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The Trump administration is laying the groundwork to allow some cheaper prescription drugs to be imported from Canada. The administration is issuing a proposed rule, along with a proposed guidance for the drug industry, that will allow states, pharmacies, wholesalers and manufacturers to import prescription drugs if they meet conditions designed to ensure that the importation poses no additional risk to safety and will save consumers money. (Weixel, 12/18)

The drafts create two pathways for importation. One would let states, drug wholesalers, or pharmacies apply to import certain drugs from Canada, pending a sign-off from the Department of Health and Human Services. A second would let drug makers import their own products sold in other countries. Both must still undergo a formal regulatory review, a process that can take months or even longer. But the administration insists it is moving as fast as the law will allow. (Florko, 12/18)

The decision is an unusual one for a Republican administration. Progressives have long supported such a policy, but the pharmaceutical industry vehemently opposed drug imports by claiming they were unsafe. Food and Drug Administration commissioners had also opposed importing drugs intended for overseas use, citing safety issues. In a telephone call with reporters Tuesday, Alex M. Azar II, the secretary of health and human services, described the announcement as momentous. “For the first time in history, H.H.S. and the F.D.A. are open to importation as a means to lower drug prices,” he said. (Thomas, 12/18)

Opening up U.S. markets to imported drugs is a central plank of the administration’s effort to tackle drug prices, and federal officials say it would let Americans attain the same cost savings as consumers in other countries. It is also likely to be a major talking point for President Trump as the 2020 election kicks off. When the administration outlined its plan in July, industry groups argued it could undermine patient safety by letting in substandard or counterfeit drugs. (Armour and Burton, 12/18)

HHS is legally allowed to approve importation programs as long as the agency can certify that the program would present no additional safety risk and would save consumers money. It remains unclear from preliminary analyses whether prescription drug importation programs will save substantial amounts of money, and Azar hinted on a call with reporters Tuesday evening that HHS has several options in how it defines the cost savings requirement. "We will seek comment on how that should be interpreted," Azar said. (Cohrs, 12/18)

It's unclear that either idea will have an impact on patients' costs ahead of the 2020 election, but the Trump administration has advanced beyond its predecessors in trying to set up a supervised system for importing drugs. Medicines cost less in other advanced countries because the governments take an active role in setting prices. “A new pathway for importation can move us to a more open and competitive market,” Health and Human Services Secretary Alex Azar said. (12/18)

It also remains unclear whether the plan will survive expected legal challenges from the pharmaceutical industry, and whether it will be possible to import significant quantities of drugs from Canada. The Canadian government has fiercely pushed back against importation proposals, warning that the drug supply for Canada’s 37 million residents cannot possibly fulfill the demands of the much larger U.S. market and that allowing importation would cause severe drug shortages for Canadians. (Abutaleb and McGinley, 12/18)

The plans have been in the works for months, and Trump promised a plan “soon” in November. Azar said the proposals announced Wednesday are “largely very consistent” with an action plan his department put out in July but that this is the “fleshing out of all of the legal and implementation parameters of it.” HHS will not allow biologic drugs, including insulin, to enter the U.S. from a foreign country. He said, though, that based on the success of the programs early on, Congress could consider later whether to permit some biologics, some of the most expensive drugs, to come to the U.S. from Canada. (Morrison, 12/18)

Both the House of Representatives and the Senate are putting forth drug pricing bills that contain some of the proposals Trump has advocated for, such as indexing public drug reimbursements to foreign drug costs. However, Trump has said he will veto the Democrat-led House bill if it comes to his desk, on the grounds that it would slow down innovation. (Erman and O'Donnell, 12/18)

Canada and its provinces get drugs at lower cost as a result of price regulation and negotiations with drug companies. There's no way to estimate how much Americans might save from the Trump plan because it will depend in part on importation applications HHS will receive, Azar said. (Owermohle and Karlin-Smith, 12/18)

Nearly a decade after its passage along party lines under President Obama, the Affordable Care Act is deeply ingrained in the U.S. health-care system, influencing everything from seniors’ drug costs to calorie disclosures on restaurant menus. It added about 20 million people to the ranks of the insured. But it also remains a political flashpoint. After a decade of funding fights and a series of court challenges, the ACA faces a fresh legal case, brought by a group of Republican-led states and backed by the Trump administration, that aims to strike it down. (Wilde Mathews, 12/17)

Enrollment in Maryland’s health insurance exchange grew to a four-year high, even as the national health care law known as Obamacare continues to come under legal and regulatory assault. About 158,000 people signed up for private health insurance in 2020 through Maryland Health Connection, the state’s online marketplace created for people who do not get their coverage through an employer or government program. (Cohn, 12/17)

Democratic voters eager to see “Medicare for all” or some other major health overhaul pass the next time they control the White House may want to take a close look at what happened this week in Congress. Leaders from both parties had unveiled legislation to stop surprise medical bills, the often exorbitant bills faced by patients when they go to a hospital that takes their insurance but are treated by a doctor who does not. The White House and major consumer groups had also endorsed the plan, which was to be included in the year-end spending bill. But to the negotiators’ consternation, the spending package that emerged on Monday — and was passed on Tuesday by the House — had nothing about surprise bills. (Sanger-Katz, 12/17)

The House on Tuesday approved a $1.4 trillion spending package that would stave off a looming shutdown and fund the federal government through September, acting in a burst of bipartisanship just a day before Democrats plan to impeach President Trump. The legislation would also remove three controversial taxes from the Affordable Care Act, the 2010 law that was a top legislative achievement of President Barack Obama. (Werner and DeBonis, 12/17)

The sweeping legislation, introduced as two packages for political and tactical purposes, is part of a major final burst of legislation that’s passing Congress this week despite bitter partisan divisions and Wednesday’s likely impeachment of Trump. Thursday promises a vote on a major rewrite of the North American Free Trade Agreement, while the Senate is about to send the president the annual defense policy bill for the 59th year in a row. (12/17)

The repeal of three ObamaCare taxes in the bipartisan government funding deal poised to pass Congress this week will deprive the government of $373.3 billion over 10 years, according to a nonpartisan analysis. The analysis released Tuesday by Congress’s Joint Committee on Taxation, the companion of the Congressional Budget Office, analyzed the cost of repealing three taxes that were passed in ObamaCare as a way to help fund the law’s coverage expansion. (Sullivan, 12/17)

