Category: The Lancet
Federal Regulators split on antimalarials for COVID-19
Volume 395 Number 10231
11 April 2020
WORLD REPORT US and French authorities have authorised the use of chloroquine and hydroxychloroquine, but the EU regulator and WHO say the science doesn’t support the decision. Susan Jaffe reports.
With no “adequate, approved and available” alternative, the US Food and Drug Administration (FDA) is allowing the use of the antimalarial drugs hydroxychloroquine and chloroquine to treat coronavirus disease 2019 (COVID-19).
The FDA’s emergency use authorisation (EUA) issued last week gives physicians the option to prescribe the drugs, which President Donald Trump has recommended. However, both drugs are unproven and untested for COVID-19, and have rare but potentially deadly side-effects. The decision bypassed the usual drug approval process including doubleblind, placebo-controlled clinical trials, stoking a worldwide debate about whether the drugs are appropriate for treating the disease.
“I think it was resorted to more out of a sense of desperation”, said Joseph Masci, an infectious disease specialist and director of global health at Elmhurst Hospital in Queens, a borough of New York City, which is at the centre of the epidemic in the USA. “It is just an indication of how sudden and massive this outbreak has been.” [Continued here.]
…Leadership changes at USAID
Volume 395 Number 102295 28 March 2020
WORLD REPORT Mark Green, the respected head of the US Agency for International Development, has resigned. Susan Jaffe reports from Washington.
“The timing is unfortunate”, said Jen Kates, senior vice president and director for global health and HIV policy at the Kaiser Family Foundation. “The agency is going to be significantlychallenged by the COVID-19 pandemic, potentially at a level that it has not seen before.” [continued here]
…Medicare for All scrutinised in Democratic primaries
Volume 395 Number 10225 29 February 2020
WORLD REPORT On March 3, 14 states will pick their nominees for the US presidential election. The feasability of a single payer insurance plan is a key issue. Susan Jaffe reports from Washington, DC.
Anxiety about rising health-care costs— the top issue for Democratic voters, according to recent polls—propelled Bernie Sanders to the head of the pack in last week’s Democratic primary contest in Nevada. Of the six leading candidates vying for the party’s presidential nomination, Sanders, a Vermont senator and self-described democratic socialist, has proposed the most radical solution for lowering medical bills and reaching universal coverage. His signature policy initiative, the Medicare for All single-payer programme, would eliminate private health insurance, including employment-based plans that cover about half of the US population. [Article compares Medicare for All and the public option proposal favoured by former Vice President Joe Biden; continued here]
Decisions to be made on US gun violence research funds
Volume 395 Number 10222 8 February 2020
WORLD REPORT The National Institutes of Health and the Centers for Disease Control and Prevention will decide how to spend new federal funds later this year. Susan Jaffe reports from Washington, DC.
After a hiatus of more than two decades, Congress and President Donald Trump agreed to add funding for gun violence research to the federal budget in December. With grants expected to be awarded in September, the priorities for research and its potential impact are crucial for halting the US’s record-breaking gun-related death toll. [Continued here.]
…Will Trump snuff out e-cigarettes?
Volume 394 Number 10213 30 November 2019
WORLD REPORT President Trump promised to ban flavoured e-cigarettes, but 11 weeks later, they are still on the shelves. Susan Jaffe reports from Washington.
When US President Donald Trump announced a plan on Sept 11 to prohibit the sale of most flavoured electronic cigarettes, more than 450 people in the USA had a mysterious lung disease associated with vaping, and six had died, according to the Centers for Disease Control and Prevention (CDC). The ban would be finalised within 30 days, said Health and Human Services Secretary Alex Azar.
The number of cases of the lung disease has since soared to 2290, as of Nov 20, in 49 states, Washington, DC, and the US Virgin Islands. 47 e-cigarette smokers (vapers) have died, according to the CDC. However, as this report went to press, officials from the Trump administration would not disclose when the promised ban would be issued.
