First Edition: November 27, 2019

Kaiser Health News: Nothing To Sneeze At: The $2,659 Bill To Pluck Doll’s Shoe From Child’s Nostril
It was supposed to be a fun evening out for Katy and Michael Branson. But their 3-year-old daughter, Lucy, apparently had other ideas. The couple had tickets for a Saturday night show in April in their hometown of Las Vegas, and had arranged for a sitter to watch their two girls. But as Mom and Dad were getting dressed, Lucy came upstairs to their bedroom coughing and looking rather uncomfortable. “I think she has something up her nose,” Michael said. (Hawryluk and de Marco, 11/26)

California Healthline: Coping With (Power) Loss: California’s Hospitals, Clinics, Patients Face New Reality
We all know that when the power goes out, refrigerators, heaters and air conditioners stop running. Homes go dark, and desktop computers shut down. But those are mere inconveniences. If you need regular dialysis or chemotherapy at a clinic, or you have an infant in a neonatal intensive care unit or a loved one on a hospital ventilator, a loss of power carries far more dire implications. (Kreidler, 11/26)

Kaiser Health News: Did Joe Biden Overstate Democratic Voters’ Opposition To ‘Medicare For All’?
When the subject of “Medicare for All” came up during the Democratic debate last week, former Vice President Joe Biden claimed that the majority of his party does not favor it. “The fact is that right now the vast majority of Democrats do not support Medicare for All,” he said, adding, “It couldn’t pass the United States Senate right now with Democrats. It couldn’t pass the House.” (Knight, 11/26)

Kaiser Health News: KHN’s ‘What The Health?’: How’s That Open Enrollment Going?
Open enrollment for 2020 health coverage under the Affordable Care Act is halfway over. So far, sign-ups appear to be lagging behind last year’s, but not dramatically. Meanwhile, President Donald Trump and Congress still say they want to do something about the teen vaping epidemic, the high cost of prescription drugs and “surprise” medical bills. But it’s Thanksgiving week, and official Washington has not much to show for any of those issues. (11/26)

Kaiser Health News: ‘An Arm And A Leg’: A La ‘Hamilton,’ Revue Takes On History Of Health Insurance
“Bills, Bills, Bills” — the 1999 hit from mega-group Destiny’s Child — has gotten a remix of sorts from the New York City musical troupe Heck No Techno. The troupe’s show “Explanation of Benefits” charts the history of the U.S. health care system, borrowing Beyoncé swagger and adding new lyrics. (Weissmann, 11/27)

Politico: Clashes Among Top HHS Officials Undermine Trump Agenda
President Donald Trump’s health secretary, Alex Azar, and his Medicare chief, Seema Verma, are increasingly at odds, and their feuding has delayed the president’s long-promised replacement proposal for Obamacare and disrupted other health care initiatives central to Trump's reelection campaign, according to administration officials. Verma spent about six months developing a Trump administration alternative to the Affordable Care Act, only to have Azar nix the proposal before it could be presented to Trump this summer, sending the administration back to the drawing board, senior officials told POLITICO. Azar believed Verma’s plan would actually strengthen Obamacare, not kill it. (Pradhan, Cancryn and Diamond, 11/26)

CBS News: Supreme Court Abortion Lawsuit: Opening Brief Filed By Center For Reproductive Rights In June Medical Services V. Gee Monday
The lawsuit that will decide the future of abortion access in Louisiana – and the rest of the country – is officially underway. A 63-page opening brief was filed late Monday night by the Center for Reproductive Rights (CRR) in a Supreme Court case that could leave Louisiana without access to legal abortion and provide a roadmap for other anti-abortion access states to follow. (Smith, 11/26)

The Hill: Supreme Court Sets Date For Louisiana Abortion Case 
In February, the court ruled to prevent the law from taking effect while it faces a legal challenge. Chief Justice John Roberts joined the liberal justices in this decision, but it is unclear whether he would vote to block the law permanently. A similar law in Texas was struck down 5-3 in 2016, but Roberts voted to uphold that law at the time. Justice Anthony Kennedy has retired since then. (Frazin, 11/26)

The Associated Press: US Judge Bars Trump’s Health Insurance Rule For Immigrants
A U.S. judge in Oregon on Tuesday granted a preliminary injunction blocking a Trump administration proclamation that would require immigrants to show proof of health insurance to get a visa. U.S. District Court Judge Michael Simon said in a written opinion that the proclamation could not take effect while a lawsuit challenging its constitutionality makes its way through the courts. (Flaccus, 11/26)

Politico: Judge Halts Trump's Insurance Mandate For Immigrants
Simon noted that the requirement that immigrants buy unsubsidized insurance — meaning they couldn't get financial assistance through Obamacare — barred poor people from entering the country, which he said clearly infringed on the law. "The proclamation is anticipated to affect approximately 60 percent of all immigrant visa applicants," the judge wrote. "The president offers no national security or foreign relations justification for this sweeping change in immigration law." (Luthi, 11/26)

Stat: Our Drug Policy Prioritizes Eliminating Rare Disease. Is That The Right Goal?
Dr. Peter Bach wants to turn the entire philosophical underpinnings of America’s health care system upside down. In a new argument — first laid out in a zippy 10-minute speech at last week’s STAT Summit in Cambridge, Mass. — Bach suggests the incentives created by policymakers to improve public health aren’t actually the best ideas for achieving that overarching goal. It centers on a seemingly heretical question: Is Washington’s obsession with eliminating rare diseases really the best use of taxpayer resources? (Florko, 11/26)

Stat: New CDC Report Offers A Possible Clue About Why Vaping Illnesses Sprang Up In 2019
A new report adds to the evidence that vitamin E acetate might play a role in a spate of vaping-related illnesses that have sickened thousands. It could also offer an early clue about why the illnesses appeared seemingly suddenly this year — though experts caution it’s too soon to rule out other potential culprits. The chemical — used as an additive or thickener in some vaping products — was found in vaping products used by 11 of 12 patients sickened with vaping-related illness in Minnesota, the Centers for Disease Control and Prevention reported Tuesday. (Thielking, 11/26)

The Associated Press: More Clues Point To Chemical Compound In US Vaping Illnesses
Health officials said Tuesday they have more evidence that a certain chemical compound is a culprit in a national outbreak of vaping illnesses. Researchers analyzed black market vaping cartridges seized in Minnesota during the outbreak this year, and vaping liquid seized in that state last year. The newer cartridges contained the compound vitamin E acetate, but none of the older samples did. (Stobbe, 11/26)

The Wall Street Journal: Researchers Say FDA Has Fallen Down On E-Cigarette Testing
The Food and Drug Administration has come under fire for not moving quickly to address the health risks of e-cigarettes, but outside the public spotlight it is also under attack for not prioritizing study of whether those vaping products may well be an important way to reduce deaths from traditional smoking. More than 480,000 Americans die each year from causes related to cigarette smoking. Some leading academic researchers believe e-cigarettes may be an effective and safer alternative. (Burton, 11/27)

The Associated Press: New York City Lawmakers Vote To Ban Flavored Vaping Products
New York City lawmakers voted Tuesday to ban flavored electronic cigarettes after a lawsuit halted a statewide ban. “We are acting to protect our kids by banning the e-cigarette flavors that have been hooking them for years,” Democratic City Council member Mark Levine said before the Council voted 42-2 to adopt the ban on flavored vaping products. (11/26)

The Wall Street Journal: New York City Bans Flavored E-Cigarettes
The council’s proceedings were briefly interrupted by pro-vaping protesters who shouted and threw $1 bills at council members, accusing them of bending to tobacco companies that the protesters have said will benefit from the ban. Councilman Mark Levine, the bill’s primary sponsor and chairman of the committee on health, said at a news conference, that the nation has been “woefully slow” in responding to the teen vaping epidemic. Mr. Levine acknowledged that underage people are already prohibited from buying e-cigarette products, but those age restrictions haven’t kept children from vaping. (West, 11/26)

The Associated Press: DC Government Sues E-Cigarette Maker Juul Over Teen Use
The District of Columbia is joining several states in suing the nation’s largest e-cigarette maker Juul Labs, saying the company’s online ads and promotions illegally targeted minors. Washington, D.C., Attorney General Karl Racine announced the lawsuit Tuesday, alleging that Juul’s viral marketing contributed to the surge in underage vaping by teens in the district and across the U.S. (Perrone, 11/26)