Just in time for the holidays, Congress appears ready to give health insurers several gifts in its year-end spending deal, unveiled Monday and passed by the U.S. House of Representatives Tuesday. One of those includes a permanent repeal of a loathed industry tax that insurers have been lobbying to kill for years. Commercial health insurers serving employers and individuals generally passed that tax, known as the HIT, along to their members in the form of higher premiums. Medicaid managed-care insurers are reimbursed for the tax by the states they contract with. (Livingston, 12/17)

Congress is moving to pass the biggest new sales restrictions on tobacco products in more than a decade, with support from two unlikely backers: Marlboro-cigarette maker Altria and vaping giant Juul Labs. The legislation would raise the minimum age to purchase all tobacco products, including electronic cigarettes, from 18 to 21 nationwide, a step long-sought by health advocates. (Perrone and Lardner, 12/17)

Doctors and advocates are hopeful that new funding for federal agencies to study gun violence will prove to be the first step in preventing mass shootings, suicides and other firearm deaths. For the first time in 23 years, a government spending bill will set aside funds — in this case, $25 million — for the Centers for Disease Control and Prevention (CDC) and National Institutes of Health (NIH) to collect data on what the American Medical Association has called a public health crisis. (Hellmann, 12/18)

Among the many provisions included is one that California and other Western states still recovering from destructive wildfires have sought for years. It ends a long-standing practice known as “fire-borrowing,” which required the U.S. Forest Service to raid its other funds whenever it ran out of money to pay for fighting wildfires. Faced with increasingly long and costly fire seasons, the Forest Service often wound up strapped for cash as a result of a firefighting budget that amounted to a fraction of what it actually cost to fight fires. (Phillips, 12/17)

President Donald Trump intervened to cut the federal government's Medicaid funding for Puerto Rico as part of a larger government spending deal, according to four sources with knowledge of the discussions. The budget deal unveiled by lawmakers this week allocates up to $5.7 billion in Medicaid funds for the island over two years — instead of $12 billion over four years that Republican and Democratic leaders on two key congressional committees had endorsed after months of negotiating a long-term financial path for Puerto Rico. (Pradhan, 12/17)

Lawmakers quietly tucked a boost for the pharmaceutical industry in the massive, end-of-year spending package they unveiled late Monday — a surprising turn for a Congress that has, at least rhetorically, pushed to rein in pharma’s high prices. The provision, just three lines and 17 words in a 1173-page bill, would effectively expand the definition of biologic drugs, a category that includes presumably more complicated medicines made from living cells. (Florko, 12/17)

Special Olympics spared from cuts: The Trump administration tried to kill the popular program in its budget. Education Secretary Betsy DeVos defended the cut before Congress. But after the administration faced backlash on social media and from lawmakers, President Donald Trump said he had “overridden” his people to restore funding for the games. Now, Special Olympics funding will rise to $20.1 million, a more than 14 percent boost. (12/17)

The U.S. Congress on Tuesday approved the largest overhaul to the American military’s housing program in more than two decades, vowing to end slum-like living conditions and hold private landlords and defense officials accountable for them. The reforms, included in the yearly National Defense Authorization Act, aim to protect some 200,000 military families living on U.S. bases from health hazards including mold, lead, asbestos and pest infestations. (12/17)

The U.S. House on Tuesday approved a $1.4 trillion spending package that would significantly boost defense spending in Connecticut and increase funding for a slew of social programs as well, including Head Start and child care programs. The spending bill would provide a total of $738 billion in fiscal 2020 funding for the military and $632 billion for non-defense departments such as Education, Housing and Urban Development, and Health and Human Services, increasing spending for both “guns and butter” and adding to the federal deficit. (Radelat, 12/17)

Four senior Democratic lawmakers said HHS must turn over more documents about Medicare and Medicaid chief Seema Verma's extensive use of public relations consultants, claiming the department has largely been uncooperative with their investigation. The lawmakers said information so far provided by the health department has prompted new questions about Verma’s role in shaping communications contracts, including some that helped burnish her personal brand. (Diamond, 12/17)

When Alex Azar took over as Health and Human Services secretary, he was advised not to meet one-on-one with Seema Verma, one of his most important deputies. HHS staff said Verma was difficult to work with and quick to level accusations of sex discrimination — exactly where Azar finds himself now. (Owens, 12/18)

The U.S. government is overhauling parts of the nation's transplant system to make sure organs from the dead no longer go to waste — and to make it easier for the living to donate. The rules proposed Tuesday aim to ease an organ shortage so severe that more than 113,000 Americans linger on the transplant waiting list — and about 20 die each day. (Neergaard, 12/17)

The effort could yield 6,000 more organs annually, health officials said, a step toward reducing the huge waiting list for kidneys, livers, hearts and other organs. More than 114,000 people are on that list; many wait years for an organ. Thirty-three of them die each day. The proposed changes, which would take effect in 2022, could increase organ donation and transplantation from about 36,000 annually to 42,000 by 2024, officials said. (Kindy and Bernstein, 12/17)

It is estimated that 20 U.S. patients die every day from lack of donor organs, the officials said, which can come from accident victims who donate an organ or, in some cases, from relatives of a patient. Transplant-organization officials estimate that 115,000 people are on transplant waiting lists, about 95% of whom need a kidney or liver. (Burton, 12/17)

“Every day, twenty Americans die waiting for an organ and thousands of Americans are languishing on waitlists,” said Centers for Medicare and Medicaid Services Administrator Seema Verma. “That is unacceptable and represents a missed opportunity to save lives and improve patients’ quality of life.” (Sullivan, 12/17)

CVS Health Corp and its Omnicare unit were sued on Tuesday by the U.S. government, which accused them of fraudulently billing Medicare and other programs for drugs for older and disabled people without valid prescriptions. The Department of Justice joined whistleblower litigation accusing Omnicare of violating the federal False Claims Act for illegally dispensing drugs to tens of thousands of patients in assisted living facilities, group homes for people with special needs, and other long-term care facilities. (Stempel, 12/17)

The Department of Justice said in federal court papers filed Tuesday that Omnicare’s pharmacies sent drugs to people living in residential facilities based on “stale, invalid prescriptions.” It accused the company of fraudulently billing government-funded programs like Medicaid and Medicare for drugs dispensed without a valid prescription from 2010 to 2018. The DOJ said the practice put the safety of thousands of patients at risk because people kept taking the same drugs for months — or in some cases, years — without talking to a doctor. (Murphy, 12/17)

