First Edition: September 30, 2019

Kaiser Health News: States Target Vaping With Bans. In California, The Action Is Local.
States are piling on. Michigan took the first statewide shot at vaping early this month when it announced a ban on the sale of flavored e-cigarette products. It was soon joined by New York, and Rhode Island jumped in Wednesday. Massachusetts went further, announcing Tuesday that it would prohibit the sale of all vaping flavors and devices for four months. But in California — which prides itself on progressive policies — lawmakers this year punted on a proposal for a statewide ban on flavored tobacco products. (Ibarra, 9/30)

Kaiser Health News: Listen: Five Oklahoma Hospitals Collapsed – What Happened?
KHN Midwest correspondent Lauren Weber joined StateImpact Oklahoma reporter Jackie Fortiér to discuss why a series of rural hospitals collapsed, leaving hundreds of residents without jobs and their communities without lifesaving emergency medical care. (9/27)

The Associated Press: Can Washington Deliver On Drug Costs Amid Impeachment Probe?
Major legislation to reduce prescription drug costs for millions of people may get sidelined now that House Democrats have begun an impeachment inquiry of President Donald Trump. Proposals had been moving in Congress, but there are more ways for the process to break down than to succeed. Still, nobody says they’re giving up. Some questions and answers about the legislation and its uncertain prospects. (Alonso-Zaldivar, 9/29)

The New York Times: Democrats’ 2020 Campaign Message: Not Impeachment, They Insist 
[Speak Nancy] Pelosi has already advised the newest members of her caucus — the ones who secured the majority last year — that they will have to execute a careful balancing act in the coming weeks, to show voters in their districts that they can continue to pass important legislation. She is said to be particularly focused on a proposal to lower prescription drug prices that she unveiled last week, before the Ukraine saga began. But even before impeachment, House Democrats were gaining little traction with policy bills that withered in the Republican-controlled Senate. Polls have shown their proposals to be popular, but they have been routinely overshadowed in the news by Mr. Trump. (Burns and Corasaniti, 9/28)

The Washington Post: ‘Out Here, It’s Just Me’: In The Medical Desert Of Rural America, One Doctor For 11,000 Square Miles
In the medical desert that has become rural America, nothing is more basic or more essential than access to doctors, but they are increasingly difficult to find. The federal government now designates nearly 80 percent of rural America as “medically underserved.” It is home to 20 percent of the U.S. population but fewer than 10 percent of its doctors, and that ratio is worsening each year because of what health experts refer to as “the gray wave.” Rural doctors are three years older than urban doctors on average, with half over 50 and more than a quarter beyond 60. Health officials predict the number of rural doctors will decline by 23 percent over the next decade as the number of urban doctors remains flat. (Saslow, 9/28)

The Associated Press: US Probe Of Vaping Illnesses Focuses On THC From Marijuana
U.S. health officials said Friday that their investigation into an outbreak of severe vaping-related illnesses is increasingly focused on products that contain the marijuana compound THC. Most of the 800 people who got sick vaped THC, the ingredient in marijuana that causes a high, according to the Centers for Disease Control and Prevention. But officials said they didn’t know if the THC is the problem or some other substance added to the vaping liquid, such as thickeners. (Stobbe, 9/27)

The New York Times: Dank Vapes, TKO And Other THC Vaping Brands Are Linked To Illnesses, C.D.C. Says
Health officials said on Friday that the products include THC-filled vaping cartridges labeled “Dank Vapes,” as well as some other illicit brands that people bought from friends or family or on the street. But officials said Dank Vapes appeared to be a label that THC sellers can slap on any product and is not a specific formulation or a single product. THC is the psychoactive ingredient in marijuana. “Dank Vapes appears to be the most prominent in a class of largely counterfeit brands, with common packaging that is easily available online and that is used by distributors to market THC-containing cartridges with no obvious centralized production or distribution,” said a report published on Friday by state health officials from Illinois and Wisconsin, and from the federal Centers for Disease Control and Prevention. (Grady, 9/27)

NPR: Many Vaping Illnesses Linked To Black Market 'Dank Vapes' Or Other THC Products
The CDC has been warning since the outbreak began about the risks of buying products "off the street," and Friday's update highlighted the risks of the black market. Sometimes young consumers don't even realize that they're buying unregulated or illicit products. "THC-based products were most often acquired from informal sources such as down the street from friends or from a dealer," said Jennifer Layden of the Illinois Department of Public Health at the press briefing. (Aubrey, 9/27)

USA Today: THC Products Like 'Dank Vapes' Are Playing A Major Role In Outbreak Of Lung Illnesses, CDC Says
The Centers for Disease Control and Prevention said of 514 injured patients who reported details on their use of vaping devices and e-liquids, 77% used products that contained THC, alone or combined with nicotine. Only 16% of injured vapers said they used nicotine-only products. (Alltucker, 9/27)

