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Sen. Kamala Harris on Monday unveiled a plan to achieve universal coverage by growing Medicare with the help of private insurers, an effort that splits the difference with her chief Democratic presidential rivals and finally equips the California Democrat with her own signature health proposal ahead of this week’s debates. “Medicare works,” Harris writes in a Medium essay posted Monday morning. “Now, let’s expand it to all Americans and give everyone access to comprehensive health care.” (Diamond and Cadelago, 7/29)

Instead of completely replacing private coverage with a government-run, single-payer system based on traditional Medicare, Ms. Harris would allow people to choose plans modeled on Medicare Advantage, which would be run not by the government but by private insurers. More than one-third of the Medicare population already chooses Medicare Advantage, which offers extra benefits and limits out-of-pocket costs but is strict about which doctors and hospitals enrollees can use. Her plan would also allow people to choose a somewhat expanded version of traditional, government-run Medicare. But by preserving a major role for private insurers — and calling for a 10-year phase-in period instead of the four-year transition that Mr. Sanders envisions — it could go a long way toward neutralizing fierce opposition from insurance companies, many of which have profited handsomely from Medicare Advantage plans. (Goodnough and Herndon, 7/29)

Those insurers will have to “adhere to strict Medicare requirements on costs and benefits,” Harris writes in a post on the web site Medium published Monday. It is, she says, similar to today’s private Medicare plans, also known as Medicare Advantage, which covers about a third of seniors on Medicare today. “Unlike the current system, private plans in the new Medicare system will be held to stricter consumer protection standards than they are today, such as getting reimbursed less than what the Medicare plan will cost to operate, to ensure that they are delivering meaningful value,” Harris writes. (Cadei, 7/29)

The plan also calls for an audit of prescription drug costs. Harris wants a 10-year phase-in period as opposed to Sanders' plan, which called for a four-year transition. Her plan would automatically enroll newborns and those uninsured. The Harris campaign said that extending the transition period would decrease the overall cost of Medicare for All, but it did not specify what that new estimated cost would be. Sanders estimates that his plan could cost up to $40 trillion over a decade. (Ramirez, 7/29)

Harris would have a 10-year transition, and both would allow a public option, where Americans below age 65 could buy into the government's Medicare program, in the first year. This comes with costs and benefits — on the one hand, it's a more extended time to make a big transition in how America does health care. On the other hand, a 10-year phase-in window necessarily means counting on the transition to continue smoothly under the next president — whichever party he or she might come from. (Kurtzleben, 7/29)

"We will allow private insurers to offer Medicare plans as part of this system that adhere to strict Medicare requirements on costs and benefits," writes Harris. "Medicare will set the rules of the road for these plans, including price and quality, and private insurance companies will play by those rules, not the other way around." But this means she would still jettison employer-sponsored health plans, which now cover more than 150 million Americans. (Lah, Luhby and Krieg, 7/29)

The balancing act could also open Harris up to criticism from the left and right. Forceful single-payer advocates such as Sen. Bernie Sanders are averse to participation from corporate health insurers, while moderates like former Vice President Joe Biden have warned that Medicare for all would be too disruptive, particularly for the many Americans who get healthcare through their employers. (Mason, 7/29)

Ms. Harris, who has been criticized by some more progressive members of her party for her lack of clarity on her support for Medicare for All, released the plan a day before the start of the second round of Democratic presidential debates, where health care is expected to be a key topic. In the last debate series in June, Ms. Harris raised her hand when candidates were asked if they would abolish private health insurance, but she said the next day she had misunderstood the question. (Armour and Parti, 7/29)

Sanders has said as recently as this month that the sweeping overhaul of the U.S. health system he envisions could cost up to $40 trillion over a decade, and he has said that one option for paying for it would be a 4% tax hike on families making more than $29,000 each year. Harris said that "hits the middle class too hard," and she is calling for exempting households making less than $100,000 each year from that 4% tax, with "a higher income threshold for middle-class families living in high-cost areas." (Summers, 7/29)

“I would describe the Harris plan as an effort to balance idealism and pragmatism,” said Andy Slavitt, who oversaw health care programs under the Obama administration and provided input to the Harris campaign on the new plan. He said using Medicare Advantage was “a clever approach” to preserving a role for private insurance. (Kapur, 7/29)

Read Kamala Harris' plan on Medium:

In the first congressional hearing held on “Medicare for all” in April, Michael Burgess, a Republican congressman from Texas and a physician, called such a proposal “frightening” because it could limit the treatments available to patients. The debate over Medicare for all has largely focused on access and taxpayer cost, but this raises a question that hasn’t gotten much attention: What treatments would it cover? A good starting place for answers is to look at how traditional Medicare currently handles things. In one sense, there are some important elements that Medicare does not cover — and arguably should. But a little digging into the rules governing treatments also reveals that Medicare allows a lot of low-value care — which it arguably should not. (Frakt and Pearson, 7/29)

Democratic presidential candidates launched their campaigns promising to expand health-care coverage. But in the second set of Democratic debates, front-runners backing Medicare for All will likely have to defend their pledges to take private health insurance away in the process. Sens. Bernie Sanders, Kamala Harris and Elizabeth Warrenmade headlines in the first pair of debates by raising their hands in support of ending private coverage. Other Democratic contenders have criticized that position by saying it goes too far. It is an uncommon stance, even in the global health-care debate: Most countries with government health systems also have private health plans. (Armour, 7/28)

America's much-maligned health care system is covering 9 out of 10 people, a fact that hasn't stopped the 2020 presidential candidates from refighting battles about how to provide coverage, from Bernie Sanders' call for replacing private insurance with a government plan to President Donald Trump's pledge to erase the Affordable Care Act and start over. The politicians are depicting a system in meltdown. The numbers point to a different story, not as dire and more nuanced. (Alonso-Zaldivar, 7/27)

In other 2020 news —

The Democratic presidential contenders have some inconvenient truths to grapple with. It's not easy, for example, to summon foreboding words on the economy — accurately — when the U.S. has been having its longest expansion in history. Health care for all raises questions of costs to average taxpayers that the candidates are loath to confront head on. (7/28)

