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In a scene more like a battlefield than an emergency room in a large American city, dozens of people hit by gunfire poured into the Orlando Regional Medical Center in the dark predawn hours of Sunday morning, lining the hallways and filling the operating rooms. The largest mass shooting in American history happened just a few blocks from the region’s only major trauma care hospital — an event that illuminates the new challenges facing emergency medicine. The gunman fired on his victims in a packed gay nightclub with an assault rifle that caused deep, gaping wounds. He also shot at them with a handgun whose smaller-caliber rounds, in some cases, bounced around inside their bodies, inflicting internal injuries. “If they had not been three blocks from the hospital, they might not have made it to the hospital,” said Dr. William S. Havron, a trauma surgeon at the center. (Grady, 6/14)

Top House Democrats are eying more funding for the Food and Drug Administration (FDA) to help speed up the agency’s effort to eliminate the decades-old policy preventing many gay men from donating blood. (Ferris, 6/14)

House Democrats said Tuesday they may try to pass legislation to end a Food and Drug Administration policy that prevents gay and bisexual men from donating blood unless they have been celibate for one year. Such a measure may be difficult to get past Republicans. Even President Barack Obama’s administration has been reluctant to urge the FDA to change its policy, saying that the decision should solely be based on scientific evidence provided by the agency. (Rahman, 6/15)

The White House said Tuesday it has no plans to lift restrictions on gay men who want to donate blood in the wake of a mass shooting at a gay nightclub in Orlando. (Fabian, 6/14)

"Our first patient was relatively stable, awake and talking, and we thought, 'Maybe they are all going to be like this," she says. But the next patient -- was critical. Then there were four or five more close behind him. "The patients just kept coming,” says trauma surgeon Dr. Chadwick Smith. “One came and another came and another came." They came without warning, or paramedics to stabilize them and help the doctors and nurses assess their injuries. (6/14)

The first victim of the nightclub shooting arrived shortly after 2 a.m. and was relatively stable, giving doctors working the overnight shift hope that any others would arrive in a similar condition.Then five more came, in much worse shape, and then more, and more still, until so many bleeding people were lining up in the emergency room that even hardened trauma surgeons and nurses were brought to tears."They were dropped off in truckloads, in ambulance-loads," said Dr. Kathryn Bondani. (6/14)

Uncontrolled gun ownership is a serious threat to public health — and Congress needs to pay for research on the hot-button issue, the American Medical Association said Tuesday. Two days after 49 people were shot to death at an Orlando nightclub, the influential doctors' body voted to declare gun violence a public health issue and pledged to start lobbying Washington lawmakers. (Fox, 6/14)

Supporters of the proposal said applying a public health approach to gun violence requires ending a de facto ban implemented by Congress in 1996 that prevents the Centers for Disease Control and Prevention from funding research on gun violence. (Johnson, 6/14)

Other doctors groups, including the American College of Physicians and American College of Surgeons, have already declared gun violence a public health crisis. But the topic has been trickier for the AMA, which represents a far more diverse field including all 50 state medical associations. (Ferris, 6/14)

The AMA policy has been a topic of debate among member physicians for more than two years. But the governing board nearly unanimously adopted it during the group's annual meeting in Chicago, which started on Sunday, the day of the Orlando massacre. (Rice, 6/14)

The loss of so much life in the Orlando shootings is exceptional, but the kind of bullet wounds and the extreme nature of the physical trauma that people suffered in this incident is not as uncommon as it was even a decade ago, according to new study. And it is time for this "hidden public health issue" to come out of the shadows, the authors argue. (Christensen, 6/14)

The issue of gun control is expected to come up at a House committee markup this week on mental health legislation, with at least one Democrat considering introducing an amendment on the issue and others likely to come. (Williams, 6/14)

Democratic lawmakers are planning to offer gun-related amendments to a major mental health bill being considered in committee days after the deadliest mass shooting in U.S. history, according to Democratic aides. (Sullivan, 6/14)

The House Energy and Commerce Committee is poised to mark up a long-stalled mental health bill on Wednesday, which lead sponsor Rep. Tim Murphy (R-Pa.) thinks could be brought swiftly to the House floor. “I think it’s going to come, we just have to work towards a date,” he told reporters Tuesday after a press conference to rally support for the bill. “I don’t want this to languish over the summer. I don’t want anybody to have to face another tragedy, whether it’s just a single tragedy in their family or a mass tragedy, while Congress is waiting.” Both House Speaker Paul Ryan and Majority Leader Kevin McCarthy have expressed support for the bill, he said. Ryan pointed to the bill as a way to curb gun violence early on in his speakership. (McIntire, 6/14)

The Olympic Games should go on as planned, the World Health Organization said Tuesday, and athletes and spectators, except for pregnant women, should not hesitate to attend so long as they take precautions against infection with the Zika virus. Pregnant women were advised not to go to Brazil for the event or the Paralympics. The W.H.O. previously told them to avoid any area where Zika is circulating. Some attendees may contract the mosquito-borne infection and even bring it back home, but the risk in August — midwinter in Rio de Janeiro — is relatively low, W.H.O. officials said. (McNeil and Tavernise, 6/14)

The WHO’s emergency committee on Zika said that while mass gatherings can pose a risk to attendees and amplify the spread of infectious diseases, it had found a “very low risk” of further international spread of the virus from the Olympics, which open Aug. 5 and are expected to attract up to 500,000 tourists and more than 10,000 athletes. Brazil is hosting the Games during its winter, when the concentration of mosquitoes that spread Zika and other viruses is low, the panel noted. The country is also intensifying its efforts to control mosquitoes around cities and event venues, the panel said. (McKay, Connors and Futterman, 6/14)

The latest meeting was touched off by a letter drafted by Amir Attaran, a professor of law and medicine at the University of Ottawa, and signed by a group of more than 200 bioethicists, lawyers and health experts urging the WHO to move or postpone the Rio Games because of the risk that they could amplify the spread of Zika. Attaran had been invited to take part in WHO's Emergency Committee meeting, but he declined to sign WHO's required confidentiality agreement, and was not permitted to take part. (Nebehay and Steenhuysen, 6/15)

If and when a mosquito infects a person in the continental United States or Hawaii with the Zika virus, US health officials will deploy a strike team to further limit the virus’s spread, with the ultimate goal of protecting pregnant women. The rapid-response teams — which will help local officials with surveillance, mosquito control, and lab testing — were highlighted in a draft plan released Tuesday by the Centers for Disease Control and Prevention. (Joseph, 6/14)

Lawmakers say Washington is dithering while a dangerous epidemic threatens American shores. They suggest darkly that the government is playing down the risk to avoid panic. They warn: Don’t wait for it to arrive at the airports and establish a perilous foothold. Fear of the Zika virus today? No, those were Republicans in 2014 as they hammered the Obama administration in the final weeks of the midterm campaign for failing to react quickly and decisively enough to the possible spread of the Ebola virus, which never really became a domestic threat. The politically heated attacks cooled quickly after the election, but the message was credited with helping Republicans sow unease about the administration as they chalked up big wins in Congress. (Hulse, 6/14)

The nation’s opioid epidemic is focusing new attention on a strategy Rutgers pioneered back in 1988. Oregon State University will offer substance-free housing to students this coming school year. (Wiltz, 6/15)

Accidental overdoses aren't the only deadly risk from using powerful prescription painkillers — the drugs may also contribute to heart-related deaths and other fatalities, new research suggests. Among more than 45,000 patients in the study, those using opioid painkillers had a 64 percent higher risk of dying within six months of starting treatment compared to patients taking other prescription pain medicine. Unintentional overdoses accounted for about 18 percent of the deaths among opioid users, versus 8 percent of the other patients. (6/14)

U.S. Surgeon General Vivek Murthy on Tuesday called for more government investment in addressing the nation's opioid epidemic, saying only half of the 2 million people who need treatment for addictions have access to it. Murthy's comments came as he toured a substance abuse center in Albuquerque, New Mexico's largest city. New Mexico had one of the highest overdose death rates in 2014, especially among adults 21 to 35, the most recent federal data showed. (6/14)

New York state may limit opioid prescriptions for acute pain to seven days as part of a broader effort to combat a staggering rise in addiction and overdose deaths. The new limits on prescriptions are one of several proposals contained in a deal announced by Democratic Gov. Andrew Cuomo and legislative leaders on Tuesday. The full Legislature is expected to formally pass the proposals later this week. (6/14)

Maryland would be eligible for up to $17 million over two years to expand access to treatment for opioid addiction, according to an estimated breakdown of a $1.1 billion emergency funding request made by President Barack Obama to Congress. (Cohn, 6/14)

Ohio would get an estimated $45 million over two years to fight the opioid epidemic under a national program outlined Tuesday by the Obama administration. The $1.1 billion proposal from Obama, which must still be approved by Congress, would expand access to drug treatment, particularly medication-assisted treatment, federal drug czar Michael Botticelli said in a national conference call. (Johnson, 6/15)

New Hampshire would be eligible for up to $5 million over two years to help expand access to treatment for opioid and heroin abusers under President Barack Obama’s proposed $1.1 billion request to Congress. (Tuohy, 6/14)

A drug central to the push to reduce Pennsylvania's soaring opioid overdose death rate isn't on the shelves of many pharmacies, and numerous drug stores Tuesday showed confusion about a state order meant to put naloxone in the hands of any resident who could witness an overdose. (Giammarise, 6/15)

Fentanyl, a synthetic opioid often used to cut heroin, is raising the overdose death toll in Northern Kentucky. The state's 2015 overdose deaths report released Tuesday cites striking deaths from the powerful analgesic that, narcotics agents say, is largely manufactured overseas and sometimes sold straight on the streets to users who are unwittingly injecting it. (DeMio, 6/14)

Police hope that a new program announced Tuesday will steer drug addicts into treatment and rehabilitation centers rather than jail. Under the Newark Addiction Recovery Initiative, addicts can come to the Newark police station and seek help and treatment. They can surrender any unused drugs and paraphernalia, and they will not be charged with a crime. (Smola, 6/15)

