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The Senate on Tuesday approved a wide-ranging, $854 billion bill that funds the military and a host of civilian agencies for the next year and provides a short-term fix to keep the government open through early December. The measure includes $675 billion for the Defense Department and boosts military pay by 2.6 percent, the largest pay raise in nine years. The bill also approves spending for Health and Human Services, Education, Labor and other agencies, including a 5 percent boost for the National Institutes of Health. (Daly, 9/18)

Funding for the Labor, Education and Health and Human Services departments would total $178 billion, a $1 billion increase from 2018 and almost $11 billion more than Trump requested in his budget proposal for 2019. The Trump administration has objected to the increases in domestic budgets Congress is approving, but that is the price Democrats exacted for agreeing to big military spending increases sought by Republicans and Trump. Although Congress again finds itself nearing the end of the fiscal year without completing action on the 12 must-pass spending bills that fund all government agencies, the situation still represents a major improvement over recent years of budget dysfunction. (Werner, 9/18)

Congress is steaming ahead with a spending package that would claw back billions of dollars from the Children’s Health Insurance Program, just months after Democrats ripped the Trump administration for attempting the same tactic. (Ferris, 9/18)

To combat the opioid epidemic, the bill appropriates $3.8 billion, an increase of $2.7 billion over 2017. Of that, $1.5 billion will go to states for grants. The Senate on Monday passed broad, bipartisan legislation aimed at combating the opioid epidemic through new research, treatment and help for families affected by addiction. (Andrews, 9/18)

To become law, the package would have to pass the House of Representatives, which is out of Washington until Sept. 25, and then be signed by President Donald Trump. (Zengerle, 9/18)

A bipartisan group of senators want Congress' final opioids package to lift a decades-old restriction on Medicaid funding for substance abuse treatment. Sens. Rob Portman (R-Ohio), Ben Cardin (D-Md.), Dick Durbin (D-Ill.) and Sherrod Brown (D-Ohio) introduced a proposal Tuesday to allow states to use Medicaid money to pay for coverage at addiction treatment facilities for people with diagnosed substance use disorders for up to 90 consecutive days — something prohibited under federal Medicaid law. (Hellman, 9/18)

A bipartisan group of senators is unveiling a draft measure to crack down on surprise medical bills, which they say have plagued patients with massive unexpected charges for care. The measure would prevent a health care provider that is outside of a patient’s insurance network from charging additional costs for emergency services to patients beyond the amount usually allowed under their insurance plan. (Sullivan, 9/18)

Kaiser Health News: Senators Unveil Legislation To Protect Patients Against Surprise Medical Bills

“Our proposal protects patients in those emergency situations where current law does not, so that they don’t receive a surprise bill that is basically uncapped by anything but a sense of shame,” Sen. Bill Cassidy (R-La.) said in his announcement about the legislation. Kevin Lucia, a senior research professor at Georgetown University’s Center on Health Insurance Reforms who had not yet read the draft legislation, said the measure was aimed at a big problem. “Balance billing is ripe for a federal solution,” he said. States regulate only some health plans and that “leaves open a vast number of people that aren’t covered by those laws.” (Bluth, 9/19)

The Senate's health committee on Tuesday questioned how the government should be involved in healthcare price transparency and whether Congress can change the incentives to encourage more patient shopping. It isn't clear what Congress could do legislatively to improve transparency. Sen. Lamar Alexander (R-Tenn.), chair of the Senate Health, Education, Labor and Pensions Committee, asked witnesses during Tuesday's hearing what federal mandates on the issue could look like for Medicaid and Medicare. They largely agreed that everyone in the system, from hospitals to physicians to the patients, need to know the actual price and need better access to quality data. But spelling that out through federal mandates could prove elusive. (Luthi, 9/18)

Last year, Cigna Corp. and the New York hospital system Northwell Health discussed developing an insurance plan that would offer low-cost coverage by excluding some other health-care providers, according to people with knowledge of the matter. It never happened. The problem was a separate contract between Cigna and NewYork-Presbyterian, the powerful hospital operator that is a Northwell rival. Cigna couldn’t find a way to work around restrictive language that blocked it from selling any plans that didn’t include NewYork-Presbyterian, according to the people. (Wilde Mathews, 9/18)

The Senate on Monday overwhelmingly passed a bill that would let pharmacists inform consumers when it’s cheaper to buy a drug without insurance, as lawmakers inched closer to delivering the Trump administration a win — albeit a small one — in the effort to lower drug prices. So-called gag clauses prevent a pharmacist from telling consumers when their insurance co-pay is higher than the cash price for a drug. The administration has sought to outlaw the clauses, and its push to do so is one of the few ideas in its drug pricing plan to advance so far in Congress. (Florko, 9/17)

"By ensuring pharmacists can provide their customers with all the information - even the information Big Pharma doesn't want them to know - we can save Ohioans money, improve health care, and increase transparency in the pharmaceutical industry," said a statement from Ohio Democratic Sen. Sherrod Brown, who cosponsored the bill. (Eaton, 9/17)

Drug-pricing advocates are launching a six-figure ad campaign to try to stop Congress from rolling back a move targeting drug companies. The ads from Patients for Affordable Drugs Now seek to counteract an aggressive lobbying push by drug companies to undo a change from February that shifted billions of dollars in new costs onto them. (Sullivan, 9/18)

