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Thursday, Sep 1 2016

麻豆女优 Health News Original Stories 4

  • Mylan鈥檚 Generic EpiPen 鈥 A Price Break Or Marketing Maneuver?
  • How To Fight For Yourself At The Hospital 鈥 And Avoid Readmission
  • Taxpayers Foot 70 Percent Of California鈥檚 Health Care Tab, Study Finds
  • Trans And Adopted: Exploring Teen Identity

Administration News 3

  • With Tough Warning Label, FDA Aims To Curb Fatal Overdoses From Mixing Opioids, Sedatives
  • 'Women Have Had To Be Strong For So Long. Opioids Are A Good Way Out. Benzos Are A Good Way Out'
  • Off-Label Drug Communication Restrictions To Be Discussed At FDA Meetings

Health Law 2

  • Marketplace Insurers, Already Under Fire For Limited Networks, Double Down To Cut Costs
  • Georgia Business Group Lays Out Proposals For Medicaid Expansion

Capitol Watch 1

  • Congress Needs To Fund Zika Battle, Most Americans Say

Campaign 2016 1

  • When It Comes To Health Care, Voters Trust Clinton More, Poll Finds

Quality 2

  • Emails, Reports Show How Detroit Hospital Struggled With Dirty Or Missing Instruments
  • Surgical Cap, Which Doctors See As 'Symbolic Of Profession,' Comes Under Fire

Marketplace 1

  • Health Care System's Problems Intensified For Those With Greatest Medical Need

Women鈥檚 Health 1

  • Drinking In Moderation Doesn't Affect Women's Ability To Conceive, Study Finds

Public Health 2

  • Recovery High Schools Offer Students With Addiction Safe Space For Second Chance
  • Adults' Attitudes Shifting Toward Marijuana, Analysis Shows

State Watch 1

  • State Highlights: Fla.'s Price Transparency Law; N.J. Audit Reveals Incorrect Hospital Incentive Payments

Editorials And Opinions 3

  • Perspectives On Obamacare Premiums, Exchanges And Consumer Choices
  • Opinions Continue To Swirl Around EpiPen Controversy
  • Viewpoints: Congress Failing In Zika Fight; Lack Of Buzz About Clinton's Mental Health Plan

From 麻豆女优 Health News - Latest Stories:

麻豆女优 Health News Original Stories

Mylan鈥檚 Generic EpiPen 鈥 A Price Break Or Marketing Maneuver?

As news that Mylan will make available a generic version of its own brand-name product, KHN answers key questions about how this development could affect consumers. ( Julie Appleby , 9/1 )

How To Fight For Yourself At The Hospital 鈥 And Avoid Readmission

This new column explains what older adults and their families can do to avoid hospital readmission. ( Judith Graham , 9/1 )

Taxpayers Foot 70 Percent Of California鈥檚 Health Care Tab, Study Finds

The public spending on health care outpaces the nation. ( Ana B. Ibarra , 9/1 )

Trans And Adopted: Exploring Teen Identity

A Boston health clinic that treats transgender kids and teens finds that the percentage of its young patients who are adopted is higher than expected. These kids might need extra support, doctors say. ( Martha Bebinger, WBUR , 9/1 )

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Summaries Of The News:

Administration News

With Tough Warning Label, FDA Aims To Curb Fatal Overdoses From Mixing Opioids, Sedatives

The agency will require "black box warnings" -- its strongest type -- on more than 400 products. The move comes following criticism that it has not done enough to stem the rising tide of the opioid crisis.

The Food and Drug Administration announced on Wednesday that it would require its toughest warning labels to caution patients against taking opioid painkillers together with benzodiazepines, like Xanax and Valium. The combination makes an overdose more likely and the warning is aimed at making sure people understand that. Benzodiazepines are prescribed for anxiety, insomnia and seizures, and opioids for pain. The drugs work by depressing the central nervous system. Increasingly, doctors have been prescribing them together. The number of patients who were prescribed both drugs rose by 41 percent 鈥 about 2.5 million people 鈥 from 2002 to 2014, the agency said. (Tavernise, 8/31)

The Food and Drug Administration said it will add a boxed warning 鈥 the strongest type 鈥 to nearly 400 medications about the interaction, including opioid painkillers, opioid-containing cough medicines and benzodiazepines, which are used to treat anxiety, insomnia and seizure disorders. (Perrone, 8/31)

In a call with reporters, FDA Commissioner Robert Califf implored doctors 鈥渢o heed these new warnings鈥 and to carefully evaluate, on a patient-by-patient basis, whether the benefits of using opioids and benzodiazepines together outweigh the serious risks involved. Current labels on the drugs warn of potentially dangerous interactions. But FDA officials said the tougher warnings, sometimes called 鈥渂lack box warnings,鈥 are designed to catch the attention of physicians and patients and to underscore the seriousness of the threat. (McGinley, 8/31)

The move comes after an extensive review of scientific evidence by the FDA showing that physicians have been increasingly prescribing these drugs together. There was also a request for action in February, when health officials in cities and states across the country petitioned the agency for the change to the drug labels, citing an increase in overdoses from simultaneous use of the drugs. (Neel, 8/31)

