Oct 31, 2019

Axios Vitals

Caitlin Owens

Good morning, and happy Halloween!

Situational awareness: The White House seems to be distancing itself from House Speaker Nancy Pelosi's plan to lower prescription drug prices, Politico reports.

  • "I admire the ambition, but I don't know how you're going to get it through. It might be time to start thinking about [the Senate Finance bill]," domestic policy adviser Joe Grogan told Politico.

Today's word count is 925, or ~3 minutes.

1 big thing: Today's health problems are tomorrow's health crises
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Data: National Health and Nutrition Examination Survey; Chart: Andrew Witherspoon/Axios

The health troubles we're seeing now — especially among young people — will continue to strain the system for years and even decades to come, Axios' Sam Baker writes.

The big picture: Rising obesity rates now will translate into rising rates of type 2 diabetes and heart disease. The costs of the opioid crisis will continue to mount even after the acute crisis ends. And all of this will strain what's already the most expensive health care system in the world.

By the numbers: 18% of American kids are now obese, according to new CDC data. So are roughly 40% of adults. And it's projected to get worse.

  • That helps explain why diabetes rates are also rising, and why roughly 30% of adults have high blood pressure.

Why it matters: More obese children means there will be more adults down the road with chronic conditions like diabetes, and these diseases in turn increase the risk of further complications, such as kidney disease and stroke.

  • Diabetes roughly doubles your lifetime health care bills, according to the CDC, and costs the U.S. a total of $245 billion per year.

We're only beginning to see the full costs of the opioid crisis, even though it has raged for years.

  • A White House report earlier this week pegged the cost of the epidemic at a staggering $696 billion in 2018 alone, and many survivors of the epidemic will face long-term health costs.

The bottom line: The U.S. health care system rewards doctors and hospitals for performing more treatment on sick people, and those treatments are expensive. That leaves big gaps in prevention, which drives the need for more expensive treatment.

  • That's how we ended up with the world's most expensive health care system, but without a particularly healthy population to show for it. And that trajectory isn't changing.
2. Opioids litigation unlikely to be resolved soon

A settlement resolving all of the pending lawsuits over the opioid crisis is "unlikely in the near term," according to state attorneys general and attorneys involved in the litigation brought by communities, the Washington Post reports.

Why it matters: That means that it could be a long time before places still plagued by the opioid epidemic receive substantial new funding to address it.

Details: The Post found that a global settlement framework pitched by four state attorneys general — worth $48 billion — is supported by only three other states so far.

  • Getting all the parties involved on board with such an agreement could take a long time, leaving communities across the country to make their own cases against the drug companies and compete against one another.

"No matter how much goes in there, it will not be enough," Roger Michalski, an associate professor at the University of Oklahoma College of Law, told the Post. "The scale of the problem is so massive, and it's much easier to cause harm than to fix harm."

The bottom line: Regardless of how the lawsuits end, as Sam just told you, we're going to be dealing with the impact of the opioid epidemic for decades.

Go deeper: We're all paying for the opioid epidemic

3. A health care settlement parade

Illustration: Sarah Grillo/Axios

There's still no settlement in the national opioids case, but plenty of other large health care cases have been laid to rest recently, Axios' Bob Herman reports.

The bottom line: Allegations of wrongdoing are rampant in health care. For defendants, it's often easier — and in their interest — to settle and eat the result as a cost of doing business.

Driving the news: None of these companies admitted wrongdoing.

  • Allergan is shelling out $750 million to settle allegations that it used tactics to impede generic competitors to one of its Alzheimer's drugs.
  • 15 drug companies are paying a combined $248 million to resolve allegations they gamed the pricing system to inflate their payments from state Medicaid programs.
  • Sanford Health paid a $20 million settlement to kill a case that accused one of its neurosurgeons of performing unnecessary spine surgeries and profiting from the devices that were used.
  • Two disease-focused nonprofits paid a combined $6 million to clear allegations that pharmaceutical companies were using them as conduits to pay for patients' medications.

Go deeper: Two new articles in JAMA Internal Medicine here and here) highlight the problems with health care settlements — especially when important documents that could affect public health are unearthed but are kept secret.

4. Report: Louisiana's "cancer alley"

Petrochemical facilities in Louisiana are releasing cancerous chemicals into predominantly black and poor areas, ProPublica reports in partnership with the Times-Picayune and The Advocate.

The impact: Since the 1990s, some Louisianans have been forced to deal with the consequences of living near huge petrochemical facilities, including air that smelled of rotten eggs, blue fluid in their ditches, miscarriages and cancer diagnoses, Axios' Marisa Fernandez writes.

The big picture: Air quality in the U.S. has been improving for decades. But in Louisiana, where seven large chemical plants along the Mississippi River corridor have been approved since 2015, it's getting worse.

  • The stretch of the river between New Orleans and Baton Rouge has been dubbed "cancer alley" due to the high concentration of petrochemical facilities.

What to watch: Five more major projects are awaiting approval.

5. New Juul lawsuit makes explosive allegations

A former Juul executive alleged Tuesday in a lawsuit that the company sent to market at least "one million mint-flavored e-cigarette nicotine pods that it admits were contaminated."

  • A Juul spokesperson said the company denies the claims and is contesting the suit, Axios' Rebecca Falconer writes.

Details: Siddharth Breja, Juul's former senior vice president of global finance, alleges that Juul ignored his protests to issue a product recall for the contaminated pods, "or at a minimum, issue a public health and safety notice to consumers."

Go deeper.

Caitlin Owens