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From Kaiser Health News:

Kaiser Health News Original Stories

1. To Fight Chinese Outbreak, Doctors Deploy Drugs Targeting HIV, Malaria And Ebola

Chinese doctors and public health officials are turning to a variety of drugs as they seek an effective treatment for patients sickened by the novel coronavirus. The evidence behind some of these medicines is flimsy, researchers acknowledge, but human trials are the only way to know whether these drugs work. (Carmen Heredia Rodriguez, 2/13)

3. Political Cartoon: 'Drug Drag?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Drug Drag?'" by John Cole, The Scranton Times-Tribune.

Here's today's health policy haiku:

SETTING YOUR OWN TERMS ON MEDICAL BILLS

Mutual assent?
Impossible! Travesty!
Downright sick system.

- Micki Jackson

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:

Global Health Watch

4. 14,840 New COVID-19 Cases Confirmed Overnight In Hubei, Raising Questions About Accuracy Of Reporting

It wasn't a sudden spike of cases that led to the increase but rather a change in the diagnostic criteria being used. The eye-popping numbers highlight how hard it has been for Chinese officials to get accurate counts in the outbreak, especially considering more than 80% of the confirmed cases have been mild. Meanwhile, two Communist Party leaders were ousted following the announcement of the new numbers.

The New York Times: Coronavirus Cases Seemed To Be Leveling Off. Not Anymore.
The news seemed to be positive: The number of new coronavirus cases reported in China over the past week suggested that the outbreak might be slowing — that containment efforts were working. But on Thursday, officials added more than 14,840 new cases to the tally of the infected in Hubei Province alone, bringing the total number to 48,206, the largest one-day increase so far recorded. ... The sharp rise in reported cases illustrates how hard it has been for scientists to grasp the extent and severity of the coronavirus outbreak in China, particularly inside the epicenter, where thousands of sick people remain untested for the illness. (Rabin, 2/12)

Reuters: Coronavirus Deaths, Cases Leap In China; Markets Shiver
Health officials in Hubei said 242 people had died from the flu-like virus on Wednesday, the fastest rise in the daily count since the pathogen was identified in December. That took total deaths in China from the newly discovered virus to 1,367, up 254 from the previous day, the National Health Commission said. (Zhou and Patton, 2/13)

Reuters: What Spurt In China's Cases Reveals About Coronavirus
A new diagnostic method has led the Chinese province at the epicentre of a coronavirus outbreak to report a record rise in deaths and thousands more cases on Thursday. The central province of Hubei had previously only allowed infections to be confirmed by RNA tests, which can take days to process. RNA, or ribonucleic acid, carries genetic information that enables identification of organisms such as viruses. (2/13)

The New York Times: How Many Coronavirus Cases In China? Officials Tweak The Answer
The news was abrupt and, to some, surprising: Overnight, a Chinese province near Russia, had cut its count of confirmed coronavirus cases by more than a dozen. The revision stemmed from what appeared to be a bureaucratic decision, buried in a series of dense documents from the national government. Health officials said that they would reclassify patients who had tested positive for the new coronavirus but did not have symptoms, and take them out of the total count of confirmed cases. ... World Health Organization officials seemed caught off guard when asked about the move at a news conference this week. The change in counting cases is only one factor that has made it difficult for experts to determine the true scale of the epidemic. (Wang, 2/12)

Stat: Why Reports About Coronavirus Death Rates Can Be Misleading
When a new disease starts to spread, the most pressing questions are: How deadly is this? And how many people are likely to die? One way to measure the severity of disease is by calculating the case fatality rate, or CFR. Watch the video above to find out more about how CFR is determined and how this relates to Covid-19, the disease caused by the new coronavirus. (Empinado, 2/13)

The Washington Post: Coronavirus Update: More Than 80 Percent Of Cases Are Mild, Complicating Efforts To Respond
But the virus's destructive potential has overshadowed one encouraging aspect of this outbreak: So far, about 82 percent of the cases — including all 14 in the United States — have been mild, with symptoms that require little or no medical intervention. And that proportion may be an undercount. ... "The fact that there are so many mild cases is a real hallmark of this disease and makes it so different from SARS," said Jennifer Nuzzo, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health's Center for Health Security. "It's also really challenging. Most of our surveillance is oriented around finding people who require medical intervention." (Bernstein and Johnson, 2/12)

The Wall Street Journal: China Ousts High-Level Officials As Coronavirus Cases Soar
China ousted two top Communist Party officials in Hubei province, the center of the new coronavirus outbreak, hours after health officials there confirmed 14,840 new infections on Wednesday alone—an almost 10-fold increase from a day earlier—indicating that the epidemic is far from tapering off. The high-level firings of the Communist Party secretaries of both Hubei province and its capital of Wuhan, where the contagion is believed to have started last month at a market with live, wild animals, demonstrated Beijing's disapproval of how they handled a threat that has since mushroomed into an epidemic killing more than 1,000 people and halting business across the country. (Woo, 2/13)

Reuters: China's Coronavirus Epicenter Boosts Medical Waste Treatment As New Cases Spike
The Chinese province at the center of the coronavirus outbreak has almost doubled its medical waste handling capacity after media images of bags of garbage piling up uncovered in hospital yards raised public concerns over secondary infections. Adding to the pressure on authorities Hubei province, in central China, on Thursday reported a spike in new cases. Provincial health officials said 242 people had died from the flu-like virus on Wednesday, the fastest daily rise in fatalities so far, with another 14,840 new infections after a change in diagnostic methods. (Xu and Stanway, 2/13)

Reuters: Chinese Public Dial In For Support As Coronavirus Takes Mental Toll
Hundreds of 24-hour mental health support telephone hotlines have sprung up in China in recent weeks as millions of people fret about catching the coronavirus - and try to avoid infection by staying at home. Medical professionals welcomed the launch of several official services in a country where mental health remains a relatively taboo subject, but cautioned that unofficial talk lines could do more harm than good. (Kirton, 2/13)

The New York Times: An American In A Locked Down Chinese Town: 'Everyone Here Is So Bored.'
Weeks before the coronavirus became a national health crisis in China, authorities threatened a doctor, Li Wenliang, who warned about early cases. State media reported that Dr. Li was illegally spreading rumors. That was a red flag for Bob Huang. "People here tend to believe the government. Not me," said Mr. Huang, who is 50 years old and lives with his mother, Zhang Wanrong, and her caretaker in Zhichang, a town of 300,000 in northern Zhejiang Province. "I've watched too many episodes of 'The X-Files.'" (Stevenson, 2/13)

5. America Is Buying Time With Containment Strategy, CDC Director Says As 14th Coronavirus Case In U.S. Is Confirmed

CDC Director Robert Redfield says it's likely the U.S. is going to see human-to-human transmission and thus more cases of the coronavirus. "We're not going to be able to seal this virus from coming into this country," Redfield said. Meanwhile, the CDC says that some coronavirus testing kits that have been sent to states are flawed. And a 14th person tests positive for coronavirus.

Stat: CDC Director: More Person-To-Person Coronavirus Infections In U.S. Likely
Health officials believe there is still opportunity to prevent widespread transmission of the coronavirus in the United States, the director of the Centers for Disease Control and Prevention said Wednesday, even as he warned that more human-to-human transmission here is likely. "We're still going to see new cases. We're probably going to see human-to-human transmission within the United States," Dr. Robert Redfield said in an interview with STAT. (Branswell, 2/12)

The New York Times: Coronavirus Test Kits Sent To States Are Flawed, C.D.C. Says
Some of the coronavirus testing kits sent to state laboratories around the country have flaws and do not work properly, the Centers for Disease Control and Prevention said on Wednesday. The kits were meant to enable states to conduct their own testing and have results faster than they would by shipping samples to the C.D.C. in Atlanta. But the failure of the kits means that states that encountered problems with the test should not use it, and would still have to depend on the C.D.C.'s central lab, which could cause several days' delay in getting results. (Grady, 2/12)

The Wall Street Journal: Newly Confirmed Coronavirus Cases In China's Hubei Province Rise Sharply
The likely culprit is a reagent—a compound used to cause a chemical reaction—that isn't behaving consistently, health authorities said. The CDC is working to remanufacture the reagent and send it back out. This could result in delays in running diagnostics. Local and state health authorities were eager to access the tests themselves, to avoid the wait involved in sending samples through the CDC. (Mendell and Kubota, 2/12)

The Wall Street Journal: Test Kits For Novel Coronavirus Hit A Snag In The U.S.
Local and state health authorities are eager to access the tests themselves and avoid the wait time involved in sending all their samples through the CDC. Right now, the Illinois Department of Public Health can test for the virus, the first state in the country to do so. Some labs will face a delay in running the diagnostics, as health authorities work out the kinks in testing. "We are looking into all of these issues to understand what went wrong," Nancy Messonnier, director of the National Center for Immunization and Respiratory Diseases at the CDC said on a press call with reporters. "This is really part of a normal process and procedure, and we have the quality control set up specifically to allow us to identify these kinds of problems." (Abbott, 2/12)

CNN: Some Coronavirus Test Kits Shipped To States Are Not Working As Expected, The CDC Says
Some states notified the CDC that they were unable to validate the test, and the agency is remanufacturing a reagent used in the test that's not performing consistently. Not all states have been affected. The Illinois Department of Public Health said it has not had any issues with the kits and it's continuing with its testing for the coronavirus. (Karimi and Christensen, 2/13)

Miami Herald: Uncertainty Over Whether CDC Coronavirus Testing Kits Work
Florida health officials received testing kits for novel coronavirus earlier this week but can't use them yet because it's unclear whether the tests are working. The U.S. Centers for Disease Control and Prevention on Wednesday morning said issues with the tests the agency has developed for the respiratory illness spreading rapidly through China surfaced after they were sent out to state labs. After state labs receive testing kits from the CDC, they must verify their accuracy, but the labs flagged "inconclusive results," or returns that were neither positive nor negative, CDC officials said on a call with journalists Wednesday. (Conarck, 2/12)

Cleveland Plain Dealer: National Council For Occupational Health And Safety Says Coronavirus Could Be A Health Risk To U.S. Healthcare, Transportation Workers
The National Council for Occupational Health and Safety on Wednesday declared Wuhan coronavirus a "significant occupational health risk for tens of millions of U.S. workers" and said that employers are responsible for implementing policies that keep workers safe.Workers in transportation industry and healthcare fields may be at the most at risk, the organization said on its website Wednesday. Workers in other industries may be at lower risk. Regardless, all workers "need guidance on assessing their risk of exposure." (Kilpatrick, 2/12)

Reuters: CDC Confirms 14th U.S. Case Of Coronavirus With Patient In San Diego
A second person evacuated from Wuhan, China, to a U.S. Marine base near San Diego has been diagnosed with the new coronavirus, raising the tally of confirmed cases in the United States to 14, the Centers for Disease Control and Prevention (CDC) reported on Wednesday. The patient was among 232 individuals placed under quarantine at the Marine Corps Air Station Miramar after being airlifted from the epicenter of the coronavirus outbreak in Wuhan earlier this month, CDC spokeswoman Ana Toro said. (Gorman, 2/12)

Los Angeles Times: Second Coronavirus Case Confirmed In San Diego
Like the first, which was announced Monday, the infected patient is an evacuee hospitalized with UC San Diego Health System shortly after arriving at Marine Corps Air Station Miramar on Friday. The university also said Wednesday that it has received an additional patient for testing from the quarantined group of evacuees living at Miramar, bringing the total to nine since last week. The three patients who remain under the university's care are said to be doing well; others have been returned to quarantine. (Sisson, 2/12)

The Hill: Fourteenth Case Of Coronavirus Diagnosed In US
"At this time there is no indication of person-to-person spread of this virus at the quarantine facility, but CDC will carry out a thorough contact investigation as part of its current response strategy to detect and contain any cases of infection with this virus," said Dr. Chris Braden, leader of CDC's on-site team. (Klar, 2/12)

ABC News: What Life Is Like Under Novel Coronavirus Quarantine
As novel coronavirus, or COVID-19, continues to spread around the globe, Americans are wrestling with an uncomfortable side effect of widespread infectious disease: the possibility of quarantine. A quarantine is designed to keep high-risk individuals who may have been exposed to the virus in isolation during the disease's infectious period, to see if they became sick. (Schumaker, 2/13)

MPR: If New Virus Gets Here, Health Systems Say They're Prepared
The university says that since Jan. 22, the Boynton pharmacy has sold more than 8,200 ear-loop masks. The U has suspended study-abroad travel to China and has been communicating with students and faculty about precautions to take while traveling. Golden said there are instructions greeting anyone coming into the Boynton offices about COVID-19. (Cox, 2/12)

6. WHO Effusively Praises China For 'Setting A New Standard' In Outbreak Response.' Critics Beg To Differ.

Critics question WHO Director-General Tedros Adhanom Ghebreyesus deferentially lauding China and calling on other countries not to cut off travel and trade. Some experts say that while praising China's response so strongly, the WHO is compromising its own epidemic response standards and sending the wrong message to other countries that might face future epidemics. Meanwhile, an infectious disease expert says the outbreak is "just beginning" outside of China.

The Wall Street Journal: The World Health Organization Draws Flak For Coronavirus Response
When the World Health Organization declared a global public-health emergency at the end of last month, it praised China's "extraordinary" efforts to combat the coronavirus epidemic and urged other countries not to restrict travel. "China is actually setting a new standard for outbreak response," WHO Director-General Tedros Adhanom Ghebreyesus said. Many governments ignored the travel advice. Other public-health experts criticized his unqualified praise for China. (Page and McKay, 2/12)

Reuters: Coronavirus Outbreak 'Just Beginning' Outside China, Says Expert
The coronavirus epidemic may be peaking in China where it was first detected in the central city of Wuhan but it is just beginning in the rest of the world and likely to spread, a global expert on infectious diseases said on Wednesday. The Chinese government's senior medical adviser has said the disease is hitting a peak in China and may be over by April. He said he was basing the forecast on mathematical modelling, recent events and government action. (Geddie, 2/12)

The Associated Press: Fear, Boredom, Adventure Fill Each Day On Quarantined Ship
Fear. Surprising moments of levity. Soul-crushing boredom. Life on the Diamond Princess, the cruise ship quarantined in a Japanese port with scores of cases of a new virus, means experiencing all these things, according to interviews by The Associated Press with passengers and a growing stream of tweets and YouTube videos. (2/13)

Reuters: Red Cross Seeks Sanctions Exemptions As North Korea Steps Up Anti-Virus Campaign
The Red Cross called for an urgent exemption from sanctions on North Korea on Thursday to help prevent an outbreak of the coronavirus, following an epidemic in neighbouring China. "We know that there is urgent need of personal protective gear and testing kits, items which will be vital to prepare for a possible outbreak," Xavier Castellanos, Asia Pacific director for the International Federation of Red Cross and Red Crescent National Societies (IFRC) said in a statement. (2/13)

Los Angeles Times: Coronavirus Outbreak Spurs Hoarding In Asia
On Friday evening, supermarkets in Taipei put out their usual stocks of toilet paper, stacked floor-to-ceiling in brick-sized packets stuffed into bags decorated with colorful cartoon characters. By Monday, just barren racks — and bewildered shoppers — were left. In Taiwan, Hong Kong and Singapore, shoppers are stockpiling toilet paper, hand sanitizers, rice, instant noodles, cured meats, sanitary napkins and other products as fears over the new strain of coronavirus from China continue to ripple across Asia. (Bengali and Jennings, 2/12)

7. Gilead Bulks Up Operations In Case Its Promising Drug Proves Effective Against COVID-19

Gilead invented remdesivir several years ago and first developed it to treat Ebola. Although the treatment proved less effective than others in fighting Ebola, company researchers working with academic scientists found that remdesivir was effective in treating mice infected with another coronavirus. Meanwhile, other doctors and researchers are searching for existing drugs in hopes that they'll land on one that's effective against COVID-19.

The Wall Street Journal: Coronavirus-Drug Development Becomes A Top Focus At Gilead
A team of a dozen executives at drugmaker Gilead Sciences Inc. meets daily to discuss the coronavirus epidemic in China and the company's cross-continental scramble to develop the first drug for the new disease. If the company's drug succeeds in studies in China, it could become the first treatment proven to work against a respiratory virus that has killed more than 1,000 people and infected some 42,600 in fewer than three months. (Walker, 2/12)

NPR: Is A Coronavirus Vaccine Coming Soon? Maybe By Fall, Scientists Say
Right now scientists are trying to accomplish something that was inconceivable a decade ago: create a vaccine against a previously unknown virus rapidly enough to help end an outbreak of that virus. In this case, they're trying to stop the spread of the new coronavirus that has already infected tens of thousands of people, mainly in China, and given rise to a respiratory condition now known as COVID-19. Typically, making a new vaccine takes a decade or longer. But new genetic technologies and new strategies make researchers optimistic that they can shorten that timetable to months, and possibly weeks — and have a tool by the fall that can slow the spread of infection. (Palca, 2/12)

Kaiser Health News: To Fight Chinese Outbreak, Doctors Deploy Drugs Targeting HIV, Malaria And Ebola
As the scientific community scrambles to find a drug that can effectively treat tens of thousands of patients sickened by a new respiratory virus, they are trying some surprising remedies: medicines targeting known killers like HIV, Ebola and malaria. American drugmakers have shipped two antiviral medications to China as doctors and public health officials there seek an effective treatment for patients sickened by the novel coronavirus, which has recently been named COVID19. The virus has afflicted 45,000 people worldwide and killed more than 1,100. Most of the cases and deaths occurred in Hubei province, China, where the outbreak began. (Heredia Rodriguez, 2/13)

PBS NewsHour: WATCH: WHO Deliberates How To Design Novel Coronavirus Drugs
More than 300 researchers from around the world convened in Geneva, Switzerland, on Wednesday to figure out how to treat people diagnosed with novel coronavirus and develop the first vaccines and medications to combat the disease. Public health experts and scientists are discussing easy-to-apply community-level diagnostic tests, best prevention practices and potential therapies, said Soumya Swaminathan, chief scientist for the World Health Organization, during a news conference Wednesday. (Santhanam, 2/12)

Elections

8. Powerful Nevada Union Chastises Sanders Supporters For 'Vicious Attacks' Provoked By Its 'Medicare For All' Warnings

Nevada's Culinary Workers Union said that its members have been the subject of attacks "simply because our union has provided facts on what certain health care proposals might do." Labor unions have spent years negotiating high quality, union-backed health care plans they fear will be snatched from them if a single-payer model is adopted. The state holds its presidential caucuses next week.

Reuters: Democrat Sanders, Nevada Union In Escalating Feud Ahead Of State Nominating Contest
Democratic presidential candidate Bernie Sanders, who bills himself as a champion of organized labor, found himself in an escalating feud with Nevada's Culinary Workers Union on Wednesday, 10 days before the state holds the party's third nominating contest. Tensions have been simmering for months between the powerful 60,000-member union and the 77-year-old U.S. senator, who comes to Nevada after a strong showing in Iowa and victory in New Hampshire on Tuesday. The union, which criticized Sanders' universal healthcare plan in a flyer to its members on Tuesday, said on Wednesday his supporters responded by "viciously" attacking the organization via Twitter, text, voicemails and direct messaging. (Reid, 2/12)

Politico: Nevada Culinary Union Lays Into Sanders Supporters After Health Care Backlash
The flier's circulation also coincides with heightened fears among the party establishment about putting a self-declared democratic socialist and Medicare for All proponent atop the ticket. But the group, which boasts 60,000 members from the hospitality industry in Las Vegas and Reno and bills itself as the one of the state's largest health care consumers, doubled down on its criticism amid the outcry from supporters of the senator. "Our union believes that everyone has the right to good health care and that health care should be a right, not a privilege," said Geoconda Argüello-Kline, the group's secretary-treasurer, adding that the union had already negotiated its own health care plan for "what working people need." (Oprysko, 2/12)

The Hill: Powerful Nevada Union Warns Against Sanders Health Plan
The flyer also notes that Sen. Elizabeth Warren (D-Mass.) would "replace Culinary Healthcare after 3-year transition," given that she also proposes Medicare for All, but not right away. An earlier flyer from the Union, also reported by the Independent, issued a broader warning about Medicare for All. (Sullivan, 2/12)

The Wall Street Journal: Democratic Candidates Set For Long Haul Following Sanders's New Hampshire Win
Mr. Sanders aims to maintain his momentum in Nevada, but he faces an immediate obstacle to winning there, with the state's powerful Culinary Union telling its 60,000 members that their union-negotiated health-care plans would be put at risk by a Medicare-for-All single-payer system that is a signature Mr. Sanders's campaign policy. The union hasn't endorsed a candidate in the race. Mr. Buttigieg on Wednesday morning made a move for the union's support, saying in a television interview that he supported the union's desire to keep their health benefits. Mr. Buttigieg is ramping up his staffing in Nevada to capitalize on his recent success, with immediate plans to double the campaign's head count there to around 100. He'll also soon be up on Nevada airwaves with a health care-focused ad. (Parti, Rubin and Day, 2/12)

HuffPost: Why A Powerful Nevada Union Is Undermining Bernie Sanders On Medicare For All
On paper, the Culinary Workers Union and Sen. Bernie Sanders (I-Vt.) look like a perfect match. The powerful Las Vegas-based local of Unite Here represents service workers throughout the city, making it one of the few places in the U.S. where housekeepers, busboys and cocktail waitresses can lead middle-class lives. Sanders is arguably the most pro-labor presidential candidate to wage a viable campaign in generations. The way the Culinary's organizing muscle has lifted up the Strip's most vulnerable workers could make for an entire Sanders stump speech. But the Culinary has been making Sanders seem a little scary. According to the Nevada Independent, the union recently posted flyers inside employee areas of casinos and hotels warning that Sanders would end the Culinary's health care program if elected, through his Medicare for All proposal. (Jamieson, 2/12)

Bloomberg: Health Insurers Rally After Bernie Sanders Wins New Hampshire
Managed care is leading gains in the health-care sector after Bernie Sanders won the New Hampshire primary for the Democratic nomination for president. It may seem counter-intuitive, but investors have been shaking off worries about the self-avowed democratic socialist and his progressive politics and are becoming increasingly convinced that Donald Trump will be able to beat Sanders. (Flanagan, 2/12)

In other news from the election trail —

The Hill: Flight Attendants Union Head Blasts Buttigieg For Saying Union Members 'Fought Hard' For Private Insurance Plans
Association of Flight Attendants President Sara Nelson criticized former South Bend, Ind., Mayor Pete Buttigieg Wednesday for a tweet defending private health insurance, that appeared to characterize the employer-provided health benefits as gains won by union workers. Buttigieg defended his proposed "Medicare for All Who Want It" plan, saying 14 million union members have "fought hard for strong employer-provided health benefits" in a tweet Wednesday morning. (Budryk, 2/12)

Marketplace

9. Juul Vows It's Never Marketed To Teens, But New Suit Finds Company Bought Ads On Nickelodeon, Cartoon Network

The suit, filed by Massachusetts Attorney General Maura Healey, presents some of the starkest evidence to date that the company was targeting young, nonsmokers during its launch period.

Reuters: Juul Bought Ad Space On Kids' Websites, Including Cartoon Network - Lawsuit
E-cigarette maker Juul Labs Inc bought online advertisements on teen-focused websites for Nickelodeon, Cartoon Network and Seventeen magazine after it launched its product in 2015, according to a lawsuit filed on Wednesday by the Massachusetts attorney general's office. The allegations in the lawsuit, stemming from a more than year-long investigation, contradict repeated claims by Juul executives that the company never intentionally targeted teenagers, even as its products became enormously popular among high-school and middle-school students in recent years. (Kirkham, 2/12)

The New York Times: Juul Bought Ads Appearing On Cartoon Network And Other Youth Sites, Suit Claims
According to the lawsuit, Juul rejected an initial marketing proposal by a marketing firm it had hired, Cult Collective, that would have branded it as a technology company with a target audience of adult smokers. The proposed campaign featured images of outdated technology like clunky telephones and joysticks, with a picture of a sleek Juul e-cigarette and the words, "The evolution of smoking. Finally, a truly satisfying alternative." Instead, the lawsuit says, Juul dropped Cult Collective and hired an in-house interim art director to produce "Vaporized," a youth-oriented campaign, featuring beautiful models in provocative poses. (Kaplan, 2/12)

The Associated Press: Massachusetts Sues Juul Over E-Cigarette Marketing Tactics
Attorney General Maura Healey's office said the nation's biggest e-cigarette maker is responsible for "creating a youth vaping epidemic" with deceptive advertising tactics designed to lure in teen users. "Our message today is simple: Juul can't profit off the addiction of young people," Healey said. Healey announced her investigation into Juul in July 2018 and asked the company to turn over documents to determine whether it was tracking underage use of its products and whether its marketing practices were intentionally driving its popularity among young people. (Leblanc, 2/12)

WBUR: Mass. AG Healey Sues Juul Over Youth Vaping Epidemic
"While we have not yet reviewed the complaint, we remain focused on resetting the vapor category in the U.S. and earning the trust of society by working cooperatively with attorneys general, regulators, public health officials, and other stakeholders to combat underage use and transition adult smokers from combustible cigarettes," Juul spokesperson Austin Finan said in a statement following Healey's announcement, adding, "Our customer base is the world's 1 billion adult smokers and we do not intend to attract underage users." (Enwemeka, 2/12)

CNN: Juul Sued By Massachusetts, Allegedly Advertised On Children's Websites
The suit makes Massachusetts the latest state to sue the company for allegedly advertising to children. Illinois filed suit on similar grounds in December. California and New York sued the company in November. But the Massachusetts suit is the first to cite internal documents discussing the company's advertising strategy. (Simko-Bednarski, 2/13)

In other tobacco news —

Stat: Trump Plan To Remove Tobacco Regulation From FDA Draws Fire
One paragraph in a 132-page budget proposal reopened, seemingly overnight, a long-simmering debate over whether the Food and Drug Administration should oversee the tobacco industry. On Monday, the Trump administration's proposed stripping the FDA of its power to regulate tobacco products, including e-cigarettes. This has angered tobacco control advocates and former FDA officials, who insist it's an attempt to further weaken tobacco laws. But it's not an entirely new idea. Top Republicans and even a former FDA commissioner have long questioned whether the FDA should be involved with the tobacco business at all. (Florko, 2/12)

The Associated Press: Company Efforts To Stamp Out Tobacco Often Go Up In Smoke
U-Haul has an unusual wellness goal for 2020: hiring fewer smokers. The truck rental company said in January it will stop hiring people who use tobacco or nicotine products in the 21 U.S. states where it is legal to do so. Executives said the new policy, which takes effect this month, is expected to the cut company costs by improving the health of U-Haul's 30,000-person workforce. (Perrone, 2/12)

Miami Herald: Most Young Vape Users Say They Feel Safe Doing It: Study
Most young people who vape feel safe doing so, despite an outbreak of illnesses, a study found.The study, done by health data management firm Harmony Healthcare IT, surveyed 1,800 Americans between the ages of 18 and 38 who use vape products and found that the vast majority feel safe using them despite knowing they're unhealthy. (Aldridge, 2/12)

10. Bayer Is Facing Tens Of Thousands Of Roundup Cancer Suits. But It Still Has A Product To Sell, Too.

Past mass-litigation suits often resulted in a company discontinuing their product, changing it, or adding a warning label. None of the options are workable for Bayer, who is still arguing that its weedkiller is safe, and so the company is stuck in a bind. "I don't know how they can insulate themselves from future liability," said Carl Tobias, a University of Richmond law professor.

The Wall Street Journal: Bayer Strives To End Lawsuits Over Roundup—While Still Selling It
Bayer AG faces an extraordinary challenge as it tries to settle tens of thousands of claims that its Roundup weedkiller causes cancer: The product remains on the shelves, making it almost impossible to put the litigation to rest forever. Experts have said Bayer is in an unusual position compared with other companies that have faced multibillion-dollar lawsuits over their products. To end mass-tort litigation, other companies generally have discontinued or altered their products or added warning labels—all of which are problematic for the German pharmaceutical and agricultural company. (Kusisto, Bender and Bunge, 2/12)

San Francisco Chronicle: Monsanto Cancer Case Pits Federal Product Label Against California Law
As Monsanto challenged a $78.5 million damage award to a Bay Area groundskeeper who was stricken with cancer after spraying the company's herbicide, California Attorney General Xavier Becerra stepped into the case Wednesday, telling a state appeals court that the verdict was validly based on state laws requiring warning labels for cancer-causing chemicals. The 2018 verdict was the first of three, all in the tens of millions of dollars, in Bay Area trials of suits by users of the glyphosate herbicide, widely sold as Roundup, who were later diagnosed with cancer. A central issue is whether the suits could rely on California law, which classifies glyphosate as a carcinogen, or should have been dismissed under federal law because the U.S. Environmental Protection Agency considers it a safe chemical. (Egelko, 2/12)

11. Ways & Means Advances Surprise Medical Bills Measure That Would Rely On Hospital-Friendly Arbitration Method

Insurers, employers and labor unions oppose the method, but providers favor it. With so many powerful stakeholders involved, lawmakers are being bombarded with opinions on the matter. Meanwhile, at the state level, Kansas is also taking aim at surprise medical costs.

Modern Healthcare: House Committee Advances Provider-Friendly Surprise Billing Fix
The House Ways & Means Committee on Wednesday advanced a bill that would ban balance billing using an arbitration process favored by hospitals and specialty physician groups but opposed by insurers, employers and labor unions. The Ways & Means Committee is the last of three House panels with jurisdiction over surprise billing to mark up legislation addressing the issue, which lawmakers are aiming to resolve before a deadline to fund expiring Medicare and Medicaid programs on May 22. (Cohrs, 2/12)

KCUR: Surprise Medical Bills Leave Kansans Struggling To Pay. Lawmakers Say These Ideas Would Help
A flurry of proposals in the Kansas Statehouse this session take aim at rising medical costs, including one that may be the state's first attempt to rein in "surprise bills." Republican Sen. Richard Hilderbrand has introduced two price-transparency proposals and Democratic Sen. Barbara Bollier unveiled a plan to join 28 other states with consumer protection laws against such bills.Surprise bills come, for example, when you're being treated in-network but an out-of-network medical professional gets involved. To collect more than your insurer will pay, the out-of-network providers send you extra bills directly. (Llopis-Jepsen, 2/13)

And in related news —

Boston Globe: So How Much Would That Bill Cost? New Tufts Center Wants To Provide The Answer
Tufts University is launching a nonpartisan center to provide real-time analysis of legislation, state policies, and ballot questions, filling what its director called a void for state lawmakers and the public alike. The Center for State Policy Analysis's goal is to provide an independent look into the impact of Massachusetts policy making — from potential costs to comparisons to elsewhere in the country — similar to the role filled in Washington by the independent Congressional Budget Office. (Stout, 2/13)

12. A Loophole In Medical Privacy Laws Can Lead To Children's Health Care Data Being Vulnerable To Exposure

Health care provided by school nurses falls outside the the privacy protections that protect other health data. That can lead to school officials and others having access to more medical information than parents realize.

Reuters: Privacy Law Covering Most Medical Care May Not Apply In Schools
The privacy protections Americans have come to expect when it comes to their medical information may not always apply in school settings, a new report suggests. When a school nurse is involved in a student's medical care, information on that care may end up in the child's educational record - which is accessible without consent to school officials and parents, according to the report in Pediatrics. (Carroll, 2/12)

In other health and privacy news —

Modern Healthcare: Nearly 438,000 Patients Affected In January-Reported Breaches
Providers, health plans and their business associates reported 29 breaches affecting nearly 438,000 patients to the federal government in the first month of 2020. While the overall number of breaches is down in January compared to December, 10% more patients were affected, according to data from the HHS' Office for Civil Rights, the agency that maintains the government's database of healthcare breaches. But it's down from last year's January, when breaches exposed data of almost 578,000 patients. (Cohen, 2/12)

Modern Healthcare: Lawmakers Press VA Officials On App Privacy
Lawmakers on Wednesday pressed leaders from the Veterans Affairs Department on how the agency reviews apps for inclusion in the VA App Store, its marketplace of nearly 50 smartphone apps designed to help veterans manage their healthcare. While VA leaders said it inspects apps and developers promoted on its store, lawmakers questioned whether the agency has gone far enough to protect patient data. (Cohen, 2/12)

Women's Health

13. Legislation Stokes Abortion Wars On Hill Ahead Of Supreme Court Oral Arguments On Major Case

The Democrats are pushing for the ratification of the Equal Rights Amendment, which critics say would protect abortion access, while Republicans want to vote on a 20-week ban. The moves come just before long-awaited and closely watched oral arguments in front of the Supreme Court on hospital admitting privileges for abortion providers.

The Hill: Abortion Wars Flare Up In Congress
Democrats are trying to gain the upper hand in the abortion debate months before an election where President Trump is expected to paint the party as being extreme on the issue. House Democrats are pushing legislation that would codify Roe v. Wade, while Senate Republicans are gearing up for a vote on a measure that would ban the procedure after 20 weeks of pregnancy. Democrats in the House also expect to vote on a bill that would remove barriers to ratifying the Equal Rights Amendment, which opponents argue would make it easier to protect access to abortions. (Hellmann, 2/13)

Roll Call: Investors Push Companies To Make Business Case On Abortion
Shareholder groups that have won corporate boardroom concessions on climate change and diversity are beginning to press corporations on women's reproductive health issues, as the Supreme Court prepares to hear arguments in a case that could fundamentally alter abortion rights in the United States. A group of 36 investors managing $236 billion in assets sent a letter to CEOs of more than 30 companies asking them to discuss their positions related to sexual and reproductive health care, including contraception and abortion, according to a copy of the letter reviewed by CQ Roll Call. (Weiss, 2/12)

Pharmaceuticals

14. After Drug Is Granted Orphan Status, Hospitals Can Be Left Paying Millions For Treatment That Was Cheap, Attainable

Drugmakers argue that they've pumped millions into research and so they can charge a lot more for drugs that used to be available cheaply. But experts find flaws in their logic. In other pharmaceutical news: the price of insulin and CVS' fourth-quarter profits.

Stat: After A New Version Of An Old Drug Gets Orphan Status, The Price Skyrockets
For years, hospitals and clinics have used an injectable medicine called dehydrated alcohol to treat such maladies as chronic pain or to prevent infections in patients who must receive nutrients intravenously. Yet after a small company won a monopoly to sell its version for use with a specific heart procedure, the cost for a pack of 10 vials is about to spike from about $1,300 to nearly $10,000. Not surprisingly, the sudden jump in price has outraged medical facilities, which now expect to pay untold millions of dollars more each year for a medication that has been available for decades. (Silverman, 2/12)

Stat: Insulin Makers Object To FDA Plan For Speeding Arrival Of Biosimilar Insulins
Amid growing rancor over the cost of insulin, two of the largest manufacturers are objecting to a Food and Drug Administration proposal designed to make it easier for other companies to develop lower-cost alternatives and, presumably, get these products to patients sooner. And their protests may open up the companies to still more criticism over their pricing. At issue is a draft guidance the agency issued last November to eliminate the need for immunogenicity studies for biosimilar versions of insulin. Such studies are used to determine whether an immune response occurs in the body, but there has been a growing belief they are unnecessary. The European Medicines Agency, for instance, dispensed with such studies for biosimilar insulin in 2015. (Silverman, 2/12)

The CT Mirror: Insulin Bill Would Cap Monthly Supplies Of Drug At $50
Lawmakers who want to tackle the high cost of prescription drugs in a short legislative session will roll out a bill Thursday that caps the monthly cost of insulin at $50. The measure is more aggressive than similar efforts in Illinois and Colorado, which last year championed legislation capping insulin costs for users at $100 per month. (Carlesso, 2/13)

The Associated Press: CVS Health Swings To 4Q Profit, Lays Out Leadership Changes
CVS Health swung to a fourth-quarter profit and is starting the new year with a management shakeup for its largest business. The company will replace Derica Rice with Dr. Alan Lotvin as the leader of its pharmacy benefit management segment. CVS Health also named former Concerto Healthcare executive Alec Cunningham to lead its Aetna insurance business as it focuses more on government programs like Medicare Advantage. (2/12)

The Wall Street Journal: CVS Swings To Profit, Forecasts 2020 Results In Line With Estimates
The company also said that the head of its pharmacy-benefits unit, Derica Rice, will leave. His exit comes after the departure earlier this year of Kevin Hourican, the leader of the pharmacy operations, who left to take a CEO job elsewhere. CVS said Alan Lotvin, currently an executive vice president, will take over the PBM. The company previously said that chief operating officer Jonathan Roberts would temporarily lead the pharmacy unit. (Wilde Mathews and Sebastian, 2/12)

Opioid Crisis

15. 'Clean Needles Important': Injected Heroin Use Might Explain Rising Rates Of Hepatitis C, Study Finds

"We were intrigued by the idea that the opioid crisis might be behind the massive increase in hepatitis C," said Dr. Nora Volkow, director of the National Institute on Drug Abuse. News on the epidemic is from Massachusetts, Maryland, Missouri, New York and Ohio, as well.

Boston Globe: Opioid-Related Overdose Deaths Down In Mass.
Fatal overdoses are dropping in Massachusetts, the state Department of Public Health said Wednesday. In a statement, the DPH said the rate of opioid-related overdose deaths in Massachusetts fell by 5 percent in 2019 from the peak of the crisis in 2016. (Andersen, 2/12)

The Baltimore Sun: Auditors Question $750,000 Grant From State Opioid Office To Buy Former Caroline County Country Club
State auditors are questioning a $750,000 grant awarded by a state body created to fight opioid addiction to an Eastern Shore nonprofit for the purchase of a former country club and golf course. That grant, awarded in fiscal year 2019 but never funded, and several others were deemed "questionable" in a report released Wednesday by investigators at the Office of Legislative Audits, which launched the review after receiving a tip to the state's fraud, waste and abuse hotline. (Opilo, 2/12)

Kaiser Health News: No Quick Fix: Missouri Finds Managing Pain Without Opioids Isn't Fast Or Easy
Missouri began offering chiropractic care, acupuncture, physical therapy and cognitive-behavioral therapy for Medicaid patients in April, the latest state to try an alternative to opioids for those battling chronic pain. Yet only about 500 of the state's roughly 330,000 adult Medicaid users accessed the program through December, at a cost of $190,000, according to Josh Moore, the Missouri Medicaid pharmacy director. (Weber, 2/13)

HuffPost: How Hospitals Are Helping Patients Manage Pain With Fewer Opioids
Dane Fischer, a 31-year-old personal trainer and former professional athlete, had torn his ACL during a pickup soccer game in a New York City park. To repair the painful injury, he turned to orthopedic surgeon Kirk Campbell at NYU Langone Health. As part of the reduced-opioid protocol, Fischer was released with a prescription for one oxycodone pill a day, for up to 10 days after surgery, with no refills: just enough to get him to his first follow-up appointment. Instead, the emphasis is on replacing opioids with nonaddictive, nonsteroidal anti-inflammatory drugs like acetaminophen (Tylenol) and ibuprofen (Advil). (Gertz, 2/12)

Cincinnati Enquirer: Meth Wave Is Latest Drug In U.S. Epidemic Of Addiction, Opioids
The floor seemed filthy and she could not get rid of the grime. Amie Detzel frantically scrubbed that nursing home floor with cleaning supplies she'd found when no one was looking. On hands and knees, dragging her IV pole with her, the gravely sick woman incessantly scrubbed. Meth had found its way into the nursing home. She was suffering from addiction. So she used it. (DeMio, 2/13)

Health IT

16. Motion Capture Technology Most Widely Known For Its Use In Blockbuster Films Could Be A New Rehab Tool

The movements of patients with mobility-limiting conditions such as Parkinson's disease can be tracked and give health care providers better data on the patient's condition.

Stat: Hollywood Motion Capture Technology Finds A New Role In Hospital Rehab
Motion capture technology is a staple of blockbuster films. You may have seen A-listers like Tom Hanks or Jim Carrey in behind-the-scenes bonus features dressed in what looks like spandex suits covered in ping-pong balls. Those small spheres are actually reflective markers, which are tracked by infrared cameras during an actor's performance. The data from those cameras is then used by Hollywood visual effects artists to give computer-generated characters realistic movement. (Hogan, 2/12)

In other technology news —

The Wall Street Journal: Advances In Health Care, Technology Open New Job Prospects For The Disabled
When Virginia Jacko began losing her eyesight in her 40s, she left her job as a senior financial executive at a university and enrolled in a vocational-rehabilitation program. Using new technology, she was soon able to use a spreadsheet, read a financial statement and even pick out matching clothes. Fifteen years later, she is chief executive of the Miami Lighthouse for the Blind, which runs the program. Ms. Jacko's experience shows how advances in technology and health care, as well as changes in the labor market, have created new work opportunities for disabled and older workers. People are living longer, healthier lives. Automation has made many tasks at work easier. (Davidson, 2/13)

Public Health And Education

17. Employers Tip Toe Around Requests From Younger Workers Seeking Help For Mental Health Conditions

Because they might have received treatment or special arrangements in school, a generation with a higher rate of mental health challenges wants the same accommodations at work. Businesses are weighing how to respond, a Wall Street Journal story reports. Public health news also looks at the backstory on the fly emoji, insulin pump recall, car booster seat probe, babies' sleep schedules, early signs for altruistic behavior, childhood poisonings, easing childbirth pain with virtual reality, and longevity tips from the world's oldest man.

The Wall Street Journal: Young Workers Seek Mental Health Accommodations, Employers Try To Keep Up
Managers and younger employees are struggling to adapt as a generation of people with higher rates of reported mental illness enter the workforce. Many of these new workers are coming to offices from colleges and high schools where they received accommodations, such as extra time to take tests or complete assignments—in some cases from elementary school onward. They are confronting a world of work that operates under different legal standards and less-flexible pressures and deadlines. (Weber, 2/12)

NPR: New Emojis Include Rocks And Flies: Scientists Have Mixed Feelings
Scientists can get very excited about what they study, and that means they can be pretty jazzed when what they study gets turned into one of the official emojis of the world and enters our shared visual language. But sometimes that enthusiasm is tempered by more complex feelings, which is the case with some of the latest emojis that are about to hit our smartphones. Consider the "rock" emoji. (Greenfieldboyce, 2/12)

CNN: Medtronic Recalls Certain MiniMed Insulin Pumps Tied To 1 Death
Medtronic has recalled some of its insulin pumps after injuries and one death were reported due to the device malfunctioning, according to a US Food and Drug Administration announcement on Wednesday. The FDA identified it as a Class I recall, the most serious type of recall. (Howard, 2/12)

ProPublica: House Subcommittee Opens Investigation Of Evenflo, Maker Of 'Big Kid' Booster Seats
A congressional subcommittee is launching an investigation of Evenflo, a major maker of children's car booster seats, over its product marketing and testing practices. A ProPublica investigation last week showed how the company put marketing over safety in pushing its booster seats as "side impact tested," even though its own tests showed a child using that seat could be paralyzed or killed in such a crash. (Callahan, 2/12)

Reuters: Sleep Difficulties Are Perfectly Normal For Babies, Study Confirms
New parents who struggle to get babies to sleep through the night may not be doing anything wrong, according to new research suggesting that many apparent sleep problems are really part of normal infant development. For example, the study found that 6-month-old babies still take 20 minutes, on average, to fall asleep. And by age 2, toddlers still wake up an average of once each night. (Rapaport, 2/12)

CNN: Parents, Grandparents To Blame For Half Of Child Poisonings, Study Says
Parents and grandparents, listen up -- this is serious. More than half of children under age five poisoned by prescription pills ate them after an adult removed the childproof safety packaging. These medications include those to treat diabetes or cardiac conditions, which are hazardous to children even in small doses. (LaMotte, 2/12)

Reuters: Virtual Reality May Help Relieve Pain During Childbirth
Immersion in virtual reality may relieve some of the pain of contractions before childbirth, a small study suggests. In a half-hour test among 40 hospitalized women in labor, those who used VR headsets that provided relaxing scenes and messages reported pain reductions compared with those who didn't get headsets, researchers said in a presentation at the annual meeting of the Society for Maternal-Fetal Medicine in Grapevine, Texas. (Goodier, 2/12)

State Watch

18. State Highlights: Iowa Governor Won't Discuss Center's Sexual Arousal Research On Disabled Residents; Oklahoma Judge Allows Transgender Inmate's Lawsuit To Go Forward

Media outlets report on news from Iowa, Oklahoma, Florida, Minnesota, Missouri, Georgia and Hawaii.

The Associated Press: Iowa Governor Won't Discuss Center's Sexual Arousal Research
Iowa Gov. Kim Reynolds wouldn't comment Wednesday on accusations made against state officials in a federal lawsuit involving sexual arousal experiments performed on residents of a state n Iowa care center for people with intellectual disabilities. Two doctors and other former employees of Glenwood Resource Center filed a federal civil rights lawsuit Monday against a state agency and several officials alleging a conspiracy to silence complaints about sexual arousal research they claim exploited fragile and dependent residents. (2/12)

Kansas City Star: Lawsuit Claims Former KU Prof Used Disabled For Sex Research
More than 200 severely disabled patients at a state-run home in Iowa were used as subjects in research of sexual arousal that was led by a former University of Kansas assistant professor, according to a lawsuit filed this week. Jerry Rea, who had been a researcher at KU for 16 years, is accused in the suit of using "highly vulnerable" Glenwood Resource Center patients "as the subjects or 'guinea pigs' in research experiments." (Williams, 2/12)

The Associated Press: Judge Rules Oklahoma Transgender Inmate Lawsuit Can Proceed
A transgender inmate can sue the state of Oklahoma and prison officials who she says stopped her hormone therapy because they thought she was faking her gender identity, a federal judge has ruled. A physician's assistant ordered an end to Glenn Porter's hormone therapy after a staff psychologist at Dick Conner Correctional Center suggested she was 'masquerading as a woman,' according to the complaint. (2/12)

Health News Florida: Restrictions Removed For New Disabled Facilities By Florida Legislature
After making community-based care a priority for people with developmental and intellectual disabilities, lawmakers are moving forward with bills that would make it easier for providers to open institutions. Members of the House Health Care Appropriations Subcommittee on Tuesday unanimously approved a measure (HB 1163) that would allow providers to build institutions to house people with developmental disabilities without first having to obtain approval from the state through the "certificate of need" regulatory process. The bill wouldn't cap the number of new institutions that could be built nor is there an expiration date on the exemption. (Sexton, 2/12)

MPR: U Leaders Address Student Mental Health Needs
Addressing student mental health has been a priority for University of Minnesota President Joan Gabel since taking office last summer. This week, she's unveiling the first step she's taken toward that initiative, a comprehensive scan of programs and services the university offers to support the mental health and wellness of students on all the campuses. On Thursday and Friday, Gabel and the Board of Regents will review the report. It shows that while individual parts of the university are making good efforts to meet those needs, there are ways to make those services easier to access. (Roth, 2/12)

Kansas City Star: Dental Screenings At UMKC Dentistry School For Free Care
The School of Dentistry at the University of Missouri-Kansas City needs a few good — or not so good — mouths. Seniors at the school need patients for their clinical exams in March, preferably people who may not have been to the dentist in a while. The school will host free screenings for potential patients Saturday. Anyone chosen to participate will get their teeth worked on next month, also for free. (Gutierrez, 2/13)

Georgia Health News: Medical Marijuana Cards Show Big Rise In Georgia
The number of Georgians with cards allowing possession of medical cannabis has soared more than 70 percent in one year.Currently, 14,511 people in Georgia have permission to possess ''low THC oil,'' officials of the state's Department of Public Health said this week. That's up from 8,402 about a year ago. (Miller, 2/12)

Milwaukee Journal Sentinel: Native Hawaiians Return To Their Agriculture, Wellness Traditions
National surveys have consistently ranked Hawaii, the 50th state to join the union, as among the healthiest in the nation, but these national metrics consistently miss the nuances and inequities of health in Hawaii, where disparities between Native Hawaiians and other groups are stark. Certain inequities, such as the higher rates of preventable diseases like heart disease among Native Hawaiians, are commonly regarded through narrow, simplistic metrics and incomplete understandings of complex sociocultural, economic and historical intersections. (Eleni Gill, 2/13)

Health Care Personnel

19. Research Roundup: Medicaid Work Requirements, Gender's Role In Care, Air Pollution, And More

Each week, KHN compiles a selection of recently released health policy studies and briefs.

Urban Institute: New Hampshire's Experiences With Medicaid Work Requirements: New Strategies, Similar Results
In June 2019, New Hampshire began requiring beneficiaries to report work and community engagement hours as a condition of eligibility for its Medicaid expansion program, Granite Advantage, becoming the second state to do so following Arkansas' work requirements implemented a year earlier. Though state officials implemented numerous strategies to try and avoid the problems experienced in Arkansas – where over 18,000 Medicaid adults were disenrolled in the first six months of Arkansas Works – they found themselves at nearly the same end point: on the brink of disenrolling a large share of the state's Medicaid expansion population. Moreover, New Hampshire reached this point in a fraction of the time, facing the prospect of disenrolling up to 17,000 beneficiaries after just two months, a startling 67 percent of those subject to the requirements. However, state officials suspended the program before this occurred, and federal courts subsequently halted the program indefinitely. (Hill, 2/10)

JAMA Internal Medicine: Clinical Advances In Sex- And Gender-Informed Medicine To Improve The Health Of All: A Review
Clinicians should consider incorporating sex and gender in their decision-making to practice precision medicine that integrates fundamental components of patient individuality. Recognizing the biological and environmental factors that affect the disease course is imperative to optimizing care for each patient. Research highlights the myriad ways sex and gender play a role in health and disease. However, these clinically relevant insights have yet to be systematically incorporated into care. The framework described in this review serves as a guide to help clinicians consider sex and gender as they practice precision medicine. (Bartz et al, 2/10)

CNN: Air Pollution Can Cross State Lines, And With Deadly Consequences, Study Says
Air pollution is known to have negative -- even deadly -- effects on our health, and studies have shown that breathing pollution can kill, even at levels below air quality guidelines. Now, a new study shows that air pollution produced in one state often blows across state lines, and can contribute to health issues and even premature deaths hundreds of miles away. (Crespo, 2/12)

Reuters: More Evidence Links Ozone Pollution To Premature Death
People who live in cities where the air is polluted by factories and traffic fumes may not live as long as they would have with cleaner air, a recent study suggests. Researchers focused on ozone, an unstable form of oxygen produced when various types of traffic and industrial pollution react with sunlight. Worldwide, about four in five people in urban areas are exposed to ozone levels that exceed safe levels recommended by the World Health Organization, the study team notes in The BMJ. (2/12)

The New York Times: Excess Vitamin B12 May Be Deadly
High levels of Vitamin B12 may be too much of a good thing. Vitamin B12 is an essential nutrient, important in nerve and blood cell health, and most people obtain enough of it in food. Those with B12 deficiency, or an inability to absorb it, can use supplements. But a study in JAMA Network Open suggests that very high blood levels of vitamin B12 may be life-threatening. (Bakalar, 2/11)

American Academy Of Pediatrics: Cognition After Early Tonsillectomy For Mild OSA
A total of 141 children (75.8%) attended baseline and 12-month assessments, and BIA was obtained at baseline and 12-month follow-up for 61 and 60 participants in the adenotonsillectomy versus NoAT groups, respectively. No cognitive gain was found after adenotonsillectomy compared with NoAT, adjusted for baseline; BIA scores at 12-month follow-up were as follows: adenotonsillectomy, 465.46 (17.9) versus NoAT, 463.12 (16.6) (mean [SD]). Improvements were seen for polysomnogram arousals and apnea indices and for parent reports of symptoms (Pediatric Sleep Questionnaire), behavior (Behavior Assessment System for Children behavioral symptoms, P = .04), overall health, and daytime napping. (Waters et al, 2/1)

Editorials And Opinions

20. Different Takes: Coronavirus Alerted World To The Value Of Whistleblowers; A Look Behind All Those Masks

Editorial pages focus on public health issues triggered by the coronavirus.

