The Associated Press: Stable Costs But More Uninsured As 'Obamacare' Sign-Ups Open
More Americans are going without health insurance, and stable premiums plus greater choice next year under the Obama health law aren't likely to reverse that. As sign-up season starts Friday, the Affordable Care Act has shown remarkable resiliency, but it has also fallen short of expectations. Even many Democrats want to move on. (Alonso-Zaldivar, 10/31)

Politico: Obamacare Is Stronger Than Ever — And A Trump-Backed Lawsuit Could Destroy It.
Three years into a presidency that promised to kill Obamacare, the health care law has never been stronger. Millions of people buying coverage during the enrollment period starting Friday will find that average premiums have dropped across the country. When consumers go to HealthCare.gov, they’ll be paying 4 percent less on average for the most popular health plans — with six states reporting a double-digit decline. (Goldberg, 10/31)

Politico: Senate Democrats Fail In Bid To Block Trump’s Obamacare Opt-Out
A largely symbolic attempt to kill a Trump administration policy allowing states to skirt Obamacare mandates fell well short in the Senate on Wednesday, even after Sen. Susan Collins crossed party lines to support the measure. The Senate voted 43-52 to reject the resolution, which aimed to block new guidance that provides states greater leeway to overhaul their insurance markets under the Affordable Care Act. (Cancryn, 10/30)

The Hill: Senate Blocks Effort To Roll Back Trump Administration's ObamaCare Rule
Democrats wanted to overturn a Trump administration rule that makes it easier for states to opt out of certain ObamaCare requirements and prioritize cheaper, less-inclusive plans than ones offered under ObamaCare. Members of the party have termed the plans “junk insurance” because companies can refuse to cover people with pre-existing conditions. (Carney, 10/30)

CBS News: Senate Rejects Democrats' Effort To Undo Some Of Trump's Obamacare Waivers
In a tense congressional hearing last week, Seema Verma, the administrator of the Centers for Medicare and Medicaid Services, spent hours dodging questions about what the contingency plan is if Obamacare isn't upheld. It was her first time appearing before a Democratic-led House committee. At one point, Verma argued that people don't really have protections for preexisting conditions as it stands, because they can't afford to buy health insurance in the first place. Her comments follow reports that Obamacare premiums are expected to drop next year, for the second year in a row. (Cournoyer, 10/30)

Meanwhile, in the states —

Atlanta Journal-Constitution: Georgia Governor To Unveil Health Care Waiver Proposal
Gov. Brian Kemp is set to unveil a proposal Thursday that he has said would create a “reinsurance” program to help stabilize volatile insurance costs on the individual market. The program would require obtaining a waiver from the federal government, asking it to free the state from some standard rules in order to tailor a program officials here think would work best for Georgia. (Bluestein and Hart, 10/30)

Nashville Tennessean: Affordable Care Act Open Enrollment: New Options In Tennessee
Open enrollment for insurance plans on the Affordable Care Act Marketplace starts Nov. 1 and runs through Dec. 15. Here's what to look for in 2020. (Nelson, 10/30)

The Wall Street Journal: Vulnerable House Democrats Wary Of Campaigning For Medicare For All In 2020 Race
Some Democratic lawmakers key to holding the House majority worry that the health-care pledges made by Sens. Elizabeth Warren and Bernie Sanders could hurt their re-election chances. Of the 17 candidates in the Democratic primary race, Mr. Sanders and Ms. Warren have offered the clearest support for a single-payer health-care system, which would largely end private health insurance. Both candidates are consistently in the top three spots in national polls, along with former vice president Joe Biden, who supports giving people the option of buying into a government-run insurance program. (Andrews and Collins, 10/31)

CNN: Elizabeth Warren: 'I'm Glad To Talk To Bernie' About Medicare For All
Sen. Elizabeth Warren said Wednesday that she will "of course" consult with Sen. Bernie Sanders about her soon-to-be-released plan on how to pay for "Medicare for All," but that she has not yet discussed those details with him. "I'm glad to talk to Bernie about this," Warren told reporters after a campaign rally in Durham, New Hampshire. (Krieg and Lee, 10/30)

The New York Times: Why ‘Medicare For All’ Could Both Raise Taxes And Lower Costs
[These charts] compare two leading sets of health care proposals advocated by Democrats running for president. The first, a “public option” plan, is similar to proposals from Joe Biden, Pete Buttigieg and other candidates. It would allow most Americans to buy insurance from the government and make other changes that would enable fewer people to go without coverage, but it would preserve much of the existing health insurance system. The second, a “Medicare for all” plan introduced by Bernie Sanders and endorsed by Elizabeth Warren, would replace most Americans’ current health insurance with a generous government-run plan that covers more benefits. (Sanger-Katz, 10/31)

Des Moines Register: Joe Biden Calls His Health Care Plan 'Medicare For All Who Want It,' Using Pete Buttigieg's Term
Former Vice President Joe Biden on Wednesday referred to his health care plan as "Medicare for All Who Want It," employing the phrase used by Pete Buttigieg, one of his rivals for the Democratic presidential nomination. Biden used the phrase while answering a question from voter Susan Reighard about high health care costs at a town hall in eastern Iowa. (Gruber-Miller, 10/30)

The Hill: Biden Aide: 'Alarming' That Sanders Won't Release Details Of Paying For 'Medicare For All'
Former Vice President Joe Biden’s campaign is attacking Sen. Bernie Sanders (I-Vt.) for saying he does not need to release details on how to pay for "Medicare for All" right away, part of an escalating battle over the issue in the Democratic presidential primary. “It’s alarming that Senator Sanders, who has been up-front for years that Medicare for All would require middle class tax hikes, won’t tell voters 'right now' how much more they will pay in taxes because of his plan,” Biden deputy campaign manager Kate Bedingfield said in a statement. “If not now, then when?” (Sullivan, 10/30)

The Associated Press: Former Juul Exec Alleges Company Shipped Tainted Products
A Juul Labs executive who was fired earlier this year is alleging that the vaping company knowingly shipped 1 million tainted nicotine pods to customers. The allegation comes in a lawsuit filed Tuesday by lawyers representing Siddharth Breja, a one-time finance executive at the e-cigarette maker. The suit claims that Breja was terminated after opposing company practices, including shipping the contaminated flavored pods and not listing expiration dates on Juul products. (Perrone, 10/30)

BuzzFeed News: Juul Shipped At Least A Million Contaminated Nicotine Pods, New Lawsuit Says
Breja says he was worried when the company, in February 2019, wanted to resell pods that were at that point almost one year old. He protested their resale and urged the company to at least include an expiration or “best by” date, or a date of manufacture, on the packaging. The lawsuit claims that then-CEO Kevin Burns shot down that idea, saying, “Half our customers are drunk and vaping like mo-fos, who the fuck is going to notice the quality of our pods.” (Lee, 10/29)

The New York Times: Juul Knowingly Sold Tainted Nicotine Pods, Former Executive Says
Mr. Breja detailed a culture of indifference to safety and quality-control issues among top executives at the company and quoted the then-chief executive Kevin Burns saying at a meeting in February: “Half our customers are drunk and vaping” and wouldn’t “notice the quality of our pods.” Mr. Burns, who left the company in September, issued a statement Wednesday afternoon strongly disputing the quote. “I never said this, or anything remotely close to this, period,” the statement said. “As CEO, I had the company make huge investments in product quality, and the facts will show this claim is absolutely false and pure fiction.” (Kaplan and HOffman, 10/30)

CNBC: Former Juul Executive Sues Over Retaliation, Claims Company Knowingly Sold Tainted Pods
Breja alleges that Burns took a “win-at-all costs” approach to running Juul, telling employees who challenged him that there could “only be one king at Juul,” and that “king” was him. Burns allegedly once told Breja and other executives to “tell that motherf----- that I’ll take him out of the room and shoot him with a shotgun if he challenges my decisions.” (LaVito, 10/30)

The Hill: Lawsuit Claims Juul Knowingly Sold 1 Million 'Contaminated' Pods
In his lawsuit, Breja did not say what the shipped pods were allegedly contaminated with, but he noted they were mint flavored — one of the company's best-selling products. (Hellmann, 10/30)

The Washington Post: Juul Sold 1 Million Contaminated Vaping Pods, Lawsuit Says
Juul is already facing scores of lawsuits and federal scrutiny stemming from allegations it created a youth vaping epidemic. Meanwhile, medical officials are scrambling to unravel a rash of lung illnesses tied to vaping devices that have sickened more than 1,600 users and caused 34 deaths, according to the national Centers for Disease Control and Prevention. Although many of the cases have been linked to black market THC products, public health officials have not ruled out nicotine-based e-cigarettes as a culprit. The panic has caused seven states and several cities, including San Francisco, where Juul is headquartered, to restrict e-cigarettes to various degrees. (Telford, 10/30)

Bloomberg: Fidelity Fund Says Value Of Juul Stake Declined 48%
Fidelity Investments slashed the estimated value of its stake in Juul Labs Inc. amid a government crackdown on the e-cigarette company. The Fidelity Blue Chip Growth Fund disclosed online that the value of its Juul shares plunged about 48% during September. The fund held almost two-thirds of the 4.1 million Juul shares that Fidelity reported owning on a combined basis at the end of July. (Weiss, Alexander and Moore, 10/30)

In other news on the vaping crisis —

CNN: One Town's Flavor Ban Seemed To Work To Cut Youth Vaping
Limiting kids' access to flavored tobacco products like e-cigarettes, smokeless tobacco and cigars seems to work, according to a new study that looks at two towns that took different approaches to vaping in Massachusetts. That will come as good news to the governments that are adding more restrictions on flavors. (Christensen, 10/24)

CNN: More Than 50 Organizations Pressure Trump Administration To Follow Through With Vaping Flavor Ban
More than 50 health and advocacy groups are sending a clear message in letters to US Health and Human Services Secretary Alex Azar and first lady Melania Trump: Stick with the plan that was announced last month that would require e-cigarette companies to take their flavored products off the market, including mint and menthol. According to an announcement Tuesday, the groups are responding to recent media reports that the Trump administration could back down from its earlier stance by including exceptions for mint and menthol. (Rogers and Nedelman, 10/29)

Modern Healthcare: Doctors Call For More Vaping Regulation
Leading medical organizations urged Congress and the Trump administration to increase the regulation of vaping products on Wednesday.The American Medical Association, the American Academy of Pediatrics and the American College of Physicians want more e-cigarette regulation because they're worried about the short- and long-term health consequences of vaping, especially for children. They asked Congress and the administration to ban flavored vaping products, including mint and menthol flavors, and raise the national age to buy tobacco and e-cigarettes to 21. (Brady, 10/30)

NPR: As Big Tobacco Defends Itself In Court, It Gets Help From Academics
In 1998, major tobacco companies reached a historic legal settlement with states that had sued them over the health care costs of smoking-related illnesses. But individual smokers have continued to sue, and to this day the tobacco industry remains tied up in hundreds of court fights with sickened smokers, or with family members who lost a loved one to cancer, heart disease, or other smoking-related illness. These days, tobacco companies no longer try to claim that cigarettes aren't harmful — in fact, in an ironic reversal, a favorite legal defense in current cases is the argument that nearly everyone was aware of the dangers, even back in the 1950s. (Farmer, 10/30)

The Associated Press: US Sued Over Health Insurance Rule For Immigrant Families
A lawsuit Wednesday accused the Trump administration of preventing Americans from bringing their foreign spouses and parents to live with them in the United States by requiring those immigrants to prove they can afford health care before they get visas. Seven U.S. citizens and a nonprofit organization filed the federal lawsuit in Portland, Oregon, over the rule that's set to take effect Sunday. It applies to people seeking immigrant visas from abroad, not those already in the country, and doesn't affect asylum seekers, refugees or children. (Taxin, 10/30)

The Oregonian: Class-Action Suit Filed In Portland To Bar President Trump From Restricting Visas For Immigrants Without Health Insurance
The suit alleges the requirement is arbitrary, an “abuse of discretion” and discriminatory. It asks a judge to declare the proclamation unlawful and bar the Trump administration from putting it into practice. The president signed the proclamation on Oct. 4, saying immigrants applying for U.S. visas will be denied entry into the country unless they can show they’ll be covered by health insurance within 30 days or show they have the financial resources to pay for any medical costs. The measure goes into effect Sunday. (Bernstein, 10/30)

CBS News: Groups Sue To Block Administration From Denying Visas To Immigrants Who Can'T Afford Health Care
"Based on the latest data, up to an estimated 375,000 immigrants are at risk each year of being banned due to a lack of "approved" health insurance coverage, or close to two-thirds of all qualified immigrant visa applicants, many of whom are people of color," the groups wrote in their filing. "This is repugnant not only to our values, but also our nation's laws and Constitution." (Montoya-Galvez, 10/30)

The Hill: Lawsuit Challenges White House Policy Requiring Migrant Health Insurance
"Suspending the entry of potentially two thirds of all legal immigrants to the United States, the Proclamation represents an unprecedented abuse of... power," the suit said. The legal filing also noted, "The Proclamation, like the recent Public Charge Rule, attempts to radically rewrite Congressional decision about which immigrants may enter the country based on wealth considerations." (Frazin, 10/30)

In other news on immigration —

The Associated Press: Top Trump Official Regrets Immigrant Medical Relief Decision
A top federal immigration official said Wednesday that he takes responsibility for and regrets how the Trump administration’s now rescinded decision to stop considering requests from immigrants seeking to defer deportation for medical treatment and other hardships played out. Acting U.S. Citizenship and Immigration Services Director Ken Cuccinelli told congressional lawmakers he was solely responsible for the widely criticized Aug. 7 policy change. (Marcelo, 10/30)

WBUR: ICE Is Checking Immigrant Kids' Teeth To Determine Their Age. Does The Science Hold Up?
Undocumented minors seeking asylum in the U.S might be met with an unusual demand: Border officials want to see their teeth.Many unaccompanied migrants who claim to be under 18 years old must undergo a dental exam, after which some of them may be mistakenly moved to maximum-security facilities with adults instead of youth shelters with other children and teenagers. (Young and Saxena, 10/30)

The Washington Post: How Much Money Will It Take To Undo The Damage From Opioids?
Inside the plaintiffs’ war room, bleary-eyed, caffeinated lawyers worked on what would be one of the most important cases of their careers — the first bellwether trial in the national opioid litigation against the country’s biggest drug companies. Their rented office space across from the federal courthouse was crammed with copy machines, boxes of documents, whiteboards and — to capture the gravity of the work — some World War II-era propaganda posters. (Achenbach, Bernstein, Kornfield, Higham and Horwitz, 10/30)

In other news on the crisis —

Colorado Public Radio: Colorado Lawmaker’s Latest Ideas To Take On Opioids Need About $17M
A bipartisan group of state lawmakers wants a little budget help as Colorado tackles the opioid epidemic. There are five different measures on the table for the next state budget, including money for housing assistance for people coming out of recovery. The proposed cost is nearly $17 million. (Birkeland, 10/30)

The Wall Street Journal: Startups Offer Apps, Digital Tools To Provide Addiction Care
Startups are designing new tools and services that are intended to make access to addiction care easier. With millions of people battling substance abuse and not receiving treatment, venture-backed companies aim to lower those barriers by opening treatment centers and providing online services. They include CleanSlate Centers Inc., which operates outpatient treatment centers in 11 states, and startups that provide digital-treatment programs such as DynamiCare Health Inc. (Gormley, 10/30)

The Washington Post: Missouri Tracked Menstrual Cycles Of Women Seen At Planned Parenthood State Health Director Says
Missouri’s top health official said Tuesday the state monitored detailed personal information about Planned Parenthood patients, in some cases reviewing women’s menstrual cycles, with the aim of identifying those who had failed abortions. Randall Williams, the state health director, said his goal was protecting patient safety. But critics called it an invasion of women’s privacy and demanded his resignation and an investigation by the governor. (Abutaleb and Wax-Thibodeaux, 10/30)

Kansas City Star: MO Health Department’s Spreadsheet Of Abortion Patients Angers Many
On Wednesday medical professionals expressed puzzlement and outrage about the practice, asserting that it served no legitimate purpose. OBGYN Jennifer Villavicencio, a fellow with the American College of Obstetricians and Gynecologists, said what the state did “defies both logic and ethics” and called it “skin-crawling.” “I spent some time thinking about how this director would be using this information in any form that would be meaningful medically and I really can’t think of any,” said Villavicencio, a clinical lecturer with the Department of Obstetrics and Gynecology at the University of Michigan. (Gutierrez and Thomas, 10/30)

The Associated Press: Doctor At Missouri Abortion Clinic Defends Patient Care
The top doctor at Missouri's sole abortion clinic on Wednesday defended its handling of four patients who faced complications — women whose care has been cited by the state as it seeks to revoke the clinic's license. The testimony from Dr. Colleen McNicholas at a hearing that could determine the St. Louis clinic's fate came as the state faced fallout over a revelation a day earlier from Missouri's top health official that he kept a spreadsheet that tracked the menstrual cycles of women who obtained abortions. (Salter, 10/30)

In other women's health news —

MPR: Legal Fight Opens Over State Abortion Restrictions
A unique legal challenge attempting to wipe a slate of Minnesota abortion laws off the books has had its first day in court Wednesday — the opening salvo in a case almost certain to take many months, if not years, to ultimately decide. Groups that brought the case urged a Ramsey County District Court judge to let the fight move ahead, while state attorneys argued that it should be tossed at the start. (Bakst, 10/31)

Health News Florida: Senate President Backs Parental Consent Requirement
Senate President Bill Galvano on Tuesday said he supports legislation that would require minors to get consent from their parents before obtaining abortions, increasing the chances that the proposal will pass during the 2020 session. ...The Florida House passed a parental-consent bill during the 2019 session, but the proposal died in the Senate. (Sexton, 10/30)

Politico Pro: Judge Says Trump 'Conscience' Rule Doesn't Have Force Of Law
A federal judge today criticized the Trump administration for trying to impose an ideologically charged health care “conscience clause” that he contended does not have the force of law. U.S. District Court Judge William Alsup said Congress didn’t give HHS the authority to expand health workers' ability to refuse to provide care on religious or moral grounds. (Colliver, 10/30)

Modern Healthcare: Dems Caution More Medicaid Regs Could Hurt Legitimate Enrollment
Republicans want to curb the number of ineligible people on Medicaid, but Democrats worry that more red tape will make it harder for people to get the coverage they qualify for. The Republican-led Senate Finance Committee's healthcare subcommittee, citing several federal reports, is looking into improper Medicaid payments to states that are enrolling people in the program who aren't eligible. Federal and state spending on Medicaid reached $629 billion in fiscal year 2018. (Brady, 10/30)