The Washington Post: Most Vaping-Related Lung Injuries Linked To Marijuana Products, CDC Says
Other brands identified by people with the lung injury include TKO, Off White, Moon Rocks, Chronic Carts and others. Industry experts said many THC products on the black market come from distributors who buy empty cartridges, fill them with THC mixtures, then purchase packaging with those brand labels. (Sun and McGinley, 9/27)

The Wall Street Journal: Majority Of Vaping-Related Illnesses Involve THC Products: CDC Report
Authorities have urged people to stop using electronic cigarettes and other vaping products while they continue to investigate the illness. The Food and Drug Administration and the Trump administration recently said they would pull e-cigarette flavored products off the market. (Ansari, 9/27)

Stat: Flu Season Threatens To Complicate Diagnoses Of Vaping-Related Illness
Public health experts are cautioning that the coming flu season could complicate attempts to diagnose new cases of a mysterious vaping-related illness — and, in turn, make it more difficult to track down the cause. The issue, experts say, is that flu and other respiratory viruses can, in many ways, look strikingly similar to a case of vaping-related illness: Symptoms include shortness of breath, night sweats, low oxygen levels, and hazy spots on a lung X-ray. (Thielking, 9/27)

NPR: Store Owners Resist State Vaping Bans As 'A Death Sentence For Their Business'
The recent numbers of vaping-related illness are alarming, at best; at worst, in the eyes of federal officials, the U.S. is embroiled in a deadly, mysterious and "ongoing outbreak" across the country. ... But in Massachusetts, where Gov. Charlie Baker earlier this week declared a public health emergency, some store owners fear the severity of state officials' response as much as the outbreak itself. One vape store owner, Behram Agha, filed a lawsuit Thursday against officials at the Massachusetts Department of Public Health, seeking an injunction to lift Baker's immediate four-month ban on the sale of all vaping products in the state. (Dwyer, 9/27)

The Wall Street Journal: Teen Vaping Didn’t Cool Juul’s Celebrity Push
In a lounge at the Sundance Film Festival last year, Juul Labs Inc. doled out $1 bundles of e-cigarettes to guests passing through. A-listers, including Elijah Wood, Nicolas Cage and Black Eyed Peas frontman will.i.am, stopped in front of a Juul-branded backdrop and posed for photographs. On its face this was standard marketing practice, cozying up to celebrities to lend cachet to the brand. But by this time, Juul was already aware of teen use of its products, having learned about it in local media reports. (Maloney and McKay, 9/28)

Los Angeles Times: Student Vaping Epidemic Has California Schools Frantically Mobilizing
The recent surge of lung illnesses and deaths linked to vaping, an increasingly entrenched habit among many youths, largely caught school authorities flat-footed, and educators are urgently mobilizing anti-vaping efforts against what they see as a dangerous teen epidemic. (Blume, Kohli and Agrawal, 9/30)

The Washington Post: Maryland Law Curbing Nicotine Sales To Youths Takes Effect Amid Vaping Concerns
Nearly all teenagers will be barred from buying e-cigarettes or their analog counterparts in Maryland after Tuesday, when hundreds of new laws — including a higher smoking age — take effect. Maryland joins the District and 14 other states that restrict nicotine sales in an effort to curb an alarming surge in teen vaping. (Cox, 9/29)

The Wall Street Journal: Dissecting The Vaping Illness Mystery
Vaping related illnesses are on the rise, and it appears to be related to a black market of THC vapes. WSJ’s Daniela Hernandez sat down with doctors and experts to understand what’s happening with the outbreak. (9/30)

The Washington Post: The Health 202: The Trump Administration Considered Defending The ACA In Court
The Trump administration is taking major political heat for opposing Obamacare in a high-stakes legal challenge, which a federal appeals court could rule on any day now. But that wasn’t always the plan. It turns out the administration originally intended to embrace all of the Affordable Care Act — including its protections for patients with preexisting conditions — until an influential trio of conservative advisers convinced President Trump earlier this year to do exactly the opposite. The reversal of course has not previously been reported and sheds new light on how the Trump administration has struggled to uphold and message its health-care plans following Congress's failure to repeal and replace Obamacare in summer 2017. It also suggests at least some Republicans close to Trump are concerned about the potential political backlash and likely chaos if the court rules to strike down the ACA. (Winfield Cunningham, 9/27)

The Associated Press: Idaho Submits Work-Requirement Waiver For Medicaid Expansion
Idaho officials on Friday submitted a work-requirement waiver to the U.S. Department of Health and Human Services for Medicaid expansion, and they say four other waivers will likely be submitted by December. The Idaho Department of Health & Welfare is also taking public comments on another waiver, taking steps to fix problems with a rejected waiver, and is negotiating with the federal agency. (Ridler, 9/27)