An HIV outbreak linked to heroin and other injected drugs could hit five counties in the Cincinnati region, a new federal analysis warns. ... The national Centers for Disease Control and Prevention released the analysis June 3 of the more than 3,100 counties across the United States that puts 220 at risk of the potentially deadly immunodeficiency disease and hepatitis C, a virus that attacks the liver, among people who inject drugs.(DeMio, 6/14)

The World Health Organization's research arm has downgraded its classification of coffee as a possible carcinogen, declaring there isn't enough proof to show a link to cancer. But the International Agency for Research on Cancer, or IARC, also announced in a report published on Wednesday that drinking "very hot" beverages of any kind could potentially raise the cancer risk, and it classified them as "probably carcinogenic" to humans. (6/15)

From New York state to Seattle to Chicago, proposed taxes on soda and other sugary drinks have failed in just about every place that has tried to enact one. That’s largely thanks to Big Soda — specifically, spending by the American Beverage Association. In New York, for instance, the ABA spent $12.9 million in 2010 to halt a sugary drink tax — almost more than the next three biggest lobbying groups combined that year. The group dropped $9.1 million in San Francisco two years ago. It says it has defeated 45 soda tax measures nationwide since 2008. But one big city is now on the verge of defeating Big Soda. That’s Philadelphia, whose City Council this Thursday is expected to finalize a new tax on sugary beverages. (Premack, 6/14)

Operating was also a tremendous risk. The brain material was too big to fit back in his skull. And Bentley’s situation was so unusual, doctors couldn’t predict what would happen once they shaved off his luxurious light brown curls and cut into the mass. Their quest to give Bentley a future would lead his parents, Dustin and Sierra Yoder, from their small town in Ohio to Boston Children’s Hospital, which just completed a $12 million surgical simulation center to help doctors practice difficult operations before making the first incision. (Weintraub, 6/14)

Jess Thom says the word “biscuit,” about 16,000 times every day. Her brother-in-law counted once. That’s just one of the tics that Thom, a London-based performance artist, has to manage as part of her life with Tourette syndrome. (Fine, 6/14)

A new kind of water contamination has shown up all over the United States, including in New England. This time it’s not lead, — as was the case in Flint Michigan — but a chemical used to manufacture everything from Teflon pans to firefighting foam. ... Although companies have stopped using this chemical because of potential health risks, a new replacement chemical is also causing concerns. (Corwin, 6/15)

Premiums for health plans sold through the federal insurance exchange could jump substantially next year, perhaps more than at any point since the Affordable Care Act marketplaces began in 2013. An early analysis by the Kaiser Family Foundation shows that proposed rates for benchmark silver plans — the plans in that popular tier of coverage that determine enrollees’ tax subsidies — are projected to go up an average of 10 percent across 14 major metropolitan areas. The analysis, released Wednesday, is based on insurers’ initial filings in 13 states and the District of Columbia. As in previous years, it shows how differently the health-care law is playing out across the country depending on regions and insurers. (Levine and Sun, 6/15)

A new study says premiums for popular low-cost medical plans under the federal health care law are expected to go up an average of 11 percent next year. The analysis from the nonpartisan Kaiser Family Foundation foreshadows sharp increases in an election year. The study looked at 14 metro areas with complete data available. It found that premiums for a level of insurance called the "lowest-cost silver plan" will go up in 12 of the areas, while decreasing in two. (6/15)

Next year’s premiums for health coverage under the Affordable Care Act could rise more than in past years in most markets and declines might be rare, according to a preliminary analysis of insurers’ plans. Overall, premiums for a popular type of plan -- the second-lowest silver plan -- could rise 10 percent on average next year in 14 major metropolitan areas, according to an analysis released Wednesday by the Kaiser Family Foundation. Kaiser based its projections on insurers’ preliminary rates filed with state regulators, which remain subject to state or federal review. (KHN is an editorially independent program of the foundation.) (Galewitz, 6/15)

The California Public Employees’ Retirement System, one of the biggest health insurance buyers in the country, is proposing substantially lower premium hikes for its members in 2017 than they saw this year, the agency announced Tuesday. CalPERS has recommended a 4.1 percent average hike in HMO premiums, a 3.7 percent raise in PPO premiums and a 1 percent increase in premiums for commercially administered Medicare plans. The agency’s Board of Administration is scheduled to vote Wednesday on the proposed rates. (Ibarra, 6/15)

EDTA judge delivered the Federal Trade Commission a major setback Tuesday in one of its biggest hospital cases in years, and experts say the decision could embolden even more hospitals to consolidate. The federal judge in Chicago declined to grant the FTC a preliminary injunction to temporarily stop a merger between Downers Grove, Ill.-based Advocate Health Care and Evanston, Ill.-based NorthShore University HealthSystem. (Schencker, 6/14)

Judge [Jorge] Alonso said the FTC hadn’t shown it would succeed in proving the hospital merger was anticompetitive. The judge, who held a six-day court hearing in April, in an order didn’t elaborate on the reasons for his decision. His full written ruling wasn’t immediately made public because it contains confidential business information. (Kendall, 6/14)

Last December, the F.T.C. sought to prevent the merger, arguing that the 16-hospital system would dominate the North Shore area of Chicago. Federal officials said the combination could result in people there paying higher prices for medical care and receiving lower-quality care. But the hospitals justified the merger by pointing to the major changes occurring in health care, including health systems being held more accountable for the overall cost of care for their patients. Hospital executives said the proposed merger was in keeping with the federal government’s goal of promoting alliances among hospitals and doctors so they could better coordinate care and improve quality while reducing prices. (Abelson, 6/14)

A November 1999 report by the Institute of Medicine titled To Err is Human: Building a Safer Health System estimated that between 44,000 and 98,000 deaths a year were caused by medical error .... Despite all the adverse public attention and criticism the report drew, hospitals and medical professionals were slow to respond. ... A new study published this week by JAMA, the Journal of the American Medical Association, concludes that hospitals and the medical profession have finally begun to make improvements. Notably, there was a sharp decline in the rate of harmful medical mistakes between 2010 and 2014. (Pianin, 6/15)

The MetroHealth System, Cleveland's oldest medical institution, is undergoing a rapid -- and seemingly paradoxical -- shift in business strategy: It is trying to stop patients from coming to the hospital. In a series of recent moves, the health system has sought to lessen patients' reliance on its flagship medical center in Cleveland by increasing access to primary and preventive care services at other MetroHealth facilities. (Ross, 6/14)

The latest Nationwide Children’s Hospital expansion will create 2,000 jobs in less than a decade and add an eight-story tower, office and research buildings and more parking to its sprawling campus. ... What Children’s has been doing during the past decade has been duplicated in cities across the country. Older hospitals nestled in dense urban neighborhoods have expanded their footprints, gobbling up vacant lots in some cases, adjacent homes and businesses in others, changing an area’s fabric and leaving those who live and work there wondering what’s coming next. (Ferenchik, 6/15)

Last year, a group of federal scientists was debating whether as many as 2,100 Air Force veterans should qualify for cash benefits for ailments they claimed stemmed from flying aircraft contaminated by Agent Orange. ... The scientists within the U.S. Department of Veterans Affairs agreed the airmen had a strong case. But they had a more calculated concern: If the VA doled out cash to these veterans, others might want it too, according to an internal document obtained by ProPublica and The Virginian-Pilot. (Ornstein and Hixenbaugh 6/15)

The land where the South Texas Veterans Health Care System built its North San Antonio outpatient clinic a decade ago has been sold, but the U.S. Department of Veterans Affairs said the clinic will continue providing patients a full range of health care services at that location. (O’Hare, 6/14)

With more than 1.65 billion members worldwide posting regularly about their behavior, Facebook is planning to take a more direct role in stopping suicide. On Tuesday, in the biggest step by a major technology company to incorporate suicide prevention tools into its platform, the social network introduced mechanisms and processes to make it easier for people to help friends who post messages about suicide or self-harm. With the new features, people can flag friends’ posts that they deem suicidal; the posts will be reviewed by a team at the social network that will then provide language to communicate with the person who is at risk, as well as information on suicide prevention. (Isaac, 6/14)

The dark thoughts that flow through the minds of people contemplating suicide might find their way to a social media site, and Facebook wants to make it easier for friends and family to help. The tech firm on Tuesday said it is rolling out worldwide tools aimed at preventing suicide, expanding its reach beyond the United States. Working with mental health groups such as Forefront, Lifeline and SAVE.org, Facebook started working on suicide prevention about a decade ago after a string of teen suicides in Palo Alto...But the tools also drew some criticism from advocacy groups, including Consumer Watchdog, which raised concerns that Facebook wasn't doing enough to protect users from the misuse of the tools. (Wong, 6/15)

Research on the patient safety risks posed by health technology remains fragmented with no central authority to guide what to do with the research data, according to two reports released recently by federal regulators. (Ruoff, 6/14)

Healthcare is currently one of the most prevalent and growing topics in the startup community. Within the healthcare technology niche, cancer is also a popular topic. While treatments vary across patients, the aim of these cancer-related innovations is to introduce disruptions through highly effective and engaging tools that have a unique approach to healthcare. (Toben, 6/15).

Zenefits on Tuesday said it is laying off another 9% of its staff, the latest restructuring by the once highflying health-benefits broker that is reeling from regulatory issues and missed sales targets. In an email to staff Tuesday morning, Chief Executive David Sacks said Zenefits would let go 106 employees. That figure includes 61 people in the company’s Arizona sales office, which is being shut down, and 45 others, mostly from the company’s operations team. (Winkler, 6/14)

Some people receive constant reminders on their personal smartphones: birthdays, anniversaries, doctor's appointments, social engagements. At work, their computers prompt them to meet deadlines, attend meetings and have lunch with the boss. Prodding here and pinging there, these pop-up interruptions can turn into noise to be ignored instead of helpful nudges. Something similar is happening to doctors, nurses and pharmacists. And when they're hit with too much information, the result can be a health hazard. The electronic patient records that the federal government has been pushing -- in an effort to coordinate health care and reduce mistakes -- come with a host of bells and whistles that may be doing the opposite in some cases. What's the problem? It's called alert fatigue. (Luthra, 6/15)

Kansas has “reconsidered” its decision to terminate the participation of 11 Planned Parenthood physicians and other medical providers in the state’s Medicaid program, although it’s still trying to cut off Planned Parenthood itself. In a letter Monday to the federal judge overseeing a lawsuit filed by Planned Parenthood and the providers to block their termination, a lawyer for the state said the decision to prohibit the medical providers from receiving Medicaid reimbursement “was made primarily to prevent PPKM (Planned Parenthood of Kansas and Mid-Missouri) and PPSLR (Planned Parenthood of the St. Louis Region) from evading the effect of their terminations by having providers at their facilities use their individual (Medicaid) numbers.” But after court briefings and arguments, the letter said, the Kansas Department of Health and Environment “decided to rescind the terminations of the providers.” (Margolies, 6/14)

Kansas is abandoning plans to block 11 people who have provided services to Planned Parenthood from participation in its Medicaid program, though the state still intends to cut those funds from the organization's regional affiliates. A lawyer for the state's health department announced the move in a letter filed Monday with a Kansas City, Kansas, federal judge weighing two Planned Parenthood affiliates' request to scuttle any halting of Medicaid reimbursements. That funding cutoff could come as early as July 7, by which time U.S. District Judge Julie Robinson is expected to rule on the preliminary injunction sought by Planned Parenthoods for Kansas and Mid-Missouri as well as another for the St. Louis region. (Suhr, 6/14)

Lawyers for antiabortion clinics known as crisis pregnancy centers argued to a federal appeals court Tuesday that California is violating their free-speech rights by requiring them to notify patients that the state makes abortion and other reproductive services available at little or no cost. (Egelko, 6/14)

A Harris County judge has dropped one of the criminal charges against an anti-abortion activist who was indicted after making undercover recordings of a Houston Planned Parenthood facility. David Daleiden, one of the videographers who infiltrated Planned Parenthood Gulf Coast, had been charged with the very crime he tried to secretly catch Planned Parenthood committing — a misdemeanor charge for offering to sell or buy fetal tissue. But that charge was dismissed on Monday, according to the Harris County District Clerk website. (Ura, 6/14)

A new weight loss device offers a novel approach to cutting calories: draining them from the stomach before they are fully digested. The AspireAssist system consists of a thin tube implanted in the stomach, connecting to an outside port on the skin of the belly. (Perrone, 6/14)

A weight-loss device lampooned on late-night TV as "machine-assisted abdominal vomiting" because it allows users to drain some of their stomach contents after eating has won federal approval. (Giordano, 6/15)

The U.S. Food and Drug Administration has agreed to let folic acid be added to corn masa flour, a change expected to spare Hispanic babies from devastating birth defects - and a change that some advocates say is long overdue. (McCullough, 6/15)

The Food and Drug Administration has sent Whole Foods Market a letter over “serious violations” at a Massachusetts kitchen, warning the grocer that food prepared there “may have been contaminated with filth.” The FDA’s Public Health Service describes multiple inspections conducted during February at the North Atlantic kitchen in Everett, which had condensate from ceiling joints dripping onto work surfaces below. (6/14)

The Food and Drug Administration sent a warning letter to Whole Foods co-CEOs John Mackey and Walter Robb about what the FDA called "serious violations" it found after inspecting a Whole Foods food preparation facility in Everett, MA, in February. The FDA said in the letter -- dated June 8 -- that it found various items, including pesto pasta, mushroom quesadillas, egg salad and couscous, were in areas where "condensate" was leaking from ceiling joints, a doorway and condenser fan. (La Monica, 6/14)

The U.S. Food and Drug Administration has cited Austin-based Whole Foods Market in a warning letter for several food safety violations, saying the retailer must take several correction actions to address the concerns. The agency said in a June 8 letter to co-CEOs John Mackey and Walter Robb that in February it inspected the organic food giant’s food manufacturing facility in Everett, Mass. and “found serious violations” of the agency’s regulations for manufacturing, packing or storing food. (Grisales, 6/14)

Regardless of whether Georgia has the highest rate of maternal death in the nation, or whether it is merely one of the riskiest places to give birth, the prospects for new mothers remain dimmer here than in most places. In 2006, The National Women’s Law Center (NWLC) ranked Georgia 49th. (6/14)

African-American babies are dying in Milwaukee at a rate that is more than three times that of white babies, according to data released Tuesday by the Milwaukee Health Department. Approaching historic levels, it is the worst racial disparity in infant deaths that the city has seen in more than a decade. And while the average infant mortality rate for both black and white babies decreased during the three-year period ending in 2015, it now appears all but impossible that the city will reach the goal it set in 2011 of reducing the black infant mortality rate 15% by 2017. (Stephenson, 6/14)

Cincinnati's public library Tuesday stood by its previous decision not to cover an employee's transgender transition surgery, citing costs. Public Library of Cincinnati and Hamilton County Library employee Rachel Dovel, who legally changed her name from Nathan last year, brought the issue to light earlier this year after her insurance declined to cover gender confirmation surgery. The board initially declined to change their policy, (Coolidge, 6/14)

St. Louis agencies that serve people living with HIV have seen a sharp rise in requests for emergency housing. More than 5,900 people were living with HIV in the city of St. Louis and six nearby Missouri counties at the end of 2015, according to the St. Louis Regional HIV Health Services Planning Council. (Bouscaren, 6/14)

Kellogg Co. joined competitors on Tuesday in recalling a variety of cookies and brownies because of fears of peanut-residue contamination with no warning on the label. The company stressed it was a voluntary and precautionary recall for products associated with a flour mill in Georgia. (6/14)

Settling a major lawsuit from environmentalists, San Jose city officials on Tuesday agreed to spend more than $100 million over the next decade and beyond to reduce tons of trash that flows into creeks and San Francisco Bay, repair miles of leaking underground sewage pipes and clean stormwater contaminated with harmful bacteria. (Rogers, 6/15)

You can add Mylan Laboratories to the list of drug makers boosting prices by big amounts. Over the past six months, the company, which is one of the world’s largest purveyors of generic medicines, raised prices more than 20 percent on two dozen products. And Mylan also boosted prices by more that 100 percent on seven other products, according to Wells Fargo analyst David Maris, who called some of the price hikes “exceptionally large.” (Silverman, 6/10)

A months-long political and public firestorm over large drug price increases hasn’t been enough to bring the practice to a full stop. Now, Mylan ($MYL) is under the radar as a new report documents several price hikes this year, ranging from 15% for EpiPen to much larger increases of 400% and 500% for other meds. Documenting price increases from January to June across the specialty pharma sector, Wells Fargo ($WFC) noted that Mylan raised the prices of 7 products by 100% or more and 24 products by 20% or more. Gallstone medication ursodiol saw the biggest jump at 542% over the period, while GERD drug metoclopramide and IBS med dicyclomine increased 444% and 400%, respectively. In a note to clients, Wells Fargo's David Maris called the price increases “beacons for scrutiny” in the current drug pricing climate, what with Congress, payers and the public all bearing down on the industry’s pricing ways. (Sagonowsky, 6/14)

Mylan NV fell as much as 6 percent after Wells Fargo analyst David Maris said the generic drugmaker could be the next target of public criticism on drug price increases. In a report titled “Is Mylan Next in Line for Pricing Scrutiny?,” Maris said the generic drugmaker could follow companies like Valeant Pharmaceuticals International Inc. and Turing Pharmaceuticals AG, which faced intense criticism and have had to appear before Congress to defend their drug-pricing tactics. (Koons, 6/10)

Drug pricing was on Wall Street’s mind again Friday, as Wells Fargo tapped Mylan as the next target for activists, while RBC considered the impact of a potential new law limiting prices in California. Wells Fargo analyst David Maris wrote that after Valeant Pharmaceuticals and Turing Pharmaceuticals were hauled in front of Congress and scrutinized by the press for their policies of drastically hiking the prices of recently acquired drugs, he’s been keeping an eye out for other companies in his universe that have been doing a lot of price increases. “In the last six months, Mylan has raised prices more than 20% on 24 products, and more than 100% on seven products,” Maris wrote in his research note late Thursday. (Reeves, 6/10)

While the coupons have improved patient compliance, drug manufacturers are covering all or part of the copays to bypass efforts by insurers and pharmacy benefit managers to rein in the rising price of drugs. (Wolinsky, 6/11)

When Philip Kucab was a boy at a summer camp for kids with hemophilia in 1990, a staff member casually sat down next to him on the last day and asked where Kucab's family got their medication. After the boy explained it came from the hospital pharmacy, the camp staffer, who worked for a specialty pharmacy, explained that he could save them a trip and send the drugs in the mail. "At the time, we actually liked it. This nice man came to our house, had dinner with us," Kucab said. "It was kind of a nice relationship in a way because it was very personal. So when we used to order medication, we'd call up this nice person on the phone — 'How are the boys doing?' It was like a friend, almost." Kucab, today a physician starting residency at Detroit Medical Center, remembers big baskets of cheese and crackers arriving at Christmas — a thank-you for their business. He remembers thinking it was kind of cool. (Johnson, 6/14)

Cancer drugs have mostly been immune to the pricing pressure affecting many drugmakers. That's likely to change, even for new and potentially curative drugs. (Nisen, 6/13)

Drug companies are using marketing strategies normally aimed at physicians to target patients, particularly children, and the practices could be pushing more patients into prescriptions for costlier medicines, a new PLOS Medicine paper argues. The authors say their paper is the first known documentation of drug companies using these methods — including gifts, financial support and one-on-one marketing — to target patients as opposed to doctors. (Karlin-Smith, 6/14)

File this under “What controversy?” ... Pfizer increased the list prices of its medicines in the United States by an average of 8.8 percent, according to an investor note by Morgan Stanley analyst David Risinger. This marks the second time this year that the drug maker has substantially boosted prices for its prescription drugs. Back on Jan. 1, Pfizer raised prices by an average of 10.4 percent, Risinger pointed out. (Silverman, 6/9)

Drug makers are sick and tired of coming under attack for high prices. And they’re spending tens of millions to try to make it stop. “We’re under unprecedented pressure because there really is profound misunderstanding out there,” Acorda Therapeutics CEO Ron Cohen, who chairs the industry trade group Biotechnology Innovation Organization, told a crowd at BIO’s conference. (Robbins, 6/9)

Ever-rising drug prices are beginning to put a serious squeeze on the bottom lines of hospitals, which do not see much wiggle room for negotiation at this point, Crain's Detroit Business reported. Total prescription spending on drugs increased at a 12.2 percent clip last year, up from a 2.4 percent increase in 2014, according to Crain's, which cited data from the Centers for Medicare & Medicaid Services. Pharma giants such as Amgen, Allergan and Pfizer have imposed double-digit percentage price increases on dozens of their branded drugs since late last year. (Shinkman, 6/13)

Things might finally be calming down with Valeant Pharmaceuticals International Inc. On Tuesday, the company participated in a typically uneventful ritual performed annually by corporations -- in a 100-person conference room in a Montreal suburb, stocked with coffee and bottles of Perrier, it held its annual meeting. And for the first time in a while, Valeant’s public interaction with shareholders wasn’t followed by a steep drop in its stock. During the sparsely attended, 40-minute session, the stock tracked the broader market, rising as much as 1.1 percent, then declining by about 1.2 percent. (Tracer, 6/14)

In a dramatic move, the Colombian health minister plans to unilaterally force Novartis to lower the price for its Gleevec cancer medicine after more than two weeks of talks over a price cut went nowhere, according to reports and sources in Colombia. In public comments today, Health Minister Alejandro Gaviria said he will declare a lower price for the widely used cancer medicine as being in the public interest because it would save the country needed health dollars. Under this scenario, Novartis would be obligated to sell Gleevec at the new price, although he did not specify what that might be. (Silverman, 6/9)

Selling prescription drugs is a classic principal-agent problem. The key decision-makers are the doctors who write the prescriptions, but they're not the ones paying for the drugs, or taking them. So competing on, for instance, price is dumb. Doctors may not even know how much the drugs they provide cost, and they don't have much in the way of fiduciary responsibility to insurance companies. Competing on effectiveness is better; I gather that most doctors do care about their patients' health. But at some level the simplest way to sell prescription drugs is to bribe doctors to prescribe them. This is all well known, and bad and illegal. You can't just bribe doctors to prescribe your drugs, come on. So you have to fall back to competing on effectiveness. (Matt Levine, 6/10)

Skyrocketing drug prices are forcing states to take unprecedented measures to rein in health care spending. Vermont just became the nation’s first state to require prescription drug pricing transparency. The New York and Massachusetts attorneys general have launched investigations into major pharmaceutical companies’ and insurers’ drug pricing policies and strategies. These are important steps. But they ignore a key driver of the problem: secondary patents. (Priti Radhakrishnan, 6/14)

Philadelphia tort attorney Stephen Sheller argues in his new book that the 2000 election of George W. Bush brought about what he calls "Pharmageddon," in which pharmaceutical industry CEOs "were permitted to buy elections, purchase state legislatures, appoint judges, and write laws to benefit themselves." Sheller details how both Bush presidents, several of their cabinet members and other appointees acquired stock in Eli Lilly and, in various ways, "were beholden to the industry." Although Sheller makes a compelling case, the pharmaceutical industry has paid politicians to rig the system in its favor long before 2000. (Daniel R. Hoffman, 6/14)

Part B drug payment policy. Boring. Obscure. But an ongoing battle over these policies will affect you — especially what you pay for drugs. Everyone is outraged over exorbitant — and ever-rising — prescription drug prices. Over the last two years drug prices have gone up double digits even when general inflation — and even health care inflation — has been historically low. Politicians have proposed many ideas to curb them: Drug importation from Canada; Medicare drug price negotiation. And in California voters will decide on an initiative that ties what state agencies pay for drugs to the price paid by the Veteran’s Administration, which are among the lowest in the country. (Ezekiel J. Emanuel, 6/9)

The specter of drug pricing can’t seem to disappear from public discourse. On the one hand, this isn’t a bad thing – wanting to tie drug prices (and healthcare prices overall) to some measure of value is a noble goal. But the devil is in the details – and Vermont’s attempt to “do something” on drug pricing moves the needle in the wrong direction. The non-controversial-sounding bill – “An act relating to prescription drugs” – was signed by Governor Shumlin several days ago and sold as “healthcare transparency” legislation. One part of the bill does indeed deal with transparency. Health insurers are required to make information on their formularies easily available and hospitals are required to make cost-sharing information available to affiliated physicians. (Yevgeniy Feyman, 6/10)

There has been a great deal of recent news coverage of Medicare’s proposal for a “value-based” payment program for prescription drugs. Two important ideas are missing from these discussions: The need to increase competition among drug manufacturers by allowing the safe importation of brand name prescription drugs from select countries, and the need to negotiate bulk buying as almost every other western country has been doing for years. (Robert Denz, 6/10)

