The past 2 years have seen a surge in the number of prescription drugs approved through a special process that was designed to help foster new treatments for rare diseases.

• Under President Trump, the Food and Drug Administration has approved 174 drugs to treat rare diseases.
• The approval pathway has been around for 35 years, but about 23% of all orphan approvals have come in the past 2 years.

Why it matters: Rapid scientific advances have helped fuel this rise. But the sheer volume of rare-disease approvals is also sparking a debate about whether they're too easy to obtain, or whether they give drugmakers a way to game the system.

How it works: Federal law gives extra market protection and tax credits to "orphan" drugs — those that treat conditions affecting fewer than 200,000 people. The financial incentives are there to help offset the fact that not many people will buy these drugs.

• The rise of personalized medicine, especially through highly complex biologic drugs, has made it easier to target products toward specific rare conditions.
• But orphan drugs are often very expensive. In 2017, the average annual cost per patient of the top 100 orphan drugs — excluding blockbusters with additional orphan uses — was $147,308, while the average cost for the top 100 non-orphan drugs was $30,708, according to EvaluatePharma.

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Amazon is the latest tech company to crack down on content spreading false information about vaccines from its platform.

• Buzzfeed News reported on Friday that anti-vax documentaries were available on Amazon Prime Video on Friday morning, but appeared to have been removed by the afternoon.
• Around noon, Rep. Adam Schiff (D-Calif.) — chairman of the House Intelligence Committee — sent a letter to Amazon CEO Jeff Bezos expressing concern that the company was "surfacing and recommending products and content that discourage parents from vaccinating their children, a direct threat to public health."

The big picture: Amazon's actions follow similar ones taken by other tech companies like Google and Facebook, which have also taken steps to reduce the availability of anti-vaccine content on their platforms in response to increased public pressure.

• Recent measles outbreaks have been attributed, in part, to reduced vaccination levels in some areas.
• While tech companies have tried to avoid becoming content arbiters, "the issue is harder to duck when the spread of false information can lead to real-world harm," my colleagues Sara Fischer and Kia Kokalitcheva wrote last month.

There are hundreds of gene therapies in the development pipeline, raising the question of how these drugs — which could have price tags upwards of $1 million — will be paid for, and whether our system is built to handle that, the Wall Street Journal reports.

• These gene therapies could treat or cure illnesses that currently cost the system even more over time, via long-term maintenance drugs.
• Other drugs serve small populations and have huge benefits. Luxturna, a drug that's already approved, treats a hereditary disease that causes blindness, but has a list price of $425,000 per eye.
• Wall Street expects that these drugs will generate billions in revenue.

But even if these costs are justified, our health care system isn't designed for large, one-time payments.

• Medicare and Medicaid aren't allowed to pay for drugs in installments.
• Private insurers usually only insure a patient for a few years at a time. This means they don't reap the long-term savings from these therapies.

There is a new battle brewing among doctors, patient advocates and pharma companies over — believe it or not — human excrement.

• More specifically, the fight is over fecal microbiota transplants, a remarkably effective treatment for the bacterial infection Clostridioides difficile, the New York Times reports.
• The battle is over whether the treatment — which involves transplanting healthy fecal matter into the bowels of patients suffering from the infection — should be classified as a drug or as a procedure akin to organ, tissue and blood transplants.

The FDA is expected to make a final decision soon, although in 2013 it made a draft decision to regulate the procedure as a drug.

• The market for drug-based treatments for C. diff is expected to hit $1.7 billion by 2026, according to GlobalData.
• Following the success of the procedure, scientists are currently trying to come up with similar treatments for disorders like obesity, autism, ulcerative colitis, and Alzheimer’s and Parkinson’s diseases.
• Investors are pouring money into such endeavors.

One major concern for critics: Treating the therapy as a drug will give it a 12-year monopoly period upon approval.

• They say this could slow innovation and cause patients who can't afford the procedure to attempt to replicate it at home.
• And, of course, there's fear that this would lead to high prices for stool transplants.
• Drug companies say that regulating the procedure as a drug will help ensure its safety and efficacy.

• States are rethinking their policy approaches to lowering prescription drug prices after the Supreme Court refused to hear an appeal of a ruling that struck down an ambitious Maryland law, StatNews reports.
• Beth Israel Deaconess Medical Center and Lahey Health have officially merged into Beth Israel Lahey Health, Modern Healthcare reports. The deal includes a 7-year price cap.
• As more women use the VA for health care, the department has responded by improving its women's health services, although some say there's more work to be done, the WSJ reports.