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Trump’s ‘excellent’ health report called out as fake news on late-night TV circuit

Comedians took aim at President Donald Trump’s doctor on Tuesday after he said the president’s “overall health is excellent,” according to his recent physical assessment.

Dr. Ronny Jackson shared the outcome of Trump’s exam at a White House press briefing on Tuesday afternoon, including his 6-foot-3 height and 239-pound weight, which puts him right on the brink of obesity.

“That’s awfully convenient,” Stephen Colbert, host of “The Late Show,” said Thursday in his opening monologue, before going on to insinuate that Trump may have bribed the doctor with cash.

“Listen, Doc, I don’t want to be obese, but I feel like this wad of cash is about one pound. Why don’t you take this off my hands and weigh me again, OK,” Colbert said in his best Trump impersonation.

Jimmy Kimmel also opened “Live” with a few jokes on the president’s weight.

PHOTO: President Donald Trump and Melania Trump pass out food and meet people impacted by Hurricane Harvey during a visit to the NRG Center in Houston, Sept. 2, 2017.Susan Walsh/AP
President Donald Trump and Melania Trump pass out food and meet people impacted by Hurricane Harvey during a visit to the NRG Center in Houston, Sept. 2, 2017.

“Despite the fact that he is borderline obese, Trump is in excellent health. How could he be in excellent health? When he sneezes gravy comes out. Look at him,” Kimmel joked.

“The doctor said the is examination went exceptionally well, which means he stopped eating chicken long enough to get a reading,” Kimmel added, referring to Trump’s reported love of junk food.

Over on “The Daily Show,” host Trevor Noah said he still had a few questions about the health report.

“So it turns out, according to the official White House doctor, Trump is completely sane, which makes me more worried because that means he’s doing all of this s–t on purpose,” Noah said. “You covfefe in your normal mind?

“No heart problems, no dementia, no dentures? But did you test for racism,” he asked sarcastically.

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Trump’s health report raises questions for late-night hosts

Trevor Noah, Stephen Colbert, and Jimmy Kimmel all have questions for the official White House physician, Dr. Ronny Jackson, who determined President Donald Trump to be in “excellent” health after his first physical as president.

“No heart problems, no dementia, no dentures? But did you test for racism?” Noah asked during a segment on The Daily Show Tuesday. But more concerning for the late-night TV host is what Trump’s flourishing health actually means.

“So it turns out, according to the official White House doctor, Trump is completely sane, which makes me more worried because that means he’s doing all of this s— on purpose?!” he said. “You ‘covfefe’ in your normal mind? Because to us, the non-experts, the only thing that looks healthy about Donald Trump is that he’s shaped like a food pyramid, right? To say that his health is excellent, it’s like medicine is gaslighting us now. I mean, how is this even possible?”

Even Dr. Jackson, who performed the exam, couldn’t determine the exact reason for Trump’s health score. When asked by a reporter how Trump could be in as good of health as Jackson says he is when the president “eats McDonald’s and fried chicken and all those Diet Cokes and never exercises,” he said, “It’s called genetics. I don’t know. Some people just have great genes.”

“Okay, great genes,” Colbert quipped on The Late Show, “but he can’t fit in them.”

Trump’s check-up — which included a cognitive test the president passed — came after Michael Wolff’s book Fire and Fury: Inside the Trump White House questioned his mental capacity. Colbert, though, is still skeptical of these new health results.

For one, Jackson told the press that Trump stands at 75 inches (6 feet 3 inches) and weighs 239 pounds. “According to the body mass index by the Federal Health and Human Services Department, Trump is overweight and just one pound shy of obesity,” Colbert said. “One pound shy of being obese! That’s awfully convenient.”

Even more perplexing for Colbert is that “despite all evidence, Donald Trump does have a heart.”

“How can he be in excellent health? When he sneezes, gravy comes out of his mouth,” Kimmel mocked on Jimmy Kimmel Live. “A quick way to figure out Trump is not in excellent health is to look at him.”

The host then put on a spoof of the White House press briefing to declare “President Trump’s hair has taken over his brain.”

“Our tests have discovered that the chemical used in his preferred shade of Just For Men, which is Burnt Marshmallow, has combined with the high levels of French-fry oil in his blood to create a hair parasite — or hairasite,” the fake doc said before he was literally devoured by the sentient hair.

Watch more of late-night TV’s reaction to Trump’s health report above.

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EPA eases path for new chemicals, raising fears of health hazards

WASHINGTON — The Environmental Protection Agency is shifting course under the Trump administration on how it assesses new chemicals for health and environmental hazards, streamlining a safety review process that industry leaders say is too slow and cumbersome.

But some former EPA officials, as well as experts and advocates, say the agency is skipping vital steps that protect the public from hazardous chemicals that consumers have never used before, undermining new laws and regulations that Congress passed with overwhelming bipartisan support in 2016.

According to these critics, that could mean that manufacturers might get approval to introduce a new chemical for one purpose, without getting a thorough, timely review of the chemical’s safety if it is later used for a different purpose. Asbestos, for example, was commonly used in building insulation before the EPA cracked down on its use, but the carcinogenic chemical is still found in brake pads for automobiles — posing hazards for garage mechanics — and is widely used to manufacture chlorine.

Image: TPC petrochemical plant

Image: TPC petrochemical plant

In recent months, the EPA has quietly overhauled its process for determining whether new chemicals — used in everything from household cleaners and industrial manufacturing to children’s toys — pose a serious risk to human health or the environment. Among other changes, the agency will no longer require that manufacturers who want to produce new, potentially hazardous chemicals sign legal agreements that restrict their use under certain conditions.

Such agreements, known as consent orders, will still be required if the EPA believes that the manufacturer’s intended use for a new chemical poses a risk to the public health and the environment. But the agency won’t require consent orders when it believes there are risks associated with “reasonably foreseen” uses of the new chemical — ones that go beyond what a manufacturer says it’s intending to do, but which the agency believes are reasonable to anticipate in the future.

Instead the EPA will rely on a broader measure, known as significant new-use rules, to regulate chemicals that are likely to pose a risk if they’re used for a different purpose. The agency typically has to issue these rules whenever they want to restrict the broad use of potentially hazardous chemicals, since consent orders apply only to a single manufacturer.

