From Medicine and Health

Viewpoints: Doctors Facing Racism In The Exam Room; Medication’s Role In Curbing Addiction

A selection of opinions on health care from around the country.

The Washington Post: Racist Patients Often Leave Doctors At A Loss
Patients refuse care based on health-care providers’ ethnicity and religion so often that this phenomenon has been dubbed “medicine’s open secret.” A new poll shows that a majority of health-care professionals say they have faced prejudice from patients. In 2013, a nurse in Flint, Mich., sued a pediatric intensive care unit after it granted a request from a father to enter “no African American nurses” on his infant’s care plan. Damon Tweedy, an African American psychiatrist, describes similar experiences in bruising detail throughout his memoir, “Black Man in a White Coat.” And when Esther Choo, an Asian American emergency department physician, tweeted last month that white nationalists refused her care, she set off a Twitter storm of health-care providers responding with similar stories. (Dorothy R. Novick, 10/19)

The Des Moines Register: To Prevent Full-Blown Opioid Crisis, Iowa Needs Overdose Of Vigilance
Drug overdoses are now the leading cause of death for Americans under age 50, killing roughly 64,000 people in the United States last year. An increase in fatalities is largely fueled by opioids, including fentanyl, a powerful synthetic substance considered up to 50 times more potent than heroin. Although Iowa has not been hit as hard as some other states by the opioid epidemic, we have not been spared. (10/19)

Stat: Long-Acting Medications For Addiction Help Patients Maintain Recovery
Many addicted people try to bind their future selves to a commitment to stop using drugs. Some move across the country to a place where they don’t know any dealers or fellow users. Others throw away all their drugs and injection equipment. … Such tactics are often thwarted by the future self of the addicted person who adopted them. Like other drugs to which people become addicted, opioids cause enduring adaptations in the brain that weaken self-control and increase the urge to use these drugs. In addition, many people with drug addictions inhabit social networks that provide repeated stimuli and opportunities to use drugs. (Keith Humphreys, 10/19)

The New York Times: The Trump Administration’s Power Over A Pregnant Girl
In early September, a 17-year-old girl from Central America was apprehended trying cross the border between the United States and Mexico. After being taken to a shelter for unaccompanied minors in South Texas to await immigration proceedings, she learned she was pregnant. The girl, referred to as Jane Doe in court filings, was adamant that she wanted an abortion. … For almost a month, some of these Trump appointees have been waging a crusade to force the young woman, whose future in this country is extremely uncertain, to carry her pregnancy to term. Their standoff shows us the real-world consequences of this administration’s radical disregard for women’s autonomy. (Michelle Goldberg, 10/20)

Los Angeles Times: The U.S. Government Can’t Hold Undocumented Pregnant Teens Hostage When They Want An Abortion
It is unconscionable that the federal government would so flagrantly undermine the rights of a person in its custody. The girl, known in court papers simply as Jane Doe, may not be here legally, but, while she is here, she has a constitutional right — like every other pregnant girl or woman in the United States — to a legal abortion. Even U.S. District Judge Tanya Chutkan, who ruled Wednesday that Doe could get the abortion, shook her head in disbelief when a U.S. Department of Justice lawyer at the hearing would not concede that Doe has constitutional rights. (10/20)

Los Angeles Times: A Judge Calls Foul On Allergan’s Attempt To Hide Its Drug Patents Behind An Indian Tribe’s Sovereignty
In the annals of cynical corporate subterfuges, it would be hard to top the effort by the drugmaker Allergan to fend off a patent challenge by selling its drug rights to a rural New York Indian tribe. … [Judge William] Bryson didn’t invalidate the tribal deal because that wasn’t at issue in the case before him, but he expressed “serious reservations” about whether the deal should be treated as valid. That could function as a guidepost for the U.S. Patent Office, which will have to rule on the transaction’s validity. Legal authorities say Bryson’s opinion should be taken as a red light by other companies thinking about using the same maneuver. (Michael Hiltzik, 10/19)

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Policy Perspectives: When It Comes to Health Care, Why Is Compromise So Difficult?; Ideas On How To Move Forward

Opinion writers offer their thoughts on the outlook for the Obamacare fix advanced by Sen. Lamar Alexander (R-Tenn.) and Sen. Patty Murray (D-Wash.) as well as on President Donald Trump’s recent executive order loosening some restrictions on health insurance and how Medicare prices can help advance efforts at reform.

Bloomberg: Why There’s No Compromise On Obamacare
Senators Alexander and Murray may well have tried and tried to devise a deal that gave both sides a real win. In health care, though, it is extremely hard to find one, because there is little overlap between liberal and conservative policy objectives. If you allow catastrophic plans, a lot of young and healthy people will choose them, and the comprehensive plans liberals prefer will have high premiums. So liberals see almost any step conservatives want to take as a way of undermining or unraveling Obamacare. (Ramesh Ponnuru, 10/19)

The Washington Post: How Republicans Can Get Everyone To Stop Blaming Them
Republicans may have unified control of government, but they seem curiously incapable of getting major agenda items through. Maybe it’s because Republicans have insisted on cutting out Democrats and doing things unilaterally. Or at least they had been until Thursday, when a bipartisan coalition of 24 senators signed onto a bill to patch up Obamacare. While President Trump and congressional Republican leadership remain skeptical about working with the enemy, this could be the start of a turnaround for the GOP. To be clear, “bipartisan” ideas are not necessarily “good” ideas. Sometimes a policy that both parties support turns out to be a huge mistake. As a political matter, though, it can be extremely useful for the majority party to get buy-in from the other side, for three reasons. (Catherine Rampell, 10/19)

The New England Journal Of Medicine: Lessons From The Latest ACA Battle
At the end of the 2017 Obamacare repeal-and-replace legislative battle (and before the next one begins), it is worth taking stock of why — defying the odds — the Affordable Care Act (ACA) still stands. From my perspective as an Obama administration veteran of every near-death experience of the law to date, this one is notable for its unlikely heroes. (Jeanne M. Lambrew, 10/18)

The Columbus Dispatch: Breaking The Gridlock On Obamacare
For seven years, congressional Republicans and Democrats battling over Obamacare have agreed on only one thing: They couldn’t agree on anything. As more Americans dropped or skipped coverage because of soaring premiums, lawmakers of the two parties couldn’t — wouldn’t — agree on how to fix the 2010 law. (10/20)

The Wall Street Journal: The Limits Of Trump’s Health-Care Order
Give President Trump an A for effort with his latest executive order, which tries to expand health-insurance options for individuals battered by exploding premiums and fleeing insurers. At least somebody is trying to do something after congressional Republicans failed to repeal and replace ObamaCare. While the executive order represents progress, Congress still needs to act. (Merrill Matthews, 10/19)

The New England Journal Of Medicine: Strengthening The ACA For The Long Term
Most complaints about the Affordable Care Act (ACA) (e.g., high and rising insurance premiums, large deductibles, and insurer exits) relate to nongroup insurance markets. These markets, the ones that were the most dysfunctional before the ACA, provide coverage to just 7% of the nonelderly population (under 65 years of age) and 6% of the full U.S. population. The ACA’s changes to employer-sponsored insurance plans, Medicare, and Medicaid were more limited, and enrollees are generally satisfied with those coverage options. The problems with the nongroup market, though significant, are fixable, and correcting them does not necessitate disruption of coverage for the remaining 94% of the population. (Linda J. Blumberg and John Holahan, 10/18)

The New England Journal Of Medicine: Using Medicare Prices — Toward Equity And Affordability In The ACA Marketplace
As the U.S. Congress debates the future of the Affordable Care Act (ACA), the public has increasingly called for bipartisan solutions on health care reform. An immediate challenge is stabilizing the ACA marketplace, where 10.3 million people enroll in coverage. Given that certain areas of the country have few insurers participating in the marketplace — because of high enrollee costs, uncertainty over cost-sharing–reduction payments from the federal government, and the expiration of protections for insurers such as reinsurance and risk corridors (which limit how much they can gain or lose through risk sharing) — policies that encourage insurers to enter and stay in the marketplace are needed. (Zirui Song, 10/18)

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Research Roundup: Hospital Readmissions; HPV Vaccine; Housing And Asthma

Each week, KHN compiles a selection of recently released health policy studies and briefs.

The New England Journal of Medicine: Effect Of A Hospital-Wide Measure On The Readmissions Reduction Program
The Hospital Readmissions Reduction Program penalizes hospitals that have high 30-day readmission rates across specific conditions. There is support for changing to a hospital-wide readmission measure to broaden hospital eligibility and provide incentives for improvement across more conditions. … We used Medicare claims from 2011 through 2013 to evaluate the number of hospitals that were eligible for penalties, in that they met a volume threshold of 25 admissions over a 3-year period for a specific condition or 25 admissions over a 1-year period for the cohorts included in the hospital-wide measure. … Changing to the hospital-wide measure would result in 76 more hospitals being eligible to receive penalties. (Zuckerman et al., 10/19)

Annals Of Internal Medicine: Sex Differences In Prevalence And Concordance Of Oral Vs. Genital HPV
The burden of human papillomavirus (HPV)–positive oropharyngeal squamous cell carcinoma (OPSCC) is disproportionately high among men, yet empirical evidence regarding the difference in prevalence of oral HPV infection between men and women is limited. … The overall prevalence of oral HPV infection was 11.5% … in men and 3.2% … in women (equating to 11 million men and 3.2 million women nationwide). (Sonawane et. al, 10/17)

The Kaiser Family Foundation: The HPV Vaccine: Access And Use In The U.S.
The human papilloma virus (HPV) vaccine is the first and only vaccination that helps protect women and men from getting many different types of cancer that are associated with different HPV strains. The vaccine protects young people against infection from certain strains of the HPV, the most common sexually transmitted infection (STI) in the United States.1 Since HPV vaccines were first introduced in the U.S. in 2006 there have been changes in the range of protection they offer and the dosing regimen. Furthermore, the vaccines were originally recommended only for girls and young women and were subsequently broadened to include boys and young men. This factsheet discusses HPV and related cancers, use of the HPV vaccines for both females and males, and insurance coverage and access to the vaccines. (10/19)

Urban Institute: The Relationship Between Housing And Asthma Among School-Age Children
Interest in the intersection between health and housing is rising within both sectors as they work together to prevent asthma attacks and reduce related emergency room (ER) and hospital use. Initiatives to reduce asthma triggers in the home—including mold, pests, and tobacco smoke—are under way across the country, from home remediation to new regulations (e.g., a public housing smoking ban). Understanding the relationship between asthma, ER and urgent care visits, and housing-related triggers is difficult, but the 2015 American Housing Survey includes a special module with questions on asthma and triggers in the home. (Ganesh, Scally, Skopec and Zhu, 10/16)

Commonwealth Fund: Preventable Spending High-Cost Medicare Patients
A large share of Medicare spending is generated by a relatively small group of patients with expensive medical needs. These patients, many of whom are frail and elderly, account for the vast majority of potentially preventable Medicare spending. Interventions targeting the health conditions of these patients could significantly reduce avoidable expenditures in Medicare. (Jha et. al, 10/17)

JAMA Internal Medicine: Gestational Diabetes And Long-Term Cardiovascular Disease Risk
In this cohort study, with follow-up of nearly 90 000 US women older than 26 years, women with a history of gestational diabetes had 43% greater risk of CVD (myocardial infarction or stroke) compared with women without prior gestational diabetes , although absolute rates in this cohort were low. Adhering to healthy lifestyle factors over follow-up mitigated this modestly elevated risk. (Tobias et al., 10/16)

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State Highlights: Minn. Gov. Blasts Medica For $120M Funds Transfer; In Mass., Closing Arguments In Murder Trial Related To Compounding Pharmacy Meningitis Outbreak

Media outlets report on news from Minnesota, Massachusetts, Texas, New Hampshire, Kansas, Arizona, Pennsylvania, Ohio, Georgia and Ohio.

The Associated Press: Closing Arguments Set In Deadly Meningitis Outbreak Trial
Attorneys are preparing to make their closing arguments in the case of a Massachusetts pharmacist charged with second-degree murder in a deadly meningitis outbreak. Closing arguments in Glenn Chin’s trial are expected Friday in Boston’s federal courthouse. Chin faces second-degree murder, mail fraud and other charges under federal racketeering law. (Richer, 10/20)

Dallas Morning News: Two Texas ERs Got Bad Reviews Online. Now They Want Google To Help Them Find Out Who Did It 
Two North Texas free-standing emergency room operators want tech giant Google to give up the identities of nearly two dozen reviewers who rated them poorly online. Highland Park Emergency Center on Lemmon Avenue and Preston Hollow Emergency Room on Walnut Hill Lane filed a joint petition Tuesday in Dallas County District Court. The 30-page pre-suit deposition lists the screen names used by 22 individuals, who the facilities claim never were treated in their emergency centers. (Rice, 10/19)

Kansas City Star: Fungus Destroyed Inmate’s Brain While Kansas Prison Contractor Did Nothing, Suit Says
Marques Davis was in the infirmary at Hutchinson Correctional Facility on Dec. 27, 2016, back with the same symptoms he’d been complaining of for months, including numbness and weakness in his legs. But on that day there was something new. “It feels like something is eating my brain,” Davis told Corizon Health employees who staff the prison infirmary. According to a lawsuit filed in federal court Monday, something was infecting his brain: a fungus that slowly killed the 27-year-old over the next four months, as he pleaded for help. (Marso, 10/17)

Arizona Republic: Arizona Heat Takes An Extra Toll On People With Mental Illness
Out of all the people who died of heat-associated causes in Maricopa County in 2016, around 15 percent had a history of mental illness, according to an Arizona Republic analysis of autopsy reports. …Some medications, including certain types of antidepressants and antipsychotics, block the body’s ability to regulate its temperature, said Dr. David Eisenman, a professor of medicine at the University of California, Los Angeles. (Altavena, 10/19)

The Philadelphia Inquirer/Philly.com: Major Sanctions At Darby Nursing Home After Neglect Found
The Pennsylvania Department of Health revoked the regular license of St. Francis Center for Rehabilitation & Healthcare last month and installed a temporary manager at the Darby nursing home after an August inspection found that a patient had developed “wounds that went down to the bone with exposed tendon.” The 273-bed facility, one of five sold in 2014 by the Archdiocese of Philadelphia to Center Management Group of New York, appealed the decision and remains open under a temporary manager installed by the health department. The revocation was the first in Pennsylvania since at least the beginning of 2014. (Brubaker, 10/20)

Des Moines Register: Quadriplegic Spent Hours In Dirty Diaper After Services Cut
Throughout last summer, 25-year-old quadriplegic Louis Facenda Jr. spent as much as half of each day in a dirty diaper after his caregiver services provided through Iowa’s Medicaid program were dramatically cut. …The cuts ended payments for at least 16 visits each week for an in-home care program that helped the family dress, feed and change the diapers of Facenda Jr. two to three times each day. (Clayworth, 10/19)

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Pollution Kills More People Than AIDS, Tuberculosis And Malaria Combined

A recent study has found just how dangerous pollution is to the world’s health. In other public health news: high blood pressure, obesity and cholesterol, tobacco, adult-onset ADHD, broken hearts and concussions.

The Associated Press: Study Finds Pollution Is Deadlier Than War, Disaster, Hunger
Environmental pollution — from filthy air to contaminated water — is killing more people every year than all war and violence in the world. More than smoking, hunger or natural disasters. More than AIDS, tuberculosis and malaria combined. One out of every six premature deaths in the world in 2015 — about 9 million — could be attributed to disease from toxic exposure, according to a major study released Thursday in the Lancet medical journal. The financial cost from pollution-related death, sickness and welfare is equally massive, the report says, costing some $4.6 trillion in annual losses — or about 6.2 percent of the global economy. (Daigle, 10/20)

The New York Times: Women Are More Likely To Address High Blood Pressure
Hypertension is dangerous. High blood pressure damages the inner lining of the arteries, limits the ability of the heart to pump blood and strains the organ in a way that can lead to heart failure. The condition increases the risk for stroke and vascular dementia, and hypertension is one of the most common causes of kidney failure. It impairs vision by damaging the blood vessels in the eyes. (Bakalar, 10/19)

Los Angeles Times: Scientists Engineer Proteins That Caused Obese Animals To Lose Weight And Lower Cholesterol
As the U.S. obesity rate has galloped toward 40%, doctors, drug designers and dispirited dieters have all wondered the same thing: What if a pill could deliver the benefits of weight-loss surgery, but without the knife? New research brings that hope a notch closer. Scientists from the biotechnology company Amgen Inc. report they have identified and improved upon a naturally occurring protein that brought about significant changes in obese mice and monkeys, including weight loss and rapid improvements on measures of metabolic and heart health. (Healy, 10/19)

Bloomberg: 8 Million Tobacco Deaths Could Be Avoided By Slashing Nicotine
Reducing nicotine levels in cigarettes to nonaddictive levels could prevent as many as 8 million tobacco-related deaths and keep 30 million people from becoming regular smokers this century, according to new estimates from the Food and Drug Administration. FDA Commissioner Scott Gottlieb revealed the initial estimates on Thursday during a tobacco discussion at the Johns Hopkins Bloomberg School of Public Health. (Edney and Kaplan, 10/19)

The New York Times: New Study Casts Doubt On Diagnosis Of Adult-Onset A.D.H.D.
In just the past few years, researchers have identified what they believe is an adult version of attention deficit disorder: a restless inability to concentrate that develops spontaneously after high school, years after the syndrome typically shows itself, and without any early signs. The proposed diagnosis — called adult-onset A.D.H.D. and potentially applicable to millions of people in their late teens or older — is distinct from the usual adult variety, in which symptoms linger from childhood. (Carey, 10/20)

The Washington Post: A Woman’s Dog Died, And Doctors Say Her Heart Literally Broke
Joanie Simpson woke early one morning with a terrible backache. Her chest started hurting when she turned over. Within 20 minutes, she was at a local emergency room. Soon she was being airlifted to a hospital in Houston, where physicians were preparing to receive a patient exhibiting the classic signs of a heart attack. But tests at Memorial Hermann Heart & Vascular Institute -Texas Medical Center revealed something very different. Doctors instead diagnosed Simpson with Takotsubo cardiomyopathy, a condition with symptoms that mimic heart attacks. It usually occurs following an emotional event such as the loss of a spouse or child. That link has given the illness its more colloquial name: broken-heart syndrome. (Brulliard, 10/19)

The Washington Post: State Laws Have Reduced Concussion Risks In High School Kids, Study Finds
A lot has changed in the past 10 years when it comes to sports concussions. As evidence has grown of the devastating effects of traumatic brain injuries, athletes and parents have become increasingly alarmed and demanded preventive steps. Some of the most tangible results of that concern are new laws passed in all 50 states and the District of Columbia that try in some form to address head injuries among young athletes. (Wan, 10/19)

Columbus Dispatch: New Laws Appear To Be Helping To Reduce Concussion Rates In High School Athletes
A study of more than 8,000 concussions sustained by U.S. high-school athletes indicates that traumatic brain injury laws aimed at protecting children in the aftermath of such injuries are having their intended effect. In the 11-year study of nine sports, researchers found that the rate of repeat concussions significantly declined beginning a little more than 2 1/2 years after the laws went into effect, said senior author Ginger Yang, a principal investigator in the Center for Injury Research and Policy at Nationwide Children’s Hospital. (Viviano, 10/19)

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Prices For Cancer Drugs Creeping Up Much Higher Than Inflation Warrants

“Some [increases] exceeded inflation drastically and some increased at a slower rate,” said Dr. Daniel Goldstein, the author of the study. “But overall, we’re seeing a gradual creep each year.”

Stat: Cancer Drug Prices Have Been Rising Much, Much Faster Than Inflation
The prices for injectable cancer drugs — including older medicines that face competition — rose over a recent eight-year period at rates that far exceeded inflation, according to a new study. Specifically, the mean price increase for 24 branded cancer medicines that were approved in the U.S. between 1996 and 2012 was a whopping 25 percent. After adjusting for inflation, the increase was 18 percent. Moreover, gradual price increases over the years can result in substantial cumulative increases. In this instance, the mean cumulative price increase for all two dozen drugs was 36.5 percent. (Silverman, 10/19)

In other pharmaceutical news —

Stat: Allergan Faces A Cheaper, Compounded Version Of Its Restasis Eye Drops
Hoping to capitalize on consumer outrage, Imprimis Pharmaceuticals (IMMY) plans to sell a cheaper, compounded version of the Restasis dry-eye treatment that is sold by Allergan (AGN) and has been at the center of a widening controversy in recent weeks. The company plans to sell its version for a fraction of the roughly $500 monthly cost for Restasis, which generated nearly $1.5 billion in sales last year, although may now face generic competition next year after a federal court judge last week invalidated several patents for the medicine. (Silverman, 10/19)

Stat: Celgene Just Lost A Crucial Drug For Its Revenue Stream After A Clinical Trial Blowup
Celgene just lost one of the most important drugs in its research pipeline to a late-stage clinical trial blowup. The drug is mongersen, a key component in Celgene’s burgeoning immunology and inflammation franchise. On Thursday, a phase 3 study of mongersen in Crohn’s disease was halted prematurely following a finding of clinical futility by independent monitors, the company said. (Feuerstein, 10/19)

CNN: City Of Los Angeles Opens Investigation Into Drugmaker Following CNN Report
Los Angeles City Attorney Mike Feuer has launched an investigation into California-based drugmaker Avanir Pharmaceuticals, the subject of a CNN report into its aggressive targeting of nursing home residents with a drug called Nuedexta that may be unnecessary or unsafe for this population. Feuer confirmed the investigation to CNN, saying that his office is seeking information and tips from the public to help determine whether state or federal laws have been broken in the sale, marketing or prescribing of Nuedexta. (Ellis and Hicken, 10/19)

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As Medicaid Enrollment Stabilizes, States Seeing Modest Rise In Spending

The Kaiser Family Foundation’s annual survey of 50 states looks at changes expected in Medicaid programs. In other Medicaid news, Pennsylvania’s governor vetoes a bill that would impose work requirements for enrollees, Louisiana lawmakers weigh new contracts for managed care companies and New Hampshire approves coverage of gender reassignment surgeries.

The Associated Press: Report: Medicaid Enrollments, Costs Begin To Stabilize
States are seeing more stability in their Medicaid programs after experiencing a surge in enrollment and costs associated with the Affordable Care Act, suggesting that one of the major pillars of former President Barack Obama’s health overhaul may be nearing its peak. At the same time, they are experiencing a high level of uncertainty as Republicans in Congress continue to advocate for a major overhaul of a program that provides health insurance to tens of millions of lower-income and disabled Americans. Thursday’s report by the Kaiser Family Foundation found Medicaid enrollments in the states slowed considerably to an increase of just 2.7 percent in fiscal year 2017. (Cassidy, 10/19)

CQ: Medicaid Spending Likely To Rise While Enrollment Growth Slows
Medicaid spending is expected to grow modestly in the coming year, fueled in part by rising prescription drug costs, provider rate increases and growth in the cost of long-term care services, a new report released Thursday says. That’s despite the fact that enrollment in the health program for the poor is projected to grow less rapidly during the same time period, according to the nonpartisan Kaiser Family Foundation’s annual survey of state Medicaid programs. (Williams, 10/19)

The Associated Press: Louisiana Medicaid Contracts Proposed For 2-Year Extension
Louisiana’s health department wants to keep the five managed-care companies that coordinate health services for most state Medicaid patients in place, extending the lucrative government contracts for another two years. Lawmakers on the joint House and Senate budget committee on Friday will consider whether to approve the extensions, expected to cost $15 billion with federal and state dollars. (Deslatte, 10/19)

Concord Monitor: Vote Allows Medicaid Funds To Be Used For Gender Reassignment Surgeries
New Hampshire Medicaid money may now be used for gender reassignment surgeries, after legislators on the state’s administrative rules committee narrowly approved a change Thursday. Submitted by the Department of Health and Human Services, the change eliminates a provision of the rules that stipulates “sex change operations shall be non covered.” (DeWitt, 10/19)

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Medicare Agency May Have ‘Overcorrected’ When Canceling Cardiac Pay Models

Also in the news from the Centers for Medicare & Medicaid Services, the agency will begin evaluating some of the changes put in place by MACRA to reduce Medicare spending.

Modern Healthcare: CMS May Have Overcorrected In Cancellation Of Cardiac Models
The CMS may have overcorrected when it honored some hospitals’ request to cancel mandatory cardiac pay models. The move means hospitals that were ready to embrace the models could be out millions of dollars. Those hospitals are also missing out on millions in bonus payments they would have received had they improved care. The CMS wants to cancel models for acute myocardial infarction, coronary artery bypass and as well as the Cardiac Rehabilitation Incentive Payment Model, all of which were scheduled to begin on Jan. 1, 2018. Comments on the termination were due Oct. 16. (Dickson, 10/19)

Modern Healthcare: CMS Makes First Move To Hold Docs Accountable For Medicare Spending 
The CMS is taking its first steps to evaluate whether MACRA will lead to reduced Medicare spending with a new pilot test. The test will evaluate eight new measures to determine if physicians in the Merit-based Incentive Payment System, known as MIPS, are actually reducing the cost of care. The CMS unveiled the initiative just two weeks after the Medicare Payment Advisory Commission suggested repealing MIPS over concerns it wouldn’t lead to better quality of care for patients or lower costs. (Dickson, 10/19)

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Court Of Appeals Stays Ruling To Allow Undocumented Girl’s Abortion; Hearing Set For Friday

The court did, however, allow for the girl to see a counselor — which Texas law requires before obtaining an abortion. If the stay is lifted, she could decide to seek the procedure later today or tomorrow.

The Associated Press: Court To Review Ruling Allowing Abortion For Immigrant Teen
An appeals court on Thursday temporarily stayed a judge’s ruling that would have allowed a pregnant 17-year-old being held in a Texas facility for unaccompanied immigrant children to obtain an abortion. The U.S. Court of Appeals for the District of Columbia issued a short ruling that still allowed the teenager to be taken to a counseling meeting with the doctor who would perform the abortion. Texas state law requires women to receive counseling 24 hours before an abortion. (Merchant, 10/19)

The Wall Street Journal: Appeals Court To Review Case Of Undocumented Teenager Seeking Abortion
In a rare move Thursday, a federal appeals court hastily scheduled an oral argument for Friday morning after U.S. District Judge Tanya Chutkan in Washington, D.C., sharply criticized the administration’s position and ordered it to release the teen to travel to the nearest abortion clinic this week. The government appealed the decision immediately. The appeals court put the court order on hold temporarily so it could consider the case, which raises questions about whether undocumented immigrants in custody have the same constitutional right to an abortion that is accorded to U.S. citizens. (Kendall and Meckler, 10/19)

The Washington Post: Appeals Court To Review Judge’s Order Allowing Abortion For Undocumented Immigrant
Federal officials say the 17-year-old, who entered this country in September, could solve the problem herself by voluntarily leaving or finding a sponsor in the United States to take custody of her. “The Administration stands ready to expedite her return to her home country,” the White House said in a statement. But the American Civil Liberties Union, which is representing the teenager, says she is entitled to have an abortion, which she would pay for, under the 1973 Supreme Court ruling in <i>Roe v. Wade</i>. (Sacchetti and Marimow, 10/19)

Reveal: Immigrant Girl In Federal Custody Must Wait For Abortion Until Appeals Court Can Rule
The ACLU, which is representing the girl, has produced internal emails from the Department of Health and Human Services Office of Refugee Resettlement suggesting the agency has quietly implemented a new policy banning abortion for immigrant minors in its care. The office’s new director under President Trump, Scott Lloyd, has told his staff to refer pregnant girls to pro-life religious pregnancy counseling instead of abortion clinics. In at least one case, he has personally met with a girl considering abortion. (Michels, 10/19)

In other news on abortion —

The Washington Post: U.S. Abortion Rate Fell 25 Percent From 2008 To 2014; One In Four Women Have An Abortion
The U.S. abortion rate has fallen dramatically, by 25 percent, in recent years. The procedure continues to be common: One in  four women will have an abortion by 45, according to a report published in the American Journal of Public Health on Thursday. Researchers used data from three surveys, two conducted by the federal government and the third by the Guttmacher Institute, to estimate abortion rates. They found that in 2008, there were 19.4 abortions per 1,000 women ages 15 to 44. By 2014, the number had dropped to 14.6 per 1,000. (Cha, 10/19)

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In Mostly Symbolic Gesture, Democrats Introduce Bill To Stop Rollback Of Contraception Mandate

“President Trump wants to make birth control about ideology, but let’s be clear: for women and their families in the 21st century, birth control is about being healthy and financially secure,” said Sen. Patty Murray (D-Wash.).

