51��Ƶ

The Trump administration appears ready to roll back health care protections for transgender people, and advocates are gearing up for a fight. A proposed rule from the Department of Health and Human Services that’s expected in the coming days would make it easier for doctors, hospitals and insurance companies to deny care or coverage to transgender patients, as well as women who have had abortions. (Weixel, 4/23)

Transgender adults may be more likely to have unhealthy habits and medical issues that negatively impact their quality of life than people whose gender identity matches what it says on their birth certificates, a U.S. study suggests. Researchers examined survey data from 3,075 transgender adults as well as 719,567 adults who are cisgender, meaning their gender identity matches the sex they were assigned at birth. (4/22)

Given the health-care rout that’s wiped out $234 billion of market value in April, you’d be forgiven for thinking investors are panicking. Options prices show they aren’t, according to Goldman Sachs & Co. The S&P 500 Health Care Index fell as much as 0.4 percent on Monday, pushing its decline in April to 6.8 percent. It’s the only major industry group that has fallen this year as concerns deepen about disruptive policy proposals in Congress, including “Medicare-for-All” legislation that would replace private medical insurance with a government-run system. (Darie and Calderone, 4/22)

Nearly all of the largest publicly traded health insurance companies gave their CEOs a pay raise in 2018. That includes UnitedHealth Group, whose CEO David Wichmann's total compensation reached $18.1 million. That's an increase of 4.3% over Wichmann's 2017 total compensation. Based on stock options exercised and stock awards that vested in 2018, Wichmann's realized compensation totaled $21.5 million. The company—which includes the nation's No. 1 health insurer, UnitedHealthcare, and the fast-growing health services subsidiary Optum—said in its annual proxy statement that Wichmann makes about 316 times the company's median employee salary. (Livingston, 4/22)

Lawyers for Theranos Inc. founder Elizabeth Holmes on Monday fought off efforts by the U.S. government to set a trial date as the two sides argued over the enormity of evidence involved in the case and the difficulty in lining up high-profile witnesses. Ms. Holmes and her former deputy, Ramesh “Sunny” Balwani, who both appeared in court on Monday, were charged last year with lying to doctors and patients about their blood-testing startup’s test results and misleading investors about the company’s financial health. In addition to 20 years in prison, they face fines of more than $2 million apiece, as well as additional restitution to victims. (Copeland, 4/22)

Holmes and Balwani are charged with two counts of conspiracy to commit wire fraud and nine counts of wire fraud. They each face a maximum of 20 years in prison and up to $2.7 million in fines, a figure that doesn’t include any cash the government might demand as restitution for the alleged fraud. Holmes and Balwani have each pleaded not guilty. (Robbins and Garde, 4/22)

A lawyer for Holmes told a federal court judge Monday that the defense team was expecting documents from the Food and Drug Administration and the Centers for Medicare & Medicaid Services. Those documents, lawyer Kevin Downey said, are “in many instances exculpatory.” However, assistant U.S. attorney John Bostic told the judge that what Holmes’ team receives will depend on “whether the prosecution is deemed to have access to the documents in possession of those agencies.” (Baron, 4/22)

Federal immigration authorities faced with overburdened detention centers are scouring the country to find space to house migrants as the crush of asylum seekers that has overwhelmed the Southwest border spreads deep into the nation’s interior. With mounting federal initiatives to hold more and more migrants in custody, officials at Immigration and Customs Enforcement, which oversees long-term detention centers for migrants, are looking for additional space that can be rented inside existing jails, as well as fast-tracking the deportations of current detainees and releasing as many migrants as possible into the country to make room for newcomers. (Dickerson, 4/22)

Kaiser Health News: Sparse Treatment Options Complicate Cancer Care For Immigrants In South Texas

Edgar carries a red folder bulging with paperwork, bills and medical records. Before his lung cancer diagnosis in September, he had about $11,000, he said, money he was saving to purchase a used truck and to pay an immigration attorney to pursue legal residency. By February, it was gone, and Edgar was relying on friends and family to cover doctor appointments, food and other basics. His treatment had been complicated by a collapsed lung. “I’m not able to work — I’m breathing with just one lung,” said the 50-year-old painter, who asked to be identified by only his first name because he’s an undocumented immigrant from Mexico. (Huff, 4/23)

Some migrants arrive in need of medical care. Others become sick while they're in government custody. Volunteer medics are stepping in to provide care once those families are released. (Falk, 4/23)

When children visiting Disneyland in 2015 contracted and then transmitted measles across the country, President Barack Obama lent his voice to the containment campaign. “You should get your kids vaccinated. It’s good for them,” he told an interviewer. “There is every reason to get vaccinated. There aren’t reasons not to get vaccinated.” A few years earlier Obama was photographed getting immunized against H1N1, the flu virus that triggered the 2009 pandemic. Gerald Ford famously got vaccinated in the 1976 “swine flu” pandemic scare. Jimmy Carter and Bill Clinton created and expanded programs to immunize children against childhood diseases. White House photographers recorded Ronald Reagan getting multiple flu shots. (Branswell, 4/23)

Outbreaks in New York state continue to drive up the number of U.S. measles cases, which are approaching levels not seen in 25 years. Health officials say 71 more cases were reported last week, with 68 of them from New York. That brings this year's total to 626. That is already the most since 2014, when 667 were reported for the whole year. The most before that was 963 cases in 1994. (4/22)

New York City health officials have said they expect the number of cases to increase over the next several weeks after Passover, one of the holiest Jewish celebrations, when there are large get-togethers. Many of those who have contracted measles in the current outbreaks are children, including babies too young to be vaccinated. Some of the sick have been adults, including those who were vaccinated. (McKay, 4/22)

The U.S. outbreak is part of a worldwide rise in the once nearly eradicated disease. The World Health Organization reported last week that global cases had risen nearly four-fold in the first quarter of 2019 to 112,163 compared with the same period last year. A vocal fringe of parents in the United States oppose vaccines believing, contrary to scientific evidence, that ingredients in them can cause autism or other disorders. (4/22)

Meanwhile, the rise in measles cases prompted the Food and Drug Administration on Monday to stress the importance of the measles, mumps and rubella vaccine, saying large, well-designed studies confirmed its safety and effectiveness long ago and demonstrated it is not associated with the development of autism, false information that anti-vaccine groups have claimed for two decades. “We cannot state strongly enough – the overwhelming scientific evidence shows that vaccines are among the most effective and safest interventions to both prevent individual illness and protect public health,” Peter Marks, director of the FDA’s Center for Biologics Evaluation and Research, said in a statement. (Sun, 4/22)

Los Angeles County public health officials said Monday that they’re investigating a measles cluster after reports of residents acquiring the vaccine-preventable virus. Over the past few weeks, L.A. County has four confirmed measles cases linked to one another after international travel, and an additional single case of measles after international travel. These numbers exclude Long Beach and Pasadena, which have their own health departments. (Cosgrove and Karlamangla, 4/22)

The Liberty-Dayton Regional Medical Center and First Liberty National Bank have partnered together so sponsor a one-day clinic with free MMR vaccine shots on Saturday, April 27, from 8 a.m. to noon. ... As recently as late Friday, there were at least 465 recent cases in 19 states including Texas. ... The day the clinic was announced, the Center for Disease Control (CDC) sent an email to health providers across the country cautioning the potential for outbreaks during the holidays. The CDC has vaccination rates that they prefer for each community to have and the Houston area is at 87 percent of the required 90 percent. (Taylor, 4/23)

The U.S. will soon break the record for the number of confirmed measles cases this year after health officials found dozens of new measles cases in the last week. As of April 19, the Centers for Disease Control and Prevention (CDC) has identified 626 cases of measles in 22 states across the country, an increase of 71 cases and two additional states in the past week. (Weixel, 4/22)

The proposal — Senate Bill 277 — cut the personal belief exemption from a list of approved reasons not to immunize a child.The new law dealt a major blow to anti-vaccine advocates who relied on religion or philosophical convictions to avoid vaccinations. California parents who wanted to send their children to school now had to vaccinate their kids. Now [Richard] Pan is taking his defense of California’s vaccination system a step further with a measure that would put the decision to grant any exemptions in the hands of a state public health official. (Wiley, 4/23)

The state of Georgia requires children to be vaccinated for diseases such as diphtheria, polio, hepatitis and measles. (There are religious and medical exemptions.) But health officials worry that misinformation about the safety of vaccines has circulated online and interfered with progress against infectious diseases. (Herbert, 4/22)

When Ava Terranove began feeling oral pain last July, her parents took her to her regular dentist. The dentist determined that Ava, who has an autism-like condition, needed two root canal procedures to treat infected teeth. Because of her developmental disability, Ava, now 15, requires general anesthesia for nonroutine dental work. The dentist, like most of his peers, was not equipped to provide it. (Tuller, 4/22)

Children and teens who drink water are less likely to consume sugary beverages throughout the day, according to a new study. Researchers analyzed data from 8,400 children and teens ages 2 to 19 collected between 2011 and 2016 as part of the National Health and Nutrition Examination Survey, which is administered yearly by the US Centers for Disease Control and Prevention. Parents and kids were asked to recall what the children had consumed in the previous 24 hours, and the calories were added up. (Bracho-Sanchez, 4/22)

Skipping breakfast may increase your risk for cardiovascular disease. The connection, found in a study of 6,550 adults aged 65 to 75, was particularly strong for stroke. Almost 60 percent of the participants had breakfast every day, a quarter on some days, and 16 percent rarely or never. All were free of heart disease at the start of the study. Over an average 17 years of follow-up there were 2,318 deaths, including 619 from cardiovascular diseases. (Bakalar, 4/22)

About 70 countries around the world nudge their clocks back and forth each year -- but some people want to "spring forward" permanently, citing health and other benefits. Some of those same people are also pushing for later school start times, but experts argue the benefits for tired teenagers could be canceled out by permanent daylight saving time, according to correspondence in the journal Current Biology. The authors argue that California lawmakers pushing for both policies are "confused." (Nedelman, 4/22)

Kansas' new Democratic governor on Monday vetoed a measure that would require clinics and doctors to tell their patients about a disputed treatment to stop a medication abortion after a woman has taken the first of two pills. The action by Gov. Laura Kelly, an abortion-rights supporter, sets up a confrontation with a Republican-controlled Legislature that has had solid anti-abortion majorities for more than two decades. Supporters of the abortion "reversal" bill appeared to have the two-thirds majorities needed in both chambers to override Kelly's veto once lawmakers return on May 1 from a weekslong break. (Hanna, 4/22)

Non-surgical, or medical, abortions are carried out with a sequence of pills. The first, Mifepristone, more widely known as RU-486, stops the growth of the fetus by blocking the hormone progesterone. Misoprostol, taken about two days later, makes the uterus contract to complete the abortion, according to the American College of Obstetricians and Gynecologists, or ACOG. Some pro-choice gynecologists and lawmakers say medical abortions can be halted if the mother is given a dose of the hormone progesterone before the second pill is administered. The hormone is often used to prevent miscarriages. (Korte, 4/22)

A proposal that would effectively outlaw most abortions in Tennessee if the U.S. Supreme Court overturns Roe v. Wade is headed to the governor's desk. State lawmakers in both the House and Senate overwhelmingly advanced the legislation on Monday, with just a handful of Democrats voting against. The legislation is expected to be signed into law after newly elected GOP Gov. Bill Lee has repeatedly promised to support any bill that limits abortion in Tennessee. (Kruesi and Mattise, 4/22)

The national president of Planned Parenthood visited New Hampshire on Monday, thanking members of the Granite State’s congressional delegation for their support of women’s health initiatives and their opposition to pending restrictions to a federal funding program set to take effect next month. After touring a health center in Derry, Dr. Leana Wen spoke to a gathering at New England College’s Concord campus about the potential ramifications that a so-called domestic gag rule on Title X funding could have on millions of patients who rely on it for basic medical needs. (Alden, 4/22)

Connecticut stepped up its legal fight with Purdue Pharma Monday, adding new defendants, a new charge and new allegations of wrongdoing by the Sackler family to a complaint that says the company and its wealthy owners promoted deadly opioid addiction. The amended lawsuit, which was initially filed in December, says Stamford-based Purdue, the maker of OxyContin and other addictive pain relievers, and the Sacklers told doctors addiction was “not caused by drugs,” but instead was the result of “susceptible individuals.” (Radelat and Carlesso, 4/22)

Florida Attorney General Ashley Moody is suing the nation’s largest drug makers and distributors, accusing them of recklessly supplying Floridians with millions of drugs per year. But a bill that is critical to the lawsuit moving forward has stalled in the committee of a powerful lawmaker: Sen. Lizbeth Benacquisto. The Fort Myers Republican said her committee won’t hear it because of concerns that it could invade the privacy of patients. She said her objections aren’t related to her brother-in-law. (Mower, 4/22)

The Mount Carmel Health System has settled three of what Monday became 28 wrongful-death lawsuits, including a $250,000 settlement in the death of a 78-year-old woman cared for by a physician accused of ordering excessive amounts of painkiller for at least 35 intensive-care patients, court documents show. The $250,000 settlement was reached in the May 29, 2017, death of Lora Stone of the South Side, who was given a “grossly inappropriate dosage” of the opioid fentanyl ordered by former Mount Carmel Dr. William Husel, according to a lawsuit filed in Franklin County Common Pleas Court. (Viviano and Wagner, 4/22)

Post-traumatic stress disorder has long been one of the hardest mental health problems to diagnose because some patients try to hide symptoms while others exaggerate them. But a new voice analysis technique may be able to take the guesswork out of identifying the disorder using the same technology now used to dial home hands-free or order pizza on a smart speaker. A team of researchers at New York University School of Medicine, working with SRI International, the nonprofit research institute that developed the smartphone assistant Siri, has created an algorithm that can analyze patient interviews, sort through tens of thousands of variables in their speech and identify minute auditory markers of PTSD that are otherwise imperceptible to the human ear, then make a diagnosis. (Philipps, 4/22)

A computer program can analyze the voices of war veterans and determine which of them have post-traumatic stress disorder with 89 percent accuracy, according to a study published this week in the journal Depression and Anxiety. The results suggest voice could be a biomarker for PTSD, providing the basis for an objective test to diagnose the disease. (Pattani, 4/22)

One of the biggest corporations on the planet is taking a serious interest in the intersection of artificial intelligence and health. Google and its sister companies, parts of the holding company Alphabet, are making a huge investment in the field, with potentially big implications for everyone who interacts with Google — which is more than a billion of us. The push into AI and health is a natural evolution for a company that has developed algorithms that reach deep into our lives through the Web. (Harris, 4/22)

Virtual health kiosks opening up inside in Arizona Safeway stores are similar to using the self-checkout line for groceries — only in this case, the commodity is medical care. There's no doctor or nurse inside the walk-in Akos Med Clinic. Rather, the clinics use technology powered by artificial intelligence and augmented reality to gather symptoms and vitals, as well as determine possible diagnoses. (Innes, 4/22)

Grandparents have long indulged their grandchildren with sweets, toys and late bedtimes, often to the dismay of the parents stuck in the middle. But concerns about screen time and cellphone usage are creating a whole new set of issues. When they hear that the grandparents are giving the children extra screen time, parents debate whether to lay down the law or let it go. Grandparents themselves are wondering: What’s the big deal? Usually, neither side wants to rock the boat too much. Grandparents don’t want to lose time with the kids and parents don’t want to lose the babysitting. (Jargon, 4/23)

The pitch: Health apps for users who are battling depression or want to quit smoking. The problem: Many of the apps designed to track a user’s progress are sharing the personal details they collect with third parties, like Google and Facebook, without consent. That’s according to a study published Friday in the journal JAMA Network Open. Researchers say the findings are especially important in mental health, given the social stigmas and the risks of having sensitive information shared unknowingly. (Siegel, 4/22)

An unauthorized user recently accessed several employee email accounts at physician-staffing firm EmCare, compromising personal information from roughly 31,000 patients. EmCare said it became aware of the data security incident "recently," leading to an internal investigation. It has engaged a forensic security firm to determine the scope of the breach, according to a notice the company posted online Saturday. EmCare determined on Feb. 19 that the email accounts in question contained patient data, including some names, dates of birth, clinical information and Social Security numbers. (Cohen, 4/22)

In recent years, many Illinois consumers were socked with steep price increases when buying health insurance on the Obamacare exchange. A bill that’s gaining traction in Springfield, however, could prevent that. The bill would give the Illinois Department of Insurance the power to say no to certain sky-high price increases proposed by insurance companies for plans sold to individuals and small businesses. The bill wouldn’t apply to plans offered by large employers. (Schencker, 4/22)

Round two gets underway Tuesday in California’s fight over how best to limit fatal shootings by police through nation-leading reforms. State legislators are debating a measure that proponents said would set a national precedent by creating statewide guidelines on when officers can use lethal force and requiring that every officer be trained in ways to avoid opening fire. (Thompson, 4/23)

Since joining the Philadelphia Inquirer a year ago, I’ve been studying your medical bills. I’ve talked to insurers, hospitals, economists and analysts about the problems you’ve experienced; and written about what I found out. Everyone seems to have a medical bill horror story and while they’re each unique, there are some common themes. (Gantz, 4/22)

Child advocates are calling for the creation of an outside, independent agency to regularly review foster care placements in Massachusetts, saying the current system is rife with conflicts of interest and lacks transparency and accountability. Under the current system, the Department of Children and Families is responsible for reviewing its own performance, something the advocates say is ineffective. (Lazar, 4/22)

On a typical day, thousands of homeless and mentally ill people are behind bars in Los Angeles County’s jails. But more than half of them would be good candidates to divert into housing with supportive services instead, according a new study from the Department of Health Services. If enough housing and services were available, nearly 3,000 people in custody at any given time would be eligible for release — either before their trials or before finishing their sentences. The study, released Monday, shows the potential to break the well-worn cycle of homelessness, incarceration and return to homelessness, said Peter Espinoza, a retired judge who heads the Office of Diversion and Reentry. (Smith, 4/22)

Nursing home managers — most of them from out of state — had fallen behind on bills for basics like food and utilities, putting residents’ health and safety at risk. Now the Republican-controlled Legislature and Democratic Gov. Laura Kelly have come together on a plan to keep it from happening again. Lawmakers this month passed a bill requested by the Kelly administration that will require much more financial information from people who apply for licenses to operate nursing homes. (Marso, 4/23)

Psychiatry experts have agreed that solitary confinement can harm any prisoner, but it is especially detrimental for those with mental illness: the isolation and sensory deprivation often exacerbates symptoms and leads to increased suicide attempts. As part of an attempt to decrease the use of solitary confinement, the Texas prison system in 2014 created a mental health therapeutic diversion program to shift isolated inmates back into the general housing population. (McCullough, 4/23)

Foster children often bounce from school to school, suffer chronic absenteeism, experience disciplinary problems, and drop out more frequently than their peers. Yet poor communication between state child welfare administrators and local schools and conflicting regulations create significant hurdles and educational delays for abused and neglected children as they are moved from foster home to foster home, according to a new state auditor’s report. (Lazar, 4/23)