The new FDA order calls for some 400 products to carry one of several 鈥渂lack box warnings.鈥 Those aim to alert physicians and patients to the dangers of mixing opioids with benzodiazepines and other drugs 鈥斅爄ncluding insomnia medications, muscle relaxants, antipsychotic drugs and alcohol 鈥斅爐hat depress the central nervous system. The new warnings tell physicians and patients that the combined use of drugs that reduce the reflexive urge to breathe can cause dizziness, extreme sleepiness, slowed or difficult breathing, and unresponsiveness. (Healy, 8/31)

Dr. Leana Wen, Baltimore鈥檚 city health commissioner and one of the public health officials who pushed the FDA to require stronger warnings, told reporters that prescribing the two drugs together had become routine clinical practice, despite there being 鈥渘o scientific reason鈥 to do so. (Scott, 8/31)

鈥淚t is nothing short of a public health crisis when you see a substantial increase of avoidable overdose and death related to two widely used drug classes being taken together,鈥 FDA Commissioner Robert Califf said in a statement. (Wheeler, 8/31)

The FDA has been heavily criticized for doing too little to stop overuse and abuse of opioids such as OxyContin, Vicodin and Percocet. The drugs, which are similar to morphine and heroin, are highly addictive and are easy to overdose on. (Fox, 8/31)

'Women Have Had To Be Strong For So Long. Opioids Are A Good Way Out. Benzos Are A Good Way Out'

The Washington Post offers a series on why death rates have risen for whites in midlife, particularly women.

While death rates are falling for blacks and Hispanics in middle age, whites are dying prematurely in growing numbers, particularly white women. One reason: a big increase in overdoses, primarily from opioids, but also from anti-anxiety drugs, which are often prescribed in tandem. Between 1999 and 2014, the number of middle-aged white women dying annually from opiate overdoses shot up 400 percent, according to a Washington Post analysis of data from the Centers for Disease Control and Prevention. Anti-anxiety drugs known as benzodiazepines contributed to a growing share聽of the 54,000 deaths over that period, reaching a third in the last several years, The Post found, though spotty reporting in death records makes it likely that the combination is even more widespread. (Kindy and Keating, 8/31)

When doctors cut off her painkillers, Samantha Burton went through withdrawal. Experts say it can feel like an extreme case of the flu, but Burton found the experience far more punishing. Opioids 鈥渕ake your brain鈥檚 ability to create happy chemicals completely flaccid,鈥 she said. 鈥淚t wasn鈥檛 like I felt bad. I felt like I was going to die.鈥 So Burton, a professional illustrator who grew up in nearby Bakersfield, joined a stealthy parade of middle-aged white women trolling for drugs in Oildale, a dusty little town in central California known for its bountiful oil fields, its Appalachian-grade poverty and an open-air market for illicit drugs dubbed 鈥淗eroin Alley.鈥 (Kindy, 8/31)

Life as a 鈥減arty girl鈥 caught up with Beverly Layman in March. She had gone to the doctor to receive a new treatment for hepatitis C. She was excited by the prospect of getting her energy back. But the blood tests showed it was too late. Layman, 58, was dying. 鈥淭he doctor said, 鈥業 think you need to start looking at hospice.鈥 That just blew me away,鈥 Layman said. 鈥淚 thought I was invincible. I thought nothing was going to kill me.鈥 (Kindy, 8/31)

Off-Label Drug Communication Restrictions To Be Discussed At FDA Meetings

Pharmaceutical companies want regulators to loosen strict limits currently in place on what information they can provide to doctors about unapproved uses of prescription medications.

After years of anticipation, the US Food and Drug Administration will hold a public, two-day meeting in November to review the extent to which so-called off-label information about medicines may be disseminated to physicians. Off-label information is regulatory parlance for materials that describe unapproved uses of a drug. Doctors are, in fact, allowed to prescribe a medicine for an unapproved use, but drug makers have long chafed at restrictions on their ability to distribute such information 鈥 reprints of medical studies, for example 鈥 and have lobbied Congress and the FDA to loosen regulations. (Silverman, 8/31)

The Food and Drug Administration on Wednesday announced in the Federal Register that the agency will hold a public hearing in November to gather input about how companies communicate about their products. Specifically, the agency will focus on how companies discuss off-label uses of their products, the notice says. The FDA regulates how drug and device makers communicate about their products through approved labels, but many of those companies say there鈥檚 more information about their products worth sharing to help providers and others provide better care to patients. (McIntire, 8/31)

Health Law

Marketplace Insurers, Already Under Fire For Limited Networks, Double Down To Cut Costs

A McKinsey & Co. analysis of regulatory filings for 18 states and the District of Columbia found that only about 25 percent of the plans offered on those exchanges would be preferred-provider organizations or similar options that generally give consumers the ability to choose from larger selections of doctors and hospitals and include out-of-network coverage, The Wall Street Journal reports. Other health law news includes a look at a statement about insurance costs by the White House press secretary and previews of Minnesota health plan rates.

Under intense pressure to curb costs that have led to losses on the Affordable Care Act exchanges, insurers are accelerating their move toward plans that offer limited choices of doctors and hospitals. A new McKinsey & Co. analysis of regulatory filings for 18 states and the District of Columbia found that 75% of the offerings on their exchanges in 2017 will likely be health-maintenance organizations or a similar plan design known as an exclusive provider organization, or EPO. Both typically require consumers to use an often-narrow network of health-care providers鈥攊n some cases, just one large hospital system and its affiliated facilities and doctors. (Wilde Mathews, 8/31)

A number of readers asked about this tweet, which was a summary of comments made by [White House press secretary Josh] Earnest during a White House press briefing. The tweet included a video of Earnest鈥檚 remarks, in which he said: 鈥淲hat is clear is that the vast majority of people all across the country will have access to a plan that costs $75 a month or less.鈥 Earnest made these comments in response to a question about a Washington Post report about how enrollment in the insurance exchanges established by the Affordable Care Act is at less than half its initial forecast. Officials say he was referring to people in the exchanges, not the population as a whole, when he referred to the $75 figure. (Kessler, 9/1)

Three years ago, premiums generated from state residents who buy health insurance on their own exceeded claims for medical care by nearly $130 million. But the market for individuals and families 鈥 about 5 percent of state residents 鈥 changed significantly in 2014 with the federal health law, which stopped insurers from denying coverage to those with preexisting health problems. In 2014, claims exceeded premiums in the market by some $9 million, state Commerce Department figures show, and the gap swelled in 2015 to more than $166 million. (Snowbeck, 8/31)

Minnesota鈥檚 insurance companies will unveil their proposed 2017 rates Thursday聽鈥 and Minnesotans should expect some sticker shock. The new rates for the state鈥檚 individual insurance marketplace are expected to see increases of at least 25 percent and perhaps far more. Affected will be people who buy individual insurance plans 鈥 about 300,000 people today, of whom 70,000 buy through the state-run MNsure exchange and about 230,000 directly from insurers. People who get health insurance from providers or from government programs such as Medicare, Medical Assistance or MinnesotaCare won鈥檛 be directly affected. (Montgomery, 8/31)

Georgia Business Group Lays Out Proposals For Medicaid Expansion

A task force set up by the state's Chamber of Commerce offers Georgia lawmakers three conservative options to cover the state's uninsured. About 16 percent of Georgia's residents are uninsured, one of the highest rates in the nation.

A widely anticipated plan to reduce the number of Georgians without health coverage, unveiled Wednesday, takes a unique, conservative approach to Medicaid expansion. The plan, created by a health care task force, contains three proposals with differing eligibility standards and designs. The group鈥檚 leaders said Wednesday that they hope the options will serve as a kick start for discussion this fall and into next year鈥檚 General Assembly session. Included in the blueprint is an array of features that may please many Republican legislators, who are clearly the target of the task force effort. (Miller, 8/31)

None of the three plans suggest adopting conventional Medicaid expansion as called for under the Affordable Care Act, or "Obamacare." States that have taken this route simply expanded eligibility for Medicaid, the federal health program for the poor and disabled, to all individuals whose income falls at or below 138 percent of the federal poverty line, or about $16,000. Rather, all three proposals outlined by the Georgia [Chamber of Commerce鈥檚] task force call on lawmakers to seek a 1115 Waiver, which other Republican-majority states have used to cover the same low-income population, but on their own terms. (Eloy, 8/31)

One of the chamber's options extends Medicaid to adults without children and who are making less than the federal poverty level, $11,700. That proposal wouldn't cover people making up to 138 percent of the poverty level, a key benchmark for federal officials when evaluating other waivers. The other options include coverage for adults making 138 percent of the poverty level, totaling $16,242 annually. In one plan, everyone is covered by Medicaid. The other option requires those making more than the poverty level to find private insurance coverage through marketplaces created by the health care law rather than being covered by Medicaid. (Foody, 8/31)

Gov. Nathan Deal has long opposed accepting more federal funds to expand Medicaid, saying it will be too costly in the long run. But a growing number of Republicans say it is past time for Georgia to begin accepting tens of billions in federal money to expand coverage to more than 600,000 low-income residents and shore up the struggling network of rural hospitals. Just how to do that promises to be a main theme of next year鈥檚 legislative session. (Bluestein, 8/31)

In Alaska, there's growing concern about costs of the state's Medicaid program 鈥

Costs for Alaska's expanded Medicaid program have exceeded first-year estimates by roughly $30 million so far, leaving some concerned about the impact the program may have on the state budget once the federal government stops covering the entire tab. Gov. Bill Walker expanded Medicaid to provide coverage to thousands more lower-income Alaskans. Enrollment began last September, and as of July 31, nearly 20,400 people had signed up. The federal government is expected to fully cover the health care expenses for the expansion enrollees through December; then, the state will start chipping in. The state share next year is expected to be 5 percent and grow to as much as 10 percent by 2020. (Bohrer, 8/31)

Capitol Watch

Congress Needs To Fund Zika Battle, Most Americans Say

A new survey finds that three-quarters of Americans rank the allocation of money for Zika as an important or top priority for Congress when it is back in session.

Summer is winding down, but when members of Congress return to Washington from their vacations next week, many of their constituents want them to do something about the mosquitoes 鈥 the ones carrying Zika virus, to be specific. A new survey shows that three quarters of Americans say Congress should make the allocation of more money to deal with the Zika outbreaks in Florida and Puerto Rico an "important" or "top priority" when they return to Washington. (Kodjak, 9/1)

House Republican leaders next month will seek a short-term spending patch to keep the government running in the fall, in addition to finding a way forward on Zika funding and other priorities outlined in a memo sent Wednesday to the GOP conference. 鈥淥nce we return, Conference discussions will continue on overall government funding, including a Continuing Resolution and a path forward for the $1.1 billion supplemental funding package to address the Zika crisis that the House passed on June 23, 2016,鈥 House Majority Leader Kevin McCarthy (R-Calif.) said in the memo. ... The memo said there could also be action on the annual defense authorization, 鈥渞eauthorization of career and technical education programs, and protecting seniors from a harmful Obamacare tax.鈥 (Reid, 8/31)

In other Zika news聽鈥

In seven countries that recently experienced Zika outbreaks, there were also sharp increases in the numbers of people suffering from a form of temporary paralysis, researchers reported Wednesday. The analysis, published online in The New England Journal of Medicine, adds to substantial evidence that Zika infections 鈥 even asymptomatic ones 鈥 may bring on a paralysis called Guillain-Barr茅 syndrome. (Saint Louis, 8/31)

The Zika virus appears to be spreading rapidly in Singapore, with 115 confirmed cases as of Wednesday, according to government officials. At least one pregnant woman is among them. The virus鈥檚 emergence in the Asian city-state is raising lots of questions that will likely preoccupy experts on the World Health Organization鈥檚 Zika Emergency Committee, which meets Thursday. The most pressing: Is this a sign the epidemic virus racing through the Americas will do the same in Asia and Africa? 聽(Branswell, 9/1)

The Florida Department of Health reported three new, non-travel related cases of Zika in Miami-Dade County on Tuesday. One of the cases is reportedly associated with the Miami Beach investigation, but the other two are being investigated to determine where the exposure happened. There have now been 46 non-travel-related cases of Zika reported in Florida. (8/31)

Campaign 2016

When It Comes To Health Care, Voters Trust Clinton More, Poll Finds

But, still, most said neither candidate would improve access to affordable care.

A new poll finds that more voters trust Democratic presidential candidate Hillary Clinton to do a better job on health care issues, from Medicare to medical costs. But they're not holding out hope for big improvements. The survey from the nonpartisan Kaiser Family Foundation found that Clinton leads Republican opponent Donald Trump when it comes to the future of Medicare, Medicaid, the federal health care law, and the cost of medications. (9/1)

The majority of voters say they trust Hillary Clinton over Donald Trump to address top health care issues, according to a new Kaiser Family Foundation poll released Thursday. Sixty-six percent listed the future of Medicare and access to affordable care as the most important health care issues they want the candidates to discuss on the campaign trail, the poll found. About half of survey respondents said the future of Medicaid, the rising cost of prescription drugs and the future of Obamacare were top health issues the candidates should address. Further down the list were the opioid epidemic, women's access to reproductive care, and the Zika virus. (Ehley, 9/1)

In other 2016 election news聽鈥

On Monday, Clinton unveiled her latest major policy initiative: an overhaul and reform of the nation鈥檚 troubled mental health system. Although the two parties are far apart on Obamacare and health care reform more generally, they have been trying for months to find common ground on mental health issues in the wake of numerous mass shootings and terrorists attacks in recent years. (Pianin, 8/31)

Bill Clinton has promised to leave the Clinton Foundation board if Hillary Clinton is elected president, but his potential departure from another Clinton charity could have far greater consequences for global health. Though it鈥檚 less well-known than the foundation, the Clinton Health Access Initiative has played a central role in bringing down drug prices in the developing world and helping governments in Africa and Asia build health care delivery systems. Known as CHAI, it relies so heavily on the former president, say global health experts, that his exit would raise a fundamental dilemma for the influential organization: Can it operate in any meaningful way without the Clinton clout? (Piller and Kaplan, 8/31)

Quality

Emails, Reports Show How Detroit Hospital Struggled With Dirty Or Missing Instruments

A series of articles in the Detroit News used internal reports and emails to explore problems over 11 years at the Detroit Medical Center to keep surgical instruments cleaned. 鈥淲e are putting patients at risk frequently," the chief surgeon at Children鈥檚 Hospital, Joseph Lelli, wrote in an email in 2015.

The Midtown hospitals of the Detroit Medical Center have struggled for years to properly clean surgical instruments, stoking doctors鈥 fears about patient safety, a Detroit News investigation has found. The News has obtained more than 200 pages of internal emails and reports indicating that surgeons and staffers have complained for at least 11 years about improperly cleaned, broken and missing instruments. The complaints have continued under the tenure of the for-profit Tenet Healthcare of Dallas, Texas, which acquired the DMC in 2013, the documents show. (Bouffard and Kurth, 8/26)

No state requires that hospitals report exposures to dirty instruments, which may or may not lead to infection. As a result, it can be difficult to track whether patients become sick or die as a result. State reporting requirements, if they exist, typically are based on the National Quality Forum鈥檚 list of reportable events. That list includes contamination by drugs, devices or biologics, but only if the exposure results in serious injury or death. 鈥淚t鈥檚 a resource issue and it鈥檚 also a politically tense issue,鈥 said Jill Rosenthal, senior program director at the National Academy for State Health Policy. (Bouffard and Kurth, 8/25)

Other stories included in the Detroit News special report:
聽(Kurth and Bouffard)
聽(Bouffard and Kurth)
(Kurth)

Surgical Cap, Which Doctors See As 'Symbolic Of Profession,' Comes Under Fire

There are concerns the traditional cap worn by surgeons is creating situations that promote infection.

Surgeons for years have stepped into operating rooms wearing their surgical cap 鈥 a snug covering that ties in back and comes in standard-issue blue or hundreds of personalized designs. But a crackdown appears to be underway on that almost sacred piece of headgear. Inspectors in January reprimanded operating room staff at Brigham and Women鈥檚 Hospital in Boston for having the hair around their ears uncovered during surgery 鈥 and for sporting visible facial hair. And a New York surgeon was written up for showing 3 inches of hair at the nape of his neck. (Kowalczyk, 9/1)

In other news concerning doctors聽鈥

On the first day of battle at Gettysburg, a moment of hesitation cost the Confederacy a chance at an early advantage. On a steamy morning 153 years later, a group of hospital employees聽walked the meadows of this famous battlefield to ask themselves how that misstep happened. The 50 staff members from Florida Hospital Waterman, a full-service medical center in suburban Lake County,聽did not travel to Gettysburg last week for a history lesson, or for a casual respite. They made the trek as part of a leadership program designed to train doctors, nurses, and administrators to think strategically in the face of the bureaucratic and logistical challenges 鈥 and the personality clashes 鈥 that can undermine medical care. (Ross, 9/1)

With little fanfare earlier this summer the humanitarian group Doctors Without Borders did something it had never done before. It reelected its international president. Dr. Joanne Liu, a 50-year-old French-Canadian who practices pediatric emergency medicine, had seen her first three-year term whiz by, subsumed by the civil war in Syria and the West African Ebola outbreak. (Branswell, 8/31)

Marketplace

Health Care System's Problems Intensified For Those With Greatest Medical Need

A new analysis finds that the sickest Americans pay about four times the amount on health care than does the average patient.

American adults with chronic illnesses that limit their ability to care for themselves spend more than $21,000 per person for health care, about four times the average for all adults. Despite that higher spending, however, a new analysis from the Commonwealth Fund finds that those with the greatest medical need 鈥 defined as people with at least three chronic diseases and a limited ability to care for themselves 鈥 were more likely than other patients to have delayed or done without medical care or a prescription, and they鈥檙e more likely to say that their doctors were disrespectful, didn鈥檛 spend enough time with them, or didn鈥檛 listen or explain things carefully. (Braverman, 8/31)

In other news about health care costs聽鈥

This year, taxpayers will cover about 70 percent of what is spent on health care in California, according to a new analysis released Wednesday by the UCLA Center for Health Policy Research. Many people assume that the U.S. health care system is primarily supported by private dollars, such as insurance premiums from employer-based coverage, said Gerald Kominski, director of the UCLA Center for Health Policy Research and the study鈥檚 lead author. (Ibarra, 8/31)

Women鈥檚 Health

Drinking In Moderation Doesn't Affect Women's Ability To Conceive, Study Finds

In other news, a medical patch -- or "electronic tattoo" -- could help monitor pregnant women's health.

A new study has found that moderate alcohol consumption does not affect a woman鈥檚 ability to get pregnant, although higher amounts might. Danish researchers studied 6,120 women trying to conceive in stable relationships with male partners. The women reported their drinking habits in questionnaires. By the end of the study, 4,210 of the women had gotten pregnant. Women who drank the alcoholic equivalent of one to 13 four-ounce glasses of wine a week were no less likely to conceive than those who abstained completely. (Bakalar, 8/31)

The聽鈥渆lectronic tattoo鈥 may sound like an attempt by Silicon Valley to encroach on聽one of the last few activities still requiring an聽actual human being. But what the term actually refers to is a sensor聽that adheres like a Band-Aid to parts of your body in order to monitor vital signs like heart rate, blood pressure and breathing. Another term for the devices鈥 equally evocative鈥搃s 鈥渟mart skin.鈥澛燫esearchers around the country are designing electronic tattoos, which look a bit like a child鈥檚 sticker but come聽outfitted with wireless antennae. (McClurg, 8/31)

Public Health

Recovery High Schools Offer Students With Addiction Safe Space For Second Chance

Right now there are 27 public or charter recovery high schools in 11 states, with more slated to open. Meanwhile, in Louisville, Kentucky, doctors see an overdose outbreak as a clear sign of a public health emergency, New Hampshire gets $1 million to expand access to medication-assisted treatment and Denver cracks down on drug use in parks.

