The Associated Press: Romaine Lettuce Is Not Safe To Eat, CDC Warns
Health officials in the US and Canada told people on Tuesday to stop eating romaine lettuce because of a new E. coli outbreak. The US Food and Drug Administration said it is working with officials in Canada on the outbreak, which has sickened 32 people in 11 states and 18 people in the Canadian provinces of Ontario and Quebec. The strain identified is different than the one linked to romaine earlier this year but appears similar to last year’s outbreak linked to leafy greens. (Choi, 11/20)

CNN: Don't Eat Romaine Lettuce, CDC Urges Amid E. Coli Concerns
People have become sick in California, Connecticut, Illinois, Massachusetts, Maryland, Michigan, New Hampshire, New Jersey, New York, Ohio and Wisconsin. The Public Health Agency of Canada has identified an additional 18 people who have become sick with the same strain of E. coli in Ontario and Quebec. (Scutti, 11/20)

The Washington Post: Romaine Lettuce Is Not Safe To Eat, CDC Warns U.S. Consumers
The CDC told consumers to throw away any romaine lettuce they may already have purchased. Restaurants should not serve it, stores should not sell it, and people should not buy it, no matter where or when the lettuce was grown. It doesn’t matter if it is chopped, whole head or part of a mix.The unusually broad warning, issued just two days before Americans sit down for their Thanksgiving dinners, reflects the uncertainties about the origin and extent of the bacterial contamination. The CDC is not claiming that all romaine contains the dangerous bacteria — something the millions of people who have eaten the popular lettuce recently should bear in mind — but investigators don’t know precisely where, when or how the contamination happened. (Achenbach and Sun, 11/20)

The New York Times: Do Not Eat Romaine Lettuce, Health Officials Warn
“If you do not know if the lettuce is romaine or whether a salad mix contains romaine, do not eat it and throw it away,” the C.D.C. statement said. “Wash and sanitize drawers or shelves in refrigerators where romaine was stored.” Officials said such measures were necessary while they track down the source of the contamination, and at the moment all they could say was that investigators believe the tainted lettuce was grown or processed in Canada or the United States. (Jacobs, 11/20)

Politico: CDC Tells Consumers To Not Eat Romaine Lettuce
FDA Commissioner Scott Gottlieb suggested the agency was taking quick action to try to prevent more illnesses, particularly before the Thanksgiving holiday. "We want to get this information out to consumers early," he said. (Bottemiller Evich, 11/20)

The Wall Street Journal: Regulators Urge Consumers To Avoid Romaine Lettuce As They Probe E. Coli Outbreak
The U.S. outbreak last spring was linked to romaine lettuce from the Yuma, Ariz. growing region, which supplies most lettuce in the U.S. during winter months. Federal investigators weren’t able to determine exactly how romaine lettuce in the desert region became contaminated, though the FDA has said water from an irrigation canal is the most likely culprit. The FDA earlier this month said it would boost surveillance of the salad green. The agency plans to collect and analyze samples of romaine lettuce for pathogen contamination through a “new special surveillance sampling assignment” to determine whether products are safe to eat, according to an earlier statement from Mr. Gottlieb. (Newman, 11/20)

Los Angeles Times: Don't Eat Romaine Lettuce, CDC Warns Amid Another E. Coli Outbreak
The agency recently was granted power to force a recall, under the Food Safety Modernization Act — previously, it had to rely on voluntary measures, said Michael Droke, a partner with Dorsey & Whitney law firm who has represented the produce industry. “Food and ingredient companies should prepare in advance for the need to recall their products to minimize the risk of a mandatory order,” Droke said. (Mohan, 11/20)

The Hill: CDC Warns Against Eating Romaine Lettuce Amid E. Coli Outbreak 
The Centers for Disease Control and Prevention (CDC) is warning people across the U.S. not to eat romaine lettuce, citing an outbreak of E. coli. The CDC said the broad warning is in place until it can gather more information. “CDC is advising that U.S. consumers not eat any romaine lettuce, and retailers and restaurants not serve or sell any, until we learn more about the outbreak,” the agency said Tuesday. “This investigation is ongoing and the advice will be updated as more information is available.” (Sullivan, 11/20)

The Washington Post Fact Checker: The Recurring GOP Myth About John McCain’s ‘No’ On Obamacare Repeal
Sen. John McCain (R-Ariz.) may have passed away in August, but his late-night thumbs-down vote that in 2017 blocked passage of a slimmed-down repeal of the Affordable Care Act continues to be an all-purpose excuse for Republicans. We’ve documented in our database of President Trump’s false and misleading claims that the president repeatedly claims he was just one vote away from triumphally killing Barack Obama’s signature achievement. He’s made the claim at least 30 times. (Kessler, 11/21)

In other health law news —

Kaiser Health News: Attention, Marketplace Shoppers: Don’t Delay On 2019 Enrollment
Don’t procrastinate. Most consumers who buy their own insurance on the federal health insurance marketplace face a Dec. 15 deadline. Advocates are reminding these customers that if they miss the deadline, they may not have a plan that starts in January 2019. Despite repeated efforts by Republicans to repeal the Affordable Care Act, it remains the law of the land, and subsidies that help bring down premiums and reduce cost sharing are still available to help people afford plans sold on the marketplaces, also called exchanges. (Andrews, 11/21)

The New York Times: The Price Tag Of Migrant Family Separation: $80 Million And Rising
The federal government has spent $80 million to care for and reunite migrant children who were separated from their parents by immigration authorities, a figure that continues to grow months after the policy ended because more than 140 children are still in custody. The first official price tag on family separations — which ended abruptly in June in the face of widespread public opposition — comes to about $30,000 per child. That data, along with new details on the children who remain mired in the policy’s lingering effects, were handed over last week by the Health and Human Services Department to members of Congress, who shared the report with The New York Times. (Dickerson, 11/20)

The Hill: Trump Administration Has Spent $80M So Far On Family Separations 
According to HHS, a total of 2,667 children were separated from their parents and placed into agency custody for an average of 83 days per child. Shelter costs for those children, including food and education, cost a total of nearly $59 million, the agency said. The rest of the cost included medical care, legal fees and program support. (Weixel, 11/20)

