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The Trump administration said on Wednesday that it would ban the sale of most flavored e-cigarettes, at a time when hundreds of people have been sickened by mysterious lung illnesses and teenage vaping continues to rise. ... Alex M. Azar II, the health and human services secretary, said that the Food and Drug Administration would outline a plan within the coming weeks for removing flavored e-cigarettes and nicotine pods from the market, excluding tobacco flavors. The ban would include mint and menthol, popular varieties that manufacturers have argued should not be considered flavors. (Kaplan, 9/11)

The administration’s move comes as health officials across the country investigate more than 450 cases, including six deaths, of lung disease linked to vaping. Many patients have reported using cannabis-related products, but authorities have not ruled out any specific type of vaping. With the picture still murky, critics have seized the moment to press for tougher regulation of conventional e-cigarettes, which come in sweet and fruity flavors that have been favored by many young people. (McGinley, 9/11)

Public-health officials have encouraged adult smokers to switch to less risky products such as e-cigarettes, which deliver nicotine in a cloud of vapor. Tobacco companies have invested in the technology to offset declining sales as smokers switched to new entrants like Juul. But the sleek devices also proved popular with teens and young people who had never smoked. About eight million adults use e-cigarettes, and about five million children are also vaping, including more than a quarter of high-school students, according to the latest government estimates. “We have a problem in our country. It’s a new problem,” Mr. Trump, a Republican, said in the Oval Office on Wednesday as he met with top health officials. “It’s called vaping, especially vaping as it pertains to innocent children.” (Maloney and Leary, 9/11)

Trump, whose son Barron is 13 years old, said vaping has become such a problem that he wants parents to be aware of what's happening. "We can't allow people to get sick and we can't have our youth be so affected," he said. Melania Trump recently tweeted her concerns over the combination of children and vaping, and at the meeting, the president said, "I mean, she's got a son — together — that is a beautiful, young man, and she feels very, very strongly about it." (9/11)

"The Trump administration is making it clear that we intend to clear the market of flavored e-cigarettes to reverse the deeply concerning epidemic of youth e-cigarette use that is impacting children, families, schools and communities," HHS Secretary Alex Azar said in a statement. "We will not stand idly by as these products become an on-ramp to combustible cigarettes or nicotine addiction for a generation of youth." (Brady, 9/11)

"We must act swiftly against flavored e-cigarette products that are especially attractive to children. Moreover, if we see a migration to tobacco-flavored products by kids, we will take additional steps to address youth use of these products," Acting FDA Commissioner Ned Sharpless, said in a statement. (Harris and Wroth, 9/11)

The FDA had been looking to limit most flavored e-cigarette product sales, excluding mint and menthol, to online sales with age verification and vaping shops. Former FDA Commissioner Scott Gottlieb originally viewed e-cigarettes as a possible way to help adult smokers quit and sought in 2017 to ease regulation on them, pushing back to 2021 the date vape manufacturers would have to apply for agency approval to stay on the market. The deadline was moved up to May 2020 by a judge in July who also ruled e-cigarettes could stay on the market for a year while FDA reviews their application. (Edney, Wingrove and Fabian, 9/11)

The first lady was not the only driving force. ... But Trump said his wife’s pressure was key. In comparison with past first ladies, she has had a low profile on public policy. Here, in contrast, she persuaded her husband to dramatically shift the government's approach to a massive, growing and politically connected industry. That's something that neither federal regulators nor Capitol Hill had been able to do. (Owermohle, Kumar and Cancryn, 9/11)

Lawmakers on Capitol Hill largely applauded the Trump administration’s plan to ban all nontobacco flavors of e-cigarettes, with some saying the move is long overdue. On Wednesday, top administration health officials said they are finalizing a ban on all flavors of e-cigarettes in response to a massive spike in underage vaping. (Weixel, 9/11)

Lawmakers and public health groups have urged the agency to do more, with Minority Whip Dick Durbin last week telling Sharpless to take “decisive action” or else resign. “Finally, the FDA is doing its job,” Durbin said in a statement Wednesday. (LaVito, 9/11)

Juul CEO Kevin Burns — the head of what’s arguably the country’s most controversial company at the moment — met with The Chronicle’s editorial board Wednesday. He addressed a number of concerns, including youth vaping, the recent flood of vaping-related lung illnesses, and President Trump’s call for a federal ban on flavored e-cigarettes. ... Burns said he does not yet know if Juul products are connected to any of the illnesses. “It’s absolutely a possibility. We don’t know the facts. The indication (health officials) have said are the cases they’ve explored and done diligence on are related to tetrahydrocannabinol (THC) and illegal and illicit products. And there are reports of nicotine-only products they’re still investigating. Whether they’re truly nicotine-only products or not... we don’t know." (Ho, 9/11)

Juul CEO Kevin Burns, during a visit to The Chronicle’s editorial board on Wednesday, said the company supports a federal “reset” of flavor restrictions and would comply with any guidelines the Food and Drug Administration issues on the matter. “Flavors today are problematic,” said Burns, adding that many popular fruit- and candy-flavored nicotine products are made by other companies. (Ho, 9/11)

Europe does not appear to be experiencing an outbreak of the “vaping sickness” gripping the U.S.It’s not clear anyone would know if it was. (Wheaton, 9/12)

Juul Labs has spent millions of dollars on lobbying, hired high-profile Trump administration officials, and blanketed Washington with ads touting its efforts against underage vaping. None of that was enough to keep President Donald Trump from moving to ban flavored e-cigarettes on Wednesday, delivering a blow to the dominant vaping company and its rivals. (Meyer, 9/11)

Efforts to ban flavored e-cigarettes and reduce their appeal to youngsters have sputtered under industry pressure in over a half-dozen states this year even as one state, Michigan, moves ahead with its own restrictions and President Donald Trump promises federal ones. In many cases, the fight by the industry and its lobbyists has focused on leaving the most popular flavors — mint and its close cousin, menthol — alone. But public health experts say that all flavors should be banned, and that menthol can still hook kids on vaping. (9/12)

New Yorkers who vape do not seem to mind if President Donald Trump pushes through a proposed ban on flavored e-cigarettes, admitting that widespread youth addiction needed to be controlled and expressing hope that it might help them quit. ... "He would be doing me a favor," said Antoinette Quiles, a 31-year-old carpenter, as she inhaled from her Juul outside a New York subway stop. "Hopefully, if it’s not available, I won’t buy it. I’ve tried to stop and put it away, but it’s available." (9/11)

America's vaping industry has in recent years taken its fight to fend off regulation directly to President Donald Trump's doorstep, with a lobbying group twice booking annual meetings at his Washington hotel and e-cigarette maker Juul hiring two of his former White House officials. In 2017 and 2018, the Vapor Technology Association met at Trump's hotel to strategize how to lobby the administration, with a Republican lawmaker at one conference advising it to emphasize jobs created by the growing industry and how regulation could devastate hundreds of small vaping businesses. (9/11)

U.S. e-cigarettes maker Juul Labs Inc, which faces a widening crackdown on vaping at home, has entered China, with online storefronts on e-commerce sites owned by Alibaba Group and JD.com to tap the world’s largest market of smokers. Juul, in which tobacco giant Altria Group owns a 35% stake, has been launching its products in international markets such as South Korea, Indonesia and Philippines. It recently raised over $750 million in an expanded funding round. (9/12)

Juul said it approaches each country differently depending on its culture, laws and regulations. In Ireland, where there is no minimum age to purchase e-cigarettes, Juul said it has required retailers to enforce a minimum age of 18, matching the legal minimum for traditional cigarettes. It said it is gathering data on youth vaping rates in all the countries where it sells—from government agencies and through its own surveys—and could take additional steps if it sees an uptick among young people. (Maloney, 9/11)

Adam Hergenreder's vaping habit almost killed him. Late last month, the 18-year-old student athlete in Gurnee, Illinois, was hospitalized after using e-cigarettes for more than a year and a half. Now his lungs are similar to those of a 70-year-old adult, doctors told him. "It was scary to think about that -- that little device did that to my lungs," Adam said, remembering the news from his doctors about his lung health. (Howard and Nedelman, 9/12)

Though she might not look like it today, Simah Herman said she was sure she was going to die last month as she sat in the car unable to breathe, her father racing her to the hospital. “I just remember feeling like absolute...nothing. Like I just couldn't do anything,” Herman, 18, said. “I couldn’t drink water. I couldn’t move. Like, I literally just wanted to crawl out of my skin.” (Hawkins, Walker, Riegle and Rivas, 9/11)

Authorities in charge of Oregon's legal marijuana market said Wednesday that they will ask store owners to voluntarily review pot products on their shelves and pull any they feel might be unsafe as concern mounts about severe lung illnesses and deaths tied to vaping across the U.S. The Oregon Liquor Control Commission, which also regulates pot, will ask stores to put up signs warning about the potential dangers of vaping, executive director Steve Marks told The Associated Press. (Flaccus, 9/11)

Forty-two people in Illinois have been stricken by the sickness, officials said late Wednesday — nearly twice the previous total announced in the state. The Centers for Disease Control and Prevention has identified more than 450 possible cases across the country that have been attributed to both cannabis and nicotine vaping products. Following a fatality reported in Kansas Tuesday, six total deaths have been linked to the outbreak. (Schuba, 9/11)

Seven medical cannabis users in Maryland have come forward to report unexplained respiratory symptoms since the state’s Medical Cannabis Commission asked users and providers to alert regulators of any lung problems in light of the mounting cases of illnesses locally and nationally linked to vaping. In light of those illnesses, and a half dozen deaths across the country, the commission sent an advisory in late August to the medical marijuana community asking those who suffer unexplained symptoms to seek medical attention and report cases to the commission. (Cohn, 9/12)

New York officials investigating a deadly vaping-related lung illness plan to subpoena records of an Amherst company, amid concerns that it is selling a potentially harmful substance thought to be fueling the national crisis. Mass Terpenes, an online business registered by an Athol man, was one of three companies nationwide hawking products shown in lab tests to be “nearly pure” vitamin E acetate oil, New York officials said. That ingredient, added to marijuana oil by illicit vape producers, is among the possible chemicals suspected of causing lung problems. (Martin and Adams, 9/11)

Police are crediting the parents of a Wisconsin high school student for coming forward with information that led to a massive drug bust involving an operation that manufactured thousands of counterfeit vaping cartridges loaded with THC oil every day. ... The probe reportedly led back to two Kenosha County brothers — Tyler and Jacob Huffhines — and a major drug operation running out of a condominium in an upscale neighborhood that officials said was rented under a fake name. (Rutledge and Spicuzza, 9/11)

As President Donald Trump vowed Wednesday to force companies to stop selling flavored vaping products, two Bay Area cities this week moved forward on legislation banning the sale of e-cigarettes altogether, regardless of flavor. (Ho, 9/11)

The Bureau of Tobacco Free Florida told The News Service of Florida on Monday that state health officials have “received several potential reports of illness” and that the Department of Health and the Florida Poison Information Center Network are working with the Centers for Disease Control and Prevention on investigating a multistate outbreak of severe pulmonary disease. The Department of Health declined to give the precise number of reported cases or disclose where the residents live. (Sexton, 9/11)

Amazon has quietly removed several products that buyers could use to make counterfeit marijuana vaping devices — the same ones which, along with nicotine vapes, have been tied to hundreds of injuries and at least six deaths reported nationwide this year. The products pulled from Amazon mimicked marijuana products that are sold legally in the several U.S. states that have approved recreational cannabis. They range from packaging materials for the Exotic Carts brand of marijuana oil cartridges to bulk “California compliant” stickers indicating the object to which the labels are affixed is legal under the state’s marijuana law. (Nelson, 9/11)

The explosive rise in a serious lung illness linked to vaping spotlights the popularity of e-cigarettes among teens and young adults — and how little is known about the devices’ safety and use. As of Tuesday, federal health officials were investigating at least 450 possible cases of the mysterious pulmonary illness across 33 states, including six cases that resulted in death. California has reported nearly 60 cases of lung illness since late June in patients with a history of vaping; one of those patients, in Los Angeles County, has died. (Rowan, 9/11)

Thousands of municipal governments nationwide and nearly two dozen states that sued the pharmaceutical industry for the destructive opioid crisis have tentatively reached a settlement with Purdue Pharma and its owners, members of the Sackler family. The deal is a landmark moment in the long-running effort to compel Purdue, the company whose signature opioid, OxyContin, is seen as an early driver of the epidemic, and its owners, the Sacklers, to face a reckoning for the deaths of hundreds of thousands of people from overdoses and the calamitous systemic costs. (Hoffman, 9/11)

If the deal becomes final, it would be the first comprehensive settlement in the broad effort to hold drug companies accountable for their role in the opioid epidemic. To date, Purdue has also settled with one state, Oklahoma, for $270 million, and won a victory when a North Dakota judge threw out that state’s case against the company. The deal also would mark the demise of Purdue as a private company widely blamed for its role in driving the prescription opioid epidemic in the late 1990s and the first years of this century. In 2007, Purdue and three of its executives pleaded guilty to criminal charges of misleading doctors and the public about the safety of OxyContin and paid a $635 million fine. (Bernstein, Davis, Achenbach and Higham, 9/11)

The agreement with about half the states and attorneys representing roughly 2,000 local governments would have Purdue file for a structured bankruptcy and pay as much as $12 billion over time, with about $3 billion coming from the Sackler family. That number involves future profits and the value of drugs currently in development. In addition, the family would have to give up its ownership of the company and contribute another $1.5 billion by selling another of its pharmaceutical companies, Mundipharma. (9/11)

Purdue has valued the settlement at between $10 billion and $12 billion, though much of that relies on future sales of its signature painkiller and the development of drugs to treat opioid addiction. States that oppose the deal have questioned the settlement’s valuation. A Purdue spokesman said Wednesday the company “continues to work with all plaintiffs on reaching a comprehensive resolution to its opioid litigation” that will include billions of dollars and overdose-rescue medicines. Representatives for the Sacklers didn’t respond to a request for comment. (Randazzo and Hopkins, 9/11)

More than a dozen other states remain opposed or uncommitted to the deal, setting the stage for a legal battle over Purdue's efforts to contain the litigation in bankruptcy court, they said.States on Wednesday updated a federal judge on the settlement offer's support, which could evolve as the day progresses, the people said. (9/11)

