1 big thing: GOP lawmakers expand gender-affirming care restrictions to adults

2. Congress eyes "zombie drug" designation

3. FDA advisers to weigh OTC birth control

4. Quote du jour: Baby formula problems not fixed 

5. Catch up quick

Happy Wednesday, Vitals readers. Today's newsletter is 851 words or a 3-minute read.

💻 Tune in today: Axios' second annual What's Next Summit kicks off this morning at 8:10am. Register to livestream the event here.

Thanks for reading, and thanks to senior health care editor Adriel Bettelheim and senior copy editor Bryan McBournie for the edits.

Plus, FDA to eye OTC birth control hearing scheduled

Vitals

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Keep up with health care politics, policy and business

Axios Vitals

1 big thing: The quiet privatization of government health insurance programs

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2. FDA proposes overhaul of cancer drug fast-track

3. Ohio sues big pharmacy benefit managers

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4. Data du jour: Female docs face family "penalty"

Good morning, Vitals readers. Today's newsletter is 1,004 words or a 4-minute read.

🎺 Tune in tomorrow: Axios' second annual What's Next Summit is happening all day tomorrow, March 29, starting at 8:10am ET! 

Check out our day-of agenda, including interviews with music producer Timbaland and Whole Foods Market CEO Jason Buechel. Register to livestream the event here. 

🏀 1 last thing: Turns out, sports may just be good for the soul — at least when you catch the game in person, Axios' Kendall Baker writes. New research has found that attending live sporting events improves levels of well-being and reduces feelings of loneliness.

💰 Plus, family penalty hits female docs' pay hard

1 big thing: Social media companies under fire

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2. What labor shortage?

3. Dem lieutenant governors align on abortion rights

4. Food insecurity and cognitive decline

5. Financial incentives and addiction treatment

6. While you were weekending

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Good morning, Vitals readers. Today's newsletter is 1,046 words or a 4-minute read.

📆 Axios' second annual What's Next Summit is this Wednesday, March 29, in Washington, D.C.! 

Among the speakers: White House Office of Science and Technology Policy director Arati Prabhakar, CVS Health CEO Karen Lynch and more on the issues and innovations shaping our future. Register to livestream the event here.

1 big thing: Transplant breakup

Illustration of an organ transplant cooler as a toolbox filled with tools

2. FDA advisers give partial backing to ALS drug 

3. Nearly half of Americans live with obesity

4. Quote du jour: What the market will bear

Good morning, Vitals readers. Today's newsletter is 8765 words or a 3½-minute read.

💻 Tune in: Join me and Axios' Adriel Bettelheim today at 8am ET in Washington, D.C., for an event exploring how the U.S. can improve its public health preparedness. 

Guests include HHS Assistant Secretary Dawn O'Connell, the Bipartisan Commission on Biodefense executive director Asha George, and Johns Hopkins Center for Health Security director Tom Inglesby. Register here to livestream the event or attend in person.

🙉 1 last thing: A new study published in JACC: Advances found road noise can make your blood pressure rise — literally. 

The study found an association between long-term exposure to road traffic noise and the incidence of hypertension, with a stronger effect when also associated with air pollution.

1 big thing: State public option plans keep hitting obstacles

2. Why America was uniquely vulnerable to COVID

3. N.C. lawmakers approve Medicaid expansion

4. Utah passes law limiting kids' social media use


5. Dog of the week

😎 Happy Friday, Vitals readers. Today's newsletter is 994 words or a 4 minute read.

😃 1 last thing: Turns out, the chattiest coworkers can be found in the healthcare industry, according to a survey of about 1,000 Americans by the e-learning platform Preply. Now, what specialties do we think they're talking about?

Atlanta

Georgia saw the 9th-highest adjusted COVID death rate, according to an analysis published by The Lancet.

Zoom out: D.C., Arizona and New Mexico saw the three-worst rates, Axios' Tina Reed writes.

Why it matters: The paper is among the first deep dives to explore the social and economic factors at play during the pandemic.

Between the lines: The analysis found states with more mandates, such as those that encouraged mask use, mobility restrictions and vaccination — and kept them longer — experienced lower infection rates.

But, the authors said, only vaccine coverage had a strong association with the state-by-state variation in COVID death rates.

Of note: 59% of Georgians have received two vaccine doses. But just 27% have received the recommended four.

The better news: Hawaii had the lowest adjusted COVID death rate with 147 COVID deaths per 100,000 people. It was followed by New Hampshire (215 per 100,000) and Maine (281 per 100,000).

"Our study suggests that the policy mandates and protective behaviors adopted in this pandemic were effective in reducing SARS-CoV-2 infections but might have been associated with employment and educational trade-offs," the authors wrote.

Flashback: Georgia Gov. Brian Kemp faced much criticism in the spring of 2020, including from the Trump White House, for pushing to ease restrictions and reopen some of the state's businesses earlier than most other states. He's consistently defended his decisions as protecting "lives and livelihoods."

Georgia has the 9th-highest COVID death rate

That's according to an analysis published by The Lancet.

COVID-19

Georgia saw the 9th-highest adjusted COVID death rate, according to an analysis published by The Lancet.Zoom out: D.C., Arizona and New Mexico saw the three-worst rates, <a class="gtmContentClick" data-vars-link-text="Axios&#x27; Tina Reed writes." data-vars-click-url="https://www.axios.com/2023/03/24/why-america-uniquely-vulnerable-covid" data-vars-item="in_content_link" href="https://www.axios.com/2023/03/24/why-america-uniquely-vulnerable-covid" target="_self">Axios&#x27; Tina Reed writes.</a>

COVID

National

The pandemic experience varied sharply from state to state, with some of the highest adjusted death rates reported in Arizona, the District of Columbia and New Mexico, according to an analysis published in The Lancet.

Why it matters: It's among the first deep dives to explore the social and economic factors at play during the pandemic in the U.S., and found a nearly four-fold variation in COVID infection and death rates between states.

What they're saying: "What is clear from our study is that COVID-19 exploited and compounded existing local racial inequities, health disparities, and partisan politics," co-lead author Thomas J. Bollyky, director of the Council on Foreign Relations' Global Health Program in the USA, said in a statement. The combination of local factors increased the burden of disease and the likelihood of poor outcomes, he said.

By the numbers: States with higher poverty, lower rates of educational attainment, less access to quality health care and lower levels of interpersonal trust saw disproportionately higher rates of COVID infections and deaths. 

When adjusting the data to account for age and comorbidities, Arizona saw the highest COVID death rate (581 deaths per 100,000 people) in the nation. Washington, D.C. (526 per 100,000) and New Mexico (521 per 100,000) were the second and third worst.

On the flip side, Hawaii had the lowest adjusted COVID death rate with 147 COVID deaths per 100,000 people. It was followed by New Hampshire 215 per 100,000) and Maine (281 per 100,000), respectively.

The big picture: Previous studies have connected state politics with better or worse COVID outcomes or honed in on racial disparities links to poorer outcomes.

But this study offers a more nuanced view of how the combination of factors made certain states more vulnerable than others. For example, the analysis found no association between the political affiliation of the state governor and death rates. But one key predictor of infections and total COVID deaths was the share of people that voted for President Trump in the 2020 presidential election.

Researchers also considered the benefits of protective measures like mandates against their harms, such as lost employment and drops in test scores.

"Our study suggests that the policy mandates and protective behaviours adopted in this pandemic were effective in reducing SARS-CoV-2 infections but might have been associated with employment and educational trade-offs," the authors wrote, adding the tradeoffs warrant study that could inform future protective measures. 

"The more robust a health system, the better a state performed in the pandemic, but only in states where the public was willing to make use of health care services for vaccination or to get early treatment for their conditions," senior author Joseph Dieleman, an associated professor from Institute for Health Metrics and Evaluation, said in a statement.

Between the lines: The analysis found states with more mandates, such as those that encouraged mask use, mobility restrictions and vaccination — and kept them longer — experienced lower infection rates. 

But, they said, only vaccine coverage had a strong association with the state-by-state variation in COVID death rates.

"Ultimately our public health policies seem capable of preventing transmission, but other societal factors like poverty, education attainment, and access to high-quality healthcare might have muddled the response and led to death rates being highest in some states that didn't have tremendously high infection rates," the authors wrote.

Why America was uniquely vulnerable to COVID

The pandemic experience varied sharply from state to state, according to an analysis published in The Lancet.

Health

From IT failures that cost patients a chance at a life-saving organ to doctors salvaging kidneys from a battered box with tire tracks on it, the nation's organ transplant system has come to be defined by harrowing anecdotes. Not to mention inequities and mismatched supply and demand.

Driving the news: After years of complaints from transplant surgeons and patient advocates, the Biden administration is breaking up the monopoly held for nearly four decades by the non-profit United Network for Organ Sharing (UNOS).

The federal plan would open the system up to competitive bidding and make an immediate priority of upgrading the computer system which matches patients and organs.

The overhaul follows scathing reports from the National Academies of Sciences, Engineering, and Medicine and the White House's U.S. Digital Service, as well as a congressional probe that last year raised alarms about long wait times, disparities, creaky infrastructure, and organs lost in transit.

 What they're saying: "The announcement to break up the national organ monopoly is a huge win for patients," Jennifer Erickson, a senior fellow at the Federation of American Scientists who served in the Obama White House Office of Science and Technology Policy working on organ donation policy, told Axios.

She called a Senate Finance Committee investigation, which blamed transplant screening mistakes for 70 deaths and another 249 patients developing diseases, "damning." UNOS' "failures have led to thousands of unnecessary patient deaths, which fall disproportionately on patients of color," she said.

The big picture: More than 100,000 people are awaiting organ transplants in the U.S. with about 117 transplants a day, per UNOS. The organization, which Congress created in 1984 and works with local procurement groups, marked its 1 millionth transplant last fall. 

There are about 90,000 people waiting for kidneys, about 11,000 waiting for livers, about 3,400 waiting for hearts and about 1,000 waiting for lungs, UNOS data shows.

With about 5,000 a people a year dying on waiting lists, advocates argue the number of transplants — particularly hearts or lungs that have smaller waiting lists — could be much higher. About one in five kidneys from deceased donors are not used, per the National Academies report.

"If we had a fully effective system, we could actually fully service the waiting list for hearts, lungs and livers within a couple of years," said Greg Segal, co-founder of Organize, a non-profit patient advocacy group focused on increasing the number of transplantable organs. His father waited five years for a heart transplant and his aunt died while awaiting a transplant.

"The idea that there is meaningful competition to not only replace UNOS, but ensure that any contractor or contractors that operate in this system understand there is true accountability for performance and always feel that pressure, is crucial," he told Axios.

The other side: "We welcome a competitive and open bidding process," UNOS said in a statement. "We believe we have the experience and expertise required to best serve the nation’s patients and to help implement HRSA's proposed initiatives." 

What we're watching: Health Resources and Services Administration chief Carole Johnson told the New York Times she envisions multiple bidders for different transplant system tasks with her agency setting the standards.

It's unclear whether Congress will go along with President Biden's bid to fund the changes with $67 million.

It's also unclear whether they'll back legislative proposals to remove an appropriations cap on the Organ Procurement and Transplant Network contracts to help expand the pool of entities eligible to compete.

Long-troubled transplant system to get an overhaul

The Biden administration announced Wednesday it would make some changes to the U.S. transplant network.

Congress

From IT failures that <a class="gtmContentClick" data-vars-link-text="cost patients a chance at a life-saving organ" data-vars-click-url="https://www.washingtonpost.com/health/2022/07/31/unos-transplants-kindeys-hearts-technology/" data-vars-content-id="248f7809-3c20-44d6-82c7-cf0d83b4d020" data-vars-headline="Long-troubled transplant system to get an overhaul" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.washingtonpost.com/health/2022/07/31/unos-transplants-kindeys-hearts-technology/" target="_blank">cost patients a chance at a life-saving organ</a> to doctors salvaging kidneys from a <a class="gtmContentClick" data-vars-link-text="battered box with tire tracks on it" data-vars-click-url="https://www.npr.org/sections/health-shots/2022/08/17/1118009567/damaged-and-diseased-organs-the-agency-overseeing-transplants-faces-intense-scru" data-vars-content-id="248f7809-3c20-44d6-82c7-cf0d83b4d020" data-vars-headline="Long-troubled transplant system to get an overhaul" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.npr.org/sections/health-shots/2022/08/17/1118009567/damaged-and-diseased-organs-the-agency-overseeing-transplants-faces-intense-scru" target="_blank">battered box with tire tracks on it</a>, the nation&#x27;s organ transplant system has come to be defined by harrowing anecdotes. Not to mention inequities and mismatched supply and demand.Driving the news: After years of complaints from transplant surgeons and patient advocates, the Biden administration <a class="gtmContentClick" data-vars-link-text="is breaking up the monopoly" data-vars-click-url="https://www.hrsa.gov/organ-procurement-transplantation-modernization" data-vars-content-id="248f7809-3c20-44d6-82c7-cf0d83b4d020" data-vars-headline="Long-troubled transplant system to get an overhaul" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.hrsa.gov/organ-procurement-transplantation-modernization" target="_blank">is breaking up the monopoly</a> held for nearly four decades by the non-profit United Network for Organ Sharing (UNOS).

Social media companies are increasingly being blamed for historically high rates of depression, suicidality and other mental health issues in youths. And now, states and local governments are increasingly pursuing legislation and legal action.