Hurricane-wracked North Carolina faced a health and environmental crisis after at least 17 hog-waste lagoons were compromised and sewage plants across the state flooded, releasing millions of gallons of partially treated human discharge. On an aerial tour Monday of a swath of swine country -- the dozen top hog-producing counties cover an area the size of New Jersey -- many lagoons appeared intact. Roughly the size of a soccer field, they are blue-green or red, thanks to bacteria that break down the feces and urine. Several, though, were swamped with water from the torrential rains and creeks that had burst from their banks. (Niquette, Natter and Vasquez, 9/18)

When a pig in a large-scale farm urinates or defecates, the waste falls through slatted floors into holding troughs below. Those troughs are periodically flushed into an earthen hole in the ground called a lagoon in a mixture of water, pig excrement and anaerobic bacteria. The bacteria digest the slurry and also give lagoons their bubble gum-pink coloration. North Carolina has 9.7 million pigs that produce 10 billion gallons of manure, mostly on large-scale farms, primarily in low-lying Sampson and Dupin counties. Both counties were affected by Florence. (Pierre-Louis, 9/19)

These fears have existed for years in a low-lying state with a network of rivers that can disperse pollutants for miles. Now climate change is increasing concerns that storms like Florence will strike more often, altering the calculus for where industries will be safe from flooding. "This is a time to recognize that there's a new normal in environmental protection right now,” said Thomas A. Burke, an associate dean at the Johns Hopkins Bloomberg School of Public Health. (Megerian, 9/18)

Like Hurricanes Harvey and Katrina before it, most of Hurricane Florence's damage will not be from the wind but the water. Yes, some people died when they were crushed by trees felled by Florence's winds as it swept across the Carolinas and some homes were destroyed. But most of Florence's victims died in the massive floods that will cause wide and long-term damage to houses, businesses, roads and other infrastructure and produce a spike in water-borne illness. (9/18)

As evacuees make their way out of harm’s way to shelters across eastern and southern North Carolina, health care providers from Charlotte-based Atrium Health headed toward the floods on Sunday afternoon. State officials summoned Carolinas MED-1, a 14-bed mobile hospital, to Pender County, just north of Wilmington. (Duong, 9/17)

As Hurricane Florence bore down on eastern North Carolina, Louise Bledson and her neighbors from Trenton, the tiny county seat in Jones County upstream from New Bern, got the word that buses would come to Jones Senior High School to take people out of the path of the rising Trent River. (Hoban, 9/18)

Hurricane Florence has left thousands of North Carolinians displaced from their homes, or unable to leave because of flooding. Medical issues are bound to arise in the coming days. So for all of those non-emergency issues, there are a number of companies providing free virtual doctor visits. (Knopf, 9/18)

Hurricanes can bring all sorts of trouble — winds, rains, floods. And early fatality data from Florence’s assault on the Carolinas suggest that being in your car, on the road, after the storm hits land has been especially deadly. An analysis by the Los Angeles Times of 35 deaths officials have linked to the storm so far showed that more than half — 20 victims — died when they were apparently trapped in their cars by flooding or were involved in auto crashes during inclement weather. (Pearce and Etehad, 9/18)

When meteorologists downgraded Hurricane Florence from a powerful Category 4 storm to a Category 2 and then a Category 1, Wayne Mills figured he could stick it out. He regrets it. The Neuse River, normally 150 feet away, lapped near his door in New Bern, North Carolina, on Sunday even as the storm had "weakened" further. (Borenstein and Breed, 9/18)

Her son cried out for help via text message on the morning of October 17, a month after Hurricane Maria wrecked this Caribbean island. "Where are you??" the 18-year-old wrote at 11:32 a.m. "Mami call me it's important." Cellular networks in Puerto Rico were still damaged after the Category 4 hurricane, and the messages from her son didn't go through, the boy's mother said. When his frantic words finally appeared on her phone, she panicked. (Sutter, 9/17)

As weeks turned into months, the seats of the small plane began to empty out. In the beginning, 15 passengers flew from Vieques to the Puerto Rican mainland — refugees from Hurricane Maria. The storm had ruined the only dialysis center on this tiny island, their home; without treatment, the kidney patients would die. (Coto, 9/19)

President Donald Trump is privately lashing out at one of his top allies, Ron DeSantis, angrily accusing the Florida Republican gubernatorial nominee of publicly betraying him. The president has told close associates in recent days that he views DeSantis — who won his Aug. 28 GOP primary thanks to Trump’s strong support — as profoundly disloyal for distancing himself from the president’s assertion that the Hurricane Maria death toll was inflated by Democrats for political purposes. (Isenstadt and Caputo, 9/18)

The woman who has accused President Trump’s Supreme Court nominee of sexual assault all but ruled out appearing at an extraordinary Senate hearing scheduled for next week to hear her allegations, insisting on Tuesday that the F.B.I. investigate first. Speaking through lawyers, Christine Blasey Ford said she would cooperate with the Senate Judiciary Committee and left open the possibility of testifying later about her allegations against Judge Brett M. Kavanaugh. But echoing Senate Democrats, she said an investigation should be “the first step” before she is put “on national television to relive this traumatic and harrowing incident.” (Baker, Stolberg and Fandos, 9/18)

