First Edition: February 12, 2018

Kaiser Health News: Doctors Learn How To Talk To Patients About Dying
Lynn Black’s mother-in-law, who had lupus and lung cancer, was rushed into a hospital intensive care unit last summer with shortness of breath. As she lay in bed, intubated and unresponsive, a parade of doctors told the family “all good news.” A cardiologist reported the patient’s heart was fine. An oncologist announced that the substance infiltrating her lungs was not cancer. An infectious-disease doctor assured the family, “We’ve got her on the right antibiotic.” (Bailey, 2/12)

Kaiser Health News: Could A Rare, Deadly ‘Superbug’ Fungus Be Gaining A Foothold?
The number of U.S. patients infected with a rare but dangerous fungal “superbug” called Candida auris has climbed quickly to 200 as of Dec. 31, according to the latest figures from the federal Centers for Disease Control and Prevention. In 2016, there were only seven cases of the multidrug-resistant infection on the national radar. (Thill, 2/12)

Kaiser Health News: Podcast: KHN’s ‘What The Health?’ There’s A Really Big Health Bill In That Budget Deal
The bipartisan budget deal that passed Congress this week includes enough health policy changes to keep reporters and analysts busy for months. In addition to renewing funding for Community Health Centers for two more years, the bill extends funding for the Children’s Health Insurance Program for four years beyond the six approved last month; repeals the controversial (but never implemented) Independent Payment Advisory Board for Medicare and permanently repeals Medicare’s caps on certain types of outpatient therapy. (2/9)

The Washington Post: In Big Reversal, New Trump Budget Will Give Up On Longtime Republican Goal Of Eliminating Deficit
President Trump on Monday will offer a budget plan that falls far short of eliminating the government’s deficit over 10 years, conceding that huge tax cuts and new spending increases make this goal unattainable, three people familiar with the proposal said. ... The budget is expected to target spending cuts at social welfare programs such as Medicaid and the Supplemental Nutrition Assistance Program, large segments of government spending that have long been eyed by Republicans for cuts. The White House is looking at ways to curb these programs by expanding work requirements for beneficiaries, but it is unclear how much money changes like this would save or whether it would find enough political support. (Paletta, 2/11)

The Associated Press: Trump’s $4 Trillion Budget Helps Move Deficit Sharply Higher
The original plan was for Trump’s new budget to slash domestic agencies even further than last year’s proposal, but instead it will land in Congress three days after he signed a two-year spending agreement that wholly rewrites both last year’s budget and the one to be released Monday. The 2019 budget was originally designed to double down on last year’s proposals to slash foreign aid, the Environmental Protection Agency, home heating assistance and other nondefense programs funded by Congress each year. (Taylor, 2/12)

The Hill: Five Questions About The New Trump Budget And Health Issues
The White House is expected to release its fiscal 2019 budget request on Monday, and health advocates will be watching closely to see if this year’s proposal will contain deep cuts to the agencies charged with bolstering public health and finding cures for complex diseases. Lawmakers from both parties are also waiting to see if the budget will propose major changes to the anti-drug office that have already sparked an outcry. (Roubein, 2/11)

The Hill: Trump Budget To Include Billions To Combat Opioid Epidemic
President Trump’s budget will propose billions of dollars to combat the opioid epidemic plaguing the country, months after the administration designated the crisis a national public health emergency. The White House’s fiscal 2019 budget set to be released Monday will include nearly $17 billion for the opioid epidemic that’s killing more Americans per year than car accidents, according to an outline from the Office of Management and Budget (OMB). (Roubein, 2/11)

Politico: Trump To Demand Tough Budget Cuts For Domestic Programs
The budget calls for roughly $17 billion in “opioid-related spending,” with the vast majority going to treatment, prevention and recovery. For veterans' health care, Trump’s budget would set aside $85.5 billion, far above last year’s levels. (Ferris and Scholtes, 2/11)

The New York Times: F.D.A. Chief Goes Against The Administration Stereotype
Scott Gottlieb, the commissioner of the Food and Drug Administration, came to the job with a résumé straight out of the Trump administration’s playbook. A millionaire with a libertarian bent, he made his money working for the industry he now regulates, and had investments in 20 health care companies whose products could come before the agency for approval. Pharmaceutical and medical device executives enthusiastically supported his nomination, while consumer and public health groups sounded the requisite alarms. (Kaplan and Thomas, 2/11)

The New York Times: Kentucky Rushes To Remake Medicaid As Other States Prepare To Follow
With approval from the Trump administration fresh in hand, Kentucky is rushing to roll out its first-in-the-nation plan to require many Medicaid recipients to work, volunteer or train for a job — even as critics mount a legal challenge to stop it on the grounds that it violates the basic tenets of the program. At least eight other Republican-led states are hoping to follow — a ninth, Indiana, has already won permission to do so — and some want to go even further by imposing time limits on coverage. (Goodnough, 2/10)

The Associated Press: Kentucky Hopes Website Will Track Medicaid Work Requirements
Kentucky became the first state with a work requirement for Medicaid, and now it has to do something arguably more daring: Build a mobile-friendly website that works. This summer, the state will require many people who get taxpayer-funded health insurance to work or volunteer at least 80 hours a month. They hope nearly half a million people will use their smartphones to log their hours so the government can keep track of who is meeting the requirements. (Beam, 2/9)

The New York Times: Lower Drug Prices: New Proposals Carry Lots Of Promises
When it comes to high drug prices, President Trump and members of Congress have been long on promises but short on action. But that appears to be changing: The White House on Friday released a report recommending significant changes that would affect drug costs and the president’s budget proposal on Monday is expected to include some plans to expand drug coverage under Medicare. In addition, a spending bill passed by Congress on Friday included a provision that would accelerate closing a payment gap in Medicare for prescription drugs. (Thomas and Abelson, 2/9)

The Washington Post: White House Releases White Paper On Lowering Drug Prices
The White House released a 30-page white paper Friday morning that promotes easing government regulations and spurring innovation to lower drug prices, while roundly rejecting the idea of government price setting. The document, written by the White House’s Council of Economic Advisers, comes on the heels of reports that President Trump will include a list of proposals to lower patients’ out-of-pocket spending on drugs in the budget he will release next week. (Winfield Cunningham, 2/9)

The Wall Street Journal: Trump Moves To Cut Costs For Prescription Drugs
Alex Azar, the newly confirmed Secretary of Health and Human Services, said the main objectives of the administration’s initiatives were to “reduce out-of-pocket expenses for seniors” and to “increase the ability of the government to get a good deal” in purchasing prescription drugs. “We do think drug prices are too high,” he said. (Burton, 2/9)

The Associated Press: Trump's Big Promises On Drug Costs Followed By Modest Steps
The White House Council of Economic Advisers has released a 30-page strategy for reducing drug costs, and it calls current policies "neither wise nor just." The plan, outlined before Trump releases his new budget proposal Monday, focuses mainly on Medicare and Medicaid changes, along with ideas for speeding drug approvals and fostering competition. (Alonso-Zaldivar and Perrone, 2/12)

Stat: McCain And Baldwin To Trump: Hold Pharma's Feet To The Fire On Drug Prices
Frustrated by White House efforts to tackle rising drug prices, a pair of U.S. lawmakers is urging the Trump administration to more squarely focus on drug makers — by backing legislation requiring them to justify their pricing and provide a breakdown of expenses before raising prices on some medicines. In a letter to be sent on Monday to President Trump, U.S. Senators Tammy Baldwin (D-Wis.) and John McCain (R-Ariz.) urge him to “make good on your promise” to fix a problem that is vexing an increasing number of Americans. They call on Trump to back the Fair Accountability and Innovative Research Drug Pricing Act, which they introduced last May. An identical bill was also introduced in the House, but both have languished. (Silverman, 2/11)

The Associated Press: States Look To Lower Drug Costs, Consider Canadian Imports
Lawmakers in more than two-thirds of the states are considering ways to reduce prescription drug costs, including importing them from Canada, as they strive to balance budgets without knowing for sure what their government's share of the tab will be. A total of 87 bills in 34 states of all political stripes seek to save money on prescription drugs, according to the nonpartisan National Academy for State Health Policy. Six of those states are considering bills that would allow drugs to be imported from Canada, where they cost an average 30 percent less than in the United States. (Ring, 2/11)

