Tagged Public Health

Viewpoints: Applause For Push To Rescue Mo.’s In-Home, Nursing Care For Senior Citizens, Disabled People; Moving Toward Medical Quality

Here’s a review of editorials and opinions on a range of public health issues.

The Kansas City Star: Don’t Give Up On Restoring In-Home And Nursing Care In Missouri
Kudos to those Democratic Missouri lawmakers who still have not given up on trying to stop Gov. Eric Greitens from single-handedly taking in-home and nursing care away from 8,300 seniors and disabled people. On Monday, several legislators asked the state to drop plans to request a federal waiver from the Centers for Medicare and Medicaid Services that would allow them to cut the program. (7/25)

KevinMD: 5 Steps To Create Medical Quality Without Trying
The need for what we are calling medical “quality” is acute, yet the strategies employed to obtain it are destroying medicine. Patient outcomes are inconsistent, care varies depending on many factors outside of disease state, and the cost of our medical system is not sustainable. But to fix this, most health systems employ non-clinicians to audit charts while checking boxes such as “A1C<8%?” and “DVT prophylaxis ordered within 24 hours?” These non-providers then send threatening letters and cut salaries with “pay-for-performance.” Unsurprisingly, such efforts are not working, and only end up creating distorted physician-patient relationships. Yet, obtaining improved quality requires only a few key steps. (Kjell Benson, 7/25)

Stat: Doctors Have The Power To Help Their Patients Thrive Financially
StreetCred’s formula is simple. It takes advantage of the trusting relationships that families have with their pediatricians and makes productive use of the time typically wasted in doctors’ waiting rooms. In partnership with the IRS-sponsored Volunteer Income Tax Assistance program and other government agencies, StreetCred uses trained volunteers and staff to help families file taxes, attain tax refunds, and apply for anti-poverty government programs. (Andrea Levere, 7/25)

Stat: Human Trafficking Must Be Officially Recognized As A Medical Diagnosis
Early this week, nearly 100 people were found trapped in a sweltering tractor-trailer in San Antonio, Texas. Ten have died and others are in critical condition. Many were sent to local hospitals for treatment of severe dehydration and shock, medical conditions that are common in the emergency department. What may not be as obvious to emergency physicians is that these people are possibly victims of human trafficking. As physicians who have treated victims of human trafficking and research this scourge, we believe that this form of severe exploitation is under-recognized in health care settings and live are being lost because of that. (Abraar Karan and Hanni Stoklosa, 7/25)

Los Angeles Times: The ‘it’s All In Your Head’ Diagnosis Is Still A Danger To Women’s Health
TV personality Maria Menounos stunned fans when she announced this month that she was in recovery from surgery for a nonmalignant brain tumor, which she discovered while her mother was battling brain cancer. Perhaps most surprising was how quickly Menounos was treated. She explained to People magazine that when she told her mother’s doctor about her symptoms — headaches, dizziness, slurred speech — he immediately investigated what was wrong. (Emily Dwass, 7/26)

The Des Moines Register: Attorney General Sessions Should Not Re-Escalate War On Drugs
Attorney General Jeff Sessions has apparently learned nothing regarding the War on Drugs. He wants to re-escalate this failed policy at a time when many states are realizing its futility and trying to move in different directions. Drug treatment doesn’t work 100 percent of the time, but it is certainly more effective (and less costly) than incarcerating people with this illness. And as long as there are addicts, there will always be dealers, so incarcerating dealers has little long-term impact on the drug problem. (Allen Hays, 7/25)

Boston Globe: Mass. Should Pass Gun Restraining Order Bill
Representative David P. Linsky, a Natick Democrat, has filed legislation that would allow family and household members, police, district attorneys, and health care providers to go to court and seek “extreme risk protective orders” for individuals who pose a significant danger to themselves or others. The bill, which has raised the hackles of gun rights groups, stands up to constitutional scrutiny and builds in an important hearing mechanism before long-term restrictions can be imposed. (7/26)

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

Analyzing The Issues: Cadillac Plans, The ‘Single-Payer Trap’, Health Care Appropriations And Medicare’s Future

Opinion writers offer their takes on health policies that operate as context to the current congressional debate.

Bloomberg: Democrats And The Single-Payer Trap
For seven and a half years, Republicans have campaigned and voted to replace the Affordable Health Care Act. When given a real chance at success, with governing control, they were impeded by a president who’s ignorant on the issue. Then, after Republican senators slipped behind closed doors to come up with their own plans, they provided products that voters, even some Trump supporters, overwhelmingly spotted as frauds. (Albert R. Hunt, 7/25)

Huffington Post: A Message For House Republicans: Actions Speak Louder Than Words
Republicans on the House Appropriations Committee offered some promising phrases when describing their fiscal year 2018 Labor-HHS budget: “Invest in essential health,” “focus investments in programs our people need the most,” and “targeting investments in … public health. ”House LHHS Subcommittee Chair Tom Cole concluded, “This bill is one that reflects the priorities that Americans value, and will continue to support the well-being of Americans through funding these vital programs.” (Clare Coleman, 7/24)

The Wall Street Journal: The Deadline To Kill The Death Panel
All eyes are on the Senate as it debates what to do about ObamaCare. But the House has a last chance this week to abolish one of the law’s most dangerous creations: a board with sweeping, unchecked power to ration care. The Independent Payment Advisory Board—what critics call the death panel—would be an unelected, unaccountable body with broad powers to slash Medicare spending. But the law contains a living will for IPAB. If the president signs a congressional resolution extinguishing the panel by Aug. 15, it will never come into existence. (Grace-Marie Turner and Doug Badger, 7/25)

Milwaukee Journal Sentinel: Medicare Cuts Are A Raw Deal For Wisconsin Seniors
Unfortunately, a federal advisory panel is urging lawmakers to cut Medicare Part B, the program that covers chemotherapies, immunotherapies and other advanced drugs that must be administered by doctors. If Congress implements this recommendation, these trends could reverse, as Wisconsin seniors would lose access to life-saving medications. (Sandra Gines and Carrie Riccobono, 7/25)

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: Audit Of Colo. Insurance Exchange Still Finds Deficiencies; Indian Reservation Declares Public Emergency Over Opioid Crisis

Media outlets report on news from Colorado, Missouri, Minnesota, California, Florida, Massachusetts, Texas, Kansas and Wisconsin.

Denver Post: Connect For Health Colorado Is Making Progress To Fix Accounting Troubles
Colorado’s health insurance exchange has made progress in addressing repeated accounting troubles but still fails to always follow its own policies when it comes to contracts and purchases, according to a state audit released Tuesday. The audit of the exchange, known as Connect for Health Colorado, found that 11 percent of payments analyzed — which came out to about $50,000 — did not have the proper documentation. The same was true for nearly $4 million in contract costs. In one instance, the audit found that Connect for Health’s general counsel signed off on a nearly $3 million database contract despite not having the authority to do so for contracts that big. (Ingold, 7/25)

The Star Tribune: Red Lake Indian Reservation Declares Public Health Emergency Over Drug Epidemic
A rampant heroin and opiate epidemic on the Red Lake Indian Reservation has prompted tribal leaders to declare a public health emergency, seek outside help in addressing the crisis and consider the extraordinary step of banishing tribal members involved in drug dealing. … Overdoses on the northern Minnesota reservation have increased significantly in the past few months, tribal leaders said, adding that the problem has worsened with the arrival of more heroin and more of it laced with deadly fentanyl. (Smith, 7/26)

Los Angeles Times: Pasadena Officer Who Investigated Overdose Was Skeptical Of USC Med School Dean’s Story, Recording Shows
The police officer who last year questioned the then-dean of USC’s medical school about his role in the drug overdose of a young woman expressed skepticism at Dr. Carmen Puliafito’s account, according to an audio recording that was made by the officer and released Tuesday. Puliafito told the officer he was at the Pasadena hotel room where the overdose occurred as a family friend to help the woman, who was later rushed to Huntington Memorial Hospital. (Elmahrek, Pringle, Parvini and Hamilton, 7/25)

Miami Herald: Jackson Health Proposes $1.9 Billion Spending Plan For 2018
Jackson Health System is counting on growth in its core operations — plus an estimated $442 million from Miami-Dade taxpayers — to break even on a proposed $1.9 billion spending plan for 2018 approved by hospital trustees on Tuesday. Salaries and benefits for Jackson’s 12,000 full-time employees, who will receive an average 2 percent pay raise next year, tops the hospital system’s list of expenses for next year at about $1.1 billion or 59 percent of the total. (Chang, 7/25)

The Star Tribune: Minneapolis Menthol Tobacco Sales Restriction Vote Delayed Until Aug. 2
Opponents of restricting menthol tobacco sales in Minneapolis claimed victory Tuesday after a City Council committee failed to vote on the ordinance and send it to the full council, though members will vote on the proposal Aug. 2. An already-depleted Health, Environment and Community Engagement Committee fell to three members and lost its quorum when Council Member Alondra Cano stepped out near the end of a lengthy public hearing, delaying the vote. (Belz, 7/25)

St. Louis Public Radio: Missouri Doctor Grapples With State’s High Rate Of Deaths In Childbirth
Twice as many United States women are dying in childbirth today as in 1990, even though all other wealthy nations have seen declines in maternal mortality rates. …Dr. Shilpa Babbar, who specializes in high-risk pregnancies at SSM Health St. Mary’s Hospital in St. Louis County, said that rising rates of obesity and women having children later in life may help explain these figures. (Bouscaren, 7/26)

Health News Florida: Nonprofit Group: HIV Infections Up In Florida
A nonprofit that serves Central Florida residents with HIV and AIDS says the rates are going up. …[Joshua] Meyers said the Ryan White figures show 600 new HIV infections in Orlando last year, which made Orlando the city with the sixth highest infection rate in the country – up from No. 8. (Aboraya, 7/25)

KQED: California Decides All Drinking Water Must Be Tested For A Toxin. But Who Pays?
The State Water Resources Control Board on July 18 adopted the strictest possible standard (5 parts per trillion or less) for the contaminant in public drinking water. …Statewide, the tap water of about a million Californians is known to contain TCP at levels higher than that, according to data from the state water board. (O’Neill, 7/25)

Minnesota Public Radio: Threats To Drinking Water Supplies Intensifying, Health Dept. Says
Minnesota’s public drinking water supplies are in good shape, according the state’s Department of Health, but a new report also warns agencies should remain prepared for that to change. …Minnesota also needs to be prepared to address other pollution in the water supply, including nitrate contamination, which the report states is an ongoing concern for a several areas of the state. (Richert, 7/25)

The Star Tribune: Baby Deliveries To End At St. Joseph’s Hospital In St. Paul
Facing changing demographics and a steep dropoff in demand, the state’s oldest hospital will discontinue maternity care this year. HealthEast Care System’s St. Joseph’s Hospital made the move because fewer women are choosing the St. Paul facility for their baby deliveries. Health system leaders announced the decision Tuesday, noting that women will still be admitted for maternity care through Sept. 7 and that babies will still be delivered until Sept. 10 at HealthEast’s flagship hospital — Minnesota’s first hospital when it was founded in 1853. (Olson, 7/25)

