First Edition: November 15, 2018

California Healthline: For Wildfire Safety, Only Particular Masks Guard Against Toxic Particulate Matter
Toby Lewsadder stepped outside an Ace Hardware store wearing a simple one-strap dust mask. He knew it wasn’t the right defense against the wildfire smoke lingering in the air, but it was all he could find. The local hardware stores he checked Tuesday didn’t have the more substantial respirator mask that public health officials recommend to defend against the harmful wildfire smoke that is blanketing communities across the state. One pharmacy he contacted was selling surgical masks for only a quarter. (Young and Ibarra, 11/15)

The Hill: ObamaCare Enrollment Down Compared To Last Year
Fewer people are signing up for ObamaCare plans this year compared to a similar period last year, according to data released Wednesday by the Trump administration. About 1.2 million people signed up for ObamaCare plans in the first ten days of this year's sign up period, which began Nov. 1. In the first nine days of last year's enrollment period, 1.5 million people signed up for plans — a different of more than 300,000. (Hellmann, 11/14)

Reuters: U.S. State Spending Exceeds $2 Trillion In Fiscal 2018: Report
U.S. state spending topped $2 trillion for the first time in fiscal 2018, with Medicaid expenditures rising the most along with a significant increase in transportation spending, according to a report released on Thursday. Total expenditures grew an estimated 4.8 percent compared to 3.8 percent in fiscal 2017, the National Association of State Budget Officers' (NASBO) annual state expenditure report said. (11/15)

Modern Healthcare: CMS May Allow Hospitals To Pay For Housing Through Medicaid 
HHS Secretary Alex Azar on Wednesday said Medicaid may soon allow hospitals and health systems to directly pay for housing, healthy food or other solutions for the "whole person." In a speech supported by the Hatch Foundation for Civility and Solutions and Intermountain Healthcare in Washington, Azar said Center for Medicare and Medicaid Innovation officials are looking to move beyond existing efforts to partner with social services groups and try to manage social determinants of health as they see appropriate. (Barr and Dickson, 11/14)

The Hill: Incoming Dem Chairman: Medicare Negotiating Drug Prices Is A Priority 
Rep. Frank Pallone Jr. (D-N.J.), who is slated to be the next chairman of a House committee overseeing drug prices, said Wednesday that his top priorities on the issue are allowing Medicare to negotiate prices and speeding the approval of cheaper generic drugs. Pallone, who is set to become chairman of the House Energy and Commerce Committee in January, pointed to President Trump’s support for those two policies in expressing hope for a bipartisan deal. (Sullivan, 11/14)

Stat: In Michigan, Medicaid Can Now Pay For Drugs Based On How Well They Work 
The Trump administration gave Michigan’s Medicaid program permission to pay for drugs based in part on how well the drugs work, Centers for Medicare and Medicaid Services Administrator Seema Verma announced Wednesday. “Michigan’s waiver will empower it to demand results from drug manufacturers in exchange for paying for medicines,” Verma said in a speech at an industry conference. (Swetlitz, 11/14)

Stat: Covering Pricey Therapies Like CAR-T Is ‘Not Sustainable,’ Hospital Chief Says 
Hospitals are thrilled that they’re now able to offer cancer patients pioneering CAR-T treatments, but they’re also running into the omnipresent problem surrounding these and other next-generation therapies: cost. In a speech Wednesday at the Personalized Medicine Conference, Dr. Betsy Nabel, the president of Brigham and Women’s Hospital, said her hospital and others in the Partners HealthCare system are not being reimbursed fully when they treat patients with CAR-T therapies, leaving the providers to subsidize the treatments. (Joseph, 11/14)

Politico: Democratic Lawmakers Warn Pompeo Against Possible Ban On Sex Health Terminology
Several Democratic members of Congress are warning Secretary of State Mike Pompeo to not move forward with a possible ban on State Department employees using terms like “sexual and reproductive health” and “comprehensive sexuality education”. The lawmakers — Reps. Eliot Engel (D-N.Y.), Jan Schakowsky (D-Ill.), Nita Lowey (D-N.Y.), Barbara Lee (D-Calif.) and Lois Frankel (D-Fla.) — argue in a letter sent Wednesday to Pompeo that banning State Department employees from using those terms would be regressive for U.S. global health programs. The letter comes after POLITICO reported that conservative political appointees in the Trump administration were pushing for the proposal two weeks ago. (Choi, 11/14)

The Wall Street Journal: Big Tobacco Warns It May Fight FDA Over A Menthol Ban
The possibility of a nationwide ban on menthol cigarettes puts the tobacco industry into an all-too-familiar spot: having to defend the minty smokes, which are popular among younger smokers and African-Americans. Menthol-flavored cigarettes account for nearly a third of the roughly 250 billion cigarettes sold annually in the U.S., and the industry has a long history of marketing them to blacks and in minority neighborhoods. More than a dozen municipalities have adopted bans on menthols but cigarette makers have so far avoided federal restrictions. (Maloney and McGinty, 11/15)

PBS NewsHour: The Good, The Bad And The Ugly Of Picking Medicare Advantage Plans
Nearly half of all new Medicare enrollees are signing up for Medicare Advantage plans, which now account for about 35 percent of the entire Medicare market. The other 65 percent of Medicare beneficiaries are in what’s called original Medicare, which consists of Part A (hospital, nursing home) and Part B (doctors, equipment, outpatient expenses). Those patients usually have a private Part D drug plan, and a quarter have a private Medigap supplement policy. Anyone can get a Medicare Advantage plan or switch to one during open enrollment. Medicare Advantage (MA) plans must cover everything that original Medicare covers, and they can’t discriminate against people who are ill or have preexisting conditions. Anyone, regardless of their health, can get an MA plan or switch to one during open enrollment, which continues through Dec. 7. (Moeller, 11/14)

The Wall Street Journal: To Curb Wasteful Health Spending, Walmart To Send Employees Traveling For Spine Surgery
Walmart Inc. said it will require its employees to use certain hospitals for costly spine surgeries, an effort to weed out unnecessary procedures and lower its health-care spending. The retailer has been trying since 2013 to encourage employees to undergo the surgeries at hospital systems known for their quality by offering to pay the full cost of the procedures and travel. But not all workers took Walmart up on the offer, and the retailer continued to pay for surgery elsewhere. (Evans, 11/14)

Stat: A Startup For Diabetes Patients Will Only Get Paid By Insurers If Its Service Works
An ambitious startup that uses digital coaching and monitoring to try to help patients reverse type 2 diabetes, is making a big change to the way it makes money: Insurers and employers will now only pay Virta if its service works. Under Virta Health‘s new business model, announced on Wednesday, a health plan or employer will pay Virta a fee only if the patient is sufficiently engaged with its program after one month. The second payment comes after a year, only if patients lower their A1C, a measure of glucose in the blood, to a certain level determined on a case-by-case basis. (Robbins, 11/14)

The Washington Post: School Shootings Have Fueled A $2.7 Billion School Safety Industry. What Makes Kids Safer?
The expo had finally begun, and now hundreds of school administrators streamed into a sprawling, chandeliered ballroom where entrepreneurs awaited, each eager to explain why their product, above all others, was the one worth buying. Waiters in white button-downs poured glasses of chardonnay and served meatballs wrapped with bacon. In one corner, guests posed with colorful boas and silly hats at a photo booth as a band played Jimmy Buffett covers to the rhythm of a steel drum. For a moment, the festive summer scene, in a hotel 10 miles from Walt Disney World, masked what had brought them all there. (Woodrow Cox and Rich, 11/13)

NPR: Vicarious Trauma For Doctors And Nurses Who Treat Victims Of Gun Violence
Gun violence has become a part of everyday life in America and of the work lives of doctors, nurses and first responders, too. After the National Rifle Association told doctors to "stay in their lane" in response to a policy proposal from the American College of Physicians for reducing gun-related injuries and deaths, there was a backlash. Health care professionals shared heart-wrenching stories about treating people harmed by firearms. (Gordon, 11/14)

NPR: How Doctors And Nurses Cope With The Human Toll Of Gun Violence
Gun violence has become a part of everyday life in America and of the work lives of doctors, nurses and first responders, too. After the National Rifle Association told doctors to "stay in their lane" in response to a policy proposal from the American College of Physicians for reducing gun-related injuries and deaths, there was a backlash. Health care professionals shared heart-wrenching stories about treating people harmed by firearms. How do doctors and nurses cope with their regular encounters with the human toll of gun violence? How does exposure to trauma affect them? (Gordon, 11/14)

The Associated Press: Florida School Massacre Panel To Hear From Criticized Deputy
The then-sheriff's deputy on campus during the Florida high school massacre is scheduled to testify Thursday before a state commission investigating the shooting, a day after members called him "not a real cop" and "a coward." Former Broward County Deputy Scot Peterson is subpoenaed to appear before the Marjory Stoneman Douglas High School Public Safety Commission, where he will be asked why he did not enter the building where 14 students and three staff members died Feb. 14 and try to stop the shooter. (Spencer and Anderson, 11/15)

The Associated Press: Report Cites Weak Reporting On Missing, Killed Native Women
Numerous police departments nationwide are not adequately identifying or reporting cases of missing and murdered indigenous women and girls as concerns mount over the level of violence they often face, according to a study released by a Native American nonprofit Wednesday. The report from the Seattle-based Urban Indian Health Institute, the research arm of the Seattle Indian Health Board, was conducted over the past year amid worry in tribal communities and cities that Native American and Alaska Native women are vanishing in high numbers, despite a lack of available government data to identify the full scope of the problem. (Hudetz, 11/14)

Stat: FDA Official Hints At A Tough Road Ahead For ‘Right To Try’ 
A top Food and Drug Administration official seemed to suggest that the new “right-to-try” law, which skirts around the FDA’s traditional authority to help patients get access to unapproved therapies, might have harmful consequences. Dr. Peter Marks, director of the Center for Biologics Evaluation and Research, said the agency’s experience with stem cell clinics might foreshadow its future with right to try. He pointed to some clinics that purported to treat patients for a variety of conditions and instead ended up blinding them or causing tumors. (Swetlitz, 11/14)

Stat: Obtaining Abortion Pill From Pharmacies And Online Gains Support Among Women
As debate intensifies in the U.S. over abortion, a new survey finds nearly half of all women support alternatives to visiting a medical facility in order to obtain the abortion medicine to terminate pregnancies. And the findings suggest there is potential to expand access to abortion care, if regulators can be persuaded to loosen regulations governing access to the medicine, according to the researchers. Currently, women in the U.S. must obtain mifepristone at a doctor’s office, clinic, or hospital under a risk management program required by the Food and Drug Administration. The restrictions were imposed when the drug was approved in 2000 and stipulate Mifeprex may not be sold in pharmacies and health care providers must complete a certification process. (Silverman, 11/15)

The Washington Post: ‘Rapid Release’ Tylenol Gelcaps Are Slower To Dissolve Than Cheaper Tablets, Study Finds
The Extra Strength Tylenol “Rapid Release gels” package depicts a blue-and-red capsule gushing a cloud of pain-relieving medicine from laser-drilled holes, a visual depiction of relief. But the gels actually dissolved more slowly than less expensive Tylenol tablets in a laboratory test, according to a study published in the journal Advances in Investigational Pharmacology and Therapeutic Medicine — with the rapid-release gelcaps taking about 30 seconds longer than a tablet of the same dose. The researchers from Valisure, a start-up pharmacy that screens medicines, found a similar effect when they compared rapid-release gelcaps to regular tablets of generic acetaminophen from Walgreens, Rite Aid and Walmart Equate. (Johnson, 11/14)

The Wall Street Journal: Ginkgo Supplement Was Ginkgo-Free, U.S. Watchdog Finds
Two dietary supplements promoted as improving memory using Ginkgo biloba contained either none of the ingredient or a lower amount than advertised, a government watchdog said Wednesday. The products tested for Ginkgo biloba—the plant species commonly known as the ginkgo or maidenhair tree—contained other, unknown ingredients instead, according to a report by the U.S. Government Accountability Office. Because it couldn’t identify those ingredients, “the safety of the substitute ingredients could not be determined by the laboratory,” the GAO said. (Hopkins, 11/14)

Reuters: Pfizer Loses Blockbuster Drug Patent Fight In UK Supreme Court
Pfizer lost the final round in a long-running patent battle in Britain on Wednesday after the country's highest court ruled against it in a case involving its $5 billion-a-year pain drug Lyrica. The Supreme Court decision is a blow for the U.S. drugmaker -- which had sought to affirm a secondary medical use patent for the product -- and a win for generic drug companies Actavis, now renamed Allergan, and Mylan. (Hirschler, 11/14)

