Tagged Health Industry

Perspectives: A Nonprofit Drug Company? It’s Not As Wild An Idea As It Seems

Read recent commentaries about drug-cost issues.

The New York Times: Escaping Big Pharma’s Pricing With Patent-Free Drugs
How’s this for a great deal? The United States government funded research and development of a new vaccine against Zika. But the Army, which paid a French pharmaceutical manufacturer for its development, is planning to grant exclusive rights to the vaccine to the manufacturer, Sanofi Pasteur, along with paying Sanofi up to $173 million. (Fran Quigley, 7/18)

Stat: Importing Drugs From Other Countries Undermines Safety
The Food and Drug Administration was established to ensure the safety of food and medicines sold in the United States. That original charter seems to be ignored by the advocates of drug importation, who brush aside legitimate safety concerns to advance a political agenda. (Jim Greenwood, 7/14)

The New England Journal Of Medicine: The Economics Of Indication-Based Drug Pricing
Pharmaceutical treatments and medical devices often have varying effectiveness depending on the indication for which they’re used: in oncology, for instance, response to a treatment varies with the type of tumor and stage of disease. The advent and proliferation of precision medicine in which biomarkers — whether genomic, proteomic, or structural — identify patients likely to receive greater treatment benefits only increase the range of variability in the effectiveness of the same product. (Amitabh Chandra and Craig Garthwaite, 7/13)

Bloomberg: Trump’s New Drug-Pricing Move Won’t Cut Prices
We’ve come a long way from President Donald Trump telling the pharmaceutical industry it was getting away with murder. His administration’s Center for Medicaid and Medicaid Services (CMS) on Thursday proposed deep cuts to reimbursement rates for the 340B drug-discount program, which mandates big price cuts for “safety-net” hospitals that treat a lot of poor patients. (Max Nisen, 7/14)

Stat: The Art Of The Deal? Why A Money-Back Guarantee For Drugs Is A Bad Idea
President Trump likes to boast that he mastered the “art of the deal.” But one option his administration is considering to encourage lower drug prices, which surfaced in a recent draft executive order, may not be much of a deal for consumers. The concept has a clunky name — value-based pricing — but it’s fairly simple. One increasingly popular version works like this: A drug maker refunds some money to an insurer if its medicine fails to improve patient health or prevent a costly incident, such as a heart attack. (Ed Silverman, 7/17)

The New England Journal Of Medicine: Targeting Unconscionable Prescription-Drug Prices — Maryland’s Anti–Price-Gouging Law
Why, in the early 21st century, are so many drugs that were cheaply available in the 20th century becoming prohibitively expensive? The past few years have seen a series of dramatic price hikes on essential off-patent medications, from albendazole to albuterol, digoxin to naloxone, Daraprim to EpiPen. In the storm of allegations and indignation that has followed each of these revelations, one explanation has remained consistent. To paraphrase Senators Susan Collins (R-ME) and Claire McCaskill (D-MO), who were the chair and the ranking member of the Senate Special Committee on Aging, firms that corner the market on off-patent medications and raise prices wildly often do so simply because they can. When the committee issued a 130-page report last December documenting the parallel strategies used by firms to engage in monopolistic price gouging on older essential drugs, the senators pointed out that these actions, though arguably unethical, have so far not been found to be illegal. (Jeremy A. Greene and William V. Padula,, 7/13)

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

More And More, States Are Becoming Battleground For Drug Pricing War

News outlets report on stories related to pharmaceutical pricing.

The Wall Street Journal: Drug Prices Under Fire, In The States
All eyes are on Washington as the Senate grapples with health care legislation. Investors in drug companies should give some attention to state capitals, where a wave of bills designed to limit drug price increases are under consideration. Maryland is the first of about 30 states weighing such bills to pass a new law on drug pricing. The law, scheduled to take effect in October, outlaws “excessive” price hikes on generics and gives Maryland’s attorney general sweeping powers to roll back price hikes and fine companies for violations. Bills with similar enforcement mechanisms have been introduced in several other states, including New York, Missouri, Massachusetts, Maine, and Rhode Island. (Grant, 7/12)

Stat: Sanofi Denies Rejecting Army Request For A Fair Price On A Zika Vaccine
In a series of letters to the U.S. Army and several senators, Sanofi is denying that it rejected so-called fair pricing for a Zika virus vaccine that the company is developing with American taxpayer funds. The missives were sent as a growing number of federal and state lawmakers push the U.S. Army to negotiate a more favorable agreement with Sanofi, which is one of the world’s largest vaccine makers and has already received a $43 million U.S. research grant. (Silverman, 7/17)

Stat: Hurt By A Drug? You Can File Suit In California If A Clinical Trial Took Place There
Last month, the U.S. Supreme Court made it more difficult for people who file product-liability lawsuits against drug makers to engage in “forum shopping,” a practice in which someone files a lawsuit in a state where courts are seen as more hospitable to consumers. In that closely watched case, the court ruled hundreds of out-of-state plaintiffs failed to demonstrate a sufficient connection between injuries they allegedly suffered from a Bristol-Myers Squibb drug and company activities in California. The state has been a favorite venue for such suits, but the court noted the plaintiffs did not buy or ingest the drug there, and Bristol-Myers is not headquartered there. (Silverman, 7/18)

CQ Roll Call: Generics Could Get A Boost In Bid To Rein In Prescription Prices
The most talked about strategies to bring down sky-high drug costs involve letting the government more aggressively negotiate prices with manufacturers and permitting the importation of lower-cost drugs from abroad. But neither idea has sufficient support on Capitol Hill to move this year. That’s why, for now, the only likely bipartisan solutions that could move the needle on drug prices involve promoting competition from lower-cost generic drugs. When a drug’s patent expires, it opens the door for other companies to copy it. Since the generic makers don’t have to recoup the research costs, they can offer much lower prices. Still, while policy improvements now under consideration in Congress could help, they’re not a panacea. (Siddons, 7/17)

ProPublica: The Myth Of Drug Expiration Dates
The dates on drug labels are simply the point up to which the Food and Drug Administration and pharmaceutical companies guarantee their effectiveness, typically at two or three years. But the dates don’t necessarily mean they’re ineffective immediately after they “expire” — just that there’s no incentive for drugmakers to study whether they could still be usable. (Allen, 7/18)

Stat: What Are You Taking? Most-Prescribed Drugs Across The Nation Last Year
More than 4.4 billion prescriptions were filled in the United States last year, and the top 10 were all written for drugs now available in generic versions of pricier brand-name originals. Nearly half of all Americans are prescribed a drug at any given time. The most common ones, as you might expect, treat the most common chronic conditions — managing high blood pressure, for example, or controlling diabetes. Painkillers are also on the list, carrying with them the risk of substance abuse. But there are some surprises, too. (Blau, 7/19)

Stat: Trying A New Tack: Delivering Insulin To The Liver To Control Type 1 Diabetes
Type 1 diabetics, armed with glucose meters and insulin pens, are caught in a delicate high-wire act. Too much glucose wreaks havoc on nerves and blood vessels, while too little causes dizziness and nausea. A Cleveland biotech company is trying to change that by delivering insulin to the liver, where it naturally goes. (Woosen, 7/17)

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

State Highlights: USC To ‘Examine And Address’ Accusations Against Former Med School Dean; Disabled Residents Protest Conn. Budget

Media outlets report on news from California, Connecticut, Massachusetts, Missouri, New Hampshire, New York, Minnesota and Wisconsin.

Los Angeles Times: USC President Tries To Quell Outrage Over Drug Allegations Against Former Medical School Dean
Acknowledging widespread concern on campus, USC President C.L. Max Nikias said Tuesday the university would “examine and address” a report in The Times that its former medical school dean abused drugs and associated with criminals and drug users. Nikias, speaking about the controversy for the first time in a letter to the campus community, said that “we understand the frustrations expressed about this situation” involving Dr. Carmen A. Puliafito and “we are working to determine how we can best prevent these kinds of circumstances moving forward.” (Parvini and Hamilton, 7/18)

The CT Mirror: Malloy Enlists Disabled In Budget Fight — Gets Protest At His Office
A day after Gov. Dannel P. Malloy all but invited disabled recipients of state services to lobby for a new budget, some did: They targeted him in a demonstration that ended with the arrest of five protesters in his outer office at the Capitol. State Capitol police issued summonses for third-degree trespassing to five protesters, three of whom arrived in either wheelchairs or a motorized scooter, after they refused to leave. (Werth and Pazniokas, 7/18)

WBUR: Gov. Baker Pushes Lawmakers For MassHealth Reform
In June, Baker announced a suite of proposals to rein in MassHealth spending — including shifting 140,000 low-income people from MassHealth onto commercial insurance plans. … Now, the governor has given them a two month deadline to take another look at his reforms, or face additional budget cuts elsewhere. (Bruzek and Chakrabarti, 7/18)

The New York Times: Uber Discriminates Against Riders With Disabilities, Suit Says
All around Valerie Joseph, there is a fleet of Uber cars rolling by on New York City streets. But though she could really use the ride-hailing app, Ms. Joseph said she does not bother because Uber has so few wheelchair-accessible cars to dispatch. “It’s plain unfair,” said Ms. Joseph, 41, who relies on a wheelchair. (Hu, 7/18)

Sacramento Bee: Sacramento’s Western Health Advantage Expands Health Coverage In Bay Area
Western Health Advantage, the managed-health plan founded by Sacramento and Solano County doctors in 1996, is further expanding its coverage in the Bay Area and will partner with providers in the UCSF medical system and John Muir Health to cover more populous counties, CEO Garry Maisel said Tuesday. … Those North Bay counties are home to roughly 911,132 residents, according to January 2017 population estimates by the California Department of Finance, compared with 4,429,303 in the counties now being added: San Francisco, San Mateo, Alameda and Contra Costa counties. (Anderson, 7/18)

Milwaukee Journal Sentinel: Democrats Say Gov. Scott Walker Accepted Donation From Marijuana Trade Group
Two Democratic lawmakers and a liberal advocacy group criticized Gov. Scott Walker on Tuesday for accepting a donation from a marijuana trade group on behalf of the Republican Governors Association at the same time he’s championing drug testing for Medicaid and food stamp recipients. The state’s budget-writing committee approved Walker’s proposal to drug test able-bodied adults who want public assistance in May. (Price, 7/18)

WBUR: Here Are The Details Of The Compromise Marijuana Bill
More than eight months after adult recreational use marijuana was approved by Massachusetts voters, a group of state lawmakers has reached a compromise bill making changes to the law, setting the stage for the opening of retail cannabis shops on July 1 of next year… <span>Both the House and Senate are expected to approve the compromise later this week, with the bill likely landing on Gov. Charlie Baker’s desk before the weekend.</span> (Brown, 7/18)

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

GOP Senators Balk At Repeal-Only Proposal: ‘There Is Enough Chaos And Uncertainty Already’

Jul 19 2017

Three Republican senators have already said they won’t vote for a plan that only repeals the Affordable Care Act without coming up with a replacement. But Senate Majority Leader Mitch McConnell, wanting the lawmakers on record, says he’ll still hold a vote to proceed next week.

The New York Times: The 3 Republican Women Who Doomed A Senate Repeal Of The Health Law
It was men who started it. It may be women who finished it. The Senate effort to repeal the Affordable Care Act, a process that began with 13 Republican men drafting a plan behind closed doors, collapsed Tuesday, as three Republicans said they would not support an ultimately futile attempt to simply roll back the current health care law without a replacement. (Huetteman, 7/18)

The Washington Post: Senate Republicans’ Effort To ‘Repeal And Replace’ Obamacare All But Collapses
Hours after GOP leaders abandoned a bill to overhaul the law known as Obamacare, their fallback plan — a proposal to repeal major parts of the law without replacing them — quickly collapsed. A trio of moderate Republicans quashed the idea, saying it would irresponsibly snatch insurance coverage from millions of Americans. “I did not come to Washington to hurt people,” tweeted Sen. Shelley Moore Capito (R-W.Va.), who joined Sens. Susan Collins (Maine) and Lisa Murkowski (Alaska) in opposing immediate repeal. (Eilperin, Sullivan and O’Keefe, 7/18)

The Wall Street Journal: GOP Stares Down Loss On Health-Care Bill
“To just say, ‘Repeal and trust us—we’re going to fix it in a couple years,’ that’s not going to provide comfort to the anxiety that a lot of Alaskan families are feeling right now,” GOP Sen. Lisa Murkowski of Alaska told reporters. “There is enough chaos and uncertainty already.” (Peterson, 7/18)

Bloomberg: McConnell’s New Obamacare Repeal Lacks GOP Votes To Pass 
Collins of Maine told reporters that repealing the law now and then hoping for a replacement “would create great anxiety for individuals who rely on the ACA.” She said she would oppose bringing a repeal bill up for debate. “I believe it would cause the insurance markets to go into turmoil.” (Litvan and Dennis, 7/18)

Politico: New GOP Plan To Repeal Obamacare Meets Fatal Opposition
But McConnell said Tuesday evening that he would hold a vote to proceed to the bill “early next week,” which would put senators on the record even if the vote’s outcome was preordained. McConnell said the vote was “at the request of the president and vice president and after consulting with our members.” (Kim, Haberkorn and Everett, 7/18)

The Hill: McConnell: Senate To Try To Repeal ObamaCare Next Week 
“For the information of all senators, at the request of the President [Trump] and Vice President [Pence] and after consulting with our members, we will have the vote on the motion to proceed to the ObamaCare repeal bill early next week,” McConnell said from the Senate floor on Tuesday night. (Carney, 7/18)

NPR: Repealing Obamacare Is A Risky Gambit Without A Replacement At Hand
The replacement bill’s language is based on the repeal bill that that passed by the House and Senate in 2015 but was vetoed by President Barack Obama. Here’s how the repeal would have changed the Affordable Care Act, compared with the House and Senate bills. (Kodjak, Hurt and Grayson, 7/18)

Boston Globe: What Happens If Obamacare Is Repealed Without A Replacement?
Republicans on Monday abandoned their latest effort to replace the Affordable Care Act, and some — including President Trump — are now considering an attempt to repeal President Obama’s signature health care law without a replacement bill. Any effort to simply repeal Obamacare is likely to be blocked, but what would happen if the landmark 2010 heath care bill was repealed? (Rocheleau, 7/18)

A look at where other politicians stand on the issue —

New Orleans Times-Picayune: Bill Cassidy Won’t Say Whether He Supports GOP Leadership On Health Care Vote 
Louisiana Sen. Bill Cassidy stopped short of saying he would vote against U.S. Senate Majority Leader Mitch McConnell’s latest proposal to repeal the Affordable Care Act with no immediate replacement. But Cassidy also wouldn’t say he would support McConnell’s effort either in an interview Tuesday (July 18). Instead, the Republican senator said he would continue to pursue the health care replacement plan he put together with South Carolina Sen. Lindsay Graham, also a Republican. A few weeks ago, he had been working with Maine Sen. Susan Collins, another Republican, on a health care replacement strategy as well. Neither plan assembled by Cassidy has gained traction with the rest of the Senate.  (O’Donoghue, 7/19)

The Baltimore Sun: Hogan Balks At Repeal-Only Plan, Saying It Would Leave Millions Without Coverage 
For months, Maryland Gov. Larry Hogan has mostly avoided the political storm raging in the nation’s capital, skirting questions about President Donald Trump and the policy changes his new administration has embraced. But on health care, Hogan appears to be finding his voice. For the second time in as many months, the centrist Republican governor who has eschewed national politics weighed in directly about his party’s faltering efforts to repeal Obamacare — arguing Tuesday that the latest push by Senate leaders could leave millions without insurance. (Fritze, 7/18)

Denver Post: John Hickenlooper Joins Other Governors In Urging Senate Not To Just Repeal Obamacare
Colorado Gov. John Hickenlooper joined his Republican counterparts Tuesday — including Ohio Gov. John Kasich and Nevada Gov. Brian Sandoval — in urging the U.S. Senate not to repeal Obamacare without a replacement. “Congress should work to make health insurance more affordable by controlling costs and stabilizing the market, and we are pleased to see a growing number of senators stand up for this approach,” Hickenlooper and 10 other governors said in a written statement. “The Senate should immediately reject efforts to ‘repeal’ the current system and replace sometime later.” (Paul, 7/18)

Orlando Sentinel: Gov. Scott Still Seeking Obamacare Repeal Despite Senate Health Bill Failure
Gov. Rick Scott, whose political career is largely defined by opposition to the Affordable Care Act, still wants Republicans to repeal the federal health care law despite their apparent failure to do so… The statement appears at odds with President Donald Trump’s solution, to “let Obamacare fail,” in light of the Senate GOP’s inability to pass its own health care bill, dubbed the Better Care Reconciliation Act. (Rohrer, 7/18)

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

Latinos Left Out Of Clinical Trials … And Possible Cures

Two decades ago, Luis Antonio Cabrera received devastating news: He likely had only three months to live.

The Puerto Rican truck driver, then 50, had attributed his growing leg pain to spending so many hours on the road. The real culprit was a malignant tumor in his left kidney that was pressing on nerves from his lower spine.

His initial treatment involved removing the organ, a complex surgery that, by itself, proved insufficient, as the cancerous cells had already spread to his lungs. Therefore, his primary care physician in Puerto Rico contacted doctors at the National Institutes of Health (NIH), in Bethesda, Md., and managed to enroll Cabrera in a medical study to test an innovative therapy: transplanting blood stem cells to destroy the cancer cells.

Today, at 70, Cabrera, a father of five and grandparent who moved to West Virginia with his wife to be closer to NIH, feels strong and healthy. “I come to do tests every six months — I’m like a patient at large,” he said.

However, Cabrera is one of a relatively small number of Hispanics who participate in clinical trials. “Only less than 8 percent of enrollees are Hispanic, even though Hispanics comprise 17 percent of the population,” said Dr. Eliseo Pérez-Stable, director of NIH’s National Institute on Minority Health and Health Disparities.

That means not only do Hispanics have less access to experimental cutting-edge treatments but researchers have less data on how a drug works in that population. Studies have shown that different ethnic groups might respond differently to treatments. The lack of patients from minority groups is an endemic problem in clinical trials; minorities typically are represented at a very low rate.

“Studies should represent the demographics of the country,” said Dr. Jonca Bull, an assistant commissioner on minority health at the Food and Drug Administration. “We need to close that gap so we can better understand how a particular drug or therapy works in different communities.”

Two Pioneering Initiatives

There are many reasons why Latinos do not enroll in these studies, Perez-Stable said: lack of information, disparities in access to health care and not being fluent in English are among main factors. Dr. Otis Brawley, chief medical officer with the American Cancer Society (ACS), said Latino families are open to participating in clinical trials, especially to help treat a sick son or daughter, but they need advice from a doctor to navigate the process.

Federal officials aim to augment these numbers. In March, the FDA launched a campaign to educate Hispanics about medical studies. “Primary care physicians have to be the champions. … In addition, the community health centers can help, because they are places of care that people trust,” said Bull.

As of July 5, there were 94,545 ongoing clinical trials in the United States, according to the NIH’s official website, clinicaltrials.gov. As in Cabrera’s case, the primary physician usually helps a patient find a medical study, although the advent of the internet in recent decades has meant a growing number of patients discover trials themselves online. To participate, the person must meet the researchers’ criteria for eligibility: age, gender or condition. Often, the center conducting the study covers related costs of drugs, treatments and tests.

For Brenda Aldana, receiving care at Holy Cross Hospital in Silver Spring, Md., made all the difference.

Luis Antonio Cabrera, 70, during his appointment at the NIH Clinical Center in Bethesda, Md., in June.
Two decades ago, he was told he likely had only three months to live, due to a kidney cancer. He
was enrolled in a clinical trial that saved his life. (Paula Andalo/KHN)

Aldana, 34, arrived in the United States from Zacatecoluca, El Salvador, nine years ago. During her first year in the U.S., she began to feel tired and her hair began to fall out. She initially thought those were symptoms of the stress of starting a new life in a new country, but while visiting her sister in Frederick, Md., Aldana fainted. It turned out she was suffering more than nerves: She had a pulmonary embolism. Within two weeks of tests, she was diagnosed with lupus, a debilitating chronic condition with a high incidence among Latinas.


“At Holy Cross, the doctors told me that they were going to help me get into a medical program for a medication to treat arthritis [caused by her lupus],” said Aldana, who has three children, ages 17, 6 and 5.

Aldana travels from Olney, Md., to the NIH Clinical Center once a month to receive intravenous medication.

These days, “Hispanics receive less quality medical care, so it’s important for them to be more involved in clinical trials,” said Brawley, noting that enrolling in a clinical trial gives patients access to a high-quality physician they might not otherwise see.

“In a medical study, instead of having the opinion of a single doctor, you’ll get the opinion of a group of highly qualified doctors who can say, ‘This is good for people like you,’” Brawley said. The American Cancer Society has an information service to help patients find clinical trials that match their medical condition. This service is also available in Spanish.

John Vasquez, 21, of San Antonio, Texas, needed only internet access and a cellphone to find the medical study that could change his life. In September 2015, while on his way to his brother’s football game, he lost feeling in his leg, arm and right part of his face. “I thought I was having a stroke,” he said.

He had aplastic anemia, a potentially deadly rare blood disorder that was destroying his red and white cells, and platelets, which aid the body’s clotting mechanism.

In a Facebook group for people with severe blood conditions, he was advised to contact the NIH, which sent him a kit for blood tests. After analyzing his clinical history, they told him he was eligible to participate in a medical study, which opened the gates to an innovative transplant that could change the course of his disease. Temporarily living with a sister in Maryland, he is scheduled for a bone marrow transplant on Aug. 1. His donor: his 14-year-old brother.

Categories: Health Industry, Public Health


Latinos quedan fuera de estudios médicos… y posibles curas

Hace dos décadas, Luis Antonio Cabrera recibió una noticia devastadora: le dijeron que le quedaban tres meses de vida.

El puertorriqueño conductor de camiones, que entonces tenía 50 años, había atribuido su creciente dolor en la pierna al hecho de pasar tantas horas en la ruta. Pero el diagnóstico fue más grave que una simple tensión muscular: tenía cáncer en el riñón izquierdo, y tuvieron que extirparle el órgano, una compleja cirugía que, encima, no fue suficiente, ya que las células malas se habían diseminado en el pulmón.

Su doctor en Puerto Rico lo contactó con médicos de los Institutos Nacionales de Salud (NIH), el organismo federal con sede en Bethesda, Maryland, en donde se investigan nuevas drogas y tratamientos, quienes dijeron que podían incluir a Cabrera en un estudio médico. Era para probar una terapia innovadora, un trasplante de células madre sanguíneas para destruir las células cancerígenas.

Use Nuestro Contenido

El trasplante funcionó, y el cáncer no volvió a aparecer. Hoy, a sus 70, Cabrera, quien tiene cinco nietos y se mudó a West Virginia con su esposa para estar más cerca de los NIH, se siente fuerte y sano. “Vengo a hacerme pruebas cada seis meses, soy como un paciente vitalicio”, contó sonriendo.

Cabrera es uno de los pocos hispanos que participan de estas pruebas clínicas. “Menos del 8% de los pacientes que están participando ahora de estudios médicos son latinos, aunque los hispanos representan al 17% de la población del país [56.6 millones de personas]”, dijo el doctor Eliseo Pérez-Stable, director del Instituto Nacional de Salud de Minorías y Disparidades de Salud de los NIH.

Luis Antonio Cabrera, de 70 años, durante una cita en el Clinical Center de los NIH, en Bethesda, Maryland, en junio.  Dos décadas atrás, le dijeron que le quedaban tres meses de vida por un cáncer de riñón. Lo inscribieron en un estudio médico que le salvó la vida. (Paula Andalo/KHN)

Esto significa que los latinos no sólo tienen menos acceso a tratamientos de avanzada sino también que los investigadores tienen menos información sobre el funcionamiento de las drogas y terapias en esta población. Estudios han mostrado que diferentes grupos étnicos pueden responder de manera distinta a los tratamientos. La falta de pacientes de minorías es un problema endémico en los ensayos clínicos; generalmente están representadas en una tasa mucho más baja.

“Los estudios deberían representar la demografía del país”, expresó la doctora Jonca Bull, comisionada asistente para la salud de minorías en la Administración de Drogas y Medicamentos (FDA). “Debemos zanjar esa brecha para poder comprender mejor como una droga o terapia en particular funciona en diferentes comunidades”.

Dos iniciativas pioneras

Hay muchas razones por las cuales los latinos no participan en estos estudios, dijo Perez-Stable: falta de información, disparidades en el acceso a la atención médica y no hablar inglés son algunos de los factores. El doctor Otis Brawley, oficial médico jefe de la Sociedad Americana de Cáncer (ACS), dijo que las familias latinas suelen estar dispuestas a participar de estudios médicos, especialmente si se trata de ayudar a que un hijo o hija enfermos reciban tratamiento, pero necesitan el consejo y apoyo de un doctor para guiarlos en todo el proceso.

Oficiales de salud tienen la meta de aumentar el número de hispanos en estos estudios innovadores. En marzo, la FDA lanzó una campaña para educar a los hispanos sobre los ensayos médicos. “Los médicos de cabecera tienen que ser los campeones, y también los centros comunitarios de salud, porque son espacios de atención en los que la gente confía”, remarcó Bull.

Al 5 de julio de 2017, solo en los Estados Unidos se están realizando 94.545 ensayos clínicos, de acuerdo con el sitio oficial clinicaltrials.gov. Como en el caso de Cabrera, usualmente el médico de cabecera ayuda al paciente a encontrar un estudio, aunque la llegada de internet en décadas recientes ha permitido que un número creciente de pacientes puedan descubrir por sí mismos los estudios médicos. Para participar, la persona debe cumplir con los criterios de elegibilidad de los investigadores: edad, género o condición. A menudo, el centro que conduce el estudio cubre costos relacionados con drogas, tratamientos o pruebas.

Para Brenda Aldana, atenderse en el hospital Holy Cross, de Silver Spring, Maryland, hizo esa diferencia en su cuidado de salud. Aldana, de 34 años, llegó a los Estados Unidos desde Zacatecoluca, en el departamento salvadoreño de La Paz, hace nueve años.

Brenda Aldana, de 34 años, durante su cita mensual en el Clinical Center de los NIH, en junio, en la que recibe medicación intravenosa para tratar su artritis. Aldana fue diagnosticada con lupus hace nueve años y participa de un estudio médico. (Paula Andalo/KHN)

Durante el primer año en el país, comenzó a sentirse cansada y se le empezó a caer el pelo, pero Aldana pensó que eran síntomas del estrés de iniciar una nueva vida en los Estados Unidos. Sin embargo, era algo más que nervios: durante una visita a su hermana, quien vivía en Frederick, Maryland, Aldana se desmayó. Fue internada de emergencia con una embolia pulmonar. A las dos semanas le dijeron que tenía lupus, una condición crónica debilitante de alta incidencia en latinas.


“En el Holy Cross los médicos me dijeron que me iban a ayudar a entrar en un programa médico para una medicación para tratar la artritis (una de las derivaciones del lupus)”, contó Aldana, quien tiene tres hijos de 17, 6 y 5 años.

Aldana viaja desde Olney, Maryland, al Clinical Center de los NIH cada mes para recibir la medicación por vía intravenosa. “Me siento mejor, me duelen menos las articulaciones”, dijo.

En estos días, “los hispanos reciben menos atención médica de calidad, por eso es importante que participen más de ensayos clínicos”, opinó Brawley, destacando que enrolarse en un estudio médico le da al paciente acceso a excelentes especialistas, que de otra manera quizás no verían.

“En un estudio médico, en vez de tener la opinión de un solo doctor, tendrá la opinión de un grupo de médicos altamente calificados que podrán decirle: ‘esto es bueno para gente como usted’”, enfatizó Brawley. La Sociedad Americana de Cáncer tiene un servicio de información para ayudar a los pacientes a encontrar ensayos clínicos de acuerdo a su condición médica. El servicio está disponible en español.

John Vasquez, de 21 años, de San Antonio, Texas, solo necesitó acceso a internet y un celular para dar con el estudio médico que puede cambiar su vida. En septiembre de 2015, cuando estaba en camino a un juego de fútbol americano de uno de sus hermanos, dejó de sentir su pierna, brazo y parte derecha de la cara. “Pensé que estaba teniendo un ataque cerebral”, contó.

Vasquez fue diagnosticado con anemia aplásica, una rara enfermedad de la sangre que literalmente estaba destruyendo todos sus glóbulos rojos, glóbulos blancos y plaquetas, que ayudan al cuerpo con el mecanismo de coagulación.

En un grupo de Facebook para personas con graves condiciones de la sangre, le recomendaron contactarse con los NIH; lo hizo y le enviaron un kit para pruebas de sangre. Luego de examinar su caso le dijeron que era elegible para un participar de un estudio médico, que le abrió las puertas a un novedoso trasplante que podría cambiar el curso de su enfermedad.

Bajo el cuidado del centro, Vasquez está viviendo temporalmente en Maryland con su hermana, esperando el momento del trasplante de médula ósea, programado para el 1 de agosto. El donante fue su hermano menor, de 14 años.

Categories: Health Industry, Noticias En Español, Public Health

Congress Squares Off Over Drug Pricing And A Controversial Drug Discount Program

House Democrats are calling foul on Republican assertions that cuts to a little-known discount drug program will eventually reduce skyrocketing drug prices.

At a hearing Tuesday, Rep. Diana DeGette (D-Colo.) said high drug prices should be investigated separately from the focus on oversight of the drug discount program, known as 340B.

“I think we need an investigation, a robust investigation, and a series of hearings that explore in-depth the reasons for exorbitant cost of drugs and why the prices continue to rise,” DeGette said.

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Last week, Health and Human Services Secretary Tom Price proposed steep cuts in what Medicare reimburses some hospitals for outpatient drugs under the 340B program. In a release, Price said such cuts would be “a significant step toward fulfilling President [Donald] Trump’s promise to address rising drug prices.”

DeGette countered Tuesday that the proposal “would do nothing” to address high drug prices and said making that connection “seems more like fantasy than reality.”

Also on Tuesday, there were other hints at Trump Administration efforts to address drug pricing. Food and Drug Administration Commissioner Scott Gottlieb talked in a public meeting about lowering drug prices on a different front — saying that the agency needs to increase generic drug competition.

Trump routinely criticized high drug prices on the campaign trail last year and promised to take action during his presidency. In June, a leaked draft of an executive order on drug prices, first reported by The New York Times, spoke of facilitating more drug competition but also targeted the 340B program. That strategy immediately drew criticism from Sen. Al Franken (D-Minn.), who said scaling back the program would drive up what hospital patients pay for drugs and force Americans “to choose between health and other basic life necessities, like putting food on the table and a roof overhead for the family.”

The federal 340B program requires pharmaceutical manufacturers to provide outpatient drugs at a significant discount to hospitals and clinics that serve a largely low-income population.

After buying the discounted drugs, the hospitals and clinics can bill Medicare or other insurers at their regular rate, pocketing the difference.

About 40 percent of hospitals nationwide participate in the program and, as House members pointed out Tuesday, the program has grown dramatically in recent years to become a significant force in the pharmaceutical marketplace. The Medicare Payment Advisory Commission estimated that hospitals and other participating entities spent more than $7 billion to buy 340B drugs in 2013, three times the amount spent in 2005.

Advocates of the program say the discounts — and the money hospitals make on payments from Medicare — are necessary to combat skyrocketing drug prices.

But federal reports in recent years from the Medicare advisory board, as well as the Government Accountability Office and the Office of Inspector General, have raised concerns about oversight and abuse of the 340B program.

Rep. Joe Barton (R-Texas) noted “this is a difficult hearing” because while the program was created with good intent, its complexity makes it challenging to understand. For example, hospitals and clinics aren’t required to pass any discounts they receive on to patients — they can direct the money to their general fund.

Looking at his colleagues, Barton said: “We all support the program but it has grown topsy-turvy. We need to put the best minds on this.”

Republican lawmakers are not the only ones raising concerns about 340B oversight. The Pharmaceutical Research and Manufacturers of America, which represents drugmakers, advocates ensuring hospitals are “good stewards” of the money they gain from the program’s discounts.

Peggy Tighe, who represents hospitals in the 340B program as a principal at the D.C. law firm Powers, said “PhRMA has done a particularly good job of getting the attention of the administration …. They haven’t let up on 340B.”

The rule that Price proposed last week would cut what hospitals are paid for drugs from the Medicare Part B program, which covers outpatient drugs including those delivered through infusion.

Currently, Medicare pays hospitals an average sales price plus 6 percent for most of the Part B drugs they purchase. The administration’s proposal is to cut that to average sales price minus 22.5 percent.

340B Health, a coalition that represents hospitals, immediately responded to the proposal saying the cuts would be “devastating” to hospitals and would “lead to cuts in patient services.”

KHN’s coverage of prescription drug development, costs and pricing is supported in part by the Laura and John Arnold Foundation.

Categories: Health Care Costs, Health Industry, Medicare, Pharmaceuticals

Viewpoints: History Offers Lessons In Addressing Opioid Addiction Crisis; Minority Communities And Access To Mental Health Care

Opinion writers offer their thoughts on a range of health issues.

Bloomberg: This Isn’t The First U.S. Opiate-Addiction Crisis
It’s true that there’s an opioid epidemic, a public health disaster. It’s not true that it’s unprecedented. A remarkably similar epidemic beset the U.S. some 150 years ago. The story of that earlier catastrophe offers some sobering lessons as to how to address the problem. (Stephen Mihm, 7/17)

Lexington Herald Leader: Ky.’s New Opioid Law Will Only Result In More Death, Pain
As the death toll from opioid overdoses in Kentucky and the rest of the Midwest continues to soar, it’s truly disconcerting to see that policymakers are taking steps that are not only devoid of medical and common sense, but virtually guaranteed to make matters worse. The recent passage of the ill-conceived House Bill 333, which imposes a three-day limit (with certain exceptions) on opioid prescribing, reflects a fundamental misunderstanding of the reasons behind the addiction epidemic. (Josh Bloom, 7/14)

Miami Herald: Minority Communities Lack Access To Mental Healthcare
Despite the need for mental health services, minorities are not seeking medical care. Even when they do seek treatment, they are less likely to receive adequate mental health care and tend to drop out of treatment two to three times more frequently. (Daniel Jimenez, 7/17)

Lincoln Journal-Star: Nebraska Needs Family Planning Clinics
In our neighboring state of Iowa, 15,000 people lost access to preventive care and contraception as Planned Parenthood clinics shut down earlier this month after Iowa politicians passed a law to stop reimbursing the trusted provider for health services. (Mia Fernandez, 7/18)

Stat: It’s Time To Break Down The Wall Between Dentistry And Medicine
In 1840, dentistry focused on extracting decayed teeth and plugging cavities. Today, dentists use sophisticated methods for prevention, diagnosis, and treatment. We implant teeth, pinpoint oral cancers, use 3-D imaging to reshape a jaw, and can treat some dental decay medically, without a drill. We’ve also discovered much more about the intimate connection between oral health and overall health. Periodontal disease, also known as gum disease, has been linked to the development of diabetes, high blood pressure, and cardiovascular disease. Pregnant women with periodontitis are more likely to develop pre-eclampsia, a potentially serious complication of pregnancy, and deliver low-birth-weight babies. (Bruce Donoff, 7/17)

Austin American-Statesman: Vaccines Protect Texas Children
When kids are vaccinated, there is less concern that they will contract diseases when they go with their friends to the local swimming pool or the playground… Pockets of parents in Texas and other states have become complacent because they don’t regard these diseases as threats to their children, while others don’t believe these diseases exist any longer. (Terry Cook, 7/18)

The Des Moines Register: Postpartum Psychosis Claimed Molly Roth. Her Husband Hopes To Save Others
But two weeks after Gracelyn arrived Jan. 5, Molly encountered her biggest hurdle. A nurse practitioner called it the “baby blues,” a benign term for a sometimes monumental change that affects about one in five new mothers. Normally a whirlwind of energy, the 32-year-old Molly, who used to make sure everyone else was OK, now had to drag herself through the motions of daily life. She would cry uncontrollably and say she had made a mistake. About a month in, she was diagnosed with postpartum depression and put on a handful of medicines, Jamison says. By then she was struggling just to bathe: “I had to show her the simple steps of turning on the water and getting a towel.” She talked of suicide. What she was suffering from, according to Jamison, was actually a rarer, more dangerous perinatal mood disorder called postpartum psychosis, compounding her existing anxieties. (Rekha Basu, 7/17)

Los Angeles Times: Domestic Violence Victims Shouldn’t Have To Choose Between Deportation And Medical Care
When Elena attempted to break up with her abusive boyfriend, he beat her horribly, saying he would leave her with scars by which to remember him. Although badly injured, she did not contact the police to report the domestic violence. Nor did she seek medical care for her open wounds or the ringing in her ear. She had heard news of President Trump’s expanded immigration enforcement policies and stories of immigration agents arresting domestic violence and human trafficking victims inside courthouses. She had also learned that her state, California, requires medical professionals to report domestic violence and sexual assault to the police, and she feared deportation more than she desired medical care. (Jane K. Stoever, 7/17)

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Perspectives: The Senate GOP Health Bill Appears To Have Collapsed… But What Could Happen Next?

Editorial pages parse the breaking news late Monday night when two more Republican senators announced their opposition to the measure. What has gone wrong? What paths could go forward? And what issues remain in play?

The New York Times: In Congress, Obstructionists Are Obstructing Themselves
Republican legislative leaders are in a bind. While they appear to have failed for now in their goal of destroying the Affordable Care Act, their eagerness to shower tax breaks on the wealthy at the expense of health coverage for millions of Americans has crimped their ability to pass other fiscal legislation. (7/18)

The Washington Post: Is Trumpcare Finally Dead?
Perhaps the two “no” votes from Sens. Susan Collins (R-Maine) and Rand Paul (R-Ky.) would have been enough to sink the GOP health-care effort. Senate Republicans and virtually all political watchers have been cultivating a sense of suspense — who would be the third “no” vote? — when in fact there are likely, according to Collins, many more “no” votes (eight to 10, she said in TV interviews Sunday). Then a very public and simple barrier to passage emerged — Sen. John McCain’s (R-Ariz.) undetermined recuperation time. With two “no” votes already clinched, Senate GOP leaders could not even pretend to have sufficient support without McCain (who actually might be a “no” vote in the end). Now comes perhaps the death knell for Trumpcare: Sens. Mike Lee (R-Utah) and Jerry Moran (R-Kan.) both announced their opposition Monday night. (Jennifer Rubin, 7/17)

RealClear Health: The Disturbing Process Behind Trumpcare
Since I came to Washington in 1969, I have been immersed in Congress and its policy process. I have seen many instances of unpopular bills considered and at times enacted. I have seen many instances of bills put together behind closed doors. I have seen bills enacted and repealed after a public backlash. I have seen embarrassing mistakes in bills, and lots of intended consequences. (Norm Ornstein, 7/17)

Los Angeles Times: Is Rand Paul’s Opposition To The GOP Health Bill Principled, Or Cynical?
Thhe greatest trick any politician can pull off is to get his self-interest and his principles in perfect alignment. As Thomas More observed in Robert Bolt’s “A Man for All Seasons,” “If we lived in a State where virtue was profitable, common sense would make us good, and greed would make us saintly.” Which brings me to Sen. Rand Paul, the GOP’s would-be Man for All Seasons. Paul has managed to make his opposition to the GOP’s healthcare bill a matter of high libertarian principle. The fact that the bill is terribly unpopular in his home state of Kentucky — where more than 1 out of 5 Kentuckians are on Medicaid — is apparently just a coincidence. (Jonah Goldberg, 7/18)

McClatchy: The GOP Is Bungling Obamacare Repeal, And Democrats Could Be The Winners
The Republican Party in Congress could be on the verge of losing the 2018 midterm elections 16 months before they happen. Since 2010, the GOP has been vowing and planning and stunting to repeal the Affordable Care Act, that transformative legislative Frankenstein that Democrats crammed through Congress in 2010 without a single Republican vote. (Andrew Malcolm, 7/18)

The Wichita Eagle: Enough Flim-Flam: Move On Now To Solve Health Care Puzzle
When the Senate majority leader wields the possibility of bipartisanship as a threat and dismisses massive cuts to Medicaid as a shell game, you know it’s time to move on. Sen. Mitch McConnell’s desperate scramble for one or two more votes to repeal and replace the Affordable Care Act has actually reached those moral depths. And it isn’t working for congressional Republicans, let alone the American people. (Dave Merritt, 7/18)

Los Angeles Times: How I Got Caught In The Crossfire Between V.P. Pence And Ohio Gov. Kasich Over Medicaid
At the National Governors Conference on Friday, Vice President Mike Pence took Ohio Gov. John Kasich to task in a speech attacking the Affordable Care Act’s Medicaid expansion. Pence presumably had two goals. The first was to silence Kasich, the loudest voice among GOP governors opposed to congressional Republicans’ efforts to drastically roll back Medicaid as part of their ACA repeal plans. The second was to justify that rollback by claiming that the Medicaid expansion eroded services for the program’s traditional beneficiaries, including the disabled. (Michael Hiltzik, 7/17)

The Wall Street Journal: Return Medicaid To Its Rightful Role
Rolling back ObamaCare’s Medicaid expansion has become the focal point of the health-care debate, and rightly so. Without fundamental change, Medicaid—expanded or not—will push state budgets to the brink even as it fails to help the most financially vulnerable Americans. Consider Oklahoma, our home state. Despite intense lobbying by hospital corporations, the state Legislature stood strong and refused the Medicaid expansion. But the Medicaid rolls increased anyway, and at a dramatic cost to priorities like education, public safety and transportation. (Frank Keating and Doug Beall, 7/17)

Bloomberg: HSAs Can Show The Way To Bipartisan Health Reform
The Senate Republicans’ latest plan to overhaul Obamacare includes a significant expansion of Health Savings Accounts (HSAs), but exacerbates a key longstanding problem: HSAs provide significant tax benefits to those Americans who need the least help. That provides an opening for bipartisan compromise. Democrats and Republicans could find agreement on creating “equitable HSAs” — that is, HSAs that are subsidized more equally for everyone — to reform the healthcare system. (Samuel Estreicher and Clinto Wallace, 7/17)

Bloomberg: Taxing Hospitals Is A Lousy Way To Fix Health Care
Before Obamacare passed, we were bombarded with statistics about the uncompensated care that hospitals provide. The numbers were large — in the tens of billions — and the implication was that this was something of a national emergency. Certainly it was one very good reason to pass the Affordable Care Act, so that hospital budgets wouldn’t groan under unpaid bills, and the people getting care could be sure that they wouldn’t get turned away at the hospital door. (Megan McArdle, 7/17)

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Health Insurers Defend Price Hikes, Pointing To Confusion In Washington

They say they don’t even know if the government will continue to require Americans to sign up, and higher costs may mean fewer people do so. Meanwhile, KHN answers some questions about what consumers can expect on the marketplaces next year.

The Baltimore Sun: Uncertainty In Washington Driving Up Health Insurance Rates, Insurers Say 
Two Maryland health insurance companies defended hefty rate increases they were seeking for insurance plans offered on the state’s exchange under Obamacare in part by citing the uncertainty in Washington over the law’s future. Representatives of both Evergreen Health and Kaiser Health Plan of the Mid-Atlantic testified Monday before the Maryland Insurance Administration, which must decide whether to accept or adjust the requested rate increases before the next enrollment period begins this fall. The administration already held a hearing on a large increase being sought by CareFirst BlueCross BlueShield, the state’s dominant insurer. (Cohn, 7/17)

Kaiser Health News: Unpaid Premiums? Switching Plans? What Changes Are Coming For 2018 Coverage
People are anxious about what’s going to happen with marketplace coverage next year. Even if Republicans succeed in passing a bill to replace the Affordable Care Act, the marketplaces will offer plans this fall for 2018 coverage. Below I explain some of the important changes that are in the works that could affect consumers’ enrollment and coverage next year. (Andrews, 7/18)

And in Georgia —

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When It Comes To Path Forward, Intra-Party Discord Isn’t Limited To GOP

There’s a strong push from the left-wing of the Democratic Party for a single-payer system, but others aren’t convinced that’s the way to go.

McClatchy: Obamacare Repeal: Democrats Divided On Single Payer Health Care
Democrats showed uncommon unity in fighting Republican efforts to repeal and replace the Affordable Care Act, and it appeared to be working Monday as two more GOP senators said they can’t support the latest version. But Democrats’ discipline masks a deep and fundamental divide within the party that could complicate efforts to gain ground in the 2018 election and beyond. (Clark, 7/17)

The Hill: Sanders ‘Delighted’ By Failure Of GOP Health Plan 
Sen. Bernie Sanders (I-Vt.) said he’s “delighted” to see GOP senators fleeing from the chamber’s latest version of an ObamaCare repeal-and-replace bill. “I am delighted to see that the disastrous Republican health care plan will not succeed,” he wrote in a statement. (Master, 7/17)

Meanwhile, in New York —

The Wall Street Journal: Cuomo And De Blasio Team Up To Oppose GOP’s Health-Care Efforts
The Republican push to repeal the Affordable Care Act on Monday momentarily united two New York Democrats who are often at odds. Gov. Andrew Cuomo and New York City Mayor Bill de Blasio have long sparred with one another, most recently blaming the other for troubles at the Metropolitan Transportation Authority, and they rarely appear together. (Vilensky and Alfaro, 7/17)

Reuters: New York Attorney General Says Will Sue Over Obamacare Repeal
New York state Attorney General Eric Schneiderman intends to sue the federal government if Republican lawmakers pass proposed legislation to overhaul the U.S. healthcare system, his office said on Monday. Schneiderman’s office said it has identified “multiple constitutional defects” with the Republican healthcare bills. (Levine, 7/17)

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Trump Wants To Score A Health Care Win — And Doesn’t Necessarily Matter What It Looks Like

President Donald Trump was wining and dining senators last night in a push to build support for the GOP’s proposed legislation while two Republicans announced their plans to oppose the bill. Soon after, the president took to Twitter, urging Congress to focus on repeal first measures instead.

Politico: Trump Blindsided By Implosion Of GOP Health Care Bill
President Trump convened a strategy session over steak and succotash at the White House with senators Monday night, trying to plot an uphill path to repealing Obamacare and replacing it with a GOP alternative. … Meanwhile, two senators – neither invited to the dinner – were simultaneously drafting statements saying how they couldn’t support the current bill, which they released just after Trump’s White House meal concluded. (Dawsey, 7/18)

The Associated Press: Trump Blasts Congress Over Failure Of GOP Health Care Bill
President Donald Trump blasted congressional Democrats and “a few Republicans” Tuesday over the failure of the GOP effort to rewrite the Obama health care law, and warned, “we will return.” Trump’s early morning tweet unleashed a barrage of criticism at Congress over the collapse of the GOP’s flagship legislative priority. For seven years, the party has pledged to repeal President Barack Obama’s law. “Most Republicans were loyal, terrific & worked really hard,” Trump tweeted Tuesday morning, but said, “We were let down by all of the Democrats and a few Republicans.” (Fram and Werner, 7/17)

The Hill: White House On ObamaCare Repeal: ‘Inaction Is Not An Option’ 
The White House on Monday responded to the stalling of the Senate GOP’s healthcare legislation, saying “inaction is not an option” on the efforts to repeal and replace ObamaCare. “Insurance markets continue to collapse, premiums continue to rise, and Obamacare remains a failure. Inaction is not an option,” a White House spokesperson said in a statement. (Shelbourne, 7/17)

The Washington Post: Vice President Pence’s Bushel Of False And Misleading Claims About Health Care
Vice President Pence recently spoke at the National Governors Association meeting in Providence, R.I., and made several questionable claims about the Senate GOP health-care proposal, the Better Care Reconciliation Act (BCRA). When he gave his speech, on Friday, the new version of the Republicans’ health proposal was released but had not been analyzed by the Congressional Budget Office, a nonpartisan agency that studies the budget impact of legislation. (Lee, 7/18)

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Perspectives: Governors Step Up As Senators Step Back; More Tough Takes On The GOP Health Plan

Opinion writers examine the policy and political dynamics in play as the Senate GOP continues its efforts to replace the Affordable Care Act.

The Washington Post: Governors Push Back While GOP Lawmakers Roll Over
If House and Senate Republicans have largely been supine in the face of President Trump’s assaults on the truth, fiscal probity, conflicts of interest, climate change and health care, governors have not and therefore point the way toward restoration of a once admirable party. (Jennifer Rubin, 7/16)

Los Angeles Times: Here Are The Hidden Horrors In The Senate GOP’s New Obamacare Repeal Bill
enate Republicans unveiled a new, “improved” version of their Affordable Care Act repeal bill Thursday, so the treasure hunt is on: the search for provisions so horrifically inhumane that they’ve had to be concealed deep in the measure’s legislative language and procedural maze. We’ve found quite a few, with the help of professional spelunkers Andy Slavitt, David Anderson, Larry Levitt and others. Here are some of the provisions in the so-called Better Care Reconciliation Act, or BCRA, that the Senate GOP really doesn’t want you to know about. (Michael Hiltzik, 7/14)

Bloomberg: Put Trumpcare Out Of Its Misery
Congressional Republicans have just produced their latest version of Trumpcare. On the plus side, this one gives up on earlier proposals to repeal three taxes that the Affordable Care Act imposes on the wealthy, making it a bit less fiscally reckless. On the minus side, it’s still a terrible plan. (7/14)

The Washington Post: On Health Care, History Is Watching. And It’s Watching Four Senators In Particular.
Over the past century, there has been a characteristic American cycle of response to far-reaching social reforms. When the breakthroughs are first proposed, conservatives fight them with a devout passion, warning that the measures on offer would move the nation toward socialism and perdition. Then, over time, the disastrous consequences never materialize, the reforms prove their worth, and Americans come to see the once-new benefits as rights. (E.J. Dionne, 7/16)

USA Today: The ‘Pro-Life’ Movement Is A Joke And Trumpcare Proves It
They might have gotten away with it if not for those meddling disability activists. Until several members of ADAPT were yanked from their wheelchairs and arrested for conducting a sit-in outside Senate Minority Leader Mitch McConnell’s office on the day the Senate GOP’s first draft of Trumpcare went public, Republicans had done a beautiful job of hiding the truth about their effort to “repeal and replace” Obamacare. (Jason Sattler, 7/17)

The Washington Post: The Fundamental Error In The CBO’s Health-Care Projections
In the coming days, the Congressional Budget Office will release an updated analysis of the Senate bill to repeal and replace Obamacare. The CBO will likely predict lower health insurance coverage rates if the bill becomes law. The American people and Congress should give this prediction little weight in assessing the bill’s merit. (Marc Short and Brian Blase, 7/14)

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More Americans Getting Sick From Making Mistakes With Their Medication

Accidentally taking the wrong dose or drug is leading to more “serious medical outcomes,” a study finds. Today’s other public health news headlines cover Alzheimer’s, artificial sweeteners’ role in weight loss, diet and exercise counseling, anorexia, the benefits of dirt, diabetes, belly fat and a bizarre medical case.

NPR: High Alzheimer’s Rates Among African-Americans May Be Tied To Poverty
Harsh life experiences appear to leave African-Americans vulnerable to Alzheimer’s and other forms of dementia, researchers reported Sunday at the Alzheimer’s Association International Conference in London. Several teams presented evidence that poverty, disadvantage and stressful life events are strongly associated with cognitive problems in middle age and dementia later in life among African-Americans. (Hamilton, 7/16)

NPR: Artificial Sweeteners Don’t Help With Weight Loss
The theory behind artificial sweeteners is simple: If you use them instead of sugar, you get the joy of sweet-tasting beverages and foods without the downer of extra calories, potential weight gain and related health issues. In practice, it’s not so simple, as a review of the scientific evidence on non-nutritive sweeteners published Monday shows. (Hobson, 7/17)

The New York Times: ‘To The Bone’ Opens Frank Dialogue On Eating Disorders: ‘They Steal Your Voice’
When Marti Noxon set out to make “To the Bone,” a film about a 20-year-old battling an eating disorder, she initially faced the question: Was the topic too niche? The answer came in the form of a rousing premiere in January at the Sundance Film Festival, Netflix’s reported $8 million purchase of the film, a trailer that went viral with 54 million views in the first week and arguments over whether it glamorized excessive thinness. The film debuted on Netflix on Friday. (Minsberg, 7/14)

NPR: ‘Dirt Is Good’: New Book Explores Why Kids Should Be Exposed To Germs
As a new parent, Jack Gilbert got a lot of different advice on how to properly look after his child: when to give him antibiotics or how often he should sterilize his pacifier, for example. After the birth of his second child, Gilbert, a scientist who studies microbial ecosystems at the University of Chicago, decided to find out what’s actually known about the risks involved when modern-day children come in contact with germs. (Garcia-Navarro, 7/16)