Texas Tribune: Texas Senate Approves Teacher Bonuses, Benefits — But Not Pay Raises
The Texas Senate on Tuesday approved legislation to give teachers bonuses and to improve retired teachers’ health benefits — but only after the bill’s author removed a controversial provision requiring school districts to cover the cost of teacher pay raises. The upper chamber voted 28-3 to give initial approval to Senate Bill 19, authored by Sen. Jane Nelson, R-Flower Mound, which would borrow money from the Texas Health and Human Services Commission to pay for $193 million in statewide teacher bonuses and inject $212 million into a faltering state-run health insurance program for retired teachers. (Swaby, 7/25)

Pioneer Press: St. Joseph’s Hospital Plans To Close Maternity Ward
Minnesota’s oldest hospital will no longer be a destination to deliver babies. St. Joseph’s Hospital in downtown St. Paul will close its maternity ward Sept. 10, according to Fairview HealthEast, which operates the 164-year-old downtown hospital. The decision comes after HealthEast merged with Fairview Health Services earlier this year and is the result of mothers choosing to give birth in the suburbs, according to a Fairview HealthEast statement Tuesday. (Orrick, 7/25)

Kansas City Star: Kansas City Chatbot To Help Prescription Filling
A Kansas City team this week won an award from the Robert Wood Johnson Foundation for developing a robotic chat app that could steer you to a place where that prescription won’t break your budget. Project Helix — a collaboration of KC Digital Drive and two consulting outfits — aimed to help patients navigate the dizzying worlds where prescriptions, pharmacy prices and often inscrutable insurance plans overlap. (Canon, 7/25)

Milwaukee Journal Sentinel: Wisconsin DNR Says Milwaukee Industrial Barrel Plants Broke Environmental Laws
Three Milwaukee-area industrial barrel refurbishing plants have been cited by state regulators for violating 19 environmental laws, including misrepresenting information and sending hazardous ash to a landfill not permitted to handle such waste. Inspectors found that the plants handled, stored and shipped hazardous waste without permits, failed to keep numerous required records, and continued to spew putrid odors over neighborhoods three years after similar smells were noted by inspectors. (Diedrich and Barrett, 7/25)

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

Male Reproductive Health On The Decline

The decline in quality and concentration of men’s sperm has been a matter of hot debate, but one comprehensive study hopes to put any doubts to rest. In other public health news: flesh-eating bacteria, medical ethics, boosting resilience in midlife, injuries in young athletes and stem cell clinics.

The Washington Post: Sperm Concentration Has Declined 50 Percent In 40 Years In Three Continents
The quality of sperm from men in North America, Europe and Australia has declined dramatically over the past 40 years, with a 52.4 percent drop in sperm concentration, according to a study published Tuesday. The research — the largest and most comprehensive look at the topic, involving data from 185 studies and 42,000 men around the world between 1973 and 2011 — appears to confirm fears that male reproductive health may be declining. (Cha, 7/25)

Stat: Flesh-Eating Bacteria: 5 Things To Know After A Hiker’s Almost-Fatal Infection
Last month, a few minor blisters turned into a flesh-eating nightmare for hiker Wayne Atkins, who developed a dangerous bacterial infection after climbing Mount Garfield, a 4,500-foot peak in New Hampshire. Atkins survived, but barely: He spent 2 1/2 weeks in a medically induced coma while doctors pumped him full of antibiotics and removed chunks of his flesh to get rid of the infection. And Atkins was lucky, relatively speaking: Infection with flesh-eating bacteria is considered a surgical emergency, and can require limb amputation. One in four people with necrotizing fasciitis dies. (Caruso, 7/25)

WBUR: Medical Ethics: In The Charlie Gard Case, Listen To The Nurses
The tragic spectacle of the legal battle over Charlie Gard, the 11-month-old British baby whose genetic disease has inflicted catastrophic and irreversible brain damage, appears to be drawing to a close. …<span>But perhaps most troubling of all for me is the abuse of the nurses and other medical staff caring for Charlie, who has lived nearly his all his days on life support and mechanical ventilation.</span> (McLean, 7/25)

NPR: Young Athletes Who Specialize Too Soon Risk More Injuries
If you’re involved in high school athletics, you know the scene. There’s increasing pressure to specialize in a single sport and play it year-round. The upside? Focusing on one sport can help give kids the edge they need to compete on elite club teams — or travel teams. Many athletes hope to attract the attention of college recruiters, or be offered a sports scholarship. This emphasis on competitive success has become widespread throughout the U.S., according to a consensus statement from the American Medical Society for Sports Medicine. (Aubrey, 7/25)

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

Comprehensive Brain Injury Study Finds Extreme Prevalence Of Brain Injury In NFL Players

The study showed that 110 out of 111 brains had signs of chronic traumatic encephalopathy, causes myriad symptoms, including memory loss, confusion, depression and dementia.

The New York Times: 111 N.F.L. Brains. All But One Had C.T.E.
Dr. Ann McKee, a neuropathologist, has examined the brains of 202 deceased football players. A broad survey of her findings was published on Tuesday in The Journal of the American Medical Association. (Joe Ward, Josh Williams and Sam Manchester, 7/25)

Atlanta Journal-Constitution: Study: CTE Found In 99 Percent Of Former NFL Players’ Brains
In the 202 total brains belonging to men who played football on all levels, researchers found CTE in 177. Out of the 14 brains of men who only reached the high school football level, three brains were diagnosed with CTE. Forty-eight of 53 brains belonging to men who stopped playing football after the college level also were also diagnosed with CTE. (Culpepper, 7/25)

WBUR: Study: CTE Found In Nearly All Donated NFL Player Brains
“While we still don’t know what the incidence is in the general population or in the general population of football players,” [Dr. Ann McKee] says, “the fact that we were able to gather this many cases [in that time frame] says this disease is much more common than we previously realized.” (Goldman, 7/25)

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Paid Parental Leave May Be The Idea That Transcends Politics

Tameka Henry takes care of her disabled husband, her 87-year-old grandfather and her four children, ages 10 to 16. Two of her kids have asthma. Her husband has a chronic intestinal condition, diabetes and congestive heart failure. He’s unemployed.

Henry, who makes around $30,000 a year as a case administrator for a behavioral health care provider, saves up sick days and vacation time to use when someone in the family is sick or needs help. Her husband, she said, often needs hours of daily care.

“I haven’t had a vacation in over 10 years,” said Henry, who lives in Las Vegas. “But I know I’m lucky because my employer understands my situation and does give me some time off.”

The problem is that she can’t afford to take much time off without pay. “Money is way too tight for that,” she said.

What Henry’s employer does not provide, nor does her state or the federal government, is paid family or medical leave. Indeed, the U.S. is the only wealthy industrialized country that does not guarantee paid leave to care for a new or adopted child, an ill family member or to address an individual’s own serious health condition.

Both Republicans and Democrats may be moving to change that.

In its 2018 budget, the Trump administration included a national paid leave plan for parents after the birth or adoption of a child. It’s a rare call for a new entitlement program from the administration and not yet been endorsed by GOP leaders on Capitol Hill. Those lawmakers are weighing options to rein in spending on other entitlements, including Medicaid.

First daughter Ivanka Trump heads up the initiative at the White House. Proposed are six weeks of paid leave for mothers and fathers at an estimated annual cost of $25 billion, funded by restructuring the federal unemployment insurance system.

Congressional Democrats, meanwhile, have reintroduced the Family and Medical Insurance Leave, or FAMILY, Act, which they first submitted in 2013. It would permit all workers to take up to 60 individual days of paid leave per year to care for a new child, a sick family member or one’s own illness. Workers would receive up to 66 percent of their regular wages to a maximum $1,000 per week. The program, initially introduced in 2013, would be funded by a 0.4 percent payroll tax on workers’ wages, split evenly between employers and employees.

“We strongly believe this is the right thing to do,” says Vicki Shabo, vice president of the National Partnership for Women & Families in Washington, D.C., which supports the Democrats’ bill. “Why should some people have this benefit and not others based on where they live or the job they have, when it’s clear everyone needs it?”

Republican lawmakers have countered this year with the Strong Families Act. That bill would give employers offering at least two weeks of paid family or medical leave a 25 percent tax credit for wages paid to workers taking up to 12 weeks of leave. The credit would be capped at $3,000 per employee per year. The credit would cease entirely two years after enactment.

Opponents of such government programs don’t dispute the benefits of paid leave. Instead, they argue, it’s best left as a voluntary choice by businesses, which can tailor their policies to the needs of their workforces.

Ivanka Trump recently acknowledged that argument and said any national plan should encourage private companies to provide paid-leave benefits to employees. In a letter to The Wall Street Journal this month, she said a government-run paid-leave program for new parents was necessary for those “who need it the most and are least likely to receive it from their employer.”

“The reality is that in 63% of American homes with children, all parents work. Providing a guaranteed paid-leave program — with a reasonable time limit and benefit cap — isn’t an entitlement, it’s an investment in America’s working families,” Trump wrote. “We see a national paid-leave benefit as the necessary floor from which private sector companies and state governments can build.”

She said the White House was “working with lawmakers on both sides of the aisle to design a paid-leave policy.”

Rush Back To Work

Shifting trends in the economy and increased support for better work-life balance are driving forces behind the interest in paid leave. Just half of new mothers take paid time away from their jobs to care for a new child, and about one-quarter of mothers are back at work within two weeks of giving birth.

As a result, paid leave now has broad public support. According to a Pew Research Center survey of 2,029 adults released in March, 82 percent support paid maternity leave, 69 percent support paid paternity leave, 67 percent support paid family care leave (for an illness in the family), and 85 percent support paid leave to deal with one’s own serious health condition.

“This is an idea whose time has absolutely come,” said Aparna Mathur, an economist at the conservative American Enterprise Institute and co-director of a joint project on paid leave with the liberal Brookings Institution. “But, of course, there’s disagreement about how best to do it. And, yes, it will be an uphill political battle.”

Proponents view paid leave as a win-win for businesses and workers, and the economy as well. They cite research showing that worker retention and loyalty is improved and that abuse of the benefit is rare in states that have enacted paid leave.

States As Testing Ground

Five states and the District of Columbia have enacted paid parental and medical leave laws to date. California, Rhode Island and New Jersey have implemented their programs. New York, Washington, and the District will implement programs in coming years.

The laws require all but the smallest employers to offer between four and 12 weeks of leave after the birth or adoption of a child or to care for a sick family member. Workers are guaranteed from 50 to 90 percent of their income, up to a per-week cap that varies by state. In 2017 for example, that cap was $1,173 in California and $633 in New Jersey.

In April 2016, San Francisco became the first U.S. city to mandate that businesses provide paid leave.

Most U.S. firms do not offer any paid parental or medical leave. That’s especially the case for firms with fewer than 100 workers, which employ about a third of the workforce. All told, about 40 percent of workers have access to some paid leave for the birth of a child, including saved-up sick days. But only an estimated 15 to 18 percent have access to both paid parental leave and medical leave of some sort.

A 1993 law, the Family and Medical Leave Act (FMLA), gives some workers 12 weeks of unpaid parental or medical leave, with a federal guarantee of job protection. But, with eligibility restrictions, it covers only 60 percent of the workforce. About half of people eligible for FMLA leave use the benefit, according to the National Partnership for Women & Families.

Katie Rock, 32, of Des Moines, Iowa, had her third child on June 30. She works at a university that offers no paid parental leave. She plans to use almost all of her 2017 paid sick and vacation days for her first month off and then take the full 12 weeks of FMLA, unpaid.

“Of course, it would be much better if that was paid time,” Rock said. “It’s definitely a hit on the finances.”