States that want more from the Sacklers, including Massachusetts, New York and Connecticut, will have to battle in bankruptcy court to extract it from the multibillionaire family, said Chuck Tatelbaum, a Florida-based lawyer who has worked on mass-tort cases that wound up in Chapter 11. “Without the super majority of 35 states, the case becomes infinitely more complicated,” Tatelbaum said. “A bankruptcy judge will be less inclined to sign off on a deal without that number and then it becomes a question of who gets what and who gives what.” (Feeley, 9/11)

[Massachusetts Attorney General Maura] Healey, who has been resistant to a reported settlement of between $10 billion to $12 billion with Purdue Pharma over apparent concerns that the family that owns the company would not contribute enough of its own fortune, is not one of the attorneys general who signed onto the settlement, her office said. (Young, 9/11)

“The families who were hurt by Purdue and the Sacklers have spoken loud and clear that this case demands real accountability, and I will continue to fight for that,” Massachusetts Attorney General Maura Healey said in a statement. “It’s critical that all the facts come out about what this company and its executives and directors did, that they apologize for the harm they caused, and that no one profits from breaking the law.” (Lovelace, 9/11)

Saying it does not do enough to atone for the havoc wrecked by the opioid epidemic, Connecticut has rejected a tentative settlement reached by Purdue Pharma and the Sackler family that would settle thousands of lawsuits nationwide. “I cannot speak to other states or divulge confidential negotiations, but Connecticut has not agreed to any settlement,” said Attorney William Tong, who was involved in the negotiations. (Radelat and Carlesso, 9/11)

The American opioid crisis has left a lethal mark. Experts estimate as many as 400,000 people may have died from overdoses and related problems in the past several decades. Now, more than 20 states appear to have reached a comprehensive settlement against Purdue Pharma, maker of opioid OxyContin. Amna Nawaz talks to Connecticut Attorney General William Tong about why he thinks it’s not enough. (9/11)

The attorney general of North Carolina, who opposes the deal, issued a statement Wednesday saying that a "large number of states" think the Sackler family needs to guarantee more money. "We believe they created a mess and must help to clear it up," said Attorney General Josh Stein. "I am now preparing filings to sue the Sackler family." (Strickler, 9/11)

Wisconsin Attorney General Josh Kaul called the tentative settlement with other states inadequate. But for now, the Democratic attorney general couldn't finalize a deal with the pharmaceutical giant even if he wanted because of his disagreement with Republican state lawmakers. (Marley, 9/11)

Ohio Attorney General Dave Yost is a supporter. “The proposed settlement with Purdue provides the greatest certainty for all Ohioans to receive relief as quickly as possible in light of rumored bankruptcy,” Yost spokesman David O’Neil said in a statement. “AG Yost continues to fight to get resources for those impacted statewide and has been actively involved in the negotiations.” (Heisig, 9/11)

Reports of Purdue Pharma — manufacturer of the popular painkiller OxyContin — reaching a major settlement with multiple states and cities on Wednesday is being injected into Kentucky's race for governor. (Bailey, 9/11)

The tentative settlement involving the opioid crisis and the maker of OxyContin could mean that thousands of local governments will one day be paid back for some of the costs of responding to the epidemic. But for public officials in Akron, no amount of money will restore the families and institutions that were upended by prescription painkillers, heroin and fentanyl. (Carr Smyth, 9/12)

In other news —

The state of Maryland is uncomfortable with Insys Therapeutics Inc. ’s proposed sale of the opioid drug Subsys, raising concerns the buyer would fuel further illegal sales of the drug. In an objection filed in the U.S. Bankruptcy Court in Wilmington, Del., where Insys is selling off its assets, Maryland authorities said they believe the proposed buyer is linked to a company that has its roots in a mail-order pharmacy that they said “knowingly aided” off-label sales of Subsys, a powerful fentanyl painkiller. The state said Subsys shouldn’t be sold unless safeguards are in place to prevent the buyer from following Insys in feeding drug addiction. (Brickley, 9/11)

A quarter of all adults in Britain take prescription medication for pain, anxiety, depression or insomnia, and half of those people had been taking the drugs for a year or more, according to a government report released this week. The report, based on an analysis of prescription data in 2017 and 2018, is the first snapshot of prescription drug use in Britain. Though the numbers did not suggest the same degree of opioid abuse as in the United States, public health officials said the report underscored the need to find alternatives to prescribing medications. (Abdul, 9/11)

Count on two things happening at Thursday’s Democratic presidential debate: The candidates will distill their complex health care proposals into convoluted 30-second sound bites. Few Americans will understand what they’re saying. (Garofoli, 9/12)

What does Medicare for All mean? It represents a fundamental restructuring of the US health care system, giving government a greater role in a system now dominated by private companies. The phrase often stands for a national single-payer system, but it has become a catch-all, representing a spectrum of different ideas to expand access to health care and tackle rising costs. (Dayal McCluskey, 9/11)

The winnowing phase of the Democratic primary kicks into high gear Thursday in Houston when the top presidential candidates debate on stage together for the first time in a one-night event. Only 10 candidates met the Democratic National Committee’s higher thresholds for the third debate—half the number that qualified for the last two debates, which were split into two nights. (Parti, Naranjo and Collins, 9/11)

Meanwhile —

A new poll finds that more voters favor an optional government-run health insurance plan, as former Vice President Joe Biden advocates, than full-scale "Medicare for All" that eliminates private health insurance, as advocated by Sen. Bernie Sanders (I-Vt.). The poll could give credence to Biden's argument against his main two rivals in the Democratic White House race, Sanders and Sen. Elizabeth Warren (D-Mass.), that an optional plan is more popular in a general election than the full-scale Medicare for All that Sanders and Warren advocate. (Sullivan, 9/11)

A hearing on Capitol Hill Wednesday produced more questions than answers around why the Trump administration moved to quietly end a humanitarian immigration policy known as "medical deferred action." Though little clarity was provided by federal immigration officials, the distinct partisan divide on immigration policy was laid bare, with Republican lawmakers suggesting the hearing itself was a scare tactic and the Democrats calling this an inhumane move by the Trump administration. (Dooling, 9/11)

Democratic lawmakers criticized federal immigration officials Wednesday for refusing to explain their decision to stop considering requests from immigrants seeking to defer deportation for medical treatment and other hardships. Officials with two agencies — U.S. Citizenship and Immigration Services, and Immigration and Customs Enforcement — declined to answer many questions posed during a contentious House hearing, citing a recent legal challenge from civil rights groups. (Marcelo, 9/11)

Asked whether ICE would be taking any steps to ensure that critically ill immigrants would continue to receive the protections afforded by deferred action, Timothy Robbins, the acting executive associate director of enforcement and removal operations for ICE, said the Department of Homeland Security is “still considering a pathway forward, and those are internal discussions that we are not prepared to discuss.” Renaud and Robbins addressed the committee after lawmakers heard from legal experts, a pediatrician, and two young people, both of whom said they were dependent on lifesaving medical treatment available to them in the United States through deferred action. A forced return to their native countries, Guatemala and Honduras, they said, would be a “death sentence.” (Hauslohner, 9/11)

One immigrant went to California as a child to participate in a drug study that has helped Americans survive with a rare genetic disease. Another, an adolescent girl from Spain, was told by a cardiologist that she must remain in Boston to receive critical care for which her family borrowed thousands of dollars. A teenage boy with cystic fibrosis arrived in the United States “literally dying,” he said, but now has a new lease on life. (Jordan, 9/11)

A Concord woman who immigrated to the United States as a young girl to receive life saving medical care urged Congress on Wednesday to do what it can to prevent her from being deported, possibly to die from her illness. “Thinking about you’re going to die when you have so many dreams and hopes for your life, it’s devastating,” Isabel Bueso testified during a congressional hearing in Washington, D.C. (Sciacca, 9/11)

In a direct and urgent call to address gun violence in America, the chief executives of some of the nation’s best-known companies were set to send a letter to Senate leaders on Thursday, urging an expansion of background checks to all firearms sales and stronger “red flag” laws. “Doing nothing about America’s gun violence crisis is simply unacceptable and it is time to stand with the American public on gun safety,” the heads of 145 companies, including Levi Strauss, Twitter and Uber, say in the letter, a draft of which was shared with The New York Times. (Sorkin, 9/12)

Fights over abortion and President Donald Trump's U.S.-Mexico border wall have thrown Senate efforts to advance $1.4 trillion worth of agency spending bills into disarray, threatening one of Washington's few bipartisan accomplishments this year. A government shutdown remains unlikely, but agencies face weeks or months on autopilot while frozen at this year's levels if the logjam isn't broken. (Taylor, 9/11)

Physician associations on Wednesday called on U.S. House of Representatives lawmakers to pass legislation to streamline prior authorization, claiming it places undue burden and costs on physicians. During a hearing before the House Committee on Small Business, four doctors representing physician associations said onerous prior authorization requirements delay necessary patient care, lead to burn out in physicians and result in worse outcomes. (Livingston and Luthi, 9/11)

Kaiser Health News: Legislation To End Surprise Medical Bills Has High Public Support — In Both Parties
Nearly 8 in 10 Americans support legislation to protect people from surprise medical bills, a new poll from the Kaiser Family Foundation shows. That support persisted no matter which party was asked: 84% of Democrats, 78% of independents and 71% of Republicans said they support surprise billing legislation, according to the poll. (Huetteman, 9/12)

The folded American flag from her father’s military funeral is displayed on the mantel in Tawanda Rhodes’s living room. Joseph Victorian, a descendant of Creole slaves, had enlisted in the Army 10 days after learning that the United States was going to war with Korea. After he was wounded in combat, Joseph was stationed at a military base in Massachusetts. There he met and fell in love with Edna Smith-Rhodes, a young woman who had recently moved to Boston from North Carolina. The couple started a family and eventually settled in the brick towers of the Columbia Point housing project. Joseph took a welding job at a shipyard and pressed laundry on the side; later, Edna would put her southern cooking skills to use in a school cafeteria. In 1979, Joseph and Edna bought a house in Boston’s Dorchester neighborhood for $24,000. (Corbett, 9/11)

Virginia's inspector general is investigating a contract worth up to $1.5 million that the state's Medicaid office awarded to a company owned by a former U.S. government employee who helped oversee federal oversight of the state. The Department of Medical Assistance Services said earlier this week that it asked for the investigation to "ensure full transparency." The agency did not say what prompted the request and declined to answer questions. (Suderman, 9/11)

A Republican version of a proposal to expand Medicaid to hundreds of thousands of additional working adults in North Carolina will get another look in the state House now that the chamber has voted to override Democratic Gov. Roy Cooper's budget veto. Speaker Tim Moore said Wednesday he anticipates more action on the GOP-written Medicaid measure next week. That's because he says he's keeping his earlier promise to consider expansion after a successful override vote, which occurred Wednesday morning when dozens of Democrats were absent from the House floor. (9/11)

Michigan's Legislature has approved a bill that would exempt some Medicaid recipients from having to meet monthly reporting rules if the state can verify their compliance with work requirements through other data. Democratic Gov. Gretchen Whitmer is expected to sign the measure that won final passage from the Republican-led Senate Wednesday. (9/11)

The Maryland attorney general’s office says a woman has been convicted of felony Medicaid fraud after claiming that she was providing care for a client with developmental disabilities and autism when she was actually working elsewhere. Attorney General Brian Frosh said in a news release that a judge gave 55-year-old Shelia Vines a suspended three-year sentence, five years’ probation and ordered her to repay the Medicaid program more than $18,900. (9/12)

The chemical N-Nitrosodimethylamine, or NDMA, is a yellow liquid that dissolves in water. It doesn’t have an odor or much of a taste. It’s known to cause cancer in animals and is classified as a probable carcinogen in humans—it’s most toxic to the liver. A single dose of less than a milligram can mutate mice cells and stimulate tumors, and 2 grams can kill a person in days. An Oklahoma man poisoned the family of an ex-girlfriend in 1978 by pouring a small vial of NDMA into a pitcher of lemonade. In 2018 a graduate student in Canada sickened a colleague by injecting the chemical into his apple pie. (Edney, Berfield and Yu, 9/12)

Twenty years ago, the fight against cancer seemed as if it were about to take a dramatic turn. Traditionally, cancer doctors fought the disease with crude weapons, often simply poisoning fast-growing cells whether they were cancerous or healthy. But then a team of researchers hit on a new strategy: drugs targeting proteins produced by cancer cells that seemed necessary to their survival. (Zimmer, 9/11)

Jason Sheltzer thought he was learning answers to a simple question, but one that, for cancer patients, could mean the difference between life and death: Which genes can’t tumor cells survive without? Identifying DNA that seems essential to cancer cells’ survival tells drug developers which genes or gene products to target — a tried-and-true approach that has led to such lifesaving cancer drugs as Herceptin. (Begley, 9/11)

When Colorado earlier this year became the first state in the country to cap the price that some people will pay for insulin starting next year, skeptics questioned whether the change would raise insurance prices for everybody else. The answer, according to regulatory filings from insurance companies, is no. The Colorado Sun reviewed the documents that 21 health plans submitted to the state Division of Insurance to justify their proposed 2020 rates for the individual and small-group markets. Most plans didn’t mention the insulin caps at all as being a factor in their calculations. (Ingold, 9/11)

By the time Kelly Pfaff got home from driving her son to school that morning, it was too late. Her husband, John, was supposed to be taking their 4-year-old daughter to school. But the girl and the nanny were still at the Pfaffs’ house near San Diego. So were John’s wallet, cellphone and wedding ring. John was gone. (9/11)

Kaiser Health News: Congress Rakes In Millions From Drugmakers
Members of Congress raked in almost $4 million from pharmaceutical manufacturers and their trade groups in the first six months of 2019. Two members — Sen. Chris Coons (D-Del.) and Sen. Thom Tillis (R-N.C.) — each received over $100,000. Rep. Greg Walden (R-Ore.) is $5,000 shy of qualifying for the “million-dollar club,” a group of current members who’ve received $1 million or more since 2007. (Lucas, 9/12)

A FRONTLINE investigation uncovers the extent of a deadly Legionnaires’ disease outbreak during Flint's water crisis — and how officials failed to stop it. (9/11)

For years, state health officials in Michigan have set the official death toll for the Legionnaires’ outbreak amid the Flint water crisis at 12 people. But during the roughly year-and-a-half the outbreak spanned, Frontline reporters found that 115 people in Flint died of non-viral pneumonia. The stark difference in numbers, along with evidence culled from court records, internal emails among state government officials, interviews with victims and data analysis, suggests there were dozens of deaths that stemmed from undiagnosed and untreated cases of Legionnaires’ disease that ultimately fell outside the state’s official count (which, per standard public health reporting methods, only counts people diagnosed with Legionnaires’ who either died in the hospital or within a month of leaving it). (Bellware, 9/11)

Exposure to "conversion therapy" — efforts by a secular or religious professional to change a transgender person’s gender identity — is associated with thoughts of and attempts at suicide, according to a study published Wednesday in the journal JAMA Psychiatry. Dr. Jack Turban, the study’s lead author and a resident physician in psychiatry at Harvard Medical School, said it was the first study "to show that gender identity conversion efforts are associated with adverse mental health outcomes, including suicide attempts.” (Fitzsimons, 9/11)

Researchers analyzed survey responses from more than 27,000 transgender adults across the United States and U.S. territories and military bases, roughly evenly divided between those who had been identified as boys at birth and those who had been identified as girls. People who said they had undergone conversion therapy at any point during their lifetime were twice as likely to have attempted suicide than those who had never undergone such therapies. And those who were subjected to conversion efforts during childhood were four times as likely to have tried to take their own lives, the researchers said. (Bever, 9/11)

The City Council is planning to repeal the ban on conversion therapy it passed with much fanfare just two years ago, an unusual maneuver designed to sidestep a lawsuit from an anti-LGBTQ hate group based in Arizona. Conversion therapy aims to alter a person’s sexual orientation or gender identity, and has been banned in a host of states. Speaker Corey Johnson on Thursday plans to introduce legislation that would repeal New York City's prohibition on the practice. (Anuta, 9/11)

McKrae Game, the man who founded one of the biggest conversion therapy programs in the country, is opening up about his decision to come out as gay after leading the homophobic organization for 20 years. Game, 51, appeared on Tuesday’s episode of Tamron Hall, the former NBC journalist’s new self-titled talk show, where Game spoke candidly about his decision to go public with his truth after vehemently preaching that being gay would send someone to hell. (Adams, 9/10)

Maria Davila lay mute in a nursing home bed, an anguished expression fixed to her face, as her husband stroked her withered hand. Ms. Davila, 65, suffers from a long list of ailments — respiratory failure, kidney disease, high blood pressure, an irregular heartbeat — and is kept alive by a gently beeping ventilator and a feeding tube. Doctors recently added another diagnosis to her medical chart: Candida auris, a highly contagious, drug-resistant fungus that has infected nearly 800 people since it arrived in the United States four years ago, with half of patients dying within 90 days. (Richtel and Jacobs, 9/11)

A cutting-edge cancer treatment can also cure certain kinds of heart failure in mice, scientists reported on Wednesday. The treatment is a type of immunotherapy known as CAR-T, which has proved life-changing for some patients with blood cancers. CAR-T relies on engineered white blood cells — T cells — that seek out and destroy malignant cells in the body. (Kolata, 9/11)

Often, when she got high on meth, “Melanie,” who suffers from schizophrenia, would strip naked and run screaming straight into San Francisco traffic. Invariably, police would bring her to the hospital, where she’d undergo treatment. There, her psychotic symptoms would quickly subside. But by law, Melanie, who is homeless, couldn’t be held for longer than 72 hours without her consent, so back on the street she would go. Until she relapsed, and her drug use triggered yet another psychotic episode, and she ended up in the emergency room all over again. And each time, she got a little worse. (Wiltz, 9/11)

At Mayo Clinic last year, a male patient groped a female doctor in the presence of several other staff members. She immediately notified hospital administrators using a new reporting system, and the patient was terminated from the physician’s practice within 48 hours. Before this reporting process was created in 2017, the renowned Rochester, Minn., hospital had no procedures for how to deal with patients who harass staff — or even language addressing the issue in hospital guidelines. (Corley, 9/12)

Recently, Netflix announced that it would not include depictions of smoking in any new programming aimed at younger viewers. In a similar vein, on the advice of medical experts, it has removed the suicide scene from the first season of its teen drama “13 Reasons Why.” These efforts to protect the physical and mental health of young people are commendable. But if we are reconsidering what gets set before adolescents in the context of entertainment, there’s a serious and striking omission in the announced changes: depictions of rape. (Damour, 9/12)

Late last month, Kathleen Eaton of Amelia Island, Fla., went online to buy a dog. She found a miniature black schnauzer named Holly at a site she thought was puppyspot.com. She emailed the company and was told she could get the dog for a discounted price of $750. She asked to pay with a credit card, but was told to wire the money to a Western Union in Oklahoma City. The company would then send her information about Holly’s flight the next day. (Ellin, 9/12)

Dr. David Fajgenbaum has nearly died not once, but five times. The cause each time was a rare disorder called Castleman disease, an affliction on the boundary between cancer and an autoimmune disorder. It caused his entire body to swell up. Previously a muscled college football player, he first became bloated, then very thin. Fajgenbaum, who was in medical school when he got sick, did something extraordinary. (Herper, 9/12)

We were so confused. My wife’s mother was going through medical issues that could potentially have left her needing long-term care. But we had never taken a hard look at our options if that happened. She lives 2,000 miles away, and we all had to start thinking about what the next steps would be if things did not go well with her. And we had no idea where to start. (Schwartz, 9/12)

A Sacramento woman went to the emergency room in July with numbness in her hands and feet, slurred speech and trouble walking. The 47-year-old mother of five wasn’t having a stroke or heart attack. She was suffering from mercury poisoning from a tainted anti-wrinkle cream imported from Mexico, KCRA-TV reported. She has been in the hospital since then, according to her son, who told KCRA he wished to remain unidentified. (Beachum, 9/11)

Scientists have invented a device that can quickly produce large numbers of living entities that resemble very primitive human embryos. Researchers welcomed the development, described Wednesday in the journal Nature, as an important advance for studying the earliest days of human embryonic development. But it also raises questions about where to draw the line in manufacturing "synthetic" human life. (Stein, 9/11)

Kaiser Health News: In Search Of Age-Friendly Health Care, Finding Room For Improvement
A month ago, during a visit to her doctor’s office in Sequim, Wash., Sue Christensen fell to her knees in the bathroom when her legs suddenly gave out. The 74-year-old was in an accessible stall with her walker, an older model that doesn’t have brakes. On her left side was a grab bar; there was nothing to hold onto on the right. Christensen tried to pull herself up but couldn’t. With difficulty, she rearranged her clothing and, inching forward on her knees, exited the stall. There, she tried calling the front desk on her cellphone but was placed on hold by the automated phone system. (Graham, 9/12)