The Hill: Dems Introduce Bill To Overrule Trump On Birth Control Mandate 
Nineteen Senate Democrats have signed on to a bill that would reverse the Trump administration’s new exemption for ObamaCare’s birth control mandate. The administration recently announced it will allow most employers to stop providing birth control coverage in their insurance plans if they have moral or religious objections. (Hellmann, 10/19)

Seattle Times: Sen. Patty Murray Legislation Targets Trump’s Rollback Of Birth-Control Coverage 
Democratic Sens. Patty Murray of Washington and Bob Casey of Pennsylvania introduced a bill Thursday to overturn the rule issued by the U.S. Health and Human Services Department last week allowing more employers to opt out of providing no-cost contraceptives by claiming religious or moral objections. The bill, which is co-sponsored by Sen. Maria Cantwell, D-Wash., and others, says the rule would not take effect and would be treated as if it never happened. (Blethen, 10/19)

CQ: Arguments Over Impact Of Contraceptive Rules Continue
Lawmakers and advocates continue to argue about the scope of two rules creating moral and religious exemptions for employers who do not want to cover birth control, two weeks after the Trump administration revealed the policies. The rules significantly expanded the types of organizations that can apply for exemptions to a mandate established under the 2010 health care law (PL 111-148, PL 111-152), which requires most private plans to cover birth control without a copay. Under the rules, any employer is able to qualify for an exemption, provided they have a religious or moral objection to contraception. (Raman, 10/19)

In other news from Capitol Hill —

Stat: These Health Programs Work. But Congress Has Left Their Future Uncertain
Another program that lost funding helps seniors navigate the complexities of Medicare, still another gives payments aimed at keeping smaller, often rural hospitals financially afloat. Others offer grants to providers and other businesses working to address childhood obesity or improving abstinence education efforts. In the past, Congress has reauthorized this slate of extenders with bipartisan support. Already this year, two House committees have approved tweaks or reauthorizations of many of the programs, teeing them up for further consideration from the full legislative body. The Senate also approved several of the programs, including a broad expansion of the Independence at Home program, as part of a bill aimed at improving care for individuals with chronic conditions. (Mershon, 10/19)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Amid For-Profit Surge, Rural Hospice Has Offered Free Care for 40 Years

PORT ANGELES, Wash. — Rose Crumb can’t even count the number of people she’s helped die.

The former nurse, 91, who retired in her mid-80s, considers the question and then shakes her head, her blue eyes sharp above oval spectacles.

“Oh, hundreds,” estimates Crumb, the woman who almost single-handedly brought hospice care to this remote Pacific Northwest city nearly 40 years ago.

But the actual number of deaths she has witnessed is likely far higher — and Crumb’s impact far greater — than even she will admit, say those affiliated with the Volunteer Hospice of Clallam County.

“[Rose] let people know hospice is not all about dying,” said Bette Wood, who manages patient care for VHOCC. “Hospice is about how to live each and every day.”

In a nation where Medicare pays nearly $16 billion a year for hospice care, and nearly two-thirds of providers are for-profit businesses, the tiny Washington state agency is an outlier.

Since 1978, the hospice founded by Crumb — a mother of 10 and devoted Catholic — has offered free end-of-life care to residents of Port Angeles and the surrounding area. She was the first in the region to care for dying AIDS patients in the early days of the epidemic. Her husband, “Red” Crumb, who died in 1984 of leukemia, was an early patient.

“He died the most perfect death,” Rose Crumb told visitors on a recent afternoon. “He spent time alone with each of our kids. That meant so much to him.”

At the same time, Crumb and her successors have refused to accept federal funding or private insurance, relying instead on a mostly volunteer staff and community donations to keep the hospice going.

Since 1978, the Volunteer Hospice of Clallam County has offered free end-of-life care to residents of Port Angeles, Wash. (Dan DeLong for KHN)

That’s rare, said Jon Radulovic, a spokesman for the National Hospice and Palliative Care Organization, NHPCO, an industry trade group. Most of the nation’s 4,000-plus hospices receive Medicare payments for their services. He estimates there are only a few volunteer hospices like Crumb’s in the U.S.

There was pressure in the early years to “take the money,” as Crumb put it. But she had little use for the regulations that accompanied federal Medicare reimbursement starting in 1982.

“It was our experience that we could operate on a much smaller budget and we could be more flexible in providing services,” Crumb wrote in a 2007 newsletter.

Today, the hospice relies on 10 paid staff, 160 volunteers and an annual budget of less than $400,000 to provide end-of-life care for 300 patients each year, according to federal records.

Patients don’t have to meet Medicare’s criteria of having six months or less to live to be enrolled, though most do. They can keep their own doctors instead of turning over care to a hospice physician. If families need medical equipment, the hospice supplies it for free.

“I don’t know how I would have made it without them,” said Eve Farrell, 82, whose husband, Daniel, had cardiopulmonary obstructive disorder, or COPD. He died in January at age 80 after four months of hospice care at the couple’s Port Angeles home.

Eve Farrell holds a portrait of her husband, Daniel, in her Port Angeles, Wash., home. Daniel died on Jan. 15, 2017, of complications of COPD — chronic obstructive pulmonary disease. (Dan DeLong for KHN)

Staffers helped her husband shower when she couldn’t lift him, offered advice about medication and gave her breaks from relentless caregiving.

“We felt like Dan was the only patient they had,” Eve Farrell said.

Crumb was drawn to hospice care in the 1970s, after the book “On Death and Dying” by Dr. Elisabeth Kübler-Ross galvanized conversations in the U.S. about how to treat the terminally ill. Years earlier, when Crumb’s father was diagnosed with lymphoma, she helped him die at home.

“It was the most meaningful experience in my nursing career,” she said.

In April 1977, when Crumb attended a convention that included a program on hospice, she was hooked.

“Everything clicked,” she recalled. “I thought ‘Yes!’”

Organizers had little money and less support, Crumb said. The local medical community was skeptical about hospice, which started in the U.S. in Connecticut in 1974.

“Some of the doctors called us ‘the death squad,’” Crumb said. Crumb’s refusal to take federal funds put her at odds with the for-profit hospice industry, which lobbied state lawmakers in 1992 to eliminate an exemption that allowed volunteer hospices to remain unlicensed.

Bette Wood is patient care manager at the Volunteer Hospice of Clallam County. “[Rose] let people know hospice is not all about dying,” Wood says about Crumb. “Hospice is about how to live each and every day.” (Dan DeLong for KHN)

Crumb had to enlist the services of her eighth child, Patrick Crumb, then a corporate lawyer, to fight back.

“In my view, they were clearly misrepresenting the current status of the law,” recalled Patrick Crumb, 55, who is now president of the AT&T Sports Network. “I told them, ‘If you do what you’re threatening to do, I’m going to sue you and I’m going to win.”

Lawmakers eventually agreed to create an exemption to state law that allows volunteer hospices to remain unlicensed and unregulated. Crumb’s hospice remains the only agency in state history to use it.

In 2002, the volunteer hospice faced a for-profit rival, Assured Home Health and Hospice, now owned by the LHC Group based in Lafayette, La. Documents show that Assured officials predicted they’d serve 70 percent of the local hospice market within two years.

But competition was fierce, recalled Dr. Tom Kummet, medical director at the Olympic Medical Cancer Center, who referred dying patients to hospice care.

“It was a bit of an awkward time,” he said.  “Assured hospice wanted to be a successful business. And Volunteer Hospice was going to negatively impact their chances of being a successful business.”

“We don’t have oversight from the government, but we have minute oversight from the community,” says Astrid Raffinpeyloz, volunteer services manager and community outreach committee co-chair of the Volunteer Hospice of Clallam County. (Dan DeLong for KHN)

Fifteen years later, Assured still struggles, said Leslie Emerick, director of public policy and outreach for the Washington State Hospice and Palliative Care Organization.

“They tread lightly up there because of Rose,” Emerick said.  “Rose is a beloved person in that community.”

Officials with LHC declined to discuss competition in the Port Angeles market or to say how many patients Assured has enrolled.

“We value the care that Volunteer Hospice provides for our community,” Candace Hammer Chaney, a local Assured manager and community liaison, said in a statement.

Emerick and other hospice industry officials said volunteer hospices don’t offer the range of services required of those who receive federal funding. And, Emerick added, there’s little oversight.

“They don’t have a reputation of negligence or complaints as far as I’m aware, but there’s always the possibility of that when they’re unlicensed or unregulated,” she said.

But Astrid Raffinpeyloz, VHOCC’s volunteer services manager, said the hospice wouldn’t have lasted long in a small town if there were problems.

“We don’t have oversight from the government, but we have minute oversight from the community,” said Raffinpeyloz.

Mike Clapshaw poses with a picture of himself and his wife, Deborah, in his Port Angeles, Wash., home. (Dan DeLong for KHN)

For Mike Clapshaw, 71, there was no question about who would care for his wife, Deborah, when her cancer came back for the third time, leading to her death in December 2014. She was 60. For the last four months of her life, VHOCC staff eased her pain — and his.

“It was always, ‘What can I do to help?’” he said.

Helping was always the point, said Rose Crumb, whether the pain at the end of life was physical, emotional — or both.

“Some people just need someone to listen to them,” she said.

Crumb, at nearly 92, now suffers from osteoporosis, congestive heart failure and other ailments that plagued her patients in earlier years. But she’s not worried about her final days.

“I’m all signed up for hospice,” she said.  “I have everything written down.”

KHN’s coverage of end-of-life and serious illness issues is supported by The Gordon and Betty Moore Foundation.

Categories: Aging, Public Health

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First Edition: October 20, 2017

Oct 20 2017

Today’s early morning highlights from the major news organizations.

Kaiser Health News: Podcast: ‘What The Health?’ Whiplash
The bipartisan leaders of the Senate Health, Education, Labor and Pensions Committee this week agreed on a bill they say could help stabilize the struggling health insurance exchanges. But despite compromises made by Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.), it’s still unclear whether Congress can pass the measure, particularly in time for the Affordable Care Act’s 2018 open enrollment season, which begins Nov. 1. (10/19)

California Healthline: Calif. Locks In Plans For Open Enrollment As Congressional Bipartisanship Fades
A sudden burst of bipartisanship this week on health care just as quickly appeared to lose steam in Washington. Two key senators, Republican Lamar Alexander and Democrat Patty Murray, announced a bill Tuesday aimed at stabilizing the health insurance marketplaces under the Affordable Care Act. It would guarantee payment of “cost-sharing reduction” subsidies that help lower-income consumers with their deductibles and copays for 2018 and 2019. President Donald Trump had halted those payments last week. (Other federal subsidies that help people pay for their premiums weren’t affected and remain intact.) (10/19)

The Hill: Key Senate Republican Warns GOP To Change Course On ObamaCare
Senate Health Committee Chairman Lamar Alexander (R-Tenn.) on Thursday told GOP colleagues bluntly that their efforts to repeal ObamaCare have failed and urged them to change course. Alexander said Republicans need to come up with a new path on health care after holding dozens of votes over the years to repeal ObamaCare and always ending in failure. (Bolton, 10/19)

The Hill: 24 Senators Co-Sponsor Bipartisan ObamaCare Deal
The bipartisan deal to stabilize ObamaCare’s markets has 24 co-sponsors, Senate Health Committee Chairman Lamar Alexander (R-Tenn.) announced Thursday. Twelve Republicans and 12 Democrats signed on to the bill, which would continue ObamaCare’s insurer subsidies for two years and give states more flexibility to waive ObamaCare rules. (Hellmann, 10/19)

Los Angeles Times: Senators Push Forward With Bipartisan Obamacare Fix — And Trump’s Encouragement
Sen. Lamar Alexander (R-Tenn.), chairman of the Senate Health committee, and the top Democrat on the panel, and Sen. Patty Murray of Washington jointly announced 22 bipartisan co-sponsors to their effort, more than typical for a bill. Alexander noted that Trump, too, continued to encourage him to push forward. The president called the senator twice Wednesday, even after speaking critically of the plan.”I want to thank him for his encouragement,” Alexander said. (Mascaro, 10/19)

The Hill: Graham, Cassidy Trying To Move New ObamaCare Deal To The Right
Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.) say they are working to make changes to a bipartisan health-care deal to make it more likely to win favor in the House. Graham and Cassidy, authors of a failed bill to repeal and replace ObamaCare earlier this year, are supporting a bipartisan measure aimed at stabilizing ObamaCare, but they are also looking for changes to move the proposal to the right. (Sullivan, 10/19)

Politico: GOP To Trump: Stop Flip-Flopping On Obamacare Deal
Key Senate Republicans are urgently trying to get President Donald Trump to reconsider his apparent opposition to a bipartisan deal shoring up health insurance markets, several senators said Thursday morning. Sens. Lindsey Graham of South Carolina and Lamar Alexander of Tennessee, who negotiated the deal with Democratic Sen. Patty Murray of Washington, both spoke to the president about it on Wednesday evening. (Everett and Haberkorn, 10/19)

The New York Times: Will Mitch McConnell Help His Friend Get A Health Care Deal?
Mitch McConnell and Lamar Alexander go way back. The two Southern Republicans met in Washington in 1969 when Mr. Alexander was a promising young aide at the Nixon White House and Mr. McConnell an up-and-coming legislative assistant to Senator Marlow W. Cook of Kentucky. The story goes that Senator Howard H. Baker Jr. suggested to Mr. Alexander, his fellow Tennessean, that he should look up Mr. McConnell, that he was a “smart young man and I think you’d like him.” A nearly 50-year friendship and political alliance was born. (Hulse, 10/19)

The Wall Street Journal: Trump’s Support For Bipartisan Health Bill Hinges On Rollbacks Long Sought By Conservatives
“We are certain that it can be improved,” Mr. Alexander said on the Senate floor Thursday. But the White House made clear Thursday that Mr. Trump was seeking more than minor tweaks to the legislation, which would shore up the ACA’s individual insurance markets by extending for two years federal payments known as “cost-sharing reductions” that help insurers offset subsidies they provide to some low-income consumers, while giving states greater say in how the law is implemented. In order for Mr. Trump to support such legislation, it must provide relief from the ACA’s requirement that most people have health coverage or pay a penalty, the spokesman said Thursday. (Armour and Peterson, 10/19)

Reuters: White House Says Rollback Of Obamacare Must Be Part Of Short-Term Fix
A senior White House aide said on Thursday that U.S. President Donald Trump would demand steps toward repealing Obamacare in any healthcare legislation, comments that cast doubt on the prospects for a short-term bill to shore up insurance markets. Marc Short, the White House’s top liaison to Congress, said on CNN that Obamacare’s mandates and taxes would have to be rolled back and consumers be allowed to more heavily invest in health-savings accounts for Trump to sign off on any congressional deal. (Cowan and Abutaleb, 10/19)

The Washington Post: Health Insurers’ Most Pressing Concern Right Now? Consumer Confusion.
Health insurers heading into the 2018 Affordable Care Act enrollment season say they’re staying laser focused on maximizing sign-ups, even as Republicans remain in disarray and even denial over the seven-year-old health-care law. A big funding infusion that could help lower Obamacare premiums is in flux just 12 days before enrollment starts. President Trump sent mixed signals this week about whether he’d support legislation funding subsidies for lower-income Americans to get coverage. (Winfield Cunningham, 10/19)

Reuters: Some Middle-Class Americans Worry Trump Health Subsidies Cut Will Hurt
Tom Westerman voted for Donald Trump in last year’s election but says he might not do so again after the president cut off billions of dollars in Obamacare subsidies to health insurance companies. “It really upset me,” said Westerman, 63, a self-described “middle-class guy” with an annual household income of about $60,000 in the western Pennsylvania city of Arnold. (Reid and Abutaleb, 10/19)

The Wall Street Journal: 5 Ways This ACA Open Enrollment Period Will Be Different
In less than two weeks, the first Trump-era open enrollment season for health insurance will commence. Whether consumers look to renew insurance plans or join the individual market for the first time, here are some ways the experience may be different this year compared to years prior, according to a presentation to reporters Wednesday by the nonpartisan Kaiser Family Foundation. (Jamerson, 10/19)

Los Angeles Times: With Obamacare, Fewer Americans Were Uninsured When They Were Told They Had Cancer
As President Trump and his allies in Congress keep pushing to get rid of Obamacare, new research shows that the contentious law has succeeded in expanding health insurance coverage for Americans with cancer. But not everywhere. This upside of Obamacare — known formally as the Patient Protection and Affordable Care Act, or ACA — was seen primarily in states that participated in the Medicaid expansion that the law made possible. (Kaplan, 10/19)

The Associated Press: Report: Medicaid Enrollments, Costs Begin To Stabilize
States are seeing more stability in their Medicaid programs after experiencing a surge in enrollment and costs associated with the Affordable Care Act, suggesting that one of the major pillars of former President Barack Obama’s health overhaul may be nearing its peak. At the same time, they are experiencing a high level of uncertainty as Republicans in Congress continue to advocate for a major overhaul of a program that provides health insurance to tens of millions of lower-income and disabled Americans. (10/19)

Politico: Trump Blindsides Advisers With Promised Opioid Plan
President Donald Trump overrode his own advisers when he promised to deliver an emergency declaration next week to combat the nation’s worsening opioid crisis. “That is a very, very big statement,” he said Monday. “It’s a very important step. … We’re going to be doing it in the next week.” (Ehley and Dawsey and Karlin-Smith, 10/20)

Stat: While Federal Standards To Battle The Opioid Epidemic Take Shape, States Codify Their Own
There is little that resembles a current and all-encompassing drug policy in the United States. A national drug control plan issued by the Obama administration last year was written immediately prior to a White House transition, and many hoping for a newer framework are waiting for next month’s reveal of a new presidential commission’s final report on the opioid epidemic.  A new analysis by the Kaiser Family Foundation, however, shows that many of the elements that could soon be codified as federal guidance are already creeping toward national standards in a patchwork fashion, apparent in the regulations imposed by a number of states for implementing Medicaid. (Facher, 10/19)

The Hill: Dems Introduce Bill To Overrule Trump On Birth Control Mandate 
Nineteen Senate Democrats have signed on to a bill that would reverse the Trump administration’s new exemption for ObamaCare’s birth control mandate. The administration recently announced it will allow most employers to stop providing birth control coverage in their insurance plans if they have moral or religious objections. (Hellmann, 10/19)

The Associated Press: Court To Review Ruling Allowing Abortion For Immigrant Teen
An appeals court on Thursday temporarily stayed a judge’s ruling that would have allowed a pregnant 17-year-old being held in a Texas facility for unaccompanied immigrant children to obtain an abortion. The U.S. Court of Appeals for the District of Columbia issued a short ruling that still allowed the teenager to be taken to a counseling meeting with the doctor who would perform the abortion. Texas state law requires women to receive counseling 24 hours before an abortion. (10/19)

The Wall Street Journal: Appeals Court To Review Case Of Undocumented Teenager Seeking Abortion
In a rare move Thursday, a federal appeals court hastily scheduled an oral argument for Friday morning after U.S. District Judge Tanya Chutkan in Washington, D.C., sharply criticized the administration’s position and ordered it to release the teen to travel to the nearest abortion clinic this week. The government appealed the decision immediately. The appeals court put the court order on hold temporarily so it could consider the case, which raises questions about whether undocumented immigrants in custody have the same constitutional right to an abortion that is accorded to U.S. citizens. (Kendall and Meckler, 10/19)

The Washington Post: Appeals Court To Review Judge’s Order Allowing Abortion For Undocumented Immigrant
Federal officials say the 17-year-old, who entered this country in September, could solve the problem herself by voluntarily leaving or finding a sponsor in the United States to take custody of her. “The Administration stands ready to expedite her return to her home country,” the White House said in a statement. But the American Civil Liberties Union, which is representing the teenager, says she is entitled to have an abortion, which she would pay for, under the 1973 Supreme Court ruling in <i>Roe v. Wade</i>. (Sacchetti and Marimow, 10/19)

The Washington Post: U.S. Abortion Rate Fell 25 Percent From 2008 To 2014; One In Four Women Have An Abortion
The U.S. abortion rate has fallen dramatically, by 25 percent, in recent years. The procedure continues to be common: One in  four women will have an abortion by 45, according to a report published in the American Journal of Public Health on Thursday. Researchers used data from three surveys, two conducted by the federal government and the third by the Guttmacher Institute, to estimate abortion rates. They found that in 2008, there were 19.4 abortions per 1,000 women ages 15 to 44. By 2014, the number had dropped to 14.6 per 1,000. (Cha, 10/19)

Stat: Cancer Drug Prices Have Been Rising Much, Much Faster Than Inflation
The prices for injectable cancer drugs — including older medicines that face competition — rose over a recent eight-year period at rates that far exceeded inflation, according to a new study. Specifically, the mean price increase for 24 branded cancer medicines that were approved in the U.S. between 1996 and 2012 was a whopping 25 percent. After adjusting for inflation, the increase was 18 percent. Moreover, gradual price increases over the years can result in substantial cumulative increases. In this instance, the mean cumulative price increase for all two dozen drugs was 36.5 percent. (Silverman, 10/19)

Stat: Allergan Faces A Cheaper, Compounded Version Of Its Restasis Eye Drops
Hoping to capitalize on consumer outrage, Imprimis Pharmaceuticals (IMMY) plans to sell a cheaper, compounded version of the Restasis dry-eye treatment that is sold by Allergan (AGN) and has been at the center of a widening controversy in recent weeks. The company plans to sell its version for a fraction of the roughly $500 monthly cost for Restasis, which generated nearly $1.5 billion in sales last year, although may now face generic competition next year after a federal court judge last week invalidated several patents for the medicine. (Silverman, 10/19)

The Associated Press: Study Finds Pollution Is Deadlier Than War, Disaster, Hunger
Environmental pollution — from filthy air to contaminated water — is killing more people every year than all war and violence in the world. More than smoking, hunger or natural disasters. More than AIDS, tuberculosis and malaria combined. One out of every six premature deaths in the world in 2015 — about 9 million — could be attributed to disease from toxic exposure, according to a major study released Thursday in the Lancet medical journal. The financial cost from pollution-related death, sickness and welfare is equally massive, the report says, costing some $4.6 trillion in annual losses — or about 6.2 percent of the global economy. (Daigle, 10/20)

The New York Times: Women Are More Likely To Address High Blood Pressure
Hypertension is dangerous. High blood pressure damages the inner lining of the arteries, limits the ability of the heart to pump blood and strains the organ in a way that can lead to heart failure. The condition increases the risk for stroke and vascular dementia, and hypertension is one of the most common causes of kidney failure. It impairs vision by damaging the blood vessels in the eyes. (Bakalar, 10/19)

Los Angeles Times: Scientists Engineer Proteins That Caused Obese Animals To Lose Weight And Lower Cholesterol
As the U.S. obesity rate has galloped toward 40%, doctors, drug designers and dispirited dieters have all wondered the same thing: What if a pill could deliver the benefits of weight-loss surgery, but without the knife? New research brings that hope a notch closer. Scientists from the biotechnology company Amgen Inc. report they have identified and improved upon a naturally occurring protein that brought about significant changes in obese mice and monkeys, including weight loss and rapid improvements on measures of metabolic and heart health. (Healy, 10/19)

The New York Times: New Study Casts Doubt On Diagnosis Of Adult-Onset A.D.H.D.
In just the past few years, researchers have identified what they believe is an adult version of attention deficit disorder: a restless inability to concentrate that develops spontaneously after high school, years after the syndrome typically shows itself, and without any early signs. The proposed diagnosis — called adult-onset A.D.H.D. and potentially applicable to millions of people in their late teens or older — is distinct from the usual adult variety, in which symptoms linger from childhood. (Carey, 10/20)

The Washington Post: State Laws Have Reduced Concussion Risks In High School Kids, Study Finds
A lot has changed in the past 10 years when it comes to sports concussions. As evidence has grown of the devastating effects of traumatic brain injuries, athletes and parents have become increasingly alarmed and demanded preventive steps. Some of the most tangible results of that concern are new laws passed in all 50 states and the District of Columbia that try in some form to address head injuries among young athletes. (Wan, 10/19)

The Washington Post: A Woman’S Dog Died, And Doctors Say Her Heart Literally Broke
Joanie Simpson woke early one morning with a terrible backache. Her chest started hurting when she turned over. Within 20 minutes, she was at a local emergency room. Soon she was being airlifted to a hospital in Houston, where physicians were preparing to receive a patient exhibiting the classic signs of a heart attack. But tests at Memorial Hermann Heart & Vascular Institute -Texas Medical Center revealed something very different. Doctors instead diagnosed Simpson with Takotsubo cardiomyopathy, a condition with symptoms that mimic heart attacks. It usually occurs following an emotional event such as the loss of a spouse or child. That link has given the illness its more colloquial name: broken-heart syndrome. (Brulliard, 10/19)

The Associated Press: Closing Arguments Set In Deadly Meningitis Outbreak Trial
Attorneys are preparing to make their closing arguments in the case of a Massachusetts pharmacist charged with second-degree murder in a deadly meningitis outbreak. Closing arguments in Glenn Chin’s trial are expected Friday in Boston’s federal courthouse. Chin faces second-degree murder, mail fraud and other charges under federal racketeering law. (Richer, 10/20)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Podcast: ‘What The Health?’ Whiplash

The bipartisan leaders of the Senate Health, Education, Labor and Pensions Committee this week agreed on a bill they say could help stabilize the struggling health insurance exchanges. But despite the compromises made by Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.), it’s still unclear whether Congress can pass the measure, particularly in time for the 2018 open enrollment that begins Nov. 1.

President Donald Trump, who in the past week has taken multiple positions on whether he supports or opposes the bipartisan efforts, is not helping the effort.

In this episode of “What The Health?” Julie Rovner of Kaiser Health News, Joanne Kenen of Politico, Margot Sanger-Katz of The New York Times, and Alice Ollstein of Talking Points Memo discuss these issues, as well as the fate of the Children’s Health Insurance Program, whose funding authorization expired on Oct. 1.

The Senate compromise would appear to be a win-win: Democrats restore Obamacare markets’ stability and Republicans help bring down premium prices. But politics keep getting in the way.

The panelists agreed that the bipartisan bill faces a perilous path to passage, with Republicans in both the House and Senate loath to vote for something that could be seen as shoring up the health law they promised voters they would repeal. Even if it appears “really, really dead,” proposals often come back to life in health care. Keep an eye on end of the year congressional compromises.

But it also seems that Trump’s cutoff last week of subsidies that reimburse insurers for discounts they provide to lower-income enrollees has had less of an impact than many predicted. In some states, insurance regulators had insurers file two separate sets of rates, including a higher one in case the president stopped the payments. In other states, insurers are letting states file new rates, even though the deadline for that has technically passed.

Plus, for “extra credit,” the panelists recommend their favorite health stories of the week they think you should read, too.

Julie Rovner: The Washington Post’s “The Drug Industry’s Triumph Over the DEA,” by Scott Higham and Lenny Bernstein.

Joanne Kenen: The Pacific Standard’s “Doctor and Advocate: One Surgeon’s Global Fight For The Rights Of Rape Survivors,” by Fabiola Ortiz and Megan Clement.

Margot Sanger-Katz: Vox.com’s “Dark chocolate is now a health food. Here’s how that happened,” by Julia Belluz.

Alice Ollstein: Bloomberg News’ “The Health Plans Trump Backs Have a Long History of Disputes,” by Erik Larson and Zachary Tracer.

To hear all our podcasts, click here.

And subscribe to What the Health? on iTunesStitcher or Google Play.

Categories: Repeal And Replace Watch, The Health Law

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Viewpoints: Learning Cybersecurity Lessons From Medical Devices; Big Pharma Should Be Embarrassed — But Are They?

A selection of opinions on health care from around the country.

