- KFF Health News Original Stories 5
- Inside The Global Race To Deliver A Vital Radioactive Isotope Used To Detect Cancer
- Kentucky Is First State Granted Approval For Medicaid Work Requirements
- Trump's Work-For-Medicaid Rule Puts Work On States’ Shoulders
- Postcard From California: Alzheimer’s 'Looks Like Me, It Looks Like You'
- When You Need A Breast Screening, Should You Get A 3-D Mammogram?
- Political Cartoon: 'Forever Young?'
- Administration News 4
- Azar Poised To Head Back To HHS, But This Time Around Health Landscape Looks A Lot Different
- Head Of HHS' Family Planning Division, An Anti-Abortion Advocate, Abruptly Resigns
- Doctor Reports Trump Is In 'Excellent Health,' Though More Details Expected Today
- CDC Switches Training Topic From Nuclear War To Severe Flu Preparedness
- Veterans' Health Care 1
- Veteran Suing VA Hospital Claiming Doctor Left Scalpel In His Body After Surgery
- Public Health 3
- Maps Of Opioid-Related HIV Outbreak Show The Multiple Times It Could Have Been Stopped
- Vicious Flu Season Reveals Weaknesses In Health System That Don't Bode Well For Future Pandemics
- Hype Of Precision Medicine Getting Too Far Ahead Of The Facts, Experts Worry
From KFF Health News - Latest Stories:
KFF Health News Original Stories
Inside The Global Race To Deliver A Vital Radioactive Isotope Used To Detect Cancer
Moly-99, as it’s called, is created in just six government-owned nuclear research reactors — none in North America — raising concerns about the reliability of the supply. (Sarah Varney, 1/16)
Kentucky Is First State Granted Approval For Medicaid Work Requirements
The program will also set monthly premiums for Medicaid coverage and penalties for those who don’t make the payments. (Phil Galewitz, 1/12)
Trump's Work-For-Medicaid Rule Puts Work On States’ Shoulders
States that opt to change their Medicaid program must figure out how to delineate who is covered by the new mandate, how to enforce the rules and how to handle the people seeking exemptions. (Phil Galewitz and Pauline Bartolone, 1/12)
Postcard From California: Alzheimer’s 'Looks Like Me, It Looks Like You'
At a panel discussion this week in Sacramento, patients, caregivers and others shared their perspectives on how Alzheimer’s disease affects women, who account for two-thirds of those living with the condition. (Ana B. Ibarra, 1/16)
When You Need A Breast Screening, Should You Get A 3-D Mammogram?
The newer images are more expensive, but it’s not yet clear if they are more effective in catching cancers that will kill. (Michelle Andrews, 1/16)
Political Cartoon: 'Forever Young?'
KFF Health News provides a fresh take on health policy developments with "Political Cartoon: 'Forever Young?'" by Darrin Bell.
Here's today's health policy haiku:
CHIP FUNDS DWINDLE CREATING CHALLENGES FOR PARENTS, CHILDREN’S DOCTORS
Cash is getting tight.
Kids care could fall through the cracks.
What’s the work around?
- Anonymous
If you have a health policy haiku to share, please Contact Us and let us know if we can include your name. Haikus follow the format of 5-7-5 syllables. We give extra brownie points if you link back to an original story.
Opinions expressed in haikus and cartoons are solely the author's and do not reflect the opinions of KFF Health News or KFF.
Summaries Of The News:
Azar Poised To Head Back To HHS, But This Time Around Health Landscape Looks A Lot Different
Alex Azar served at the Department of Health and Human Services under President George W. Bush and is likely to take the helm there soon. But much has changed, and he's going to have a host of new problems to manage. In other administration news, the president's nominee to run the Indian Health Service Agency may be facing some choppy waters over his failure to disclose donations to the Trump campaign.
Modern Healthcare:
Mr. Azar Goes Back To Washington
It's a propitious time, at least for conservatives, for Alex Azar to take the top job at HHS. All elements have aligned for him to mold the Affordable Care Act, Medicaid and Medicare according to a vision they can support. Things have changed since Azar last served at HHS under President George W. Bush. The ACA didn't exist then, and the Bush era's major overhaul to Medicare with Medicare Advantage and Medicare Part D became Azar's signature accomplishments during his time at the department. (Luthi, 1/13)
Roll Call:
Questions Could Derail Confirmation Of Trump’s Indian Health Nominee
President Donald Trump’s nominee to oversee health care services for two million Native Americans — who already faces questions about whether he is qualified — failed to disclose donations to the Trump campaign in his official Senate questionnaire, Roll Call has learned. Robert Weaver, a health insurance salesman and consultant who was nominated in October to lead the $6.1-billion Indian Health Service, has been touted by the administration as “a staunch advocate of innovative programs to improve Native American health.” But some lawmakers are concerned that the administration inflated his qualifications. (Siddons, 1/12)
Head Of HHS' Family Planning Division, An Anti-Abortion Advocate, Abruptly Resigns
Teresa Manning was one of several anti-abortion activists selected by the Trump administration to serve in top roles at the Department of Health and Human Services. A department spokeswoman did not give a reason for her resignation.
The Hill:
Top Anti-Abortion Advocate Resigns At Health Department
A top anti-abortion advocate at the Department of Health and Human Services (HHS) abruptly resigned Friday evening. Teresa Manning, the deputy assistant secretary for population affairs, left after less than a year on the job. A department spokeswoman did not give a reason for her resignation, but said HHS "would like to thank her for her service to this administration and the American people." (Hellmann, 1/12)
Politico:
Anti-Birth Control Official Who Led Title X Departs HHS
Manning stated in a 2003 public radio interview that "contraception doesn't work." She also has separately suggested a link between abortion and breast cancer, which has not been proved, and helped craft state legislation to limit access to abortion. ... Valerie Huber, who had been serving as chief of staff for the HHS' assistant secretary of health, was named acting deputy assistant security of OPA. Huber is an advocate for abstinence education who joined HHS in June. (Diamond, 1/12)
The Washington Post:
Antiabortion Activist Abruptly Steps Down As Head Of HHS’s Family Planning Division
Manning was escorted from the building by security officials Friday. According to an HHS official, who spoke on the condition of anonymity to discuss a personnel matter, Manning already had turned in her badge and the escort allowed her to get back out through security. (Eilperin and Winfield Cunningham, 1/13)
CQ:
HHS Official Manning Steps Down From Post
At HHS, one of Manning’s key responsibilities was overseeing the Title X program, which administers family planning grants to states and entities across the country. CQ reported earlier this week that the program is delayed in releasing a routine announcement to allow states to apply for funding for 2018. (Raman, 1/13)
In other news —
The Hill:
Trump Admin Releases Immigrant Teenager To Obtain Abortion
The Trump administration has released a pregnant immigrant minor in U.S. custody to a sponsor so she can obtain an abortion, Vice News reported Sunday. The teenager, known as “Jane Moe,” was set to be released by Friday, Jan. 26, but was instead released nearly two weeks early. Moe had requested an abortion but was prevented from obtaining one by the Office of Refugee Resettlement (ORR), an office within the Department of Health and Human Services. (Thomsen, 1/14)
Doctor Reports Trump Is In 'Excellent Health,' Though More Details Expected Today
President Donald Trump's first physical exam in office came amid renewed chatter about his cognitive health.
The New York Times:
Trump Is In ‘Excellent Health,’ Doctor Says After Exam
President Trump is in excellent health, his doctor said on Friday after his first comprehensive physical exam since he was elected. “The president’s physical exam today at Walter Reed National Military Medical Center went exceptionally well,” Dr. Ronny L. Jackson, a rear admiral in the Navy and the White House physician, said in a statement. “The president is in excellent health.” (Shear and Altman, 1/12)
The Associated Press:
Trump Declared In 'Excellent Health' After First Presidential Physical Exam
Trump spent about three hours at the medical facility in Bethesda, Md., outside Washington, for the Friday afternoon checkup, his first as president, before departing for Florida for the weekend. The fairly routine exam for previous presidents has taken on outsized importance in the age of Trump, given the tone of some of his tweets, comments attributed to some of his close advisors and Trump's recent slurring of words on national TV. (1/12)
The Associated Press:
White House Doc To Provide More Details About Trump's Health
A fuller readout of President Donald Trump’s health following his first medical check-up is expected later Tuesday. ... White House press secretary Sarah Huckabee Sanders said Jackson will attend her briefing Tuesday to provide a more complete readout on Trump’s physical health. (1/15)
CDC Switches Training Topic From Nuclear War To Severe Flu Preparedness
The Centers for Disease Control and Prevention had scheduled a training session on how health officials should handle the fall out from nuclear war. Although it was planned months in advance, it coincided with tweets from President Donald Trump referencing nuclear action related to North Korea, and garnered the agency a good bit of media attention.
The New York Times:
C.D.C. Postpones Session Preparing U.S. For Nuclear War
The Centers for Disease Control and Prevention has decided to postpone its session on nuclear attack preparedness next week. Much attention had been drawn to the timing of the agency’s session, which was publicized just days after President Trump touted the size of his nuclear button compared with North Korea’s. Late Friday afternoon, the C.D.C. announced that it had changed its mind about next Tuesday’s topic, making a last-minute revision to reflect concerns about cases of severe flu. (Kaplan, 1/12)
The Washington Post:
CDC Postpones Session On 'Preparing For The Unthinkable': A Nuclear Blast
The session was to feature presentations from U.S. experts on public health preparedness and response and radiation, including one titled “Preparing for the Unthinkable.” It was planned months ago as part of a regular series of monthly webinars the CDC called Public Health Grand Rounds, officials said. But media interest in the topic was unusually strong, given the escalating tensions between President Trump and North Korean leader Kim Jong Un and their most recent war of words over which leader has the larger nuclear arsenal and bigger “nuclear button.” About three dozen media outlets had expressed interest in attending the session, which is broadcast from CDC’s headquarters in Atlanta. The initial CDC announcement featured a photograph of the distinctive mushroom cloud from a nuclear blast. (Sun, 1/12)
The Hill:
CDC Postpones Nuclear Disaster Response Briefing
The Centers for Disease Control and Prevention (CDC) has postponed a briefing on how to plan and prepare for nuclear disaster. The briefing, originally scheduled for Jan. 16, has now been replaced on CDC’s website with an event focused on public health responses to severe influenza. CNN first reported that the nuclear briefing had been postponed. (Chalfant, 1/15)
With Individual Mandate Scrapped, Employers Say 'It's Our Turn'
Employers have long-chafed at what they see as the onerous rules that came with the Affordable Care Act. But now that Congress has killed the individual mandate, employers say that their requirements should be the next to go. In other news: Sen. Lamar Alexander (R-Tenn.) says he expects bipartisan legislation aimed at stabilizing the marketplace to pass in the coming months; the Trump administration could approve short-term insurance plans soon; and a look at the health law and enrollment in the states.
