First Edition: April 9, 2019

Kaiser Health News: Consumers Rejected Drug Plan That Mirrors Trump Administration Proposal
Unraveling how much of a prescription drug price gets swallowed by “middlemen” is at the forefront of Tuesday’s drug price hearing in the Senate. One thing bound to come up: rebates. Both major political parties have shown interest in remedying high drug prices, and drugmakers have bemoaned how rebates to middlemen keep them from reaping every dollar associated with those price tags. (Lupkin, 4/9)

California Healthline: Big Soda Pours Big Bucks Into California’s Capitol
Dinners at an expensive restaurant in Maui — with ocean views. Tickets to professional sports games. A free screening of “Black Panther” at a Sacramento IMAX theater. And a $250,000 donation to a group that funds the governor’s travel. That’s just a sampling of the $11.8 million that soft drink companies and their lobbyists spent at the state and local levels in the past two years in California to block proposals such as taxing sugary beverages and slapping health warnings on their drinks, a California Healthline analysis found. “They exercise extraordinary influence in this building,” state Sen. Bill Monning (D-Carmel) said of the industry. “We don’t underestimate the power of the opposition.” (Young, 4/8)

NPR: Senators Set To Grill PBMs About Drug Costs
Consumers, lawmakers and industry players all seem to agree that prescription drugs prices are too high. What they can't always agree on is whom to blame. On Tuesday, though, fingers are expected to point toward pharmacy benefit managers, the industry's mysterious middlemen. The Senate Finance Committee will hear from executives from the biggest pharmacy benefit managers, led by CVS Caremark and Cigna's Express Scripts. (Kodjak, 4/8)

Bloomberg: Drug Middlemen Face State Probes Over ‘Complex’ Pricing System 
Several states are probing pharmacy-benefit managers’ business practices in government-sponsored health programs, adding to the scrutiny the middlemen face in Washington for their role in the cost of drugs. At least three state attorneys general are investigating PBMs, in addition to other state probes looking into how the companies contract with Medicaid and other programs. CVS Health Corp., Cigna Corp.’s Express Scripts unit and UnitedHealth Group Inc., which dominate the PBM market, are scheduled to appear before the Senate Finance Committee in Washington Tuesday to discuss their role as the nation grapples with soaring drug prices. (Langreth, 4/9)

The Hill: Sanders To Roll Out Updated 'Medicare For All' Proposal Wednesday
Sen. Bernie Sanders (I-Vt.) will roll out an updated version of his "Medicare for all" plan Wednesday on Capitol Hill. Sanders, who is again seeking the Democratic nomination for president, will unveil the bill alongside Senate co-sponsors, some of whom are also candidates for president. Sanders last introduced the bill in 2017, with support from presidential candidates Sens. Cory Booker (D-N.J.), Kirsten Gillibrand (D-N.Y.), Kamala Harris (D-Calif.) and Elizabeth Warren (D-Mass.). (Hellmann, 4/8)

Politico: DOJ Asks For Speedy Hearing In Case That Could Kill Obamacare
The Trump administration wants oral arguments in the appeal of a lower court ruling invalidating Obamacare to take place the week of July 8. The Justice Department filed a motion to expedite oral arguments in the 5th Circuit Court of Appeals Monday. It indicated that its proposed timeline is unopposed by the other parties in the case. Sixteen largely Democratic-led states and the District of Columbia have appealed the December ruling, which has been put on hold while the case proceeds. (Demko, 4/8)

The New York Times: Trump Signals Even Fiercer Immigration Agenda, With A Possible Return Of Family Separations
President Trump’s purge of the nation’s top homeland security officials is a sign that he is preparing to unleash an even fiercer assault on immigration, including a possible return of his controversial decision last summer to separate migrant children from their parents, current and former administration officials said Monday. Mr. Trump shook up the ranks of his top immigration officials after spending months demanding that they take tougher action to stop the surge in migrant families at the border and seething about what he considers their overly legalistic refusals to do what he has said was necessary. (Shear, Kanno-Youngs and Haberman, 4/8)

The Wall Street Journal: White House Seeks Tighter Grip On Immigration Policy
Mr. Trump has also told aides he wants to reinstate his family-separation policy, which provoked a political outcry when it was implemented last spring, in order to deter would-be migrants. An administration official said Mr. Trump recently told Stephen Miller, one of his most hard-line advisers: “You’re in charge” of the administration’s immigration policy. Immigration policy was a central plank of Mr. Trump’s 2016 campaign, and the Republican president has indicated he plans to run on the issue again as he seeks re-election next year. (Ballhaus and Salama, 4/8)

The Washington Post: Trump Removes Secret Service Director As Purge Of DHS Leadership Widens
President Trump continued to dismantle the leadership of the nation’s top domestic security agency Monday, as the White House announced the imminent removal of U.S. Secret Service Director Randolph D. “Tex” Alles, the latest in a series of head-spinning departures from the Department of Homeland Security. A day after Secretary Kirstjen Nielsen was forced to step aside following a White House meeting with Trump, senior DHS officials remained in a fog about the fate of their agency’s leaders, expecting more firings as part of a widening purge. (Miroff, Olorunnipa, Dawsey and Leonnig, 4/8)

Politico: Trump’s DHS Purge Floors Republicans
President Donald Trump’s congressional allies are alarmed by his purge at the Department of Homeland Security — urging him not to fire more top officials and warning him how hard it will be to solve twin crises at the border and the federal agencies overseeing immigration policy. (Everett, Bresnahan and Zanona, 4/8)

The Hill: HHS Considering Moving Migrant Children To New Shelters In Dallas, Atlanta: Report
The Department of Health and Human Services (HHS) is reportedly considering moving migrant children to new shelters in cities including Dallas and Atlanta in response to overcrowded shelters that are currently housing migrants. The Dallas Morning News reported Monday that HHS is looking at vacant properties in several cities in Texas, including Dallas, Fort Worth, San Antonio and Houston. The agency is also looking at Phoenix and Atlanta, the newspaper reported. (Burke, 4/8)

The Washington Post: CDC Finds 78 New Measles Cases As Outbreak Sprints Toward Record And Experts Blame Anti-Vaxxers
For the second week in a row, U.S. health officials added dozens of new reports to the year’s list of confirmed measles cases, bringing the total to 465 — already the highest number in the past five years. It’s another significant milepost on the road to what will probably become a record outbreak after vaccines led to the disease’s “elimination” in the United States. The number of people sickened by the highly contagious, occasionally deadly disease climbed by 78 during the first week of April, as four more states reported their first cases of 2019. Now, measles has been found in more than a third of U.S. states — up and down both coasts, and across the plains, the Midwest and the South — with most of the illnesses occurring in children. (Thebault, 4/8)

The Wall Street Journal: Spread Of Measles Accelerates, With U.S. Cases Rising To 465 So Far This Year
Most of the cases involve children, the agency said. And though the cases span 19 states, many are tied to an outbreak among Orthodox Jews in New York City. The twin developments suggest the measles virus, which authorities declared eliminated in the U.S. in 2000, has surged as a result of exposures overseas and then been transmitted among populations that have shunned vaccinations. Health authorities are now trying both to halt the virus’s spread and correct misperceptions about vaccinations. (McKay, West and Abbott, 4/8)

The Associated Press: US Measles Tally Hits 465, With Most Illnesses In Kids
Outbreaks have hit several states, including California, Michigan and New Jersey. New York City accounted for about two-thirds of the U.S. cases reported last week. The Centers for Disease Control and Prevention updated the numbers Monday. Roughly 80% of the cases are age 19 or younger. The CDC recommends that all children get two doses of measles vaccine. It says the vaccine is 97% effective. (Stobbe, 4/8)

The Wall Street Journal: Measles Q&A: Disease Is Serious, But Preventable
Measles symptoms appear roughly seven to 14 days after a person is infected and initially include a high fever, cough, runny nose and conjunctivitis. Tiny white spots, called Koplik spots, typically appear inside the person’s mouth two or three days later, followed by a rash of flat, red spots that most people typically associate with measles. The person’s fever sometimes spikes, and conditions including ear infections, diarrhea and more severe and potentially long-term complications can also emerge. (Abbott, 4/8)

The Washington Post: Missouri Bill Would Bar Discrimination For Not Vaccinating
A panel of Missouri lawmakers on Monday considered enacting a ban on discrimination against unvaccinated children, an effort that comes as other states look to increase immunization amid disease outbreaks. Parents testified to lawmakers that their unimmunized children were turned away from daycares and doctors. Republican Rep. Lynn Morris, a pharmacist from southwest Missouri, said parents are being pressured to vaccinate their children. (Ballentine, 4/8)