Stat: Trying A New Tack: Delivering Insulin To The Liver To Control Type 1 Diabetes
Type 1 diabetics, armed with glucose meters and insulin pens, are caught in a delicate high-wire act. Too much glucose wreaks havoc on nerves and blood vessels, while too little causes dizziness and nausea. A Cleveland biotech company is trying to change that by delivering insulin to the liver, where it naturally goes. Diasome has three phase 2 clinical trials in progress testing nanoparticles known as hepatocyte-directed vesicles. These particles, smaller than the period at the end of this sentence, stick to insulin like Velcro and bring it to the liver. Diasome believes its approach will better manage patients’ blood sugar than administering insulin alone. (Wosen, 7/17)

Stat: Redeeming Qualities For Belly Fat? When It’s Actually The Omentum, Sure
Look down. See any belly fat? The answer should be yes, for everyone — because that fat pad isn’t just sitting there quietly. Some of it is actually part of an organ called the omentum. And the omentum — specifically, its immune cells — may be where researchers need to focus if they want to find new treatments for some stubborn cancers that have spread. Researchers like Troy Randall hope that might be possible if we understand a bit better how the omentum works. Randall and his team at the University of Alabama at Birmingham have looked at how omentum’s immune cells respond in ovarian cancer; they published a review paper about the organ’s immune system in Trends in Immunology in June. (Sheridan, 7/14)

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Anthem Sues Insys Therapeutics Over Reimbursement ‘Scheme’ For Painkiller

Anthem, one of the nation’s largest health insurers, is alleging that the drugmaker used a “creative, illegal, and fraudulent” scheme in pursuing reimbursement for the painkiller Subsys.

Stat: Anthem Sues Insys Over A ‘Creative’ Scheme To Win Reimbursement For Its Painkiller
Anthem, which is one of the nation’s largest health insurers, has filed a lawsuit accusing Insys Therapeutics of engaging in a “creative, illegal, and fraudulent” scheme to obtain reimbursement for its Subsys painkiller, adding a new layer of legal challenges for the beleaguered drug maker. In its lawsuit, which was filed on Wednesday in federal court in Arizona, Anthem accused the company of bribing doctors with “sham” speaker fees to write prescriptions for unapproved uses for its drug, which contains fentanyl and carries a high risk of dependency. We asked Insys for comment and will update you accordingly. (Silverman, 7/14)

Arizona Republic: Chandler’s Insys Therapeutics Sued By Insurers Over Opioid Marketing
Insys Therapeutics of Chandler, already facing numerous legal challenges over the alleged improper marketing of a powerful opioid drug, was hit this week with a lawsuit from health insurer Anthem Inc. The lawsuit came the same week that two of the company’s former sales representatives — one of them the wife of the company’s former CEO — pleaded guilty to arranging kickbacks for medical professionals. (Wiles, 7/14)

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Hospitals Lobbied Hard To Keep Tax Breaks Under ACA, But They’re Not Sharing Their Windfall

Through millions of newly insured patients, hospitals have raked in money since the Affordable Care Act was passed. But their spending on direct charity care has actually fallen.

Politico: How Hospitals Got Richer Off Obamacare
A decade after the nation’s top hospitals used all their advertising and lobbying clout to keep their tax-exempt status, pointing to their vast givebacks to their communities, they have seen their revenue soar while cutting back on the very givebacks they were touting, according to a POLITICO analysis. (Diamond, 7/17)

Politico: How The Cleveland Clinic Grows Healthier While Its Neighbors Stay Sick
On the Cleveland Clinic’s sprawling campus one day last year, the hospital’s brain trust sat in all-white rooms and under soaring ceilings, looking down on a park outside and planning the next expansion of the $8 billion health system. A level down, in the Clinic’s expansive alumni library, staff browsed century-old texts while exhausted doctors took naps in cubbies. And in the basement, a cutting-edge biorobotics lab was simulating how humans walk using a cyborg-like meld of metallic and cadaver parts. (Diamond, 7/17)

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States Scramble To Cajole, Entice and Pressure Insurers Back Into Marketplace

“There is a general feeling that we’re on the front lines,” says Julie Mix McPeak, Tennessee’s insurance commissioner.

The Wall Street Journal: States To Health Insurers: Please Come Back
Nevada officials were stunned last month to learn that Anthem Inc., the only insurer selling plans statewide through the insurance exchange, was planning to pull back next year, leaving consumers in most counties with no way to get plans under the Affordable Care Act. “It felt like a gut punch,” says Heather Korbulic, executive director of Nevada’s insurance exchange, where consumers buy ACA coverage online. When she learned of the situation from insurer filings, she says, she blurted out loud: “Holy shit, what are we going to do?” Nevada officials quickly began pushing to solve the problem. (Wilde Mathews, 7/14)

Seattle Times: Health Insurers Seek Double-Digit Rate Increases In Washington State — Despite Billion-Dollar Reserves | The Seattle Times
At the same time Regence is abandoning customers in Washington’s market for individual insurance, it is seeking rate increases in the state averaging 30 percent next year…Regence is not alone, according to filings with the state Office of the Insurance Commissioner. Premera Blue Cross has proposed 28 percent increases, on average, and reported a surplus of $1.5 billion at the end of 2016. Kaiser Permanente is asking for rate increases averaging 13 percent and had a $917 million surplus. Insurers say they need deep reserves in the event of unforeseen disaster. (Young, 7/16)

Denver Post: Colorado Health Insurers Seek 27 Percent Premium Hike
Colorado health insurers are asking to charge customers in the individual market nearly 27 percent more on average in premiums next year, the state Division of Insurance announced Friday. The division must still review and approve the requests — after receiving public comment. But insurers can back out of the market if the state doesn’t OK their premium hikes. (Ingold, 7/14)

Meanwhile, places that were finally finding their feet in terms of health care are worried they’re going to be pushed back to the ground —

The Washington Post: In An Arid, Lonely Stretch Out West, The Health Coverage That Bloomed Is Now At Risk
In this speck of high desert, along a stretch of highway that Life magazine once called the loneliest road in America, the only doctor in town comes just one day a week. In the past few years, though, health insurance has arrived in force. The county that includes Silver Springs now has more than 3,500 additional residents on Medicaid, because Nevada’s governor was the first Republican in the country to expand the program through the Affordable Care Act. Nearly 1,400 others have private plans through the law and the Silver State Health Insurance Exchange. (Goldstein, 7/16)

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Preventive Care Efforts Were Boosted Under ACA, But GOP’s Plan Would Make Them Vulnerable Again

Regular screenings and preventive care are responsible for catching serious problems before they become expensive disasters. But with the cuts under the GOP’s proposed legislation, some worry the progress made through the Affordable Care Act will be lost. Meanwhile, the Republicans’ plan depends on young people buying insurance even though that lesson was already learned, and a look at the winners and losers under the plan.

The Associated Press: Trump’s No ‘Dying In The Streets’ Pledge Faces Reality Check
President Donald Trump has often said he doesn’t want people “dying in the streets” for lack of health care. But in the United States, where chronic conditions are the major diseases, people decline slowly. Preventive care and routine screening can make a big difference for those at risk for things such as heart problems and cancer, especially over time. (Alonso-Zaldivar, 7/15)

The Associated Press: New GOP Health Care Bill Will Determine Winners, Losers
Republicans’ latest health care plan would create winners and losers among Americans up and down the income ladder, and across age groups.It would give consumers more responsibility for their insurance choices, a goal long held by conservatives who argue that’s key to a true health care market. Younger adults and healthy people in the solid middle class may find more agreeable options. But low-income people may not be able to afford coverage, along with older and sicker adults. (7/15)

In other news on the Republicans’ proposed legislation —

The Wall Street Journal: Health-Law Taxes Divide The GOP, Signaling A Shift
Republican efforts to pass a health-care bill have revealed a party fissure on tax policy with potentially far-reaching repercussions. In his latest attempt to rewrite President Barack Obama’s signature health-care law, Senate Majority Leader Mitch McConnell (R., Ky.) retained a 3.8% investment-income tax and a 0.9% payroll tax that apply to individuals earning more than $200,000 and married couples earning more than $250,000. (Rubin, 7/17)

Kaiser Health News: Podcast: What The Health? Senate Health Bill 2.0. Still On Life Support
Julie Rovner of Kaiser Health News, Joanne Kenen of Politico, Sarah Kliff of Vox.com and Margot Sanger-Katz of The New York Times discuss the changes to the proposed Senate health bill, and whether they can win the 50 votes needed to pass it. Plus, for “extra credit,” the panelists recommend their favorite health stories of the week they think you should read, too. (7/14)

Des Moines Register: 58% Of Iowans Oppose Congress’ Actions On Health Care, New Iowa Poll Shows
Few Iowans like how Congress is attempting to revamp the nation’s health care system, a new Des Moines Register/Mediacom Iowa Poll shows. Just 29 percent of Iowa adults say they mostly support the direction congressional Republicans are taking on health care, according to the poll. Twice as many — 58 percent — say they mostly oppose that direction. Thirteen percent are unsure. (Leys, 7/15)

Bloomberg: Obamacare’s Pocketbook Problems Made Worse In GOP Health Bill 
Concern about patients spending too much of their own money on health care has driven the debate over repealing and replacing Obamacare. But the latest Senate Republican health bill does little to address those fears and may exacerbate them. The bill, rolled out anew on Thursday after a raft of Republican defections threatened to sink the original legislation, faces a narrow road to passage despite alterations aimed at winning over lawmakers who balked at the earlier draft. Two Republican Senators signaled their opposition; a third dissent could doom the measure, and a long-held GOP vow to overturn the Affordable Care Act. (Tracer and Edney, 7/14)

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Possible Return Of ‘Junk Insurance’ Worries Those Who Remember Bare Bones Coverage All Too Well

Many Republicans, including President Trump, say giving insurers the leeway to offer less-comprehensive plans will give people greater choice and cheaper options, but experts say it will skew the marketplace in favor of young, healthy people at the expense of sick people.

The New York Times: In Clash Over Health Bill, A Growing Fear Of ‘Junk Insurance’
Julie Arkison remembers what it was like to buy health insurance before the Affordable Care Act created standards for coverage. The policy she had was from the same insurer that covers her now, but it did not pay for doctor visits, except for a yearly checkup and gynecological exam. “I couldn’t even go to my regular doctor when was I sick,” said Ms. Arkison, 53, a self-employed horseback-riding teacher in Saline, Mich. (Abelson, 7/15)

The Associated Press: Health Plan Hinges On The Young, But They’re A Tough Sell
Julian Senn-Raemont isn’t convinced he needs to buy health insurance when he loses coverage under his dad’s plan in a couple of years — no matter what happens in the policy debate in Washington, or how cheap the plans are. The 24-year-old musician hasn’t known a world without a health care safety net. But he hates being forced by law to get coverage, and doesn’t think he needs it. (Johnson, 7/17)

The Hill: Insurers Warn Cruz Provision Will ‘Skyrocket’ Premiums For Sick People 
The two leading health insurer trade groups sent a strongly-worded letter Friday expressing opposition to a controversial conservative provision included in the latest GOP ObamaCare replacement bill. America’s Health Insurance Plans and the Blue Cross Blue Shield Association warned that the provision from Sen. Ted Cruz (R-Texas) would mean “premiums will skyrocket for people with preexisting conditions” and “millions of more individuals will become uninsured.” (Sullivan, 7/14)

The Wall Street Journal: Senate Health Bill Frays Republicans
Insurers have worried that under the Cruz proposal, the health market would be split in two. Healthy and younger people would flock to cheaper, less comprehensive plans, while people with pre-existing conditions who need more comprehensive coverage could have to pay far more. That has alarmed centrist GOP senators who want to maintain protections for people with pre-existing conditions. And although conservatives sought the Cruz measure, its current version has left them divided because of a change in the way the market where people buy insurance when they don’t get coverage on the job would be structured. (Armour and Peterson, 7/14)

Kaiser Health News: Analysis: Senate’s Latest Health Blueprint Cuts Costs At The Expense Of Chronically Ill
The latest Senate health proposal reins in costs by effectively splitting the individual insurance market, with healthy people diverted into stripped-down plans and chronically ill individuals left with pricey and potentially out-of-reach options, insurance analysts said. This draft — a fresh attempt by the Republican Party to undo the Affordable Care Act — injects more uncertainty into plans for people with preexisting conditions such as cancer, asthma, diabetes or other long-term ailments. Those people, insured through ACA marketplaces now, could be more isolated than in an earlier version of the Senate bill. (Hancock, 7/17)

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Calif. Hits Nerve By Singling Out Cardiac Surgeons With Higher Patient Death Rates

Michael Koumjian, a heart surgeon for nearly three decades, said he considered treating the sickest patients a badge of honor. The San Diego doctor was frequently called upon to operate on those who had multiple illnesses or who’d undergone CPR before arriving at the hospital.

Recently, however, Koumjian received some unwelcome recognition: He was identified in a public database of California heart surgeons as one of seven with a higher-than-average death rate for patients who underwent a common bypass procedure.

“If you are willing to give people a shot and their only chance is surgery, then you are going to have more deaths and be criticized,” said Koumjian, whose risk-adjusted death rate was 7.5 per 100 surgeries in 2014-15. “The surgeons that worry about their stats just don’t take those cases.”

Now, Koumjian said he is reconsidering taking such complicated cases because he can’t afford to continue being labeled a “bad surgeon.”

California is one of a handful of states — including New York, Pennsylvania and New Jersey — that publicly reports surgeons’ names and risk-adjusted death rates on a procedure known as the “isolated coronary artery bypass graft.” The practice is controversial: Proponents argue transparency improves quality and informs consumers. Critics say it deters surgeons from accepting complex cases and can unfairly tarnish doctors’ records.

“This is a hotly debated issue,” said Ralph Brindis, a cardiologist and professor at UC-San Francisco who chairs the advisory panel for the state report. “But to me, the pros of public reporting outweigh the negatives. I think consumers deserve to have a right to that information.”

Prompted by a state law, the Office of Statewide Health Planning and Development began issuing the reports in 2003 and produces them every two years. Outcomes from the bypass procedure had long been used as one of several measures of hospital quality. But that marked the first time physician names were attached — and the bypass is still the only procedure for which such physician-specific reports are released publicly in California.

California’s law was sponsored by consumer advocates, who argued that publicly listing the names of outlier surgeons in New York had appeared to bring about a significant drop in death rates from the bypass procedure. State officials say it has worked here as well: The rate declined from 2.91 to 1.97 deaths per 100 surgeries from 2003 to 2014.

“Providing the results back to the surgeons, facilities and the public overall results in higher quality performance for everybody,” said Holly Hoegh, manager of the clinical data unit at the state’s health planning and development office.

Since the state began issuing the reports, the number of surgeons with significantly higher death rates than the state average has ranged from six to 12, and none has made the list twice. The most recent report, released in May, is based on surgeries performed in 2013 and 2014.

In this year’s report, the seven surgeons with above-average death rates — out of 271 surgeons listed — include several veterans in the field. Among them were Daniel Pellegrini, chief of inpatient quality at Kaiser Permanente San Francisco and John M. Robertson, director of thoracic and cardiovascular surgery at Providence Saint John’s Health Center in Santa Monica. Most defended their records, arguing that some of the deaths shouldn’t have been counted or that the death rates didn’t represent the totality of their careers. (Kaiser Health News, which produces California Healthline, is not affiliated with Kaiser Permanente.)

“For the lion’s share of my career, my numbers were good and I’m very proud of them,” said Pellegrini. “I don’t think this is reflective of my work overall. I do think that’s reflective that I was willing to take on tough cases.”

During the two years covered in the report, Pellegrini performed 69 surgeries and four patients died. That brought his risk-adjusted rate to 11.48 deaths per 100, above the state average of 2.13 per 100 in that period.

Pellegrini said he supports public reporting, but he argues the calculations don’t fully take the varying complexity of the cases into account and that a couple of bad outcomes can skew the rates.

Robertson said in a written statement that he had three very “complex and challenging” cases involving patients who came to the hospital with “extraordinary complications and additional unrelated conditions.” They were among five deaths out of 71 patients during the reporting period, giving him an adjusted rate of 9.75 per 100 surgeries.

“While I appreciate independent oversight, it’s important for consumers to realize that two years of data do not illustrate overall results,” Robertson said. “Every single patient is different.”

The rates are calculated based on a nationally recognized method that includes deaths occurring during hospitalization, regardless of how long the stay, or anytime within 30 days after the surgery, regardless of the venue. All licensed hospitals must report the data to the state.

State officials said that providing surgeons’ names can help consumers make choices about who they want to operate on them, assuming it’s not an emergency.

“It is important for patients to be involved in their own health care, and we are trying to work more and more on getting this information in an easy-to-use format for the man on the street,” said Hoegh, of the state’s health planning and development office.

No minimum number of surgeries is needed to calculate a rate, but the results must be statistically significant and are risk-adjusted to account for varying levels of illness or frailty among patients, Hoegh said.

She acknowledged that “a risk model can never capture all the risk” and said her office is always trying to improve its approach.

Surgeons sometimes file appeals — arguing, for example, that the risk was improperly calculated or that the death was unrelated to the surgery. The appeals can result in adjustments to a rate, Hoegh said.

Despite the controversy it generates, the public reporting is supported by the California Society of Thoracic Surgeons, the professional association representing the surgeons. No one wants to be on the list, but “transparency is always a good thing,” said Junaid Khan, president of the society and director of cardiovascular surgery at Alta Bates Summit Medical Center in the Bay Area.

“The purpose of the list is not to be punitive,” said Khan. “It’s not to embarrass anybody. It is to help improve quality.”

Khan added that he believes outcomes of other heart procedures, such as angioplasty, should also be publicly reported.

Consumers Union, which sponsored the bill that led to the cardiac surgeon reports, supports expanding doctor-specific reporting to include a variety of other procedures — for example, birth outcomes, which could be valuable for expectant parents as they look for a doctor.

“Consumers are really hungry for physician-specific information,” said Betsy Imholz, the advocacy group’s special projects director. And, she added, “care that people receive actually improves once the data is made public.”

But efforts to expand reporting by name are likely to hit opposition. Officials in Massachusetts, who had been reporting bypass outcomes for individual doctors, stopped doing it in 2013. Surgeons supported reporting to improve outcomes, but they were concerned that they were being identified publicly as outliers when they really were just taking on difficult cases, said Daniel Engelman, president of the Massachusetts Society of Thoracic Surgeons.

“Cardiac surgeons said, ‘Enough is enough. We can’t risk being in the papers as outliers,’” Engelman said.

Engelman said the surgeons cited research from New York showing that public reporting may have led surgeons to turn away high-risk patients. Hoegh said research has not uncovered any such evidence in California.

In addition to Koumjian, Robertson and Pellegrini, the physicians in California with higher-than-average rates were Philip Faraci, Eli R. Capouya, Alexander R. Marmureanu, Yousef M. Odeh. Capouya declined to comment.

Faraci, 75, said his rate (8.34 per 100) was based on four deaths out of 33 surgeries, not enough to calculate death rates, he said. Faraci, who is semi-retired, said he wasn’t too worried about the rating, though. “I have been in practice for over 30 years and I have never been published as a below-average surgeon before,” he said.

Odeh, 45, performed 10 surgeries and had two deaths while at Presbyterian Intercommunity Hospital in Whittier, resulting in a mortality rate of 26.17 per 100. “It was my first job out of residency, and I didn’t have much guidance,” Odeh said. “That’s a recipe for disaster.”

Odeh said those two years don’t reflect his skills as a surgeon, adding that he has done hundreds of surgeries since then without incident.

Marmureanu, who operates at several Los Angeles-area hospitals, had a mortality rate of 18.04 based on three deaths among 22 cases. “I do the most complicated cases in town,” he said, adding that one of the patients died later after being hit by a car.

“Hospital patients don’t care” about the report. he said. “Nobody pays attention to this data other than journalists.”

KHN’s coverage in California is funded in part by Blue Shield of California Foundation.

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Viewpoints: Public Health Implications Of Information Security; Who’s Looking Out For Nursing Home Residents?

Opinion writers offer their thoughts on a range of health issues.

The New England Journal Of Medicine: Threats To Information Security — Public Health Implications
In health care, information security has classically been regarded as an administrative nuisance, a regulatory hurdle, or a simple privacy matter. But the recent “WannaCry” and “Petya” ransomware attacks have wreaked havoc by disabling organizations worldwide, including parts of England’s National Health Service (NHS) and the Heritage Valley Health System in Pennsylvania. These events are just two examples of a wave of cyberattacks forcing a new conversation about health care information security. With the delivery of health care increasingly dependent on information systems, disruptions to these systems result in disruptions in clinical care that can harm patients. Health care information security has emerged as a public health challenge. (William J. Gordon, Adam Fairhall and Adam Landman, 7/12)

The Des Moines Register: Feds Fail To Protect Nursing Home Residents
The nation’s worst nursing homes have never received enough oversight, and the problem is getting worse. In 1998, federal regulators attempted to crack down on homes that had an established pattern of injuring and, in some cases, killing elderly residents, then briefly cleaning up their act, sometimes by adding temporary workers, to appease state inspectors and maintain their licenses. (7/13)

The New York Times: An Ancient Cure For Alzheimer’s?
In 2011, Ben Trumble emerged from the Bolivian jungle with a backpack containing hundreds of vials of saliva. He had spent six weeks following indigenous men as they tramped through the wilderness, shooting arrows at wild pigs. The men belonged to the Tsimane people, who live as our ancestors did thousands of years ago — hunting, foraging and farming small plots of land. Dr. Trumble had asked the men to spit into vials a few times a day so that he could map their testosterone levels. In return, he carried their kills and helped them field-dress their meat — a sort of roadie to the hunters. (Pagan Kennedy, 7/14)

RealClear Health: Digital Health Hope: Telemedicine And Increasing Access To Care
Telemedicine—which can be strictly defined as a remote virtual doctor-patient interaction—is rapidly gaining popularity. When initially developed, telemedicine was designed to allow health care professionals to evaluate, diagnose and treat patients in remote and rural locations using telecommunications technology. Now, many are beginning to utilize telemedicine as a replacement for the traditional doctor visit even when they are located in a city or town with many brick and mortar offices. The push for an increased use of telemedicine by insurers, third party payers, and many global businesses has led its development as a worldwide multi-billion dollar industry. (Kevin Campbell, 7/14)

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Critics’ Take: The Updated Senate Health Bill Is Still Ugly After Cosmetic Changes; An ‘Abomination’

Opinion writers reacted with tough talk to Senate Majority Leader Mitch McConnell’s latest health bill tweaks. The Wall Street Journal, however, terms the bill a “net improvement over the Obamacare status quo.”

USA Today: Senate Health Bill: Don’t Throw Momma From The Medicaid Train
In the river of retrograde effects certain to follow if the latest version of the Senate Republican health care bill passes largely intact, none is more surprising than the injury to elderly Medicaid recipients. To state this is not to prioritize poor elderly over other deserving beneficiaries. It is simply to say that nearly two-thirds of Americans in nursing homes are, well, on Medicaid. And while not every American has a loved one who is disabled, or a poor child, or struggling with opioids, or belongs to another beneficiary group, it does seem fair to say that at one time in their life every American had parents. If they live long enough, most will be on Medicaid. (Peter Fromuth, 6/14)

The New York Times: The Cruelty And Fraudulence Of Mitch McConnell’s Health Bill
A few days ago the tweeter in chief demanded that Congress enact “a beautiful new HealthCare bill” before it goes into recess. But now we’ve seen Mitch McConnell’s latest version of health “reform,” and “beautiful” is hardly the word for it. In fact, it’s surpassingly ugly, intellectually and morally. Previous iterations of Trumpcare were terrible, but this one is, incredibly, even worse. (Paul Krugman, 7/13)

The Wall Street Journal: ObamaCare Moment Of Truth
Republican leaders unveiled a revised health-care bill on Thursday, setting up a Senate watershed next week. Few votes will reveal more about the principles and character of this Congress. Months of stations-of-the-cross negotiations between conservative and GOP moderates have pulled the bill towards the political center, and for the most part the new version continues the journey. This leftward shift is Majority Leader Mitch McConnell’s bid to meet the demands of still-recalcitrant Republican moderates. The bill remains a net improvement over the Obama Care status quo, but the question now is whether they’ll take yes for an answer. (7/13)

The Washington Post: The New Senate Health-Care Bill May Be Worse Than The Old One
Senate Republicans released Thursday a new version of their Obamacare repeal-and-replace bill. It is arguably worse than the unpopular bill that preceded it. The Congressional Budget Office projected that the previous iteration would result in 22 million more uninsured in a decade. “Looking at the revised Senate health bill, it’s hard to see how it could meaningfully alter CBO’s projection of how the uninsured will grow,” the Kaiser Family Foundation’s Larry Levitt noted. “The revised Senate bill reinstates taxes on wealthy people, but it mostly does not spend that money on health care for low-income people.” (7/13)

The Washington Post: The New GOP Health-Care Plan Is Still An Abomination
Senate Republicans are releasing the latest version of their health-care plan today, and there’s a temptation to focus solely on what’s changed from the previous iteration. The changes are important, and we have to understand them. But what we shouldn’t do is allow a relative judgment (maybe it’s better in this way but worse in that way) to distract us from the big picture, because what’s still in the bill from before is even more important than what has changed. (Paul Waldman, 7/13)

The Washington Post: The Senate Health Bill Would Make The Opioid Epidemic Worse. Here’s How.
Over the past two decades, the number of Americans dying each year from opioid overdoses has quadrupled. In the hardest-hit state, West Virginia, where the overdose death rate is about three times the national average, the crisis has resulted in an overwhelmed foster-care system and a state burial program for the poor that ran through its entire annual budget three months into the year. (Jonathan Gruber and Angela Kilby, 7/13)

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State Highlights: Minn. Marks New Measles Case; Three Mass. Hospitals Reach Merger Agreement

Media outlets report on news from Minnesota, Massachusetts, Georgia, Missouri, California, Ohio, Michigan, Texas and Florida.

The Star Tribune: New Measles Case In Minnesota Extends Threat
A new measles case in Minnesota, reported just as the recent outbreak seemed to be winding down, has state health officials on alert because it involved a white adult who had visited public places in Hennepin, Ramsey and Carver counties while infectious and who had circulated among several people known to be unvaccinated. Reported Thursday by the Minnesota Department of Health, the case brings the total for the current measles outbreak to 79. (Olson, 7/13)

WBUR: Proposed Beth Israel-Lahey Merger Includes 13 Hospitals
A proposed hospital merger, spearheaded by Beth Israel Deaconess Medical Center and Lahey Health, became formal Thursday with the signing of a definitive agreement and a filing with the state’s Health Policy Commission. If approved, it would be the largest hospital merger in Massachusetts since Partners HealthCare formed in 1994 — and it would include more hospitals. (Bebinger, 7/13)

Atlanta Journal-Constitution: Georgia To Pursue $49 Million For School Nurses
In a joint effort with the Georgia Department of Education, the Department of Community Health board voted to approve a nursing services reimbursement program that would draw an estimated $48.6 million in additional federal dollars, assuming no major changes to Medicaid. There were 1,629 nurses and 307 unlicensed health care and clinic workers in Georgia schools last spring. (Tagami, 7/13)

The Associated Press: Confusion Over How Anti-Abortion Bill Could Affect St. Louis
Missouri lawmakers are at a standstill on broad anti-abortion legislation more than a month after Republican Gov. Eric Greitens called them into a special session to deal with abortion issues. The legislation calls for several new regulations, such as annual state inspections of abortion clinics. But one of the provisions causing the most confusion addresses a St. Louis ordinance that city leaders say is intended to prevent discrimination based on reproductive health decisions, such as pregnancy and abortion. (7/14)

Atlanta Journal-Constitution: Best Hospitals In US: 8 Georgia Hospitals Among Most Advanced In Tech
And according to Hospitals and Health Networks 19th annual “Most Wired Hospitals and Health Systems” survey, eight Georgia hospitals or health systems (including four in metro Atlanta) rely heavily on digital innovation “to improve population health, capitalize on data analytics, boost patient engagement and introduce new efficiencies” …The survey, conducted with the help of the American Hospital Association and health care experts, showed 82 percent of the nation’s hospitals and hospital systems use technological analysis tools to help improve quality and reduce costs, both clinically and administratively. (Pirani, 7/13)

Detroit Free Press: Beaumont Trumpets, Defends New Pricey Proton Beam Cancer Center
Beaumont Health officials showed off their new $40-million cancer-fighting machine on Thursday — the first of its kind in Michigan and purportedly more advanced and less costly to operate than earlier models of the sometimes controversial technology. The proton beam device is the centerpiece of the new Proton Therapy Center on Beaumont’s Royal Oak hospital campus and one of just 25 in the country. (Reindl, 7/13)

Austin American-Statesman: Lawmakers Propose Reining In Health Costs For Texas Retired Teachers
After failing to temper soaring health care costs for retired teachers, state lawmakers are considering giving retired teachers up to $1,200 more a year and pumping $200 million into their health care over the next two years. Starting in January, many retired teachers, particularly those under the age of 65, will see higher premiums and deductibles grow as much as 10 times what they’re paying now. (Chang, 7/13)

Minnesota Public Radio: Crisis Connection Hotline Rescued, As Least Temporarily
A mental health hotline that’s served Minnesotans for nearly 50 years will keep operating thanks to an eleventh-hour infusion of money. Crisis Connection had been scheduled to shut down Friday evening, but a grant from the state health department means the service will continue linking people suffering mental health emergencies to professional counselors. (Sepic, 7/14)

The Star Tribune: Minnesota Mental Health Crisis Line Gets Rescued At The Last Minute
<p class=”Text_Body”>In a last-minute move, the agency agreed late Thursday to provide enough funding, $139,000, to keep the crisis hot line open until late September. Canvas Health, the Oakdale-based nonprofit agency that operates the service, had previously announced the hot line would go dark on Friday, citing financial difficulties and a lack of state funding. The planned closing of Crisis Connection concerned state health officials and mental health advocates, because the line is so widely used and remains the only mental health crisis line that serves the entire state. (Serres, 7/13)</p>

Health News Florida: Federal Judge Dismisses Request To Stop Spraying Pesticide Naled In Miami-Dade County
A federal judge has dismissed a request to stop aerial spraying of the pesticide Naled in Miami-Dade County, describing the plaintiffs’ complaint as “poor” and recommending they get a lawyer before pursuing further legal action. Judge Federico Moreno, of the Southern District of Florida, gave the two Miami Beach residents who filed the complaint 60 days to amend it by clarifying why the case belongs in federal court and which laws they contend are being violated. (Stein, 7/13)

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Impact Debated Of Large Nurses Strike At Boston-Area Tufts Medical Center

The hospital is telling patients that care quality has not suffered as a result of the walkout by its nurses union. But studies indicate that such work stoppages can have negative consequences.

Boston Globe: In Tufts Nurse Strike, Some Worry About Patient Care
Tufts Medical Center has gone to great lengths to reassure patients during this week’s strike by nurses, but there is some evidence that medical care can suffer when nurses walk the picket line. One of the few studies examining this question found that more patients die and are readmitted to the hospital during nurses’ strikes. (Kowalczyk and Arnett, 7/13)

Boston Globe: Tufts Medical CEO: Calm Tone, Tough Stance In Nurses Strike
Union leaders say Wagner and other Tufts executives are the ones doing the bullying by denying nurses the compensation and better working conditions they deserve. The strike began after the union and the hospital failed to agree on wages, benefits, and staffing levels for the more than 1,200 unionized nurses at Tufts. (Dayal McCluskey, 7/14)

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