The New York Times:
Individual Mandate Now Gone, G.O.P. Targets The One For Employers
Having wiped out the requirement for people to have health insurance, Republicans in Congress are taking aim at a new target: the mandate in the Affordable Care Act that employers offer coverage to employees. And many employers are cheering the effort. (Pear, 1/14)
Nashville Tennessean:
Sen. Lamar Alexander Say Bipartisan Health Care Proposal Should Pass Soon
U.S. Sen. Lamar Alexander said Friday the bipartisan health care reform measure he’s sponsored with Democratic Sen. Patty Murray is expected to pass through Congress as part of the omnibus spending bill in February or March. “The president supports it. He asked me about it twice while he was here in Nashville (on Monday),” Tennessee's senior senator said during an interview at The Tennessean's offices. “(Senate Majority Leader Mitch McConnell) reiterated his support for it this week. The vice president did the same.” (Buie, 1/12)
Modern Healthcare:
It's Buyer Beware For Short-Term Health Plans, As Insurers Await New HHS Rule To Expand Them
The Trump administration's next swipe at relaxing Affordable Care Act regulations could come any day now. The Office of Management and Budget has been reviewing an HHS proposal aimed at making it easier for consumers to buy short-term insurance plans. It's part of the administration's overall goal of giving individuals and businesses access to cheaper health plans, albeit with fewer benefits and consumer protections. ... Under the HHS proposal, consumers could buy short-term plans for up to 364 days, compared to 90 days under current law. (Meyer, 1/10)
Los Angeles Times:
Number Of Americans Without Health Insurance Grows In Trump's First Year, New Figures Show
The number of Americans without health coverage, which declined for years after passage of the Affordable Care Act, shot up in President Trump's first year in office, according to data from a new national survey. At the end of 2017, 12.2% of U.S. adults lacked health insurance, up from 10.9% at the end of 2016, as President Obama was completing his final term. (Levey, 1/16)
Seattle Times:
Enrollment In Washington State’s Obamacare Could Top Last Year’s
Washington state is on pace to increase the number of people with health insurance despite efforts by the Republican Congress and the Trump administration to gut the laws known as Obamacare that expanded insurance coverage across the nation. So far consumers have selected 234,000 plans during Washington Health Benefit Exchange’s 2018 enrollment period, which ends Monday. That’s 9,000 more than last year. Of the 225,000 plans picked for the 2017 enrollment period, 204,000 followed through to purchase the coverage. (Blethen, 1/13)
Nashville Tennessean:
Three Health Care Tips For Tax Time
Mid-January marks the start of tax season, and health care items throughout the past year can impact how you file your taxes. This time of year typically creates a lot of consumer confusion, and getting all the facts straight can be tricky. With the repeal of the Affordable Care Act’s individual mandate recently in the news, this topic is certain to cause particular issues this year. Aside from the individual mandate, other health care expenses can also affect your tax return, including Health Savings Accounts and high-cost medical expenses. (Tolbert, 1/12)
The Star Tribune:
Minnesota Finds 'Cause For Optimism' In Individual Health Insurance Market
As consumers approach a Sunday deadline for buying coverage through MNsure, state officials say there’s a glimmer of hope for less volatility in the troubled market where individuals buy health insurance. A report released Friday by the Minnesota Department of Health details “some cause for optimism” based on partial-year information suggesting individual market insurers last year weren’t losing nearly as much money compared with previous years, and might instead post a small profit. (Snowbeck, 1/12)
The Star Tribune:
Hopeful Signs For Minnesota Health Insurers
The long-suffering market where individuals buy health insurance continues to show signs of improvement. A series of national reports this month show that individual market insurers through the first three quarters of 2017 were doing a much better job covering claims with premium revenue than in previous years. The improvement suggests that after years of red ink, carriers could soon see financial results on the horizon ranging from break-even to small profits. (Snowbeck, 1/12)
Congressional Budget Cuts Leave Safety-Net Hospitals Facing Shortfalls
The hospitals are facing $3.6 billion in federal funding reductions and could be left with other cuts too if Congress doesn't extend some programs that could be affected by the budget stalemate. Also caught up by the congressional inaction is the Children's Health Insurance Program.
Stateline:
'Safety Net' Hospitals Face Federal Budget Cuts
A double whammy of federal budget cuts might force many hospitals, particularly those that serve poor or rural communities, to scale back services or even shut their doors. The $3.6 billion in cuts this year — $2 billion from a program that sends federal dollars to hospitals that serve a high percentage of Medicaid or uninsured patients, and $1.6 billion from a drug discount program — will have the greatest effect on so-called safety net hospitals that provide medical care for all comers, no matter their ability to pay. (Ollove, 1/16)
Marketplace:
With Kids’ Health Funding Set To Expire, Families And Doctors Make Plans
The Childrens Health Insurance Program is healthcare for kids whose parents make too much to qualify for Medicaid, but not enough to afford private healthcare. If Congress doesn't reauthorize it, the program starts to run out of funding on Friday, leaving up to nine million children without coverage. (Beras, 1/15)
Cleveland Plain Dealer:
Ohio Hospitals Want Congress To Renew Children's Health Insurance Funding
Without the federal Children's Health Insurance Program (CHIP), Crystal Lett and her Columbus-area family wouldn't be able to afford the care her six-year-old son needs for Prader-Willi Syndrome, a complex genetic condition that affects many parts of the body. Although Republicans and Democrats alike say they want to continue the program that insures roughly 9 million low- to moderate-income children nationwide, it ran out of money in September as Congress bickered over how it should be funded. (Eaton, 1/12)
Veteran Suing VA Hospital Claiming Doctor Left Scalpel In His Body After Surgery
Sen. Richard Blumenthal (D-Conn.) says he was appalled and stunned by the “egregious medical malpractice case" and is asking for a detailed explanation of the incident.
The Associated Press:
Army Vet Sues VA Over Scalpel Left In Body After Surgery
An Army veteran who says someone left a scalpel inside him after surgery is suing a veterans affairs hospital. Bridgeport resident Glenford Turner says the scalpel was only discovered years later, after he suffered from long-term abdominal pain. He sued the VA in U.S. District Court last week, seeking unspecified compensatory damages. (1/15)
Boston Globe:
VA Surgeon Left Scalpel Inside Patient For Nearly Four Years, Lawsuit Alleges
Glenford Turner, 61, who spent at least 20 years in the Army before being honorably discharged, had his cancerous prostate removed in robot-assisted laparoscopic surgery at VA Connecticut Healthcare System, West Haven Campus, said his lawyer, Joel Faxon. The surgery took about five hours instead of the hour it should have taken, and afterward there was no X-ray performed to ensure that no surgical materials had been left behind — a standard measure after surgery, Faxon said in a phone interview Monday. (Fox, 1/16)
In other veterans' health care news —
Denver Post:
Overdue And $1 Billion Over Budget, Aurora VA Hospital Is Still Incomplete And Will Likely Be Understaffed, Document Says
In a matter of weeks, the U.S. Department of Veterans Affairs is expected to announce that it has all but completed construction of a new hospital in Aurora — a major milestone for a project that drew national outrage in 2015 when the agency admitted it was $1 billion over budget. But according to a congressional document obtained by The Denver Post, the Jan. 23 target will be little more than an illusion as the team building the $1.7 billion facility expects to spend several more months finishing hundreds of items on its to-do list. (Matthews, 1/12)
Maps Of Opioid-Related HIV Outbreak Show The Multiple Times It Could Have Been Stopped
New visualizations of Indiana's HIV outbreak that was linked to the opioid crisis give a clearer picture of who was affected and how it spread.
NPR:
Mapping How The Opioid Epidemic Sparked An HIV Outbreak
When people started to show up to Dr. William Cooke's primary care office in Austin, Ind., in 2014 with HIV, Cooke knew it was probably related to the region's opioid epidemic. But what he and the rest of the public health community didn't know was who they were missing or how long the HIV outbreak had been going on. Now they've got a clearer picture — literally. In visualizations published in the Journal of Infectious Diseases, dots and lines define the constellations of Indiana's HIV outbreak. (Boerner, 1/14)
Cincinnati Enquirer:
Will NKY Ramp Up Needle Exchange To Curb HIV Cases Tied To Heroin?
