First Edition: October 31, 2019

Kaiser Health News: Grief Grew Into A Mental Health Crisis And A $21,634 Hospital Bill
Arline Feilen lost her husband to suicide in 2013. Three years later, she lost her dad to cancer. And this February, she lost her 89-year-old mom to a cascade of health problems. “We were like glue, and that first Mother’s Day without her was killer. It just dragged me down,” said Feilen, who is 56 and lives in suburban Chicago. “It was just loss after loss after loss, and I just crumbled.” (Ungar, 10/31)

Kaiser Health News: Haiku Winner Unmasked! From Gobs Of Frightening Entries, One Rises Above
A big thanks to our readers! The number of Halloween haiku submissions ⁠— more than 70 ⁠— in KHN’s first annual Halloween Haiku Contest gave us chills. And, based on a review by our expert panel of judges, here’s the winner and a sampling of finalists. They range from eerie and haunting to downright spooky. (10/31)

The Associated Press: Stable Costs But More Uninsured As 'Obamacare' Sign-Ups Open
More Americans are going without health insurance, and stable premiums plus greater choice next year under the Obama health law aren't likely to reverse that. As sign-up season starts Friday, the Affordable Care Act has shown remarkable resiliency, but it has also fallen short of expectations. Even many Democrats want to move on. (Alonso-Zaldivar, 10/31)

Politico: Obamacare Is Stronger Than Ever — And A Trump-Backed Lawsuit Could Destroy It.
Three years into a presidency that promised to kill Obamacare, the health care law has never been stronger. Millions of people buying coverage during the enrollment period starting Friday will find that average premiums have dropped across the country. When consumers go to HealthCare.gov, they’ll be paying 4 percent less on average for the most popular health plans — with six states reporting a double-digit decline. (Goldberg, 10/31)

Politico: Senate Democrats Fail In Bid To Block Trump’s Obamacare Opt-Out
A largely symbolic attempt to kill a Trump administration policy allowing states to skirt Obamacare mandates fell well short in the Senate on Wednesday, even after Sen. Susan Collins crossed party lines to support the measure. The Senate voted 43-52 to reject the resolution, which aimed to block new guidance that provides states greater leeway to overhaul their insurance markets under the Affordable Care Act. (Cancryn, 10/30)

The Wall Street Journal: Vulnerable House Democrats Wary Of Campaigning For Medicare For All In 2020 Race
Some Democratic lawmakers key to holding the House majority worry that the health-care pledges made by Sens. Elizabeth Warren and Bernie Sanders could hurt their re-election chances. Of the 17 candidates in the Democratic primary race, Mr. Sanders and Ms. Warren have offered the clearest support for a single-payer health-care system, which would largely end private health insurance. Both candidates are consistently in the top three spots in national polls, along with former vice president Joe Biden, who supports giving people the option of buying into a government-run insurance program. (Andrews and Collins, 10/31)

The New York Times: Why ‘Medicare For All’ Could Both Raise Taxes And Lower Costs
[These charts] compare two leading sets of health care proposals advocated by Democrats running for president. The first, a “public option” plan, is similar to proposals from Joe Biden, Pete Buttigieg and other candidates. It would allow most Americans to buy insurance from the government and make other changes that would enable fewer people to go without coverage, but it would preserve much of the existing health insurance system. The second, a “Medicare for all” plan introduced by Bernie Sanders and endorsed by Elizabeth Warren, would replace most Americans’ current health insurance with a generous government-run plan that covers more benefits. (Sanger-Katz, 10/31)

Des Moines Register: Joe Biden Calls His Health Care Plan 'Medicare For All Who Want It,' Using Pete Buttigieg's Term
Former Vice President Joe Biden on Wednesday referred to his health care plan as "Medicare for All Who Want It," employing the phrase used by Pete Buttigieg, one of his rivals for the Democratic presidential nomination. Biden used the phrase while answering a question from voter Susan Reighard about high health care costs at a town hall in eastern Iowa. (Gruber-Miller, 10/30)

The Hill: Biden Aide: 'Alarming' That Sanders Won't Release Details Of Paying For 'Medicare For All'
Former Vice President Joe Biden’s campaign is attacking Sen. Bernie Sanders (I-Vt.) for saying he does not need to release details on how to pay for "Medicare for All" right away, part of an escalating battle over the issue in the Democratic presidential primary. “It’s alarming that Senator Sanders, who has been up-front for years that Medicare for All would require middle class tax hikes, won’t tell voters 'right now' how much more they will pay in taxes because of his plan,” Biden deputy campaign manager Kate Bedingfield said in a statement. “If not now, then when?” (Sullivan, 10/30)

