THE PROGNOSIS

President Trump today will emphasize that the death penalty can be extended to drug dealers. But compared to his tough talk about executing a class of people he seems to view as street thugs, the president's proposal aimed at curbing the opioid epidemic is a little less than it seems.

On a visit to New Hampshire, one of the states hardest-hit by opioid addiction and overdose, Trump will officially propose that his Justice Department pursue stiffer penalties — including capital punishment — for traffickers when appropriate under the law.

That last part is important as the administration had been considering making trafficking in even small doses of fentanyl -- a deadly synthetic opioid -- a capital offense. But instead, Trump is urging more aggressive prosecution of drug dealers, and only seeking the death penalty when it's already available.

U.S. law allows for the death penalty to be applied in four types of drug-related cases, according to the Death Penalty Information Center: murder committed during a drug-related drive-by shooting, murder committed with the use of a firearm during a drug-trafficking crime, murder related to drug trafficking and murder of a law-enforcement officer that relates to drugs.

The measures are part of a three-pronged approach to fighting opioid abuse and overdose the White House rolled out last night. It's aimed at reducing the demand for opioids by slowing overprescribing, cutting off the supply of illicit drugs and helping those who are addicted, my colleague Katie Zezima reports.

“The opioid crisis is viewed by us at the White House as a nonpartisan problem searching for a bipartisan solution,” White House counselor Kellyanne Conway told reporters.

For weeks, whenever the president mentioned opioid abuse, he has praised the leaders of countries where people are executed for drug crimes, or even shot in cold blood. Exhibit A: Philippines President Rodrigo Duterte, whose brutal campaign to crack down on illicit drug has resulted in the deaths of more than 12,000 people without due process, as police and hired guns have slaughtered suspected users and distributors on the streets and in their homes.

Trump applauded Duterte last spring for doing an “unbelievable job” in combating the illegal drug trade, and after meeting with Duterte in November he said the two have a “great relationship.” Last month, Axios’s Jonathan Swan reported that Trump often compares drug dealers to serial killers and advocates they get the death sentence, as in the Philippines and a handful of other countries mostly in Asia and the Middle East.

And a week ago, at a political rally in Pennsylvania, the president again suggested the United States should join the handful of other countries in allowing capital punishment for drug crimes.

“You kill 5,000 people with drugs because you’re smuggling them in, and you are making a lot of money and people are dying,” Trump said, prompting cheers from the gathered crowd. “And they don’t even put you in jail. That’s why we have a problem, folks. I don’t think we should play games.”

Trump's “tough guy” stance stood in stark contrast to the more measured approach preferred by some of his top administrators, such as Health and Human Services Secretary Alex Azar. Azar has gone out of his way to stress better treatment as key to quashing the epidemic.

The United States is one of 32 countries with death penalty laws for drug offenses, but only seven nations actually conduct executions routinely, according to a March report from Harm Reduction International. They include Iran, Saudi Arabia, Vietnam and Malaysia, as well as China and Singapore, two countries Trump also referred to as examples of ways he thinks the United States should approach the issue.

(The Philippines doesn’t actually allow the death penalty for drug crimes, but executions are being carried out ad hoc under Duterte as noted above.)

Ashok Kumar, Singapore’s U.S. ambassador, argued in a recent letter to The Washington Post that his country is one of the few that have kept drug abuse under control through its “clearheaded approach,” which includes education, rehab programs — and stiff penalties.

But experts in drug law say there’s no evidence that capital punishment on its own reduces dealing or drug use -- and it could even worsen the behavior. The most likely scenario is that lower-level operators, such as drug runners, would be caught and executed while organized criminal leaders remained free to carry on their activities, Georgetown Law professor Larry Gostin told me.

“In the case of trafficking, the economic rewards are so lucrative and the supply networks so sophisticated that, in my view, it would provide no deterrent to organized crime,” Gostin said.

Iran, for example, has one of the highest addiction rates in the world. According to the United Nations Office of Drugs and Crime, 2.2 million people — nearly 3 percent of the population — are hooked on drugs. Yet Iran also carries out more executions per capita for drug offenses than any other country, with 242 people executed last year, according to HRI.

Columbia University law professor Jeffrey Fagan also said he sees no scientific evidence that executing drug dealers deters dealing or drug use. “It’s not a smart policy, even if it has some emotional appeal,” Fagan told me.

But it’s well known that Trump acts — and speaks — from his gut, not necessarily because he believes there’s evidence to support his views. From his own blunt rhetoric, he has made clear he admires the same trait in other world leaders, even leaders such as Duterte who show a blatant disregard for human rights.