The Texas Tribune: The Number Of Migrant Children In Texas Shelters Continues To Rise, Reaching A New High Under Trump
The number of unaccompanied migrant children held in Texas shelters reached a new high in November, months after the administration of President Donald Trump ended its policy of separating immigrant children from their parents at the border. There were 5,620 children living at privately run shelters for unaccompanied youth as of Nov. 15, according to the Texas Health and Human Services Commission, which regulates the federally funded shelters. That’s a record high under the Trump administration, up from 5,385 children last month. (Walters, Murphy and Cameron, 11/20)

And, in other news —

St. Louis Public Radio: Study: Fewer Immigrant Families Signing Up For Federal Food Assistance
After 10 years of consistent gains, the number of immigrant families enrolled in SNAP, or the Supplemental Nutrition Assistance Program, fell by 10 percent in 2018. New, preliminary research presented this month at the American Public Health Association conference showed the drop was highest for for families who had been in the U.S for fewer than five years. It’s a reflection of what Harvest Public Media and other outlets reported earlier this year: that some families are choosing not to participate in federal benefit programs out of fear it could impact their immigration status. (Honig, 11/20)

The New York Times: Task Force Calls For Offering PrEP To All At High Risk For H.I.V.
An influential government task force has drafted a recommendation that would for the first time urge doctors to offer a daily prophylactic pill to patients who are at risk for contracting H.I.V. The recommendation would include all men and women whose sexual behavior, sex partners or drug use place them at high risk of contracting the virus that causes AIDS. (Rabin, 11/20)

The Washington Post: Everyone At High Risk Of HIV Should Be Offered Preventive Meds, Panel Says
The U.S. Preventive Services Task Force estimated that 1.2 million people are eligible for the daily drug regimen, which is very effective at preventing HIV infection, but that only 78,360 took the medication in 2016. About 40,000 people were newly diagnosed with HIV that year. John Epling, a member of the task force and a professor of community medicine at the Virginia Tech Carilion School of Medicine and the Carilion Clinic, said routine discussion of the medication has not permeated primary care. He said he suspects that some doctors are not having conversations with patients who should be considered high risk. (Bernstein, 11/20)

Stat: Panel Recommends Everyone At High Risk Of HIV Be Offered A Prevention Pill 
The panel also noted that the CDC had estimated 1.2 million people were eligible for the pill three years ago, although only 78,300 actually used the medicine in 2016, when roughly 40,000 were diagnosed with HIV. Since 2012, usage climbed from 3.3 people per 100,000 to 36.7 percent in 2017, a 56 percent rise, according to a study published earlier this year in the Annals of Epidemiology. (Silverman, 11/20)

The Associated Press: US Judge: Mississippi 15-Week Abortion Ban Unconstitutional
A federal judge on Tuesday struck down a Mississippi law that bans most abortions after 15 weeks, one of the most restrictive in the United States. U.S. District Judge Carlton Reeves ruled that the law "unequivocally" violates women's constitutional rights. "The record is clear: States may not ban abortions prior to viability," Reeves said, citing Supreme Court rulings. (Pettus, 11/20)

The Hill: Federal Judge Rules Mississippi's 15-Week Abortion Ban Is Unconstitutional
The law, which was enacted in March, would have prohibited abortions 15 weeks after the woman’s last menstrual period. It would have been one of the nation’s most restrictive abortion bans. The law made exceptions in cases of a medical emergency that threatened the mother or "a severe fetal abnormality" that would have prevented the fetus surviving outside of the womb. (Gstalter, 11/20)

In other news —

The Hill: Anti-Abortion Group Launches Digital Ads To Support Hyde-Smith 
Anti-abortion group Susan B. Anthony List is jumping into the Mississippi Senate race with a five-figure digital ad campaign targeting Democrat Mike Espy. Espy is facing a runoff election against incumbent freshman Republican Sen. Cindy Hyde-Smith on Nov. 27. Women Speak Out PAC, which is a partner of the group, is releasing the ads targeting inconsistent pro-life voters. The ads attack Espy for being “too extreme” for Mississippi because of his support for abortion. (Weixel, 11/20)

The Washington Post: Some Veterans With ALS Were Deprived Of Health Care Benefits, VA Watchdog Finds
The Veterans Affairs Department’s internal watchdog has uncovered widespread errors in how the agency awards benefits to some of its most vulnerable patients: those diagnosed with the devastating neurological disease Amyotrophic Lateral Sclerosis. VA Inspector General Michael Missal, in a review released Tuesday, found that dozens of veterans suffering from ALS were deprived of financial support because staff mishandled their benefits claims. (Rein, 11/20)

The Wall Street Journal: Apple In Talks To Give Veterans Access To Electronic Medical Records
Apple Inc. is in discussions with the Department of Veterans Affairs to provide portable electronic health records to military veterans, a partnership that would simplify patients’ hospital visits and allow the technology giant to tap millions of new customers, according to people familiar with the effort and emails reviewed by The Wall Street Journal. Under the plans being discussed, Apple would create special software tools allowing the VA’s estimated nine million veterans currently enrolled in the system to transfer their health records to iPhones and provide engineering support to the agency. Apple in January announced its foray into the electronic-records field with a feature that allows patients to import and store medical information. (Kesling and Mickle, 11/20)

The Wall Street Journal: Walgreens, Humana Are In Preliminary Talks To Take Stakes In Each Other
Drugstore owner Walgreens Boots Alliance Inc. and health insurer Humana Inc. are in preliminary discussions to take equity stakes in each other, according to people familiar with the matter, as health-industry players scramble for tie-ups that will help them compete in a rapidly evolving environment. The companies, which already have a partnership focused on serving seniors from two Walgreens locations, are having wide-ranging talks that also include the possibility of expanding that venture, the people said. Details of the talks couldn’t be learned and there’s no guarantee there will be any new deal between the companies. (Mattioli, Siconolfi and Cimilluca, 11/20)

