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Morning Briefing

Summaries of health policy coverage from major news organizations

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Thursday, May 30 2019

吃瓜不打烊 Original Stories 3

  • Your Wake-Up Call On Data-Collecting Smart Beds And Sleep Apps
  • A Doctor Speaks Out About Ageism In Medicine
  • The Unexpected Perk Of My Group Pregnancy Care: New Friends

Women鈥檚 Health 2

  • Louisiana's Democratic Governor Poised To Sign Heartbeat Bill, Diverging From Party On Issue
  • Planned Parenthood Head Says Missouri's Claims That State's Last Clinic Had 'Deficiencies' Are Not Based In Reality

Quality 1

  • 'This Is Beyond Horrifying': When Even Low-Risk Children Were Dying After Surgeries, Doctors Couldn't Keep Quiet Any Longer

Coverage And Access 1

  • Following Sharp Outcry From Private Insurers, Connecticut Lawmakers Pause On Creating Public Option

Administration News 2

  • Proposal To Force Insurers, Hospitals To Disclose Secretly Negotiated Prices Stirs Such Vocal Opposition It May Get Dropped
  • Trump Appointee Who Oversaw Refugee Office While 'Zero Tolerance' Policy Was Enacted Is Departing HHS

Elections 1

  • He 'Has A Sixth Sense For People Who Are Struggling': Personal Tragedy Helps Joe Biden Connect With Voters

Capitol Watch 1

  • Durbin Does 'Not Have Confidence' New FDA Head Will Satisfactorily Address Teen Vaping Epidemic

Opioid Crisis 1

  • Tragic Opioid Losses Continue To Mount: A Tiny Infant In The Bronx, A Best Friend In Philadelphia, A College Football Star In Oklahoma

Pharmaceuticals 1

  • California Measure Would Allow People To Receive Their First 30-Days Of PReP Without A Prescription

Public Health 1

  • Not Every Veteran Comes Home With PTSD. Can The Ones Who Don't Teach Us Enough To Help The Ones Who Do?

State Watch 1

  • State Highlights: Number Of 'Unsheltered' Homeless People In New York City Inches Downward; New Hampshire Becomes 2nd State To Sue Makers Of Dangerous PFAS Chemicals

Health Policy Research 1

  • Research Roundup: The Public Charge Rule; Youth Suicide; Mental Health Stigma

Editorials And Opinions 2

  • Perspectives: Abortion Restrictions Would Cause Women To Carry Children Who Have Fatal, Painful Conditions To Term
  • Viewpoints: Trump's Latest Attack On Transgender People Is The Most Devastating So Far; Lessons On Organ Donations, Saving More Lives

From 吃瓜不打烊 - Latest Stories:

吃瓜不打烊 Original Stories

Your Wake-Up Call On Data-Collecting Smart Beds And Sleep Apps

An array of products 鈥 from mattresses and sensors to sleep trackers and apps 鈥 are catching consumers鈥 attention. But privacy experts are concerned about what becomes of all the personal information these products collect. ( Julie Appleby , 5/30 )

A Doctor Speaks Out About Ageism In Medicine

A frank conversation with geriatrician and author Dr. Louise Aronson about medicine鈥檚 biased treatment of older adults and what needs to change. ( Judith Graham , 5/30 )

The Unexpected Perk Of My Group Pregnancy Care: New Friends

Group prenatal visits are catching on 鈥 they save money and reduce the risk of premature births. It turned out to be the best decision one couple made during their pregnancy. ( Jenny Gold , 5/30 )

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Summaries Of The News:

Women鈥檚 Health

Louisiana's Democratic Governor Poised To Sign Heartbeat Bill, Diverging From Party On Issue

Lawmakers sent the heartbeat legislation -- which was written by a Democratic state senator -- to Gov. John Bel Edwards (D-La.), who has voiced his support for the measure. 鈥淎s I prepare to sign this bill,鈥 Edwards said in a statement after it passed, "I call on the overwhelming bipartisan majority of legislators who voted for it to join me in continuing to build a better Louisiana that cares for the least among us and provides more opportunity for everyone.鈥 The bill follows a slew of other restrictive legislation that has passed in recent weeks in Republican-leaning states.

On the heels of a spate of anti-abortion legislation passed in recent months across the South, Louisiana lawmakers voted on Wednesday to ban the procedure after the pulsing of what becomes the fetus鈥檚 heart can be detected. The restriction, backed by the state鈥檚 Democratic governor, could prohibit abortions as early as six weeks into a woman鈥檚 pregnancy. Several other states have passed versions of so-called fetal heartbeat bills this year, and Alabama approved a law about two weeks ago that would forbid nearly all abortions in the state. (Blinder, 5/29)

The Wednesday vote came after an ardent debate over amendments to the bill, including one that would have added an exception to the abortion ban for cases of rape and incest. That change, and others that sought to make the law more lenient, were rejected. After nearly two hours, 79 lawmakers voted to pass the bill, while 23 voted against it. More than a dozen Democrats supported it. 鈥淎s I prepare to sign this bill,鈥 Edwards said in a statement after it passed, "I call on the overwhelming bipartisan majority of legislators who voted for it to join me in continuing to build a better Louisiana that cares for the least among us and provides more opportunity for everyone.鈥 (Kantor and Thebault, 5/29)

The heartbeat bills are part of growing efforts by abortion opponents to seek to challenge the legality of the procedure frontally rather than pursuing incremental restrictions that raise regulatory and other hurdles. The new approach has gained momentum in the wake of President Trump鈥檚 appointment of conservative Justice Brett Kavanaugh to the Supreme Court last year. 鈥淥ur ultimate goal is to outlaw every abortion, including those that occur at any time after conception,鈥 said Democratic state Sen. John Milkovich, a sponsor of the bill. 鈥淏ut we believe this is an important blow to be struck in defense of the lives of the unborn.鈥 (Campo-Flores, 5/29)

The Louisiana state聽legislature on Wednesday聽approved聽a "heartbeat" abortion bill with no exceptions for cases of rape or incest, sending the measure to Gov.聽John Bel Edwards (D), NBC News reported. The law would be among the strictest in the nation and would聽ban women from terminating a pregnancy once a fetal heartbeat has been detected, typically聽around six weeks. (Rodrigo, 5/29)

Planned Parenthood Head Says Missouri's Claims That State's Last Clinic Had 'Deficiencies' Are Not Based In Reality

A Missouri health agency is conducting an investigation into the state's remaining abortion clinic, and officials say they have serious concerns about patients' safety. The clinic's license is scheduled to expire this week, and if the stand-off is not resolved, Missouri could become the first state since Roe v. Wade not to have an operating clinic. A court hearing on the group鈥檚 lawsuit is set for Thursday morning.

Missouri's health department said Wednesday that the license for the state's only abortion clinic is in jeopardy because of a litany of problems, including "failed surgical abortions in which patients remained pregnant" and concerns about patient safety. The Missouri Department of Health and Senior Services responded to the lawsuit filed a day earlier by Planned Parenthood that seeks to keep open the clinic in St. Louis. A judge on Thursday will hold a hearing on the request for a restraining order that would stop the state from its threat to not renew the license. (5/29)

Missouri Gov. Mike Parson (R) on Wednesday said that the state's sole abortion provider will be unable to perform abortions after Friday聽if it doesn't comply with an ongoing investigation into potential violations of state law.聽Parson said the Planned Parenthood clinic is suspected of breaking several state laws and regulations, including one that requires patients receive pelvic exams 72 hours before getting abortions.聽(Hellmann, 5/29)

Lawyers for Planned Parenthood will ask a St. Louis Circuit Court judge to block Missouri health officials from using an investigation into a patient鈥檚 complaint to close the state鈥檚 only licensed abortion provider. Planned Parenthood went to court Wednesday to prevent the state Department of Health and Senior Services from denying a renewed license to Reproductive Health Services of Planned Parenthood of the St. Louis Region. But Judge Michael Stelzer rescheduled the hearing for Thursday, a day before the clinic鈥檚 license expires. (Fentem and Davis, 5/29)

An emergency hearing on this case originally was scheduled for Wednesday afternoon in the Circuit Court of St. Louis. But it was then postponed to late Thursday morning for reasons "outside everybody's control," said Judge Michael Steltzer. The court filing says the withholding of the license is another tactic in a years-long effort to "restrict abortion access and deny Missourians their right to choose abortion." (Ravitz, 5/29)

In other news on abortion 鈥

New state abortion laws likely to become bogged down in legal challenges face another potential obstacle: prosecutors who refuse to enforce them. The Associated Press reached out to nearly two dozen district attorneys across seven states, and several said they would not file criminal charges against doctors who violate the laws. Even a few who left open potentially charging doctors said they would not prosecute women for having an abortion, which some legal observers say could be a possibility under Georgia鈥檚 law. (Thanawala, 5/30)

Planned Parenthood officials expect greater expenses for abortions in Indiana following a U.S. Supreme Court ruling upholding a state law requiring burial or cremation of fetal remains after an abortion. Abortion opponents cheer the court鈥檚 decision as 鈥渞ecognizing the dignity of unborn children鈥 even as the justices sidestepped other provisions of the Indiana law that could have blocked some women from undergoing abortions because of fetal gender, race or disability. (Davies, 5/29)

An Iowa judge has temporarily blocked enforcement of a law that would have cut off Planned Parenthood's federal sexual education funding. Gov. Kim Reynolds signed the law earlier this month. It聽prevents Planned Parenthood of the Heartland, the Iowa chapter of the national group, from accessing two federal grant programs for sex education funding because the group performs abortions.聽No state or federal dollars pay for abortions in Iowa. (Gruber-Miller, 5/29)

Quality

'This Is Beyond Horrifying': When Even Low-Risk Children Were Dying After Surgeries, Doctors Couldn't Keep Quiet Any Longer

The New York Times obtained unfiltered recordings of conversations between doctors at the North Carolina Children's Hospital about concerns that their patients seemed to be faring much more poorly after surgery than they should be. "I ask myself, 鈥榃ould I have my children have surgery here?鈥" said Dr. Blair Robinson. "In the past, I鈥檇 always felt like the answer was 鈥榶es鈥 for something simple. ... But now when I look myself in the mirror, and what鈥檚 gone on the past month, I can鈥檛 say that." The turmoil at UNC underscores concerns about the quality and consistency of care provided by dozens of pediatric heart surgery programs across the country.

Tasha and Thomas Jones sat beside their 2-year-old daughter as she lay in intensive care at North Carolina Children鈥檚 Hospital. Skylar had just come out of heart surgery and should recover well, her parents were told. But that night, she flatlined. Doctors and nurses swarmed around her, performing chest compressions for nearly an hour before putting the little girl on life support. Five days later, in June 2016, the hospital鈥檚 pediatric cardiologists gathered one floor below for what became a wrenching discussion. Patients with complex conditions had been dying at higher-than-expected rates in past years, some of the doctors suspected. Now, even children like Skylar, undergoing less risky surgeries, seemed to fare poorly. (Gabler, 5/30)

Cardiologists at North Carolina Children鈥檚 Hospital had worried for several years that children with complex conditions were dying at higher-than-expected rates. By 2016, it seemed that even patients undergoing lower-risk heart surgeries were suffering more complications. In meetings in 2016 and 2017, captured on secret recordings provided to The New York Times, doctors urged their bosses to take action. (Gabler, 5/30)

In other news on hospitals 鈥

Approximately 1 in 5 hospitals fully met national standards for performing lower rates of cesarean sections and other maternal care medical interventions that may unnecessarily increase health risks for mothers and infants, according to a report released Wednesday. The Leapfrog Group surveyed more than 2,000 U.S. hospitals and found most providers failed to meet all of the organization's standards for best practices for three maternity care interventions, including C-sections, early elective deliveries and episiotomies. (Johnson, 5/29)

Houston and its surrounding area is known for some of the best hospitals in the United States. But not all of them share the same stellar reputation. According to the Leapfrog Hospital Safety Guide's Spring 2019 report,聽 eleven Houston-area hospitals received a C grade. The Leapfrog Hospital Safety Grade uses 28 national performance measures from the Centers for Medicare & Medicaid Services (CMS), the Leapfrog Hospital Survey and other supplemental data sources. (Dawson, 5/29)

Nearly half of hospital boards lack a formal CEO succession plan, according to an American Hospital Association's governance survey, a finding that shocked governance experts. Developing a CEO succession plan is considered a core function of boards. Yet 24% of hospital system boards, 50% of free-standing hospital boards, and 59% of subsidiary boards had no succession plan, according to the comprehensive survey of 1,316 hospital CEOs who responded in the spring of 2018, the AHA's first such survey in five years. (Meyer, 5/29)

Most people don't put much thought into whether to spell out "Street"聽or use the abbreviated "St."聽in an address.聽Come July, though, hospitals that choose the wrong one won't get paid by Medicare, at least temporarily, for certain outpatient services. That's when the CMS will start enforcing its exact match program. It requires that the addresses hospitals use on their claims for services provided at off-campus, outpatient departments exactly match those entered for its Medicare enrollment of those locations.聽And when CMS says exactly, they mean exactly. In a test run last summer, the agency found a number of discrepancies鈥攎ainly minor things like writing out "suite"聽or "road"聽versus abbreviating them to "Ste."聽or "Rd." But even those would be enough to have claims returned. (Bannow, 5/29)

Southern California health care business KPC Health has acquired Promise Hospital of Baton Rouge, a former subsidiary of Promise Healthcare, a Boca Raton, Florida-based hospital business. Promise Healthcare Group鈥檚 hospital network across Louisiana was acquired several months after it filed for bankruptcy protection in 2018. The network was split between聽 KPC Health and Lexmark Holdings. (Mosbrucker, 5/29)

Federal authorities announced Wednesday they are ending Medicare and Medicaid payments to a rural Tennessee hospital that has become so woefully broke that it cannot pay its employees, its vendors or even keep the lights on. Portions of the hospital lost power last month because a $33,000 electricity bill had not been paid. Federal officials also allege the hospital has聽withheld taxes from employees' paychecks but then kept the money instead of paying it to the government. (Kelman, 5/29)

Coverage And Access

Following Sharp Outcry From Private Insurers, Connecticut Lawmakers Pause On Creating Public Option

鈥淲e are taking a step back and evaluating where things stand," said state Sen. Matt Lesser, a Democrat who led the proposal. He said many of the complaints from the insurance industry revolved around displeasure with competing with the government for customers. Meanwhile, California lawmakers move ahead with plans to expand coverage for undocumented immigrants in the state.

Legislation to create a public health-insurance option in Connecticut is off the table after an outcry from private insurers. State Sen. Matt Lesser, a Democrat who led the proposal, said other components of the health-care legislation might still move forward this year, including seeking permission from the federal government to buy prescription drugs from Canada and looking for ways to contain costs in the state鈥檚 health-care system. (de Avila, 5/29)

New, state-sponsored plans for individuals and small businesses, which would have been rolled out in 2022 if the legislation succeeded in its latest form, are expected to be removed from the bill, along with a provision to re-establish an individual mandate, its proponents said. What triggered the revisions is less clear. The Hartford Courant reported Wednesday that Comptroller Kevin Lembo claimed a threat from Cigna to move out of state had derailed the public option. But a spokesman for Cigna denied that a threat had been made, and Lembo made himself unavailable after his visit to The Courant. (Carlesso and Pazniokas, 5/29)

The California State Assembly voted overwhelmingly this week to pass legislation that would allow adult undocumented immigrants to receive health insurance benefits. According to The Associated Press, the state legislature passed the bill聽in a 44-11 vote Tuesday. The bill now heads to the state Senate for consideration. (Folley, 5/29)

Administration News

Proposal To Force Insurers, Hospitals To Disclose Secretly Negotiated Prices Stirs Such Vocal Opposition It May Get Dropped

President Donald Trump is working on an executive order intended to increase price transparency across the health care landscape. But one of the aspects to the order is provoking intense backlash. Compelling disclosure of negotiated rates 鈥渨ould have the ultimate anti-competitive effect,鈥 said Tom Nickels, the American Hospital Association鈥檚 executive vice president for government relations and public policy.

President Trump is preparing to issue an executive order to foster greater price transparency across a broad swath of the health-care industry as consumer concerns about medical costs emerge as a major issue in the lead-up to next year鈥檚 presidential election. The most far-reaching element favored by the White House aides developing the order would require insurers and hospitals to disclose for the first time the discounted rates they negotiate for services, according to health-care lobbyists and policy experts familiar with the deliberations. (Goldstein and Dawsey, 5/29)

In other news from the health industry 鈥

Hill Ferguson thinks telemedicine can become a routine option for patients, not just an easy way to handle middle of the night ear infections. The CEO of Doctor on Demand says primary care is a new frontier for companies like his that offer telemedicine, which involves seeing a doctor or nurse from afar, often through a secure video connection. His company is teaming with the insurer Humana to launch a new plan in Texas and Florida next month that connects some patients with employer-sponsored coverage virtually to a regular doctor licensed in their state. (5/29)

Universal Health Services has become the latest health system to partner with a primary-care specialty company to provide intensive primary-care services to its health plan enrollees. The company announced Wednesday that it signed one of its first value-based payment deals with Seattle-based Vera Whole Health to operate two new primary-care centers in Reno and Carson City, Nevada, serving members of UHS' 100,000-member Prominence Health Plan. (Meyer, 5/29)

Trump Appointee Who Oversaw Refugee Office While 'Zero Tolerance' Policy Was Enacted Is Departing HHS

Scott Lloyd served as director of the Office of Refugee Resettlement during the tumultuous time period when the government was separating children from their families at the border. Lloyd testified in February that he failed to alert HHS leaders about the health risks of separating migrant children, and HHS leaders previously concluded that Lloyd mismanaged efforts to reunite families.

Scott Lloyd, whose nearly two-year tenure leading the Department of Health and Human Services refugee office sparked lawsuits and congressional inquiries, will leave the Trump administration next week, HHS announced Wednesday. Lloyd ran the refugee office for most of 2017 and 2018 as HHS was taking custody of thousands of migrant children separated from their families under the administration's zero-tolerance border enforcement policy. The administration struggled to reunite those families after a federal court order, and House Democrats this year have probed Lloyd鈥檚 role in the separations and whether his testimony before Congress was truthful. (Diamond, 5/29)

He is best known for his role in the administration's short-lived "zero tolerance" immigration policy that resulted in thousands of migrant children being separated from their families at the U.S.-Mexico border. ORR took custody of those children, but the agency faced criticism for its slow reunification efforts. Some children remain separated from their parents. (Hellmann, 5/29)

Elections

He 'Has A Sixth Sense For People Who Are Struggling': Personal Tragedy Helps Joe Biden Connect With Voters

Former Vice President and 2020 presidential hopeful Joe Biden lost his son to cancer four years ago, giving him a perspective that allows him to reach grief-stricken voters. In other news, Biden released a plan on education that would boost the number of psychologists and other health providers in schools.

Joseph R. Biden Jr. has a habit of bringing people to tears. For Teri Inverso, a Pennsylvania voter attending Mr. Biden鈥檚 Philadelphia rally this month, the moment came as she talked about her late parents and recalled how the former vice president coped with the death of his son Beau. For Lisa Gatto, a sister-in-law of former Representative Steve Israel, it was when she once opened up to Mr. Biden about her experience battling breast cancer, Mr. Israel recalled. (Glueck, 5/30)

Former vice president Joe Biden on Tuesday unveiled his first major policy plan as a 2020 presidential candidate, an education proposal that would help teachers tackle debt, triple funding for districts with a high proportion of low-income students, and boost the number of psychologists and other health professionals in schools. (Sonmez, 5/28)

Capitol Watch

Durbin Does 'Not Have Confidence' New FDA Head Will Satisfactorily Address Teen Vaping Epidemic

Former Commissioner Scott Gottlieb had deemed the issue a public health epidemic, but Sen. Dick Durbin (D-Ill.) accused acting chief Ned Sharpless of not taking it as seriously.

Sen. Dick Durbin (D-Ill.) charged in an unusually sharp attack Wednesday that acting FDA Commissioner Ned Sharpless seemed to have "no intention" of addressing youth e-cigarette use, which his predecessor deemed a public health epidemic. His May 14 meeting with Sharpless was "one of the most alarming and disappointing meetings in my time in public service," the No. 2 Senate Democrat wrote in a letter to Sharpless, a longtime cancer researcher who took the top FDA post in April as Scott Gottlieb left. (Owermohle, 5/29)

鈥淚t is my belief that any person leading the FDA 鈥 must, first and foremost, feel a deep sense of responsibility to protect the health and well-being of all Americans, especially our nation鈥檚 children. Unfortunately, based on our meeting, I do not have confidence that you are that leader,鈥 Durbin said. Durbin urged Sharpless not to appeal a federal judge鈥檚 ruling earlier this month that would require the agency to speed up its review of thousands of e-cigarettes on the market 鈥淲e know that kids are attracted to these products because of the kid-friendly flavors that your agency is currently, and inexplicably, refusing to regulate,鈥 Durbin wrote. 鈥淵ou have the explicit authority to end FDA鈥檚 senseless decision to suspend public health review of e-cigarettes and cigars and take action today.鈥 (Weixel, 5/29)

Opioid Crisis

Tragic Opioid Losses Continue To Mount: A Tiny Infant In The Bronx, A Best Friend In Philadelphia, A College Football Star In Oklahoma

The death rate for young people due to opioid poisoning nearly tripled from 1999 to 2016, and the crisis continues to devastate a wide range of people from different backgrounds. News on the epidemic also focuses on the former president of Purdue Pharma, a physician opposed to strict opioid regulations, a push for free fentanyl test strips and more.

Two days after Christmas, Darwin Santana-Gonzalez, a curly-haired 1-year-old, was toddling around a Bronx apartment where, the police said, a potent mixture of heroin and fentanyl was being prepared, stamped and packed for sale. The powerful opioids had been placed in packages, the authorities said, along with a related drug, acetylfentanyl, creating the sort of deadly cocktail that has led to a surge of overdose deaths in the Bronx and beyond. Somehow, some of the mix also ended up in Darwin. (Otterman and Correal, 5/29)

Emma Semler sobbed in court on Wednesday as she faced Jenny Werstler鈥檚 grieving family. 鈥淚 should be dead as well,鈥 she told them through tears, according to the Philadelphia Inquirer. 鈥淚 don鈥檛 know why I鈥檓 still here and not Jenny.鈥 The two young women had both struggled with devastating addictions to heroin. On one fateful evening in 2014, they shot up together at a KFC in West Philadelphia. Werstler overdosed and Semler fled, abandoning her friend in the fast-food restaurant鈥檚 restroom. Later that night, Werstler died. It was her 20th birthday. (Farzan, 5/30)

Craig Box couldn't hold back tears in an Oklahoma courtroom on Wednesday as he described his late son Austin as "a special young man." Austin Box, a football star at the University of Oklahoma, died of an opioid overdose at the age of 22 in 2011. Now his father hopes to use his death to provide context to a historic trial in Norman that will test whether a state can make a pharmaceutical company pay for the opioid epidemic impacting Americans today. (Howard, 5/29)

The former chairman and president of pharmaceutical giant Purdue Pharma was warned by a friend that the addictive nature of the powerful pain killing opioid OxyContin could make him the next Pablo Escobar, according to a recently obtained deposition. The deposition, which took place in March and is part of the multidistrict litigation, saw Richard Sackler grilled over several aspects of the company's operation, from marketing of the drug, to his interaction with the sales team. The deposition showed that Sackler, who said his memory suffered from brain injuries stemming from a stroke, would at times say he could not remember. (Morales, 5/29)

[Dr. Stefan] Kertesz, a primary care physician who also specializes in addiction medicine, had not spent his career investigating long-term opioid use or chronic pain. But he grew concerned by the medical community鈥檚 efforts to regain control over prescribing patterns after years of lax distribution. ...Now, Kertesz is a leading advocate against policies that call for aggressive reductions in long-term opioid prescriptions or have resulted in forced cutbacks. He argues that well-intentioned initiatives to avoid the mistakes of the past have introduced new problems. He鈥檚 warned that clinicians鈥 decisions are destabilizing patients鈥 lives and leaving them in pain 鈥 and in some cases could drive patients to obtain opioids illicitly or even take their lives. (Joseph, 5/30)

Public health officials are urging drug users to pick up free fentanyl test strips amid a wave of fatal overdoses linked to a mixture of the opioid and crack-cocaine. Officials believe the drugs contributed to 18 drug overdose deaths over a recent eight-day period, including eight deaths over Memorial Day Weekend. (MacDonald, 5/29)

The American Civil Liberties Union of New Hampshire and the New Hampshire Medical Society filed a brief in federal court Wednesday, saying the state should continue to fight a request made by federal law enforcement for access to the state鈥檚 prescription drug database. The brief, also filed by the national ACLU and four other ACLU affiliates, is part of the federal case U.S. Department of Justice v. Jonas, and explains that not only are these types of searches unconstitutional, but they can also have adverse consequences and deter patients from receiving needed medical care. (Feely, 5/29)

Pharmaceuticals

California Measure Would Allow People To Receive Their First 30-Days Of PReP Without A Prescription

The bill faces opposition from the California Medical Association, which represents doctors and major insurance companies, because it says Truvada has potential side effects, including impaired kidney function, and that people who take it need to be closely monitored by doctors. In other pharmaceutical news, the weekend kicks off the annual meeting of the world鈥檚 biggest gathering of cancer doctors; a pharmaceutical company settles claims of kickbacks; and a look at the medications that have been linked to thousands of deaths.

Pharmacies throughout California could soon dispense an HIV-prevention drug without a doctor鈥檚 prescription 鈥 a move a San Francisco state senator says is necessary to remove barriers to people鈥檚 access to medication that could end new infections. Democratic Sen. Scott Wiener has proposed a bill that would allow people to receive their first 30 days of PrEP, an oblong blue pill sold under the trade name Truvada, over the counter if they first receive counseling and an HIV test. (Gardiner, 5/29)

This weekend marks the start of the annual meeting of the world鈥檚 biggest gathering of cancer doctors, and it鈥檚 going to be a big one for Roger Perlmutter, the head of research and development at Merck. Keytruda, the company鈥檚 cancer immunotherapy, is expected to reach annual sales of $10 billion by the end of its fifth year, making it the best drug launch in history over that time period, according to the investment bank Jefferies. But Perlmutter is gushing about the effects the drug has had on survival over that same time frame. New data on that metric will be presented at the upcoming meeting of the American Society of Clinical Oncology. (Herper, 5/29)

The U.S. attorney's office in Philadelphia says a pharmaceutical company is agreeing to pay $3.5 million to settle claims it paid kickbacks to dermatology providers to encourage them to prescribe their drugs. U.S. Attorney William McSwain said Wednesday the matter involved allegations that between 2012 and 2017, Almirall LLC's sales representatives and other employees gave doctors improper meals, entertainment, trips and other gifts. (5/29)

Among all prescription drugs over the last 15 years, the biologics Humira and Enbrel are the most-cited in the FDA鈥檚 database, the Journal Sentinel review found. Humira was linked to 169,000 reported serious adverse events and 13,000 reports of deaths, followed by Enbrel with 135,000 serious events and 8,000 deaths. Yet neither is among the top 20 prescribed medications in America, according to IQVIA data. (Fauber and Crowe, 5/30)

Public Health

Not Every Veteran Comes Home With PTSD. Can The Ones Who Don't Teach Us Enough To Help The Ones Who Do?

Melissa Thomas is a veteran who also lost her husband unexpectedly. Neither trauma set led to PTSD for her. Now as she studies medicine, she realizes it's important to know how to help those who do struggle with it. In other public health news: medical ethics, Ebola, dexterity in surgeons, microbes, bullying, and more.

A few years ago, my husband, Chris, who survived four deployments to Iraq and Afghanistan, was killed by an avalanche in Colorado. I am an Army veteran who was deployed to combat zones twice, in 2005 and 2008, without any serious lingering psychological ramifications. But I thought my husband鈥檚 death, that New Year鈥檚 Eve day, would be the final trigger for post-traumatic stress disorder; it would be what sent me over the edge. The next few months were filled with sleeplessness and drinking, but also exercising and thoughtful introspection as I scoured self-help books and sought therapy. I never had trouble getting out of bed in the morning, and I continued to make it to work on time. I was sad yet functional. (Thomas, 5/30)

Scholars and physicians have long debated the use of Nazi medical data, in particular from experiments on hypothermia and phosgene gas (data collected by exposing Jewish prisoners to freezing and poisoning). The U.S. military even redesigned Army flak jackets based on Nazi data so downed airmen had a better chance of surviving the cold, said Dr. Michael Grodin of Boston University School of Public Health, an expert on Nazi medicine and co-author of the Surgery paper. (Begley, 5/30)

An experimental drug has protected monkeys against infection with Nipah virus, a lethal disease and emerging pandemic threat for which there is no approved vaccine or cure, scientists reported on Wednesday. The antiviral drug, remdesivir, is also being tested against the Ebola virus in the outbreak now underway in the Democratic Republic of Congo. The only current treatment for Nipah virus infection is a monoclonal antibody that is still experimental; it was tested during an outbreak in India last year. (McNeil, 5/29)

Could you tie a series of square knots around the neck of a teaspoon without, even slightly, moving the teaspoon? How about using tweezers to extract a grape from inside a roll of toilet paper, without piercing the grape鈥檚 skin or touching the sides of the roll? Aspiring surgeons should have the dexterity to accomplish such tasks. But increasingly, they don鈥檛. (Murphy, 5/30)

We share our bodies with trillions of microbes that are critical to staying healthy, but now scientists are getting a much-needed close look at how those bugs can get out of whack and spur disease. One lesson: A single test to see what gut bacteria you harbor won't tell much. Research published Wednesday found repeat testing spotted the microbial zoo changing in ways that eventually may help doctors determine who's at risk of preterm birth, inflammatory bowel disease, even diabetes. (5/29)

For the last seven years, Michael Snyder has meticulously tracked his microbiome, monitoring how much glucose and how many proteins from immune cells were in his blood and which bacteria were living in his nose and gut 鈥 as he became diabetic, got his diabetes under control, and then lost that control. And now, that research on his own gut 鈥 and similar tracking for more than 100 other participants in a major study he led as part of the NIH-backed Human Microbiome Project 鈥 is being made public this week in Nature and Nature Medicine, along with two other major microbiome analyses. (Sheridan, 5/29)

School can be tough on kids who have overweight or obesity. They're often cruelly teased and bullied. And this type of bullying may lead to long-term consequences, according to a study published Thursday in the journal Pediatric Obesity. The study, conducted by researchers at the Uniformed Services University of the Health Sciences in Bethesda, Md., found that making fun of kids for their weight is linked to increased weight gain well into adulthood 鈥 and the more teasing that kids and teens experience, the more weight they may gain. (Neilson, 5/30)

When she was born, the baby girl weighed about the same as an apple. A San Diego hospital on Wednesday revealed the birth of the girl and said she is believed to be the world's tiniest surviving micro-preemie, who weighed just 8.6 ounces when she was born in December. (5/29)

In three civil cases so far, U.S. juries have ordered Roundup's inventor, Monsanto, now owned by Bayer, to pay enormous damages to cancer survivors. Thousands more lawsuits have been filed.For this chemical, and for Monsanto, it's a stunning change in fortunes. (Charles, 5/30)

Kaiser Health News: A Doctor Speaks Out About Ageism In Medicine

Society gives short shrift to older age. This distinct phase of life doesn鈥檛 get the same attention that鈥檚 devoted to childhood. And the special characteristics of people in their 60s, 70s, 80s and beyond are poorly understood. Medicine reflects this narrow-mindedness. In medical school, physicians learn that people in the prime of life are 鈥渘ormal鈥 and scant time is spent studying aging. In practice, doctors too often fail to appreciate older adults鈥 unique needs or to tailor treatments appropriately. (Graham, 5/30)

There's nothing magical about the number 10,000.In fact, the idea of walking at least 10,000 steps a day for health goes back decades to a marketing campaign launched in Japan to promote a pedometer. And, in subsequent years, it was adopted in the U.S. as a goal to promote good health. It's often the default setting on fitness trackers, but what's it really based on? (Aubrey, 5/29)

Kaiser Health News: The Unexpected Perk Of My Group Pregnancy Care: New Friends

I had always imagined going through pregnancy surrounded by family and friends. But when I found out I was pregnant, my husband, Alex, and I had just moved from San Francisco to Chicago. I knew almost no one. I ended up finding a community where I least expected it: at a medical office. (Gold, 5/30)

State Watch

State Highlights: Number Of 'Unsheltered' Homeless People In New York City Inches Downward; New Hampshire Becomes 2nd State To Sue Makers Of Dangerous PFAS Chemicals

Media outlets report on news from New York, New Hampshire, Hawaii, North Carolina, Minnesota, Wisconsin, Ohio, Kansas, California and Arizona.

They are the most visible sign of New York鈥檚 homelessness crisis: A man covered in dirt sits outside a subway station in Jamaica, Queens. Another man, cross-legged and ragged on a Midtown sidewalk, begs for money. A dozen people form an encampment in Central Park. While the overwhelming majority 鈥 about 95 percent 鈥 of the more than 78,000 people who qualify as homeless in New York actually have temporary shelter, others live on the streets, for a host of reasons. They represent a persistent challenge. (Stewart, 5/30)

New Hampshire has sued eight companies including 3M and the DuPont Co. for damage it says has been caused by a class of potentially toxic chemicals found in pizza boxes, fast-food wrappers and drinking water. The substances 鈥 known collectively as PFAS 鈥 have been used in coatings meant to protect consumer goods and are commonplace in households across the United States. Studies have found potential links between high levels of PFOA in the body and a range of illnesses including kidney cancer, increased cholesterol levels and problems in pregnancies. (5/29)

Hawaii public health authorities are urging both islanders and tourists to take precautions against rat lungworm, a parasitic worm that has infected five people in the state this year. Officials with Hawaii鈥檚 Department of Health announced last week that lab tests have confirmed two visitors contracted rat lungworm disease while traveling in western Hawaii earlier this year. Over the past several months, three residents have also been sickened by the parasite, and 10 cases were confirmed statewide in 2018, officials said. (Bever, 5/29)

State Senate leaders rolled out their two-year budget proposal for North Carolina on Tuesday, highlighting several health care provisions. State senators want to address mental health needs by funding a psychologist for every North Carolina school district, adding additional money for addiction recovery treatment, and by adding staffing and beds to Broughton psychiatric hospital. (Knopf and Davis, 5/29)

Staff at the Anoka Metro Regional Treatment Center say safety conditions have deteriorated so badly at the state-run psychiatric hospital that many are afraid to go to work. Workers say staff members have been knocked unconscious, dragged across the floor by their hair and had feces and urine thrown at them. Recently, a nurse was hospitalized after being beaten by a patient 鈥 it was the 28th injury at the center due to patient aggression that was reported to the Occupational Safety and Health Administration this year. (Magan, 5/29)

Introduced May 15, the act proposes an expansion of Medicaid coverage to expectant mothers who seek services provided by doulas and midwives. These health care workers provide mothers with key support throughout pregnancy that mitigates birth complications and other adverse outcomes. (Peryer, 5/29)

For children born this year, exposure to lead in homes, water and the soil will cost Ohio nearly $3 billion in reduced productivity and premature mortality, as well as added health care, education and social assistance spending. That鈥檚 according to a new online tool released today by Altarum, a non-profit research and consulting organization that focuses on solutions to health problems. (Zeltner and Dissell, 5/30)

Johnson County mental health officials 鈥 facing what they say is the highest suicide rate in any county in Kansas 鈥 told U.S. Rep. Sharice Davids on Wednesday they need private insurers to pay more for treatment, especially outpatient care. Erin Dugan, the president and CEO of the KidsTLC treatment center in Olathe, told Davids that Medicaid pays more for those services than the private sector 鈥 something that鈥檚 almost unheard of in the physical health realm. (Marso, 5/29)

Latthivongskorn completed the program in Medical Education for the Urban Underserved, a five-year track for students focused on serving marginalized communities. He鈥檒l start his residency training in family and community medicine at Zuckerberg San Francisco General Hospital in June, through a UCSF program. (Sanchez, 5/29)

An increase in year-round sports has led to overuse injuries in young athletes, which raises the question: Is the quest for athletic glory worth the toll it exacts on kids? At least one Kansas City-area sports official believes the hypercompetitive nature of high school sports has robbed it of its reason for being 鈥 namely, simply to have fun. ...Another byproduct of year-round sports is overuse injuries like little league shoulder. It鈥檚 caused by stress to the arm bone nearest the shoulder and commonly occurs in youth overhand pitchers between the ages of 11 and 16, according to Cincinnati Children鈥檚 Hospital. (Margolies, 5/29)

The co-owner of an Overland Park vitamin IV business claims she was sanctioned by the Kansas medical board not because her business had unsafe practices but because the board is biased against chiropractors. The Kansas Board of Healing Arts issued an emergency order in December barring Tara Zeller from working at IV Nutrition, 6301 W. 135th St., or similar IV therapy clinics, while it investigated allegations of improper advertising and unsafe practices there. (Marso, 5/29)

Milwaukee County and the company that formerly provided health care at the jail have paid $6.75 million to settle a lawsuit brought by the estate of Terrill Thomas, who died of dehydration in his cell in 2016. The Milwaukee Journal Sentinel first reported the proposed settlement in January. The payments, about $5 million from the county and $1.7 million from Armor Correctional Health Services, have now been made. (Vielmetti, 5/29)

Class-action lawyers have been circling on social media since a jury decided earlier this month that a California couple deserves more than $2 billion for the cancer they say was caused by using Roundup on their lawns for more than three decades. The verdict against Monsanto, the maker of the country鈥檚 most widely used herbicide before it was bought by Bayer last year, was the third since last summer. An estimated 11,000 more cases are waiting in the wings. Judging by the number of lawyers on social media hoping to make it rain, that number seems destined to climb. (Barnes, 5/30)

In a pivotal legal settlement, the city of Los Angeles has agreed that it won鈥檛 put a ceiling on the total amount of property that homeless people can keep on skid row, but will throw away sofas, refrigerators and other large items crowding the squalid 50-block area of downtown. The agreement, released Wednesday and reached after months of closed-door negotiations, applies only to skid row and adjoining streets. (Holland and Zahniser, 5/29)

Concentrated forms of marijuana are likely to continue with explosive growth in sales following a Tuesday Arizona Supreme Court decision that affirms their legality, according to experts. The court decided in a 7-0 decision that Yavapai County was wrong to prosecute and convict a man who had a valid, state-issued medical-marijuana card and was in possession of a concentrated form of the drug, hashish in his case. (Randazzo, 5/29)

Health Policy Research

Research Roundup: The Public Charge Rule; Youth Suicide; Mental Health Stigma

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

In October 2018, the Trump administration proposed an expansion of the 鈥減ublic charge鈥 rule, signaling a significant departure from current immigration policy. The proposed rule would consider an immigrant鈥檚 past use of noncash public benefit programs, such as the Supplemental Nutrition Assistance Program (SNAP) or Medicaid, as a negative factor in applications for green cards (i.e., permanent residency) or temporary visas. The rule would also weigh low income, poor health status, and other characteristics as negative factors. (Bernstein et al, 5/21)

In this time series analysis of monthly suicide data from 1999 to 2017, an immediate increase in suicides beyond the generally increasing trend was observed among the target audience of 10- to 19-year-old individuals in the 3 months after the show鈥檚 release. Age- and sex-specific models indicated that the association with suicide mortality was restricted to 10- to 19-year-old individuals, and proportional increases were stronger in females. (Niederkrotenthaler et al, 5/29)

Although the US has made progress in raising awareness of mental health and normalizing conversations about the topic, a great deal of stigma remains around mental illness and poor mental health, and many still face barriers to accessing services and supports. Among Asian American and Pacific Islander (AAPI) communities, these issues are often shrouded by silence and shame, allowing misconceptions and minimization of mental health concerns to thrive. (Hu, 5/20)

Low SES and TSEs are associated with common and unique differences in symptoms, neurocognition, and structural and functional brain parameters. Both environmental factors are associated with earlier completion of puberty by physical features and brain parameters. These findings appear to underscore the need for identifying and preventing adverse environmental conditions associated with neurodevelopment. (Gur et al, 5/29)

As the opioid epidemic continues to devastate many parts of the country, Medicaid plays an important role in efforts to address the crisis. In 2017, nearly two million nonelderly adults had opioid use disorder (OUD)1,2 and there were 47,600 opioid overdose deaths in the United States, more than double the number in 2007. Medicaid has historically filled critical gaps in responding to public health crises, such as the AIDS epidemic in the 1980s and the Flint water crisis. As with these other public health crises, Medicaid provides health coverage and access to necessary health care for those struggling with OUD. Additionally, as of May 2019, 36 states and Washington, D.C. have adopted Medicaid expansion, with enhanced federal funding, to cover adults with income up to 138% of the federal poverty level ($17,236 for an individual in 2019). All Medicaid expansion benefit packages must include behavioral health services, including mental health and substance use disorder services. (Orgera and Tolbert, 5/24)

In this secondary analysis of 8270 participants in the Anglo-Scandinavian Cardiac Outcomes Trial鈥揕ipid Lowering Arm, nonfasting lipid levels were similar to fasting lipid levels measured 4 weeks apart in the same participants in association with incident cardiovascular events overall and by randomized statin therapy. Concordance of fasting and nonfasting lipid levels for classifying participants into appropriate risk categories was high. (Mora et al, 5/28)

Editorials And Opinions

Perspectives: Abortion Restrictions Would Cause Women To Carry Children Who Have Fatal, Painful Conditions To Term

Opinion writers weigh in on abortion issues.

Recent state-imposed limits on abortion 鈥 from Georgia to Missouri, from Ohio to Mississippi 鈥 are rightly seen as a broadside aimed at women鈥檚 reproductive freedoms. But it is also worth examining a more particular, and potentially agonizing, consequence of these new restrictions. It is a hard one to talk about. It is, to some extent, taboo. But it must be discussed. Namely: These new laws, should they survive judicial scrutiny, would ensure that a generation of women would be forced to carry pregnancies to term despite the detection of fetal anomalies 鈥 some of them cruel, painful and fatal. (Jennifer Senior, 5/29)

The ink was barely dry on Missouri鈥檚 draconian new anti-abortion-rights law before state regulators delivered the second blow against women鈥檚 control over their own bodies. Using 鈥 and blatantly abusing 鈥 their official licensing powers, regulators are threatening to shut down the last abortion provider in Missouri when its license expires Friday. (5/29)

Over the past few months, several states have moved to severely limit access to abortion, prompting a court fight that could make its way to the Supreme Court. Conservatives are hoping the new right-leaning majority will overturn (or at least chip away at) Roe v. Wade. Liberals, meanwhile, are looking to 2020 to more firmly enshrine the right to have an abortion into law. One candidate for the Democratic presidential nomination, Sen. Kamala D. Harris (Calif.), has a novel idea for how to do that. She has proposed legislation modeled after the landmark Voting Rights Act of 1965 that would require states with a history of limiting women鈥檚 abortion rights to get clearance from the Justice Department before passing laws that limit abortion. (Eugene Scott, 5/29)

Why has the abortion issue had such staying power, compared, for example, with the steady liberalization of views on homosexuality and interracial marriage? Part of the reason for this is that the abortion issue taps into competing, deep-rooted views on the role of men and women in society. The sexual revolution and the radical transformation of the work and personal lives of women after the introduction of the contraceptive pill in the early 1960s 鈥 and the guarantee of women鈥檚 reproductive rights by the Supreme Court decisions Griswold v. Connecticut in 1965 and Roe v. Wade in 1973 鈥 brought these antithetical beliefs about abortion to the fore. (Thomas B. Edsall, 5/29)

Viewpoints: Trump's Latest Attack On Transgender People Is The Most Devastating So Far; Lessons On Organ Donations, Saving More Lives

Editorial writers express views about these health issues and others.

The Trump administration announced a proposal Friday that would essentially allow health-care providers to discriminate based on gender identity. For the 1.4 million transgender people in the United States, it鈥檚 the cruelest move yet from a government that鈥檚 been openly hostile to us. The proposed rule, which must go through a public comment period before being finalized at a later date, would replace an Obama-era rule that included gender identity and sexual orientation under the definition of sex discrimination, as many courts have ruled. (Katelyn Burns, 5/29)

Sometimes I wonder if, as far as the news is concerned, I鈥檝e begun to resemble the protagonist in 鈥淭he Princess Bride,鈥 who develops an immunity to a poison, iocane powder, simply by ingesting a little bit of it every day. Incredibly, the monstrousness of our age no longer shocks me, not least because I spend part of each day taking it all in. But on Friday, for the first time, I read the newspaper and just collapsed in a chair and wept actual hot tears. My wife and son came over and held me in their arms, fearing, perhaps, that I felt unloved. But that鈥檚 not why I wept. (Jennifer Finney Boylan, 5/29)

Three a.m. 鈥 that鈥檚 the hour we find ourselves sitting in a soulless lounge waiting for someone to die. This person, whose death is imminent, at some point wanted to donate their organs. Now, he has severe, irreversible brain damage but doesn鈥檛 fulfill the criteria of brain death. His family鈥檚 only option to save lives in the wake of his death is 鈥渄onation after circulatory determination of death鈥 鈥 DCDD in medical lingo 鈥 in which life support is removed and his heart must arrest on its own before he can donate. As two transplant recovery surgeons, we cannot be near the donor while his heart still beats, so we remain in that lounge, watching the minutes creep by. (N. Thao N. Galvan, Abbas Rana and Matthew Goss, 5/29)

Progressives are changing the Democratic Party鈥檚 focus from building stronger safety nets for the disadvantaged to subsidizing everything for everybody. Whereas Barack Obama once appeared radical for subsidizing health-care costs for the middle class as well as the poor, Democrats now promise free college, free health care and more鈥攆or everyone. Republicans can鈥檛 outspend Democrats, but they can make the case for freedom and against the idea that everything is 鈥渇ree鈥 without sounding like Scrooge. (Bobby Jindal, 5/29)

To battle poverty at home or abroad, we provide cash and food, clean water and medical care 鈥 and all of this is important. But a growing body of evidence suggests that the most fundamental need may be for something less tangible. It is hope. When aid breaks the cycle of poverty, the mechanism often seems to be that it raises self-confidence and engenders a new sense of possibilities that people then work harder to achieve. (Nicholas Kristof, 5/29)

The EPA has recently demonstrated that the health of any American comes second to the goals of industry. Despite the established connection between air pollution and human health, the current administration has relaxed policies that protect clean air, helping those very industries that are spewing chemicals into our air.Recently appointed officials and staff have ties to the industries that are poisoning Americans. (Colleen Chierici, 5/29)

Measles was declared eliminated in 2000, but so far this year 940聽individual cases have been reported throughout the country. All because a growing number of parents, in thrall to 鈥渁nti-vaxxer鈥 conspiracy theories, refuse to follow medical advice and immunize their children. This is terrifying, and not just because measles is a life-threatening disease. The revival of measles is an indication of a serious political problem. The case for democracy is that voters in the aggregate will make better decisions than a lone monarch or dictator would. But does majority rule still work when so many people believe so many things that simply aren鈥檛 so? (Max Boot, 5/29)

Our聽coalition of GOP legislators is proud to be represented by 13 veterans spanning every branch of the military. Since this also is Military Appreciation Month, we recognize and thank Sens. Martha McSally (R-Ariz.) and Todd Young (R-Ind.) and Reps. Don Bacon (R-Neb.), Larry Bucshon (R-Ind.), Paul Cook (R-Calif.), Mike Gallagher (R-Wisc.), Bill Johnson (R-Ohio), 聽Adam Kinzinger (R-Ill.), Brian Mast (R-Fla.), Steve Stivers (R-Ohio), Michael Waltz (R-Fla.), Lee Zeldin (R-N.Y.) and Steve Watkins (R-Kan.) for their service. Though no longer on the front lines, these members continue to serve and protect the well-being of their veteran colleagues by addressing the mental health crisis plaguing the military community. (Sarah Chamberlain, 5/29)

When I interviewed for my first job with The Post at age 25, I wore an oversize jacket in hopes of concealing the fact that I was pregnant. (The ruse failed to fool any of the seasoned journalists who interviewed me.) I knew that it is technically illegal to discriminate against pregnant women in hiring, and I knew that it happens anyway. A trove of pregnancy-obscuring wardrobe advice posts scattered across mom forums suggests that plenty of women find themselves facing the same dilemma: When you鈥檙e badly in need of a job, why add one more downside for potential employers? (Elizabeth Bruenig, 5/29)

It鈥檚 time to step back from the brink, and to deliberate carefully and collectively about whether the future to which we aspire should include any form of heritable genome modification. Until then, the law of the land should keep the door closed on clinical uses of these techniques. Otherwise individual scientists will race ahead, and it will be too late for us to decide. (Marcy Darnovsky, 5/29)

The vast majority of Americans 鈥 nearly 95% of us 鈥 support the use of medical cannabis. Thirty-three states plus the District of Columbia have legalized it, and that number is likely to rise.But like all swiftly embraced changes in public health, there can be unintended consequences of legalizing cannabis for medical uses. My colleagues and I are seeing this one: the rise of a new health care disparity, because it is harder for poor people to access medical cannabis than it is for wealthier people. (Julia Arnsten, 5/30)

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