As the nation struggles with an opioid-addiction epidemic, states increasingly have experimented with recovery high schools that enroll only kids who have drug and alcohol addiction problems as a way to help treat and support them. Today, there are 27 public or charter recovery high schools in 11 states, including Texas, Minnesota and New Jersey. This month, Florida will open its first public recovery high school, in Jacksonville. In July, Pennsylvania Gov. Tom Wolf, a Democrat, signed a bill to create a four-year pilot program to allow public school students to attend the state鈥檚 lone recovery high school, which is private. (Wiltz, 9/1)

During a recent shift spent treating numerous overdoses, Dr. Robert Couch heard a similar refrain from patients: they couldn't believe that the small amounts of heroin they took nearly killed them. On Tuesday, at Norton Hospital in Louisville, Couch treated eight overdose patients in five hours 鈥 an unprecedented number for the emergency physician. He sees it as a clear sign of a public health emergency. (Schreiner, 8/31)

New Hampshire is one of nearly a dozen states getting a one million dollar federal grant to expand access to medication-assisted treatment for drug addiction.聽New Hampshire currently has the fewest number of physicians in New England who are certified to prescribe Suboxone, a drug used to reduce opioid cravings and ease withdrawals. Recently the federal government raised the number of patients doctors are聽allowed to treat with聽Suboxone聽from 100 to 275. (Sutherland, 8/31)

More than 3,500 needles have been collected on the Cherry Creek trail and in other downtown Denver parks this year, an official said Wednesday, and that聽uptick in open drug use has spurred聽a new crackdown. Beginning Friday, Denver police will issue 90-day park or trail suspension notices to people they observe involved in illegal聽drug activity, whether it鈥檚 use, possession, selling or buying. (Murray, 8/31)

Adults' Attitudes Shifting Toward Marijuana, Analysis Shows

More people are using the drug, while fewer are reporting that they think it is harmful.

Marijuana use is聽losing some of its taboo among US adults, according to a new analysis聽of government survey data. In a report published in the journal Lancet Psychiatry Thursday, federal researchers conclude that pot use began increasing in about 2007, coinciding with a drop in the number of Americans who see the drug as harmful. (Samuel, 8/31)

An increasing number of U.S. adults are using marijuana, and attitudes about the drug are shifting聽鈥撀爁ewer people perceive pot as harmful, according to a new study published in The Lancet Psychiatry. Though the study cannot answer the question of why more Americans are聽using聽marijuana, the researchers say聽the data is consistent with other, similar research. The trend聽comes as a growing聽number of states are聽changing laws to聽legalize聽medical, and to a lesser extent, recreational marijuana, which聽may be playing a role in public perception of the drug. (Welch, 8/31)

State Watch

State Highlights: Fla.'s Price Transparency Law; N.J. Audit Reveals Incorrect Hospital Incentive Payments

Outlets report on health news from Florida, New Jersey, California, Illinois, Texas, New York and Ohio.

A Google search for the term 鈥渕edical prices鈥 turns up several tools you can use to look up healthcare costs. If you have insurance, you may have seen a similar tool on your provider's website. Florida lawmakers even passed a price transparency law this year that will create a database of prices for medical procedures. But how do you know what the price comparison tools are really telling you?...On one side are for-profit sites that contract with health care providers. The sites list cash prices of common procedures that consumers can pay for up-front. (Ochoa, 8/31)

The New Jersey Department of Human Services made inaccurate incentive payments to 15 hospitals, according to an audit released Wednesday of a federal program designed to encourage the health care industry to adopt electronic health records. The agency overpaid 10 hospitals by $2.4 million and underpaid five hospitals by $137,329, according to the audit of Medicaid incentive payments by the U.S. Department of Health and Human Services' Office of Inspector General. (Brubaker, 8/31)

The California Assembly passed AB 72 late this afternoon. The bill heads next to Gov. Jerry Brown鈥檚 desk. It passed by a huge margin with bipartisan support, unlike a similar bill last year which stalled by three votes on the last day of the 2015 legislative session. (Klivans, 8/31)

A report published Aug. 25 by short-selling investment firm Muddy Waters and cybersecurity company MedSec Holdings claims that St. Jude's cardiac devices, particularly its Merlin@Home Transmitter, 鈥渓ack even the most basic forms of security.鈥 The analysis states that its devices lack hardware identify protection, encrypted software and anti-debugging mechanisms. St. Jude officials have consistently denied the allegations since the report published. (Castellucci, 8/31)

The Florida Supreme Court on Tuesday declined to take up an appeal by a woman who sued tobacco companies after her husband died of cancer following decades of smoking. The 4th District Court of Appeal in March overturned a multimillion-dollar verdict against R.J. Reynolds Tobacco Co. and Lorillard Tobacco Co. and ordered a new trial in the case filed by Kathleen Gafney. The appeals court found that Gafney's attorneys during a trial in Palm Beach County circuit court made improper comments aimed, in part, at getting jurors to "send a message" to tobacco companies. (8/31)

A federal jury on Tuesday found a South Holland woman guilty of pocketing kickbacks in exchange for referring patients to home health care agencies while she was running a Homewood -based business, according to the FBI...The jury convicted Williams on one count of conspiracy to solicit and receive remuneration in return for the referral of Medicare patients, and six counts of soliciting and receiving remuneration in return for the referral of Medicare patients, according to the FBI. Each count carries a sentence of up to five years in prison. (Swedberg, 8/31)

Bexar County District Attorney Nico LaHood continued his anti-vaccination crusade Tuesday night on his official Facebook page聽where he engaged in discussions, arguments and advocated for parents' rights to not immunize their children against diseases. (Bradshaw, 8/31)