The Associated Press: Trump To Nominate Jim Carroll As Next Drug Czar
President Donald Trump has tapped deputy White House chief of staff Jim Carroll to serve as the administration's next drug czar. Carroll's position as head of the Office of National Drug Control Policy will make him the most public face of the administration's efforts to fight the opioid epidemic — an effort critics say hasn't gone nearly far enough. (2/9)

The Washington Post: White House Official Nominated As Nation's Drug Czar
Jim Carroll would be the first Trump appointee to lead the Office of National Drug Control Policy. Trump’s first pick, Rep. Tom Marino (R-Pa.), withdrew his nomination after The Washington Post reported that he was the chief advocate of a law that weakened DEA enforcement against drug manufacturers who aggressively peddled opioids. The office has been leaderless despite Trump calling the opioid epidemic one of his top priorities. He declared it a public health emergency in October, a designation that was extended last month. But the White House has offered no concrete solutions on how to solve the crisis, and little has happened in the months since the declaration was made. (Zezima, 2/9)

The New York Times: To Cut Drug Deaths, City Considers Sanctioned Places To Shoot Up
In 2016, the opioid epidemic claimed 1,374 lives in New York City. That’s roughly four drug overdose deaths each day. One death every seven hours. It’s a harrowing statistic that continues to soar, and New York City officials are floating an idea that so far has not been tried in the United States: sanctioned locations where drug users can shoot up under the supervision of medical staff ready to revive them if they overdose. (Ferre-Sadurni, 2/9)

Reuters: OxyContin Maker Purdue Pharma Stops Promoting Opioids, Cuts Sales Staff
OxyContin maker Purdue Pharma said on Saturday that it has cut its sales force in half and will stop promoting opioids to physicians, following widespread criticism of the ways drugmakers market addictive painkillers. The drugmaker said it will inform doctors Monday that its sales representatives will no longer visit physicians’ offices to discuss the company’s opioid products. It will now have about 200 sales representatives, Purdue said. (2/10)

The Washington Post: Kratom Is Hailed As A Natural Pain Remedy, Assailed As An Addictive Killer. The U.S. Wants To Treat It Like Heroin.
Andrew Turner’s years in the military left him suffering from post-traumatic stress disorder, anxiety, back pain and the effects of an injury that mangled his hand. “I was a broken toy,” he said. Tossed aside. Barely able to get off the couch. Then he started using an herbal supplement that he says saved his life: kratom. (McGinley and Zezima, 2/10)

Reuters: U.S. Budget Deal Grants $1.5 Billion For Drug-Affected Babies, Families
A U.S. budget deal adopted by Congress on Friday includes what advocates call a landmark compromise to provide an estimated $1.5 billion over 10 years to try to keep struggling families together, including those with babies born dependent on opioids. The provision allows assistance on mental health, substance abuse and parenting whenever any child is deemed at imminent risk of entering foster care. It also offers support for relatives who unexpectedly assume responsibility for a child when a parent cannot. (Wilson and Shiffman, 2/9)

The Washington Post: At The Heart Of Canada’s Fentanyl Crisis, Extreme Efforts That U.S. Cities May Follow
Beneath a blue tarp that blocks out a gray sky, Jordanna Coleman inhales the smoke from a heated mixture of heroin and methamphetamine, sucking the addictive vapor deep into her lungs. The drugs and pipe, acquired elsewhere, are hers. But the shelter, the equipment she uses to prepare her fix and the volunteers standing by to respond if she overdoses are provided by a small nonprofit. Funding and supplies come from the city of Vancouver and the province of British Columbia. (Bernstein, 2/11)

Stat: How Will Amazon Revolutionize Health Care? Follow Its Footprints In Seattle
Amazon’s effort to shake up health care is as tantalizing as it is opaque — a giant black box hanging over one-fifth of the American economy. But several clues about its plans are plainly visible in its hometown of Seattle, where it has hired executives from health industry heavyweights and spurred adoption of technologies it may eventually use to upend drug distribution and other aspects of care. (Ross, 2/12)

The Washington Post: This Flu Season Has Now Reached Pandemic Levels (But It's Not Technically A Pandemic)
This flu season is turning out to be so intense that the number of people seeking care at doctors' offices and emergency rooms has surged to levels not reported since the peak of the 2009 swine flu pandemic, federal officials said Friday. For yet another week, the flu continues to get worse. “We were hoping to have better news,” said Anne Schuchat, acting director of the Centers for Disease Control and Prevention. “This does not mean we’re having a pandemic,” Schuchat said. “But it is a signal of how very intense the flu season has been. We may be on track to break some recent records.” (Sun and Bever, 2/9)

NPR: CDC: 1 In 10 Deaths Last Week Caused By Flu Or Pneumonia
The peak of the flu season could still be several weeks away, federal health officials cautioned Friday. "We may be on track to break some recent records," said Dr. Anne Schuchat, acting director of the Centers for Disease Control and Prevention. Nearly all states are still reporting widespread flu activity, with less severe reports only coming from Oregon and Hawaii. (Harris, 2/9)

The Washington Post: 2018 Flu: Outbreaks Spread With More Deaths In Nasty Season
Angie Barwise had come down with the flu around the holidays. Days after Christmas, the 58-year-old Texas mother and grandmother was diagnosed with influenza, along with bronchitis and strep, her family told Fox affiliate KDFW. Doctors gave her antibiotics and Tamiflu, an antiviral medication used to help treat the flu, and, soon after, she started to bounce back. But almost exactly a month later, her family said, she was in the emergency room — this time, with a different strain of the virus. (Bever, 2/9)

Los Angeles Times: Flu Deaths Reach A High, But Outbreak Shows Signs Of Easing
California health officials said Friday that 36 Californians under the age of 65 died of the flu in the first week of February — more than in any other week this season. The flu season nationwide is considered among the worst in a decade. Hospitals in California set up tents to triage flu patients, many pharmacies ran out of flu medicines and the death toll has been unusually high. Gabriella Chabot, a student at La Reina High School in Thousand Oaks, was among those who died of complications of the flu. (Karlamangla, 2/9)

Bloomberg: Historic Flu Season Drives Sales Across The Health-Care Industry 
A historically bad flu season has sent Americans to the doctor in droves -- and given a boost to companies across the health-care business. Hospitalization rates for flu have reached record levels, according to the Centers for Disease Control and Prevention. The rapid spread of the illness is worrisome, with a higher-than-normal number of deaths related to flu and pneumonia, including 53 children. (Levingston, 2/9)

Politico: Houston District Becomes Unlikely Battleground For Vaccine Policy Fight
Texas House District 134 in southwest Houston, with its teeming 50 million-square-foot medical complex that includes Baylor College of Medicine, MD Anderson Cancer Center and 100,000 health workers, seems an improbable battleground for a political fight over vaccines. Yet it's the latest front in the war over vaccination requirements — and a proxy for the broader struggle between social conservatives and moderates for the soul of the Texas Republican Party. (Rayasam, 2/9)

The New York Times: The Most Dreaded Opponent At The Olympics: The Common Cold
Lari Lehtonen, an Olympic cross-country skier from Finland, pulled his two sons out of kindergarten a month ago. They were not allowed to attend birthday parties. They were prohibited from crowded indoor spaces. They could have play dates, but only after a call to the friend’s parents. This may sound like a peculiar style of helicopter parenting, but Lehtonen was not worried about his children — he was worried about himself. (Segal, 2/11)

The New York Times: Promising Malaria Drug Has A Striking Drawback: Blue Urine
Tests in West Africa have found that a safe drug long used to treat urinary tract infections is also effective against malaria. But the medication has one disadvantage: it turns urine a vivid blue. “This is something we need to solve, because it could stop people from using it,” said Teun Bousema, a microbiologist at Radboud University Medical Center in the Netherlands and an author of the study, which was published Tuesday in The Lancet Infectious Diseases. (McNeil, 2/9)