Don't expect a flurry of needle exchanges to pop up quickly in Northern Kentucky, even after the recently revealed huge upswing in HIV cases among people who inject drugs. The law allowing needle exchanges in Kentucky requires both the host city and county to approve the service. (DeMio, 1/14)
In more opioid news —
The Washington Post:
Ohio Opioid Woes One Reason Drug Lawsuits Brought To State
The role that drugmakers and drug distributors played in contributing to the nation’s deadly opioid epidemic is now front and center in a federal courtroom in Cleveland. Judge Dan Polster is overseeing more than 200 lawsuits against drug companies brought by local communities across the country, including those in California, Illinois, Kentucky, Ohio and West Virginia. The lawsuits have been consolidated into what is known as “multidistrict litigation,” an approach taken when lawsuits of a similar nature are filed around the country. (Welsh-Huggins, 1/14)
Pioneer Press:
Sen. Tina Smith Takes Battle Over Daily Opioid Deaths To D.C.
To combat the growing opioid crisis Minnesota needs more funding and flexibility from federal officials to support unique and successful prevention, treatment and law enforcement strategies. That’s the message state experts asked Democratic Sen. Tina Smith to take back to Washington D.C. as federal lawmakers debate the best way to address what has become a public health crisis. (Magan, 1/12)
KCUR:
Substance Abuse And Poor Mental Health Drive Up Deaths Among Missouri's Rural Whites
White residents in Missouri are dying at a higher rate than they did nearly two decades ago, according to a report from the Missouri Foundation for Health. The increased death rate largely is occurring in the state's rural counties, especially in the Ozarks and the Bootheel region and substance abuse appears to be a major factor. For example, deaths by drug overdose have increased by nearly 600 percent in many rural counties. Poor mental health also plays a significant role, as suicides among young and middle-aged adults have increased by 30 percent since 1995. (Chen, 1/15)
Vicious Flu Season Reveals Weaknesses In Health System That Don't Bode Well For Future Pandemics
This season's severe virus is straining hospitals. But if something as foreseeable as the flu is too much for the medical system to handle, what does that say about future public health crises?
Stat:
A Severe Flu Season Is Stretching Hospitals Thin. That Is A Very Bad Omen
A tsunami of sick people has swamped hospitals in many parts of the country in recent weeks as a severe flu season has taken hold. In Rhode Island, hospitals diverted ambulances for a period because they were overcome with patients. In San Diego, a hospital erected a tent outside its emergency room to manage an influx of people with flu symptoms. Wait times at scores of hospitals have gotten longer. But if something as foreseeable as a flu season — albeit one that is pretty severe — is stretching health care to its limits, what does that tell us about the ability of hospitals to handle the next flu pandemic? (Branswell, 1/15)
The Washington Post:
CDC Says, ‘There's Lots Of Flu In Lots Of Places.’ And It's Not Going Away Anytime Soon.
“Flu is everywhere in the United States right now. There’s lots of flu in lots of places,” said Daniel Jernigan, director of CDC’s influenza division. Of particular concern, he said, is the “very rapid increase” in the number of people hospitalized with laboratory-confirmed cases. The overall hospitalization rate for the week ending Jan. 6 — 22.7 per 100,000 — is almost double that of the previous week. Seven children died in the first week of January, bringing the total number of pediatric deaths to 20. Nearly 6,500 people were hospitalized since the season started Oct. 1. (Sun, 1/12)
Stat:
Flu Season Is Shaping Up As One Of The Worst In Years, Officials Say
The entire continental United States is experiencing widespread flu right now, the first time in the 13 years of the current tracking system that that has happened, according to the Centers for Disease Control and Prevention. Officials said that this flu season is shaping up to be one of the worst in recent years. The rate of flu hospitalizations — the number of people hospitalized with flu per 100,000 — rose sharply last week compared with the previous week. Last week it was 22.7 per 100,000 people; the week before that rate was 13.7. (Branswell, 1/12)
NPR:
Flu Season Is Shaping Up To Be Nasty, CDC Says
But the most recent data show that the proportion of people rushing to their doctors to get treated for the flu has already hit 5.8 percent, which is as high as that number gets during the peak of a really bad flu season, the CDC says. In addition, the rate at which Americans are being hospitalized for the flu almost doubled in the last week, to 22.7 for every 100,000 hospitalizations, according to the CDC. (Stein, 1/12)
Bloomberg:
Think Flu Season Is Bad? It Might Get Even Worse
The most optimistic assumption among government experts is that the season peaked a few weeks ago, marking the apex of what was already an early and severe outbreak. However, such an outlook requires observers to ignore that outpatient doctor visits have continued to climb (albeit more slowly) in the first week of 2018, yielding the most flu cases ever for this time of the year. (Cortez, 1/16)
The New York Times:
‘Smart Thermometers’ Track Flu Season In Real Time
A company making “smart thermometers” that upload body temperatures to its website claims to be tracking this year’s flu season faster and in greater geographic detail than public health authorities can. This year’s flu season — which the Centers for Disease Control and Prevention considers “moderately severe” — has left Missouri and Iowa the “sickest states in the country,” said Inder Singh, the founder of Kinsahealth.com. (McNeil, 1/16)
The New York Times:
In The Flu Battle, Hydration And Elevation May Be Your Best Weapons
According to the misery map of influenza activity in the United States, there’s a good chance that you or someone you know has experienced, or will experience, the agony of this year’s strain, H3N2. The map, from the Centers for Disease Control and Prevention, shows that it is a particularly wicked and widespread virus. And the current flu vaccine seems to be mismatched to the virus — in Australia, where flu season comes earlier, it was estimated to be only 10 percent effective. (Murphy, 1/12)
In local flu news from California, Missouri, Florida, Georgia and Arizona —
Los Angeles Times:
Flu Death Toll Rises In California
The number of Californians under 65 who've died of the flu has jumped to 42, compared with nine at the same time last year, state officials said Friday. The flu season, which runs from October through May, typically peaks in February. Public health officials say they don't yet know whether the flu season is peaking earlier than normal, or if this year will be a particularly tough one for the flu. (Karlamangla, 1/12)
San Jose Mercury News:
Flu Deaths Rise, Patients Pack Bay Area Emergency Rooms
At hospitals around the Bay Area and across the country, those on the front lines of what is shaping up to be the worst flu season in a decade are struggling to keep up — and wondering whether it will get worse. (Prodis Sulek, 1/14)
St. Louis Public Radio:
Number Of Flu Cases Remains High In St. Louis County
The St. Louis County Department of Public Health reports 1,282 cases of influenza in the first week of January. That's compared to 1,304 in the last week of December, a record for the county. (Lewis-Thompson, 1/12)
Miami Herald:
Flu Is In All States As CDC Says Disease Widespread
Federal health officials said Friday that influenza is widespread across the continental United States and causing a sharp rise in hospitalizations and visits to doctors’ offices in just the past week — with the H3N2 subtype of the virus appearing to be the most predominant strain, according to Dr. Daniel Jernigan, director of the influenza division at the Centers for Disease Control and Prevention. ...In Florida, health officials have reported a rise in flu activity, including two child deaths, over the past several weeks, with the northern regions of the state seeing higher incidence of illness. (Chang, 1/12)
Georgia Health News:
Flu Slams Georgia, Nation As Season Appears To Peak
Georgia hospitals are seeing “a significant and rapid increase of patients’’ coming in with flu, the Georgia Hospital Association said Saturday. “This has placed an added strain on already limited supplies of IV solutions and medicines.” (Miller, 1/14)
Arizona Republic:
Latest Arizona Flu Numbers Show Sharp Rise Over Last Year
Cases of the flu in Arizona have continued to rise through the first week of January, as there were 11,515 confirmed cases from mid-October through Jan. 6, according to the Arizona Department of Health Services. ADHS reported that this is a 938 percent increase from the 1,109 reported cases in 2016-17 for the same period. (Ren, 1/13)
Hype Of Precision Medicine Getting Too Far Ahead Of The Facts, Experts Worry
"We're getting better, but like many things in life, there's hope and hype. And that's also the reality with precision medicine right now," says Ben Park, an oncology professor at the Sidney Kimmel Comprehensive Cancer Center at Hopkins. In other public health news: breast cancer, skin lightening, in-womb surgery, musical therapy, salty diets, and more.
NPR:
DNA Sequencing Holds Some Promise For Treating Tumors
People diagnosed with cancer understandably reach for the very best that medical science has to offer. That motivation is increasingly driving people to ask to have the DNA of their tumors sequenced. And while that's useful for some malignancies, the hype of precision medicine for cancer is getting far ahead of the facts. It's easy to understand why that's the case. When you hear stories about the use of DNA sequencing to create individualized cancer treatment, chances are they are uplifting stories. Like that of Ben Stern. (Harris, 1/15)
The Washington Post:
First Treatment Approved For Breast Cancer With BRCA Genetic Mutation
The Food and Drug Administration on Friday cleared the first treatment for patients with advanced breast cancer caused by BRCA mutations, which are genetic defects that raise the risk of malignancies. The drug, called Lynparza, already is approved for certain patients with advanced ovarian cancer associated with the same mutations. Richard Pazdur, director of the FDA’s Oncology Center of Excellence, said in a statement that expanding the approval to breast-cancer patients “demonstrates the current paradigm of developing drugs that target the underlying genetic causes of a cancer, often across cancer types.” (McGinley, 1/12)
Kaiser Health News:
When You Need A Breast Screening, Should You Get A 3-D Mammogram?
When I went to the imaging center for my regular mammogram last year, the woman behind the desk asked me if I’d like to get a “3-D” mammogram instead of the standard test I’d had in the past. “It’s more accurate,” she said. What do you say to that? “No, thanks, I’d rather have the test that gets it wrong?” Of course, I agreed. (Andrews, 1/16)
Stat:
A Health Advocate's Crusade Brings Skin Lightening Out Of The Dark
[Amira Adawe's] visits are more than social, however. The public health advocate scans market shelves for skin lightening creams that may contain harmful toxins — tubes and jars sold under names such as Fair & Lovely, Prime White, and Miss Beauty 7 Days White. Some women use the creams in hopes of erasing dark spots, but many rub them over their entire bodies multiple times a day in hopes of whitening their brown skin. The practice pervades many cultures in Africa, Asia, the Middle East — and many immigrant communities in the U.S. — and Adawe has made it her mission to end it. (Eldred, 1/16)
The New York Times:
After Surgery In The Womb, A Baby Kicks Up Hope
For a small person who had surgery before he was even born, and who’d just spent an hour and a half squeezing through a tight space that clamped down on his head every few minutes, Baby Boy Royer was showing a feisty spirit. He arrived pink and screaming on Friday at 5:35 a.m., two days before his official due date, weighing 8 pounds 8 ounces, and almost 20 inches long. (Grady, 1/15)
The New York Times:
Music Therapy Offers An End-Of-Life Grace Note
At 90, Beverly Herzog is writing songs for the first time. Once a week, a music therapist helps Mrs. Herzog transform her thoughts into lyrics, then sings them back to her mellifluously over the strums of her guitar. The result can be transformative. When Mrs. Herzog listened during a session in December, she marveled at how magically the music reflected her views on love and life. (Otterman, 1/15)
Los Angeles Times:
Even Without Nudging Blood Pressure Up, High-Salt Diet Hobbles The Brain
A high-salt diet may spell trouble for the brain — and for mental performance — even if it doesn't push blood pressure into dangerous territory, new research has found. A new study has shown that in mice fed a very high-salt diet, blood flow to the brain declined, the integrity of blood vessels in the brain suffered, and performance on tests of cognitive function plummeted. (Healy, 1/15)
The New York Times:
He Helped Ex-Players Get Benefits. His Family Is Still Waiting.
When the Pittsburgh Steelers begin their march to a potential seventh Super Bowl championship on Sunday afternoon, Garrett Webster will be delivering pizza from his 14-year-old Honda Pilot. This might surprise fans and his customers, but Mr. Webster, the 33-year-old son of Mike Webster, the stalwart center of the Steelers’ dynasty of the 1970s, has to make ends meet. Playoff game days are especially busy. (Belson, 1/13)
The Washington Post:
Why It's So Hard To Understand What A Doctor Says
Few simple questions are as difficult to answer as the perennial “What did the doctor say?” The words are so natural as to be virtually automatic. They spring from our lips, almost of their own accord, whenever a loved one returns from a doctor’s visit. Whether we recognize it or not, the answer has the potential to make us face our own mortality. (Klasco and Glinert, 1/14)
Los Angeles Times:
Too Much Business Travel Can Lead To Depression, Anxiety And Trouble Sleeping, Study Says
If you are a business traveler who has to be away from home more than two weeks a month, no one has to tell you that this much travel can wear you down. But a study from Columbia University's Mailman School of Public Health confirms that people who travel for business two weeks or more a month are more likely to report symptoms of anxiety, depression and trouble sleeping than those who travel less than one week a month. (Martin, 1/13)
The Washington Post:
Back Pain Turned Into Terrifying Paralysis For 20-Year-Old
The 200-mile drive from Chicago to his home in Springfield, Ill., seemed longer than usual as James Weitzel tried, with little success, to relieve the dull pain near his right shoulder blade that had dogged him for months. His family doctor had told the 20-year-old he had probably pulled a muscle or injured a disk in his back while hoisting cases of beer at the pizza shop where he worked. Over-the-counter painkillers hadn’t helped, and Weitzel discovered that sitting on his hand while piloting his blue Cadillac down Interstate 55 made the pain less bothersome. (Boodman, 1/13)
The Washington Post:
Toilet Training Age Varies So Much Parents Should Forget Anxiety
Are 2-year-olds too young to start toilet training? For many children, yes. Especially boys. At least, that’s what American pediatricians would probably say. Only about half of the children in the United States are fully toilet-trained by age 3. Chinese grandmothers would be appalled. They would probably point out that with “split pants,” most kids are trained by age 2. (Gottlieb, 1/15)
The Washington Post:
Brain Timing May Trick You Into Delusional Thoughts
Have you ever felt as though you predicted exactly when the light was going to turn green or sensed that the doorbell was about to ring? Imagine the possibility that these moments of clairvoyance occur simply because of a glitch in your mind’s time logs. What happened first — your thought about the doorbell or its actual ringing? It may have felt as if the thought came first, but when two events (ringing of doorbell, thought about doorbell) occur close together, we can mistake their order. This leads to the sense that we accurately predicted the future when, in fact, all we did is notice the past. (Bear, Fortgang and Bronstein, 1/13)
The Washington Post:
Tide Pod Challenge: What Is It, And Why Is The Viral Video Dare Dangerous?
First, it was the “gallon challenge” and the “cinnamon challenge.” Then some teenagers started playing the “bath-salt challenge.” They have dared each other to pour salt in their hands and hold ice till it burns, douse themselves in rubbing alcohol and set themselves ablaze, and throw boiling water on unsuspecting peers. Now videos circulating on social media are showing kids biting into brightly colored liquid laundry detergent packets. Or cooking them in frying pans, then chewing them up before spewing the soap from their mouths. (Bever, 1/13)
Kaiser Health News:
In Wisconsin, Hopes Rise For Production Of A Lifesaving Radioactive Isotope
In a cornfield here, past the shuttered General Motors plant and the Janesville Terrace trailer home park, a facility not seen in the United States in three decades could soon rise: a manufacturing plant that will make a vital radioactive isotope used to detect cancer and other potentially fatal maladies in millions of people every year. (Varney, 1/16)
NPR:
Teens' Self-Esteem Grows When Volunteering To Help Strangers
At the start of the new year, parents may encourage their teens to detox from social media, increase exercise, or begin a volunteer project. While kids may bristle at the thought of posting fewer selfies, surveys indicate 55 percent of adolescents enjoy volunteering. And according to a recent study, when it comes to helping others, teens may benefit psychologically from spending time helping strangers. (Fraga, 1/13)
Community Meeting Highlights Rift Between Nashville General And Meharry Medical College
Recent developments between Nashville General Hospital and Meharry Medical College officials could impact inpatient care at the city's only public hospital. Outlets also report on hospital and health system news from Maryland, Ohio and Illinois.
Nashville Tennessean:
Nashville General Hospital: Community Meeting Exposes Tension With Meharry Medical College
Hours after Mayor Megan Barry abruptly reversed plans to end inpatient care at Nashville General Hospital, a pre-planned community meeting exposed a rift that months of uncertainty have created between two institutions, which long have partnered to provide health care to the city's poor and uninsured patients. Nashville General Hospital and Meharry Medical College officials have worked together for decades to provide care at the city's only public hospital, which is located on the college's campus. Meharry residents have trained at the hospital and its staff have provided healthcare to hospital patients. Both institutions have deep roots in Nashville's African-American communities. (Wadhwani, 1/11)
Nashville Tennessean:
Weathering Criticism, Meharry Medical College President Vows To Continue Push On Indigent Care
When Mayor Megan Barry backpedaled on her controversial plan to downsize the city's only public hospital Thursday, she also distanced herself from its affiliated medical college. Meharry Medical College, which trains students and residents at Nashville General Hospital, had volunteered to convene stakeholders to help guide the mayor and Metro Council in the aftermath of her announcement. It was an offer Barry gladly accepted. She had just publicly lauded the college for its new partnership with HCA that gave medical students access to training at another local hospital besides Nashville General. (Wadhwani, 1/12)
The Baltimore Sun:
State Investigating University Of Maryland Hospital Where Woman Was Found In Gown, Outside On Baltimore Street
A state agency charged with ensuring health facilities meet federal and state standards is investigating a University of Maryland Medical Center hospital where a woman was found outside in just a gown and socks in a case that some are calling patient dumping. The incident at the medical center’s midtown campus in Baltimore was caught on tape by local psychotherapist Imamu Baraka. The woman in the video appears disoriented and is stumbling about. What appears to be four security guards are walking back into the hospital. One has a wheelchair. (McDaniels, 1/12)
Cincinnati Enquirer:
No IV Bags? Cincy Hospitals Say They Are Adapting To Shortage Through Flu Season
As hospitals in Greater Cincinnati and across the country cope with a bad flu season, they also are figuring out how to deliver medicine without an important tool of the trade: the intravenous fluid bag. Hurricane Maria’s devastation of Puerto Rico, the key American manufacturing hub for medical supplies, triggered a monthslong shortage in fundamental hospital gear, especially IV fluids. (Saker, 1/15)
Chicago Sun Times:
ACLU Urges City Council To Deny $5.5M Subsidy To Presence Health
The American Civil Liberties Union of Illinois on Monday urged the City Council to deny a $5.5 million subsidy to Illinois’ largest Catholic health system because of Presence Health’s anti-abortion policy. “At a time when reproductive health care is under attack, the city of Chicago should work to expand access to the full range of women’s health care — not use taxpayer dollars to support an institution that imposes its religious beliefs to deny patients basic health care,” the ACLU wrote in a letter addressed to all 50 Chicago aldermen. (Spielman, 1/15)
Media outlets report on news from Massachusetts, Illinois, California, Connecticut, New York and Minnesota.