Joe Biden had just rolled out his health care plan when he made what could be a fateful pledge to a crowd in Iowa: "If you like your health care plan or your employer-based plan, you can keep it." The remark echoed assurances President Barack Obama made repeatedly as he sold the Affordable Care Act, which became known as "Obamcare." But Obama's promise proved an exaggeration, if not a falsehood, and it anchored early GOP attacks on the law as new regulations led private insurers to cancel certain policies, even if they had to offer replacements to consumers. (7/28)

Jay Inslee is running for president as the climate change candidate. But the two-term Washington state governor can credibly claim to have accomplished more than most of his peers on health care, a signature issue in the 2020 campaign. (Goldberg, 7/27)

A coalition of environmental groups wants presidential candidates to treat drinking water as a top policy priority, and is asking them to build out their positions on how to ensure access to safe and affordable water for all Americans. But some politicos are skeptical the issue can compete for voters' attention at a time when much of the conversation is focusing on universal health care, the economy and climate change. (Payne, 7/26)

Bernie Sanders wanted to make a point about a crippling injustice. So he crossed the border. Well, the northern one. On Sunday, he took about a dozen people with diabetes on a bus from Detroit to Windsor to get insulin at a Canadian pharmacy, just minutes from the border. Because of traffic, and multiple stops along the way, it took an hour and 17 minutes to get there and about the same time to get back. But the duration and the mileage were not really the main points. (Ember, 7/28)

Sitting in the back of a chartered bus organized by members of advocacy group Insulin4All, Sanders spoke to families who said they go to great lengths to ration their insulin because of high U.S. costs, often putting their health at risk. "We should be doing what the Canadians do, and that means sitting down with the drug companies and negotiating a price," he said. Democrats seeking to take the White House in 2020 see President Donald Trump as increasingly vulnerable to criticism on healthcare costs, since his administration has failed to push through several initiatives to lower drug prices. (Spalding, 7/28)

Sanders' trip, which began a little more than 48 hours before the second round of Democratic debates, was designed to bring new attention to the hardships facing people with Type I diabetes -- issues, he said again on Sunday, that can be traced directly back to "greedy" pharmaceutical companies and lawmakers who refuse to take on the crisis. By traveling to Canada, which has a single-payer, government-backed health care system, he was also making an implicit case for his "Medicare for All" plan, which would create a similar system in this country. (Krieg, Sullivan and Luhby, 7/28)

It was [Rachel] Lockwood's story, along with a dozen other people with diabetes, that prompted Sanders, as part of his presidential campaign trip to Detroit for Tuesday's debate in Detroit, to charter a bus in Detroit and head to the Olde Walkerville Pharmacy in Canada. The families' stories provided a focal point to Sanders' argument that corporate greed, fueled by political contributions to campaigns, could only be stopped by progressive policies. (Gray, 7/28)

Kathy Sego, whose son, Hunter, suffers from Type I diabetes, addressed the crowd gathered outside the pharmacy. In an emotional testimony, she spoke about the financial stress her family feels to keep her son alive. "[My son] said, "Mom, something's really wrong. Can you please call the pharmacy because I think our insurance isn't right." And I said, "What's wrong honey?", and he said, "Our insulin-- my insulin's almost costing $1,500 dollars." And I said, "Oh, that's right. That's how much we pay a month." (Korte, 7/28)

During an interview with CNN's Jake Tapper, 2020 Democratic presidential candidate Sen. Bernie Sanders doubled down on a comment he made at a fundraiser in Detroit comparing pharmacy executives to murderers. (7/28)

Meanwhile, in other news on diabetes care —

Diabetes patients are increasingly using electronic skin patches and their phones, instead of pricking their fingers, to do the complex job of managing a disease that affects more than 30 million Americans. The transformation in blood-sugar testing suggests how harnessing technology and data may drive improvements for disease management—and profits for manufacturers. Many patients now wear coin-sized skin patches on their arms or abdomens that test for blood-sugar levels automatically, then send the data to a patient’s smartphone or even to a wearable insulin pump that delivers the medicine. (Loftus, 7/29)

President Donald Trump's administration has rejected Utah's planned request for enhanced federal funding for partial expansion of its Medicaid program, state officials said Saturday. A statement released Saturday by Gov. Gary Herbert, Senate President Stuart Adams and House Speaker Brad Wilson, all Republicans, said the White House told Utah officials late Friday that the state's waiver request awaiting formal submission wouldn't be approved. (7/27)

Utah received approval from the Centers for Medicare and Medicaid Services, under the Health and Human Services Department, in March to move forward with a Medicaid expansion to provide access to health insurance for up to 90,000 low-income adults. Under that agreement, the federal government will pay for 70 percent of the expanded program, with the state funding the remaining 30 percent. People have been able to apply for coverage since April 1. Under the Affordable Care Act, the federal government may pay for more than 90 percent of the program, as it does in the more than 30 other states that have expanded Medicaid, and Utah hoped to receive such support. (Abutaleb, 7/26)

The HHS inspector general could soon call on Florida to refund the federal government $436 million in Medicaid funds that were improperly paid to the country’s largest public hospital, according to a draft report obtained by POLITICO. The independent auditor’s office forthcoming report could provide a politically awkward moment for top Florida Republicans closely allied with President Donald Trump. Florida officials warn the state and Jackson Memorial Hospital, which treats tens of thousands of poor patients each year, could face devastating consequences if the state is forced to pay back the money. (Pradhan, 7/26)

Miami-Dade’s public hospital network, Jackson Health System, may have wrongly received hundreds of millions of dollars in Medicaid funds that Florida will have to refund to the federal government, according to a forthcoming audit by the U.S. Department of Health and Human Services cited in a story first reported by POLITICO. A draft of the HHS inspector general audit found that Florida’s Medicaid program between 2010 and 2014 wrongly paid Jackson Health $436 million that was not allowed under the terms of the Low Income Pool or LIP program that reimburses hospitals for care delivered to low-income and uninsured persons, POLITICO reported. (Chang and Koh, 7/26)