“A full investigation by law enforcement officials will ensure that the crucial facts and witnesses in this matter are assessed in a non-partisan manner, and that the committee is fully informed before conducting any hearing or making any decisions,” lawyers for the woman, Christine Blasey Ford, said in a letter to the panel late Tuesday. (Kim, Costa and Wagner, 9/18)

Mr. Grassley indicated the committee wasn’t willing to wait for a full FBI investigation of Dr. Ford’s allegations. “Dr. Ford’s testimony would reflect her personal knowledge and memory of events. Nothing the FBI or any other investigator does would have any bearing on what Dr. Ford tells the committee, so there is no reason for any further delay,” Mr. Grassley said in a statement Tuesday night. (Peterson, Andrews and Nicholas, 9/18)

Sen. Bob Corker (R-Tenn.) tweeted: “Republicans extended a hand in good faith. If we don’t hear from both sides on Monday, let’s vote.” But Democrats backed Ford’s call for an FBI investigation and hinted they may not attend the hearing if she does not testify. “We should honor Dr. Blasey Ford’s wishes and delay this hearing,” Sen. Dianne Feinstein (D-Calif.) said in a statement. “A proper investigation must be completed, witnesses interviewed, evidence reviewed and all sides spoken to. Only then should the chairman set a hearing date.” (Haberkorn, 9/18)

The Trump administration on Tuesday released a new biodefense strategy that it said takes a more comprehensive approach to preparing the nation for deliberate biological attacks and natural outbreaks of infectious disease. The goal of the strategy, which was required by Congress, is to more effectively prevent, prepare for and respond to biological threats, which the document said are "among the most serious threats" facing the U.S. and the world. (Burns, 9/18)

“My Administration is focused on strengthening our Nation’s defenses against the full range of threats to our health and security, including those of a biological nature,” Trump said in a statement. “With these actions today, I am reaffirming my unwavering commitment to protecting the American people, the American homeland, and the American way of life.” (Sullivan, 9/18)

The committee includes officials from the Pentagon, Agriculture and Homeland Security departments and will review capabilities across the intelligence community and 15 executive branch agencies. It will assess the agencies' ability to respond to both man-made and naturally occurring biological threats, HHS Secretary Alex Azar said during a press briefing. That survey will influence spending priorities in fiscal 2020, with the biggest effects likely to be seen in 2021, he said. (Owermohle, 9/18)

The Trump administration is unable to account for the whereabouts of nearly 1,500 migrant children who illegally entered the United States alone this year and were placed with sponsors after leaving federal shelters, according to congressional findings released on Tuesday. The revelation echoes an admission in April by the Department of Health and Human Services that the government had similarly lost track of an additional 1,475 migrant children it had moved out of shelters last year. (Nixon, 9/18)

Democrats believe they have their best chance in years to flip crucial state attorney general seats by trumpeting the same message that drew furious protesters to town halls and to the polls last year: Republicans are trying to take away your health care. These down-ballot races usually fly under the radar, but they are front and center in 2018 as many Democratic officeholders have turned the positions into the cornerstone of resistance to President Donald Trump, challenging dozens of his policies in court, from the separation of immigrant families at the border, to the ban on travel from several Muslim countries, to the crackdown on marijuana sales in states that legalized the drug. (Ollstein, 9/18)

Rep. Beto O'Rourke (D-Texas) on Monday called for the state of Texas to expand Medicaid. "Texas should expand Medicaid today," O'Rourke, who is challenging Sen. Ted Cruz (R-Texas), for a U.S. Senate seat this November, tweeted, linking to an editorial from The Houston Chronicle about the program that helps people with limited resources receive medical care. (Wise, 9/18)

In the past four years, the opioid crisis has grown from an afterthought in political campaigns to an important issue in some of this fall’s biggest midterm races, according to television advertising data from Kantar Media/CMAG. An analysis by The Wall Street Journal found that, so far in 2018, ads containing opioid messaging have aired more than 50,000 times across 25 states. At this point in 2014, there had been only one political TV ad touching on the topic that aired 70 times—in Kentucky’s Senate race. (Chinni, Jamerson and Dougherty, 9/19)

Chronic-pain patients in Maryland are asking for help in easing restrictions they face in getting drugs to treat their pain because of the crackdown on opioids. About two dozen people attended a rally in front of the Maryland State House on Tuesday where participants held signs that said: “Don’t Punish Pain,” and “Make Health Care Again.” (9/18)

The opioid crisis has gotten so bad that some employers are struggling to find sober workers. “The drug-testing challenge is a significant one for hiring,” said Charlie Weaver, executive director of the Minnesota Business Partnership, an organization of 120 CEOs from companies that employ about 400,000 Minnesotans. (Magan, 9/18)

It’s a promising new drug for multiple myeloma, one of the most savage blood cancers. Called Ninlaro, it can be taken as a pill, sparing patients painful injections or cumbersome IV treatments. In a video sponsored by the manufacturer, Takeda Pharmaceutical Co., one patient even hailed Ninlaro as “my savior.” The Food and Drug Administration approved it in 2015 after patients in a clinical trial gained an average of six months without their cancer spreading. That trial, though, had a major shortcoming: its racial composition. One out of five people diagnosed with multiple myeloma in the U.S. is black, and African-Americans are more than twice as likely as white Americans to be diagnosed with the cancer. (Chen and Wong, 9/19)