Boston Globe:
Lawmakers Call On AG To Investigate Company Closing Local Nursing Homes
Eight state legislators are asking the Massachusetts attorney general to investigate a health care company that plans to close four nursing homes and an assisted living facility in Greater Boston, accusing it of misusing state money at the facilities it plans to shut down. ...The letter alleges that senior executives may have mismanaged state funding intended to pay wages and benefits for some of the lowest-paid nursing home workers. (Fox, 1/16)
Chicago Sun Times:
Passenger With Measles May Have Exposed Others At O'Hare
A passenger on a flight that landed Wednesday at O’Hare International Airport may have exposed others at the airport to measles. The passenger, who was infectious at the time, arrived on an international flight at Terminal 5 and departed on a domestic flight from Terminal 1, according to the Illinois Department of Public Health. (1/14)
Los Angeles Times:
Residents Call On Candidates For Governor To Shut Down Aliso Canyon Gas Facility
A mysterious disease is spreading through Kyoko Hibino's neighborhood, but you'd never know it by glancing at her sunny, tree-lined Southern California community, she says. The Porter Ranch resident has suffered bronchitis, heart palpitations, headaches and nosebleeds, none of which amount to a diagnosis by doctors. Hibino said her cat also started getting nosebleeds, and now has cancer. (Lau, 1/13)
Boston Globe:
CVS Health Confirms That Aetna Will Stay In Hartford
A spokesman for CVS Health confirmed Friday that it will keep Aetna in Hartford and make the city one of the pharmacy giant’s “centers of excellence,” where it locates major operations of its business lines. ...The insurer last summer announced plans to relocate its headquarters to New York City, in what would have been yet another blow to Connecticut’s economy and its civic pride. (Chesto, 1/12)
Sacramento Bee:
California's Lack Of Early Health Screening For Children Delays Proper Treatment
In 2016, less than 21 percent of California parents reported that their young children’s health care providers had them complete a standardized developmental screening tool, according to an analysis of the National Survey of Children’s Health data, which was released recently by the Child and Adolescent Health Measurement Initiative at the Johns Hopkins Bloomberg School of Public Health. ...Formal developmental screening questionnaires are critical for catching issues in children while they’re young enough that intensive interventions might alter the course of their lives. (Wiener, 1/15)
Minnesota Public Radio:
In Occupation Where Stress Is Ample, Farmers Have Few Options For Mental Health Care
State reports show that farmers and rural people already lag significantly in access to mental health services. Even more concerning, suicide rates are much higher for farmers than the average worker. (Collins, 1/16)
The Washington Post:
What Does Someone With Mental Illness Look Like? A Museum Tries To Answer
What does someone with mental illness look like? That’s a trick question. There is no one face of mental illness, and it crosses boundaries of age, sex, race and economic status. Often, it’s invisible — and it’s common. According to the Centers for Disease Control and Prevention, about 25 percent of adults in the United States have a mental illness. (Blakemore, 1/14)
Marin Independent Journal:
California Leading Way To Addressing Rising U.S. Maternal Mortality
In California, where more babies are born than in any other state (approximately 500,000 a year — one-eighth of the U.S. total) — the California Maternal Quality Care Collaborative (CMQCC) is continuing to take a leading role in adopting new practices to reduce maternal mortality risks as well as life-threatening complications and racial disparities in obstetric care. Run as a collective and directed by Dr. Elliott Main, a visionary practitioner and professor of obstetrics and gynecology at Stanford and the University of California-San Francisco, CMQCC provides doctors and nurses with recommendations and toolkits to help improve procedures and safety protocols for obstetric emergencies, including hemorrhage and preeclampsia, the most common causes of U.S. maternal mortality (along with heart disease) and the most preventable. (La Follette, 1/15)
San Jose Mercury News:
Three Bay Area Black Female Doctors Share Insights, Journeys
Stanford surgeon Dr. Leah Backhus is an esteemed member of a relatively tiny club in U.S. medicine she sometimes refers to as “two-fers:” female African-American doctors. They represent about 2 percent of the nation’s 877,616 active physicians but are among a growing trend in the country: A report last year from the Association of American Medical Colleges indicated that by 2013, black women 49 and younger made up a greater percentage of the U.S. physician workforce than black men in the same age group. (Seipel, 1/15)
Last week's decision by the Trump administration to add work requirements to the Medicaid program drew both praise and criticism from opinion writers across the country.
Bloomberg:
Give Medicaid Work Rules A Try — Carefully
Requiring some Medicaid recipients to work is not the worst idea to come out of Donald Trump's administration. It might nudge some beneficiaries toward more productive lives, and it could help subdue persistent sentiment that the program allows adults who should be working to get free health insurance at taxpayers' expense. But these aspirations will not be realized unless there is strict oversight. (1/12)
The Washington Post:
Trump Is Hoping You Won’t Notice His Backdoor Repeal Of Obamacare
One of the bigger, and more heartening, surprises of the past year was just how fervently it turned out Americans supported health care for low-income people. Republican politicians, after all, had been running against Obamacare — including its Medicaid expansion and income-based subsidies for buying insurance — from the moment the law passed. And the public appeared to back this agenda: The Affordable Care Act polled terribly. (Catherine Rampell, 1/15)
Los Angeles Times:
'Work Requirements' For Public Benefits Are Really Just Time Limits
David A. SuperOnce upon a time, everyone knew what a work requirement was. The agency administering a public benefit program would offer unpaid work to a recipient and reduce or terminate assistance if she or he refused to comply. Supporters extolled the requirements as character-building; critics worried about displacing regular employees and sometimes hazardous workplace conditions. Those days are long gone.Today, politicians — including in the Trump administration, which last week said it would allow states to tie Medicaid benefits to employment — use the term “work requirement” to hide the true nature of their proposals. (David A. Super, 1/15)
St. Louis Post Dispatch:
Job Requirements For Medicaid Recipients Won't Work And Might Actually Backfire
The Trump administration last week approved the state of Kentucky’s request to require able-bodied adults who receive Medicaid benefits to work at least 20 hours a week. Nine other states have made similar requests. A bill that would add Missouri to the list is pending in the Legislature. It is an article of faith among many conservatives that federal safety net programs are abused by able-bodied Americans too lazy to work. In reality, that is rarely the case. (1/15)
A selection of opinions on health care from news outlets around the country.