North Carolina Democratic Gov. Roy Cooper often got steamrolled by Republicans when they held comfortable legislative majorities during his first two years on the job. They could usually ignore his objections about their conservative agenda and override his vetoes. That's changed since the 2018 elections, when enough Democrats got elected to end the GOP's veto-proof control. Cooper raised millions of dollars for Democratic legislative campaigns, and a court ordered districts to be redrawn in the closely-divided state, aiding Democrats. (7/27)

Health clinics that quit the federal family planning program over new Trump administration anti-abortion rules may have to destroy or return tens of thousands of dollars of contraceptives and other medications. Federal health officials confirmed to POLITICO that clinics might need to get rid of drugs, intrauterine devices and other treatments they bought at a discount while part of the Title X program, a long-standing requirement that's catching some providers by surprise as they weigh whether to comply with new rules that, among other things, forbid abortion referrals. (Roubein and Ollstein, 7/26)

In other women's health news —

The National Institutes of Health issued instructions on Friday for how scientists seeking grants for research using fetal tissue must comply with recent Trump administration restrictions on federal funding of such studies. The new requirements triggered an immediate outcry from leaders in the field. In a notice spelling out the rule changes, NIH says that all grant applications and renewals for research relying on tissue collected from elective abortions must provide a detailed justification, documenting why no alternative methods could accomplish the same research goals. (Goldstein, 7/26)

At critical moments, disconnects between liberals and moderates on both policy and style have exploded into public view, and Mr. Trump has diverted attention from key Democratic victories at almost every turn. A vote on a meticulously negotiated agreement among Democrats on legislation to raise the minimum wage was overshadowed this month after Mr. Trump made an incendiary attack on four freshman congresswomen of color; House Democrats spent the first half of their week debating and passing a resolution to condemn his comments as racist. “He knows exactly how to distract us, and we take the bait — we take the bait every time,” said Representative Elissa Slotkin, Democrat of Michigan, another first-term lawmaker from a Trump district. “And then I go home and people say, ‘How come your party isn’t helping me with the cost of inhalers or EpiPens, or health care in general?’ And we do care about those things; it’s just not what makes sexy headlines.” (Hirschfeld Davis, 7/28)

Two lawmakers have banded together to whip members of a U.S. House of Representatives health panel to vote on an alternative policy to ban "surprise" medical bills. The effort by Reps. Donna Shalala (D-Fla.) and Phil Roe (R-Tenn.) within the House Committee on Education and Labor focuses on a bill more generous to physicians and hospitals than legislation already approved by the House Energy and Commerce Committee. The move could further tangle the already contentious debate over how the feds should end the practice of balance billing. The issue of "surprise" medical bills is often instigated by specialty physician groups that contract with hospitals without joining their insurance networks. (Luthi, 7/26)

The Senate on Thursday passed a two-month extension of a Medicaid demonstration enabling innovative mental health centers in eight states to offer broad, coordinated services for serious mental illness and substance use disorders. Advocates hope the House will approve the temporary funding measure next week as a routine, consent calendar item. The Senate bill, sponsored by Sen. Roy Blunt (R-Mo.), would provide about $60 million to the program through Sept. 13. It previously was delayed by holds by Republican senators. Two-year funding for the $1 billion certified community behavioral health clinic (CCBHC) ended on July 14. (Meyer, 7/26)

States have led the way in pushing Congress to lighten up about marijuana and other products that come from the cannabis plant. That’s because they see the potential for new industries benefiting their residents, and new tax revenue. But now that Congress is helping, it turns out the states will need a lot of help from Washington regulators to make sure the products don’t hurt people.Earlier this month, attorneys general from 33 states filed comments with the Food and Drug Administration letting the agency know just how much they would need its help now that Congress has authorized the sale of some cannabis-related products (though not marijuana). (Zeller, 7/29)

Pfizer is near a deal to combine its off-patent drugs division — which includes best-selling treatments like Viagra — with Mylan, the maker of the EpiPen emergency allergy treatment, to create a new giant in the business of drugs without patent protections, two people briefed on the matter said. A deal could be announced as soon as Monday, according to these people, who were not authorized to speak publicly about the confidential discussions. (de la Merced and Thomas, 7/28)

The deal, which hasn’t been completed, could be announced as early as Monday if an agreement is reached, the people said. The companies have discussed a stock deal in which Mylan shareholders would own a little more than 40% of the new entity and Pfizer shareholders the remainder, one of the people said. Pfizer would also receive about $12 billion in proceeds from a new sale of debt, this person said. Mylan’s market value currently stands at just under $10 billion. (Rockoff and Lombardo, 7/29)

Michael Goettler, who runs Pfizer’s off-patent drug unit, would become chief executive of the combined company, and Mylan Chairman Robert Coury would be executive chairman, one of the people said. Current Mylan CEO Heather Bresch would depart. Mylan President Rajiv Malik, who faces civil suits accusing him of taking part in an alleged price-fixing scheme, would ultimately leave the combined company, one of the people said.(Annett and Griffin, 7/27)

Pharmaceutical behemoth Pfizer Inc. has transformed itself under new leadership through a series of spinouts and joint ventures, mitigating risk by placing some units at arm’s length while continuing to reap rewards from them. Chief Executive Officer Albert Bourla, 57, who took the helm in January after serving as the drugmaker’s operations chief, has rapidly transformed the company through a new deal-making strategy. His next major step may come as soon as Monday with a plan to combine Pfizer’s less-lucrative off-patent drug business with Mylan NV to form a generic-drug giant. (Griffin, 7/28)

The U.S. Food and Drug Administration is requiring that health warnings be added to Pfizer Inc. ’s drug Xeljanz, advising patients they could experience a higher risk of blood clots or death with a specific dose. The FDA’s warnings are specifically geared toward patients who take the 10-milligram dose of the medicine, known as tofacitinib, twice a day. The regulatory agency also said it is limiting the use of the treatment for ulcerative colitis so that patients can only take it if they have severe side effects from other medicines or aren’t treated effectively. (Prang, 7/26)

