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Mayor Pete Buttigieg of South Bend, Ind., has recently emerged as a leader in some Iowa polls, and Senator Bernie Sanders of Vermont appears re-energized by the endorsement of Representative Alexandria Ocasio-Cortez of New York. But the two candidates at center stage remain the same: former Vice President Joseph R. Biden Jr. and Senator Elizabeth Warren of Massachusetts. Together, these four have separated themselves from the 2020 pack. The debate stage has shrunk since the October clash, with former Representative Beto O’Rourke of Texas quitting the race and the former federal housing secretary Julián Castro failing to qualify. (Goldmacher and Ramic, 11/20)

Perhaps no issue has divided the field of Democratic 2020 presidential hopefuls more than the debate over "Medicare for All." Progressive candidates favor the sweeping proposal, which would replace private health insurance with a single government-run plan. More moderate candidates have embraced less drastic measures they say would achieve universal healthcare coverage while allowing individuals to choose their plan. (11/19)

No single issue has dominated the initial Democratic primary debates more than health care, and it’s safe to assume that will be the case again Wednesday night. And no one has more riding on that specific debate than Warren, who hurt herself last month by stumbling through questions about the cost of her single-payer health care plan. Given that policy specifics make up the backbone of her candidacy, she can’t afford another underwhelming performance on the defining policy debate of the primary season. (Peoples, 11/20)

Once again, former President Barack Obama is looming over the debate -- not only his health care policy and immigration record, as during previous gatherings, but now his gentle scolding for the 2020 Democratic field. The former president recently injected himself into the race in the biggest way yet, offering no implicit endorsement, but delivering a stern admonition at the campaign's direction. By imploring candidates to offer plans "rooted in reality" to avoid turning off key swaths of the electorate, Obama was trying to nudge the conversation toward the middle. (Bradner, Krieg, Merica and Zeleny, 11/20)

Over six nights of debates since June, the Democratic presidential candidates have spent a lot of time talking — 659 minutes in total, or nearly 11 hours. They’ve spent the most time discussing health care, which has become a proxy for the fight between the liberal and moderate wings of the party. Other topics, like climate change and reproductive rights, have received less attention, drawing some complaints. (11/20)

When Bryan Keith was diagnosed with prostate cancer three years ago, he underwent a blizzard of tests, specialist consultations, a month of radiation treatment and a surgical procedure. His out-of-pocket costs? Zero. “I’ve never had to reach into my wallet for anything other than my health-care card,” said Keith, 71, who is now in remission. In this picturesque mountain town of about 10,000 people, Keith’s experience is the norm — and the model often cited by Sens. Bernie Sanders and Elizabeth Warren as they promote Medicare-for-all as an antidote to some of the problems afflicting U.S. health-care consumers. (Abutaleb, 11/19)

A majority of Iowans who will likely attend the state’s 2020 Democratic caucuses want a health care option other than “Medicare for All,” a new poll finds. More than a third of Democratic respondents in a CNN-Des Moines Register-Mediacom poll — 36 percent — support Medicare for All, but nearly as many others — 34 percent — want a public option to buy into, CNN reports. (Campisi, 11/19)

Atrio of senators — including presidential candidates Elizabeth Warren and Bernie Sanders — wants more scrutiny of for-profit institutional review boards, which decide whether to green-light clinical trials. In letters sent this week to the U.S.’s two largest commercial IRBs — WCG Clinical, better known as WIRB-Copernicus Group, and Advarra — the senators wrote that such boards “can be inherently vulnerable to conflicts of interest that could inhibit their ability to protect research subjects.” (Robbins, 11/19)

President Donald Trump said Tuesday he went through a “very routine physical” when he visited Walter Reed National Military Medical Center over the weekend. The president complained that first lady Melania Trump and some of his staff members expressed concern about his health based on media reports about Saturday’s trip to the hospital. He said it’s the media that’s “sick.” (Freking, 11/19)

[Trump] told reporters that he was greeted by a panicked first lady and communications department when he arrived back at the White House due to media coverage of the trip. “I went for a physical. And I came back and my wife said, ‘Darling are you OK? … Oh they’re reporting you may have had a heart attack,’” Trump explained. “I said, ‘Why did I have a heart attack?’ ‘Because you went to Walter Reed Medical Center’ — that's where we go when we get the physicals.” (Oprysko, 11/19)

The White House has offered shifting descriptions of President Donald Trump's medical exam in the days since he made an unscheduled Saturday visit to Walter Reed National Military Medical Center. Trump and White House press secretary Stephanie Grisham initially billed Trump's visit as the first part of the President's annual physical. But two days later, the President's doctor described the hospital visit as an "interim checkup," a term physicians told CNN implies a separate visit that is not part of an annual physical. (Diamond, 11/19)

Although there is nothing unusual about a president visiting the hospital for an annual physical, these events are typically announced on the president’s public schedule, and the White House press corps is given advance notice. Annual presidential physicals are not typically conducted in two parts. Trump had no events on his public schedule on Saturday when he made the hospital visit. His last physical was in February. (Egan, 11/19)

Newly revealed correspondence shows that federal health officials discussed with contractors a publicity plan to feature President Donald Trump’s Medicare and Medicaid chief Seema Verma in magazines like Glamour, win recognition for her on “Power Women” lists and get her invited to attend prestigious events like the Kennedy Center Honors. The correspondence – emails between high-profile media consultant Pam Stevens, whose services cost hundreds of dollars per hour, and Verma and Brady Brookes, Verma’s deputy chief of staff — offers fresh insight into the Centers for Medicare and Medicaid Services’ use of federal funds to employ a range of communications contractors. (Diamond and Cancryn, 11/20)

CMS Administrator Seema Verma on Tuesday criticized hospitals and insurers for opposing the Trump administration's efforts to increase price transparency, saying they want to maintain the status quo even if it's not in patients' best interests. Verma took providers and payers to task for getting in the way of new policies that she believes would improve healthcare quality, improve access to care and slash healthcare spending over the long run. People that oppose the Trump administration's efforts on price transparency like the status quo but that's not fair to patients, she said. (Brady, 11/19)

Stephen Hahn, President Trump’s nominee to helm the Food and Drug Administration, will today face his first real test in Washington — a confirmation hearing packed with hours of questions from senators on nearly every aspect of the agency’s sprawling portfolio, from mysterious vaping illnesses to the promise of gene therapies. Hahn, who currently serves as the chief medical executive of MD Anderson Cancer Center, is auditioning for the FDA’s top job at a transformational time for the agency. (Florko, 11/20)

Five former FDA commissioners today called on Senate leadership to swiftly confirm President Donald Trump's pick to lead the agency in a letter shared exclusively with POLITICO ahead of a confirmation hearing Wednesday. The letter cites cancer doctor Stephen Hahn's seven years of experience in clinical research at NIH's National Cancer Institute, his work on FDA-regulated biomedical research while in academia and his leadership experience at the University of Pennsylvania School of Medicine and MD Anderson Cancer Center, where he currently is chief medical executive. (Karlin-Smith, 11/19)

Right now, there are dozens of patients — U.S. citizens — in New Zealand hospitals who are fighting the clock. They have only a few weeks to recover and get home to the tiny island of American Samoa, a U.S. territory in the South Pacific. "We have a cancer patient that is coming back in December," says Sandra King Young, who runs the Medicaid program in American Samoa. "We can only give him six weeks of chemo, radiation and surgery. He has a good chance of survival if he has the full year of treatment, but not six weeks. The patient and family understand, and since they have no money, they have agreed to come back." (Simmons-Duffin, 11/20)

Gov. Laura Kelly’s administration is warning lawmakers against including work requirements in Medicaid expansion, cautioning the rules would cause many people to cycle in and out of the program, raising costs and possibly increasing the number of residents without health insurance. As states across the country have expanded eligibility for Medicaid, the health insurance program for low-income families, Republicans have pushed several to adopt work requirements. Many of those states now face legal roadblocks that have kept the rules from going into effect. (Shorman, 11/19)

Though its Medicaid contract is still at stake, Aetna Better Health is making progress, Kansas lawmakers and state regulators said this week. ...State regulators had put Aetna on notice in July that it wasn’t in compliance with its state contract and risked being fired. The state initially rejected Aetna’s proposal to correct issues this summer, but approved an updated plan in September that included concrete deadlines to fix specific issues like delayed payments to hospitals. (Koranda, 11/19)

North Carolina's Medicaid program won't shift to managed-care benefits as scheduled early next year, the largest casualty to date of the monthslong budget stalemate between Democratic Gov. Roy Cooper and Republican lawmakers. Although the Department of Health and Human Services' Tuesday announcement about the rollout suspension was anticipated, the indefinite delay still represents a significant failure for both the legislative and executive branches. (11/19)

Sen. Joni Ernst is battling with Senate Minority Leader Chuck Schumer over the Violence Against Women Act, with Ernst suggesting Schumer is halting her bill to thwart her reelection campaign and Schumer charging that Ernst is "afraid of the NRA." The rare conflict between the Iowa Republican and New York Democrat underscored the political tension on legislation ahead of next year's election, when Ernst will be fighting to win a second term and Schumer will be leading the charge to defeat her. Ernst's seat is one of a half-dozen competitive seats being targeted by Democrats in 2020. (Levine and Everett, 11/19)

Ernst is expected to introduce her bill this week, and hopes to pass legislation by the end of the year. Her legislation, according to Ernst and a one-page outline of the forthcoming bill, would reauthorize and provide funding for VAWA, and includes provisions that triple the amount of funding for sexual assault prevention and enhance penalties for abusers. (Carney, 11/19)

Ernst had been working with Democratic Sen. Dianne Feinstein of California for months on a bipartisan reauthorization bill before both sides said the negotiations fell apart earlier this month. Democrats argued they had reached an impasse on gun rights provisions that the House, over the objection of most GOP members, added to the bill earlier this year. (Macagnone, 11/19)

Senate Minority Leader Charles Schumer (D-N.Y.) said Tuesday that congressional leadership is trying to work out differences between competing measures to protect patients from getting hit with massive, “surprise” medical bills. The effort is a rare area for possible bipartisan action this year, given that lawmakers in both parties and President Trump say that patients should be protected from getting medical bills for thousands of dollars when they go to the emergency room and one of the doctors in the facility happens to be outside their insurance network. (Sullivan, 11/19)

Thousands of lawsuits across the United States have accused a drug company owned by the billionaire Sackler family of using false claims to push highly addictive opioids on an unsuspecting nation, fueling the deadliest drug epidemic in U.S. history. Yet, even as its U.S. drugmaker collapses under the charges, another company owned by the family has used the same tactics to peddle its signature painkiller, OxyContin, in China, according to interviews with current and former employees and documents obtained by the Associated Press. (Kinetz, 11/20)

Purdue Pharma LP has convinced 24 states and the District of Columbia to comply with a bankruptcy court injunction halting opioid lawsuits against the company and the controlling Sackler family at least temporarily, Purdue’s lawyer said at a bankruptcy hearing. Last month, the judge presiding over Purdue’s bankruptcy enjoined lawsuits against the maker of the opioid OxyContin and the Sacklers. Roughly half of all state attorneys general and the District of Columbia had argued against the injunction, which extends until April 8. (Biswas, 11/19)

