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Pharmacists protesting deteriorating working conditions inside the nation’s largest retail chains launched their third and largest walkout of the season on Monday with a three-day movement they've dubbed "Pharmageddon." Organizers estimated the effort has drawn as many as 4,500 pharmacists and pharmacy technicians from multiple chains, including CVS, Rite Aid and Walgreens. It also drew support from the American Pharmacists Association, the industry’s largest professional organization, which said in a statement it stands with every participant of the movement. (Le Coz, 10/30)

Walgreens and CVS employees are mostly not unionized, which makes a largescale walkout difficult to execute. Staff and organizers in multiple states confirmed to CNN that the walkouts have begun and will take place through November 1, but it remains unclear how widespread the action is. Workers at Walgreens and CVS have previously staged walkouts in Arizona, Washington, Massachusetts and Oregon in September and early October. Those work actions closed a handful of pharmacies briefly, and slowed business at several others. At the time, Walgreens told CNN the impact has been “minimal.” (Goodkind and Rothenberg, 10/30)

Amy Thibault, a spokeswoman for Woonsocket-based CVS Health, told the Globe the pharmacy chain was “not seeing any unusual activity” regarding unplanned pharmacy closures or pharmacist walkouts. “We’re making targeted investments to address their key concerns, including enabling teams to schedule additional support as needed, enhancing pharmacist and technician recruitment and hiring, and strengthening pharmacy technician training,” said Thibault. (Gagosz, 10/30)

A Kansas judge on Monday put a new state law on medication abortions on hold and blocked older restrictions that for years have spelled out what providers must tell patients and forced patients to wait 24 hours to end their pregnancies. The ruling was another big victory for abortion rights advocates in Kansas, where a statewide vote in August 2022 decisively confirmed protections for abortion access under the state constitution. District Judge K. Christopher Jayaram’s order suspends some restrictions that have been in effect for years. The waiting period had been in place since 1997. (Hanna, 10/30)

A U.S. appeals court on Monday revived a challenge to an Arizona law banning abortions from being performed solely because the fetus has a genetic abnormality. A three-judge panel of the 9th U.S. Circuit Court of Appeals unanimously ruled that a group of healthcare providers can sue the state over the law because they are harmed by it, reversing a lower court ruling. (Pierson, 10/30)

Medical professionals in Tennessee say doctors are leaving the state. It’s a part of a nationwide movement where many of them are begging hospitals for help with key decisions in the abortion conversation. This week State Senator Heidi Campbell raised the question to Governor Bill Lee and Attorney General Jonathan Skrmetti of what is being done to support both doctors and women during this time. (Sloan, 10/31)

Democrats and Republicans have spent the last decade trading control of both chambers of Virginia’s state legislature and the governor’s mansion, with Democrats winning all three in 2019 only to lose the statehouse and the governorship just two years later. The November elections are set to be extremely close: a mid-October poll found that 42% of voters plan to support the local Democratic candidate, while 41% will support the Republican. If such a ban were to take effect in Virginia, many abortion clinics outside the state would likely feel the effects. In the year after Roe’s demise, the rate of abortions in Virginia surged. Clinics in the state performed, on average, roughly 550 more abortions each month compared with the months before Roe disintegrated, according to research from the Society of Family Planning. An abortion ban could force many of those patients to flee even farther north, to clinics that are already overwhelmed. (Sherman, 10/31)

When questions about abortion have been put directly to voters in the months since the Supreme Court overturned Roe v. Wade, voters overwhelmingly have signaled support for abortion access. Now, abortion rights activists in Ohio are wondering if that same energy that fueled success in states like Kansas and Michigan will translate to their state this year. ... If approved, the measure would amend Ohio's constitution to guarantee the right to make reproductive healthcare decisions, including abortion. (McCammon, 10/31)

Senate Democrats are urging federal regulators to require health insurance companies and government health programs to cover over-the-counter birth control pills at no cost as the first nonprescription contraceptive medication is poised to hit the market next year. Under the Affordable Care Act, insurers must cover all Food and Drug Administration-approved contraceptives without cost-sharing. But the Health and Human Services, Labor, and Treasury departments' standing guidance refers only to prescription products. (McAuliff, 10/30)

