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Republican-led states that already expanded Medicaid now are coming back to the Obama administration with requests to move their expansion programs in more conservative directions, including higher cost sharing for beneficiaries, work requirements, and coverage time limits. These moves may test the limits of the administration's flexibility and could lead to rollbacks in Medicaid expansion across the country. (Dickson, 5/7)

The Legislature has been in special session for ten days, and held a half dozen budget hearings. On the other issues lawmakers have been called back for — Medicaid expansion and a sexual abuse prevention program — there have been zero meetings. The special session has mainly been characterized by gridlock. ... [Attorney Douglas] Mertz says there could be some merit in bringing in a third party to help guide the key players. And there’s precedent. (Gutierrez, 5/7)

[T]he debate over the 2010 law has roiled Florida's politics in ways unimaginable in many other states, especially those like Florida in which Republicans control the government. Florida lawmakers have fought so bitterly over the question of expanding Medicaid under the Affordable Care Act that the Senate last month sued the House for cutting short its legislative session before finishing the state budget. The challenge they face is figuring out how to provide healthcare for the poor without participating in a law most of the state's GOP leadership detests. (Berman, 5/8)

Gov. Rick Scott took another jab at the Obama Administration Thursday, asking the court to take immediate action in his lawsuit against federal healthcare officials. The lawsuit, filed last week in federal court, alleges that the U.S. Department of Health and Human Services is trying to coerce Florida into expanding Medicaid by threatening to end a $2.2 billion program that helps hospitals pay for uncompensated care. The Republican governor now wants a court-ordered injunction to stop federal health officials from tying the two programs. (McGrory, 5/7)

The top executive at Georgia's largest safety-net hospital said Thursday he is pleased to see signs that state officials could seek federal approval to make changes to its Medicaid program. The state budget awaiting Republican Gov. Nathan Deal's signature includes a provision allowing state health officials to seek a waiver from federal Medicaid authorities. The same strategy, called a Section 1115 waiver, has been used in conservative states where governors resisted full Medicaid expansion under the Affordable Care Act but worked with federal officials to craft alternatives that still covered more people. (Foody, 5/7)

Touting $380 million in savings from the Affordable Care Act's first test of accountable care, Medicare says the pilot did well enough to expand. But it's unclear how the participants got the savings and to what extent others can replicate the success. Dr. Patrick Conway, head of the CMS Innovation Center, and his colleagues announced the savings this week in JAMA. They detailed medical spending for Medicare patients who received care from 32 accountable care organizations during the first two years of the Innovation Center's Pioneer ACO program. (Evans, 5/7)

Insurance companies selling health plans through the state’s health insurance exchange are seeking to raise rates next year, with average increases between 2 percent and nearly 14 percent. (Levin Becker, 5/7)

Federal authorities have subpoenaed records related to the Massachusetts Health Connector, including a period covering the breakdown of the health care exchange's website, The Associated Press has learned. "The administration received a subpoena regarding the Health Connector's difficulties dating back to 2010 and we are fully cooperating with the Department of Justice," said Elizabeth Guyton, a spokeswoman for Gov. Charlie Baker, in a statement to The AP. (5/7)

Drugmakers have long argued they should have the right to talk to doctors about unapproved uses for their products, as long as they are being truthful. And in some cases, courts have agreed. But the federal government still frowns on the practice and, in recent years, has fined drug companies billions of dollars for talking to doctors about so-called off-label uses for their medications. (Thomas, 5/7)

In a move that may have broad ramifications for the pharmaceutical industry, a small drug maker called Amarin has filed a lawsuit against the FDA to argue that its right to distribute information about unapproved uses of a medicine is protected by the First Amendment. Amarin wants to be able to provide doctors with clinical trial data that does not directly pertain to the approved uses of its Vascepa prescription fish-oil pill, the lawsuit states. The FDA endorsed drug to treat people with very high levels of triglycerides, a type of fat in the blood that can lead to heart disease. (Silverman, 5/7)