Scientists are reporting the first use of the gene-editing tool CRISPR to try to cure a patient's HIV infection by providing blood cells that were altered to resist the AIDS virus. The gene-editing tool has long been used in research labs, and a Chinese scientist was scorned last year when he revealed he used it on embryos that led to the birth of twin girls. Editing embryos is considered too risky, partly because the DNA changes can pass to future generations. (9/11)

While the treatment did not rid the man of the AIDS virus, the researchers and others are calling the report promising. That's because it indicates that so far the gene-editing technique seems to safely and effectively make the precise DNA change intended. "It is a first step," says Hongkui Deng, a professor of cell biology at the Peking University, who helped lead the research. The case was published in the New England Journal of Medicine. "It is promising." (Stein, 9/11)

“They attempted a moonshot, and while they did not land on the moon, they got back home safely,” said Fyodor Urnov of the Innovative Genomics Institute at the University of California, Berkeley, who previously helped lead a study for Sangamo Therapeutics (SGMO) of whether an older genetic technology, zinc fingers, could cure HIV/AIDS. Crucially, Urnov said of the Chinese study, “they highlighted how to get to the moon.” (Begley, 9/11)

The government may be required to pay billions of dollars in emergency care claims to veterans after a federal court ruled this week that the Department of Veterans Affairs improperly denied reimbursements for such care received at non-VA facilities. The ruling by the U.S. Court of Appeals for Veterans Claims said federal law mandated the VA to pay the emergency medical expenses if they are not covered by private insurance. (9/11)

"All of this is unacceptable," said the ruling, which ordered the VA secretary to "readjudicate these reimbursement claims." Plaintiffs' lawyers say that based on past estimates by the VA, the department is now on the hook for between $1.8 billion and $6.5 billion in reimbursements to hundreds of thousands of veterans who have filed or will file claims between 2016 and 2025. (Kube, Gains and Kaplan, 9/10)

In other veterans' health care news —

A lawyer representing relatives of patients who died at a Veterans Affairs hospital in West Virginia said investigators contacted three more families, indicating a federal probe into about 10 suspicious deaths is expanding. The VA's Office of Inspector General has been looking into the deaths at Louis A. Johnson VA Medical Center in Clarksburg, West Virginia. At least two of those deaths were reclassified as homicides after the bodies were exhumed. The elderly patients received insulin injections they did not need, causing their blood sugar to plummet. They died one day apart in April 2018. (Alltucker, 9/10)

Federal authorities are investigating allegations of sexual assaults at a Veterans Affairs hospital in West Virginia. The VA inspector general issued a statement this week saying the office is working with federal law enforcement to look into multiple assaults at the Beckley VA Medical Center. Hospital spokeswoman Sara Yoke says an “individual” was fired in response to the allegations but she didn’t release the person’s identity or job title. (Izaguirre, 9/11)

Austin became the first city in the nation Tuesday to approve public funding to help women better access abortion. The Austin City Council on Tuesday amended next year's budget and set aside $150,000 to supplement incidental expenses like travel, lodging and childcare for women seeking the procedure. The money will not go directly toward the expense of the procedure itself. The amendment comes just days after a new state law prohibiting local and state governments from giving taxpayer dollars and some public resources to abortion providers and their affiliates went into effect. (Fernandez, 9/11)

A federal judge has temporarily halted a North Dakota law that required doctors to tell patients the effects of abortion drugs can be reversed. U.S. District Court Judge Daniel Hovland issued an order Tuesday granting a preliminary injunction on that part of the law, known as H.B. 1336. (Frazin, 9/11)

Maine might use state tax dollars to replace at least a portion of a $2 million shortfall in federal funds for family planning clinics created when the Trump administration imposed a “gag rule” on the Title X program this year. Deirdre Fulton-McDonough, spokeswoman for Maine Family Planning, said the nonprofit is in early discussions with the Mills administration and state lawmakers on securing funding to replace the federal funding. Maine Family Planning provides abortion services and reproductive health services at 18 locations throughout Maine. (Lawlor, 9/11)

A landmark bill, which would offer new wage and benefit protections to workers in California's gig economy and a host of other industries, is headed to the governor's desk. ... In steering more workers to employee status, the bill would force companies to offer basic worker protections that contractors don't currently receive, such as guaranteed minimum wage, overtime pay, contributions to Social Security and Medicare, and unemployment and disability insurance. Those workers would also be eligible for workers’ compensation and sick and family leave and would be protected from discrimination at work, none of which are currently afforded to contractors. (Orr, 9/11)

Proponents say that companies call workers independent contractors to avoid paying minimum wage, overtime, workers’ compensation, unemployment insurance and a range of other benefits that can add 30% to labor costs. Misclassification costs California some $8 billion a year because of lost wages, taxes and expenses, as well as subsidizing social safety-net assistance for the workers, said the bill’s author, Assembly member Lorena Gonzalez, D-San Diego. But opponents, who include both companies and workers, say they value the flexibility of independent contractors. (Said and Gardiner, 9/11)

The California legislature has passed a bill that aims to force app-based platforms like Uber and Lyft to reclassify as employees some workers currently defined as independent contractors. So-called “gig” work on app-based technology platforms has increased dramatically since the Great Recession. But, taken as a whole, non-traditional work arrangements (including freelance and independent contractor work, contract, temporary and on-call work) have not risen dramatically as a share of work done by the U.S. labor force. (Hartman, 9/11)

California’s new law restricting medical exemptions for vaccines has a challenge from a group of protesters who want voters to overturn it. Three women who protested the vaccine law, Senate Bill 276, at the Capitol this year on Wednesday submitted a petition for a referendum on it, according to an announcement from the Attorney General’s Office. They submitted a separate petition for a referendum on Senate Bill 714, which is a companion law that Gov. Gavin Newsom requested to narrow the vaccine law. (Ashton, 9/11)

Though the calendar has flipped to September and daytime temperatures are a bit cooler and people may no longer have mosquitoes on the mind, Eastern equine encephalitis remains a “serious concern” in Massachusetts, Public Health Commissioner Monica Bharel said Wednesday. ... Risks have been flagged in more than half of the state’s 351 communities: 36 are at critical risk for EEE, 42 are at high risk, and 115 are at moderate risk, according to the DPH. (Lannan, 9/11)

Nonprofit hospitals in Georgia soon will face tough new financial transparency rules, under a law passed earlier this year by the General Assembly. The new law will require disclosure of data on executives’ compensation and the financial holdings of hospitals. The state is developing regulations on how it will be implemented, and there is considerable anxiety among Georgia hospital executives as they await the deadlines and rules about the disclosures. (Miller, 9/11)

Hundreds of state jobs would be eliminated and positions frozen — from consumer protection staffers and drivers license workers to school safety coordinators — under plans drawn up to meet Gov. Brian Kemp’s demand to cut spending. ... Not everything will be cut equally across state government. Some massive enrollment-driven programs — such as K-12 schools, universities and Medicaid, the health care program for the poor and disabled — are exempt. ... Grants to local domestic violence shelters and sexual assault centers would be cut $1.3 million over the next two years. The Department of Public Health would cut grants to county health departments by $12.6 million and trauma care would take a $1.67 million hit. (Salzar, 9/11)