Seeking to kick-start the sprawling nationwide opioid litigation, a federal judge on Tuesday scheduled a trial against major pharmacy chains for next October and proposed sending three other cases back to other federal courts where they originated. Judge Dan Aaron Polster, the Ohio federal judge in charge of the nearly 2,500 lawsuits filed against the drug industry in federal courts across the country, said he would preside over a case that pits two Ohio counties, Summit and Cuyahoga, against some of the nation’s largest pharmacy chains. (Bernstein, 11/19)

Since 2016, public health advocates in Miami-Dade County have led the state in confronting Florida’s opioid epidemic by starting a needle exchange that also widely distributed naloxone, a drug that counters overdoses, and getting it onto the streets. With the latest data, experts believe those efforts have saved nearly 100 lives in 2018 alone. (Conark, 11/19)

By the time Juul’s co-creator stood before a tech audience in April 2016, ads for the e-cigarette aimed to distance the product from a toxic past: “Our company has its roots in Silicon Valley, not in fields of tobacco.” But when James Monsees, a soon-to-be billionaire, projected a 30-year-old tobacco document on the screen behind him, he grinned. It was an internal memo from the research troves of R.J. Reynolds, the maker of Camel cigarettes. It was stamped “SECRET.” (Baumgaertner, 11/19)

The New York state attorney general’s office sued Juul Labs Inc. on Tuesday, accusing the country’s largest e-cigarette maker of engaging in deceptive marketing of its products, which state officials blame for contributing to a youth vaping epidemic. The lawsuit, filed in New York Supreme Court, follows a similar one filed Monday in California and another filed in May by North Carolina. New York is seeking restitution, penalties and disgorgement of profits from the company. (West and Maloney, 11/19)

According to the complaint, Juul’s advertising and social media posts misled consumers about the content of its products by failing to warn that they contain nicotine. The complaint alleged that even when Juul began including nicotine warnings in its advertising in 2018, it continued to mislead consumers by claiming the nicotine levels in a single pod were equivalent to a pack of cigarettes, when in fact a user consumes far more. (Weixel, 11/19)

Massachusetts lawmakers are expected to vote Wednesday on a bill that would be the most stringent state-level ban on flavored tobacco, including menthol cigarettes, as they seek to combat youth vaping and cut down on broader tobacco use. The menthol ban would take a restriction already imposed in some U.S. counties and cities to the statewide level for the first time. Convenience-store owners have been pushing back, arguing a menthol ban will fuel a black market and hurt business, but proponents say they don’t want to allow flavor options that could lure young users. (Kamp, 11/20)

The American Medical Association on Tuesday called for an immediate ban on all electronic cigarettes and vaping devices. The group adopted the sweeping stance at a policy-making meeting in San Diego. It aims to lobby for state and federal laws, regulations or legal action to achieve a ban, but the industry is sure to fight back. (Tanner, 11/19)

More than two months after saying he would ban flavored vaping products other than menthol and tobacco and facing heavy opposition, Trump has not said what — if anything — he plans to do. His administration says the rule-making process is "ongoing" but the ban expected by now is thought to be on hold while the administration considers next steps. The Washington Post and New York Times reported over the weekend Trump was convinced to back off from the plan because he could lose voters in 2020. (O'Donnell and Jackson, 11/19)

The Trump administration’s apparent decision to back off a plan to ban flavored e-cigarettes has outraged public health officials and others, who warn that the president risks making a decision that is politically expedient but that will do lasting damage to American health. Some experts also believe President Trump may be underestimating the potential blowback over the decision. Trump’s retreat from the ban, at least for now, is said to reflect concerns that any such move could have a dramatic impact on vape shops and other small businesses, many of which are seen as key supporters of his reelection campaign. (Thielking and Florko, 11/19)

The battle over youth vaping escalated Tuesday, with leading conservative women’s groups joining anti-tobacco groups to urge President Trump to make good on his September vow to ban flavored e-cigarettes. In addition, a House committee approved a bill that outlaws flavored tobacco products, and the New York attorney general sued the e-cigarette giant Juul Labs for allegedly targeting teens in its marketing, the day after California brought a similar suit. (McGinley, 11/19)

A House panel on Tuesday advanced a sweeping ban on flavored tobacco — including vaping products — as Democrats condemned President Donald Trump’s decision to stall his plans for muscular restrictions amid lobbying from political allies and the vape industry. The bill approved by the House Energy and Commerce Committee is far more aggressive than the ban Trump proposed two months ago to combat surging public health crises tied to vaping. (Owermohle, 11/19)

Police plan to conduct undercover compliance checks in enforcement of a new ordinance expected to have a big impact in the college town by prohibiting anyone under 21 from buying cigarettes and vaping products. The ordinance, passed unanimously by the Durham town council Monday night, was scaled back from its original form, which also targeted use and possession of nicotine products. The ordinance requires merchants to ID people before selling nicotine products. Similar ordinances have passed in Dover and Keene. (Haas, 11/19)

Missouri Gov. Mike Parson on Monday announced the launch of the state’s new youth vaping education campaign to bring attention to the dangers of e-cigarettes and vaping products. Parson signed an executive order in October giving the departments of Health and Senior Services, Elementary and Secondary Education, and Public Safety one month to get the program running without any additional funding. (Driscoll, 11/19)