The Associated Press: New Kansas Council On Expanding Medicaid To Have 1st Meeting
Democratic Gov. Laura Kelly’s new council on expanding Medicaid is scheduled to have its first meeting Monday at the Statehouse. The agenda for the meeting includes a welcome from Kelly and briefings about other states’ experiences in expanding Medicaid health coverage for low-income residents. (9/28)

The Associated Press: Mylan Agrees To Pay $30M In SEC EpiPen Settlement
Mylan has agreed to pay $30 million in a settlement tied to its failure to tell investors about a Justice Department investigation into whether the company overcharged Medicaid for the EpiPen. The Securities and Exchange Commission said Friday that Mylan NV classified the EpiPen as a “generic” drug under the Medicaid drug rebate program. This led to the pharmaceutical company paying much lower rebates to the government than if the EpiPen had been classified as a “branded” drug. (9/27)

The Wall Street Journal: Mylan Settles SEC Suit For $30 Million
Prosecutors had accused the company of wrongly classifying the EpiPen, its best known product used for treating allergic reactions, as a generic product, when it should have been considered a brand product. The generic classification allowed Mylan to pay a smaller rebate on EpiPen sales to Medicaid programs, regulators said. Drugmakers are required by law to pay rebates for sales to patients insured by Medicaid, which is funded jointly by states and the federal government. (Thomas, 9/27)

The Associated Press: Feds Crack Medicare Gene Test Fraud That Peddled Cheek Swabs
Federal agents took down an alleged Medicare scam Friday that exploited seniors’ curiosity about genetic medicine by enticing them to get their cheeks swabbed for unneeded DNA tests. Medicare was billed $2.1 billion. Dubbed “Operation Double Helix,” the crackdown targeted telemedicine companies, doctors and labs, in a joint effort by the Justice Department , the FBI, U.S. attorneys’ offices, and the Health and Human Services inspector general. Thirty-five people were charged around the country. (Alonso-Zaldivar, 9/27)

NPR: U.S. Justice Department Charges 35 People In Fraudulent Genetic Testing Scheme
In announcing a crackdown Friday on companies it says were involved in fraudulent genetic testing, the U.S. Department of Justice brought charges against 35 individuals associated with dozens of telemarketing companies and testing labs. The federal investigation, called Operation Double Helix, went after schemes that allegedly targeted people 65 and older. According to the charges, the schemes involved laboratories paying illegal kickbacks and bribes to medical professionals who were working with fraudulent telemarketers, in exchange for the referral of Medicare beneficiaries. (Neighmond, 9/27)

The Washington Post: Purdue Pharma Family Will Profit From Ski Resorts In Counties Hit Hard By Opioids
Mitchell Yeaton is battling a wave of opioid addiction from his counseling center in New Hampshire ski country, just a short drive from two winter resorts that are engines of the local economy, Atti­tash and Wildcat. In this tourist mecca, jarring contrasts between well-to-do visitors and impoverished families shattered by addiction are part of the job, Yeaton said. But even so, a ski area deal unfolding here is rankling Yeaton and some other community leaders. Some members of the billionaire Sackler family — the owners of Purdue Pharma, the company widely blamed for fueling America’s opioid crisis — will reap about $60 million in financial gains from the sale of 17 ski resorts in the Northeast and Midwest, according to financial disclosure filings. (Rowland, 9/29)

The Associated Press: Waiver Gives Ohio More Options In Treating Opioid Addiction
The federal government is allowing Ohio more flexibility in what services it can provide to Medicaid patients addicted to opioids. The expanded options are coming through a substance use disorder demonstration waiver that the Centers for Medicare and Medicaid Services recently approved. (9/30)

The New York Times: At The Border, Lawmakers See A Broken System And Little Common Ground
In the past six months, dozens of members of Congress and their aides have descended upon the southwestern border in an effort to see what is happening there. To witness the visits is to understand the nub of the deep divide over how to repair the nation’s broken immigration system. The fact-finding tours, detailed in interviews with more than two dozen lawmakers and aides, are sometimes sanitized for the V.I.P.s who take them, as the Trump administration works to put the best face on an often inhumane situation. But they have yielded moments of raw emotion and glimpses of human suffering that have prompted passionate testimony, viral videos of lawmakers on their tours, new legislative proposals and, in one case, a book. (Cochrane, 9/28)