JAMA: Cybersecurity Concerns and Medical Devices: Lessons From a Pacemaker Advisory
Medical devices increasingly include capabilities for wireless communication and remote monitoring systems that relay clinical information from patients to clinicians. For example, many cardiac implantable electrical devices can transmit data regarding arrhythmia burden and heart failure metrics with minimal patient effort. This technology can improve patient care, but also introduces possible risks to data security and patient safety. (Daniel B. Kramer and Kevin Fu, 10/18)

The New York Times: ‘Drug Dealers In Lab Coats’
Big Pharma should be writhing in embarrassment this week after The Washington Post and “60 Minutes” reported that pharmaceutical lobbyists had manipulated Congress to hamstring the Drug Enforcement Administration. But the abuse goes far beyond that: The industry systematically manipulated the entire country for 25 years, and its executives are responsible for many of the 64,000 deaths of Americans last year from drugs — more than the number of Americans who died in the Vietnam and Iraq wars combined. The opioid crisis unfolded because greedy people — Latin drug lords and American pharma executives alike — lost their humanity when they saw the astounding profits that could be made. (Nicholas Kristof, 10/18)

The Washington Post: Democrats Are The Real Abortion Extremists
What would America’s abortion policy be if the number of months in the gestation of a human infant were a prime number — say, seven or eleven? This thought experiment is germane to why the abortion issue has been politically toxic, and points to a path toward a less bitter debate. The House has for a third time stepped onto this path. Senate Democrats will, for a third time, block this path when Majority Leader Mitch McConnell (R-Ky.) brings the House bill to the floor, allowing Democrats to demonstrate their extremism and aversion to bipartisan compromise. (George F. Will, 10/18)

JAMA: End-Of-Life Care Among Immigrants Disparities Or Differences In Preferences?
Although describing a “good death” is an existentially challenging exercise, most people, if asked to do so, would note the importance of the presence of friends and family, relief from distressing symptoms, time at home, completing life goals, and other values. Although these goals are likely shared quite widely, how they are prioritized, and how they relate to other goals, may vary among individuals and across cultures. (Michael O. Harhay and Scott D. Halpern, 10/17)

JAMA: Blood Transfusions From Previously Pregnant Women And Mortality: Interpreting The Evidence
The availability of large databases of blood donors and transfusion recipients has facilitated investigation of associations of donor characteristics with recipient outcomes. These databases are available in Sweden-Denmark, Canada, and the Netherlands, using government health data, and in the United States, using a donor-recipient database funded by the National Heart, Lung, and Blood Institute. (Ritchard G. Cable and Gustaf Edgren, 10/17)

JAMA: Better
I was in my first year of medicine residency, still losing my way to radiology, still forgetting the codes I needed to access one room or another, still desperately trying to learn how to keep track of my multiple patients and their multiple problems when I assumed his care. As the intern, it fell to me to examine Mr Jones and write admission orders. As the intern, I’d also been up all night. My new white coat was stained with coffee spilled while sprinting to accomplish one forgotten task or other. My pager was chirping regularly, a constant reminder of the calls I’d yet to return. Tired, anxious, and painfully aware of his nurse’s brisk competence as she quieted a beeping alarm and tugged the bed sheet, I introduced myself. (Jessica Gregg, 10/17)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Some Tips To Help Decide Whether Popular Medicare Advantage Plans Are Right For You

These private insurance plan take the place of traditional Medicare and vary in coverage and cost.

CNBC: Here’s How To Snag The Best Medicare Advantage Plan
Medicare open enrollment is underway, which means you have until Dec. 7 to sign up for an Advantage Plan or to make changes to the one you already have. If you’re uncertain whether one of these plans is right for you, it’s important to first understand your options. … In simple terms, these plans provide coverage from an insurance company and take the place of original Medicare, comprised of Part A (in-patient coverage) and Part B (outpatient care). While regulated by the government, Advantage Plans are administered by insurers and can vary in terms of coverage and cost. (O’Brien, 10/18)

Kaiser Health News: Medicare Vs. Medicare Advantage: How To Choose
As health insurers struggle with shifting government policies and considerable uncertainty, one market remains remarkably stable: Medicare Advantage plans. That’s good news for seniors as they select coverage for the year ahead during Medicare’s annual open enrollment period (this year running from Oct. 15 to Dec. 7). … Despite Medicare Advantage plans’ increasing popularity, several features — notably, the costs that older adults face in these plans and the extent to which members’ choice of doctors and hospitals is restricted — remain poorly understood. (Graham, 10/19)

And in news on Medicare payment models —

Modern Healthcare: ACOs For Specialty Providers Could Be Key To Medicare Savings
Providers saw promising savings from accountable care organization models over the last year, and recent data has shown the value-based programs could find more success in a relatively untapped area: specialty medicine. The CMS last week quietly released data showing that three ACO programs saved providers millions of dollars. Last year, the Comprehensive End-Stage Renal Disease Care Model saved $75 million, according to the agency. That’s more than the $68 million saved by Pioneer ACOs, and the $48 million saved by NextGen ACOs in the same period. Pioneer and NextGen ACOs mainly focused on better coordinating the primary care needs for Medicare patients. (Dickson, 10/18)

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Parsing Health Policies And Politics: Examining The Alexander-Murray Obamacare ‘Fix’; Why Does It Have To Be So Difficult?

Opinion writers offer a variety of takes on the deal announced this week by Sen. Lamar Alexander (R-Tenn.) and Sen. Patty Murray (D-Wash.) as well as what it can and cannot accomplish. They also take a tough inventory of the politics in play and examine other health policy issues, such as Medicare Advantage networks and the status of the Children’s Health Insurance Program reauthorization.

The New York Times: Bipartisan Health Proposal Is Too Late For 2018, But A Salve For 2019
The new bipartisan health proposal is far from a cure-all for Obamacare’s problems, but if it passed it would send health insurers a message they have sought all year: that it’s safe to stay in the marketplaces. Insurers have already signed contracts and are making final arrangements to sell their products in time for next year’s enrollment period, which begins on Nov. 1. (Reed Abelson and Margot Sanger-Katz, 10/19)

Bloomberg: A Congress That Can’t Make Anything Easy
Time for another test of whether this Congress can do the easy things — on health care this time. Republican Senator Lamar Alexander of Tennessee and Democratic Senator Patty Murray of Washington have reached a deal to “fix” the Affordable Care Act — a seemingly reasonable agreement designed, in very general terms, to help the insurance markets work better while giving states more flexibility to administer things. Both parties have incentives to approve something like this. Democrats care about preserving their big policy win in the original Affordable Care Act; Republicans don’t want chaos in health insurance while they control the White House and have majorities in both chambers of Congress. Sure, Republicans in theory would rather repeal and replace Obamacare, but if they didn’t realize earlier that they don’t actually have any realistic plan for doing so, most of them surely know it now. (Jonathan Bernstein, 10/18)

Bloomberg: Bipartisan Health Care Deal Is Too Late To Fix Much 
A bipartisan proposal to shore up the Affordable Care Act and guarantee the U.S. government keeps helping insurers cover low-income patients would have been something like a best-case scenario for the companies participating in the market — if it happened several months ago. As it stands, the bill, spearheaded by Senators Patty Murray and Lamar Alexander, has only a small chance of passing. And even if it does pass, it is unlikely to entirely mitigate the Trump administration’s active sabotage of the ACA. (Max Nisen, 10/18)

The Washington Post: If Republicans Kill This Health-Care Bill, They’ll Prove Their Cowardice
Bipartisan negotiators announced Tuesday that they had struck a deal to temporarily stabilize Obamacare markets. Republican Sen. Lamar Alexander (Tenn.) agreed to continue paying “cost-sharing reduction” payments that the government promised insurance companies, and Democratic Sen. Patty Murray (Wash.) agreed to relax health-market regulations a bit. Both sides of this deal contain good policy. (10/18)

The Wall Street Journal: Republicans, Stand Up For Health Freedom
While there is plenty of blame to go around for Republicans’ inability to repeal and replace Obama Care, the effort was all but doomed as soon as the GOP chose to fight on the wrong battlefield. Trying to pass a replacement through the budget process known as reconciliation was powerfully attractive, since it would have permitted the Senate to act on ObamaCare with only 51 votes. (Phil Gramm, 10/18)

Chicago Tribune: Breaking The Gridlock On Obamacare
For seven years, congressional Republicans and Democrats battling over Obamacare have agreed on only one thing: They couldn’t agree on anything. As more Americans dropped or skipped coverage because of soaring premiums, lawmakers of the two parties couldn’t — wouldn’t — agree on how to fix the 2010 law. (10/18)

The Wall Street Journal: More Freedom For More Money
That’s the question to ask about this week’s deal between Republican Lamar Alexander and Democrat Patty Murray to appropriate two years of funding for Obama Care’s “cost-sharing” reductions that flow to insurers. The Trump Administration last week cut off these subsidies, which the Obama Administration paid without an appropriation from Congress. A federal judge ruled last year that those payments are illegal. Democrats would also get about $100 million for advertising ObamaCare. (10/18)

The New York Times: Congress, End The Health Care Chaos. You Have 9 Million Kids To Protect.
President Trump and Republicans in Congress have brought chaos to the American health care system by trying to destroy the Affordable Care Act and failing to reauthorize the Children’s Health Insurance Program, which, with bipartisan support for the past 20 years, has provided care for millions of children. Over the next few weeks they can choose to set things right or to destroy them. (10/18)

JAMA Forum: What Do Medicare Advantage Networks Look Like?
The recent, strong growth of Medicare Advantage—private plan alternatives to traditional Medicare—makes understanding the program a priority for policy makers. Of the 57 million Medicare beneficiaries, approximately 33% are now enrolled in Medicare Advantage, an increase from 13% in 2004. Although we know a great deal about Medicare Advantage, there’s one thing we know almost nothing about: the extent and value of plans’ networks of physicians and hospitals at which enrollees can obtain covered care. This is important, because establishment and oversight of networks is a principal way Medicare Advantage plans manage cost and quality, and there has been a trend toward more narrow networks in insurance markets, raising concerns about access and patient cost. (Austin Frakt, 10/18)

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Longer Looks: PTSD Or Hate?; In The Wake Of Hurricanes; And Male Fertility

Each week, KHN’s Shefali Luthra finds interesting reads from around the Web.

The New York Times: A Marine Attacked An Iraqi Restaurant. But Was It A Hate Crime Or PTSD?
The DarSalam Iraqi restaurant, with its steaming plates of falafel and kebab, has for years served as a popular community gathering spot here. The Iraqi family who ran it felt welcome in this eclectic city. But all of that changed one night last spring when a man with a shaved head walked in and took a seat. As other customers chatted, he refused to order, instead staring at photos of the Iraqi countryside on the wall. (Dave Philips, 10/18)

Vox: Harvey And Irma: Pollution, Mold, And Other Lingering Health Risks
In the weeks following Hurricane Irma, parts of Florida have been awash in millions of gallons of sewage. Meanwhile, in Texas, oil refineries and chemical plants have dumped a year’s worth of cancer-causing pollutants into the air following Hurricane Harvey. In both states, doctors are on the lookout for an uptick in respiratory problems, skin infections, and mosquito-borne diseases brought on by the water and mold the storms left behind. (Julia Belluz, 10/16)

The Atlantic: A New Hope For Male Fertility After Cancer Treatment
When Branden Lischner was 18, he got testicular cancer. Between surgery and radiation, which can cause infertility, he saved a sperm sample. But he was so removed from the idea of fatherhood that he soon stopped paying for his banked sperm. Then, in 2013, shortly after he got married, his cancer came back. Lischner only wanted to worry about the surgery to remove his second testicle, but his urologist pushed him to take the time to store sperm. (Rachel Mabe, 10/13)

The New Yorker: How Anti-Trump Psychiatrists Are Mobilizing Behind The Twenty-Fifth Amendment
On October 8th, the outgoing Republican senator Bob Corker sent a tweet calling the White House “an adult day care center.” Corker then told the Times that President Trump’s recklessness could set the nation “on the path to World War III”; he said that most Senate Republicans shared his concerns, as should “anyone who cares about our nation.” Days later, Gabriel Sherman reported in Vanity Fair on the crisis-level discussions among Trump’s aides about how to contain a President who they fear is “unstable” and “unraveling.” According to Sherman’s reporting, the former chief strategist Steve Bannon warned Trump several months ago that “the risk to his presidency wasn’t impeachment, but the 25th Amendment.” That Amendment to the Constitution provides that the Vice-President and a majority of the Cabinet—or, alternatively, a congressionally appointed body—can determine that the President is “unable to discharge the powers and duties of his office” and remove him. (Jeannie Suk Gersen, 10/16)

Politico Magazine: Trump’s Obsessed With His IQ. Here’s What He Should Worry About Instead.
What are we to make of President Donald Trump’s boasts that he has a higher IQ than a member of his Cabinet, Secretary of State Rex Tillerson? Amid reports that Tillerson called Trump a “moron”—a claim Tillerson passed up a chance to deny on Sunday—Trump told Forbes magazine, “I guess we’ll have to compare IQ tests. And I can tell you who is going to win.” White House press secretary Sarah Huckabee Sanders later clarified that Trump “never implied that the secretary of state was not incredibly intelligent”—suggesting that Trump believes his IQ is astronomically high, maybe even the very best. In the past, he has described his IQ as “very high,” “much higher than [that of Presidents Bush and Obama],” “much higher than [the intellectuals’],” and “the highest, asshole!” Before Tillerson, Trump challenged the mayor of London and anyone who said he doesn’t understand global warming to IQ smackdowns. But what would an IQ face-off between Trump and Tillerson—or anyone else—even tell us? Should we care whether our president has a high IQ? (Zach Hambrick, 10/17)

FiveThirtyEight: The Grandfather Of Alt-Science
Arthur B. Robinson, renegade chemist, failed politician, grandpa of the climate skeptics — and maybe, just maybe, our nation’s next scientist-in-chief — padded across the carpet of his homemade lab in a pair of white athletic socks. “This room, everything you see here, was built by my own sons with their own hands, including the concrete,” he said. Robinson raised and home-schooled six children in this tawny valley scratched into the hills near the town of Cave Junction, Oregon. Now his wife is dead and one of his daughters has moved away, but the rest of his kids — two veterinarians, a biochemist and a pair of nuclear engineers — remain nearby. They have a lot to do: Feed the animals; maintain the lab; ward off cougars; publish their popular home-school curriculums; manage Robinson’s repeated, unsuccessful congressional campaigns; and, of course, perform high-stakes research into medicine and biochemistry. (Engber, 10/12)

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State Highlights: Md. Website Will Help Consumers Compare Costs For Common Medical Procedures; NYC’s Public Hospital System To Get Infusion Of Funding

Media outlets report on news from Maryland, New York, Colorado, Illinois, Pennsylvania, Ohio and Minnesota.