Muhlaysia Booker was a nurturer: the 22-year-old transgender woman took care of her community and loved to make people laugh. She told relatable stories in live videos, made sure friends had a place to sleep, enjoyed getting her makeup done and dreamed of traveling to Austin. She shouldn't be dead, says one childhood friend, who, six months later, is still seeking an explanation to why a man killed Booker, leaving her lying face down in the street and shattering their plans for the future. (Lam, 11/20)

2019 is the year Ash Penn, a passionate transgender resident of Spartanburg, South Carolina, was able to “come out as a whole” and feel the warm embrace of acceptance. It has been a year that saw a wow moment in politics when transgender rights popped up in platforms of the Democratic presidential candidates. But 2019 is also the year in which transgender people were barred from the U.S. military. (Miller, 11/19)

Amid their annual vigils for transgender homicide victims, trans rights activists in the U.S. are trying to maintain long-term optimism even as many hard-won protections are under threat. Just a few weeks ago, President Donald Trump’s administration argued before the Supreme Court that employers should be allowed to fire workers because they are transgender. (Crary, 11/19)

The night that Jeffrey Epstein hanged himself in a Manhattan jail, one of the guards on duty was catching up on sports news and looking at motorcycle sales on a government computer. The other spent time shopping online for furniture. For about two hours, they appeared to be asleep at a desk just 15 feet away from Mr. Epstein’s cell. Those details were revealed in an indictment unsealed on Tuesday against the two jail employees. The indictment said neither guard made the required rounds every 30 minutes to check on inmates. Yet they filed paperwork claiming they had. (Gold, Ivory and Hong, 11/19)

The indictment, leaning in part on images from security cameras on the cell block, also contains new details reinforcing the idea that, for all the intrigue regarding Epstein and his connections to powerful people, his death was a suicide and possibly preventable. “The defendants had a duty to ensure the safety and security of federal inmates in their care at the Metropolitan Correctional Center,” U.S. Attorney Geoffrey S. Berman said. “Instead, they repeatedly failed to conduct mandated checks on inmates, and lied on official forms to hide their dereliction.” (11/19)

Doctors are reporting the first evidence that genetically edited cells could offer a safe way to treat sickle cell disease, a devastating, incurable disorder that afflicts millions of people around the world. Billions of cells that were genetically modified with the powerful gene-editing technique called CRISPR have started working, as doctors had hoped, inside the body of the first sickle cell patient to receive the experimental treatment, according to highly anticipated data released Tuesday. (Stein, 11/19)

The first two patients to receive a CRISPR-based treatment for the inherited blood disorders sickle cell disease and beta thalassemia have benefited from the experimental therapy and experienced only temporary and treatable side effects, the companies developing the treatment announced on Tuesday. The two patients, enrolled in a pair of ongoing clinical trials, have been free from blood transfusions and disease symptoms for a relatively short time, but the encouraging data offer hope that genome editing might one day offer a safe, durable cure for both blood diseases. (Begley and Feuerstein, 11/19)

Hospitals have been overhauling facilities and procedures in psychiatric wards nationwide in response to new guidelines for suicide prevention. Some mental health advocates and officials say the changes have come at the expense of patient privacy and dignity, making mental health units feel more like correctional institutions. (11/19)

Donors around the world are injecting another $2.6 billion into eradicating polio, a goal that remains elusive despite years of pursuit. The new money, from the Bill & Melinda Gates Foundation, Rotary International, the crown prince of Abu Dhabi and others, is to help the Global Polio Eradication Initiative, a group of public and private organizations, strengthen its activities as it confronts numerous challenges from antivaccine sentiment to outbreaks of a virus from a former polio vaccine. (McKay, 11/19)

Black girls are being pushed out of school and into jails at alarming rates. But this issue often is overlooked because youth incarceration reform focuses so much on boys. Reporter Ko Bragg explains how the cycle begins and what researchers hope will break it. (Bragg, 11/19)

Anal cancer cases and deaths are rising dramatically in the United States, especially among older people and young black men, a new study says. Researchers examined trends in anal cancer cases over about 15 years, and identified about 69,000 cases of anal cancer and more than 12,000 deaths during this time. "Our findings of the dramatic rise in incidence among black millennials and white women, rising rates of distant-stage disease, and increases in anal cancer mortality rates are very concerning," the study's lead author, Ashish A. Deshmukh, an assistant professor at UTHealth School of Public Health, said in a statement. "Given the historical perception that anal cancer is rare, it is often neglected." (Rogers, 11/19)

People who never learned to read and write may be at increased risk for dementia. Researchers studied 983 adults 65 and older with four or fewer years of schooling. Ninety percent were immigrants from the Dominican Republic, where there were limited opportunities for schooling. Many had learned to read outside of school, but 237 could not read or write. (Bakalar, 11/19)

Shortly after the birth of her first son, Monika Jones learned that he had a rare neurological condition that made one side of his brain abnormally large. Her son, Henry, endured hundreds of seizures a day. Despite receiving high doses of medication, his little body seemed like a rag doll as one episode blended into another. He required several surgeries, starting when he was 3 1/2 months old, eventually leading to a complete anatomical hemispherectomy, or the removal of half of his brain, when he turned 3. (Sheikh, 11/19)

Delos is what’s known as a “wellness real estate” brand. Founded in New York in 2012, it aims to make homes healthier places to live by installing a system that monitors and controls a property’s air and water quality and lighting. Delos introduced the technology, called Darwin Home Wellness Intelligence (Darwin), in Australia last fall. (Vora, 11/20)

Earlier this year, Madison was accepted into the It Takes a Village Initiative Pre-Accelerator Program through the Atlanta Tech Village, which is a diversity and Inclusion program for women and people of color. It’s a 16-week program in which students receive mentorship and leadership development as they work to develop tech products. (Perry, 11/19)