The New York Times: N.R.A.’s LaPierre Asks Trump To ‘Stop The Games’ Over Gun Legislation In Discussion About Its Support
President Trump met in the White House on Friday with Wayne LaPierre, the chief executive of the National Rifle Association, and discussed prospective gun legislation and whether the N.R.A. could provide support for the president as he faces impeachment and a more difficult re-election campaign, according to two people familiar with the meeting. During the meeting, Mr. LaPierre asked that the White House “stop the games” over gun control legislation, people familiar with the meeting said. It was not clear whether Mr. Trump asked Mr. LaPierre for his support, or what that support would look like. (Haberman and Karni, 9/27)

Politico: NRA Denies Discussing 'Special Arrangements' With Trump In Return For Its Support
The National Rifle Association confirmed that CEO Wayne LaPierre met with President Donald Trump at the White House on Friday but denied any discussions took place about "special arrangements" involving the group's ongoing support of the president. The response came after The New York Times reported on the meeting Friday, stating Trump and LaPierre "discussed prospective gun legislation and whether the N.R.A. could provide support for the president" amid upcoming impeachment proceedings and his reelection campaign. (Semones, 9/27)

The Associated Press: Hospital Owners, Operators Agree To Pay Federal Settlement
A whistleblower claim brought a $530,000 settlement from a Louisiana hospital. A news release from U.S. Attorney David Joseph on Thursday says the claim targeted owners and operators of University Health Hospital in Shreveport. The statement says Biomedical Research Foundation of Northwest Louisiana and Louisiana State University got Medicare payments for devices to treat abnormal heart rhythms without making required reports to a qualified registry. (9/27)

The Associated Press: Bayer Using AI To Improve Disease Diagnosis, Drug Design
Drugmakers have embraced artificial intelligence — using computers to analyze reams of data and then make predictions or recommendations. Germany’s Bayer has been testing how the technology can help diagnose complex or rare conditions, hasten drug development and more. The aspirin-creator has partnered with startups and other tech companies to develop software and apps to speed diagnosis and guide treatment. The company is working with hospitals, academic researchers and others to compile everything the AI software needs to “learn” before it analyzes a patient’s condition. (Johnson, 9/29)

The Wall Street Journal: Pfizer CEO Albert Bourla To Succeed Ian Read As Chairman
Pfizer Inc. said Ian Read, its executive chairman, will retire at the end of the year, with Chief Executive Albert Bourla set to assume the additional post on Jan. 1. ... Mr. Read, who joined Pfizer in 1978 as an operational auditor, has been chairman since 2011 and served as CEO of the drugmaker from 2010 to 2018. Mr. Bourla, who joined Pfizer’s animal-health division in 1993, succeeded Mr. Read as chief executive earlier this year. (Sebastian and Kellaher, 9/27)

Stat: Two Drugs Reduce Risk Of Ovarian Cancer Returning
Two different pills reduce the risk of ovarian cancer coming back after surgery and chemotherapy, according to studies presented at the annual meeting of the European Society for Medical Oncology in Barcelona Saturday. The results represent a step forward in treating a cancer that is diagnosed in 28,000 women annually in the U.S. and kills 14,000 women a year. Currently, women are treated with surgery to remove their tumors, followed with a type of chemotherapy. But in 85% of cases, the cancer comes back. (Herper and Garde, 9/28)

Bloomberg: Abortion Law Cases Stack Up In US Supreme Court's 2019-2020 Term 
Abortion cases are coming to the U.S. Supreme Court, and they’re only getting harder for the justices to avoid. The court next week starts a new term that will give the clearest indication yet of how eager the justices are to roll back the right to end a pregnancy. ... Abortion opponents are likely to get a more receptive audience now that Justice Brett Kavanaugh has replaced the retired Justice Anthony Kennedy. The eventual goal is to overturn the 1973 Roe v. Wade ruling, which legalized the procedure nationwide. (Stohr, 9/30)

The Associated Press: Tyler Perry Says He Can't 'Up And Leave' Filming In Georgia
Tyler Perry said he cannot “just up and leave” filming in Georgia despite Hollywood’s backlash against the state’s “heartbeat” abortion law. The actor-director-writer made the remarks to The Associated Press on Friday while discussing the upcoming opening of his massive Atlanta-based studio. Some celebs have urged TV and film companies to abandon the state after Republican Gov. Brian Kemp signed the restrictive abortion bill in May. (Landrum Jr., 9/27)

The New York Times: ‘We Need Each Other’: Seniors Are Drawn To New Housing Arrangements
As a graying population confronts the limited options for senior housing, seeking ways to maintain independence without the isolation that can accompany so-called aging in place, various grassroots alternatives are gaining footholds. Shared housing, cohousing and village organizations appeal to those hoping to avoid the high costs and institutional nature of assisted-living and nursing homes, or at least stave them off for as long as possible. (Span, 9/27)