KFF Health News Original Stories
As Covid Infections Rise, Nursing Homes Are Still Waiting for Vaccines
“People want covid-19 to be in the rearview mirror,” one nursing home official says. Faced with a slow rollout of the updated covid vaccines, and without state mandates for workers to get vaccinated, most skilled nursing facilities are relying on persuasion to boost vaccination rates among staff and residents. (Jordan Rau and Tony Leys, )
Who Polices Hospitals Merging Across Markets? States Give Different Answers
Increasingly, hospitals are merging across separate markets within states. It’s a move that health economists and the Federal Trade Commission have been closely watching, as evidence shows such mergers raise prices for patients with no improvement in care. (Samantha Liss, )
New Medicare Advantage Plans Tailor Offerings to Asian Americans, Latinos, and LGBTQ+
As more seniors opt for Medicare Advantage, a few small insurers have begun offering plans that provide culturally targeted benefits for cohorts including Asian Americans, Latinos, and LGBTQ+ people. The approach, policy researchers say, has potential and perils. (Stephanie Stephens, )
Readers Rail at Social Security Overpayments and Insurers' Prior Authorizations
KFF Health News gives readers a chance to comment on a recent batch of stories. ( )
Here's today's health policy haiku:
Shutting down … or not.
Health care is too important
for government games
– Anonymous
If you have a health policy haiku to share, please Contact Us and let us know if we can include your name. Haikus follow the format of 5-7-5 syllables. We give extra brownie points if you link back to an original story.
Opinions expressed in haikus and cartoons are solely the author's and do not reflect the opinions of KFF Health News or KFF.
Covid-19
HHS: Insurers Are Committed To 'Fully Covering' New Covid Vaccines
Department of Health and Human Services Secretary Xavier Becerra met with insurance executives Wednesday and received commitments that the updated covid vaccines will be covered, following reports of issues during the initial rollout last week. Other covid vaccine news is on nursing homes, the Los Angeles school system, and more.
The Hill: Biden Administration Draws Commitment From Health Insurers To Cover COVID-19 Shots
The Department of Health and Human Services (HHS) met with representatives from the health insurance industry on Wednesday, receiving commitments that the updated COVID-19 vaccines will be covered after reports arose of some people having to pay out-of-pocket for their immunizations. HHS Secretary Xavier Becerra met with executives from Anthem, Blue Cross Blue Shield (BCBS), the Better Medicare Alliance, CareFirst, Cigna, Humana, and CVS Health, which owns Aetna as well as AHIP, the trade organization that represents the health insurance industry. (Choi, 9/27)
NBC News: Insurance Hurdles For New Covid Vaccines Have Largely Been Resolved, Biden Administration Says
Last week, as the updated Covid vaccines rolled out to pharmacies across the U.S., some people eager to get their doses were met with unexpected insurance issues … On Wednesday, the Department of Health and Human Services said the issue has been "largely, if not completely," resolved. The insurance companies made it clear that they are "fully covering the new vaccine shots," according to a rundown of the meeting shared by HHS. They described the problem of some people being denied coverage as "systemic technical issues." (Lovelace Jr., 9/27)
Stat: The United States Is Paying Nearly Triple For New Covid Vaccines
After Pfizer and Moderna hiked the prices of their Covid-19 vaccines this year, the federal government will now pay nearly three times more than it did previously for each dose. And it’s paying more than countries that did far less to support vaccine development. Health and Human Services Secretary Xavier Becerra glossed over the dramatic increase in the amount the government is paying for vaccines in a public appearance last week, when he got vaccinated at a CVS pharmacy in D.C. (Cohrs, 9/28)
In other covid vaccine developments —
The New York Times: As Covid Infections Rise, Nursing Homes Are Still Waiting For Vaccines
“Covid is not pretty in a nursing home,” said Deb Wityk, a 70-year-old retired massage therapist who lives in one called Spurgeon Manor, in rural Iowa. She has contracted the disease twice, and is eager to get the newly approved vaccine because she has chronic leukemia, which weakens her immune system. (Rau and Leys, 9/27)
Los Angeles Times: LAUSD Repeals Employee COVID-19 Vaccine Mandate
“Yes, this board approved, required vaccinations, as a means of reducing transmission, reducing the severity of a disease that in this community, across this country and across the world killed millions,” L.A. Unified Supt. Alberto Carvalho said. “This was a necessary requirement, and it was adopted so that schools could reopen safely based on information that was known, then accepted, then verified, then validated … not by speculation, but by scientists. “In 2023,” he added, “we face vastly different circumstances.” (Blume, 9/27)
On funding for an innovative covid vaccine —
Stat: Next-Gen Covid Effort Gives Small Biotech Up To $433 Million
The U.S. government’s “Project Nextgen,” its effort to accelerate and streamline the rapid development of the next generation of Covid vaccines and treatments, said Wednesday that it would give a small biotechnology firm, Gritstone bio, up to $433 million to conduct a 10,000-volunteer clinical trial testing a new approach to creating a vaccine. (Herper, 9/27)
Reuters: Gritstone Bio Wins $433 Million US Contract For COVID Vaccine Study
Gritstone bio (GRTS.O) on Wednesday secured a $433 million contract by the U.S. government to conduct a mid-stage study of its self-amplifying mRNA COVID-19 vaccine candidate. The contract is a part of "Project NextGen," an initiative by the U.S. Department of Health and Human Services to advance a pipeline of new, innovative vaccines and therapeutics providing broader and more durable protection against COVID-19 infection. (9/27)
Reproductive Health
Ohio Justices Consider Legal Strategy Behind State's Abortion Law Push
The state's Solicitor General faced vigorous questioning by Ohio Supreme Court Justices over the legal strategy Ohio is pursuing in an attempt to revive a strict abortion ban. Elsewhere: abortion protests hit a women's health clinic; a Texas county considers a road access ban for abortion-seekers; and more.
AP: Ohio Wants To Revive A Strict Abortion Law. Justices Are Weighing The Legal Arguments
Ohio Supreme Court justices vigorously questioned the state’s lawyer Wednesday about a legal strategy that Ohio is attempting in hopes of reviving its law banning most abortions except in the earliest weeks of pregnancy. Before Ohio Solicitor General Benjamin Flowers even finished the first sentence of his argument, justices began peppering him with technical questions that suggested they may be reticent to step in and lift a county judge’s order that has been blocking the law since last October. (Carr Smyth, 9/27)
The Statehouse News Bureau: Ohio Supreme Court Hears Case That Could Lead To The Return Of The State's Six-Week Abortion Ban
At issue is if the doctors and providers who challenged the near total abortion ban in a Hamilton County Common Pleas case had the standing and if that court had theauthority to issue an injunction stopping what’s commonly known as the Heartbeat Bill. If the court decides they didn’t have standing or the county court didn’t have the authority, the abortion law could be enforced again, like it was last summer in the days and months following the decision by the U.S. Supreme Court to overturn the landmark Roe v. Wade ruling. (Ingles, 9/27)
Meanwhile, in developments on abortion access —
Los Angeles Times: Newsom Signs Abortion Bill Allowing Doctors In Republican States To Train In California
Gov. Gavin Newsom signed another round of reproductive health bills into law on Wednesday, including legislation that allows doctors living under “hostile” laws in states where abortion is banned to receive training in California. The new California law comes as medical professionals in red states could face jail time for providing abortion care, and opportunities for abortion training are disappearing for obstetrician-gynecologists in places like Texas, where the procedure is banned. (Mays, 9/27)
The Texas Tribune: A Texas County Near New Mexico Considers Abortion Travel Ban
A rural Texas county that borders New Mexico is expected to consider a proposal Thursday that would make it illegal to travel on its roads seeking an abortion. The proposed blockade in Cochran County, home to about 2,500 people, is the latest example of a Texas county attempting to restrict access to its highways to certain people — a move abortion-rights activists and legal scholars say is unconstitutional and meant to stoke fear. (Carver, 9/27)
The Boston Globe: Abortion Protests On Cape Cod Begin At Hyannis Health Clinic
Activists staged competing protests over abortion Wednesday outside a women’s health clinic. By 9 a.m., seven men and women from the Cape Cod Pro-Life Alliance and the international organization 40 Days For Life took up positions on the sidewalk outside Health Imperatives. The clinic began offering medication abortions over the summer and is the first abortion provider physically on the Cape in 15 years. At noon, the mood shifted when 50 people descended onto the same sidewalk supporting abortion rights. An invisible line kept the two groups apart. (Treffeisen, 9/27)
The Colorado Sun: Abortion-Rights Groups File 2024 Ballot Initiatives To Protect Abortion Access In Colorado Constitution
Abortion access would be protected in Colorado’s constitution under a pair of 2024 ballot measures filed earlier this month by abortion-rights groups. Each of the initiatives would also lift the state’s nearly 40-year-old constitutional ban on state dollars being used to pay for abortions. (Paul, 9/28)
In other reproductive health news —
The Oklahoman: More Oklahoma Men Are Seeking Vasectomies After Roe V Wade
Oklahoma health care providers say there’s been an increase in demand for vasectomies since the Supreme Court overturned long-standing abortion protections with its Dobbs v. Jackson Women’s Health Organization decision last summer. After the court’s ruling, Oklahoma banned all abortions except those necessary to preserve the life of a pregnant woman in a medical emergency. (Foreman, 9/28)
Capitol Watch
Health Programs Brace For Shutdown As Congressional Options Shrink
While most attention is focused on the shutdown clock that will count down to zero on Saturday night without lawmakers' action, there are some other issues being discussed on Capitol Hill, including Medicare solvency, AI, and reproductive data privacy.
The Hill: McCarthy Options On Shutdown Endgame Shrinking
Speaker Kevin McCarthy (R-Calif.) is running short on viable options to get House Republicans some wins while averting a shutdown. Outside the House, the Democratic-controlled Senate — with the help of Minority Leader Mitch McConnell (R-Ky.) — has aimed to take the reins on a continuing resolution (CR), advancing a stopgap that Republicans say is dead on arrival in the House. (Brooks, 9/28)
The Hill: How A Shutdown Would Impact Key Health Care Programs
The federal government is staring down a shutdown as a handful of ultra-conservative House Republicans remain opposed to a short-term agreement to keep the government funded. The current spending laws expire at 11:59 p.m. Sept. 30. Without a deal by that night, funding will lapse and many government functions, including some health care programs, will temporarily stop. Here’s how a shutdown will, and won’t, impact health agencies and services. (Weixel, 9/28)
Axios: Abortion Pill Measure Likely Dooms GOP Spending Bill
House Republicans appear to be well short of the votes they need to pass a spending bill for the USDA and FDA due to language that would restrict access to abortion pills. The bill's failure would further complicate the already difficult path to keeping the government open, with a shutdown by Sept. 30 growing increasingly likely. It’s also the latest sign of GOP divisions on how to handle abortion in the wake of last year’s Supreme Court decision overturning Roe v. Wade. (Solender and Knight, 9/27)
In other congressional news —
Stat: Senate Starts Talks On Medicare Solvency
The Senate Budget Committee started what could become a bipartisan effort to extend Medicare’s solvency for seniors and people with disabilities. The fund for Medicare’s hospital benefit is scheduled to run dry by 2031, according to Medicare trustees. However, Budget Committee members in both parties said they expect that the government would borrow money to cover benefits once the fund runs out, adding to a deficit that is already well more than $1 trillion annually. (Wilkerson, 9/27)
Politico: Congress Doc Wants States To Regulate AI
Rep. Greg Murphy (R-N.C.), a co-chair of the GOP Doctors Caucus, called for artificial intelligence in health care to be regulated at the state level first, not nationally, Ben reports. Speaking Tuesday at the Connected Health Initiative’s AI and the Future of Digital Healthcare event in Washington, D.C., Murphy warned against the FDA “controlling” AI regulation, saying the agency should be viewed as a partner in regulation. (Cirruzzo and Leonard, 9/27)
Politico: Markey Calls For Legal Crackdown When Tech Companies Endanger Children
Markey sent a letter today to Meta CEO Mark Zuckerberg, obtained by POLITICO, asking the company to pause the release of AI-powered chatbots it plans to integrate into its social media platforms. Markey, at the summit, cited statistics on suicide among minors and pointed to a May advisory from the Surgeon General that social media has a significant effect on their mental health.“Just wait a minute here. We’re not going to be able to handle devices talking to young people in our society without understanding what the safeguards are going to be,” Markey said. (Robertson, 9/27)
Roll Call: Lawmakers Look At Data Privacy In Post-Dobbs World
Personal health data collected via apps, other technology becomes subject of congressional scrutiny in the aftermath of Roe reversal. Advocates worry there are limited guardrails protecting data from law enforcement during abortion investigations. (Bridges, 9/28)
FDA Updates Ozempic Label Warnings; Advisory Panel Votes Against ALS Drug
The label for diabetes treatment Ozempic, popularized by its use as a weight loss drug, will now list blocked intestines as a potential side effect. Two other similar drugs, Wegovy and Mounjaro, already do. In other FDA news, its panel of independent advisers voted 17-1 against recommending a new ALS therapy.
CBS News: FDA Updates Ozempic Label With Potential Blocked Intestines Side Effect, Also Reported With Wegovy And Mounjaro
The label for the diabetes drug Ozempic — which has become popular for weight loss — now acknowledges reports of blocked intestines following use of the medication. The change comes after the Food and Drug Administration greenlighted a series of updates from drugmaker Novo Nordisk for its product. Ozempic now joins other products in this booming class of so-called GLP-1 agonist medications which acknowledge increased reports of what doctors call ileus, or a blockage in the intestines. (Tin, 9/27)
CNN: FDA Updates Ozempic Label To Acknowledge Some Users’ Reports Of Blocked Intestines
The US Food and Drug Administration has updated the label of the diabetes drug Ozempic to acknowledge reports of blocked intestines in some people using the medication. (Dillinger, 9/27)
Meanwhile the FDA took action on another drug, this time against ALS —
Stat: FDA Advisers Vote Against ALS Treatment From BrainStorm
A panel of independent advisers to the Food and Drug Administration voted overwhelmingly against a polarizing potential treatment for ALS on Wednesday, concluding that the medicine’s messy supporting data did not meet the standard for approval. (Garde, 9/27)
Reuters: US FDA Panel Votes Against BrainStorm's ALS Therapy Over Effectiveness Concern
Advisers to the U.S. health regulator on Wednesday voted against BrainStorm Cell Therapeutics' (BCLI.O) therapy for a rare and fatal neurodegenerative disease called amyotrophic lateral sclerosis (ALS), marking the newest hurdle in a lengthy regulatory review. While 17 panel members voted that the data presented does not demonstrate substantial evidence of the effectiveness of NurOwn for the treatment of mild-to-moderate ALS, one voted in favor and one member abstained. (Sunny, 9/28)
In other Biden administration news —
Politico: Boehringer Ingelheim To Opt Into Medicare Price Talks
Boehringer Ingelheim said Wednesday it will enter Medicare price negotiations for its diabetes drug Jardiance, potentially avoiding a hefty tax on sales. Jardiance is one of 10 drugs selected late last month by CMS for price negotiations created under the Inflation Reduction Act. The agency gave manufacturers of the drugs until Oct. 1 to decide whether to enter what is expected to be lengthy talks over a price to be implemented in 2026. (King, 9/27)
Politico: Biden Declares Emergency For Mississippi River Saltwater Influx
The White House has issued an emergency declaration in response to a massive influx of salt water in Louisiana that has threatened drinking water supplies. In an announcement Wednesday, President Joe Biden said he would approve a disaster declaration in response to a plea from Gov. John Bel Edwards (D). The move will direct federal assistance toward state and local response efforts as Louisiana grapples with a spiraling crisis. (Crunden, 9/27)
Reuters: US Judge Blocks FTC Bid To Review Louisiana Hospital Deal
A U.S. judge on Wednesday said a hospital consolidation in Louisiana was beyond the reach of federal antitrust law, delivering a setback to the U.S. Federal Trade Commission in a clash over the scope of its power to review certain acquisitions. U.S. District Judge Lance Africk in New Orleans in a 29-page order said Louisiana's consideration and approval of the hospital transaction made it exempt from federal antitrust law. In the deal, nonprofit Louisiana Children's Medical Center acquired three hospitals from HCA Healthcare (HCA.N). (Scarcella, 9/28)
The New York Times: Peace Corps Sued Over Mental Health Policy
Searching online, Ms. Iodice discovered that her experience was not uncommon. For years, comparing notes under anonymous screen names, Peace Corps applicants have shared stories about being disqualified because of mental health history, including common disorders like depression and anxiety. The practice is the subject of a lawsuit filed this week in federal court, accusing the Peace Corps of discriminating against applicants with disabilities in violation of the Rehabilitation Act, which prohibits discrimination in programs receiving federal funds. (Barry, 9/27)
Also —
KFF Health News: Readers Rail At Social Security Overpayments And Insurers' Prior Authorizations
KFF Health News gives readers a chance to comment on a recent batch of stories. (9/28)
Elections
Second Republican Debate Included Health Care, Costs, And Trans Misinfo
The second Republican presidential debate included discussion about the health care industry, the opioid crisis, drug prices, abortion, and other hot-button topics. A false link between transgenderism and mental health disorders was also mentioned.
Stat: Republicans Aren’t Quite Done Talking About Obamacare, After All
In a far-ranging debate that touched on everything from border control issues to TikTok, Republican presidential candidates could not escape hotly contested health care cost issues. The second GOP primary debate, still missing lead candidate Donald Trump, spanned drug prices, the opioid crisis, gender affirming care, and even the notion to resurrect Obamacare repeal attempts. (Owermohle, 9/27)
Axios: Second Republican Debate Reveals Subtle Shifts On Health Policy
Republican candidates during the second GOP presidential debate Wednesday night offered some unconventionally tough talk about the health care industry, even if they failed to offer substantive policy answers. (Owens, 9/28)
Misinformation on trans matters was also heard during the debate —
The New York Times: 2nd Debate A Frenzy Of Attacks As Non-Trump Rivals Try To Shake Up Race
“Transgenderism, especially in kids, is a mental health disorder.”— Vivek Ramaswamy. This is false. Being transgender is not a mental health disorder. Many transgender people experience gender dysphoria, or psychological distress as a result of the incongruence between their sex and their gender identity. Gender dysphoria is a diagnosis in the psychiatric Diagnostic and Statistical Manual of Mental Disorders and can be given to children, adolescents or adults. (Ghorayshi, 9/27)
And abortion played a part in the discussion —
The Hill: DeSantis Calls Out Trump On ‘Terrible Thing’ Abortion Comments
Florida Gov. Ron DeSantis called out former President Trump during Wednesday’s Republican debate for calling Florida’s six-week abortion ban a “terrible thing” during an interview earlier this month. Responding to a question about his own position on abortion, DeSantis said Trump was “missing in action.” “He’s had a lot to say about that. He should be here explaining his comments to try to say that pro-life protections are somehow a terrible thing. I want him to look into the eyes and tell people who’ve been fighting this fight for a long time,” DeSantis said. (Meyn, 9/27)
Science And Innovations
Stand Up And Take Notice: All-Day Sitting Linked To Higher Dementia Risk
Older adults who spend a lot of time sitting are at higher dementia risk than those who don't, it's reported. And researchers also found that even if you exercise a lot, sitting all day at work or home worsens dementia risks. Also: studies into toxic chemicals, young adult cannabis use, and more.
The Boston Globe: Older Adults Who Sit More Have Higher Dementia Risk, Study Says
Older adults who spend a lot of time sitting could be at a heightened risk for dementia, according to a study published this month in the JAMA medical journal. “Among older adults, more time spent in sedentary behaviors was significantly associated with higher incidence of all-cause dementia,” said the study, which was released Sept. 12 and authored by researchers at the University of Southern California and University of Arizona. “Future research is needed to determine whether the association between sedentary behavior and risk of dementia is causal.” (Andersen, 9/27)
The Washington Post: Sitting All Day Increases Dementia Risk — Even If You Exercise
In news that we shouldn’t take sitting down, a study just published in JAMA finds that people who stay seated for long hours at work and home are at much higher risk of developing dementia than people who sit less. The negative effects of extended sitting can be so strong, researchers found, that even people who exercise regularly face higher risk if they sit for much of the day. (Reynolds, 9/27)
In other research and innovations news —
Stat: Study: Disparities In Harm To Children From Toxic Chemicals
Children are often exposed to harmful chemicals in air, water, soil, food, food packaging, and plastics. However, low-income children and children of color are disproportionately impacted by these exposures, according to the authors of a study that examines disparities in neurotoxic exposures and their harmful effects on children by race, ethnicity, and economic status. (Nayak, 9/27)
Stat: Study Points To New Risk In Gene Therapy Death Of Terry Horgan
Last October, a 27-year-old man with Duchenne muscular dystrophy died after receiving a CRISPR-based treatment custom built to treat his particular genetic mutation. Results of a detailed investigation released on Wednesday suggest that the patient, Terry Horgan, likely died of a previously undocumented adverse effect of the virus used to deliver the CRISPR machinery to his cells. (Mast, 9/27)
Fox News: For Autoimmune Disease Sufferers, Ginger May ‘Play A Critical Role’ In Controlling Inflammation, Study Finds
Researchers from the University of Michigan and the University of Colorado School of Medicine focused on the impact of ginger supplements on a type of white blood cell called the neutrophil. Their findings indicated that ginger supplements could even help treat people with COVID. The team that conducted the study, which was published Friday in the journal JCI Insight, was especially interested in an immune response called neutrophil extracellular trap (NET) formation. It's also known as NETosis and is linked to the inflammation that can trigger autoimmune diseases. (Rudy, 9/27)
Fox News: As Amoxicillin Shortage Continues, Prescriptions Have Plummeted, Study Finds: ‘Immediate, Sweeping Effect’
In a recent study published in the journal Pediatrics, a group of physicians from Boston Children’s Hospital determined that since the shortage began, the odds of a child being prescribed amoxicillin for ear infections have plummeted by 91%. The study included 3,076 children averaging 3 years of age who were treated at one health care provider. Most manufacturers did not share a reason for the amoxicillin shortage or provide an estimated timeframe for a resolution, the study found. (Rudy, 9/27)
CBS News: Anti-Vax Pet Parents Put Animals At Risk, Study Shows. Why Experts Say You Shouldn't Skip Your Dog's Shots
The impact of anti-vaccine activists is spreading beyond humans. A recent study found many dog owners are skeptical of vaccinating their pets — even though that leaves animals and humans at risk. "My co-authors and I were stunned by how prevalent this phenomenon is," lead author Dr. Matt Motta told CBS News. Motta says an unvaccinated pet is a danger not just to other animals but also to the humans around them. "If there are more unvaccinated dogs out there, the risk of disease transmission grows," Motta said. (Moniuszko and Bacchus, 9/27)
CIDRAP: Looking To General Practice For Clues About Long COVID
In another new study to quantify the clinical features of long COVID, or post COVID condition (PCC), authors publishing in PLoS One describe the key clinical features noted in the UK general-practice setting. Using information about symptoms recorded in primary care consultation notes, the study authors reviewed the health records of those diagnosed by a general practitioner (GP) in England during the first year of the pandemic. (Soucheray, 9/27)
Politico: Young Adult Cannabis Consumers Age Out Of Risky Use, Study Finds
Adult-use marijuana legalization in Ontario, Canada, did not have a major impact in young adults who are most at-risk for substance misuse, according to a new study published in JAMA Network Open. Among young adults in the study, those who used “cannabis frequently prelegalization showed significant reductions in use and consequences over time, reflecting an aging out pattern,” researchers wrote. (Zhang, 9/27)
NBC News: Even Short-Term Exposure To Air Pollution May Raise Risk Of Stroke, Study Finds
This past summer, wildfire smoke periodically blanketed the U.S., bringing stinging air and hazy skies to the Northeast and the Midwest, regions that are unaccustomed to the itchy eyes, scratchy throats and breathing problems that come from being downwind of such natural disasters. But with air pollution come more serious health problems, too. Among them, a meta-analysis published Wednesday in the journal Neurology finds, is exposure to air pollution that may increase a person’s risk of stroke within five days. (Sullivan, 9/27)
CIDRAP: 1 In 6 US Patients Hospitalized With 2 Flu Strains Had More Severe Outcomes
A Centers for Disease Control and Prevention (CDC)-led study finds that more than 1 in 6 US patients infected with the influenza A(H1N1)pdm09 or influenza B virus had severe in-hospital outcomes such as intensive care unit (ICU) admission or death during nine recent flu seasons. (Van Beusekom, 9/27)
Stat: New Oral Drug Delivery Patch Is Modeled After Octopus Tentacles
The story of the latest development in drug administration technology — a mouth patch that can deliver peptides and proteins without injection — begins with Chinese fondue. (Merelli, 9/27)
Stat: Researchers Use Wearables Data And AI To Predict Preterm Birth Risk
For all their potential to drive changes in health, wearables have struggled to gain a foothold in medicine. The dramatic changes during pregnancy are a fertile ground to test their potential, though — and new research shows how applying machine learning methods to streams of data from wearable devices could be used to understand the mystery of premature birth. (Palmer, 9/28)
Reuters: Newer Antibiotic Effective Against Deadly Staph Infection In Trial
An antibiotic already in use in Europe to treat pneumonia controlled deadly bloodstream infections with Staphylococcus aureus bacteria just as effectively as the most powerful antibiotic currently in use, according to data from a late-stage trial. Ceftobiprole from Swiss drugmaker Basilea Pharmaceutica (BSLN.S) appeared to be equally effective as the older drug daptomycin in the roughly one-in-four patients who had particularly difficult to treat methicillin-resistant S. aureus (MRSA) infections, researchers reported on Wednesday in The New England Journal of Medicine. (Lapid, 9/27)
NPR: Japanese Scientists Pioneer Potential Breakthrough For Infertility
Katsuhiko Hayashi, a developmental geneticist at Osaka University in Japan, is a pioneer in one of the most exciting — and controversial — fields of biomedical research: in vitro gametogenesis, or IVG. The goal of IVG is to make unlimited supplies of what Hayashi calls "artificial" eggs and sperm from any cell in the human body. That could let anyone — older, infertile, single, gay, trans — have their own genetically related babies. Besides the technical challenges that remain to be overcome, there are deep ethical concerns about how IVG might eventually be used. (Stein, 9/28)
Health Industry
CVS Promises To Boost Hiring, Avoids A Repeat Pharmacists Strike
The goal is to ease workloads of overburdened pharmacists. But the company was also sued by a small Iowa pharmacy alleging that CVS violated antitrust laws. Among other news: Google led a funding round for Midi Health; Pfizer's chief sees a "scientific renaissance" emerge as populations age; and more.
AP: CVS Responds Quickly After Pharmacists Frustrated With Their Workload Don't Show Up
CVS found the right prescription on Wednesday to keep its stores open in the Kansas City area and avoid a repeat of a work stoppage last week by pharmacists: It promised to boost hiring to ease workloads that sometimes make it hard to take a bathroom break. But it won’t be easy to resolve the problems that have been growing as pharmacists at CVS and other drug stores in the U.S. took on more duties in recent years and are gearing up to deliver this year’s latest flu and COVID-19 vaccines. (Funk, 9/28)
Bloomberg: CVS Faces Lawsuit From Local Pharmacy Alleging Unfair Fees For Dispensing Drugs
CVS Health Corp. was sued by a small Iowa pharmacy alleging that the health-care giant violated antitrust laws, the latest salvo in a conflict between independent drugstores and companies that manage drug plans for millions of Americans. Osterhaus Pharmacy Inc. said in the suit that CVS’s pharmacy benefit management unit demanded unfair fees to fill and dispense prescriptions for certain Medicare beneficiaries, putting it and other independent drugstores at a competitive disadvantage. (LaPara, 9/27)
On news on financial matters across the health industry —
Modern Healthcare: Google Ventures Leads $25M Funding Roundup For Midi Health
GV (Google Ventures) led a $25 million Series A funding round in women's health startup Midi Health, the companies said Wednesday. Midi Health, a telehealth company focused on women between the ages of 35 and 65, will use the funding to expand operations and launch additional partnerships with U.S. health systems and employers. The company's goal is to offer care in 50 states by the end of next year, said Midi Health CEO and co-founder Joanna Strober. (Turner, 9/27)
Modern Healthcare: Tendo To Buy MDSave For $150M
Tendo, a patient engagement software company, said on Wednesday it plans to acquire MDsave, a nationwide provider marketplace company, for $150 million. Tendo CEO Dan Goldsmith said the $150 million deal will be entirely financed by Tendo's balance sheet and is expected to close in October. Goldsmith said the deal will allow his company to expand product offerings for its health system customers and incorporate its platform into MDsave’s provider marketplace. (Turner, 9/27)
Modern Healthcare: Blackstone, Morgan Health, PE Firms Back Employer Tech Company
Private equity firms New Mountain Capital and Marlin Equity Partners are merging employer health tech companies Virgin Pulse and HealthComp in a $3 billion deal announced Wednesday. Virgin Pulse, a digital health navigation company for employers, is backed by Marlin Equity Partners while HealthComp, a third-party health plan administrator, is funded by New Mountain Capital. New Mountain Capital will be the majority owner of the combined entity. (Turner, 9/27)
Modern Healthcare: Intermountain's Select Health Inks UCHealth Deal
Intermountain Healthcare has struck a deal to add a third-party administrator to its Select Health insurance portfolio. The Aurora, Colorado-based nonprofit health system UCHealth sold UCHealth Plan Administrators to Salt Lake City-based nonprofit Intermountain Health for an undisclosed amount, Select Health announced Tuesday. The new owner has renamed the asset Simplified Benefits Administrators, according to a news release. (Tepper, 9/27)
The (Cleveland) Plain Dealer: Rite Aid Could Close 500 Stores Due To Bankruptcy
American drugstore chain Rite Aid could close 400- 500 of its stores due to bankruptcy, according to reports. Rite Aid has proposed closing about one-quarter of its more than 2,100 stores in bankruptcy, the Wall Street Journal reports. Rite Aid would either sell the stores or allow creditors to take control of operations. The company currently has more than $3.3 billion in debt, according to WSJ. (Mentz, 9/27)
In other industry news —
The Boston Globe: Catholic Medical Center To Explore ‘Partnership’ With HCA Healthcare
Catholic Medical Center is pursuing an agreement for its acquisition by HCA Healthcare, a for-profit healthcare provider headquartered in Nashville, Tenn., CMC leadership announced Wednesday. HCA operates 182 hospitals and 2,300 “care sites” in 20 states and the United Kingdom, according to its website. That includes three hospitals in New Hampshire: Parkland Medical Center in Derry, Frisbie Memorial Hospital in Rochester, and Portsmouth Regional Hospital in Portsmouth. (Gokee, 9/27)
Crain's Cleveland Business: Gale App Connects Northeast Ohio Nurses, Healthcare Facilities
The Gale app functions like many popular messaging platforms. Using the company’s app, facility managers post their staffing needs, and available nurses in the local area receive a notification. Nurses set their availability and can accept or decline shifts. Once a nurse takes a shift, it appears on the healthcare facility’s schedule. Tony Braswell, the company’s founder and president, said the platform’s goal is to give nurses the ability to work flexibly while also helping healthcare systems decimated by staffing shortages fill critical roles. (Bennett, 9/27)
The Boston Globe: Pfizer Chief, Visiting Boston, Sees ‘Scientific Renaissance’ Over Coming Decade
Rapid advances in biology and technology will combine with the growing health needs of an aging population to fuel a “scientific renaissance” over the coming decade, the chief executive at drug giant Pfizer told Boston business and civic leaders Tuesday. “Those two [trends], when they come together, will produce solutions that were impossible to find before,” helping to treat long-intractable diseases such as Alzheimer’s and cancer, Pfizer chief executive Albert Bourla said. (Weisman, 9/27)
Stat: Biogen Shutters Digital Health Group, Ends Apple Study, In Cost Cutting Move
Biogen, the iconic but embattled biotech firm, is shuttering Biogen Digital Health, its roughly 150-person group focused on using new types of data like those from mobile phones and smart watches, and ending a clinical trial being conducted with Apple early, STAT has learned. Biogen confirmed the organizational change, but said it might lean even more on digital tech startups in the future. (Aguilar and Herper, 9/27)
Reuters: Pharma Lobby Says EU Ban On 'Forever Chemicals' Would Halt Drug Production
European drugmakers warned that a proposed complete ban on substances known as PFAS or "forever chemicals" would render medicine production in the region impossible, part of a high-stakes wrangle between manufacturers and environmental regulators. The European Union started to consider in February a ban of the widely used but potentially harmful substances, in what could become the bloc's most extensive piece of regulation of the chemical industry. (Burger, 9/27)
Stat: Some Top Drug Companies Are Starting To Take Action On Climate
Drug companies are major contributors to climate change, both through direct greenhouse gas emissions and especially through their supply chains. But the pharmaceutical industry has lagged behind others when it comes to understanding and cutting down on its climate impact. In an exclusive analysis that ranks top companies on their efforts to combat global warming, STAT found that, with increasing pressures from investors and other stakeholders, many biotech and pharma companies are now starting to take action. (Ladyzhets, 9/28)
Modern Healthcare: Health Equity Leaders Bring DEI Initiatives To Hospitals, Classrooms
Healthcare companies promoting diversity, equity and inclusion face the twin challenges of persuading veteran clinicians to change their practices and training emerging providers to make tackling disparities an integral part of what they do. Increasingly, health systems are turning to leaders with feet in both the corporate and academic worlds to tackle this joint mission. (Hartnett, 9/27)
Axios: Charted: Medical Claims Related To Opioid Dependence
Private insurers saw the percentage of medical claims stemming from opioid dependence fall slightly from 2018 to 2022 in the United States, according to data released by FAIR Health. Opioid use and dependence accounted for about two-tenths of 1% of total claims in 2022, compared to one-quarter of 1% in 2018. (Goldman, 9/28)
LGBTQ+ Health
Montana's Ban On Youth Gender Care Blocked On Constitutional Grounds
Enforcement of the state's recently enacted ban on gender-affirming care for minors is now blocked, as Missoula County District Judge Jason Marks ruled it likely discriminates based on minors' transgender status. Separately, HHS proposed a rule to protect LGBTQ+ children in foster care.
The Hill: Montana Judge Blocks State Ban On Gender-Affirming Care For Trans Youth
Two transgender minors, their parents and two pediatric endocrinologists sued Montana in May, alleging in a lawsuit filed in Missoula County that the new law, Senate Bill 99, would violate their rights under the state constitution if it is allowed to take effect. District Judge Jason Marks granted a preliminary injunction Wednesday. He wrote in his opinion that Senate Bill 99 “is unlikely to survive any level of constitutional review” and “barring access to gender-affirming care would negatively impact gender dysphoric minors’ mental and physical health.” (Migdon, 9/27)
Reuters: Montana Judge Blocks Ban On Gender-Affirming Care For Transgender Youth
A Montana judge on Wednesday blocked enforcement of the state's recently enacted ban on gender-affirming medical care for minors, marking the latest ruling nationally in battles over state restrictions on treatments for transgender youth. Missoula County District Judge Jason Marks ruled that the law likely discriminated based on minors' transgender status and infringed on their privacy rights in violation of Montana's constitution. (Trotta and Raymond, 9/27)
Missouri Independent: Missouri Families Feel Duped As Health Providers Halt Trans Care
Harry Castilow said his family did “all the things you’re supposed to do” when his teenage son Jay came out as transgender. Jay began his social transition in 2021 when he was 15, choosing his name and living as a teenage boy. He went to therapy throughout that first year and got appointments with a new primary-care doctor and an endocrinologist, a doctor that specializes in hormones. (Hanshaw, 9/27)
Meanwhile, moves are made to protect LGBTQ+ foster children —
AP: New Rules Aim To Make Foster Care With Family Easier, Provide Protection For LGBTQ+ Children
The Biden administration is moving to make it easier for caregivers to take in family members in the foster care system, requiring states to provide them with the same financial support that any other foster home would receive. It also proposed a new regulation aimed at ensuring that LGBTQ+ children are protected in their foster homes from mistreatment due to their sexual orientation or gender identity. (Murphy, 9/27)
Politico: HHS Proposes Rule To Protect LGBTQ Foster Kids
HHS proposed a rule Wednesday that would require states’ child welfare agencies to train foster parents in providing for LGBTQ children in their care. The proposal, part of a slate of actions the Biden administration took Wednesday to expand the child welfare system, follows an executive order signed last year amid a rise in anti-LGBTQ state laws. (Cirruzzo, 9/27)
And some new Medicare Advantage plans are aimed at LGTBQ+ people —
KFF Health News: New Medicare Advantage Plans Tailor Offerings To Asian Americans, Latinos, And LGBTQ+
As Medicare Advantage continues to gain popularity among seniors, three Southern California companies are pioneering new types of plans that target cultural and ethnic communities with special offerings and native-language practitioners. Clever Care Health Plan, based in Huntington Beach, and Alignment Health, based in nearby Orange, both have plans aimed at Asian Americans, with extra benefits including coverage for Eastern medicines and treatments such as cupping and tui na massage. Alignment also has an offering targeting Latinos, while Long Beach-based SCAN Health Plan has a product aimed at the LGBTQ+ community. All of them have launched since 2020. (Stephens, 9/28)
State Watch
Death In Colorado Linked To The Plague
After the death of an Archuleta County resident, officials stressed the disease is very rare but that people should take precautions when interacting with some animals. Meanwhile, in New York, "ghost" guns were found in a day care site. Other news is from Texas, Florida, and elsewhere.
CIDRAP: Colorado Reports Fatal Plague Infection
Health officials in Colorado this week announced a fatal plague infection in a resident of Archuleta County, located in the southwest corner of the state. San Juan Basin Public Health (SJBPH) said an investigation is underway. It said it monitors prairie dog die-offs to track potential plague threats, and it urged area residents to report the sudden disappearance of active prairie dog colonies. "Residents should not eradicate or kill prairie dogs on their property as this increases the risk of exposure to plague-infested fleas," SJBPH said. (Schnirring, 9/27)
Kansas City Star: Death In Colorado Linked To Case Of Plague: Health Agency
A death in Colorado has been linked to a case of the plague, health officials said. Laboratory tests confirmed the death of an Archuleta County resident was associated with the plague, according to a Sept. 25 news release from the San Juan Basin Public Health. The health department said the “disease is very rare” but the public should be informed on what precautions to take in regards to people’s interactions with animals. (Chavez, 9/26)
In news from New York —
The New York Times: ‘Ghost’ Guns Found At East Harlem Day Care Site, Officials Say
An East Harlem apartment functioning as a state-licensed day care site was being used by the son of the site’s operator to produce 3-D-printed “ghost” guns and parts for them, officials said on Wednesday. It was the second time this month that a lethal hazard had been found at a home-based day care in New York City. On Sept. 15, a 1-year-old boy died of suspected fentanyl poisoning at a Bronx apartment where the potent drug was discovered near nap mats and under the floor. (Shanahan and Otterman, 9/27)
The Wall Street Journal: Fight To Save A New York Birth Center Tests State Law
When a medical system submitted a plan in June to close Samaritan Hospital’s maternity ward here—just two days before a state law requiring an independent assessment of such closures went into effect—a group of women who call themselves the “Burdett moms” went to work. (Qi, 9/27)
In other health news from across the country —
The Texas Tribune: 900,000 Texans Have Lost Medicaid
Almost 900,000 Texans have lost Medicaid since April and a backlog of applications has piled up, overwhelming the system and setting off a ripple effect that advocates worry is delaying families’ access to SNAP food benefits. (Bohra, 9/28)
CBS News: Rise Of Health Insurance Costs Has Raised Anxiety Among Some In South Florida
First it was home insurance. Then it was auto insurance. And now some South Floridians could see a dramatic rise in their health insurance costs. Industry analysts are predicting a big rise in health insurance costs in 2024. Open enrollment for health plans will open shortly and the true costs will become apparent. For private health insurance offered by many companies, worker premiums could go up anywhere from 5 to 20 percent, according to health insurance experts. (Murray, 9/27)
The Boston Globe: Jason And Keely Krantz Make Big Cancer Research Donation To MGH
Massachusetts General Hospital has received the largest gift for cancer research in its history, officials said Wednesday. In a statement, the hospital said the gift is from Jason and Keely Krantz and the hospital’s Center for Cancer Research will be known as the Krantz Family Center for Cancer Research. The hospital didn’t disclose the amount of the donation but said it includes annual funding for collaborative research projects, advanced technologies for lab research, and “an endowment to ensure sustainability.” (Andersen, 9/27)
Tampa Bay Times: 6 People Died By Suicide In The Aftermath Of Hurricane Ian. Experts Fear More
In the aftermath of disaster, beyond the toppled buildings, twisted street signs and billions of dollars in repairs, communities have to reckon with another, insidious harm: the burden on mental health. Research has found that up to half of people who live through a disaster struggle with anxiety and depression, substance use or posttraumatic stress disorder, said Jennifer Horney, an epidemiology professor at the University of Delaware who studies the effects of catastrophe on health. The result is often an increase in suicides. (Peace, 9/27)
Politico: Reference-Based Health Pricing Pilot Vote For Public Workers Delayed To October
A committee of state and labor officials on Wednesday delayed a vote to implement a reference-based pricing pilot program on the state’s public worker health insurance. Members of the State Health Benefits Plan Design Committee, which oversees components of the health plan for public-sector employees, voted to instead address the matter at its meeting scheduled for Oct. 27. (Han, 9/27)
CBS News: New Simulation Center At Regions Hospital Uses AI To Train Thousands Of Health Care Workers
A new 7,000-square-foot HealthPartners Institute Clinical Simulation Center at Regions Hospital is now open and finding high-tech ways to train their employees. … Made possible in part by donors, the $5 million project is aimed at enhancing training for health care workers across Minnesota and Wisconsin using AI. The goal is to train employees to deal with complex medical scenarios by using tools like virtual headsets, three-dimensional printing and high-fidelity mannequins. (9/27)
The Philadelphia Inquirer: Philly Mayor Jim Kenney Vetoes Bill That Prohibits Supervised Injection Sites In Most Of The City
Mayor Jim Kenney plans to veto legislation that prohibits supervised drug consumption sites across most of Philadelphia, writing in a letter to City Council that the bill is “troublingly anti-science and misleading.” Kenney’s move will send the bill back to Council, which passed the legislation earlier this month, 13-1. Overriding a mayoral veto requires a two-thirds vote, so Council is poised to make the legislation law during its scheduled meeting Thursday. (Whelan and Orso, 9/27)
Axios: No Link Between Decriminalizing Drugs And Overdose Deaths, Study Finds
When Washington and Oregon lowered criminal penalties for drug crimes two years ago, it didn't lead to a sudden rise in overdose deaths in either state, a new study finds. Critics have tied the states' more lenient approaches to drug crimes to recent rises in overdose deaths. But the researchers found no apparent connection. (Santos, 9/27)
WUSF Public Media: New Clinic Expands Access To Opioid Addiction Treatment In Citrus County
Previously, Citrus residents had to travel to other counties in the region to access drugs like methadone, which can reduce opioid cravings and withdrawal symptoms in patients. (Colombini, 9/27)
The 19th: Sandy Hook Parents Focus On Gun Control Education, School Safety Training
Mark Barden describes his then-7-year-old son Daniel as having had a “profound sense of compassion. He literally looked out for everybody. He wanted to make sure everyone was okay.” When the family would take walks together, Daniel would pick up worms he saw on the sidewalk and move them to safety, tucking them between the blades of grass to try to keep them out of harm’s way. It was actions like these that earned him his family nickname, “The Caretaker of All Living Things.” (Gerson, 9/27)
Axios Richmond: Average Emergency Room Wait Time Is Getting Longer In Virginia
The median time Virginians spent in emergency rooms was 2 hours, 52 minutes last year — the longest in a steady increase from pre-pandemic times, according to the latest Centers for Medicare and Medicaid Services data. Time spent in the ER is a key metric for tracking hospital performance. (Fitzpatrick, 9/27)
Health Policy Research
Research Roundup: Antibiotic Resistance; Cancer; Genetic Risk-Scoring; Parkinson's
Each week, KFF Health News compiles a selection of recently released health policy studies and briefs.
CIDRAP: Study Suggests Poor Environmental Controls May Aid Spread Of Resistant Pathogens
A new study by an international team of researchers suggests that in countries where people and livestock live in proximity and use many of the same antibiotics, inadequate sanitation and environmental controls could be aiding the spread of antibiotic-resistant pathogens. (Dall, 9/27)
ScienceDaily: How A Small Strand Of RNA Is Key To Fighting Cancer
A team of researchers has shown that a single, small strand of microRNA, or miRNA, known as let-7, governs the ability of T-cells to recognize and remember tumor cells. This cellular memory is the basis for how vaccines work. Boosting cellular memory to recognize tumors could help improve cancer therapies. The research suggests a new strategy for the next generation of cancer-fighting immunotherapies. (University of Massachusetts Amherst, 9/25)
ScienceDaily: New Method Can Improve Assessing Genetic Risks For Non-White Populations
A team led by researchers has developed a new algorithm for genetic risk-scoring for major diseases across diverse ancestry populations that holds promise for reducing health care disparities. (Johns Hopkins Bloomberg School of Public Health, 9/25)
NPR: A Gene Variant Raises The Risk Of Parkinson's For Some People Of African Descent
A global effort to make genetic studies more diverse has led to a discovery about Parkinson's disease, a common brain disorder that can impair a person's ability to move and speak. A team that included scientists from Lagos, London and the U.S. found a previously unknown gene variant that can nearly quadruple the risk of Parkinson's for people of African ancestry. (Hamilton, 9/24)
Editorials And Opinions
Viewpoints: Americans Should Focus On Health Span Versus Life Span; Hospital Prices Are Clear As Mud
Editorial writers discuss living a long, healthy life, hospital price transparency, health care innovation and more.
The New York Times: America’s Next Public Health Moonshot Should Tackle Health Spans
When I ask my patients about their long-term health goals, they seldom say they want to live to be 100. Instead they talk about aging with independence and dignity, being free from aches and pains or having the strength to play with their grandchildren. “I’d just like to blow out the candles on my birthday cake without coughing,” a 60-something patient suffering from emphysema told me. (Dave A. Chokshi, 9/28)
Bloomberg: Hospital Prices Are Too High, And Transparency Is The Cure
It is hard to get a straight answer about prices for medical procedures in the US, unlike in much of the rest of the world. The US also has some of the world’s highest health-care costs, in part due to insufficient competition. (Tyler Cowen, 9/27)
Newsweek: Will Amazon And Walmart Replace Our Hospitals?
The U.S. remains a bastion for health care innovation. We grow organs in labs, surgeons use augmented reality, and the Biden administration launched the Cancer Moonshot to reduce the death rate by 50 percent. So why are Americans getting sicker? (Derek Streat, 9/27)
Modern Healthcare: Maternal Mortality Is A Battle We Can Win
Maternal mortality remains a health crisis in the U.S., where in 2021 the maternal mortality rate was 32.9 deaths per 100,000 live births, according to Centers for Disease Control and Prevention data released this year. That’s up from 23.8 in 2020 and 20.1 in 2019. (Dr. Sean Tedjarati, 9/28)
Bloomberg: Long Covid Is Real. Now The Evidence Is Piling Up
Finally, the hunt for answers about long Covid is yielding some clues. A new study, led by the Icahn School of Medicine at Mount Sinai and the Yale School of Medicine and published in Nature, defines some critical differences in certain biomarkers of people with long Covid. The next step is even more critical: coming up with a way to cure them. (Lisa Jarvis, 9/27)
Stat: Stop Congress From Blocking Public Access To Science
Have you ever needed to read a research paper, only to find it was locked behind a paywall? Your next step was likely to search on Sci-Hub, an illegal repository created by Kazakh graduate student Alexandra Elbakyan, that provides free access to millions of research papers. While Sci-Hub is controversial, its widespread use points to a crucial question: Shouldn’t taxpayer-funded research be freely and immediately accessible to the public? We’re finally close to achieving this vision — so long as Congress doesn’t stand in the way. (Mayank Chugh and Jessica Polka, 9/28)
The Baltimore Sun: With Medical Mistakes On The Rise, Maryland Needs A Long-Term Plan To Boost Hospital Staffing
The latest findings on hospital patient safety in Maryland shows an alarming increase in what are termed “events” or, in plain English, medical mistakes that can (although not always) result in a patient’s death or serious disability. For close to two decades, Maryland hospitals have been required to track these errors with an eye toward making them less frequent. In the recent report from the Maryland Department of Health’s Office of Health Care Quality, a dangerous multi-year trend continues: The number of adverse events has continued to rise since the COVID-19 outbreak began. They have gone from fewer than 300 annually in 2019 to more than 800 in Fiscal Year 2022 (which ended June 30, 2022). (9/27)
Scientific American: The Complete Human Y Chromosome Marks An Opportunity To Move Away From Stigma
Early studies of the Y chromosome were tinged with eugenics. Some of the first studies of inheritance linked to this chromosome were conducted in 1922 by geneticist and eugenicist William E. Castle, who pointed to the inheritance of webbed toes as an example of a Y-linked trait. In the following decades, many other scientists ventured to connect the Y to an array of problematically framed human traits. (Christopher R. Donohue and Anna Rogers, 9/27)
The New York Times: People In Their 20s Aren’t Supposed To Be This Unhappy
The data come from the Behavioral Risk Factor Surveillance System surveys of the C.D.C. One question asks, “Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?” The percentages in these charts are for people who answered 30 out of 30 — no good days at all. Blanchflower terms that “despair.” (Peter Coy, 9/27)
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