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Judge Brett M. Kavanaugh and his accuser faced off Thursday in an extraordinary, emotional day of testimony that ricocheted from a woman’s tremulous account of sexual assault to a man’s angry, outraged denial, all of which played out for hours before a riveted nation and a riven Senate. The two very different versions of the truth, unfolding in the heated atmosphere of gender divides, #MeToo and the Trump presidency, could not be reconciled. The testimony skittered from cringe-worthy sexual details to accusations and denials of drunken debauchery to one juvenile exchange over flatulence. (Stolberg and Fandos, 9/27)

The day began with an emotional punch as a self-described “terrified” Ford, her voice shaking at times, described in stark detail being pinned on a bed by a drunken Kavanaugh at a high school gathering. Hours later, the drama escalated as a seething Kavanaugh faced the Senate Judiciary Committee from the same chair and adamantly denied her charges. “You may defeat me in the final vote, but you’ll never get me to quit. Never,” the red-faced and defiant nominee told Democrats. (Barnes, Kim and Viebeck, 9/27)

The Senate Judiciary Committee is scheduled to vote Friday on the nomination. Republican senators said they expected the full chamber would hold its first procedural vote Saturday, and a final vote is expected early next week. (Hook, Peterson and Andrews, 9/27)

Publicly, Republicans do not have the votes yet to confirm Kavanaugh, but GOP leaders seem confident they can push him through with brute force. Majority Whip John Cornyn (R-Texas) wouldn’t say whether undecided Republicans would back Kavanaugh. “We’re still talking through all those issues, and I’m optimistic we’ll get to confirmation,” Cornyn said as he left the Capitol. (Everett and Bresnahan, 9/27)

The American Bar Association has asked the Senate Judiciary Committee to suspend its consideration of Brett Kavanaugh’s nomination to the Supreme Court until an FBI investigation is completed into multiple sexual assault allegations. (Kiggins, 9/28)

“Can you tell us what impact the events had on you?” Senator Dianne Feinstein asked Christine Blasey Ford during Thursday’s Senate Judiciary Committee hearing. It was the first of several questions aimed at getting Dr. Blasey to outline the toll on her life of a sexual assault that she testified involved Judge Brett M. Kavanaugh. Many people who work in the area of trauma found her answers, which included “anxiety, phobia and PTSD-like symptoms,” familiar and credible. But they said it’s important to remember something Dr. Blasey, a research psychologist, drew attention to during her testimony. (Murphy, 9/27)

What Christine Blasey Ford remembers best about that night 30-plus years ago is the laughter. It came, she said, from Supreme Court nominee Brett Kavanaugh and his friend Mark Judge — two high school boys who drunkenly locked her into the bedroom of a friend’s house where she was sexually assaulted by Kavanaugh. (Healy, 9/28)

In her testimony to a Senate committee, the woman who accused Brett Kavanaugh of sexually assaulting her when they were teenagers dipped briefly into the mechanics of memory. Experts say she got it pretty much right. When asked Thursday how she could be sure it was Kavanaugh who put a hand over her mouth to keep her quiet, psychologist Christine Blasey Ford cited levels of chemical messengers called norepinephrine and epinephrine in her brain at the time of the alleged attack. (Ritter, 9/27)

Millions of people heard Christine Blasey Ford tell the Senate Judiciary Committee about a long-ago gathering where she said Supreme Court nominee Brett M. Kavanaugh pinned her to a bed, pushed his body against hers, tried to remove her clothes and held his hand over her mouth as she tried to scream for help. The story was difficult to take in, and that’s especially true for victims of sexual assault. (Kaplan and Healy, 9/27)

Dr. Lynn Ponton, a psychiatrist in San Francisco and a professor of psychiatry at UCSF, said she wasn't surprised when she started getting phone calls from clients on Thursday during the Blasey-Kavanaugh hearing before the Senate Judiciary Committee. And she says other Bay Area psychiatrists she's been talking with are also seeing their phones light up. (McEvoy, 9/27)