Eliminating consent orders in these cases would be “more efficient,” said Jeff Morris, director of the EPA’s toxics program. He laid out the agency’s shift to significant new use rules at a public meeting in early December: “It’s our belief that they could be equally protective but eliminate this one step.”

Chemical industry lobbyists had pushed for the change, arguing that the EPA’s rising use of consent orders was unwarranted. Chemical manufacturers “are burdened by the delay of waiting for EPA to draft the orders, negotiating them with EPA, and then waiting for EPA to issue the orders,” the American Chemistry Council, the industry’s largest trade association, told the agency days before President Donald Trump took office.

But consumer advocates, along with some former agency officials and research experts, believe that EPA’s moves are sabotaging a safety review process that Congress had taken great pains to bolster. Richard Denison of the Environmental Defense Fund, an advocacy group, points out that the 2016 law requires the EPA to assess the broad use of chemicals because manufacturers frequently find different uses for hazardous substances over time, as in the use of asbestos.

“EPA is explicitly disavowing and downplaying a tool that’s really been a cornerstone of new chemical regulation,” said Bob Sussman, a former EPA attorney under Obama and counsel for the Safer Chemicals, Healthy Families coalition, which represents environmental and public health advocates. “We believe EPA is taking a big step backward in the protection of health and the environment without an offsetting benefit.”

‘Playing a dangerous game’

Under EPA administrator Scott Pruitt’s leadership, the agency has taken major industry-friendly steps to loosen its regulation of legacy chemicals. Last year, the EPA delayed bans on chemicals already in widespread use, including a lethal substance in paint strippers and a pesticide linked to developmental disabilities in children.

But the agency is also overhauling its process of reviewing new, unproven chemicals that have yet to hit the marketplace. The changes come in the wake of intense lobbying by the chemical industry, which complained that the EPA was taking too long to clear innovative new products for commercial use that the industry considered safe.

Image: Environmental Protection Agency (EPA) Administrator Scott Pruitt testifies about the fiscal year 2018 budget

Image: Environmental Protection Agency (EPA) Administrator Scott Pruitt testifies about the fiscal year 2018 budget

“We were very concerned as an industry — that was one of our top priorities when I talked to the administration,” said Robert Helminiak, a lobbyist for the Society of Chemical Manufacturers and Affiliates, who met with Pruitt last year.

When the Trump administration took office, the EPA was facing a serious backlog of new chemicals awaiting safety reviews. About 600 cases had piled up after Congress approved the sweeping reforms to the 1976 Toxic Substances Control Act (TSCA), which passed in June 2016 after decades of deliberation and was called the Frank R. Lautenberg Chemical Safety for the 21st Century Act, after the Democratic senator from New Jersey.

For the first time, the EPA under the act was required to make an explicit determination that a new chemical was safe before it could be sold to consumers, using stricter criteria to evaluate their health and environmental risks. The new law also required the EPA to evaluate the risks of chemicals already in commercial use, by specific deadlines.

At the urging of industry, Pruitt promised to expedite the post-Lautenberg review process for new chemicals “to make the process faster and more efficient, while ensuring chemical safety.” With great fanfare, he announced the EPA had cleared its backlog in August and unveiled its early reforms to the safety review process.

But some public-health experts and former officials say that the EPA’s efforts to streamline the program are undermining its newly expanded authority to require testing when it believes there is insufficient data, or when future uses may pose a risk.

“What I’m observing is an effort by the agency and also some in the industry to turn back the clock and behave as though the Lautenberg Act was never passed in the first place,” said Lynn Goldman, dean of George Washington University’s school of public health and a former EPA official under Clinton. “The agency has been granted more authority to do testing, then it put hands in its pockets and said it doesn’t want to use this authority.”

Critics say there’s a big difference between the consent orders they want the EPA to issue and the agency’s proposed alternative. Consent orders often include mandatory testing of new chemicals for potential health and environmental hazards. By contrast, significant new-use rules typically don’t require testing, though they can recommend that it should happen in the future if a manufacturer wants to use a restricted chemical.

At that point, however, the harm may have already been done, says Veena Singla, an environmental health researcher at the University of California, San Francisco. “Chemicals do end up being used for many different applications than what the manufacturer originally thought or intended,” she said. “After the fact, we’ve seen what the problem is: The chemical is out there.”

The Trump administration says that its safety reviews will be just as robust under its changes to the program. If a manufacturer wants to use a chemical for a new purpose that might be risky — say, by putting the substance in water — it’s still legally required to seek the EPA’s approval if there are significant new-use restrictions in place. The EPA can then mandate more testing at that point, said Morris: “The end result is that there would be the same amount of testing.”

But public-health advocates say there’s no guarantee that the EPA will require the same testing further down the line, arguing that consent orders provide far more assurance that the agency is properly scrutinizing toxic substances. They now fear that the EPA will go even further to relax the law: The agency is currently deciding whether it will allow manufacturers to commercialize new chemicals while it is still hammering out the rules restricting future, reasonably foreseen uses — something that industry groups are currently pushing for.

If the EPA lets these chemicals on the marketplace early, then it will be “blatantly violating the law” that Congress passed to tighten these safety reviews, said Sen. Tom Udall, D-N.M., who co-authored the Lautenberg Act and help push it into law after Lautenberg’s death in 2013.

The new law requires the EPA “to review the safety of all uses of a new, and potentially dangerous, chemical before allowing it to be sold to consumers, not just selective uses,” said Sen. Tom Carper, D-Del., the top-ranking Democrat on the Senate Environment and Public Works Committee. If the agency allows a chemical to be sold before putting all its restrictions into place, that “contradicts the spirit and letter of the law,” he added.

“This may please Pruitt’s corporate allies, but it is playing a dangerous game, with the safety of millions of Americans at stake,” Udall said.

‘Regrettable substitutions’

Consumer advocates say that it’s critical for the EPA to be aggressive about putting the 2016 law into effect, given the agency’s past failures to protect the public from toxic chemicals.

Older flame retardants linked to cancer were phased out in the 1970s, only to be replaced by new flame retardants that were also linked to cancer, hormone disruption and development problems, despite passing the EPA’s safety review process.

Image; GenX Protest

Image; GenX Protest

Other “regrettable substitutions” include BPA, which was intended to be a safe replacement for bisphenol-S; and GenX, a substitute for a carcinogenic substance used to make Teflon, only to be later linked to cancer as well. Right before Trump took office, the federal government agreed to pay more than $2 billion to veterans who developed leukemia, liver cancer and Parkinson’s disease after exposure to GenX-contaminated water at a North Carolina military base.

Such horror stories helped build broad bipartisan support for the 2016 overhaul, which Congress passed on a nearly unanimous vote. Under the old regime, the EPA didn’t have to sign off on new chemicals if it concluded that they were likely to be safe. If the manufacturer never heard anything from the agency within 90 days, it could go ahead and start making its new product. Under the new law, the EPA has to make an affirmative decision that a new chemical is safe before it can be commercialized — the crux of its new safety review process.

Getting to market sooner

The chemical industry, however, insists that the 2016 overhaul was never intended to make radical reforms across the board. The new law “really doesn’t do very much for new chemicals — the process was the part of TSCA that was really working pretty well,” Helminiak said.

Before the EPA had unveiled its Trump-era changes, industry groups argued that the agency was taking a needlessly draconian approach toward new chemicals reviews, requiring consent orders where none were necessary. When a manufacturer wants the EPA to approve a new chemical, it describes its intended use for the substance. So the EPA “accomplishes nothing useful” by subjecting them to consent orders for other purposes they have no intention of pursuing, the American Chemistry Council (ACC) said in January. Instead, it would simply burden manufacturers with onerous testing requirements and other conditions that make it harder for them to sell innovative new products, industry groups said.

The EPA’s new approach is likely to reduce the testing that manufacturers who first bring these new chemicals to market are required to do. Using significant new-use rules (SNURs) “reduces the testing that the EPA is seeking to impose, because testing is rarely required in a SNUR,” said Richard Engler, a former EPA scientist who now works for Bergeson Campbell, a law firm that represents chemical manufacturers. “If someone is of the view that every consent order should have testing in it, then yes, switching to SNURs is going to produce less data,” Engler said, though he believes EPA’s new approach will be just as protective.

But industry groups say the agency still hasn’t gone far enough to speed up the safety review process, warning that the latest reforms could bring their own delays.

Significant new-use rules can take far longer to finalize than consent orders, since they are regulations subject to a public notice and comment period. If the EPA determines that a new chemical is safe for its intended use, a manufacturer should be able to start making and selling that product immediately, without waiting for the EPA to finalize its new rules for separate, reasonably foreseeable uses, said the ACC’s Michael Walls: “There’s got to be a way to get to market earlier.”

Denison of the Environmental Defense Fund warns the EPA against giving the green light too early. Even if a company sticks to the use of a chemical that the agency has deemed safe, it can’t predict what other parties might do with it once it’s on the market, said Denison: “Companies say they can’t control how chemicals are being used.”

‘This EPA has worked very well with industry’

The EPA says that it’s still deliberating how long manufacturers will have to wait to bring their new chemicals to market. “This is an area that we are discussing,” Morris said in December.

Consumer advocates fear the EPA will ultimately heed industry’s call. Under the new administration, industry heavyweights have been able to appeal directly to their former colleagues: Trump appointee Nancy Beck, a former senior executive at the ACC, is now a top deputy for the EPA’s chemical safety office. Trump’s nominee to lead the office, Michael Dourson, spent decades conducting industry-friendly research for the ACC and Dow Chemical, among others. He worked as a senior EPA adviser for months before withdrawing his nomination in December, under fire for his industry ties.

Image: Nancy Beck

Image: Nancy Beck

In recent months, the agency has worked closely with the ACC to revamp the paperwork that manufacturers must submit to get new chemicals approved. With the group’s help, the EPA consulted three industry giants — Dow Chemical, Procter Gamble, and the BASF Corporation — to revise its new chemical application process.

“It’s always important to get feedback from companies using the document,” David Tobias, an EPA scientist, said at the agency’s December meeting. “We’ve already made some changes based on this consultation.” (The EPA declined to specify the changes it’s made and said it is working with “a variety of stakeholders” on the new chemicals program.)

Industry groups say they’re hardly getting a free pass: From their perspective, the EPA hasn’t hesitated to tighten its scrutiny of new chemicals, placing more stringent restrictions on their use and expanding the scope of their reviews. But they acknowledge that Pruitt’s EPA has been receptive to their concerns.

“This EPA has worked very well with industry,” Helminiak said. “They really have certainly listened to what the specialty chemical industry has to say.”

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White House doc to provide more details about Trump’s health

A fuller readout of President Donald Trump’s health following his first medical check-up is expected later Tuesday.

Trump’s White House physician – Navy doctor Ronny Jackson – declared Trump to be in “excellent health” following last Friday’s exam at the Walter Reed military hospital in Maryland.

White House press secretary Sarah Huckabee Sanders said Jackson will attend her briefing Tuesday to provide a more complete readout on Trump’s physical health.

Not expected are any conclusions about Trump’s mental acuity. Questions about Trump’s mental fitness have been raised following comments attributed to some of his close advisers in a new book, and his recent slurring of words on national TV.

Presidents aren’t required to get a checkup, but modern presidents do so regularly and release a doctor’s report on the findings.

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The Health 202: NIH wants 1 million Americans to contribute to new pool of gene data


Starting this spring, Americans across the country will be invited to contribute to a massive new pool of genomic information being assembled by the government, a project that represents the most ambitious effort yet to capitalize on the promising new frontier of gene-based medicine.

Three years after the National Institutes of Health first announced its Precision Medicine Initiative — subsequently redubbed “All of Us” — the agency’s director, Francis Collins, says the large-scale project is ready to expand beyond its initial testing stages. In early spring, on a date yet to be announced, NIH is planning a nationwide launch to start enrolling what it hopes will eventually be as many as 1 million participants.

“It will be a big deal. You’ll hear a lot about it,” Collins told The Health 202 in an interview last week at NIH headquarters in Bethesda, Md. “We want the world of American folks to know about this and have a chance to sign up.”

Collins and I discussed that project and a range of topics, including the directives by President Trump to address the opioid abuse crisis and the agency’s finances, which after several tough years Congress has been closely guarding despite deep cuts proposed last year by the White House.

‘All of Us’

I was most excited to hear from Collins about the Precision Medicine Initiative, an effort that has been happening mostly behind the scenes for the past several years. It’s an idea Collins first wrote about in the early 2000s — and private companies such as 23andMe and AncestryDNA have already genotyped more than 2 million people. But the effort only recently grew more realistic for NIH as the cost of genome sequencing has dropped and electronic-health records are being more widely used.

First rolled out under President Barack Obama, the program’s aim is to essentially compile the world’s largest genetic library intended to be widely available to scientists and researchers. This rich collection of DNA information is designed to assist scientists and researchers exploring the genetic basis for all sorts of health conditions — and those working to develop targeted therapies calibrated to an individual’s genetic makeup instead of the traditional one-size-fits-all approach.

The ultimate goal is faster advances in the cutting-edge field of what’s known as precision medicine. But the tall, wiry and ever-enthusiastic Collins emphasizes that the aim is also to give participants a deeper knowledge of their own health and health risks. Volunteers won’t be study subjects; they’ll be partners, he stresses. He has found that to be one of the strongest arguments in attracting participants.

“People want information about themselves — that’s a big part of why you’d want to sign up,” Collins told me. “For the most part, in these kinds of studies, we haven’t done that in the past.”

Collins, who Trump notably retained as NIH director last year even as he replaced most other Obama appointees, said progress with the initiative in 2015 and 2016 was somewhat slow as the agency grappled with questions about how to recruit a diverse pool of volunteers, sources of funding and, most importantly, how to collect and securely store so much private genetic information.

Private companies that offer genetic screening have already been grappling with such problems for years. The company 23andMe has been sued over claims that certain tests could help consumers prevent or mitigate serious diseases such as diabetes or breast cancer. It has also faced pointed criticism over its handling of consumers’ genetic information, which it provides to other private companies for genetic research if the consumer has consented.

“Of course, we can’t guarantee anybody that privacy is going to be absolutely protected no matter what, because we’ve all seen situations where hacking can happen,” Collins said.

But Collins said he can promise this: There will be end-to-end encryption and all identifiable information gathered from participants will be removed before data is consolidated in one place.

“We will continue to do — as we have been — all the hackathons, penetration tests, all the things you need to do to figure out if you have any vulnerabilities in your system,” he said. “So far, I think we are top of the line here in terms of our security system.”

Another big piece of the puzzle was finding the right person to lead the project. In April 2016, NIH brought on Intel’s Eric Dishman, who fought a rare form of kidney cancer for 23 years and went into remission only after genome sequencing revealed his cancer had more in common with pancreatic disease than renal cancer, allowing his doctors to much better target Dishman’s treatment plan.

Later that year, the project got a messaging makeover when NIH renamed it “All of Us” to better portray its aims to the many Americans who may not understand exactly what precision medicine is (three years ago when the project was first announced, I was certainly among these folks).

“I think ‘precision medicine initiative’ didn’t exactly light up a lot of people’s excitement,” Collins told me with a grin.

Collins said he wanted an inclusive-sounding name because one of his key goals is a diverse range of participants. In fact, he’s aiming for groups typically underrepresented in medical research — including racial minorities and lower-income Americans — to comprise at least half of the 1 million-person pool. Toward that end, NIH is working with federally qualified community health centers to find volunteers and is publishing all materials in Spanish, too.

The project got its biggest boost last May, when NIH started enrolling people as part of a pilot phase with the help of eight major health providers operating in several dozen cities across the United States. Collins said that as of last week, about 10,780 people are enrolled in the pool — more enrollees than he’d initially imagined in this early phase.

“The beta test now is really going great guns,” Collins said. He’d initially cited 2019 as the goal for reaching 1 million participants but has since said he’s aiming for 2022 — and he’s sticking with that year for now, he told me.

“I’m still saying 2022 because I don’t want to overpromise,” he said. “The beta test has been interesting … as with most things, you have a bit of a slow start as people are trying to figure out how to make all the pieces work.”

The agency has created a website — — where all the information on the project will be housed, once the agency opens enrollment more broadly within the next few months. Exactly what does participation involve? It’s pretty simple: A participant submits blood and urine samples and basic measurements such as their height and weight, and fills out a questionnaire about family and health history.

Once an individual’s data has been stored at the biobank at the Mayo Clinic in Rochester, Minn., he or she could request to have their complete DNA sequenced. Or they could could get a pared-down analysis called SNP genotyping, showing only the key places in their genetic code associated with health risks or benefits.

In the perfect world, every participant would get a full genome sequencing — and that might eventually be possible as the costs of such a procedure have been coming down rapidly. But a full sequence still comes with a price tag of about $800, compared to just $30 for partial genotyping, probably making it too expensive a goal for NIH at the moment.

NIH’s budget

Collins worked under Obama for most of his two terms after he was appointed to NIH in 2009. I asked whether he feels supported in the agency’s endeavors by his new boss, Trump, who last year asked for a nearly 20 percent budget cut to his agency as part of his budget proposal to Congress. Collins shrugged off the request as a move by a young administration.

“I think that was very early in the administration, coming in and needing to have a budget shortly after arrival,” Collins said. “I think a lot of talk and conversation in a very productive way has gone on over the past year since that original budget.”

Collins is used to making the case for more medical research funding; after all, he spent nearly a decade pleading with Congress to infuse NIH with more dollars as year after year the agency’s budget either remained flat or even shrank under sequester cuts.

Over the past three years, Republicans in Congress have appeared more enthusiastic about supporting the agency, growing its budget by $2 billion annually. Yet NIH’s approximately $34 billion budget is still 19.3 percent down from 2003 when adjusted for inflation.

The government funds about 23 percent of medical research and development in the United States, its lowest share since World War II. But Collins insists he’s focusing on the recent positive indicators from lawmakers that bipartisan support for medical research is strong and growing.

“Sure, we have not made up the lost ground that happened between 2003 and 2015,” he said. “But at least we’re on this upward trajectory, which gives a lot of encouragement to a community that had gotten to feel pretty oppressed and pretty discouraged.”

What Trump wants

Obama and then Vice President Joe Biden were vocal supporters of medical research, frequently cheerleading Collins as he rolled out not just the Precision Medicine Initiative but also projects to advance cancer research (dubbed the “cancer moonshot”) and better understand the human brain.

So, what excites our current president, I asked Collins? He had a prompt and ready response: combating the opioid abuse epidemic. Collins recalled an Oval Office meeting last March, where he and Trump discussed research opportunities.

“We quickly settled into the direction of opioids as the thing he wanted to be sure every possible effort was being made,” Collins said.

At that meeting, the president asked Collins to both channel NIH’s resources in that direction and work with private industry on developing better ways to treat addiction. Over the past 10 months, the agency has partnered with more than 30 companies to work on addiction treatments and alternatives to opioid painkillers that can be used by patients with chronic pain, Collins said.

A few other agencies are also taking steps to addressing opioid abuse, which kills more than 60,000 Americans every year. The FDA recently approved a new 30-day injectable treatment, while the CDC has launched a campaign to raise awareness about the dangers of addiction.

But the White House has come under criticism for talking about opioid abuse without actually doing that much to address it. Trump declared opioid abuse a public health emergency last fall, but the declaration expires Jan. 23 unless the administration extends it. No new funding has been provided, and the Department of Health and Human Services has provided few details about what new steps — if any — have recently been taken to target the problem.

There’s also a disconnect between how Trump and some of his appointees talk about opioid abuse versus how Collins and other medical professionals believe it should be tackled. Attorney General Jeff Sessions frequently uses the “just say no” terminology to argue that drug addiction is a personal failing people can prevent.

“People should say no to drug use,” Sessions said in October at the Heritage Foundation. “They have got to protect themselves first.”

Bu once addicted, people generally don’t have the capabilities to just quit, Collins warned. “Let nobody imagine that once you get to the point where your brain has been rewired with opioids that you can just decide to stop,” he said.

That’s a message Collins said he has been able to present to executive branch officials on occasion, and he believes it has been well received.

“I’ve had many occasions to make that case and provide the data that backs that up,” Collins said. “That has generally been well received by the White House when that’s been presented.”

A radiologist compares an image from earlier, 2-D technology mammogram to the new 3-D Digital Breast Tomosynthesis mammography in Wichita Falls, Texas. (Torin Halsey/Times Record News via AP)

AHH: Last week, the FDA cleared the first treatment for patients with advanced breast cancer caused by BRCA mutations, which are genetic defects that raise the risk of malignancies, The Post’s Laurie McGinley reports.

“Lynparza belongs to a class of drugs called PARP inhibitors that block an enzyme involved in repairing damaged DNA,” Laurie writes. “By blocking the enzyme, the DNA in cancer cells may be less likely to be fixed, leading to the death of those cells and potentially a slowdown or halt in tumor growth…The agency said its approval was based on a randomized clinical trial of more than 300 advanced breast cancer patients with BRCA 1 or BRCA 2 mutations. The trial found that the length of time during which the tumors did not grow significantly…was a median of 7 months for patients treated with Lynparza compared to 4.2 months for patients receiving chemotherapy only.”

In an interview Friday, Mark Robson, an oncologist at Memorial Sloan Kettering Cancer Center who led a multisite trial on the drug, called it an “exciting new option” for patients with BRCA-caused cancer. “It’s a building block,” he told Laurie, adding researchers now need to determine whether results can be improved by using it in combination with other treatments.

The National Cancer Institute estimates about 253,000 women will be diagnosed with breast cancer this year and more than 40,000 will die of the disease. About 5 percent to 10 percent of patients with breast cancer have a BRCA mutation.

Several types of birth control on display at the American College of Obstetricians and Gynecologists Museum. (Photo by Carolyn Van Houten/The Washington Post)

OOF: The Post’s Juliet Eilperin and I scooped Friday night that Teresa Manning — the staunchly antiabortion head of family planning programs for the HHS — has left her job. Although some sources said Manning was let go, HHS said she resigned – either way, an agency official said Manning was escorted from the building by security officials after she’d turned in her badge.

Manning will be replaced by Valerie Huber, a prominent abstinence education advocate who has been named acting deputy assistant secretary for the Office of Population Affairs, the office in HHS overseeing the Title X program that provides contraception to low-income women. Like Manning — who once suggested that contraception doesn’t work — Huber has a record of skepticism about birth control.

Huber managed Ohio’s abstinence program from 2004 to 2007 and subsequently led Ascend, a group initially founded as the National Abstinence Education Association. She says she prefers to use the term “sexual risk avoidance,” telling Focus on the Family’s Citizen magazine that Ascend’s mission is broader than telling teens not to have sex.

“I bristle at the terminology ‘abstinence only,’ because our programs are so holistic,” Huber said. “They contextualize a whole battery of different topics that surround a young person’s decision whether to have sex or not. Rather than someone telling a young person, ‘Do this, don’t do that,’ it’s casting a vision for a young person’s future.”

People demonstrate for the Affordable Care Act in Newark, N.J., (REUTERS/Stephanie Keith)

OUCH: Now that Republicans have repealed the Affordable Care Act’s individual mandate, what’s next? The New York Times’s Robert Pear reports the party’s next target could be the employer mandate, which requires mid- and large-size employers to offer health benefits.

There may be momentum behind gutting the requirement. Republican Reps. Devin Nunes (Calif.) and Mike Kelly (Pa.) have introduced a bill to suspend the employer mandate and halt any penalties that would be issued from 2015 to 2018. James Klein, president of the American Benefits Council, told Robert it’s “inequitable to leave the employer mandate in place when its purpose — to support the individual mandate — no longer exists.”

“Opposition to the employer mandate could increase as more employers are fined for not offering coverage or for not meeting federal standards for adequate, affordable coverage,” Robert writes. “Since October, the Internal Revenue Service has notified thousands of businesses that they owe money because they failed to offer coverage in 2015, when the mandate took effect…The Congressional Budget Office has estimated that employers will pay $12 billion in penalties this year and a total of more than $200 billion in the coming decade.”

What’s the argument against repealing the employer mandate? For one, people would lose coverage from their employers, which could leave fewer people insured overall. The shift would cost the federal government, too. As people lose coverage from their employers, more people purchasing plans through the public ACA marketplace would quality for subsidized coverage. Republicans charge the mandate encourages employers to reduce employees and hours, and slows job creation, but Democrats argue it hasn’t harmed employment, hours of work or wages ever since the ACA was passed in 2010.

President Trump meets with members of the U.S. Coast Guard to play golf in December. (AP Photo/Evan Vucci, File)

–The doctor who examined Trump last week is expected to provide more details about the president’s health and answer reporters’ questions at a White House briefing today. Dr. Ronny Jackson, who also served as a White House physician under Obama, declared Trump in “excellent health” Friday after giving the president his first checkup at Walter Reed military hospital.

Jackson said the examination “went exceptionally well,” in a statement released by the White House. “The president is in excellent health and I look forward to briefing some of the details on Tuesday,” he added, per the Associated Press. During the exam, Trump’s blood pressure, cholesterol, blood sugar, heart rate and weight were taken, but the White House did not provide specific results of those tests.

–How did Taylor Weyeneth — a 24-year-old whose only professional experience after college and before becoming an appointee was working on Trump’s presidential campaign — nab a prime appointment helping lead the government’s drug policy office? A Washington Post investigative reporter Robert O’Harrow Jr. takes a look at Weyeneth, his vault through the executive ranks and how it reflects the troubled state of the White House’s Office of National Drug Control Policy.

Less than a year after receiving an undergraduate degree, Weyeneth was a political appointee and rising star at the ONDCP, which is responsible for supporting the president’s efforts to curb the opioid epidemic. Weyeneth would soon become the office’s deputy chief of staff, a role recently occupied by a lawyer and veteran government official, yet his only professional experience after college and before joining the administration was working on Trump’s presidential campaign.

“Weyeneth’s ascent from a low-level post to deputy chief of staff is the result, in large part, of staff turnover and vacancies,” Robert writes. “The story of his appointment and remarkable rise provides insight into the Trump administration’s political appointments and the troubled state of the drug policy office.”

Trump has pledged to marshal government resources to address the opioid crisis, but nearly a year after his inauguration the drug policy office lacks a permanent director. At least seven of his administration’s appointees have departed, among them the general counsel and acting chief of staff, some of whose duties were assumed by Weyeneth, according to a memo obtained by The Post.

“ONDCP leadership recognizes that we have lost a few talented staff members and that the organization would benefit from an infusion of new expert staff,” said the Jan. 3 memo from acting director Richard Baum, a civil servant. “The functions of the Chief of Staff will be picked up by me and the Deputy Chief of Staff.”

Current and former ONDCP officials who have served under Democratic and Republican presidents said in interviews that the turmoil, including the elevation of Weyeneth, hinders efforts to rally the government at a time when the nation is going through the worst opioid crisis in its history.

“It sends a terrible message,” said Gil Kerlikowske, a former Seattle police chief who ran the office during the Obama administration. “It’s a message that we’re not taking this drug issue seriously.”

Alex Azar II testifies before the Senate Finance Committee on his nomination to be Health and Human Services secretary. (REUTERS/Joshua Roberts)

–Tomorrow, the Senate Finance Committee will meet in executive session to vote on Alex Azar, Trump’s pick to lead HHS. Committee chairman Sen. Orrin Hatch (R-Utah) announced yesterday Azar would be considered during a hearing on United States Trade Representative nominees. 

The Health 202 noted last week Democrats generally view Azar as a better pick than his predecessor, Tom Price. Two Democrats so far have announced their support: Sens. Heidi Heitkamp (D-N.D.) and Joe Manchin (D-W.Va.).

House Speaker Paul Ryan speaks during a news conference last week on Capitol Hill. (AP Photo/Pablo Martinez Monsivais)

–A government shutdown is growing more likely. Concluding yesterday they would be unable to reach a long-term spending accord by the Friday deadline, GOP leaders are now turning to a short-term funding measure in hopes of keeping agencies open while talks continue, but Democratic leaders say they are unlikely to support any deal that does not protect young illegal immigrants, The Post’s Mike DeBonis, Ed O’Keefe and Sean Sullivan report.

Republicans are trying to leverage long-term funding for the Children’s Health Insurance Program, which technically runs out of funds at the end of March although some states will run short sooner. “One option Republicans are strongly considering to win over Democrats…is attaching a long-term renewal of CHIP to the stopgap,” my colleagues write. “Republicans believe that many Democrats — especially senators seeking reelection this year — will have a tough time voting against the program, which they have called a top priority.”

Kentucky Gov. Matt Bevin (R) announces federal approval of the state’s Medicaid waiver in the Capitol Rotunda in Frankfort on Friday. (Alex Slitz/Lexington Herald-Leader via AP)

–Kentucky is the first state granted permission by the Trump administration to institute work requirements for Medicaid enrollees after the Centers for Medicare and Medicare Services approved the state’s waiver request Friday. The approval came on the heels of a Thursday announcement by the administration that states will be allowed to institute work requirements for non-disabled recipients of the health insurance program for the poor.

Becoming the first-in-the-nation state to move forward with work requirements is a victory for Kentucky’s Gov. Matt Bevin (R), who during his campaign had promised to roll back the ACA’s Medicaid expansion but then allowed the program to stand with extra strings attached, The Post’s Amy Goldstein reports. At a news conference Friday, Bevin said state agencies will phase in the “community engagement and employment initiative” in different parts of the state from July to November.

“Why should a working-age person not be expected to do something in exchange for what they are provided?” Bevin said.

About half of 350,000 able-bodied, working-age Medicaid recipients subject to the “community engagement” requirement meet its terms to work at least 80 hours per month, volunteer or be in job training, per Bevin aides. Under the new rules, individuals will need to send documentation to prove their compliance.

“Those who do not will receive a notice after a month, then be given one more month,” Amy writes. “After that, their benefits will cease until they prove they have begun following the rules. … The requirement is among several changes that the CMS is allowing Kentucky to adopt. They include a system that will require some people in the program to make small monthly premium payments, incentives to adopt healthy behaviors and different benefits provided to certain groups.”

The Hill’s Rachel Roubein and Peter Sullivan report on the legal obstacles already brewing over the Medicaid policy shift. As soon as Kentucky was granted approval, the National Health Law Program (NHeLP) released a statement threatening litigation. “Advocacy groups are gearing up to sue the administration, arguing that it doesn’t have the power to allow work requirements and other rules for Medicaid without action from Congress,” Rachel and Peter write.

“It’s not that work creates health. It’s that creating health allows people to work,” said Leonardo Cuello, NHeLP’s health policy director. “They have taken two things that are correlated — work and health — and made up a false causation, and they’re trying to use that to justify what is really a square peg they are trying to fit into a round hole.”

Eliot Fishman, a former Medicaid officer in the Obama administration who now works for liberal advocacy group Families USA, warned the policy shift would lead to people losing coverage, which he called “antithetical to the objectives of the Medicaid program.” 

–A few more good reads from The Post and beyond:


  • The House Committee on Rules holds a hearing on the Born-Alive Abortion Survivors Protection Act.

Coming Up

  • The Senate Homeland Security and Governmental Affairs Committee holds a hearing on “Unintended Consequences: Medicaid and the Opioid Epidemic” on Wednesday.
  • The Senate Judiciary Subcommittee on Crime and Terrorism holds a hearing on the “long-term care needs of first responders injured in the line of duty” on Wednesday.
  • The Senate Health, Education Labor and Pensions Committee holds a hearing on “Facing 21st Century Public Health Threats: Our Nation’s Preparedness and Response Capabilities, Part I” on Wednesday.
  • The House Ways and Means Oversight Subcommittee holds a hearing on the opioid crisis on Wednesday.
  • The Bipartisan Policy Center holds an event on “Reinventing Rural Health Care” on Wednesday.
  • The Bipartisan Policy Center holds a discussion on “Reinventing Rural Health Care: A Case Study of Seven Upper Midwest States” on Wednesday.
  • The House Veterans’ Affairs Subcommittees on Health and on Economic Opportunity hold a joint hearing on addressing veteran homelessness on Thursday.
  • The Cato Institute Policy Perspectives 2018, including a keynote address on “Misdiagnosing the Opioid Crisis”, takes place on Thursday.
  • Kaiser Health News holds an event on what’s in store for health care in 2018 on Thursday.

Here’s a history of physical fitness in the Oval Office: 

Here’s a brief history of presidents using profanity: 

When asked about his remarks about Haiti, El Salvador and African nations, President Trump declared: “I am not a racist:” 

Watch a car in Santa Ana hit a median and fly into the second story of a building: 

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‘Smart Thermometers’ Track Flu Season in Real Time

Hospitalization and death rates, though climbing, are still lower than was expected, Dr. Jernigan added, even though most of this season’s cases are H3N2, which is typically the most deadly seasonal strain.

Although 20 children and teenagers have already died of flu or its consequences, the 2014-2015 season — the one this season most closely resembles — killed 148. (This year’s final death toll will not be known until summer, because the deaths from lingering pneumonia may occur as late as June.)

The C.D.C. data comes from hospitals and clinics that report how many cases of “influenza-like illness” they treat. Delays can result if clinic statisticians are busy or if state health departments do not pass on the figures quickly.

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Kinsa, by contrast, is able almost instantly to spot fever spikes in states — or even in cities and neighborhoods. More than 500,000 households now own its smartphone-connected oral and ear thermometers, Mr. Singh said, and the company gets about 25,000 readings each day.

(Of course, the company cannot measure hospitalizations, deaths, or which strains of flu are circulating, or consistently distinguish flu from other febrile illnesses.)

Kinsa’s technology was approved by the Food and Drug Administration in 2014 and gathered data in subsequent flu seasons; the company hopes to soon publish a study by outside experts assessing its accuracy in measuring the seasonal spread.

Those experts, Mr. Singh said, found the data to be more accurate than Google’s Flu Trends, which Google shut down three years ago after it missed the peak of the 2013-2014 season.

Google tracked internet searches for terms like “flu,” “fever” and so on, but could be misled by, for example, searches triggered by news coverage.

Kinsa’s smartphone app uses a bubble game to entice children to take their temperatures. If fever is detected, it asks parents about other symptoms and then offers basic medical advice or urges the user to see a doctor.


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The makers of cold medications, disinfectants, toothbrushes and even orange juice buy advertising on the app, Mr. Singh said.

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WHO, UNEP Collaborating on Environmental Health

WHO, UNEP Collaborating on Environmental Health

It is the most significant formal agreement on joint action about environment and health issues in more than 15 years, according to the partner organizations.

UN Environment and the World Health Organization announced Jan. 10 they have agreed to collaborate to accelerate action on environmental health risks that cause an estimated 12.6 million deaths a year. In Nairobi, Erik Solheim, head of UN Environment, and Dr. Tedros Adhanom Ghebreyesus, director-general of WHO, signed an agreement to combat air pollution, climate change, and antimicrobial resistance and also improve coordination on waste and chemicals management, water quality, and food and nutrition issues. The collaboration includes joint management of the BreatheLife advocacy campaign to reduce air pollution.

It is the most significant formal agreement on joint action about environment and health issues in more than 15 years, according to the partner organizations. “There is an urgent need for our two agencies to work more closely together to address the critical threats to environmental sustainability and climate, which are the foundations for life on this planet. This new agreement recognizes that sober reality,” Solheim said.

“Our health is directly related to the health of the environment we live in. Together, air, water, and chemical hazards kill more than 12.6 million people a year. This must not continue,” agreed Tedros. “Most of these deaths occur in developing countries in Asia, Africa, and Latin America, where environmental pollution takes its biggest health toll.”

They reported that their collaboration sets up a more systematic framework for joint research, development of tools and guidance, capacity building, monitoring of Sustainable Development Goals, and global and regional partnerships. They will develop a joint work program and hold an annual high-level meeting to evaluate progress and make recommendations for continued collaboration. Their pact follows a Ministerial Declaration on Health, Environment and Climate Change calling for the creation of a global “Health, Environment and Climate Change” Coalition at the United Nations Framework Convention on Climate Change (UNFCCC) COP 22 in Marrakesh, Morocco in 2016.

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6 digital health predictions for 2018

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Steve Kraus, one of the most active health-tech investors in the industry, gave his predictions for 2018, following the J.P. Morgan Healthcare Conference this week in San Francisco.