Modern Healthcare: Walgreens In Talks With Humana: Report 
The move comes on the heels of news that the $69 billion tie-up between Walgreens' archrival, CVS, and Aetna, announced last December, is expected to close after Thanksgiving. Healthcare players from hospitals and insurers to pharmacies have spent the past several years racing to strike deals, as increasing scale seems to be the only way to weather a rapidly changing industry with multiple headwinds. (Sweeney, 11/20)

NPR/ProPublica: A CPAP Machine Can Help Some Get Better Sleep But Insurers Don't Make It Easy
As many CPAP users discover, the life-altering device comes with caveats: Health insurance companies are often tracking whether patients use them. If they aren't, the insurers might not cover the machines or the supplies that go with them. And, faced with the popularity of CPAPs — which can cost $400 to $800 — and their need for replacement filters, face masks and hoses, health insurers have deployed a host of tactics that can make the therapy more expensive or even price it out of reach. (Allen, 11/21)

Meanwhile, a study reveals the hidden cost benefits of wishes granted to sick children —

NPR: Critically Ill Children Who Received Wishes Cut Their Health Care Costs
Researchers looked back at the cases of nearly 1,000 children with serious illnesses who were treated at Nationwide Children's Hospital in Columbus, Ohio. Half the children had received wishes and the other half hadn't. The children granted wishes were substantially less likely to visit the emergency department or to have an unplanned hospital admission within two years as compared with children who hadn't received wishes. (Researchers matched the children's personal and disease characteristics in the study.) "My hypothesis is that these kids, when they come back, are more engaged with their families and medical providers, and perhaps they're more adherent to their treatment plan," says the study's lead author Dr. Anup D. Patel, section chief of neurology at Nationwide Children's Hospital and an associate professor of pediatrics at Ohio State University College of Medicine in Columbus. (Haelle, 11/20)

The Washington Post: After Chicago Mercy Shooting Doctors Respond To NRA With #ThisIsOurLane Tweets
An emergency room physician in Rhode Island said one of her own had been “murdered” and vowed to fight. A Baltimore trauma surgeon proclaimed that “Gun Violence is not just a statistic,” and named the police officer, physician and pharmacy resident who were killed Monday at Mercy Hospital & Medical Center in Chicago. Physicians and nurses from Atlanta and Chicago to New York and Washington and even abroad expressed anger and anguish after another instance of gun violence — one that an emergency physician said “hits too close to home.” (Bever, 11/20)

Modern Healthcare: Mercy Shooting Highlights Importance Of Drills, Preparing Staff 
Two months ago, staff at Chicago's Mercy Hospital and Medical Center participated in an active shooter drill. That training came into play and likely saved lives Monday when a gunman opened fired on the hospital campus. The tragedy left four people dead: a physician, pharmacy resident and police officer as well as the gunman. (Johnson, 11/20)

Chicago Tribune: Mercy Hospital, Site Of Shooting, Has A Storied History In Chicago
Until Monday’s tragic shooting, Mercy Hospital & Medical Center rarely made the news. It’s often been overshadowed by powerhouse hospitals to its north and south, Rush University Medical Center and University of Chicago Medical Center, respectively. But that wasn’t always the case. The hospital has been a stalwart of its Bronzeville community for more than 160 years, tending to patients caught up in historic events and patients who made history themselves. In 1871, victims of the Great Chicago Fire were rushed to the hospital, which was beyond reach of the flames, according to the hospital. (Schencker, 11/20)

The Associated Press: A Look At 3 Lives Lost In Chicago Hospital Shooting
An emergency room doctor devoted to her community. A pharmacy resident who helped children with a disorder similar to her own. A police officer and father who responded to a shooting without being called. Chicago's mayor said the three people fatally shot at a local hospital on Monday were "doing what they loved" when they were attacked by the doctor's ex-fiance . Here is a look at their lives. (11/20)

And in Florida —

The Associated Press: Florida Cities Hit By Massacre Get $1 Million Art Grant
The Florida cities hardest hit by February's high school massacre are receiving a $1 million grant to create artwork aimed at community healing. Bloomberg Philanthropies announced Tuesday that it is making the grant to Parkland and Coral Springs for their project, "Inspiring Community Healing After Gun Violence: The Power of Art." Five artists and teams will create temporary projects for public display. Community workshops and talks will discuss using art for emotional healing. (11/20)

CNN: North Carolina Chickenpox Outbreak Blamed On Vaccination Exemptions
A chickenpox outbreak among students at Asheville Waldorf School in North Carolina has grown to 36 cases as of Monday, and exemptions from vaccination were a contributing factor, according to the Buncombe County Health Department, which has been monitoring the situation since the end of October. Asheville Waldorf School, which serves students from nursery through sixth grade, is part of an educational movement that subscribes to a philosophy focused on physical activity and learning through hands-on tasks, according to its website. There are more than 900 Waldorf schools in 83 countries, and the Asheville school, which was founded in 2009, is one of about 160 in the United States. (Scutti, 11/20)

The New York Times: Chickenpox Outbreak At School Linked To Vaccine Exemptions
The school has 152 children in nursery school through sixth grade, and one of the state’s highest rates of religious exemptions for vaccination. “The size of this outbreak and the fact that this school continues to have a large number of unvaccinated students makes it very likely there will be continued spread of chickenpox within the school,” Dr. Mullendore said. “This also poses a risk of spread to the surrounding community.” (Caron, 11/20)

The New York Times: How Turkey Trots Became A Thanksgiving Tradition
In a matter of mere hours, you are likely to ingest a heaping plate of food: turkey, gravy and stuffing — need we go on? Then, a bit later, you may well return for seconds. You know this. And so you set your alarm a few hours early, lace up your running shoes and pile into the family van for a brisk Thanksgiving Day 5K. (Stevens, 11/21)

The New York Times: Regular Exercise May Keep Your Body 30 Years ‘Younger’
The muscles of older men and women who have exercised for decades are indistinguishable in many ways from those of healthy 25-year-olds, according to an uplifting new study of a group of active septuagenarians. These men and women also had much higher aerobic capacities than most people their age, the study showed, making them biologically about 30 years younger than their chronological ages, the study’s authors concluded. (Reynolds, 11/21)

The Wall Street Journal: Banks Monitor Older Customers For Cognitive Decline
Banks, brokerage firms and other financial institutions are starting to monitor older customers for mental capacity and susceptibility to fraud. But then the question is this: Once a financial institution suspects that a customer is becoming cognitively impaired or increasingly at risk of fraud, what does it do with this information? Financial exploitation of seniors is an underreported problem. (Ward, 11/20)

The New York Times: Breathing Through The Nose May Offer Unique Brain Benefits
Folklore, spiritual traditions and even mothers have for ages drawn an implicit connection between respiration and state of mind: Breathe in deeply through your nose, we are told, to clarify thoughts, achieve serenity, defuse tantrums. There isn’t a lot of scientific evidence to back up these ideas, but a growing number of experiments have been looking at the influence that breathing has on our cognition. In October, a study in The Journal of Neuroscience considered the relationship between memory and how we breathe. (Reynolds, 11/20)

Stat: To Catch Misconduct, Journals Are Hiring Research Integrity Czars 
Scientific journals’ creation of dedicated positions for rooting out misconduct before publication comes amid growing awareness of such issues, and stems from a recognition that spot-checking and other ad hoc arrangements were insufficient. ...A 2016 study found that roughly 4 percent of published papers have evidence of doctored or duplicated images, but researchers have been sounding the alarm since at least 1994, according to Mike Rossner, the founder of Image Data Integrity Inc., which consults with publishers and universities. (Oransky and Marcus, 11/21)

CNN: Lawsuits Filed Over Drinking Water In South Carolina After CNN Report
Two lawsuits have been filed on behalf of residents of Denmark, South Carolina, where a CNN investigation revealed that a chemical was being added to the water supply for 10 years without EPA approval. The city of Denmark has been under scrutiny from residents suspicious of the rust-colored water coming from their taps, even though the local and state government assured them it was safe. (Ganim, 11/20)

North Carolina Health News: Blood Tests Show 4 PFAS, But No GenX
Blood samples taken from more than 300 New Hanover County residents contain man-made chemicals unique to their drinking water source, but GenX is not one of them. Results of blood tests from a GenX exposure study reveal four per- and polyfluoroalkyl substances, or PFAS, specific to customers of the Cape Fear Public Utility Authority, according to the North Carolina State University researchers who conducted the tests. (Talton, 11/21)

New Orleans Times-Picayune: These 12 Public Schools In The New Orleans Area Tested Too High For Lead In Drinking Water: Report
At least 12 public schools in Jefferson, Orleans and St. Tammany parishes failed tests for lead levels in drinking water, WVUE television reports. Jefferson conducted its own tests over the summer at 20 of its 86 schools, and the Louisiana Department of Health tested five New Orleans and St. Tammany schools that were built before 1986 and had no plumbing changes since then. The American Academy of Pediatrics recommends no more than 1 part per billion of lead in children’s drinking water, but at a cafeteria drinking fountain at Mildred S. Harris Elementary in Bridge City, Jefferson found 23.3 parts per billion. (Broach, 11/20)

Reuters: U.S. Judge Selects First Case In Federal Monsanto Weed-Killer Litigation
A U.S. judge overseeing the federal litigation against Bayer AG's Monsanto unit over glyphosate-based weed-killers allegedly causing cancer on Tuesday selected the first case to be tried in federal court in February 2019. U.S. District Judge Vince Chaabria in San Francisco in an order said the case of California resident Edwin Hardeman will be the first out of more than 620 cases pending in the federal litigation to go to a jury. (11/20)

The Associated Press: Monsanto Appeals $78M Verdict In California Weed Killer Suit
Agribusiness giant Monsanto on Tuesday appealed a $78 million verdict in favor of a dying California man who said the company’s widely used Roundup weed killer was a major factor in his cancer. The company filed a notice of appeal in San Francisco Superior Court challenging a jury verdict in favor of DeWayne Johnson. In August, the jury unanimously found that Roundup caused Johnson’s non-Hodgkin’s lymphoma and awarded him $289 million. (11/20)

Los Angeles Times: California Fires: Heavy Rains Could Wash Away Human Remains In Paradise, Searchers Fear
Four members of the Oakland Fire Department’s Urban Search and Rescue Task Force removed a charred mattress spring and began combing through a mixture of ash, dirt, shredded wood and pieces of roofing tiles. Using their gloves to move around the blackened dirt, they looked for human remains. “This is hard,” one of the recovery workers said. “But we’re trying. Let everyone know we’re trying.” (Vives, 11/20)

Los Angeles Times: California Fires: Anxiety And Nightmares Grip Evacuees In Paradise Fire Zone
Inside the cafeteria of Bidwell Junior High School, 63-year-old Deborah Laughlin sipped on coffee and scooped up some apple pie. A lot was on her mind. Laughlin said she lost her home in Paradise. She had been living at Evergreen Mobile Home Park. Since the evacuations, she has been at the middle school, where the Red Cross operates a shelter. She said she registered with FEMA and hopes she’ll be able to get housing. (Vives, 11/20)

The Washington Post: UMd Student Dies From Adenovirus; Virus Confirmed In Five Other Students
A student at the University of Maryland died recently of an adenovirus-associated illness, the university said Tuesday. Eleven children have died recently in New Jersey after an adenovirus outbreak at a health center there. In a statement, U-Md. said it learned Nov. 1 of what it said was then an “isolated case” of adenovirus. However, the statement, issued by David McBride, head of the campus health center, said that since then five more cases have been reported of students with confirmed adenovirus-associated illness. (Weil, 11/20)