The Washington Post: Maryland To Offer Online Shopping Tool For Common Medical Procedures
The Maryland Health Care Commission, the state’s independent regulatory agency, is unveiling a website on which people scheduling a hip replacement, knee replacement, hysterectomy or vaginal delivery can see price differences among different providers for the same procedure. The site is launching amid rising health-care costs and as some consumers turn to insurance plans with high deductibles. (Itkowitz, 10/18)

The Baltimore Sun: New Website Will Let Maryland Consumers Compare Hospital Rates For The First Time
A new website — wearthecost.org — being launched Thursday by the Maryland Health Care Commission will help consumers compare these types of costs among hospitals and bring more transparency to hospital pricing practices. While patients can request all or some of this data from other agencies and the hospitals themselves, the commission said the website compiles the information all in one place and in an easy-to-navigate, consumer-friendly way. The commission hopes the website will arm users with more information to help them make more informed decisions when choosing a hospital. (McDaniels, 10/19)

The Wall Street Journal: New York City Public Hospital System To Get Relief From State
The head of New York City’s public hospital system said New York Gov. Andrew Cuomo’s administration has agreed to disperse hundreds of millions in aid to the agency, ending a funding dispute that left the hospitals dangerously low on cash. Stanley Brezenoff, interim president and chief executive of NYC Health + Hospitals, said in a letter to agency employees Wednesday that the state had agreed to distribute some $380 million in federal and city funds under the state’s control to the system over the coming months. (Gay, 10/18)

Denver Post: Colorado Spending More On Prison Inmate Health Care, Report Finds
Colorado is spending more per inmate on health care as the state’s prison population ages, according to a national report released Wednesday. The report, from the Pew Charitable Trusts, found that Colorado spent $6,641 per inmate on health care in the 2015 fiscal year. That placed the state in the middle of the pack nationally: 21st  for the highest spending and about $900 per inmate more than the national median. (Ingold, 10/18)

Chicago Tribune: Legislators Want Answers On Illinois’ Failure To Screen Babies For Deadly Krabbe Disease 
utraged by a Chicago Tribune report, state Rep. Mary Flowers, D-Chicago, is asking officials from the Illinois Department of Public Health to explain at a legislative hearing next week why they never implemented a 2007 law that mandated screening Illinois babies for a deadly genetic condition. Flowers, chair of the Illinois House Health Care Availability and Access Committee, was a co-sponsor of the law that added Krabbe disease to the state’s newborn screening program a decade ago. (Callahan, 10/18)

The Philadelphia Inquirer/Philly.com: Einstein Healthcare Network Credit Downgraded
Moody’s Investor Service downgraded Einstein Healthcare Network’s credit rating by one notch, to just above junk bond status, citing the nonprofit system’s large and unexpected loss of $23 million on an operating basis in the year ended June 30, a decline in liquidity, and uncertain state funding. Einstein said in a statement that it “remains committed to providing high-quality care while balancing the demands of today’s challenging health-care environment. There are initiatives already underway which we believe will put the organization in a stronger financial position moving forward while increasing access to care.” (Brubaker, 10/18)

The Baltimore Sun: Maryland Health Department Gets $7.5 Million To Support Home Visits For Families
A federal grant of almost $7.5 million to the Maryland Department of Health will go to helping teach parenting skills and provide other resources to pregnant women and parents of young children, health department officials said Wednesday. The department will use the funds from the U.S. Health Resources and Services Administration, an agency of the U.S. Department of Health and Human Services, to support local agencies that make home visits to women and parents through the state’s Maternal, Infant and Early Childhood Home Visiting Program. The goal of the program is to help the families raise children who are physically, socially and emotionally healthy and ready to learn. (Cohn, 10/18)

Pioneer Press: Roseville Care Center At Fault In Resident’s Death, Health Department Says 
The resident was fine when Sunrise Assisted Living staff checked in around 9 p.m. When staff returned around 12:30 a.m., the resident’s neck was wedged between a bed and a transfer pole, and the resident was no longer breathing, according to a report by the Minnesota Health Department. The department determined earlier this month that the Roseville facility was at fault for neglect, having placed the pole too close to the bed. (Chavey, 10/18)

Chicago Sun Times: Suit: Suburban Couple Defrauded Millions From Medicare 
The federal government has filed a lawsuit accusing a south suburban couple of defrauding Medicare out of millions of dollars through false claims by their medical companies. The suit, filed Tuesday in U.S. District Court, accuses Gateway Health Systems Inc. and its owners – 58-year-old Ajibola Ayeni and his wife, Joy H. Turner-Ayeni – of violating the federal False Claims Act by seeking and accepting Medicare payments for fraudulent services, according to a statement from the U.S. attorney’s office. (10/18)

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Despite Growing Trend, Doctors Warn Against Women Eating Their Placenta

Proponents have said eating placenta reduces pain, improves mood and energy level, increases milk production, but scientists find any evidence to support those claims lacking. In other public health news: diabetes during pregnancy, other viruses to look out for this flu season, concussions in teenagers, infectious diseases, and postpartum depression.

The New York Times: Lack Of Sleep Tied To Diabetes In Pregnancy
Lack of sleep may raise the risk for gestational diabetes. Gestational diabetes — abnormally high blood sugar that develops during pregnancy — can lead to excessive birth weight, preterm birth or respiratory distress in the baby, among other problems. It can also increase the mother’s risk for Type 2 diabetes later in life. (Bakalar, 10/18)

The Philadelphia Inquirer/Philly.com: The Other Virus That Kills During Flu Season
Most people probably know by now that flu can make fall and winter dangerous for older adults. But another virus that circulates at the same time and causes similar symptoms is now getting more attention as a killer of older people, especially those who are frail, or have chronic health problems or weakened immune systems. …Long thought to be a threat mostly to infants, respiratory syncytial virus (RSV) is increasingly recognized for its impact on adults. (Burling, 10/18) <div></div>

The New York Times: Concussions In Teenagers Tied To Multiple Sclerosis Risk
Here’s yet another reason to protect young athletes from head trauma: A large-scale new study found that concussions in adolescents can increase the risk of later developing multiple sclerosis. The risk of multiple sclerosis, or M.S., an autoimmune nervous system disorder with an unknown cause, was especially high if there were more than one head injury. (Reynolds, 10/18)

Bloomberg: Ex-Biogen CEO Raises $500 Million To Conquer Infectious Diseases 
Veteran biotechnology executive George Scangos has been busy since leaving Biogen Inc. and setting up an infectious-disease startup: After founding Vir Biotechnology Inc. in January, he’s done seven deals and raised more than $500 million. That’s one of biggest fundraising rounds for any biotechnology startup this year, particularly for one focused on infectious diseases, an arena that traditionally hasn’t made a lot of money. Vir, which won’t start human trials for about 18 months, is setting its sights on treatments for tricky ailments that have long thwarted researchers, such as drug-resistant tuberculosis, Zika, hepatitis B and HIV. (Chen, 10/18)

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Rumor Mill Churning About Who Next Drug Czar Will Be After Original Pick Bows Out

Rep. Tom Marino (R-Pa.) withdrew his name from consideration after reports tying him to legislation that undermined the Drug Enforcement Administration’s power during the opioid crisis.

Stat: Next In Line As Trump’s Drug Czar? Candidate Names Start To Circulate
The Trump administration has gone nine months without a permanent drug czar. But within hours of the announcement that Rep. Tom Marino (R-Pa.) had withdrawn his name from consideration on Tuesday, the D.C. rumor mill was up and running. Potential candidates, according to administration officials, Capitol Hill staffers, and others in the world of drug and addiction treatment policy, include a who’s-who of players in the current battle against the opioid crisis. (Facher, 10/18)

The Associated Press: Former Drug Czar Nominee Marino Defends Role In Opioid Law
President Donald Trump’s former nominee to be the nation’s drug czar is defending his role in writing a law that critics say weakened the government’s authority to stop companies from distributing opioids. Rep. Tom Marino, R-Pa., said he’s proud of his work on the 2016 law, which passed without opposition in the House and Senate and was signed by President Barack Obama. (10/18)

In other news on the opioid epidemic —

Stat: California Wants To Pull Cardinal Health License Over ‘Red Flags’
The state of California wants to revoke the wholesale license for a facility run by Cardinal Health, one of the nation’s largest pharmaceutical distributors, for failing to note a series of unusual sales of an opioid painkiller and three other tightly regulated medicines to a pharmacy. Between 2013 and 2015, the Cardinal Health outpost in Valencia, Calif., sold increasingly large quantities of the controlled substances — including Norco, which is a mixture of acetaminophen and hydrocodone — to the pharmacy, which state officials called “red flags.” Another medicine was the Xanax anxiety pill. (Silverman, 10/18)

Stat: Vivitrol, Monthly Shot For Opioid Addiction, Works As Well As Daily Medication
Aonce-a-month shot to treat opioid addiction was as effective in maintaining short-term abstinence from heroin and similar drugs as a more commonly prescribed daily treatment, according to a Norwegian study released Wednesday. The study is believed to be the first to directly compare Vivitrol — administered as a monthly shot — with a combination drug treatment sold under the brand name Suboxone. In the U.S. and many other countries, Suboxone or methadone have been the standard medical treatment for people with an opioid use disorder. (Armstrong, 10/18)

KQED: It’s Treatment Before Trial In Experimental Opioid Court
Federal, county and city court officials are looking hard at Buffalo, N.Y.’s new opioid crisis intervention court as one potential model solution to the epidemic of heroin and opioid overdoses that continue to devastate families and communities across America, taxing local governments, first responders and the nation’s criminal justice system. (Westervelt, 10/18)

The Associated Press: Maryland Congressman Joins Fight Against Opioid Epidemic
Rep. John Delaney, D-Potomac, announced Tuesday that he is co-sponsoring legislation to make it easier for the Drug Enforcement Administration to combat the opioid epidemic. The bill, called the “Opioid Immediate Suspension Order Act of 2017,” was introduced Monday by Rep. Gerry Connolly, D-Virginia. Four Democratic representatives, including Delaney, have co-sponsored the legislation, but no Republicans, according to Connolly’s office. (Jacob, 10/18)

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Second Version Of Groundbreaking Immunotherapy Treatment Approved By FDA

The therapy is part of a hot new field that uses a patient’s own immune system to turn the cells into a “living drug” that attacks disease.

The New York Times: F.D.A. Approves Second Gene-Altering Treatment For Cancer
The Food and Drug Administration on Wednesday approved the second in a radically new class of treatments that genetically reboot a patient’s own immune cells to kill cancer. The new therapy, Yescarta, made by Kite Pharma, was approved for adults with aggressive forms of a blood cancer, non-Hodgkin’s lymphoma, who have undergone two regimens of chemotherapy that failed. (Grady, 10/18)

The Washington Post: Cutting-Edge Immunotherapy Treatment Approved For Another Deadly Cancer
The treatment is for adults with certain types of large B-cell lymphoma who have not responded to or who have relapsed after at least two other kinds of treatment, such as chemotherapy and bone-marrow transplants. The group numbers about 7,500 patients a year in the United States.The one-time infusion, known as CAR T-cell therapy, is made by Kite Pharma, which is based in Santa Monica, Calif., and recently was bought by Gilead Sciences for $11.9 billion. Kite announced Wednesday that the treatment’s brand name will be Yescarta and its price will be $373,000. (McGinley, 10/18)

Stat: FDA Approves A Game-Changing Treatment For Blood Cancer
In a six-month trial on 101 patients, 36 percent saw their cancer completely disappear thanks to a single dose of Gilead’s therapy, and 82 percent had their tumors shrink by at least half. But the treatment is not without risks. More than 40 percent of patients suffered anemia during the trial, and common side effects include a dangerous lowering of white blood cell counts and toxicity in the brain. Two patients in the study died of treatment-related complications. (Garde, 10/18)

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Anthem, Spurning Express Scripts, Will Join With CVS To Start A Drug Plan Business

The new business, which will start in 2020, will be a new pharmacy benefit manager (PBM) company. PBMs serve as intermediaries between drug companies and the prescription plans, but they have come under increasing pressure for not being transparent about how much money they save and how much is passed along to consumers.

Bloomberg: Anthem Breaks With Express Scripts, Will Start Own Drug Plan 
Health insurer Anthem Inc. plans to set up its own pharmacy benefits management unit, signaling a final break with Express Scripts Holding Co. after accusing it of overcharging by billions of dollars. The move means Express Scripts will not only lose its biggest client but also face a new rival. Anthem’s new unit, called IngenioRx, will grow its own business with a “full suite” of services, the insurer said in a statement on Wednesday. (Flanagan and Rausch, 10/18)

Modern Healthcare: Anthem’s New PBM To Spark Change Throughout The Industry 
There has been heightened scrutiny on the role PBMs play in the pricing of drugs in recent years. PBMs, which oversee prescription drug benefits for employers and insurers, negotiate drug discounts with pharmaceutical companies, build pharmacy networks and create their own drug benefit plans, are involved in a blame game across the secretive pharmaceutical supply chain. PBMs, drug manufacturers, insurers and wholesale distributors have pointed fingers at each other to try to explain why savings via negotiated rebates aren’t ultimately passed to the consumer. (Kacik, 10/18)

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Federal Judge Rules Undocumented Pregnant Girl Can Get An Abortion

Judge Tanya Chutkan ordered the government to move “promptly and without delay.” The administration is appealing the ruling.

The Associated Press: Judge Orders Government To Allow Abortion For Immigrant Teen
A federal judge on Wednesday ordered the government to allow a pregnant 17-year-old immigrant, who was detained after entering the country illegally, to undergo an abortion. After a brief hearing that included a testy exchange with government lawyers, Judge Tanya Chutkan ordered the government to move “promptly and without delay” to transport the teenager or allow her to be transported by others to the nearest abortion provider. (10/18)

The Washington Post: Federal Judge Bars Govenrment From Blocking Abortion For Jane Doe, Undocumented Teen Immigrant
Lawyers for the American Civil Liberties Union, which represents the pregnant teen, cheered the judge’s ruling as a major victory for abortion and immigrant rights. “We never should have had to fight this in the first place,” said Brigitte Amiri, a senior ACLU staff attorney who argued the case on Wednesday. “It should never have been something that we needed to go to court over.” (Sacchetti, 10/18)

Los Angeles Times: Judge Rules Detained Teenage Immigrant Must Be Allowed To Have An Abortion
At a hearing Wednesday, a lawyer for Atty. Gen. Jeff Sessions had suggested that because the woman was not legally a U.S. resident, she was not covered by the constitutional right to end her pregnancy. U.S. District Judge Tanya S. Chutkan rebuked the government lawyers at the hearing. Her order directs officials to transport Jane Doe to the clinic of her choice and allow her to obtain an abortion by Saturday. (Lauter, 10/18)

Reveal: Government Must Allow Access To Abortion For Migrant Girl In Custody, Judge Rules
In late September, a Texas court granted her request to get an abortion without her parents’ approval, according to the state’s “judicial bypass” provision. But officials at the Department of Health and Human Services Office of Refugee Resettlement blocked Doe from leaving the South Texas shelter where she’s being held, sending her instead to a religious crisis pregnancy center. The government is required to provide healthcare for immigrant minors in its custody, and has paid to help girls end pregnancies that resulted from incest or rape, an ever-present risk for those crossing north from Central America. (Michels, 10/18)

KCUR: Judge Considers Planned Parenthood Challenge To New Missouri Abortion Restrictions
A Jackson County judge on Wednesday took under advisement Planned Parenthood’s request to block a Missouri law requiring that abortion physicians meet with their patients three days before they undergo the procedure. The law, enacted this summer during a special session of the Missouri Legislature called by Gov. Eric Greitens, is set to take effect Oct. 24. The two Planned Parenthood affiliates in Missouri and two obstetrician-gynecologists at the Washington University School of Medicine in St. Louis sued last week to have the law declared unconstitutional under the Missouri Constitution and sought a temporary restraining order blocking it. (Margolies, 10/18)

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Desperate Quest For Herpes Cure Launched ‘Rogue’ Trial

As 20 Americans and Brits flew to a Caribbean island for a controversial herpes vaccine trial, many of them knew there were risks.

The lead U.S. researcher, William Halford, openly acknowledged he was flouting Food and Drug Administration regulations in the consent forms they signed. He would be injecting them with a live, though weakened, herpes virus without U.S. safety oversight.

Still, many of them felt upbeat when they arrived on St. Kitts and Nevis in the spring of 2016. They had struggled for years with debilitating, painful herpes. Halford, the creator of the vaccine, sounded confident.

Maybe they could be cured.

“It felt like paradise,” one of the participants recalled. “Or therapy combined with vacation.”

A year later, their optimism has turned to uncertainty. Memories of kicking back in a Caribbean hotel during the trial have been overshadowed by the dread of side effects and renewed outbreaks.

But they can’t turn to Halford, a Southern Illinois University professor. He died of cancer in June.

They also can’t rely on his university, which shares in the vaccine’s patent but says it was unaware of the trial until after it was over. Because the FDA didn’t monitor the research, it can’t provide guidance. Indeed, there is little independent information about what was in the vaccine or even where it was manufactured, since Halford created it himself.

At a time when the Trump administration is pushing to speed drug development, the saga of the St. Kitts trial underscores the troubling risks of ambitious researchers making their own rules without conventional oversight.

“This is exactly the problem with the way the trial was conducted,” said Jonathan Zenilman, an expert on sexually transmitted diseases at Johns Hopkins Bayview Medical Center in Baltimore. “These people are supposed to have rights as human subjects, but now there’s nowhere for them to go. We may never know if this vaccine worked, didn’t work or, even worse, harmed anyone.”

Rational Vaccines, the U.S. company co-founded by Halford, still hopes to market the vaccine. It touted success online and to other researchers, prompting millions of dollars of recent investment, including from a company run by Peter Thiel, a backer of President Donald Trump.

Thiel, a PayPal co-founder who has excoriated the FDA as too bureaucratic, declined to answer questions about his investment, which occurred after the trial had ended.

Kaiser Health News interviewed five of the 20 participants in the clinical trial and several associates of Halford.

The participants agreed to speak on condition of anonymity because they don’t want to be known as having herpes. Most also said they feared retaliation from Halford’s company but hoped by speaking out some of their concerns might be addressed.

Their accounts, along with documents, a video and emails obtained by KHN from the offshore trial, pointed to what experts said were serious irregularities:

  • Halford did not rely on an institutional review board, or an “IRB,” which monitors the safety of research trials.
  • The company has said it doesn’t know where Halford manufactured the vaccine, so it isn’t known whether he followed U.S. government guidelines when transporting it.
  • Halford offered booster shots of the unapproved vaccine inside the United States. FDA regulations prohibit such injections.
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“The FDA goes after these types of violations,” said Holly Fernandez Lynch, a lawyer and assistant professor who specializes in medical ethics at the University of Pennsylvania’s Perelman School of Medicine. “[Researchers] can be prosecuted.”

SIU, however, did little to discourage Halford. The university, which has a financial interest in the patent, said it learned of “the concerns” only after his death. In August, after KHN asked about the trial, the medical school’s IRB launched an investigation into whether Halford violated U.S. regulations or university rules.

In a statement to KHN, Rational Vaccines acknowledged that Halford “discussed a myriad of concerns … including the potential need for booster shots.”

“Unfortunately, Dr. Halford is no longer with us to address all the ways in which he may have investigated his concerns …,” stated the company. It added, “We nevertheless wholeheartedly intend to continue his line of investigation in a clinical setting to international good clinical practice standards.”

Racing Against Time

Halford first broke with scientific protocols in 2011, shortly after he was diagnosed with nasal cancer and treated with chemotherapy and radiation, according to an account he later posted on his blog.

By then, Halford was in his 40s and had worked almost a decade at SIU’s School of Medicine.

Halford, who did not have herpes, realized his cancer might not give him much time. If he submitted to the FDA’s oversight, it would take years, he reasoned in his account.

He decided to become his own research subject, injecting himself more than two dozen times with the vaccine.

“There is an ongoing herpes pandemic that demands the scientific community’s attention today, not tomorrow,” he wrote in his blog, which by his count received thousands of hits.

The experiments on himself, Halford believed, demonstrated the vaccine was safe.

In 2015, Halford set his sights on launching an offshore clinical trial.

However, his unorthodox approach made some of his peers recoil.

“He sat in my kitchen and tried to convince me to join him,” said Terri Warren, a nurse practitioner in Oregon who was approached by Halford in 2016 to help with the trial. “He believed so firmly in his vaccine. He said, ‘Think of all of the herpes patients who are suffering.’”

Warren had previously worked with Halford on a different, IRB-approved trial studying a new blood test to diagnose herpes. This time, she said, she became concerned about his methods, including how he was selecting his participants.

“I told him absolutely not,” she recalled. “I didn’t want anything to do with it. I felt bad for him because he was dying, but I thought he had lost perspective.”

But Halford did find backers, including Hollywood filmmaker Agustín Fernández III, whose credits include action films and an award-winning documentary.

Fernández recently declined to respond to questions. But in an earlier interview this year with KHN, he said he initially contacted Halford to try to help someone he knew who was battling the disease. He said he didn’t have herpes, or a background in science.

Fernández, however, became such a believer in Halford, he said, he allowed Halford to inject him with the vaccine. In 2015, he co-founded Rational Vaccines with Halford and invested his own money into the company. That same year, the company licensed two patents related to the vaccine from SIU.

“I felt like Bill had the answer, and we had to make sure he got a chance to prove it,” Fernández said.

‘Finally … Someone Who Cared’

As soon as news began spreading in the tight-knit herpes online community that Halford may have a cure, he began hearing from the most desperate who asked to be included in any future research.

For many, herpes is a mild disease that can be controlled by antiviral medicines. However, for some, it becomes a life-altering disease that destroys any hope of intimate relationships.

To several of the participants, Halford was an empathetic scientist who refused to give up on finding a cure.

“After dealing with doctors who had no answers, it felt like you were finally talking to someone who cared and could help,” said a participant in his 30s from the South who had described the trial as “paradise.”

There were other perks as well.

Rational Vaccines told some participants they would be reimbursed for their flight and hotel expenses. If they got through the entire trial, they would be given an extra $500.

As Halford organized two groups of 10 participants, he instructed them on drawing their own blood for the trial, according to a video filmed in a medical lab.

He proceeded with the trial from April to August 2016, giving participants three shots over three months.

Once in St. Kitts, many of them quickly bonded with one another and Halford. Even though they ranged in age from their 20s to 40s and came from different regions, they had the disease in common. They commiserated about how herpes had wreaked havoc on their lives.

“It was a relief to meet people who understood what we were talking about,” the Southerner said.

But other participants now say they noticed some troubling signs.

They received the injection in a house in St. Kitts, not a medical clinic.

Halford, whose gaunt frame made his cancer apparent by then, at times appeared disoriented.

Fernández, a constant presence, was introduced to them by name and made some of them uncomfortable when they socialized over drinks and dinner.

Some patients became anxious about their participation soon after receiving the vaccine.

One, a web developer in his 20s, felt ill after receiving just one dose.

“I experienced tiredness and ringing in my ears,” said the web developer, who reported the feelings along with “disequilibrium and slurred speech” continue to this day.

He said he decided not to return to St. Kitts for follow-up shots after Halford dismissed his symptoms as arising from a common cold.

Another participant, a Colorado woman in her 40s, said she told Halford she experienced flu-like aches and pains and tingling and numbness soon after the second shot. The symptoms were followed by an “excruciating” 30-day outbreak of herpes.

“I have new symptoms every day,” that woman later wrote Halford in an email exchange provided to KHN. “This is terrifying.”

Halford initially dismissed her symptoms, speculating they were caused by a mosquito-borne virus, she said.

She returned for the third shot but had her doubts. Halford and Fernández met her at a café to talk about her concerns, she recalled.

“[Fernández] kept saying, ‘You signed the consent form. You knew the risks,’” said the Colorado woman, who said Halford then removed her from the trial.

Another participant, a Californian in his 30s, said he went through with all three shots despite feeling a “terrible pain in my stomach.”

Halford then told him he had noticed in his research of mice that another version of the virus entered the gut of the mice and killed them, the participant said.

“I then thought maybe this is dangerous,” said the Californian, whose pain went away but his outbreaks did not.

Warren, the nurse practitioner in Oregon, said two participants tracked her down as a herpes expert. She said that they described possible side effects from the vaccine.

Halford had told participants he would follow up on their reactions to the vaccine for a year, according to the consent form. But he stopped sending questionnaires to the two participants who said they had been dropped from the trial.

Warren said that even when researchers stop administering a vaccine because of possible side effects, known as adverse events, they have a duty to track the subjects’ reactions.

“There is no doubt that these were adverse events that should have been reported,” Warren said.

Rational Vaccines did not respond to questions about the complaints. In previous public statements, it acknowledged that one of the 20 participants was concerned about possible side effects.

Some participants also wonder where Halford made the vaccine and how he transported it to St. Kitts.

Halford told his business partner he had made it outside of the United States, without disclosing where.

After the trial ended, some participants began complaining that the vaccine hadn’t worked. Halford and Fernández offered booster shots, according to four participants.

One participant, a man in his 40s who was also from California, declined to get the booster. He said he decided to go back to antiviral drugs when his outbreaks returned.

The Southerner said he agreed to allow Halford to give him booster shots at an office in Springfield, Ill., where Halford worked.

“It was between me and him,” said the participant. “He was doing me a favor.”

“I don’t know if it was a different strain or what, but he gave me a set of double boosters at the same time, one in each leg,” recalled the Southerner, who said he didn’t have records of the injections. He said he received them as Halford continued to collect data for the trial.

Months later, he said, he returned a second time for another set of boosters.

Courting Support Without Results

Halford, meanwhile, tried to persuade a U.S. scientific journal to publish a lengthy manuscript detailing the results of both his experiments on himself and his offshore trial. Halford put the cover letter on SIU letterhead.

In December 2016, only months after the trial had ended, Halford’s paper was rejected by the journal.

“This manuscript is partly a vision, partly science, and partly wishful thinking …,” said one reviewer for the journal. “Neither safety nor efficacy has been demonstrated by the data presented.”

Halford asked his former doctoral adviser, Daniel Carr, to attend a Rational Vaccines advisory board meeting. Carr, a University of Oklahoma Health Services Center professor, said he and other invitees heard glowing reports about the trial.

Carr agreed in May to present the trial data at a conference of herpes experts in Colorado.

A published summary of the event listed Carr as a lead author, though he said he wasn’t involved in the research.

“I just did it to help him out,” said Carr, who asked for his university’s permission to be on Rational Vaccines’ advisory board and is waiting for word on federal funding to study another version of Halford’s vaccine. “I also presented it because I thought that the scientific community would find it interesting.”

Despite its patent agreement reached in 2015, SIU said it was in the dark about Halford’s offshore activities until October 2016 — months after the trial had ended.

Halford, meanwhile, promoted his work at events attended by university officials.

In October 2016, Halford was a keynote speaker at an SIU-sponsored technology and innovation event to discuss his vaccine work.

Then, in April 2017, Halford and Rational Vaccines held a press conference to trumpet an investment pledge by Thiel’s company, according to materials handed out at the event. University officials, including SIU’s medical school dean, were invited speakers.

The university’s IRB is continuing its investigation, which includes scrutinizing whether Halford used university resources.

“If there are areas of concern, SIU will report those findings promptly to Department of Health and Human Services,” said SIU spokeswoman Karen Carlson. “We will also communicate our findings with the scientific community and the public.”

FDA spokeswoman Lauren Smith Dyer declined to comment on the trial except to say the FDA does not have jurisdiction over offshore trials that don’t seek agency approval.

Dyer, however, added that the export from the United States of an unapproved vaccine for research use and the injection of it on U.S. soil would be within the agency’s jurisdiction.

Even so, some participants don’t regret taking part in the trial.

“When you feel like a disease has ruined your life, you become desperate,” said the Southerner, who believes the boosters have lessened his outbreaks. “Some people contemplate suicide. You’re willing to do almost anything.”

Other participants still hope for some sort of accountability.

“I feel like without a doubt that my symptoms were vaccine-related,” said the Colorado woman. “I feel like it triggered something that I’ll have for the rest of my life.”

No matter what, experts said, the university has a responsibility to conduct an in-depth investigation. So far, the university has not reached out to participants who spoke to KHN.

“This researcher went rogue,” said Fernandez Lynch, the lawyer who specializes in medical ethics. “It’s true that universities can’t stand behind their researchers watching their every move. But when one of their own goes rogue, a university should launch an aggressive investigation, interview the participants and make sure it never happens again.”