With investor interest in antibiotics dwindling, companies in the sector are crafting survival strategies that include seeking out alternative sources of funding and avoiding reliance on hospitals as customers. (Gormley, 7/26)

Last January, we compiled a list of “burning questions” for a group of the largest and most closely followed biotech companies. Answers to these questions — encompassing financial performance, clinical trial milestones, and regulatory approvals — can make or break a company’s performance during the year. August is almost here, so we figured it was a good opportunity to see how many of this year’s biotech burning questions have been answered, and what lies ahead. (Feuerstein and Garde, 7/29)

Johnson & Johnson wants its day in court to fight a lawsuit intended to force it to put a cancer warning on the company’s Baby Powder. So, it’s urging a judge not to let a law firm that’s been arguing for the warning to suddenly drop the lawsuit. It’s an unusual twist for a defendant not to go along with plaintiffs who want their case dismissed. But it’s being fought because J&J doesn’t want to give the Lanier Law Firm a chance to refile the suit with more defendants. (Pettersson, 7/27)

In other health care industry news —

Tenet Healthcare Corp.’s plan to spin off its revenue-cycle subsidiary could be good news for the future independent company, which will be free to spend money as it wishes. “You’re liberating the spinoff company to redeploy capital in a way that is most aligned with the nature of that subsidiary as opposed to the nature of the parent,” said Brian Brownschidle, executive director with XMS Capital Partners. (Bannow, 7/26)

Livongo and Health Catalyst began trading on the Nasdaq on Thursday, joining a slew of companies to end a nearly three-year drought since the last initial public offering of a digital health company. The two companies joined Phreesia, a healthcare software provider that went public one week earlier on July 18, and Change Healthcare, a revenue cycle management company formed through a series of acquisitions and a merger with McKesson's technology business, which began trading in June. (Cohen, 7/26)

Universal Health Services, the company that has contracted to provide inpatient care for patients now treated at the Milwaukee County Behavioral Health Division’s hospital in Wauwatosa, has reached a tentative agreement with the federal government and various state attorneys general to pay $127 million to settle allegations that some of its hospitals fraudulently billed Medicare and Medicaid. The company won approval this month from the West Allis Common Council to build a $33 million behavioral health hospital at 1706 S. 68th St. The 120-bed hospital is expected to open in 2021. (Boulton, 7/27)

Physicians thinking about prescribing opioid painkillers for women around the time of delivery should think twice, a new study suggests, because some go on to “persistent” opioid use. A report published Friday in JAMA Network Open examined opioid prescriptions among more than 300,000 women who gave birth between 2008 and 2016. Nearly half were given an opioid prescription shortly before or after giving birth. Among the women who filled the prescriptions, about 2% showed signs of “persistent” opioid use, defined as two subsequent refills within one year after the delivery. (Joseph, 7/26)

Two and a half billion pain pills. That's how many opioids were supplied to Tennessee over six years, according to data recently released by The Washington Post. The data from the Drug Enforcement Administration shows the top distributors, manufacturers and pharmacies for pain pills across the nation — a glimpse into the legal but opaque world of opioid prescriptions. One out of every three opioid overdose deaths nationwide involved prescription pain pills in 2017, according to the Centers for Disease Control and Prevention. (Reicher and Hineman, 7/29)

A recent Washington Post analysis of a federal Drug Enforcement Administration database shows nearly 290 million prescription pain pills were supplied to New Hampshire from 2006 to 2012. The national analysis broke down the data by county, revealing that Grafton County had the highest rate of oxycodone and hydrocodone prescriptions in the state, amounting to 38.5 pills per person per year. There were 23.7 million pain pills supplied during that time period, with more than four million pills supplied by Dartmouth-Hitchcock Pharmacy in Lebanon. There were 36 pills per person per year supplied in both Merrimack and Strafford counties in that period, according to the Washington Post. (Wickham, 7/28)

Syringe exchanges, once seen as an answer to the public health crisis of AIDS, are coming under criticism from elected officials in parts of Washington who believe they are making a new public health crisis — opioids — worse. Syringe exchanges were born in Washington in the ’80s. Today, 39 states have them, and the practice has been endorsed by the national Centers for Disease Control and Prevention. In response to the opioid epidemic, hundreds of syringe exchanges have opened across the country in the past two years, according to Dr. Paul LaKosky, who helps run the North American Syringe Exchange Network. (Greenstone, 7/28)

Health officials have hailed the Centers for Disease Control’s preliminary data for 2018 as a rare bit of positive news, with drug-related deaths declining about 5% after reaching a historic high of 72,000 in 2017. It would be the first year-over-year decrease since 1990, before the opioid epidemic ramped up. But even as most states are projected to show decreases when death reports are finalized, Kansas and Missouri are among those that are not. (Marso, 7/29)

It’s estimated that out of every 10 people with a substance use disorder, four to six reach the point where they no longer use drugs in a harmful way, although getting there takes time and often multiple tries. How do they do it? What enables people to get and stay sober? (Freyer, 7/27)

The medics loaded Sgt. Sylvester Cline into an ambulance with the air conditioning running at full blast. It was 4:20 p.m., 20 minutes after he’d been helped off a live-fire training range at Fort Chaffee in Arkansas, where it was 93 degrees and humid. Cline, an Iraq combat veteran, and two other soldiers were being evacuated to a nearby barracks to rehydrate and cool off after nine hours of drills on parched training grounds on that sweltering day in June 2016. Despite a forecast for extreme heat, base safety officers who prepared the daily risk assessment had decided soldiers faced only moderate danger. Later that morning, the temperature had reached 90 Fahrenheit, triggering “black flag” conditions, the military’s signal for a high risk of heat casualties. Commanders were supposed to allow at least 40 minutes rest for each hour of training, but they did not heed the requirement, an Army investigation found. (Hasemyer, 7/23)

In other news —

The father of 1-year-old twins who died Friday after the police said he had left them in a hot car was charged with manslaughter and criminally negligent homicide. The father, Juan Rodriguez, 39, of New City, N.Y., was arrested and charged late on Friday, the police said. He left the children inside a parked silver Honda Accord in the morning in the Bronx and reported for his job at the James J. Peters V.A. Medical Center, officials said. (Schweber and Salcedo, 7/27)

To the strains of the hymn “If We Just Talk of Thoughts and Prayers,” the largest Presbyterian denomination in the United States ordained The Rev. Deanna Hollas as its first minister of gun violence prevention this month. Ms. Hollas is believed to be the first person in the country to be given a national ecclesiastical role of this kind. And the choice of the hymn was a deliberate underlining of what she sees as a desperate need: to do more than react to the latest mass shooting with an offer of benedictions. That, she said, is not sufficient in a country where 40,000 people are killed by guns each year. (Hassan, 7/28)

Three people are dead and at least 15 injured after a shooting Sunday evening at a food festival in Gilroy, Calif., according to police. One gunman was killed by officers at the scene, Gilroy Police Chief Scot Smithee said early Monday morning. Police are still searching for a possible second suspect, although it’s unclear if that person also fired on the crowd or assisted the shooter. “We believe based on witness statements that there was a second individual involved in some way,” Smithee said at a news conference. “We just don’t know in what way.” (Chiu, Siddiqui and Flynn, 7/29)

Police officers stationed at the festival were on the scene within a minute. They returned fire and killed the gunman, said Mr. Smithee. Cheryl Low was working as a vendor in a booth when she spotted the shooter, who appeared to load his weapon and then began firing. “It was just, ‘Bam! Bam! Bam! Bam! Bam!’ just randomly shooting everywhere he could shoot,” she recalled. (Elinson, Frosch and Lazo, 7/29)

Videos from the scene showed people screaming and running across the festival grounds. “Please pray everyone. Random shooters started shooting everywhere,” one person tweeted. “One boy is dead so far and others injured. We’re still waiting while they find them.” “Scariest moments of my life at the Gilroy garlic festival,” another person tweeted. “I hope everyone made it out okay.” (Newberry, Cosgrove, and Winton, 7/28)

Stephen Romero, 6, was killed during the shooting, Gilroy City Councilmember Fred M. Tovar told CNN.Tovar said he was "deeply saddened by the news." "I pray that God will grant his family strength. My most sincere condolences. I will keep your family close in my thoughts and prayers in the coming weeks as you are going through the process of grieving," he said in a statement. (Maxouris and Vercammen, 7/29)

A New York police officer was found dead at his Staten Island home on Saturday after shooting himself in what was the fifth police suicide in the city since June, officials said. Officials did not immediately release the officer’s name, rank or tenure with the department; however, the Sergeants Benevolent Association said on Twitter that it was a sergeant who had died. “Once again terrible news,” the message said. “Tonight the NYPD lost a sergeant to suicide. We ask that everyone pray for his family, friends and Co-workers. The NYPD continues to go through a difficult time.” (Zaveri, 7/27)

"The tragic news today that another member of the NYPD has been lost to suicide breaks our hearts, and is a deep sorrow felt by all of New York City," Police Commissioner James O'Neill said in a statement released late Saturday. "To every member of the NYPD, please know this: it is okay to feel vulnerable. It is okay if you are facing struggles," he said. "And it is okay to seek help from others. You may not know this, and it may be hard to imagine, but you are not out there all by yourself." (Morales and Almasy, 7/28)

On June 5, Deputy Chief Steven Silks, 62, was found dead in a police vehicle in Queens just days away from retirement. About 24 hours later, Detective Joseph Calabrese, 58, was found dead at Brooklyn's Plum Beach. Just a few days later, a 29-year-old officer died outside a precinct on Staten Island. Kevin Preiss, 53, a 24-year veteran of the force, was found dead at his Long Island home at the end of the month. "This is a mental health crisis," O’Neill declared in June after the third death. (Madani, 7/28)

It’s been four years now, but Gloria Benitez remembers that day so vividly. It was March 10, 2015. She had come home from work and went to look for her son Jose. She discovered him dead in his room, a result of suicide.“I tried to help him but I think it was too late,” Benitez. “But the way they treated him, it was not right.” (7/26)

Eight teens were hospitalized in July with seriously damaged lungs in Wisconsin, the state Department of Health Services reported Thursday. "We suspect that these injuries were caused by vaping," said Dr. Michael Gutzeit, chief medical officer at Children's Hospital of Wisconsin where the teens were admitted, at a press conference. Their symptoms, including cough, shortness of breath, and fatigue, worsened over days or weeks before the patients arrived at Children's Hospital. (Scutti, 7/26)

Health officials in Wisconsin said Friday they received six more reports of teens and young adults with lung damage that doctors suspect may be tied to vaping. The reports are being investigated and have not been confirmed, said Jennifer Miller, spokeswoman for the state Department of Health Services. (Rutledge and Spicuzza, 7/26)

Electronic cigarettes and heated tobacco products are not helping fight cancer, the World Health Organization (WHO) said on Friday, urging smokers and governments not to trust claims from cigarette firms about their latest products. The seventh "WHO report on the global tobacco epidemic" said blocking the industry's interference was critical to cutting the harm from tobacco use. (7/26)

Lyme disease is on the rise. The 30,000 cases reported annually to the Centers for Disease Control and Prevention by state health departments represent only a fraction of the cases diagnosed and treated around the country. About half the cases occur in people under the age of 21, and boys from 5 to 9 years old are the most commonly affected group, possibly because they spend a good deal of time outdoors. (Klass, 7/29)

What’s a concentration camp — and, more importantly, who owns the term? U.S. Rep. Alexandria Ocasio-Cortez (D-N.Y.) ignited a national debate last month when she compared the government-run facilities packed with migrant detainees near the U.S.-Mexico border to Nazi “concentration camps.” Many Republicans have pushed back in recent weeks, including Stephen Miller, a senior advisor to President Trump, who said that the comments outraged him “as a Jew.” (Watanabe, 7/26)