President Biden ordered the nation’s leading health agencies on Monday to develop a plan for regulating artificial intelligence tools already widely in use within hospitals, insurance companies, and other health-related businesses. (Ross, 10/30)

President Joe Biden signed a sweeping executive order and invoked the Defense Production Act on Monday to establish the first set of standards on the use of artificial intelligence in healthcare and other industries. As the hype, promise and usage of AI has grown in healthcare, health system leaders and developers have sought more concrete guardrails on its usage, particularly for clinical purposes. Biden signed the order at an afternoon AI-focused event at the White House. (Perna and Turner, 10/30)

In medicine, the cautionary tales about the unintended effects of artificial intelligence are already legendary. There was the program meant to predict when patients would develop sepsis, a deadly bloodstream infection, that triggered a litany of false alarms. Another, intended to improve follow-up care for the sickest patients, appeared to deepen troubling health disparities. (Jewett, 10/30)

Healthcare providers that engage in so-called information blocking to impede appropriate access to patient information in electronic health records would be subject to significant penalties under a proposed rule published Monday. ... “HHS is committed to developing and implementing policies that discourage information blocking to help people and the health providers they allow to have access to their electronic health information,” HHS Secretary Xavier Becerra said in a news release. (Bennett, 10/30)

GSK Plc will pay 23andMe Holding Co. $20 million for access to the genetic-testing company’s vast trove of consumer DNA data, extending a five-year collaboration that’s allowed the drugmaker to mine genetic data as it researches new medications. Under the new agreement, 23andMe will provide GSK with one year of access to anonymized DNA data from the approximately 80% of gene-testing customers who have agreed to share their information for research, 23andMe said in a statement Monday. The genetic-testing company will also provide data-analysis services to GSK. (Brown, 10/30)

When patients go shopping today, they might find themselves checking out with more than the vitamins or bulk toilet paper on their list. Several retailers have recently launched telehealth programs that let patients pick their medical concern off a menu of options, from hair loss and erectile dysfunction to acne and ear infections. Then they pay cash — no insurance accepted — to have a text or video visit with a provider. (Palmer, 10/30)

Many of the state’s more than 75,000 farmworkers lack high-speed internet, limiting their access to digital services that have been shown to improve health outcomes for people in rural communities. The N.C. Department of Health and Human Services’ Office of Rural Health hopes to address the divide with a “digital equity initiative” funded by the National Institutes of Health. Over the next five years, DHHS will receive nearly $6 million from the federal agency to help connect agricultural workers and their families to affordable broadband. (Baxley, 10/31)

One of the first studies of publicly available insurer price data found generally higher rates for office visits and medical procedures in the Upper Midwest and Southeast, and the lowest costs in the Central U.S. and Florida. The findings published in JAMA Health Forum could help shine a light on regional price variations and whether higher costs translate to more value in markets. (Goldman, 10/30)

More workplaces are offering at least one health plan that is free to employees or offers no-deductible coverage for certain services as many workers struggle to afford care. The number of large employers offering at least one free medical plan to employees increased from 11% this year to 15% in 2024 coverage, according to a new Mercer survey. (Reed, 10/30)

Healthpeak Properties Inc. agreed to buy Physicians Realty Trust in an all-stock transaction, creating a company with a 52 million-square-foot real estate portfolio. Under the terms of the agreement, each Physicians Realty share will be converted into 0.674 of a newly issued Healthpeak common share, the companies said in a statement Monday. The purchase price is about $2.64 billion based on Physicians’ closing price Friday. (Taub, 10/30)

Physician groups are pressuring the Centers for Medicare and Medicaid Services to forestall looming penalties associated with the Merit-based Incentive Payment System, citing systemic challenges facing doctors and the ongoing effects of the COVID-19 pandemic. MIPS, as the Medicare reimbursement program for physician services is known, makes doctors eligible for bonus payments or penalties based on factors such as quality, cost and electronic health record use. (Bennett, 10/30)

Changes to registration requirements for the offsite clinics of 340B-eligible hospitals represent the latest clash between providers, regulators and drugmakers amid the program’s exponential growth. The federal government on Thursday reversed a policy that streamlined 340B certification during the COVID-19 pandemic. ... “The [policy] reversal is a gut punch to hospitals hoping for more permanent flexibility,” said Susan Banks, a healthcare attorney at the law firm Holland & Knight. (Kacik 10/30)

Hospitals place an unnecessary coronary stent in a Medicare beneficiary every seven minutes, costing taxpayers $800 million annually, according to a new analysis of claims data. Overuse of stents comes with hefty costs for patients and the federal government, and it can sometimes pose serious health risks. (Goldman, 10/31)

Need to see a doctor right away? Today, that can be challenging. The average wait for an appointment with a physician for new patients is 26 days, according to a 2022 survey of 15 metropolitan areas by the physician recruiting firm Merritt Hawkins. That’s the longest it has been since the company began doing the survey in 2004. In addition, 22 percent of adults 65 or older waited six days or more for a doctor’s appointment when they were sick, according to a 2021 survey of 11 high-income countries by the Commonwealth Fund, a nonprofit group. Only Canada had a higher percentage of long waits. (Levine, 10/30)

The U.S. health-care system is the costliest in the world and often difficult to navigate for many Americans. On Wednesday, Nov. 1 at 9:00 a.m. ET, Sen. Bill Cassidy (R-La.), Atul Gawande, USAID assistant administrator for global health, and top experts join Washington Post Live for a series of conversations about ways to improve the health-care system, enhance patient care and rein in costs. (10/31)

�鶹Ů�� Health News: Start Shopping: Enrollment Begins Nov. 1 For Most Obamacare Insurance Plans 

For millions of Americans who buy their own health insurance through the Affordable Care Act marketplace, the end of the year brings a day of reckoning: It’s time to compare benefits and prices and change to a new plan or enroll for the first time. Open enrollment starts Nov. 1 for the ACA’s federal and state exchanges. Consumers can go online, call, or seek help from a broker or other assister to learn their 2024 coverage options, calculate their potential subsidies, or change plans. (Appleby, 10/31)

Months ahead of his bloody rampage in Lewiston last week, suspected Maine gunman Robert Card had displayed glaring signals that his mental health was on a drastic decline – signals which his immediate family members knew about, were concerned by – and explicitly warned law enforcement that something needed to be done, according to documents obtained by ABC News via records requests. ... Despite some follow-up between local police and the Army Reserves regarding Card’s apparent paranoia, verbalized threats to shoot people and recurrent aggressive behavior in recent months, the documents do not indicate that Card was ever taken into protective custody or judged mentally incompetent by a medical professional which is required to trigger Maine’s yellow flag law. (Pezenik, Courts, Simpson, Margolin, Estrada and Barr, 10/31)

The warnings about Mr. Card were far more explicit than Maine officials had publicly acknowledged in the days since the shooting on Oct. 25. ... Mr. Card’s family told a sheriff’s deputy in May that Mr. Card had become angry and paranoid starting early this year. In particular, he had begun to claim — wrongly, the family said — that people were accusing him of being a pedophile. (Bogel-Burroughs and Marcius, 10/30)

Deputies were unable to locate Card and issued a missing persons report, the sheriff said, adding that deputies made contact with Card’s brother, who told him he would work to secure Robert Card’s firearms. (Vielkind and Palazzolo, 10/30)

Last week's mass shooting in Lewiston is renewing scrutiny of a 3-year-old state law that aims to keep guns away from potentially dangerous people. But it's unclear whether police considered using Maine's so-called "yellow flag" law against the suspected gunman. And critics say Maine's law could be much stronger. (Miller, 10/30)