The California Supreme Court on Thursday revived a class-action lawsuit that accuses German pharmaceutical giant Bayer of paying another drug company to delay introducing a generic version of a Bayer antibiotic. The practice is known as “pay to delay” and can violate antitrust law, according to a 2013 U.S. Supreme Court decision. (Dolan, 5/7)

In a win for consumers, the California Supreme Court ruled Thursday that settlement agreements between pharmaceutical companies that keep cheaper, generic drugs off the market may be illegal if they include excessive cash payments. (Thanawala, 5/7)

If Actavis were allowed to discontinue sales of an older Alzheimer’s pill and steer patients toward a newer version in order to blunt generic competition, the move could cost Medicare Part D as much as $288 million during the last six months of 2015, according to a new government analysis. The analysis comes as a federal appeals court panel decides whether to permit Actavis to conduct a so-called forced switch. As reported previously, the drug maker planned to prematurely end sales of its older, twice-a-day Namenda IR in favor of a newer, once-daily Namenda XR. The patent on the older pill expires in July, while the patent on the newer version does not expire until 2025. (Silverman, 5/7)

New draft guidelines for the 340B discount drug program are under review at the White House Office of Management and Budget, a final step needed before the Obama administration reveals the much anticipated oversight framework. Administrators of many hospitals and drugmakers have been at odds about expanding program. Hospitals, clinics and other participants saved about $3.8 billion on the cost of medicines in fiscal 2013. The program was created in the 1990s with a goal of helping hospitals that treat many people living in poverty. Participants have complained about a lack of transparency about drugmakers' prices, while others have criticized a lack of rules on who should benefit from the discounted medicines. (Young, 5/7)

Rates of hepatitis C are soaring, largely driven by an epidemic of prescription painkiller abuse, a new report shows. The incidence of acute hepatitis C infections among young people in rural areas of four Appalachian states more than tripled from 2006 to 2012, according to a report released Thursday by the Centers for Disease Control and Prevention. New hepatitis cases among people age 30 and younger rose from 1.25 per 100,000 in 2006 people to 4 per 100,000 in 2012 in Kentucky, Tennessee, Virginia and West Virginia, states known to have high rates of hepatitis C. (Szabo, 5/7)

Rates of hepatitis C infections more than tripled in four Appalachian states from 2006 to 2012, fueled by prescription drug abuse among those who inject drugs, especially in rural areas, U.S. health officials said on Thursday. National data show rising rates of hepatitis C virus infection across the nation, with the biggest increases among people under age 30 living in Kentucky, Tennessee, Virginia, and West Virginia, according to a report by the U.S. Centers for Disease Control and Prevention. (5/7)

After months of mounting HIV cases, a rural county that's facing Indiana's worst-ever HIV outbreak is seeing a dwindling number of new infections, possibly signaling that the outbreak is winding down, a state health official said Thursday. Deputy State Health Commissioner Jennifer Walthall said there have been 149 confirmed HIV cases and one preliminary positive case in Scott County and adjacent areas since December, but only about 15 new cases during the past two weeks. (5/7)

Republican lawmakers have long opposed needle exchanges to help drug addicts avoid diseases spread by the use of dirty syringes, but a surge in prescription drug abuse, HIV and Hepatitis C cases have forced GOP legislators in Indiana and Kentucky to reconsider their opposition. An HIV outbreak attributed by the U.S. Centers for Disease Control and Prevention to the sharing of needles by opioid addicts has led to 149 cases in Scott and Jackson Counties in southeastern Indiana. There are 146 positive cases and three preliminary cases. (Evans, 5/7)

Oklahoma’s governor this week approved a law extending to 72 hours the mandatory waiting period before a woman can have an abortion. Here in Florida, lawmakers enacted a 24-hour waiting period that requires two separate appointments — one for an ultrasound and information about fetal development and another for the actual procedure. These are just two laws in a surge of bills passed by Republican-controlled state legislatures this year that make it harder for women to have abortions. (Robles, 5/8)