Bloomberg:
Presidential Physicals Should Include The Brain
Right now, the technology exists to detect the very early stages of Alzheimer’s disease -- as well as to flag abnormal protein deposits that can grow in peoples’ brains long before symptoms of dementia become apparent. No tests of this sort will apparently be featured in Donald Trump’s Jan. 12 physical, according to those in the know, but some brain experts and medical ethicists argue they should be. Such early evaluations might one day become important for ordinary citizens, if drugs now in the pipeline prove effective in forestalling dementia symptoms. In the meantime, it behooves us all to have more information when the brain in question belongs to someone with access to classified information and nuclear codes. (Faye Flam, 1/12)
Miami Herald:
The United States Must Be Prepared To Respond To Deadly Infectious Diseases
Miami knows better than most what the spread of disease can do. Thousands of Chikungunya cases still plague the city, something it has in common with New York City and San Juan. The city was on guard for Zika before much of the rest of the country and its experience with biological weapons goes back to the anthrax events of 2001. The healthcare providers here in Miami and throughout the state are among the best in the nation. However, business as usual will not work against a widespread outbreak. Former U.S. Rep. Jim Greenwood and I are taking up this issue at a meeting of the Blue Ribbon Study Panel on Biodefense on Jan. 17 at the University of Miami. We will address state, local, tribal and territorial ability to respond to large-scale biological events. As former Secretary of Health and Human Services, I know that the federal government would move resources to affected areas throughout the United States. (Donna Shalala, 1/15)
Cleveland Plain Dealer:
More Fed Oversight Needed To Ensure Accurate Genetic Testing
This year, over 200,000 Americans will order genetic tests to see if they're at risk for more than 2,000 hereditary diseases, including cancer. Patients and their doctors can choose tests from over 500 different laboratories. Most people don't think twice about their choice of lab. They figure all lab tests are of similar quality. They're wrong. (Jill Levy-Fisch, 1/14)
St. Louis Post Dispatch:
The Most Dangerous Wealthy Nation To Be Born Into? The U.S.A.
As funding renewal for the Children’s Health Insurance Program continues to languish in Congress, a study published last week in the journal Health Affairs illustrates how badly the United States takes care of its children. Compared with 19 other economically developed nations, the study says, the United States is the most dangerous of wealthy nations for a child to be born into. Among the 20 industrialized nations studied, the United States ranked worst in childhood mortality. A child born here is 70 percent more likely to die before his 20th birthday than a child born in the 19 economic peer nations. (1/14)
Columbus Dispatch:
Broad Efforts Will Save Babies' Lives
If a society is measured by how it protects its most vulnerable citizens, Ohio’s latest poor showing in infant-mortality rankings is a terrible badge of shame. In a new national report based on birth and death statistics from 2013 through 2015, Ohio was one of just three states — along with Alabama and Indiana — in which infant-mortality rates overall and for the three subsets noted were all higher than the national rates. For African-American babies in particular, Ohio’s high mortality rate of 13.46 deaths for every 1,000 births was second only to Wisconsin’s. ... Reducing infant mortality in central Ohio long-term will come from what may seem to be unrelated efforts, but in truth, the solution requires a broad and deep focus. (1/16)
Lexington Herald Leader:
Raise Ky. Cigarette Tax By $1 For Healthier Babies
As a certified nurse-midwife, I see the negative effects of smoking on women and babies on a daily basis. Twenty-four percent of women in Kentucky smoke, giving us the distinction of being ranked the 49th-worst state in the nation. Fifteen percent of pregnant women in Kentucky smoke. Tobacco-exposed pregnancies result in increased rates of miscarriage, fetal death, stillbirth, preterm birth, low birth-weight, respiratory problems in newborns and Sudden Infant Death Syndrome. Low birth-weight, preterm babies require extended stays in the Neonatal Intensive Care Unit which costs, on average, $3,000 per day. (Kendra Adkisson, 1/12)
Cleveland Plain Dealer:
When It Comes To Opioid Addiction, Prevention Is Key
Ohio's opioid overdose rate has increased at an alarming rate over the last 17 years. A recent report from The Ohio State University paints a stark picture of its social and economic cost in our state and communities. Overdose deaths involving other drugs, including alcohol and cocaine, are also increasing. Each year as the death toll increases, families and communities are torn apart. ... At The Center for Community Solutions, we have sought to identify and explore next steps. It is clear that it is not enough to treat the symptoms of the crisis; the root causes must also be addressed. Prevention of substance abuse plays a major role in quelling the opioid crisis and sparing future generations from suffering and loss. (Brie Lusheck, 1/14)
Lexington Herald Leader:
Economic Inequality Produces Sickness And A Politics Of Rage
Kentucky citizens need to be reminded of the out-of-state corporate plutocrats and their homegrown enablers making Kentucky one of the most unequal as well as most unhealthy states. Independent studies of economic and physical well-being consistently rank Kentucky as one of the poorest and unhealthiest states. Kentuckians are literally dying of inequality. Inequality, high poverty and ill health are closely connected. In 2016 Kentucky’s 18.5 percent poverty rate was one of the highest in the nation. Almost a third (30.8 percent) of African-Americans and just over one in four children living in poverty. Kentucky ranks second in the rate of abused children, double the national average. (Ron Formisano, 1/12)
St. Louis Post Dispatch:
Self-Dealing By Nursing Home Owners Threatens Patient Care
The outsourcing of logistical support services, which became commonplace in the U.S. military in the 1990s and later was adopted by state prison systems, has now come to dominate the nursing home industry. And while nursing homes, unlike the military or prisons, are not part of federal or state governments, Medicaid pays for the care of 62 percent of all nursing home patients, amounting to $55 billion in 2015. So the question of who’s profiting from meeting — or not meeting — their needs is a matter of great public import. People’s lives can and do hang in the balance. (1/14)
The New York Times:
Britain’s N.H.S. In Crisis: ‘We Might Break’
Britain’s National Health Service, put in place by the country’s post-World War II Labour government, holds a unique place in the country’s psyche as both source of constant frustration, object of affection and — somehow — a central pillar of arguments both to leave and remain in the European Union. In a country riven over Brexit, at least most people can agree on the importance of the N.H.S. What its future should be is less clear. (1/6)