In early August, Robert Card went to a gun store in Auburn, Maine, to finalize a purchase he had made online. According to reporting from ABC News, Card was hoping to take possession of a firearm suppressor — known more commonly as a silencer — he had bought, a purchase that necessitated completing the paperwork mandated for such a purchase by federal law. One of the forms Card filled out included yes/no questions he had to complete. One asked if he was an unlawful drug user. The next asked if he had ever been “adjudicated as a mental defective OR … ever been committed to a mental institution?” Card indicated that he had; over the summer he had spent two weeks in a facility after claiming to hear voices. (Bump, 10/30)

In Maine, which suffered the deadliest mass shooting in its history on October 25, guns are a fact of life. Nearly half of all households own one, mostly for hunting and recreation, sometimes for self-defense. The state’s gun access laws are permissive — there are no background checks on private sales, and residents don’t need a permit or training to carry a concealed gun in public. Its gun homicide rate is so low that it’s been hard to justify the need for tighter regulation. And with no history of public mass shootings to point to, this arrangement seemed to be working. (Mascia and Brownlee, 10/30)

Several companies are pursuing gene therapies to treat sickle cell. A federal advisory panel will review the first of those proposals in an all-day meeting on Tuesday. Dr. Jeffrey Glassberg, who has had several patients go through gene therapy trials, said the results were impressive. "These people simply don't have sickle cell anymore," said Glassberg, a hematologist at the Icahn Sinai School of Medicine at Mount Sinai in New York. (Weintraub, 10/31)

M&Ms, Reese’s, gummy bears, and even cotton candy made an appearance at the Food and Drug Administration on the day before Halloween. Commissioner Robert Califf was not throwing a costume party. Regulators were debating the potential benefits and pitfalls of “candy-like” nonprescription drug products such as gummies, particularly for children who often cannot, or do not want to, swallow actual pills. (Florko, 10/30)

Cassava Sciences has long claimed its experimental drug, called simufilam, slows the cognitive decline of people with Alzheimer’s. On Friday, we learned how: The company recruited a large number of people into its clinical trial who don’t have Alzheimer’s. People who almost certainly had Alzheimer’s were also included in the study, but in this group, a placebo outperformed Cassava’s drug. (Feuerstein, 10/30)

The claim: Republican presidential candidate Vivek Ramaswamy ... urged the U.S. to declare “pharmaceutical independence,” saying that “95% of over-the-counter pharmaceuticals are coming from our enemy in China.” PolitiFact ruling: False. The 95% figure is greatly exaggerated. Available data puts the share at no bigger than 20%, and possibly even lower. (Jacobson and Putterman, 10/30)

�鶹Ů�� Health News: An Arm And A Leg: John Green Vs. Johnson & Johnson (Part 2)

The final episode of this two-part series about YouTube star John Green and his fight to make tuberculosis drugs more affordable takes listeners halfway around the world to India. For nearly two decades, activists there have been organizing for patent reform. Host Dan Weissmann and producer Emily Pisacreta speak with one of them, drug patent expert Tahir Amin, about how legal victories in India (and some extra pressure from John Green’s online community of fans) have set the stage for generic manufacturing and lower-priced TB drugs.   (10/31)

There’s some good news about flu season this year. Doctors and scientists don’t expect the worst. The flu season in the Southern Hemisphere, where the cold-weather illness period wraps up as we head into ours, often serves as a harbinger of what’s to come for us. There, cases picked up a little earlier than usual in some countries but didn’t result in an especially large number of hospitalizations and deaths, say public health experts and doctors. Also encouraging: The components in this year’s flu vaccine are a good match to the predominant strain so far. (Reddy, 10/30)

Administration officials have acknowledged the problems when the vaccines moved to commercial payers but said ample supply plus a relatively long transition period for antivirals should make it so those same issues — delayed insurance coverage and lack of supply — don’t happen again. “The federal product will continue to be available for days to weeks. And that gives a chance for the insurers, the [pharmacy benefit managers], the pharmacies, providers, all to work through the system changes needed to distribute the product commercially and effectively,” a senior Health and Human Services (HHS) official told reporters during a recent briefing. (Weixel, 10/30)

