THE PROGNOSIS

President Trump’s expansive new tariffs could work against one of his most-repeated promises — to lower drug prices.

A slew of advanced medical products and drug ingredients are among the 1,300 items that could be subject to a new 25 percent tariff on Chinese imports. The list, proposed Tuesday by the Office of the U.S. Trade Representative, is aimed at penalizing China for trade policies that Trump says put U.S. companies at a disadvantage. China responded yesterday by threatening its own 25 percent import taxes on 106 U.S. products worth about $50 billion.

If the administration goes through with the threatened tariffs — which are inciting widespread fears of a trade war with China — it could affect more than the prices of electronics, aerospace and machinery products. It could also have a big impact on the cost of insulin, antidepressants, MRI machines, artificial joints and pacemakers, just to name a few products on which millions of Americans rely.

That’s because drug and device makers import a huge share of the materials they use. According to the Food and Drug Administration,  about 80 percent of the active ingredients in drugs used in the United States and at least 30 percent of all medical devices used are from outside the country. China, which is striving for dominance in cutting-edge technologies as part of its “Made in China 2025” industrial plan, is quite happy to be a dominant supplier.

A project manager at the Florida Hospital Association: 

A director of the health policy at the Minnesota Department of Health:

A health-policy analyst on the Senate Budget Committee:

Now, it’s not yet entirely clear how big an impact the tariffs could have on drug and device prices. And because the administration has set a 30-day review period for the proposal, the's a chance for some kind of deal short of an all-out trade war with China.

But some corners of the drug industry are ringing alarm bells. The Association for Accessible Medicines, the trade group that represents generic drugmakers, expressed worry the tariffs might hike production costs — and noted that President Trump has promised to lower drug costs, not raise them.

“Our members who manufacture generic and biosimilar medicines are aligned with the president’s goal of lowering prescription drug prices for patients in the U.S.,” AAM general counsel Jeffrey Francer said. “We are concerned that the proposed tariffs may lead to increased costs of manufacturing for generics and biosimilars and thus higher prescription drug prices.”

Pharmaceutical Research and Manufacturers of America said it’s “still reviewing” the list of affected products to determine the potential impact on the biopharmaceutical industry. “We look forward to working with the administration to ensure that American innovation is protected and valued and that we maintain a robust global environment for innovative medicines,” a spokeswoman said.

The advocacy group Patients for Affordable Drugs said Trump's move could do "the exact opposite" of what he's promised on drug prices. “We are eager to read the comprehensive set of recommendations the administration promised to release in the next few weeks, but the tariffs announced yesterday would be a step in the wrong direction. It’s a tax that would raise prices on prescription drugs," said executive director Ben Wakana.

Trump has backed away from some parts of a pledge to lower drug prices he backed on the campaign trail, namely allowing Medicare to negotiate lower prices with drug companies. But his budget proposal in February laid out some ways to tweak downward Medicare and Medicaid drug costs, and Health and Human Services Secretary Alex Azar has recently been touting reducing costs as a top priority for his agency.

Despite the pushback on his proposed tariffs, Trump seems to be serious, even as the markets wobbled and business groups protested, my colleagues David J. Lynch and Emily Rauhala report. The president tweeted this Wednesday morning:

The Dow Jones industrial average fell more than 500 points in early trading Tuesday before rebounding by midday, and prices for soybeans plunged more than 5 percent. “In acting, the president swept aside opposition from business groups such as the U.S. Chamber of Commerce and the National Association of Manufacturers, which agree that China’s mercantilist policies must be confronted but fear the consequences of a tit-for-tat trade conflict,” David and Emily write.

Voters broadly disapprove of how the president is handling trade policy, by 54 percent to 34 percent, according to the latest Quinnipiac University poll. But some voters -- especially in states where manufacturing has suffered from the globalization of trade -- seem happy with the move, as Erica Werner reports from Ohio.

“If history is any indication, these proposed tariffs will not work and will be entirely counterproductive. Tariffs penalize U.S. consumers by increasing prices on technology products and will not change China’s behavior,” Dean Garfield, chief executive of the Information Technology Industry Council, told David and Emily.

AHH, OOF and OUCH

AHH: A study appearing today in Issues in Law and Medicine, a journal with ties to an antiabortion group, says there's evidence abortions can be reversed or halted even after women take one of two pills to terminate their pregnancies, The Post's Ariana Eunjung Cha reports.

San Diego physician George Delgado -- who published anecdotes in 2012 from seven women who followed this procedure -- looked at 754 patients who called a U.S. information hotline from 2012 to 2016 after taking mifepristone, the first drug aimed at terminating an unwanted pregnancy, but before taking misoprostol, the second drug. The overall rate of a pregnancy continuing without taking the second-line drug was 48 percent, Delgado wrote. He concluded the use of progesterone to stop a medical abortion “appears to be both safe and effective.”

Delgado's research consists only of observational case studies rather than being part of a rigorous clinical trial, but it provides numbers sure to add to the abortion debate, Ariana writes. Several states, including Idaho, Utah, South Dakota, Arizona and Arkansas, have passed laws requiring abortion clinics to inform women their abortions could be reversed. The American College of Obstetricians and Gynecologists says no “credible” evidence supports the idea of reversing a medical abortion.

OOF: Education campaigns aimed at persuading people to get vaccines are far less effective than using indirect behavioral nudges to change their behavior, a study published yesterday in the journal Psychological Science in the Public Interest finds. The reason most people don’t get vaccinations for themselves or their children, the study found, isn’t because they need convincing but because they perceive the shots as inconveniences or obstacles.

“When it comes to vaccines, I think we have this optimistic belief that just by telling people facts you can change their behavior,” Noel Brewer, the study’s lead author, told my colleague William Wan. “But when was the last time someone told you one fact and suddenly you lost five pounds or started brushing your teeth?”

In the face of a vocal, growing resistance to vaccines, a common reaction among state health departments is to mount new education campaigns. “Wednesday's report suggests that focusing on education and persuasion usually fails to make much difference,” William writes. “Instead, the study concludes, doctors and health officials should focus on indirect behavior modification — actions like automatically scheduled vaccination appointments, phone and text reminders from doctors' offices and monetary incentives from employers.”

OUCH: The 15-year-old who was shot five times while shielding his classmates during the shooting at Parkland, Fla.'s Marjory Stoneman Douglas High School in February, has finally been released from the hospital. Anthony Borges barricaded the door to try to protect his classmates and was shot through the door, our colleague Lindsey Bever writes. After spending weeks in the hospital, he’s the last of the wounded survivors to go home.

Anthony’s attorney Alex Arreaza said the teen was released over the weekend in “good spirits" and is "happy he's home." Doctors had to remove part of one of his lungs and he will need physical therapy and possible treatment for post-traumatic stress disorder. “Arreaza said it’s unclear at this time whether the teen will return to Marjory Stoneman Douglas High School," Lindsey writes. "He said last month that the teen’s family intends to sue Broward County, Broward County Public Schools and the Broward County Sheriff’s Office for failing to protect the students."

OPIOID OPTICS

—FDA Commissioner Scott Gottlieb is calling on Internet providers to help stop online sales of opioids and illegal drugs contributing to the nationwide crisis, our colleagues Lenny Bernstein and Elizabeth Dwoskin report. 

“Internet firms simply aren't taking practical steps to find and remove these illegal opioid listings,” Gottlieb said yesterday at a national summit on the drug crisis. “I know that Internet firms are reluctant to cross a threshold where they could find themselves taking on a broader policing role. But these are insidious threats being propagated on these Web platforms.”

There's evidence of how easy it is to purchase drugs online, Gottlieb said, citing a recent congressional investigation that identified 500 transactions worth $230,000 with 300 people in 43 states. He said the FDA is planning to meet with Internet company leaders, as well as researchers and advocacy groups to figure out a way to tackle the issue.

"The FDA’s concerns come at a moment when technology platforms are being increasingly held to task for distributing information that is against the public interest," Lenny and Elizabeth write. "YouTube’s algorithms have been manipulated by outsiders to make hoax videos go viral; Facebook’s software has spread false news stories and Russian disinformation to more than 100 million people."

—At least a quarter of the people in U.S. prisons and jails are addicted to opioids. A recent study published in JAMA Psychiatry found that in the first year of a new Rhode Island program providing addiction medication to all inmates, opioid overdose deaths dropped by nearly two-thirds among recently incarcerated people, Stateline’s Christine Vestal reports.

Rhode Island is the only state that provides all three FDA-approved medications – methadone, buprenorphine and the long-acting, injectable form of naltrexone known as Vivitrol – to all inmates. The research found that in Rhode Island, the treatment “not only reduces overdose deaths after the inmates are released, but also increases the likelihood they will stay in treatment and avoid getting arrested again.” Traci Green, lead author of the study, told Christine “what we’ve done here is entirely replicable.”

Other states are considering the possibility of expanding such programs. Lawmakers in Massachusetts, which doesn’t provide methadone or buprenorphine, “are considering a corrections bill that would require the state’s prisons and jails to offer all three FDA-approved medications,” Christine writes. “A similar proposal is advancing in Connecticut, which has provided methadone to some inmates in some jails for six years. The bill there would expand the program to all medications for all inmates.”

HEALTH ON THE HILL

—Yesterday, leaders on the Senate Health, Education, Labor and Pensions Committee released a discussion draft of bipartisan legislation to combat the opioid epidemic, which includes measures making it easier for doctors to prescribe smaller supplies of opioids for shorter periods, encouraging the development of nonaddictive painkillers and boosting the ability of law enforcement to detect illegal drugs at U.S. borders.

The draft bill, which resulted from six committee hearings over the past half year, is scheduled for a hearing next Wednesday. “The opioid crisis is currently our most serious public health epidemic and despite efforts in every state, it’s getting worse,” Chairman Lamar Alexander (R-Tenn.) said in a statement. “Our response needs to be urgent, bipartisan and effective.”

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

AGENCY ALERT
At least seven alcohol-advertising studies were funded in the decade before George Koob became director of the National Institute on Alcohol Abuse and Alcoholism in 2014. No new grants have been awarded since, a STAT analysis found.
Stat News
INDUSTRY RX
Walmart is the one to watch, health industry executives tell CNBC.
CNBC
STATE SCAN
Maryland Politics
But the bill has other measures that need to be more carefully considered, some say.
Rachel Chason
MEDICAL MISSIVES
Morning Mix
Amanda and Sara Eldritch underwent deep brain stimulation to treat obsessive compulsive disorder.
Samantha Schmidt
DAYBOOK

Coming Up

  • MedPAC holds a public meeting on Thursday and Friday.
  • The Advisory Committee to the Director of the National Institutes of Health will host a meeting on an opioid report on Friday.
  • Harvard School of Public Health holds an event on the gun violence epidemic on Friday.
SUGAR RUSH

President Trump has been pushing Senate Republicans to go "nuclear" in order to pass bills he supports. But what is the so-called "nuclear option"?:

A squirrel in Turkey received a set of prosthetic wheels after losing both its front paws in a wild animal trap:

Former President Jimmy Carter talks to Stephen Colbert about his new book and tells him he prays for President Trump: