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President Trump spent at least 30 minutes on the phone Tuesday with Wayne LaPierre, the chief executive of the National Rifle Association, the latest conversation in an aggressive campaign by gun rights advocates to influence the White House in the weeks since the back-to-back mass shootings in Texas and Ohio. The call ended the way that Mr. LaPierre had hoped it would: with Mr. Trump espousing N.R.A. talking points in the Oval Office and warning of the radical steps he said Democrats wanted to take in violation of the Second Amendment. (Haberman, Karni and Hakim, 8/20)

“It’s going to be great, Wayne,” Trump said, according to both a former senior White House official and an NRA official briefed on the call. “They will love us.” And if they—meaning the roughly 5 million people who make up the NRA’s active membership, and some of Trump’s electoral base—didn’t, Trump reportedly assured LaPierre, “I’ll give you cover.” “Wayne’s listening to that and thinking, Uh, no, Mr. President, we give you cover,” the former senior White House official said in describing the conversation. The president reportedly asked LaPierre whether the NRA was willing to give in at all on background checks. LaPierre’s response, the sources said, was unequivocal: “No.” With that, “the Rose Garden fantasy,” as the NRA official described it to me, was scrapped as quickly as it had been dreamed up. (Plott, 8/20)

Trump told LaPierre that the White House remained interested in proposals that would address weapons getting into the hands of the mentally ill, including the possibility of backing so-called “red flag” laws that would allow the police to temporarily confiscate guns from people who have been shown to be a danger to themselves or others. Nonetheless, the president’s conversation with LaPierre, which was first reported by the Atlantic, further reduced hopes that major new gun-safety measures will be enacted after the latest round of mass shootings. (Hamburger and Dawsey, 8/20)

The president said on Tuesday that his supporters are strong believers in a constitutional right to bear arms, and that he is, too. “You know they call it the slippery slope, and all of a sudden everything gets taken away,” he said. “We’re not going to let that happen.” “We have very, very strong background checks right now, but we have sort of missing areas, and areas that don’t complete the whole circle. And we’re looking at different things,” Mr. Trump said Tuesday. He didn’t elaborate on what areas he considers lacking, talking instead about looking at mental-illness issues. (Leary, 8/20)

On Aug. 9, before leaving the White House, Trump said, "frankly, we need intelligent background checks," adding that "this isn't a question of NRA, Republican, or Democrat." Trump also told reporters that Senate Majority Leader Mitch McConnell was "totally onboard." On August 18, arriving at Morristown Airport in New Jersey, Trump said "Congress is meeting. Bipartisan. A lot of people want to see something happen. But just remember this: Big mental problem, and we do have a lot of background checks now." (Wu, 8/20)

The about-face followed a familiar pattern for Trump, a native New Yorker who lacks a personal affinity for guns but has championed gun rights since entering politics. Before he ran for president in 2015, he supported restrictions championed by Democrats, but now he fears upsetting his hardcore Republican supporters — especially as he heads into what polls indicate will be a difficult reelection race. (Megerian, 8/20)

Sen. Richard Blumenthal said Tuesday that he and Senate Judiciary Committee Chairman Lindsey Graham are "very, very close" to introducing "red flag" legislation to curb gun violence.The bipartisan bill would assist states in adopting red flag laws by creating a federal grant program. The grants would go to law enforcement "so they can hire and consult with mental health professionals to better determine which cases need to be acted upon," Graham, R-S.C., said in a statement. (Schroeder and Bauman, 8/20)

Iowa Republican Gov. Kim Reynolds said Tuesday she will “take a look at” multiple ways to prevent gun violence, adding that she has already done a lot toward that goal. But Reynolds did not take a position on any specific gun-related laws. Some Republican elected officials including Sen. Chuck Grassley, R-Iowa, say they support the concept of “red flag” laws. Those can allow police or family members who see warning signs in others to seek a court order temporarily blocking that person from accessing a gun. (Sostaric, 8/20)

Less than a month after a mass shooting in California, San Jose is considering a proposal that would make it the first city in the U.S. to require gun owners to carry liability insurance. Mayor Sam Liccardo, who introduced the legislation last week, says the mandate would follow the “harm reduction” approach used with car insurance: rewarding safe behavior, while covering the cost of accidents and neglect. (Mosley and Paris, 8/20)

When President Trump targeted mental illness as the cause of the mass shootings in El Paso and Dayton that killed 31 people, federal health officials made sure no government experts might contradict him. A Health and Human Services directive on Aug. 5 warned communication staffers not to post anything on social media related to mental health, violence and mass shootings without prior approval. That alarmed some government mental health experts who said they felt muzzled at a moment when many Americans were searching for answers to the U.S. epidemic of mass shootings, said three agency employees. (Abutaleb and Wan, 8/20)

An HHS employee told the Post he had “no doubt this was meant to prevent anybody from making any statements that might contradict the president.” “We understand we’re not supposed to contradict the president, but it’s not typical” for the administration to mandate senior officials clear social media posts, he added. (Axelrod, 8/20)

The student activists who crashed the political arena after the mass shooting last year at their high school in Parkland, Fla., are throwing their weight behind a new and ambitious gun-control program that they hope will set the tone for the debate following the most recent mass shootings and headed into the 2020 elections. The students are speaking out for the first time since 31 people were killed in one weekend in El Paso and Dayton, Ohio. They hope their plan — unveiled Wednesday morning — will be considered by President Trump as well as his Democratic presidential rivals and will serve as a catalyst for a surge of youth voters next year. (Alemany, 8/21)

Gun sellers are using a simple trick to do business on Facebook Inc. Marketplace at a time when more mass shootings in the U.S. have renewed the debate in Washington over access to firearms. The Marketplace feature, which Facebook launched four years ago, enabled its more than two billion users to buy and sell almost any secondhand item by clicking a button on their home page. However, the private sale of many items, including guns, is specifically forbidden under Facebook policy. (Olson and Elinson, 8/20)