When Beryl Cummings asked her first-ever question in the auditorium at a genetics conference, she chose a topic she knew a lot about, formulated her question as meticulously as she could, and addressed her query to a female presenter. In science, questions matter a lot, said Cummings, who was then working on her doctorate in computational genomics at Harvard. But as a young female scientist speaking up in a public forum, she said, the stakes just felt a little higher. (Healy, 7/26)

My son Erik, then 23, was playing basketball when an opponent stepped on his foot and the anterior cruciate ligament in his right knee ruptured with an audible pop. This critically important ligament, best known as the A.C.L., is a ropelike structure that connects the femur (thigh bone) to the tibia (shin bone), stabilizing the knee joint. A torn A.C.L. is an all-too-common injury that typically results in complex surgery and prolonged rehabilitation. (Brody, 7/29)

Kaiser Health News: New Protocol For HIV Prevention Drug Reduces The Number Of Pills Required
Health officials and AIDS advocates in San Francisco hope to expand the use of an effective HIV prevention drug with a new approach that requires fewer pills than the standard once-a-day regimen. San Francisco’s public health department and the San Francisco AIDS Foundation have long promoted what is known as preexposure prophylaxis, or PrEP, for those at high risk of contracting HIV. With regular PrEP, the daily pill is taken indefinitely. But both organizations now endorse a strategy that requires taking just four pills timed to a specific sexual encounter — two within two to 24 hours before sex and one on each of the two following days. (Tuller, 7/29)

Victoria Gray is waiting patiently in a hospital room at the Sarah Cannon Research Institute in Nashville. "It's a good time to get healed," she says. The 34-year-old from Forest, Miss., has struggled with sickle cell disease throughout her life. Gray is at the hospital because she volunteered for one of the most anticipated medical experiments in decades: the first attempt to use the gene-editing technique CRISPR to treat a genetic disorder in the U.S. (Stein, 7/29)

Premenstrual food cravings are the punchline of endless jokes. Like most good jokes, they’re funny because they’re true. Certain parts of a woman’s menstrual cycle do seem to go hand in hand with the desire for chocolate ice cream and potato chips. I hear about this every day from my OB/GYN patients. Researchers have studied food cravings for years; one of the most cited studies dates back to 1953. Scientists — and lots of others — want to know who has food cravings and why, what they crave, when they crave it and how to minimize the cravings. (Twogood, 7/28)

Kaiser Health News: Creator Of Brain Exam That Trump Aced Demands New Training For Testers
Last year, Dr. Ronny Jackson, then the White House physician, gave Donald Trump a standard test to detect early signs of dementia — and said the president had scored a perfect 30. “There is no indication whatsoever that he has any cognitive issues,” Jackson said at the time in front of TV cameras. Trump’s team embraced the result, with Donald Jr. boasting on Twitter: “More #winning.” The publicity sparked a wave of interest in the screening tool. Much was written about what the test showed — or didn’t — about the president’s mental acuity. A media outlet even posted its questions online, suggesting readers could measure whether they were “fit to be U.S. president.” (Aleccia, 7/29)

[Dan] Adler’s story is an example of why the American Cancer Society now recommends that most people — those who are at average risk for colorectal cancer — start screenings at age 45. The new guidelines, announced in 2018, set an age that’s five years younger than the previous recommendation. The age was lowered in an attempt to reverse a trend that’s seen a rise colorectal cancer rates in men and women under 50, said Dr. James Church, colorectal surgeon at the Cleveland Clinic. (Washington, 7/28)

Anne Hathaway, who announced this week she was expecting her second child, says she came forward about her struggles with getting pregnant because infertility can be deeply isolating. “I think that we have a very one-size-fits-all approach to getting pregnant,” Hathaway told The Associated Press on Saturday. “And you get pregnant and for the majority of cases, this is a really happy time. But a lot of people who are trying to get pregnant: That’s not really the story. Or that’s one part of the story. And the steps that lead up to that part of the story are really painful and very isolating and full of self-doubt. And I went through that.” (Lennox, 7/28)

Recent research supports the reluctance of educational experts and parents to place electronic readers within reach of very young children. The most recent study to scrutinize the emerging trend of e-readers for young audiences was published in the American Academy of Pediatrics’ (AAP) journal Pediatrics. The study, which analyzed interactions of 37 parent–toddler pairs while reading together electronic versus print books, found that parents and toddlers verbalized and collaborated less when parents read stories from e-readers than from the pages of a book. (Heubeck, 7/28)

Kaiser Health News: Doctor Alexa Will See You Now: Is Amazon Primed To Come To Your Rescue?
Now that it’s upending the way you play music, cook, shop, hear the news and check the weather, the friendly voice emanating from your Amazon Alexa-enabled smart speaker is poised to wriggle its way into all things health care. Amazon has big ambitions for its devices. It thinks Alexa, the virtual assistant inside them, could help doctors diagnose mental illness, autism, concussions and Parkinson’s disease. It even hopes Alexa will detect when you’re having a heart attack. At present, Alexa can perform a handful of health care-related tasks: “She” can track blood glucose levels, describe symptoms, access post-surgical care instructions, monitor home prescription deliveries and make same-day appointments at the nearest urgent care center. (Rae-Dupree, 7/29)

Kathy Hipsher was having a horrible year. She spent months battling a vicious stomach virus, followed by lingering nausea and pain that left her subsisting on a bland diet consisting largely of Cream of Wheat and applesauce. Her gut problems were accompanied by days of fatigue so extreme that at times she could barely drag herself up the stairs of her Bellevue, Idaho, home. In October 2016, just as Hipsher was recovering, the 45-year-old sign-language interpreter and Grand Canyon river guide suddenly confronted a new and alarming symptom: visible blood in her urine. (Boodman, 7/27)

Concerns about burnout among doctors are growing as new research is beginning to quantify the dangers and costs of the problem. In the past few years, researchers have found that 54 percent of doctors report feeling burned out. Doctors experiencing burnout are twice as likely to log major medical errors. The suicide rate among physicians is twice that of the general population and one of the highest among all professions. (Wan, 7/26)

Altovise Ewing was a senior at Rhodes College in Memphis, Tenn., when she first learned what a genetic counselor was. Although she had a strong interest in research, she suspected working in a lab wasn't for her — not enough social interaction. Then, when a genetic counselor came to her class as a guest lecturer, Ewing had what she recalls as a "lightbulb moment." Genetic counseling, she realized, would allow her to be immersed in the science but also interact with patients. And maybe, she thought, she'd be able to help address racial health disparities, too. (Stallings, 7/27)

Researchers across the country have been investigating why this happens and how to bring health equity to children, regardless of skin color, religion, gender, orientation or other factors tied to disparities in outcomes. What they’ve found is this: Most of the time, health-care providers have no intention of treating a patient differently, but sometimes they do.Why? Implicit bias. (Roth, 7/28)

Little heralds the arrival of summer like the smell of open water, smokey grills and sunscreen. Since the late 1970s, as medical researchers linked sun exposure to skin cancer, Americans have been told to dutifully slather, spray and rub on sunscreen as part of a broader package of sun protection. But does it make sense for me, a dark-skinned black woman, to wear it? With record-breaking heat this summer, it’s an especially relevant question, and you might even expect the answer to be “absolutely.” It’s more complicated than that. (Pierre-Louis, 7/26)

The two brothers sat a few houses apart, each tending to his own anger. Justice is slow in Alaska villages, they have learned. Sometimes it never arrives. Chuck Lockwood, 69, grew up in this Yup’ik Eskimo village of 400 along the Norton Sound coast but left as a child for boarding school. His rage is fresh. Two years ago this month, the body of his 19-year-old granddaughter, Chynelle “Pretty” Lockwood, was found on a local beach. (Hopkins, 7/26)

Shannon Wood, a disease intervention specialist for the Iowa Department of Public Health, often sends such messages via Facebook and other online services people use to meet each other. Her job is to discreetly warn Iowans who have been exposed to sexually transmitted diseases, such as gonorrhea or chlamydia, which have been surging in Iowa and across the country. Wood and other public-health detectives start by interviewing patients who have tested positive for the bacteria or viruses that cause sexually transmitted diseases. The officials then search for the patients’ past sex partners, so they can encourage those partners to seek testing and treatment to keep the infections from spreading. (Leys, 7/28)

Chances are, most Oregonians have never met a Native American doctor -- even if they live on a reservation or an urban center with a high concentration of Native people. Less than half a percent of Oregon’s 11,000 physicians identify as American Indians or Alaska Natives. ...The number of Native Americans in medical schools has steadily declined over the last three decades, with only 39 in the entire U.S. last year out of more than 21,600. In 1980, that number was 60. It is a crisis that few have tried to solve. Native people face a complex and intertwined set of obstacles to get into medical school the traditional way -- high rates of poverty, cultural clashes and few models of how it can be done. (Harbarger, 7/28)

A judge on Friday let stand Michigan's toughest-in the-nation drinking water regulations that were created after the Flint crisis, dismissing a lawsuit that was brought by major Detroit-area water systems over concerns such as the cost of having to replace hundreds of thousands of underground lead pipes. State Court of Claims Judge Christopher Murray said the rules, which former Gov. Rick Snyder's administration finalized more than a year ago, are procedurally, substantively and constitutionally valid. (7/26)

Child welfare advocates marched in front of the State House on Saturday to point out what they called flaws in New Hampshire’s Division for Children, Youth and Families. The event was hosted by New Road Project, a non-profit aiming to reform the state’s child protection system. Adults and kids walked down the streets of Concord, holding pinwheels, a symbol of childhood, and handmade signs. Organizers chanted “support improvements for DCYF" and "save New Hampshire's greatest resource: our children and families." (Willa Ernst, 7/29)

A big bump in funding for crisis pregnancy centers in Ohio’s new state budget is fueling a fight around the controversial facilities that supporters say help needy women while critics decry them as “fake health clinics” meant to steer women away from abortions. The final budget sets aside $7.5 million over the next two years for the Ohio Parenting and Pregnancy Program, which funds several crisis pregnancy centers throughout the state. (Deeter and Rouan, 7/26)

Illinois Gov. JB Pritzker (D) signed legislation requiring every single-occupancy bathroom in public buildings in the state to be labeled gender neutral. Under Senate Bill 556, also dubbed the “The Equitable Restrooms Act,” all single-occupancy restrooms “in a place of public accommodation or public building shall be identified as all-gender and designated for use by no more than one person at a time or for family or assisted use,” the law states. (Folley, 7/27)

Dr. Jennifer Keller’s last performance review at the White River Junction Veterans Affairs Medical Center described a star anesthetist. ...But if that strong appraisal represented a pinnacle of Keller’s eight years at the VA, the last 13 months have represented a professional nadir, one involving a tangle of conflicting allegations of assault, medical negligence, and whistle-blower retaliation that has reverberated to the upper levels of the federal agency. (MacQuarrie, 7/28)

The Florida panel that regulates medical doctors will begin putting in place rules next week that are designed to make the state’s new telehealth law a reality. But physicians who serve on the Florida Board of Medicine will have no say over one of the most-contentious parts of the law: registration costs for out-of-state doctors who can use telehealth to begin caring for Florida residents. (Sexton, 7/26)

The St. Louis Department of Health and Division of Corrections are vaccinating 800 people at the city’s two jails to prevent a national hepatitis A outbreak from spreading among inmates. Since 2016, more than 22,000 people have caught the highly contagious liver virus, which can cause nausea and jaundice and require long periods of hospitalization. Inmates are among the most at risk of contracting the disease, St. Louis Health Department Director Fred Echols said. (Fentem, 7/28)

A new federal grant could help end the spread of hepatitis B virus in Sacramento County.The $500,000 grant from the U.S. Department of Health and Human Services Office of Minority Health will help health care service providers screen patients, primarily pregnant women, as well as Asian Americans, the population found to have the highest percentage of diagnosed cases for hepatitis B. Regardless of race or ethnicity, providers would vaccinate those who are not infected and link individuals at risk to care. (Yu, 7/27)

