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The quality of the evidence supporting the Dietary Guidelines for Americans, the influential nutritional advice from the federal government, came under steady attack at a Congressional hearing Wednesday, with representatives complaining that the credibility of the national advice has been eroded by shifts in science. Salt? Saturated fat? Eggs? Meat? Opinions about each of these were aired as members of Congress directed their skepticism at the two cabinet secretaries who oversee the development of the nutritional guidelines, Health and Human Services Secretary Sylvia Burwell and Agriculture Secretary Tom Vilsack. (Whoriskey, 10/7)

Federal officials said they won’t consider food products’ impact on the environment as they prepare new U.S. dietary guidelines, rejecting a proposal by a government advisory panel. The decision by Agriculture Secretary Tom Vilsack and Secretary of Health and Human Services Sylvia Burwell marks a victory for the U.S. meat industry, which pushed back against the February recommendation by a committee of nutrition experts recruited by the Obama administration. (Gee, 10/7)

Lawmakers on Wednesday asked federal officials whether Americans should trust the government’s dietary guidelines, which inform everything from school lunches to advice from a doctor. Health and Human Services Secretary Sylvia Burwell and Agriculture Secretary Tom Vilsack defended the guidelines before the House Agriculture Committee, pointing out that the latest guidelines haven’t even been written yet. They are released every five years and the 2015 version is due by the end of this year. (Jalonick, 10/7)

Amid a national conversation about high rates of diabetes, obesity and heart disease, uncertainty over what to eat has unnerved many Americans trying to sift through marketing and dieting trends. The latest tussle over the next edition of the government’s nutrition guidelines may not help much. Federal officials and experts are drawing up the 2015 Dietary Guidelines, a series of recommendations updated every five years that will be released in December. ... A congressional committee veered on Wednesday from health to politics, highlighting worries that what ends up on American tables could be affected by special interest groups, environmental concerns and private sector bias as much as by science. (Hauser, 10/7)

President Barack Obama has signed legislation aimed at preventing premium increases that some smaller businesses were expecting next year under his signature health care law. The White House says Obama signed the bill into law Wednesday. It represents an uncommon instance in which both parties rallied behind an effort to revamp part of the Affordable Care Act. (10/7)

With more of the cost burden shifting to you, the consumer, it is imperative that you take control of your health care decisions. Start by figuring out what each plan covers, how much it costs (premiums plus out of pocket costs for deductibles, coinsurance and copays) and whether your preferred doctors are in the network. The most widely used plans are health maintenance organizations (HMOs) and preferred provider organizations (PPOs). In an HMO, you select a primary care physician, who directs your health care decisions and makes any necessary referrals. In most cases, the plan will not cover care outside the network. A PPO provides more flexibility, because you can see any health care professional without a referral, either inside or outside of your network. The enhanced choice comes with a heftier price tag. ( Schlesinger, 10/7)

Republican presidential candidate Donald Trump filled an iconic Waterloo ballroom with more than 12 hundred supporters. The crowd at the Electric Park Ballroom repeatedly chanted "USA" and "Trump, Trump, Trump". The GOP front runner got some of the loudest applause when he talked about repealing the Affordable Care Act, or "Obamacare". (Blank, 10/7)

Ending Medicaid expansion in Arkansas could have a “substantial cost” for the state, according to a consultant’s report. Representatives of The Stephen Group appeared Wednesday before the state Health Reform Legislative Task Force to discuss a report the panel hired them to produce containing recommendations on reforming health care. The task force is charged with recommending a model that could replace Arkansas’ Medicaid expansion program, known as the private option, which uses federal Medicaid money to subsidize private health insurance for Arkansans earning up to 138 percent of the federal poverty level and is slated to end on Dec. 31, 2016. If Arkansas continues with some form of Medicaid expansion in 2017, it will begin paying a share of the cost that will increase gradually to 10 percent by 2021. (Lyon, 10/8)

Consultants hired by Arkansas legislators to review the state's "private option" Medicaid plan recommended Wednesday that the program continue but suggested changes that would move participants into jobs and ensure they are leading healthy lives. Under its own approach to the federal Affordable Care Act, Arkansas uses federal money to help buy private insurance for poorer residents. (Kissel, 10/7)

Low-income Utahns pleaded with lawmakers Tuesday to pass legislation that they said could enable them to get urgent treatment for illnesses, but the proposal met with a barrage of criticism from doctors and other health providers who said taxing them to pay for the health care is unfair and damaging. Members of the Health Reform Task Force heard hours of testimony about the recently unveiled Utah Access Plus proposal, the first and perhaps only hearing on the plan hammered out in months of negotiations between Gov. Gary Herbert and legislative leaders. The message was mixed. (Gehrke, 10/7)

A coalition of health representatives and state and tribal officials established by Gov. Dennis Daugaard to explore the possibility of expanding Medicaid in South Dakota is first focusing on how to free up enough funds to pay for the state's share. The Health Care Solutions Coalition met for the first time Wednesday in Fort Pierre. The Daugaard administration has broadly outlined to federal officials a proposal to expand the health coverage program for low-income and disabled people and the federal government is taking the ideas seriously, said Kim Malsam-Rysdon, a senior adviser to the governor. (Nord, 10/7)

Former Kansas Gov. and U.S. Health and Human Services Secretary Kathleen Sebelius returned to the Midwest on Wednesday to chime in on growing debates in Kansas and Missouri over whether those states should expand their Medicaid programs, as allowed under the federal Affordable Care Act. “In Kansas, a hospital just closed,” Sebelius said, referring to the pending closure of a community hospital in Independence, in southeast Kansas. “The CEO of that hospital said there were a number of financial pressures, as there are in a lot of small towns, but he particularly identified the failure of the Kansas Legislature to push forward the Medicaid expansion as one of the significant cost issues that they just couldn’t balance anymore,” she said. (Hancock, 10/7)

Health care has been a hot-button policy issue for years in the Florida Legislature, and it’s starting to look like the session scheduled to start on Jan. 12 will be no different. Battles over Medicaid expansion and payments to hospitals treating low-income patients were so bitter in the spring, it brought the Legislature to a halt. (Shedden, 10/7)

The average small business in Minnesota should see a relatively small increase in health insurance premiums next year, as rates in the market continue to be more stable than for people who buy individual policies. Last week, the state Department of Commerce released data on premium rates for 2016, including average jumps of about 41 percent in the individual market. But for “small groups” that provide health insurance coverage to between two and 50 people, the average rate of increase next year will be 1.29 percent, after factoring market share projections among different insurers, Commerce said. (Snowbeck, 10/7)

U.S. oncologists, aware that patients are paying more of the costs of expensive cancer drugs, are increasingly declining to prescribe medicines that have scant or no effect, even as a last resort. At least half a dozen drugs, including colon cancer treatments Cyramza, from Eli Lilly & Co, and Stivarga, sold by Bayer AG, aren't worth prices that can exceed $100,000 a year, top cancer specialists said in interviews with Reuters. If specialists do start considering a drug's cost in their prescribing habits, such decisions could dent the multibillion-dollar cancer drug business of companies from Roche Holding AG to Celgene Corp. Worldwide spending on cancer medicines reached $100 billion in 2014, a year-over-year jump of more than 10 percent. (Beasley, 10/8)

Walmart Stores Inc. this Saturday afternoon, Oct. 10, is holding what it calls "America's Biggest Health Fair" at more than 4,400 stores nationwide, with free blood pressure, blood glucose, and vision screenings, as part of a larger effort to brand itself as a health and wellness destination. ... Walmart predicts it will set record-breaking numbers for the number of screenings and immunizations that will take place during the one-day event, including estimates that "3,000 people will learn they have diabetes, and 7,000 will learn they have high blood pressure." The world's largest retailer said Tuesday's announcement builds on its previous initiatives to offer commonly prescribed drugs for $4 and make healthcare and healthier food more affordable and accessible. (Cho, 10/7)

A Kentucky pharmacy has agreed to pay $9.25 million to settle allegations that it solicited and received kickbacks from a manufacturer in exchange for promoting a drug with nursing home patients, federal prosecutors announced Wednesday. The settlement with Louisville-based PharMerica Corp. resolves claims that it received kickbacks from Abbott Laboratories in exchange for recommending that physicians prescribe the Abbott-manufactured drug Depakote. The federal government alleged the kickbacks were disguised as rebates, educational grants and other financial support. (10/7)

The price of routine medical procedures can vary wildly from state to state, and even within metropolitan areas, according to a new study. In the Los Angeles metropolitan area, which includes Orange and Riverside counties, the price paid for a mammogram can range from $86 to $954. That means that on average, women in the L.A. area pay about $237 for a mammogram, making L.A. the 19th most expensive city of the 30 surveyed by Castlight Health Inc., a San Francisco-based healthcare information company. (Masunaga, 10/7)

Health-care stocks in the S&P 500 rose 1.5% after a selloff in those shares had snapped the index’s five-day winning streak on Tuesday. The yearslong rally in health-care shares took a turn in August as the broader market pulled back, and fears of legislation targeting drug pricing deepened losses. The sector has fallen 12% from its high for the year, set in July, and has slipped 0.9% for the year. Still, investors note that profits at certain health-care companies likely won’t be dragged down by a slowdown in global growth, an issue in the third-quarter reporting season. (Vaishampayan, 10/7)

U.S. stocks ended stronger after a volatile session on Wednesday, led by a rebound in biotechnology companies that pushed the S&P 500 to its highest level in three weeks. ... The S&P health index, up 1.47 percent, was the biggest gainer. A selloff in healthcare and biotech stocks had weighed on the market on Tuesday. Healthcare was led by Regeneron Pharmaceuticals and Amgen, both up more than 4 percent. Express Scripts said it reached deals to cover two costly new cholesterol drugs produced by the two companies. (Randewich, 10/7)

A government watchdog agency rejected a high-profile whistleblower’s claims that the Food and Drug Administration improperly approved medical imaging devices for breast-cancer and colon-cancer screening. In a report to President Barack Obama made public late Wednesday, the head of the U.S. Office of Special Counsel said the complaints weren't substantiated. Special Counsel Carolyn N. Lerner, whose agency evaluates whistleblower allegations within federal departments, concluded that the investigations by the FDA and its parent agency, the Department of Health and Human Services, “appear to be reasonable.” Those investigations turned up no agency wrongdoing. (Burton, 10/7)

President Obama’s nominee to lead the Food and Drug Administration recently coauthored a series of scientific papers raising concerns about the agency’s oversight of clinical trials but asked that his name be removed before publication, according to other authors. ... The heart of the series is an examination of what are known as pragmatic clinical trials — an increasingly popular type of study that seeks to compare two or more treatments in a real-world setting instead of in a traditional clinical environment. Portions of the papers are critical of the agency and recommend policy changes that would be highly divisive. (Kaplan, 10/7)

VA Secretary Robert McDonald disputed an audit’s conclusions that his department needs a “systemwide reworking,” saying Wednesday that he’s already fixed many of the problems and what he really needs is a bigger budget and more flexibility to move that money around. (Shastry, 10/7)

William Shakespeare's words from more than 400 years ago are proving to be healing for modern-day veterans. A group of Milwaukee-area actors started workshops in which veterans depict conflict-heavy scenes from Shakespeare's plays, aimed at helping the former service members deal with post-traumatic stress disorder, addiction and reintegration issues, and mental health problems. "One of the reasons that the Shakespeare works so well is ... it's this language that just holds big emotion," said actress and project director Nancy Smith-Watson. "It elicits it but it also holds it, the metaphor just enables a lot of emotion to be put on them." (Antlfinger, 10/8)

Experts in violence prevention say that many, if not most, perpetrators of such shootings have intensively researched earlier mass attacks, often expressing admiration for those who carried them out. The publicity that surrounds these killings can have an accelerating effect on other troubled and angry would-be killers who are already heading toward violence, they say. ... The potential for cultural contagion, many experts say, demands a public health response, one focused as much on early detection and preventive measures as on politically charged campaigns for firearm restrictions. But in some cases, efforts to identify and monitor potentially violent people can raise concerns about civil liberties. (Goode and Carey, 10/7)

When the Institute of Medicine came out last month with a report saying almost every American will experience a medical diagnostic error, Leslie Michelson wasn’t surprised. He runs Private Health Management, a Los Angeles based company that – for a substantial fee – helps patients figure out what’s wrong with them, often after an array of doctors have failed to do so. ... KHN spoke with him about how to navigate the health system and avoid diagnostic errors. (Appleby, 10/8)