Duterte announced Wednesday that he's withdrawing the Philippines from the Rome Statute, the treaty that established the International Criminal Court, which is looking into his violent campaign to determine whether it justifies an official investigation into charges of crimes against humanity. Duterte said the decision to withdraw was because of “baseless, unprecedented and outrageous attacks” by U.N. officials and an attempt by the ICC prosecutor to seek jurisdiction “in violation of due process and presumption of innocence.”

And last year, Duterte said this: “Hitler massacred 3 million Jews. There are 3 million drug addicts. I'd be happy to slaughter them ... You destroy my country, I kill you. It's a legitimate thing. If you destroy our young children, I will kill you.”

AHH, OOF and OUCH

AHH: Many Obamacare insurers turned a profit for the first time last year after three years of pretty heavy losses. Politico’s Paul Demko writes premium spikes led to the profitable year, citing analysis of financial filings of 29 regional Blue Cross Blue Shield plans. Steven Udvarhelyi, CEO of Blue Cross and Blue Shield of Louisiana, told Paul that 2017 "was the first year we got our head above water in the individual market since the ACA passed."

“The healthier balance sheets are a welcome development for insurers after three years of major Obamacare losses, estimated at more than $15 billion by McKinsey,” Paul writes. “That led many national insurers, including UnitedHealth Group and Aetna, to flee the law’s marketplaces, in some cases leaving Blue Cross Blue Shield plans as the only option for customers.”

But one profitable year doesn't totally rescue insurers from potential instability moving ahead. The Trump administration is expected to finalize a rule making it easier to buy cheaper plans that are exempt from parts of the health-care law, following Congress's repeal of the law’s individual mandate. These big changes to the law are weighing on insurers as they decide what to do for 2019.

OOF: The leading candidate to head the Centers for Disease Control and Prevention is Robert Redfield, a longtime AIDS researcher who is well-respected for his work but once expressed a controversial position on HIV testing, our colleague Lena H. Sun reports.

Redfield was previously floated as a candidate for the top post at the CDC as well as at the National Institutes of Health under other GOP admnistrations, Lena writes. He would fill the role left vacant by Brenda Fitzgerald, who stepped down in January amid reports that she had investments in tobacco, drug and food stocks while heading the CDC.

Redfield is a former Army physician, and currently the director of clinical care and research at the Institute of Human Virology at the University of Maryland School of Medicine. He oversees a major clinical program providing HIV care and treatment to more than 6,000 patients in the Baltimore-Washington region and a care program that is part of the President’s Emergency Plan for AIDS Relief, known as PEPFAR. He has also served as a member of the Presidential Advisory Council on HIV/AIDS.

In the early 1990s, while he was an AIDS researcher in the Army, Redfield stirred controversy over an experimental AIDS vaccine that ultimately failed. “He had been known as a strong supporter of mandatory patient testing for HIV during the 1980s, at a time before effective treatments were available and intense stigma surrounded people infected with the virus," Lena writes. Some felt the policies he advocated weren't embracing sound public health approaches to the AIDS epidemic and were stigmatizing of those who were infected.

OUCH: Watch out, opioid epidemic. Six months after Trump declared opioid abuse a public health emergency, his administration has a detailed plan for how it plans to counter the abuse and overdose crisis. We wrote extensively above about the penalties it's proposing, but the plan officials released yesterday also calls for a slew of other policies to limit access to opioids and improve education. Here are some of the White House's goals and strategies, per Katie:

  • Sharply reduce the number of painkillers that are prescribed nationwide, aiming to slash opioid prescriptions by one-third over three years.
  • Tighten the number of opioid prescriptions that can be reimbursed by Medicaid as a way to curb overprescribing.
  • Create a national prescription-drug monitoring system so suspicious prescriptions can be flagged. Right now, each state operates its own, and a few states have data-sharing agreements.
  • Test all federal inmates for opioid addiction and provide options for treatment when inmates complete their sentences and reenter society.

  • Put more naloxone, a drug that can reverse opioid overdoses, in the hands of more first responders. 

REPRODUCTIVE WARS

— Tomorrow, the Supreme Court is set to hear oral arguments in a major case on free-speech rights for antiabortion “crisis” pregnancy centers, a hearing The Health 202 wrote about in November. The Post's Robert Barnes reports from Gilroy, Calif., about clinics that are challenging a new state law requiring them to publicly post a notice informing clients about the availability of free or low-cost access to family-planning services, including abortion.

These centers say they're being forced to deliver a message antithetical to their mission: encouraging women to carry out their pregnancies rather than end them. But California cites Supreme Court precedent upholding those abortion language requirements in contending it is requiring the clinic to deliver only a neutral and factual message, Bob reports. The message “doesn’t move in one direction or another on the political spectrum,” either in encouraging abortion or discouraging it, California Attorney General Xavier Becerra told Bob.