Nearly 35 years ago, long before the current mass influx of Central American families making their way to America’s southern border, a different and more brutal migrant crisis was unfolding. In El Salvador, government death squads were stalking suspected insurgents. Farmers, human rights activists and even priests were being caught in the crossfire. The widening civil war would leave more than 75,000 people dead, and send tens of thousands of people fleeing to the United States. (Jordan, 8/20)

The Trump administration plans to release a regulation Wednesday aiming to make it easier to keep migrant families locked up together for long periods of time, according to a former Homeland Security Department official familiar with the move. The final rule, which will likely require court approval before it becomes effective, outlines standards for the care of migrant children and families in the custody of federal immigration authorities. (Hesson, 8/20)

This month, the Trump White House unveiled a new policy it had aggressively pushed through the regulatory process that makes it much harder for low-income immigrants, especially those who had used public benefits, to come to or remain in the United States. The proposal — known as the “public charge” rule, since it creates a complicated test to determine whether an immigrant is “likely to be a public charge” — has the potential to dramatically restrict who’s allowed to settle in the country. And many people who work with immigrants, including social service providers and local and state governments, are worried that it will scare them away from using benefits they and their families need to thrive. (Lind and Torbati, 8/20)

New York state, New York City, Connecticut and Vermont sued the federal government Tuesday over new Trump administration rules blocking green cards for many immigrants who use public assistance including Medicaid, food stamps and housing vouchers. The states and city join a growing list of entities suing over the change, one of the Republican administration's most aggressive moves to restrict legal immigration. (Klepper, 8/20)

The suit is joined by the city of New York, Connecticut and Vermont and was filed in the Southern District of New York, challenging the Trump administration’s attempt to target immigrants of color. “The Trump Administration’s thinly veiled efforts to only allow those who meet their narrow ethnic, racial and economic criteria to enter our nation is a clear violation of our laws and our values,” James said in a news release. “Under this rule, more children will go hungry, more families will go without medical care and more people will be living in the shadows and on the streets.” (Kim, 8/20)

Connecticut has joined a multi-state lawsuit that aims to stop the Trump administration from denying green cards to immigrants who receive public assistance, including food stamps, Medicaid and housing vouchers. The lawsuit was filed on Tuesday by Connecticut, New York and Vermont. (Radelat, 8/20)

U.S. immigration authorities do not vaccinate migrants in custody against the flu virus, and Customs and Border Protection (CBP) does not have any plans to do so ahead of the upcoming flu season. “In general, due to the short term nature of CBP holding and the complexities of operating vaccination programs, neither CBP nor its medical contractors administer vaccinations to those in our custody,” an agency spokeswoman told The Hill in an emailed statement.  (Weixel, 8/20)

On her first day out of quarantine Thursday, 6-year-old Fernanda Martinez was ecstatic. She raced a mini-green quad up and down the hall outside the dark room where she spent four weeks separated from everyone because of a severe case of chicken pox. Greeting all the other children at the Agape Misión Mundial shelter in Tijuana, Martinez decided they were all her best friends. She announced she was equally excited to see everyone. (Fry, 8/20)

The U.S. agency charged with caring for unaccompanied migrant children is eyeing California’s Inland Empire as a potential location for a major new shelter facility, according to official records. The proposal, which was posted earlier this month on the Federal Business Opportunities website, comes at a time when the number of minors in federal custody has dipped since the beginning of the year but still remains at historic highs. (Wiley, 8/20)

The administration of D.C. Mayor Muriel E. Bowser (D) has enacted emergency regulations that would stop a planned federal shelter for unaccompanied migrant children in Northwest Washington. The emergency rules prohibit the city’s child welfare agency from licensing facilities housing more than 15 residents. That would block a 200-bed shelter that a federal contractor is trying to open in the Takoma neighborhood, part of the Trump administration’s efforts to address a surge of minors apprehended at the southern border without a parent. (Nirappil, 8/20)

A pathologist fired from an Arkansas veterans hospital after officials said he had been impaired while on duty was charged Tuesday with involuntary manslaughter in the deaths of three patients who authorities say he misdiagnosed and whose records he later altered to conceal his mistakes. A grand jury indictment unsealed Tuesday charged Dr. Robert Morris Levy in the patients' deaths and on multiple charges of fraud and making false statements for his alleged attempts to conceal his substance abuse and incorrect diagnoses. (DeMillo, 8/20)

During 12 years as chief pathologist here and in leadership roles on multiple oversight boards and medical committees, Levy, 53, read almost 34,000 pa­thol­ogy slides from aging veterans. He had their lives in his hands, prosecutors said in unsealing their indictment. But his addiction and attempts to cover it up with lies and dangerous practices — even after VA paid for a lengthy inpatient treatment program — led to multiple deaths and other life-threatening trauma for veterans, they said. (Rein, 8/20)

Prosecutors allege Levy cheated drug tests and falsified records to cover up his relapses. As a result, he continued reviewing sensitive patient medical information while intoxicated, potentially issuing incorrect or dangerous diagnoses for thousands of veterans. In at least three cases, investigators believe that directly resulted in patient’s deaths. On two of those occasions, the indictment says, Levy doctored medical records to make it appear that other pathologists agreed with his mistaken work. (Shane, 8/20)

Two inquiries were conducted into the misdiagnoses, both by the Office of the Inspector General of the federal Department of Veterans Affairs, according to previous department announcements. One was a clinical and administrative review of what went wrong to allow Levy to continue work. The other was a criminal investigation. The system of the Ozarks worked closely with the Veterans Affairs Office of Inspector General and local authorities on this investigation, according to a statement from the system. (Thompson, 8/20)