The Washington Post: D.C. Sues Juul, Alleging E-Cigarette Maker Marketed To Teens
Vaping has exploded in popularity in recent years, including among teenagers, and has raised alarms in schools and among anti-tobacco advocates. “There is a teenage vaping epidemic, and usage levels are spiking at an unprecedented rate, which importantly is reversing a decades-long decline in smoking rates among young people,” Racine said in an interview. (Nirappil, 11/26)

The Associated Press: Trump Order Creates Task Force On Missing American Indians
President Donald Trump signed an executive order Tuesday creating a White House task force on missing and slain American Indians and Alaska Natives. The task force will be overseen by Attorney General William Barr and Interior Secretary David Bernhardt. It will develop protocols to apply to new and unsolved case and create a multi-jurisdictional team to review cold cases. Trump called the scourge facing American Indian women and girls “sobering and heartbreaking.” (11/26)

Reuters: U.S. Prosecutors Open Criminal Probe Of Opioid Makers, Distributors
Federal prosecutors are investigating six pharmaceutical companies for potential criminal charges in connection with shipping big quantities of opioid painkillers that contributed to a healthcare crisis, according to regulatory filings. Five companies have received subpoenas from the U.S. Attorney's office in the Eastern District of New York as part of the investigation: drugmakers Teva Pharmaceutical Industries Ltd, Mallinckrodt Plc, Johnson & Johnson and Amneal Pharmaceuticals Inc, and distributor McKesson Corp, regulatory filings showed. (11/26)

The Wall Street Journal: Federal Prosecutors Launch Criminal Probe Of Opioid Makers, Distributors
The investigation, if it results in criminal charges, could become the largest prosecution yet of drug companies alleged to have contributed to the opioid epidemic, escalating the legal troubles of businesses that already face complex, multibillion-dollar civil litigation in courts across the country. Prosecutors are examining whether the companies violated the federal Controlled Substances Act, a statute that federal prosecutors have begun using against opioid makers and distributors this year. (Ramey, 11/26)

Reuters: Judge Partly Vacates Convictions Of Opioid Maker Insys' Founder, Executives
A federal judge on Tuesday partially overturned the convictions of Insys Therapeutics Inc's founder and three former executives accused of bribing doctors to prescribe an addictive opioid, but declined to disturb the remainder of the jury's verdict. U.S. District Judge Allison Burroughs in Boston ruled the evidence prosecutors presented at trial did not support finding that John Kapoor and the others intended for doctors to prescribe the drug, Subsys, to patients who did not need it. (Raymond, 11/26)

Los Angeles Times: Are Drug-Addicted Mothers Liable For Babies’ Deaths?
[Chelsea] Becker is at the center of a legal and ethical debate over the criminalization of drug abuse and pregnancy that’s playing out across the country. Legal experts have raised questions about how the justice system is policing women’s bodies and treating mothers who struggle with addiction. California’s penal code defines murder as the unlawful killing of a human being or unborn child. The statute was amended to include the word “fetus” in 1970. Legislators made the change after the state Supreme Court overturned the conviction of a Stockton man charged with murder for beating his estranged pregnant wife and causing her to lose the baby. (Wigglesworth, 11/26)

The Associated Press: Trump Donates 3rd-Quarter Salary To Help Fight Opioid Crisis
President Donald Trump is donating his third-quarter salary to help tackle the nation’s opioid epidemic. A White House official says Trump has given the $100,000 he would be paid in the quarter to the Office of the Assistant Secretary of Health, which oversees federal public health offices and programs, including the surgeon general’s office. (Miller, 11/26)

The Washington Post: The Post Released The DEA’s Data On Pain Pills. Here’s What Local Journalists Are Using It For.
On July 18, The Washington Post made publicly accessible part of a Drug Enforcement Administration database that tracked the path of every pain pill sold in the United States between 2006 and 2012. Since then, we have registered more than 38,000 downloads of the data, in whole or in part, and over 550 messages from local journalists, educators, researchers, federal and local government workers, health-care professionals, volunteers, advocates and citizens. Our hope in releasing the data was that local reporters, in particular, would use it to tell stories about the impact of the opioid crisis in their communities. (Sanchez Diez, 11/26)