Sacramento Mayor Darrell Steinberg and other California elected officials are skeptical as the Trump administration focuses attention on homelessness in California cities, but are hopeful more federal funding could be on the way to address the growing crisis. ... “Homelessness is our most serious problem and deserves a serious response,” Steinberg said in a statement. “I am wary of any such offer from an administration that consistently demonizes vulnerable people. And yet, if the federal government wants to offer resources to help bring people indoors and to offer federal facilities to shelter and house people, we should readily listen. We cannot afford to politicize an issue which needs real thought and real commitment.” (Clift, 9/11)

The Department of Public Health told The Chronicle that it decided to stop admitting people into a long-term care facility for mentally ill patients last year — and instead leave more than 20 beds empty every night — because the facility was unsafe due to staff negligence and errors. Officials said that decision, made in 2018, was spurred by years of anonymous complaints filed with the state regarding the Adult Residential Facility, a long-term treatment site located on the San Francisco General Hospital campus. The complaints, state records show, include a staff member allowing a patient to walk naked to the bathroom in front of others and medication mismanagement. (Thadani, 9/11)

Patricia Baker, a founding member of the Connecticut Health Foundation and the group’s leader since its 1999 inception, said Wednesday that she will retire next year. ... In the foundation’s early days, Baker focused the group’s efforts on tackling children’s mental health issues, addressing gaps in oral health care and taking on racial and ethnic health disparities. Its work included early intervention strategies and public support for children at risk of mental health issues, funding and advocacy to confront untreated dental problems, and data-driven studies of health inequalities. (Carlesso, 9/11)

A Florida health care executive is facing sentencing following his conviction on 20 criminal charges in what prosecutors described as a $1 billion Medicare fraud scheme. A Miami federal judge Thursday is set to sentence 50-year-old Philip Esformes in one of the biggest such cases in U.S. history. Prosecutors are seeking a 30-year prison term, while Esformes' lawyers as asking for a lenient sentence. (9/12)

Four months after the town of Paradise was incinerated in the most destructive wildfire in California history, Gov. Gavin Newsom issued an emergency proclamation, ordering agencies to thin trees and clear shrubs near some of the state’s most fire-threatened communities. Saying the $32 million in projects were vital “to protect the lives and property of Californians” he swept aside environmental reviews and competitive bidding requirements to speed the work. (Boxall, 9/11)

One in four college students suffers from depression. The suicide rate among Americans, ages 15 to 24, has reached its highest level since 1960, and suicide is the second leading cause of death for this age group. [Author Reggie] Burton thinks these statistics should resonate at this time of year, as the school year ramps up at Stanford, UC Berkeley, San Jose State and other schools. (Ross, 9/11)

Since 2006, every school district in the nation has been required to have a school wellness policy. Whether that means a few words on a paper that gets pulled out at inspection time, or real efforts to make healthy changes, however, is entirely up to each district. Over the past several years, Marlene Shwartz, a professor at UConn’s Rudd Center for Food Policy and Obesity, has analyzed the wellness policies at each school across Connecticut. “We thought the wealthier districts would have stronger policies, but we found the opposite,” Shwartz said. “Wealthier districts thought they didn’t have a problem. They kind of blew it off. We found the best policies in the cities, with New Haven being the best.” (Werth, 9/12)

The Milwaukee County Behavioral Health Division has signed a multi-year agreement with federal regulators to correct problems at the Mental Health Complex in Wauwatosa after a series of inspections found ongoing problems with documentation at the psychiatric hospital. The agreement was signed last month with the federal Centers for Medicare and Medicaid Services and requires the Behavioral Health Division to take steps, including hiring an outside consultant, to address violations of federal regulations. (Boulton, 9/11)

California’s black market for cannabis is at least three times the size of its regulated weed industry, according to an audit made public Wednesday, the latest indication of the state’s continued struggle to tame a cannabis economy that has long operated in legal limbo. The audit, conducted by the United Cannabis Business Assn., found approximately 2,835 unlicensed dispensaries and delivery services operating in California. By comparison, only 873 cannabis sellers in the state are licensed, according to the Bureau of Cannabis Control. (Queally and McGreevy, 9/11)

Temple University Health System CEO Dr. Larry Kaiser will step down at the end of the year, capping an eight-year tenure at the institution. The academic health system's chief restructuring officer Stuart McLean will become the acting CEO on Sept. 30 as Kaiser focuses on the transition, Temple announced Tuesday. Emeritus Dean John Daly will replace Kaiser at the university's medical school as the interim dean of the Lewis Katz School of Medicine. (Kacik, 9/11)

One year after a Utah firefighter was killed when a supertanker dropped nearly 20,000 gallons of fire retardant near his position, his widow is suing Cal Fire and the aircraft company for alleged negligence. Matthew Burchett, a 42-year-old battalion chief from Draper, Utah, was killed Aug. 13, 2018, when a modified Boeing 747-400 owned by Global SuperTanker Services LLC dropped its load of retardant from only 100 feet above the treetops and knocked an 87-foot-tall Douglas fir directly onto Burchett and three other firefighters, the lawsuit and a Cal Fire report say. (Stanton, 9/11)

For more than 20 years, the eastern Michigan town of Lapeer sent leftover sludge from its sewage treatment plant to area farms, supplying them with high-quality, free fertilizer while avoiding the expense of disposal elsewhere. But state inspectors ordered a halt to the practice in 2017 after learning the material was laced with one of the potentially harmful chemicals known collectively as PFAS, which are turning up in drinking water and some foods across the U.S. (Flesher and Casey, 9/11)

Health officials say a California State University, San Bernardino, student has been diagnosed with tuberculosis and they're urging about 400 students and employees to be tested. San Bernardino County health officials say they're contacting those who may have been exposed to the illness from April through August. However, authorities say the risk of infection is low. (9/11)

In this cohort study of 6595 US adolescents, increased time spent using social media per day was prospectively associated with increased odds of reporting high levels of internalizing and comorbid internalizing and externalizing problems, even after adjusting for history of mental health problems. (Riehm et al, 9/11)

During DTC telemedicine consultations for RTIs, pediatric patients were frequently prescribed antibiotics, which correlated with visit satisfaction. Although pediatricians prescribed antibiotics at a lower rate than other physicians, their satisfaction scores were higher. Further work is required to ensure that antibiotic use during DTC telemedicine encounters is guideline concordant. (Foster et al, 9/1)

The high cost of fruit and vegetables can be a barrier to healthy eating, particularly among lower-income households with children. We examined the effects of a financial incentive on purchases at a single supermarket by primary shoppers from low-income households who had at least one child. Participation in an in-store Cooking Matters event was requested for incentivized subjects but optional for their nonincentivized controls. (Moran et al, 9/1)

Private insurance companies are expecting to pay out a record of at least $1.3 billion in rebates to consumers this fall based on their share of premium revenues devoted to health care expenses in recent years, surpassing the previous record high of $1.1 billion in 2012, according to a new �鶹Ů�� analysis. Individual market insurers are driving this record year, with expected rebate payments of at least $743.3 million, their highest ever, finds the analysis of data reported by insurers to the Centers for Medicare and Medicaid Services. (9/10)