Modern Healthcare: Hospital Workplace Violence Needs Federal Attention: Sen. Blunt
A Republican senator is pressing federal agencies to get together on a regulatory plan for how hospital employees can deal with violent outbursts and confrontations inside hospitals. Sen. Roy Blunt (R-Mo.), who chairs the Senate health appropriations subcommittee, told an audience at the American Hospital Association's annual meeting on Monday that he discussed a now-overdue interagency report on the issue with HHS Secretary Alex Azar. (Luthi, 4/8)

NPR: Facing Escalating Workplace Violence, Hospital Employees Have Had Enough
Across the U.S., many doctors, nurses and other health care workers have remained silent about what is being called an epidemic of violence against them. The violent outbursts come from patients and patients' families. And for years, it's been considered part of the job. When you visit the Cleveland Clinic emergency department these days — whether as a patient, family member or friend — a large sign directs you toward a metal detector. (Harris-Taylor, 4/8)

NPR: How HHS Secretary Alex Azar Reconciles Medicaid Cuts With Stopping The Spread Of HIV
In his State of the Union address this year, President Trump announced an initiative "to eliminate the HIV epidemic in the United States within 10 years." The man who pitched the president on this idea is Alex Azar, the Secretary of the Department of Health and Human Services. "We have the data that tells us where we have to focus, we have the tools, we have the leadership — this is an historic opportunity," Azar told NPR's Ari Shapiro Monday. "I told the president about this, and he immediately grabbed onto this and saw the potential to alleviate suffering for hundreds of thousands of individuals in this country and is deeply passionate about making that happen." (Shapiro and Simmons-Duffin, 4/8)

The Associated Press: Medicaid Expansion Fight Delaying Work On Next Kansas Budget
A legislative fight over expanding Medicaid in Kansas is delaying approval of the state’s next annual budget as expansion supporters try to keep Republican opponents from blocking it for another year. Some top GOP lawmakers are conceding that an expansion plan could pass because expansion is a priority for Democratic Gov. Laura Kelly and has bipartisan support in the Republican-controlled Legislature. However, opponents hope for time this summer and fall to develop a smaller program than Kelly wants with restrictions she opposes, such as a work requirement for participants. (Hanna, 4/8)

The Washington Post: Opioids Advocate Now Working With Plaintiffs In Lawsuits
A doctor who spent decades advocating for broader use of powerful prescription painkillers is now working with the state and local governments that are suing drug companies over the opioid crisis. Dr. Russell Portenoy, a professor at Albert Einstein College of Medicine in New York, is helping the plaintiffs in exchange for having claims against him dropped. His cooperation was made public late last week in a court filing from a special court master who is helping manage more than 1,500 lawsuits against the drug industry that are consolidated under a federal judge in Cleveland. (Mulvihill, 4/8)

Bloomberg: Opioid Evangelist Switches Sides In Case Alleging Pharma Abuse 
Dr. Russell Portenoy, a medical-school professor who studied pain for more than 30 years, has agreed to testify against the industry in trials of lawsuits brought by local governments seeking billions in social costs associated with addiction, according to unsealed court filings. In a sworn statement, he said drug makers were too aggressive in promoting opioids for all kinds of ailments. “The opioid manufacturers should have tempered their positive messaging about opioids with a greater focus on risk, particularly as early signals of opioid risk emerged,” Portenoy said in his court declaration. Drug makers also “should have responded as evidence of increasing adverse affects mounted” to increased awareness and “reduce inappropriate or risky prescribing,” he said. (Feeley, 4/8)

Stateline: As Drug Crises Surge, Babies Enter Foster Care At Higher Rate 
Babies and toddlers are entering the foster care system at a higher rate, a trend that some child welfare experts fear is correlated to the opioid and methamphetamine epidemics wreaking havoc across the country. And that is further straining the nation’s already overburdened child welfare system. From 2009 to 2017, the rate of very young children entering foster care grew incrementally, exceeding the rates of older children, which remained steady, according to data compiled by Child Trends, a Maryland-based research organization that focuses on child welfare issues. In fiscal year 2017, children age 3 and under entered foster care at a rate of 6.6 in 1,000, more than twice the 2.8 rate of children ages 4 to 17. (Wiltz, 4/9)