Stat: How Difficult Is A $1 Billion Health-Tech Fraud? 
Building a health-technology startup on nothing but hot air may be easier than you’d think — at least, according to a federal indictment unsealed Monday and related civil charges brought by the Securities and Exchange Commission. Federal prosecutors charge that executives at Outcome Health, a high-flying startup, are guilty of defrauding their clients, lenders, and investors, leading to nearly $1 billion in fraudulently obtained investments and debt. The SEC made its own complaint, alleging that Outcome raised $487 million by falsely portraying itself as a success to its investors, which included Goldman Sachs, Google-affiliated CapitalG, and the Pritzker Group. (Herper, 11/26)

The New York Times: Fertility Rate In U.S. Hit A Record Low In 2018
The fertility rate in the United States fell in 2018 for the fourth straight year, extending a steep decline in births that began in 2008 with the Great Recession, the federal government said on Wednesday. There were 59.1 births for every 1,000 women of childbearing age in the country last year, a record low, according to the National Center for Health Statistics. The rate was down by 2 percent from the previous year, and has fallen by about 15 percent since 2007. (Tavernise, 11/27)

The New York Times: It’s Not Just Poor White People Driving A Decline In Life Expectancy
As the life expectancy of Americans has declined over a period of three years — a drop driven by higher death rates among people in the prime of life — the focus has been on the plight of white Americans in rural areas who were dying from so-called deaths of despair: drug overdoses, alcoholism and suicide. But a new analysis of more than a half-century of federal mortality data, published on Tuesday in JAMA, found that the increased death rates among people in midlife extended to all racial and ethnic groups, and to suburbs and cities. (Kolata and Tavernise, 11/26)

The Washington Post: U.S. Life Expectancy: Americans Are Dying Young At Alarming Rates
Despite spending more on health care than any other country, the United States has seen increasing mortality and falling life expectancy for people age 25 to 64, who should be in the prime of their lives. In contrast, other wealthy nations have generally experienced continued progress in extending longevity. Although earlier research emphasized rising mortality among non-Hispanic whites in the United States, the broad trend detailed in this study cuts across gender, racial and ethnic lines. By age group, the highest relative jump in death rates from 2010 to 2017 — 29 percent — has been among people age 25 to 34. (Achenbach, 11/26)

Los Angeles Times: Suicides, Overdoses, Other 'Deaths Of Despair' Fuel Drop In U.S. Life Expectancy
In an editorial accompanying the new report, a trio of public health leaders said the study’s insight into years of cumulative threats to the nation’s health “represents a call to action.” If medical professionals and public health experts fail to forge partnerships with social, political, religious and economic leaders to reverse the current trends, “the nation risks life expectancy continuing downward in future years to become a troubling new norm,” wrote Harvard public health professors Dr. Howard K. Koh, John J. Park and Dr. Anand K. Parekh of the Bipartisan Policy Center in Washington, D.C. (Healy, 11/26)

Stat: With Ketamine, Researchers Rewrite Memories In Bid To Curb Drinking
Our memories are immensely powerful. For a person with alcohol use disorder, a memory triggered by a simple cue — like walking by a favorite bar or spotting a beer billboard — can drive a desire for a drink. But they’re also surprisingly pliable. And scientists are trying to curb harmful drinking by dredging up memories and rewriting them — with the help of a dose of ketamine, a longtime anesthetic which is also used recreationally and to treat certain mental health conditions. (Thielking, 11/26)

The Associated Press: 1 Year Later, Mystery Surrounds China’s Gene-Edited Babies
Chinese scientist He Jiankui shocked the world by claiming he had helped make the first gene-edited babies. One year later, mystery surrounds his fate as well as theirs. He has not been seen publicly since January, his work has not been published and nothing is known about the health of the babies. "That's the story — it's all cloaked in secrecy, which is not productive for the advance of understanding," said Stanford bioethicist Dr. William Hurlbut. (11/26)