“This indictment should remind us all that this country has a responsibility to care for those who have served us honorably,” Duane Kees, the United States attorney for the western district of Arkansas, said in a statement. “When that trust is violated through criminal conduct, those responsible must be held accountable. Our veterans deserve nothing less.” In addition to the manslaughter charges, a federal grand jury indicted Mr. Levy on 12 counts of wire fraud, 12 counts of mail fraud and four counts of making false statements. (Victor, 8/21)

Two of the government’s top scientists detected the first signs of the emerging opioid crisis back in 2006 and tried to warn health officials and the public of the coming catastrophe, according to a confidential document obtained by POLITICO. The effort didn’t lead to any real action, and the toll of death and addiction climbed. More than 133,000 people have died from prescription opioids since then — and hundreds of thousands more from street drugs including heroin and illicit fentanyl. (Ehley, 8/21)

In other news on the opioid epidemic —

Officials at the Franklin County House of Correction in Greenfield said their facility is the first in the state and among the first in the country to choose this arduous approach to providing methadone, a key medication for treating opioid addiction. The few jails and prisons that provide methadone typically contract with community providers rather than becoming methadone clinics themselves. (Freyer, 8/20)

William “Buddy” Christopher, a longtime City Hall insider , was appointed in June by Mayor Martin J. Walsh as Boston’s first-ever czar to coordinate its response to the intersection at Massachusetts Avenue and Melnea Cass Boulevard, known as Methadone Mile because of the concentration of addiction recovery services in the area. Seemingly overnight, Christopher has been thrust into the spotlight as tensions flared in recent weeks between the area’s addiction service providers, advocates, residents, and businesses over the open-air drug dealing and disorder in the area. (Valencia 8/20)

Democratic presidential candidate Kirsten Gillibrand said seeing the toll of the opioid epidemic in New Hampshire helped frame her policy on mental health. The New York senator is expected to talk extensively about her new plan during a round table on the topic at Amoskeag Health in Manchester Tuesday morning. ... The Union Leader obtained a copy of the plan in which the candidate vows, if elected, to help end the stigma around mental illness. She said the stigma has made many uncomfortable to talk about how the system has failed them. (Landrigan, 8/20)

Endo International Plc and Allergan Plc have agreed to pay $15 million to avoid going to trial in October in a landmark case by two Ohio counties accusing various drug manufacturers and distributors of fueling the U.S. opioid epidemic. The tentative deals disclosed on Tuesday came ahead of the first trial to result from 2,000 lawsuits pending in federal court in Cleveland largely by local governments seeking to hold drug companies responsible for the deadly epidemic. (Raymond, 8/20)

The trial, which is scheduled to begin in Oct. 21, will be the first to test arguments made by numerous cities, counties, Native American tribes, and still others that several drug makers and distributors fomented the crisis. Some 2,000 lawsuits have been combined in a massive litigation in a federal court in Cleveland, where a judge has been urging a settlement. The local governments and other entities are seeking compensation to cover the costs of treating addiction and abuse. (Silverman, 8/20)

Endo officials said the Ohio settlement didn’t reflect what it expects to pay to resolve the other opioid suits. “The cash portion of the settlement approximates the estimated cost to Endo of proceeding through trial,” Matthew Maletta, Endo’s executive vice president and chief legal officer, said in an emailed statement. (Feeley and Griffin, 8/20)

The companies are on the smaller end of those facing similar suits. OxyContin maker Purdue Pharma, generic drug manufacturer Mallinckrodt and Ohio-based distributor Cardinal Health are also defendants. The settlements are not final. Endo, which manufactures Opana, has agreed to pay $10 million and provide $1 million of two of its drugs free of charge, according to a news release the company put out Tuesday. Frank Gallucci, an attorney representing Cuyahoga County, confirmed the tentative terms. (Heisig, 8/20)

U.S. health insurer Cigna Corp is exploring a sale of its group benefits insurance business, which could be valued at as much as $6 billion, four people familiar with the matter said on Tuesday. The unit for sale offers disability insurance as well as life and accidental death and dismemberment coverage to clusters of company employees. Cigna's move to shed it underscores its decision to focus on healthcare following its $54-billion acquisition of pharmacy benefits manager Express Scripts Holding Co last year. (8/20)

Apple’s health team has seen a slew of departures in the past year after a series of leadership changes and internal disagreements about direction. Tension has been increasing within the team in recent months, according to eight people familiar with the situation, although that undercurrent started several years ago. Some employees have become disillusioned with the group’s culture, where some have thrived while others feel sidelined and unable to move their ideas forward, the people said. (Farr, 8/20)

Earlier this year, Ascension, the nation's largest Catholic health system announced a major shake-up in its C-suite. After 15 years, Anthony Tersigni would retire his position as president and CEO while continuing to serve on the executive committee of the system's investment fund. Three other top executives also would leave the organization. ...Joseph Impicciche took over the corner officer a little over two months ago ...He recently sat down with Modern Healthcare Editor Aurora Aguilar for his first one-on-one interview. (8/20)

The new chief executive officer at Fortis Healthcare Ltd. plans to cut a fifth of costs to resuscitate India’s second-largest hospital chain after a regulator found it was defrauded of tens of millions of dollars by its former owners. Fortis is now looking to squeeze spending in everything from energy-efficient light fixtures to automating its business analysis unit and even renegotiating doctors’ salaries. The goal is to reduce expenses by $31 million over the next two years, Ashutosh Raghuvanshi, the CEO who took over in March, said in an interview at the company’s headquarters outside New Delhi. Fresh capital expenditure of $84 million is also in the offing. (Altstedter, 8/20)