Don’t expect IPOs

I think the public markets will remain closed in 2018 for health-tech companies. However, I do expect 2019 and the years beyond that to start to look more fruitful for initial public offerings, as well-funded start-ups like Health Catalyst, Flatiron Health, Welltok, Grand Rounds Health and others start to scale beyond $100 million in revenue and some of them start to reach positive EBITDA levels.

Healthcare mergers and acquisitions will remain robust but will focus more around health-care service businesses — many of which may be tech-enabled — rather than pure health-care IT companies.

Start-ups need to do more

I’m bullish on so-called “full-stack” or vertically-integrated health-care companies continuing to thrive. And by that I mean, companies that provide all of the necessary services and support around conditions like diabetes or the palliative care experience.

These services are the ones that are getting real engagement from patients and they are able to go to risk-bearing entities with a pitch to take a population off their hands — and provide better care more affordably. These solutions will also work better for the patient as they take care of their totality of their medical issue.

The truth about artificial intelligence in medicine

Few could have missed the hype around artificial intelligence and machine learning technologies in health care in 2017, specifically related to fields like radiology and pathology.

A vast array of companies are developing algorithms to improve clinical care, but these will take time to develop commercially. In my view, 2018 will be the year that these technologies are instead applied to the “guts” of healthcare, meaning such unsexy applications as improving workflow, allowing doctors to spend more time on clinical care and less time on paperwork or operations, improving the operational efficiency of hospitals, and so on.

Biology isn’t just a tech problem

2017 was the year that Silicon Valley started to invest in computational biology. A lot of these venture dollars were poured into companies focused on improving the early discovery process, such as identifying targets and “hits” of those targets.

I’m betting that 2018 will be the year where these companies and investors realize that biology is not “programmable” or “codeable.” The problem isn’t that pharma and biotech are short of “hits” or drug candidates. What these companies really need is clinical-stage programs. If these start-ups really want to scale and actually get traction among the traditional industry, they will need to become real biotech and drug development companies. And this will be a different, much more capital-intensive bet than their original investors probably realized.

The year of humble pie

I have seen far too many companies in recent months that have raised behemoth rounds at mammoth valuations return to the market with their tail between their legs — finally open to valuation adjustments. These could still be potentially successful companies, but their investors were potentially mistaken that such companies could reach hyper-scale.

Steve Kraus is a partner at Bessemer Venture Partners.

The proven health benefits of honey

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State pitches health insurance bill

State Insurance Commissioner Mike Kreidler’s office was shocked when it received 2018 health plan proposals last spring.

Not only were plans requesting double-digit premium increases, but no insurers were willing to offer health plans in two counties — Klickitat and Grays Harbor.

“We weren’t expecting that,” said Stephanie Marquis, spokeswoman for the insurance commissioner’s office. “That got us thinking, ‘What’s going to happen next year?’”

Kreidler was able to find insurers to offer plans in those two “bare counties,” but in nine counties — mostly rural areas — one insurer is providing health plans. That, coupled with the premium increase of more than 30 percent, had health officials worried the uncertainty could lead to a market collapse, similar to what Washington experienced in the 1990s.

Last week, Kreidler’s office proposed legislation it says will help to stabilize the market by reducing the risk for insurers and lowering premiums for consumers.

The legislation — sponsored by Sen. Annette Cleveland, D-Vancouver, and Rep. Eileen Cody, D-Seattle — would create a state reinsurance program. The program would provide partial reimbursement to insurance companies for high-cost medical claims that exceed a certain threshold. It would be funded by a fee placed on all health plans.

The state program would mirror the federal reinsurance program, which expired in 2016, that was part of the Affordable Care Act. Implementing a state reinsurance program would be contingent on the state securing a $40 million federal waiver. Alaska, Minnesota and Oregon received waivers and operate state reinsurance programs.

Some healthcare stakeholder groups have expressed misgivings about how the program will be funded and how it could invite a lawsuit that would further complicate implementation. Lawmakers will need to pass legislation by early February, so Kreidler’s office can submit the waiver application and secure the federal funding before insurance companies file their 2019 rate proposals in May.

“We need to act with expediency so that this can actually work,” said state Sen. Ann Rivers, a La Center Republican who sits on the Senate Health and Long Term Care Committee.

The goal of a reinsurance program — both the federal and state programs — is to level the playing field for insurers, Marquis said. The program would ensure that if one insurer had a large population of sicker patients, it wouldn’t be saddled with those high costs while another insurer with a healthier population had far less costs, she said.

“There’s more incentive for them to stay in the market because they’re not taking on that risk,” Marquis said.

The proposed program would set a threshold — $75,000, for example — that, once an individual’s claims surpassed, the state program would begin paying the costs. The program would also have a cap, between $500,000 and $1 million, at which point the claims costs are no longer eligible for reinsurance payments. The insurance commissioner would set those amounts. The program would be capped at $200 million in payments.

Speaking last week at a hearing of the Senate Health and Long Term Care Committee, Kreidler said that the individual market has been the most vulnerable he’s seen in his nearly two decades as insurance commissioner.

“It’s clear that 2019 has the distinct potential of being worse than what we had when we were coming into 2018,” he said.

Kreidler said a reinsurance program was the best option for 2019, although he said it’s not a “silver bullet.” He said that prescription drug price increases are the No. 1 driver in premium increases. The federal reinsurance program did, however, help to keep premiums down by as much as 10 percent, according to Kreidler’s office.

During the short hearing, representatives from the Washington State Medical Association, the Washington State Hospital Association, the Association of Washington Healthcare Plans as well as several health care providers all expressed support for the program. But each expressed varying concerns with the funding mechanism.

Rivers said she is supportive of the program but described the current proposal as “not feasible.” She said that the costs would be $200 million a year to cover 300,000 enrollees.

“When you do the math on that, you realize it’s about $667,000 per (enrollee) per year,” she said.

Rivers also said the program’s funding mechanism is problematic and could add to rising premiums. Additionally, she said she expects the bill to attract a lawsuit seeking to exclude health care plans covered by the federal Employee Retirement Income Security Act. If the lawsuit succeeded, the cost would be redistributed to other health care plans.

Rivers said she is currently working with other legislators to make the bill workable.

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