Oct 1, 2019

Axios Vitals

Good morning. Today's word count is 712 words, or <3 minutes.

1 big thing: Genetic technology's double-edged sword

Illustration: Sarah Grillo/Axios

As gene-altering technologies become more accessible, there's also a growing risk that they'll be dangerously misused or abused.

Why it matters: "You're talking about manipulating DNA to create a designer pathogen. That’s a terrorist threat," former FDA commissioner Scott Gottlieb told me.

The big picture: Ethical questions about CRISPR, the gene editing tool, are as old as the technology itself, and they intensified last year with the news of the first gene-edited babies in China.

  • These questions have been further complicated by the fact that genetic alteration technologies are now relatively cheap and easy to use.

Driving the news: NPR reported last week that as synthetic DNA gets cheaper and easier to make, there's growing concern about the technology being used to create bioweapons or dangerous viruses.

  • Josiah Zayner, a "biohacker" who became notorious for using CRISPR on himself in 2017, runs The ODIN, a company that sells DIY gene-editing kits online and teaches people how to use CRISPR. The kits are available on Amazon.
  • California passed a law this summer that outlaws the sale of DIY genetic engineering kits unless they come with explicit warnings that they're not to be used for self-administration, Vox reports.

Meanwhile, scientific advances in genetics have made breakthrough therapies possible.

Gene testing — as opposed to gene altering — poses new risks, as well.

  • When consumer DNA testing databases began being used by law enforcement to crack criminal cases, privacy questions arose. And privacy issues have been amplified as medical and sperm donors have lost their assurance of anonymity.
  • DNA testing has also opened the door to creative forms of fraud.

Go deeper: The ethical red flags of genetically edited babies

2. Drugmakers eye unusual opioids settlement

Drug companies facing expansive litigation over their role in the opioid crisis are exploring settling the cases by participating in Purdue Pharma's bankruptcy, the Wall Street Journal reports.

Why it matters: If successful, this would either end or shrink the massive federal case pending in Ohio. But it would require a lot of buy-in, including from state attorneys general.

Details: The companies — Endo, Johnson & Johnson, Teva, Allergan and Mallinckrodt — want to contribute money to a trust while being released from all liability.

3. How some jails avoid medical bills

Illustration: Aïda Amer/Axios

Sheriffs across Alabama are relying on what's known as "medical bond" to avoid paying for inmates' hospital bills, ProPublica reports — meaning that jails release the inmates from custody when they need medical care.

  • This includes treatment that is only necessary because an inmate didn't receive adequate care while incarcerated.
  • After they're treated, some inmates are quickly rearrested and head back to jail.

The big picture: ProPublica and AL.com reviewed media reports of sheriffs using these medical bonds in 25 states.

Between the lines: Medical care is expensive, and county budgets are often strained. But regardless of any ethical or legal concerns this approach raises, it doesn't just make these health care costs go away — it inevitably forces someone else to foot the bill.

Go deeper: The states where private prisons are thriving

4. Doubling down on wellness programs

Wellness programs that reward people for exercising or stopping smoking are common in employer plans, and soon they will be an option in individual health plan marketplaces, the Trump administration said in a bulletin yesterday.

The big picture: 10 states will get to experiment with wellness programs in their Affordable Care Act markets, and they generally have to comply with federal rules for employer wellness programs, Axios' Bob Herman reports.

  • That means, among other things, participants cannot receive a discount on their coverage of more than 30% of their premiums. Health insurers also must have "reasonable alternative standards" for sick or disabled people who can't do the program.

The bottom line: We've said this before, but we'll say it again. All reputable evidence has concluded wellness programs don't lower costs, don't improve people's health, and raise legal and privacy concerns.

5. Patients blindsided by facility fees

Patients are getting blindsided by "facility fees" in their hospital bills, a controversial charge that some medical facilities defend as necessary for additional income, Axios' Marisa Fernandez reports.

Driving the news: In Detroit, a facility fee was responsible for more than half of an insured patient's bill after she had a benign cyst removed from her abdomen, Kaiser Health News reports.

The state of play: The Health Care Cost Institute found that facility fee charges nearly doubled from 2009 to 2016, outpacing overall health spending four times over, NPR reports.

  • Hospitals argue that facility fees help with overhead costs so that care can be provided to sick patients 24/7, all year-round.
  • Hospitals are not legally obligated to give patients a heads up, though some are trying to be more transparent.

The bottom line: Ultimately, bills come out higher than patients budget for. Critics have called these fees a tax on sick people and argue that there's no formula for pricing.