Categories: Public Health


Viewpoints: Talking About Suicide; Military Life’s Toll On Women; Listening To Patients

Here’s a review of editorials and opinions on a range of public health issues.

The New York Times: Let’s Talk About Suicide
Chester Bennington, the lead singer of the band Linkin Park, was found dead on Thursday in his home near Los Angeles. The coroner’s office has confirmed that the 41-year-old died of suicide. That’s something I — and so many millions of other Americans suffering from mental illness — have considered. … more often than not, we don’t talk about mental health. And shows like Netflix’s “13 Reasons Why” or artists like indie pop singer Lana Del Rey have sensationalized or glamorized mental illness and suicide rather than taking it seriously. Worldwide, 350 million people (that’s 5 percent of the population) suffer from depression every day. And they are suffering – and sometimes dying – in silence because we can’t seem to talk openly about mental health. (Robert Rigo, 7/24)

Stat: Protecting Interns And Other Physicians From Depression And Suicide
This month, more than 25,000 medical school graduates will begin working at hospitals and medical centers across the United States. By the end of September, nearly one-third of these new doctors could become depressed and 24 percent could have thoughts of suicide. First-year interns often move away from family and friends to start the next chapter of intensive training. It is an exciting time, but also a difficult time. A recent study in Academic Medicine confirms that their suicide risk is highest in the early months of training. (George Keepers and Mary Moffit, 7/24)

Los Angeles Times: What Military Recruiters Aren’t Telling Women: You’ll Face Disproportionate Health Risks
Recently, 18 brave women graduated from the U.S. Army Infantry School, pioneers headed for fully gender-integrated “ground close-combat” units. Women have long served valiantly and effectively in almost every military role, but now they are tackling extremely physical combat jobs that, until recently, were designated men-only. … In this push for more female recruits, it’s not at all clear that young women — or the civilian population in general — understand the unique, disproportionate health risks women face in combat roles. The dangers, which have been known for decades, will undoubtedly be exacerbated as women serve in the most physically demanding units. (Julie Pulley and Hugh P. Scott, 7/25)

Bloomberg: Trump’s Quiet Progress On Veterans Affairs
[I]n one area, Veterans Affairs, there actually has been progress. Since the Senate approved his appointment unanimously in February, Secretary David Shulkin has sought to improve accountability at hospitals by publicly posting wait times and care-quality data, and has extended much-needed mental health services to veterans with less-than-honorable discharges. Even Congress has made a contribution, passing a bill to streamline the agency’s hiring and firing processes — legislation that Trump signed and tweeted about three times. (Mark Whitehouse, 7/24)

WBUR: Against Medical Advice: Sometimes, When Patients Defy Accepted Wisdom, So Must Doctors
Keeping the whole patient in view, including the social challenges they will return to after their short stint in a hospital, is as much a part of medical decision-making as the understanding of disease, or selection of the right medication. While this lesson is far from new — you’ll hear it taught to every medical student across the country — it is much harder to apply it in practice than to learn in principle. (Abraar Karan, 7/24)

Cincinnati Enquirer: Heroin Epidemic Must Be A Priority
Currently, human services funding is allocated towards increasing gainful employment, reducing homelessness, and preventing violence, all in need of our attention. Heroin is often a component of these other issues but the acute nature of this crisis demands prioritized attention not secondary. (Amy Murray, 7/24)

RealClear Health: Ending The Opioid Epidemic: Only The US Can Stop China’s Counterfeit Pharmaceutical Trade
The United States is facing an explosion of counterfeit opioids from China. Illegal synthetic opioids like carfentanil and fentanyl are being packaged as legal prescription opioids (like oxycodone) and sold on the black market. The US has dealt with counterfeit drug scandals before, notably in 2008 when 149 Americans died from a counterfeit blood thinner found to have originated in China. Today, counterfeit opioid compounds with carfentanil and fentanyl are blamed for the sudden increase in overdose deaths in the United States, making drug overdoses the current leading cause of death for Americans under age 50. (Emily Foecke Munden, 7/25)

Sacramento Bee: Reparations For Drug War? Consider It California
The same people who went to prison in disproportionate numbers for selling marijuana are on the verge of being cut out of California’s multibillion-dollar legal marijuana industry – and, without help, could even become victims of it. …Together, they are demanding that local governments adopt a reparations strategy that would begin to repair the damage done to communities of color. (Erika Smith, 7/24)

The Kansas City Star: Scrutiny Of Overland Park Pain Doctor Highlights Challenge Of Fighting Opioid Addiction
An Overland Park doctor is in the crosshairs of an expanding investigation into the business practices that are fueling American’s addiction to opioids. The records of Steven Simon of The Pain Management Institute have been seized by the FBI. He earns more than only a handful of other doctors in the U.S. from payments by drug manufacturers to promote both opioids and the medications that treat side effects of the drugs. It’s a revenue stream that can influence doctors to write more prescriptions. (7/23)

USA Today: Trump Budget Would Set Back Global AIDS Fight Just When We’re On Track To Win It
When we started our HIV/AIDS Initiative at Saddleback Church 13 years ago, we reminded our congregation, “If you’re going to be like Jesus, you have to learn to be compassionate toward people when they’re sick.” Even in this time of tight budgets, America’s leaders should show precisely this kind of compassion for our brothers and sisters living with HIV and AIDS in Africa and around the world. (Rick and Kay Warren, 7/25)

The New York Times: Fixes: The Tasmanian Hep C Buyers’ Club
In 2014, when Greg Jefferys’s urine started smelling like dead meat, he knew there was something seriously wrong. For weeks, Jefferys, an Australian then 60 years old, had felt fatigued and noticed that just a slight bump would leave a dark purple bruise on his skin. Blood tests revealed to Jefferys that he had chronic hepatitis C – a disease he’d never heard of. (Sophie Cousins, 7/25)

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: In Special Session, Texas Senate Takes Up Abortion Bills; Ohio’s Cost Transparency Law Stalls Amidst Strong Opposition

Media outlets report on news from Texas, Ohio, Pennsylvania, Minnesota, California, Tennessee, Florida, Maryland and Kansas.

Texas Tribune: Texas Senate Tackles Special Session Abortion Bills
Under state Sen. Donna Campbell’s Senate Bill 10, in procedures where complications occur, physicians would be required, within 72 hours, to submit reports to the state health commission that include detailed information like the patient’s year of birth, race, marital status, state and county of residence, the date of her last menstrual cycle, the number of previous abortions, and the number of previous live births. Physicians who failed to comply with the reporting requirements would face a $500 fine for each day of each violation. (Smith, 7/24)

Texas Tribune: Texas Senate OKs Maternal Mortality Task Force
State senators on Monday tentatively approved a bill that would give a state task force more time to study why an alarming number of Texas mothers are dying less than a year after childbirth. Under Senate Bill 17, the state’s Task Force on Maternal Mortality and Morbidity would be able to continue its work until 2023. (Evans, 7/24)

Kaiser Health News: Price Transparency In Medicine Faces Stiff Opposition — From Hospitals And Doctors
Two years after it passed unanimously in Ohio’s state Legislature, a law meant to inform patients what health care procedures will cost is in a state of suspended animation. One of the most stringent in a group of similar state laws being proposed across the country, Ohio’s Healthcare Price Transparency Law stipulated that providers had to give patients a “good faith” estimate of what non-emergency services would cost individuals after insurance before they commenced treatment. (Bluth, 7/25)

The Philadelphia Inquirer/Philly.com: New Five-Year Contract Between Independence And Jefferson
Independence Blue Cross is pushing for new contracts with area health systems that accelerate the hoped-for transition from paying for volume of services to paying for positive results. But it is not taking a one-size-fits-all approach. “We need to adapt to different providers” because they have “different states of readiness,” Anthony V. Coletta, president of Facilitated Health Networks at Independence, said Monday after the announcement of a contract with Jefferson Health that starts Sept. 1 and will last five years. (Brubaker, 7/24)

The Star Tribune: Minneapolis Proposal To Restrict Menthol Tobacco Sales Sparks Debate
While public health advocates pushed for the restrictions at a packed public hearing — arguing that tobacco companies target black smokers and young people with menthol products — Minneapolis store owners said it’s the latest example of City Hall overreach and would devastate their livelihoods. …The City Council heard from dozens of speakers Monday in crowded council chambers and is expected to vote on the policy in August. (Belz, 7/24)

San Francisco Chronicle: Jahi McMath’s Family Wins Backing For Argument That She’s Alive
It’s been more than three years since 13-year-old Jahi McMath was declared dead after something went terribly wrong following throat surgery at Children’s Hospital Oakland. Her family has never accepted the declaration and has kept her on life support ever since — and in a new twist, a prominent neurologist says recent videos of the girl show she is alive, with a partially functioning brain. (Johnson, 7/24)

The Philadelphia Inquirer/Philly.com: Horizon Blue Cross Ordered To Turn Over Omnia Documents
The New Jersey Supreme Court on Monday ordered Horizon Blue Cross Blue Shield, the state’s largest health insurer, to turn over a McKinsey & Co. report and other documents it used to establish two tiers of health systems for an insurance plan introduced in 2015. Providers in the second tier, including Capital Health System Inc. and St. Peter’s University Hospital Inc., sued, alleging that Horizon treated them unfairly and breached their contracts when it set up the tiers for its Omnia insurance plan. At the seven Tier One health systems in the Omnia Health Alliance consumers have lower out-of-pocket costs. (Brubaker, 7/24)

Texas Tribune: Texas To Lose Galveston And Hill Country Children’s Therapy Providers
Children in the Galveston and Hill Country areas are going to be without state-funded speech, occupational and physical therapy services as two more providers prepare to leave the Early Childhood Intervention program. The Texas Health and Human Services Commission confirmed Monday that the University of Texas Medical Branch and Hill Country MHDD Centers are ending services through the program. (Evans, 7/24)

Nashville Tennessean: Children’s ER At TriStar Centennial Opens
A new children’s emergency room in Nashville — the city’s second — is now seeing patients. The first patient at The Children’s Hospital at TriStar Centennial arrived at 9:21 a.m. on July 24 to the new seven-bed, 6,000-square foot facility on the hospital’s campus in Midtown Nashville. (Fletcher, 7/24)

Columbus Dispatch: Mount Carmel Adding 80 Beds For Mental-Health Treatment
Mount Carmel Health System and Acadia Healthcare announced on Monday that they are teaming up to open an 80-bed inpatient behavioral health hospital in Columbus to replace a 20-bed hospital at Mount Carmel West hospital in Franklinton. Officials say they are still finalizing a site for the $26 million, 64,300-square-foot freestanding facility that will have units for adult and geriatric patients as well as for dual-diagnosis patients — those who are suffering from both mental-health and drug-addiction illnesses. (Viviano, 7/25)

The Baltimore Sun: CVS Opens First Maryland Hearing Center
CVS Pharmacy opened its first Maryland hearing center in an Ellicott City store, as part of the drug store chain’s move to capture more health related business in its retail outlets. The store, which sells and services hearing aids, is staffed by audiologists and can provide hearing screenings and fittings. Insurance is accepted for some services. (Cohn, 7/24)

Cleveland Plain Dealer: Johnson Amends Cleveland ‘Lead Safe’ Law Proposal To Exclude Owner-Occupied Homes
Cleveland City Councilman Jeff Johnson, after hearing from a slew of residents said today he’s changing the ‘Lead Safe’ ordinance he plans to propose next month so that it excludes mandatory compliance and fines for homeowners who live in their properties. The ordinance — which proposes that all city homes built before 1978 be certified safe from lead hazards by 2021 — would still apply to rentals and apartments, which comprise the majority of the city’s homes, as well as child care centers and schools constructed prior to 1978, Johnson said. (Dissell and Zeltner, 7/24)

KCUR: Safety Net Clinic To Reopen Facility In Quindaro Neighborhood 
Southwest Boulevard Family Health Care, a safety net clinic in Kansas City, Kansas, will reopen its Quindaro facility after several years’ hiatus. The satellite clinic will be located in a church building owned by Family Health Care. Initially, it will be open a couple of half-days per week and, depending on demand, may increase its hours of operation. (Margolies, 7/24)

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Prominent Psychiatry Group Relaxes Stance On Speaking About Mental Health Of Public Figures

The rule against psychiatrists offering their analysis of behaviors, such as ones exhibited by the president robs the public “of our professional judgment and prevents us from communicating our understanding” of the president’s mental state, one psychiatrist said. In other public health news: the next revolution in HIV treatment, Zika testing, ticks and disease, dental services, pollution and more.

Stat: Psychiatry Group Tells Members They Can Discuss Trump’s Mental Health
Aleading psychiatry group has told its members they should not feel bound by a longstanding rule against commenting publicly on the mental state of public figures — even the president. The statement, an email this month from the executive committee of the American Psychoanalytic Association to its 3,500 members, represents the first significant crack in the profession’s decades-old united front aimed at preventing experts from discussing the psychiatric aspects of politicians’ behavior. (Begley, 7/25)

The Washington Post: Monthly Shot Could Be The ‘Next Revolution’ In HIV Therapy, Replacing Daily Pills
HIV/AIDS is no longer the death sentence it once was, but maintaining the strict regimen required to keep the virus at bay — one or more pills daily — still poses a major challenge to many people who are infected. Adherence is low among some populations, given the effort that is required to obtain, keep and store the medications. That may soon change. On Monday, scientists reported an important advance in the development of a long-acting antiretroviral shot. According to an international study involving 309 patients, an injection that combines two drugs, cabotegravir and rilpivirine, appears to be as safe and effective at suppressing HIV as the daily oral regimen. (Cha, 7/24)

The Washington Post: New Zika Testing Recommendation Issued For Pregnant Women
Federal health officials are changing their testing recommendations for pregnant women who may be exposed to the Zika virus through travel or sex or because of where they live. In updated guidance released Monday, the Centers for Disease Control and Prevention is no longer recommending routine testing for pregnant women without any Zika symptoms but who may have been put at risk because they have traveled to a region where Zika is circulating. (Sun, 7/24)

The Washington Post: A New Way To Fulfill The Single Biggest Need Of Poor Patients: Teeth
Larry Bays has seen his share of hard times, but on this day he was blessed. The 71-year-old goat farmer from Gate City, Va., had come to the annual free medical clinic held over the weekend here in coal country so his wife, Joyce, could have her asthma and arthritis checked. When her doctor realized she had no teeth, he sent the couple over to a trailer operated by the Mission of Mercy dental team. (Schneider, 7/24)

ProPublica: Has The Moment For Environmental Justice Been Lost?
Given how President Donald Trump has taken aim at the Environmental Protection Agency with regulatory rollbacks and deep proposed budget cuts, it may come as no surprise that the Office of Environmental Justice is on the chopping block. This tiny corner of the EPA was established 24 years ago to advocate for minorities and the poor, populations most likely to face the consequences of pollution and least able to advocate for themselves. (Buford, 7/24)

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Physicians, Often In Fear Of Losing License, Know How To Hide Signs Of Addiction To Escape Notice

“Somehow they believe their knowledge is going to be more powerful than addiction,” said Dr. Marvin Seppala, an addiction expert. Meanwhile, FDA Commissioner Scott Gottlieb is looking to tap unlikely sources as allies in the battle against opioids: benefit payers and insurance administrators.

Los Angeles Times: Doctors And Drug Abuse: Why Addictions Can Be So Difficult
Allegations that Dr. Carmen A. Puliafito used methamphetamine and ecstasy while he was dean of USC’s medical school have opened a window into the pervasiveness of drug use and addiction among physicians and the challenges they face when confronting it. Experts say physicians become substance abusers at about the same rate as the general population. But they are often reluctant to seek treatment out of fear of losing their medical licenses and livelihoods. (Karlamangla, 7/24)

Bloomberg: Trump’s FDA Chief Takes Wide Aim At Opioid Addiction Crisis 
The Food and Drug Administration, as part of a sweeping overhaul in how it regulates opioid painkillers, plans to look to some unusual allies to limit the flood of the addictive pills — health insurers and companies that manage prescription drug benefits. Food and Drug Administration Commissioner Scott Gottlieb plans to meet in September with the benefit payers and insurance administrators, groups the FDA hasn’t typically worked with in its role as a drug regulator. The plan, Gottlieb said, is to stem the tide of addiction to the pills by limiting the number of people exposed to them in the first place. (Edney, 7/24)

And in other news on the epidemic —

The New York Times: Economy Needs Workers, But Drug Tests Take A Toll
Just a few miles from where President Trump will address his blue-collar base here Tuesday night, exactly the kind of middle-class factory jobs he has vowed to bring back from overseas are going begging. It’s not that local workers lack the skills for these positions, many of which do not even require a high school diploma but pay $15 to $25 an hour and offer full benefits. Rather, the problem is that too many applicants — nearly half, in some cases — fail a drug test. (Schwartz, 7/24)

Arizona Republic: Hepatitis C: The Public-Health Worry Lurking Behind The Opioid Crisis
Hepatitis C, a blood-borne virus that attacks the liver and causes inflammation, is so infectious it can spread through a few microscopic dots of blood. Intravenous drug users are among the most high-risk populations for infection because they share syringes, cookers, cotton, water, ties and alcohol swabs, according to the Centers for Disease Control and Prevention. (Stanford, 7/24)

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In Unexpected Turn, Democrats Block Once-Bipartisan Bill Funding VA Choice Program

Under the rules set for the bill, supporters needed support from two-thirds of members to pass the bill. Lawmakers voting against it cited opposition from a large group of veterans organizations that called on Congress to reject the bill because it pays for the choice program through cuts in the VA.

The New York Times: Future Unclear For Veterans Choice Program After House Bill Falters
Congressional lawmakers struggled on Monday to reach an agreement to prop up a popular multibillion-dollar health care program that allows veterans to see a private doctor at government expense. This was supposed to be a relatively easy task, meant to buy lawmakers time as they debated the future of the program. As recently as last week, Republican leaders were considering using a bill temporarily funding the Veterans Choice Program as a vehicle to raise the debt ceiling, a perennially bitter pill for Republicans. (Fandos, 7/25)

Politico: House Democrats Stun GOP By Sinking Veterans, Intel Bills
Kicking off a busy week in the House, most Democrats and a handful of Republicans joined forces to deny GOP leaders big-enough majorities to pass an annual intelligence policy bill and legislation to restore funding for a key veterans health care program. (O’Brien, 7/24)

CQ Roll Call: Veterans’ Health Care Funding Patch Blocked By House
The legislation would add roughly six months of funding to what’s known as the Veterans Choice Program, which provides a route to private care for certain veterans having difficulty getting medical care at traditional Department of Veterans Affairs facilities. (Mejdrich, 7/24)

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Scope Maker Olympus Hit With $6.6 Million Verdict In Superbug Outbreak Case

A jury ordered the giant medical scope maker Olympus Corp. to pay a Seattle hospital $6.6 million in damages tied to a deadly superbug outbreak — and told the hospital to pay $1 million to a deceased patient’s family.

But jurors on Monday also handed the Tokyo-based manufacturer a key win, rejecting claims that its flagship duodenoscope was unsafe as designed.

The decision follows an eight-week trial, the first in the U.S. related to gastrointestinal scopes causing outbreaks of drug-resistant infections.

The case was filed by Theresa Bigler, 61, and her four children in connection with the August 2013 death of Richard Bigler, a pancreatic cancer patient who contracted an infection linked to a contaminated Olympus scope. The hospital, Virginia Mason Medical Center, later joined in the suit against Olympus, but the jury found it shared some blame in the case.

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An Olympus official offered condolences to the Bigler family in a statement and praised the jury’s decision.

“We are appreciative that the jury recognized that Olympus’ duodenoscope design was not unsafe and did not contribute to Mr. Bigler’s unfortunate passing in 2013,” said Sam Tarry, an attorney for the company.

But the jury also said Olympus failed to provide adequate warnings about the scope or instructions for its use after it was manufactured. The jury said that failure harmed Virginia Mason Medical Center.

Theresa Bigler’s attorneys cast the decision as a win for patient safety.

Theresa Bigler sued Olympus for the death of her 57-year-old husband, Richard, a pancreatic cancer patient who contracted an infection linked to a contaminated Olympus scope. (Courtesy of the Bigler family)

“Olympus hasn’t been playing by the rules for some time and this verdict holds them accountable,” lawyer David Beninger said in a statement.

He said the case should send a broad signal to Olympus and other device manufacturers.

They “must make patient safety a priority and not just a sales pitch,” Beninger’s statement said. “As Olympus’ own expert admitted at trial, lawsuits can change behavior and big lawsuits can make big changes. Hopefully this verdict will convince Olympus and others to listen.”

Medical and legal experts said they were surprised at how well Olympus fared in this case, which was closely watched by other plaintiffs’ lawyers who are waging similar suits against the company.

“In the jury’s opinion, the hospital shared some of the blame,” said Lawrence Muscarella, a hospital-safety consultant in Montgomeryville, Pa.

Muscarella said each case is different and plaintiffs’ attorneys can learn from the evidence presented at this trial. “It remains to be seen what this portends for other cases on the docket,” he said.

More than 25 patients and families, from Pennsylvania to California, have sued Olympus alleging wrongful death, negligence or fraud. Federal prosecutors also are investigating Olympus and two smaller manufacturers over their potential roles in patient infections.

Richard Bigler was one of at least 35 patients in American hospitals to have died since 2013 after developing infections tied to Olympus duodenoscopes — snake-like tubes threaded down a patient’s throat. Doctors use the scope to diagnose and treat problems in the digestive tract, such as gallstones, cancers and blockages in the bile duct. About 700,000 such ERCP procedures are performed annually in the U.S.

Last year, Olympus recalled all 4,400 of its TJF-Q180V duodenoscopes — the model used in Bigler’s case — and made repairs to reduce the risk of bacteria becoming trapped inside after cleaning.

Bigler’s attorneys said Olympus had acted recklessly by not warning U.S. hospitals about previous outbreaks and failing to fix a design flaw that hindered cleaning and allowed dangerous bacteria to become trapped inside these reusable scopes.

Olympus had said its gastrointestinal scopes were safe and effective with proper cleaning and disinfection. At trial, the company said Virginia Mason was to blame for Bigler’s infection because the hospital didn’t follow the company’s cleaning instructions.

Olympus criticized Virginia Mason for not telling Bigler and other families about the scope-related infections, forcing them to find out from a newspaper account about the outbreak.

In his closing argument, Olympus attorney Mark Anderson told the jury that the Seattle outbreak would have occurred regardless of whether Olympus’ or another company’s scopes had been used.

“The proof in this case, from their witnesses, is there is no increased risk with the [Olympus scope],” Anderson told the jury.

Hospital officials said the faulty Olympus scopes were the cause of Bigler’s infection and others, and they implemented an expensive test-and-hold protocol for cleaning the devices that halted the spread.

“We’re sorry for the grief and anguish experienced by the Bigler family,” the hospital said in a brief statement. “This was a complicated trial that lasted more than eight weeks. The verdict includes multiple decisions and we will continue reviewing them over the next few days.”

Theresa Bigler was not available for comment, lawyers said.

Olympus is the industry leader for these devices and other specialty endoscopes, with an 85 percent share of the U.S. market.

One of the largest superbug outbreaks in the nation occurred at Virginia Mason, where 39 people’s infections were linked to Olympus scopes. Eighteen patients died. The Seattle hospital said the patients who died, including Richard Bigler, had other underlying illnesses.

The 12-member jury, which had begun deliberating July 18, said the damages to Virginia Mason amounted to $25.4 million. But jurors agreed the hospital had been negligent, so they sharply reduced the damages owed to Virginia Mason.

The plaintiffs’ attorneys repeatedly reminded jurors that three key Olympus executives declined to testify at trial and instead invoked their Fifth Amendment right against self-incrimination.

The three executives who declined to testify were Susumu Nishina, Hisao Yabe and Hiroki Moriyama. They hold top roles in regulatory affairs, quality assurance or medical manufacturing. All three have declined to comment, citing the pending litigation.

Several of Nishina’s internal company emails were introduced as evidence. In one email exchange in February 2013, Nishina told the company’s U.S. managers not to issue a broad warning to American hospitals despite reports of scope-related infections in Dutch, French and U.S. hospitals, court records show.

In addition to Olympus, device makers Pentax and Fujifilm sell these sorts of duodenoscopes, which can cost up to $40,000 apiece. Overall, as many as 350 patients at 41 medical centers worldwide were infected or exposed to contaminated scopes made by those three manufacturers from 2010 to 2015, according to the U.S. Food and Drug Administration.

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Over-The-Counter Devices Hold Their Own Against Costly Hearing Aids

Hearing aids that can cost more than $2,000 apiece are only slightly more effective than some over-the-counter sound-amplification devices that sell for just a few hundred dollars, according to a recent study.

The study bolsters legislation pending in Congress, which would have the Food and Drug Administration set regulations for cheaper over-the-counter products and is designed to make the devices more widely accessible and safer. Consumers with mild to moderate hearing loss would be able to purchase the devices without a prescription and without a medical exam, knowing they meet federal safety standards.

For the study, researchers compared how well 42 older adults with mild to moderate hearing loss repeated sentences spoken in the presence of background noise. The researchers first tested their ability to understand the speaker without any devices. Then they tested the subjects successively with a hearing aid and with five “personal sound amplification products” sold over the counter.

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The hearing aid used in the study was a brand commonly dispensed in audiology clinics. The personal sound amplification products (PSAPs) that were selected either had the best electroacoustic properties or were commonly available in retail pharmacies. PSAPs perform like hearing aids but can’t be marketed as hearing aids because they don’t meet standards set by the FDA.

The results, published this month in JAMA, found very little difference between the hearing aid, which costs about $1,900 per ear, and some of the PSAPs, which mostly cost between $300 and $350 each.

On average, study participants were able to accurately repeat about three-quarters of the words spoken to them without using any device. Using the hearing aid boosted their understanding to an average 88.4 percent. And four out of the five PSAPs were nearly as effective as the hearing aid, with average word understanding ranging from 81.4 percent to 87.4 percent. The fifth PSAP performed poorly: People could hear better with their naked ears.

Age-related hearing loss is a common problem, but only about a quarter of the roughly 30 million people who have it use hearing aids, said Nicholas Reed, an audiology instructor at Johns Hopkins School of Medicine who was the study’s lead author.

“That’s a lot of people who aren’t getting in through the door,” he said.

Cost is a deciding factor for many consumers. Medicare doesn’t cover hearing aids, nor do most private health insurance plans.

Identical versions of the bipartisan Over-the-Counter Hearing Act of 2017 were introduced in the House and Senate this year. The text of those bills has been added as an amendment to the FDA Reauthorization Act of 2017, a bill that is key to FDA operations because it sets the government’s system for collecting fees during the drug approval process.

Not surprisingly, hearing aid manufacturers and distributors are against the bill. So are gun owners, who claim that regulating hearing amplifiers, which some hunters use to detect game, is in effect a way to regulate hunting and undermine their Second Amendment rights.

Reed said that by requiring the FDA to issue regulations on over-the-counter hearing aids, the proposed amendment would improve the products sold. Many of them, he said, are not effective and some are dangerous because there’s no control over amplification levels.

“When it gets to a certain amplification, it will just blow your hearing out,” he said. “Over-the-counter hearing measures would regulate these devices and force them to meet standards.”

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KHN’s coverage related to aging & improving care of older adults is supported by The John A. Hartford Foundation.

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Viewpoints: Is Silicon Valley Losing The Lead In Medical Technology?; Doctors And Hand Writing

Here’s a review of editorials and opinions on a range of public health issues.

The Wall Street Journal: Silicon Valley Trails In Medical Tech
People who develop medical technology have long assumed that Silicon Valley would pioneer smartphone-based devices to make Americans fitter and healthier than ever. To some degree, that forecast is coming true: Tech giants are working with doctors and hospitals on highly sophisticated devices — automated radiology, supercomputer-based oncology, fitness-tracker-based analytics — to monitor the sick, provide better automated care, and keep people out of hospitals in the first place. But it turns out the biggest gains from mobile medicine will come from deploying it in poor countries across Africa and Asia. (Michael S. Malone, 7/23)

KevinMD: Doctor, We Can’t Read Your Writing
So to future pharmacists who will read my prescriptions, and other health care professionals who will read my notes: I pledge from here on in to write as neatly as possible within the time constraints allowed, for the safety of my patients, the posterity of cursive writing, and for the sake of my grandfather (who likes reading my blog on his iPad). (Sarah Fraser, 7/23)

USA Today: Veterans Affairs Secretary: VA Health Care Will Not Be Privatized On Our Watch
As a physician, my professional assessment is that the Department of Veterans Affairs has made significant progress over the past six months — but it still requires intensive care. In order to restore the VA’s health, we must strengthen its ability to provide timely and high quality medical care while improving experiences and outcomes for veterans. (David Shulkin, 7/24)

Lexington Herald Leader: A Woman’s Death, Kentucky’s Opioid Crisis
Jenny Fulton’s brief life and brutal death hold important lessons, especially for Kentuckians in positions of public trust. The 27-year-old woman died in 2014 in the Mason County jail where she was sent because she had relapsed into heroin use, violating her parole. Despite widespread recognition that incarceration is not the solution, Kentucky still spends millions of dollars jailing people who have drug use disorders when that money could be better spent on evidence-based treatment. (7/23)

St. Louis Post-Dispatch: Trump Takes A ‘Just Say No’ Approach To Sex Education
In today’s version of “Just Say No,” first lady Nancy Reagan’s approach to drug use in the 1980s, President Donald Trump’s administration is cutting more than $213 million in funding to help prevent teen pregnancy. The move eliminates evidence-based pregnancy prevention and research programs, and family planning services, but leaves money for abstinence-only education. In addition, Trump appointed a prominent abstinence-only advocate as assistant secretary of Health and Human Services. (7/22)

San Jose Mercury News: Reject Climate Change Skeptic For Top Science Post
President Trump’s disdain for science apparently knows no bounds. He has now nominated climate change skeptic Sam Clovis, a talk radio host, to serve as the Department of Agriculture’s chief scientist — a slap in the face of the scientific community and a disservice to those responsible for the integrity of the USDA’s research. (7/23)

Sacramento Bee: California Workers’ Comp System Remains Nation’s Most Expensive
Obviously, working in California is not inherently more dangerous than in other states, and cash benefits to disabled California workers are not out of line, so the enormous cost differential must be rooted in the system itself, which explains why its rules are the subject of constant political infighting. One factor in those costs is what officials say is an enormous amount of fraud, concentrated in Southern California. (Dan Walters,  7/23)

Los Angeles Times: Don’t Believe The American Heart Assn. — Butter, Steak And Coconut Oil Aren’t Likely To Kill You
Last month, the American Heart Assn. once again went after butter, steak and especially coconut oil with this familiar warning: The saturated fats in these foods cause heart disease. The organization’s “presidential advisory” was a fresh look at the science and came in response to a growing number of researchers, including myself, who have pored over this same data in recent years and beg to differ. A rigorous review of the evidence shows that when it comes to heart attacks or mortality, saturated fats are not guilty. (Nina Teicholz, 7/23)

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A Cure For HIV? One Child May Give The World Hope

Scientists presented the case study of a boy who has remained HIV-free since his early treatment as an infant. But Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, struck notes of both optimism and caution when speaking about him. In other public health news: gene therapy, vaccinations, arrest in old age, concussions, inflammation and a flesh-eating bacteria.

The Washington Post: New Hope For HIV Cure As Child Remains Virus-Free Years After Final Treatment
A South African boy, believed to have been infected with HIV around the time of his birth, has remained free of the virus for 8½ years after early treatment — renewing hope among scientists that such outliers may hold clues to help end the decades-old epidemic. The case study, described by researchers before a presentation Monday at an international AIDS conference in Paris, suggests a paradigm shift in the treatment of those infected. It establishes that HIV may be controllable in some way other than a daily and lifelong regimen of antiretroviral drugs. (Cha, 7/24)

The New York Times: Companies Rush To Develop ‘Utterly Transformative’ Gene Therapies
The approval of gene therapy for leukemia, expected in the next few months, will open the door to a radically new class of cancer treatments. Companies and universities are racing to develop these new therapies, which re-engineer and turbocharge millions of a patient’s own immune cells, turning them into cancer killers that researchers call a “living drug.” One of the big goals now is to get them to work for many other cancers, including those of the breast, prostate, ovary, lung and pancreas. (Grady, 7/23)

NPR: Alternatives To Vaccination Shots Are In Development
News this summer of a flu vaccine patch sparked a lot of chatter. Could getting vaccinated be as easy as putting on a bandage? Could there be fewer, or at least smaller, needles in our future? Some companies and academic labs are working to make those things happen. (Columbus, 7/23)

The New York Times: Another Possible Indignity Of Age: Arrest
It was the sort of incident that happens at facilities that care for people with dementia. At a residence for older adults in San Francisco last summer, Carol King momentarily left a common sitting area. When Ms. King returned, she found that another resident had taken her chair, a nurse who witnessed the episode later reported. She grabbed the usurper’s wrist. (Span, 7/21)

NPR: Concussions May Hit Female Brains Harder, Research Suggests
Thanks to research on boxers and football players, both athletes and the public are becoming more aware of the dangers of sports-related head injuries. Yet there is little data on participants like Mazany. That’s because, unlike the vast majority of athletes studied, she is a woman. “We classically have always known the male response to brain injury,” says Mark Burns, at Georgetown University. But there have been remarkably few studies of females. The bias runs throughout the scientific literature, even in studies of mice. (Hamilton, 7/24)

NPR: Inflammation Can Be Bad For Your Health, Or Good
Chronic, low-level inflammation seems to play a role in a host of diseases, including type 2 diabetes, heart disease, Alzheimer’s, cancer and even depression. And even though the science on inflammation and disease is far from settled, tests and treatments are being promoted that claim to reduce that risk. (Hobson, 7/21)

The Washington Post: He Thought He Just Had Blisters From A Hike. He Had Flesh-Eating Bacteria And Nearly Died.
Wayne Atkins thought little of the blisters he had gotten while hiking. He was trekking up and down the 4,500-foot-high Mount Garfield in New Hampshire — 10-miles round-trip — and blisters were no surprise. He was in the Granite State for a family member’s early June wedding, which went off without a hitch, even with the blisters. But things soured when he returned to Miami, according to Manchester, N.H., ABC affiliate WMUR-TV. (Wootson, 7/23)

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States Urged To Sue Drug Companies Over Painkiller Epidemic By Lawyers Who Drove Tobacco Litigation

The Wall Street Journal reports on a one-time attorney general who is aiding in lawsuits filed by Mississippi and Ohio against pharmaceutical makers. In another story on the business front of the drug crisis, McKesson’s board will be greeted by picketing teamsters organized by the father of an overdose victim.

The Wall Street Journal: Lawyers Hope To Do To Opioid Makers What They Did To Big Tobacco
The legal front widening against makers of opioid painkillers has something in common with landmark tobacco litigation of the 1990s: attorney Mike Moore. As Mississippi’s attorney general in 1994, Mr. Moore filed the first state lawsuit against tobacco companies, saying they harmed public-health systems by misrepresenting smoking’s dangers. He helped marshal the subsequent spate of state litigation and then the talks that led to a $246 billion settlement. (Whalen, 7/23)

Bloomberg: Overdose Victim’s Dad Rallies Teamsters In Fight With McKesson 
When McKesson’s board and executives gather near Dallas for their annual shareholders meeting on July 26, they’ll be greeted by a throng of picketing Teamsters. Representatives of the union, which owns more than $30 million of McKesson shares, will call on investors to reject the company’s executive-pay plan and for the board to claw back some of Chief Executive Officer John Hammergren’s compensation. (Melin, 7/21)

State efforts to combat the epidemic are reported from Massachusetts, New Jersey, Virginia, Colorado and Connecticut —

The Associated Press: Tool To Help Police In Opioid Crisis Draws Privacy Concern
New Jersey is the latest state amid a national opioid crisis to consider allowing police and law enforcement officials to access its prescription drug monitoring database without a court order, pitting patient rights to privacy against the government’s ability to investigate so-called doctor shopping. (Catalini, 7/23)

Boston Globe: Key Part Of Opioid Legislation Is Not Working
As originally proposed by Governor Charlie Baker, the law would have required those taken to the emergency room after an overdose to be held involuntarily for up to 72 hours to receive treatment. But the final version approved by the Legislature excised that requirement, dictating instead that hospitals must simply offer substance abuse treatment to these patients after a voluntary assessment. (Edmondson, 7/23)

Denver Post: Colorado Medicaid Program Reduces Opioid Dosages To Combat Addiction
Colorado’s Medicaid program is reducing the amount of opioid painkillers it allows its recipients to receive, part of a growing campaign to restrict how many of the highly addictive drugs are in circulation. The new policy, announced this month, will roll out in two phases. The first, which goes into place in August, applies to Medicaid recipients who are prescribed opioids for the first time in at least a year. The policy will limit those patients to receiving only a seven-day supply to start, with two additional one-week refills possible if the patient requests them. Another refill request beyond that will require additional scrutiny. (Ingold, 7/24)

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Both Sides Rack Up Wins On Battlefield Over Women’s Health In The States

While some states are stripping Planned Parenthood of funds, others are passing laws to protect contraception for women. Outlets report on other women’s health news out of Kentucky, Texas, Tennessee, Georgia and Texas.

Stateline: Flurry Of Laws Enacted On Women’s Access To Health Care
As Washington moved to reduce federal funding for women’s health this year, adversaries in the war over affordable birth control and other women’s health services shifted the battleground to state capitals — resulting in a spate of new laws that both expand and contract women’s access to care. … Medicaid pays for three-quarters of all publicly supported women’s health programs. So when Iowa abruptly cut off Medicaid dollars to Planned Parenthood, it was game over, said Jodi Tomlonovik, executive director of the Family Planning Counsel of Iowa, which oversees distribution of federal and state money to women’s health clinics. (Vestal, 7/24)

Reuters: U.S. Abortion Support Groups Put On More Public Face
Patricia Canon drives poor rural Kentucky women to distant abortion clinics each week, part of a national army of volunteers who are growing bolder even as abortion foes ratchet up opposition to the activists they have branded as “accomplices to murder.” The Kentucky Health Justice Network, where she volunteers, is one of dozens of non-profit U.S. abortion funds providing money for procedures or covering travel costs to help women obtain abortions, particularly in states where Republican-backed laws have narrowed options. (Kenning, 7/22)

The Washington Post: Dying After Childbirth: Women In Texas Are At High Risk, Especially If They’re Black
Black women in Texas are dying with frightening frequency after childbirth — at a rate up to nearly three times higher than that of white women. And no one has figured out why. In a state with the worst overall maternal mortality in the nation, the Texas legislature opened a special session this week that will address the issue as one of 20 items that Gov. Gregg Abbott (R) listed in calling lawmakers back to work. The most they may do, however, is extend and expand the scope of a task force that started studying the problem a few years ago. (Murgia, 7/21)

The Associated Press: Tennessee Inmates Get Reduced Sentences For Birth Control
A program in a Tennessee county reduces inmates’ jail time if they voluntarily undergo birth control procedures, in a move that has drawn criticism from the local district attorney and the American Civil Liberties Union. WTVF-TV reports General Sessions Judge Sam Benninfield signed a standing order in May that provides 30 days’ credit toward jail time for men who agree to free vasectomies in White County and women who agree to receive free Nexplanon implants, which prevent pregnancies for up to four years. (7/21)

Atlanta Journal-Constitution: Fed Cuts In Teen Pregnancy Grants Hamstrings Georgia Recipients
Quest for Change, a youth and family development-focused nonprofit run out of tiny Dawson, Ga., trained Jackson and other teenagers in how to discuss pregnancy, sexually transmitted diseases and healthy relationships with their peers. … [Shaunae] Motley’s organization and 80 others across the country were recently notified by the federal Department of Health and Human Services that the five-year grants they applied for and won in 2015 would be cut off two years ahead of schedule.

Austin American-Statesman: Abortion-Related Bills Sent To Full Senate For A Vote
The state Senate Health and Human Services Committee approved five bills Friday, the first of the legislative session to be sent to a full chamber for a vote since Gov. Greg Abbott expanded the scope of the agenda early Thursday. Three of the bills dealt with abortion and passed on a party-line 6-3 vote. (Chang and Silver, 7/21)

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Committee’s Plan To Shift Money To Veterans’ Choice Program Draws Immediate Backlash

Eight major organizations spoke out against the proposal, saying it was unacceptable privatization of veterans’ health care.

The Associated Press: House Unveils Plan To Fix VA’s Budget Gap As Deadline Looms
A House committee unveiled a disputed plan Friday to allow the Department of Veterans Affairs to shift $2 billion from other programs to cover a sudden budget shortfall that could threaten medical care for thousands of patients in the coming weeks. The proposal by the House Veterans Affairs Committee would provide a six-month funding fix to the department’s Choice program, which offers veterans federally paid medical care outside the VA and is a priority of President Donald Trump. To offset spending, the VA would trim pensions for some veterans and collect fees for housing loans. (Yen, 7/21)

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Opioid Treatment Funds In Senate Bill Would Fall Far Short Of Needs

At a lunch last week, President Trump tried to persuade some reluctant senators to endorse repealing the Affordable Care Act. During the meeting, he mentioned a provision in the Senate Republican proposal that allocates funding for opioid treatment, saying, “We’re committing $45 billion to help combat the opioid epidemic, and some states in particular like that.”

But addiction treatment specialists warn that sum of money is far from enough to address a crisis that has escalated across the United States in recent years, killing tens of thousands of people.

The federal money would be spent over about a decade, and is part of a bill that also dramatically cuts Medicaid, which is helping many people get treatment now. Those cuts will hit people in some states especially hard — those living in states that expanded the Medicaid program under the Affordable Act.

“You’re going to take a lot of people, take away their health care benefit, and basically do just a small grant to each state. It’s going to be real big problem,” said Richard Edley, executive director of the Rehabilitation and Community Providers Association, which includes hundreds of mental health and substance use disorder providers in Pennsylvania. “You hate to say you’re opposing [$45 billion], but it’s packaged with a rollback of benefits to these same individuals.”

In Pennsylvania in 2016, Medicaid expansion helped 124,000 people get treatment for their substance use disorder. Democratic Gov. Tom Wolf has said his state won’t be able to maintain Medicaid expansion if the federal government cuts back its share of spending. Without the program, many of those people would have limited access to help for their addiction.

Edley did some back-of-the-envelope math, and is really concerned at what he found.

If $45 billion is distributed to all 50 states by population, Pennsylvania would get about $1.8 billion, spread out over nine years. Depending on other variables, that could range from somewhere between $1,000 to $2,000 per person per year who might need treatment, based on how many people got treatment under expanded Medicaid in Pennsylvania last year.

By contrast, one year of maintenance treatment with methadone costs about $4,700 per year, according to the National Institute on Drug Abuse. Methadone is an evidence-based treatment that makes it possible for a person with opioid addiction to work and lead a normal life.

But the cuts to Medicaid would amount to billions of lost dollars in Pennsylvania.

The state says it can’t make up the difference. So, many of the people who get opioid treatment through Medicaid could lose coverage and then turn to the grant that’s specifically meant for opioid treatment.

And, like any chronic disease, opioid treatment takes many steps — medication and, perhaps, a lifetime of management.

“Your typical individual doesn’t get treatment right in 10 days on their first try,” said Jennifer Smith, Pennsylvania’s acting secretary for the Department of Drug and Alcohol Programs.

“[The funding] doesn’t even come close. Doesn’t even come close,” Smith added. “We can piece together some solutions that might help get us a little closer to where we had been, but the end result is more people are going to die.”

Every day in Pennsylvania an average of 13 people die from a drug overdose.

And there also would be ripple effects from that drop in funding, Smith said — grandparents taking care of grandkids, bankruptcies because of treatment costs, and more work for each county’s department of children and youth services. Smith also worries that less treatment would mean more people would be desperate to support their habit.

“And they end up with a criminal record,” she said. “Nobody wants to hire them.”

So they drop out of the workforce.

Experts like Smith and Edley are concerned that if the federal government pulls back spending on Medicaid, the costs simply will be shifted somewhere else.

“You stop funding for [treatment and] they don’t go away” said Edley. “People end up in emergency rooms. They end up in uncompensated care, homelessness. You talk to people in the criminal justice system — you see increased incarcerations.”

He expects that if the Senate GOP health bill is approved, lawmakers will have to come back to this issue in six months or a year.

“They’re going to be back at the drawing board,” Edley said, “realizing, ‘All right, that didn’t work, and there are too many people being hurt.’”

Edley and Deb Shoemaker, executive director of the Pennsylvania Psychiatric Society, also see a double standard with how the Senate GOP bill treats people who have a substance use disorder.

Shoemaker is very active on substance use issues in Pennsylvania, and said she often tries to personalize her pitch to lawmakers.

“Would you want to say, ‘Hey, I’m sorry that you have cancer but you can only get treatment once a week,’ or ‘you can only get dialysis once a week,’” she said, pointing to the disparity in the way the proposal treats substance abuse versus other physical conditions.