Detroit Free Press: Coronavirus Shows Importance Of Whistleblowers
During a trip to China in 2018, we were watching BBC News in our hotel room. When the anchorman started to talk about something going on in the country's western provinces, the screen went blank. After a minute or so, the picture returned. The newscaster had moved on to the next story. The next day, we mentioned the interruption to one of our tour guides. "The government wants us to be happy," the guide said with a wry, tight-lipped smile. "So they try not to show us things that would make us unhappy."I recalled that exchange last week when I heard about the fate of Li Wenliang, a Chinese doctor who tried to sound the alarm about the new virus now spreading around the world. (Bill Sternberg, 2/13)

The New York Times: Why Do People Really Wear The Coronavirus Masks?
The latest coronavirus epidemic has sent people scrambling for face masks like never before. "The world is facing severe disruption in the market for personal protective equipment," Tedros Adhanom Ghebreyesus, the director-general of the World Health Organization, warned last week. "Demand is up to 100 times higher than normal and prices are up to 20 times higher." This, even though face masks are not, on their own, a proven prophylactic against infection from the new coronavirus (hand washing is more important, medical experts seem to agree). (Christos Lynteris, 2/13)

The Washington Post: As Health Experts Sound The Alarm, Trump Fights Coronavirus With Alternative Facts
President Trump's governing strategy is on a collision course with a novel foe. Can alternative facts stop a pandemic? Some of the nation's leading public-health experts assembled before the Senate Homeland Security and Governmental Affairs Committee on Wednesday morning with some worrisome warnings: The dangerous Wuhan novel coronavirus is probably already in the United States in greater numbers than we know and should show itself in clusters in the coming weeks. There's reason to doubt its spread will die down when the weather warms. And it could ultimately affect hundreds of thousands of Americans. (Dana Milbank, 2/12)

21. Viewpoints: With America Facing Serious Problems Like Obesity, Why Retreat On Healthy School Lunches?; Lessons On Caring For Elderly During Climate Crisis

Opinion writers weigh in on these health care issues and others.

The Hill: USDA Abandons America's Schoolchildren
In his State of the Union message, President Trump focused on giving all American schoolchildren the chance to succeed. Unfortunately, Sonny Perdue, his secretary of Agriculture, is doing just the opposite. The U.S. Department of Agriculture's (USDA) proposed "School Meals Flexibilities" rule for school menus is a disaster for millions of children. It is a full retreat from science-based health and nutrition principles, is severely misaligned with today's research, and could be considered a human rights violation of young Americans. In context, America is facing a health epidemic of biblical proportions. The explosion of lifestyle-related diseases including obesity, diabetes, heart disease, dementia, stroke and cancer is adding trillions of dollars to our national health care costs, and much of it is preventable and can be traced to the food choices made by Americans, which are adopted at a young age. (Casey Means and Grady Means, 2/12)

New England Journal of Medicine: The Climate Crisis And Clinical Practice
A wave of heat hit us as we opened the door, like we were in the Sahara Desert!" Sweat was beading on the forehead of the emergency medical technician as he wheeled in an elderly man with a reported fever, whose apparent confusion had led his wife to call 911. In the midst of a record-breaking heat wave, the pair was found in a top-floor apartment with no air conditioning and only one partially open window. The man was transferred to a bed, where a rectal thermometer registered nearly 106°F. We diagnosed heatstroke and rushed him to our highest-urgency area to begin cooling him. Increasingly, such patients are becoming the human face of the climate crisis, as recognition of its health harms grows. (Renee N. Salas, 2/13)

The Hill: Who's Hungry: Erasing Food Insecurity
When I suggested to my patients during their regular visits that they buy fresh vegetables or 1 percent fat milk for a healthier diet, many stated those items were not available close to where they lived. They spoke of food deserts on the South Side of Chicago years before any reports had been published. Despite efforts to eradicate food deserts in Chicago, they persist. The same geographical areas also correlated with high rates of obesity, congestive heart failure, hypertension and obesity, and diabetes. Fresh food was not grown or sold there, but diseases, nourished by racism, were. The food that people bought was not healthy and did not last until the end of the month. They did not have money and access to buy healthy food. (Irene Martinez, 2/12)

St. Louis Post Dispatch: Trump's Budget Proposal Would Take From The Poor To Prop Up The Rich — Again
President Donald Trump on Monday released a $4.8 trillion fiscal 2021 federal budget proposal that would cut food stamps, tighten Medicaid and other safety-net programs and reduce environmental protection spending, while extending tax cuts that have already added $1 trillion to the deficit. The GOP, which spent the entire Obama era harping that deficit spending was irresponsible even in those dire economic times, is now proposing far deeper deficit spending in a strong economy. Trump and the GOP are sending a clear message with this budget: They think they can ride to reelection on the growing economy that they inherited. Meanwhile, they're banking on voters not recognizing that the overwhelming beneficiaries of that growth are the already-rich. (2/11)

Philadelphia Inquirer: Overdose Prevention Sites Promote Public Health And Don't Increase Crime
In Philadelphia, 1,116 people died of a preventable drug overdose in 2018. When the city Department of Public Health released this data last May, many community members saw a success: an 8% reduction in deaths from the year prior. But we cannot neglect the loss of 1,116 sons, daughters, friends, and neighbors when overdose deaths are preventable. The reported decrease is not only from fewer individuals experiencing overdose — it happened because more overdoses were nonfatal, thanks to the access and distribution of naloxone throughout the city. From July 1, 2017, to June 6, 2018, the Department of Public Health distributed more than 37,000 doses of naloxone throughout Philadelphia. Because naloxone is available without a prescription, can reverse an overdose, and lower the fatality risk of fentanyl exposures, it is a highly successful strategy for harm reduction. (Brittany Salerno and Jeanmarie Perrone, 2/12)

The New York Times: An Army Doctor's First Loss Of The Vietnam War: The Woman He Loved
I was 26 when I was sent to Vietnam, along with 2.7 million men and women of my generation. As an infantry battalion surgeon, I cared for soldiers' wounds and helped treat their pain — but for me, going to war was also tied to the distress of leaving my first love. I was a doctor and she was a licensed practical nurse at a hospital in Hartford, Conn. Our work had brought us together. Going to war would break us apart. Medical school was the academic equivalent of military boot camp. My fellow hospital interns and I endured a draconian schedule that left us in a constant state of sleep-deprived exhaustion; we might enter the hospital on Thursday morning and not leave until early Saturday. (Jeffrey Brown, 2/13)

Stat: Federated Learning Offers Safer Collaborations For Health Research
What if we could learn from massive collections of data while avoiding the privacy and other risks typically associated with sharing such information? The Mayo Clinic has taken a step toward making that possible with its announcement that the first venture of the Mayo Clinic Platform will use federated learning as a foundational technology of if its privacy model. (Marielle S. Gross and Robert C. Miller, Jr. 2/13)

Boston Globe: Mental Health Care Is A Vital To Routine Health Care
According to a 2018 report from the Blue Cross Blue Shield of Massachusetts Foundation, nearly 1 in 4 adults sought mental health or substance use disorder care for themselves or a family member, and over half experienced difficulty obtaining that care. That is unacceptable, and would never be tolerated for traditional medical or surgical services.There is virtually no area of our economic, civic, and personal lives that is not touched by the need for mental health and wellness care. (Karen E. Spilka, Julian Cyr, and Cindy F. Friedman, 2/13)

The Washington Post: New Mothers Don't Get Enough Sleep. That Needs To Change.
"He only sleeps if he's being held," I told my pediatrician at my son's 2-week checkup. "Or," I paused, fearful of shame, "in the swing." Without looking up from his doctor computer thing, my pediatrician immediately lectured me about safe sleep and SIDS. When I told him we had tried everything and nothing else worked and sleep deprivation had plunged me into postpartum depression after the births of my two older kids, he lectured me about therapy. When I told him I was on Zoloft and in weekly communication with my therapist, he told me to hang in there. (Sara Petersen, 2/12)