Title X-funded health centers also serve as the point of entry into the health care system for millions of Americans - the majority of women cite these health centers as their sole source of care, and the number of men participating in the Title X program has nearly doubled since 2006. Therefore, it should come as no surprise that Title X-funded health centers play a vital role in HIV prevention and treatment, and therefore Trump’s overall "Ending the HIV Epidemic" strategy. However, Trump’s gag rule will cut off access to millions of patients who rely on Title X for critical preventative health services — including HIV screening. (Sequoia Ayala, 4/22)

Homelessness and how to address its social, public health and criminal implications has stirred strong reactions from every corner of our region and unfortunately has led to polarization about how to solve some of the toughest issues our communities face.Rather than engage in another round of “I’m right and you’re wrong” we should make constructive change and do something about these problems. A good start would be to recognize there are numerous different pathways that lead to homelessness, and that criminal-justice-based interventions, including the leverage of incarceration for criminal behavior, can and should be a part of our conversation. (Steve Strachan, 4/22)

Surgeons must perform at the top of their game day in and day out. So do athletes, singers, and other professionals, but a mistake in surgery has far greater ramifications than a fumble or a missed note. Top performers in highly specialized fields get there with some combination of natural talent and hard work. But even the most elite — the Tom Bradys of sport, the Beyoncés of music — turn to coaches to help ensure their best performance. Should surgeons? (Jason C. Pradarelli, 4/22)

There is nothing “wholesome” about chicken products contaminated with feces. But as long as feces aren’t visible to the naked eye when chickens are on the inspection line, the U.S. Department of Agriculture slaps a “wholesome” label on them and unwitting consumers are exposed to fecal contaminants, according to testing conducted by the Physicians Committee for Responsible Medicine, as well as testing conducted by the Consumer Reports. It dribbles out of the chicken package onto their kitchen counters, cutting boards sponges and taints the other foods they are preparing. The public deserves to know about this health risk. In 2011, the Physicians Committee sampled 120 chicken products from 15 grocery store chains in 10 U.S. cities; 48 percent showed fecal contamination. (Neal Barnard, 4/22)

When was the last time you read a story where the villain was celery? Pull up a chair. Food and agriculture are complicated, and I end up writing a lot of click-proof pieces chock full of eye-glazing detail concluding that there’s no easy answer. So it’s a pleasant change of pace when I encounter an issue that is black and white. Crystal clear. A no-brainer. (Tamar Haspel, 4/22)

Yes, infertility is a medical disease. It’s recognized as such by the American Medical Association, the American Society for Reproductive Medicine, the American Congress of Obstetricians and Gynecologists and the World Health Organization. But the insurance industry doesn’t see it that way, choosing to view childbearing as elective. (Buffy Wicks, 4/23)

As many Democrat candidates for president ramp-up their campaigns and begin stumping for early votes, we will likely hear more about their plans to provide free healthcare or “Medicare for All” as a way to rally support. Providing affordable healthcare while keeping spending in check is no easy feat. But in signing a Medicaid waiver bill into law in March, Gov. Brian Kemp signaled that’s the approach he will take in his effort to improve health care access for poor and middle-class Georgians. (Dan Weber, 4/20)

Those who choose to work with the elderly often cite early life relationships that resulted in a fondness for this particular demographic. As a final-year medical student, I used to stare at the ceiling and ask myself, “Do I want to be an obstetrician or a geriatrician?” I loved both! For this, I chose family medicine. Based at Concord Hospital, the three-year residency program prepares us for comprehensive, full-spectrum family medicine practice. Now in our final year at the New Hampshire Dartmouth Family Medicine Residency, the eight graduating residents are gearing up for transition into independent practice this summer. For almost all, this will undoubtedly include caring for older adults. (Brian McKenna, 4/22)