Thursday, Christine Blasey Ford provided emotional testimony about her allegation that Kavanaugh sexually assaulted her at a party when she was 15. Kavanaugh also testified, denying he assaulted Blasey Ford. Experts say the allegations and testimony may be a trigger for survivors dealing with their own trauma. According to the National Sexual Violence Resource Center, one in three women and one in six men in the United States have experienced a form of contact sexual violence. (Castle, 9/27)

HHS Secretary Alex Azar on Thursday praised President Donald Trump for taking "decisive action" to stabilize the individual insurance market and lower health insurance exchange premiums for American consumers. Health insurers have proposed to reduce benchmark exchange premiums by 2% in 2019 following years of increasing rates, Azar said, providing evidence that the Trump administration's moves to gives states flexibility to prop up their insurance markets and expand the types of health plans allowed have been successful. (Livingston, 9/27)

Speaking in Nashville on Thursday, Azar said premiums for a popular type of “silver” plan will drop by 2 percent in the 39 states served by the federal HealthCare.gov website. The number of marketplace insurers will grow for the first time since 2015. Azar’s comments track with a broader independent analysis earlier this month. (Alonso-Zaldivar, 9/27)

"It turns out, when you have a president who’s willing to take decisive action, who understands business, who’s willing to work with the private sector, you can find a way to help American patients, even within a failed system like the ACA," Azar said. “The president who is supposedly trying to sabotage the Affordable Care Act has proven better at managing it than the president who wrote the law.” (Kelman, 9/27)

The Trump administration’s top health official on Thursday dismissed “Medicare for all” as a promise that’s too good to be true. “When you drill down into the details, it’s clear that Medicare for all is a misnomer. What’s really being proposed is a single government system for every American that won’t resemble Medicare at all,” Health and Human Services Secretary Alex Azar said during a wide-ranging speech in Nashville, Tenn. (Weixel, 9/27)

And in other health law news —

Some business associations and insurers are plunging ahead in launching a cheaper type of health plan newly permitted by the Trump administration, while others are holding back due to big regulatory and legal uncertainties about the future of these products. Since the U.S. Labor Department issued a final rule in June allowing small employers and self-employers to band together across state lines and form association health plans, or AHPs, there have been intensive discussions between business groups, state insurance commissioners and Labor Department officials about how states can regulate these plans. (Meyer, 9/27)

Small Business Owners say that the most important issue affecting them is the cost of health care, according to the National Small Business Association’s annual Politics of Small Business Survey. When asked what issues they raised most with elected officials, 40 percent of the surveyed owners said health care costs. Local issues were second on the list at 28 percent and tax reform came third with 37 percent. (Elis, 9/26)

Aetna is selling its Medicare prescription drug business, potentially clearing the way for CVS Health to complete its $69 billion takeover of the insurer. CVS announced plans to buy Aetna late last year. The deal is expected to give the drugstore chain a bigger role in health care, with the companies combining to manage care through CVS stores, clinics and prescription drugs. (9/27)

The announcement marks a major step forward for CVS’s planned acquisition of Aetna, a nearly $70 billion deal that will unite the third-biggest health insurer with the drugstore and pharmacy-benefit company. The Wall Street Journal previously reported that Justice Department antitrust enforcers were preparing to give the green light to the deal, and that WellCare was in talks to acquire Medicare drug plan assets from the merger partners. (Wilde Mathews and Prang, 9/27)

Medicare Part D plans offer prescription-drug insurance for the elderly and disabled, subsidized by the federal government. As of June, CVS had the biggest Part D business, with about 6.1 million customers, while UnitedHealth Group Inc. was No. 2 at 5.4 million members, according to data compiled by Bloomberg. Aetna was smaller, with about 2.2 million members. (Tracer, 9/27)

"Aetna and CVS Health continue to engage in productive discussions with the DOJ. Aetna’s expectations regarding the timing of the closing of the CVS Health Transaction remain unchanged," the SEC filing reads. (Burke, 9/27)

In other health industry news —

After two failed buyout attempts that could have put it in a better position to compete against larger rivals, Rite Aid is shuffling its board of directors and dividing power at the top of the drugstore chain. Rite Aid said Thursday that three new, independent directors will be nominated to its board and that CEO John Standley will no longer hold the title of chairman. That goes to current board member Bruce Bodaken. (Murphy, 9/27)

UnitedHealth Group Inc. bought pharmacy company Genoa Healthcare from private equity group Advent International. The price was about $2.5 billion, according to a person familiar with the transaction. UnitedHealth, the biggest U.S. health insurer, beat out other parties including drugstore chain Walgreens Boots Alliance, which was said to be interested in Genoa in August, according to the person, who requested anonymity because the talks were private. (Tozzi, Porter and Tracer, 9/27)

Rep. Buddy Carter (R-Ga.) on Thursday touted legislation to use telehealth to prescribe drugs to treat opioid addiction, a move he said would make it easier to fight the epidemic. “This will give the opportunity for physicians, through telemedicine, to actually prescribe controlled substances such as what we use in medication assisted treatment,” Carter said at an event on telehealth hosted by The Hill and sponsored by the Health Care Alliance for Patient Safety. (Sullivan, 9/27)

Kaiser Health News: Buried In Congress’ Opioid Bill Is Protection For Personal Drug Imports 
The final version of the massive opioid bill Congress released Wednesday would grant the Food and Drug Administration new powers to crack down on drug imports, but it also includes a provision — nearly killed in the Senate — to shield people who are just trying to buy cheaper, needed prescription medication from other countries. Broadly, the bill seeks to enlist the FDA in combating the opioid crisis by mandating that the agency take steps to accelerate development of non-opioid painkillers and to limit the supplies of the drugs, both illegal and legitimate, that claimed the lives of more than 49,000 people last year. (McAuliff, 9/27)

Congressional negotiators on Thursday made a pair of changes to the sweeping opioid response bill after the Congressional Budget Office projected the legislation would grow the deficit by $44 million over a decade, Republican and Democratic aides confirmed to POLITICO. One change would broaden Obamacare's religious exemption to the health law's individual mandate so it applies to people who forgo medical care for religious reasons. (Ehley and Karlin-Smith, 9/27)

It took more than 10 minutes for paramedics to arrive after a housekeeper found a man collapsed on the floor of a bathroom in a Boston Veteran Affairs building. The paramedics immediately administered naloxone, often known by its brand name Narcan, to reverse the man's opioid overdose. But brain damage can begin after just a few minutes without oxygen. (Bebinger, 9/27)

Over 13 people died a day on average in Ohio due to drug overdoses last year, a new high as the state battles the opioid epidemic. Gov. John Kasich, who will leave office in January, played defense during a Thursday afternoon news conference where the death tally was announced, emphasizing the work he's accomplished to make some progress in the battle against the drugs - such as heroin and prescription opioid-related overdose deaths decreasing. (Hancock, 9/27)

An opioid task force arrested 76 people on drug charges in a sweep of traffickers on western North Carolina tribal land, U.S Interior Secretary Ryan Zinke said Thursday. Federal, state, local and tribal officers fanned out in recent days to serve arrest warrants on the Eastern Band of Cherokee Indians' reservation and in nearby communities as the culmination of an undercover operation begun weeks ago, Zinke said at a news conference in Asheville. (Drew, 9/27)

Ten Kansas nurses and nurse aides have been charged with Medicaid fraud, stealing narcotic medications and mistreating vulnerable adults after an enforcement sweep by the state’s attorney general. At least eight are still licensed to work in the state, according to the Kansas State Board of Nursing and Kansas Department for Aging and Disability Services online search tools. (Marso and Rizzo, 9/28)

A day after a law requiring abortion providers to have hospital admitting privileges in Louisiana was upheld, providers at New Orleans' only remaining abortion clinic say the decision could immediately impact their ability to provide care for patients. Katie Caldwell, the clinic coordinator at the Women's Healthcare Center said that providers at the clinic have been trying to get hospital admitting privileges since 2014 when Louisiana passed a law that requires abortion providers to be able to admit patients to a particular hospital or medical center within 30 miles from the clinic where they perform abortions. The law was upheld on Wednesday (Sept. 26) by the Fifth Circuit Court of Appeals in New Orleans in a 2-1 ruling that determined the law did not place an 'undue burden on women.' (Clark, 9/27)

Kaiser Health News: ‘Contraception Deserts’ Likely To Widen Under New Trump Administration Policy
When Nikia Jackson needed to be screened for a sexually transmitted disease, she wanted a clinic that was reputable, quick and inexpensive. After searching online, Jackson, 23, ended up at the Obria Medical Clinics’ sparkling new facility in an office park in suburban Atlanta. She was unaware that the clinic does not offer condoms or other kinds of birth control beyond so-called natural family planning methods. (Varney, 9/28)

A grant program intended to boost enrollment in a state health program for low-income women fell far short of its goal to serve 155,000 patients in 2017 even after contractors spent $13 million, according to data from the Texas Health and Human Services Commission. Among grant recipients that received the largest amounts was Round Rock-based Heidi Group, whose founder Carol Everett is a vocal opponent of abortions. (Chang, 9/27)

Gov. Jerry Brown has until Sunday to decide the fate of 350 bills on his desk, including legislation that would create net neutrality regulations in California, expand access to abortion pills at public universities and increase public access to police misconduct records. Brown can either sign or veto bills or let them become law without his signature. (Gutierrez, 9/27)

And in news on maternal death rates —

Lawmakers waded into growing concerns over the nation's high maternal mortality rate, as the House Energy and Commerce Health Subcommittee on Thursday discussed a bipartisan bill that would create a new grant opportunity to improve data related to maternal health. The draft legislation, by Reps. Jaime Herrera Beutler, R-Wash., and Diana DeGette, D-Colo., would support state efforts to eliminate the disparities in maternal health and identify solutions to improve health care for mothers. A similar bill (S 1112) by Sen. Heidi Heitkamp, D-N.D., was approved by the Senate Health, Education, Labor, and Pensions Committee in June. (Raman, 9/27)

U.S. health officials are trying to increase the rate of flu vaccinations this year after a severe outbreak last season killed a record number of children and led to spot shortages of antiviral medications like Tamiflu. In a panel hosted by the National Foundation for Infectious Diseases and the Centers for Disease Control and Prevention in Washington on Thursday, U.S. Surgeon General Jerome Adams took a nasal vaccine -- an effort, he said, to make flu prevention “go viral.” The lighthearted demonstration was accompanied by grim statistics from the 2017-18 flu season: 80,000 deaths overall, including 180 children. (Dodge, 9/27)

The most recent flu season was the worst in Colorado history with 4,650 residents going to the hospital with the disease between fall 2017 and spring 2018, state officials announced Thursday. In light of that, Colorado health officials are urging people go get vaccinated. ...Last year’s record-setting number of flu hospitalizations in Colorado between Oct. 1, 2017, and May 26 is a clear reminder of how serious and unpredictable the virus can be, [Dr. Rachel] Herlihy said in a news release. (Mitchell, 9/27)

Flu killed and sent more people in the United States to the hospital last winter than any other season in recent history, according to new data released Thursday. And in Minnesota, more than 6,400 people were hospitalized and five children died from influenza or related complications last year. Those stark numbers underscore how severe the flu can be and come with a warning from state public health officials who say that not enough children are being vaccinated. (Zamora, 9/27)

As Daniel Te’o-Nesheim’s sister picked through her brother’s belongings after the former N.F.L. defensive lineman died last year, she came across a plastic container filled with several pages from a journal he kept during his days in pro football — a scrawled catalog of his seemingly endless injuries and attempted treatments. The entries are a sad coda to a life cut tragically short. (Belson, 9/27)

It can be notoriously difficult for psychiatrists and patients to determine which antidepressant might be most effective, or which might cause side effects. And so Color Genomics, a company that already sells genetic tests to determine someone’s risk of developing certain cancers, said this week that it will also begin to offer a DNA test to determine how well widely used antidepressants are likely to work for patients. (Robbins, 9/28)

Consuming caffeine regularly may increase the ability to withstand pain, a small study suggests. Researchers recruited 62 men and women, ages 19 to 77, and had them record their daily caffeine intake from coffee, tea, soda, energy drinks and chocolate. They averaged 170 milligrams of caffeine a day, about the amount in two cups of coffee, although 15 percent of the group consumed more than 400 milligrams a day. The study is in Psychopharmacology. (Bakalar, 9/27)

In my first Feldenkrais class, we lay on our backs with eyes closed and drifted our eyeballs left to right and back again. We shifted our heads from side to side as our eyes followed in their sockets. Then we changed it up, moving our eyes in the opposite direction from our heads. This may sound like a simple sequence. It’s deceptively challenging. And it continued for an hour, with sitting variations, eyes alternately open and shut, a brain workout that included tracking our thumbs as our bent arms moved at eye level from left to right and back again. (Rein, 9/27)

The other day, we hosted an hourlong webinar on how to analyze clinical trials to best spot red flags before they cause trouble. The response was terrific and we thank you for your interest. But because we only had a limited time for the webinar, we weren’t able to address all of your questions. We have collected some more and compiled the responses below. (Feuerstein and Begley, 9/28)

The Drug Enforcement Administration on Thursday morning categorized a cannabis-based seizure medicine as a schedule V drug, clearing the path for the FDA-approved drug to go to market. GW Pharma’s Epidiolex was approved by FDA in June to treat two rare types of childhood epilepsy. (Owermohle, 9/27)

For more than a decade, it’s been clear that there’s a gaping hole in American food safety: Growers aren’t required to test their irrigation water for pathogens such as E. coli. As a result, contaminated water can end up on fruits and vegetables. (Shogren and Neilson, 9/27)

Kaiser Health News: KHN Conversation On Overtreatment
From duplicate blood tests to unnecessary knee replacements, millions of American undergo screenings, scans and treatments that offer little or no benefit every year. Doctors have estimated that 21 percent of medical care is unnecessary — a problem that costs the health care system at least $210 billion a year. Such “overtreatment” isn’t just expensive. It can harm patients. (9/27)

Members of the council charged with creating a health information exchange for Connecticut seemed stunned Thursday as they realized the state Department of Social Services is continuing to create its own products for exchanging this information. As a DSS official gave a presentation on her agency’s work, members of the Health IT Advisory Council reacted with disbelief and frustration. (Werth, 9/27)

More information has been released about the veteran whose death sparked a federal review of the Minneapolis Veterans health care system. In a statement before the House Committee on Veterans' Affairs, U.S. Rep. Tim Walz laid out the details of the last four days of Justin Miller's life. (Enger, 9/27)

Wisconsin prosecutors charged a former nurse Thursday with abusing multiple infants in a Madison hospital's intensive care unit, accusing him of bruising them and breaking their bones. Christopher Kaphaem faces 19 felony child abuse counts involving nine infants. All but one of the counts carries a maximum sentence of six years in prison. The 19th count, intentional child abuse causing great bodily harm, carries a maximum 25 years behind bars. (9/27)

The state attorney general’s office and the Department of Public Health on Thursday signaled that they are drafting conditions for the biggest health care merger proposed in Massachusetts in decades, after a state watchdog agency stood firm behind projections that the deal could sharply raise costs for consumers. The comments from the three public agencies indicated that nearly two years after it was first proposed, a merger between Beth Israel Deaconess Medical Center and Lahey Health may be nearing final approval — but with guardrails. (Dayal McCluskey, 9/27)

It's now up to Attorney General Maura Healey to decide whether she'll challenge a proposed hospital merger that the Massachusetts Health Policy Commission estimates could increase state health care spending by tens of millions of dollars a year. The commission on Thursday approved a final assessment of the plan to combine Beth Israel Deaconess Medical Center and Lahey Health. (Goldberg and Bebinger, 9/27)

State environmental officials plan to test the drinking water at more schools after an initial round of testing found unsafe chemical levels at two schools. Last week, the state health department recommended that all schools test their water for lead. Now, the Department of Environmental Conservation said it is looking at a list of about 25 schools to figure out which should be in line for testing for chemicals known by the acronym PFAS. The state recently tested 10 schools for the chemicals and found that both Grafton Elementary School and Warren Elementary School had levels above the state's safe drinking standard. (9/27)

Officials in San Francisco, San Diego and Los Angeles counties will be able to expand conservatorship rules to give them more control over who can be involuntarily held for mental-health treatment. Gov. Jerry Brown signed SB1045 by Sen. Scott Wiener, D-San Francisco, on Thursday. The bill creates a five-year pilot program in the three counties intended to get more mentally ill people who suffer from substance abuse off the streets and into treatment. (Gutierrez, 9/27)

Safety measures to ensure that children are protected from the dangers of lead poisoning while living in District homes may soon become a lot more stringent. The D.C. Council is considering a bill to shore up weaknesses in lead-poisoning-prevention laws that in recent years have led to elevated blood lead levels for some low-income children in subsidized rental housing. (McCoy, 9/27)

In Los Angeles, members of the City Council have had the power to block funding for homeless and affordable housing projects by refusing to hand over a required letter. Critics have sued the city over it, denouncing the rule as an unfair and arbitrary “pocket veto.” Now the city must get rid of that requirement — or end up losing out on state funding for housing projects. (Reyes, 9/27)

It's known as implicit bias and is present among the calmest of people in the best of times. But a high-trauma environment, such as the urban center of Milwaukee, can scramble the brain’s fast-moving neurobiological triggers, intensifying the impact of implicit bias, multiplying the instances of unconscious racial profiling and compounding the psychological suffering for those with traumatized minds, according to researchers speaking Thursday at a major trauma conference in Milwaukee. (Schmid, 9/27)

Hospitals can receive Medicare penalties if too many of their patients are readmitted within a month of their discharge. And recently released federal data show that 85 percent of such facilities in Georgia are set to be penalized. The readmission penalties, created by the Affordable Care Act, have brought increased scrutiny to the care of patients after discharge. (Miller, 9/27)

Summa Health on Oct. 1 will begin searching for a potential partnership or merger with another health system, officials said. The Akron-based system has struggled financially in recent years, and this move will help ensure "long-term financial stability," according to a press release. Dr. Cliff Deveny, interim president and CEO of Summa Health, said the system wanted to "proactively reach out to larger health systems" while it was in a financial position to do so. (Christ, 9/27)

Denver officials have removed large outdoor storage containers set up last year for homeless people after discovering that people were living inside them. The city paid $30,000 for 10 4-by-6-foot (1-by-2-meter) containers meant to give homeless people a safe place to store clothing and other possessions. But the city decided to do away with the containers for now because people were staying in the unventilated units day and night, Chris Conner, director of the city’s Denver Road Home homelessness agency, told The Denver Post. (9/27)

From November 2016 to November 2017, a special task force that battles human trafficking in Northeast Ohio recovered more than 130 victims and placed them in a myriad of recovery services, from shelters to substance abuse counseling. That task force is on track to pull even more victims out of traffickers' clutches, and on the road to improved lives. (Washington, 9/28)

A licensed nurse in Johnson County is one of 10 nurses and aides accused of Medicaid fraud and other criminal charges in a statewide crackdown on Kansas health care facilities that get Medicaid funding. In a complaint filed in Johnson County District Court, Catherine M. Santaniello is charged with one count of Medicaid fraud, two counts of mistreatment of a dependent adult, and battery.The complaint contains few details and the person she allegedly mistreated is not identified. (Margolies 9/27)

Whipsawed is not a medical condition, but it describes exactly how Lee Henderson feels about his on-again, off-again care at UC Davis Medical Center, a place he’s been visiting since he was a child. For the second time in three years, Henderson is about to lose access to his primary care team at the Sacramento institution. (Waters, 9/26)

The World Health Organization recommends drug-susceptibility testing of Mycobacterium tuberculosis complex for all patients with tuberculosis to guide treatment decisions and improve outcomes. Whether DNA sequencing can be used to accurately predict profiles of susceptibility to first-line antituberculosis drugs has not been clear. (9/26)

The primary outcome was survival to hospital discharge. Secondary outcomes were return of spontaneous circulation at emergency department arrival and favorable functional outcome at hospital discharge (defined as a modified Rankin scale score ≤3). Multivariable hierarchical logistic regression models were used to adjust confounders and clustering of patients within EMS agencies, and calculated median odds ratios (MORs) were used to quantify the extent of residual variation in outcomes between EMS agencies. (Okubo et al, 9/26)

Persons with motor complete spinal cord injury, signifying no voluntary movement or sphincter function below the level of injury but including retention of some sensation, do not recover independent walking. We tested intense locomotor treadmill training with weight support and simultaneous spinal cord epidural stimulation in four patients 2.5 to 3.3 years after traumatic spinal injury and after failure to improve with locomotor training alone. Two patients, one with damage to the mid-cervical region and one with damage to the high-thoracic region, achieved over-ground walking (not on a treadmill) after 278 sessions of epidural stimulation and gait training over a period of 85 weeks and 81 sessions over a period of 15 weeks, respectively, and all four achieved independent standing and trunk stability. One patient had a hip fracture during training. (Angeli et al, 9/27)

In this study of 54 drugs receiving pediatric exclusivity under the Best Pharmaceuticals for Children Act from September 27, 2007, to December 31, 2012, 31 (57%) demonstrated safety and efficacy in children. Pediatric exclusivity provided pharmaceutical manufacturers with a median net return of $176.0 million and a median ratio of net return to cost of investment of 680%. (Sinha et al, 9/24)

Since taking office, the Trump administration has dramatically reduced funding for federal marketplace Navigators. The Affordable Care Act (ACA) created Navigator programs to provide outreach, education, and enrollment assistance to consumers eligible for marketplace and Medicaid coverage and requires that they be funded by the marketplaces. Since 2015, the Centers for Medicare and Medicaid Services (CMS) has funded Navigator programs in the 34 states that use the federal marketplace through a multi-year agreement that ends on September 1, 2018.  In 2017, as the third year of that funding agreement was about to begin, CMS reduced funding for Navigators by 43%, from $63 million awarded in 2016 to $36.1 million for 2017. On a state-by-state basis, funding reductions ranged from 0% to 96% from the amounts grantees had previously been notified to expect for the 2017-2018 program year. (Pollitz, Tolbert and Diaz, 9/24)

On graduation, most medical students swear some version of the ancient Hippocratic oath — a promise to act morally in their role as physicians. Human nature being what it is, some will break their promise. But we still expect those who provide health care to behave more ethically than the average member of society. When it comes to how political figures deal with health care, however, we’ve come to expect the opposite, at least on one side of the aisle. It often seems as if Republican politicians have secretly sworn a Hypocrite’s oath — a promise to mislead voters to the best of their ability, to claim to support the very protections for the sick they’re actively working to undermine. (Paul Krugman, 9/27)

During the 2016 presidential campaign, Donald Trump proclaimed what has become almost a clarion call to his supporters and detractors alike, "I could stand in the middle of Fifth Avenue and shoot somebody, and I wouldn't lose any voters." Although he hasn’t followed through on that experiment, the President has taken many positions that would seemingly prompt him to lose some of his support. Polls show his approval rating ranging consistently between 35 and 45 percent. And among the GOP his support is especially strong. The most recent polls show that 84 percent of Republicans approve of his job — almost the same level of support he had among Republicans during the first weeks of his presidency. ...But one key issue — health care — threatens to erode his support. (Arthur Garson and Ryan Holeywell, 9/27)

The polls over the last few weeks have been quite bad for Republicans. FiveThirtyEight now gives the Democrats roughly an 80 percent chance to take the House and a 30 percent chance to take the Senate. ... There are many reasons that the polls are looking even better for Democrats, starting with President Trump. But it’s important to remember that most voters are not following the day-to-day twists involving the Kavanaugh nomination, Rod Rosenstein or any number of other big news stories. And most congressional candidates are not running campaigns about those stories. (David Leonhardt, 9/27)

As policymakers grapple with next steps in responding to the opioid drug crisis, it’s common to hear concerns that “harm-reduction strategies,” such as needle exchange and safe-injection sites, only encourage continued drug use. These approaches, some argue, should be combated with good, old-fashioned law-and-order. The reality is that addiction to heroin means the drug user is well past the point of being “encouraged” in their drug use. Addiction, by definition, means users continue the behavior despite its harms. So safe-injection sites and needle exchange, far from encouraging additional use, only transition unsafe to safer use, providing users more time to make the choice for sober living. (Nicole Schramm-Sapyta, 9/27)