When the results of tests for lead in the water at more than 1,500 New York City school buildings were announced in July, officials said that fewer than 1 percent of all the samples taken showed lead concentrations that exceeded Environmental Protection Agency guidelines. Given other safety measures in place, officials assured parents, the water was safe to drink. But a review of how the testing was conducted suggests that the amount of lead in the water that students consume could be greater than the results indicate. (Taylor, 8/31)

About 30,000 children in Ohio, including 7,000 in the Columbus area, will suffer asthma attacks each year by 2025 because of smog created by oil and gas operations, according to a new report. The report, released Wednesday by the Boston-based Clean Air Task Force, also quantified the average days of school missed and hours spent inside due to air pollution. The report should serve as a wake-up call for U.S. and Ohio residents, said Melanie Houston, director of oil and gas for the Ohio Environmental Council. (Tate, 8/31)

Cleveland's Building & Housing department says it has a plan it hopes will increase landlords who currently register their rental properties with the city and revenue from that registration. The work started with the city's ongoing effort to reduce childhood lead poisoning cases, because children are more often lead poisoned in rental properties. Having more rentals registered would help the city perform planned health and safety inspections for city rentals, according to Ron O'Leary, director of the Building & Housing department. (Dissell, 9/1)

Editorials And Opinions

Perspectives On Obamacare Premiums, Exchanges And Consumer Choices

Opinion writers offer their thoughts on issues related to the federal health law's marketplaces.

In the last few years, even though premiums in the Affordable Care Act鈥檚 health insurance marketplaces were rising, most customers could avoid a big price rise by shopping for a cheaper plan. Next year, according to a preliminary analysis, that is going to be a lot harder. (Margot Sanger-Katz, 9/1)

In 2010, the problem with the U.S. health-care system was that we had a fragmented market that created regulatory headaches and all sorts of inefficiencies regarding the provision of care. We had four major government health care systems 鈥 Medicare, Medicaid/SCHIP, the Veterans Administration, and the military鈥檚 Tricare program 鈥 along with a bevy of smaller ones...Unfortunately, while basically everyone in the country thought that the U.S.聽health care system was as messed up as a party-school group house on graduation day, most people actually liked whatever coverage they had. (Megan McArdle, 8/31)

Now that United Healthcare, Humana, and Aetna are dropping out of or have already left the vast majority of the ACA (Affordable Care Act) Exchanges they were previously serving, and almost three-fourths of the non-profit CO-OP insurers established by the ACA with taxpayer start-up funds have gone bankrupt or otherwise out of business, it should be clear to anyone without a political ax to grind that something about the ACA Exchange system is not just flawed, but fatally flawed. (Robert Book, 8/31)

The term 鈥減ro-choice鈥 has a politically charged meaning, one that Democrats proudly assert when it comes to defending abortion. They also claimed that mantle for Obamacare. As we approach the fourth year of the exchanges, however, it鈥檚 clear that Democrats and Barack Obama have been as anti-choice in practice as it鈥檚 possible to be. (Edward Morrissey, 9/1)

Opinions Continue To Swirl Around EpiPen Controversy

Editorial pages across the country continue to offer perspectives on aspects of the EpiPen pricing news.

The EpiPen pricing controversy is enough to trigger mental anaphylactic shock. First, Mylan raised the list price of EpiPens to more than $600 a pair. When protests predictably erupted, Chief Executive Officer Heather Bresch went on TV to say that if she cut the price of EpiPens, some people wouldn鈥檛 be able to get them anymore. Which is weird, because usually a lower price makes things easier to get. Then, on Aug. 29, Mylan announced it will sell a generic version of EpiPens at half the price鈥攂ut keep selling the identical brand-name version at full price. ... None of this, including the original price hike, makes sense if you think of brand-name pharmaceuticals as normal products whose prices are set by the forces of supply and demand. (Peter Coy, 9/1)

Mylan made a somewhat surprising announcement Monday that it would launch a generic version of its EpiPen and sell it for half the list price of its branded product. The company said it would launch the generic version in several weeks, pending label revisions. So, if the company can launch a generic product in a matter of weeks, where have these generic plans been all along? (Adam Rubenfire, 8/31)

It鈥檚 official. Mylan has gone too far. When the drug company raised the price of the EpiPen by 400 percent and boosted the CEO鈥檚 salary to $18 million, it definitely went beyond what the public will accept. In less than 10 years, the price for a two-pack of EpiPen Auto Injectors for life-threatening allergy relief has risen from approximately $100 to over $600. Some analysts have estimated that the tiny amount of epinephrine in an EpiPen is worth barely $1, and the auto injectors might cost as little as $5. (Twila Brase, 8/31)

Epinephrine is a naturally-occurring substance, made by the adrenal gland. It was discovered more than 100 years ago. It is readily available in glass ampules for less than five bucks. By coupling with a syringe and a needle, which cost pennies, one can make a cheap EpiPen. Mylan sells its product for more than $600. So what happened? The EpiPen story is the story of crony capitalism, government meddling in medical care, and the lack of price discovery and competition in the medical markets. It is a microcosm of the broader failures of Obamacare. (Dr. Cameron S. Schaeffer, 8/29)

It鈥檚 bizarre that Mylan NV, the same company that owns EpiPen, would commission an identical generic version of the same product and sell it for half the price. After all, Anheuser-Busch InBev wouldn鈥檛 make half-price generic Budweiser at its Pestalozzi Street plant. But the pharmaceutical business plays by different rules. It ruthlessly eliminates competition. It often collaborates with insurance companies and pharmacy benefits managers, the entities that are supposed to restrain it. It has co-opted much of the scientific research community and Congress. (8/31)