In at least 1,766 residential facilities, Omnicare allowed prescriptions to “roll over.” And in at least an additional 1,476 residential facilities, Omnicare rolled over prescriptions through its so-called cycle fill system, which is an automated system used to refill large volumes of medications in bulk on a periodic basis. The lawsuit described how Omnicare automatically filled prescriptions up to 99 times without a prompt requiring pharmacy staff to contact treating physicians. (Silverman, 12/17)

Omnicare frequently assigned new numbers to prescriptions once they expired or ran out of refills – enabling the company to bill Medicare Medicaid, and Tricare, which serves military personnel. Omnicare billed the federal programs for hundreds of thousands of drugs from 2010 to 2018, according to the lawsuit. (Coolidge, 12/17)

"A pharmacy's fundamental obligation is to ensure that drugs are dispensed only under the supervision of treating doctors who monitor patients' drug therapies. Omnicare blatantly ignored this obligation in favor of pushing drugs out the door as quickly as possible to make more money," Manhattan U.S. Attorney Geoffrey Berman said in a statement. (Livingston, 12/17)

Accidental overdoses cause 90% of all U.S. opioid-related deaths while suicides account for far fewer of these fatalities than previously thought, a new analysis published Tuesday suggests. Rising use of heroin and illicit, highly potent synthetic opioids including fentanyl has likely contributed to the unintentional death rate, which surged nine-fold between 2000 and 2017, the researchers said. Opioid suicides also went up during that time but their share of all opioid-related deaths shrank. (12/17)

OxyContin maker Purdue Pharma shouldn't give its CEO a bonus next year as the company goes through bankruptcy and tries to settle 2,700 lawsuits over the opioid crisis, 11 U.S. senators said in a letter Tuesday. A bankruptcy judge approved the company's plan to award bonuses to other employees earlier this month, but delayed a decision on whether CEO Craig Landau should receive an expected $1.3 million next year. (12/17)

Michigan on Tuesday sued four companies over the deadly painkiller epidemic, becoming what state Attorney General Dana Nessel said is the first state to sue major opioid distributors under a liability law that is typically used to go after drug dealers. The lawsuit was filed in Wayne County and names as defendants AmerisourceBergen, Cardinal Health, McKesson and Walgreens, which have also been sued in other states. (12/17)

[David] Fowler, the long-serving and well-regarded chief medical examiner, told The Baltimore Sun last month he planned to leave. He’d been in the position for 17 years and said the opioid crisis factored in his decision to leave. The record overdose deaths, more than 200 a month in Maryland, as well as record homicides have taken a toll on Fowler and the staff, he said. The office performed so many autopsies that it risked losing its national accreditation in 2017, a vital rating for prosecutors and source of faith in the findings for the public. (Cohn, 12/17)

A former physician assistant for a Utah minor league hockey team who continued to prescribe hundreds of Percocet pills to an ex-player was sentenced Tuesday in Portland to three years of supervised release after serving 47 days in jail. Oscar Johnson, 64, had worked as a health care provider for the Utah Grizzlies and began prescribing pills to help player Jordan Hart with a shoulder injury between 2007 and 2009. (Bernstein, 12/17)

Teenagers are drinking less alcohol, smoking fewer cigarettes and trying fewer hard drugs, new federal survey data shows. But these public health gains have been offset by a sharp increase in vaping of marijuana and nicotine. These diverging trend lines, published Wednesday, are among the findings in the Monitoring the Future survey — a closely watched annual study by the National Institute on Drug Abuse, or NIDA, of eighth, 10th and 12th graders. The survey shows that youth drug use and experimentation continue to undergo significant evolution. (Richtel, 12/18)

About 1 out of 5 high school students in the U.S. say they vaped marijuana in the past year, and its popularity has been booming faster than nicotine vaping, according to a report released Wednesday. “The speed at which kids are taking up this behavior is very worrisome,” said Dr. Nora Volkow of the National Institute on Drug Abuse, the federal agency that pays for the large annual teen survey. (12/18)

“Any marijuana use among kids is a bad idea,” said Neal Benowitz, a clinical pharmacologist and emeritus professor of medicine at the University of California at San Francisco who studies vaping. “From my perspective, marijuana use is much more hazardous” than tobacco or nicotine use. He noted research that has shown marijuana’s impact on memory and learning, traffic accidents and, among some heavy users, the onset of psychosis, as well as the risk of contaminants in black-market products. (Bernstein, 12/18)

Concerns about the rapid rise of youth vaping, particularly nicotine vaping, has spurred bans and regulation across the country, including a proposal to raise the minimum age to purchase tobacco products to 21 years old in a year-end congressional spending bill. But an increasing number of adolescents are also vaping marijuana oils, specifically THC, the psychoactive ingredient in cannabis. The overall percentage of middle-school and high-school students who said that they had tried vaping THC increased 32% from 2017 to 2018, an increase of roughly one million students, said Daisy Dai, an associate professor at the University of Nebraska Medical Center and author of the second report, which used data from the National Youth Tobacco Survey. (Abbott, 12/18)

Stanton Glantz, a tobacco control expert at the University of California San Francisco who was not involved in the study, said kids who try vaping nicotine are more prone to vaping THC or smoking cigarettes. "It's like the Bermuda Triangle of substance abuse. There's good research out there showing any kid who does any of those is more likely to do the other ones," Glantz said in a phone interview. (12/18)

In a yearly poll of U.S. high school students, 14% of 12th-graders acknowledged they had used an e-cigarette to “vape” marijuana at least once in the past month. That’s nearly double the figure from the year before, when 7.5% of high school seniors said they had vaped marijuana in the past 30 days. In the 44 years that 12th-graders have shared details of their tobacco, drug and alcohol use with public health researchers, only one substance has taken hold more quickly: The share of high school seniors who had used an e-cigarette to inhale nicotine in the previous month jumped from 11% in 2017 to nearly 21% in 2018. (Healy, 12/17)

Volkow said there are several policy changes that could help to curb youth vaping, including restricting e-cigarette sales to anyone under age 21 and hitting retailers who sell to underage customers with hefty fines. She also said that taxing vaping products in the same way traditional cigarettes are taxed could make a significant impact. “If we can make vaping devices more expensive, you will see a reduction of vaping among teenagers,” Volkow said. (Thielking, 12/18)

Federal officials are still looking into the causes of vaping-related deaths around the country, but in New Hampshire, schools are continuing to see a surge in teenage vaping. The Centers for Disease Control and Prevention reports a quarter of high schoolers here are vaping at least occasionally. (Gibson, 12/17)

U.S. health officials on Tuesday endorsed a type of cigarette that could help ease the addictive grip of smoking by delivering very low levels of nicotine. The Food and Drug Administration will allow 22nd Century Group to begin selling the first low-nicotine cigarettes reviewed by federal health regulators. The products contain roughly 95% less nicotine than standard cigarettes, according to the FDA. (12/17)

The nicotine formula used by controversial e-cigarette maker Juul Labs Inc is nearly identical to the flavor and addictive profile of Altria Group Inc's highly successful Marlboro cigarette brand, new research suggests. A study released on Tuesday from researchers at Portland State University in Oregon helps to explain why a growing number of young people who never smoked cigarettes have become regular users of Juul vaping devices. (12/17)

The products differ from conventional cigarettes in nicotine content only, FDA said. Cigarettes can still cause cancer, lung disease and a number of other health problems. The agency emphasized that there are no safe tobacco products, and those who do not use tobacco products should not start. (Weixel, 12/17)

Kaiser Health News: Don’t Toss That E-Cig: Vaping Waste Is A Whole New Headache For Schools And Cities

In her office at Boulder High School, the assistant principal has a large cardboard box where she can toss the spoils of her ongoing battle with the newest student addiction. “This is what I call the box of death,” said Kristen Lewis. “This is everything that we’ve confiscated.” The box is filled with vape pens like Juuls, the leading brand of e-cigarettes, dozens of disposable pods for nicotine liquid, and even a lonely box of Marlboros. (Daley, 12/18)

San Francisco Unified School District and four other Bay Area school districts have joined a growing number of school districts around the country in suing Juul, seeking unspecified damages allegedly incurred by schools seeking to stop students from vaping. San Francisco Unified filed its complaint Monday in U.S. District Court for the Northern District of California. One of the attorneys leading the case is former San Francisco City Attorney Louise Renne, a vocal Juul critic who supported the Board of Supervisors’ recent legislation banning the sale of vaping products in the city. (Ho, 12/17)

The teenager had pink cheeks from the cold and a matter-of-fact tone as she explained why she had started using methamphetamine after becoming homeless last year. “Having nowhere to sleep, nothing to eat — that’s where meth comes into play,” said the girl, 17, who asked to be identified by her nickname, Rose. “Those things aren’t a problem if you’re using.” She stopped two months ago, she said, after smoking so much meth over a 24-hour period that she hallucinated and nearly jumped off a bridge. (Goodnough, 12/17)

Black and Hispanic Americans are especially vulnerable to Alzheimer's disease. Yet they're often underrepresented in scientific studies of the disease. So on a cool Sunday morning in Cleveland, two research associates from Case Western Reserve University's School of Medicine have set up an information table at a fundraising walk organized by the local chapter of the Alzheimer's Association. (Hamilton, 12/17)

Top athletes’ brains are not as noisy as yours and mine, according to a fascinating new study of elite competitors and how they process sound. The study finds that the brains of fit, young athletes dial down extraneous noise and attend to important sounds better than those of other young people, suggesting that playing sports may change brains in ways that alter how well people sense and respond to the world around them. (Reynolds, 12/18)

When hunter-gatherers living in what is now southern Denmark broke down pieces of birch bark into sticky, black tar about 5,700 years ago, they almost certainly didn’t realize that they were leaving future scientists their entire DNA. Ancient people used the gooey birch pitch to fix arrowheads onto arrows and to repair a variety of stone tools. When it started to solidify, they rolled the pitch in their mouths and chewed on it, like some sort of primitive bubble gum. (Sheikh, 12/17)

Every decade has its culinary trends, from gelatin molds in the ’50s to pasta salads in the ’80s. In the 2010s, the defining development was the social-media-fueled fetishization of food. It was the sheer number of Instagram-worthy food crazes and sensations. Think avocado toast, the croissant-donut hybrid known as the Cronut, and anything and everything related to kale or bacon (or possibly both—say, a paleo-friendly kale-bacon salad). (Passy, 12/17)

Wey is the founder of BabyZoos, a start-up food company focusing its work in Kalamazoo, Mich. He launched the company this year after learning a startling statistic: Black infants born in Kalamazoo County are three times as likely to die before their first birthday as white children. (Godoy, 12/17)

Increasingly, surgeons are talking about a once-taboo topic: the pain they feel after hours spent contorted into positions the human body was not meant to sustain. Surveys show that a high percentage of surgeons regularly feel musculoskeletal pain related to work and that they have twice the risk of such injuries as the general population. The pain is severe enough that some fear they will have to reduce their workloads or retire early. (Burling, 12/18)

Puppies: cute balls of fur. But according to the Centers for Disease Control and Prevention, they're also linked to a multi-state outbreak of an infection that's resistant to multiple drugs. An outbreak strain of Campylobacter jejuni has been reported in 30 states and so far 30 people have been infected, the CDC said. Four have been hospitalized but no deaths have been reported, the center said. (Maxouris, 12/18)

A cacophony of slapping noises filled the food lab at the High School for Environmental Studies in Manhattan one afternoon in late October. “Think of all the hands that have done this for thousands of years,” said Andrew Margon, an English teacher, as his students energetically pummeled lumps of corn masa into tortillas. The students were taking a cooking class as part of Food Ed., an interdisciplinary curriculum developed by the Stone Barns Center for Food and Agriculture, a nonprofit farm and educational center based near Tarrytown, N.Y., which also has a partner high-end restaurant. (Schiffman, 12/17)

While the relationship between gun violence and mental health get lots of attention, numerous studies have established a much stronger link between excessive alcohol consumption and gun violence. While politicians and media give a lot of attention to mental health in relation to gun violence, such a link has not been established in research. In fact, roughly 3 to 5% of violent crime is thought to be caused by people with a mental illness. (Dunn, 12/17)

A 7-year-old child who is unable to contain her own waste due to a congenital illness and who had been refused entry to the United States three times was finally allowed into the country Tuesday, after U.S. border agents exempted her and her mother from the Trump administration's “Remain in Mexico” policy. The reversal came after U.S. Customs and Border Protection received inquiries from The Associated Press and other media about the case. (Merchant, 12/17)

More than 60% of methamphetamine seized by Customs and Border Protection across the country came through California ports, according to data from the federal agency. During fiscal 2019, which ended Sept. 30, CBP agents in California seized more than 80,000 pounds of methamphetamine at the border. That figure accounted for 63% of all methamphetamine seized by CBP agents nationwide this year and represented a 66% increase from the amount seized in California in the last fiscal year. (Solis, 12/17)

The Navajo Nation is seeking become one of the first Native American tribes to create it’s own managed healthcare entity, the tribe recently announced. The tribe said it plans to contract with Molina Healthcare to work toward a managed healthcare offering under New Mexico’s Centennial Care Medicaid program. Navajo Nation Counselor Daniel Tso, chair of the Health, Education and Human Services Committee, said the new entity “will be a one-of-a-kind medicaid program” designed to improve access and quality of healthcare on the largest Native American reservation. (12/18)

As the sun begins to set on a blustery fall day, the rugged buttes of Navajoland glow red in the soft light and swift gusts spiral dust through the air. About 40 women, most draped in traditional dress, stand in a circle as Melissa Brown, an indigenous midwife, asks the group to reflect on the day just ending — and the mission still ahead. “We have talked about being safe here. That is our goal,” she tells them. “We’re going to cry, and we’re going to laugh. And that’s OK.” (Warren, 12/17)

It would be easy to wonder what Zachi Attia is doing in the cardiac operating rooms of one of America’s most prestigious hospitals. He has no formal medical training or surgical expertise. He cannot treat arrhythmias, repair heart valves, or unclog arteries. The first time he watched a live procedure, he worried he might faint. But at Mayo Clinic, the 33-year-old machine learning engineer has become a central figure in one of the nation’s most ambitious efforts to revamp heart disease treatment using artificial intelligence. (Ross, 12/18)

DexCom Inc. said a switch in its cloud-computing service provider led to the recent failure of the data-sharing feature of the company’s blood-sugar monitoring devices for people with diabetes. Chief Executive Kevin Sayer said the San Diego, Calif., company switched cloud-service providers earlier this year for its data-sharing feature. “During that move, we introduced new components to our platform that weren’t configured for optimal performance,” Mr. Sayer said in a video that the company posted online Friday. “Those components failed, and when they did, there was disruption to core processes within the platform.” (Loftus, 12/17)

Hackers are getting more sophisticated and creative in their ransomware attacks, putting pressure on companies by threatening to publish stolen data and pointing out that such a move might bring regulatory fines. Ransomware attacks have become more common over the past year, with hackers attacking businesses, organizations and cities—and demanding ever higher sums from their victims. (Stupp, 12/18)

The CMS may have doled out $93.6 million in erroneous Medicare incentive payments to acute-care hospitals using electronic health record systems, according to new estimates from HHS' Office of Inspector General. The CMS plans to attempt to recover some, but not all, of the possible erroneous payments, according to the OIG's report. (Cohen, 12/17)

Brightly-colored artwork by patients adorns the walls of the waiting room at a small community healthcare center in New York City, the result of a project by two young doctors on a mission to humanize medicine. The two, who met in medical school, felt the decor of the waiting room at the Charles B. Rangel Community Health Center in Harlem did not reflect the identities and experiences of the patients it serves, who are mainly low-income African-American and Hispanic families dependent on Medicaid for healthcare costs. (12/17)

Some patients treated by a Tennessee dentist have been advised to get tested for HIV, hepatitis B and hepatitis C. The Tennessee Department of Health issued the recommendation after finding that Knoxville dentist Clarence “Buzz” Nabers did not ensure proper sterilization of dental equipment, news outlets reported. The recommendation was included in a letter Nabers sent to patients who visited his practice between Sept. 15, 2016, and Sept. 15, 2019. (12/17)

PG&E Corp. won court approval for a $13.5 billion settlement with victims of fires linked to its equipment but the utility said it expects talks to continue with California Gov. Gavin Newsom, who last week said its bankruptcy-exit plan falls short of needed reforms. The pact with fire victims is the third and largest in a series of settlements aimed at putting a lid on damage claims from a series of blazes in recent years that left people dead, destroyed homes and businesses and plunged PG&E into bankruptcy in January. (12/17)

The California Public Utilities Commission filed the proposed settlement after investigating the role of PG&E’s equipment in igniting wildfires in 2017 in Butte, Calaveras, Lake, Mendocino, Napa, Nevada, Sonoma and Yuba counties, and the deadly 2018 Camp fire. Under the terms of the proposed settlement, PG&E would also be required to spend $50 million in shareholder money on system enhancements that regulators hope will lessen the risk of the utility’s equipment causing further disastrous wildfires. (Cosgrove, 12/17)

With the state’s unemployment rate dipping below 3 percent, many employers are now seeking to accommodate working caregivers through more family-friendly leave benefits and increased flexibility about when and where employees work. Business leaders joined with their health care, education, and government counterparts last month to launch a Massachusetts Caregiver Coalition aimed at finding ways to support employees. (Weisman, 12/17)

If you were traveling to Denver or Los Angeles last week, or even changed planes at their airports, you might have been exposed to measles, officials say. Three infectious nonresidents with measles traveled through LAX on Dec. 11, the L.A. County Department of Public Health said in a statement. Visitors to the airport may have come in contact with an infectious person between 6:50 a.m. and noon that day at Terminals 4 and 5. (Clanton, 12/17)

A college freshman found dead in his Virginia jail cell this summer died of opioid toxicity compounded by asthma, according to the state medical examiner’s office. Aris Lobo-Perez, who had attended Radford University for three weeks, was found dead at New River Valley Regional Jail on Sept. 12 after his arrest by campus police the night before for public intoxication. (Miller, 12/17)

The New York City Board of Health on Tuesday moved to allow death certificates to be issued with the gender designation of “X” for decedents who didn’t identify as male or female. The change follows a city law that went into effect on Jan. 1, 2019, that permits people born in New York City to apply to the city’s Department of Health and Mental Hygiene for a corrected birth certificate with an X designation for a gender marker. (West, 12/17)

Eight Illinois hospitals have been named among the best 120 in the nation for safety and quality, but some of Chicago’s most prestigious institutions didn’t make the list. ...Four prominent Chicago hospitals aren’t on the list — Northwestern Memorial Hospital, Rush University Medical Center, University of Chicago Medical Center and Lurie Children’s Hospital. Two of those hospitals — Northwestern Memorial and University of Chicago Medical Center — made last year’s list. Altogether, seven Illinois hospitals made the cut in 2018. (Schencker, 12/17)

Slowing revenue growth and rising costs have prompted San Francisco Mayor London Breed to mandate belt-tightening in an effort to stave off a budget deficit as the city steps up spending on homelessness and mental health. Breed issued instructions Monday calling on city departments to find ways to shrink their budgets by 3.5% in each of the next two fiscal years to deal with a projected $420 million budget shortfall over those fiscal years. (Fracassa, 12/17)

Nurses at SSM St. Louis University Hospital have reached a contract agreement with management that raises their pay and ensures they have a say in staffing levels. SSM Health and the National Nurses Organizing Committee/National Nurses United, which represents the more than 600 nurses at the hospital, ratified the contract late last week. The agreement ends a six-month dispute over the contract. (Fentem, 12/17)

As San Francisco prepares to open 200 Navigation Center beds on the Embarcadero, Supervisor Matt Haney is trying — again — to force the city to open shelters in every part of the city, even those without large numbers of homeless people. Haney wants to encourage the Department of Homelessness and Supportive Housing to open a Navigation Center within 30 months in every supervisorial district that doesn’t have one. (Thadani, 12/17)

In an effort to re-evaluate Ohio’s mental health care system, Gov. Mike DeWine on Tuesday visited a state psychiatric hospital on the West Side. Twin Valley Behavioral Healthcare on West Broad Street hosted DeWine and Lori Criss, director of the Ohio Department of Mental Health and Addiction Services. ...DeWine’s decision to review Ohio’s six psychiatric facilities came in the wake of the Aug. 4 mass shooting in Dayton’s Oregon District, where a gunman killed nine people in around 30 seconds. (Filby, 12/17)

The Oregon State Hospital, overburdened with patients from the criminal justice system, won’t accept people with a mental illness who are a danger to themselves or others for at least 10 days, state health officials said Monday. Patients who haven’t been charged with a crime but need treatment at the state hospital will have to wait in community hospitals until beds become available, no earlier than Dec. 27, according to a letter the Oregon Health Authority sent to advocacy and health care groups. (Zarkhin, 12/17)

Dr. Nathan Chomilo, a respected Twin Cities pediatrician and internist, has been named the state's new Medicaid medical director by the Minnesota Department of Human Services (DHS). It is the latest hire by Human Services Commissioner Jodi Harpstead, who took the helm at DHS in September, as she fills out her leadership team at an agency racked by turmoil earlier this year. (Howatt, 12/17)

The year after five prison officers were killed by inmates in 2017, the state prison system almost doubled the number of inmates with mental illness held in solitary confinement. Previously, North Carolina’s prison system made significant strides to reduce the number of prisoners with mental illness who are held in isolation for up to 23 hours a day. Prison officials were also meeting regularly with mental health advocates. (Knopf, 12/18)

Yet another South Florida pain-pills-and-Medicare-fraud scheme, this one perpetrated in Hialeah by a doctor, his wife and two other people who worked for his practice, ended Monday with the doctor’s sentencing in federal court. The Justice Department said Dr. Rodolfo Gonzalez Garcia called himself the “El Chapo of Oxycodone” while running his scam. Now, after getting an eight-year sentence for conspiring to distribute a controlled substance, Gonzalez Garcia can call himself “U.S. federal prison inmate,” which is the same life status as the infamous drug lord Joaquin “El Chapo” Guzman. (Neal ,12/17)

Research shows that just being around plants can make people feel good, and mental health providers now believe working with greenery specifically offers benefits such as stress relief, anxiety reduction and aggression control. There is growing evidence that learning to care for plants also can boost self-esteem while providing work experience. Perkins isn’t a prison; rather it’s a hospital run by the Maryland Department of Health. It offers mental evaluations to assess detainees’ fitness for trial or treatment after they are found not criminally responsible, the state’s version of an insanity defense. The hospital has gotten some of the state’s toughest cases. (Cohn, 12/17)

Pointing to a federal law that makes marijuana illegal, a U.S. district judge has tossed out a lawsuit filed by a Tampa firm that argues Florida health officials violated its due-process rights in a long-running dispute about a medical-marijuana license. Louis Del Favero Orchids, Inc., filed a notice that it is appealing U.S. District Judge Robert Hinkle’s decision to the 11th U.S. Circuit Court of Appeals. The firm contends Florida Department of Health officials violated its federal constitutional rights in not granting a potentially lucrative medical-marijuana license after Florida voters broadly legalized marijuana for patients in 2016. (Saunders, 12/17)

President Donald Trump has not yet delivered a promised comprehensive plan to curb prescription drug prices, but his tweets and pronouncements have created momentum for one strategy: the importation of cheaper medications from Canada — and maybe from elsewhere. For years, the importation of cheaper versions of drugs already sold here has been a cherished goal of consumer advocates and others. But federal resistance, from both Republican and Democratic administrations, has always stood in the way, at least in part because of full-throated opposition from drugmakers. (Ollove, 12/18)

After months of wrangling, House Democrats finally passed a massive bill aimed at lowering drug prices. And Senate Republicans are flummoxed at how to respond. The GOP is in a jam that makes action appear somewhere between unlikely and impossible. But if Republicans fail to act, it could easily become a major political liability for the party given the salience of high drug prices in public polling and President Donald Trump’s desire for sweeping reforms. (Everett and Owermohle, 12/16)

The Pharmaceutical Research and Manufacturers of America (PhRMA) is the lone major trade group not supporting President Trump's new North American trade deal after the drug industry lost crucial intellectual property (IP) protections in the agreement. The loss was a blow to a powerful industry group that has long held sway in Washington, and while other industries are rallying behind the trade deal, PhRMA finds itself relatively alone in opposing it. (Gangitano, 12/17)

Several months ago, Eli Lilly (LLY) launched a new version of its Humalog insulin at half of the list price, a move the company claimed would help lower costs for people with diabetes and blunt criticism of its pricing. But a new survey by a pair of lawmakers finds the new version is often out of stock at pharmacies, many of which were unaware the product was available. The findings prompted renewed criticism of the drug maker for failing to take steps to ensure its strategy would lower costs for consumers. (Silverman, 12/16)

Eli Lilly set 2020 financial targets that are higher than Wall Street expectations as it anticipates regulatory approvals and drug launches next year, though it lowered its full-year outlook for 2019. The drugmaker on Tuesday said it expects 2020 revenue of $23.6 billion to $24.1 billion, ahead of the $23.49 billion analysts polled by FactSet are expecting. Should the company meet its revenue forecast, it said it would achieve or exceed the 7% revenue compound annual growth rate target it had set for the 2015 to 2020 period. (Sebastian, 12/17)

