Apr 25, 2019

Axios Vitals

Caitlin Owens

Good morning. Here's to hoping that today's health care news is that the pollen count is lower than yesterday's.

1 big thing: Everything's deadlier in the South
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Data: Centers for Disease Control, 2017 data; Interactive: Lazaro Gamio/Axios

The death rates in the U.S. from pretty much every major cause — heart disease, cancer, Alzheimer's, diabetes, suicide, sepsis, guns, infant mortality — remain highest in the South, according to updated data from the Centers for Disease Control and Prevention.

Between the lines: Rural Appalachia has higher death rates from drug overdoses, Axios' Bob Herman reports. But a lot of the poorest health outcomes in the South reflect longstanding poverty, fewer health care resources and longstanding barriers to care.

2. HIV prevention drug patent issue escalates

The Justice Department is reviewing the government patent for use of an HIV prevention drug, potentially signaling that it's considering action against the drugmaker that sells it, the Washington Post reports.

  • The drug, Truvada, is owned by Gilead, which sells it for between $1,600 and 2,000 a month.
  • A retired Centers for Disease Control scientist told the Post that a Justice Department lawyer visited the CDC last month to talk to government scientists who discovered Truvada's preventative use.
  • Gilead says the government's patent is invalid.

Why it matters: Truvada is key to the administration's goal of eradicating HIV by 2030, as it helps prevent new infections. But its price tag is creating patient access issues.

  • "We are in discussions with the government to determine the best ways to broaden access to Truvada for PrEP to vulnerable populations in the United States and support the federal plan to end the HIV epidemic," Gilead told the Post in a statement.

The big picture: It's rare for the government to sue for drug patent infringement, although the Department of Health and Human Services has patented more than 2,500 products since 1976, WashPost reported last month.

  • These discoveries were publicly financed, but the government often licenses them to private drug companies, which commercialize them.
3. Health care earnings roundup

The health care industry's earnings season is picking up, with 27 major companies reporting this week, Bob reports. As always, you can follow along with our tracker.

Driving the news: It's been the usual bonanza for health care thus far, despite Wall Street's fears of an unclear future.

  • Anthem tallied a quarterly profit of almost $1.6 billion, up 18% from a year ago. The suspension of the Affordable Care Act's health insurance tax saved Anthem $83 million in this first quarter alone. Yeah, that's a big reason why the industry wants that fee killed.
  • Novartis posted a 16% profit margin in the quarter. Cosentyx, Novartis' major psoriasis treatment, had more sales than any other Novartis drug in Q1 ($791 million, a 36% increase year over year) — and it's probably worth remembering that Novartis hiked the price of Cosentyx by 9.9% earlier this year.
  • Johnson & Johnson and UnitedHealth Group continue to register the largest overall profits, because they are so big. But the 2 companies with the highest profit margins thus far were pharmaceutical company Biogen (40%) and surgical robot maker Intuitive Surgical (31%).

What we're watching: AbbVie, which is facing "patent thicket" lawsuits over Humira, comes out this morning. Sanofi, which is facing more political heat over its insulin prices, comes out Friday morning.

4. WHO: Get kids away from the screens

Illustration: Lazaro Gamio/Axios

Here's some news you can use: Keep your babies away from the iPad, or any other screen for that matter. Or at least that's what the World Health Organization says you should do.

  • The WHO said in new guidelines yesterday that children under 5 need to spend less time in front of screens and more time doing interactive, non-screen-based activities, Axios' Orion Rummler writes.
  • It added that screen time isn't recommended for infants or 1-year-olds at all. For kids ages 2–4, sedentary screen time shouldn't last longer than an hour.

What they're saying: The WHO said that less screen time and more physical activity "will contribute to children's motor and cognitive development and lifelong health."

Go deeper:

5. Addiction recovery as free labor

It’s not unusual for work to be part of the equation in addiction recovery, my colleague Sam Baker notes — a job can provide access to health insurance, and some business owners want to help. But a company called the Cenikor Foundation is turning recovery into unpaid labor, often in unsafe conditions.

Driving the news: Reveal, a project of the Center for Investigative Reporting, pulled back the curtain on Cenikor's practices, which many experts say are likely illegal.

Details: Patients who enter Cenikor's program — sometimes via a court order — are put to work doing physical labor, often in warehouses or on oil platforms.

  • For the first 18 months of the 2-year program, they don't get to keep any of the money they earn from that work. Cenikor keeps it, as the cost of its program.
  • The company also enrolls its participants in government assistance, including Medicaid and food stamps, rather than paying those costs itself.
  • Patients work up to 80 hours per week, and Cenikor staff routinely cancel treatment appointments to make time for more work, according to Reveal. Some patients go for long stretches with no counseling at all, and sources told Reveal that the company would falsify records to hide that fact.
  • Cenikor's workers often don't get the same safety equipment or other protections that non-Cenikor workers on the same site have.

What they're saying: "I can't fathom this being legitimate," John Meek, a former Labor Department investigator, told Reveal.

Caitlin Owens

Editor's note: The third story in yesterday's newsletter said that hospitals all get paid a certain dollar amount for CAR-T therapy. That's not true; hospitals' payment rates vary.

Thanks to the very smart Vitals reader who flagged this to me! All of you should feel free to do the same if you see something that isn't quite right.