Big pharmaceutical companies may have finally crossed the line this time. The outrageous increase in the cost of the EpiPen 鈥 32 percent this year alone 鈥 is certain to enrage and engage the country鈥檚 Number One voting bloc: moms. When Turing Pharmaceuticals increased the price of Daraprim, a drug used to treat an infection in HIV patients, from $13.50 to $750, there was outrage in the press followed by hearings in Congress. Although Turing promised to reduce the price of the drug, the company still hasn鈥檛. And there is nothing 鈥 aside from public relations pressure 鈥 that can force Turing to keep its promise. (Dr. John M Scherr, 8/31)

American brand and specialty drug prices are among the highest anywhere despite the fact that the U.S. pharmaceutical market is the largest in the world. Some of that problem may stem from public healthcare program fraud and an inefficient medical insurance system, but much more is the result of a long pattern of anti颅competitive tactics in this highly concentrated industry. (Glenn B. Manishin, 8/31)

Viewpoints: Congress Failing In Zika Fight; Lack Of Buzz About Clinton's Mental Health Plan

A selection of opinions on health care from around the country.

The potential cost of a funding shortfall will be measured in human misery and even death. Every child born with microcephaly as a result of the Zika infection of the mother during pregnancy could require care that costs the family and our health-care system anywhere between $1聽million and $10 million over the lifetime of the child. Every child born with microcephaly faces a difficult future, filled with intensive therapy and support. It is a price that no child 鈥 no mother, no father, no family 鈥 should have to pay, especially given that it can be avoided. ... Congress returns next week. In the past, it has shown that it understands the importance of safeguarding Americans鈥 health and has supported biomedical research and vital public health priorities. It has proved that it can act in moments of crisis and in our nation鈥檚 hours of need. We鈥檙e asking Congress to do so again. (Tom Frieden and Anthony S. Fauci, 8/31)

Hillary Clinton made one of the most consequential announcements of her campaign on Monday 鈥 and hardly anyone is talking about it. The Democratic presidential nominee released a wide-ranging mental-health strategy 鈥 and, unlike much of what she has proposed this election season, it has a real chance of becoming law. Congress has over the past several years put serious effort into reforming the federal government鈥檚 mental-health efforts, producing 鈥 but not yet passing 鈥 a slew of bills with bipartisan backing. This is one of the few issues on which lawmakers may be able to agree, even in a severely divided Washington, over the coming months. (8/31)

After a slow start in 2011, the Center for Medicare & Medicaid Innovation (CMMI) at the Centers of Medicare & Medicaid Services (CMS) seems to have gone into overdrive. As part of the Department of Health and Human Services鈥 pledge to move the majority of Medicare payments away from undifferentiated fee-for-service payments to some type of value-based care, CMMI has been sponsoring a wide variety of models. These include models that feature fee-for-service payments with incentives added, bundled or episode-based payments, and population-based payments. (Gail Wilensky, 8/31)

Condoms alone will not restore the American Dream for today鈥檚 low-income families. The lesson here is not that IUDs obviate income transfers to the poor or inclusive housing policy in rich metros. The lesson, instead, is that improvements in early childhood achievement (and, with luck, those children鈥檚 adult outcomes) can come from surprising places. Perhaps birth control doesn鈥檛 just give women power over their own future; it empowers their future children, as well. (Derek Thompson, 8/31)

In spite of massive public outcry which included testimony from medical professionals, warnings from vision and dental experts, fact-driven data from advocates and pleas from Kentuckians who will be devastated by the loss of health care, Gov. Matt Bevin has submitted a harsh, draconian expanded Medicaid waiver proposal to the U.S. Department of Health and Human Services for consideration. In doing so, the governor has made good on his campaign promise to strip health care away from 440,000 Kentuckians. (State Rep. Darryl T. Owens, D-Louisville, 8/31)

Child care facilities, preschool programs and schools are particularly prone to outbreaks of infectious diseases. Kids in these settings can easily spread illnesses to one another and staff due to typical child behavior 鈥 poor hand washing, not covering their coughs, and other factors. Infants and toddlers in child care and preschool settings are also more vulnerable to vaccine-preventable diseases and their complications. In fact, children under the age of 5聽are聽five times more likely聽than older children to be hospitalized with a serious vaccine-preventable disease. (Stephanie Wasserman, 8/31)

Cleveland, which has struggled to reduce the number of lead-poisoned children, ought to become the state's second city to do so. It's that important. The problem is horrendous. John Sobolewski, who supervises Cuyahoga County's lead poisoning program, told The Plain Dealer that 40,000 children living in the county over the last 15 years have tested positive for lead. About 80 percent of them live in Cleveland. (8/30)

The economics of health care aren鈥檛 working for the poor and disabled. But somehow, they work just fine for hospital CEOs. As the Globe鈥檚 Robert Weisman recently reported, pay increases for top Massachusetts hospital CEOs outpaced the growth of state health spending, according to the most recent filings of compensation data by nonprofits with the IRS. (Joan Vennochi, 9/1)

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