“So think about it that way,” she said. “Yes, [treatment for substance use disorder] is a cost, but in the long run, they’re healthier. They’re alive.”

Sen. Pat Toomey (R-Pa.) has defended the proposed cuts.

“If it’s not worth it to the state to buy this coverage at 43 cents on the dollar [about what the state contributes to non-expansion Medicaid recipients], then how is it worth it to those very same taxpayers — who, at the end of the day, have to provide the funding for the federal program — why is it worth it to them to pay 90 cents on the dollar? It just doesn’t make sense,” he told NPR in June.

In a written statement, Toomey has said “fighting the scourge of opioid and heroin abuse remains a top priority of mine.” His office also says current Medicaid funding is unsustainable.

An earlier version of the bill included just $2 billion in grants for substance use disorder treatment. Senate GOP leaders included the $45 billion as a concession to moderate Republicans like Sen. Rob Portman of Ohio and Sen. Shelley Moore Capito of West Virginia, who represent states that have been hit particularly hard by the crisis.

This story is part of a reporting partnership with WITF’s Transforming Health, NPR and Kaiser Health News.

Categories: Medicaid, Mental Health, Public Health, Repeal And Replace Watch, States

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Viewpoints: The Opioid Epidemic Through The Lens Of Neuroscience; Prognostic Uncertainty, Outcomes And Medical Decisions.

Here’s a review of editorials and opinions on a range of public health issues.

Bloomberg: Neuroscience Offers Insights Into The Opioid Epidemic
Most Americans say they’re interested in scientific discoveries, but they may be thinking of the kinds of findings that lead to new gadgets and wonder drugs. When it comes to discoveries about hazards and risks — especially the risks of those wonder drugs — Americans seem more likely to tune out. (Faye Flam, 7/21)

The New England Journal Of Medicine: Managing Uncertainty — Harnessing The Power Of Scenario Planning
Although prognostic certainty remains elusive, many clinicians use statistics to quantify outcomes. We strive to achieve increasing precision with risk calculators and use the best available evidence to report probabilities of discrete complications. Decision aids allow us to share these predictions with patients and facilitate comparison between treatments. Although numbers quantify uncertainty, they offer little guidance to patients for managing this uncertainty. Moreover, these strategies fail to illuminate logical connections between the patient’s current condition, downstream outcomes, and events experienced along the way. (Margaret L. Schwarze and Lauren J. Taylor, 7/20)

The New England Journal Of Medicine: Certain About Dying With Uncertainty
Mrs. C., a woman with whom we’d had a long-standing patient–physician relationship, one of us for over 25 years, died recently in the 87th year of her life. A woman who had always maintained her cheerful spirit even in the midst of quite trying medical setbacks, she was one of our favorite patients. But what made her most special was her perspective on life and death: we learned a lot from her. … when her husband died of a brain tumor about 5 years ago, she witnessed the good and the not-so-good that medicine had to offer. She saw interventions that improved things slightly for a short while but did not provide meaningful and sustained benefit. After he died, we had “the conversation”; we had broached the subject before but had never discussed it in great depth. She knew what she wanted. … We vowed to keep our part of the bargain. If we had only known how hard that would be. (Jeffrey M. Drazen and Maria A. Yialamas, 7/20)

Los Angeles Times: Dear Media: When You Cover Death By Suicide, Do It Thoughtfully
When a family member died by suicide, my parents chose not to tell me his method. They wanted me to remember him as he lived, for both of our sakes. While I didn’t understand their decision at the time, I now see it as one borne out of deep care. I was especially thankful for my parents’ thoughtfulness after reading the media coverage of Linkin Park singer Chester Bennington’s death by suicide this week. (Melissa Batchelor Warnke, 7/21)

The Wall Street Journal: In The Netherlands, The Doctor Will Kill You Now
In 2002 the Netherlands became the first country to legalize euthanasia and physician-assisted suicide for those suffering deadly diseases or in the last stages of life. Not long after the legislation was enacted, eligibility was expanded to include those experiencing psychological suffering or dementia. Today pressure is mounting for the Dutch government to legalize a “euthanasia pill” for those who are not ill, but simply consider their lives to be “full.” (Kees van der Staaij, 7/20)

RealClear Health: Digital Health Hope: Personalized Care Is The Final Frontier
For many health care providers, personalized or precision medicine is the holy grail of their practice. While we have made great gains as new technologies develop, progress in medicine in the past decade has been lacking despite all-time spending highs in research. In order to improve outcomes and make significant progress, physicians must accept change and move toward the more precise approach that personalized medicine affords. Today, medicine revolves around standards of care: the best courses of prevention or treatment for the general population, or the average person on the street—not necessarily what is best for the individual. In personalized medicine, physicians cater medical treatment to a patient based on their particular genetic, environmental and clinical information. This personalized approach results in a more precise treatments that are much more likely to be effective. (Kevin Campbell, 7/21)

St. Louis Post-Dispatch: The U.S. Attorney General Is Stuck In A ‘Reefer Madness’ Time Warp
For reasons that defy understanding, science, public opinion and most state governments, Attorney General Jeff Sessions has decided that cracking down on the use of medical marijuana is a priority. Assuming he survives President Donald Trump’s pique, he wants Congress to roll back rules that prohibit the Justice Department from going around state laws to enforce a federal ban against medical cannabis. As recently as May, Congress reaffirmed that the Justice Department can’t spend money to prevent states from “implementing their own laws that authorize the use, distribution, possession, or cultivation of medical marijuana.” (7/20)

Los Angeles Times: USC Bosses Flunk The Leadership Test Amid Shocking Allegations About Former Medical School Dean
By now you probably know the details. Dr. Carmen Puliafito, a $1.1-million-a-year professor, doctor, dean and big-bucks rainmaker for the University of Southern California, left plenty of time in his busy schedule for extracurricular activities. They included drug-fueled parties with a prostitute, convicted criminals and drug addicts. Los Angeles Times sleuths dug up photos of Puliafito’s exploits in hotel rooms, apartments and even the dean’s office at USC, including a shot of him using a butane torch to light a glass pipe while a female companion smoked heroin. (Steve Lopez, 7/20)

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How D.C. Pulled Itself Back From The Brink Of An AIDS Epidemic

A decade ago, city officials realized they had to take action, and they turned the numbers around. Stateline looks at how they did it. In other public health news: a breakthrough on cancer, mental illness, female homicide victims, antibiotics and birth defects, heart health and more.

Stateline: Fighting AIDS In The Nation’s Capital
Ten years ago, Washington, D.C., was on the verge of a public health disaster: It had the highest reported rates of HIV in the country. And in a city of 588,000, 1,333 people tested positive for HIV in 2007 alone. By the time they were tested, most had full-blown AIDS.Back then, city officials acknowledged that they didn’t have a complete picture of the problem. But they estimated that as many as one in 20 residents were infected with the disease, rivaling rates in sub-Saharan Africa. (Wiltz, 7/21)

Stat: One Cancer Breakthrough Is On Its Way. Here’s What’s Coming Next
CAR-T is having a moment. The Food and Drug Administration looks poised to approve the first hot-wired white blood cell treatment from Novartis, promising to change the lives of patients with a particularly deadly form of cancer and usher in an entirely new definition of the word “drug.” But scientists around the world are hardly standing pat in the glow of this success. Instead, they’re toiling to discover, refine, and re-invent cellular therapies for cancer in hopes of treating more tumor types, improving safety, and pushing the still-nascent field forward. Some of the most promising applications of the technology remain on the horizon — though plenty of challenges stand in the way. (Garde, 7/21)

Stat: This Biotech Aims To Simplify Diagnosis Of Mental Illness. Can It Work?
Asmall Australian biotech has drawn big-name backers — including swimming superstar Michael Phelps — to its audacious goal: to develop a quick, cheap, and objective way to diagnose an array of mental illnesses. The tool would be a stunning breakthrough in the field of mental health —  if it works. And there’s the rub. Researchers have been trying for decades to find reliable biomarkers for mental illness — that is, tangible biological clues that conclusively indicate whether a person has a particular psychiatric disease. Effort after effort has failed, leaving doctors to diagnose such conditions mostly on the basis of screening checklists and conversations with their patients. (Keshavan, 7/21)

The Washington Post: Most Female Homicide Victims Are Killed By Husbands Or Other Intimate Partners, New Report Shows
A report out Thursday by the Centers for Disease Control and Prevention about homicides and women provides some disturbing numbers about just how common this is. Homicide is the fifth leading cause of death for women ages 18 to 44. In 2015 alone, 3,519 women and girls were killed. More than half of these killings were perpetrated by current or former boyfriends, husbands or other intimate partners. (Cha, 7/20)

The New York Times: Certain Antibiotics May Increase Risk Of Birth Defects
A large study published in the British Journal of Clinical Pharmacology found that certain antibiotics taken during pregnancy may increase the risk for birth defects. Canadian researchers followed 139,938 mothers of babies born in Quebec from 1998 to 2008, tracking their antibiotic use in the first trimester, and their babies’ birth defects through the first year of life. (Bakalar, 7/20)

NPR: Just Thinking That You’re Slacking On Exercise Could Boost Risk Of Death
In a fitness-crazed land of spin classes and CrossFit gyms, Octavia Zahrt found it can be tough to feel as though you’re doing enough. “When I was in school in London, I felt really good about my activity. Then I moved to Stanford, and everyone around me seems to be so active and going to the gym every day,” she says. “In the San Francisco Bay Area, it’s like 75 percent of people walk around here wearing exercise clothes all day, every day, all the time, and just looking really fit.” (Chen, 7/20)

The Washington Post: Coffee With Viagra-Like Ingredient Recalled After FDA Discovery
Albert Yee said the coffee is everywhere you look in the densely packed vendor stalls along avenues in Malaysian cities: an instant mix with a natural ingredient similar to what’s found in Viagra that helps men with erectile dysfunction. And he wanted a piece of the action. “There are whole streets of it, like tequila in Mexico,” Yee told The Washington Post by phone Thursday, describing how his one-man import business outside of Dallas is now at the center of a nationwide voluntary recall coordinated by the U.S. Food and Drug Administration. (Horton, 7/20)

The New York Times: Long Workdays May Be Bad For Your Heart
Working long hours may increase the risk for atrial fibrillation, or irregular heartbeats that can lead to serious cardiovascular complications, a new study in the European Heart Journal found. Lengthy work hours have been shown in several previous studies to increase the risk for cardiovascular disease. (Bakalar, 7/20)

The Philadelphia Inquirer/Philly.com: New Transplant Rules Help More African Americans Get Kidneys
UNOS data he presented this month show that in 2016, a third of those on the waiting list (31,830 people) were African American, and just over a third of transplant recipients (4,284) were African American.  The rates at which other racial groups were wait-listed and transplanted were also even. There still aren’t enough kidneys for those in need. But the system no longer unintentionally works against blacks as it did in the 1990s, when UNOS data show they made up more than a third of the wait inglist, but got only about a quarter of kidney transplants. (McCullough, 7/20)

The Philadelphia Inquirer/Philly.com: A Philly Pediatrician Looks At Why Too Many Babies Die Suddenly
Philadelphia, like most major cities, has a team that regularly reviews the most tragic events many of us can imagine: the deaths of children. The goal is to look for any patterns that might help prevent these deaths, and the circumstances that allowed them to occur. A recent report from the city’s Department of Public Health shows that we still have a long way to go, specifically when it comes to the number of infants who die at what should be a safe time, when they are put to sleep. (Taylor, 7/20)