No state has a better track record on reproductive rights than Oregon, according to a new report. Seven states and the District received the highest grade, an A-, based on nine indicators chosen by the Institute for Women’s Policy Research (IWPR), a think thank that promotes women’s rights, which did the report as part of its Status of Women in the States series. Ten states earned B’s, 20 earned C’s, nine earned D’s and four states — South Dakota, which ranked last, Nebraska, Kansas and Idaho — received F’s. The Northeast and the West are home to the highest grades, while the South and Midwest scored lowest. (Chokshi, 5/7)

Bowing to demands from consumer advocates, state regulators will hold a hearing next month on Blue Shield of California's proposed acquisition of Medicaid insurer Care1st for $1.25 billion. The California Department of Managed Health Care said both companies will explain their rationale for the deal at the June 8 hearing in Sacramento. The public will also have a chance to chime in. (Terhune, 5/7)

Limits on monetary damages in medical malpractice lawsuits have been reinstated in Missouri. Gov. Jay Nixon signed Senate Bill 239 into law Thursday at SSM Health St. Mary's Hospital in Jefferson City. The state's Supreme Court overturned the previous limits three years ago. Since 2005 they had been at $350,000. (Howze, 5/7)

A federal appeals court on Thursday heard arguments over whether to revive a Department of Labor regulation that would grant nearly 2 million home-care workers minimum wage and overtime protection, but was struck down in December just weeks before it was to take effect. The arguments at the U.S. Court of Appeals for the D.C. Circuit before Circuit Judges Thomas Griffith, Sri Srinivasan and Cornelia Pillard, focused on whether Congress intended to include employees of home-health agencies in a 1974 amendment to the Fair Labor Standards Act that exempted workers who provide "companionship services" from the law's wage standards. (Pierson, 5/8)

More than 200,000 low-income Ohioans have been removed from Medicaid rolls since Jan. 1 through an annual process to determine whether they remained eligible for tax-funded health-care benefits. That’s more than a third of the Medicaid beneficiaries who underwent so-called redetermination in January, February and March, the most-recent statistics available. A soon-to-be disclosed legal settlement could reduce those numbers. (Candisky, 5/7)

Inspired by the California measles outbreak, the Connecticut House voted 86 to 56 Thursday to require parents to annually declare if they are refusing to vaccinate their children on religious grounds. (Pazniokas, 5/7)

Drugmakers won skirmishes in California and Oregon last month, but the fight against high prices for specialty drugs appears to be spreading to other states, as well as the national theater. (Lauer, 5/7)

Forget accelerators and incubators. The Prime Health Collaborative, a casual group of Coloradans interested in digital health care, wants to become the nation's first digital-health integrator. The organization, which started as a Meetup group in 2012, focuses on growing Colorado digital-health startups, which, by its count, jumped to 120 from 20 in three years. But helping these startups requires more than a monthly meeting. (Chuang, 5/7)

With 10 days left in the 2015 session, Gov. Mark Dayton, House Republicans and Senate Democrats have some major differences to resolve. After more closed-door meetings Thursday to try to reach a compromise on a new two-year state budget, they remain far apart in their approaches to many big spending areas, especially health and human services, House Speaker Kurt Daudt said. (Pugmire, 5/7)

The southern California city of San Bernardino has proposed virtually eliminating retiree health insurance costs under a bankruptcy exit plan it must produce by May 31, according to an attorney involved in negotiations with city officials. Steven Katzman, who represents a committee of retirees in talks with the bankrupt city, says a tentative deal has been struck under which retirees would sacrifice the city subsidies they currently receive for health care coverage in exchange for a guarantee that San Bernardino continues to fund and not cut current pension benefits. (Reid, 5/7)

The Hawaii Legislature has approved a plan to create a system of medical marijuana dispensaries 15 years after the drug was legalized in the state. The development could provide relief to the state's 13,000 patients who have been left to grow their own marijuana or buy it on the black market. (Bussewitz, 5/7)

Thirty-three people have been indicted in a wide-ranging scam to sell more than $150 million in illegal pharmaceuticals in California and several other states, federal prosecutors in San Francisco announced Thursday. Officials said Ara Karapedyan, 45; Mihran Stepanyan, 29; and Artur Stepanyan, 38, were central to the conspiracy, which involved the selling illegally obtained drugs to a Minnesota company that sold the drugs wholesale. (Queally, 5/7)

Carolinas HealthCare System monitors ICUs in 10 of its hospitals from this command center near Charlotte. The command center is staffed 24-7 with a rotating crew of seven to nine nurses and doctors who specialize in critical care. Everyone on the team also does bedside shifts. Carolinas HealthCare started this project about two years ago and says it’s good for staff and patients. (Tomsic, 5/8)

This study compared the numbers of carriers and plans and premium levels in 2014 for plans offered through SHOP Marketplaces with those of plans offered only outside of the Marketplaces. An average of 4.3 carriers participated in each state’s Marketplace, offering a total of forty-seven plans. Premiums for plans offered through SHOP Marketplaces were, on average, 7 percent less than those in the same metal tier offered only outside of the Marketplaces. Lower premiums and the participation of multiple carriers in most states are a source of optimism for future enrollment growth in SHOP Marketplaces. Lack of broker buy-in in many states and burdensome enrollment processes are major impediments to success. (Gabel et al., 5/4)

To gain a greater perspective on the ACA at 5 years, it may help to recall the three basic criteria that, in our opinion, will ultimately be used to judge the effects of the legislation: its effects on access to health insurance and services, on cost of care, and on quality of care. ... First, the ACA has brought about considerable improvements in access to affordable health insurance in the United States. ... Second, the implementation of the ACA has coincided with another important development — a slowdown in the rate of increase in national health care spending. ... Third, if it is premature to draw conclusions about the cost effects of the ACA, it is doubly so for the quality effects of the law. The reductions in hospital-acquired conditions and Medicare readmissions since the enactment of the ACA are unprecedented and encouraging, but here again, the causes of these favorable trends are uncertain. (Blumenthal, Abrams and Nuzum, 5/6)

In our analysis, we sought to understand the effect of HCR [health care reform] on survival following traumatic injury by comparing mortality rates in Massachusetts before and after [the state established it own insurance expansion in 2006] with those of a contiguous state (New York) that did not implement HCR. ... We find that although the percentage of uninsured residents in Massachusetts sharply decreased following HCR, the percentage of uninsured trauma patients showed no such inflection. Instead, the percentage of uninsured trauma patients steadily declined during the 10 years surrounding HCR. In addition, we find that HCR in Massachusetts was associated with a transiently increased adjusted mortality rate, accounting for as many as 604 excess deaths during 4 years. (Osler et al., 5/6)

[A] process improvement team at New York City’s Mount Sinai Medical Center developed the GEDI WISE (Geriatric Emergency Department Innovations in Care through Workforce, Informatics, and Structural Enhancements) model. .... ED triage nurses screened patients ages sixty-five and older to identify those at high risk of ED revisit and hospital readmission. ... ED nurse practitioners identified high-risk patients suitable for and desiring palliative and hospice care, then expedited referrals. Between January 2011 and May 2013 the percentage of geriatric ED admissions to the intensive care unit fell significantly, from 2.3 percent to 0.9 percent, generating an estimated savings of more than $3 million to Medicare. The decline ... cannot be confidently attributed ... because other geriatric care innovations were implemented during the study period. (Grudzen, 5/4)

For patients with limited prognosis, some medication risks may outweigh the benefits, particularly when benefits take years to accrue; statins are one example. [Researchers sought to] evaluate the safety, clinical, and cost impact of discontinuing statin medications for patients in the palliative care setting. ... A total of 381 patients were enrolled; 189 of these were randomized to discontinue statins, and 192 were randomized to continue therapy. ... The proportion of participants in the discontinuation vs continuation groups who died within 60 days was not significantly different .... Total QOL [quality of life] was better for the group discontinuing statin therapy .... Few participants experienced cardiovascular events (13 in the discontinuation group vs 11 in the continuation group). Mean cost savings were $3.37 per day and $716 per patient. (Kutner et al., 5/5)

Regular breast, cervical, and colorectal cancer (CRC) screening with timely and appropriate follow-up and treatment reduces deaths from these cancers. Healthy People 2020 targets for cancer screening test use have been established, based on the most recent U.S. Preventive Services Task Force (USPSTF) guidelines. National Health Interview Survey (NHIS) data are used to monitor progress toward the targets. CDC used the 2013 NHIS, the most recent data available, to examine breast, cervical, and CRC screening use. Although some demographic subgroups attained targets, screening use overall was below the targets with no improvements from 2010 to 2013 in breast, cervical, or CRC screening use. Cervical cancer screening declined from 2010 to 2013. Increased efforts are needed to achieve targets and reduce screening disparities. (Sabatino et al., 5/8)

This brief examines state network adequacy standards for marketplace plans in the 50 states and District of Columbia. We identify state requirements in effect at the outset of marketplace coverage, focusing on quantitative measures of network sufficiency and rules designed to ensure the delivery of accurate and timely provider directories. We then explore the extent to which those standards evolved for 2015. Though regulatory changes were limited in year one, states were most likely to act to promote network transparency and enhance oversight. (Corlette, Giovannelli and Lucia, 5/5)

In this report, we provide new projections of the impact of Medicaid expansion ... and costs in states that have not expanded Medicaid. We find that if the 21 states that have not expanded Medicaid as of April 2015 were to do so: The number of nonelderly people enrolled in Medicaid would increase by nearly 7 million, or 40 percent. 4.3 million fewer people would be uninsured. There would be $472 billion more federal Medicaid spending from 2015 to 2024. States would spend $38 billion more on Medicaid from 2015 to 2024. Savings on reduced uncompensated care would offset between 13 and 25 percent of that additional state spending. (Buettgens, Holahan and Recht, 4/29)

The Medicaid program, signed into law by President Lyndon B. Johnson on July 30, 1965, will reach its 50th anniversary this year, a historic milestone. At the Kaiser Commission on Medicaid and the Uninsured, where we have closely studied and analyzed Medicaid for nearly 25 years, we are recognizing this important occasion by documenting Medicaid’s evolution and its role in our health care system today. This report reflects on Medicaid’s accomplishments and challenges and considers the issues on the horizon that will influence the course of this major health coverage and financing program moving forward. (Paradise, Lyons and Rowland, 5/6)

Many proposals to accelerate and improve medical product innovation and regulation focus on reforming the product development and regulatory review processes that occur before drugs and devices get to market. ... As drugs and devices begin to be used in larger and more diverse populations and in more personalized clinical combinations, evidence from real-world use during routine patient care is increasingly important for accelerating innovation and improving regulation. ... [The researchers offer] short- and long-term proposals that would bolster the current systems for postmarket evidence development, create new mechanisms for generating postmarket data, and enable individual initiatives on evidence development. (McClellan et al., 4/28)

A small number of very premature babies are surviving earlier outside the womb than doctors once thought possible, a new study has documented, raising questions about how aggressively they should be treated and posing implications for the debate about abortion. The study, of thousands of premature births, found that a tiny minority of babies born at 22 weeks who were medically treated survived with few health problems, although the vast majority died or suffered serious health issues. Leading medical groups had already been discussing whether to lower the consensus on the age of viability, now cited by most medical experts as 24 weeks. (Belluck, 5/6)

In hospitals where extremely premature babies are given intensive care, a small fraction of infants are surviving outside the womb earlier than was once believed possible. That finding, from a study published Thursday in the New England Journal of Medicine, is heartening news in the world of pediatrics. But it also adds to a list of questions for parents, doctors and lawmakers by challenging the accepted age for “viability” — a standard that has defined the debates about abortion and intensive neonatal care. (Kaplan, 5/7)