When HCA Healthcare purchased nonprofit Mission Health, the rules of charitable giving in communities across Western North Carolina changed. With a for-profit owner running medical facilities, the foundations that raised funds from donors to support the local hospitals that had become part of Mission Health over time could no longer do so. ...In Franklin, where the foundation for Angel Medical Center had ceased operating earlier, the startup Nantahala Health Foundation will fill the same role as the other new foundations. All six foundations are now helping to build the capacity of local nonprofits to meet community needs. (Cotiaux, 8/21)

After years of eye-popping rate increases for individual coverage through the Affordable Care Act, premium prices in Houston for most plans will go down next year, signalling the volatile market may have finally stabilized. Three of four insurers offering plans through the federal exchange in Harris County  have lowered their prices slightly with only one asking for a modest increase, according to filings to the Texas Department of Insurance and the federal healthcare.gov. (Deam, 8/20)

More women may benefit from gene testing for hereditary breast or ovarian cancer, especially if they've already survived cancer once, an influential health group recommended Tuesday. At issue are genes called BRCA1 and BRCA2. When they're mutated, the body can't repair damaged DNA as well, greatly increasing the chances of breast, ovarian and certain other cancers. Gene testing allows affected women to consider steps to lower their risk, such as when actress Angelina Jolie underwent a preventive mastectomy several years ago. (Neergaard, 8/20)

The task force, a government-backed panel of experts in prevention and medicine, said women with previous breast, ovarian, fallopian-tube or abdominal cancer diagnoses who have completed treatment should be assessed for mutations of the BRCA1 and BRCA2 genes. Normally, BRCA1 and BRCA2 genes are responsible for repairing damaged DNA, which ultimately helps lessen the chances for certain cancers developing. But when the genes undergo a rare mutation, it can result in further gene mutations that could lead to breast, ovarian and other cancers. (Ansari, 8/20)

A federal task force is now recommending that people take their ancestry into consideration when deciding whether to get screened for genetic mutations linked to breast cancer—guidance that appears to be aimed at Ashkenazi Jews. Studies have shown that one in 40 Ashkenazi Jews have one of the BRCA1 or BRCA2 mutations, compared with one in 300 people in the general population. The recommendation published in the Journal of the American Medical Association does not specify which ancestry should think about getting tested, but the task force is certainly referring to Ashkenazi Jews, who are disproportionately affected by the mutations. (Feder, 8/20)

Previously, it was recommended for women who have a family history of breast, ovarian, tubal or peritoneal cancer to be assessed for harmful BRCA1 or BRCA2 mutations. That recommendation was last made in 2013 by the US Preventive Services Task Force, a volunteer panel of national experts that makes evidence-based recommendations for the primary care community. (Howard, 8/20)

In more women's health news —

Britni Hebert was chief resident, on track for a career in the highly demanding field of oncology, when she found out she was having twins. “Everything kind of just tilted on its head,” she said. She couldn’t imagine 80-hour workweeks with two newborns at home, while her husband was doing an equally intensive radiology fellowship. But she didn’t leave the profession. Instead, Dr. Hebert, 37, decided to practice internal medicine and geriatrics, with more control over her hours. She has been able to change her schedule three times as her family’s needs have changed (the twins are 6, and the couple has a baby), and now works about 85 percent of full-time hours. (Miller, 8/21)

The rise of drug-resistant urinary tract infections has been particularly burdensome for the significant subset of people who suffer from them on a regular, recurrent basis. These individuals, mostly women, can wind up on a carousel of antibiotics, sometimes the wrong ones, and many experiment with homeopathic alternatives that have not been scientifically validated. (Richtel, 8/20)

For women with serious depression, a single session of exercise can change the body and mind in ways that might help to combat depression over time, according to a new study of workouts and moods. Interestingly, though, the beneficial effects of exercise may depend to a surprising extent on whether someone exercises at her own pace or gets coaching from someone else. (Reynolds, 8/21)

Mifepristone is one of a regimen of two drugs approved by the Food and Drug Administration to end an early pregnancy. It's also prescribed to help reduce the severity of miscarriage symptoms. But it is heavily regulated in ways that can make it hard for women to obtain. Along with its approval in 2000, the FDA restricted its use because of safety concerns. In a perspective article published this summer in the New England Journal of Medicine, former FDA Commissioner Dr. Jane Henney and co-author Dr. Helene Gayle argue that the agency should reevaluate whether such measures are still necessary and take into consideration recent studies that show mifepristone is both effective and safe. (Torres, 8/20)

Planned Parenthood and a number of other health providers across the U.S. have formally withdrawn from Title X — the nation's family planning program for low-income people — after the Trump administration imposed new restrictions. Earlier this year, the U.S. Department of Health and Human Services issued new rules prohibiting Title X funding recipients from providing or referring patients for abortion, except in certain cases. (Mosley, 8/20)

A Trump administration rule banning clinics that receive Title X grant money from discussing abortion options with patients is causing Oregon clinics to reject that source of funding. After a Trump administration rule that “prohibits the use of Title X funds to perform, promote, refer for, or support abortion as a method of family planning” was allowed to go into effect by the Ninth Circuit Court of Appeals pending litigation, Planned Parenthood and other family planning clinics that received government funds are removing themselves from the program. (Acker, 8/20)

Dr. Leana Wen, the former Baltimore health commissioner who was ousted last month as the Planned Parenthood CEO, has a new job as a professor at George Washington University’s Milken Institute School of Public Health. Mina Radman, a spokeswoman for the D.C. university’s school of public health, said Wen is rejoining the university as a visiting professor in health policy and management. She also said Baltimore’s former health commissioner will be a distinguished fellow at the Fitzhugh Mullan Institute for Health Workforce Equity. (Oxenden, 8/20)

