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The maker of OxyContin, Purdue Pharma, and its owners, the Sackler family, are offering to settle more than 2,000 lawsuits against the company for $10 billion to $12 billion. The potential deal was part of confidential conversations and discussed by Purdue's lawyers at a meeting in Cleveland last Tuesday, Aug. 20, according to two people familiar with the mediation. Brought by states, cities and counties, the lawsuits — some of which have been combined into one massive case — allege the company and the Sackler family are responsible for starting and sustaining the opioid crisis. (Strickler, 8/27)

The Sackler family would give up ownership of Purdue Pharma, the company blamed for much of the opioid epidemic, and pay $3 billion of their own money under terms of a settlement proposal to resolve thousands of federal and state lawsuits, according to a person familiar with the negotiations. The discussions have been going on for months as Purdue and the Sacklers have sought to prevent any new lawsuits against individual members of the family as well as their company. (Hoffman, 8/27)

The plan under discussion envisions Purdue restructuring into a for-profit "public benefit trust" that would last for at least a decade, one of the people familiar with the matter said. Purdue would contribute between $7 billion and $8 billion to the trust, with some of the money coming from the sales of its drugs, including those that combat opioid overdoses, the person said. Additional payments would come from the company's cash and insurance policies, the person said. Three experts would be approved by a bankruptcy judge as trustees who would select board members to run the trust, this person said. (Spector and DiNapoli, 8/28)

“While Purdue Pharma is prepared to defend itself vigorously in the opioid litigation, the company has made clear that it sees little good coming from years of wasteful litigation and appeals," the company said Tuesday in a statement. "The people and communities affected by the opioid crisis need help now. Purdue believes a constructive global resolution is the best path forward, and the company is actively working with the state attorneys general and other plaintiffs to achieve this outcome.” (Bomey, 8/27)

The company and plaintiffs’ lawyers face a Friday deadline to give an update on the talks to U.S. District Judge Dan Polster in Cleveland, who is overseeing the bulk of the opioid lawsuits and has been a strong proponent of settling the cases. State attorneys general, whose separate lawsuits aren’t in front of Judge Polster, also are involved in the discussions. (Randazzo and Hopkins, 8/27)

Paul Farrell Jr., a lead plaintiffs’ lawyer representing local governments, said all sides remain under a gag order: “All we can confirm is that we are in active settlement discussions with Purdue.”Attorneys general representing several states also confirmed the accelerated negotiations. Ohio Attorney General David Yost is “actively engaged in conversations with Purdue,” said spokeswoman Bethany McCorkle, declining further comment. (Welsh-Huggins, 8/28)

Purdue settled separately with Oklahoma for $270 million in March. In May, a North Dakota judge threw out that state’s lawsuit against the company. Purdue is widely blamed for sparking the prescription opioid crisis in the United States with the introduction of OxyContin in 1996, followed by an aggressive marketing effort that persuaded doctors to prescribe it more widely and at higher doses. (Bernstein and Higham, 8/27)

Some attorneys general seem determined to take a tough line. “From the day we filed our complaint, I and other attorneys general from around the country said the Sackler family needs to be held accountable for their actions hooking this country on OxyContin,” New York Attorney General Letitia James said in an emailed statement. “This family started a national fire, and an arsonist should never give advice on fire prevention.” (Feeley and Griffin, 8/27)

Four years ago this week, Dr. Richard Sackler sat in a conference room at a law office in a Louisville, Kentucky, office park. Lawyers for the Kentucky attorney general’s office were taking his deposition as part of the state’s lawsuit alleging that the family business, Purdue Pharma, illegally marketed the opioid painkiller OxyContin by understating its addictive properties. Sackler, who has been at various times Purdue’s president and co-chairman of its board, testified for more than eight hours. (Armstrong, 8/27)

In the 1980s, Johnson & Johnson needed a reliable supply of opium for a popular product, Tylenol with codeine. So the health care conglomerate, better known for baby shampoo and Band-Aids, bought a business that grew and processed opium poppies in faraway Tasmania, off the coast of Australia. By 2015, at the height of the nation’s opioid epidemic, Johnson & Johnson was the leading supplier for the raw ingredients in painkillers in the United States. It even developed a special strain of poppy, called Norman, that produced a core painkilling agent used in OxyContin, which would become Purdue Pharma’s blockbuster drug. (Thomas and Hsu, 8/27)

Larry Biegelsen, an analyst at Wells Fargo & Co., wrote in a note to clients after speaking with Johnson & Johnson management that the verdict is a “net positive” for the New Brunswick, N.J., company, because of how much less it was when compared with the $17.5 billion requested by the Oklahoma attorney general. Analysts at Raymond James Equity Research said they were disappointed with Judge Balkman’s decision, adding that if J&J were skilled at convincing physicians to prescribe their drug, then its market share would be higher than 1%. Both analysts rate the company “outperform.” (Hopkins, 8/27)

Oklahoma's legal fight against the opioid industry has racked up settlements and judgments of nearly $1 billion, but as the numbers keep rising, so do concerns over how that money will be spent. Experts say the $572 million judgment issued Monday against consumer products giant Johnson & Johnson could pay for a year's worth of statewide drug-treatment efforts. But the company has already announced plans to appeal, which could tie up the money for years. Meanwhile, addiction counselors worry about when their clients might get more help. (Murphy, 8/27)

Now that an Oklahoma state court judge has ruled Johnson & Johnson (JNJ) must pay $572 million to the state for contributing to the opioid crisis there, Wall Street is engaged in a parlor game seeking to answer a key question: How will this decision affect the massive amount of litigation elsewhere? Sorting this out takes us in a number of directions because there are lawsuits filed against different drug makers in different states, along with a huge case consolidated in a federal court in Cleveland. There are also varying legal issues in play, increasing pressure to reach settlements, and uncertainty about the extent to which drug companies have the ability to reach any number of deals. (Silverman, 8/27)

Attorney General Dave Yost is backing new legislation that would seek to allow his office to take over nearly 100 pending lawsuits filed by Ohio cities and counties against opioid manufacturers and distributors. The legislation, which has not yet been introduced in the Ohio General Assembly, also might -- according to at least one critic -- give the attorney general control over pending lawsuits involving sexual misconduct by former Ohio State University team doctor Richard Strauss and Columbus-area doctor William Husel, who has been accused of ordering potentially fatal doses of painkillers for 25 of his patients. (Pelzer, 8/27)

New Hampshire will have its own day in court in a lawsuit against Big Pharma next June, according to a state official overseeing four state lawsuits that challenge the marketing and distribution practices of opioids. But despite the potential for a multi-million dollar award, it won’t be enough to compensate for the lives and human potential lost to opioids, said James Boffetti, an associate New Hampshire attorney general and director of the Attorney General Division of Legal Counsel. (Hayward, 8/27)

The Ohio hospital system that found an intensive care doctor ordered excessive painkillers for about three dozen patients who died has reached settlements totaling $9 million in lawsuits over two deaths, which would be the highest known payouts so far in the related wrongful-death lawsuits. The latest cases settled by the Columbus-area Mount Carmel Health System alleged Dr. William Husel ordered drugs that caused the death of 58-year-old Donald McClung last September and hastened the death of 75-year-old Rebecca Walls in November, according to court records. (Franko, 8/27)

Kaiser Health News: In India’s Burgeoning Pain Market, U.S. Drugmakers Stand To Gain

Pain, like death, is a universal phenomenon. The sour grimace on the woman’s face, registering her bodily complaints to Dr. G.P. Dureja in his East Delhi office, would be recognized anywhere. Slouched shoulders, pinched forehead. She wore a willowy black kurta and cast a disapproving glance at the five pain physicians-in-training huddled behind Dureja, founder of Delhi Pain Management Centre and one of India’s pioneering pain physicians. (Varney, 8/28)

Joseph R. Biden Jr.’s presidential campaign on Tuesday made an extraordinarily emotional appeal for his candidacy and his health care proposal through a new ad that highlights his struggles with grief and family loss, a message that reminds voters of the good will and empathy many have for the former vice president while accentuating one of his central policy goals. In the 60-second television spot, called “Personal,” Mr. Biden tells the stories of his family tragedies that he often shares on the campaign trail as he discusses the importance of health care access. But the ad is striking for the wrenching images of Mr. Biden with his two sons who survived a car crash that killed his first wife and a daughter in 1972. One of those children, Beau Biden, would die of cancer in 2015, a development that drew widespread sympathy in Washington and around the country toward the end of Mr. Biden’s second term in the Obama administration. (Glueck, 8/27)

Wrapping himself in the legacy of "Obamacare," Joe Biden is offering restless Democrats a health care proposal that goes far beyond it, calling for a government plan almost anybody can join but stopping short of a total system remake. Recent polls show softening support for the full government-run system championed by Sen. Bernie Sanders, and Biden is pitching his approach in a new ad aimed at Democrats in Iowa. His "public option" would give virtually everyone the choice of a government plan like Medicare, as an alternative to private coverage, not a substitute. (Alonso-Zaldivar, 8/27)

"ObamaCare is personal to me," Biden narrates in the ad. "When I see the president try to tear down, and others propose to replace it and start over that's personal to me too. We've got to build on what we did because every American deserves affordable health care." (Manchester, 8/27)

Health care has emerged as a fault line in the Democratic primary debate, with Biden calling for building upon President Barack Obama’s signature achievement while other leading candidates, including Sens. Bernie Sanders (Vt.) and Elizabeth Warren (Mass.), advocate for a Medicare-for-all single-payer plan. In his 60-second spot, Biden highlights the importance to his family of having had health insurance at key moments as well as the passage of the Affordable Care Act in 2010 while he was vice president. (Wagner, 8/27)

As the Democratic presidential field continues to grapple with plans to address health care, a significant majority of Democratic voters are more likely to back a 2020 primary candidate who supports “Medicare for All” than building on the Affordable Care Act, a new poll found. According the POLITICO/Morning Consult poll out Wednesday, 65 percent of Democratic primary voters would be more likely to support a candidate who wants to institute a single-payer health care system like Medicare for All; 13 percent said they’d be less likely to back a candidate based on that support. (Oprysko, 8/28)

A slate of Democrats running for president in 2020 are sitting down for interviews with activist Ady Barkan to discuss health care policies as the party’s presidential primary heats up. Barkan, who was diagnosed with ALS in 2016 and has garnered social media fame with his activism fighting for more affordable health insurance, said the current primary is not engendering substantial discussions or plans on the topic. (Axelrod, 8/27)

A U.S. federal judge on Tuesday blocked Missouri from enforcing a law banning abortion in the state after eight weeks of pregnancy except in cases of medical emergency, acting just a day before the law was set to take effect. U.S. District Judge Howard Sachs in Kansas City temporarily halted the law, pending litigation or a further order of the court, saying it would negatively impact the rights of hundreds of women. (8/27)

"The various sections specifying prohibitions on abortions at various weeks prior to viability cannot be allowed to go into effect on August 28, as scheduled," writes US District Judge Howard Sachs in an 11-page opinion. "However formulated, the legislation on its face conflicts with the Supreme Court ruling that neither legislative or judicial limits on abortion can be measured by specified weeks or development of a fetus; instead, 'viability' is the sole test for a State's authority to prohibit abortions where there is no maternal health issue," Sachs wrote. (Kelly, 8/27)

Planned Parenthood and the American Civil Liberties Union of Missouri sued the state, saying the law was unconstitutional and contrary to the Roe v. Wade decision. The Missouri law signed in May would ban abortions before many women know they are pregnant, with no exceptions for rape or incest, making it one of the strictest in the country. If the court doesn’t uphold the ban, the bill includes less-strict bans ranging from 14 weeks to 20 weeks, the Associated Press reported. (Horton, 8/27)

Lawyers said the eight-week ban would have a devastating effect and cause irreparable harm to clinics and patients. “What little abortion access in Missouri is left will stay in place for the time being,” Alexis McGill Johnson, Planned Parenthood’s acting president and chief executive, said in a statement Tuesday. (Calfas, 8/27)

The law carves out exceptions only for a "medical emergency," defined as a situation in which the pregnant woman faces death or "substantial and irreversible impairment of a major bodily function." It contains no exceptions for incest or rape. Under the law, abortion providers face from five to 15 years in prison and the loss of their medical license if they violate any of the gestational age bans. (Margolies, 8/27)

Missouri already has some of the nation's most restrictive abortion regulations. A clinic in St. Louis is the only one in the state that performs abortions. Sachs' ruling says allowing the eight-week abortion ban to be enforced would have blocked about half of reported abortions in Missouri. The judge wrote that it would amount to "significant interference with plaintiffs' service and the rights of its prospective patients." (Ballentine and Stafford, 8/27)

Kristan Hawkins, president of the anti-abortion group Students for Life of America, said the ruling would motivate anti-abortion voters next year. "Rulings like these will motivate voters in 2020 because the courts should not be able to ignore the legislative process," she said in a statement. (McIntire, 8/27)

A federal judge Tuesday temporarily blocked part of Missouri’s new abortion law, pausing prohibitions against abortion based on gestational age, but letting stand the provision barring the procedure for reasons of sex, race, or Down Syndrome diagnosis. The decision, by U.S. District Court Judge Howard Sachs, was handed down on the eve of the law’s scheduled implementation. It followed a two-hour Monday hearing in the U.S. District Court of the Western District of Missouri’s Kansas City courthouse. (Thomas, 8/27)

Oregon's health care agency said Tuesday it will no longer use federal dollars to fund family planning clinics because of new Trump administration rules that impose additional hurdles for women seeking abortion. Patrick Allen, director of the Oregon Health Authority, said in a statement that banning taxpayer-funded clinics from making abortion referrals — as the newly implemented federal rules require — would cause Oregon to violate its own laws on reproductive care. (Flaccus, 8/27)

Oregon on Tuesday announced it has exited a federal family planning program over opposition to the Trump administration’s new abortion restrictions. In a letter sent Monday to the Department of Health and Human Services, the Oregon Health Authority said it would withdraw from the Title X family planning grant program rather than follow new rules banning grantees from referring women for abortions. (Weixel, 8/27)

The tobacco giants Philip Morris International and the Altria Group are in talks to reunite, the companies said on Tuesday, in a deal that would combine the most popular brands of both traditional and electronic cigarettes. The merger would be a boost for Altria’s investment in Juul, the e-cigarette juggernaut. Juul has been trying to expand overseas, but it lacks the global distribution network of Philip Morris, which has grown since it was spun off from Altria in 2008. (Kaplan, 8/27)

Philip Morris said Tuesday that there is no guarantee of success in what would be an all-stock deal. But analysts said the merger is likely to pass muster with anti-trust regulators. Both companies have been investing in alternatives to traditional cigarettes amid declining use. The companies are already partnering on the U.S. launch of a heat-not-burn cigarette alternative, iQOS, made by Philip Morris. Separately, Altria has taken a roughly $13 billion-dollar stake in vaping giant Juul, betting on more smokers switching to electronic cigarettes. (Perrone, 8/27)

The board of the combined company would be split evenly between Philip Morris and Altria directors, the source said. If the deal negotiations prove successful, an agreement could be reached by the end of September, the source added. The two U.S.-headquartered companies separated 11 years ago to focus on different geographic markets, at a time when tobacco stocks generated steady yields. Since then, the industry has been disrupted by a move away from traditional smoking into e-cigarettes and vaping. (Kumar and Roumeliotis, 8/27)

Analysts have long speculated that the two companies would come back together. The talks come at a time when cigarette sales are falling and both companies are searching for new ways to grow. Combining Altria and PMI would create a global tobacco powerhouse with investments in e-cigarettes and cannabis. PMI’s shares lost nearly 8% on Tuesday, closing at $71.70 a share, while Altria’s fell about 4%, closing at $45.25 a share. PMI’s shares were pressured Monday amid merger speculation. (Faber and LaVito, 8/27)

The discussions are also motivated by the risks—and opportunities—that Juul presents for both companies as the startup expands outside the U.S., the people said. Philip Morris is the bigger of the two companies both in terms of revenue and market value. Based on share prices before the companies disclosed their talks early Tuesday, Philip Morris had a market capitalization of about $121 billion and Altria sported a market value of roughly $88 billion. (Maloney and Lombardo, 8/27)

HHS on Monday approved Rhode Island's 1332 waiver application to create an individual market reinsurance fund supported by federal funding. Rhode Island anticipates the move will lower premiums and expand coverage statewide. The state expects the 1332 waiver will reduce premiums by 5.9% in 2020 compared to what they would be without the waiver, according to HHS. Rhode Island thinks the lower premiums will grow individual market enrollment by about 1% in 2020. (Brady, 8/27)

Lafayette General Health has created a second health care innovation fund that will seek funding for advancement in the local, state and national health care marketplace. Lafayette General Health made the announcement Monday of the Healthcare Innovation Fund II, a limited liability company that will target investments in health care companies seeking seed or growth capital. It will be an investor along with Acadian Companies, LHC Group, Ochsner Health System and the William C. Schumacher Family Foundation. (8/27)

Attorney General Ashley Moody’s office wants a judge to toss out a lawsuit challenging a legislative decision that would strip Medicaid money from two South Florida hospitals with ownership ties to a nursing home where residents died after Hurricane Irma. Moody’s office, representing Agency for Health Care Administration Secretary Mary Mayhew, filed a 32-page document last week arguing that a Leon County circuit judge should dismiss the lawsuit by Larkin Community Hospital and Larkin Community Hospital Palm Springs Campus, both in Miami-Dade County. (Saunders, 8/27)

Florida is planning a major overhaul to its Medicaid program that serves more than 30,000 people with disabilities, and hundreds of Floridians have told the state what they want — and fear — from the change in both an emotional public meeting that ran overtime and comments submitted in writing. Though administrators at the Agency for Persons with Disabilities asked the public for feedback, it now says those written comments are private health information that needs to be protected from public view. (Koh, 8/27)

Kansas’s newest KanCare insurance company, Aetna, has experienced a range of problems — from missed payments to incomplete information.Tuesday, its leader sought to make amends. (Shorman, 8/27)

Adree Edmo is one step closer to becoming the first inmate to receive a gender confirmation surgery in Idaho as the result of a court order. After years of struggling with her gender identity, attempting suicide and trying to castrate herself twice in an all-male Idaho prison, a court ruled that Edmo should be provided the surgery. After that, she will serve the remainder of her sentence at a women’s correctional facility. (Beachum, 8/27)

A mysterious outbreak of critical lung disease in scores of teenagers and young adults is forcing federal agencies to grapple with a vast, nearly unregulated market of nicotine- and marijuana-based vaping products. At least 193 potential cases, including one death, have been reported to the federal government this summer. Yet since the first case was logged in June, agencies have released no product recalls, nor any details or broad public awareness campaigns about which specific vaping products might be causing the illness. (Owermohle, Ehley and Roubein, 8/27)

Utah health officials say they are investigating 21 cases of a severe lung disease linked to vaping. The state Department of Health announced the new number Monday, a jump from the five cases in teenagers and young adults reported last week. The department says the cases stem from the use of a mix of nicotine and marijuana electronic cigarette products. (8/27)

The CDC has not publicly identified a cause yet, but many of the reported cases have involved products that contain THC, the key element in marijuana that causes users to get high. Before experiencing symptoms of respiratory distress, some patients have reported shortness of breath and chest pains, as well as gastrointestinal problems like nausea and diarrhea, according to the CDC. (Pitofsky, 8/27)

North Carolina's top prosecutor expanded his efforts to halt e-cigarette sales to teens on Tuesday by suing eight more manufacturers and sellers of vaping products. Josh Stein, the Democratic attorney general in the traditionally tobacco-friendly state, said he's filing lawsuits against eight companies that make or sell e-cigarettes and related products in an announcement timed to grab attention during the first week of school. (Drew, 8/27)

“One look at their marketing materials demonstrates just how egregious their sales tactics are — with flavors like cotton candy, gummy bear, unicorn, and graham cracker, they’re clearly targeting young people,” Stein said. “To teenagers, the health and addiction risks of vaping are simply too high.” (Weixel, 8/27)

The Trump administration plans to use $271 million of Department of Homeland Security funds, including some designated to help hurricane-stricken areas, to detain and remove immigrants who cross the southern U.S. border illegally. DHS plans to divert money that lawmakers had designated for other purposes at the agency to increase its capacity to handle people crossing the U.S.-Mexico border, many of whom are Central Americans seeking asylum from violence in their home countries. (Andrews and Hackman, 8/27)

The move comes amid an intensifying battle between Democrats and President Trump over the administration’s response to the flow of migrants and asylum seekers from Central America into the United States. It also comes as a hurricane watch has been issued for Puerto Rico ahead of Tropical Storm Dorian, which could force the Federal Emergency Management Agency to tap the relief funds. Rep. Lucille Roybal-Allard (D-Calif.), chairwoman of the House Appropriations subcommittee on homeland security, said the move was indicative of “a growing disconnect between the will of Congress” and the implementation of immigration enforcement operations. (Sonmez and Sacchetti, 8/27)

In a statement to CBS News, FEMA said the transfer of funds to "support the border emergency" will leave the agency with $447 million in funding for future disaster relief efforts. "This amount will be sufficient to support operational needs and will not impact ongoing long-term recovery efforts across the country," the agency added. FEMA said the current pool of funding for ongoing recovery efforts, including those for natural disasters in 2017, will not be affected by the transfer. In its notification to Congress, DHS said the disaster relief funds left intact at FEMA will be sufficient to sustain operations "absent significant new catastrophic events." (Montoya-Galvez, 8/27)

The Trump administration instituted a recent immigration rule change, one that's a year in the making. This rule, on public charge, links immigrants' future legal status to their use of public benefits: food stamps, housing assistance and Medicaid. (Dearing, Bologna and Mitchell, 8/27)

The U.S. Department of Veterans Affairs said Tuesday it is investigating allegations of “potential wrongdoing” resulting in multiple patient deaths at a VA hospital in West Virginia. VA Inspector General Michael J. Missal said in a statement his office has been looking with federal law enforcement into allegations at the Louis A. Johnson VA Medical Center in Clarksburg. Sen. Joe Manchin of West Virginia, a member of the Senate Veterans Affairs Committee, said in a statement he “will do everything in my power to investigate these accusations and get to the bottom of what happened.” (8/27)

A 28-year veteran of the Navy Medical Service Corps will be the new director of the Hampton Veterans Affairs Medical Center in Virginia. The Daily Press reports David Collins’ hiring was announced Tuesday by VA’s Mid-Atlantic Health Care Network, which covers veteran’s hospitals in Virginia and North Carolina. He’ll oversee care at the hospital and outpatient clinics in Virginia Beach and Elizabeth City, North Carolina. (8/28)

Adults of a wide range of ages should be screened for hepatitis C, according to a new draft recommendation from the U.S. Preventive Services Task Force that could greatly expand the number of people treated for the disease. The independent panel of volunteer experts, backed by the government, aims to recommend that all adults ages 18-79 undergo screening for hepatitis C, a viral infection that can damage the liver and lead to long-term and potentially fatal health problems including cirrhosis and liver cancer. (Abbott, 8/27)

This is an update from its 2013 recommendation, in which the USPSTF recommended screening those at high risk for HCV, as well as a one-time screening for adults born between 1945 and 1965. Support for an update calling for universal screening has been building in the hepatology and public health communities, so the USPSTF's shift did not come as a surprise. (Walker, 8/27)

The change is a direct result of the steady rise in hepatitis C infections seen over the past decade as a result of the ongoing opioid epidemic. The number of hepatitis C cases reported in the U.S. nearly tripled from 2010 to 2015, according to the Centers for Disease Control and Prevention. All in all, an estimated 41,200 acute hepatitis C cases occurred in 2016. (Johnson, 8/27)

Progress in reducing the number of deaths related to cardiovascular disease has been waning in recent years, heightening concerns that the obesity epidemic in the United States is undoing improvements in heart health. A research letter published Tuesday in Journal of the American Medical Association confirms that although the death rates from heart disease, diabetes, stroke and related disorders have been decreasing for decades, the rates have recently slowed or stalled. (Bever, 8/27)

Artificial intelligence could help doctors learn more than the condition of a patient’s heart from an electrocardiogram: Applying AI to the heart test data could indicate overall health status, researchers at the Mayo Clinic have discovered. (McCormick, 8/28)

Men and women who move around throughout the day, even if they just stroll or clean the kitchen and do not formally exercise, are less likely to die prematurely than people who almost never leave their chairs, according to a heartening new study of physical activity and mortality. The study, the largest of its kind to date, finds that any activity, no matter how modest, can reduce mortality risks, with some of the greatest gains seen when people shift from being almost completely sedentary toward rising and ambling for even an extra hour each day. (Reynolds, 8/28)

Amid a boom in genetic testing that aims to predict a person’s response to medication, the Food and Drug Administration has been quietly pressuring a handful of companies to stop reporting results to patients about how their genes may interact with specific drugs. The agency’s concern? That unsupported claims about gene-drug links could be dangerous, if they spur patients to start, stop, or switch medications in ways that aren’t appropriate. (Robbins, 8/28)

As schools begin reopening their doors to children nationwide, the U.S. government has told a federal judge that states have no power to sue over new rules they say make school meals less healthy. In a Monday night court filing, the government said New York, five other states and Washington, D.C., could not sue based on speculation that changes to the federally funded National School Lunch Program could cause health problems for children and require more spending on treatment. (Stempel, 8/27)

“When I took a testosterone test, I got my score and panicked,” said Eugene, a 42-year-old film director and editor in Beverly Hills who started noticing hair and energy loss in 2016 and realized he was suffering from low testosterone. That’s when he started a two-year regimen of DHEA, a supplement that promises to boost testosterone, taking the pills daily. “Unfortunately, I didn’t notice much of a change,” he said. His doctor told him to stop taking any supplements. (Popescu, 8/28)

Researchers hoping to study marijuana for scientific and medical purposes are one step closer to expanding their limited supply of the plant. This week, the federal government announced it would begin processing dozens of pending applications for permission to cultivate the plant for scientific research. The U.S. Drug Enforcement Administration's decision comes after several years of delay for some applicants and a lawsuit filed against the agency by one cannabis researcher. (Stone, 8/27)

Air pollution, even at modest levels, is deadly. An international team of researchers used data from 652 cities in 24 countries to correlate levels of particulate matter pollution with day-to-day mortality rates. They measured the concentrations of two microscopic particles of soot, PM 2.5 and PM 10, particles small enough to enter the lungs or the bloodstream. (Bakalar, 8/27)

More teens and young adults — particularly girls and young women — are reporting being depressed and anxious, compared with comparable numbers from the mid-2000s. Suicides are up too in that time period, most noticeably among girls ages 10 to 14. (Kamenetz, 8/27)

Hey, women: Dr. Jen Gunter wants you to understand your own vagina. The California gynecologist is on a quest to help women get the facts about their own bodies. It isn't always easy. In an era of political attacks on women's reproductive choices and at a time when Internet wellness gurus are hawking dubious pelvic treatments, getting women evidence-based information about their health can be a challenge, she says. (Gordon, 8/27)

New Jersey can move ahead with a new law allowing terminally ill patients to seek life-ending drugs, a state appeals court ruled Tuesday, overturning a lower court's temporary hold on the law. Judges Carmen Messano and Arnold Natali ruled Tuesday that a state Superior Court "abused its discretion" in blocking the law earlier this month. (Catalini, 8/27)

Kaiser Permanente may face a new California transparency law targeted at its finances. The state Legislature passed a union-sponsored bill that would force each of the health system's facilities to disclose its profits. The state Legislature sent the bill to Democratic Gov. Gavin Newsom's desk on Monday, where he has 12 days from receiving it to sign it into law. A spokesperson for Newsom said the governor is still evaluating the legislation. (Luthi, 8/27)

Katrina Dennis was a 36-year-old corporate lawyer in Baltimore in 2015 with lots of demands on her time from business and civic groups and a tight-knit group of family and friends. Today she lies in a hospital bed at Johns Hopkins Hospital with cancer in her organs, blood and bones that is certain to end her life. Several miles north in Towson, a jury will decide whether this outcome could have been prevented by her doctor, head of the Breast Center at the University of Maryland St. Joseph Medical Center who diagnosed her with a curable form of the disease more than four years ago. (Cohn, 8/28)

Renee Coleman-Mitchell, Connecticut’s public health commissioner, said Tuesday that she has no plans to release the most recent round of statewide school-by-school immunization data, despite calls this week from lawmakers who say parents should have access to the information as the school year begins. ...The commissioner said the department would disclose county-level immunization data, which has been common practice, in October. (Carlesso, 8/27)

Four employees of a South Florida nursing home where a dozen people died amid sweltering heat in September 2017 were arrested and charged with manslaughter and tampering with evidence, police said Tuesday. In announcing the charges, police officials assailed the four employees — the facility’s administrator and three nurses — and said the deaths were all avoidable and due to their behavior. (Berman, 8/27)

OHSU Hospital has revealed the names of the three cardiologists it hired this summer to restart the hospital’s heart transplant program. The announcement comes with days left before a deadline that would require the hospital to go through a lengthy recertification process. Now the program must perform a transplant to retain its status with the U.S. Centers for Medicare and Medicaid Services. (Harbarger, 8/27)

The contours of the latest battle over patents on the CRISPR genome editing technology are becoming a little clearer: In a decision released Monday evening, the U.S. patent office told the Broad Institute, on one side, and the University of California and its allies, on the other, what they’ll be allowed to fight about. And in tennis terms, it’s advantage, Broad. (Begley, 8/27)

San Francisco General Hospital recently changed a controversial policy at the psychiatric emergency room intended to keep patients awake and shorten their visits, so the unit could keep up with its overwhelming demand. For the past 18 months, the majority of people who entered the psychiatric emergency unit were only allowed to sit upright in armchairs that did not recline. (Thadani and Fracassa, 8/27)

A health-care system in Massachusetts said it was conducting a review of US HealthVest, its partner in a proposed psychiatric hospital, two days after a Seattle Times investigation of the company’s operations in Washington and other states. “Our foremost priority is to assure that any partnership is consistent with both our mission and our core goals as an organization: quality care, increased access to critical health services, financial stability and investment in community health.” (Gilbert, 8/27)

After a Bay State woman infected with Eastern Equine Encephalitis died over the weekend, and the Massachusetts Department of Public Health announced the disease killed a horse in Methuen, New Hampshire’s border towns are on alert. Jeff Emanuelson, assistant chief of the Salem Fire Department, said a contractor working for the town has been treating standing water with a chemical meant to kill mosquito larva since June. The contractor is also monitoring mosquito traps, and regularly testing batches of mosquitoes for EEE and West Nile Virus. (Albertson-Grove, 8/27)

The homeless outreach agency that was meant to move hundreds of people from the streets into housing, shelters or treatment for mental illness and substance abuse has failed dramatically to meet the goals of its contract with the city of Los Angeles, according to an audit set to be released Wednesday by Controller Ron Galperin. The audit found that, despite having more than doubled its staff of outreach workers in the last two years, the Los Angeles Homeless Services Authority missed seven of nine goals during the 2017-18 fiscal year and five of eight last fiscal year. (Smith, 8/27)

Gov. Brian Kemp said Monday that his administration would not seek to close plants in Covington and Smyrna where cancer-causing gas emissions have sparked an uproar from worried residents. ...Though state law gives authorities leeway to shut down the plants, Kemp was seen as unlikely to do so, since it would trigger a legal battle with two companies. (Galloway, Bluestein and Hallerman, 8/27)

The state’s Environmental Protection Division launched an immediate investigation Tuesday of a previously undisclosed leak of toxic gas at a Smyrna medical sterilizing facility. The amount of the ethylene oxide leaked last month was less than 6 pounds, said Sterigenics, the company that runs the sterilization plant. If it had been more than 10 pounds, the company would have been obligated to report the leak quickly to state regulators. (Goodman and Miller, 8/27)

The Evers administration is broadening efforts to crack down on a group of harmful chemical compounds by taking steps to regulate “forever” chemicals in both drinking water and in lakes, streams and rivers. The state Department of Natural Resources said on Tuesday that the agency has been directed by Gov. Tony Evers, a Democrat, to take additional steps to address a spate of compounds coming under growing scrutiny because of their potential health consequences on humans. (Bergquist, 8/27)

A homeless man was burned to death on skid row on Monday night, and Los Angeles police have captured one suspect in connection with the gruesome killing, authorities said late Tuesday. The incident occurred near 6th and San Pedro streets about 11:30 p.m. Monday, according to Capt. Gisselle Espinoza, a Los Angeles Police Department spokeswoman. (Queally, 8/27)

As it navigates a raft of high-profile scandals, the University of Southern California has selected a new provost and second-in-command: Charles F. Zukoski, an accomplished chemical engineer and the current provost of the University at Buffalo. President Carol L. Folt announced her choice on Tuesday, marking her most significant appointment since taking over the helm of USC this summer and pledging to rapidly address the university’s challenges. (Hamilton, 8/27)

Dawn Patterson keeps a multimillion-dollar drug in the fridge, next to a bottle of root beer and a jar of salsa. The drug, Strensiq, treats a rare bone disease that afflicted her with excruciating pain and left her struggling to work or care for her family. A year after she began taking the drug, Ms. Patterson, 49, credits it with nearly vanquishing her pain, enabling her to return to work part time for a hospital. (Thomas and Abelson, 8/25)

The Canadian government reassured pharmaceutical industry representatives that “all options are on the table” regarding the Trump administration’s plan to import drugs from Canada at a closed-door briefing last week, according to an attendee. “The Government of Canada continues to monitor the situation and is engaging U.S. officials,” Health Canada, the government’s health department, said in a slide presentation obtained by STAT, which was distributed prior to the meeting. “All options available to the Government to respond to this issue are being considered.” (Facher, 8/27)

Sen. Richard Blumenthal, D-Conn., continued his long -running criticisms of Mylan, which markets the EpiPen at a press conference in Hartford on Monday, saying “the reason for its short supply is to keep prices up.” ...While Mylan markets the EpiPen, Meridian — a unit of Pfizer — manufactures the injectors that are used to deliver an emergency antidote to severe allergic reactions to peanuts, bee stings and other substances that can trigger a life-threatening reaction known as anaphylaxis. (Radelat, 8/26)

A conservative political group launched a $2.5 million ad campaign on Monday targeting the prescription drug pricing plan House Democrats are set to release next month. The American Action Network will run a mail, digital and radio ad campaign in 35 congressional districts held by Republicans. The ads promote Republican incumbents, including the top three House Republicans and key members on committees that work on drug pricing issues. (McIntire, 8/26)

Maryland officials named members of a new board that’s supposed to investigate high drug prices, but Gov. Larry Hogan has not released the money that’s needed to get the board up and running. State lawmakers created the Maryland Prescription Drug Affordability Board this year, charging it with reviewing the prices for prescription drugs paid by health insurance plans for state and county government employees. It also plans to study whether maximum prices should be set for prescription drugs. (Wood, 8/22)

Specifically, spending on multiple sclerosis drugs per 1,000 beneficiaries by the health program jumped from nearly $7,800 in 2006 to more than $79,400 in 2016. Meanwhile, out-of-pocket patient spending per 1,000 beneficiaries rose from $372 to nearly $2,700 for patients with multiple sclerosis during that same period of time. And the annual cost of treatment for those patients climbed from about $18,600 to almost $75,900, or 12.8% a year, according to the analysis in JAMA Neurology. (Silverman, 8/26)

AstraZeneca said on Wednesday that the U.S. Food and Drug Administration granted orphan drug status for its drug to treat eosinophilic esophagitis and unveiled positive results from a late-stage trial on a triple-drug therapy targeting a severe lung disease. Fasenra would treat allergic oesophagitis, an allergic inflammatory disease of the esophagus. The health regulator grants orphan status to drugs that are intended to treat and prevent rare diseases or disorders that affect fewer than 200,000 people in the U.S. (8/28)

U.S. stocks have been wobbly lately, but the health-care deal market is still vibrant. Amgen said Monday it plans to purchase the anti-inflammatory drug Otezla from Celgene for $13.4 billion in cash. Shares of Bristol-Myers Squibb, which is planning to acquire Celgene for $74 billion in cash and stock, rallied in response. There was a good reason for that. (Grant, 8/26)

China said it would reduce the penalties for the sale and import of unapproved drugs, effectively giving poor and critically ill patients the green light to access cheaper generic pharmaceuticals from other countries. The move, announced on Monday, could help fill a gaping hole in the country’s overburdened health care system. For years, Chinese patients and their relatives risked the threat of heavy criminal penalties in their hunt for affordable drugs in a country increasingly suffering from chronic diseases like cancer. (Wee, 8/27)

Kaiser Health News: Pharma Cash Rolls Into Congress To Defend An Embattled Industry

In the heat of the most ferocious battle over drug prices in years, pharmaceutical companies are showering U.S. senators with campaign cash as sweeping legislation heads toward the floor. In the first six months of this year alone, political action committees run by employees of drug companies and their trade groups have given the 30 senators expected to run for reelection nearly $845,000, the latest update to Kaiser Health News’ “Pharma Cash to Congress” database shows. That hefty sum stands out with Election Day more than 14 months away. (Huetteman, Hancock and Lucas, 8/27)

Biologic drugs are one of this century’s great medical triumphs. They’ve reshaped the treatment of diverse and debilitating diseases from cancer to multiple sclerosis to heart attacks.They’re also one of the fastest-growing segments of drug spending. Medicare’s total tab for biologics has increased 9.5% a year since 2009, to about $20 billion in 2016. Across the entire market, spending on biologics totaled $125.5 billion in 2018, up 50% since 2014. (Scott Gottlieb, 8/25)

A major reason drugs are even mildly affordable in the U.S. is that cheap generic copies can eventually flood the market. But first the Food and Drug Administration grants new drugs a few years of monopoly “exclusivity.” For decades this high-price-before-low-price model has fueled astounding pharmaceutical innovation while also providing long-term access to important treatments.But today this model is in trouble. An entire class of high-priced medicines, called biologics, may never face strong competition from copycats. These drugs—which are used for cancer, rheumatoid arthritis, and other serious illnesses—accounted for 37% of all spending on drugs in 2017 even though they were only 2% of all medicines dispensed. While chemical drugs can be easily mimicked by generic drugs, biologic drugs are made in genetically engineered cells, a process that cannot be perfectly copied. (Peter B. Bach and Mark Trusheim, 8/21)

Chronic disease is the leading cause of disability and death in the United States. Six in 10 US adults live with at least one chronic condition. And 4 in 10 adults battle two or more. It's also a major driver of health care spending, accounting for 90 cents of every dollar spent. Unfortunately, new efforts on Capitol Hill could make matters worse. Some lawmakers are pushing to weaken vital intellectual property protections for new medicines that improve health, reduce side effects and help patients take their medicines as prescribed. (Randall Rutta, 8/22)

Republicans, including many so-called free market conservatives, sometimes fall back into a nasty habit of doing the Democrats’ leg work for them. Such is the case with recent Senate legislation that would impose an inflationary cap or penalty on prescription drugs as part of Medicare Part D. By all means, the rising cost of prescription drugs in the United States is a major problem afflicting millions of Americans who deserve better. (Adam Brandon, 8/27)

Prescription drugs don’t work if they're not affordable. That’s why the Senate needs to pass the Prescription Drug Pricing Reduction Act when they return from August recess. It’s time. We urge senators like Lamar Alexander (R-TN) and Marsha Blackburn (R-TN) to back this vital legislation, which passed the Senate Finance Committee in July with strong bipartisan support. (Rebecca B. Kelly, 8/27)

New additions to Congress like Republican Senators Josh Hawley and Rick Scott are advocating for socialist style price controls on medicine. It is shocking since they were fierce critics of government involvement in health care just a few short months ago. When Hawley ran for office, he campaigned on a platform of lower drug prices and health care freedom. He penned an editorial column last year calling on Congress to “eliminate the one size fits all dictates from Washington.” Now Hawley is endorsing the government takeover of medicine. Why the 180 degree turn here? (Adam Brandon, 8/22)

More effective, less debilitating and easier to administer therapies are now available for many cancers.Many of these new therapies are easier to administer because they come in pill form rather than being administered intravenously or injected in liquid form, an enormously important innovation for both patients and healthcare providers. Many insurance plans, however, refuse to cover oral cancer treatments at the same rate as intravenous or injected cancer treatments. (Samantha Guild, 8/23)

As a 51-year-old man with Parkinson’s disease, I think a lot about medications. A couple of months ago, I began taking a new one called a dopamine agonist, which sells under the brand name Neupro. We are taking it slowly, but I think I’m in love. Agonists work by mimicking dopamine, a neurotransmitter that affects movement and mood. (Allan Hugh Cole, 8/26)

In 1977, after an electrical fire destroyed the Beverly Hills Supper Club in Southgate, Kentucky, killing 165 people, a plaintiffs’ lawyer named Stanley Chesley came up with a novel way to recover money for the families of the victims. The fire made it impossible to know which company had made the aluminum wiring for the building, so Chesley sued every wiring company in the country, on the grounds that they all bore some blame because aluminum wiring was inherently dangerous. It worked: the plaintiffs wound up with about $50 million, most of which came, by definition, from companies that had nothing to do with the fire. (Joe Nocera, 8/27)

As drugmakers are being held responsible for fueling the U.S. opioid epidemic, it might look at though they have nothing to fear in Europe, where, it’s often assumed, opioid misuse isn’t so rampant. The European Union, though, should take a closer look at the data and make its own move against the irresponsible marketing of opioid painkillers. (Leonid Bershidsky, 8/28)

Last fall, speaking to a far-right Austrian magazine, the Iowa Republican congressman Steve King succinctly laid out his theory of Western decline. The problem, he suggested, was a demographic born at the nexus of reproduction and immigration. “If we continue to abort our babies and import a replacement for them in the form of young violent men, we are supplanting our culture, our civilization,” King said. (Marissa Brostoff, 8/27)

If you read high-profile medical journals, the high-end popular press, and magazines like Science or Nature, it is clear that the medicalization of artificial intelligence, machine learning, and big data is in full swing. Speculation abounds about what these can do for medicine. It’s time to put them to the test. From what I can tell, artificial intelligence, machine learning, and big data are mostly jargon for one of two things. (Michael J. Joyner, 8/28)

At a time when many insurers and health information technology companies are busily assembling databases of hundreds of millions of medical records, Americans find it difficult to get access to their own. If you try to get yours, be prepared for confusing policies, ill-informed staff, wasted time and high costs. Even then, you may not get the records you seek. And all of this is at odds with your federal rights. (Harlan Krumholz, 5/28)

Four years ago, with my white coat on, I stepped out of my pediatric clinic and held a news conference. Lifting a baby bottle filled with water from Flint, Mich., I shared my research: Lead was increasingly in the blood of Flint’s children. The powers-that-be tried to silence me initially, but persistence, activism, teamwork and science prevailed. Since then, Flint has been on a slow but sure path toward recovery. Flint is an extreme case but not unique. A troubling number of cities across the country — Pittsburgh, Chicago, Portland, Ore. — are struggling with elevated lead in their drinking water. (Mona Hanna-Attisha, 8/27)

The Trump administration last week announced a new regulation that would allow the government to indefinitely detain migrant families who cross the border. If it goes into effect, it would terminate an agreement known as the Flores settlement that has been in place since 1997 to ensure that children are kept in the least restrictive setting possible, receive certain standards of care, have access to lawyers, and are generally released within 20 days. The effect would be to extend the well-documented suffering of migrant children in detention centers. (Leah Hibel and Caitlin Patler, 8/27)

Philip Morris and Altria, two tobacco giants valued at about $100 billion each, are in talks to merge in what would be the industry’s biggest deal ever. Their goal: join forces to quickly concentrate nicotine addicts around new non-cigarette products before competition heats up or more people quit smoking altogether. On Tuesday, amid recent M&A speculation, Philip Morris International Inc. confirmed that it is, in fact, in discussions to recombine with its sister company, Altria Inc., from which it was spun off in 2008. (Tara Lachapelle, 8/27)

The recent Democratic debates confirmed that universal access to health care insurance is a core issue for the 2020 election, although it’s difficult keeping up with all the proposals. "Medicare for All" gets the most press, but its cost may be prohibitive, and has no chance of surviving the health care industry lobbying in Congress. Former Vice President Joe Biden and Mayor Pete Buttigieg want to bolster the Affordable Care Act by creating a new “public option” within it. Sen. Kamala Harris has introduced a proposal to include Medicare Advantage alongside the publicly run Medicare program. (Ken Janda and Vivian Ho, 8/27)

I believe that health care providers aren’t paid anything close to what they are worth to society. I don’t mean this in the sappy emotional sense in which the “value of any human’s life is infinite,” or any other subjective standard. I am talking about real world, measurable economic impacts. Using the entrepreneurs’ 10% reward as a guide, health care providers create astronomical value for which they are paid a small token. (Jay Crawford, 8/28)

As Connecticut’s population gets older – more than 575,000 residents, or 16 percent of the population, were over age 65 in 2016, with more aging into that group every year since – a ticking time bomb awaits them. Long-term care insurance was a good investment in years past, but the cost of that insurance is now skyrocketing. That leaves seniors in a dangerous situation. (Saud Anwar, 8/28)

It was probably inevitable that we would have a “retirement crisis” as hordes of baby boomers (people born between 1946 and 1964) sprint and stumble into their “golden years.” But it’s a fake crisis, even though it’s already becoming a staple of journalism and politics. It presumes that most Americans can’t afford to retire comfortably. Not so. It’s important to get this right. If we don’t, we risk harboring a fundamentally mistaken and misleading view of the elderly’s well-being. This has political and social consequences in the real world, where more government spending on the old often comes at the expense of the young. (Robert J. Samuelson, 8/27)

The FDA has drafted a guidance — currently available for public comment — which aims to re-evaluate the endpoints that the agency should consider when determining whether a given heart failure drug should be approved. If finalized, the guidance holds the potential to facilitate the development of truly innovative cardiovascular medicines. It comes at a unique inflection point, as our understanding of the genetics and the biology of the heart has advanced enough to enable the discovery of more targeted treatments, and our tools for monitoring outcomes are validated to enable the evaluation of heart failure medicines on endpoints other than survival or hospitalization. (Dr. Jay Edelberg, 8/27)

Back-to-school season is upon us and the future of child surveillance may soon be underway in Florida. Last month I referenced a proposed school surveillance program in the state, where lawmakers were planning to introduce a statewide database “that would combine individuals’ educational, criminal-justice and social-service records with their social media data, then share it all with law enforcement.” (Charlie Warzel, 8/27)

The term “type 1 diabetes” generally conjures up images of insulin. That makes sense, because insulin is the main treatment for this common disease. But it isn’t a cure. A type of cell transplant that comes close to a cure for some people with type 1 diabetes, a technique pioneered and tested in the United States, is now available in many countries but is still deemed an experimental procedure in the U.S., making it almost impossible to get. That doesn’t make sense to us. (Camillo Ricordi and Anthony Japour, 8/27)

When Congress reconvenes in September, President Trump has a golden opportunity to “own the libs,” as the conservative kids online say. The Democrats, helped by the media, have spent August taunting the president and Senate Majority Leader Mitch McConnell (R-Ky.), claiming they don’t have the guts to buck the National Rifle Assn. and put a gun reform package on the floor. Republicans have a golden opportunity to refute the claim and show suburban America — which, according to the latest polls and focus groups have gone south on the GOP — that they are listening when it comes to this tragic American problem. (Scott Jennings, 8/28)

One of the most pressing issues facing Connecticut citizens and the small businesses where they work is surprise medical billing also known as “balance billing.” Many patients who do the right thing by going to the emergency room or in-network hospitals often are surprised when doctors or hospitals send them large, unexpected bills. (Tim Phelan, 8/27)