Modern Healthcare: Texas Awards Nearly $10 Billion In Medicaid Contracts
Health insurers Anthem, Cigna Corp. and Molina Healthcare stand to lose millions in premium revenue after losing ground in the Texas Medicaid Star+Plus program, a managed care program worth nearly $10 billion in premium revenue for managed care organizations. The Texas Health and Human Services Commission on Tuesday evening announced three-year contract awards for the program, which serves about 525,000 seniors and people who are blind and disabled. Contracts start on Sept. 1, 2020. It's likely that some insurers will challenge the contract awards. (Livingston, 10/30)

Columbus Dispatch: 1.2 Million Ohio Medicaid Recipients May Be In Dark Over Losing Coverage For Walgreens
Walgreens, Ohio’s second-largest pharmacy retailer, and CareSource, the state’s largest Medicaid managed-care plan have cut ties, according to Walgreens executives. Yet, with open enrollment starting on Friday, neither CareSource nor Ohio Medicaid have acknowledged the split, much less notified Medicaid recipients. (Schladen, 10/31)

The Detroit News: Emails: Michigan Health Chief Sought To Suspend Medicaid Work Rules
Fearing more than 100,000 people could lose insurance coverage, Michigan’s health and human services director privately pushed Gov. Gretchen Whitmer’s administration to do an end-around the Legislature to suspend Medicaid work requirements, according to emails obtained by The Detroit News. The law passed last year by the Republican-controlled Legislature requires able-bodied adults participating in Michigan's Medicaid expansion program for low-income residents to work 80 hours a month, get job training or pursue formal education to keep their health coverage. (Mauger, 10/31)

Stat: Insurance, Pharma Figures Spar Over Impact Of Pelosi Drug Pricing Bill
Pharmaceutical and health insurance industry representatives on Wednesday sparred over the potential impacts of legislation to lower drug prices, underscoring an emerging flashpoint here as Congress attempts to broker sweeping pharmaceutical industry reforms. The debate centered on a recent analysis showing Democrats’ signature drug pricing legislation would reduce the number of new drugs approved in the U.S. by eight to 15 in the coming decade. Yet Matt Eyles, the CEO of the insurance lobbying group America’s Health Insurance Plans, disagreed with the projection. (Facher, 10/30)

Politico Pro: White House Aide: Time To Abandon Pelosi Drug Plan, Make Changes To Senate Bill
A bipartisan, bicameral group of lawmakers today reintroduced the CONNECT for Health Act, a wide-ranging bill that expands payment for telehealth services.Some provisions of the bill, originally introduced in 2017, made it into the 2018 Bipartisan Budget Act. They allow Medicare Advantage plans to offer telehealth coverage as a basic benefit, and remove some geographic restrictions for telestroke and end-stage renal disease treatment. (Ravindranath, 10/30)

The Associated Press: Bill Aims To Make Generic Drugs More Affordable For Seniors
U.S. Reps. Annie Kuster of New Hampshire and David McKinley of West Virginia have introduced a bill to make generic drugs more affordable for seniors. Kuster, a Democrat, and McKinley, a Republican, said Wednesday that last year, low-cost generic medications saved Medicare patients over $90 billion, but those savings are at risk because a growing number of these medicines have been moved into the same category as more expensive brand-name drugs. (10/30)

And in other pharmaceutical news —

Reuters: Novartis' Zolgensma Study Halted By FDA Amid Safety Questions
U.S. regulators have halted a trial of Novartis's Zolgensma treatment after an animal study raised safety concerns, the company said on Wednesday, in a setback for the drugmaker's plan to expand its use to older patients. The U.S. Food and Drug Administration's partial hold on the so-called STRONG trial impacts patients aged up to five with spinal muscular atrophy (SMA) who were to receive a higher dose of the gene therapy via a spinal infusion. (10/30)

The Wall Street Journal: Novartis Trial Of World’s Most Expensive Drug Halted Over Safety Concerns
The halt doesn’t affect the use of the therapy in children up to the age of two, which was approved earlier this year, because that version is given through intravenous injection rather than through the spine. Zolgensma provides a working version of the gene at fault in SMA. The news is a setback for Novartis, which hoped the trial targeting older children with type 2 SMA—a milder form of the disease—would pave the way to treat a much broader group of patients. (Roland, 10/30)

Stat: Social Capital First, Science Second: Biotech's Recipe For Success Has Limits
When Laura Indolfi set out to launch a biotech in Boston, she had an idea — and little else. She had never run a company before. She had no practical experience in fundraising. But she was undeterred. In 2014 she founded PanTher Therapeutics, with the goal of turning a postdoctoral side project into a bona-fide drug delivery company. “I took a leap of faith,” she told STAT. (Sheridan, 10/31)

Modern Healthcare: Outcome Health Reaches $70M Settlement With Justice Department
Outcome Health agreed to a $70 million settlement with the Department of Justice to settle a fraud scheme that hobbled the once-high-flying startup. Outcome, which sold advertising to pharmaceutical companies on a network of TV screens in doctors offices, admitted to defrauding advertisers by selling inventory that it did not have, the Justice Department said in a statement. (Pletz, 10/30)

Boston Globe: New MS Drug From Biogen And Alkermes Wins Approval
The Food and Drug Administration approved the oral drug Vumerity to treat relapsing forms of multiple sclerosis, a serious chronic disease that affects the central nervous system. The disorder stems from overactive immune cells that cause inflammation and can result in debilitating symptoms, including difficulty walking and seeing. (Saltzman, 10/30)

ProPublica: The Wrong Goodbye
The neck brace held the unconscious man’s head at a 30-degree angle. The patient’s face — scraped and bruised — was largely covered with a plastic rig holding a breathing tube. Every two hours, hospital staff administered artificial tears. Shortly before midnight on July 13, 2018, police and hospital records show, the victim of a suspected drug overdose had arrived by ambulance at St. Barnabas Hospital in the Bronx. Officers responding to a 911 call had found the man on the ground at the corner of East 174th Street and Bryant Avenue. CPR administered by the officers had managed to produce a pulse. A breathing tube had been inserted on the way to the hospital. (Sexton and Schweber, 10/31)

ProPublica: End-Of-Life Care Laws Were Supposed To Help New Yorkers. They Don’t Always Work.
The case of the wrong person being taken off life support at St. Barnabas Hospital in the Bronx in 2018 is in many ways an aberration, a mix of bad luck, missed opportunities and unlikely coincidences. It thus only touched in a limited way on the complex, emotional and legally fraught issues surrounding end-of-life care — what patients are entitled to, what doctors are obligated to do and who is responsible for making sure everything is done appropriately. (Sexton, 10/31)

The New York Times: How Contaminated Stool Stored In A Freezer Left A Fecal Transplant Patient Dead
In a frank and public act of self-examination, a group of doctors at Massachusetts General Hospital published an article Wednesday in the New England Journal of Medicine detailing the missteps that led to the death of a cancer patient who received a fecal transplant as part of an experimental trial. The man who died, and another who became severely ill, had received fecal matter from a donor whose stool turned out to contain a type of E. coli bacteria that was resistant to multiple antibiotics. (Jacobs, 10/30)

Stat: New Details Emerge In Case Of First Death From Fecal Transplant
The man was a participant in a clinical trial run at Massachusetts General Hospital and received fecal transplant capsules made in November with fecal material from one stool donor, according to a paper published Wednesday in the New England Journal of Medicine. Tests after the man’s death revealed that material contained a rare type of E. coli bacteria. MGH scientists started screening for those kinds of bacteria in January. However, the hospital did not test capsules they’d already produced, researchers disclosed in a paper published in the New England Journal of Medicine. (Sheridan, 10/30)

NBC News: A Fecal Transplant Led To A Patient's Death. Here's What Happened.
“This is a cautionary and sad tale,” Hohmann told NBC News. “It points out some of the important medical issues about immune-compromised [patients] and maybe that changing the microbiome is not always a good idea.” Following the patient death, the FDA announced guidelines requiring that both donors and their stool be screened for multidrug-resistant organisms, including the one implicated in these two cases. But it’s important to remember that there may be other such organisms out there that aren’t being screened for, Hohmann said. “We can increase the ways we look for this, but we can’t 100 percent eliminate it,” she added. (Carroll, 10/30)

Stat: Bill Gates Spends Billions On Global Health. With Alzheimer’s, His Science Adviser Says, Money Is Not The Issue
He’s one of the richest men in the world. He’s sought to eradicate malaria, pledged $10 billion to help fund childhood vaccinations, and poured another $3 billion into fighting HIV. But Bill Gates has been far more restrained in bankrolling research into Alzheimer’s disease. One of the first investments made by the billionaire’s Gates Ventures was in the Dementia Discovery Fund, which invests in novel science. But, all told, Gates’ Alzheimer’s investments only total roughly $100 million, which even Gates’ chief science adviser, Niranjan Bose, acknowledges is a “drop in the bucket.” (Florko, 10/31)

The Wall Street Journal: The Link Between Diet, Exercise And Alzheimer’s
In his 40s and a self-described fitness nut, Stephen Chambers doesn’t seem like someone who would be worrying about Alzheimer’s. But when his father was diagnosed with the disease about five years ago, he went to the Alzheimer’s Prevention Clinic in New York to see what he could do. Though he had no noticeable memory issues, cognitive testing showed less than ideal levels in certain areas. His neurologist told him there were a number of lifestyle changes that might help his cognition and possibly reduce the risk of developing Alzheimer’s disease. (Reddy, 10/30)

CNN: Lifestyle Changes Improved Cognition In People At Risk For Alzheimers, Study Shows
A new study finds personalized lifestyle interventions not only stopped cognitive decline in people at risk for Alzheimer's, but actually increased their memory and thinking skills within 18 months. "Our data actually shows cognitive improvement," said neurologist Dr. Richard Isaacson, founder of the Alzheimer's Prevention Clinic at NewYork-Presbyterian and Weill Cornell Medical Center. (LaMotte, 10/30)

McClatchy: Why Are So Many Iraq, Afghanistan War Veterans Getting Cancer?
Veterans saw a spike in urinary, prostate, liver and blood cancers during nearly two decades of war, and some military families now question whether their exposure to toxic environments is to blame, according to a McClatchy investigation. McClatchy found that the rate of cancer treatments for veterans at Department of Veterans Affairs health care centers increased 61 percent for urinary cancers ⁠— which include bladder, kidney and ureter cancers ⁠— from fiscal year 2000 to 2018. The rate of blood cancer treatments ⁠— lymphoma, myeloma and leukemia ⁠— rose 18 percent in the same period. Liver and pancreatic cancer treatment rates increased 96 percent and prostate cancer treatment rates increased 23 percent. (Copp, Dasgupta and Wieder, 10/30)

The Wall Street Journal: ‘Ebola Is Now A Disease We Can Treat.’ How A Cure Emerged From A War Zone.
The Ebola virus kills in terrifying ways, shutting down the body’s organs and draining victims of the fluids that keep them alive. In outbreaks, it has claimed as many as 9 in 10 patients. In a medical breakthrough that compares to the use of penicillin for war wounds, two new drugs are saving lives from the virus and helping uncover tools against other deadly infectious diseases. They were proven effective in a gold-standard clinical trial conducted by an international coalition of doctors and researchers in the middle of armed violence. (McKay, 10/30)

Bloomberg: Global Fertility Crisis Has Governments Scrambling For An Answer
At least two children per woman—that’s what’s needed to ensure a stable population from generation to generation. In the 1960s, the fertility rate was five live births per woman. By 2017 it had fallen to 2.43, close to that critical threshold.Population growth is vital for the world economy. It means more workers to build homes and produce goods, more consumers to buy things and spark innovation, and more citizens to pay taxes and attract trade. While the world is expected to add more than 3 billion people by 2100, according to the United Nations, that’ll likely be the high point. Falling fertility rates and aging populations will mean serious challenges that will be felt more acutely in some places than others. (Tartar, Recht and Qiu, 10/31)

The New York Times: Mediterranean Diet May Help Ease Some Symptoms Of Depression
A healthy diet may help relieve the symptoms of depression. There is good evidence from observational studies that diet can affect mood, and now a randomized controlled trial suggests that healthy eating can modestly improve clinical levels of depression. (Bakalar, 10/30)

PBS NewsHour: Why Minority Representation In Medical Research Is A Matter Of Life And Death
U.S. racial and ethnic diversity is ever increasing, but the medical representation of minority groups is not. A recent review of government-funded cancer research studies found that participants were disproportionately white, and fewer than 2 percent of these clinical trials focused on minorities specifically. (Wise and Kane, 10/30)

The New York Times: Room For Everyone At The Table
Steve Palmer has opened dozens of restaurants over the course of his career. He knows how to coax the best flavors out of a piece of fish, how to light a restaurant so all the customers look good and how to make a couple celebrating an anniversary feel special. But 18 years ago, he was so strung out on alcohol and cocaine that his boss at the restaurant where he worked gave him an ultimatum: Get treatment or get fired. (Severson, 10/31)

Stat: The World Health Organization's Emergencies Chief Is Put To The Test
Walk into Mike Ryan’s office here on the orderly campus of the World Health Organization and you are in a train station. Staff members rush in to see the agency’s ruddy, fast-talking emergencies chief to seek guidance on the various disease outbreaks they are trying to end. People crowd into the office where a pair of assistants are stationed, waiting their turn. When Ryan’s door is closed, it’s not long before a hand is rapping on the other side. (Branswell, 10/30)

The CT Mirror: Pedestrian Advocates Urge Commission To Consider "National Crisis" When Searching For Next Chief State's Attorney
The commission held a public forum in mid-October to gauge what qualities it should look for when appointing Connecticut’s next chief state’s attorney. Many see the search as an opportunity for Connecticut to make even further strides on criminal justice reform and cut down on prison populations and racial disparities in the state’s justice system. There also is significant public interest in a chief state’s attorney who makes the roads safer for pedestrians and cyclists. (Lyons, 10/31)

The Associated Press: After Calorie Counts Go On Fast-Food Menus, Orders Dip A Bit
Soon after calories were posted on fast-food menus, people cut back a little bit on what they ordered. But it didn't last. Customers at fast-food chains in Louisiana, Mississippi and Texas ordered an average of 60 fewer calories per transaction in the weeks after the figures were displayed, according to a study published Wednesday in the medical journal, BMJ. That amounted to a 4% drop, and declines came largely from extras such as fries and desserts. (10/30)

Miami Herald: Ranitidine Syrup, TopCare Tablets Recalled For Carcinogen
Prescription ranitidine syrup, a form of the digestive aid sold over the counter as Zantac, has been recalled along with another over-the-counter brand sold at Winn-Dixie, Hy-Vee and other supermarkets. As with the previous recalls of versions of ranitidine, the problem is probable carcinogen NDMA (N-Nitrosodimethylamine). Neither private company testing nor the FDA testing has determined how much NDMA raises the chances of the consumer getting cancer. (Neal, 10/30)

Sacramento Bee: Wildfires, Power Outages Take Toll On California Healthcare
Healthcare leaders told The Bee that they are confronting a level of disruption to delivering care and running their businesses that they have never seen in their careers as a result of the California wildfires and Pacific Gas and Electric Co.’s planned blackouts. (Anderson, 10/30)

The New York Times: ‘Devil Winds’ Drive Southern California Fires
The downsloping gusts that begin inland and blow toward the ocean in autumn and winter bring with them warmth and dread in equal measure. They howl through the canyons of Santa Monica and whip the palm trees that line the streets of Los Angeles, driving up dust and fraying nerves. The winds, known as the Santa Anas, loom large over the collective psyche of Southern California. They have also been the defining antagonist in this season of fire, a sinister reminder that wind has the power to provoke fear and present danger in an instant. (Arango, 10/30)

The Wall Street Journal: To Fight California Fires, Firefighters Seek To Hold The Line In Sonoma
For Theodore Hiner Jr. and his crew of Grizzly Firefighters, the mission of the day was to fight any re-ignitions of the Kincade Fire literally by hand, chain-sawing brush, digging out underground flames and hand-pumping water into fresh ditches. To find underground fires amid an unseen labyrinth of roots, the 20-person crew used the backs of their bare hands to gauge the ashen earth’s temperature. “Hot spot!” they cried when an underground fire was found, and the digging began. (Lazo, 10/30)

Los Angeles Times: Extreme Winds Fuel Explosive Fire Near Reagan Library
The biggest battle Wednesday was in Ventura County, where 800 firefighters trying to control the wind-whipped fire surrounding the presidential library were stymied by intense gusts that sent embers flying far beyond the body of the blaze. Helicopters repeatedly dropped loads of water around the Reagan complex, which is perched atop a hill blanketed in dense brush, amid 60-mph winds that were strong enough to knock a person off balance. (Winton, Cosgrove, Miller and Fry, 10/30)

The Associated Press: Anger Grows As Utility Struggles To Get Its Blackouts Right
As Pacific Gas & Electric deliberately shut off power to homes and businesses to prevent wildfires, it has failed to communicate with California officials, given conflicting accounts about when the lights would go out and advised people to get information “the old-fashioned way, through calling on a landline.” (Cooper and Williams, 10/30)

ProPublica/The Times-Picayune: Welcome To 'Cancer Alley,' Where Toxic Air Is About To Get Worse
Over a half-century, Hazel Schexnayder saw this riverside hamlet transformed from a collection of old plantations, tin-roofed shacks and verdant cornfields into an industrial juggernaut. By the early 1990s, she’d had enough of the towering chemical plants and their mysterious white plumes, the roadside ditches oozing with blue fluid, the air that smelled of rotten eggs and nail-polish remover, the neighbors suffering miscarriages and dying of cancer. (Younes, Baurick and Meiners, 10/30)

ProPublica: Why Louisiana’s Air Quality Is Going From Bad To Worse, In 3 Charts
The chemical industry is growing rapidly in Louisiana at the same time that the state is backsliding when it comes to toxic levels of cancer-causing chemicals in the air. We investigated. Here’s what we found. (Younes, 10/30)

Stateline: Rural And Safety Net Hospitals Prepare For Cut In Federal Support
Absent action by Congress in the next three weeks, Dr. Michael Waldrum, CEO of Vidant Health, is going to have to figure out what medical services to deny hard-pressed communities in rural eastern North Carolina. “It runs the gamut,” Waldrum said in an interview last week. “Do we close hospitals? Do we close services within hospitals?” With an operating margin of less than 0.5% — comparable to most other rural and safety net hospitals — and an expected loss of $7.7 million in federal money this year, which would double next year, Vidant, a multi-hospital safety net health system, could drop into the red. (Ollove, 10/31)

Dallas Morning News: East Texas Doctor Accused Of ‘Fertility Fraud’ May Face Unethical Conduct, But Not Treatment, Investigation
Brushing past its staff’s initial reluctance, the Texas Medical Board voted last month to investigate an East Texas fertility doctor for possible “unprofessional and unethical conduct” for using his own sperm to inseminate a woman who selected another donor. On Oct. 18, the board voted to reopen and continue an investigation of Nacogdoches obstetrician-gynecologist Kim McMorries. Over the summer, an out-of-state expert on fertility fraud complained to the regulatory agency that McMorries’ actions – even for the mid-1980s -- didn’t meet the required standard of care of infertile women. (Garrett, 10/30)

San Francisco Chronicle: California Has One Of The Country’s Lowest Rates Of Food Stamp Enrollment. Could Text Messages Help?
California has one of the lowest rates of enrollment in the Supplemental Nutrition Assistance Program, or SNAP, in the country. Could text messages help change that? Only 72 percent of Californians who qualify for SNAP — which is called CalFresh in the state — receive the benefit, which most experts chalk up to a convoluted application process. (Duggan, 10/30)

North Carolina Health News: NC Jail Suicides And Fatal ODs On The Rise
Suicide and drug overdose deaths are on the rise in North Carolina jails, according to a recent report released by Disability Rights NC. There have been 17 suicides so far this year, up from 12 in 2018. And the number of jail overdose deaths more than doubled from 2017 to 2018. About 80 percent of jail suicide deaths occured within an inmate’s first 12 days in jail. These were people who had been arrested, but not yet been convicted of a crime. (Knopf, 10/31)

The CT Mirror: More CT Hospitals End 2018 In The Black, But Financial Picture Mixed
A majority of Connecticut’s acute care hospitals – 24 of the 28 – ended the fiscal year in the black, up from 23 the year before, according to a report released Wednesday by the state’s Office of Health Strategy. But the average total margin – which takes into account operating revenues and non-operating revenues that include investments, endowments and donations – dropped from 7.05% in 2017 to 5.92 % last year. (Carlesso and Phaneuf, 10/30)

Atlanta Journal-Constitution: Georgia Lawmaker: Make Aiding Gender Transition Of Minors A Felony
A Cobb County lawmaker wants to make it a felony for medical professionals to help a minor with gender transition. State Rep. Ginny Ehrhart, R-Powder Springs, said the legislation aims to protect children from having irreversible procedures done when they are young. Current law requires a parent to consent to surgery or for a minor to be prescribed medication. (Prabhu, 10/30)

Concord (N.H.) Monitor: Report: Child Safety Requires Improving Problems Within, And Outside Of, DCYF 
While it’s true that more staff is needed in the state’s system overseeing the safety of children, a news analysis said dealing with serious family problems in New Hampshire requires a rethinking of systems ranging from health care to law enforcement, including the habits of other people. “It’s really disheartening to hear people on television say, ‘Oh yeah, there’s always been a problem at that house,’ but they haven’t ever called it in,” Moira O’Neill, director of the Office of the Child Advocate, said in an interview Wednesday, echoing concerns raised in the office’s first major report on critical cases. (Brooks, 10/30)

New Hampshire Public Radio: Communication Problems, Staffing Shortages, And Public Image Hinder DCYF, Child Advocate Finds
A new report by the Office of the Child Advocate says the state agency tasked with investigating allegations of child abuse is hampered by poor communication, chronic understaffing, and an outdated, inefficient records keeping system. The report, which examines systemic factors affecting child safety in New Hampshire, focuses on the deaths of five children and one parent whose families had contact with the Division for Children, Youth and Families since February 2018. (Moon, 10/30)

Cleveland Plain Dealer: Ohio Won’t Hold Any Executions In 2019 As Gov. Mike DeWine Issues More Reprieves
Ohio will not hold any executions in 2019, as Gov. Mike DeWine on Wednesday delayed execution dates for death-row inmates James Galen Hanna and Kareem Jackson because of ongoing issues with finding execution drugs. ...The reason given for the reprieves is the state’s continuing problems with finding a pharmaceutical company willing to sell drugs for use in executions. (Pelzer, 10/30)

North Carolina Health News: Does NC Help Children Affected By FASD?
The courtroom on the seventh floor of the Wake County Justice Center was quiet as Judge Vince Rozier read a report from the mother of the 28-year-old defendant awaiting sentencing. That mother, Theresa Morris-Brown, is a petite 63-year-old woman with a gargantuan will to help the man she welcomed into her life as a 4-year-old. The boy, now grown, was arrested in June for pushing her to the ground and wrapping a belt around her neck. (Blythe, 10/30)

Texas Tribune: As Texas Gets Ready To Clear Some Austin Highway Encampments, Gov. Abbott And Mayor Adler At Odds Over Homeless Residents
Ever since the Austin City Council relaxed some ordinances regulating the public spaces in which people can camp, the governor has criticized local officials and pointed to “reports of violence, used needles and feces,” mentioning potential public health risks associated with people experiencing homelessness. But Austin officials say crime and health data disprove Abbott’s narrative. (Rich and Tatum, 10/31)

The New York Times: Why Children (And Pregnant Women) May Want To Eat More Fish
Does fish make children smarter? There is some evidence that it might. In two reviews of data from 44 studies, researchers have concluded that eating seafood during pregnancy and childhood is associated with improved performance on tests of mental skills. (Bakalar, 10/30)

JAMA Internal Medicine: Physician And Trainee Experiences With Patient Bias
In this qualitative study of convenience samples of 50 trainees and physicians, participants reported a wide range of experiences with biased patient behavior ranging from belittling comments to outright rejection of care. Participants described a large negative effect on their emotional well-being and the clinical care environment, and many described uncertainty regarding appropriate and effective ways to respond to these encounters. (Wheeler et al, 10/28)

American Academy Of Pediatrics: Food Insecurity, Health, And Development In Children Under Age Four Years
Among children <4 years of age, food insecurity is associated with fair or poor health and developmental risk, not with anthropometry. Findings support American Academy of Pediatrics recommendations for food insecurity screening and referrals to help families cope with economic hardships and associated stressors. (Drennen et al, 10/1)

Urban Institute: Administration’s SNAP Proposal Could Affect Free School Lunch—And Now We Know How Much
In an earlier blog post, I highlighted how changes to the Supplemental Nutrition Assistance Program (SNAP) could limit access to free school lunches, but at the time, we had little data on just how many children would be affected. Now, Urban Institute researchers have run the numbers, and they show the consequences could be further reaching than initially estimated because of effects on schools that use the Community Eligibility Provision (CEP) to provide free lunch to all students. CEP, which has been linked to health (PDF), behavioral, and academic gains, relies on the number of students certified as free-lunch eligible through participation in SNAP or programs like it. (Tilsley, 10/30)

Bloomberg: Sanders-Warren Medicare For All? Be Ready To Wait In Line 
“Medicare for All” continues to be a top issue in the Democratic presidential campaign, and President Donald Trump isn’t waiting to see who wins to start attacking it. So far, the Democratic debate has centered on how a huge expansion of Medicare would affect private health insurance and middle-class taxes. But Trump is raising another big issue: wait times. “Medicare-for-All would force patients to face massive wait times for treatments and destroy access to quality care,” declares the White House website.Like everything else in the health-care debate, this is a disputed point. Thomas Waldrop, a health-care analyst with the Center for American Progress, a liberal group, has responded to Trump: “Wait time concerns amount to little more than fearmongering by those who oppose expansion of coverage.” (Ramesh Ponnuru, 10/30)

The Wall Street Journal: Regulators Wonder If Cancer Patients ‘Need’ New Treatments
Breakthroughs against cancer are devilishly hard to come by, as millions of Americans learn firsthand each year. Yet regulators in one state want to use an outdated law to bar desperate cancer patients from the latest hard-won treatment. The new therapy is called CAR-T, short for chimeric antigen receptor T-cells. A doctor removes the patient’s own T-cells—a type of immune-system cell—sends them off to a laboratory to be converted into cancer-fighting cells, and reinjects them into the patient. (Matthew Mitchell and Anna Parsons, 10/30)

Stat: The Cancer In Cancer Medicine: Pharma Money Paid To Doctors 
Americans are rightly furious about the high and unsustainable price of cancer drugs, which now routinely cost more than $100,000 per year of therapy. Those prices are made worse by the fact that most cancer drugs offer only modest benefits — one study put the median benefit at 2.1 extra months of life — along with the fact that expert physicians frequently recommend these drugs for off-label uses, meaning using a drug for a purpose it was not initially approved for. The House of Representatives, the Senate, presidential candidates, and even the president have floated proposals to tackle drug prices. While all contain good ideas, none address one of the elephants in the room: the experts who tell doctors how to use these medications. (Vinay Prasad, 10/30)

St. Louis Post Dispatch: Tracking Menstrual Cycles To Attack Abortion Rights Merits Investigation
In their relentless quest to build a case against Planned Parenthood and deny Missouri women the right to control their own bodies, state officials have gone full “Handmaid’s Tale,” literally tracking women’s menstrual cycles on a spreadsheet without their knowledge. News of this outrage, casually revealed during a hearing Tuesday, should put to rest any notion that this persecution of the state’s only abortion clinic is actually about concern for women’s health. It’s about using the power of the state to violate women’s medical privacy while promoting the extremist ideological agenda of ruling Republicans. (10/30)

Los Angeles Times: Should A Right To An Abortion Be A Federal Law? Of Course It Should
In the 46 years since the Supreme Court’s decision in Roe vs. Wade affirmed a woman’s constitutional right to an abortion, opponents of the ruling have steadfastly refused to accept it, fighting a never-ending battle to chip away at its protections or to overturn it altogether. State legislatures, defiantly and recklessly, have passed hundreds of bills in the last decade alone to limit the access to abortion that the Supreme Court has granted and reaffirmed over the course of three landmark decisions on abortion beginning with Roe in 1973. The latest was the high court’s 2016 decision overturning a Texas law that set unnecessary and unduly burdensome requirements for abortion clinics and for doctors working in them. (10/31)

The Washington Post: The Treatment Of Women In Childbirth Is A Scandal. We Must Change It Together. 
Issues such as abortion and the battle over the Supreme Court confirmation of Justice Brett M. Kavanaugh have left American women bitterly divided. But liberal feminists and their potential conservative allies can, and should, unite around a common cause: that of women who are being abused and unnecessarily scarred in childbirth, both emotionally and physically. The fight to overhaul how health-care systems and providers treat women as they become mothers should be the unifying feminist battle of our time. A dramatic illustration of just how bad it can be for laboring women in some countries came last week when the Lancet, a leading medical journal, released a report documenting cruel treatment women experience during childbirth in Asia and Africa. (Bethany Mandel, 10/29)

Stat: Health Information Exchanges Have Evolved. They Now Cultivate Data.
"Data is the new oil,” British data scientist Clive Humby once said. “It’s valuable, but if unrefined it cannot really be used.”I thought about that line recently when I met with the chief medical officer of a large health system. “I don’t want more data,” she told me, “we are already drowning in it.” Across the nation, we are making progress in exchanging health data. But if it isn’t refined and turned into insight, it does no one any good. That’s why health information exchanges (HIEs) — platforms that help coordinate care by allowing data sharing among various provider organizations and health plans — are stepping into a new, important role focused on bridging the gap between data overload and a data-driven, learning health care system. (Claudia Williams, 10/31)

Stat: The EMR Has Changed The Doctor-Patient Duet Into A MÉNage-à-Trois
You would have thought that my hospital was preparing for the imminent coming of the messiah. Digital countdown clocks posted around the hospital ticked down the weeks, days, minutes, and seconds till the vaunted day. For months, every medical, logistical, academic, and intrapersonal transaction was beholden to April 1. That the hospital had chosen April Fools’ Day to transition hundreds of thousands of patients and their clinicians to a new electronic medical record (EMR) was either a cosmic oversight or some techie’s idea of wit. (Danielle Ofri, 10/31)

Des Moines Register: Iowa Should Learn From Arkansas; Say No To Medicaid Work Requirements
Every once in a while you get to see what happens when a bad policy idea becomes reality. Look no further than Arkansas, which enacted work requirements for Medicaid recipients. Iowa’s Republican lawmakers and governor should take an especially close look. In 2018, Arkansas embarked on an experiment to become the only state to fully implement Medicaid work requirements. Medicaid, funded by federal and state governments, provides health insurance for low-income Americans and ensures health providers who treat poor patients are compensated. (10/30)