Most trials are run at academic medical centers and conducted by researchers there. Patients outside those centers often aren’t aware that clinical trials are an option, or they may wonder what joining a study entails. For patients who might consider a clinical trial, here are answers to some common questions. (Chen, 9/19)

The two men, high school buddies, sit in a turquoise and white booth at Rosie’s Diner, ribbing each other like they are teenagers at Sweetwater High School where they played baseball together so many years ago. A 1950s-era jukebox spits out tunes like “Peggy Sue” by Buddy Holly. Vinyl records and black-and-white pictures of celebrities like Elvis Presley and Audrey Hepburn line the walls. Now in their 70s, James Mann and Richard Eshbach are actually in Glenner Town Square, a new adult day-care center for dementia patients that is like entering a time warp. The 11 storefronts that surround an indoor park represent the time period from 1953 to 1961, when most of the patients were in the prime of their life. (Reddy, 9/18)

The Food and Drug Administration is launching a new advertising campaign aimed at educating teenagers about the dangers of vaping. The “Real Cost” campaign will target nearly 10.7 million middle and high schoolers aged 12-17 by placing ads in school bathrooms and on social media and educational platforms frequented by teens. (Weixel, 9/18)

In a rare move, the U.S. government has approved the importation of marijuana extracts from Canada for a clinical trial, highlighting a new avenue for American researchers who have long had trouble obtaining the drug for medical studies. The University of California, San Diego’s Center for Medicinal Cannabis Research announced Tuesday the Drug Enforcement Administration has OK’d its plans to import capsules containing two key cannabis compounds — CBD and THC — from British Columbia-based Tilray Inc. to study their effectiveness in treating tremors that afflict millions of people, especially those over 65. (Johnson and Watson, 9/18)

It’s estimated more than 30 percent of American adults with diabetes don’t realize they’re suffering from the potentially deadly disease. Data from the National Health and Nutrition Examination Survey show about one in seven suffered from diabetes between 2013 and 2016, with the prevalence of diagnosed diabetes at 9.7 percent and the prevalence of undiagnosed diabetes at 4.3 percent. (Tanzi, 9/19)

You have a gene called PNMA6F. All people do, but no one knows the purpose of that gene or the protein it makes. And as it turns out, PNMA6F has a lot of company in that regard. In a study published Tuesday in PLOS Biology, researchers at Northwestern University reported that of our 20,000 protein-coding genes, about 5,400 have never been the subject of a single dedicated paper. (Zimmer, 9/18)

A visit to your primary care physician may focus on your headaches or that achy back. But if your body mass index is over 30, a panel of national experts says, it should also include a referral to an intensive weight-loss program. That's the latest recommendation of the U.S. Preventive Services Task Force, an independent panel of national experts in disease and public health that advises primary care physicians on best practices. (Blakemore, 9/18)

Four European patients developed breast cancer after receiving organs from the same donor, a case report explains. The patients developed breast cancer years after their transplants, with three of them dying of the disease. (Avramova, 9/18)

Some experts believe that a high daily dose of folic acid can reduce the risk for pre-eclampsia, the dangerous high blood pressure that can occur during pregnancy. A randomized trial has found that it does not work. Folic acid in small doses is proven to reduce the risk for the serious birth defects of the brain or spinal cord called neural tube defects, so prenatal vitamins contain the nutrient. But some epidemiological evidence has suggested that the more folic acid taken, the lower the risk for pre-eclampsia. (Bakalar, 9/18)

Gaining either too much or too little weight during pregnancy may be bad for your child’s heart health. Researchers studied 905 mother-child pairs, dividing the mothers into groups that either matched or exceeded the recommended weight gain — 25 to 35 pounds for women with a body mass index between 18.5 and 24.9; 28 to 40 pounds for those with a B.M.I. under 18.5; and 15 to 25 pounds for a woman with a B.M.I. above 25. They then assessed their children’s heart health at age 7. The study is in Diabetologia. (Bakalar, 9/18)

People move differently when they walk in groups than when they walk alone. And their walking style is especially distinct when they walk with children, according to a fascinating new cross-cultural study of pedestrians in several nations. The study, which also shows that men tend to walk differently with other men than with women and that some cultures may promote walking speed over sociability, underscores that how we move is not dependent solely on physiology or biomechanics. (Reynolds, 9/19)

Today, JAMA publishes two major studies on a hot topic: physician burnout. Burnout is a buzzword that's been in the news, but what is it? How does it affect doctors and their patients? It turns out, nobody really knows. The first study, a systematic review, summarizes the research to date on physician burnout. Study authors found that researchers do not use a consistent definition of burnout, and estimates of how common it is vary widely. The second study followed doctors-in-training over six years and tracked how they felt about their work. They found that women and doctors in certain high-stress specialties were more likely to experience symptoms of burnout, like emotional exhaustion and regret about career choice. (Gordon, 9/18)

Efforts to address physician burnout may need to start as early as residency, a new JAMA study suggests. The results of one of two studies related on burnout published Tuesday in JAMA found 45% of second year residents surveyed reported having at least one symptom of the condition. (Johnson, 9/18)