The Associated Press: Former Juul Exec Alleges Company Shipped Tainted Products
A Juul Labs executive who was fired earlier this year is alleging that the vaping company knowingly shipped 1 million tainted nicotine pods to customers. The allegation comes in a lawsuit filed Tuesday by lawyers representing Siddharth Breja, a one-time finance executive at the e-cigarette maker. The suit claims that Breja was terminated after opposing company practices, including shipping the contaminated flavored pods and not listing expiration dates on Juul products. (Perrone, 10/30)

The New York Times: Juul Knowingly Sold Tainted Nicotine Pods, Former Executive Says
Mr. Breja detailed a culture of indifference to safety and quality-control issues among top executives at the company and quoted the then-chief executive Kevin Burns saying at a meeting in February: “Half our customers are drunk and vaping” and wouldn’t “notice the quality of our pods.” Mr. Burns, who left the company in September, issued a statement Wednesday afternoon strongly disputing the quote. “I never said this, or anything remotely close to this, period,” the statement said. “As CEO, I had the company make huge investments in product quality, and the facts will show this claim is absolutely false and pure fiction.” (Kaplan and HOffman, 10/30)

BuzzFeed News: Juul Shipped At Least A Million Contaminated Nicotine Pods, New Lawsuit Says
Breja says he was worried when the company, in February 2019, wanted to resell pods that were at that point almost one year old. He protested their resale and urged the company to at least include an expiration or “best by” date, or a date of manufacture, on the packaging. The lawsuit claims that then-CEO Kevin Burns shot down that idea, saying, “Half our customers are drunk and vaping like mo-fos, who the fuck is going to notice the quality of our pods.” (Lee, 10/29)

The Hill: Lawsuit Claims Juul Knowingly Sold 1 Million 'Contaminated' Pods
In his lawsuit, Breja did not say what the shipped pods were allegedly contaminated with, but he noted they were mint flavored — one of the company's best-selling products. (Hellmann, 10/30)

The Washington Post: Juul Sold 1 Million Contaminated Vaping Pods, Lawsuit Says
Juul is already facing scores of lawsuits and federal scrutiny stemming from allegations it created a youth vaping epidemic. Meanwhile, medical officials are scrambling to unravel a rash of lung illnesses tied to vaping devices that have sickened more than 1,600 users and caused 34 deaths, according to the national Centers for Disease Control and Prevention. Although many of the cases have been linked to black market THC products, public health officials have not ruled out nicotine-based e-cigarettes as a culprit. The panic has caused seven states and several cities, including San Francisco, where Juul is headquartered, to restrict e-cigarettes to various degrees. (Telford, 10/30)

NPR: As Big Tobacco Defends Itself In Court, It Gets Help From Academics
In 1998, major tobacco companies reached a historic legal settlement with states that had sued them over the health care costs of smoking-related illnesses. But individual smokers have continued to sue, and to this day the tobacco industry remains tied up in hundreds of court fights with sickened smokers, or with family members who lost a loved one to cancer, heart disease, or other smoking-related illness. These days, tobacco companies no longer try to claim that cigarettes aren't harmful — in fact, in an ironic reversal, a favorite legal defense in current cases is the argument that nearly everyone was aware of the dangers, even back in the 1950s. (Farmer, 10/30)

The Washington Post: How Much Money Will It Take To Undo The Damage From Opioids?
Inside the plaintiffs’ war room, bleary-eyed, caffeinated lawyers worked on what would be one of the most important cases of their careers — the first bellwether trial in the national opioid litigation against the country’s biggest drug companies. Their rented office space across from the federal courthouse was crammed with copy machines, boxes of documents, whiteboards and — to capture the gravity of the work — some World War II-era propaganda posters. (Achenbach, Bernstein, Kornfield, Higham and Horwitz, 10/30)

The Wall Street Journal: Startups Offer Apps, Digital Tools To Provide Addiction Care
Startups are designing new tools and services that are intended to make access to addiction care easier. With millions of people battling substance abuse and not receiving treatment, venture-backed companies aim to lower those barriers by opening treatment centers and providing online services. They include CleanSlate Centers Inc., which operates outpatient treatment centers in 11 states, and startups that provide digital-treatment programs such as DynamiCare Health Inc. (Gormley, 10/30)

