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In This Edition:

From Kaiser Health News:

Kaiser Health News Original Stories

2. Podcast: 'What The Health?' Meanwhile, In Other Health News…

In this episode of “What the Health?” Julie Rovner of Kaiser Health News, Joanne Kenen of Politico, Alice Ollstein of Talking Points Memo and Sarah Jane Tribble of Kaiser Health News discuss some of the under-covered health stories of the past several weeks, including drug price issues, the opioid epidemic and women’s reproductive health. (11/21)

5. Political Cartoon: 'Liquid Courage?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Liquid Courage?'" by J.C. Duffy.

Here's today's health policy haiku:


So forget the swamp.
Trump says to health nominee
"Fox, here's the hen house."

If you have a health policy haiku to share, please Contact Us and let us know if you want us to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

Summaries Of The News:

Health Law

6. Murkowski, A Key GOP Swing Vote, Signals Support For Repealing Individual Mandate

A spokesperson for Sen. Lisa Murkowski (R-Alaska) says that the comments should not be construed as support for the Republicans' tax bill. Meanwhile, the American Academy of Actuaries is warning Congress against repealing the mandate, and health care leaders watch with trepidation as a vote on the measure nears.

The Washington Post: Republican Sen. Lisa Murkowski Announces Support For Repealing Individual Mandate, A Potential Boost To Tax Overhaul
Sen. Lisa Murkowski (R-Alaska) said she would support repealing the Affordable Care Act’s individual insurance mandate, giving a potential boost to the Republican effort to pass a massive tax cut package next week. “I believe that the federal government should not force anyone to buy something they do not wish to buy, in order to avoid being taxed,” Murkowski wrote in an opinion piece published Tuesday by the Fairbanks Daily News-Miner. (Paletta, 11/21)

Politico: Murkowski Says She Backs Obamacare Mandate Repeal
Murkowski's renewed support for repealing the mandate — after repeatedly opposing her party's Obamacare repeal bills this year — may be a boon for Senate Republicans' tax legislation, which includes mandate repeal and is expected to be taken up on the Senate floor next week. A spokesperson for Murkowski told POLITICO that the comments should not be construed as support for the tax bill, which does not yet appear to have sufficient support to pass the chamber. (Diamond, 11/21)

The Hill: Murkowski Backs Repealing ObamaCare Mandate In Boost To Tax Reform
Murkowski, a key moderate swing vote, wrote in the Fairbanks Daily News-Miner that she supports giving people additional freedom by repealing the mandate, which requires people to have insurance or pay a fine. "Repealing the individual mandate simply restores to people the freedom to choose," Murkowski wrote. "Nothing else about the structure of the ACA would be changed." (Sullivan, 11/21)

The Hill: Actuaries Warn Congress Mandate Repeal Would Increase Premiums
The American Academy of Actuaries is warning Congress against repealing ObamaCare’s individual mandate in tax reform, saying the move could lead to higher premiums and insurers leaving the market. The group warned in a letter to Congress on Tuesday against repealing the mandate in tax reform, as Senate Republicans propose. (Sullivan, 11/21)

Modern Healthcare: Looming Senate Tax Bill Vote Making Healthcare Leaders Uneasy
Health system leaders face post-Thanksgiving indigestion as Senate GOP leaders race toward a floor vote on their sweeping tax-cut bill before the end of November. Not-for-profit executives are concerned the Senate bill would hurt hospital capital financing by prohibiting advance re-funding of prior tax-exempt bond issues, which made up about 25% of the municipal tax-exempt bond market in 2017. (Meyer, 11/21)

Bloomberg: The GOP’s Strategy For Killing Obamacare Now Looks Like This
The mandate to buy health insurance is the broccoli of Obamacare—the part you have to accept if you want the goodies, like affordable coverage of people with costly pre-existing conditions. Now Senate Republicans are saying you don’t have to eat your broccoli anymore. They eliminate the penalty for lack of coverage in their version of the $1.5 trillion tax cut bill, which they aim to vote on after Thanksgiving. (Coy and Kapur, 11/22)

Kaiser Health News: Podcast: ‘What The Health?’ Meanwhile, In Other Health News…
Most followers of health policy have been consumed lately by the potential repeal or alteration of the Affordable Care Act, as well as the ongoing open enrollment for individual insurance for 2018. But that’s far from the only health news out there. In this episode of “What the Health?” Julie Rovner of Kaiser Health News, Joanne Kenen of Politico, Alice Ollstein of Talking Points Memo, and Sarah Jane Tribble of Kaiser Health News discuss some of the important but under-covered stories you might have missed this fall, including prescription drug price fights and women’s reproductive health. (11/21)

7. Yes, Health Law Enrollment Numbers Are Up. But That Doesn't Tell Full Story.

Because the enrollment window is much shorter — it ends Dec. 15 in most states — it's not clear if the final numbers will be more than previous years.

Meanwhile, Texas lawmakers discuss the state's uninsured problem —

The Texas Tribune: Texas' Uninsured Rate, Doctor Shortage Among Topics Of Health Care Forum
Texas still has the highest uninsured rate of any state, with 4.5 million people living without health coverage. And those numbers are only worse in the Valley, where the uninsured rate is twice that of the state as a whole. “This part of Texas is even worse than the rest of Texas,” Krouse said. “We have among the worst primary care to patient ratios in the country. … The funding is woefully inadequate.” “The challenges that we have are many,” Hinojosa said. (Platoff, 11/21)

Public Health And Education

8. Navigate Thanksgiving Smorgasbord Without Piling On The Pounds

Experts say that eating a good breakfast — and not "saving" calories for later — helps people to not overeat when the big meal comes around. Meanwhile, others give advice on staying healthy while traveling during the holidays, and on important discussions to have around the dinner table.

The Wall Street Journal: How To Enjoy The Holidays—Without Gaining Weight
At this time of year, many revelers overdo it at the holiday table, unwilling to forgo the turkey or ham with fixings that mark the season. While many Americans serve their Thanksgiving meal in the afternoon, around 3 p.m. to 4 p.m., a giant food-fest at that time of day may not be optimal. Lauri Wright, the director of the Doctorate in Clinical Nutrition Program at the University of North Florida’s Brooks College of Health, dishes on midday dining and why a healthy breakfast may be the key to indulging in a big meal without guilt. (Mitchell, 11/21)

The Mercury News: Flying This Holiday? Here’s The Best Way To Avoid Getting Sick
So you’re headed to grandma’s house in Cleveland, and that jerk in 15C is hacking up a lung. With the cold and flu season in full gear, how are you — and millions of other Americans — supposed to protect yourself while flying the germ-ridden skies this holiday weekend? Good luck, if you haven’t already got your flu shot. The vaccine takes about two weeks for your immunity to fully build up against the virus. If you got your shot in time, nice going. Your odds of getting the flu — and not infecting your fellow passengers — are cut by about half. (Seipel, 11/21)

Kaiser Health News: This Thanksgiving, Carve Out Time For Lively Discourse On End-Of-Life Wishes
The roast turkey and pecan pie may be the same as always, but growing numbers of families plan to add a tradition to their Thanksgiving holiday this week: a frank talk about their wishes for end-of-life care. Paul Malley, president of Aging with Dignity, the agency behind Five Wishes, a popular living will, says requests for the documents that guide decisions surrounding serious illness and death typically surge starting now. (Aleccia, 11/22)

9. Almost 50 Years Ago, Industry Put Kibosh On Study Linking Sugar With Heart Disease, Cancer

The newly discovered research shows that the sugar industry knew about the harms associated with it, but covered up those dangers.

The New York Times: Sugar Industry Long Downplayed Potential Harms
The sugar industry funded animal research in the 1960s that looked into the effects of sugar consumption on cardiovascular health — and then buried the data when it suggested that sugar could be harmful, according to newly released historical documents. The internal industry documents were uncovered by researchers at the University of California, San Francisco, and described in a new report in the journal PLOS Biology on Tuesday. (O'Connor, 11/21)

NPR: What The Industry Knew About Sugar's Health Effects, But Didn't Tell Us
Back in the 1960s, the fact that our diets influence the risk of heart disease was still a new idea. And there was a debate about the role of fats and the role of sugar. The sugar industry got involved in efforts to influence this debate. "What the sugar industry successively did," argues Stanton Glantz of the University of California, San Francisco, "is they shifted all of the blame onto fats." (Aubrey, 11/21)

The Boston Globe: Sugar Industry Shut Down Study Linking Sucrose To Disease, Researchers Say
The University of California, San Francisco researchers, Cristin Kearns, Dorie Apollonio, and Stanton Glantz, published a paper Tuesday in the journal PLOS Biology critical of the industry’s decision to shut down the study of sucrose, the substance in common table sugar, which was launched in 1968. The sugar industry fired back, saying the paper was based on “speculations and assumptions” about long-ago events and saying the paper was written and funded by “known critics of the sugar industry.” (Finucane, 11/21)

Bloomberg: How Big Sugar Killed A 1968 Study That Pointed To A Heart Disease Link
“The sugar industry has maintained a very sophisticated program of manipulating scientific discussion around their product to steer discussion away from adverse health effects and to make it as easy as possible for them to continue their position that all calories are equal and there’s nothing particularly bad about sugar,” said Stanton A. Glantz of the University of California at San Francisco, one of the PLOS Biology study’s authors. (Shanker, 11/21)

10. Startling Upswing In Middle-School Aged Girls Self-Harming May Be Due To Cyberbullying

Self-inflicted injury, including such behaviors as cutting, burning and ingesting poisons, is one of the strongest risk factors for suicide.

Los Angeles Times: Self-Harm Rises Sharply Among Tween And Young Teen Girls, Study Shows
For girls navigating the straits of adolescence and young adulthood, there are new signs of serious emotional trouble. From 2009 to 2015, the nation's emergency rooms saw a sharp rise in treatment of girls 10 to 24 who intentionally injured themselves. But inside that increasing trend of girls and young women harming themselves — a yearly hike of 8.4% in ER visits over six years — lies an even more alarming statistic: Among girls 10 to 14 years old, rates of ER visits for treatment of self-harm surged 18.8% yearly between 2009 and 2015. (Healy, 11/21)

The Washington Post: More Middle-School Girls Are Inflicting Self-Pain. Experts Say It Might Be Because Of Smartphones
Self-harming behaviors like ingesting poisons, cutting and overdosing on drugs are strong indicators of suicide — the second-leading cause of death among people between 10 and 24 in 2015, according to data gathered by the Centers for Disease Control and Prevention’s National Center for Injury Prevention and Control, reported in a letter Tuesday by the Journal of the American Medical Association. Suicide rates for both teenage boys and girls are on the rise. But the number of emergency room visits for boys ages 10 to 24 with nonfatal self-inflicted injuries has remained stable in recent years, while the number of visits for girls in that age group surged, according to the data. (Eltagouri, 11/21)

11. Simply Asking Patients If They Use Opioids Isn't Enough. This Hospital Goes Further.

Screening alone doesn't do much for patients, experts say, but Christiana Care Health System in Delaware pairs patients with addiction counselors and gets them enrolled in community-based drug treatment program before they've even left the hospital.

NPR: Asking About Opioids: A Treatment Plan Can Make All The Difference
For years, doctors have asked people about tobacco use and excessive drinking in the hopes that the answers could help lead people to cut down or quit. But screening alone isn't usually sufficient to change behavior. As opioid use hits record highs in the U.S., Christiana Care Health System in Delaware is starting to ask people about opioid use — and then go further. (Morrison, 11/21)

Cincinnati Enquirer: Holiday Drivers In Ohio To See New Anti-Drug Messages On Billboards
Holiday drivers in Ohio might see some new signs this season that are part of a just-launched anti-drug campaign. You might see "Call #677," a number to report impaired drivers to the Ohio Highway Patrol. Or "Start Talking," a state of Ohio drug prevention program that gives parents and other adults tips on starting conversations with children about drug use. (DeMio, 11/21)

12. New Drug-Resistant Strain Of Malaria Threatens To Upend Years Of Eradication Efforts

“It has a big potential to spread,” says Dr. Arjen M. Dondorp, deputy director of the Mahidol Oxford Tropical Medicine Research Unit in Bangkok. “We should be very worried that other countries in Southeast Asia can be affected by this, and, of course, that it will reach Africa at some point.” In other public health news: stem cell treatments, breast cancer, transgender patients, Legionnaires’ disease, allergies, and more.

The New York Times: As Malaria Resists Treatment, Experts Warn Of Global Crisis
When Tran Viet Hung was a soldier patrolling these forested hills in southern Vietnam six years ago, he came down with a fever and chills. He tested positive for malaria and spent a few days recovering in a government clinic. Now Mr. Hung, 37, shrugs off the incident as an occupational hazard of working in this corner of Binh Phuoc Province, a malaria hot spot along Vietnam’s porous border with Cambodia. (McNeil, 11/21)

Stat: Bacteria Swap DNA That Spreads Antibiotic Resistance
The growing threat of antibiotic resistance has sparked calls to use antibiotics more responsibly to curb the spread of drug-resistant bacteria. The idea: If we reduce antibiotic use, we could reduce the resistance that’s been naturally selected for over time. But new research published Wednesday in Nature Communications finds that isn’t always the case. (Thielking, 11/22)

Stat: What Will FDA’s New Rules Mean For Legitimate Stem Cell Treatments?
When the Food and Drug Administration last week issued guidelines for investigative stem cell therapies, much of the attention fell to the agency’s vow to crack down further on unregulated clinics offering potentially unsafe treatments. But the guidances also have plenty of ramifications for companies trying to bring to market innovative and legitimate stem cell treatments by moving them through clinical trials and getting them approved by the FDA. (Joseph, 11/22)

The Sacramento Bee: How African-American Parents Can Lower Their Daughters’ Risk Of Breast Cancer
African-American women in the United States are about twice as likely as women of all other races to develop an aggressive form of breast cancer known as triple negative. Many believe it’s a product of their race or genetics, but science has found that the risk of this deadly disease can be drastically reduced if parents help their daughters do just one thing – help them stay lean. (Anderson, 11/21)