Bayer AG unit Monsanto on Tuesday asked a California judge to throw out a $289 million jury verdict awarded to a man who alleged the company's glyphosate-based weed-killers, including Roundup, gave him cancer. The company said in motions filed in San Francisco's Superior Court of California that the jury's decision was insufficiently supported by the evidence presented at trial by school groundskeeper Dewayne Johnson. (Bellon, 9/19)

The jury in that case ruled unanimously in favor of a former groundskeeper who sought to hold the maker of Roundup liable for his non-Hodgkin lymphoma. The verdict came only two months after the German pharmaceutical and chemical conglomerate sealed its takeover of Monsanto, the U.S. agriculture giant that invented the herbicide. Bayer shares have dropped about 22% since the verdict to five-year lows. (Bunge and Bender, 9/18)

Toting a huge olive-green backpack stuffed with medical supplies, physician assistant Joel Hunt pushes through a dense cluster of woods less than two miles from downtown Fort Worth. He approaches a suspended tarp that serves as a makeshift tent, peeking inside at an elderly woman who was evicted from her home nearly eight months ago. “So how have you been doing?” Hunt asks. The woman, who is lying on her back, warms up to Hunt’s gentle questioning. She says she is out of medicine for her back pain, and was “kicked out” of her residence in January. Hunt invites her to his clinic for a back-pain referral, then extends his hand in a fist-bump gesture. The woman reaches out and pats his wrist. (Montgomery, 9/18)

Lawyers are asking a U.S. judge to issue a preliminary injunction blocking a new Idaho law requiring doctors to report extensive personal information to the state about women who have had abortions. The law, which took effect July 1, requires health care providers to disclose information about patients who had one of several "complications" listed in the law, the Idaho Press reported . A preliminary injunction means the law would not be enforced while the matter is being discussed in court. (9/18)

DeVonte Jones began to show signs of schizophrenia as a teenager. His first public episode was nine years ago at a ball game at Wavering Park, in Quincy, Ill. "He snapped out and just went around and started kicking people," says Jones' mother Linda Colon, who now lives in a Chicago suburb. The police were called. Jones was arrested, charged with aggravated battery and placed in Adams County Jail. Colon says Jones had no recollection of what happened. (Herman, 9/19)

State health officials have increased the number of confirmed cases of Legionnaires’ disease to 18, following an outbreak in Hampton this summer which left one person dead and 16 hospitalized. Health officials believe the outbreak began near Ashworth Avenue and the surrounding area between June 10 and Aug. 26. (Feely, 9/18)

Some pretty important people — the governor, a former Supreme Court justice and a hospital CEO, to name a few — were at the State House for Monday’s official unveiling of a poster campaign to raise awareness of mental health in the schools. But it was the students who stole the show. R.E.A.C.T. is a partnership among Dartmouth-Hitchcock, the state Department of Education and the New Hampshire Interscholastic Athletic Association (NHIAA). It aims to encourage students who are dealing with emotional suffering and mental illness to get the help they need. (Wickham, 9/17)

Connecticut hospitals and health networks have received an estimated $1.2 billion in outpatient facility fees from 2015 through 2017, according to data released Tuesday. These fees are collected for a wide-range of services, including oncology, eye surgery and psychotherapy, provided at off-site facilities run by hospitals and health networks. (Kara and Rigg, 9/18)

The new director of a stem cell research facility at the University of Kansas Medical Center said he’s not concerned about recent reductions in the facility’s space. But he does think it needs more money.Sunil Abhyankar, a KU oncologist who specializes in blood cancers, was introduced to the Midwest Stem Cell Therapy Center Advisory Board as the center’s new director Monday night. (Marso, 9/18)

Veterans hoping for more mental health services may soon get it in the form of a $29.2 million grant given to the Emory Healthcare Veterans Program. The Wounded Warrior Project awarded the program with the five-year grant at Monday night’s Braves game. (Habersham, 9/18)

Department of Correction health care workers stood in the pouring rain outside a Hartford prison Tuesday to rally against staffing vacancies and demand an agreement from gubernatorial and legislative candidates to fill empty jobs they say are undermining quality inmate care. Sheltering underneath a blue and yellow umbrella as he tried to see through rain-speckled glasses, social worker Matthew Eggen said the insufficient staffing levels have left health care workers unable to provide the type of care the state and inmates in the system deserve. (Silber, 9/18)

Georgia’s obesity rate for adults is about average among states, the CDC reports. But it’s still a startlingly high figure. Almost one in three residents in the state is obese. (Miller, 9/18)

Jack Isenberg was funny and quirky, sweet-natured and kind-hearted.Jack was devoted to his family, his collie and his two cats. He liked riding his bike and playing basketball, and he loved cartoons. He wanted to become a chef. "He was just the fun in our house," his mom says. "He glued everything, all the kids, together." (Wickham, 9/16)

Dr. Grant William Robicheaux billed himself as an elite orthopedic surgeon catering to Newport Beach’s famous and wealthy. It was a lifestyle he pushed not only in his medical work but on realty TV, where he appeared on a Bravo dating show wearing his hospital scrubs and a wide smile. (Winton, 9/18)

Ruggiero is among a small but growing group of people in their 80s and 90s who have decided to experiment with marijuana, still an illegal substance under federal law. A majority of states have legalized it to treat a wide array of ailments and its popularity is rising. (Hefler, 9/19)