Since the Food and Drug Administration blasted Novartis (NVS) earlier this month over data manipulation, one of the major questions looming over the matter has been why the agency came down so publicly on the drug maker. The answer, according to a top FDA official, is because the stakes were too high to do otherwise. Dr. Peter Marks, who wrote the memo that created a storm of controversy around Novartis and data used to support approval of the drug Zolgensma, said in an interview that any case in which data are mishandled and patients are harmed could set the whole field of gene therapy back, just as the death of a patient, Jesse Gelsinger, froze research two decades ago. (Herper, 8/21)

The Novartis (NVS) scientist who was ousted by the drug maker in connection with a scandal over data manipulation broke his silence late Monday, saying through a lawyer that he categorically denied any wrongdoing and was “prepared to assert his rights and defend his conduct accordingly.” The researcher, Brian Kaspar, was dismissed from the company, along with his brother, Allan. Both were leading scientists at AveXis, which developed the gene therapy Zolgensma and which was later acquired by Novartis. The Food and Drug Administration earlier this month accused the drug maker of falsifying preclinical data related to its application for approval of the treatment. (Herper, 8/19)

Many Alaska hospitals and other healthcare providers face significant Medicaid payment cuts following Republican Gov. Mike Dunleavy's veto Monday of a bipartisan bill to restore Medicaid funding that the governor pushed to reduce. Dunleavy, an ultraconservative who narrowly won election in a four-way race in November, vetoed $50 million in state Medicaid spending and erased the $27 million in adult dental benefits from next year's budget. (Meyer, 8/20)

The question of whether to expand Medicaid and extend health insurance to thousands of Oklahomans promises to be a major topic over the next year. The Healthcare Working Group, a bipartisan legislative committee charged with deciding whether to endorse Medicaid expansion or other policy moves, kicked off its work last week and is expected to unveil recommendations before next year’s session. Meanwhile, a signature-collecting drive is underway to put a state question on a 2020 ballot to accept expansion. (Brown, 8/19)

Medicaid today approved a plan that will remove hurdles and expand the ways Ohio can use federal healthcare money to keep low-income children safe from lead in older homes. The state first pursued new funding for lead abatement in 2017 through its Children’s Health Insurance Program (CHIP). In its biennial budget, the state committed to spending about $300,000 from its general revenue fund to leverage $10 million in Medicaid funding for lead abatement work in high-risk homes across the state. (Dissell, 8/20)

On a steamy afternoon in June, Jim Poynter, the coach of the 7-on-7 touch football team at Lamar High School in Arlington, Tex., escorted one of his former players around the state tournament. In a game last spring, the player, Brett Green Jr., was knocked out after his head collided with a teammate’s shoulder as they jumped to intercept a pass. Green was airlifted to a hospital, where bleeding in his brain was discovered. He spent weeks in the hospital recovering from dizziness, headaches and blurred vision, and had eye surgery and physical therapy. He will never play football again. (Belson, 8/20)

In his writings, Gary Marcus is clear about two things: Artificial intelligence is an extremely promising technology that, if used in the right way, could significantly improve practices in health care and other industries. But right now, Marcus says, AI is getting off track, with potentially severe consequences for society and the field itself. That viewpoint makes Marcus — a tech entrepreneur, author, and psychology professor at New York University — a controversial figure in the world of artificial intelligence. He is among a few prominent scientists voicing skepticism about the dominance of deep learning, a type of AI architecture whose use has exploded in medicine and other fields. (Ross, 8/21)

Vaping and smoking habits are more common among children with asthma who are most susceptible to their harmful health effects, state health research has found. The findings might seem contradictory on the surface, because children with breathing problems might seem like the last to take up smoking, but Minnesota Department of Health experts said Tuesday that they confirm a socioeconomic picture of both asthma and smoking being more commonplace in low-income homes and conspiring to harm child health. (Olson, 8/20)

Kaiser Health News: MDMA, Or Ecstasy, Shows Promise As A PTSD Treatment
The first time Lori Tipton tried MDMA, she was skeptical it would make a difference. “I really was, at the beginning, very nervous,” Tipton said. MDMA is the main ingredient in the club drug known as ecstasy or molly. But Tipton wasn’t taking pills sold on the street to get high. She was trying to treat her post-traumatic stress disorder by participating in a clinical trial. (Stone, 8/21)

If you wanted to measure your heart rate or step count during exercise, you would use a fitness tracker. But what if you wanted a device to tell you when when you need to drink more water or should reach for a sports drink? Scientists from the University of California, Berkeley, designed a patch that can measure sodium in sweat and determine sweat rate directly from the skin. Their findings about the effectiveness of their invention were published Friday in the journal Science Advances. (Palca and Torres, 8/20)

Kaiser Health News: Joe Camel Was Forced Out Of Ads. So Why Is Juul Allowed On TV?
Why does e-cigarette maker Juul advertise its product on TV when cigarette ads are banned? The short answer: Because it can. For nearly 50 years, cigarette advertising has been banned from TV and radio. But electronic cigarettes — those battery-operated devices that often resemble oversized USB flash drives with flavored nicotine “pods” that clip in on the end — aren’t addressed in the law. (Andrews, 8/21)

As farm animals from across Minnesota head to the State Fair this week, the Board of Animal Health is asking everyone to help limit the spread of disease. Farm animal exhibits are a perennial favorite at the fair, but senior veterinarian Courtney Wheeler says from an animal health perspective, it’s a major challenge. (Enger, 8/20)

The University of California, Davis will be partnering with a pharmaceutical company to research cannabis ahead of the planned launch of its Cannabis and Hemp Research Center. In a news release, UC Davis announced its partnership with DEA-registrant Biopharmaceutical Research Company, which is an applicant to manufacture cannabis for federally-approved research into the drug. (Moleski, 8/20)

Mississippi has saved a lot of money on its prisons over the past several years. But as the experiences of next-door neighbor Alabama show, rampant violence and understaffing can eventually draw scrutiny from the U.S. Justice Department, with potentially costly consequences. In April, the Justice Department concluded that “there is reasonable cause to believe that the men’s prisons [in Alabama] fail to protect prisoners from prisoner-on-prisoner violence and prisoner-on-prisoner sexual abuse, and fail to provide prisoners with safe conditions.” It demanded that the state fix the problems or face possible litigation. (Mitchell, 8/20)

A majority of Oregonians could favor universal health care provided by the state, even if it requires a new tax to pay for it, according to a poll released last week. Seattle-based polling firm Elway Research found that there is broad support from both Democrats and Republicans for a government-run health care option, some even saying that it should replace private insurance altogether. (Harbarger, 8/20)

A group of Puerto Rican health care workers at a Florida government-run clinic reportedly said supervisors threatened that if they spoke Spanish among themselves, they would be fired. Seven women at the Haines City, Fla., health clinic, run by the Florida Health Department, filed a complaint with human resources and penned a letter to the state-level department, The Associated Press reports. (Campisi, 8/20)

Georgia is still failing to meet key parts of its agreement with the U.S. Justice Department on caring for people with mental illness and developmental disabilities, according to an independent reviewer’s report released this week. The reviewer, Elizabeth Jones, cited “preventable deaths occurring in the state system, often the product of confirmed neglect.’’ Many deaths of people with developmental disabilities were classified as ‘‘unexpected,’’ she said. (Miller, 8/20)

That relief is coming in the form of a raise for direct support professionals who work with individuals with developmental disabilities.In the state budget, Ohio lawmakers approved the increase from $11.12 an hour to $13.23 an hour by Jan. 1, 2021 – the first raise approved in 15 years. Ohio Gov. Mike DeWine vetoed the change, preferring not to lock the rate into state law, but is implementing the rate increase through state policy. (Balmert, 8/20)

Tampa General Hospital has become one of only four health care institutions in the world to open its own high-tech “mission control” command center, using artificial intelligence to predict and improve patient care. The hospital announced the milestone Tuesday, joining with GE Healthcare to open and staff the 8,000-square-foot center, to be known as CareComm. The center will use data to track patients at every stop of their care, streamlining operations and eliminating the chronic delays so common at hospitals. As a result, officials said, patients will receive better care and the hospital expects to save millions. (Griffin, 8/20)

Wisconsin prison officials who denied an inmate's requested gender confirmation surgery could not have anticipated the decision might violate her rights and are therefore immune from damages in a lawsuit, a federal appeals court ruled. The 2-1 decision from the 7th U.S. Circuit Court of Appeals reversed a pretrial ruling by a Madison federal judge that the officials were not covered by qualified immunity. (Vielmetti, 8/20)

A federal judge has rejected a request to block a new state law that ended New York's religious exemption for school vaccination requirements, delivering a setback to opponents who argue that the repeal violates U.S. education law. Judge Allyne R. Ross of the Eastern District of New York denied a request from attorneys Robert F. Kennedy Jr. and Kim Mack Rosenberg for a preliminary injunction to compel the state to admit students with disabilities to schools this fall regardless of the religious exemption repeal and their vaccination status. (Young, 8/20)

Thomas Lam Jr. says he has always tried to do right by his two daughters, but for a while, he found himself in an untenable situation: His child support payments were eating up most of his income, but most of the money wasn't even going to his kids. Lam's case isn't isolated: Some 250,000 families in California only get $50 a month in child support payments because they're receiving government assistance, like welfare or Medi-Cal. (Lagos, 8/20)

A California state senator has formally asked state Attorney General Xavier Becerra to investigate whether the powerhouse AIDS Healthcare Foundation is fraudulently misusing savings from a federal drug-discount program designed to help poor patients. The request comes from state Sen. Ben Hueso (D-Chula Vista), who has urged an investigation into the politically powerful organization that has dumped upwards of $60 million into state ballot drives since 2012, according to Hueso’s letter obtained by POLITICO. (Marinucci and Colliver, 8/20)

Democrats, [Rep. Chris Pappas (D-N.H.)] included, ran on the issue of lowering the cost of prescription drugs, and have little to show for it. The House has only passed piecemeal drug pricing reforms and House Democrats have publicly feuded over how to approach larger, systemic issues, like how the government can best negotiate over the price of drugs. And that is nothing to say of the Republican-controlled Senate, which has yet to take up any of the House’s drug pricing bills. (Florko, 8/19)

The Trump administration may brag that drug makers are dialing back price hikes, but a company that makes an essential mineral used by hospitals for feeding patients intravenously recently raised its price by a whopping 1,300%. Last month, American Regent began selling a product called Selenious Acid Injection, which is used for total parenteral nutrition, a way to provide nutrients to patients who cannot eat food. Selenious Acid is an updated version of an older product called Selenium which, along with numerous other decades-old medicines, had never actually been approved by the Food and Drug Administration. (Silverman, 8/20)

Gene therapy is bringing out the best in America’s health-care system—and its worst. Zolgensma, the first systemic gene therapy of its kind that the U.S. Food and Drug Administration has approved, appears to cure in one shot a rare muscle-destroying disease that can be a death sentence for infants and toddlers. (The kids still carry the gene mutation; they just don’t exhibit the eventually fatal symptoms.) It’s also the world’s most expensive medication. Novartis AG set the price at $2.1 million after the FDA approval came down on May 24, and some families have been left scrambling for ways to get the drug in its first several months on the market. (Koons and Cotez, 8/20)

Several Connecticut organizations joined the national “People Over Pharma Profits” movement on Tuesday, adding state voices to the campaign to reduce prescription drug costs for consumers. At an event organized by the Connecticut Citizen Action Group and hosted by the Wheeler Family Health & Wellness Center, lawmakers and activists pledged to take lobbying efforts and legislative reform through the November 2020 election. “We need to create a political movement, a new civil rights movement for health,” Blumenthal said. “Pharmaceutical drugs are not a luxury. They’re not a convenience.” (Beals, 8/21)

Consolidation in the U.S. healthcare industry, which has already witnessed a string of multi-billion dollar deals, is expected to remain a major theme for the rest of 2019. Bristol-Myers Squibb's $74 billion acquisition of Celgene set the M&A ball rolling in January, and was followed by AbbVie Inc's $63 billion bid for troubled smaller rival Allergan Plc. (8/19)

When the family of 20-month-old Maisie Green heard late last month that their insurance company in Grand Junction, Colo., had agreed to cover a new gene therapy for her spinal muscular atrophy, they were elated. They also knew it was no accident. For two months, the family and a group of more than 700 volunteers, calling themselves “Maisie’s Army,” ran a social media campaign to convince the Greens’ insurer to overturn its decision to deny Maisie access to Zolgensma — the world’s most expensive drug at $2.1 million. (Chakradhar, 8/20)

Drug companies are still raising prices for brand-name prescription medicines, just not as often or by as much as they used to, according to an Associated Press analysis. After years of frequent list price hikes, many drugmakers are showing some restraint, according to the analysis of drug prices provided by health information firm Elsevier. (Johnson and Forster, 8/19)

Medicare and its beneficiaries could have saved an estimated $17.7 billion earlier this decade on generic versions of older medicines instead of paying for newer, chemically similar but more expensive brand-name drugs that companies launched to replace those older pills, according to a new analysis in the Annals of Internal Medicine. For example, Medicare spent $13.4 billion on the Nexium acid reflux pill between 2011 and 2017, but could have saved $12.7 billion if, instead, prescriptions were written for generic copies of the older version of the drug called Prilosec. Similarly, Medicare beneficiaries spent more than $832 million on Nexium between 2011 and 2015, but could have $690 million if prescribed a generic version of Prilosec. (Silverman, 8/16)

A small drug company called TherapeuticsMD (TXMD) agreed to pay $200,000 to settle charges of illegally sharing material, non-public information with analysts after holding discussions with the Food and Drug Administration about a key medicine being developed. In a cease-and-desist order disclosing the settlement, the Securities and Exchange Commission described how company executives twice fed so-called Wall Street sell-side analysts, who follow stocks and report on their prospects, information about an estrogen therapy for postmenopausal women. (Silverman, 8/20)

Republicans are worried about their re-election prospects in 2020, and one result is a frenzy to “do something” on high drug prices. Yet two of the latest ideas are standbys of the left: foreign importation and pricing penalties, which are more about politics than results for patients. The Trump Administration says it intends to explore ways “to allow safe importation of certain prescription drugs to lower prices and reduce out of pocket costs for American patients,” as Health and Human Services said in a press release. (8/18)

Headlines proclaimed, “Illinois just became the first state to require insurance companies to cover EpiPen injectors for kids.” This followed an Aug. 14 tweet from Governor J.B. Pritzker: “I was proud to sign … laws expanding insurance coverage for children whose allergies require lifesaving EpiPens ...” ...As a physician, the hoopla seemed strange. What insurance company would not already cover a lifesaving, standard-of-care medicine like epinephrine? Wouldn’t the company risk significant liability if somebody died as a result? How would insurers survive the adverse publicity? Perhaps that was why, after 30 years on the market no other states mandate coverage of epinephrine injections? (Roger D. Klein, 8/18)

Chronic disease is the leading cause of disability and death in the United States. Six in 10 US adults live with at least one chronic condition. And 4 in 10 adults battle two or more. It's also a major driver of health care spending, accounting for 90 cents of every dollar spent. Unfortunately, new efforts on Capitol Hill could make matters worse. Some lawmakers are pushing to weaken vital intellectual property protections for new medicines that improve health, reduce side effects and help patients take their medicines as prescribed. (Randall Rutta, 8/20)

For a small biotechnology firm, Sarepta Therapeutics Inc. has made a lot of waves at the Food and Drug Administration. The 2016 approval of its first drug, Exondys 51 – which targetings the deadly muscle-wasting disease Duchenne Muscular Dystrophy (DMD) – caused a schism at the agency. A highly organized and vocal group of parents and patients saw hope for boys otherwise resigned to a short and challenging life, helping it gain green-light status, while an agency detractor called the drug an “elegant placebo.” Sarepta’s second drug-approval attempt didn’t go so well. (Max Nisen, 8/20)

The high cost of prescription drugs and that market’s maddening complexity have become almost more than the private sector can bear. A fight taking place in Washington right now is over how much control the federal government should exert over the prices of drugs that Medicare buys for its millions of clients. One thing is clear: The pharmaceutical industry should understand that, sooner or later, the government will exert more control over drug prices than it does now. (8/17)

When I served in the U.S. House of Representatives, I wrote the Americans with Disabilities Act. Today, I am concerned about efforts to blame mental illness and people with disabilities as a cause for the mass shootings that plague our country. Leading the erroneous charge is President Trump, who says “mental illness and hatred pulls the trigger”  in mass shootings, refers to perpetrators as “mentally ill monsters,” and suggests a solution of “involuntary confinement” for some with mental illness. (Former Rep. Tony Coelho, 8/20)

President Trump and his followers delight in his image as a disrupter — a dauntless fighter raring to take on entrenched political interests and sacred cows. But when it comes to addressing America’s gun problem, Mr. Trump has proved both conventional and weak. As the shock fades of this month's back-to-back massacres in Texas and Ohio, he is poised to disappoint yet again. On Tuesday, The Atlantic reported that Mr. Trump had assured Wayne LaPierre, the chief executive of the National Rifle Association, that he is no longer considering universal background checks. (8/20)