Stat: ‘We Owe Much To The Sackler Family’: How Gifts To A Top Medical School Advanced The Interests Of Purdue Pharma
In 2009, a Tufts University School of Medicine professor named Dr. Daniel Carr took stock of the accomplishments of the pain program he had helped start a decade earlier. Alumni of the master’s program included physicians, nurses, dentists, and pharmacists, he said in a post on the center’s blog. Faculty at the Pain Research, Education, and Policy program had advised policymakers and were at work on a book about pain treatment in a changing health care landscape. He also thanked the program’s donors, including the billionaire dynasty that made it possible. (Joseph, 4/9)

The Wall Street Journal: Roundup, The World’s Best-Selling Weedkiller, Faces A Legal Reckoning
For years, scientists at Monsanto Co. worked closely with outside researchers on studies that concluded its Roundup weedkiller was safe. That collaboration is now one of the biggest liabilities for the world’s most widely used herbicide and its new owner, Bayer AG, which faces mounting lawsuits alleging a cancer link to Roundup. Plaintiffs’ attorneys are putting Monsanto’s ties to the scientific community at the center of a series of high-stakes suits against Bayer. Since the German company acquired Monsanto last June, two juries in California have sided with plaintiffs who have lymphoma and blamed the herbicide for their disease. Bayer’s shares have fallen roughly 35% since the first verdict. (Bunge and Bender, 4/8)

The New York Times: Culture Of Secrecy Shields Hospitals With Outbreaks Of Drug-Resistant Infections
In January, the Centers for Disease Control and Prevention sent out an urgent public alert about a deadly bacteria, resistant to virtually every known antibiotic, that sickened more than a dozen Americans who had elective surgery at Grand View Hospital in Tijuana, Mexico. But when similar outbreaks take place at hospitals on American soil, the C.D.C. makes no such public announcement. That is because under its agreement with states, the C.D.C. is barred from publicly identifying hospitals that are battling to contain the spread of dangerous pathogens. (Jacobs and Richtel, 4/8)

The New York Times: To Improve Memory, Tune It Like An Orchestra
Anyone above a certain age who has drawn a blank on the name of a favorite uncle, a friend’s phone number or the location of a house key understands how fragile memory is. Its speed and accuracy begin to slip in one’s 20s and keep slipping. This is particularly true for working memory, the mental sketch pad that holds numbers, names and other facts temporarily in mind, allowing decisions to be made throughout the day. On Monday, scientists reported that brief sessions of specialized brain stimulation could reverse this steady decline in working memory, at least temporarily. The stimulation targeted key regions in the brain and synchronized neural circuits in those areas, effectively tuning them to one another, as an orchestra conductor might tune the wind section to the strings. (Carey, 4/8)

NPR: Scientists Test Whether Brain Stimulation Could Help Sharpen Aging Memory
Aging brains struggle especially with working memory. Called the workbench of the mind, working memory allows us to store useful bits of information for a few seconds and use that information across different brain areas to help solve problems, plan or make decisions. (Lambert, 4/8)

Stat: Zapping Brain With Electricity Boosts Working Memory, Study Finds
By stimulating the brain in precise regions with alternating current (AC), “we can bring back the superior working memory function you had when you were much younger,” psychology researcher Robert Reinhart of Boston University told reporters. “The negative age-related changes [in working memory] are not unchangeable.” For alternating current, delivered by electrodes embedded in a skull cap, to become a treatment for working memory deficits, however, it would have to overcome a long list of hurdles, starting with proof that it’s safe. But whether or not the findings, published in Nature Neuroscience, result in any practical applications, they provide some of the strongest evidence yet of why older adults aren’t as good at remembering a just-heard phone number or an address in a just-seen text: Brain circuits become functionally disconnected and fall out of synchrony. (Begley, 4/8)

The New York Times: The Diagnosis Is Alzheimer’s. But That’s Probably Not The Only Problem.
Allan Gallup, a retired lawyer and businessman, grew increasingly forgetful in his last few years. Eventually, he could no longer remember how to use a computer or the television. Although he needed a catheter, he kept forgetting and pulling it out. It was Alzheimer’s disease, the doctors said. So after Mr. Gallup died in 2017 at age 87, his brain was sent to Washington University in St. Louis to be examined as part of a national study of the disease. (Kolata, 4/8)

The Washington Post: More Seniors ‘Aging In Place’ Mean Fewer Homes On The Market To Buy
Looking for someone to blame for the years of low inventory that have pushed housing prices higher and made it harder for millennials to become homeowners? While builders share some of the responsibility, recent research by Freddie Mac finds that people between the ages of 67 and 85 who stay in their homes longer and “age in place” also play a role. Fewer Americans ages 67 to 85 are leaving their homes than their predecessors. Homeownership rates dropped 3.6 percent among people born between 1931 and 1941 when they reached 67 compared to 11.6 percent among those born before 1930 when they reached that age. (Lerner, 4/9)

The New York Times: You’re Covered In Fungi. How Does That Affect Your Health?
The connections among different parts of the human body are full of surprises, but here’s one you might not have considered: Could a thing that causes dandruff on your head also be contributing to your digestive problems? That’s one mystery that scientists are trying to unravel with research into the fungi that live in your gut. While the bacteria that colonize our intestines have been a scientific focus for more than a decade, the fungal critters there are starting to get more attention. (Rogers, 4/9)

The New York Times: Choose Foods, Not Supplements
Taking dietary supplements will not extend life, researchers report, and taken in large quantities may even be harmful. In a study in the Annals of Internal Medicine, scientists gathered dietary information in repeated in-person interviews with almost 31,000 men and women 20 and older. They also collected data on supplements used over the previous 30 days, including type, dosage and frequency of use. Slightly more than half the participants took supplements, and about a third took multivitamins. (Bakalar, 4/8)

The New York Times: With ‘Unplanned,’ Abortion Opponents Turn Toward Hollywood
It was a rare packed house for a weeknight in the suburbs, and when the movie was over, the sold-out crowd of about 100 last Wednesday spilled haltingly into the light. A few — a gaggle of nuns in their habits, at least one collared priest — wore their dispositions on their sleeves. Others communicated in muted gestures, dabbed at tears, or lingered for long stretches in the popcorn-strewn vestibule at the AMC multiplex here, as if still processing the deliberately provocative movie they had just seen. (Ugwu, 4/8)

Reuters: Baltimore City Council Urges Mayor To Resign Amid Probe Into $500,000 Book Payment
The Baltimore City Council on Monday called on Mayor Catherine Pugh to resign as the state probes a deal in which a hospital chain where she served as director paid her $500,000 for copies of her self-published children's book "Healthy Holly." Pugh, a 69-year-old Democrat first elected in 2016, last week said she would take an indefinite leave of absence for health reasons after the Baltimore Sun revealed the deal with the University of Maryland Medical System. (4/8)

The Wall Street Journal: Baltimore City Council Calls For Mayor Catherine Pugh To Resign
Fourteen of the council’s 15 members, all Democrats, wrote Monday that it wasn’t in the best interest of the city for her to continue to serve and urged her to resign immediately. Their call for Ms. Pugh to leave office was echoed Monday evening by several members of the state House of Delegates who represent Baltimore. “Baltimore will continue to have a cloud over its head while the investigations into the mayor’s business dealings go on,” Councilman Brandon Scott said. “The city deserves a mayor who can focus on reducing crime, improving schools and restoring trust in government.” (4/8)

The Washington Post: Baltimore Mayor Catherine Pugh Says She’ll Be Back, As City Council Demands Resignation
Pugh was heavily criticized after the Baltimore Sun reported that she was paid hundreds of thousands of dollars for her “Healthy Holly” book series, in most cases by businesses and organizations that work with the government and on whose boards she was sitting. The series follows an African American girl named Holly and is meant to encourage healthy living. Maryland Gov. Larry Hogan (R) has requested an investigation by the state prosecutor, and Comptroller Peter Franchot (D) has said Pugh should leave office. (Hedgpeth, 4/8)

The Associated Press: Facility Probed Over Handling Of Mentally Disabled Residents
The Louisiana Department of Health says a Lake Charles school for people with intellectual or developmental disabilities failed to protect its residents from sexual assault and physical abuse. The American Press reports the agency says those failures show Robinswood isn’t complying with federal and state requirements for nursing homes that participate in Medicare or Medicaid programs. In October, a direct care aid at the school was accused of sexually assaulting a student in 2017. He was fired months later and charged with first-degree rape. Three other school workers were later charged accessory-after-the-fact to first-degree rape. (4/9)