technique “could be applied to humans” — something he said his team has no intention of doing and sees no reason for. (Begley, 1/24)

But if everyone agrees that the old garments are horrible, and if fashion designers — working with doctors and nurses, no less — have created better gowns, why are we still having this conversation? The higher cost of new gowns is a big reason why many hospitals still use traditional tie-in-the-back johnnies. In addition, some fans of the old design think the new versions aren’t patient-friendly enough, and the standard ones are just fine; they’re convenient and functional, giving easy access to parts of the body clinicians need to poke and prod (Tedeschi, 1/25)

The corpse was already cold, but now it is well and truly buried: Researchers finally published the final results of the final clinical trial of Eli Lilly’s (LLY) experimental Alzheimer’s drug solanezumab. The bottom line — failure — has been known since Dr. Lawrence Honig of Columbia University unveiled the sad details at the 2016 Clinical Trials on Alzheimer’s Disease conference. But the reaction of outside experts, plus little asides in the New England Journal of Medicine paper, offer an intriguing glimpse into the sorry state of Alzheimer’s drug development. (Begley, 1/24)

When we exercise, far-flung parts of our bodies apparently communicate with one another, thanks to tiny, particle-filled balloons that move purposefully through the bloodstream from one cell to another, carrying pressing biochemical messages, according to an important new study of the biology of exercise. The study helps to clarify some of the body-wide health effects of working out and also underscores just how physiologically complex exercise is. (Reynolds, 1/24)

The year was 2004, and according to certain TV ads in California, great medical breakthroughs might be just around the corner. In these political ads, celebrities Michael J. Fox and Christopher Reeve, both facing serious, chronic conditions, touted the promise of stem cell research, which they believed could lead to a plethora of cures for life-threatening diseases. (Gorn, 1/25)

A California court case could turn every cup of coffee here into a jolt of reality on the risks of cancer. Under a state law, cancer warnings already follow Californians when they enter the lobby of apartment buildings, drive into parking garages and sit down at restaurants. They also pop up on products including kitty litter, ceramic plates and black licorice. (Randazzo, 1/24)

A new class of epilepsy medications based on an ingredient derived from marijuana could be available as soon as the second half of 2018 in the United States, pending Food and Drug Administration approval. Officials from GW Pharmaceuticals, the company that developed the drug, on Wednesday announced promising results from a study on 171 patients randomized into treatment and placebo groups. (Cha, 1/24)

Kaiser Health News: A Push To Get Older Adults In Better Shape For Surgery

Surgery can be hard on older adults, resulting in serious complications and death far more often than in younger patients. But many seniors aren’t adequately prepared for the risks they might face. Innovative hospitals such as Duke University Medical Center, the University of California-San Francisco Medical Center and Michigan Medicine are working to change that. In the week leading up to surgery, they prescribe exercise to seniors, make sure they’re eating healthy foods and try to minimize anxiety and stress, among other initiatives. (Graham, 1/25)

Amid deepening concern about violence in Minnesota senior care homes, state regulators on Wednesday unveiled an ambitious plan to accelerate investigations of elder abuse and reduce the state's massive backlog of unresolved cases. At a state Senate committee hearing Wednesday morning, Human Services Commissioner Emily Piper said a team of officials is sorting through more than 2,300 maltreatment complaints — reports that have never been reviewed by state regulators because of poor record-keeping and other inefficiencies at the state agency charged with protecting seniors. Another 826 maltreatment cases have been assigned for investigation but have never been resolved. (Serres, 1/24)

The Minnesota Department of Health is investigating complaints against two employees who are responsible for uncovering misconduct at senior and long-term care facilities. A department spokesman confirmed late Tuesday that there were complaints pending against Kris Lohrke, director of the Office of Health Facility Complaints, and her colleague Assistant Director Michelle Ness. Under state law, the specifics of complaints against public employees become public only after the investigation is completed and if an employee is disciplined. (Magan, 1/24)

A federal regulator has launched an investigation into a Baltimore hospital after a passerby shot a video earlier this month of a confused patient wearing just a hospital gown discharged at a bus stop on a cold night. ... Now, a Centers for Medicare and Medicaid Services spokesperson tells NPR that it has authorized a federal investigation into the hospital over potential violations of federal regulatory requirements. (Kennedy, 1/24)

California’s right-to-die law has been embraced by many around the state — from scores of patients and their families to individual doctors, some hospice caregivers and several health care systems. But as positive as the reception appears to be so far, plenty of challenges remain, according to testimony offered from experts and other stakeholders during an almost 3½ hour-long legislative hearing at the state capitol on Wednesday. (Seipel, 1/24)

Blue Cross and Blue Shield of North Carolina, the state's largest health insurer, publicly opposed the proposed merger between Carolinas HealthCare System and UNC Health Care, arguing it will drive up prices for patients. In a letter Wednesday to the health systems' CEOs, Blue Cross and Blue Shield CEO Dr. Patrick Conway wrote the insurer has a responsibility to its roughly 3.9 million members to slow rising healthcare costs. "After a thorough review of independent research which shows that when healthcare systems combine costs for consumers go up, Blue Cross NC cannot support your proposed combination," Conway wrote.  (Bannow, 1/24)

When a St. Paul nursing home resident’s ventilator tube became detached and sounded an alarm during a worship service at the facility last summer, there weren’t any nursing staff around to help, according to a report by the Minnesota Department of Health. Staff didn’t notice the detached tube for an hour, at which point it was too late to save the resident, the report said. The department blames Bethel Care Center for neglecting the resident, which led to his death. (Chavey, 1/24)

The VNA and Hospice of the Florida Keys, which has provided end-of-life services since 1984 and is based in Key West, will shutter its doors Feb. 28 due to continued financial stress only worsened by Hurricane Irma’s fallout, its operators said. The shutdown leaves no hospice care in the Lower Keys and will eliminate 10 full-time and 12 part-time jobs. (Filosa, 1/24)

Minnesota hospitals sharply increased their spending in 2016 on health fairs and other community services that identify and prevent diseases, according to a report released Wednesday, but federal policy changes could make that tough to maintain. Contributions to “targeted community services” rose from $354 million in 2011 to $567 million in 2016, partly because the federal Affordable Care Act (ACA) required hospitals, as of 2012, to assess and address local health problems. (Olson, 1/24)

Milwaukee County has proposed hiring Wisconsin Community Services at a cost of $2.7 million this year to run a treatment center for male teens on Milwaukee's north side. The center would provide county judges with an alternative to imprisonment for some youth offenders, county Health and Human Services officials said. (Behm, 1/24)

Minnesota hospitals say they're providing more care that's not paid for. The industry trade group says that's largely because more patients face health insurance deductibles they can't afford. (Moylan, 1/24)

Radon is the second most common cause of lung cancer in the state after smoking, according to the Wyoming Department of Health. Radon is an odorless, colorless, radioactive gas that exists in nature. (Elder, 1/24)

Police officers, paramedics and social workers will team up to better respond to mental health emergencies as part of a pilot program starting Monday in southern Dallas. The initiative will pair psychiatric social workers from Parkland Memorial Hospital with paramedics from Dallas Fire-Rescue and South Central patrol officers dispatched to 911 calls involving behavioral health issues. (Branham, 1/24)

The MetroHealth System is planning a $1.3 million renovation of its behavioral health inpatient unit, a handful of years before the site will be demolished as part of the overall campus transformation plan. The improvements to the unit are in response to new safety recommendations from The Joint Commission, which accredits hospitals, designed to reduce the risk of suicide in health care facilities. (Christ, 1/24)

A state dentistry board member whose company has been accused of performing painful, unnecessary dental work on children as part of a Medicaid fraud scheme has resigned. Gov. Nathan Deal asked Dale G. Mayfield, chief dental officer for Marietta-based Kool Smiles, to step down on Tuesday amid questions from The Atlanta Journal-Constitution about his position on the Georgia Board of Dentistry. (Edwards, 1/24)

Georgia received four F’s and one C grade for its anti-tobacco work in the annual “State of Tobacco Control’’ report, released Wednesday by the American Lung Association. The grades mirror those the group has given to the state for years. (Miller, 1/24)

The owner of an Addison medical company and a California laboratory have agreed to pay the government several million dollars to settle allegations in a whistleblower lawsuit that they paid kickbacks to doctors for referring patients for unnecessary genetic tests, the U.S. attorney's office in Dallas said Wednesday. Mitch Edland, owner of DNA Stat, LLC of Addison will pay $270,000, and Primex Clinical Laboratories LLC of California will pay $3.5 million under the settlement, the U.S. attorney's office said. But a Jan. 18 agreed order signed by U.S. District Judge Jane J. Boyle said Edland owes the government $6.3 million. The U.S. attorney's office was working on a clarification Wednesday night.  (Krause, 1/24)

The FBI arrested a Moreland Hills husband and wife who ran medical clinics in Cleveland, Strongsville and Parma and accused them of performing unnecessary medical tests and procedures on patients to get payouts from insurance companies, according to court documents. ...They face charges of conspiracy, health care fraud, making false statements relating to health care matters and distribution of controlled substances, as federal prosecutors say they prescribed medically unnecessary painkillers and addictive medicine to their patients. (Heisig, 1/24)

The family of a teen with autism who was injured after a Buckeye police officer mistook him for a drug user last year seeks $5 million, according to a notice of claim filed with the city this month. The notice of claim, often a precursor to a lawsuit, details the physical injuries, "emotional damages" and "significant economic harm" the teen and his family sustained after the July incident. (Gomez, 1/24)

California, the third-largest oil producing state in the nation, on Wednesday sued the Trump administration to reinstate an Obama-era rule governing hydraulic fracturing, commonly referred to as fracking. In a lawsuit filed in federal court in San Francisco, state Attorney General Xavier Becerra argued the move by Interior Secretary Ryan Zinke to repeal regulations on fracking represents a threat to public health and the environment. (Hart, 1/24)

As overdose deaths mount, leading to a decline in US life expectancy 2 years in a row, my New Year’s wish is for more people to appreciate this statement: Not all well-intentioned approaches to addressing the opioid epidemic are good ideas. Some are based on evidence and experience, others on misunderstanding, blame, fear, or frustration. What’s needed in 2018 is the wisdom — and the courage — to tell the difference. (Dr. Joshua M. Sharfstein, 1/24)

President Trump declared the opioid epidemic a public health emergency. Although some commentators have debated its merits, the declaration has already been successful in 1 regard: it has focused national attention on the problem of opioid misuse and abuse. ... As devastating as the opioid epidemic is however, its toll is modest compared to another substance: tobacco. (Dr. Ilana Richman and Dr. Harlan M. Krumholz, 1/23)

Like many of my patients, Tom Petty survived traumatizing events. As a child, his father beat him with a belt until he was covered in welts. Later on, drug use and a mounting music career led to a painful divorce from his wife of 22 years. He became depressed. Substance use and mental illness pair up like magnets to metal. My homeless and incarcerated patients have faced unspeakable pain: sexual assault, the death of a child, burned-down homes, crushing unemployment. Like Petty, they attempt to ease the pain with opioids, benzodiazepines, alcohol, and other substances. The solution isn’t simple. We must first recognize that drugs don’t really cause addiction; they are simply a tool to temporarily relieve symptoms. We must identify and address the underlying pain and suffering. (Lipi Roy, 1/23)

Safe injection sites where addicts can shoot up in a supervised setting could be a hard concept for many to grasp as anything but an invitation for users to inject poison into themselves with the city’s blessing. To believe that, though, would be a mistake. Philadelphia announced Tuesday it would support the idea of sites that will not only provide medical supervision to addicts but give them access to treatment and other services. Such a move won’t solve the deadly opioid crisis, but is intended to be damage control –literally. Such sites may control the fatal damage that drugs are inflicting, in a crisis that has laid waste to thousands of lives and families. (1/24)

You might think that the kind of extreme poverty that would concern a global organization like the United Nations has long vanished in this country. Yet the special rapporteur on extreme poverty and human rights, Philip Alston, recently made and reported on an investigative tour of the United States. Surely no one in the United States today is as poor as a poor person in Ethiopia or Nepal? As it happens, making such comparisons has recently become much easier. ... Of course, people live longer and have healthier lives in rich countries. With only a few (and usually scandalous) exceptions, water is safe to drink, food is safe to eat, sanitation is universal, and some sort of medical care is available to everyone. Yet all these essentials of health are more likely to be lacking for poorer Americans. (Angus Deaton, 1/24)

The Medicaid “community engagement” waiver awarded to Kentucky, and similar waivers expected to be awarded to at least eight other states, are viewed by both advocates and critics as a form of "welfare reform" for Medicaid. They require that beneficiaries work or take steps towards work in return for Medicaid coverage. Reality check: But they do only half of what the 1996 welfare overhaul did. They provide no new federal funding for job training, job search, transportation, child care or the other support services that were the government’s part of a new two-way bargain with beneficiaries. And without that two way street, what they will mainly accomplish is to reduce the Medicaid rolls by erecting barriers to coverage. (Drew Altman, 1/25)

While a court in Washington mulls its constitutionality, lawmakers in Frankfort should nail down the practical details of Gov. Matt Bevin’s Medicaid revamp recently approved by the Trump administration.Aside from legal questions raised by a lawsuit filed against the Trump administration on Wednesday, there are a bunch of other questions that not only haven’t been answered, they haven’t been asked, starting with costs, timetable and lines of responsibility.The legislature should bring Kentucky stakeholders to the table for this discussion. (1/24)

Advances in genomics have ushered in promising therapies tailored to the individual. Personalized medicine is promoted and has begun to positively influence care. For example, medications such as trastuzumab for the 30% of breast cancers that overexpress ERBB2 and vemurafenib for patients with late-stage melanoma who carry the V600E variant have been beneficial. Despite these advances, for many sectors of the population—children, older adults, pregnant and lactating women, and individuals with physical and intellectual disabilities—limited evidence-based therapies optimized to their specific medical needs exist. Combined, these groups comprise as much as 58% of the US population. Research focusing on or at the very least includes members of these groups is critically needed. (Dr. Catherine Y. Spong and Dr. Diana W. Bianchi, 1/23)

When I was growing up, the idea of re-engineering human DNA was a staple of science fiction. Now, it’s a reality. Adult gene therapy -- editing the genome of a person -- is expected to soon be a treatment option for a number of otherwise intractable diseases. Meanwhile, scientists have successfully edited the DNA of human embryos, raising the possibility that parents might be able to modify their children’s genomes to save them from inherited diseases. Much of the change from science fiction to science fact has come from a breakthrough technique known as Crispr. Though the technique still has a number of technical snags to work out, consensus in the biology community seems to be that these problems will be overcome.This is a watershed in the history of the human species. (Noah Smith, 1/25)

Let’s talk about the presidents’ health — not only the one we’ve got now but all of them. Their aches and pains and bumps, and how they’ve tried to hide them, and how the nation spent 12 years looking at photos of Franklin Delano Roosevelt and never knew the man could barely walk. Driven in part by a desire to never be hoodwinked again, America now keeps a much closer eye on the chief executive’s corporeal being, with the concern we usually reserve for our own children.Is he sleeping enough? Getting enough exercise? Is his temperature normal? Please describe, in detail, the president’s bowels. (Monica Hesse, 1/24)

One of the areas in which HHS has most egregiously changed course is the Title X family planning program. Instead of hiring qualified public health professionals, the administration has quietly put anti-contraception political activists in charge of reproductive health care for the people who rely on Title X, with no public debate and no meaningful oversight in Congress. (Mary Alice Carter, 1/24)

Obesity is a problem in America, and it’s a problem in Maine. In 1990, my state’s obesity rate was 11%. Now it’s 30%, putting us 26th in the nation. I’d like to be in the middle of the pack when it comes to the tax burden, but not to obesity. That’s why Maine has twice asked for a federal waiver to exclude purchases of candy and sugary beverages from our state’s Supplemental Nutrition Assistance Program. The first request was denied by the Obama administration in 2016, the second by the Trump administration last week. (Paul R. LePage, 1/23)

The euthanasia of mentally ill or cognitively impaired patients is inherently controversial. Given the risk of fatal error, how many botched cases would it take to discredit the practice completely? If you said “any number greater than zero,” you would be interested in the physician-assisted death of a 74-year-old woman with dementia in the Netherlands in 2016. The circumstances were so disturbing, even the Dutch regulatory body that retrospectively reviews, and usually rubber-stamps, euthanasias could not countenance it. (Charles Lane, 1/24)

For most Americans, refilling regular prescriptions is as simple as picking up their medicine at their local pharmacy on the way home from work or while doing weekly grocery shopping. But for more than 150,000 Missouri veterans and beneficiaries of our active duty military currently insured through Tricare, the Department of Defense health insurance program, obtaining some common maintenance prescriptions can be much more complicated. (Gary Profit, 1/24)

In the early 2000s, when I was a middle schooler in Florida, I was subjected to a trauma that was meant to erase my existence as a newly out bisexual. My parents were Southern Baptist missionaries who believed that the dangerous and discredited practice of conversion therapy could “cure” my sexuality. For over two years, I sat on a couch and endured emotionally painful sessions with a counselor. I was told that my faith community rejected my sexuality; that I was the abomination we had heard about in Sunday school; that I was the only gay person in the world; that it was inevitable I would get H.I.V. and AIDS. (Sam Brinton, 1/24)

Iowa has more than four times as many large concentrated animal feeding operations (CAFOs) as it did in 2001, and over the last decade has added nearly 500 new or expanded state-permitted CAFOs annually — now an estimated 10,000 CAFOs of all sizes. This remarkable expansion is fueled by Iowa’s robust export market for slaughtered hogs, nearly $6 billion in 2016, up 7 percent in one year. ... A tipping point has been reached. Rural Iowans have every reason to be concerned. While water quality is a stated priority of Iowa lawmakers, livestock production is an important contributor to water degradation and goes unchecked. Manure leaks and spills are associated with fish kills, nitrate and ammonia pollution, antibiotics, hormones, bacterial contamination, algae blooms, water quality impairments and closed beaches and are a major contributor to the “dead zone” in the Gulf of Mexico. (James Merchant and David Osterberg, 1/24)

When will California make it a priority to protect our children from the toxic lead contamination in many schools’ water? From the looks of Gov. Jerry Brown’s proposed budget, this threat to students’ health and academic potential remains dangerously underfunded. (Chione Flegal, 1/24)