Sedentary older adults can help lower their risk of heart disease if they start exercising, a new study confirms. Researchers examined data on more than 1.1 million people 60 and older without any history of heart disease who had two health screenings between 2009 and 2012. Most were physically inactive at the first screening, and almost 4 in 5 of these people remained sedentary throughout the study period. (Rapaport, 11/19)

The University of Maryland Medical System, rocked by a self-dealing scandal this year involving board members that caused Baltimore’s mayor to resign, has repeatedly “delayed and hindered” the work of state auditors, according to a letter from the chief auditor made public Tuesday. Maryland Legislative Auditor Gregory Hook wrote to leading state lawmakers late last month that 37 employees in his office have spent a cumulative total of 600 days working on the audit, with fieldwork beginning April 16. He also wrote that the office has spent “countless days sifting and analyzing electronic records” it has received. (11/19)

State auditors tasked with investigating the University of Maryland Medical System after a self-dealing scandal involving its board of directors have complained UMMS “delayed and hindered” their work, requiring an extension of their deadline to produce a report to the General Assembly. ...UMMS interim President and CEO John Ashworth responded that UMMS officials have “always endeavored to work collaboratively and transparently” with the Office of Legislative Audits and "look forward to the issuance of their report.” (Rector, 11/19)

Pennsylvania’s mental health laws, passed in 1976, are some of the most restrictive in the nation, requiring a person to be a “clear and present danger” to be involuntary committed to a hospital, which some critics say makes it difficult for people to receive help before tragedy strikes. ...Most states have revised their laws to increase treatment and care options. But Pennsylvania’s remain largely unchanged, the result of a lack of political motivation, access to funds, and a long-running debate within the mental health community. (Rushing, 11/20)

The District’s mental health agency acknowledged Tuesday that it failed to properly monitor a discharged psychiatric patient with a homicidal history before he allegedly killed a neighbor in an unprovoked shooting in March. But the agency assumed no blame for the attack, asserting that “any attempt” to link its lax supervision to the victim’s death “would require undue speculation.” (Duggan, 11/19)

Gov. Ron DeSantis on Monday called for legislators to pump hundreds of millions of dollars into programs for people with intellectual and developmental disabilities, as well as $20 million into the state’s prescription-drug importation effort --- or about $5 million less than what a top state health official sought. The DeSantis budget proposal recommends $94.8 million in new Medicaid funding for people with disabilities and another $239 million to offset deficits that have accumulated in past years in the Agency for Persons with Disabilities. (Sexton, 11/19)

State regulators have suspended the license of a central Minnesota home day care operator after an infant under its care suffered a serious injury and later died. The infant boy was found unresponsive at a home day care in Brainerd around 2 p.m. on Nov. 12. Deputies along with other emergency responders responded with lifesaving measures, but the infant died a short time later at Essentia Health-St. Joseph's Medical Center in Brainerd, according to a statement issued Tuesday by the Crow Wing County Sheriff's office. (Serres, 11/19)

A civil jury has awarded $58 million Tuesday to 10 people who alleged a now-closed body donation facility mishandled the donated remains of their relatives and deceived them about how the body parts would be used. The trial against Stephen Gore, owner of the Biological Resource Center of Arizona, ended with jurors finding in favor of 10 of 21 plaintiffs, awarding $8 million in compensatory damages and $50 million in punitive damages. (11/19)

It was an ordinary cram session, around midnight, when the screed appeared on students’ phones. A racist manifesto, sent to a small clutch of people sitting at a Syracuse University library on Tuesday morning, warned of “the great replacement,” a right-wing conspiracy theory that predicts white genocide at the hands of minority groups. (Randle and McKinley, 11/19)

Over a decade ago, it wasn’t uncommon for more than 100 people to be shot each year in Providence -- victims of street gangs or rival family feuds going back generations, domestic disputes, fights that broke out as the nightclubs closed. Even as Providence police were seizing more than 130 or so guns off the streets, the wave of violence plagued neighborhoods and busied hospital emergency rooms.And then, almost imperceptibly, the tide began to turn. (Milkovits, 11/20)

Postings for Anthem health insurance plans have again misinformed customers on the Affordable Care Act exchange, telling them WellStar Health System will be in the insurer’s individual network. It won’t. (Hart, 11/19)

A Texas family that disagrees with a Fort Worth hospital’s plan to take a 9-month-old girl off life support has been given more time to find a facility to take her. Texas Right to Life, which represents Tinslee Lewis’ family, said a judge Tuesday extended a temporary restraining order against Cook Children’s Medical Center until Dec. 10. The hospital didn’t immediately comment. (11/19)

At least 30 people have been charged in connection with a string of South Florida pharmacies state authorities say fraudulently billed Medicare — a scam that continues to be one of Miami’s most lucrative illegal industries. Police officers on Tuesday began arresting dozens associated with Tata Pharmacy Discount, Lozano Health Care, and in a separate case, Wynwood Family Pharmacy and Santander Pharmacy. (Ovalle, 11/20)

Multnomah County officials failed to follow-up on several reports of abuse or neglect from the first year of Unity Center for Behavioral Health’s operation, the Multnomah County District Attorney’s office acknowledged Tuesday. But District Attorney Rod Underhill announced that his office did not find any reason to press criminal charges against any county employee. The DA’s office launched an investigation in the midst of an internal review by Multnomah County of the county health department’s procedures. (Harbarger, 11/19)

Single, older people in Massachusetts are more likely to face economic insecurity than their peers in any other state, according to a new UMass Boston report. The study estimates that 61.7% of state residents older than 65 and living alone do not have enough income to cover basic expenses such as housing, food, health care, transportation, clothing and household supplies. (Ma, 11/19)

The Trump administration flouted federal law with a rule that would allow any health care worker, from doctors to receptionists, to refuse to provide abortions or other procedures for religious or moral reasons, a federal judge in San Francisco ruled Tuesday. Federal law since 1973 has allowed physicians and others directly involved in providing medical care to refuse to take part in abortions or sterilizations, as long as the refusal did not cause “undue hardship” to their employer. (Egelko, 11/19)

Pacific Gas & Electric Co. was set to begin shutting off power Wednesday to some 150,000 homes and businesses in parts of 18 Northern and central California counties as the region faced extreme fire weather that's lasted since October, CBS Sacramento reports. A virtually rainless fall has left brush bone-dry and forecasts called for low humidity and winds gusting at times to 55 mph, which could fling tree branches or other debris into power lines, causing sparks that could set off catastrophic fires in the region, PG&E officials said. (11/20)

Kaiser Health News: New California Law May Expand Use Of HIV Prevention Drugs, With Caveats

Kellen Willhite was 24 when he learned he’d been exposed to HIV. What followed was, as he describes it, a second trauma: trying to obtain the drugs that could save him before it was too late. In 2016, a day after Willhite and his then-boyfriend had engaged in unprotected sex, they visited the small offices of Golden Rule Services, a nonprofit community clinic about 7 miles south of the state Capitol. (Kreidler, 11/20)

MGP Ingredients Inc., a leading producer of distilled spirits and specialty proteins and starches, has agreed to pay a fine of $1 million in connection with a toxic chemical release at its plant in Atchison, Kansas, three years ago. MGP agreed to the fine after pleading guilty Monday to a misdemeanor charge of negligently violating the Clean Air Act. U.S. District Judge Daniel Crabtree will decide whether to accept the plea at a hearing set for Feb. 24. In exchange for MGP’s plea, the government agreed to dismiss two other charges against the company. (Margolies, 11/19)

Kaiser Permanente announced plans Tuesday a big expansion the Baltimore market as the health insurer triples the number of health care centers in the area and add tens of thousands of new patients in the next decade. Kaiser said it would invest and spend a combined $13 billion by 2028 to increase the number of Kaiser centers in the Baltimore region to 15 from 5 in an effort to expand coverage to an estimated 200,000 people from about 64,000 today. (Cohn and Reed, 11/19)

With tens of thousands of people sleeping outside every night in L.A. County, one of the most contentious debates is over what to do about homeless encampments and who should do it. A new poll conducted for the Los Angeles Times and the Los Angeles Business Council Institute found that a sizable majority of voters countywide think law enforcement should assume a larger role, despite court rulings and settlements limiting such involvement. (Oreskes, 11/19)

Record numbers of generic drugs for cancer, heart ailments and other conditions have received U.S. approval in recent years, raising hopes that the new competition would reduce high drug costs. But many of the lower-price medicines haven’t hit the market, a Wall Street Journal review found. The result: Many patients are forced to take high-price medicines, and a widely touted remedy for reining in drug costs has failed to live up to its promise. (Hopkins, 11/19)

Wearing a revolutionary-era tricorn hat, doctor Mathew Maurer stood at a lectern in front of an audience of fellow cardiologists in Philadelphia, decrying the price of a new medication that had the potential to help many of his heart-failure patients. The drug, Pfizer Inc.’s tafamidis, cost $651 a day, Maurer told them—equal to a patient’s food budget for a month. Drugs don’t work if people can’t afford to take them, he said, and the pharmaceutical company’s $225,000-a-year price was well out of bounds. (Court, 11/19)

Drug pricing regulations would not decimate the pharmaceutical industry, according to an analysis from health policy researchers at West Health and Johns Hopkins. Why it matters: This throws some cold water on Big Pharma's claims that new drug research and investments would evaporate if the federal government limits what they can charge for medications — the proposal du jour in Congress and the White House. (Herman, 11/15)

The dark-money group that has spent over $1 million on mysterious, pharma-bashing radio ads was formed by a top executive and a top lobbyist for the American Hospital Association and a former political consultant for CVS (CVS) Health, according to a 2018 tax filing released to STAT this week. The secretive group, known as Citizens for Truth in Drug Pricing, has blanketed airwaves with radio advertisements and sponsored commentary that sharply criticizes drug companies for high prices. (Facher, 11/20)

Venture capitalists aren’t exactly the most political types, but one group is trying to change that: Meet Incubate, a new lobbying coalition with the goal of correcting what the group’s executive director is calling Congress’ “fundamental misunderstanding” of the world of venture capital and biotech. The group is just getting off the ground — it’s not yet listed in the Senate lobbying database, and it hasn’t even filed formal tax paperwork yet. Instead, it’s being run out of the D.C. lobbying firm Prism Group. But it’s already speaking out vociferously against Democrats’ marque drug pricing bill. (Florko, 11/19)

Sen. John Thune (R-S.D.), the Senate’s No. 2 Republican, said Tuesday that it is unlikely the Senate will pass legislation to lower drug prices before the end of the year. “I think it would be the triumph of hope over experience to think that we could get it done before the end of the year, but there's a lot of interest in doing something on drug pricing,” Thune told reporters on Tuesday.  (Sullivan, 11/19)

One of the largest groups for doctors in the U.S. is calling for new health care oversight in an effort to counter high prescription drug costs. A new paper published by the American College of Physicians makes several recommendations the group said are aimed at improving transparency around pharmacy benefit managers — called PBMs for short — in order to provide patients and physicians with “reliable and timely information” on drug pricing. (Leggate, 18)

