THE PROGNOSIS

When it comes to solving the nation's opioid crisis there's overwhelming bipartisan agreement that Congress must act. But not too quickly, lest Democrats get any credit before the November midterm elections. 

It's a cynical view, but one held by several industry insiders in the health care sector we spoke to who believe Senate Majority Leader Mitch McConnell (R-Ky.) could delay a vote on legislation tackling the opioid crisis because passage would give vulnerable red-state Democrats an accomplishment to campaign on back home. 

"Name me the first three lawmakers who benefit from progress on opioids," one former Hill staffer asked me. “If you didn't name three Democrats, you're not paying attention."

Those who immediately come to mind are Sens. Claire McCaskill (Mo.), Joe Manchin (W.Va.), and Joe Donnelly (Ind.), who all face difficult reelection battles in states Republicans are hoping to pick off to retain control of the Senate. The last thing McConnell wants, this theory goes, is those senators going back to their states, which are ravaged by abuse of prescription painkillers, and tell their constituents they worked across the aisle to get something done. 

There's a risk to not acting before the election: More than two-thirds of Americans say opioid misuse is a very or somewhat serious problem in their state. And that's consistent among Democrats, Republicans and independents, according to a POLITICO-Harvard T.H. Chan School of Public Health poll released this week.

On Capitol Hill Wednesday afternoon, McCaskill told me it wouldn't surprise her if politics were holding up opioid legislation, but then acknowledged it could be her bias because right now, in the midst of a bitter campaign to keep her job, "I'm in that mindset that I think everything is playing politics."

“They can’t stop us from talking about it,” she said, during a brief interview on the train that runs beneath the Capitol. “How many investigations have I done?” She turned to a staffer beside her. “Four? Four investigations? It would be very difficult for them to block us from [campaigning on it.].”

McConnell's spokesman, Don Stewart, pushed back on the assertion that anyone wants to delay a vote on tackling the opioid crisis until after the election. 

"This is obviously a priority for the Leader and he's encouraged his chairmen to come to an agreement quickly and I predict they will," he said. 

But those who are following the issue closely don't feel there's a true sense of urgency to get an opioid bill to the Senate floor sometime soon, let alone before the election. In June, the House passed overwhelmingly a sweeping package of opioid-related measures aimed at fighting the crisis, which killed more than 42,000 people in 2016, according to the Centers for Disease Control and Prevention

Combined Senate legislation, spearheaded by Senate Health, Education, Labor and Pensions Chair Lamar Alexander (R-Tenn.) has been waiting for a floor vote. The aims of both chambers' approaches are similar: expanding access to treatment and prevention, as well as cracking down on the distribution of the drugs. President Trump has declared the opioid crisis a public health emergency, though advocates have criticized his approach as lacking teeth.

But the political imperatives diverge in a year when House Republicans are fighting to maintain their majority -- see the number of vulnerable House GOPers who have sponsored opioid legislation -- and Senate Republicans are trying to pick off Democrats. That's a recipe, say some observers, for stalling what may be the most bipartisan issue that exists in Washington right now. 

In the Senate, the vulnerable incumbents are almost all Democrats. many from states hit hardest by the opioid problem. "That's the cold, hard reality," one Washington, D.C.-based consultant told me.  

"Passing this legislation, it's as close to unanimous as you’re going to get," Andrew Kessler, the founder of Slingshot Solutions LLC, a consulting firm that specializes in behavioral health policy, told me. "So, let’s make the rhetoric match reality because they're holding up legislation ready to go and ready to pass. If Sen. McConnell, in his heart of hearts, believes the president that it’s public health emergency I’d like to know what the hold up is."

But Jessica Hulsey Nickel, founder and CEO of Addiction Policy Forum, took a more optimistic view. She believes a delay until after the election is actually an attempt to save the opioid bills from getting muddied by politics.  

“It feels like they’ve been trying to plot this out to be a little less partisan and not fall in a single pothole along the way,” she said. “To rush it or make it one party’s versus the other's, would go against the spirit of how this was constructed."

No one we asked in several Senate Democratic offices would openly say whether they believed McConnell was slow-walking the legislation for political purposes. But one Democratic aide told me lawmakers on both sides are trying to work in "good faith" to get it done. 

"It would be disappointing if this got caught up in election-year politics,' the aide added, "given how much of a crisis this is around the country."

AHH, OOF and OUCH

AHH: A year after the demise of the Republican effort to undo the Affordable Care Act, Democrats are highlighting health care as a key talking point heading toward midterm elections. Our Post colleagues Amy Goldstein and Mike DeBonis write that Democrats see health care “more than any other issues” as their “best chance to persuade swing voters in key races nationwide.”

“It’s effective everywhere,” Charlie Kelly, executive director of the House Majority PAC, told our colleagues. “This is an issue that’s been Number One across the board in every election. I don’t see that changing, and it’s something we’re going to be talking about from now until Election Day.”

And voters see health care as a key issue on their end, too. A Washington Post-Schar school poll this month found Democrats are leading among voters who say health care is a top issue, Amy and Mike report. Another poll by the Pew found voters trust Democrats more than Republicans by a 16-point margin on the topic of health care.

“Many Republican lawmakers and strategists interviewed this week conceded that GOP candidates are broadly vulnerable on the issue,” Amy and Mike write. And Larry Levitt, a senior vice president at the nonpartisan Kaiser Family Foundation said a lack of a different solution from Republicans on health care has further highlighted that concern. “They have tried to unravel protections that people hold dear while not successfully coming up with a replacement plan of their own,” he said.

OOF: Attorneys for disgraced former USA Gymnastics and Michigan State University team doctor Larry Nassar, who was convicted of sexually abusing young female gymnasts, is requesting a new sentence, claiming that the judge showed bias and led to Nassar being assaulted, our Post colleague Des Bieler reports.  

In a Wednesday filing in the same court where Judge Rosemarie Aquilina sentenced Nassar to 40 to 175 years in prison, attorneys said Nassar was assaulted in prison as a result of "Judge Aquilina’s efforts to demonize Dr. Nassar in front of the entire world,” Des reports.

Nassar’s lawyers filed two motions, one to seek a new sentence for Nassar, and another to seek that Judge Aquilin is disqualified and another judge is assigned to sentence him, the Lansing State Journal’s Matt Mencarini reports.

OUCH: Doctors at the Amsterdam Universitair Medische Centra led a trial to find out if the active ingredient in Viagra could be used to help at-risk premature babies survive. But when Dutch doctors gave 93 pregnant women Sildenafil, a generic version of the erectile dysfunction drug Viagra, some of the babies started dying, The Post’s Cleve R. Wootson Jr. reports.

After they were born, 11 of the 93 babies whose mothers were given the active drug developed a form of high blood pressure in the lungs, and died, Cleve reports. Another six babies developed the complication but survived. The other 90 babies in the trial were given a placebo, three of whom developed the high blood pressure disorder but survived.

“The chance of a disease of the blood vessels of the lungs appears to be greater and the chance of death after birth seems to have increased,” Amsterdam UMC said in a release about the trial. Cleve reports researchers noted there were “no positive effects for the children on other outcomes” and “all adverse effects occurred after birth.”

The study was halted immediately based on these findings. In a statement, Viagra-make Pfizer said the pharmaceutical company was “not involved in any aspect of this trial, and neither funded nor provided product for the trial,” adding “the Principle Investigators at the Amsterdam University Medical Centre have confirmed a non-Pfizer manufactured generic version of sildenafil was used but that no clinical trial participants were administered Viagra, Pfizer sildenafil or any other Pfizer medicine.”

TRUMP TEMPERATURE

— The Trump administration has repeatedly said that migrant parents who may have been deported without their children gave their consent, but Politico’s Ted Hesson, Renuka Rayasam and Dan Diamond report Homeland Security officials may have failed to document that consent with as many as three-quarters of migrants removed from the country.

An official told Politico the administration did not document consent in many cases. “That lapse increased the number of departed parents whom officials must now find and contact about whether they wish to be reunited with their children, and, if so, figure out the logistics of how to bring them together,” Ted, Renuka and Dan report. “The revelation threatens to delay reunifications one day ahead of a court-ordered deadline to return most migrant children to their parents.”

Up to 350 parents may have been deporteds without being given the choice of taking their child with them. 

The administration faces a deadline today to reunite all children with their parents after being separated at the border. “The administration had completed 1,012 reunifications by Tuesday out of 1,637 parents it deemed eligible to reunite with their children, with most of the remaining 625 expected to be reunited by the deadline,” Ted, Renuka and Dan write.

AGENCY ALERT

— Centers for Medicare and Medicaid Services Administrator Seema Verma yesterday minced no words in criticizing during a speech yesterday the idea of a single-payer health care system that’s gaining momentum among Democrats.

"We have all heard the drumbeat for what advocates of a government-run — socialized — health care system call 'Medicare for All,' " Verma said during remarks at the Commonwealth Club of California. "By choosing a socialized system, you are giving the government complete control over the decisions pertaining to your care, or whether you receive care at all."

Verma said she would not grant waivers to states to spend federal money on a single-payer system. She warned that such a program would divert focus from care for seniors, criticized it as “unaffordable” and said it “doesn’t make sense for us to waste time on something that’s not going to work.”

HEALTH ON THE HILL

—  A new poll from the Kaiser Family Foundation further highlights (as our colleagues Amy and Mike write) that health care remains a top campaign issue for voters. Broken down along party lines, Democratic voters were most likely to respond that health care is a top issue: 74 percent of Democratic voters, 64 percent of independent voters and 49 Republican voters said a candidate’s position on whether to cover preexisting health conditions is either the most or a very important factor that will determine their vote, according to the poll.

A majority of voters also pointed specifically to the Trump administration as contributing to the instability of the ACA. The poll found 56 percent of respondents said the president and his administration are trying to make Obamacare fail, compared with 32 percent who say they are trying to make the law work. It also found 58 percent say that Republican lawmakers and the president are responsible for the ACA's fate and any concerns with it.

— The Senate HELP Committee unanimously advanced four health-care bills yesterday, including the Patients Right to Know Drug Prices Act, a measure that will prohibit so-called “gag clauses” that block pharmacists from telling consumers when the cash price might be cheaper than an insurance co-pay.

“These clauses have resulted in patients paying double, triple or even more for prescription drugs than they would have if they had paid out of pocket but they just simply don’t know that fact,” said Sen. Susan Collins (R-Maine), one of the bill's co-sponsors, during the hearing.

Collins applauded the Trump administration for specifically calling out “gag clauses” in the blueprint to reduce drug costs, and HHS Secretary Alex Azar for saying he would support such a bill.

The Health 202 wrote earlier this month about legislative efforts in both chambers to do away with such opaque provisions that prohibit pharmacists from sharing cost information with patients. 

— House Democrats introduced legislation Wednesday to allow the federal government to negotiate directly with manufacturers over drug prices for Medicare.

The Hill reports that Democrats are setting up the issue now in hopes they’ll win back the House in November. It’s a position President Trump took during the campaign, but was not included in his administration’s strategy to lower drug prices.“This bill calls the President's bluff on his drug pricing promises,” bill sponsor Rep. Lloyd Doggett (D-Tex.) told The Hill.

MEDICAL MISSIVES

— Yesterday, a major study presented at the Alzheimer’s Association International Conference in Chicago revealed that for the first time in a large clinical trial to find an Alzheimer’s treatment, a drug was able to slow cognitive decline and reduce plaques in patients brains.

It could be the first drug that successfully treats brain changes and Alzheimer’s symptoms. "The treatment was administered at different dosing levels. After 18 months, those receiving the highest dose had an 81 percent reduction in amyloid buildup as measured in PET scans and a 30 percent reduction in clinical indicators of early Alzheimer’s," our Post colleague Tara Bahrampour reports.

Other drugs have been able to effectively treat the brain plaques but have not slowed cognitive decline, the New York Times's Pam Belluck reports.. A success would be a welcome milestone in the search for a treatment.

"An estimated 5.7 million Americans 65 and over have Alzheimer’s, and the Alzheimer’s Association predicts that number to mushroom to nearly 14 million by 2050 in the absence of new treatments," Tara writes. "A handful of drugs approved by the Food and Drug Administration can alleviate some symptoms, but in the past 14 years no new drugs have been approved for the disease."

“I think it’s a big deal, because we’ve definitely had some disappointments in Alzheimer’s drug development lately, so I think we just need some positive news,” James Hendrix, director of global science initiatives at the Alzheimer’s Association said, Tara reports. “We’re obviously very hopeful.”

REPRODUCTIVE WARS

— In a deeply personal speech on the Senate floor, Sen. Patty Murray (D-Wash.) laid out her forceful opposition to Trump Supreme Court nominee Brett Kavanaugh. The senator, who also serves as the ranking Democrat on the HELP panel, began by sharing this story from her youth:

“When I was in college, a friend of mine—we were very close and lived together in the dorms—went out on a date. She was raped and got pregnant. She didn’t know where to get a safe abortion—and she wasn’t wealthy, so she didn’t think she could afford it either. The botched procedure she ended up having left her, at a very young age, unable to bear children.

“I saw my friend hurt, frightened, alone, and unable to get the care she needed because someone else’s beliefs mattered more under our laws than her health and her future. That impacted me a lot, and has stayed with me to this day."

The senator continued, calling a Kavanaugh confirmation a “threat” that would “roll back reproductive rights women have had for more than four decades.”

Democrats have sharpened their attacks on Kavanaugh as Republicans push to get a vote on him before the Supreme Court returns in October. Sen. Cory Booker (D-N.J.), during a news conference, said, “In a moral moment there is no bystanders. You are either complicit in the evil, you are either contributing to the wrong, or you are fighting against it.”

Sen. John Cornyn (R-Tex.) advised Democrats who are “engaged in this kind of superheated rhetoric” to “get a grip, get a grip,” our Post colleague Elise Viebeck reports.

Meanwhile, while most Democrats are refusing to meet with Kavanaugh over a dispute regarding the judge’s documents. But Sens. Joe Manchin (W.Va.) and Joe Donnelly (Ind.) broke with their party and announced they’d sit down with Kavanaugh one-on-one in the coming days.

As Politico previously reported, neither man, both in tough reelection fights in states that voted for Trump, say Democratic leadership can influence their vote.

“I’ll be 71 years old in August, you’re going to whip me? Kiss my you know what,” Manchin told Politico.

INDUSTRY RX

— GlaxoSmithKline said it would make a $300 million investment in gene testing company 23andMe in an effort to put more resources into research, the Wall Street Journal’s Carlo Martuscelli reports.

The British pharmaceutical company signed a four-year deal with the company to research and develop new drugs. GSK’s Chief Scientific Officer Hal Barron “said Wednesday the company wanted to leverage genetic data using techniques such as machine learning to discover new medicines, with Parkinson’s disease research one area where 23andMe’s customer genetic data could be useful,’ Carlo writes.

— And here are a few more good reads from The Post and beyond:

To Your Health
Today, in vitro — or literally “in glass” — fertilization is a standard medical procedure that is the cornerstone of the multibillion-dollar fertility industry and has resulted in the birth of an eye-popping 8 million babies.
Ariana Eunjung Cha
Research conducted in cancer cell lines showed that the virus was highly effective in killing cells of most neuroblastomas.
Stat
To Your Health
J.J. Hanson fought an aggressive form of cancer for more than three years, some of which he might not have had if legally taking his life had been an option.
Lindsey Bever
Lowering blood pressure more than usually recommended not only helps prevent heart problems, it also cuts the risk of mental decline that often leads to Alzheimer's.
Associated Press
STATE SCAN
D.C. Politics
District health officials want more young people and other at-risk groups to use a HIV prevention drug.
Fenit Nirappil
DAYBOOK

Today

  • The Food and Drug Administration Antimicrobial Drugs Advisory Committee holds a meeting.
  • The House Energy and Commerce Subcommittee on Health holds a hearing on “An Update on the Merit-based Incentive Payment System.”
SUGAR RUSH

A CNN reporter was blocked from a White House event. This is what happened.:

Trump's many denials about knowledge of Michael Cohen's payments: