Tagged Public Health

California Rolls Out Program On Background Checks For Ammunition Purchases, While Gun Advocates Stock Up, File Lawsuit

Background checks can help authorities discover guns that aren’t registered with the state, gun safety advocates say, adding that the program could have prevented last week’s fatal shooting of rookie Sacramento police officer Tara O’Sullivan. Meanwhile, gun owner groups complain about the new ID requirement. News on gun violence is from Missouri, as well.

Football Players Dominate Research On CTE, But One Woman Wonders If Victims Of Domestic Violence Wouldn’t Show Same Symptoms

As many as 31 million women might have had a traumatic brain injury and 21 million might have had multiple mild ones. Yet there’s little research on the lasting effects in women. In other public health news: worker safety, burnout, genetic testing, wildfires, heart attacks, menstrual products and anger.

Link Between Common Class Of Drugs, Increase In Dementia Risk Deepened With Wide-Ranging Study

The researchers looked at anticholinergic drugs that work by blocking a chemical called acetylcholine, which acts as a neurotransmitter and is involved in many nervous system functions including muscle movements, heart rate, the widening of blood vessels, respiratory functions and muscle contractions in the stomach during digestion. Previous research has found a link between the drugs and dementia, but a new study strengthens those findings.

San Francisco Becomes First City In Nation To Ban Sale Of E-Cigarettes, Possibly Leading The Way For Others

“This is a decisive step to help prevent another generation of San Francisco children from becoming addicted to nicotine,” said City Attorney Dennis Herrera in a statement, following the vote. The city is the headquarters for Juul, one of the leading brands of e-cigarettes. The company is working on a ballot initiative to get the issue out in front of voters in November.

San Francisco Set To Ban Sales Of E-Cigarettes

San Francisco’s Board of Supervisors is slated to vote Tuesday to ban the sale and distribution of e-cigarettes in the city. The city is the corporate home of Juul Labs, the biggest producer of e-cigarettes in the country.

The ordinances would make the sale of e-cigarettes illegal in brick-and-mortar stores and online when shipping to San Francisco addresses.

San Francisco Mayor London Breed has 10 days to sign the legislation, which she has said she will do. The law will be enforced seven months from that date, in early 2020.

San Francisco Supervisor Shamann Walton, who co-authored the legislation, sees it as part of a long-term battle against the effects of smoking.

“We spent a few decades fighting big tobacco in the form of cigarettes,” Walton said. “Now we have to do it again in the form of e-cigarettes.”

Under federal law, the minimum age to buy tobacco products is 18.  California and 15 other states, however, have raised that age to 21 or passed measures that will set it to 21 by 2021. Despite this, use of e-cigarettes, or vaping, has skyrocketed among teenagers nationally.

Last year, 1 in 5 high school seniors reported vaping in the past month. That’s almost double the number from the year before. Even eighth graders are vaping in record numbers.

These increases come after years of declines in teenagers smoking traditional cigarettes.

Public health officials are concerned about the rising number of teenagers using e-cigarettes, as nicotine can harm a young person’s developing brain. The Centers for Disease Control and Prevention warns that young people who vape may be more likely to start smoking traditional cigarettes.

Walton said he’s disgusted with the actions of Juul and similar companies, who he said are “putting profits before the health of young people, and people in general.”

Despite the tobacco age limit, Walton noted that vaping devices are commonly confiscated from students in the city’s middle and high schools.

The ordinance is accompanied by another that prevents the manufacture, distribution and sale of e-cigarettes on San Francisco property. The ordinance takes direct aim at Juul Labs, which leases space from the city on San Francisco’s Pier 70. The ordinance is not retroactive, so it would not remove Juul from the company’s current space, but it would prevent other e-cigarette makers from renting city property in the future. In a statement, Juul spokesman Ted Kwong wrote that, regardless, the company does not “manufacture, distribute or sell our product from this space.”

Juul’s vaping device was introduced in 2015. It’s small, sleek and discreet, looking similar to a flash drive. The company now controls 70% of the vaping market.