NPR: Why Hospitals Have A Hard Time Swapping Old Patient Gowns For New Ones
A medical company is trying to make hospital gowns less terrible — maybe even good. The company is called Care+Wear and it's currently testing out the new gowns at MedStar Montgomery in Olney, Md. You know the old gown, sometimes called a "johnny": It's got the flimsy ties and the exposed back. The new gown from Care+Wear ties at the front like a robe. (Limbong, 2/11)

The Washington Post: The Science Behind Sugar Cravings.
If you do an online search about sugar, you may become convinced that it’s evil and addictive — and that your sweet tooth will lead you to ruin. You’ll also see plenty of advice for how to curb your craving for sugary goodness. But what do we really know about how sugar affects us? Does eating sugar make us want to eat more of it? (Adams, 2/10)

NPR: Why Can't I Put My Smartphone Down? Here's The Science
If the Russian psychologist Ivan Pavlov were alive today, what would he say about smartphones? He might not think of them as phones at all, but instead as remarkable tools for understanding how technology can manipulate our brains. Pavlov's own findings — from experiments he did more than a century ago, involving food, buzzers and slobbering dogs — offer key insights, into why our phones have become almost an extension of our bodies, modern researchers say. The findings also provide clues to how we can break our dependence. (Doucleff and Aubrey, 2/12)

The New York Times: Herpes Is Slowly Retreating, But The Infection Remains Common
The prevalence of both genital and oral herpes simplex virus infections has declined steadily since 2000. Still, roughly half of middle-aged Americans are infected. HSV-1, or oral herpes, causes cold sores around the mouth and face, and sometimes genital sores. HSV-2, genital herpes, is sexually transmitted, and causes sores around the genitals, buttocks and anus. HSV-2 can sometimes cause mouth sores as well. (Bakalar, 2/9)

The New York Times: Are Hand Dryers Actually Full Of Bacteria? A Viral Photo Doesn’t Tell The Whole Story
The assignment from Nichole Ward’s microbiology professor was simple: Choose a location, open a petri dish for three minutes and observe what grew over the next two days. No one’s sample came back clean — a foregone conclusion given that a petri dish opened in any nonsterile room will collect microbes from the air. But when Ms. Ward returned to class with a dish that she had put in an enclosed Dyson hand dryer in a women’s restroom, the colonies of fungi and bacteria that had grown in it outstripped anything her classmates had found in their chosen locations. (Astor, 2/9)

NPR: App Shows Closed Captions To Hearing-Impaired Theatergoers
Jerry Bergman is sitting in the audience at a Broadway matinée performance of The Band's Visit. Despite the fact that a huge sign above the stage tells the audience — in English, Hebrew and Arabic — to turn off cellphones, Bergman is keeping his on so he can read closed captions while watching the show. He is one of an estimated 48 million Americans who have some degree of hearing loss. And he is availing himself of new technology that allows deaf and hearing-impaired people to enjoy shows with something most people have in their pocket — a smartphone. (Lunden, 2/11)

The Washington Post: 7 Marathons, 7 Days, 7 Continents And One Man With Parkinson’s. Can He Make It?
During the first marathon, Bret Parker felt great — for the first 15 miles of ice and snow. “I was chugging along, and I had no symptoms,” he recalled the next day. “I was running a good pace. I said, ‘You got this.’ ”He paused. “And that was the kiss of death. I started slowing down. It got colder. It got windier. ”It was Jan. 30, and Bret was running a marathon on Antarctica. (Gardner, 2/11)

The Associated Press: Maryland Recovers $81M Settlement Over Medicaid Technology
Maryland will recover $81 million from a contractor that the state says failed to rebuild the state’s Medicaid computer system. Attorney General Brian Frosh announced the settlement Friday with Computer Sciences Corporation, which was a state contractor to the state health department. He says it compensates the state for the damages suffered from the failure of the company to live up to its obligations. (2/10)

The Wall Street Journal: Hawaii’s Cesspools Threaten Drinking Water, Tourism
Paradise has a sewage problem. Cesspools—holes in the ground where untreated human waste is deposited—have become a crisis in Hawaii, threatening the state’s drinking water, its coral reefs and the famous beaches that are the lifeblood of its tourist economy. (Lovett, 2/11)