The U.S. Patent and Trademark Office has removed a senior legal adviser from a high-profile case after she tweeted contentious remarks about the right of AIDS activists to challenge a patent-term extension sought by Gilead Sciences (GILD) for an HIV medicine. A spokesman for the federal agency told us that Mary Till, a 14-year employee who reviews extension requests, is “no longer working on the matter.” (Silverman, 12/13)

Multi-billion dollar drug company Gilead Sciences is awarding nearly a quarter of a million dollars to Louisiana groups fighting HIV in 2020, $163,000 of which will go to three New Orleans organizations. The grants are part of the company’s 10-year COMPASS Initiative, in which it has pledged to give a total of $100 million to community organizations in Southern United States to address the HIV/AIDS epidemic. (Poche, 12/17)

Kaiser Health News: Listen: The Cost Of PrEP, The HIV Prevention Pill

KHN correspondent Shefali Luthra joined a discussion on the Vox podcast “Today, Explained” about the cost dynamics surrounding pre-exposure prophylaxis, or PrEP, a game-changing drug that prevents the transmission of HIV. Gilead Sciences — the manufacturer of the brand-name versions of this preventive medicine, such as Truvada and Descovy — seeks to extend its patent but faces pushback from federal lawmakers, including Sen. Bernie Sanders (I-Vt.) and Rep. Alexandria Ocasio-Cortez (D-N.Y.). (12/18)

The trade group for the pharmaceutical industry has filed a lawsuit alleging a pair of Oregon laws is unconstitutional, the latest bid to push back against state efforts to shed more light on the rising cost of prescription medicines. One law required drug makers to notify the state when list prices rise by at least 10% or a new medicine is introduced that costs more than $670 for a month’s supply. (Silverman, 12/12)

Drug manufacturers are in the market for gene-therapy companies, propelled by concerns about competition for their products and looking to acquire novel medicines that could treat or cure diseases by compensating for faulty genes that cause illnesses. Earlier this month, Japanese pharmaceutical company Astellas Pharma Inc. agreed to buyAudentes Therapeutics Inc. for $3 billion to gain a toehold in gene therapy and get the San Francisco-based company’s manufacturing capabilities. (Gormley, 12/16)

In the hot-button arena of health care, the group’s leaders are focused on a widespread issue – access to necessary-but-expensive prescription medication. Their plan seems like a no-brainer: Scoop up millions of dollars in wasted, unexpired drugs from the state’s nursing homes and prisons and re-route them to charity pharmacies that serve uninsured and underinsured residents. (Carlesso, 12/16)

The rewards are eye-popping: Merck’s Keytruda, the leader in a class of medicines that harness the immune system, could attain annual sales of more than $27 billion within six years, according to estimates, more than any drug in history. Lifted by the rising tide of new treatments, the global oncology market is expected to reach $230 billion by 2024. The cancer scramble comes at the expense of conditions like multiple sclerosis, psoriasis, asthma, infectious diseases—and even opioid addiction—that have been less lucrative for pharma companies. Oncology therapies’ share of U.S. drug revenue almost quadrupled to 28% over the past two decades, even as cardiovascular drugs dropped from dominance to 1%, according to Boston Consulting Group. (John Lauerman and James Paton, 12/12)

Although lawmakers and President Trump have talked a good game about bringing down prescription drug prices, they’ve managed to take few, if any, steps toward that goal. Trump’s most dramatic proposals — tying the price of certain Medicare drugs to their prices overseas and barring payments from drug manufacturers to middlemen — have either been dropped or held up by internal bickering. And a Senate committee’s proposal to rein in drug price hikes, which garnered a rare degree of bipartisan support, has been stalled by opposition from Republican senators. (12/13)

If enacted, H.R. 3, the Elijah E. Cummings Lower Drug Prices Now Act, would, for the first time, give the government the power to negotiate lower drug prices for millions of patients enrolled in Medicare, and millions more with private insurance. The stakes are huge: Not only would this save Medicare $500 billion over the next decade, these savings would be used to expand benefits to include dental, vision and hearing coverage and help low-income seniors pay out-of-pocket costs. (Ben Jealous, 12/12)

The House of Representatives passed H.R. 3 in a nearly straight party-line vote last week. While prescription drug pricing reforms are needed, the legislation would unravel many of the market incentives that have made America the undisputed leader bringing new medicines – and new hope – to people facing devastating diagnoses. Bipartisan legislation crafted by the Senate Finance Committee, and supported by the White House, is the last opportunity Congress has to strike a sensible bargain that lowers drug costs for patients while sustaining America’s leadership in this vital field. (John Crowley, 12/17)

While the big party-line vote in the House of Representatives last week about articles of impeachment and the state of our union captured America’s attention, another near-party-line vote in the chamber on Speaker Nancy Pelosi’s legislation to impose European-style price controls on the most innovative drugs offered important lessons about the state of U.S. drug policy. (Paul Hastings, 12/17)

Prescription drug prices are rising faster than summer temperatures in the Sonoran Desert. For more than a decade now, Arizonans have seen common prescription drugs double or triple in price. What’s more, this has left many vulnerable communities, especially seniors on Medicare, struggling to pay for their life-subsisting prescription drugs. Instead of taking their medication as prescribed, many Arizonans are rationing doses or not filling their prescriptions because the cost is too high. Both options place many of our neighbors in risky and dangerous positions. However, there is a way—currently standing before Congress—to end these life-threatening scenarios. (David Bailie, 12/17)

In the richest nation in the world, every American should have access to the highest-quality, life-saving medications. And, yet, I have heard from too many Alabamians who are sacrificing basic needs such as housing, food and educational advancement to afford their prescriptions. (Terri Sewell, 12/16)

Last week's House vote to rein in skyrocketing prescription drug prices was overdue. Now it's up to the Senate and President Donald Trump to take action. Working families and seniors are struggling to pay for the high cost of often life-saving medicines, and have been for years. But price gouging isn’t the only way big drug corporations rip off the American people. Congress needs to stop other abuses, too —starting with the drug industry’s rampant tax dodging. (Margarida Jorge and Frank Clemente, 12/16)

Inever thought I’d see the day when words like “process,” “scale,” and “automation” would make news in the biopharma industry. Yet as the race heats up to bring more first-of-their-kind gene therapies to market, breakthroughs in manufacturing are often the key — or break down the barrier — to delivering these therapies to patients. (Diane Blumenthal, 12/18)