KHN’s coverage of end-of-life and serious illness issues is supported by The Gordon and Betty Moore Foundation and its coverage related to aging & improving care of older adults is supported by The John A. Hartford Foundation.

Categories: Health Industry, Pharmaceuticals, Public Health

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First Edition: October 19, 2017

Oct 19 2017

Today’s early morning highlights from the major news organizations.

Kaiser Health News: Medicare Vs. Medicare Advantage: How To Choose
As health insurers struggle with shifting government policies and considerable uncertainty, one market remains remarkably stable: Medicare Advantage plans. That’s good news for seniors as they select coverage for the year ahead during Medicare’s annual open enrollment period (this year running from Oct. 15 to Dec. 7). For 2018, 2,317 Medicare Advantage plans will be available across the country, “the most we’ve seen since 2009,” said Gretchen Jacobson, associate director of the Kaiser Family Foundation’s program on Medicare policy. (Kaiser Health News is an editorially independent program of the foundation.) (Graham, 10/19)

Kaiser Health News: Despite GOP Efforts To Corral Medicaid Spending, States Expand Benefits
While congressional Republicans and President Donald Trump have been seeking major cuts in federal funding of Medicaid, 26 states this year expanded or enhanced benefits and at least 17 plan to do so next year, according to a report released Thursday. The increased benefits were largely for mental health and substance abuse treatment, but states also added telemedicine and dental care, according to the report by the Kaiser Family Foundation and the National Association of Medicaid Directors. (Kaiser Health News is an editorially independent program of the foundation.) (Galewitz, 10/19)

The New York Times: Trump Pulls Back From Senate Deal To Fund Health Subsidies
President Trump on Wednesday backed away from his endorsement of a bipartisan Senate proposal to stabilize health insurance markets, throwing the legislative effort into doubt even as the chief architect of the deal predicted that it would become law before the end of the year. The latest actions by the White House confused Republicans on Capitol Hill and irked Democrats — but in the end, their effect was not clear. (Kaplan and Pear, 10/18)

The Associated Press: Republican Says He’ll Push Health Deal, Trump Keeps Distance
The authors of a bipartisan plan to calm health insurance markets said Wednesday they’ll push the proposal forward, even as President Donald Trump’s stance ricocheted from supportive to disdainful to arm’s-length and the plan’s fate teetered. “If something can happen, that’s fine,” Trump told reporters at the White House. “But I won’t do anything to enrich the insurance companies because right now the insurance companies are being enriched. They’ve been enriched by Obamacare like nothing anybody has ever seen before.” (Fram, 10/18)

The Wall Street Journal: Trump Signals Opposition To Bipartisan Health-Care Deal
Mr. Trump touched off confusion on Capitol Hill Wednesday morning, tweeting he “can never support bailing out ins co’s who have made fortune w/O’Care,” echoing criticism from conservatives that the deal is a bailout for insurers, a characterization the sponsors dispute. … Mr. Trump’s comments on Wednesday cheered conservatives, troubled some Republicans who support the bill and left many Democratic lawmakers frustrated. Some Capitol Hill aides said they thought Mr. Trump’s remarks might be a negotiating tactic to get more concessions from Democrats, and GOP lawmakers began looking at potential changes that might ultimately get the president’s backing. (Armour and Peterson, 10/18)

The Washington Post: Trump Appears To Back Further Away From Bipartisan Health-Care Push
President Trump became the subject of an unusual public lobbying campaign over the fate of the Affordable Care Act on Wednesday as Senate Democrats and a key Republican sought to salvage a bipartisan health deal while conservatives pressured the president to disavow the agreement. … The convoluted campaign, in which Senate Minority Leader Charles E. Schumer (D-N.Y.) insisted that a deal remained in reach even as he blasted the president’s “zigging and zagging,” underscored the unpredictable nature of dealmaking in Trump’s Washington. With constantly shifting alliances, the city’s key political players are jockeying to win the president’s support one issue at a time. (Eilperin and Sullivan, 10/18)

The Hill: 24 Hours Later, Senate Health Deal All But Completely Dead
A Senate healthcare deal to extend critical ObamaCare payments to insurers appears all but completely dead just 24 hours after it was announced. President Trump reversed course Wednesday and said he opposed the deal, while Speaker Paul Ryan’s (R-Wis.) office said the Senate should keep its focus on repealing and replacing President Obama’s signature law. (Sullivan and Roubein, 10/18)

The Hill: Ryan Opposes ObamaCare Payments Deal 
A spokesman for Speaker Paul Ryan (R-Wis.) on Wednesday indicated Ryan won’t support a bipartisan deal to stabilize the ObamaCare insurance markets as opposition to the proposal mounts. “The speaker does not see anything that changes his view that the Senate should keep its focus on repeal and replace of Obamacare,” Doug Andres wrote in an emailed statement. (Roubein, 10/18)

The Hill: Schumer: Trump Doesn’t Understand ObamaCare Payments Deal 
Senate Minority Leader Charles Schumer (D-N.Y.) ripped President Trump’s comments on a bipartisan deal to extend key ObamaCare payments to insurers, arguing he doesn’t understand the agreement.  “Frankly the president doesn’t know what he’s talking about in the compromise. … The president ought to know what he’s talking about when he tweets about bills. Because on this one he had no understanding of what it’s about,” Schumer said from the Senate floor. (Carney, 10/18)

The Hill: GOP Senator Floats Changes To Bipartisan ObamaCare Deal 
Sen. Ron Johnson (R-Wis.) is floating changes to a bipartisan deal to stabilize insurance markets that would pull the measure to the right. Johnson said he’s discussed the changes with Sen. Lamar Alexander (R-Tenn.) — the Senate Health Committee chairman who brokered the deal with Sen. Patty Murray (D-Wash.) — and Johnson contends they’re crucial to shoring up support for the bill in the House. (Roubein, 10/18)

Politico: Obamacare Fix Could End Up In Year-End Package
GOP lawmakers acknowledged they’ll eventually have to contend with shaky insurance markets and an estimated $1 billion hole Trump carved into the health care law last week when he eliminated remaining payments due this year. The money to fund a key insurance subsidy program could be resurrected as part of a year-end spending agreement. Even if the deal struck by Sens. Lamar Alexander and Patty Murray goes nowhere, Republican sources say it’s only a matter of time before Congress must find some way of addressing the reeling insurance markets — a vote the GOP sources know will infuriate lawmakers and their base. (Haberkorn and Bade, 10/18)

The Associated Press: States Ask US Court To Keep Up Health Subsidies Cut By Trump
Top government lawyers representing 19 U.S. states on Wednesday asked a federal judge in California to force the administration of President Donald Trump to make health care subsidy payments that Trump abruptly cut off last week. The monthly payments would normally be scheduled to go out Friday. The states, led by California Attorney General Xavier Becerra, asked a judge in San Francisco for an emergency court order by 4 p.m. Thursday requiring they be paid on time. (10/18)

Los Angeles Times: California And Other States Seek Emergency Order To Stop Trump Administration From Cutting Off Healthcare Subsidies
California Atty. Gen. Xavier Becerra asked a federal court Wednesday to issue an emergency temporary restraining order to block the Trump administration from cutting off cost-sharing subsidies that help reduce the price of healthcare for millions of Americans. A week after California and 17 other states filed a lawsuit challenging the decision on its merits, the same attorneys general requested a restraining order to avoid immediate harm to millions of people who get subsidized healthcare through the Affordable Care Act, Becerra said. (McGreevy, 10/18)

The Hill: Bipartisan Group Of Governors Calls On Congress To Stabilize ObamaCare Markets 
A bipartisan group of 10 governors is calling on Congress to vote on a deal to stabilize ObamaCare’s insurance markets. “We urge Congress to quickly pass legislation to stabilize our private health insurance markets and make quality health insurance more available and affordable,” the governors wrote Wednesday in a letter to House and Senate leaders from both parties. (Roubein, 10/18)

The Associated Press: Trump’s Health Subsidy Shutdown Could Lead To Free Insurance
If President Donald Trump prevails in shutting down a major “Obamacare” health insurance subsidy, it would have the unintended consequence of making free basic coverage available to more people, and making upper-tier plans more affordable. The unexpected assessment comes from consultants, policy experts, and state officials trying to discern the potential fallout from a Washington health care debate that’s becoming harder to follow. (10/19)

The Associated Press: Uncertainty Reigns Ahead Of New Health Care Sign-Up Period
Jason Sanford has heard so many rumors about the changing health care landscape that every few weeks he dials a local information desk, seeking just a rough estimate of what his diabetes medication will soon cost him. The answer is the same every time: It’s too early to say, even with the next open enrollment period under the Affordable Care Act beginning in two weeks. (10/18)

NPR: When States Asked For Insurance Waivers, They Didn’t Like The Answers
It was the Friday before a Monday deadline, and federal health officials in Washington, D.C. were working feverishly with their counterparts in Oklahoma to finalize the details of a new state reinsurance program. Emails flew between the Centers for Medicare and Medicaid Services in Washington and Oklahoma’s Department of Health. Blue Cross Blue Shield of Oklahoma, the only ACA insurer in the state, was on board. Everything had to be done by Monday, Sept. 25, so the insurance company could set new, presumably lower, health insurance rates for 2018. (Kodjak, 10/19)

The Associated Press: Judge Orders Government To Allow Abortion For Immigrant Teen
A federal judge on Wednesday ordered the government to allow a pregnant 17-year-old immigrant, who was detained after entering the country illegally, to undergo an abortion. After a brief hearing that included a testy exchange with government lawyers, Judge Tanya Chutkan ordered the government to move “promptly and without delay” to transport the teenager or allow her to be transported by others to the nearest abortion provider. (10/18)

The Washington Post: Federal Judge Bars Govenrment From Blocking Abortion For Jane Doe, Undocumented Teen Immigrant
Lawyers for the American Civil Liberties Union, which represents the pregnant teen, cheered the judge’s ruling as a major victory for abortion and immigrant rights. “We never should have had to fight this in the first place,” said Brigitte Amiri, a senior ACLU staff attorney who argued the case on Wednesday. “It should never have been something that we needed to go to court over.” (Sacchetti, 10/18)

Los Angeles Times: Judge Rules Detained Teenage Immigrant Must Be Allowed To Have An Abortion
At a hearing Wednesday, a lawyer for Atty. Gen. Jeff Sessions had suggested that because the woman was not legally a U.S. resident, she was not covered by the constitutional right to end her pregnancy. U.S. District Judge Tanya S. Chutkan rebuked the government lawyers at the hearing. Her order directs officials to transport Jane Doe to the clinic of her choice and allow her to obtain an abortion by Saturday. (Lauter, 10/18)

The Associated Press: Former Drug Czar Nominee Marino Defends Role In Opioid Law
President Donald Trump’s former nominee to be the nation’s drug czar is defending his role in writing a law that critics say weakened the government’s authority to stop companies from distributing opioids. Rep. Tom Marino, R-Pa., said he’s proud of his work on the 2016 law, which passed without opposition in the House and Senate and was signed by President Barack Obama. (10/18)

The Associated Press: Maryland Congressman Joins Fight Against Opioid Epidemic
Rep. John Delaney, D-Potomac, announced Tuesday that he is co-sponsoring legislation to make it easier for the Drug Enforcement Administration to combat the opioid epidemic. The bill, called the “Opioid Immediate Suspension Order Act of 2017,” was introduced Monday by Rep. Gerry Connolly, D-Virginia. Four Democratic representatives, including Delaney, have co-sponsored the legislation, but no Republicans, according to Connolly’s office. (Jacob, 10/18)

The New York Times: F.D.A. Approves Second Gene-Altering Treatment For Cancer
The Food and Drug Administration on Wednesday approved the second in a radically new class of treatments that genetically reboot a patient’s own immune cells to kill cancer. The new therapy, Yescarta, made by Kite Pharma, was approved for adults with aggressive forms of a blood cancer, non-Hodgkin’s lymphoma, who have undergone two regimens of chemotherapy that failed. (Grady, 10/18)

The Washington Post: Cutting-Edge Immunotherapy Treatment Approved For Another Deadly Cancer
The treatment is for adults with certain types of large B-cell lymphoma who have not responded to or who have relapsed after at least two other kinds of treatment, such as chemotherapy and bone-marrow transplants. The group numbers about 7,500 patients a year in the United States.The one-time infusion, known as CAR T-cell therapy, is made by Kite Pharma, which is based in Santa Monica, Calif., and recently was bought by Gilead Sciences for $11.9 billion. Kite announced Wednesday that the treatment’s brand name will be Yescarta and its price will be $373,000. (McGinley, 10/18)

The New York Times: Lack Of Sleep Tied To Diabetes In Pregnancy
Lack of sleep may raise the risk for gestational diabetes. Gestational diabetes — abnormally high blood sugar that develops during pregnancy — can lead to excessive birth weight, preterm birth or respiratory distress in the baby, among other problems. It can also increase the mother’s risk for Type 2 diabetes later in life. (Bakalar, 10/18)

The New York Times: Concussions In Teenagers Tied To Multiple Sclerosis Risk
Here’s yet another reason to protect young athletes from head trauma: A large-scale new study found that concussions in adolescents can increase the risk of later developing multiple sclerosis. The risk of multiple sclerosis, or M.S., an autoimmune nervous system disorder with an unknown cause, was especially high if there were more than one head injury. (Reynolds, 10/18)

The Wall Street Journal: New York City Public Hospital System To Get Relief From State
The head of New York City’s public hospital system said New York Gov. Andrew Cuomo’s administration has agreed to disperse hundreds of millions in aid to the agency, ending a funding dispute that left the hospitals dangerously low on cash. Stanley Brezenoff, interim president and chief executive of NYC Health + Hospitals, said in a letter to agency employees Wednesday that the state had agreed to distribute some $380 million in federal and city funds under the state’s control to the system over the coming months. (Gay, 10/18)

The Washington Post: Maryland To Offer Online Shopping Tool For Common Medical Procedures
The Maryland Health Care Commission, the state’s independent regulatory agency, is unveiling a website on which people scheduling a hip replacement, knee replacement, hysterectomy or vaginal delivery can see price differences among different providers for the same procedure. The site is launching amid rising health-care costs and as some consumers turn to insurance plans with high deductibles. (Itkowitz, 10/18)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.