The New York Times: Does Who You Are At 7 Determine Who You Are At 63?
On a brisk Saturday morning, one uncommonly cloudless and bright for late autumn on England’s moody North Sea coast, the filmmaker Michael Apted paced a sloping headland of mud and stubble with an air of fretful preoccupation. Though the day’s shoot would amount, in the end, to an additional five-minute increment of the documentary project that had intermittently consumed the entirety of his working life, these occasions never ceased to surprise and unnerve him. He had known Jackie, whose arrival was imminent, for 56 years, but her interviews could be volatile, and this one was particularly important, he felt, to get right. (Lewis-Kraus, 11/27)

The New York Times: For Millennials Making Their Way, A Detour: To Caregiving
In the summer of 2017, soon after starting a new job, Ariel Brandt Lautman took her two young children to Denver to visit her mother. This wasn’t purely a social call. Her mother’s memory had been deteriorating for several years, and Ms. Brandt Lautman, who lives in Silver Spring, Md., needed to plan for her care. Ms. Brandt Lautman was 35 at the time, considerably younger than the typical caregiver. Each day was a juggling act. She worked from sunrise to 2 p.m., taking a break to drive her 5-year-old son and 3-year-old daughter to camp. (Garland, 11/27)

The New York Times: What Are The Benefits Of Probiotics?
Walk into a health food store, or even a drugstore, and you’re likely to find an entire aisle, maybe two, dedicated to probiotics. Probiotics are live micro-organisms, usually bacteria, that provide health benefits when consumed at appropriate doses. According to some surveys, approximately four million Americans take probiotics, which are available as pills, powders, foods and drinks. Probiotics are a huge industry — at least a $40 billion dollar one, according to Zion Market Research — and popular brands sell for 35 cents to $1 a dose, with a shelf life of several months. (Moyer, 11/27)

The Washington Post: A German Man Died From Bacteria In His Dog’s Saliva
The 63-year-old man showed up in the hospital with a burning sensation in his left leg and muscle pain in both. His flulike symptoms were severe, with labored breathing for three days. He had petechiae, or rounds spots on the skin that look like rashes as a result of bleeding capillaries, which made his legs look discolored. The patient’s heartbeat was stable, doctors said, even though he was running a temperature of 102. His labored breathing caused an inadequate supply of oxygen to his tissue. His failing kidneys were not producing urine, researchers wrote. (Beachum, 11/26)

The Washington Post: Why Romaine Lettuce Keeps Getting Recalled For E. Coli Contamination
Once again, just in time for Thanksgiving, millions of people have been told their romaine lettuce might be contaminated with a toxic strain of E. coli bacteria, that it’s potentially deadly, and that they should throw it away immediately and sanitize the fresh-produce drawer of their refrigerator. No one knows why this is happening, exactly. There are inferences, speculation and intriguing clues, but the best minds of the U.S. government, the lettuce-growing states of California and Arizona, and the leafy greens industry have failed to figure out why romaine keeps getting contaminated — or how they can stop it from happening again and again. (Kindy and Achenbach, 11/26)

The New York Times: C.D.C. Reports More E. Coli Illnesses Linked To Romaine Lettuce
The Centers for Disease Control and Prevention said Tuesday that it had identified 27 more people who were ill from the recent outbreak of E. coli infection linked to romaine lettuce from Salinas, Calif., bringing the total number of reported cases to 67. The C.D.C. reported no fatalities but said the outbreak affected 19 states, up from 16 on Friday, and resulted in a total of 39 people being hospitalized, up from 28. Six people also had developed hemolytic uremic syndrome, a type of kidney failure, according to the agency. (Dahir, 11/26)

The New York Times: Holiday Eating Got You Anxious?
The holiday season is typically an indulgent time, especially when it comes to food and drink consumption. For people who struggle with body-image issues, food and weight-related health problems, including and especially eating disorders, this time of year can be stressful. We spoke with experts to offer tips that can help you navigate the season and its attendant anxieties: the meals, the parties and the people. (Kerr, 11/27)

NPR: How To Keep Stress Over Food Allergies Off The Menu At Thanksgiving
Out of all the Thanksgiving dishes Kim Yates has helped prepare for her large family over the years, one batch of mashed potatoes stands out clearly in her memory. About 30 guests were gathered that year, at her sister's home in Palo Alto, Calif., and Yates had made a point of taking on responsibility for the mashed potatoes so that her young daughter Tessa (who was dealing with extreme food allergies to eggs, dairy, wheat, peanuts, tree nuts and shellfish) would have at least one safe side dish to eat. (Vaughn, 11/27)