Atrio of biopharma observers recently published in STAT an analysis relevant to the ongoing drug pricing debate in Washington. The response has not been pretty. In short, the authors suggest that since two reviewed pharmaceutical companies provided relatively little innovation in drug development and were not responsible for the original invention of some of their products, current proposals to lambaste the industry are warranted — with no side effects on innovation. This follows a report from researchers at West Health Policy Center and Johns Hopkins Bloomberg School of Public Health which suggested that removing $1 trillion from the pharmaceutical industry would not negatively affect current research investments. That flawed study was soon dismissed by many, and notably debunked by a leading venture capitalist. Both of these analyses suffer from the same misconception: that “big pharma” lives in a vacuum. It doesn’t. The entire drug development process is an ecosystem. (John Standford, 12/16)

The $1.4 trillion spending bill now making its way to final passage in time to meet a Friday deadline will banish the specter of a partial government shutdown for the foreseeable future. That’s the good news. Otherwise, it is a monumental exercise in fiscal looseness that may add $500 billion to the federal debt over the next decade, according to estimates by the Committee for a Responsible Federal Budget. President Trump and his fellow Republicans deserve much of the blame for this situation, given that, under Mr. Trump, the party has abandoned any pretense of concern over balanced budgets. Yet many of the worst reported provisions enjoy significant Democratic support, too — even though they will undermine the signature policy accomplishment of the Obama administration. (12/17)

The pesticide known as chlorpyrifos is both clearly dangerous and in very wide use. It is known to pass easily from mother to fetus and has been linked to a wide range of serious medical problems, including impaired development, Parkinson’s disease and some forms of cancer. That’s not entirely surprising. The chemical was originally developed by Nazis during World War II for use as a nerve gas. (12/17)

Attend a Narcotics Anonymous meeting in Washington, and you’ll see the illicit drug scourge being vanquished — one roomful of recovering addicts at a time. In hospitals, church basements, homeless shelters and community centers, messages of hope are being heard. “You don’t have to die from the disease of addiction,” a woman who had been clean for 15 years said to an NA group that meets on Sundays at Howard University Hospital. Neither heroin nor cocaine could get the best of her. (Courtland Milloy, 12/17)

In March, the U.S. Supreme Court will hear arguments in June Medical Services v. Gee, the next big abortion rights case. Attorneys at Pennsylvania’s Women’s Law Project coauthored and filed an amicus curiae (“friend of the court”) brief highlighting the significant role antiabortion harassment and violence play in this case.At issue in June Medical Services is Louisiana’s Act 620, which forces Louisiana abortion providers to obtain a type of business contract called “admitting privileges” with a local hospital. The primary purpose of such contracts is for hospitals to secure business. Ironically, because abortion is a safe procedure with a very low medical complication rate, admitting privileges have been denied to abortion providers because they don't generate enough patients for hospitals to bother with unnecessary paperwork. (Tara Murtha and Christine Castro, 12/17)

Abortion access is facing a monumental crisis, as states across the nation continue to advance and enact restrictive abortion laws, the Trump administration puts in place reproductive health policies that ignore science, and the Supreme Court is set to decide a major case on abortion regulations next year. Amid this treacherous landscape, two key factors will help determine the future of abortion in the United States: the outcome of the 2020 presidential election, and the outcome of ongoing efforts to make medication abortion (also called the abortion pill) easier for people to get. So far, the Democratic presidential candidates have not engaged in a robust conversation about their views on the crucial issue of expanding access to medication abortion. But they should. And fortunately, that is starting to change. (Daniel Grossman, 12/18)

Ample evidence has been available for some time indicating that alcohol use is a preventable risk factor for cancer, and the World Health Organization deemed alcohol a carcinogen more than 30 years ago. In the United States, it is estimated that 5.6% of incident cancer cases (approximately 87 000 each year) are associated with alcohol, including cancers of the oral cavity, pharynx, larynx, liver, esophagus (squamous cell carcinoma), female breast, and colorectum. Type of alcohol does not appear to matter; all alcoholic beverages include ethanol, which increases levels of acetaldehyde and in turn promotes DNA damage. Moreover, even moderate levels of consumption (often defined as approximately 14-28 g/d, the equivalent of about 1-2 drinks) appear to be associated with higher risk of some cancers, including cancers of the female breast. A protective association has emerged for some cancers, with the most evidence for kidney, Hodgkin lymphoma, and non-Hodgkin lymphoma. Nonetheless, the overall cancer burden associated with alcohol use is substantial and comparable with that of other preventable risk factors such as UV exposure and excess body weight. (William M. P. Klein, Paul B. Jacobsen, and Kathy J. Helzlsouer, 12/13)

Women are underrepresented in science, technology, engineering and mathematics at the highest levels. Only one out of four full professors at American research institutions is a woman, despite the fact that equal numbers of men and women earn doctoral degrees in science each year. In the life sciences, women are less likely either to receive major grant funding or to be promoted to full professor — and they are paid less even when they produce the same amount of scholarly output as men. (Anupam B. Jena, Marc Lerchenmueller and Olav Sorenson, 12/17)

Debbie Pulley is a midwife, but if she told you that, the Georgia Board of Nursing would fine her $500. That’s because the board has barred the use of the title “midwife” by anyone who doesn’t hold a nursing license — even people like Pulley, who has spent the past 40 years delivering more than 1,000 babies. Now she is fighting back with a federal lawsuit to protect her First Amendment right to describe herself honestly. (Jim Manley and Caleb Trotter, 12/16)

Weeks of lobbying and hours of protest by vociferous groups of “anti-vaxxers” helped delay Monday’s planned vote by the New Jersey Senate on a sensible and necessary bill to eliminate the state’s long-standing faith-based exemption from common pediatric vaccinations. Supporters said they’ll try again before the legislature’s lame-duck session concludes on Jan. 14, 2020.The N.J. Assembly approved its version of the bill by a comfortable margin Monday, and Gov. Phil Murphy said Tuesday he intends to be guided by science showing immunization’s efficacy and safety. Let’s hope the governor gets the opportunity to sign a bill as soon as possible because the spread of the spurious anti-vaccination gospel is putting public health at risk. And the true believers chanting, praying, and taunting lawmakers in Trenton Monday seem unlikely to be deterred, despite the dozen cases of measles earlier this year in Ocean County. (12/18)