For a moment, it seemed as though what was usually assumed in Washington could no longer be taken for granted. President Trump was promising “very meaningful background checks” in the wake of two gruesome mass shootings. He insisted that congressional Republicans would “lead the charge” for new gun legislation, which would have been a tectonic shift in the politics of guns that only sustained pressure from a figure such as Mr. Trump could possibly have produced. (8/20)

Imagine being an Arizona police officer with its lax Wild West gun laws and with a higher than the national average for violent crime. In a sense, it’s surprising our officers don’t use their guns more often, given the danger they are surrounded by, thanks in part to our NRA owned legislators, who refuse to even hold hearings about the lightest of restrictions. (Mike McClellan, 8/20)

Dawn Usanga’s expression of grief over her 7-year-old son’s shooting death last week speaks volumes about the appalling conditions on many St. Louis streets these days. Her quote was displayed in large type on the front page of Sunday’s Post-Dispatch, but it bears repeating here: “In a way, I’m kind of happy he died at 7,” she said of her son, Xavier Usanga. “These streets didn’t have a chance to ruin him. He could have just as easily been swept up in this war, and the boy who shot him could have been my boy someday.” (8/19)

The pervasiveness of e-cigarette vaping has significantly increased among all age groups despite emerging evidence that the practice may be harmful. Some of the features of the devices contribute to these concerns. The e-cigarette inhalation system delivers nicotine as an aerosol instead of smoke. The emissions are lower than those found in combustible tobacco products. However, particles are smaller in vaping compared with combustible cigarettes and result in more toxic chemicals reaching deeper into the lungs. Vaping increases exposure to heavy metals, such as nickel, tin, and lead. Some “buttery” flavors contain diacetyl, a chemical linked to serious lung disease. A number of other chemicals are released during vaping which are potentially hazardous, including acetaldehyde, benzene, cadmium and formaldehyde, to name a few. (Sue Andersen, Diana H. Fishbein and Steve Sussman, 8/20)

President Trump signed an executive order in June that could force price disclosure in health care. Insurers, doctors, and hospitals would have to reveal the secretly negotiated rates they pay for services or charge for them. A month later, the Centers for Medicare and Medicaid Services proposed a rule requiring hospitals to make more price information publicly available. The lack of price transparency behind these efforts is the driving force behind my company — but even if it means taking attention away from what we’re doing, I wholeheartedly support these moves. (David Vivero, 8/21)

All of this is to say that influenza is not a virus to sneeze at. It’s a killer, and the decision by U.S. Customs and Border Protection not to provide vaccinations to migrant families being detained at the border is dangerous and short-sighted.The CBP’s justification, which came in response to questions from physicians about health conditions at the facilities, is that border detention is intended to be short-term, and that once children are transferred into the Department of Health and Human Services’ care, they can get vaccinations and other necessary treatment. (Mariel Garza, 8/21)

Well, the only ones who seem to be pushing for it as a litmus test are Trump, who wants to define the Democrats as socialists; the self-described socialist Sen. Bernie Sanders (I-Vt.); and Sen. Elizabeth Warren (D-Mass.), who every now and then sounds like she has room for a step-by-step approach. Harris and others who have decided against full-blown Medicare-for-all should be commended, not ridiculed as “small thinkers” for eschewing an enormously costly and choice-averse concept at a time Americans want discrete, concrete things (e.g., low drug prices). By listening to experts and voters, watching poll numbers and thinking strategically about how to beat Trump, Harris likely made the best political decision, long-term, for her campaign. There are good policy and political reasons to wind up where she did. (Jennifer Rubin, 8/20)

Simply put, climate change is an existential threat to our health and continued life on the planet. Climate change is insidious. It is an important contributor to devastating hurricanes, extreme heat, desertification, drenching rainstorms, and other life-threatening environmental changes. Yet it is not the sole cause, so it is easy for the remaining small band of climate change deniers to disavow its true impact. But the pattern of changes clearly confirms its effects are protean and increasing. (Jonathan Fielding, 8/20)

A simple over-the-counter DNA test kit revealed the father of a 24-year-old woman was not the man who raised her – the person she revered and regarded as her biological father. Instead, it is alleged in a recently filed lawsuit, the fertility clinic that assisted the woman’s parents fell far short of the standard of care by mixing the wrong sperm with the mother’s egg in a medical procedure designed to help infertility patients have children. This tragic case joins too many other recently discovered assisted conception mix-ups, casting suspicion and doubt over the entire reproductive medicine field. (Judith Daar, 8/20)

President Trump’s dismissal of “fake news” means his constituencies can believe whatever they want about him and his actions — even if their beliefs are in mind-bogglingly stark opposition to one another. Religious extremists opposed to LGBTQ equality can confidently tout Trump as being down with their agenda by pointing to a speech in February in which Trump defended state-funded adoption agencies that turn away gay couples on religious grounds. Trump supporters who want to believe the opposite will point to a tweet he sent recognizing “LGBT Pride Month.” (Michelangelo Signorile, 8/20)

Erika Zak beat Stage IV metastatic colon cancer. She survived more than 70 rounds of chemotherapy and at least 19 hospitalizations to treat infections, severe bleeding and other medical complications. She’s stayed alive more than two years despite liver failure after a botched surgery. And, as CNN reported, she prevailed in a lengthy battle with her insurer, United Health Care. The company repeatedly declined to cover the liver transplant that Ms. Zak’s doctors say she will die without, but relented last year after Ms. Zak made an impassioned plea. (8/20)

Virginia primarily operates two types of jails — local and regional. While local jails serve the area in which they are based and are managed by locally elected sheriffs, regional jails serve multiple localities. They’re governed by local boards and overseen by a superintendent. The state has little authority over their operations — which might play a significant role in the questionable and peculiar deaths of too many inmates in a number of these facilities. (8/20)