Novo Holdings, the investment firm behind pharmaceutical giant Novo Nordisk (NVO), is committing $25 million over five years to a new, early-stage biotech incubator at the Broad Institute, a research center affiliated with both Harvard and MIT. Novo Holdings’ commitment is the latest example of an ongoing push among biotech venture capitalists to invest in younger and younger startups. (Sheridan, 11/19)

Novo Holdings A/S plans to invest $25 million in biotechnology research done by scientists with ties to the Broad Institute of MIT and Harvard, in another indication of the close ties forming between venture-capital and academic groups. (Gormley, 11/19)

Novartis is considering an offer for U.S. biotechnology firm The Medicines Co, Bloomberg reported on Tuesday, a deal that could broaden the Swiss drugmaker's cabinet of heart medicines and shore up growth threatened by patent expirations. Novartis, which declined to comment on the report, is hunting for a $5 billion acquisition in the United States, two banking sources told Reuters separately without identifying a target. (11/19)

Bristol-Myers Squibb Co. won U.S. antitrust approval for its acquisition of Celgene Corp., the last regulatory approval needed for the blockbuster pharmaceutical deal. The Federal Trade Commission signed off on the tie-up after Bristol-Myers earlier this year agreed to sell one of Celgene’s most lucrative drugs to resolve concerns the deal would otherwise harm competition, the agency said Friday. Bristol-Myers said it expects to close the purchase Nov. 20. (McLaughlin, 11/15)

Former pharmaceutical executive Martin Shkreli will remain in prison after the U.S. Supreme Court on Monday rejected his effort to overturn his conviction and seven-year sentence for securities fraud and conspiracy. The justices refused to hear Shkreli's appeal of his August 2017 conviction and $7.36 million forfeiture for cheating investors in two hedge funds he founded, and trying to prop up the stock price of biotechnology company Retrophin Inc, which he once ran. (11/18)

It is hard to not be impressed by the progress Americans have made in combatting diseases. Cures for hepatitis C and advances in breast cancer treatments have changed lives. This is in part due to scientific breakthroughs at our national laboratories, universities and the pharmaceutical industry. But progress creating new drugs has led to a new problem: a drug pricing crisis. Nearly 1 in 3 American adults report not taking their medicines as prescribed because of the cost. In Washington and across the country, people are engaged in a spirited debate about the affordability of prescription drugs for households and public budgets. (Richard G. Frank, 11/13)

In response to growing bipartisan outrage over prescription drug prices, Sens. Cory Booker (D-N.J.), Bernie Sanders (I-Vt.) and Kamala Harris (D-Cal.) introduced a bill on Friday proposing the creation of a new federal agency: the Bureau of Prescription Drug Affordability and Access.Under the bill’s current stipulations, when a new drug enters the market, this new bureau would weigh the costs of its research and development against the costs of comparable therapies and any federal money that contributed to its discovery to determine an appropriate list price.It should go without saying that allowing the government to engage in price-setting for America’s most innovative industry would decimate the early-stage biotech ecosystem that allows us to lead the world in biomedical innovation. In an environment where 9 out of 10 drugs in development don’t make it to the market, drug developers already assume a massive amount of risk. (Jessica Sagers and Peter Kolchinsky, 11/18)

In today’s hyperpartisan and gridlocked political climate, we should seize any opportunity for bipartisan agreement that benefits the American public — especially one that can lower health care costs, like greater use of biosimilars. During the eight-hour markup of Speaker Nancy Pelosi’s drug pricing bill (H.R. 3), more than 300 amendments were submitted. Only one passed: an amendment from Reps. Kurt Schrader (D-Ore.) and Greg Gianforte (R-Mont.), which they had previously introduced as a bipartisan bill called the BIOSIM Act. (Juliana Reed, 11/20)

Novartis AG appears ready to put a premium on convenience. Bloomberg News reported early Tuesday that the Swiss pharmaceutical giant is conducting due diligence on Medicines Co., a New Jersey-based biotechnology company with a promising drug called inclisiran that can substantially lower so-called bad cholesterol with just two annual treatments. Its principal rivals, Amgen Inc.'s Repatha, and Sanofi and Regeneron Pharmaceutical Inc.’s Praluent, require biweekly or monthly injections. (Max Nisen, 11/19)

Americans agree that prescription drug prices are too high. Countless individuals and families across the country are grappling with impossible choices between buying the medication they need to stay healthy and paying the bills. And with no prescription is that truer than insulin. A member of the congregation I serve in Portland can’t afford the insulin he needs to manage his diabetes. Even though he works a full-time job with overtime, having worked hard to earn a promotion to a supervisory position, his low hourly salary is inadequate to cover even the co-pay on top of his rising rent and other expenses. (Sara Ewing-Merrill, 11/20)

Draw blood from someone with cancer. Engineer their blood cells to seek and destroy cancer. Reinfuse the cells and watch the cancer melt away. Chimeric antigen receptor T cell therapy (CAR-T) sounds like science fiction. But it’s the next frontier in cancer therapy. We’re weaponizing individuals’ immune systems to destroy cancer and add years to their lives. It’s incredibly exciting. But at hundreds of thousands of dollars per dose, insurance companies and the U.S. government are struggling to figure out how to pay for these breakthrough treatments. (David Mitchell, Saad Kenderian and S. Vincent Rajkumar, 11/20)