The pharma industry has an image problem, no doubt, and it’s not just about drug pricing. Underneath the outcry of the past nine months has been a drumbeat of accusations, investigations and settlements with U.S. prosecutors--even some outright arrests and criminal convictions for over-aggressive marketing. Not to mention the opioid epidemic that’s put makers of painkillers on trial for their promotional practices. Top companies and industry advocates have fought back with public comments and, now, beefed-up ad campaigns designed to polish that tarnished reputation. But that’s not enough, argues the Harvard Business Review. Not enough to fix pharma’s reputation, and certainly not enough to fix the underlying problems triggering the scrutiny. So, what if drugmakers radically overhauled their pay structure, too? (Tracy Staton, 6/14)

If Paul Ryan really wants to encourage more Americans to work, and to move up the income ladder, he could start by urging his fellow Republicans to expand Obamacare. Really. The House speaker recently rolled out his grand vision for reducing poverty and increasing upward mobility, part of his effort to brand the GOP as the “party of ideas.” A recurrent theme in his 35-page plan is how today’s social safety net discourages poor people from working, or at least from earning more money. (Catherine Rampell, 6/14)

Emergency departments are expected to respond rapidly. They must effectively and quickly assess who among the wounded needs treatment first, or triage. Hospitals must create surgical capacity in the operating rooms, and bed capacity on the floors to treat patients that require admission. ... These systematic approaches to surge planning for mass casualty responses take an “all hazards” approach to ensure that the plan is adaptable and scaleable regardless of the type or cause of the event. (Sam Shartar, 6/15)

Louisiana's nine safety net hospitals are bracing for big state funding cuts as lawmakers in a special session remain deadlocked over new Democratic Gov. John Bel Edwards' request for tax increases to fund healthcare and higher education. Meanwhile, the state is racing to enroll low-income adults in its new Medicaid expansion that starts July 1, which Edwards implemented through executive order and which the Republican-controlled Legislature did not try to block. State officials say they've already signed up more than 200,000 of a projected total of 375,000 people since enrollment started June 1. (Harris Meyer, 6/14)

As the Democratic primaries came to an end Tuesday night, Bernie Sanders and Hillary Clinton met. Mr. Sanders presumably made a strong case that the ideas and ideological direction of his campaign should be incorporated into her campaign and, if she wins, her presidency. Earlier in the day, in anticipation of the meeting, he said, “I think the time is now — in fact, the time is long overdue — for a fundamental transformation of the Democratic Party.” ... But the biggest reason that Mr. Sanders won’t shape the next progressive agenda stems from a little-noticed aspect of his campaign: His policy proposals were consistently out of step with the ideas that have been emerging from progressive think tanks like Demos or the Center for American Progress or championed by his own congressional colleagues. For example, many liberal Democrats would agree with Mr. Sanders, in theory, that single-payer health insurance could be fairer, more efficient and cheaper than our fragmented system. But the president and Congress made the decision in 2010 to build on the private insurance system, in the form of the Affordable Care Act, in part because single-payer wasn’t politically viable. A Democratic administration’s next moves will be to expand and strengthen the Affordable Care Act, not start over. (Mark Schmitt, 6/15)

The Orlando massacre reminds us that there’s an enormous amount we don’t know about gun violence — what causes it, what its consequences are for surviving families, how to stop it. You can blame our ignorance on the National Rifle Assn. – and on the federal officials the NRA has intimidated away from this crucial field of public health for 20 years. (Michael Hiltzik, 6/14)

Our aging country must come to grips with the fact that, increasingly, it’s hard to find caregivers for our most vulnerable citizens. By 2022, the number of direct care workers needed nationally is projected to exceed the number of K-12 teachers. And New Hampshire is aging faster than almost any other state. (Brendan Williams 6/14)

We’ve approached racial equity “from a place of despair,” Shawntera Hardy, commissioner of Minnesota’s Department of Employment and Economic Development, told the editorial board. We should instead be talking about assets, she said, and “celebrating and encouraging things that are working.” (6/15)

Growing up as a gay man in the suburbs of Orlando, Fla., was a challenge. After I started coming out to friends and family when I was 15, I was moved from school to school and I was subjected to the Exodus program, which attempted to change my sexuality through religious reform. In the face of this kind of discrimination, L.G.B.T. people in Orlando have carved out our own safe zones, congregating at bars and restaurants where we can dare to be ourselves, away from disapproving eyes. Pulse, the nightclub that was attacked on Sunday morning, was one of those places. My husband and I got married in Orlando on April 23. The night before, we went to Pulse with our closest friends to celebrate and to feel a sense of love and community. That’s the type of environment that Pulse offered us. (Blake Lynch, 6/15)

Any day now, the Supreme Court is going to decide whether women everywhere have full access to the right to an abortion, or just those who live in the right ZIP code — and whether any other woman in Texas, where I live, will have to go through what I did last fall. The abortion restrictions that the court is currently considering, which were passed in 2013 under the pretext of protecting women’s health and safety, are really nothing more than unnecessary obstacles. In my life, they made a devastating situation much worse. (Valerie Peterson, 6/15)

Because of lack of resolve and money, this nation has failed to meet a 2010 goal to eliminate childhood lead poisoning by attacking a problem that often exists in poor and minority neighborhoods. Paint found in many older homes in the Kansas City area and throughout the country contains lead; it was finally banned as a paint ingredient in 1978. (6/14)