The Baltimore Sun: 'This Should Never Have Happened': University Of Maryland Freshman Dies From Adenovirus
A freshman at the University of Maryland, College Park, died Sunday of complications from adenovirus, and her family is questioning whether the university — which has seen several cases of the illness — could have done more to prevent her death and whether it was related to a mold outbreak in some dorms. Olivia Paregol, an 18-year-old from Glenwood in Howard County, had been sick since early in the semester, when she first developed a cough. Her condition worsened and she contracted pneumonia. After leaving school, she was taken to the emergency room multiple times before she died at Johns Hopkins Hospital, said her father, Ian Paregol. (Meehan, 11/20)

ProPublica: 9-Year-Old Alleges Staff Member at Chicago Psychiatric Hospital Choked and Restrained Her
As Illinois’ child welfare agency works to clear out its remaining patients at a Chicago psychiatric hospital beset by allegations of sexual abuse and assault, problems continue to emerge. The Illinois Department of Children and Family Services on Monday opened an investigation into a 9-year-old girl’s allegation that a staff member at Aurora Chicago Lakeshore Hospital choked and restrained her. (Eldeib, 11/20)

North Carolina Health News: FEMA Deadline Extension Crucial For Some Storm Victims
For some in North Carolina, an extra month to apply for individual assistance through the Federal Emergency Management Agency could make all the difference as victims of Hurricane Florence struggle to settle back in. The 30-day extension, announced by FEMA earlier this month, will allow homeowners and renters in eligible counties to apply until Dec. 13. Jessica Slider Whichard, senior manager for communications at Food Bank of Central and Eastern North Carolina, said that 22 of the 34 counties her organization serves are now federal disaster areas. (Scarbrough, 11/21)

Reuters: Judge Voids U.S. Female Genital Mutilation Law
A federal judge in Detroit on Tuesday declared unconstitutional a U.S. law banning female genital mutilation, and also dismissed several charges against two doctors and others in the first U.S. criminal case of its kind. U.S. District Judge Bernard Friedman said Congress lacked authority under the Commerce Clause to adopt the 1996 law, and that the power to outlaw female genital mutilation, or FGM, belonged to individual states. (11/20)

Health News Florida: Agreement Reached In Managed Care Dispute
A legal challenge to the state’s Medicaid managed care patient-assignment system in Northwest Florida has been withdrawn. Lighthouse Health Plan, a provider-sponsored network affiliated with Pensacola-based Baptist Health Care, agreed to withdraw its administrative challenge to the assignment formula after the state approved making a series of changes to a five-year Medicaid managed care contract. (11/20)

Nashville Tennessean: Mental Health In Tennessee: 1 In 3 College Students Seek Help
She isn't alone. According to a study released earlier this month, about 1 in 3 U.S. college students sought mental health treatment in 2017. That's up from 1 in 5 just 10 years ago. The dramatic jump in demand has forced schools across the country to overhaul their offerings. In many cases, the progress on college campuses lagged behind similar efforts in other sectors. (Tamburin, 11/20)

New Hampshire Public Radio: 6 Years Later, Dispute Over Breastfeeding Accommodations Grinds On
A former state employee who claims she was wrongfully fired after requesting accommodations to breastfeed appeared in Superior Court on Tuesday, more than six years after her termination. Kate Frederick was fired from her position with N.H. Department of Health and Human Services in 2012 after she alleges supervisors denied her the ability to leave state offices during her break to breastfeed her then newborn son, who was in daycare less than a mile away. (Bookman, 11/20)

Iowa Public Radio: Iowa DHS Director Says State Is Embracing Child Welfare System Changes To Keep Families Together
Iowa’s Department of Human Services says the state’s foster care system has come a long way in helping children in unsafe home situations, but there’s more that needs to be done. The state is embracing a federal law passed earlier this year that supports keeping families together.The Family First Prevention Services Act passed in February aims to provide services like mental health and substance abuse treatment to families before their child is pushed into the foster care system. (Peikes, 11/20)

The Associated Press: State's 1st Dengue Case Confirmed In Miami-Dade County
Health officials in Florida have confirmed the state's first case of dengue. The Florida Department of Health said in a news release on Monday that the case emerged in Miami-Dade County. The agency didn't identify the person or their condition. Dengue is a mosquito-borne disease that causes fever, severe headache, along with muscle and joint pain. There is no treatment or vaccine. (11/20)

The Associated Press: Victims Of Air Ambulance Crash In North Dakota Identified
Authorities have identified the three people who died when an air ambulance plane crashed in western North Dakota. Morton County identified the victims as 48-year-old pilot Todd Lasky and 63-year-old nurse Bonnie Cook, both of Bismarck, and 47-year-old paramedic Chris Iverson, of Mandan. Lasky and Iverson worked for Bismarck Air Medical and Cook for CHI St. Alexius Health. (11/20)

Georgia Health News: Diabetes Care At An Ideal Price
A diabetes management firm is offering free “virtual” care to the first 1,000 Georgians with Type 2 diabetes to sign up for the program. The promotion by Onduo, announced Tuesday, is part of the Massachusetts-based company’s effort to honor Diabetes Awareness Month this month. (Miller, 11/20)

Iowa Public Radio: New Plan For Children's Mental Health Needs Funding
Governor Kim Reynolds' children's mental health board has new recommendations for how to better serve families with children who have a diagnosed mental illness. Under the plan being proposed, children would be routinely screened for mental health issues and services for children would be expanded. But, where will funding for the plan come from? (Moon and Kieffer, 11/20)

Austin Statesman: Watchdog Group Cites Choking Hazards, Poor Labeling On 'Dangerous' Toys
Dangerous slime, balloons, loud toys or smart devices that collect data on children have made a Texas consumer advocacy group’s naughty list this year. The Texas Public Interest Research Group’s 33rd annual list of toys it considers dangerous targets items that pose choking hazards, contain harmful chemicals and lack adequate labels.“Parents, don’t worry,” TxPIRG director Bay Scoggin said Tuesday, all that toy shopping requires is some common sense. (Bradshaw, 11/20)

The CT Mirror: Number Of Juveniles In Detention For Minor Offenses Has Dropped Since 2015
The number of youth incarcerated in the state’s juvenile detention centers for minor offenses dropped significantly between 2015 and 2017, pulling Connecticut from its number two ranking in a national study tracking juvenile confinement. That study, released last month by Pew Charitable Trust, found there were 51 juveniles detained in Connecticut for technical offenses, such as violating probation orders or failing to show up for treatment, on a single day — Oct. 28 — in 2015. (Werth, 11/20)

New Hampshire Public Radio: As Pot Shops Open In Mass., N.H. Police Warn Of Marijuana-Impaired Driving
Two stores in Massachusetts began selling recreational marijuana today, but police are reminding people in New Hampshire to be careful. State law says someone can be arrested if they have more than three quarters of an ounce of marijuana and charged with a felony if they have over an ounce with intent to distribute. (Gibson, 11/20)

New Orleans Times-Picayune: What To Know About Louisiana's Medical Marijuana Program Heading Into 2019 
Slowly, Louisiana's medical marijuana program is  gaining some traction toward getting products to patients. LSU AgCenter harvested its first crop of marijuana in October. And after more than a year of delays, Southern University's medical marijuana program is now under a new operator that says it will start the build out of a new facility starting early next year and could have crop available by the second quarter of 2019.  (Clark, 11/20)

San Jose Mercury News: Milpitas City Council Supports Permanent Cannabis Ban
The Milpitas City Council voted unanimously Tuesday night to move toward permanently banning all cannabis businesses in the city, after a discussion in which many people expressed opposition to the businesses, and one woman was arrested. The council asked city staff to work up ordinances for both an urgency ban that would go into effect quickly, as well as a permanent ban that would follow. The vote was 4-0, and followed hours of comments from members of the public, many of whom were opposed to any kind of cannabis business in the city. (Geha, 11/21)

The Hill: Drug Industry Nervous About Grassley’s New Role 
The drug industry is gearing up for a new threat in January when Sen. Chuck Grassley (R-Iowa) takes over as head of the Senate Finance Committee. Drugmakers will soon lose a reliable ally in Sen. Orrin Hatch (R-Utah), the retiring committee chairman who has been viewed by industry lobbyists and drug pricing advocates alike as a major roadblock to reform efforts pushed by Democrats and even the Trump administration. (Weixel, 11/20)

Stat: HHS Watchdog Chastises Mallinckrodt Over Giveaway Plan For Pricey Acthar Gel
In unusual language, the Department of Health and Human Services watchdog rebuked Mallinckrodt (MNK) over a proposed plan to provide free amounts of its high-priced Acthar Gel treatment to hospitals and patients, which the agency maintained could create “fraud and abuse risks.” At issue is an effort by Mallinckrodt to widen the market for its drug, which is used to combat infantile spasms and is a treatment of last resort for other serious maladies. But the decades-old medication has a controversial pricing history that the HHS Office of Inspector General made a strong point of noting in explaining why the company proposal was problematic. (Silverman, 11/19)

Reuters: BioMarin Sets Stage Early For Hemophilia Cure Off-Broadway
BioMarin Pharmaceutical Inc is turning to the theater to establish its name with hemophilia patients, long before its experimental cure for the bleeding disorder could reach the market. Earlier this month, BioMarin hosted 25 teenagers and their chaperones for an all-expenses paid trip to New York City, where they performed a Broadway-style musical based on their own experiences with bleeding disorders. Some came from as far away as Hawaii to work with a professional theater crew, have their headshots taken and meet members of the show Hamilton. (11/21)

Stat: You Have Questions On Biosimilars. We Have Answers
Not surprisingly, there are a lot of questions these days about biosimilars — nearly identical variants of biologic drugs that are expected to achieve the same results in patients as the original brand-name drug. Last week we hosted an hourlong webinar on the biosimilars, and we also fielded many questions on the subject from folks who tuned in. (Florko, 11/20)

The Wall Street Journal: Novartis CEO Bets On Cutting-Edge Science To Remake Drug Giant
Novartis AG’s recent acquisition streak is pivoting the company toward new treatments that bear little resemblance to traditional drugs. The Swiss company has spent nearly $15 billion in the past year to build its presence in cutting-edge areas of medical research, including gene therapy, or treatments that introduce new DNA into the body, and radiopharmaceuticals, which are drugs that carry radioactive particles to tumors for close-range radiotherapy. (Roland, 11/19)

CQ: Health Matters: The 'Donut Hole' Will Be On The Lame-Duck Menu
Health care lobbyists are watching to see whether Congress, in the next few weeks, will side with the drug industry against health insurers and the seniors’ group AARP in a fight over Medicare pharmaceutical benefits. The dispute is over a change lawmakers made earlier this year that was a surprise loss for drug companies, who are now seeking to overturn it. (Adams, 11/26)

Axios: Exclusive Poll: Americans Don't Think Trump Will Reduce Drug Prices
Americans don’t have much confidence in President Trump’s pledge to bring down drug prices, according to our latest Axios/SurveyMonkey poll. (Baker, 11/17)

KCUR: Kansas Agrees To Cover Potentially Life-Saving Drugs For Patients With Chronic Hepatitis C 
Kansas has agreed to cover the cost of drugs to treat Medicaid patients with chronic hepatitis C without subjecting them to a lengthy list of requirements. A legal settlement, which awaits final court approval, resolves a class action lawsuit alleging the state made it too difficult for hepatitis C patients to receive the potentially life-saving treatments. (Margolies, 11/20)

Marketplace: Big Pharma Could Face Losses If The Newly Split Government Can Reach A Consensus On Drug Prices
There is already public consensus that drug prices are too high. Both Democrats and President Donald Trump have vowed to lower them. Yet, even with a new Democratic majority in the House, they may face challenges lowering pharmaceutical costs. Politically divided governments are often synonymous with gridlock, even on an issue as widely supported as drug prices. For their part, markets are signaling a belief in continued gridlock. (Bradford, 11/9)