“We were trying to figure out the way to best get information to people about their health-care options and their rights,” Becerra said. “And this is a pretty straightforward way — neutral way — of getting that information to women.”

Abortion-rights advocates could ironically benefit in other ways, even if they lose this particular case. “If the court rules broadly against the government’s ability to have centers deliver its message, some abortion rights supporters wonder whether the same reasoning could work in their favor in other cases,” Robert writes. “They might challenge dozens of state laws that require doctors and others to deliver certain information to women about the alleged dangers that accompany abortion.”

— On Friday, the National Academy of Sciences released the first in-depth report in more than 40 years about the state of science on abortion safety and quality in the United States. The work — conducted with support from six private foundations — found that abortions done in a clinic or with drugs appear to be safe in the vast majority of cases, The Post's Ariana Eunjung Cha reports. Among the study's interesting takeaways:

  • Legal abortions in the United States, whether by medication or the three major surgical methods, “are safe and effective.”
  • The quality of abortion care depends on where a woman lives.
  • Ninety-five percent of abortions are at clinics or other office-based settings.
  • Despite much speculation about abortion's impact on future childbearing, the science shows that the procedure does not appear to increase the risk of secondary infertility, pregnancy-related hypertensive disorders, abnormal placentation, preterm birth or breast cancer.
  • Having an abortion does not appear to be linked to such mental-health consequences as depression, anxiety, and/or post-traumatic stress disorder.
HEALTH ON THE HILL

—Four former FDA commissioners say the “Right to Try” legislation the GOP-led House is teeing up for another vote would put vulnerable patients in danger, our colleague Laurie McGinley reports. Robert Califf and Margaret Hamburg, who led the FDA under the Obama administration, and Mark McClellan and Andrew von Eschenbach, who served under George W. Bush, sent a statement to lawmakers provided to The Post. “There is no evidence that either bill would meaningfully improve access for patients, but both would remove the FDA from the process and create a dangerous precedent that would erode protections for vulnerable patients," they warned.

"Right to Try" would allow seriously ill patients to bypass the FDA in order to get access to experimental drugs. A Senate version of the bill passed over the summer. The House version failed to pass last week 259-140, seven votes short of the two-thirds threshold needed to pass a bill under suspension of the rules, a procedure typically reserved only for non-controversial legislation. Afterwards, House Majority Leader Kevin McCarthy (R-Calif.) said lawmakers would try again to pass the legislation with only a majority vote.

--A few more good reads from The Post and beyond:

MEDICAL MISSIVES
Speaking of Science
Spending a year in space did not make the NASA astronaut a mutant. At no point in that process was Scott Kelly zapped by an alien laser beam, attacked by a xenomorph or otherwise transfigured into a previously unknown mutant variety of human.
Sarah Kaplan
INDUSTRY RX
Health & Science
Lawsuits and complaints about sexual harassment are piling up in the health-care industry as women take on doctors, peers and co-workers.
Christina Jewett
Scientists and National Institute of Health officials waged a concerted campaign to obtain funding from the alcohol industry for research that may enshrine alcohol as a part of a healthy diet.
New York Times
STATE SCAN
National
Humboldt County, known for decades as a haven of great dope in Northern California, cashed in on an illicit economy. Can it make it under the state’s new marijuana regulations?
Scott Wilson, Bonnie Jo Mount and Kazi Awal
DAYBOOK

Coming Up

  • The House Energy and Commerce Subcommittee on Oversight and Investigations holds a hearing on the DEA’s role in combating the opioid crisis on Tuesday.
  • The Senate Finance Committee holds a hearing on the nominations of “John J. Bartrum, of Indiana, to be an Assistant Secretary of Health and Human Services and Lynn A. Johnson, of Colorado, to be Assistant Secretary for Family Support, Department of Health and Human Services” on Tuesday.
  • The House Ways and Means Subcommittee on Health holds a hearing on “Implementation of MACRA’s Physician Payment Policies” on Wednesday.
  • The Atlantic holds an event on “The State of Care” on Wednesday.
  • Politico holds an event on “How to Improve Health Care in Nursing Homes and Bend the Cost Curve” on Wednesday.
  • The House Energy and Commerce Subcommittee on Health holds a hearing on the opioid crisis on Wednesday.
  • The Alliance for Health Policy, the Association of Health Care Journalists and the National Institute for Health Care Management hold a webinar on Thursday.
SUGAR RUSH

On Saturday Night Live, Anderson Cooper interviews members of a White House in turmoil: 

And on Weekend Update, SNL interviews Kate McKinnon as Education Secretary Betsy Devos: 

Watch the moment a family was reunited with a German shepherd that United Airlines mistakenly shipped to Japan: