Axios Vitals

A briefcase with a red cross on the front.

December 18, 2019

Good morning. Remember when I predicted there would be a lot of news this week? Point for me, I was right.

Today's word count is 670, or a 2.5-minute read.

1 big thing: Inside the bitter feud at Trump's health agencies

Illustration of a doctor wearing a red tie, with his arms crossed over his chest his stethoscope tied in knots

Illustration: Sarah Grillo/Axios

When Alex Azar took over as Health and Human Services secretary, he was advised not to meet one-on-one with Seema Verma, one of his most important deputies. HHS staff said Verma was difficult to work with and quick to level accusations of sex discrimination — exactly where Azar finds himself now.

The big picture: Verma's own behavior makes it difficult to tell whether the problem is her mismanagement or a male-dominated culture that makes it hard for a woman to hold her rightful sway, according to interviews with more than a dozen sources who know the situation well.

Verma has claimed she's been treated poorly because she's a woman under Azar's leadership. The accusations came to a head over the summer, when she raised the possibility of a discrimination lawsuit.

  • The other side: Azar's allies, and other sources close to the situation, say Verma has undoubtedly been treated differently, but not because she's a woman — rather, because she is miserable to work with.

The bottom line: These allegations, with their mix of serious misconduct and petty grievance, make it hard to envision a real working relationship ever materializing between Azar and Verma. And as they spill into public view, they're a warning to future officials, as well.

Read my story.

2. HHS and CMS' new united front

Spokespeople for both agencies issued a joint statement in response to my story, pointing to Azar and Verma's productivity:

  • "These ridiculous accusations are an attempt to distract from the Administration's policy successes. The Secretary and the Administrator are focused on executing the President's bold healthcare agenda."

Between the lines: The two officials have been instructed to find a way to work together by both President Trump and Vice President Mike Pence, and it looks like they're trying to at least appear to be doing just that.

3. Health care companies getting taken to court

The Department of Justice's lawsuit against CVS Health, alleging the falsification of old prescriptions and creation of new improper refills, wasn't the only major legal battle in health care world yesterday, Axios' Bob Herman reports.

Driving the news: The Federal Trade Commission is suing to block Illumina's $1.2 billion takeover of PacBio, which competes with Illumina for DNA sequencing that helps find disease patterns.

  • Why it matters: "When a monopolist buys a potential rival, it can harm competition. These deals help monopolists maintain power," FTC Bureau of Competition Deputy Director Gail Levine said in a release.

Michigan is the first state to sue opioid distributors — specifically AmerisourceBergen, Cardinal Health, McKesson and Walgreens — as drug dealers.

  • Why it matters: "Wall Street underestimates the magnitude and depth of the opioid situation and the extent to which plaintiffs will seek restitution," stock analysts with Robert W. Baird & Co. wrote on the news.

A new class-action lawsuit, filed by a physician in Illinois, alleges TeamHealth violated federal communications law by texting recruitment pitches to physicians without their consent.

The bottom line: The health care industry takes up a lot space in the courts, given the nature of medical treatments and the ties to taxpayer funding. And all of this is happening while we await the imminent decision on the latest ACA case.

4. A step toward reducing the organ waitlist

The Trump administration announced yesterday a new proposal aimed at making more organs available for transplant and holding organ procurement organizations accountable, part of its plan to tackle kidney disease.

Why it matters: Thousands more organs could become available each year under the proposal, which would help reduce the list of people waiting for organ donations.

  • There are 113,000 people on these wait lists, and 20 of them die every day, per HHS.

Under the proposed new rules, organ procurement organizations would receive new performance standards. If these were in place today, 37 of America's 58 organizations would be out of compliance, according to Organize, a patient advocacy group.

  • The proposal also increases financial incentives for living organ donors.

Go deeper: The Washington Post wrote an excellent deep dive into the flaws of the organ donation system' last year.

5. Teen drug use, by the numbers

Illustration of a vintage classroom with a teacher giving an anti-vaping presentation

Illustration: Sarah Grillo/Axios

Drug use among teenagers is dropping, according to new federal statistics published in JAMA on Wednesday. Fewer teens are abusing prescription drugs, alcohol and cigarettes.

Between the lines: Marijuana use is steady overall, but has shifted from smoking to vaping — and vaping THC products can be dangerous, Axios' Marisa Fernandez writes.

By the numbers: Among 12th graders...

  • Marijuana use has remained stagnant, while marijuana vaping nearly doubled — from 7.5% in 2018 to 14% this year.
  • Adderall misuse has also declined.
  • Opioid abuse is at its lowest level since 2002, with just 1.7% of 12th graders abusing OxyContin and just 1.7% misusing Vicodin.
  • Binge drinking dropped from 19.4% in 2004 to 14.4% in 2019.
  • Tobacco use is down overall, but e-cigarettes are rising.

Go deeper: Stressed out: Anxiety a bigger concern for teens than drugs