First Edition: April 5, 2019

Kaiser Health News: On The Border, Volunteer Doctors Struggle To Provide Stopgap Care To Immigrants
It wasn’t the rash covering Meliza’s feet and legs that worried Dr. José Manuel de la Rosa. What concerned him were the deep bruises beneath. They were a sign she could be experiencing something far more serious than an allergic reaction. Meliza’s mom, Magdalena, told the doctor it started with one little bump. Then two. In no time, the 5-year-old’s legs were swollen and red from the knees down. De la Rosa noticed a bandage-covered cotton ball in the crook of Meliza’s elbow, a remnant of having blood drawn. During their time at the Immigration and Customs Enforcement detention facility, Meliza had been sent to a hospital, Magdalena explained, cradling the child with her 5-foot frame. (Barry-Jester, 4/5)

California Healthline: Exemptions Surge As Parents And Doctors Do ‘Hail Mary’ Around Vaccine Laws
At two public charter schools in the Sonoma wine country town of Sebastopol, more than half the kindergartners received medical exemptions from state-required vaccines last school year. The cities of Berkeley, Santa Cruz, Nevada City, Arcata and Sausalito all had schools in which more than 30% of the kindergartners had been granted such medical exemptions. Nearly three years ago, with infectious disease rates ticking up, California enacted a fiercely contested law barring parents from citing personal or religious beliefs to avoid vaccinating their children. Children could be exempted only on medical grounds, if the shots were harmful to health. (Ostrov, 4/4)

Kaiser Health News: Podcast: KHN’s ‘What The Health’ The GOP’s Health Reform Whiplash
President Donald Trump last week insisted that Republicans would move this year to “repeal and replace” the Affordable Care Act. Or possibly not. Senate Majority Leader Mitch McConnell made it clear the GOP Senate did not plan to spend time on the effort as long as the House is controlled by Democrats. So, the president changed his tune. At least for the moment. Meanwhile, states with legislatures and governors that oppose abortion are racing to pass abortion bans and get them to the Supreme Court, where, they hope, the new majority there will overturn or scale back the current right to abortion. (Rovner, 4/4)

The New York Times: Trump Is Being Vague About What He Wants To Replace Obamacare. But There Are Clues.
We don’t know what will emerge as President Trump’s plan to replace Obamacare, which he has promised to unveil immediately after the 2020 elections. But he has recently endorsed several proposals, and they could provide clues. Over the last two weeks, he has sought to re-emphasize health care as an issue, after a set of bruising legislative defeats in 2017. He directed the Justice Department not to defend the Affordable Care Act against a legal challenge. And he issued statements and tweets calling for Republicans to become “the party of health care,” at a moment when many of his party’s leaders had hoped to focus on different issues. (Sanger-Katz, 4/5)

The Washington Post: Pelosi Questions Whether Medicare-For-All Can Deliver Benefits Of Obamacare
House Speaker Nancy Pelosi questioned whether a health-care proposal embraced by several Democratic presidential candidates would be too expensive and fail to provide the same coverage as the Affordable Care Act. Instead, Pelosi (D-Calif.) suggested Thursday that she would rather build on the 2010 law and is yet to be convinced the Medicare-for-all proposal pushed by many liberals would achieve its purported goals. “I’m agnostic. Show me how you think you can get there,” Pelosi said in an interview with The Washington Post. (Kane and Bade, 4/4)

The New York Times: A Brief History Of The 25-Year Debate Over The Violence Against Women Act
Since it was proposed in the early 1990s as a bill to protect women “on the streets and in homes,” the Violence Against Women Act has been scrutinized by lawmakers, the Supreme Court, civil rights groups and the National Rifle Association, among others. The bill, which President Bill Clinton signed into law in 1994, was designed to protect victims of domestic crimes and reduce the stigma associated with domestic abuse. It must be renewed every few years by Congress, and on Thursday the House approved a bill that would reauthorize the act for a fourth time. (Rueb and Chokshi, 4/4)

The Wall Street Journal: House Democrats Seek To Expand Domestic-Violence Bill
The most contentious change sought by Democrats would expand gun laws to prohibit people convicted of crimes related to dating violence from possessing firearms. Federal law currently prohibits people convicted of or under a restraining order for domestic violence from accessing guns, but that doesn’t apply to dating partners who don’t live together or have children together. “We know victims of domestic violence are more likely to be shot and killed if there’s a weapon in the house,” said Rep. Madeleine Dean (D., Pa.), a member of the House Judiciary Committee. “So anything we can do to keep weapons out of the hands of abusers is something we must do.” (Peterson, 4/4)