The threat of COVID and other respiratory viruses during flu season has Marin County requiring masks in patient-care settings. ... The new mandate in Marin County, requires patients, staff and visitors to wear a mask in hospitals and skilled nursing facilities for the fall and winter virus season from Nov. 1 through March 31 of next year. "Whatever's best to help our residents.  We want to make sure we protect them from the spread. I'm happy with this," said Redwoods a Community of Seniors Director of Staff Development Polly Wright. (Choi, 10/30)

More than 50% of long-COVID patients failed to improve 1.5 years after their initial diagnosis, according to a new study based on cases seen at a Danish post-COVID clinic, both before and after the Omicron variant period. The study was published yesterday in the International Journal of Infectious Diseases. The analysis included 806 patients who were infected with the wild-type strain, Alpha, Delta, or Omicron strain. All case-patients had been referred to a long COVID clinic with symptoms persisting at least 12 weeks from onset of COVID-19. Seventy percent of participants were female, with a median age of 48. (Soucheray, 10/30)

Former President Trump has called for the return of "mental institutions" as part of his plan "to get the homeless off our streets" should he be elected to a second term in office. The state-run psychiatric hospitals that largely disappeared in the mid-1900s are often associated with inhumane mistreatment. (Owens, 10/31)

Loss of slow-wave sleep as you age may increase your risk of developing dementia, according to a new study. “We found that aging was associated with a decline in the amount of the deepest stages of sleep, known as slow wave sleep,” said Matthew P. Pase, senior author of the study published Monday in the journal JAMA Neurology, via email. (Rogers, 10/30)

Rumination or overthinking is a common feature of depression in which people get stuck in a cycle of negative thoughts. Rumination Focused Cognitive Behavioral Therapy or RF-CBT has been shown to help in adults. ... The study suggests that this type of therapy can help teens break out of the "painful mental loops" that contribute to depression. (Marshall, 10/30)

Dr. David Shaffer, a Columbia University psychiatrist who transformed the study of childhood and teenage suicide with psychological autopsies that led to pioneering prevention methods, died Oct. 15 at the Mastic Beach, N.Y., summer home of his ex-wife, Vogue editor in chief Anna Wintour. He was 87.The cause was complications of Alzheimer’s disease, his son Charlie Shaffer said. (Rosenwald, 10/30)

The U.S. Food and Drug Administration is warning parents and caregivers not to buy or serve certain pureed fruit pouches marketed to toddlers and young children because the food might contain dangerous levels of lead. Children who have eaten WanaBana apple cinnamon fruit puree pouches should be tested for possible lead poisoning, the agency said. (Aleccia, 10/30)

Gen. Eric M. Smith, the Marine Corps’s commandant and top officer, was hospitalized on Sunday evening after an unspecified medical emergency, the service said on Monday. The Marines announced General Smith’s hospitalization in an email to reporters but provided no further details about his condition. One current and one former defense official familiar with his condition said he apparently had a heart attack while jogging. (Ismay and Schmitt, 10/30)

�鶹Ů�� Health News: Medical Debt And Nurse Shortages Haunt Winning Halloween Haikus 

Readers, beware! There’s a bitter chill in the air and bloodcurdling screams coming from our newsroom. We received more than five dozen spooky submissions to �鶹Ů�� Health News’ fifth annual Halloween haiku contest. Here’s the winner and the top runners-up, illustrated by Oona Tempest. The judges’ favorites were inspired by school nurse shortages and the nation’s gut-wrenching medical debt crisis. Keep an eye on �鶹Ů�� Health News’ social media accounts (X, formerly known as Twitter; Instagram; and Facebook) for more of our favorites. Enjoy! (10/31)

Tokelahoma’s days are numbered. The world’s wildest weed market — which at its peak had nearly 14,000 licensed medical marijuana businesses — has been steadily shrinking since Oklahoma voters overwhelmingly rejected a recreational legalization referendum in March. Heightened enforcement by state regulators and law enforcement is pushing some businesses to shut down. Others are simply realizing that Oklahoma is producing so much weed — a staggering 64 times the volume needed to serve the state’s medical patients, according to a recent study — that it’s impossible to make any money. (Demko, 10/30)