The New York Times: How A Low-Carb Diet Might Help You Maintain A Healthy Weight
It has been a fundamental tenet of nutrition: When it comes to weight loss, all calories are created equal. Regardless of what you eat, the key is to track your calories and burn more than you consume. But a large new study published on Wednesday in the journal BMJ challenges the conventional wisdom. It found that overweight adults who cut carbohydrates from their diets and replaced them with fat sharply increased their metabolisms. After five months on the diet, their bodies burned roughly 250 calories more per day than people who ate a high-carb, low-fat diet, suggesting that restricting carb intake could help people maintain their weight loss more easily. (O'Connor, 11/14)

Stateline: ‘On The Geaux’: How A Playground On A Truck Brings Joy
In a state with the fourth-highest rate of youth obesity in the nation, the Baton Rouge, Louisiana, parks and recreation agency wanted to lure kids away from their screens and into the parks to get moving. But the low-income youths who needed exercise the most weren’t showing up at the parks, because, officials learned, they didn’t have transportation, and their parents were too busy working to take them. So they decided to take the parks to the kids. With money donated in 2012 by corporate sponsors and a portion of their parish budget, the local parks and recreation agency, known as the Baton Rouge Recreation, or BREC, bought a box delivery truck, painted it with bright colors and filled it with scooters, hula-hoops, balls, slack lines, trampolines, sidewalk chalk and jump ropes. (Vestal, 11/14)

The New York Times: Diet, Not Age, May Account For Rising Blood Pressure
Cardiologists are generally convinced that blood pressure inevitably increases with age. Now a new study calls this belief into question. Researchers studied two communities in a remote area of the Venezuelan rain forest that can only be reached by air. The Yanomami are among the most isolated and least assimilated people in the world. Nearby live the Yekwana people, also quite isolated, but with an airstrip that allows for the regular delivery of Western food and medicine. (Bakalar, 11/14)

The Washington Post: Heat Waves Caused By Climate Change Could Impair Male Fertility Across Generations, Scientists Warn
One of the ways that heat kills is by increasing pressure in the skull, constricting blood flow to the brain. Damaged tissue can also enter the bloodstream and cause kidney failure. At a certain point, an elevated internal temperature simply incinerates cells in the body. In contrast to extreme weather events so visible and violent that they hardly escape pubic notice, such as hurricanes and tornadoes, heat waves are more of a “silent killer,” as the National Weather Service has called the prolonged periods of hot weather. (Stanley-Becker, 11/15)

The Wall Street Journal: Finally, A Fertility Clinic That Doesn’t Look Like A Fertility Clinic
At Trellis, nobody uses the c-word—“clinic,” that is. “We call it a fertility studio,” says Jennifer Huang. Huang is Chief Marketing Officer at Trellis, an egg freezing facility which opens today in Flatiron, with a grand opening party tomorrow that will include “fertility-friendly light bites.” (Larson, 11/14)

Stateline: Polio-Like Illness AFM Tests An Overstretched Public Health System
The mysterious, polio-like disease that has struck 414 people — mostly young children — across the United States since 2014 comes at a time when the public health system already is overstretched. Reported in 39 states and Washington, D.C., acute flaccid myelitis, known as AFM, causes muscle weakness and in some cases paralysis in the arms or legs, terrifying parents and puzzling medical researchers. (Ollove, 11/15)

The New York Times: What To Know About Getting A Flu Shot This Year, No Matter Who’s Paying
When I went to a pharmacy in Brooklyn to get a flu shot last year, I was presented with a choice: one vaccine with three different strains of the flu virus for about $30 or, for just $10 more, four strains. It sounded vaguely like a late-night television infomercial. I stood at the counter, confused. Didn’t I want every strain? I thought that one new vaccine was developed each year and that it was more effective some years than others. What was I missing? (Bernard, 11/15)

The Washington Post: As Ebola Outbreak Worsens In Congo, U.S. Stays Out Of War Zone
The United States has no plans to redeploy personnel to fight the growing Ebola outbreak on the ground in Congo because of worsening security concerns, administration officials said Wednesday. The outbreak in northeastern Congo is taking place in an active war zone and has now become the country’s largest in more than four decades. Attacks on government outposts and civilians by dozens of armed militias have complicated the work of Ebola response teams, who have often had to suspend crucial work tracking cases and isolating people infected with the deadly virus. Violence has escalated in recent weeks, including attacks by armed groups this weekend near the operations center in Beni, the urban epicenter in North Kivu province. (Sun, 11/14)

Stat: Scientists Hope To Translate Paralyzed Patients' Thoughts Into Speech 
Dr. Ashesh Mehta, a neurosurgeon at the Feinstein Institute for Medical Research on Long Island, was operating on his epilepsy patient to determine the source of seizures. But the patient agreed to something more: to be part of an audacious experiment whose ultimate goal is to translate thoughts into speech. While he was in there, Mehta carefully placed a flat array of microelectrodes on the left side of the brain’s surface, over areas involved in both listening to and formulating speech. By eavesdropping on the electrical impulses that crackle through the gray matter when a person hears in the “mind’s ear” what words he intends to articulate (often so quickly it’s barely conscious), then transmitting those signals wirelessly to a computer that decodes them, the electrodes and the rest of the system hold the promise of being the first “brain-computer interface” to go beyond movement and sensation. (Begley, 11/15)

The New York Times: Data-Driven Medicine Will Help People — But Can It Do So Equally?
The promise of data-driven medicine is clear. Using the latest analytical techniques can lead to better health outcomes and — over time as data technology inevitably becomes cheaper and more widely available — help many more people. But as medicine moves from the kind of clinical practice that has informed centuries of treatment to the data-driven practices that have already transformed commerce, finance and the media, it will also find itself facing some of the same social challenges. In particular, big-data technology might seem like a social neutralizer or even a leveling force, but it can have a way of increasing divisions. One hint at why this is comes from what communications theorists describe as a knowledge gap. (Tufekci, 11/15)

The New York Times: Proteomics Might Have Saved My Mother’s Life. And It May Yet Save Mine.
The sergeant with the Mount Crested Butte Police Department in Colorado appeared and I was with my wife and our two young children, ages 2 and 7, at Lake Irwin, a remote campsite at 10,200 feet in the Rocky Mountains. When the officer stepped out of his S.U.V. cruiser, its blue and red emergency strobes piercing the darkness, I thought that perhaps a neighboring camper had summoned him to silence my dissonant guitar strumming beside the campfire. “I’m looking for Mr. Behar,” the sergeant announced. My cousin, who knew our whereabouts, had called the county sheriff, who dispatched the sergeant. His name was Brad Phelps, and he had navigated a dirt road at night through rugged alpine terrain to our location, because there was no cell reception where we were. After I identified myself, Phelps read from a palm-size paper notepad: “I’m sorry to have to tell you that your mother has passed away.” (Behar, 11/15)

The New York Times: There’s A Stress Gap Between Men And Women. Here’s Why It’s Important.
I was a workaholic. I love to create things, grow them and solve problems,” said Meng Li, a successful app developer in San Francisco. “I didn’t really care about my mind and my body until they decided to go on strike.” Ms. Li said her stress led to insomnia. When she did sleep, she experienced “problem-solving dreams,” which left her feeling unrested when she woke up. “After I became a first-time mother, I quickly realized between work and family, I was so busy caring for other people and work that I felt like I’d lost myself,” she said. “I’d put my own physical and mental needs on the back burner.” (Wong, 11/14)

The Associated Press: Skulls Reveal Neanderthals, Humans Had Similarly Harsh Lives
Life as a Neanderthal was no picnic, but a new analysis says it was no more dangerous than what our own species faced in ancient times. That challenges what the authors call the prevailing view of our evolutionary cousins, that they lived risky, stressful lives. Some studies have suggested they had high injury rates, which have been blamed on things like social violence, attacks by carnivores, a hunting style that required getting close to large prey, and the hazards of extensive travel in environments full of snow and ice. (Ritter, 11/14)

Sacramento Bee: Camp Fire Death Toll Increases To 56; Names Of Missing People Released
Some are missing. Some aren’t. Some, nobody knows. As the death toll from the Camp Fire increased to at least 56 Wednesday, the Butte County Sheriff’s Office released a list of 103 people who have been reported missing since the blaze erupted last week, part of an effort to determine how many area residents actually are still unaccounted for and should be the subject of law enforcement searches. (Lillis, Yoon-Hendricks, Sullivan and Stanton, 11/14)

The New York Times: A ‘Perfectly Imperfect’ Life: The Victims Of The California Wildfires
In many ways, the story of Ernie Foss runs right alongside the narrative of the state he loved, California. He was a surfer and skateboarder as a young man. He grew up in San Francisco and worked at a store in the hippie heyday of Haight-Ashbury, selling candles and crystals, a job that allowed him to pursue his passion of music. And then tech money flooded the city, his neighborhood was gentrified, and like so many others he was priced out. (Arango, 11/14)

The Washington Post: Camp Fire: Toyota Offers To Replace Burned Truck Of California Nurse Who Helped Save Lives
By the time Allyn Pierce arrived at his job last Thursday morning, the sky in Paradise, Calif., was an eerie shade of burnt orange, choked with haze. A wildfire had exploded in the area hours before, and the flames were cutting through the Butte County town at an alarming pace. Now, at 8 a.m., they were threatening the Adventist Health Feather River hospital, where Pierce worked as a registered nurse and ICU manager. Pierce and his team quickly scrambled to help the hospital’s few dozen patients evacuate by ambulance. By 9:30 a.m., he and two colleagues were among the last to evacuate. They piled into his white Toyota Tundra and headed south for less than a mile, then east on wooded Pearson Road. (Wang, 11/14)

Sacramento Bee: No Easy Breathing: The Smoke In Sacramento Hasn’t Been This Bad In Nearly A Decade
Air quality related to fine particulate matter was expected to hit “unhealthy” or “very unhealthy” levels for the seventh time this year in the Sacramento region on Wednesday, more “code red” or worse days than any other year since at least 2009, according to the latest data from local air districts. (Reese and Finch, 11/14)

Los Angeles Times: Third Body Found Among Wreckage Of Woolsey Fire As Residents Blast Officials About Emergency Response
As a third body was discovered among the ashes of a home in Agoura Hills, residents in nearby Malibu questioned fire officials about the division of resources and rushed evacuation notices during the Woolsey fire’s devastating march through Los Angeles and Ventura counties. (Hamilton, Fry, Winton and Panzar, 11/14)

The New York Times: Not Far From Flint, Contamination Has Left Detroit School Taps Dry
For a year now, Marcel Clark, a Detroit police officer and father of three, has been filling a 50-gallon drum each week with purified water for his family to drink. Ever since he heard about the water contamination crisis in Flint, Mich., an hour’s drive away, he hasn’t trusted the aging copper and steel pipes in his house. He’s been talking to contractors about replacing them, and hopes to get the work done in the next few months. (Nir, 11/15)

The Associated Press: Accusers: 20-Plus Ohio State Staff Knew Concerns Over Doctor
Alumni who say they're victims of sexual misconduct by an Ohio State University team doctor allege more than 20 school officials and staff, including two athletic directors, knew of concerns about how the physician treated young men but didn't stop him. The list of such employees grew Tuesday as 29 plaintiffs were added to one of the two pending lawsuits alleging Ohio State didn't deal appropriately with the now-deceased doctor, Richard Strauss. (11/14)

The Associated Press: Case Reveals Shame, Trauma Of Male Sex Trafficking Victims
Like many victims of a Connecticut sex trafficking ring that preyed on troubled young men and teenage boys for more than 20 years, Samuel Marino never told his family or police about being coerced into having sexual relations with much older men. Marino ended up carjacking vehicles from two different women in 2009 and leading police on a chase that left him dead at just 26 years old. (11/15)

The Associated Press: Report: Health Department Wasted $170K On Gifts, Travel
An investigative report by the Baltimore city Office of the Inspector General says the city’s health department wasted $170,000 on unused promotional goods, excessive manager travel, snacks and staff gifts. The Baltimore Sun reports the report released Wednesday focuses on the department’s Office of Chronic Disease Prevention, which fights illnesses such as lead poisoning and asthma. The report says the department raised the money by fining landlords for lead paint violations and charging attorneys for records in lead lawsuits. (11/15)