First Edition: December 13, 2018

Kaiser Health News: For The Asking, A Check Is In The Mail To Help Pay For Costly Drugs
It’s one of the little-known secrets in health care: When financial incentives like copay coupons and debit cards won’t work, pharmaceutical companies sometimes will write a check — what they call direct reimbursement — to make sure a loyal patient will stay on a high-cost, brand-name drug. Drugmakers began using now-popular copay coupons and other forms of assistance more than a decade ago to help patients pay out-of-pocket costs for medicines, particularly high-cost specialty drugs such as those that treat autoimmune disorders. The coupons have a dual purpose: They mask the true costs of a drug for patients and give patients a financial incentive to stay on an expensive drug until their insurance deductible is met. (Tribble, 12/13)

The Associated Press: Health Law Sign-Ups Lagging As Saturday Deadline Is Looming
With just days left to enroll, fewer people are signing up for the Affordable Care Act , even though premiums are stable, more plans are available and millions of uninsured people can still get financial help. Barring an enrollment surge, the nation's uninsured rate could edge up again after a yearslong coverage expansion that has seen about 20 million people obtain health insurance. (Alonso-Zaldivar, 12/12)

The Hill: ObamaCare Sign-Ups Surge In Final Weeks But Lag Last Year's Numbers
More people are signing up for ObamaCare plans as the open enrollment period comes to a close, but the overall numbers are down compared to last year. From Dec. 2 to 8, the sixth week of open enrollment, 934,269 people signed up for coverage via healthcare.gov, the most in any one-week period this year. That compares with the 1,073,921 sign-ups from the same period in 2017. (Hellmann, 12/12)

The Baltimore Sun: Maryland Health Exchange To Allow Consumers To Finish Enrollments After Dec. 15 Deadline
The Maryland health exchange is responding to a last-minute spike in enrollment in the final week of this year’s sign-up period by allowing people who are “in line” to complete their enrollment after the Dec. 15 deadline. The state has made the same move in years past to accommodate the last-minute rush, and the federal exchange has a similar plan this year. The plans are for policies that begin Jan. 1. (Cohn, 12/12)

The Hill: Dems Aim To Punt Vote On ObamaCare Taxes 
Health-care companies are making a last-minute push to delay ObamaCare taxes as part of a year-end government funding deal, but they face resistance from Democrats who want to punt the issue until next year when they control the House. Powerful health-care lobbies are pushing lawmakers to delay the implementation of the taxes, worried about taking a financial hit. Lawmakers have voted to push off the health law’s medical device tax, health insurance tax, and tax on high-cost “Cadillac” health plans in the past with bipartisan support. (Sullivan, 12/13)

The Hill: Incoming GOP Congressman Says Vaccines May Cause Autism, Contradicting CDC 
An incoming Republican Congressman told constituents at a town hall this week that he believes vaccines may cause autism, contradicting the Centers for Disease Control and other scientific institutions, according to tennessean.com. Mark Green, a physician who won his race in November to fill the seat of Rep. Marsha Blackburn (R-Tenn.), vowed to "stand on the CDC's desk and get the real data on vaccines,"adding he was doing so "because there is some concern that the rise in autism is the result of the preservatives that are in our vaccines," according to tennessean.com. (Hellmann, 12/12)

The New York Times: Fetal Tissue Research Is Curtailed By Trump Administration
Should the government pay for medical research that uses tissue from aborted fetuses? This debate, ever smoldering, has erupted again, pitting anti-abortion forces in the Trump administration against scientists who say the tissue is essential for studies that benefit millions of patients. In a letter last week that read like a shot across the bow, the National Institutes of Health warned the University California, San Francisco, that its $2 million contract for research involving the tissue, previously renewed for a year at a time, would be extended for only 90 days and might then be canceled. (Grady, 12/12)

The Washington Post: Fetal Tissue Research Targeted By Abortion Foes Inside Administration
Since HHS announced in late September a wide-ranging audit of the use of fetal tissue in federally funded research, groups that have long sought to outlaw its use say they are finally being heard. They view such research as morally repugnant and unnecessary because they contend other techniques can be used — an assertion many scientists reject. “This is a pro-life administration,” said David Prentice, vice president and research director of the antiabortion Charlotte Lozier Institute, who said members of his group and the affiliated Susan B. Anthony List have met with Pence to press their case. “It’s just nice to have someone who will listen and not just close the door in your face.” (Bernstein, Goldstein and Sun, 12/12)