…The decision [to implement] a nationwide ban is up to President Trump. “It is a chain of command”, said Robert Califf, a professor of cardiology at Duke University School of Medicine and the FDA commissioner under Trump and former President Barack Obama. “The commissioner reports to the Secretary of Health and Human Services [HHS]and the secretary reports to the president. FDA policies are de facto policies of the Executive Branch, so if the HHS secretary or president chooses to do so, they can intercede.” [Continued here]
…Cycling safety concerns grow in US cities
Volume 394 Number 10211 16 November 2019
WORLD REPORT As more bicycle riding is encouraged for health and environmental reasons, an increase in cycling deaths is causing a public health dilemma in the USA. Susan Jaffe reports.
Photo by Susan Jaffe Copyright © 2019
A record number of cycling deaths in the USA is attracting scrutiny from the US Congress, city officials, and the National Transportation Safety Board (NTSB), the government agency better known for investigating aeroplane crashes and other transportation disasters. …Last year, 859 cyclists were killed in road traffic crashes, the highest number in the USA since 1990, and a 6·3% increase since 2017, according to research from the US Department of Transportation’s National Highway Traffic Safety Administration published last month.
…In a preliminary report issued last week, the NTSB recommended that public officials take several steps to reduce the number of cycling deaths. The last time it examined bicycle safety was 47 years ago. [Continued here]
…Congress and President Trump take on high drug prices
Volume 394 Number 10204 28 September 2019
WORLD REPORT Proposals from the White House and Congress to lower prescription drug costs, which both rejected more than a decade ago, are making a comeback. Susan Jaffe reports.
The Trump administration’s Department of Health and Human Services (HHS) is the first federal health agency to claim they are “open” to the idea of importing cheaper drugs from Canada and overseas. And both Republicans and Democrats in Congress now advocate familiar strategies to rein in drug price increases. [Continued here]
…US Planned Parenthood leadership shake-up
Volume 394 Number 10195 27 July 2019
WORLD REPORT Planned Parenthood’s board of directors decided to remove Dr. Leana Wen her after only 8 months, igniting a public debate about how the prominent women’s health-care organisation should best protect a woman’s right to abortion.[Continued here]
…US Congress wants to take the surprise out of medical bills
Volume 393 Number 10191 29 June 2019
WORLD REPORT A Texas high school teacher gets an unexpected hospital bill for $110,000 that his health insurance policy doesn’t cover. What can Congress do about it? [Continued here]
…Trump administration limits fetal tissue research
Volume 393 Number 10189 15 June 2019
WORLD REPORT The move could threaten medical research advances, say scientists, as acquisition of new fetal tissue for research is substantially hindered. Susan Jaffe reports.
“Many discoveries now in clinical practice and wide research use have come from human fetal tissue”, said Irving Weissman, director of the Stanford Institute for Stem Cell Biology and Regenerative Medicine. “For these, there was—and still is—no substitute for human fetal tissue.”
…Anti-abortion groups praised the new policy, which would “separate federal research funding from the abortion industry”, said Melanie Israel, a research associate at the conservative Heritage Foundation… Yet how the new Trump research policy would reduce abortions is still unclear. “They are conflating pro-life issues and abortion with research”, said Jennifer Zeitzer, public affairs director at the Federation of American Societies for Experimental Biology. “But there’s no evidence that women are getting abortions so they can donate fetal tissue for research.” [Continued here.] …
Legal battles over abortion heat up in the USA
Volume 393 Number 10184 11 May 2019
WORLD REPORT Changes to Title X, several legal challenges, and a change to the Supreme Court composition could mean drastic changes for access to abortion in the USA. Susan Jaffe reports.
“We are the department of life…from conception until natural death, through all of our programmes”, US Department of Health and Human Services (HHS) secretary Alex Azar said earlier this year…. The government’s anti-abortion efforts have ignited lawsuits from Maine to California. Eventually, one or more of these cases are expected to reach the Supreme Court. With its newest arrival—Justice Brett Kavanaugh, whose nomination by Trump was championed by abortion opponents—the Supreme Court’s ideological balance has now shifted towards a conservative majority [raising] opponents’ hopes that a sympathetic court will diminish, if not overturn, Roe v. Wade...
Late last week, lawyers for the HHS appealed decisions by two federal court judges in Oregon and Washington state to temporarily halt new administration rules that would limit the information about abortion services that federally funded health-care providers can tell their patients.
“We are fighting back in the courts, we are fighting back in Congress and in state legislatures all across the country”, said Planned Parenthood president Leana Wen, noting that one in four women in the USA will have an abortion in their lifetime. “The public is with us when it comes to defending access to safe legal abortion, which people understand is part of the full spectrum of reproductive health care, which is health care.” [Continued here.]…
Doctors arrested in US crackdown on illegal opioids
Volume 393, Number 10182
27 April 2019
WORLD REPORT The multiagency operation hit five states and led to the arrest of 60 people. Perpetrators face up to
50 years’ prison sentence if found guilty. Susan Jaffe reports.
Arrests of 31 doctors, pharmacists, and other health care professionals for allegedly prescribing and distributing illegal opioids affected some 28,000 of their patients. That’s why Department of Justice officials are working with state health departments, the Centers for Disease Control and Prevention and the Department of Health and Human Services to help patients by “… bringing enforcement and [opioid addiction] treatment closer together…than ever before,” says Benjamin Glassman, the US attorney for the southern district of Ohio. [Continued here.]
…Scott Gottlieb steps down from US FDA leadership
Volume 393, Number 10176
16 March 2019
WORLD REPORT The announcement came as a surprise, prompting many to ask: Can the US FDA commissioner’s policies continue without him? Susan Jaffe reports.
Unlike some government agencies that can toil peaceably in relative obscurity, the FDA is frequently in the headlines. It is responsible for ensuring the safety of products that account for about 20 cents of every dollar US consumers spend—or US$2·5 trillion annually. …When Gottlieb became commissioner in 2017, the agency had an estimated 1000 vacancies which has now risen to 1400.[Continued here.]
…US lawmakers seek cuts in prescription drug prices
Volume 393, Number 10175
9 March 2019
WORLD REPORT A committee brought together Senators and drug company representatives to discuss why drug pricing in the USA is so high, but little progress was made, Susan Jaffe reports.
A much-publicized Trump Administration proposal allows — not requires — pharmaceutical companies to pass large rebates on to Medicare patients. Savings as much as 30 percent for seniors depend on companies’ voluntarily cutting prices but several top drug makers tell Senate committee they can’t promise to do so. [Continued here.]
…USA sets goal to end the HIV epidemic in a decade
Volume 393, Number 10172
16 February 2019
WORLD REPORT The unexpected announcement in the State of the Union address could set the start of a realistic agenda to end HIV/AIDS in the USA, provided funds are secured. Susan Jaffe reports.
Nearly an hour into his 90 min State of the Union address, President Donald Trump called for a government-run health-care programme “to eliminate the HIV epidemic in the United States within 10 years”.
Although the president has promised to get rid of the Affordable Care Act (ACA) along with its health insurance marketplaces and Medicaid expansion, these and other policies did not appear to dampen his enthusiasm. [Continued here.]…
NYC guarantees health care to all
Volume 393, Number 10169
26 January 2019
WORLD REPORT The mayor of New York City is not counting on Congress for solutions to its health-care problems, Susan Jaffe reports.
By encouraging patients to seek primary and preventive care instead of more expensive emergency care, city officials expect to save money and keep people healthy.
“From this moment on, in New York City, everyone is guaranteed the right to health care—everyone”, declared New York City Mayor Bill de Blasio as he unveiled his so-called NYC Care plan this month. People who cannot pay or are ineligible for health insurance—including undocumented immigrants—will be able to get the most comprehensive and affordable health coverage in the country, at little or no cost, the mayor said, speaking in both English and Spanish. “This is a way of getting people health care here and now, regardless of what happens on the state or the federal level”. [Continued here.]
… Profile: Leana Wen, President of Planned Parenthood
Volume 393, Number 10168
19 January 2019
“If there is one thing that I can accomplish as the President of Planned Parenthood, it’s to make clear that reproductive health care is standard health care, that women’s health care is standard health care and that we must view all aspects of health care as a fundamental human right”, said Wen. [Continued here.]…
State exemptions to the Affordable Care Act expanded
Volume 392, Number 10164
15 December 2018
WORLD REPORT In its latest blow to the ACA, the Trump administration provides guidance on how states can circumvent the health law. Susan Jaffe, The Lancet‘s Washington correspondent, reports.
In its most far-reaching move yet, the Trump administration has reinterpreted a provision of the landmark Affordable Care Act so that states can apply for exemptions to some requirements of the health law for states. [Continued here.]
… Prospects for health after the US mid-terms
Volume 392, Number 10161
24 November 2018
WORLD REPORT After the mid-term elections, Susan Jaffe, The Lancet‘s Washington correspondent, looks at the consequences for health-care legislation in the USA.
In the first national election since Donald Trump won the presidency promising, among other things, to repeal the Affordable Care Act (ACA), Americans went to the polls this month still concerned about health care. It was the most important issue for 75% of Democrats and 23% of Republicans who voted in the Nov 6 elections, according to exit polls. But, unlike in 2016, voters handed Democrats—the party responsible for the ACA—their largest victory since Republican Richard Nixon resigned as president after the Watergate scandal….
“Health care was on the ballot and health care won”, said the House of Representatives’ Democratic minority leader Nancy Pelosi of California, who is expected to become speaker of the house when the new Congress convenes in January. [Continued here.]
… Funding redirected to pay for immigrant detention centres
Volume 392, Number 10157
27 October 2018
WORLD REPORT A plan to expand immigrant children detention centres requires money from medical research and
health programmes. Susan Jaffe, The Lancet‘s Washington correspondent, reports.
Trump administration officials told congressional leaders last month it will transfer as much as US$466 million from cancer research, meals for older adults, preschool for toddlers, HIV/AIDS prevention, and other initiatives that are central to the agency’s mission to protect Americans’ health. “These transfers are only a temporary solution to the sad consequence of a broken immigration system”, said HHS Deputy Secretary Eric Hargan. [Continued here.]
… Prospects for US single-payer national health care
Volume 392, Number 10149
1 September 2018
WORLD REPORT The single-payer national health-care bill, so-called Medicare for All, is gaining momentum with the public but is stalling in Congress. Susan Jaffe, The Lancet‘s Washington correspondent, reports.
Instead of fading away into legislative oblivion, some Democrats campaigning for congressional seats and candidates for state offices are supporting the Medicare for All bill—or some variation thereof—as the November election approaches. They are not alone: a Morning Consult/Politico national poll in June found that 63% of Americans support “a Medicare for All healthcare system, where all Americans would get their health insurance from the government”. [Continued here.]
…
Trump’s second Supreme Court nominee, Brett Kavanaugh
Volume 392, Number 10144
28 July 2018
WORLD REPORT If confirmed, Kavanaugh could tilt the court toward the president’s views on US public health policy. Susan Jaffe, The Lancet‘s Washington correspondent, reports.
Before Republicans chose Donald Trump as their party’s candidate for president in 
2016, some doubted whether the New York real-estate developer seeking political office for the first time was truly conservative. To shore up his conservative credentials, Trump produced a list of judges with help from the conservative Heritage Foundation and Federalist Society that he promised to choose from to fill a vacancy on the Supreme Court should an opening occur during his presidency....
Health-care issues are expected to dominate the debate over [Judge Brett] Kavanaugh’s nomination in the US Senate, which will decide if he should join the court. Several cases involving the Affordable Care Act (ACA) and reproductive rights are working their way through the legal system. …If Kavanaugh, aged 53 years, is approved, his lifetime position on the court means his vote could be a deciding factor in cases for several decades. [Continued here.]
…
Trump Administration’s Medicaid work rules hit a snag
Susan Jaffe | Washington Correspondent for The Lancet | 10th July 2018
After winning a federal court decision to stop Kentucky from requiring some Medicaid patients find paid or volunteer work to keep their coverage, beneficiary advocates are considering legal challenges to stop similar efforts in other states.
The victory may expose a major flaw in the Trump Administration’s effort to reshape the Medicaid program, advocates say. But others claim the flaw is in the court decision. [Continued here.]…
Gun violence research in the USA: the CDC’s impasse
Volume 391, Number 10139
23 June 2018
WORLD REPORT Months after the Trump Administration said that there is no ban on gun violence studies, the CDC still lacks the funding to proceed. Susan Jaffe, The Lancet‘s Washington correspondent, reports.
…Appeals for immediate federal action to make schools and communities safer have so far largely gone unanswered. And legislative efforts languish in Congress, as the chairman of a key congressional committee that oversees federal health programmes has so far resisted requests by its Democratic members to hold hearings on preventing gun violence [continued here].…