The Washington Post: Missouri Tracked Menstrual Cycles Of Women Seen At Planned Parenthood State Health Director Says
Missouri’s top health official said Tuesday the state monitored detailed personal information about Planned Parenthood patients, in some cases reviewing women’s menstrual cycles, with the aim of identifying those who had failed abortions. Randall Williams, the state health director, said his goal was protecting patient safety. But critics called it an invasion of women’s privacy and demanded his resignation and an investigation by the governor. (Abutaleb and Wax-Thibodeaux, 10/30)

Kansas City Star: MO Health Department’s Spreadsheet Of Abortion Patients Angers Many
On Wednesday medical professionals expressed puzzlement and outrage about the practice, asserting that it served no legitimate purpose. OBGYN Jennifer Villavicencio, a fellow with the American College of Obstetricians and Gynecologists, said what the state did “defies both logic and ethics” and called it “skin-crawling.” “I spent some time thinking about how this director would be using this information in any form that would be meaningful medically and I really can’t think of any,” said Villavicencio, a clinical lecturer with the Department of Obstetrics and Gynecology at the University of Michigan. (Gutierrez and Thomas, 10/30)

The Associated Press: Doctor At Missouri Abortion Clinic Defends Patient Care
The top doctor at Missouri's sole abortion clinic on Wednesday defended its handling of four patients who faced complications — women whose care has been cited by the state as it seeks to revoke the clinic's license. The testimony from Dr. Colleen McNicholas at a hearing that could determine the St. Louis clinic's fate came as the state faced fallout over a revelation a day earlier from Missouri's top health official that he kept a spreadsheet that tracked the menstrual cycles of women who obtained abortions. (Salter, 10/30)

The Associated Press: US Sued Over Health Insurance Rule For Immigrant Families
A lawsuit Wednesday accused the Trump administration of preventing Americans from bringing their foreign spouses and parents to live with them in the United States by requiring those immigrants to prove they can afford health care before they get visas. Seven U.S. citizens and a nonprofit organization filed the federal lawsuit in Portland, Oregon, over the rule that's set to take effect Sunday. It applies to people seeking immigrant visas from abroad, not those already in the country, and doesn't affect asylum seekers, refugees or children. (Taxin, 10/30)

The Hill: Lawsuit Challenges White House Policy Requiring Migrant Health Insurance
"Suspending the entry of potentially two thirds of all legal immigrants to the United States, the Proclamation represents an unprecedented abuse of... power," the suit said. The legal filing also noted, "The Proclamation, like the recent Public Charge Rule, attempts to radically rewrite Congressional decision about which immigrants may enter the country based on wealth considerations." (Frazin, 10/30)

The New York Times: ‘Devil Winds’ Drive Southern California Fires
The downsloping gusts that begin inland and blow toward the ocean in autumn and winter bring with them warmth and dread in equal measure. They howl through the canyons of Santa Monica and whip the palm trees that line the streets of Los Angeles, driving up dust and fraying nerves. The winds, known as the Santa Anas, loom large over the collective psyche of Southern California. They have also been the defining antagonist in this season of fire, a sinister reminder that wind has the power to provoke fear and present danger in an instant. (Arango, 10/30)

The Wall Street Journal: To Fight California Fires, Firefighters Seek To Hold The Line In Sonoma
For Theodore Hiner Jr. and his crew of Grizzly Firefighters, the mission of the day was to fight any re-ignitions of the Kincade Fire literally by hand, chain-sawing brush, digging out underground flames and hand-pumping water into fresh ditches. To find underground fires amid an unseen labyrinth of roots, the 20-person crew used the backs of their bare hands to gauge the ashen earth’s temperature. “Hot spot!” they cried when an underground fire was found, and the digging began. (Lazo, 10/30)

Los Angeles Times: Extreme Winds Fuel Explosive Fire Near Reagan Library
The biggest battle Wednesday was in Ventura County, where 800 firefighters trying to control the wind-whipped fire surrounding the presidential library were stymied by intense gusts that sent embers flying far beyond the body of the blaze. Helicopters repeatedly dropped loads of water around the Reagan complex, which is perched atop a hill blanketed in dense brush, amid 60-mph winds that were strong enough to knock a person off balance. (Winton, Cosgrove, Miller and Fry, 10/30)