Stat: Freeze On Fetal Tissue Procurement May Impede Work At NIH Cancer Lab
The National Institutes of Health freeze on fetal tissue procurement is threatening to hamper work at an agency lab conducting cancer research, the latest sign that a Trump administration decision could slow the efforts of some scientists who depend on the samples. ...The spokeswoman, Renate Myles, declined to identify the lab for “security reasons,” but said that the group is working on cancer immunotherapy.Two other NIH labs, one in Montana and another at the National Eye Institute, are also conducting research using fetal tissue that could ultimately be affected by the suspension. (Swetlitz, 12/12)

CNN: Fentanyl Is The Deadliest Drug In America, CDC Confirms
Fentanyl is now the most commonly used drug involved in drug overdoses, according to a new government report. The latest numbers from the US Centers for Disease Control and Prevention's National Center for Health Statistics say that the rate of drug overdoses involving the synthetic opioid skyrocketed by about 113% each year from 2013 through 2016. The number of total drug overdoses jumped 54% each year between 2011 and 2016. In 2016, there were 63,632 drug overdose deaths. (Kounang, 12/12)

The Hill: CDC: Fentanyl Is Deadliest Drug In America 
There were a total of 63,632 drug overdose deaths in 2016, with fentanyl found to be involved in nearly 29 percent of those cases, according to the report. By comparison, fentanyl was involved in only 4 percent of all drug fatalities in 2011. That year, oxycodone ranked first, involving 13 percent of all fatal overdoses. (Weixel, 12/12)

NPR: Report Highlights Fentanyl's Deadly Role In The Overdose Crisis
Back in 2011, oxycodone was the drug most commonly linked to overdose deaths. Starting in 2012 and lasting until 2015, heroin surpassed painkillers to become the drug most often involved. But then fentanyl, a synthetic opioid pain reliever 50 to 100 times more powerful than morphine, infiltrated the American drug supply — what the CDC calls "the third wave" of the opioid epidemic. By 2016, overdose deaths involving fentanyl had become more common than any other. (Wamsley, 12/12)

The Associated Press: New Effort In Maryland To Combat Upsurge In Fentanyl Deaths
A new effort in Maryland to prosecute more fentanyl cases in federal court is designed to help combat an alarming increase of fatalities caused by the potent synthetic opioid that's fueling the deadliest overdose epidemic in U.S. history. Fentanyl — a synthetic opioid both cheap to produce and up to 50 times more powerful than heroin — was the driving force behind Maryland's all-time high number of drug fatalities last year, rising from 1,119 in 2016 to 1,594 in 2017. But this year's projected total exceeds 2,000 deaths from fentanyl, a 25 percent increase from last year's grim milestone. (McFadden, 12/12)

The Hill: Drug Company To Offer Cheaper Opioid Overdose Treatment After Hiking Price 600 Percent 
A drug company is offering a significantly cheaper version of its life-saving opioid overdose treatment after a Senate investigation found that it spiked the price of its drug. A report from the Senate’s Permanent Subcommittee on Investigations last month found that the company, Kaléo, hiked the price of its drug Evzio to $4,100 for two injectors, raising the price by more than 600 percent between 2014 and 2017. (Sullivan, 12/12)

The New York Times: U.S. Diplomats With Mysterious Illness In Cuba Had Inner-Ear Damage, Doctors Say
The American government employees in Cuba who suffered mystifying symptoms — dizziness, insomnia, difficulty concentrating — after hearing a strange high-pitched sound all had one thing in common: damage to the part of the inner ear responsible for balance, according to the first doctors to examine them after the episodes. Two years after Americans posted at the United States Embassy in Havana began experiencing the peculiar phenomenon, doctors at the University of Miami on Wednesday published a scientific paper that confirms what these patients have said all along: Their condition is real, not the result of mass hysteria, a response to intense news media coverage or a stress reaction to being evacuated, as doctors in Cuba had suggested. (Robles, 12/12)

The Associated Press: Cuba Health Mystery: Diplomats Had Inner-Ear Damage Early On
"What caused it, who did it, why it was done — we don't know any of those things," said Dr. Michael Hoffer of the University of Miami Miller School of Medicine, who led the exams. The U.S. says since late 2016, 26 people associated with the embassy in Havana suffered problems that include dizziness, ear pain and ringing, and cognitive problems such as difficulty thinking — a health mystery that has damaged U.S.-Cuba relations. Cuba has adamantly denied any involvement. (Kay and Neergaard, 12/12)

CNN: Cuba 'Acoustic Attack' Mystery Continues As Study Offers More Details On US Diplomats' Symptoms
A separate study, previously published in the medical journal JAMA in March, described the symptoms of 21 personnel who sought medical attention and found that a majority of them reported problems with memory, concentration, balance, eyesight, hearing, sleeping or headaches that lasted more than three months. Three people eventually needed hearing aids for moderate to severe hearing loss, and others had ringing or pressure in their ears according to that report. (Howard, 12/12)

Stat: Kroger Starts Discount Program For Prescription Drugs, Part Of National Shift
Kroger, one of the largest grocery chains in the U.S., is rolling out a new discount program for patients who pick up prescription drugs at its pharmacies — part of a gradual nationwide shift in how consumers can pay for their medications. Under the new program, which launched on Wednesday, Kroger shoppers can pay an annual fee of $36 per person or $72 per family to get discounted prices for their drugs, including 21 cheap drugs at no additional cost. The idea is that they can bypass insurance and pay out of pocket for drugs when it’s cheaper to do so. (Robbins, 12/12)

The Wall Street Journal: Walmart, Express Scripts Extend Prescription-Services Agreement
Retail giant Walmart Inc. and pharmacy-benefit manager Express Scripts Holding Co. have extended their network agreement to provide access to Walmart’s prescription services for Express Scripts clients’ covered members. The three-year agreement will help both insured and uninsured customers save money on prescription drugs, the companies said Wednesday. Walmart also will participate in Express Scripts’s pharmacy-savings program called InsideRx, which provides discounts, on average of 40%, to uninsured Americans using brand-name prescription drugs. (Al-Muslim, 12/12)

Stat: Exploratory Trials After Approvals May Cause Too Much Off-Label Prescribing 
Although the widely prescribed Lyrica painkiller was studied for more than 30 other uses, a new analysis finds much of the subsequent testing appears to have been merely exploratory, creating perceptions that the drug could combat other maladies and encouraging off-label use. Specifically, a systematic review of 238 clinical trials for unapproved uses found that 67 percent of the studies that examined 33 additional indications generated uncertainty about the effectiveness of the drug, according to the analysis published in JAMA Internal Medicine. (Silverman, 12/12)

The New York Times: Christmas Is A Peak Time For Heart Attacks
Christmas may be the peak time for heart attacks — at least in Sweden. Swedish researchers studied 283,014 heart attacks between 1998 and 2013 that were documented in a registry that included the date and time when symptoms started. They found that compared with days in the two weeks before and after Christmas, the risk of heart attack was 15 percent higher on Christmas Day and 37 percent higher on Christmas Eve. (Bakalar, 12/12)

Los Angeles Times: On Christmas Eve, Santa Delivers Presents ... And A Few Extra Heart Attacks
On Dec. 24, the risk of a heart attack is 37% higher than normal, the researchers found. On Christmas itself, the increase in risk dips to 29%. Even on Boxing Day, it’s still 21% above normal levels. For the sake of comparison, Mondays are known to be a time of increased heart attack risk. But in Sweden, the risk was only about 10% higher on the first day of the workweek. The BMJ study isn’t the first to report an association between the holiday season and myocardial mayhem. A 2004 paper in the journal Circulation, for example, found that deaths due to all kinds of heart disease were higher in the U.S. on both Christmas and New Year’s Day. (Kaplan, 12/13)

The New York Times: Women With Heart Emergencies Less Likely To Get Proper Care
Women with cardiac emergencies are less likely than men to receive proper treatment when the ambulance arrives, a new study reports. The analysis, in Women’s Health Issues, used four years of data from a federal government database to compile information on out-of-hospital emergencies involving people 40 and older with chest pain or cardiac arrest. Almost 2.4 million people, 1.2 million of them women, were included. (Bakalar, 12/13)

CNN: FDA Sends Warning To Company At Center Of Heart Medication Recall
The US Food and Drug Administration issued a warning letter to the Chinese maker of an ingredient in popular heart drugs and said it continues to test the ingredient for cancer-causing chemicals. The letter, sent in late November, details manufacturing violations at the facility of Zhejiang Huahai Pharmaceutical Co. Ltd., pointing out cross-contamination from one line to another, control issues and impurity control problems. (Christensen, 12/12)

The Wall Street Journal: Surgery Adds Three Years To Lives Of Prostate-Cancer Patients, Study Finds
A three-decade study found that prostate-removal surgery added an average of nearly three years to lives of men with prostate cancer, compared with those who didn’t get surgery and were monitored. The results suggest the benefits of surgery in men with advanced prostate cancer. Yet men in the early stages of the slow-moving but life-threatening disease might want to wait before undergoing the procedure or forgo it entirely, the study’s authors and other experts say. (Loftus, 12/12)

Stat: Most Prostate Cancer Patients Don't Need Aggressive Treatment, Study Says
Nearly 30 years after it began, a study of prostate cancer patients shows both that the disease will not cause harm to the majority of men who have it, and that aggressive treatment is warranted for men with an intermediate risk of spread. The nuanced results come from a new update to a landmark study, published Wednesday in the New England Journal of Medicine, that has followed 695 Swedish men since they were diagnosed with localized prostate cancer between October 1989 and February 1999. (Weintraub, 12/12)

CNN: Excess Body Weight Responsible For 4% Of Cancers Worldwide, Study Says
Excess body weight was responsible for 3.9% of cancer globally, or 544,300 cases, in 2012, according to a new report. The report, published Wednesday in the journal CA: A Cancer Journal for Clinicians, also highlights a relationship between obesity and the risk of 13 cancers, including postmenopausal breast cancer and liver cancer, and a probable relationship with three others, including prostate cancer. (Thomas, 12/12)

The Wall Street Journal: Scientists Skeptical About Gene-Edited Baby Experiment
When a Chinese scientist last month claimed to have created the first gene-edited babies, scientists around the world were stunned and alarmed, saying the research had been done without proper disclosure or oversight. Now, scientists who examined the very limited available data from the experiments are questioning whether the gene edits the scientist claimed he made were even successful. One prominent scientist has called for a moratorium on genetically editing human embryos to create a pregnancy until technical, social and scientific questions are better understood. (Marcus, 12/12)

Stat: Listening To The Inner Worlds Of Children Who Can't Move Or Speak 
For a therapeutic clown, silliness is serious business. Helen Donnelly, who personifies Dr. Flap, had spent years on stages and under big tops, traveling with Cirque du Soleil, doing solo shows, speaking made-up languages, dancing in front of clotheslines hung with cuts of meat. When she started working at Holland Bloorview Kids Rehabilitation Hospital in Toronto, her absurdities took on a different aim: to transport kids out of the disorienting realities of medical treatment and into imaginary worlds where they had a sense of control. (Boodman, 12/13)

Stat: Developmental Delays Persist As Brazil’s Zika Babies Grow Up
The Zika virus has faded from the world’s headlines. But the damage the strange mosquito-borne virus inflicted on some children whose mothers were infected during pregnancy very much remains. A new study, published Wednesday in the New England Journal of Medicine, reports that in a group of Zika babies from Brazil who are being followed to assess their progress, 14 percent had severe developmental problems. (Branswell, 12/12)

The Washington Post: How Many Years Do We Lose To The Air We Breathe?
The average person on Earth would live 2.6 years longer if their air contained none of the deadliest type of pollution, according to researchers at the University of Chicago’s Energy Policy Institute. Your number depends on where you live. (12/12)

The Washington Post: Kotex Tampons: Kimberly-Clark Recalls U By Kotex Sleek Tampons After Unraveling In People's Bodies
Some Kotex tampons have been recalled after reports that the feminine-care product was unraveling and coming apart inside consumers' bodies. Kimberly-Clark, which manufacturers personal-care products, announced Tuesday that the regular absorbency U by Kotex Sleek Tampons have been recalled in the United States and Canada because of “a quality-related defect,” explaining that some consumers reported having to seek medical attention “to remove tampon pieces left in the body.” (Bever, 12/12)