NPR: Health Care System Fails Many Transgender Americans
On a recent weekday afternoon, Ruby Corado let herself into the drop-in center at the homeless shelter she founded for LGBTQ youth to make the rounds with new clients. In the basement of Casa Ruby in Washington, D.C., transgender men and women in their late teens and 20s, mostly brown or black, shared snacks, watched TV, chatted or played games on their phones. Many of them, said Corado, are part of the 31 percent. (Ulaby, 11/21)

Georgia Health News: Legionnaires’ Disease: Its Appearance Was Historic, But It’s Not History
In July 1976, a severe outbreak of a type of pneumonia occurred at a convention of the American Legion in Philadelphia. It eventually infected scores of people, and at least 29 of them died. The incident caught the attention of the nation. A mysterious illness is always scary, but this one had a kind of cruel resonance, because the military veterans had chosen the place and time of their convention as a way of celebrating the 200th anniversary of the United States. (Hensley, 11/21)

The New York Times: ‘I Have No Idea How to Tell This Horror Story’
John Branch, a sports reporter at The New York Times, has been in sporadic contact via text messaging and email with Walter Peat since writing about him and his son Stephen, a former N.H.L. player. At the time of the article, in June 2016, Stephen Peat was 36 and experiencing debilitating headaches and violent mood swings. Peat was primarily an enforcer, a player designated to drop his gloves and square off in fist-to-fist combat with an opponent. The Peats presumed that Stephen’s problems were rooted in brain trauma sustained on the ice in so many fights. (11/21)

Kaiser Health News: Got Food Allergies? Add Milk To The Worries For Your Meal
Since her son Matt was an infant, Lynda Mitchell knew he had a milk allergy. She controlled the symptoms by switching his baby formula. But when he was 1, Halloween proved horrifying. While trick-or-treating in a pumpkin costume, Matt grabbed a chocolate bar and bit through the wrapper. Although he spit out the candy, his violent allergic reaction morphed into a mess of hives, swelling and labored breathing. He ended up in the emergency room. (Heredia Rodriguez, 11/22)

The Associated Press: Hulu Sued For Not Offering Audio Service For Blind Customers
Advocacy groups have sued Hulu in an effort to force the subscription streaming service to provide an audio track that helps people who are blind or visually impaired enjoy TV shows and movies. The federal lawsuit filed in Boston on Monday asks the court to declare that Hulu's failure to provide services for the blind violates the Americans with Disabilities Act. The groups say Hulu has refused to do so despite repeated requests from advocates and blind customers. (Richer, 11/21)


13. Nursing Home Staff Did Everything Possible To Help Patients After Hurricane, Facility Tells Congress

The letter from Florida's Rehabilitation Center at Hollywood Hills, which is tied to several deaths following Hurricane Irma, says that staff followed proper procedure in handling the crisis, but that they couldn't overcome the lack of power.

The Associated Press: Nursing Home Tells Congress Irma Deaths Not Staff's Fault
A Florida nursing home under investigation for the deaths of 13 patients after Hurricane Irma says in a letter to Congress that staff members did everything possible but couldn't overcome a lack of power to the central air conditioner. In a letter released Monday, Rehabilitation Center at Hollywood Hills attorney Geoffrey D. Smith told the House Energy and Commerce Committee that employees followed proper procedures between the air conditioner losing power on Sept. 10 and when the deaths began Sept. 13. The committee is investigating the deaths as are local police detectives and the state. (11/20)

In other nursing home news —

14. Brexit Strains England's Already-Hurting Health System As Doctors, Nurses Flee Back To Europe

Long before Brexit, the N.H.S. suffered from chronic staffing shortages, but recruiting nurses from the European Union had helped plug the gap. Now though, England faces a potential mass exodus of a good percentage of its health care workers.

The New York Times: Where Brexit Hurts: The Nurses And Doctors Leaving London
Tanja Pardela is leaving London. Her last day is Nov. 26. She wells up talking about it. She will miss jacket potatoes, and Sunday roasts, and her morning commute — past playing fields, small children in school uniforms and a red telephone box — to the hospital where she has been a pediatric nurse for 11 years. Ms. Pardela does not want to leave the country she came to over a decade ago. But that country no longer exists. On June 24 last year, she said, “We all woke up in a different country.” (Bennhold, 11/21)


15. Majority Of Iowa's Medicaid Recipients Left With Only One Provider

But federal rules require states that contract out their Medicaid management to offer recipients more than one option.

And in Arkansas —

Arkansas Online: State Adds 4th Medicaid Care-Guider
A fourth company has been approved as a provider-led managed-care organization for Medicaid recipients who are developmentally disabled or mentally ill, Arkansas Insurance Commissioner Allen Kerr announced Tuesday. The newly formed Forevercare is owned by a coalition of Arkansas health care providers and Pittsburgh-based Gateway Health Plan, according to the state Insurance Department. (Davis, 11/22)

State Watch

16. Top Doctor At D.C. Public Hospital Is Fired After Alleging Mismanagement

Dr. Julian Craig, an internal medicine physician, appeared before the City Council's health committee and criticized the Veritas management company, saying it disregarded hospital programs designed to ensure patient safety. In other industry news, Medicare officials announce an expansion of a program to help rural hospitals, and a historic hospital in Massachusetts is hoping to merge with a larger system.