The Associated Press: Anger Grows As Utility Struggles To Get Its Blackouts Right
As Pacific Gas & Electric deliberately shut off power to homes and businesses to prevent wildfires, it has failed to communicate with California officials, given conflicting accounts about when the lights would go out and advised people to get information “the old-fashioned way, through calling on a landline.” (Cooper and Williams, 10/30)

Stat: Insurance, Pharma Figures Spar Over Impact Of Pelosi Drug Pricing Bill
Pharmaceutical and health insurance industry representatives on Wednesday sparred over the potential impacts of legislation to lower drug prices, underscoring an emerging flashpoint here as Congress attempts to broker sweeping pharmaceutical industry reforms. The debate centered on a recent analysis showing Democrats’ signature drug pricing legislation would reduce the number of new drugs approved in the U.S. by eight to 15 in the coming decade. Yet Matt Eyles, the CEO of the insurance lobbying group America’s Health Insurance Plans, disagreed with the projection. (Facher, 10/30)

Stat: Social Capital First, Science Second: Biotech's Recipe For Success Has Limits
When Laura Indolfi set out to launch a biotech in Boston, she had an idea — and little else. She had never run a company before. She had no practical experience in fundraising. But she was undeterred. In 2014 she founded PanTher Therapeutics, with the goal of turning a postdoctoral side project into a bona-fide drug delivery company. “I took a leap of faith,” she told STAT. (Sheridan, 10/31)

Reuters: Novartis' Zolgensma Study Halted By FDA Amid Safety Questions
U.S. regulators have halted a trial of Novartis's Zolgensma treatment after an animal study raised safety concerns, the company said on Wednesday, in a setback for the drugmaker's plan to expand its use to older patients. The U.S. Food and Drug Administration's partial hold on the so-called STRONG trial impacts patients aged up to five with spinal muscular atrophy (SMA) who were to receive a higher dose of the gene therapy via a spinal infusion. (10/30)

The Wall Street Journal: Novartis Trial Of World’s Most Expensive Drug Halted Over Safety Concerns
The halt doesn’t affect the use of the therapy in children up to the age of two, which was approved earlier this year, because that version is given through intravenous injection rather than through the spine. Zolgensma provides a working version of the gene at fault in SMA. The news is a setback for Novartis, which hoped the trial targeting older children with type 2 SMA—a milder form of the disease—would pave the way to treat a much broader group of patients. (Roland, 10/30)

ProPublica: The Wrong Goodbye
The neck brace held the unconscious man’s head at a 30-degree angle. The patient’s face — scraped and bruised — was largely covered with a plastic rig holding a breathing tube. Every two hours, hospital staff administered artificial tears. Shortly before midnight on July 13, 2018, police and hospital records show, the victim of a suspected drug overdose had arrived by ambulance at St. Barnabas Hospital in the Bronx. Officers responding to a 911 call had found the man on the ground at the corner of East 174th Street and Bryant Avenue. CPR administered by the officers had managed to produce a pulse. A breathing tube had been inserted on the way to the hospital. (Sexton and Schweber, 10/31)

ProPublica: End-Of-Life Care Laws Were Supposed To Help New Yorkers. They Don’t Always Work.
The case of the wrong person being taken off life support at St. Barnabas Hospital in the Bronx in 2018 is in many ways an aberration, a mix of bad luck, missed opportunities and unlikely coincidences. It thus only touched in a limited way on the complex, emotional and legally fraught issues surrounding end-of-life care — what patients are entitled to, what doctors are obligated to do and who is responsible for making sure everything is done appropriately. (Sexton, 10/31)

The New York Times: How Contaminated Stool Stored In A Freezer Left A Fecal Transplant Patient Dead
In a frank and public act of self-examination, a group of doctors at Massachusetts General Hospital published an article Wednesday in the New England Journal of Medicine detailing the missteps that led to the death of a cancer patient who received a fecal transplant as part of an experimental trial. The man who died, and another who became severely ill, had received fecal matter from a donor whose stool turned out to contain a type of E. coli bacteria that was resistant to multiple antibiotics. (Jacobs, 10/30)