Court and jail officials are taking steps to improve what have been described as “barbaric” conditions for mentally ill women inmates held at a south Fulton County jail, one of the county’s top judges said. The Sheriff’s Office is providing extra correctional officers to work with the women prisoners, and the jail’s healthcare provider is doubling its visits to the jail and educating guards on how to properly interact with the women, Fulton State Court Chief Judge Diane Bessen said. (Rankin, 9/18)

According to a 2017 report by the Maricopa County Department of Public Health, 26 percent of heat-associated deaths occurred among homeless individuals. The department estimated 94 homeless individuals died due to the heat between 2016-2017. (Castle, 9/18)

Drug prices increased at roughly twice their usual rate after shortages developed, a study found, suggesting that pharmaceutical companies may be reaping additional profits when urgently needed medicines become scarce. Researchers at the University of Pittsburgh and Harvard Medical School examined the prices of 617 dosages and formulations of 90 different drugs that went in short supply between December 2015 and December 2016. They found that prices rose a cumulative 16 percent, on average, in the 11 months after the shortage began, compared with 7.3 percent in the prior 11 months. (Langreth, 9/17)

The findings come amid ongoing shortages blamed on drug makers that failed to build enough production capacity, maintain equipment, or ward off contamination in aging plants. At the same time, there is concern some manufacturers are manipulating production to bolster profits. (Silverman, 9/17)

The American Hospital Association has launched a new effort it hopes will bring more transparency to the 340B drug discount program. Under the so-called 340B stewardship principle initiative, the trade association plans to encourage hospitals to release information on their 340B savings and what they usually do with that money. (Dickson, 9/18)

Patients with a rare disease are asking the Food and Drug Administration a question the agency rarely hears: Is that really your final answer? A group for people with familial chylomicronemia syndrome (FCS), a genetic condition that causes fat to build up in a person’s blood, is circulating a petition that begs the FDA to reconsider its decision to reject the one experimental treatment for FCS, Akcea’s volanesorsen. As of Monday, the petition had more than 8,000 signatures. (Sheridan, 9/18)

CVS Caremark may revisit a plan that allows its clients to exclude coverage of most new, high-priced drugs after advocacy groups complained the effort would discriminate against very sick or disabled patients. At issue is a cost-effectiveness program the pharmacy benefits manager touted last month for assessing value — in this case, any new drug exceeding $100,000 per QALY, or quality-of-life years, a benchmark that measures both the quantity and quality of life generated by providing a treatment. New drugs exceeding the threshold may be excluded from health plan and employer formularies, or coverage lists. (Silverman, 9/18)

In a wide-ranging scheme, AbbVie (ABBV) used a combination of old-fashioned kickbacks to doctors and a stealthy network of nurses to illegally boost prescriptions of its best-selling Humira treatment, according to a lawsuit filed on Tuesday by the California insurance commissioner. Over a five-year period, the drug maker offered physicians a familiar menu of tempting items, from cash, meals and drinks, to gifts and trips, along with patient referrals, in hopes they would write more prescriptions for its Humira rheumatoid arthritis treatment, a $12.3 billion seller in the U.S. last year. (Silverman, 9/18)

"Ultimately, AbbVie gambled with the health and safety of thousands of Californians' lives, including children, by making sure patients continued to take Humira at any cost, all to protect their profits not the health and well-being of patients," Jones said. Humira is an injectable drug that is widely advertised as a treatment for rheumatoid arthritis and other inflammatory conditions and comes with a warning for cancer and serious infections that can turn deadly. It had sales of over $12 billion in 2017, according to the lawsuit. (Thanawala, 9/18)

Democrat Jared Polis pledged Monday to strengthen health care consumer protections, create a system to import prescription drugs from Canada and reform the state’s health insurance zones as part of his first 100 days if elected governor. Those new campaign promises are among more than a dozen policy proposals the Boulder congressman outlined in front of a doctor’s office in this mountain town and said that if put in place they would immediately drive down the cost for health care. (Garcia, 9/17)

Democrat Ben Jealous is supporting proposals aimed at making prescription drugs more affordable in Maryland. Jealous, who is running for governor, announced his support for the measures Monday at a news conference. He is backing legislation to create a state board to focus on ensuring transparency and accountability in prescription drug pricing. He says companies would be required to provide advance notice before increasing prices and explain why. (9/17)

Novo Nordisk, the world's top maker of diabetes drugs, said on Tuesday that it will lay off 400 staff in Denmark and China as part of a broader restructuring of its research and development organisation. The firm, which employs more than 42,000 people in 79 countries, has seen growth slow due to pricing pressures in the United States, from where it sources about half its revenue. (Gronholt-Pedersen, 9/18)

In experimental pill from Viking Therapeutics (VKTX) reduced liver fat in patients with early signs of fatty liver disease, according to results from a mid-stage clinical trial announced Tuesday. The promising clinical trial results thrust Viking into the mix of companies racing to develop new treatments for NASH, the commonly used acronym for non-alcoholic steatohepatitis, a chronic disease in which fat accumulates in the liver. (Feuerstein, 9/18)