CNN: People With Eczema At Higher Risk Of Suicidal Thoughts And Attempts, Study Says
Eczema is a common skin condition that can pack a profound psychological punch: People with eczema are more likely to have suicidal thoughts and suicide attempts than others without the condition, according to new research published Wednesday in the journal JAMA Dermatology. Eczema, also known as atopic dermatitis, is a skin disease that's chronic and inflammatory -- meaning it involves an immune system reaction. It affects 18 million adults (more than 7%) and 9.6 million children (13%) in the United States, according to the researchers from University of Southern California Keck School of Medicine. (Scutti, 12/12)

CNN: Salmonella: 87 More Cases Linked To Recalled Beef
Eighty-seven more people have been sickened with salmonella linked to recalled beef products, the US Centers for Disease Control and Prevention said Wednesday. A total of 333 have become ill and 91 have been hospitalized since illnesses began in August. No deaths have been reported. Illnesses have been reported in 28 states; Michigan, Mississippi and West Virginia are the latest. The CDC said the outbreak investigation is ongoing. (Thomas, 12/12)

Reuters: Longer Breastfeeding Tied To Lower Risk Of Liver Disease
Mothers who breastfeed for six months or more may have less fat in their livers and a lower risk of liver disease, a U.S. study suggests. Breastfeeding has long been tied to health benefits for women, including lower risks for heart disease, diabetes and certain cancers. The current study focused on whether nursing might also be tied to a reduced risk of non-alcoholic fatty liver disease (NAFDL), which is usually linked with obesity and certain eating habits. (12/12)

The New York Times: Starting School Later Really Does Help Teens Get Sleep
Delaying school start times has helped Seattle teenagers get a better night’s sleep. During puberty, circadian rhythm is altered, and sleeping and waking are typically delayed to a later time. This creates a problem: Adolescent wake-sleep patterns do not coincide with those of conventional social life, and teenagers rarely get the recommended eight to 10 hours of sleep each night. (Bakalar, 12/12)

NPR: Later School Start Times Really Do Work To Help Teens Get More Sleep
In Seattle, school and city officials recently made the shift. Beginning with the 2016-2017 school year, the district moved the official start times for middle and high schools nearly an hour later, from 7:50 a.m. to 8:45 a.m. This was no easy feat; it meant rescheduling extracurricular activities and bus routes. But the bottom line goal was met: Teenagers used the extra time to sleep in. Researchers at the University of Washington studied the high school students both before and after the start-time change. Their findings appear in a study published Wednesday in the journal Science Advances. (Neighmond, 12/12)

The Associated Press: Florida School Massacre Panel Recommends Arming Teachers
The panel investigating the Florida high school massacre recommended Wednesday that teachers who volunteer and undergo extensive background checks and training be allowed to carry concealed guns on campus to stop future shootings. The Marjory Stoneman Douglas High School Public Safety Commission voted 13-1 to recommend the Legislature allow the arming of teachers, saying it’s not enough to have one or two police officers or armed guards on campus. Florida law adopted after the Feb. 14 shooting that left 17 dead allows districts to arm non-teaching staff members such as principals, librarians and custodians — 13 of the 67 districts do, mostly in rural parts of the state. (Spencer and Anderson, 12/12)

Politico: Telemedicine Demand Spurs Rural Broadband Push In Texas
Texas Republicans don’t usually look to Lyndon Johnson for inspiration. But the need for improved broadband services in rural areas — to spread telemedicine, viewed as the next frontier of medicine — has caused some to look to the former president’s efforts to connect those same areas to the electrical grid. (Rayasam, 12/12)

The Associated Press: No Psychiatric Hospital Employee Responsible For Escape
No single employee was directly responsible for the escape of a man from a Hawaii psychiatric hospital, a state investigation found, but questions remain about how he was able to walk out of the facility and fly to California, officials said Wednesday. The state attorney general's office completed an administrative investigation more than a year after Randall Saito escaped from Hawaii State Hospital. Officials on Wednesday released findings of the investigation, but they said a redacted report will be posted online later Wednesday or Thursday. (12/12)

The Associated Press: Report Says Suicide Rates In Virginia Are Slowly Increasing
A new state report says that suicide rates in Virginia have been slowly increasing in the last two decades. A recently released report from the Department of Behavioral Health and Developmental Services said suicides have increased since 1999 and there was a 5.4 percent increase from 2015 to 2016. Handguns were the most common cause of death in suicides, used in 58 percent of all cases in Virginia, the report said. (12/13)