FiercePharma: Seniors Want Drug Prices In Ads. Young People? Eh, Whatever: Survey
Who wants drug prices in ads? Older people, that’s who. A recent survey by Wells Fargo Securities found that 77% of people 65 and older think pharma companies should be required to disclose prices in ads. That compares with just 40% of people 18 to 24 who think the price should be included. Younger people also tended to be more indifferent. Among 18- to 24-year-olds, 41% of chose the middle ground in Wells Fargo's query, not picking a definitive yes or no, but rather that “it wouldn’t matter to me.” (Bulik, 11/14)

Axios: The Drug Price Middlemen
We keep mentioning “middlemen” as part of the complex, expensive drug supply chain. They’re actually called pharmacy benefit managers, or PBMs, and their role in the system is both incredibly important and incredibly opaque. (Herman, 11/17)

Stat: Only A Few Drug Makers Are Actively Targeting Medicines Needed In Poor Countries
Amid growing pressure on the pharmaceutical industry to ensure people in low- and middle-income countries have access to needed medicines, a new report finds five large drug makers are doing most of the heavy lifting, but much of the R&D is focused on only five diseases, leaving many illnesses unaddressed. Specifically, 45 different maladies have been identified as areas in which R&D should be a priority for developing medicines, vaccines, and diagnostics, but these represent only one-fifth of the total product pipeline numbering more than 1,300 projects. (Silverman, 11/20)

Masslive.Com: Gov. Charlie Baker Will Roll Out Massachusetts Drug Pricing Plan In January
Over the past five years, Massachusetts' Medicaid program has doubled its spending on drugs - from around $1 billion to $2 billion. Nationally, spending on prescription drugs makes up around 17 percent of total U.S. health care spending. Pharmacy spending is the single largest reason that health care spending in the U.S. is much higher than in Europe and other developed countries. (Schoenberg, 11/15)

Stat: SQZ Biotech Pushes Ahead With Method To Squeeze Drugs Into Cells
One Watertown, Mass.-based biotech is working to capitalize on growing momentum for cell and gene therapies — and it seems to have found its opening. The company is working on a technology that will squeeze cells to open up tiny pores in their membranes to deliver gene therapies or medicines straight into the cell. And SQZ has had a busy fall. It closed a $72 million series C fundraising round in August. Even more recently, the company extended a partnership with Roche that could bring in more than $1.3 billion, if SQZ and Roche can get some products to market. (Sheridan, 11/19)

The Wall Street Journal: Sticking It To Pharma—With Competition
Did you hear that the Trump Administration has saved Americans $26 billion on prescription drugs? Probably not, and one person who seldom mentions it, oddly enough, is President Trump. A report from his own White House shows how faster approvals at the Food and Drug Administration are lowering prices. The FDA has over 20 months of the Trump Administration approved an astounding 1,617 generic drugs, which are identical to branded versions but sold at commodity prices after patents expire. That works out to 81 a month on average—an 17% increase over the preceding 20 months. The Council of Economic Advisers in October tried to tally the savings from new entrants: $26 billion. (11/19)

Stat: We Created A Transparent Pharmacy Benefit Management Company. Here's Why
Although pharmacy benefit managers (PBMs) have been part of American health care since the 1970s, how they make money is a mystery for many people outside of the industry. Calls for transparency have resounded in the media and at all levels of government with growing frequency in recent years. Often, pharmacy benefit managers respond by touting their transparent programs, but within the industry, “transparency” can mean many different things, making it a shell game. (Michael A. Perry, 11/14)

The Post And Courier: Both Parties Agree Prescription Drug Prices Are Out Of Control
As elections earlier this month made clear, voters still care a lot about health care. And chief among their concerns are exorbitantly high drug prices. The only point of disagreement is how to bring them down.Oddly enough, however, conservatives and liberals might be closer on this issue than you expect. One party is calling for price negotiations between the federal government and drug manufacturers; the other is calling for Medicare to unilaterally set prices. Which one is the Democratic proposal, and which one is Republican? (Ezekiel Emanuel, 11/19)

The Star Tribune: Here's A Roadmap For Lowering Drug Prices
In this age of bitter political division, there’s a health care reform that Americans overwhelmingly agree on — allowing the federal government to wield its vast purchasing power to drive down medication costs for seniors. The newly elected Democratic House majority ought to leverage this rare common ground to swiftly pass a Medicare drug price negotiation bill, putting pressure on the Republican-controlled Senate to do the same. (11/16)

Bloomberg: Peanut Allergy Remedy Offers Hope And Risk
Food allergies alter lives and can have deadly consequences. That’s one of the reasons that full results of a study of Aimmune Therapeutics Inc.’s peanut allergy treatment, published Sunday in the prestigious New England Journal of Medicine, are so exciting. The findings validated and fleshed out details of the study that were first released in February. The key takeaway: After a year of  treatment, two-thirds of children who took the medication were able to eat small amounts of peanuts. This isn’t a cure. But it has a shot at U.S. government approval, and could make the lives of children with few options easier and safer. That gives the medicine huge commercial potential. (Max Nisen, 11/19)

Forbes: The Bizarre World Of Drug Pricing
There is no shortage of bad ideas when it comes to the pharmaceutical market. One such proposal would allow drugs to be imported directly from other countries, such as Canada. Then there is the Trump administration’s proposal that would effectively adopt foreign price controls on Medicare Part B drugs by implementing an international pricing index (IPI). These policies, if implemented, would harm the quality of health care in the U.S. by reducing patients’ access to medicines and harming future innovations. (Wayne Winegarden, 11/19)

Los Angeles Times: The Public Has The Right To Know About Tainted Turkeys And Sick Chickens
If the USDA doesn’t want to implicate a single turkey supplier, then perhaps it ought to consider the broader approach taken by other agencies faced with serious food-borne illness outbreaks. The U.S. Food and Drug Administration, for example, reacted quickly to an outbreak of E. coli in romaine lettuce in April and within two weeks warned consumers to avoid all romaine lettuce from the entire Yuma growing region. And on Tuesday, the Centers for Disease Control and Prevention identified a second, unrelated outbreak of E. coli in romaine lettuce and warned consumers to avoid any form of the lettuce from any source and from any location until authorities figure out where the bacteria originated, thus implicating all lettuce suppliers. Why the disclosure disparity at federal agencies? Hard to say, though the USDA has long been criticized by consumer advocates for being too cozy with the agricultural industry it is tasked with regulating. (11/21)