Biotech’s run of successful initial public offerings is showing no signs of fatigue. Five companies are queued up to go public before the month is out, and the industry is on an IPO pace not seen since its most recent boom resulted in a painful correction. Forty-three biotech companies have gone public in 2018, raising about $4.2 billion in the process. If all six of September’s planned IPOs succeed, biotech will be on pace for 60 Wall Street debuts on the year, which would be the most since 2015, when there were 68. (Garde, 9/19)

Clovis Oncology (CLVS), its chief executive, and a former chief financial officer will collectively pay more than $20 million to settle civil charges of misleading investors about a lung cancer drug that was being developed. During a four-month period beginning in July 2015, the drug maker and chief executive Patrick Mahaffy made various misleading statements about the effectiveness of its rociletinib drug compared with another treatment. (Silverman, 9/18)

The pharmaceutical industry’s most powerful lobbying group is opening its war chest to try to sway a policy fight with no clear connection to medicine or health care, spending a half-million dollars here to oppose a California ballot measure that would expand rent control protections across the state. (Facher and Robbins, 9/19)

A new gold-standard triple therapy for H.I.V. has just made its debut in Africa. It costs $75 a year. In the United States, many people with H.I.V. take an almost identical therapy. It costs $39,000 a year. The United States is infamous for its high cost of health care — and H.I.V. medicines are a big part of that. Plenty of drugs carry outrageous prices: EpiPens, insulin, cancer treatments, even some antibiotics. But no class of medicines is more scandalously expensive than for H.I.V. These medicines are by far the largest item in Medicaid’s drug budget, the third largest for the insurance exchanges and the fifth largest for commercial insurers. (Tina Rosenberg, 9/18)

The Trump administration has just announced the formation of a working group at the Food and Drug Administration to study legalizing the importation of foreign-made drugs. Although the study is limited to a narrow set of circumstances in which imports might be allowed, it sets us on a path we shouldn't step on. The goal is to lower costs and prevent price-gouging by drug makers who find themselves with monopoly power over a particular treatment -- say, an out-of-patent medication for a rare disease with only a single generic manufacturer in the market. But proponents of imports are only starting with the narrow case. Their real goal is to allow foreign imports on a massive scale. (Peter Pitts, 9/17)

The Trump administration is close to issuing a new rule that could effectively ban rebate payments from drug manufacturers to pharmaceutical benefit managers, or PBMs. The plan is misguided. A full ban would backfire and increase costs to consumers. The regulation, now under review at the Office of Management and Budget, could remove the safe-harbor protection for rebate payments under an anti-kickback law. But rebates are price discounts, not kickbacks. They reduce prices based on sales volume: Drug companies charge less when more of their drugs are sold to patients. (Josepth Antos and James C. Capretta, 9/16)

On Thursday, Dr. José Baselga resigned from his position as chief medical officer at Memorial Sloan Kettering Cancer Center. Earlier this month, ProPublica and The New York Times revealed that he’d received millions of dollars from drug and device companies whose fortunes he stood to affect. He also sat on the board of at least six companies, where his fiduciary responsibility to them might conflict with his obligations to the cancer center. Most of his outside income was not disclosed to the journals in which he published, in violation of their requirements. Although his case is extreme, these kinds of conflicts of interest are virtually universal in the upper levels of academic medicine. (Marcia Angell, 9/14)

Several pharmaceutical companies have been jacking up the prices of their drugs in unethical ways. Most recently, Nirmal Mulye, founder and president of Nostrum Pharmaceuticals, defended his decision to more than quadruple the price of nitrofurantoin, used to treat bladder infections, from about $500 to more than $2,300 a bottle. He said it was his "moral requirement to sell the product at the highest price." (Robert Klitzman, 9/18)

Cigna Corp. has successfully dodged two giant obstacles in its attempt to purchase pharmacy-benefit manager Express Scripts Holding Co. First, it got past Carl Icahn, who tried to convince investors to vote no on the deal in August, only to drop the effort days later after giving it further thought. And on Monday afternoon, it won clearance from the Department of Justice to go ahead with the transaction. But the hardest part lies ahead. This is a period of massive uncertainty for the PBM business, and Cigna is paying $54 billion for the pleasure of having to navigate it. (Max Nisen, 9/17)

The United Nations “high-level meeting” on tuberculosis will take place in less than a month and the political declaration that emerges from it will, for better or worse, shape the global response to the world’s deadliest infectious disease for years, perhaps decades, to come. There is a very real risk that the declaration could undermine, rather than improve, access to medicines for the more than 10 million people who fall ill with tuberculosis every year. To prevent this from happening, we must distinguish disagreements that are honest from those that are dishonest. (John Stephens, Brabha Mahesh and Brian Citro, 9/13)

To reduce the burden of high-cost, low-value drugs, Massachusetts has proposed establishing a closed formulary, in which certain drugs can be excluded from coverage, for its Medicaid program. In late June, however, CMS denied the state’s request without explanation. (Nicholas Bagley and Rachel E. Sachs, 9/13)

In 2017, Maryland enacted a statute that prohibits manufacturers from “price gouging” on any “essential off-patent or generic drug.” But in April 2018, a panel of the federal Fourth Circuit Court of Appeals overturned that statute. (Christopher Robertson, 9/13)