Stat: New Details Emerge In Case Of First Death From Fecal Transplant
The man was a participant in a clinical trial run at Massachusetts General Hospital and received fecal transplant capsules made in November with fecal material from one stool donor, according to a paper published Wednesday in the New England Journal of Medicine. Tests after the man’s death revealed that material contained a rare type of E. coli bacteria. MGH scientists started screening for those kinds of bacteria in January. However, the hospital did not test capsules they’d already produced, researchers disclosed in a paper published in the New England Journal of Medicine. (Sheridan, 10/30)

Stat: Bill Gates Spends Billions On Global Health. With Alzheimer’s, His Science Adviser Says, Money Is Not The Issue
He’s one of the richest men in the world. He’s sought to eradicate malaria, pledged $10 billion to help fund childhood vaccinations, and poured another $3 billion into fighting HIV. But Bill Gates has been far more restrained in bankrolling research into Alzheimer’s disease. One of the first investments made by the billionaire’s Gates Ventures was in the Dementia Discovery Fund, which invests in novel science. But, all told, Gates’ Alzheimer’s investments only total roughly $100 million, which even Gates’ chief science adviser, Niranjan Bose, acknowledges is a “drop in the bucket.” (Florko, 10/31)

The Wall Street Journal: The Link Between Diet, Exercise And Alzheimer’s
In his 40s and a self-described fitness nut, Stephen Chambers doesn’t seem like someone who would be worrying about Alzheimer’s. But when his father was diagnosed with the disease about five years ago, he went to the Alzheimer’s Prevention Clinic in New York to see what he could do. Though he had no noticeable memory issues, cognitive testing showed less than ideal levels in certain areas. His neurologist told him there were a number of lifestyle changes that might help his cognition and possibly reduce the risk of developing Alzheimer’s disease. (Reddy, 10/30)

The Wall Street Journal: ‘Ebola Is Now A Disease We Can Treat.’ How A Cure Emerged From A War Zone.
The Ebola virus kills in terrifying ways, shutting down the body’s organs and draining victims of the fluids that keep them alive. In outbreaks, it has claimed as many as 9 in 10 patients. In a medical breakthrough that compares to the use of penicillin for war wounds, two new drugs are saving lives from the virus and helping uncover tools against other deadly infectious diseases. They were proven effective in a gold-standard clinical trial conducted by an international coalition of doctors and researchers in the middle of armed violence. (McKay, 10/30)

The New York Times: Mediterranean Diet May Help Ease Some Symptoms Of Depression
A healthy diet may help relieve the symptoms of depression. There is good evidence from observational studies that diet can affect mood, and now a randomized controlled trial suggests that healthy eating can modestly improve clinical levels of depression. (Bakalar, 10/30)

The New York Times: Room For Everyone At The Table
Steve Palmer has opened dozens of restaurants over the course of his career. He knows how to coax the best flavors out of a piece of fish, how to light a restaurant so all the customers look good and how to make a couple celebrating an anniversary feel special. But 18 years ago, he was so strung out on alcohol and cocaine that his boss at the restaurant where he worked gave him an ultimatum: Get treatment or get fired. (Severson, 10/31)

The Associated Press: After Calorie Counts Go On Fast-Food Menus, Orders Dip A Bit
Soon after calories were posted on fast-food menus, people cut back a little bit on what they ordered. But it didn't last. Customers at fast-food chains in Louisiana, Mississippi and Texas ordered an average of 60 fewer calories per transaction in the weeks after the figures were displayed, according to a study published Wednesday in the medical journal, BMJ. That amounted to a 4% drop, and declines came largely from extras such as fries and desserts. (10/30)

ProPublica/The Times-Picayune: Welcome To 'Cancer Alley,' Where Toxic Air Is About To Get Worse
Over a half-century, Hazel Schexnayder saw this riverside hamlet transformed from a collection of old plantations, tin-roofed shacks and verdant cornfields into an industrial juggernaut. By the early 1990s, she’d had enough of the towering chemical plants and their mysterious white plumes, the roadside ditches oozing with blue fluid, the air that smelled of rotten eggs and nail-polish remover, the neighbors suffering miscarriages and dying of cancer. (Younes, Baurick and Meiners, 10/30)

ProPublica: Why Louisiana’s Air Quality Is Going From Bad To Worse, In 3 Charts
The chemical industry is growing rapidly in Louisiana at the same time that the state is backsliding when it comes to toxic levels of cancer-causing chemicals in the air. We investigated. Here’s what we found. (Younes, 10/30)