In a statement, Juul Labs said it shares the city’s goal of keeping e-cigarettes away from young people. The company said it has made it harder for underage buyers to purchase Juul off its website and has shut down Juul accounts on Facebook and Instagram.

But, the company argues that “the prohibition of vapor products for all adults in San Francisco will not effectively address underage use and will leave cigarettes on shelves as the only choice for adult smokers, even though they kill 40,000 Californians every year.”

Walton doesn’t buy that argument, however. He said that’s simply “trading one nicotine addiction for another.” What’s more, he’s concerned that for every adult that might benefit, dozens of young people could become addicted.

San Francisco resident Jay Friedman said the complete e-cigarette ban goes too far. The software engineer smoked a pack of cigarettes a day for 20 years, and smoking e-cigarettes has reduced his regular cigarette habit to two to three a day. He said he feels better physically.

Friedman supported a ban on flavored tobacco that city voters passed last year. “I feel like it was good to get rid of the fruit flavors for kids,” he said, “but this feels like maybe a step too far.”

If e-cigarettes are banned, he said, he would try to quit nicotine altogether. But, “there would be a point in a moment of weakness where I’d just end up buying a pack of smokes again and then it’s just a slippery slope from there.”

Small businesses in San Francisco are concerned the ban will hurt their bottom line.

Miriam Zouzounis and her family own Ted’s Market, a convenience store near downtown San Francisco. She said e-cigarettes are an “anchor” product: They draw people into the store.

“When people come and want to purchase something at the store and we don’t have that exact item that they want, they’re not going to buy the rest of the items that they might on that trip: a drink or a sandwich,” Zouzounis said.

She said sales from e-cigarettes account for at least $200 to $300 a day in sales. As a board member of the Arab American Grocers Association, she said she believes laws like this mostly affect businesses owned by immigrants.

Abbey Chaitin is a 15-year-old lifelong San Francisco resident. She isn’t drawn to using e-cigarettes, she said, because she has seen peers become addicted to them.

“I’ll see them in class fidgeting,” Chaitin said. “They need it to focus, to function.”

And Chaitin predicted that, regardless of a ban, young people will still get their hands on e-cigarettes: “People my age can find a way around that if they really need to,” she said.

Meanwhile, Juul is collecting signatures for a November ballot initiative to override the ban.

This story is part of a partnership that includes KQED, NPR and Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

Disappointment Surrounding Alzheimer’s Treatment Has Reached Almost Mythical Heights. But Is There A ‘Cabal’ Behind All Those Failures?

For some experts it is increasingly apparent that there is another, more disturbing reason for the tragic lack of progress being made in Alzheimer’s research. A group of researchers had been so determined that one approach would work, few tried anything else. In other pharmaceutical news: AbbVie announces $63 billion deal to acquire Allergan, an analysis finds drugmakers often commit to follow-up studies after approval but few of them are new; and more.

Provisions Aimed At Boosting Generic-Drug Market, Raising Legal Age For Tobacco Purchases Added To Senate Health Care Package

The Senate Health, Education, Labor and Pensions Committee will mark up the overall package on Wednesday. In other news from Capitol Hill, Democrats seek answers from the Department of Agriculture about climate change research, and Senate Majority Leader Mitch McConnell (R-Ky.) will meet with 9/11 first responders to talk about the victims’ fund.

Judge OKs Oklahoma’s $85M Settlement With Teva That Includes Agreement Not To Promote Opioids In State

“The resources and terms of the agreement will help abate the ongoing crisis the state is facing,” state Attorney General Mike Hunter (R) said in a statement released after the hearing. The deal does not release Teva from any separate claims that might be brought by individual cities or counties.

‘Access Is Hanging By A Thread’: Judge Kicks Fight Over Missouri’s Last-Remaining Clinic To An Administrative Panel

St. Louis Circuit Judge Michael Stelzer ruled that the clinic has not yet exhausted its options outside of court to handle the dispute over its license to perform abortions. The judge directed Planned Parenthood to take the issue up with the Administrative Hearing Commission, a panel that typically handles disputes between state agencies and businesses or individuals. Abortions are allowed to continue at the clinic until Friday.

Court Clears Way For Transgender Kansans To Change Birth Certificates To Reflect Their Sex

Kansas becomes the 48th state to allow these birth certificate changes. A lawsuit filed by three transgender Kansas residents and the Kansas Statewide Transgender Education Project alleged that state policy against changing the gender on birth records violated the equal protection and due process clauses of the U.S. Constitution.

Oregon Has Botched Efforts To Move Patients Out Of Restrictive Psychiatric Facilities, Investigation Finds

The Oregonian/OregonLive launched an investigation into the Oregon Health Authority’s management of moving patients out of specialized care. Chris Bouneff, director of Oregon’s branch of the National Alliance on Mental Illness, said the newsroom’s findings are “disturbing.” “We don’t have many others who look after us,” Bouneff said of people with severe mental illness. “And if that state agency can’t do it, and it didn’t do it in this instance, who can we trust?”

Many Of The Worst Mass Shootings In Recent Memory All Have Something In Common: AR-15 Style Rifles. Why?

The rounds from that style of weapon are three times faster and strike with more than twice the force of other bullets. “Organs aren’t just going to tear or have bruises on them, they’re going to be, parts of them are going to be destroyed,” says Cynthia Bir. In other public health news: gene-edited babies, alcohol, vitiligo, the cautious generation, cancer, CBD, and more.

Hundreds Camp Out Overnight At Rural Town’s First-Come, First Serve Clinic In Sign Of Just How Many People Have ‘Fallen In The Gap’

The federal government now estimates that a record 50 million rural Americans live in what it calls “health care shortage areas,” where the number of hospitals, family doctors, surgeons and paramedics has declined to 20-year lows. A look at a pop-up clinic in Tennessee shows just how bad that reality is for the people living it.

Non-English Speakers Face Health Setback If Trump Loosens Language Rules

A federal regulation demands that certain health care organizations provide patients who have limited English skills a written notice of free translation services.

But the Trump administration wants to ease those regulations and also no longer require that directions be given to patients on how they can report discrimination they experience.

The changes could save $3.16 billion over five years for the health care industry, according to the administration.

These changes are part of a broader proposed regulation that would roll back protections banning discrimination based on gender identity. The public comment period closes Aug. 13.

The proposal would not change the government’s requirements that insurers and medical facilities provide foreign language translators and interpreters for non-English speakers.

The government acknowledged in the proposal that the change would lead to fewer people with limited English skills accessing health care and fewer reports of discrimination. But it also questioned the need for these notices, pointing out that in some areas health organizations spend money to accommodate a small contingent of language speakers. For example, notices in Wyoming must account for the 40 Gujarati speakers — a language of India — in the state.

In all, the government said, the impact of doing away with these requirements would be “negligible.”

Others disagree.

“I haven’t seen any reason to believe that this will only have a negligible impact,” said Mara Youdelman, managing attorney for the Washington, D.C., office of the National Health Law Program, a civil rights advocacy group. She said it “will likely result in people just not knowing their rights but not accessing care to which they’re eligible.”

Regulations under Section 1557 of the Affordable Care Act require insurers, hospitals and others to include a “tagline” of free translation services for the 15 languages that are most prevalent in a state. Additionally, it requires a nondiscrimination clause and directions on how to file a complaint with the Department of Health and Human Services Office for Civil Rights.

This information must be posted on websites, in physical spaces and in “significant communications” to the patient. But the ambiguity of that phrase prompted health care organizations to post the required information on numerous pieces of material — such as a separate page about language options sent with each Explanation of Benefits statement from an insurer. Together, these efforts cost organizations billions of dollars.

“No one realized exactly what that definition of ‘significant communication’ — how much would be wrapped up in that,” said Katie Keith, a Georgetown University professor who specializes in the ACA.

An estimated 25.9 million people in the United States in 2017 had limited English proficiency, the Census Bureau reported. Patients facing language barriers have a higher risk of health care complications, such as surgical infections and falls, because they may misunderstand a doctor’s orders, make mistakes preparing for procedures or improperly use medications.

In this latest proposal, however, the federal government questions whether the written notices are needed. The majority of enrollees speak English — census data from 2017 showed that 91.5% of people over age 5 spoke only English at home or spoke the language “very well.” In certain states, the proposal claims, every enrollee receives a notice for translation services in a language that only a few dozen people speak in the area.

Other state and federal laws protect the rights of patients with limited language services, the proposed rule says. It also cites evidence of some enrollees not liking the extra forms and being less inclined to open their mail because of them.

“These complaints make us concerned that the Section 1557 Regulation has resulted in ‘cognitive overload,’” the document stated, “such that individuals experience a diminished ability to process information” because of the additional paperwork.

Anecdotal reports cited by the government also point out that the notices did not significantly increase the number of patients using language services and reporting complaints. However, the proposed rule also estimates at least 90% of hospitals and physicians were not complying with the requirements.

Youdelman admitted she does not have concrete data showing that these taglines translate to increased access to services. However, she added, removing them wholesale without a promise to prevent discrimination in a different way is also counterproductive.

“Eliminating taglines is not the correct solution,” Youdelman said. “There is a way to inform folks while being cost-conscious.”

Health insurers and pharmacy benefit managers’ reactions to the proposed change have been tepid. The Pharmaceutical Care Management Association — the trade organization for pharmacy benefit managers — said in an email it “believes all consumers should be informed regarding translation services.” America’s Health Insurance Plans, the trade association for health insurers, said in an email that insurers would make sure consumers get the support they need to understand information — “including providing phone interpreters and written translations for customers who need them.”

Keith said that if the proposal is finalized more patients would not understand information involving their health. Some of these details on insurance and billing documents are already difficult for native English speakers to decipher and could be a challenge for less fluent people.

“Anytime you’re not notifying people of their rights,” Youdelman said, “you disempower them.”

Meth In The Morning, Heroin At Night: Inside The Seesaw Struggle of Dual Addiction

In the 25 years since she snorted her first line of meth at a club in San Francisco, Kim has redefined “normal” so many times. At first, she said, it seemed like meth brought her back to her true self — the person she was before her parents divorced, and before her stepfather moved in.

“I felt normal when I first did it, like, ‘Oh! There I am,’” she said.

Kim is 47 now, and she has been chasing normal her entire adult life. That chase has brought her to some dark places, so she asked us not to use her last name. For a long time, meth, also known as speed, was Kim’s drug of choice.

Then she added heroin to the mix. She tried it for the first time while she was in treatment for meth.

“That put me on a nine-year run of using heroin. And I thought, ‘Oh, heroin’s great. I don’t do speed anymore.’ To me, it saved me from the tweaker-ness,” Kim said, referring to the agitation and paranoia many meth users experience, and how heroin, an opiate, calmed that.

Now, Kim has finished treatment for both drugs.

Kim was part of the previous meth wave, in the ’90s, and now she’s part of a new meth epidemic that has been sweeping through parts of the United States, especially the West. Deaths involving methamphetamine are up. Hospitalizations are up.

After struggling with addiction to both heroin and meth for decades, Kim got care at a residential treatment program for women — Epiphany Center, in San Francisco. She’s now working and plans to go back to college in the fall.(April Dembosky/KQED)

Seeking A ‘Synergistic High’

Researchers who have tracked drug use for decades believe the new meth crisis got a kick-start from the opioid epidemic.

“There is absolutely an association,” said Dr. Phillip Coffin, director of substance use research at the San Francisco Department of Public Health.

Across the country, more and more opioid users say they now use meth as well, up from 19% in 2011 to 34% in 2017, according to a study published last year in the journal Drug and Alcohol Dependence. The greatest increases were in the western United States.

That research suggests efforts to get doctors to cut down on writing opioid prescriptions may have driven some users to buy meth on the street instead.

“Methamphetamine served as an opioid substitute, provided a synergistic high, and balanced out the effects of opioids so one could function ‘normally,’” the researchers wrote.

It’s kind of like having a cup of coffee in the morning to wake up, and a glass of wine in the evening to wind down: meth on Monday to get to work, heroin on Friday to ease into the weekend.

Amelia said that’s how her drug use evolved to include meth — she also asked that we use only her first name because she has used illegal substances.

At first, drugs were just a fun thing to do on weekends — ecstasy and cocaine with her friends. Then, on Monday, Amelia went about her workweek.

“I’m a horse trainer, so I worked really hard, but I also partied really hard,” she said.

Then one weekend, when Amelia was feeling kind of hung over from the night before, a friend passed her a pipe. She said it was opium.

“I thought it was like smoking weed or hash, you know? I just thought it was like that,” Amelia said.

She grew to like the opium stuff. Eventually, Amelia met up with her friend’s dealer.

“The woman said, ‘How long have you been doing heroin for?’ and my jaw nearly hit the ground,” Amelia said. “I was just really, honestly shocked. I was like, ‘What? I’ve been doing heroin this whole time?’ I felt really naive, really stupid for not even putting the two together.”

Pretty soon, Amelia started feeling sick around the same time every day. It was withdrawal symptoms, a clear sign she was becoming dependent on the drug. Her weekend smoke became her daily morning smoke. Then it was part of her lunch-break routine.

“I just kind of surrendered to that and decided, ‘Screw it,’” she said. “‘I’ll just keep doing it. I’m obviously still working; I’m fine.’”

A heroin habit is expensive. Amelia was working six days a week to pay for it. Any horses that needed to be ridden, any lessons that needed to be taught, she said ‘yes,’ because she wanted the money.

But bankrolling her heroin habit was exhausting. One day, one of the women she worked with at the horse barn offered her some meth as a pick-me-up.

Meth is comparatively cheap. It became the thing that kept Amelia going so she could earn enough money to buy heroin.

“The heroin was the most expensive part,” she said. “That was $200 a day at one point. And the meth was $150 a week.”

This pattern lasted for three years, until Amelia discovered she was pregnant. As soon as her daughter was born, she entered a residential treatment program in San Francisco, called the Epiphany Center, that would accept her and her baby.

“I was OK with being a drug addict. I was OK with that being my life,” she said. “But I wasn’t OK with having kids and letting that be part of my life.”

Rehab Admissions On The Rise For Users Who Mix Meth, Heroin

Admissions to drug rehabilitation for heroin have remained steady in recent years in San Francisco. But the number of heroin addicts reporting methamphetamine as a secondary substance problem has been rising. In 2014, 14% of heroin users said meth was also a problem. Three years later, 22% said so.

“That is very high,” said Dr. Dan Ciccarone, a physician and professor at the University of California-San Francisco who has been studying heroin for almost 20 years. “That’s alarming and new and intriguing and needs to be explored.”

The speedball — heroin and cocaine — is a classic combination, he said.

“It’s like peanut butter cups, right? Chocolate and peanut butter together,” he said. “Methamphetamine and heroin are an unusual combination.”

The meth-and-heroin combo is referred to as a goofball, Ciccarone added, because it makes the user feel “a little bit silly and a little bit blissful.”

For Kim, adding heroin to her methamphetamine habit compounded her use. “I ended up doing both, at the same time, every day, both of them,” she said.

It was all about finding the recipe to what felt normal. Start with meth. Add some heroin. Touch up the speed.

“You’re like a chemist with your own body,” she said. “You’re balancing, trying to figure out your own prescription to how to make you feel good.”

Now Kim is trying to find balance without drugs. She’s been sober for a year. So has Amelia, the horse trainer. Her sobriety anniversary is her daughter’s birthday.

This story is part of a partnership that includes KQED, NPR and Kaiser Health News.

Must-Reads Of The Week From Brianna Labuskes

Happy Friday! The jury is still out whether we’re all growing horns out of the back of our heads because of how much we use smartphones, but apparently humans on the whole are somewhat decent people when it comes to finding wallets with cash in them. Now buckle up, because our cups have runneth over this week in terms of truly excellent health stories.

We’ll start, though, with what to look out for next week: President Donald Trump is expected to issue an executive order that would compel hospitals, insurers and others in the health industry to reveal closely guarded information about the true cost of procedures, according to The Wall Street Journal. This is the order that certain players in the health field have been dreading. It’s unclear how aggressive the administration will be with the rule, considering the rumblings of discontent already rippling through D.C. But a whopping 88% of people in a recent survey said they support such a policy — so the president is not exactly going out on a limb with voters.

The Wall Street Journal: Trump to Issue Executive Order on Health-Care Price Transparency

Speaking of voters, this executive order comes closely on heels of the official kickoff for Trump’s reelection campaign, which took place on Tuesday in Florida. The president has been searching for ways to win back ground against Democrats on the topic of health care — and promised to issue a plan within the next month or two that would counter the buzzy “Medicare for All.”

Many Republicans, though, kind of wish Trump would channel “Frozen” and let it go. With polls showing voters favor Democrats’ stance on health care, Republicans want the president to focus on issues where they think they have an edge, such as immigration.

The New York Times: Trump Wants to Neutralize Democrats on Health Care. Republicans Say Let It Go.

The New York Times: Trump, At Rally in Florida, Kicks Off His 2020 Re-Election Bid

Adding to the prevailing narrative that health care is a winning issue for the Dems, House Speaker Nancy Pelosi is using the topic to divert attention away from the more volatile talk of impeachment. “When we won the election in November, it was health care, health care, health care,” Pelosi said earlier in the week. She also promised that Democrats would fight relentlessly against Trump’s attempts to chip away at the health law.

In short, you can pretty much guarantee health care is going to play a central role in the 2020 races.

Bloomberg: Impeach Trump? Pelosi’s Dems Prefer Health Care Focus for 2020

Meanwhile, The New York Times interviewed many of the Democratic candidates about their stances on different issues, including health care. While they all agree something needs to be done about the country’s system, what that looks like becomes a dividing line in a crowded field.

The New York Times: 2020 Democrats on Health Care

A federal appeals court handed the Trump administration a win this week when a panel of three Republican-appointed judges ruled that new rules prohibiting federal family-planning grants to health clinics offering on-site abortions or referrals for the procedure can go into effect. The changes — which are largely thought to be targeting Planned Parenthood and are called a “gag rule” by opponents — have provoked fierce backlash among abortion rights groups that say the implementation of such restrictions will be devastating to women who rely on the clinics for health care. Although the decision isn’t the final say on the matter, the judges predicted the administration will prevail in this case.

The Washington Post: Trump Administration’s Abortion ‘Gag Rule’ Can Take Effect, Court Rules

Meanwhile, a look at two abortion clinics 20 minutes apart highlights the great divide evident around the country as state-level laws stand in stark contrast to one another.

The Wall Street Journal: Two Abortion Clinics, 20 Minutes and a Legal Universe Apart

Politico lifts the curtain on the ever-deepening quarrel between White House aides and HHS Secretary Alex Azar. “Alex is outnumbered and keeps losing,” an individual familiar with the simmering tensions told reporters. With Trump’s focus on health issues as he launches his campaign, the discord threatens to derail progress on key administration agenda items like high drug prices.

Politico: ‘They’re All Fighting Him’: Trump Aides Spar With Health Secretary

Major stakeholders have been anxiously watching congressional action on surprise medical bills — an issue most lawmakers agree needs to be addressed but for which there are several approaches. Industry players each have a preferred strategy (such as independent arbitration), but powerful HELP Committee leaders Sens. Alexander Lamar and Patty Murray hadn’t yet settled on theirs. That changed this week when they announced they back a “benchmark” plan, meaning insurers would pay a provider a rate similar to what the plan pays other doctors in the area for the same procedure. Alexander had “intrinsically” supported a different plan previously but changed his mind after the Congressional Budget Office ruled that this one would garner the most federal savings.

Hospitals were not pleased with the direction this is taking, calling the tactic “unworkable.”

Politico: HELP Committee Leaders Back Benchmark for ‘Surprise’ Billing

One of my favorite stories of the week looks at how those much-hated robocalls, which are mostly just a huge nuisance for most of us, become a life-and-death situation for hospitals. While the rest of us can either block or ignore the calls, hospitals don’t have that option. And when the calls come in waves of thousands, they can jam up emergency lines.

The Washington Post: Robocalls Are Overwhelming Hospitals and Patients, Threatening a New Kind of Health Crisis

I know a lot of people are creeped out by the privacy issues of having digital ears listening in on your every move, but there could be a flipside. Researchers want to train Alexa et al. to listen for gasping that could signal someone is experiencing cardiac arrest.

Stat: ‘Alexa, Are You Listening?’ A Research Tool Warns of Cardiac Arrest

Arkansas’ implementation of a Medicaid work requirement was closely watched by other conservative states eager to follow its lead. Advocates were appalled by the tens of thousands of people dropped from coverage, while state leaders and the Trump administration insisted that an improving economy was the reason behind the declining enrollment.

But a new study adds another layer to the debate: The work mandate has done nothing to affect the number of people who are unemployed in the state. So, after all of that, fewer people have insurance and fewer people have jobs.

Modern Healthcare: More Arkansans Uninsured, Unemployed Post-Medicaid Work Requirement

In news that surprised zero people, but should be noted anyway: Drugmakers made official their opposition to the new rules requiring them to include prices in TV ads. They say the requirements violate their freedom of speech rights and will be confusing to patients, since the prices aren’t what most people end up paying for the drugs.

Reuters: U.S. Drugmakers File Lawsuit Against Requiring Drug Prices in TV Ads

In the miscellaneous file this week:

• It often seems as if the anti-vaccination movement is this grassroots thing that has bubbled up through social media. But the tried-and-true “follow the money” method paints a more interesting picture, starting with a wealthy Manhattan couple who pumped millions into the cause over the past several years.

The Washington Post: Meet the New York Couple Donating Millions to the Anti-Vax Movement

• Immigrant children in U.S. custody give bleak accounts to lawyers of their experiences — including reports of toddlers without diapers being cared for by 10-year-old girls. The lawyers involved say that during their interviews the “little kids are so tired they have been falling asleep on chairs and at the conference table.”

The Associated Press: Migrant Children Describe Neglect at Texas Border Facility

• The youth suicide rate appears to have reached the highest since the government began collecting such statistics in 1960 — driven, in part, by a sharp increase among older teenage boys.

Los Angeles Times: Suicide Rates for U.S. Teens and Young Adults Are the Highest on Record

• Firefighters who die of cancer outnumber firefighters who die responding to an emergency “at least ten, 20, 30 to one.” Yet the very cities they risk their lives protecting are turning their backs on them once they become sick. “My city’s workers’ comp carrier initially flat-out said, ‘We don’t cover cancer,’” one firefighter recalled.

CBS News: Firefighters Battle Occupational Cancer: Many Sickened First Responders Are Being Denied Workers’ Comp Benefits

That was a fairly grim file to end The Friday Breeze with, so make sure to check out Stat’s list of 23 of the best health and science books to read this summer to give yourself a little boost to finish off your week. And have a great weekend!

Vaccine Drama On Display In California’s Capitol

SACRAMENTO, Calif. — They hoisted signs warning of corporate greed, raised their fists in solidarity against government tyranny and blasted fight songs over portable speakers.

As Queen’s “We Will Rock You” blared in the background, hundreds of parents and families from around the state gathered in front of the state Capitol Thursday morning to testify about a bill they said would — if passed — spark a revolution.

Not a bill to raise taxes. Not a bill to expand fracking. A bill to determine which kids must get their routine shots.

For this group of passionate Californians, a measure by pediatrician and state Sen. Richard Pan (D-Sacramento) poses a threat to their rights as parents. For the author, public health officials and other supporters, it’s a necessary step to keep kids safe — in school and beyond.

Vaccines have become an explosive topic around the country, even as numerous studies show they are safe and effective and complications are rare.

The bill, SB 276, would tighten the rules on which children would qualify for medical exemptions from vaccinations. It was passed by the state Senate in May, and had a key hearing before the Assembly Health Committee on Thursday.

State Sen. Richard Pan, author of SB 276, has been the object of much ire among vaccine opponents since offering a previous vaccine bill that tightened vaccine mandates. (Anna Maria Barry-Jester/KHN)

Before the hearing, bill opponents, many of them clad in yellow vests similar to those worn by protesters in France, listened as Robert F. Kennedy Jr., a high-profile vaccine opponent, hyped the crowd.

In a speech echoing others he has given around the country (and which have drawn a public rebuke from his siblings), he spoke of Jews in concentration camps and other minorities throughout history who have been “scapegoats” for diseases.

Behind him, poster-size photos of Pan, the object of vaccine opponents’ ire, were splattered in red, overlaid by the word “LIAR.”

The rancor continued inside the Capitol. As Pan presented his measure before the committee, parents in the back of the room, hands wrapped in yellow tape with “false” written on the palm, raised their hands, hissing as he spoke.

It wouldn’t be the last time lawmakers would have to ask them to be quiet and follow the rules.

The committee heard an amended version of the bill, which is intended to curb what has been described by public health experts as a dangerous increase in medical exemptions from vaccination. Since a state law enacted in 2016 ended vaccine exemptions based on religious and personal beliefs, children can be excused only on medical grounds.

Since then, the number of medical exemptions has jumped, and the exemptions are clustered in many of the same parts of the state that previously had high rates of religious or personal belief exemptions, according to new state data. Around the state, 117 schools reported that 10% or more of their kindergartners had been granted medical exemptions in the 2018-19 school year.

The measure underwent significant changes earlier this week to allay concerns from Gov. Gavin Newsom and others that it would put bureaucracy between doctors and patients. In the new version, officials with the state Department of Public Health would review medical exemptions for children at schools where more than 5% of kids aren’t vaccinated, and those written by doctors who have handed out more than five exemptions in a calendar year.

But the amendments didn’t seem to address the fears of its most ardent opponents, even as Newsom, a Democrat, told reporters Tuesday that he would sign the new version.

In testimony supporting the bill, Jenni Balck, a teacher and mother of an immunocompromised child who had a heart transplant, explained that her child’s health relies on community immunity.

“Parents want what’s best for their kids,” said Balck. “I understand that people who don’t want to vaccinate think they are doing what’s right for their kids. But they put my child in danger every day,” she said, noting cases of whooping cough in her Southern California neighborhood just two weeks earlier.

Doctors representing major medical providers around the state — including Kaiser Permanente and Sutter Health — spoke in support of the bill. (Kaiser Health News, which produces California Healthline, is not affiliated with Kaiser Permanente.)

“We’re seeing preventable disease on an almost daily basis,” said Dr. Alisa Awtry, a family physician in Sonoma County who came with her infant to testify in favor of the measure.

Another physician, Dr. Bob Sears of Orange County, a national leader in the anti-vaccine movement who was placed on probation by the Medical Board of California, testified on behalf of the opposition — speaking so long he didn’t leave time for Kennedy.

Sears, a pediatrician, said the bill would penalize physicians for doing their jobs, comparing it to “stop and frisk” public safety tactics that often target minorities and sow fear.

He was followed by hundreds of vaccine skeptics who spent the next three hours formally stating their opposition to the bill. Several warned of what would come if the bill passes. “You’re going to cause a revolution,” one woman said. Others said they would move out of state. Pan stood stoically at the front of the room, turning to acknowledge each person who testified.

Numerous opponents spoke of government overreach.

“I don’t think we should use taxpayer money to micromanage doctors,” said Heather Marie Levin Mulligan, 40, of Roseville.

After more than five hours of testimony, the bill passed the committee.

But the hearing didn’t appear to change many minds.

“We will not comply!” opponents chanted as they marched on Newsom’s office after the hearing.

This KHN story first published on California Healthline, a service of the California Health Care Foundation.