At 27 years old, personal trainer and Zumba instructor Klyn Elsbury should be in the prime of her life. But because she suffers from cystic fibrosis, a life-threatening genetic condition that causes severe damage to her lungs, the Escondido, California, resident is in and out of the hospital every few weeks, often staying for a week at a time. A breakthrough new drug, Orkambi, offers hope for patients like Elsbury — along with sticker shock, at an annual price tag of more than a quarter million dollars. (Thompson, Chuck and Cappetta, 10/7)

The fight to repeal California's controversial new mandatory vaccine law officially ended this week before it even got to the ballot box, as opponents on Wednesday conceded an ill-fated petition drive fell woefully short on signatures. But while the latest setback is forcing one of the state's most vocal and embittered activist groups to acknowledge an organizational breakdown and lack of resources, parents and politicians behind the cause refuse to give up the larger battle: overturning -- or, at least, weakening -- a law they say violates their parental rights. (Seipel, 10/7)

The $51 million in savings that Iowa has cited as a key reason to privatize its Medicaid program is a midpoint of wide-ranging estimates from unidentified experts, some of whom predict no savings, a state official has acknowledged in court testimony. In addition, a check by the Register with two other states that have privatized their Medicaid programs found that savings were elusive. (Clayworth, 10/7)

The death-with-dignity movement took a giant step forward this week, with 38 million people coming under its umbrella in a single swoop when California Gov. Jerry Brown signed the End of Life Option Act on Monday. But the law still leaves out a wide range of people who might want to be covered: people with progressive debilitating diseases that don't have an obvious six-months-to-live prognosis and people with dementia, the fastest-growing health threat in the U.S. That's also true of similar laws in Oregon, Washington, Montana and Vermont. (Henig, 10/7)

With overdoses from heroin and opioid painkillers a leading cause of accidental deaths in the U.S., people on the front lines of the opioid battle are increasingly turning to Narcan [a drug that can reverse the overdose] (also known as naloxone) to save lives. In many cities, police, school nurses, and family and friends of drug users, as well as drug users themselves, commonly carry Narcan now. The Centers for Disease Control and Prevention reports that the use of naloxone kits by laypeople reversed at least 26,463 overdoses between 1996 and June 2014. But being saved in the short run from an overdose is no guarantee that someone will stop using drugs. (Becker, 10/7)

Kylee Moriarty has experienced her share of ups and downs since deciding to kick her heroin habit this past summer. The 26-year-old's journey started in early July when she showed up, beaten and gaunt, at the police station in Gloucester, Massachusetts, looking to take advantage of the department's pioneering policy of connecting addicts with treatment rather than throwing them in jail. ... the department had drawn attention for offering heroin addicts a radical proposition: Commit to getting clean and police will fast-track you into treatment, no questions asked. The program, which by now has been replicated in a number of other cities, has placed more than 200 addicts into treatment. (Marcelo, 10/8)

The cost of 24-hour out-of-home care through the state's regional centers for children with developmental disabilities will drop for some parents in California. Gov. Jerry Brown (D) this week signed into law AB 564 by Assembly member Susan Talamantes Eggman (D-Stockton). The new law raises the threshold for paying a parental fee for those families with a child in 24-hour out-of-home care through the regional centers, so that families earning between 100% and 200% of federal poverty level can now be exempted from the fee. (Gorn, 10/7)

A nurse administering flu shots to dozens of employees of a pharmaceutical company reused syringes, the state Department of Health said Wednesday. There is a low risk of infection and syringes that hold the vaccine, not needles, were reused, they said. But state and local health officials, as well as the federal Centers for Disease Control and Prevention, are recommending testing for hepatitis B and C and HIV, which can spread via blood. (10/7)

Of the two landmark health-policy achievements of Democratic President Lyndon B. Johnson, Medicaid has always been more vulnerable than Medicare to Republican attacks. ... That's especially true in the 2016 Republican presidential race. (John Harwood, 10/8)

Republicans six months ago were on the brink of winning the White House back from an unpopular president and the uninspiring Hillary Clinton, while holding both houses of Congress. In control, the Republicans could legislate based on their beliefs—about ObamaCare, the tax code, spending, rampaging bureaucracies, even the federal subsidy for Planned Parenthood. That’s what winning looks like in American politics—or used to. But we have been beamed up into new political times. Ironically, the new era of American politics looks a lot like ancient Rome—bloodlettings, betrayals and mass spectacle. (Daniel Henninger, 10/7)