The Baltimore Sun: Civil Unrest Related To Freddie Gray Death Caused Depressive Symptoms Among Mothers In Affected Neighborhoods, Study Finds 
Half of the mothers who lived in the neighborhoods wracked by the civil unrest that followed the death of Freddie Gray in 2015 became so stressed by the circumstances that they suffered from insomnia, loss of appetite and other depressive symptoms, according to new research by the University of Maryland School of Medicine. While the mothers weren’t tested to see if they fit the clinical definition of depression, the researchers said the results found that the sight of burning buildings, looting, and the constant blue lights from police cars was enough to have a major emotional impact in neighborhoods located in the six ZIP codes where the brunt of the unrest took place. (McDaniels, 7/20)

Stat: Forget ‘Shark Week’: 7 Things In The Water Swimmers Should Actually Fear
It’s shark season — primarily on cable TV. As the decades-long tradition of “Shark Week” approaches, you can expect once again to hear of “serial killer” sharks, attacks near major coastal cities, and menacing, massive shark swarms. But, as you probably also know, shark attacks are incredibly unlikely. You’re 75 times more likely to be killed by lightening than by a shark. On average, one person dies of a shark attack every other year in the United States. (Wosen, 7/21)

Orlando Sentinel/Tampa Bay Tribune: Preeclampsia’s Impact On Families, Health Care Costs: Despair In A Time Of Delight
Physicians, researchers, activists and legislators across the U.S. are working to understand why preeclampsia is rising faster than other chronic conditions and prevent it. …And according to Dr. Anupam B. Jena, internal medicine physician and professor at Harvard Medical School, and his colleagues, preeclampisia increased “from 2.4% of pregnancies in 1980 to 3.8% of pregnancies in 2010.” (Cheatham, 7/20)

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Reddit Offers Dark Marketplace For Opioids, But Also Support Groups For Those Struggling To Get Clean

The online forum does not allow users to solicit illegal substances, but those seeking opioids find ways to get around those rules. On the other hand, the forums help some form a community to help get them through the difficult process of getting and staying sober.

The New York Times: On Reddit, Intimate Glimpses Of Addicts In Thrall To Opioids
Every day, thousands of people who are consumed by the nation’s opioid epidemic connect on the popular discussion website Reddit. They swap advice on getting high and offer encouragement to those who have managed to stay clean or are teetering between recovery and relapse. Addicts lament the deaths of fellow users who have suddenly stopped posting. And until last week, buyers and sellers could easily find each other, relying on coded messages that communicated their intent. (Zapler and Harris, 7/20)

In other news on the crisis —

The Washington Post: A 10-Year-Old’s Overdose Death Reveals Miami Neighborhood’s Intense Struggle With Opioids
When 10-year-old Alton Banks left the community swimming pool on the last day of his life, he walked past the elementary school where he had just finished fifth grade. He passed a cheery banner that defined a beaten-down inner-city neighborhood trying to will itself into up-and-comingness: “Experience Overtown. Eat, Live, Work, Play.” He walked past a fancy new apartment building under construction, then a long row of ragged homes and chickens clucking freely on sidewalks littered with crushed tall-boy beer cans in brown paper bags. (Sullivan, 7/20)

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Texas Sued Again Over Anti-Abortion Laws

Planned Parenthood and other groups are suing the state over its ban on a second-trimester procedure. Also in Texas, state lawmakers consider further abortion regulations. Elsewhere, women’s reproductive health issues draw headlines in Ohio and Washington state.

Texas Tribune: Abortion Rights Groups Sue Texas Over Procedure Ban
The Center for Reproductive Rights and Planned Parenthood announced on Thursday they’re suing over a provision in Texas’ Senate Bill 8 bill that outlaws dilation and evacuation abortions. In that procedure, a doctor uses surgical instruments to grasp and remove pieces of fetal tissue. (Evans, 7/20)

Austin American-Statesman: Senate Panel To Mull Abortion, Resuscitation Order Bills Friday
The Senate Health and Human Services Committee on Friday is slated to hear a suite of bills to regulate abortions as well as to improve patient protections when it comes to do-not-resuscitate orders. The 8 a.m. hearing will kick off a busy day for lawmakers who will hear some of the most controversial issues for the 30-day special legislative session, including a bill to ban transgender-friendly bathroom bills and diverting public school money to help students pay for private school tuition. (Chang and Silver, 7/20)

Columbus Dispatch: Ohio Right To Life Takes Stricter Stance On Abortions
Republicans in Ohio will have to get a little more conservative to land a coveted Ohio Right to Life endorsement in 2018. The organization drew a hard line Thursday by announcing that candidates must hold a “pro-life” position containing no exceptions to abortion stemming from rape or incest to receive their political backing. (Keiper, 7/20)

Seattle Times: Crisis Pregnancy Centers Must Post Disclaimers Stating ‘Not A Health Care Facility’ Under King County Rule 
Facilities commonly referred to as “crisis pregnancy centers,” many of which are faith-based, will be required to post a sign telling patients they are not health-care facilities, under a new rule approved Thursday by the King County Board of Health. After emotional public testimony, mostly against the signs, nine of 10 board members voted for the rule saying their action was meant to bring transparency and accurate information to pregnant women. (Young, 7/20)

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Viewpoints: The Logistics Of Overlapping Surgeries; ‘A World Without Antibiotics’

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

JAMA: The Evolving Story Of Overlapping Surgery
In December 2015, a Boston Globe investigation of Massachusetts General Hospital (MGH) sparked investigations into concurrent and overlapping surgery. Overlapping surgery refers to operations performed by the same primary surgeon such that the start of one surgery overlaps with the end of another. A qualified practitioner finishes noncritical aspects of the first operation while the primary surgeon moves to the next operation. This is distinct from concurrent surgery, in which “critical parts” of operations for which the primary surgeon is responsible occur during the same time. There is general agreement that concurrent surgery is ethically unacceptable and is prohibited for teaching hospitals under the Medicare Conditions of Participation. Overlapping surgery is common, ranging from having trainees open and close incisions to delegating all aspects of the operation except the critical parts. (Michelle M. Mello and Edward H. Livingston, 7/18)

Real Clear Health: A World Without Antibiotics
Imagine a world without antibiotics. A simple cut or scrape could become life-threatening. Childbirth would be much more dangerous, for both mother and child. We could return to tuberculosis the old-fashioned way: with just a dose of fresh air. If we don’t get antibiotic resistance under control, this world could become our reality again. (Tanya Parish, 7/20)

JAMA Forum: A Bipartisan “Moonshot” In Health: Improving Care For High-Need Patients
Drawing comparisons to a “moonshot” in health care is usually reserved for breakthroughs like curing cancer. Perhaps less hyperbolic, though no less impactful, is the idea of transforming care for high-need patients—people with multiple, and often interconnected, medical, social, and behavioral health needs. Better care for these patients is also a promising approach to reining in health care costs, a bipartisan health policy priority. ( Dave A. Chokshi, 7/19)

JAMA: The Role Of Patient Engagement In Addressing Parents’ Perceptions About Immunizations
Vaccines are frequently cited as one of the greatest successes in the history of public health. The World Health Organization estimates that vaccines for diphtheria, pertussis, tetanus, and measles save between 2 million and 3 million lives annually. However, in recent years, parental resistance toward childhood vaccinations has increased.1 Many parents have become concerned and distrusting of scientific evidence about vaccinations. As a result, cases of vaccine-preventable diseases have reemerged in the United States and other countries. Unvaccinated and undervaccinated individuals are susceptible to disease and increase the risk of transmitting diseases even to those who are fully vaccinated. (Mary C. Politi, Katherine M. Jones and Sydney E. Philpott, 7/18)

USA Today: Congress, Stand Up For Nature Conservation So Nature Can Keep Sustaining Us
Earlier this month, my wife Tracy and I explored on horseback for three days the Big South Fork National River and Recreation Area — a gem of the national park system in east Tennessee. As we rode the trails, experiencing the gently flowing creeks, the quiet wooded paths, the inspiring sounds of birds and kids playing along the way, we delightfully soaked up the present, reflected fondly on the past and what it took to make our experience possible, but also worried about the future. (Bill Frist, 7/18)

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State Highlights: Union In New York May Have Discovered Solution To High Health Costs; ‘Buffer Zone’ Requested Around Kentucky Abortion Clinic

Media outlets offer coverage out of New York, Kentucky, California, Texas, Ohio, Wisconsin and Florida.

The New York Times: A New Brooklyn Clinic For Hotel Workers Who Enjoy No-Cost Care
Tania Corchado was already quite happy with the health care promised her family for the next nine years, a plan that would be the envy of many Americans. But once she got a peek at where it would be delivered — with no paperwork or, even better, a promise of never having to wait for a doctor — she was itching to make some appointments. (McGeehan, 7/19)

Los Angeles Times: Alleged Conduct By Former USC Dean ‘Horrible And Despicable,’ Med School Head Tells Angry Students
Addressing scores of bewildered and at times angry students, the dean of USC’s medical school said Wednesday that the university had launched multiple internal investigations into the conduct of his predecessor after The Times reported that he associated with criminals and drug abusers who told of using methamphetamine and other drugs with him. (Parvini, Pringle, Hamilton and Elmahrek, 7/19)

Houston Chronicle: Memorial Hermann Executive Leaving To Head Ascension Texas 
Craig Cordola, a longtime Memorial Hermann Health System executive, is leaving to head operations at Ascension Texas, a network of hospitals in Austin and Waco, officials with both institutions said Wednesday. Cordola has been with Memorial Hermann for 14 years, most recently as senior vice president of the health system and president of its West Region, which includes its hospitals in Memorial City, Katy and Cypress. (Deam, 7/19)

Houston Chronicle: Hospitals Shift Networks As Health Care Growth Expands 
Three northwest Houston hospitals will soon be under new management, as population growth continues to expand health care in the region. Tomball Regional Medical Center has been purchased by HCA Holdings Inc., said Sylvia Saumell-Baston, marketing manager at Tomball Regional Medical Center. HCA is a Nashville-based provider of health care services, which operates 171 hospitals and 119 surgery centers in the United States and the United Kingdom. (Santana, 7/19)

Columbus Dispatch: Does Booming Columbus Have Enough OB-GYN Doctors?
With some cities across the country bracing for potential OB-GYN shortages, a new study assessing OB-GYN staffing in major metro areas shows that Columbus is well-equipped. The study was released Thursday by Doximity, a professional social network for physicians and advanced-practice clinicians designed to enhance collaboration among health-care professionals. (Smola, 7/20)

Milwaukee Journal Sentinel: State Extends Waukesha Deadline To Fully Comply With Radium Standards For Drinking Water
The Wisconsin Justice Department has agreed to extend a court-ordered deadline for Waukesha to fully comply with federal and state safe drinking water standards for radium until the city switches to a Lake Michigan water supply in 2023… The Waukesha Water Utility is allowed under a Waukesha County Circuit Court order to blend water from deep and shallow wells to meet the standards. (Behm, 7/19)

Tampa Bay Times: Medical Marijuana Chain Opens First Dispensary In St. Petersburg
A medical marijuana chain opened the doors to its first dispensary in the city on Wednesday morning… St. Petersburg will mark Trulieve’s third location in the Tampa Bay area — following openings in Clearwater and Tampa — and its ninth in the state, with dispensaries in Edgewater, Jacksonville, Miami, Pensacola, Tallahassee and Lady Lake. (Putterman, 7/19)

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