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Morning Briefing

Summaries of health policy coverage from major news organizations

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Monday, May 13 2019

ϳԹ News Original Stories 2

  • How Obamacare, Medicare And ‘Medicare For All’ Muddy The Campaign Trail
  • ‘John Doe’ Patients Sometimes Force Hospital Staff To Play Detective

Pharmaceuticals 2

  • 44 States Sue Pharma Companies Over Alleged Conspiracy To Inflate Generic Drug Prices By As Much As 1,000%
  • FDA Gives Final Word On Biosimilar 'Interchangeability' In Move That Could Boost Competition In Pricey Market

Elections 1

  • What Are 2020 Candidates Being Asked About On The Trail? Health Care, Health Care, Health Care

Capitol Watch 1

  • Doctors, Hospitals And Insurers Don Their Armor As They Prepare For A Fight Over Surprise Medical Bills

Marketplace 2

  • Washington Poised To Create 'Public Option,' Thrusting State Into National Debate Over Best Health Care System
  • Financially Crippled Hospitals In Rural America Are Fending Off Closure Hour-By-Hour

Medicaid 1

  • Montana Renews Medicaid Expansion With Work Requirements That Will Trigger An Audit If Too Many People Are Dropped

Women’s Health 1

  • Untangling The Inflammatory Rhetoric Around Abortion Bills In Georgia, Alabama

Health IT 1

  • In Hospitals Where Alarms Can Be Easily Missed, Can AI Help Predict Crises Before They Strike?

Public Health 2

  • Racing To Get Ahead Of An Outbreak: Experts Project What Cities Could Be The Next To Be Hit By Measles
  • As Many As Two-Thirds Of Older Americans Will Need Long-Term Care But Won't Be Able To Afford It

Opioid Crisis 1

  • Opioid Litigation Divides Sackler Family Over How To Respond To Charges It Bears Responsibility For Deadly Epidemic

State Watch 1

  • State Highlights: Washington Health Spending Law For Native American Groups Called Promising; Citing Abuses, 5 More Former Ohio State Students File Lawsuit Against Team Doctor

Editorials And Opinions 2

  • Perspectives: After Georgia's Abortion Law Passed, Forced Pregnancies Are Not The Only Option; So Exactly When Is Someone Pregnant?
  • Viewpoints: Latest White House Proposal Promises To Cut Programs For The Poor; Society Needs To Chime In Since Government Isn't Addressing Health Disparities

From ϳԹ News - Latest Stories:

ϳԹ News Original Stories

How Obamacare, Medicare And ‘Medicare For All’ Muddy The Campaign Trail

A talking point used by House Speaker Nancy Pelosi refers to all three of these distinct concepts in a way that could magnify public misperceptions. ( Shefali Luthra , 5/13 )

‘John Doe’ Patients Sometimes Force Hospital Staff To Play Detective

A large public hospital in Los Angeles gets over 1,000 unidentified patients a year. Most are quickly identified, but some require considerable gumshoe work — a task that can be complicated by medical privacy laws. ( Susan Abram and Heidi de Marco , 5/13 )

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Summaries Of The News:

Pharmaceuticals

44 States Sue Pharma Companies Over Alleged Conspiracy To Inflate Generic Drug Prices By As Much As 1,000%

In court documents, the state prosecutors lay out a brazen price-fixing scheme involving more than a dozen generic drug companies, including Teva, Pfizer, Novartis and Mylan. A key element of the scheme was an agreement among competitors to cooperate on pricing so each company could maintain a “fair share” of the generic drug markets, the complaint alleges.

Attorneys general from more than 40 states are alleging the nation's largest generic drug manufacturers conspired to artificially inflate and manipulate prices for more than 100 different generic drugs, including treatments for diabetes, cancer, arthritis and other medical conditions. The lawsuit, filed in federal court in Connecticut on Friday, also names 15 individual senior executives responsible for sales, marketing and pricing. (LeBlanc, 5/11)

Leading drug companies including Teva, Pfizer, Novartis and Mylan conspired to inflate the prices of generic drugs by as much as 1,000 percent, according to a far-reaching lawsuit filed on Friday by 44 states. The industrywide scheme affected the prices of more than 100 generic drugs, according to the complaint, including lamivudine-zidovudine, which treats H.I.V.; budesonide, an asthma medication; fenofibrate, which treats high cholesterol; amphetamine-dextroamphetamine for A.D.H.D.; oral antibiotics; blood thinners; cancer drugs; contraceptives; and antidepressants. (Murphy, 5/11)

Teva USA denied wrongdoing in a statement to Reuters. “The allegations in this new complaint, and in the litigation more generally, are just that – allegations,” the company said. “Teva continues to review the issue internally and has not engaged in any conduct that would lead to civil or criminal liability.” The drugs in the alleged scheme include treatments for diabetes, high cholesterol, high blood pressure, cancer, epilepsy and more, according to the news outlet. (Frazin, 5/11)

Connecticut’s new attorney general, William Tong, is dramatically expanding the scope and raising the profile of the state’s long-running investigation of drug price-fixing, accusing the generic drug industry of a massive anti-trust conspiracy that has cost American consumers, taxpayers and insurers billions of dollars. In lawsuit filed Friday in U.S. District Court and announced Sunday night by his office as “60 Minutes” aired a story about the case, Connecticut and a coalition of 43 other states accuse Teva Pharmaceuticals and 19 of the nation’s other leading generic drug manufacturers of conspiring to fix prices on more than 100 drugs. (Pazniokas, 5/12)

Congress established the current generic industry in 1984 to push prices down. The idea was that once patents on brand name drugs expired, generic makers would compete to make drugs more affordable. But 1,215 generics, many of them the most prescribed drugs, jumped on average more than 400 percent in a single year. (Whitaker, 5/12)

In other generics pricing news —

Generic drugs are supposed to work just as well as their name-brand counterparts. Once a patent lifts, generic drug companies find alternative ways to manufacture a drug that should work indistinguishably from the name-brand version. In a world of skyrocketing prescription drug prices, cheaper generics have acted as a crucial counterweight. (Lambert, 5/12)

FDA Gives Final Word On Biosimilar 'Interchangeability' In Move That Could Boost Competition In Pricey Market

The FDA released guidelines on the studies companies need to conduct to show their biosimilar is interchangeable with a biologic. Right now, biosimilars can’t automatically be substituted by a pharmacy for a brand product without the FDA’s interchangeability designation, and there are no FDA-approved interchangeable biosimilars on the market. Advocates hope this move will change that.

The FDA on Friday spelled out exactly what kind of studies biosimilar drug makers must conduct in order to be considered “interchangeable” with a biologic drug the way a generic functions for a normal medicine. It’s the agency’s final word on a controversial and long-running fight over how it will define those rules for the pricey category of biologic drugs, the complex drugs made from living organisms used to treat conditions like cancer, and their copycat biosimilars. (Florko and Silverman, 5/10)

The FDA has approved 19 biosimilar drugs, but it has not approved any drugs that are interchangeable with a biologic. Several providers say that the lack of interchangeability has been one of the barriers to more availability with others being physician reluctance. Catholic hospital chain Ascension recently complained at a U.S. House of Representatives hearing that physicians are reluctant to prescribe biosimilars and interchangeability is gravely needed. The guidance will be very helpful for healthcare systems that include pharmacies. (King, 5/10)

In other pharmaceutical news —

Seeking to blunt criticism of its pricing, Gilead Sciences (GILD) is donating enough of its HIV prevention pill to cover as many as 200,000 patients over the next 11 years. The donation will cover both the existing Truvada pill, which has been the subject of battles with AIDS activists, and still another drug the company hopes will also win regulatory approval to prevent the virus. The move was hailed by the Trump administration, which announced plans to end HIV in the U.S. by 2030, but has also been criticized by activists for not taking steps to reduce the cost of Truvada. The pill, which is also sometimes referred to as PrEP, costs about $1,675 a month, or $20,000 a year, but has been climbing steadily since it was first introduced in 2004 for treating HIV. (Silverman, 5/10)

Elections

What Are 2020 Candidates Being Asked About On The Trail? Health Care, Health Care, Health Care

The Des Moines Register analyzed the questions Iowan voters were asking visiting candidates and found that health care ranks as a top concern. Meanwhile, The Washington Post fact checks Cory Booker's statements on guns and KHN looks at how health issues are muddying Democrats' campaigns.

It was April 1 — a week before California Congressman Eric Swalwell officially announced he would run for president — and an auditorium full of high school students in Algona, Iowa, was already grilling him about his plans for the country. “About your health care policies,” one student said into the microphone. “How would you pay for that?” Swalwell didn’t simplify his answer for the students — many of whom will be allowed to caucus on Feb. 3, 2020. The congressman spoke about his plans to reinstate the inheritance tax, overhaul capital gains taxes and reduce national defense spending. (Pfannenstiel, 5/9)

Iowa caucus-goers’ top concerns appear to be health care and climate change, according to data analysis by the Des Moines Register. An analysis of more than 300 questions asked by potential voters at 46 candidate events over the course of 30 days found 27 questions about climate or environmental issues. The candidate receiving the most climate-related questions was former Rep. Beto O’Rourke (D-Texas), with seven, followed by Rep. Eric Swalwell (D-Calif.) and Sen. Cory Booker (D-N.J.), each with four. (Budryk, 5/12)

These are three examples of a catchy talking point from the 2020 presidential hopeful — that toy guns are subject to more regulation than real guns. The Medium post is rather specific: The Consumer Product Safety Commission, because of a “loophole,” does not assess the safety of guns. But in television interviews and tweets, that nuanced point gets turned into misleading shorthand — there is “more federal regulation” of toy guns, or there are “no regulations” for guns. Booker’s point is not particularly original. Gun-control advocates have been calling for consumer safety oversight of guns for decades. But he veers off course when he compares regulatory oversight of guns and toy guns. (Kessler, 5/13)

Kaiser Health News: How Obamacare, Medicare And ‘Medicare For All’ Muddy The Campaign Trail

The health care debate has Democrats on Capitol Hill and the presidential campaign trail facing renewed pressure to make clear where they stand: Are they for “Medicare for All”? Or will they take up the push to protect the Affordable Care Act? Obamacare advocates have found a powerful ally in House Speaker Nancy Pelosi, who in a recent “60 Minutes” appearance said that concentrating on the health law is preferable to Medicare for All. She argued that since the ACA’s “benefits are better” than those of the existing Medicare program, implementing Medicare for All would mean changing major provisions of current Medicare, which covers people 65 and up as well as those with disabilities. (Luthra, 5/13)

Capitol Watch

Doctors, Hospitals And Insurers Don Their Armor As They Prepare For A Fight Over Surprise Medical Bills

President Donald Trump added fuel to the fire over surprise medical bills last week when he called on Congress to take action on the issue, which has become a top concern for voters. Lawmakers are fully on board, but the question remains about who will pick up the extra costs if not patients. The powerful industries that any legislation could impact are gearing up for a battle. Other news from Capitol Hill focuses on a single-payer hearing and site-neutral pay regulation.

Three powerful players in the health care industry are gearing up for battle over surprise medical bills. Doctors, hospitals and insurers have all pledged to protect patients from being hit with massive, unexpected bills for out-of-network care, but no one wants to take on the added costs that come with it. That reluctance is setting the stage for a fight, with the insurance industry on one side and hospitals and doctors on the other (Weixel, 5/11)

The House Budget Committee on Friday announced that it will hold a hearing on single-payer health care on May 22, marking another step forward for the progressive proposal on Capitol Hill. The hearing will be the second one on the idea of single-payer, sometimes called "Medicare for All," that House Democrats have held this year since taking back the majority. (Sullivan, 5/10)

Two U.S. House of Representatives lawmakers on Thursday launched a bipartisan effort to override the Trump administration's site-neutral pay regulation. Rep. Derek Kilmer (D-Wash.) and Rep. Elise Stefanik (R-N.Y.) want to block a final CMS rule that went into effect Jan. 1 and cuts Medicare rates for hospital offsite clinics for some outpatient treatments. Their bill is backed by the American Hospital Association and the Federation of American Hospitals, which represents investor-owned systems, and they are looking for senators to introduce companion legislation in that chamber. (Luthi, 5/10)

Marketplace

Washington Poised To Create 'Public Option,' Thrusting State Into National Debate Over Best Health Care System

Washington will dictate the terms of the public option plans but hire private insurance companies to administer them, saving the state from having to create a new bureaucracy — and guaranteeing a role for the insurance industry in managing the new public options. The plan is a more incremental approach than some others that would get rid of private insurers. Meanwhile, a battle is brewing in Connecticut over a public option for small businesses.

Washington is set to become the first state to enter the private health insurance market with a universally available public option. A set of tiered public plans will cover standard services and are expected to be up to 10% cheaper than comparable private insurance, thanks in part to savings from a cap on rates paid to providers. But unlike existing government-managed plans, Washington's public plans are set to be available to all residents regardless of income by 2021. (James, 5/12)

While tolls, bonding and the budget have dominated this legislative session, a battle has been quietly brewing over the creation of a state-administered health insurance public option for small businesses. ... Backers say their legislation would provide small businesses with a desperately needed alternative to increasingly unaffordable commercial plans, while injecting greater competition to force down prices. Opponents counter that a public option would harm the state’s insurance industry, potentially leading to job losses. (Hoffman, 5/12)

And in Maryland —

A Maryland measure that’s the first of its kind could help people without health insurance find out if they qualify for free or low-cost insurance after they file their taxes. Gov. Larry Hogan is scheduled to sign the bill Monday. It will create a box for people to check on state income tax returns. If selected, the state’s health care exchange will see if the person qualifies for low-cost insurance, based on information in their tax return. Those who qualify for Medicaid will be enrolled automatically. The exchange will reach out to people who qualify for private coverage. (Witte, 5/13)

Most people who buy their health insurance through the Maryland’s exchange could see premiums drop next year, based on rate requests from the state’s two carriers filed Friday, marking what could be the second year in a row of declines. Premiums for the so-called Obamacare plans have been skyrocketing around the country, and state regulators, carriers and advocates say action taken by the Maryland General Assembly and Gov. Larry Hogan made the difference for close to 200,000 Marylanders who tap the Affordable Care Act program because they don’t receive insurance through their jobs. (Cohn, 5/10)

Financially Crippled Hospitals In Rural America Are Fending Off Closure Hour-By-Hour

More than 100 of the country’s remote hospitals went broke and then closed in the past decade, turning some of the most impoverished parts of the United States into what experts now call “health-hazard zones." “If we aren’t open, where do these people go?” asked one physician assistant at a troubled hospital. “They’ll go to the cemetery,” another employee said. “If we’re not here, these people don’t have time. They’ll die along with this hospital.”

The hospital had already transferred out most of its patients and lost half its staff when the CEO called a meeting to take inventory of what was left. Employees crammed into Tina Steele’s office at Fairfax Community Hospital, where the air conditioning was no longer working and the computer software had just been shut off for nonpayment. “I want to start with good news,” Steele said, and she told them a food bank would make deliveries to the hospital and Dollar General would donate office supplies. “So how desperate are we?” one employee asked. “How much money do we have in the bank?” (Saslow, 5/11)

In other news on hospitals and health systems —

U.S. hospital chains call themselves “health systems.” But how many really are? Hospitals have been rapidly consolidating across the country into large not-for-profit and for-profit companies containing dozens of hospitals and hundreds of clinics and other care sites in multiple states. But that doesn’t necessarily make them what experts consider an organized system of care. (Meyer and Kacik, 5/11)

Hospitals that temporarily shut their doors to ambulances have long argued the decision is driven purely by volume, so sick patients don't have to endure long waits for care in crowded emergency rooms. But a new study has uncovered evidence of another motive for the practice: Hospitals may be turning away ambulances for financial reasons by avoiding treating patients with government health insurance or no coverage at all. (Diedrich, 5/13)

Medicaid

Montana Renews Medicaid Expansion With Work Requirements That Will Trigger An Audit If Too Many People Are Dropped

The state's expanded Medicaid program would have ended this summer had lawmakers not reached a compromise to extend it. Included in the bill is a provision that requires the state to reevaluate the work requirements if a certain percentage of people get dropped for not reporting their hours. Medicaid news comes out of Kansas, as well.

Montana Republicans and Democrats reached a compromise to extend the state's Medicaid expansion program for six years and add an 80-hour monthly work requirement for enrollees. The complicated Medicaid Reform and Integrity Act, signed by Democratic Gov. Steve Bullock Thursday, would require a reevaluation of the work program if more than 5% of the 96,000 low-income adults currently enrolled were dropped from coverage due to not complying with the new work and reporting requirements. (Meyer, 5/10)

Gov. Steve Bullock signed a bill to continue and change the health coverage program for low income adults, during a crowded ceremony in the east wing the state Capitol. "When I first signed Medicaid expansion into law four years ago I said that lives would be changing and lives would be saved," Bullock said. (Cates-Carney, 5/9)

The bill continues the program, which began in 2016, and provides health insurance to about 95,000 low-income adults. It would have ended on June 30 if lawmakers had not reached an agreement. He also held ceremonial signings for other bills to lower health insurance and prescription drug costs. (Hanson, 5/9)

A deal to clear the way for Medicaid expansion next year that some Kansas lawmakers thought they had brokered in the waning hours of their just-finished legislative session appears to be unraveling. Instead, the conservative leaders and moderate rank-and-file Republicans find themselves splitting in an intra-party fight. Rep. Don Hineman led a last-minute insurrection by moderate House Republicans in the final days of this spring’s legislative session. They joined Democrats in demanding a Senate vote on Democratic Gov. Laura Kelly’s expansion bill and held up passage of the state budget to force that roll call. (McLean, 5/12)

Women’s Health

Untangling The Inflammatory Rhetoric Around Abortion Bills In Georgia, Alabama

The abortion bills are not simple, especially Georgia's, which experts say sends you "down a rabbit hole" and that you "have to be a lawyer to understand." But fear and confusion over the measures has distorted some of the facts of the bills. Meanwhile, the legislation is part of a wave a similar restrictive measures under consideration throughout the south and Midwest.

Abortion legislation in Georgia and Alabama ascended in the news cycle this week, with Georgia’s governor signing a “heartbeat bill” into law on Tuesday and Alabama’s Senate postponing until next week its vote on a near-total abortion ban. The Georgia law will ban abortions after a doctor is able to detect “a fetal heartbeat in the womb,” usually at about six weeks, before many women know they are pregnant. It was one of the nation’s most stringent proposals until the all-out ban introduced in Alabama. (Paul and Wax-Thibodeaux, 5/12)

An abortion bill introduced in Ohio’s legislature drew scorn this week for including misinformation about a dangerous medical condition that can affect pregnant women. Some health experts see the bill’s language as another example of politicians trying to legislate women’s health without considering the medical implications. The House bill, which was first introduced in April by Ohio state Rep. John Becker (R), seeks to limit insurance coverage for abortion procedures where the mother’s life is not endangered. It would also bar coverage for drugs or devices that prevent the implantation of a fertilized egg, which experts say could affect certain kinds of IUDs. (Epstein, 5/10)

If a new Mississippi law survives a court challenge, it will be nearly impossible for most pregnant women to get an abortion there. Or, potentially, in neighboring Louisiana. Or Alabama. Or Georgia. The Louisiana legislature is halfway toward passing a law — like the ones enacted in Mississippi and Georgia — that will ban abortions after a fetal heartbeat is detected, about six weeks into a pregnancy and before many women know they're pregnant. Alabama is on the cusp of approving an even more restrictive bill. (5/11)

This year, with the future of Roe v. Wade newly in question after the appointment of Justice Brett Kavanaugh to the Supreme Court, a rash of abortion-related bills have been making their way through statehouses. The vast majority are bills to restrict access to abortion, though a couple are efforts to shore up abortion rights. This week, Georgia and Alabama have made moves to restrict access to the procedure. Alabama’s is one of the most aggressive ever in the U.S., aiming to criminalize abortion. The vote, initially expected to take place on Thursday, was delayed until next week after chaos erupted on the Senate floor. (Salam, 5/10)

More actors and film production companies, such as Alyssa Milano and Duplass Brothers Productions, have joined a boycott of the state of Georgia after Gov. Brian Kemp (R) signed a new "heartbeat" abortion bill into law. Milano told BuzzFeed News in a statement Thursday that she will not return to Netflix's "Insatiable" for a third season if the show's filming does not move to a different state. (Frazin, 5/10)

A Clermont County Republican wants to ban most insurance coverage of abortions in Ohio. His bill includes an exception for re-implanting an ectopic pregnancy into the uterus. The problem? Doctors say that procedure does not exist. (Balmert, 5/10)

And President Donald Trump's statements about babies who are born alive following a failed abortion are fact checked —

President Donald Trump, in what's become a staple of his rallies, accuses doctors of executing babies who are born alive after a failed abortion attempt. His comments, meant to taint Democrats, have been embraced by many anti-abortion activists, and assailed as maliciously false by many medical professionals. What's clear is that he is oversimplifying a deeply complex issue. It's already a crime to kill babies, but not necessarily a crime to forgo sophisticated medical intervention in cases where severe fetal abnormalities leave a newborn with no chance of survival. (Crary, 5/13)

Health IT

In Hospitals Where Alarms Can Be Easily Missed, Can AI Help Predict Crises Before They Strike?

Hospital command centers, where a technician watches patients' vital signs for irregularities, have proliferated across the country. The need for such facilities in health care has increased in recent decades, as an array of monitoring devices produces tens of thousands of alarms on a daily basis, to the point where medical professionals tune out the ones that can signal a life-threatening event. In other health technology news: cyberattacks, breaches and an upgraded treadmill.

Hospital command centers have proliferated across the country in recent years, with medical centers from Oregon to Florida deploying them to tackle a range of data-monitoring tasks, such as maximizing bed capacity, calibrating staffing levels, and detecting the onset of sepsis, a life-threatening response to infection that is a common killer in hospitals. Recent advances in artificial intelligence promise to help hospitals identify new warning signs of patient deterioration and intervene earlier in the process. Administrators of command centers at Johns Hopkins and Yale New Haven Hospital both said they are exploring the use of machine learning to deliver more timely care. (Ross, 5/13)

Hospitals are pushing medical-device makers to improve cyber defenses of their internet-connected infusion pumps, biopsy imaging tables and other health-care products as reports of attacks rise. Rattled by recent global cyberattacks, U.S. hospitals are conducting tests to detect weaknesses in specific devices, and asking manufacturers to reveal the proprietary software running the products in order to identify vulnerabilities. In some cases, hospitals have canceled orders and rejected bids for devices that lacked safety features. (Evans and Loftus, 5/12)

Providers, health plans and their business associates reported 44 data breaches to the federal government last month. That's the highest number of healthcare breaches reported in a single month since HHS' Office for Civil Rights began maintaining its online database of healthcare breaches in 2010, surpassing the previous record—exactly one year ago, April 2018—when healthcare groups reported 42 breaches to the agency. (Cohen, 5/10)

On a recent evening, Elizabeth Ewens was in the middle of an intense run workout. Her coach told her to kick it up, so she did and received encouragement from a fellow runner. She finished the workout feeling good. While Ewens’s evening workout sounds like what running groups around the world do several nights a week, she was actually in her home, live-streaming a treadmill class, complete with motivational instructor, music and leader board, to a monitor on her screen. (Yu, 5/12)

Public Health

Racing To Get Ahead Of An Outbreak: Experts Project What Cities Could Be The Next To Be Hit By Measles

The cities at the top of the list? Chicago, Los Angeles and Miami. A similar analysis, which uses statistics on nonmedical exemptions and international airport hubs, from last year proved to be surprisingly accurate. Meanwhile, there's been little movement on tightening exemptions at the state level despite the sweeping measles outbreak. Advocates say that the vocal anti-vaccination movement is to blame.