Tiger Woods suffered from severe lower back pain and sciatica, which famously hampered and derailed his golf game and led to four surgeries. Few thought he would ever make it back to the top rung of professional golfers and yet, on Sunday in Atlanta, he won his 80th PGA tour tournament — his first in five years. This inspiring accomplishment clearly took heart and courage and a restoration of self-image. But the foremost question everyone’s mind this week is how was Tiger possibly able to accomplish this? Lower back pain is very common, affecting over 90 percent of people at some point in their lives and few believed that Tiger would ever play golf again, including Tiger himself. He also had the associated problem of the addiction to painkillers and alcohol to overcome. (Marc Siegel, 9/27)

When my parents came to the United States 40 years ago, they were seeking higher education. Then, in 1979, the Iranian Revolution cut them off both financially and emotionally from their home country. Through perseverance and public support, they built their American life and became citizens. I am a beneficiary of those efforts: a U.S.-born child of immigrants and a university professor. Today, people who have immigrated here, like my parents, are facing another targeted, xenophobic attack. (Goleen Samari, 9/27)

By now, black lung disease was supposed to have mostly gone away. The coal industry was supposed to have improved air quality in the mines enough to prevent miners from inhaling the coal dust that inflames, stiffens and blackens their lungs. In fact, the incidence of this deadly and incurable disease is rising. Bear this in mind the next time President Donald Trump says coal is “clean” or “beautiful,” and moves to encourage use of the world’s dirtiest fuel. (9/25)

As part of the National Science Foundation’s effort to prevent gender violence in science, its director, France A. Córdova, recently announced new terms and conditions for reporting gender violence to the organization. It is the kind of clear and bold approach that the National Institutes of Health should be taking. Instead, the NIH is sticking with its weak “guidance” on anti-sexual harassment, shirking its responsibility and placing the burden for action on survivors, though it did launch a new website on the topic. (Kelsey Priest and Caroline King, 9/28)

For all its prominence in public health, there’s little real understanding of overeating, being overweight, and how these things connect to each other and to illness. Last week, a widely circulated piece in the Huffington Post stated the obvious — “Smoking is a behavior, being fat is not” — which apparently needed to be pointed out because these factors so often appear together as the primary reasons to blame people for the high cost of health care. (Faye Flam, 9/27)

Since America is currently incapable of agreeing to sensible gun control, let’s get behind the one thing everyone might be able to agree upon: a zero-tolerance approach to any crime involving a gun, including mandatory prison any time a firearm is used threateningly. For years, our city has logged near or more than 200 homicides annually. With just over 300,000 residents, St. Louis ranks near the top nationally for homicide rates. The overwhelming majority are shootings. ...This newspaper has long argued for tighter gun restrictions as part of the answer. The current political environment makes that a hard sell. But creating tougher penalties on all gun-related crimes should be an easier one. (9/27)

Last fall, our state came together to support health care for people like me who were struggling to afford it. ...Maine made history with the first ballot question to expand Medicaid. We made a clear statement that was heard across the country: We want more health care, not less. We want politicians to stop trying to dismantle access to quality, affordable health care. But one man refused to hear the voices of Maine voters, and has been purposefully undermining us ever since by refusing to roll out the health care law voters passed. (Kathy Stewart, 9/27)

On Sept. 5, Tennessee Attorney General Herbert Slatery, along with 19 other state AGs, filed a lawsuit against the U.S. Department of Health and Human Services .If successful, this suit will render the Affordable Care Act unconstitutional, which would have dramatic effects on the health of millions of Tennesseans, whether they support the ACA or not. (Carol Paris, 9/27)

Government officials can face difficult decisions. Here’s one that isn’t: choosing to give unlimited paid sick leave to public workers made ill by their service after the Sept. 11 attacks. Yet thousands of state and local government employees in New York who were exposed to the toxic dust from the attacks are not getting that benefit, even after the state passed a law last year meant to guarantee it to many of them. (9/27)