There is no way to redo 1991, but there are ways to do better. The facts underlying Christine Blasey Ford’s claim of being sexually assaulted by a young Brett Kavanaugh will continue to be revealed as confirmation proceedings unfold. Yet it’s impossible to miss the parallels between the Kavanaugh confirmation hearing of 2018 and the 1991 confirmation hearing for Justice Clarence Thomas. In 1991, the Senate Judiciary Committee had an opportunity to demonstrate its appreciation for both the seriousness of sexual harassment claims and the need for public confidence in the character of a nominee to the Supreme Court. It failed on both counts. (Anita Hill, 9/18)

When I first called Anita Hill in 1991 to ask her, out of the blue, if she had been sexually harassed by then-Supreme Court nominee Clarence Thomas, she was very reluctant to give me any details. ... In my opinion, if Hill’s story had been handled properly earlier in the process, and she had been given time to prepare to testify, Thomas would not today be the senior associate justice on the Supreme Court. (Timothy M. Phelps, 9/18)

Even if it wins its long-desired victory at the high court and more anti-abortion legislation becomes possible, a pro-life cause joined to a party that can’t win female votes and seems to have no time for women will never be able to achieve those legislative goals, or at least never outside a very few, very conservative states. And having that long-awaited victory accomplished by a male judicial appointee confirmed under a cloud of #MeToo suspicion seems like a good way to cement a perception that’s fatal to the pro-life movement’s larger purposes — the perception that you can’t be pro-woman and pro-life. (Ross Douthat, 9/18)

The scale of America’s opioid crisis can be daunting. The latest numbers show that more than 72,000 Americans died of a drug overdose in 2017, most of them involving opioids. The tragic statistics are a reminder of why President Trump has made combating the opioid crisis a top priority for his presidency. But everywhere the crisis has struck, there are signs of hope and resilience. Earlier this year, I visited a clinic in Dayton, Ohio — one of the hardest hit communities in the country — that treats new mothers struggling with addiction and their infants born physically dependent on opioids. (Health and Human Services Secretary Alex Azar, 9/19)

Cincinnati’s coordinated approach has produced a significant drop in mortality. Not only did we increase Narcan supply throughout the community to ensure immediate access to addiction treatment, we integrated our hospitals into the continuum of addiction care in doing so. What followed was the development and implementation of novel clinical protocols across our community. While we have made progress, there’s a long way to go to ensure these methods are universally embraced and provided the necessary support. An often overlooked factor in creating the enormous gap in appropriately addressing the opioid crisis is that 17 states still haven’t expanded Medicaid. Medicaid covers nearly 4 in 10 non-elderly adults with opioid use disorder and the program supports critical access to comprehensive services, including essential, FDA-approved medications. (Navdeep Kang, 9/17)

On Sept. 27, 2017, my father died in the aftermath of the hurricane. He waited in line for 35 hours for gasoline, which he needed to run his generator. While in line, a tank exploded and he inhaled the fumes and smoke. He made it to his front door, collapsed, and died. Puerto Rico is still without power, cell phone service and supplies a week after Hurricane Maria, and it's hard for Clevelanders to check the status of their families there. My father was not part of the original list of the dead. Recently, he and 3,000 others were counted and added to that list, a list that has been disputed by our president .... Like everything else, he sees "this list" as a ploy to make him look bad. (Victor Ruiz, 9/19)

Tuberculosis remains the world’s most lethal infectious killer. It claims more lives than HIV/AIDS and malaria combined. TB is also a preventable, treatable, curable disease. Clearly there is an enormous gap here. World leaders are expected to address this chasm at the United Nations next week , and they must do more than give speeches. They need to act. (9/18)

The FDA recently announced that it considers a new surge in teen e-cigarette use to be an epidemic, and will give e-cigarette manufacturers 60 days to prove that they are not marketing to kids. This is a very welcome move for those of us who have been pushing to prevent teen tobacco use. Our city recently took on the makers of e-cigarettes and won. The FDA should take San Francisco's lead and do everything it can to protect kids from Big Tobacco. (Tomas Aragon and Derek Smith, 9/18)

Imagine government bureaucrats in Washington deciding whether your life is worth saving or not. Such a nightmare that could very well become a reality should the Democrats get their way.When the government gets involved in healthcare, it always leads to disaster and death — and “Medicare for All” is the crown jewel of social healthcare programs. (Herman Cain, 9/19)

The recent deaths of five inmates in Cuyahoga County custody -- who were being held in either the County Jail or in the Euclid Jail, which is now run by the county - should prompt a deeper investigation, along the lines of one recently undertaken in Summit County, to examine underlying problems for possible preventive measures and programs. Cleveland.com's Adam Ferrise recently reported that the five deaths represent the largest number of Cuyahoga County inmate deaths in a single year since 2009. (9/19)

In 2004, the voters of California approved Proposition 71, creating the California Institute for Regenerative Medicine and setting the state on the path to becoming a global leader in stem cell research. Today the therapies resulting from the institute’s work are not just changing lives — they are already saving lives. (Maria T. Millan and Jonathan Thomas, 9/17)

Now on Gov. Jerry Brown’s desk, SB 1192 would require restaurants that offer children’s meals to make the default option on drinks that come with them either water, sparkling water, flavored water without added sweeteners, or unflavored milk. That will help parents like me know that the healthy choice is an easy one, and that our children get the right messages about healthy behaviors. (Donna Norton, 9/18)