Chicago, Los Angeles and Miami are the cities most likely to see the next measles outbreaks, according to an unusual new study. Researchers at the University of Texas at Austin and Johns Hopkins University mapped the 25 American counties most at risk of measles because of their vaccine-exemption rates and proximity to airports. A similar map published last year proved surprisingly accurate at forecasting many of this year’s cases. But both groups of scientists failed to predict the measles outbreak that began in Brooklyn, currently the nation’s largest. (McNeil, 5/10)

Despite the worst measles outbreak in decades, few state legislatures this year have reconsidered the exemptions that families use to avoid inoculating their children. As many legislative sessions wind down, only Washington state, which has had one of the highest numbers of measles cases, has sent a measure to the governor’s desk. (Ollove, 5/10)

In other news on the outbreak —

Instagram this week blocked the hashtag #VaccinesKill amid its crackdown on vaccine-related misinformation, and it says it is looking into other hashtags typically used to promote false information about vaccines. The Facebook-owned social media network had previously declined to block the #VaccinesKill hashtag, a popular gathering place for anti-vaccine activists on Instagram, arguing that the phrase "vaccines kill" did not count as medical misinformation. An Instagram spokesperson in an email to The Hill last month claimed there have been rare instances in which vaccine side effects have caused death. (Birnbaum, 5/10)

The United States so far this year has recorded 704 cases of measles in 22 states, its largest outbreak since public health officials in 2000 declared the disease eradicated, according to the Centers for Disease Control and Prevention. The CDC on Monday released updated figures on the number of cases recorded so far this year, which have hit a 25-year-high. Here are key facts about the outbreak. (5/10)

California counties have spent more than $400,000 trying to stop measles from spreading across the state this year, according to an analysis released Friday by state officials. So far, 43 people in the state have come down with measles, with the biggest outbreak in Northern California. The figure reported Friday represents a fraction of the true cost because it does not include all of this year’s cases or the health expenses that patients may have incurred seeking medical treatment, officials said. (Karlamangla, 5/10)

Health advocates say containing and investigating the wave of measles cases this year comes with a hefty price tag. Every time a new or potential measles case is reported, it requires a thorough public health investigation. That means blood tests, informing the public and tracking down people who may have been exposed. (Jeong Perry, 5/10)

As Many As Two-Thirds Of Older Americans Will Need Long-Term Care But Won't Be Able To Afford It

Nearly 15 million middle-income adults will be hit the hardest, according to an analysis in Health Affairs, because they won't quality for Medicaid or subsidized housing. Other public health news focuses on maternal death rates, the impact of boys' early sexual initiation, a skin disorder on genitals, unidentified patients, snake bites, good gossip, organ donations and tick information.

Gretchen Harris likes the small brick house she bought in Norman, Okla., 36 years ago. She’s fond of her neighbors and the magnolia tree she planted in the front yard. And having a single-story residence proved helpful after knee replacement surgery last summer. “It’s always been a good size for me,” she said. But Ms. Harris, 72, a retired attorney, has grappled with assorted health problems — heart disease, non-Hodgkin’s lymphoma, osteoporosis, rheumatoid arthritis — and takes a long list of prescription drugs. (Span, 5/10)

Medicine continues to advance on many fronts, yet basic health care fails hundreds of women a year who die during or after pregnancy, especially women of color. Black mothers die at a rate that's 3.3 times greater than whites, and Native American or Alaskan Native women die at a rate 2.5 times greater than whites, according to a report out this week from the Centers for Disease Control and Prevention. Yet, the report concluded, roughly 3 in 5 pregnancy-related deaths are preventable. The racial disparity in maternal death rates is a dramatic argument for prevention efforts that address diverse populations, says Dr. Wanda Barfield, director of the Division of Reproductive Health and assistant surgeon general in the U.S. Public Health Service. (Neighmond, 5/10)

Every couple of years, the Centers for Disease Control and Prevention asks middle and high school students to fill out surveys in class for the Youth Risk Behavior Surveillance System. If students are sexually active, it asks for the age of first sexual intercourse, which is an important milestone. From a public health point of view, sexual intercourse initiates young people into certain kinds of risk, notably pregnancy and sexually transmitted infection. In those terms, what is called early sexual initiation — that is, intercourse before the age of 13 — is well-known as a marker for other kinds of risk, in both girls and boys, including binge drinking and having multiple sexual partners. (Klass, 5/13)

You’ve probably heard of lichens, complex organisms consisting of a fungus and an alga (and sometimes a bacterium) that break down rocks to create soil. Though lichens vary widely in color and form, most often seen are the white crusty varieties that colonize the surface of trees, rocks and barren soil. This type has lent its name to a little-known skin disease — lichen sclerosus — that typically manifests as white crusts on genital tissues and is often undiagnosed or misdiagnosed before it wreaks havoc on people’s lives. (Brody, 5/12)

Kaiser Health News: ‘John Doe’ Patients Sometimes Force Hospital Staff To Play Detective

The 50-something man with a shaved head and brown eyes was unresponsive when the paramedics wheeled him into the emergency room. His pockets were empty: no wallet, no cellphone, not a single scrap of paper that might reveal his identity to the nurses and doctors working to save his life. His body lacked any distinguishing scars or tattoos. Almost two years after he was hit by a car on busy Santa Monica Boulevard in January 2017 and transported to Los Angeles County+USC Medical Center with a devastating brain injury, no one had come looking for him or reported him missing. The man died in the hospital, still a John Doe. (Abram and de Marco, 5/13)

It was a warm, wet winter this year across much of the United States. In most states, this means more greenery, more rabbits, more rodents and more snakes — which raises the risk of snake bites for humans and their canine companions. Biologist Gerad Fox is standing next to a loud rattlesnake. "Right now he's in a classic strike posture, very defensive," says Fox. "The rattle is a warning, saying, 'Back off. I'm dangerous. You should leave me alone.' " Fox teaches biology classes at Loma Linda University in California and also runs rattlesnake avoidance training classes for dogs. (Neighmond, 5/12)

Almost everyone gossips. And a new study finds that people spend about 52 minutes per day, on average, talking to someone about someone else who is not present. But here's the surprise: Despite the assumption that most gossip is trash talk, the study finds that the vast majority of gossip is nonjudgmental chitchat. (Aubrey, 5/13)

Since 1986 the federal government has required that patients in the emergency room receive care, regardless of their immigration status or ability to pay. But caring for chronic conditions such as kidney disease or cancer in the emergency room is expensive. So some states are quietly expanding access for undocumented immigrants to obtain medical treatment beyond the ER. (O'Neill, 5/12)

Just 42 years old, Erosalyn Deveza was drifting toward death. Her kidneys were barely functioning. She was constantly exhausted. She had vertigo and vomited frequently. She was tethered to a home dialysis machine for eight hours each night as she slept. A kidney transplant was the only thing that could save her, but it was unlikely to happen in time. There is a severe shortage of kidneys from deceased donors in the United States. No one on Deveza’s side of the family could provide an organ through a living donation, doctors said, because all were at risk for the same kidney disease. It was too dangerous to leave any of them with a single kidney. Other family and friends were not a match. (Bernstein, 5/11)

Summertime is almost here, and impending camps, cookouts and vacations mean more time spent outdoors. That comes with the risk of tick bites — and tick-borne diseases. Those diseases have been on the rise in recent years, with steady increases in both frequency and distribution. Lyme disease, anaplasmosis and other diseases can be passed along by these ectoparasites, and different critters carry different pathogens. (Blakemore, 5/11)

Opioid Crisis

Opioid Litigation Divides Sackler Family Over How To Respond To Charges It Bears Responsibility For Deadly Epidemic

As communities seek billions in settlements, the family that owns OxyContin-maker Purdue Pharma is reportedly growing uneasy about defense tactics and charges of misleading marketing. Other news on the drug epidemic looks at a new CDC report on cocaine and meth deaths and unethical practices by a Delaware physician.

A united front among members of the billionaire Sackler family behind painkiller OxyContin is showing signs of strain from litigation over who bears responsibility for the deadly U.S. opioid epidemic. At least twice in recent months, eight members of the Sackler family who own OxyContin maker Purdue Pharma LP have been at odds over how to respond to allegations implicating them in deceptive marketing of prescription painkillers that led to widespread fatal overdoses, said people familiar with the matter. (5/10)

In a drug overdose epidemic that has killed more than 700,000 Americans since 1999, state and local officials have been primarily concentrating on opioids, which were involved in nearly 70% of overdose deaths in 2017. The CDC’s new analysis indicates that public health and law enforcement officials should be just as vigilant when it comes to cocaine, meth and other prescription and illicit drugs of abuse in their communities. (Vestal, 5/13)

Delaware has permanently revoked the license of a doctor accused of prescribing opioids in exchange for sexual favors from a female patient undergoing treatment for long-term drug addiction. The News Journal of Wilmington reports the state Board of Medical Licensure and Discipline this week revoked the license of Nihar B. Gala, who oversaw the pain management and addiction treatment center Alpha Care Medical. (5/10)

State Watch

State Highlights: Washington Health Spending Law For Native American Groups Called Promising; Citing Abuses, 5 More Former Ohio State Students File Lawsuit Against Team Doctor

Media outlets report on news from Washington, Ohio, California, Illinois, Maryland, Connecticut, Arizona, Georgia, New York, Minnesota, North Carolina, Utah, New Hampshire, Massachusetts, Iowa and Arkansas.

Gov. Jay Inslee signed a bill this week to direct money to tribal health-care systems and create a council focused on improving health outcomes for members of the 29 tribes here. “I think it is one of the most promising pieces of legislation I’ve seen on the state level,” said Aren Sparck, Government Affairs Officer for the Seattle Indian Health Board (SIHB). Sparck worked on the bill, which has been a couple of legislative sessions in the making and got the governor’s signature Tuesday. (Blethen, 5/11)

Five more former Ohio State University students who claim they were abused by a former university physician and team doctor have sued the school. The Columbus Dispatch reports the plaintiffs in the federal lawsuit filed Friday are identified as "John Does" to protect their identities. Three of the men say they were wrestlers and two sought treatment at a university health center. (5/11)

Gov. Gavin Newsom’s administration Friday reversed course on his plan to divert public health dollars from several counties to help provide health coverage to young adults who are in the country illegally. The administration heeded the alarm sounded by Sacramento, Placer, Santa Barbara and Stanislaus counties, which had warned that the governor’s plan would compromise their ability to cope with surging rates of sexually transmitted diseases and, in some cases, measles outbreaks. (Young, 5/10)

Officials with the Centers for Disease Control and Prevention plan a door-to-door survey this weekend in northern Illinois near where an anhydrous ammonia leak sickened dozens last month. The Lake County Health Department says CDC staff will start interviews Saturday at home within a 1-mile radius of the spill in Beach Park, about 40 miles north of downtown Chicago. The CDC also will interview first responders and nearly 40 people hospitalized after the April 25 leak. (5/10)

Starting in October, you’ll need to be 21 to buy tobacco and nicotine products in Maryland, under a bill that Gov. Larry Hogan plans to sign into law on Monday. The law is intended to cut down on the access that teenagers have to cigarettes, e-cigarettes and other tobacco and nicotine products. It contains a key exception: People age 18 to 20 with a military identification can still buy tobacco and nicotine products. (Wood, 5/10)

In all, 15 state legislatures have passed bills raising the age to 21 as of May 1. Twelve have enacted those laws and three are awaiting a governor’s final approval, according to the Campaign for Tobacco-Free Kids. More than 450 localities have passed similar laws as well. Even the federal government is getting involved. Sen. Sherrod Brown, D-Ohio, has co-sponsored a bill that would raise the tobacco age to 21. (Wehrman, 5/11)

After struggling for six years, legislators, labor advocates and municipal leaders will announce a long-awaited compromise Monday on post-traumatic stress disorder benefits for police and firefighters. Though they declined to provide details of the agreement, Sen. Cathy Osten, D-Sprague — who’s spearheaded the push to expand coverage for first responders — and Connecticut Conference of Municipalities Executive Director Joe DeLong, both predicted Friday it would draw bipartisan support. (Phaneuf, 5/13)

The Indian national who died in an Arizona jail while in the custody of Immigration and Customs Enforcement died by suicide by hanging himself, according to the Maricopa County medical examiner. Police records also show that Simratpal Singh, 21, had been accused of sexually assaulting a female passenger on a Greyhound bus on April 30, two days before he was found unresponsive and not breathing at the La Paz County Jail in Parker, a rural community in western Arizona near the California border line. (González, 5/10)

A top state regulator said the health insurance giant Anthem may have violated the law when it terminated WellStar Health System from its individual coverage, and he has ordered the company to appear at a hearing to explain itself. State Insurance Commissioner Jim Beck made the statements in an order he issued Friday. Anthem is formerly known as Blue Cross. (Hart, 5/10)

Leaders at Northwell Health realized that improving quality and reducing costs are closely tied to staff job satisfaction. Clinicians and other staff who feel burned out by workplace inefficiencies aren’t necessarily going to provide the best care to patients. So they recently launched an initiative asking the 70,000 employees at Northwell’s 23 hospitals and 700-plus ambulatory sites to identify the biggest problems they face in delivering care and to suggest solutions. It’s called the “Ideas at Northwell” campaign, focusing on common-sense practices and provider well-being. (Meyer, 5/11)

The top Republican in the Minnesota Senate, who helped defeat a proposed ban on so-called gay conversion therapy for minors, sent his daughter to a therapist opposed to gay relationships after suspecting she had a same-sex attraction when she was a teenager, the Star Tribune reported Friday. Senate Majority Leader Paul Gazelka, a conservative Christian from Nisswa, led his caucus in voting down a Democratic proposal May 1 against the practice of trying to turn gay people straight. (5/10)

Savanah Harshbarger estimates she performed as many as 10 pelvic exams last year on patients before gynecologic surgeries, feeling for fibroid tumors or other abnormalities. The Duke University medical student said the experience was a revelation. “It’s pretty empowering to know this is something you can detect with a gloved hand instead of needing an MRI or some more expensive procedure,” Harshbarger said. (McDermott and Johnson, 5/12)

Eight of the institution's residents died in the first four months of this year — triple the normal rate. State officials deny there’s a problem with the facility's medical care. More than a dozen former and current staff members of the facility have told the Des Moines Register they disagree. ...Records show one of the facility’s three doctors was fired last year without explanation. A second doctor quit after telling the state's top human services director the medical staff had been "gutted." Several other senior health-care providers have left or been pushed out from Glenwood Resource Center since Superintendent Jerry Rea was hired in 2017, critics say. (Leys, 5/12)

Dr. Jeff Kaisand, the state veterinarian, has confirmed several cases of "canine Brucellosis" coming from a commercial small-dog breeding facility in Marion County, Iowa. The sickness is known to only affect dogs and humans, according to the Iowa Department of Public Health. (Davis, 5/12)

Two and a half years after Arkansans voted to legalize medical marijuana, qualifying patients could begin buying the product Saturday morning when the state's first dispensary opened, though the celebratory mood was dampened by confusion about operating hours and fears the dispensary wouldn't be able to serve all the patients by closing time. (5/11)

Editorials And Opinions

Perspectives: After Georgia's Abortion Law Passed, Forced Pregnancies Are Not The Only Option; So Exactly When Is Someone Pregnant?

Editorial pages focus on women's health topics.

This week, Georgia became the fifth state to ban abortion at six weeks after a last menstrual period, before many people even realize they are pregnant. Its ban goes further than the others, criminalizing doctors and others who help induce abortions, as well as making those who are pregnant, potentially liable for murder if they prompt a pregnancy loss. They could even be liable if they do it in another state. On Thursday, Alabama postponed a vote on what could be the country’s most restrictive abortion ban.This is where we are headed on abortion. (Cari Sietstra, 5/11)

Dear Hollywood: Get the hell out of Georgia. Now. I understand the tax breaks are terrific, the geography diverse, the cost of living cheap and heaven knows it’s hard to beat an ice-cold glass of sweet tea when you need a pick-me-up. But by criminalizing abortion after six weeks, Georgia Gov. Brian Kemp just turned the millions you save, and the billions you infuse into the state economy, into blood money. (Mary McNamara, 5/10)

I was trying to schedule a sonogram last year when my understanding of a basic scientific principle was totally upended. The nurse, attempting to discern how pregnant I might be, turned out to be utterly uninterested in the date of conception. She only wanted to know the date of my last period. That, she explained, is how pregnancy is calculated. Which meant that as far as the medical community was concerned, I was technically five weeks along, even though there was no way I could physically be more than three. Those two previous weeks, I guess I was . . . pre-pregnant? Pregnant-in-waiting? Truly, this was stunning news. (Monica Hesse, 5/13)

Happy Mother’s Day! Your mom is the best! Save, of course, for mine. And my wife. And, I rush to add, my mother-in-law. I can’t think of any group of people more selfless and loving than mothers. But this celebration of motherhood is also hypocritical: For all our rhetoric, we routinely fail mothers here in the U.S. and around the world. (Nicholas Kristof, 5/11)

Viewpoints: Latest White House Proposal Promises To Cut Programs For The Poor; Society Needs To Chime In Since Government Isn't Addressing Health Disparities

Opinion writers weigh in on these health topics and others.

The "chained CPI" is a good idea, despite its obscure, vaguely scary name. “CPI” stands for “consumer price index,” and “chained” refers not to some sort of punishment but to the fact that, for technical reasons, it is more closely linked to people’s buying habits than the version of the CPI the government usually uses to adjust various key program benchmarks for annual inflation. Even good ideas can have bad applications, though, and so it is with the announcement Tuesday that the White House is considering a new rule that would require using the chained CPI to inflation-adjust the official poverty line, currently $25,750 for a family of four. This is crucial because a family’s receipt of subsidized housing, food-buying assistance and Medicaid can be determined by whether its income puts it below or above the poverty line, and by how much. (5/10)

There seems to be a disparity in how we view and define health disparities in the United States.Despite advances in the understanding and treatment of cancer and other diseases, the availability of appropriate health care still eludes large portions of our population and the current patchwork system of providing health services is not reaching many people who could benefit from what may be available, but not necessarily obtainable. (Nancy G. Brinker and Eric T. Rosenthal, 5/11)

Attorneys spend millions of dollars each year on ads to recruit people who may have been injured by a drug or device. Some of these fear-mongering ads frighten people to stop taking medications that can help prevent life-threatening problems like blood clots.It’s time these ads come with a warning.Given their television-viewing habits, older adults are easy targets for such ads and infomercials. The Nielsen Company reports that adults aged 65 and older spend an average of seven hours a day in front of the TV. And they often absorb the message. (F. Roosevelt Gilliam III and Susan Peschin, 5/13)

For House Democrats, this will be health-care week. How many voters will notice? The answer will be instructive about how the constitutional crisis that is upon us will affect action on every other problem voters expect their government to confront. President Trump is engaged, as is his way, in a two-faced game. He says that by demanding the Mueller report’s evidence of obstruction of justice, Democrats are mounting a vendetta that will prevent Washington from governing. (E.J. Dionne, 5/12)

Imagine yourself stuck in the hospital. Would you rather your doctors be well-rested, with a limit on how many hours they can work? Or would you rather they work longer shifts, seeing you through the critical hours of your illness and with fewer handoffs of your care? That's the choice being reexamined after a study published in March in the The New England Journal of Medicine found that longer shifts for medical residents were just as safe as shorter shifts. (Clayton Dalton, 5/10)

Obamacare gave most low-income people Medicaid coverage, extending the health-care plan to the poor and near-poor. But when they are jailed or imprisoned, an old federal law means their Medicaid coverage disappears. This callous policy must change. The problem is not that those in custody would get no health care while locked up. The Supreme Court ruled that jails and prisons must provide health services to those they are holding, because they are wards of the state. (5/12)

Among my first memories as a doctor was a disheveled man, barely older than me, handcuffed to a hospital bed, vomiting a thin brown liquid into a pale pink bucket. Between retches, he sobbed and shook violently. Driving his many medical and legal problems, I later learned, was an addiction to opioid painkillers. Driving his current misery was withdrawal. (Dhruv Khullar, 5/11)

When President George W. Bush appointed me as the nation’s first health information "czar" in 2004, my top priority was to ensure that Americans had access to their personal health information. ...Giving people their health information has been a priority for every president and health information leader since President Bush, but we haven’t made progress. (David J. Brailer, 5/11)

As we report Friday in JAMA Network Open, in almost every doctor’s practice we found the same pattern. Patients seen earlier in the day were more likely to have their doctors order cancer screening tests. At 8 a.m., for example, 64% of women eligible for breast cancer screening left their appointments with an order for a mammogram. That declined to 48% by 5 p.m. We saw a similar pattern for colon cancer screening: At 8 a.m., 37% of those eligible left with colonoscopy orders compared to 23% by 5 p.m. (Mitesh Patel, 5/10)

The 34-year-old man lay in his ICU bed for over a month — dependent on a breathing tube and artificial respirator to stay alive. The patient knew his life hung in the balance, as he was a physician himself. Some days the suffering was so intense that he contemplated ways he could unplug the machine on his own. Now, nearly 50 years later, that patient, Edward Viner, an oncologist who served as chief of the Department of Medicine at Cooper University Health Care in New Jersey for more than two decades, reflects on how he was able to survive such a harrowing experience. (Stephen Trzeciak and Anthony Mazzarelli, 5/12)

In the classic 1967 film “The Graduate,” young Benjamin Braddock was given one word of advice for his future: plastics. In that spirit, I’d like to offer Dr. Ned Sharpless, the new acting commissioner of the Food and Drug Administration, two words of advice for the future of the FDA: data standards.Like many other experts, I grow increasingly alarmed by the slow progress in the development, implementation, and acceptance of data standards for clinical trials. As the clock ticks, the capital costs and the human costs of inaction are mounting. No matter where my work takes me, I always return to the urgent need for data standards. (Sam Volchenboum, 5/13)

Heart palpitations. Dizziness. Nausea. Numbness. Trouble breathing. Chest pains. An all-encompassing feeling of dread. Heart attack? No, for many people these are the unpleasant symptoms of something much more mundane, a panic attack. They often seem to appear out of the blue. And the first time in particular, before you know what’s happening, they can be terrifying. (Cara McDonough, 5/11)

Around the world, childhood hunger is increasing for the first time in decades, and we are facing potential intergenerational losses as a result. As you’re reading this, there is a bipartisan effort in Congress to reach more of these children by deepening support for the McGovern-Dole International Food for Education and Child Nutrition Program. We urge support for this bipartisan effort.The McGovern-Dole Program is one of the most effective tools to fight childhood hunger that we have in our toolkit. (Richard Leach and Former Sen. Bob Dole, 11/12)

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