Driving the news: Utah just passed a law limiting social media for minors and school districts in Seattle and San Mateo County, California, are suing leading platforms, charging they're delivering harmful content to kids. 

It comes just as Congress ratcheted up pressure for a ban on TikTok for, among other things, the harmful impact it's had on kids. 

The Biden administration's surgeon general, Vivek Murthy, weighed in last month, telling CNN that age 13 is "too early" for kids to join social media.

"Multiple juries are in. They're all reaching the same conclusion," Jonathan Haidt, a social psychologist at New York University Stern School of Business told the Financial Times. "When social media or high-speed internet came in, [studies] all find the same story which is mental health plummets, especially for girls." 

Multiple studies — including some of the companies' own internal research —have linked social media use with increased depression among teens.

A December report from the Center for Countering Digital Hate which focused on TikTok found the platform began recommending eating disorder and self-harm content to new teen accounts within eight minutes of use.

Research published by the American Psychological Association last month found teens and young adults who cut social media use by 50% for a few weeks saw significant improvement in how they felt about both their weight and their overall appearance compared with their peers.

The big picture: There are nearly 150 product liability lawsuits filed in the U.S. against the social media platforms Facebook, Instagram, TikTok, Snapchat and YouTube, per the Financial Times.

A growing number of school districts and municipalities are among those filing suit, Axios' Jennifer A. Kingson reported.  

Among them, the San Mateo County School Board last week expanded an existing suit against social media companies to include Meta, the parent company of Facebook and Instagram, Bloomberg reported. Bucks County, Pennsylvania, filed its own lawsuit in mid-March, seeking financial damages for rising mental health costs for young people, the Philadelphia Inquirer writes.

Arkansas and Texas are also eyeing laws like Utah's limiting social media use. California previously passed a law requiring online services to install certain safeguards for users under 18, the New York Times reported.

Members of Congress have promised further regulation of social media companies, and last month, Rep. Chris Stewart (R-Utah) introduced a bill to ban social media use for kids younger than 16.

Many of the suits are built around concern about the way platforms feed targeted content to keep kids online longer, fueling negative self-image, exposing them to self-harm content and enabling bullying.

Yes, but: Oftentimes, concerns over the harms of social media seem designed to generate headlines, Wired writes, and may obscure other factors bothering kids, including the role of the pandemic and the bitterly partisan national political debate.

"Talking about the harms platforms can have on children often feels less like genuine concern and more like an attempt to capture attention by focusing on some of the most salient fears for American parents," per Wired's Vittoria Elliott. 

Civil liberties and tech advocates have raised an alarm that important privacy concerns could be tossed aside amid efforts to require identity and age verification as part of new restrictions, both The Guardian and Vox reported.

And some research has found that some use of social media benefits teens' social connections, NPR reports.

What we're watching: How social media companies will seek to deflect some of the heat by adopting more controls or restrictions on youths' time online — and whether we'll be able to measure how much any single effort to curb their use will impact anxiety, depression and thoughts of self-harm in kids.

If you or someone you know needs support now, call or text 988 or chat with someone at 988lifeline.org. En Español.

linked social media use with increases in depression

ban social media use for kids younger than 16

Pushback grows over mental health impacts of social media

Social media companies are increasingly coming under fire for their role in fueling an epidemic of mental health crises among teens and children that have resulted in historically high rates of poor mental health, depression and suicidality.

Social media

Social media companies are increasingly being blamed for <a class="gtmContentClick" data-vars-link-text="historically high rates" data-vars-click-url="https://www.cdc.gov/healthyyouth/data/yrbs/pdf/YRBS_Data-Summary-Trends_Report2023_508.pdf" data-vars-content-id="725a3b27-1513-4b62-84d1-7b8c49959d25" data-vars-headline="Pushback grows over mental health impacts of social media" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.cdc.gov/healthyyouth/data/yrbs/pdf/YRBS_Data-Summary-Trends_Report2023_508.pdf" target="_blank">historically high rates</a> of depression, suicidality and other mental health issues in youths. And now, states and local governments are increasingly pursuing legislation and legal action.Driving the news: Utah just <a class="gtmContentClick" data-vars-link-text="passed a law limiting social media" data-vars-click-url="https://www.axios.com/2023/03/24/utah-limit-kids-social-media" data-vars-content-id="725a3b27-1513-4b62-84d1-7b8c49959d25" data-vars-headline="Pushback grows over mental health impacts of social media" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.axios.com/2023/03/24/utah-limit-kids-social-media" target="_self">passed a law limiting social media</a> for minors and school districts in Seattle and San Mateo County, California, <a class="gtmContentClick" data-vars-link-text="are suing leading platforms" data-vars-click-url="https://www.mercurynews.com/2023/03/24/meta-sued-by-its-home-county-over-social-media-addiction/" data-vars-content-id="725a3b27-1513-4b62-84d1-7b8c49959d25" data-vars-headline="Pushback grows over mental health impacts of social media" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.mercurynews.com/2023/03/24/meta-sued-by-its-home-county-over-social-media-addiction/" target="_blank">are suing leading platforms</a>, charging they&#x27;re delivering harmful content to kids.

Little has been done within the Food and Drug Administration to prevent a repeat of last year's infant formula crisis, a former food safety official told a House oversight hearing on Tuesday.

Driving the news: While the direct blame falls on Abbott Laboratories for safety issues that took a key Michigan plant offline, failures by the FDA exacerbated the massive disruptions that ensued, Frank Yiannas, a former deputy commissioner of the FDA's Office of Food Policy and Response, told the House Oversight and Accountability health subcommittee.

What they're saying: "The state of the infant formula industry today is not much different than it was then," Yiannas said, pointing to an inadequate public health surveillance system and safeguards that haven't changed. He also noted the infant formula supply chain "continues to lack serious resiliency." 

"In other words, the nation remains one outbreak, one tornado, flood or cyber-attack away from finding itself at a similar place," he said.

During the hearing, Republicans on the panel focused on missteps by the Biden administration FDA while Democrats pointed to shortcomings of the FDA's budget and regulatory powers.

Yiannas pointed to longstanding concerns within the FDA's organizational structure, as well as concerns that formula-makers don't have to report if they uncover evidence of the bacterium Cronobacter sakazakii which officials say "may have contributed" to the formula problems.

Catch up quick: The facility was temporarily shut down last year after Abbott Nutrition — one of the largest suppliers of baby formula in the U.S. — recalled multiple major brands on reports of bacterial infections among several babies who consumed the product. 

The monthlong closure caused a ripple effect across the country, Axios' Shawna Chen wrote.

An FDA report found that conditions at the Michigan plant "were not consistent with a strong food safety culture," including inadequate hand-washing practices and evidence of previous bacterial contamination.

Abbott Nutrition later reached an agreement with the FDA to reopen the Sturgis, Michigan, facility. The Justice Department is investigating Abbott and the plant.

The big picture: The FDA has since released an internal investigation and commissioned an independent probe that concluded cultural and organizational problems within the FDA fed the crisis.

FDA commissioner Robert Califf has since laid out a restructuring plan within the agency under a new deputy commissioner for human foods.

Yiannas called Califf's plan "well-intentioned" but said it didn't go as far enough to reinstate the authority FDA deputy commissioners once had over the food program. 

“It’s been referred to as a new foods program vision," he said. "A vision and strategy are very different than an organizational structure. It’s a reorg. You need a strategy first and then you need a structure to support that strategy."

What we're watching: The fallout from yet another infant formula recall, this time by Perrigo Co., announced last week because it might be contaminated with bacteria.

Subcommittee Chair Lisa McClain, (R-Mich.) said FDA officials have been invited to a follow-up hearing on April 19.

under a new deputy commissioner for Human Foods

Former FDA official on baby formula: Not much has been fixed

More than a year since the baby formula recall that sparked a shortage and fears among parents about finding safe nutritional options for infants, a former FDA food safety official said little has been done to ensure the crisis won't happen again.

Frank Yiannas, former deputy commissioner of the office of food policy and response at the FDA. Photo: Ting Shen/Bloomberg via Getty Images

Food and Drug Administration (FDA)

Little has been done within the Food and Drug Administration to prevent a repeat of last year&#x27;s infant formula crisis, a former food safety official told a House oversight hearing on Tuesday.Driving the news: While the direct blame falls on Abbott Laboratories for safety issues that took a key Michigan plant offline, failures by the FDA exacerbated the massive disruptions that ensued, Frank Yiannas, a former deputy commissioner of the FDA&#x27;s Office of Food Policy and Response, told the House Oversight and Accountability health subcommittee.

Tina Reed

Stories

Former FDA official on baby formula: Not much has been fixed

Georgia has the 9th-highest COVID death rate

Pushback grows over mental health impacts of social media

Why America was uniquely vulnerable to COVID

Long-troubled transplant system to get an overhaul

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Axios Vitals: Zombie drugs

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📲 Axios Vitals: Social status

Axios Vitals: Public option woes

🫀 Axios Vitals: Transplant breakup