When regulations are contemplated to address an epidemic of teenagers using e-cigarettes, vaping advocates complain loudly. The restrictions will obstruct adult access to these products, they say, foreclosing the opportunity for smokers to use the devices to quit cigarettes. Another complaint: Regulatory action to ban flavored e-cigs, which appeal to children, could end up forcing the shutdown of small vape stores that cater to adults. The Post reported Sunday that the opposition has succeeded in stalling a Trump administration plan to implement a universal ban on flavored e-cigs as a way to stem the youth epidemic. If the concern is the impact on vape stores, as The Post reported, there are ways to address that while still taking tough steps to reduce kids’ access to e-cigs and reduce the products’ appeal to them. (Former FDA Commissioner Scott Gottlieb, 11/20)

Is there any limit to the Trump administration’s willingness to endanger public health and safety for political purposes? First, it weakened environmental protection standards, despite clear evidence that the air we breathe is irreparably harming us and our children. Then it formally left the Paris Agreement on climate change, despite its being the only available option to help address our worsening air. Now the president has walked back his promise to regulate the vaping industry and ban most flavored e-cigarettes, even as they render an entire generation more vulnerable to nicotine addiction — not to mention life-altering severe lung injury. (Vin Gupta, 11/19)

When it comes to the looming national health crisis posed by youth vaping, it looks like it will be every state for itself for the foreseeable future. President Trump’s ban on flavored vaping products has, like a lot of his other promises, just gone up in smoke. For Massachusetts, that means we need a heavy lift this week on Beacon Hill, where lawmakers will need to get their flavored tobacco ban and e-cigarette regulatory framework to Governor Charlie Baker before his temporary vaping ban expires Dec. 24. (11/20)

Faced with a troubling outbreak of a mysterious vaping-related illness and the skyrocketing use of electronic cigarettes among teens, President Trump announced in September that the Food and Drug Administration would pull flavored electronic-cigarettes from the market, possibly within weeks. “People are dying,” the president said during a televised news conference with the heads of the FDA and the Department of Health and Human Services. He promised quick action, and he was right to do so. (11/20)

Health care is a great political issue for Democrats — or at least it should be. Many Americans are anxious about medical costs, and yet Republicans have spent years pushing plans that would increase costs for most families. For Democrats, the playbook should be simple enough: Promise to make health care more affordable. The plan that Elizabeth Warren released last week takes this approach. It would, among many other things, use the 1980 Bayh-Dole Act to push down the price of drugs that were developed with government funding. (David Leonhardt, 11/19)

When Sen. Elizabeth Warren (D-Mass.) initially embraced Medicare-for-all, she was throwing her support behind an idea that was not originally her own. And what fits Sen. Bernie Sanders (I-Vt.) precisely is not going to do the same for Warren. There is always going to be a sleeve dangling or a hem that’s too long. No surprise, when Warren finally debuted her plan to pay for Medicare-for-all — after months of question of how she would pay for it — she satisfied almost no one. The plan was, depending on the viewpoint of the critic, too radical or not radical enough. (Helaine Olen, 11/19)

Perhaps the only thing worse than being told you need to go to the hospital is getting the bill for the treatment you received there. The anxiety surrounding a diagnosis is inevitable, but there’s no excuse for all the angina-generating mystery surrounding the cost of care.To its credit, the Trump administration is working on multiple fronts to give consumers more information about healthcare prices. On Friday it rolled out the latest of those efforts: a regulation that forces hospitals to reveal what they charge for a wide range of treatments, starting in 2021, and a proposal to require insurers to reveal the patient’s out-of-pocket costs for a scheduled treatment in advance, rather than after the care is provided. (11/19)

At Wednesday’s Democratic presidential campaign debate, MSNBC viewers can expect that once again Sen. Bernie Sanders will claim credit for writing “the damn bill” that would end private health plans. But the good news for patients is that voters don’t seem to want the bill enacted. Two new polls find that a government-run health system remains a tough sale. (James Freeman, 11/19)

More than 100 days have passed since mass shootings at a Walmart in El Paso, Texas, and a nightlife area in Dayton, Ohio, left 31 dead over a span of hours on a weekend. Amid the shock and horror that followed, President Donald Trump started out saying all the right things.He promised meaningful proposals like extending background checks and promoting "red flag" laws that allow judges to temporarily take guns from people deemed a danger to themselves or others. "Politically," he said, "good, bad, or indifferent. I don't care."Spoiler alert: He does care about the politics. (11/18)

Do you really think the government can solve America’s “gun violence” problem — firearms-related suicides, deadly gangbanging and deranged school shooters — by enacting “gun safety” laws? If you do, you might be deluded enough to think that Trump’s decision to abandon his previously stated willingness to seek compromise on the issue is (another) reason to hate the president’s lack of resolve. (Robert Farago, 11/18)

We have a health care emergency in the State of Tennessee, and a TennCare Block Grant will not fix it. As physicians, we see the devastation of this crisis everyday in our clinics emergency rooms, and hospitals. The painful symptoms are all around us, and they are getting worse. (Tennessee Physicians, 11/19)

Living near homeless encampments can mean navigating sidewalks taken over by tents and strewn with trash or even human waste. It can mean enduring noise — the chatter, the arguments, the screaming — of people living on the streets outside your windows. It sometimes means there’s drug use nearby, even the threat of violence. That was the grim portrait of life for a neighborhood in Hollywood that Times columnist Steve Lopez painted in his recent columns in this paper.You can’t read the columns without recognizing the obvious: that homelessness is bad for all of us. It’s clearly disastrous for those caught in its embrace, living on the streets or in shelters — troubled, destitute, fearful, vulnerable. But it’s also affecting the rest of the city, which is just another reason why efforts to solve it need to be redoubled. (11/20)