New York’s illicit marijuana market has become a public health threat, state Senator Brad Hoylman-Sigal said at a public hearing, citing sales to minors and shootings outside dispensaries. “This is a public health issue, particularly for young people. Does it not deserve a more expedited process for addressing the illegal shops?” Hoylman-Sigal said during a joint hearing of the New York State Senate. (Kary, 10/30)

State insurance regulators are exploring ways to make New Hampshire’s health care market more transparent – and keep rising medical costs in check. New Hampshire is already one of the few states with a comprehensive online tool that lets patients compare what different providers charge for common medical procedures. The rollout of that website, NH HealthCost, in 2007, led to lower prices over time, according to a 2018 study that looked at medical imaging services. (Cuno-Booth, 10/30)

For people living with HIV, the goal is to become “undetectable,” to suppress the virus so much that it’s untransmittable and that a blood test would not even distinguish it. Modern drugs make this possible — when a person takes them every day. But many of the patients who find their way to an HIV “medical home” in a nondescript, beige-brick building in east Denver don’t manage to fill their prescriptions or take their antiretroviral therapy pills regularly. That’s because they have more pressing problems — like where to sleep and how to get food. (Brown, 10/30)

Fulton County health officials say a local experiment that gives people the option of testing for sexually transmitted infections at home could become a powerful tool in public health. Metro Atlanta is home to one of the highest HIV infection rates in the country. Rates of syphilis, gonorrhea and other STIs have recently spiked, too. (Wheatley, 10/30)

Gas-powered lawn and garden equipment generates hundreds of tons of fine particle pollution in Harris County each year, more than any other county in the nation. A report published Monday by three environmental groups analyzed U.S. Environmental Protection Agency data from 2020 and found equipment in the Houston-area county released 358 tons of particles, the equivalent of almost 4 million cars on the road for a year. The next highest volume of particulate pollution emitted by a single county, 274 tons, was released in Illinois. (Ward, 10/30)

Cancer mortality rates have dropped 33% since their peak in 1991, according to a recent report from the American Cancer Society. Yet, we still have a long way to go. We've improved the life span of cancer patients. But we haven't necessarily improved the quality of life for patients − and their loved ones and caregivers. (Patrick Dempsey and Dr. John Whyte, 10/31)

.S. nursing homes have faced staffing challenges for decades.1 Registered nurses (RNs), licensed practical nurses (LPNs), and certified nurse aides (CNAs) are the primary caregivers in nursing homes. RNs and LPNs focus on the clinical tasks of resident assessment, treatment, and medication management, while CNAs provide the bulk of the hands-on care, such as assistance with eating, bathing, toileting, and dressing. (David C. Grabowski, Ph.D., and John R. Bowblis, Ph.D., 10/28)

Research and data show that behavioral risk factors are far better at predicting violence than mental health diagnosis alone. Public health experts have known for decades that the most accurate indicator of future acts of violence are past acts of violence. Combine this with other factors like drug and alcohol misuse, repeated interactions with law enforcement, and other risky behaviors, and the public will have a better understanding of indicators for potential violence than mental illness. This is about examining risk and following epidemiology, not perpetuating mental health stigma. (Kris Brown, 10/30)

Gun violence seems to have become inevitable in American society. The prevalent use of guns to cause significant harm and death in this country has skyrocketed in recent years. The constant news of gun violence from the media comes in such quick succession now that Americans no longer catch their breath. A new tragedy holds the public’s attention, and disheartening thoughts hold in our hearts. (Cheryl Mitchell and Gifty Quarm, 10/30)

Once again, our nation is devastated by a mass shooting, this time in Lewiston, Maine, where at least 18 people were killed and more than a dozen injured by a shooter armed with an assault weapon. The suspect was known by police to have threatened a mass shooting at a military base, was suffering a mental health crisis and had firearms, including assault-style weapons. (Jeremy Stein, 10/30)