Chicago Tribune: Mercy Hospital Shooting And The NRA's Cynical Cry Of 'Stay In Your Lane'
Before the deadly shooting at Mercy Hospital & Medical Center is forgotten, before it fades into the list of routine, senseless outbursts of gun violence in America, remember this: Less than two weeks ago, the National Rifle Association told doctors who support tougher regulations on gun sales and a ban on semi-automatic firearms to “stay in their lane.” Emergency room doctor Tamara O’Neal was shot dead by her ex-fiance Monday outside Mercy Hospital. The shooter then went inside the hospital, where he shot and killed Chicago police Officer Samuel Jimenez and first-year pharmacy resident Dayna Less. Police said the shooter, who was found dead in the hospital, had a valid firearm owner’s identification card and a concealed carry license and, over the last five years, legally bought at least four guns. Northwestern Memorial Hospital surgeon Emil Fernando summed things up in a tweet: “Lemme guess, @NRA, still not “our lane” even when it happens in our own hospitals? I don’t think so.” (Rex Huppke, 11/20)

Chicago Tribune: Bullets Know No Boundaries And Gun Violence Doesn’t Stay In A Lane
As a society, we need more than just damage control. We need prevention, education and regulation of firearms. When tragedy struck Mercy Hospital, Dr. Tamara O’Neal was about to start her shift to save lives when her own life was taken. We mourn her loss as much as we fear the closeness of gun violence in our own world. There are no safe havens anymore. Gun violence is Las Vegas’ lane, Orlando’s lane, Thousand Oaks’ lane, Columbine’s, Pittsburgh’s, Sandy Hook’s, Santa Fe’s, Parkland’s, San Bernardino’s, Virginia Tech’s and now Mercy Hospital’s lane. To effect change, we need to recognize that we all share this horrific lane. Rather than bickering about who owns the problem, and who has the obligation to solve it, we need to recognize that we all must share that burden. We need to reach across the aisle and resolve to find a workable solution to keep the lanes safe for our children, neighbors, co-workers, and ourselves. The death toll caused by gun violence is quickly climbing. This is an emergency. (Amy Faith Ho, 11/20)

Stat: A Week Of Football Injuries Shows The Damage The Sport Can Inflict 
One year ago, we debuted the Football Injury Highlight Reel in STAT to bring attention to the enormous amount, and variety, of damage the game of football does to players. It emphasized non-concussion injuries, both because concussion garners so much press on its own and because other injuries, while severe, disabling, and costly, draw relatively little attention in debates about the future of football. This year’s equally grim edition focuses on non-concussion injuries that football players from youth leagues, high school, and the pros sustained between Nov. 6 and Nov. 12. While serious injuries and deaths are also occurring at the college level, this highlight reel calls attention to the risks to child athletes, with NFL players included as a point of comparison. And, like last year, this is just a snapshot of the slew of major injuries associated with the game. (Kathleen Bachynski, Lisa Kearns and Arthur Caplan, 11/21)

The Hill: We Should Just Start Phasing Out All Of The Cigarettes
The FDA recently announced its intention to ban menthol flavoring in cigarettes. Commissioner Scott Gottlieb should be commended for this initiative and those of us working in public health will do all we can to support him in what is sure to be a major fight with Big Tobacco. Banning menthol will go a long way to reduce smoking in the U.S., especially among African-Americans. We should use this moment to reflect more broadly on the role of cigarettes in our society. No one wants his or her child to smoke — ever. And for good reason. Long-term cigarette consumers lose, on average, a decade of their lives and can suffer from debilitating diseases along the way. The vast majority of smokers want to quit, have tried to quit and wish they had never started. They continue to smoke because cigarettes have been highly engineered to be as addictive as possible. (Laurent Huber and Chris Bostic, 11/20)

Los Angeles Times: American Women Should Have Access To Abortion Pills Before They Need Them 
Growing up, one of the first things I learned about sex was to always be prepared. As a young man coming of age in the 1980s, that meant having a condom in my pocket. There are many more options for preventing pregnancy and infections today: new hormonal birth control methods, external and internal condoms, dental dams, emergency contraception and even medication that reduces one’s risk of contracting HIV, called PrEP. As threats to legal abortion mount and access to abortion care becomes more limited in parts of the country, there’s another option we should be adding to the list: abortion pills in advance of pregnancy. (Daniel Grossman, 11/21)

Miami Herald: Be Careful, Democrats, ‘Medicare For All’ Will Cost Americans More Than Just Money
Now that Democrats are poised to take control of the U.S. House of Representatives in January, taxpayers can expect a major push to achieve the “progressive” goal of total government control over American healthcare. Their leading legislative proposals for government-controlled health system — H.R. 676 and S. 1804 — are broadly similar.Rep. Pramila Jayapal, D-Washington, leader of the “Medicare for All Caucus” in the House, is rewriting the House bill to bring it more into line with the Senate bill, authored by Sen. Bernie Sanders, I-Vermont. The thematic message of Medicare for All is fetching, assuming one doesn’t read the fine print. When Americans start paying close attention, they’re not likely to find the substance of these bills very attractive. (Robert E. Moffit, 11/20)

The Detroit News: Mental Health Care Deserves Funding Fix
Beaumont Health recently announced it will begin construction on a new 150-bed, free-standing psychiatric hospital in early 2019. This is a need in Michigan, where the mentally ill have been woefully underserved since the closure of most state mental hospitals in the 1990s. In addition to increasing capacity, hospital systems should consider other alternatives to care for those struggling with mental illness. In 1993, community hospitals in Michigan had a collective capacity of 3,041 adult beds and 729 child/adolescent beds. Today, that number has decreased to 2,197 adult beds and 276 youth beds. The number of mentally ill people has not decreased, but the support has significantly. (11/20)