The Washington Post: United Medical Center’s Top Doctor Is Fired After Criticizing Hospital Consultants
The chief medical officer at the District’s public hospital, who this month accused the contractor running the facility of mismanagement and illegal overbilling of federal insurance programs, has been fired, his attorneys said Tuesday. Julian Craig, the top doctor at United Medical Center in Southeast Washington and a past president of the Medical Society of D.C., received a letter during the weekend from hospital board Chairwoman LaRuby May saying that his contract won’t be renewed. As a result, his employment will end Dec. 18. (Jamison, 11/21)

Modern Healthcare: 13 Hospitals Join CMS' Rural Pay Experiment
The CMS on Monday added more hospitals to a program that industry executives say has been key to ensuring access to care in underserved communities. All in all, 13 additional hospitals will participate in the Rural Community Hospital Demonstration Program, which reimburses hospitals for the actual cost of care for inpatient services provided to Medicare beneficiaries rather than standard Medicare rates. Medicare typically pays as little as 80% of inpatient services costs. (Dickson, 11/21)

The Boston Globe: Mass. Eye And Ear Says It Needs Larger System To Thrive
Almost 150 years ago, the leaders of the Massachusetts Eye and Ear Infirmary faced a difficult prospect. The hospital was treating more and more patients, but it was still losing money. “The unhappy thought was voiced that the Infirmary might not survive, that its burdens were too heavy, its revenues too small and uncertain,” according to a 1984 history of the institution. Hospital leaders took steps to shore up their finances and weathered the challenges. Today, Mass. Eye and Ear is confronting a similar crisis. (Dayal McCluskey, 11/21)

17. State Highlights: Ohio Lawmaker Offers Price Transparency Bill; Workers Fired Over Refusal To Get Flu Shot

Media outlets report on news from Ohio, Minnesota, Florida, Texas, Michigan, Virginia, Illinois and California.

The Columbus Dispatch: Doctors Back New Ohio Health-Care Price Transparency Bill
As Ohio’s health-care price transparency law remains tied up in court by Ohio hospitals and others, one of the legislature’s few doctors has introduced a replacement proposal backed by the medical community. Rep. Stephen Huffman, R-Tipp City, a physician and chairman of the House Health Committee, said the new transparency bill would give patients information upfront about out-of-pocket and covered costs of procedures with prior authorization. It also would require disclosure of costs for a number of other procedures, such as MRIs or childbirth, if the patient requests it seven days in advance. (Siegel, 11/22)

Houston Chronicle: Chronicle’s 'Blindside' Article On Surprise Medical Billing Foments Outrage In Austin
A Texas lawmaker, angry that patients are being used as leverage when doctors and insurers fight over money, said Tuesday he wants a new law to get consumers out of the middle. "There's no genuine need for them to be involved," said John Smithee, R-Amarillo, a longtime legislator who is the former head of the House insurance committee and has been on a champion of patient protection against excessively high surprise medical bills. (Deam, 11/21)

Dallas Morning News: See How Health Care Costs Have Climbed For D-FW Employers
In D-FW, employers are increasingly moving to high-deductible plans, and costs have continued to rise for both employer and employee. Nearly 2,500 U.S. companies recently took part in a survey conducted annually by the compensation and benefits consulting firm Mercer. The survey, which included 47 public and private businesses in D-FW that offer coverage to more than 505,000 North Texans, revealed some notable trends in the region. (Rice and Joseph, 11/21)

The Associated Press: Victims Of Cancer Doctor Could Receive $4.1M In Repayment
An expert is recommending approval of $4.1 million in claims, including $2 million in funeral costs, filed by victims of a Detroit-area doctor who committed fraud by putting hundreds of patients through needless cancer treatments. Randi Roth gave an update Tuesday to a judge who is overseeing the case of Dr. Farid Fata. She said 81 percent of 741 claims are fully or partly eligible for restitution. (11/21)

Richmond Times-Dispatch: "I Really Think It's Made Me A Better Person": How The People Around Carole Johnson Have Helped Her Deal With Cancer
Carole Johnson realized a few months after her breast cancer diagnosis that she doesn’t need 12 sets of sheets for one bed. She’s been going through her closets and her drawers, surprised at how unnecessary so many of her belongings seem. Clothes she bought years ago and never wore and really anything that’s been crowding the house, she’s tossed. “You wouldn’t believe how liberating it is,” she said. (O'Connor, 11/21)

The Wall Street Journal: More Than A Third Of Outcome Health’s Employees Take Buyouts
More than a third of Outcome Health’s employees elected to take buyouts this week, according to people familiar with the company’s operations. The Chicago advertising startup, which raised nearly $500 million in venture funding earlier this year, offered the voluntary buyouts to employees on Friday, The Wall Street Journal reported. Of the company’s 535 employees as of Monday, about 200 took the buyout and will be leaving by Dec. 8, these people said. (Winkler, 11/21)

Los Angeles Times: L.A. May Try To Block Reopening Of Oil Drilling Site Blamed For Health Problems
Los Angeles City Councilman Gil Cedillo is pursuing an unusual plan that could thwart the reopening of a South L.A. oil drilling site that suspended operations after a public outcry over nosebleeds and other health problems reported by neighbors. Cedillo, who represents the area near the Allenco Energy Inc. site, wants the city to use a rarely exercised power under its municipal code to cancel "oil drilling districts" where drilling is allowed. (Reyes, 11/21)

San Francisco Chronicle: Mayor Lee Wants To Pull 1,000 Homeless People Off SF Streets This Winter
San Francisco Mayor Ed Lee has set his sights on the ambitious goal of pulling 1,000 homeless people off the streets this winter and, to kick-start that effort, he wants to open two new homeless Navigation Centers. Getting that many people housed will take the combined labor of several city agencies, including the police, Public Health Department and Homelessness and Supportive Housing Department. But Lee told The Chronicle on Tuesday that he wants to “make a big move while it’s raining and cold.” (Fagan, 11/21)

Richmond Times-Dispatch: State Health Committee Endorses Medical Cannabis Oils
Doctors should be able to prescribe a pair of cannabis compounds and agencies around the state should better share statistics to track the heroin epidemic, according to recommendations made Tuesday by Virginia’s Joint Commission on Health Care. Staff for the committee, which is made up of legislators from the state Senate and House of Delegates, received more than 750 comments from the public — both individuals and organizations — regarding its presentation on the therapeutic and detrimental effects of THC-A and CBD oils, both cannabis compounds that don’t produce the high associated with marijuana. A staff report stated that there is limited research to support the use of THC-A or CBD to treat a wide variety of medical conditions, though there is strong evidence that it helps with symptoms of multiple sclerosis. (O'Connor, 11/21)

San Francisco Chronicle: Last Stop For Cannabis Advertising On Muni Buses, Trains, Stations And Stops
As the cannabis industry takes shape in California, one place it won’t be able to advertise is on San Francisco’s public transportation. The Municipal Transportation Agency’s Board of Directors on Tuesday banned ads for cannabis businesses from the transit system’s buses, trains, cable cars, stations and bus stops. The ban was a response to concerns that such ads are inappropriate for young Muni riders and might promote marijuana use among children. (Cabanatuan, 11/21)

Prescription Drug Watch

18. Alex Azar Is Just Latest In List Of People Tied To Industry Filling Trump's Top Health Spots

News outlets report on stories related to pharmaceutical pricing.

Stat: He Rails Against The Drug Industry. But Trump Is Turning To Its Ranks To Fill His Administration
President Trump has vilified the pharmaceutical industry and made bold promises to lower prescription drug prices. But when it comes to staffing the health care agencies empowered to oversee those efforts, he has turned regularly to the pharmaceutical industry. His Food and Drug Administration chief, Scott Gottlieb, was a longtime industry investor and adviser to major players like GlaxoSmithKline and Bristol-Myers Squibb. A senior adviser at the Health and Human Services Department, Keagan Lenihan, joined the administration after running the lobby shop for the drug and distribution giant McKesson. And Trump has a former Gilead lobbyist, Joe Grogan, reviewing health care regulations at the Office of Management and Budget. The chief of staff at HHS, Lance Leggitt, lobbied for a whole host of drug clients, even last year. (Mershon, 11/16)

Stat: Trump Proposal To Lower Drug Prices Targets Insurer, PBM Rebates
The Trump administration is exploring policy changes that could eventually lower the prices Medicare beneficiaries pay at the pharmacy counter. Although it’s only a small, initial step in that direction, it’s one of the first signals of how the Trump administration is trying to deliver on the president’s promises to lower prescription drug prices. (Mershon, 11/17)

Stateline: Why It’s Hard To Control Drug Prices At The Ballot Box
Just 9 percent of Americans think pharmaceutical companies put patients’ interests above their own profits, according to a Harris poll published earlier this year. That dismal finding, which mirrors other recent polling, would seem to have boded well for a ballot initiative in Ohio intended to limit the amount the state pays drugmakers for prescription medicines. (Ollove, 11/22)