Getting less than six hours of sleep a night, or more than nine hours, might increase the risk for heart attack. Previous observational studies have found an association between sleep duration and heart attack. But for the current study, researchers had DNA data about study participants and knew who had a high or low genetic risk for cardiovascular disease. This allowed them to more clearly identify the role of sleep duration by itself on heart attack risk and provided greater certainty that the relationship might be causal. (Bakalar, 9/9)

High doses of vitamin D do not increase bone density, and they may even lower it, researchers report. In a double-blinded, three-year clinical trial published in JAMA, scientists randomized 311 healthy adults without osteoporosis to daily doses of 400, 4,000 or 10,000 units of vitamin D. At the beginning and end of the study, they used CT scans to calculate bone density in the arm and leg of each participant, and estimated bone strength using mathematical techniques. (Bakalar, 9/9)

Private health insurers are punching bags of choice in the Democratic presidential primary. “The insurance companies last year alone sucked $23 billion in profits out of the health-care system,” Elizabeth Warren fulminated in a June debate. Kamala Harris charged in January that “it is inhumane to make people go through a system where they literally cannot receive the benefit of what medical science has to offer because some insurance company has decided it doesn’t meet their bottom line in terms of their profit motivation.” (Chris Pope, 9/11)

On Jan. 1, 2020, a new Medicare policy is scheduled to go into effect that will eventually require doctors to use a computer algorithm to vet imaging tests to determine “appropriateness.” If the tests, such as CT scans and M.R.I.s, do not meet certain “appropriate-use criteria,” Medicare may not reimburse the cost. Intended to reduce unnecessary imaging, the policy may penalize doctors who don’t comply by requiring them to get “prior authorization” before ordering imaging tests in the future — in other words, to follow another regulation. (Sandeep Jauhar, 9/11)

As we have a vigorous debate among Democrats about what kind of health-care reform would most effectively and affordably provide health insurance for every American, the Trump administration just got some news showing that its efforts to undermine health security seem to be bearing fruit. (Paul Waldman, 9/11)

As the nation moves into the next round of Democratic presidential debates, Sen. Bernie Sanders’ “Medicare for All” bill and others like it are once again expected to receive intensive focus. Unfortunately, the consequences for Medicaid, the nation’s single largest public insurer, have gone virtually undiscussed. This is a mistake. Any move toward a single-payer system needs to take account of Medicaid’s future and the more than 70 million Americans it covers — disproportionately people of color — who live in the most vulnerable urban and rural communities, marked by poverty, elevated health risks and a chronic shortage of accessible services. (Sara Rosenbaum and Stephen Warnke, 9/12)

After a string of mass shootings this summer, Americans are demanding a response to curtail the violence. If we are looking to deliver a solution that reduces bloodshed and respects the rights of responsible gun owners, the only realistic action must be bipartisan. This is why the recent focus on red-flag proposals from our Senate colleagues and the president are welcome. The most effective step Congress can take right now to prevent tragedies like those in Parkland, Fla.; Newtown, Conn.; and Dayton, Ohio, is to enact red-flag laws, which give law enforcement the ability to restrict gun access for unstable, potentially violent people, without infringing on other Americans’ rights. (U.S. Senator Marco Rubio, 9/12)

The recent spate of mass shootings across the United States has reignited the debate over gun violence prevention. Lawmakers returning to Washington this week are facing renewed pressure to do something — anything — in response to the shooting sprees that killed 41 people, from California to Texas to Ohio, in a little more than a month. Yet I am concerned that the debate will return to an all-too-familiar and self-defeating stalemate. From the perspective of the medical community, gun violence is not primarily a political or ideological issue. With 100 people in America dying of gun violence each day, the equivalent of multiple mass shootings, seven days a week, it’s a public health crisis. It’s an epidemic. It’s relentless, and it's spreading. (David J. Skorton, 9/10)

The number of e-cigarette users, many of them teenagers, who have been stricken by a mysterious and acute lung illness has more than doubled around the country in just the last week. More than 450 people have been hospitalized with serious respiratory distress and six people have died, including a 55-year-old man in Los Angeles County. Public health officials still don’t know what it is causing the ailment. That’s the bad news. The silver lining is that this mystery illness has lit a fire under the Food and Drug Administration, which had been moving at a glacial pace in deciding whether and how to regulate electronic cigarettes, even as their popularity exploded among teenagers. (9/12)

For weeks, the nation has been gripped by details surrounding Jeffrey Epstein and his child sex-trafficking operation. An operation uncovered more than a decade ago but badly addressed by prosecutors. Last year we learned that Larry Nasser continued to sexually abuse child athletes for 20 years after the first accusations surfaced against him. These aren’t isolated incidents. We’ve seen similar patterns of open secrets that everyone knows about and no one acts upon with Jerry Sandusky and Cardinal George Pell. With too many people in too many sectors of society, assaulting children for years or decades with impunity.  (Elizabeth J. Letourneau, 9/11)

With football season comes a bombardment of television ads for “manly man” foods — the triple-decker burgers, racks of ribs, Buffalo wings, mighty meaty pizzas galore. For those of us who are trying to eat healthier, seeing the artery-clogging junk fare during commercial breaks detracts from the game — and sometimes, even more regrettably, tempts the eyes. Call it a personal foul. Anyone still clinging to the “eat like a man” messaging would do well to see a new film, due out next week, called “The Game Changers.” (Courtland Milloy, 9/10)

One of the lesser-known complications is an increased risk for cancer of the liver, pancreas, endometrium, kidney and breast. A recent study suggests that overall cancer risk in women with diabetes may be about 6 percent higher compared to men’s disease risk. The exact reasons for this link are unclear, but excess circulating insulin, estrogen and pro-inflammatory hormones from fatty tissue are thought to play a significant role. These biological events can promote cell mutation and tumor progression. (John Termini, 9/11)

Treating cancer is one of the most difficult medical challenges of our time. In addition to requiring effective therapies and compassionate clinicians and caregivers, it demands trustworthy and transparent communication. A report in JAMA Internal Medicine that summarized payments from the drug and device industry to directors of National Cancer Institute-designated cancer centers underscores the need to develop more rigorous strategies for reporting and monitoring. (Karen E. Knudsen, 9/12)

Will Ricardo Lara survive his first term as California’s insurance commissioner? We can’t say for sure. ... He’s been caught red-handed taking sneaky donations from people connected to the insurance industry. Now he’s fighting back against suggestions that the money – over $50,000 in all – affected his decision-making as insurance commissioner. He’s also on the defensive after Politico revealed that he’s been sticking California taxpayers with the bill for rent on his apartment in Sacramento. And now he’s refusing to say who paid for his ticket to a fancy New Year’s Eve party in London that he attended with an insurance industry lobbyist. To be clear, there’s no evidence that Lara has broken the law. Yet there’s no question that he has broken his word and broken faith with voters. (9/11)

President Trump has ordered government officials to look into ways his administration can address California’s homeless crisis, calling it a “disgrace.” The effort, which was announced Tuesday and came as a surprise to local and state officials, may involve getting homeless people off the streets and into federally backed facilities. ... If Trump really wants to help homeless people in California, he could start by giving his own Housing and Urban Development department the funds and the direction to rebuild low-income housing. Washington politicians in both parties have defunded low-income housing production across the country for decades. That’s a big part of the reason why homelessness is a national problem. (9/11)