The New York Times: Don’t Get Mad, But ‘Hangry’ Isn’t Really Angry
The morning walk before a holiday meal can feel like an act of advance penance: a show of restraint before the feast, best performed under a pale sun, amid a lonely scatter of leaves and with a determination to keep the campfire in sight. March off too slowly — or too far — and you’ll only annoy the other pilgrims, who likewise skipped breakfast to save room for the banquet. Scientists have only recently begun to explore the emotional and social effects of acute hunger. (Carey, 11/27)

The New York Times: Eating After You Exercise May Provide Added Fat-Burning Benefits
Working out on an empty stomach could amplify the health benefits of the activity, according to a well-timed new study of the interplay of meal timing, metabolic health and moving. The study, which involved sedentary men and moderate cycling, suggests that whether and when we eat may affect how exercise affects us. In general, any exercise improves our health. But a wealth of recent science and personal experience indicate that different people can respond to similar exercise routines in different ways. (Reynolds, 11/27)

The New York Times: Fresh-Food Vending Machines Will Be Graded Like Restaurants
On Oct. 30, an inspector from the New York City Department of Health and Mental Hygiene was making her rounds when she came across a vending machine unlike any she seen before. Called Farmer’s Fridge, it was made of washed white wood, with a giant touch screen and a built-in recycling bin. Inside was not the usual candy and soda, but tall jars packed with salad greens, Thai noodle and falafel bowls, and yogurt parfaits. What might look like a convenient healthy-eating option to many people looked to the inspector like a food-safety time bomb waiting to blow. (Black, 11/26)

The New York Times: FEMA’s Hurricane Aid To Puerto Rico And The Virgin Islands Has Stalled
More than two years after back-to-back hurricanes ravaged this tropical island, medical workers are still treating gunshot wounds in hallways and kidney failure in a trailer. They ignore their own inflamed rashes that they say are caused by the mold that has shut down an entire hospital floor below a still-porous roof. At least they have a hospital. The lone medical center on Vieques, an idyllic island that is part of Puerto Rico, was severely damaged by Hurricanes Maria and Irma, then abandoned to wandering roosters and grazing horses. Ailing people wait at the ferry dock to catch a boat to the mainland. (Walker and Kanno-Youngs, 11/27)

The Associated Press: Hospital: Kidney Went To Wrong Transplant Patient
A New Jersey hospital says a kidney meant for one patient was mistakenly transplanted into another with the same name who was farther down the priority list. Virtua Health says the Nov. 18 operation on a 51-year-old patient at Virtua Our Lady of Lourdes Hospital in Camden was successful. But officials then discovered the patient was given the kidney out of priority order because “unusually, the individual who should have received the organ has the same name and is of similar age.” (11/27)

The Washington Post: About One Out Of Every Three Washingtonians Say They Or Someone They Know Have Experienced Gun Violence, Poll Finds
Nearly half of Washingtonians in the city’s poorest neighborhoods say they or someone they know has been threatened with a gun or shot in the past five years, a Washington Post poll finds. Across the city, about a third of District residents say they or someone they know has been menaced or been the victim of gun violence since 2014, even as a large majority of Washingtonians say they feel safe in their neighborhoods. (Schwartzman and Guskin, 11/26)

Los Angeles Times: Trump Has Limited Options To Combat Homelessness In Los Angeles
Although the White House has vowed to take action to combat homelessness in Los Angeles and other cities, President Trump’s options are limited without cooperation from the courts, Congress and local and state governments. Administration officials have floated a range of potential plans — including using police to clear skid row and other encampments, reducing regulations for building new housing, and increasing temporary shelter space by making federal facilities available or erecting temporary structures. (Bierman, 11/26)

The Washington Post: Maryland Records Lowest Number Of New HIV Cases In More Than 30 Years
For the first time in more than three decades, the state of Maryland recorded fewer than 1,000 new cases of HIV infection in 2018. The state Department of Health announced on Tuesday that 997 new cases of HIV were reported in Maryland last year. That’s the lowest since 947 people learned they’d contracted the virus in 1986, just five years after the state’s first reported HIV case. (Zauzmer, 11/26)