Residents of low-income neighborhoods with few high school graduates may be more likely to die after lung cancer surgery than more affluent patients, a U.S. study finds. Researchers reviewed records for more than 200,000 patients who had lung cancer surgery from 2003 to 2011. They found that while factors such as age, gender and other medical conditions influenced survival, so did non-clinical variables like the neighborhoods where patients lived, and the type of hospital where they were treated. (Rapaport, 5/1)

Keeping blood sugar under control is an essential part of diabetes care, but for patients in hospice, the goal is to provide the highest quality of life and that may mean less aggressive type 2 diabetes treatment, researchers say. Even though diabetes care guidelines recommend a less aggressive approach to controlling blood sugar when individuals have a limited life expectancy, many hospice patients continue their blood sugar testing and diabetes medications. (Nelson, 5/1)

Every two seconds someone in the United States needs donated blood, the equivalent of more than 41,000 three-pint donations every day. There’s a perennial need for more donors — particularly donors of type O-negative blood, which doesn’t have the A- or B-type antigens that can provoke an immune reaction in some people. But fewer than 7 percent of Americans have O-negative blood. In a new study published in the Journal of the American Chemical Society, researchers describe a way to transform A and B blood into a type that, like O, could be universally donated. (Szokan, 5/4)

Parents worry about a child getting a concussion in the heat of competition, but they also need to be thinking about what happens during practices, a study finds. High school and college football players are more likely to suffer a concussion during practices than in a game, according a study published Monday in JAMA Pediatrics. (Shute, 5/4)

The House-Senate budget conference report released last Wednesday included several interesting nuggets. Among the most surprising was the lack of explicit language endorsing the concept of premium support reforms to Medicare. Conservatives have voiced support for premium support for years—most notably in the entitlement reform proposals from then-House Budget Committee Chairman Paul Ryan—but legislative progress has been limited. (Chris Jacobs, 5/7)

If you’re a Republican presidential candidate, there aren’t too many ways you can distinguish yourself from your primary opponents on the issue of health care — I hate Obamacare, you hate Obamacare, we all hate Obamacare. But maybe there’s another way, for someone who has the courage to shift his rhetoric and present themselves as a bold truth-teller. (Paul Waldman, 5/7)

In 2011, analysts were speculating that Assurant Health might exit the insurance business, the Milwaukee Journal Sentinel reported last week. So the recent news that Assurant’s parent company was looking to “sell or shut down” the insurance carrier by year’s end was not a total surprise. The issue now is whether its demise holds larger lessons about Obamacare’s impact on insurance markets. (Chris Jacobs, 5/7)

Many have dismissed Rick Scott's lawsuit against the Obama administration over Medicaid funding as meritless, but the Florida governor might actually be doing everybody a favor. The case could help answer a huge constitutional question left over from the 2012 Supreme Court decision on Obamacare. ... what [Chief Justice John] Roberts didn't say in his ruling was where exactly the line is that separates the federal government's lawful discretion to persuade states to participate in a program from such illegal intimidation. He explicitly avoided creating a definitive test for it. ... If the Florida case gets to the high court, it would give the justices a chance to be a little more precise. (Dylan Scott, 5/7)

With Alaska's new minimum wage, an Alaskan working full time would earn roughly $18,000 a year and fall $2,500, or 286 working hours, short of federal subsidies for health insurance. This person would have to spend approximately $6,000 for health insurance. In contrast, an Alaskan earning $22,000 a year can purchase health insurance for less than $1,000. This kind of an inequity cries out for a response from our elected leaders. (Pastor Max Lopez-Cepero and Fr. Fred Bugarin, 5/7)