Kaiser Health News: Massachusetts Grabs Spotlight By Proposing New Twist On Medicaid Drug Coverage
In the absence of new federal policies to tame break-the-bank drug prices, Massachusetts’ state Medicaid program hopes to road-test an idea both radical and market-driven. It wants the power to negotiate discounts for the drugs it purchases and to exclude drugs with limited treatment value. “This is a serious demonstration proposal,” said Sara Rosenbaum, a health policy expert and professor at George Washington University. “They’re not simply using [this idea] as an excuse to cut Medicaid. They’re trying to take a step toward efficiency.” (Luthra, 11/21)

Stat: In Wake Of Shortages, Lawmakers Are Urged To Force Pharma To Disclose Manufacturing Info
In the wake of shortages caused by Hurricane Maria, half a dozen groups that represent hospitals, doctors, and pharmacists are urging Congress to examine the lack of information provided by drug makers about product supplies. The storm has caused shortages of various medicines — notably, solutions such as saline — but the extent to which manufacturing for many other drugs has been disrupted remains unclear. That’s because federal and state laws do not require companies to disclose which products are made at which plants. (Silverman, 11/20)

Wall Street Journal: Eli Lilly Bets Big On Insulin-Delivery Devices
Eli Lilly & Co., one of the biggest makers of insulin, has been planning a risky new business venture: making the high-tech devices that deliver insulin to diabetes patients. In a research laboratory Lilly opened here in 2015, scientists have been developing a wearable, automated insulin-delivery device designed to reduce the decision-making and guesswork of conventional insulin injections. They are also developing a “smart pen” injection device that can wirelessly transmit dosing information to a patient’s phone, to ensure proper dosing. (Loftus, 11/21)

Healthline: Competition Doesn't Slow Cancer Drug Price Increases
Cancer drug prices seem to defy the laws of economics. They steadily increase regardless of competition, a new study concluded. An international team of researchers tracked the average monthly sale prices of 24 injectable anticancer drugs, using price data from the U.S. Centers for Medicare and Medicaid Services. They took into account factors such as rebates and discounts. (Curley, 11/20)

Stat: Not A Dutch Treat: Drug Prices Prompt Debate Over ‘Last Resort’ Options In Amsterdam
For the second time this week, the Netherlands will gain the attention of the pharmaceutical industry, but the latest developments may not please many drug makers. One day after Amsterdam was chosen as the next home of the European Medicines Agency, the government is readying debate over its pharmaceutical policies, but the session may be hijacked by concerns over high prices and the overall influence of drug makers, according to reports. (Silverman, 11/21)

Stat: Roche Reshuffles Lung Cancer Immunotherapy Market With Positive Clinical Trial Results
With positive results from a closely watched clinical trial announced Monday, Roche (RHHBY) is on the cusp of joining Merck (MRK) in owning an immunotherapy combination proven effective for patients with newly diagnosed lung cancer. In the so-called IMpower 150 study, Roche’s checkpoint inhibitor Tecentriq combined with Avastin and chemotherapy demonstrated a “statistically significant and clinically meaningful” reduction in disease worsening compared to Avastin and chemotherapy alone in patients with newly diagnosed non-small cell lung cancer, the Swiss pharma giant announced. (Feuerstein, 11/20)

Reuters: Britain Says Canada's Concordia Overcharging Health Service For Thyroid Drug
Drug company Concordia overcharged Britain's health service millions of pounds for an essential thyroid drug by abusing its position as the only supplier, the country's Competition and Markets Authority said on Tuesday. The National Health Service spent 34 million pounds on liothyronine tablets last year, up from 600,000 pounds a decade ago, after Concordia increased the price per pack by almost 6,000 percent from 4.46 pounds to 258.19 pounds. (Sandle, 11/21)

FiercePharma: Concordia Catches Antitrust Scrutiny Over 5,700% Price Rise For Thyroid Drug
In the U.K., the CMA asserted that the National Health Service paid £258 per pack of Concordia's liothyonine as of July 2017, up from about £4.46 per pack in 2016 at a time when the company's production costs didn't appreciably increase. The health system's spending on the drug rose to more than £34 million last year from just £600,000 in 2006, the agency said. "Pharmaceutical companies which abuse their position and overcharge for drugs are forcing the NHS—and the U.K. taxpayer—to pay over the odds for important medical treatments," CMA chief Andrea Coscelli said in a Tuesday statement. "We allege that Concordia used its market dominance in the supply of liothyronine tablets to do exactly that." (Staton, 11/21)

Kaiser Health News: FDA Raids Florida Stores That Consumers Use To Buy Drugs From Canada
The Food and Drug Administration last month sent criminal investigation agents with search warrants into nine storefronts across Central Florida that help customers order drugs from pharmacies in Canada and overseas at big discounts. The agents notified the store owners that importing drugs from foreign countries is illegal and that those helping to “administer” such medicines could face fines or jail time. (Galewitz, 11/20)

19. Perspectives: Orphan Drug Tax Credit Gives People With Rare Diseases Hope. GOP Plan Could Crush That

Read recent commentaries about drug-cost issues.

Stat: Cutting The Orphan Drug Tax Credit Would Take Away My Day In The Sun
In the Republican-led campaign to reform the U.S. tax code, the tax incentive for making orphan drugs is on the chopping block. The House bill eliminates this credit, while the Senate bill decreases it by about half. Both versions worry me and likely the millions of other Americans living with orphan diseases who are waiting, often in vain, for effective therapies. (Amy Dickey, 11/21)

The Washington Post: Three Things Trump Can Do To Bring Drug Prices ‘Way Down’
President Trump nominated Alex Azar to serve the next secretary of health and human services last week, tweeting that he would be “a star for better healthcare and lower drug prices!” In fact, Trump has made many grand claims that he will bring drug prices “way down.” But if the president is serious about drug pricing, Azar’s record isn’t promising. During his tenure as head of the U.S. division of pharmaceutical giant Eli Lilly and Co., Azar tripled the price of that company’s insulin, and he has played down the problem of high drug prices, arguing that they do not drive health-care costs. (Amy Kapczynski and Aaron S. Kesselheim, 11/21)

Bloomberg: Roche's Two Good-News Scoops May Have A Short Shelf Life
Reporting solid drug-trial results is a big deal for any pharma firm. Roche Holding AG just pulled it off twice in one day. Roche announced Monday that its recently FDA-approved hemophilia medicine Hemlibra succeeded in a final-stage trial that could broaden its use. And in a separate study, its immune-boosting cancer drug Tecentriq helped patients with newly diagnosed lung cancer, in combination with chemotherapy and another Roche medicine, Avastin. Roche ADRs rose 6 percent on the double-dip of good news -- a $12 billion market-cap move for the pharma giant. (Max Nisen, 11/20)

Forbes: Burdened By High Medication Costs? Your Boss May Be Able To Help
Pharmaceutical companies have been charging way too much for way too many of their products. Both Donald Trump and Hillary Clinton complained about drug prices during the election campaign, but neither political party has taken action since November to tackle the problem. Insurance companies aren’t doing much about this problem either, despite having a huge incentive to tackle high prices. ( Ubel, 11/17)

Forbes: Rex Jacobsen's Target Price For Nvidia Is $310
Rex Jacobsen, one of my managers, just set a $310 target price for Nvidia providing us with a good example to see if the wisdom of the crowd can improve our analysis. First, let's see why Rex is so bullish on Nvidia. Then, lets see what information might improve our analysis. (Ken Kam, 11/20)

The State-Journal: Drug Pricing: Marketplace Or Monopoly?
You probably sense that few drug makers can compete in arenas with the likes of a mega-pharmaceutical giant like AbbVie, which employs 30,000, raked in $26 billion last year alone and deserves blame for some of those irksome TV prescription-drug commercials. You’ll also likely detect that prescription prices may be out of reach and possibly a matter of life and death for some. (Jim Waters, 11/17)

Editorials And Opinions

20. Viewpoints: Murkowski Explains Her Opposition To Individual Mandate; Cost-Sharing Burdens

A selection of opinions on health care from around the country.

Fairbanks (Alaska) Daily News-Miner: Alaskan Senator Supports Free Choice For Health Care
I have always supported the freedom to choose. I believe that the federal government should not force anyone to buy something they do not wish to buy in order to avoid being taxed. That is the fundamental reason why I opposed the Affordable Care Act from its inception and also why I cosponsored a bill to repeal the individual mandate tax penalty starting as early as 2013. And that is why I support the repeal of that tax today. (Sen. Lisa Murkowski, 11/21)

Huffington Post: Lisa Murkowski Says She’s OK With Killing The Health Insurance Mandate
Sen. Lisa Murkowski (R-Alaska) cast a decisive, dramatic vote to save health care for millions of people over the summer. The chances of her doing it again just went way down. With Republicans preparing to vote on tax cut legislation next week, Murkowski announced on Tuesday that she would not oppose the bill simply because it includes a provision repealing the Affordable Care Act’s individual mandate. (Jonathan Cohn, 11/21)

Axios: The Biggest Health Issue We Aren’t Debating
Thanksgiving is always a time to think about those in need. How about, then, a group we don't worry about enough: the many lower and moderate income Americans who can't cover their cost sharing if they get sick? It raises the question: How much cost sharing is too much? (Drew Altman, 11/22)

Los Angeles Times: There's A Grim Reality Behind Your Thanksgiving Turkey
No animals raised on factory farms are kept and killed under worse conditions than turkeys and chickens, which make up most of the animals raised for food in the U.S. Nearly 9 billion chickens are slaughtered each year for food. And because poultry is exempt from the federal Humane Methods of Slaughter Act, which the U.S. Department of Agriculture enforces, there are not even minimum federal standards governing how they live or die. (11/22)