President Barack Obama signed a bill into law Wednesday, which is pretty boring in and of itself. The legislation is kind of boring, too. But what made the moment significant is it's the first time in four years that Congress has sent the president a bill expressly intended to make Obamacare work better, not ruin it. (Young, 10/7)

The 2015 [dietary] guidelines, which are currently in preparation by the Departments of Agriculture and Health and Human Services for release by the end of the year, have triggered an especially ferocious backlash. The issue has been the agencies' intention to include advice on "sustainability"--that is, the environmental impact of what we grow to eat. ... But on Tuesday, HHS Secretary Sylvia Burwell and Agriculture Secretary Tom Vilsack announced that sustainability wouldn't be part of the guidelines after all. ... Responded nutrition expert Marion Nestle: "This is about politics, not science." She might have added that it's about big business, too. (Michael Hiltzik, 10/7)

When Nina Teicholz called out the authors of the federal dietary recommendations for shoddy science and conflicts of interest in a prominent medical journal late last month, she left out some key details about herself. ... Her most recent book is a take-down of the nutrition establishment called, “The Big Fat Surprise: Why Butter, Meat and Cheese Belong in a Healthy Diet,” which advocates the health benefits of a high-fat diet – considered heresy in many quarters. ... She’s also an organizer of a fledgling group that is engaged in a vigorous advocacy campaign to reshape how the U.S. government determines what makes a healthy diet. That effort is being bankrolled by billionaire Houston philanthropists, John and Laura Arnold. (Chase Purdy and Helena Bottemiller Evich, 10/7)

The Affordable Care Act has boosted the number of Americans with health insurance coverage but has not resolved the disparate way in which many insurers treat the costs of mental and physical health care, according to an April report released by the National Alliance on Mental Illness. The report found that federal changes (part of the Affordable Care Act) mandating so-called parity between mental and physical health-care benefits do not, in practice, exist for the vast majority of Americans who are insured. (Janell Ross, 10/7)

Not to complain, but the world we doctors inhabit is looking more and more like it was designed by Franz Kafka. The road to successful treatments and cures is cluttered with expanding red tape: courses to take, certifications to achieve, endless electronic record keeping that takes the place of patient contact, and now, a chokehold list of insurance billing codes that has been expanded from less than 15,000 disease/health issue entries to 68,000. The International Classification of Diseases, 10th edition, is a cumbersome mess that is supposedly designed for flexibility and precision. But with more than 100 choices for diabetes alone, (affects the retina versus the kidneys versus the heart, versus the nervous system, glucose controlled, uncontrolled, etc.), I must spend more time than ever in front of a computer screen, trying to decide what accurately describes my patient. If I don’t get it exactly right, I might not be paid. (Marc Siegel, 10/7)

So “defunding” Planned Parenthood would primarily mean telling low income people that their Medicaid coverage is of no use for the health care provided by Planned Parenthood. That would be cruel and foolish: Every dollar spent on Medicaid family planning services saves $5.60 in publicly-subsidized medical care and benefits for pregnant women, according to a 2012 study by the Brookings Institution. It would also be unconstitutional, according to a recent article by David S. Cohen, a law professor at the Thomas R. Kline School of Law at Drexel University. (Teresa Tritch, 10/7)

Republican state lawmakers' refusal to accept billions in Virginians' federal taxes to subsidize insurance for some 400,000 uninsured people has repeatedly been exposed as the partisan political ploy that it is. The expansion of Virginia's managed-care Medicaid program, the most efficient of two divisions of Medicaid in Virginia, is a prime objective of Democratic President Barack Obama's signature domestic achievement, the Affordable Care Act. ... The effects of that fiscally irresponsible position extend far beyond the health care of lower-income, uninsured Virginians. (10/7)

Thanks to a former Fairview Hospital patient with the courage to speak out about his mistreatment, the University of Minnesota is finally ending a controversial research practice. As of last month, the university will no longer test experimental drugs on mentally ill patients who have been involuntarily confined to a locked psychiatric unit under a 72-hour hold. Yet instead of thanking the patient who spoke out, or apologizing for recruiting him under coercive conditions, the university has done its best to discredit him. (Carl Elliott, 10/7)