Despite what the U.S. Preventive Services Task Force said recently in its draft recommendations, oncologists, surgeons and radiologists like us who specialize in breast cancer know patients are living longer because new technology is discovering cancer at earlier, more treatable stages. The task force's draft advised against breast cancer screening for any woman aged 40-49 unless her physician had reviewed her individual medical history, assessed screenings' risks and benefits, and then recommended a mammogram. For women aged 50-74, the task force weakly endorsed screening mammograms, but only every other year. If the draft is approved, insurance companies now required to cover annual screening may no longer provide that coverage. (Drs. Linda Greer, Coral Quiet and Lise Walker, 5/5)

I was relieved when at age 41, my first-ever mammogram came back clean. However, the report did indicate I was at risk for calcification buildups. Though not abnormal, that alert made me more vigilant about breast health self-awareness. Indeed just six weeks later I found a lump in my breast during a routine self-exam, and shortly thereafter I was diagnosed with breast cancer. (Rep. Debbie Wasserman Schultz, D-Fla., 5/7)

There are many ways to understand what is happening in Baltimore and, to varying degrees, across the United States. The problems reflect a long-standing dysfunctional relationship between law enforcement and citizens, structural poverty, and the legacy of discrimination in housing and finance policy. The problems also deeply engage public health—in addressing immediate needs, in understanding the basis of unrest, and in shaping long-term solutions. (Leana S. Wen and Joshua M. Sharfstein, 5/7)

CHIP enjoys political advantages that give it a strong bipartisan foundation: insuring children is a popular cause, the costs of doing so are modest, the program's block-grant structure and state flexibility appeal to conservatives, and it has a strong constituency among state officials. ... CHIP, in other words, is not Obamacare, and the bipartisan coalition behind it remains largely intact. ... The bipartisanship that underlay CHIP's extension and [Medicare doctor payment] reform does not, however, mark the emergence of new, less polarizing health care politics. That Congress can agree on the necessity of continuing insurance coverage for children and payments to doctors seeing Medicare patients does not mean that Democrats and Republicans see eye to eye on other issues. (Jonathan Oberlander and David K. Jones, 5/6)

Over the past two decades, largely because of a few widely publicized episodes of unacceptable behavior by the pharmaceutical and biotechnology industry, many medical journal editors (including me) have made it harder and harder for people who have received industry payments or items of financial value to write editorials or review articles. The concern has been that such people have been bought by the drug companies. Having received industry money, the argument goes, even an acknowledged world expert can no longer provide untainted advice. But is this divide between academic researchers and industry in our best interest? I think not. (Jeffrey M. Drazen, 5/7)

Biologics have provided major advances in the treatment of cancer, rheumatologic disease, and other conditions. Though they account for less than 1% of all prescriptions dispensed in the United States, expenditures on them amount to 28% of prescription-drug spending, and both their use and their cost are forecast to grow sharply. ... The introduction of generic versions of small-molecule drugs can reduce prices by 90% from the brand-name version, which has saved U.S. consumers more than $1.5 trillion over the past decade. Cost savings for biologic drugs, however, are inherently limited because they are more complex and therefore harder to produce than small-molecule drugs. This complexity raises the cost of development and reduces the number of potential market entrants. (Ameet Sarpatwari, Jerry Avorn and Aaron S. Kesselheim, 5/6)

In the first 2 months of the 2014-2015 academic year, 2 New York City medical interns died in apparent suicides. In response, an intern from Yale School of Medicine wrote an op–ed in the New York Times highlighting the link between medical training and isolation, depression, and suicide among trainees. Physician suicide is a common occurrence. According to the American Foundation for Suicide Prevention, 300 to 400 physicians commit suicide each year, approximately 1 physician per day. Medical training involves numerous risk factors for mental illness, such as role transition, decreased sleep, relocation resulting in fewer available support systems, and feelings of isolation. A substantial body of evidence has demonstrated that trainees in particular are at high risk for depression and suicidal thinking, but many training programs have not been able to identify and provide treatment for these residents and fellows in a systematic way. (Matthew L. Goldman, Ravi N. Shah and Carol A. Bernstein, 5/7)