Atlanta Mayor Keisha Lance Bottoms recently announced the appointment of Dr. Angelica Geter Fugerson to serve as the first-ever Chief Health Officer for the city of Atlanta, according to a press release. Dr. Fugerson is a 15-year health expert with experience working at the federal, state, and local levels. Her research and program experience have focused on HIV/AIDS and public health services as well as equity and health disparities in the Southern United States. (Miller, 7/26)

[Ileana] Brenes is one of hundreds of patients who have been sued by Bayfront Health St. Petersburg in recent years as the hospital evolved from a nonprofit institution to a for-profit arm of a national chain. The number of patients sued individually in Pinellas County civil and small claims court has risen from about 500 in 2015 to more than 730 so far this year, putting the hospital on pace to double that number by the end of 2019, a Tampa Bay Times analysis shows. The increase represents a stark change from past practice. In 2012, when Bayfront was still a non-profit, the hospital filed hundreds of small claims cases against patients' insurance companies, not the patients themselves. That continued in 2013 and 2014 as the hospital quickly changed hands to one corporate chain, then another. (Griffin, 7/29)

An increasing number of Minnesotans covered by Blue Cross health plans are finding that their scans and medical procedures are being denied, even though their doctor said the care is needed and would be in the Blue Cross network. The increasing trend is intentional. Dr. Craig Samitt, the company’s CEO, told the Star Tribune that Blue Cross is taking bold action to force change in a health care system that is unsustainably expensive. (Carlson, 7/27)

Maryland health officials are investigating a spike this year in the number of reported cases of Cyclospora, a microscopic parasite that causes intestinal infection. The Maryland Department of Health said in a statement Thursday that there have been 42 lab-confirmed cases in the state this year, 37 of which were reported in the last two weeks. (Reed, 7/26)

According to the CDC, the annual number of new HIV diagnoses has remained relatively stable at about 40,000 in recent years. Yet, within some demographics, those numbers are on the rise. About one in seven people still aren’t aware they have HIV, close to 50% are not engaged in care, and less than 50% are virally suppressed.The urgency of HIV/AIDS is ever-present. (Claire Sterk, 7/27)

Just this week, another patient came to see me for the last time because her employer’s health insurance plan was changing to one that my practice doesn’t accept. I have known this patient for several years and have followed her through two births, a bout of depression, a divorce and remarriage, two episodes of flu and one of pneumonia, and an ongoing struggle to keep her cholesterol down. She has always been polite and appreciative through all this care. I am sad to see her go. She wanted to stay, too, and tried to change her insurance plan to one I accept but was ultimately not successful. (Marc Siegel, 7/29)

A very small group of patients with major illnesses is responsible for an outsized share of health care spending, and new data show that prescription drugs are a big part of the reason their bills are so high. The big picture: Among people who get their coverage from a large employer, just 1.3% of employees were responsible for almost 20% of overall health spending, averaging a whopping $88,000 per year. Between the lines: “Persistently high spenders” are people who have accumulated big health care bills for at least 3 consecutive years. (Drew Altman, 29)

The antidepressant Prozac came on the market in 1986; coincidentally, it was the year I was born. By the time I saw my first psychiatrist, as an early-2000s teenager, another half-dozen antidepressants belonging to the same class of drugs, selective serotonin reuptake inhibitors, or S.S.R.I.s, had joined it on the market — and in the public consciousness. The despondent cartoon blob from a memorable series of TV ads for the S.S.R.I. drug Zoloft became a near-instant piece of pop culture iconography after its May 2001 debut. (Kelli Maria Korducki, 7/27)

I am not prone to shedding tears or being overly emotional. I prefer to use my innate sarcasm and wit instead of crying when emotion hits harder than I expect. But when I read Dr. Leana Wen’s tweet about being shoved out of Planned Parenthood, where she served as president, I cried. Tears seemed like an appropriate response as I stood in solidarity with Wen. I was reminded of my own loss of security and friendships when I left Planned Parenthood 10 years ago. (Abby Johnson, 7/28)

You might think that since President Trump opposes abortion, he’d want to help young women get birth control to avoid unwanted pregnancy. You might think that someone who claims to be “pro-life” would want to help young men and women get cancer screenings and treatment for sexually transmitted infections. (Nicholas Kristof, 7/27)

Over my 54 years, I’ve pinned my hopes on my parents, my teachers, my romantic partners, God. I’m pinning them now on a shrub. It’s called mastic, it grows in particular abundance on the Greek island of Chios and its resin — the goo exuded when its bark is gashed — has been reputed for millenniums to have powerful curative properties. Ancient Greeks chewed it for oral hygiene. Some biblical scholars think the phrase “balm of Gilead” refers to it. (Frank Bruni, 7/26)

Food stamps are a lifeline for about one in nine Massachusetts residents. This isn’t filet mignon money: The subsidies work out to about $1.38 per meal per person, according an analysis by the Center on Budget and Policy Priorities. If the new rules go into effect, the state estimates that about 90,000 residents will be affected. (7/25)

As a nation we should all want to get more people off food stamps — not by shrinking the eligibility requirements or tinkering with the poverty index, which the Trump administration is also trying to do, but by supporting policies that help families boost their earnings. ...It could be done through long-overdue adjustments to the minimum wage. But it won’t be accomplished by telling hungry people they’re just not destitute enough. (7/26)

No corner of San Francisco is free from the sight of sprawled bodies, makeshift camps, or tin cup panhandlers. Homelessness is a shared worry, and that should be a starting point for serious work. This week The Chronicle will explore the changes, both positive and negative, in life on the streets. The series will offer a close look at the mix of people mired in homelessness, answer questions on the topic and offer ways for readers to help. (7/27)

With rising housing costs, fewer pensions, and a fraying safety net, many older adults are one crisis away from losing the roof over their head. This is particularly true for black Americans, who are at three to four times the risk of homelessness nationally. In San Francisco, the disparity is worse: while fewer than 6% of San Franciscans are black, 37% of those who experience homelessness are. (Margot Kushel and Kevin Prindiville, 7/28)