Politico: Senators Desperately Try To Sway Trump Amid Disaster Aid Debacle
President Donald Trump received a ring from an unusual caller on Wednesday evening: Democratic Sen. Doug Jones. The vulnerable Alabama Democrat urged Trump to accept more money for Puerto Rico as a way to unstick a $13 billion disaster aid bill that's stalled in the Senate. But Trump so far has been unmoved by pleas from both Democrats and Republicans. (Everett, 4/4)

Modern Healthcare: Senators Want To Intervene In Organ Allocation Policy
Two senators are eying Congress' appropriations authority to influence a contentious debate over a change to national organ distribution policy. The issue was raised Thursday in a Senate health appropriations panel hearing with HHS Secretary Alex Azar. Panel Chair Roy Blunt (R-Mo.) and Sen. Jerry Moran (R-Kan.) are trying to intervene against a sweeping new policy that changes the geography-based system of liver allocation to one that prioritizes the sickest patients. (Luthi, 4/4)

Stat: House Committee To Weigh Bills Aimed At Shedding Light On High Drug Prices
The House Ways and Means Committee is poised to vote on a slate of as-yet-unintroduced drug pricing bills that would require sweeping disclosures from both drug middlemen and drug makers, according to summaries of the legislation obtained by STAT. The committee’s markup, which lobbyists say will be held Tuesday, will follow a flurry of drug pricing action on Capitol Hill in recent days. (Florko, 4/4)

The Hill: Dems Struggle To Unite Behind Drug Price Plan
Divisions are opening up among Democrats as they struggle over how to craft their signature legislation to lower drug prices. Progressive House lawmakers met this week with Speaker Nancy Pelosi's top health care staffer, Wendell Primus, to push for a drug pricing bill authored by Rep. Lloyd Doggett (D-Texas) that would impose severe punishments on pharmaceutical companies that refuse to negotiate prices with the federal government. (Sullivan, 4/5)

The New York Times: Scott Gottlieb Says He Will Return To Conservative Think Tank After Leaving F.D.A.
Dr. Scott Gottlieb plans to work on drug prices and other health policy issues as a part-time fellow at the American Enterprise Institute, after he leaves his post as commissioner of the Food and Drug Administration. His last day at the F.D.A. is Friday. In an interview, Dr. Gottlieb said he was not yet sure what other work he would pursue beyond the half-dozen or so days he’d spend each month at the conservative think tank. Although A.E.I., where Dr. Gottlieb once worked, opposed some regulations of vaping, it did not take part in the vituperative public attacks on Dr. Gottlieb for his work to end the youth vaping epidemic like much of the rest of the Washington conservative establishment. (Kaplan, 4/4)

The Washington Post: FDA’s Gottlieb Heads Back To AEI To Tackle Drug Prices
Gottlieb said he is especially interested in trying to figure out how to pay for innovative treatments — including gene therapies for diseases such as hemophilia and sickle-cell anemia — that will be administered to patients just once but could have lifelong benefits. Some of those treatments are likely to have price tags of several hundred thousand dollars or more. (McGinley, 4/4)

The Hill: Departing FDA Chief To Work At Conservative Think Tank 
"My colleagues and I am thrilled that [Gottlieb] is coming home to AEI," Michael Strain, an AEI resident scholar, tweeted Thursday. "It will be wonderful to have him back at the lunch table. And we will benefit so much from AEI being his intellectual home. I'm excited for the work he will be doing." (Hellmann, 4/4)

The Hill: Trump Administration Urging Alaska To Be First To Apply For Medicaid Block Grant 
The Trump administration has been urging Alaska’s governor to apply to be the first state to change its Medicaid program funding to a block grant. "Your Medicaid administrator, Seema Verma, has urged us to be the first state to receive Medicaid dollars as a block grant," Gov. Mike Dunleavy (R) wrote in a letter to President Trump. "We are eager to do this, but your support of her on this 'first' will keep the proper focus and speed on this application." (Weixel, 4/4)

The New York Times/ProPublica: Memorial Sloan Kettering Leaders Violated Conflict-Of-Interest Rules, Report Finds
Top officials at Memorial Sloan Kettering Cancer Center repeatedly violated policies on financial conflicts of interest, fostering a culture in which profits appeared to take precedence over research and patient care, according to details released on Thursday from an outside review. The findings followed months of turmoil over executives’ ties to drug and health care companies at one of the nation’s leading cancer centers. The review, conducted by the law firm Debevoise & Plimpton, was outlined at a staff meeting on Thursday morning. (Ornstein and Thomas, 4/4)

Reuters: Drug Company Founder Put 'Profits Over Patients' To Push Opioid: U.S. Prosecutor
The founder of Insys Therapeutics Inc put profits over patients' safety by bribing doctors to prescribe an addictive fentanyl spray, fueling the U.S. opioid epidemic, a federal prosecutor said Thursday at the end of a landmark trial. John Kapoor, who served as the drugmaker's chairman, and four colleagues are the first executives of a painkiller manufacturer to face trial for conduct that authorities say was tied to a drug abuse epidemic that kills tens of thousands of Americans each year. (Raymond, 4/4)

The Washington Post: Oklahoma Drops Some Claims Against Opioid Manufacturers
A week after reaching a $270 million settlement with the maker of OxyContin, Oklahoma’s attorney general Thursday dropped some claims in its lawsuit against other drugmakers in an effort to force them to pay the cost of the nation’s deadly opioid crisis. Attorney General Mike Hunter’s office filed a motion that dismisses claims of fraud and deceit, unjust enrichment and violations of the state’s Medicaid laws against about a dozen drugmakers. Hunter said dismissing those claims does not reduce the amount of damages the state is seeking. (Talley, 4/4)

The New York Times: N.Y. Attorney General Sues Manhattan Stem Cell Clinic, Citing Rogue Therapies
Attorney General Letitia James of New York said on Thursday that she had filed a lawsuit against a for-profit stem cell clinic, Park Avenue Stem Cell, claiming it performed unproven, rogue procedures on patients with a wide range of medical conditions, from erectile dysfunction to heart disease. “Misleading vulnerable consumers who are desperate to find a treatment for serious and painful medical conditions is unacceptable, unlawful, and immoral,” Ms. James said in a statement. “We will continue to investigate these types of clinics that shamelessly add to the suffering of these consumers by charging them thousands of dollars for treatments that they know are ineffective.” (Abelson, 4/4)

The Washington Post: Federal, State Officials Crack Down On Stem Cell Clinics
The actions are part of a growing attempt by government officials to regulate a burgeoning industry that critics say has injured at least two dozen patients in recent years and cheated thousands more. Hundreds of clinics have popped up selling stem cell procedures — not covered by insurance, unproven by science and unauthorized by the government — that the clinics claim can treat ailments ranging from creaky knees to Alzheimer’s, Crohn’s disease and multiple sclerosis. Such clinics are “misleading vulnerable consumers who are desperate to find a treatment for serious and painful medical conditions,” New York Attorney General Letitia James (D) said in a statement, calling such behavior “unacceptable, unlawful, and immoral.” (Wan and McGlinley, 4/4)

The Washington Post: CVS Spreads Same-Day Prescription Deliveries To 36 States
CVS Health is expanding same-day prescription deliveries nationwide in the latest push by drugstores to keep customers who don’t want to wait and are doing more shopping online. The drugstore chain says it can deliver medications and other products within a few hours to homes or offices from 6,000 locations. The company started this service, which comes with a fee, in late 2017 in New York and expanded it to several cities last year. Rival Walgreens Boots Alliance Inc. also offers same-day deliveries in major cities and plans to expand this year. It has a partnership with FedEx Corp. to provide next-day deliveries as well. (Murphy, 4/4)

The Wall Street Journal: CVS, Walgreens Look To The Chronically Ill For A Pharmacy Cure
America’s two biggest pharmacy chains are attempting to reverse their sagging fortunes by becoming go-to treatment centers for people with chronic illnesses. CVS Health Corp. and Walgreens Boots Alliance Inc. are remodeling hundreds of stores into medical-service centers targeted at customers with conditions like diabetes, heart disease and hypertension. The idea is to make customers just as likely to stop in for medicine, consultations and lab tests as for lipstick or a candy bar. The need is urgent. Both chains are under tremendous pressure to find new ways to counter slowing revenue from prescription drugs, which drive the bulk of their sales. (Al-Muslim and Terlep, 4/4)

The Wall Street Journal: Three Drug Companies To Pay $122.6 Million To Resolve Kickback Allegations
The Justice Department said on Thursday that three pharmaceutical companies— Jazz Pharmaceuticals PLC, Lundbeck LLC and Alexion Pharmaceuticals Inc.--agreed to pay a total of $122.6 million to resolve allegations they paid drug copays for their pharmaceuticals through copay-assistance foundations. The Justice Department alleged the companies violated the False Claims Act by illegally paying copays required by two federal health programs for the companies’ own products through purportedly independent foundations that the companies used as conduits. The Justice Department also said the claims in the settlement are allegations and there has been no determination of liability. (Dabaie, 4/4)

Stat: Three Drug Makers Settle Allegations Of Using Charities To Pay Kickbacks To Medicare Patients
A federal law known as the Anti-Kickback Statute prohibits pharmaceutical companies from offering or paying, directly or indirectly, any remuneration — which includes money or anything else of value — to induce Medicare or Department of Veterans Affairs patients to purchase their drugs. The agreements come as federal prosecutors are more aggressively pursuing drug makers for wayward programs that provide patients with free medications, copay assistance, or help with navigating insurance coverage, as well as donations that are made to foundations that provide copay assistance. The feds are concerned these arrangements contribute to rising drug prices. (Silverman, 4/4)

The New York Times: Beyond Biden: How Close Is Too Close?
On Wednesday, the former vice president and potential presidential candidate Joe Biden released a video in which he discussed the importance of personal space. “Social norms have begun to change,” he said. “They’ve shifted, and boundaries of protecting personal space have been reset — and I get it.” Mr. Biden was responding to allegations by two women that he made them uncomfortable by coming too close, and by being too familiar and hands-on. His video was, in part, an acknowledgment that the rules of social engagement can change over time — along with perceptions of how much physical contact is appropriate, and where the boundaries of personal space lie. (Carey, 4/4)

The New York Times: Cancer’s Trick For Dodging The Immune System
Cancer immunotherapy drugs, which spur the body’s own immune system to attack tumors, hold great promise but still fail many patients. New research may help explain why some cancers elude the new class of therapies, and offer some clues to a solution. The study, published on Thursday in the journal Cell, focuses on colorectal and prostate cancer. These are among the cancers that seem largely impervious to a key mechanism of immunotherapy drugs. (Richtel, 4/4)

CNN: Before His Suicide, Sandy Hook Dad Sought Origins Of Violence In The Brain
Soon after the December 2012 shooting at the Sandy Hook Elementary school in Connecticut, in which a gunman murdered 20 children and six adults, a question began to haunt the parents of 6-year-old Avielle Richman, one of the victims that day. "I remember asking, 'Why would somebody walk into a school and kill my child?' " Jennifer Hensel told Anderson Cooper in 2013. "I need to know that answer. I have to have that answer." To search for that answer, Hensel and her husband, Jeremy Richman, drew on their unique expertise. (Hodge, 4/4)

Stat: Your Sexual Partners Can Change Your Microbiome, Finds A Study In Mice
People’s sexual partners could impact both their gut microbiome and their immune system, according to a new study from the University of Colorado, Denver, done in mice. Mice that received stool transfers from men who had anal intercourse had different microbiomes than mice whose stool donors only had vaginal intercourse, the study found. When researchers checked the mice’s immune systems, the mice whose stool donors had anal intercourse also showed signs that, were they human, they might have a higher risk of HIV infection. (Sheridan, 4/5)

Stat: Fining One 'Predatory' Publisher Won't End Bad Science In Journals 
Science publishers aren’t supposed to be in the disinformation business. And that’s precisely what a federal judge in Nevada was saying late last month when she slapped OMICS International with a $50 million penalty in a suit brought by the U.S. Federal Trade Commission. Judge Gloria M. Navarro agreed with regulators that OMICS, which publishes hundreds of journals and puts on scientific conferences, was guilty of “numerous express and material misrepresentations regarding their journal publishing practices.” (Marcus, 4/5)

The Wall Street Journal: IVF Often Doesn’t Work. Could An Algorithm Help?
Trying to get pregnant with in vitro fertilization is a gamble. But some fertility doctors think artificial intelligence could help tilt the odds in their patients’ favor. Currently, birth rates from IVF vary widely, from 31% for women age 35 and under to around 3% for women age 42 and older when using fresh embryos, according to the Centers for Disease Control and Prevention. To get pregnant, many women ultimately have to go through multiple rounds of IVF. The process can be time-consuming, emotionally exhausting and expensive. (Mullin, 4/4)

The New York Times: Night Shifts May Raise The Risk Of Miscarriage
Pregnant women who work night shifts may have an increased risk for miscarriage. Researchers studied 22,744 pregnant Danish women, tracking their work schedules and hospital admissions for miscarriage using government databases. The study, in Occupational & Environmental Medicine, found that after eight weeks of pregnancy, women who had worked two or more night shifts during the previous week had a 32 percent increased risk of miscarriage compared with women who did not work nights. Working only one night shift a week did not significantly increase the risk. (Bakalar, 4/5)

The Wall Street Journal: Does Your Smartphone Know If You’re Depressed?
Depressed patients don’t enunciate vowels as much as people who aren’t depressed. Their smiles are smaller. Suicidal individuals who speak in a breathy voice rather than a tense tone are more likely to re-attempt suicide. And patients with psychotic disorders, such as one form of schizophrenia, raise their eyebrows often when averting their gaze. These are among the behavioral biomarkers researchers have established using facial and acoustic analysis. With technology, they measure shifts not always discernible to the eye or ear, such as slight movements of facial muscles as well as subtle changes in tone and language. (Reddy, 4/4)

CNN: Cancer Testing: A 'Holy Grail' Blood Test Could Be The Future
Testing for cancer in blood, urine or even saliva: That approach has been called the "holy grail" for diagnosing the second leading cause of death in the world, and it has been fueling an area of research that continues to raise eyebrows and questions. Doctors can diagnosis cancers in a number of ways, including taking biopsies of tissue where a suspected tumor might be; imaging tests such as X-rays, ultrasounds or MRIs; and screening tests such as endoscopies or colonoscopies. (Howard, 4/3)

The Washington Post: Study Challenges Health Benefits Of Moderate Drinking
It might just be enough to kill your buzz: A new study challenges the idea that a drink or two a day could actually be good for you. In a study conducted in China, the researchers found that moderate drinking slightly raised the risk of stroke and high blood pressure. They weren’t able to figure out, though, whether small amounts of alcohol might also increase the chances of a heart attack. People who have a drink or two a day have long been thought to have a lower risk of stroke and heart problems than nondrinkers. But scientists were unsure if that was because the alcohol was beneficial or if the people who didn’t drink had other health issues. (Cheng, 4/5)

The New York Times: A Diet To Ward Off Gum Disease?
The right diet may improve gum health, a small study has found. German researchers studied 30 people with gingivitis, the inflammation of the gums that can cause redness, swelling and bleeding. A dentist measured the severity of their gingivitis and their levels of plaque, the bacteria-laden film that builds up on the teeth and can cause gum disease. (Bakalar, 4/4)

CNN: Assaults Against Elderly Men In The US Up 75%, Study Finds
The rate of nonfatal assaults on American men 60 and older increased 75.4% between 2002 and 2016, a new government report estimates. For women, the assault rate increased 35.4% between 2007 and 2016. "These findings highlight the need to strengthen violence prevention among older adults," concluded the researchers from the US Centers for Disease Control and Prevention. "Unfortunately, few strategies have been rigorously evaluated." (Scutti, 4/4)

Stateline: Surprise Medical Billing: Some States Ahead Of Feds 
At least 25 states now have laws protecting patients from surprise out-of-network bills, usually for emergency care they received at hospitals or ambulatory surgical centers. At least 20 states are considering legislation this year, according to the National Academy for State Health Policy. While states have provided protections for consumers with commercial health insurance plans, the laws do not apply to self-insured employer-sponsored health plans, which cover 61% of privately insured employees, according to the Kaiser Family Foundation. (Ollove, 4/5)

The Washington Post: Massachusetts To Offset Loss Of Federal Health Clinic Funds
Massachusetts has become the first state to approve money to offset the potential loss of federal funding to women’s reproductive health organizations since the Trump administration adopted a new rule meant to ban federally funded family planning clinics from making abortion referrals. Massachusetts follows Maryland, which in 2017 passed a similar law meant to protect funding for Planned Parenthood. (Leblanc, 4/4)

The Washington Post: Georgia Latest State To Legalize Needle Exchange To Stop HIV
James Lane has a backpack full of syringes slung across his shoulder as he goes to exchange used needles for sterile ones at a small booth set up by an Atlanta needle exchange clinic. The clinic, which operates in an area known as a hot spot for drug use in Atlanta, collects and distributes syringes. It’s among just a few of its kind operating publicly in Georgia and a godsend to Lane, who says he turned to heroin and cocaine to self-medicate for post-traumatic stress. “It’s not the right answer. I know that. But right now I’m able to sustain my life,” he said. He said he also exchanges needles on behalf of five friends who are embarrassed to show up in person. (Mansoor, 4/4)

The Associated Press: Hawaii Legislative Committee Kills Flavored E-Cigarette Ban
Hawaii lawmakers on Thursday killed a proposal that would have banned flavored electronic smoking devices and e-liquids, saying they suspected teenagers would continue to get the products online even if sales were prohibited. Supporters said the bill was needed to fight an alarming surge in teenage vaping. Hawaii would have been the first state in the nation to impose such a ban if it was enacted. (4/4)