THE PROGNOSIS

As the chorus of medical professionals  weighing in on the gun debate grows louder, House Democrats are vowing to push gun legislation and funding for research with their new majority in the next Congress.

After an Oct. 27 shooting at a Pittsburgh synagogue, a Nov. 7 shooting in a country-music bar in Thousand Oaks, Calif., and then another at a hospital in Chicago two weeks ago, the medical community took to social media to express outrage, creating hashtags and Twitter accounts dedicated to speaking out about gun violence and calling for movement on gun policies. Now, Democrats in Washington seem to be responding.

Rep. Robin Kelly (D-Ill.), vice chair of the House Gun Violence Prevention Task Force, told me in an interview that she’s spoken about gun policies with House Minority Leader Nancy Pelosi (D-Calif.), who won her party’s nomination last week to serve as speaker in the next Congress.

“From listening to and speaking with leader Pelosi … gun violence prevention strategies and bills will be on the list of priorities,” Kelly said.

The Illinois Democrat held a news conference last week calling for bipartisan solutions to gun violence, alongside Reps. Mike Thompson (D-Calif.), Eric Swalwell (D-Calif.) and Frank Pallone Jr. (D-N.J.); incoming Democrat from Florida Debbie Mucarsel-Powell; and several medical professionals. The group called for funding for the Centers for Disease Control and Prevention to research gun violence and for federal legislation on universal background checks, among other ideas.

During the news conference, Pallone, the likely next chairman of Energy and Commerce Committee, said he plans to authorize legislation to fund gun violence research.

“I’m telling you today … we on Energy and Commerce Committee, we will make it our business when we take office after January 3 that we’re going to authorize legislation that we have not been able to move because of Republicans,” he said. “That we’ll make sure that kind of funding is available through the CDC.”

Pallone also suggested the committee could take up one of the bills Kelly has introduced to mandate that the U.S. surgeon general submit an annual report to Congress on the effects of gun violence on public health.

During the news conference, Kelly lamented the lack of progress thus far on gun-related legislation and pointed to the GOP as the reason for any stall. “Despite the fact that we’ve had a mass shooting nearly every day in 2018, this Republican-controlled Congress has done nothing for the last eight years to prevent gun violence,” she said.

She applauded the doctors and nurses who have been speaking out on this issue. “They have seen things that would make most of us sick,” Kelly said. “I could not be prouder to welcome them to Capitol Hill because they want to be part of the solution. They, like House Democrats and many of my Republican colleagues, want to stop the violence with commonsense, bipartisan solutions.”

At last week's news conference, the doctors in the room chimed in calling for more research and for effective gun policies, telling story after story of toddlers who were accidentally shot and killed by family members, of domestic violence that leads to gun violence, and of their own experiences in trauma and operating rooms. One surgeon, Joseph Sakran, shared the details of his own near-death experience after being shot in the neck at age 17.

They stood behind a lectern with a sign that read “This is our lane,” a phrase that has been repeated by doctors and nurses on social media in recent weeks. Earlier this month, the National Rifle Association tweeted telling doctors who tried to speak out about gun policies to “stay in their lane.”

But the medical community has responded in kind. One forensic pathologist tweeted that the issue “isn’t just my lane. It’s my [expletive] highway:”

Sakran, a trauma surgeon at Johns Hopkins Hospital in Baltimore, launched a recent Twitter account @ThisIsOurLane to share the perspective of doctors who encounter gun violence on a daily basis.

“This is really in my mind a movement of not just one individual but the entire medical community saying enough is enough,” Sakran told me.

At its interim meeting in November, delegates from the American Medical Association adopted a policy calling for stronger background checks at the state level.

Specifically, the policy seeks to “encourage the enactment of state laws requiring the reporting of all classes of prohibited individuals, as defined by state and federal law, to the National Instant Criminal Background Check System” and "support federal funding to provide grants to states to improve NICS reporting.”

We see this as an epidemic and public health crisis and we think intervening as early as possible is smarter than just building more intensive care units for people who are either killed or damaged and badly hurt by the violence,” AMA President Barbara McAneny said in an interview. “We need to increase firearm background checks … so we know if there are people who have a history of violent crimes, if they’re at risk of hurting someone else or themselves, we can look at all those factors.”

Recent research points to why what the AMA is calling for may be needed. The initial findings from a comprehensive survey of firearms and violence conducted by the University of California at Davis Violence Prevention Research Program found nearly 1 in 5 people who purchased a recent firearm in California reported they did not undergo a background check.

Nicole Kravitz-Wirtz, a researcher who led the survey, told me this was an unexpected finding because the state has mandated background checks for nearly all firearm purchases since 1991. She said the findings suggest “we have some more digging in terms of research to do to figure out what’s going on here, so we can actually make more informed claims about how to improve policy.”

“We know at the individual level that comprehensive background check policies work, that they prevent future firearm violence at this level," she said. 

Garen Wintemute, director of the Violence Prevention Research Program, said that background checks are meant to prohibit gun purchases by those with criminal convictions, those with histories of domestic violence or who have restraining orders against them, or people with mental-health concerns who have been involuntarily committed to treatment.

He added the “background check is really only as good as the data it’s run on. We know that there is massive underreporting, but we don’t always have the estimates of how massive the underreporting problem is.”

Wintemute pointed to another recent study from UC Davis and the Johns Hopkins Bloomberg School of Public Health that found in the ten years following the implementation of California’s law, there were no changes in the rate of firearm or nonfirearm homicides -- and while there was a decrease in firearm-related suicide rates, the same decrease was seen in nonfirearm-related suicides.

He said more research needs to be done. “A study like this one in California is going to be interpreted [as] background checks are useless, and that’s not what we’re saying,” he said. “What we’re learning is this policy, which makes intuitive sense, is not well implemented.”

He pointed to the new AMA policy as a productive step. “What the AMA is endorsing is a continued effort to improve the quality and completeness of reporting so that the background checks will be run on accurate data and accomplish its purpose.”

AHH, OOF and OUCH

AHH: New data from the CDC may provide a silver lining on opioid deaths nationwide, especially after the agency’s data on 2017 mortality and drug overdoses was described as “a very dismal picture of  health in the United States.”

My Post colleague Christopher Ingraham writes provisional monthly estimates “show more detail and are more recent than the year-end figures. Those numbers show that nationwide, drug overdose deaths peaked in September 2017 and have been steadily declining in the months since.”

They show that “nationwide, the estimated number of overdose deaths for the 12-month period ending April 2018 was 70,859, a decline of more than 2,000 deaths vs. the 12-month period ending in September 2017.”

Broadly, the data is encouraging. The information shows “12-month drug overdoses declined in 20 states between April 2017 and April 2018,” and while the information is preliminary, Ingraham notes it’s the first sign of decline since the CDC has released monthly data in 2015.

OOF: Following a meeting between President Trump and Chinese President Xi Jinping during the Group of 20 summit over the weekend, the White House announced that China agreed to label fentanyl, the deadly synthetic opioid, as a controlled substance.

The synthetic drug has been linked to thousands of overdoses in the United States. "Very importantly, President Xi, in a wonderful humanitarian gesture, has agreed to designate Fentanyl as a Controlled Substance, meaning that people selling Fentanyl to the United States will be subject to China’s maximum penalty under the law," White House press secretary Sarah Sanders said in a statement.

But NBC’s Phil McCausland and Tom Winter report that a separate statement from Chinese officials stopped “short of announcing that it had fully changed the drug's designation or the penalties sellers might face. Instead, the country remained somewhat vague, committing only to enforcing the laws around fentanyl and stating that it would examine how it managed the drug.”

“The announcement around fentanyl could have major implications for drug overdoses in the United States,” they write. “The DEA and many other agencies have played a form of whack-a-mole to combat the pipeline from these Chinese factories that produce fentanyl, but it has not been easy.”

OUCH: Another Canadian diplomat has been diagnosed with the mysterious illness that has afflicted only government employees from Canada and the United States. Named “Havana syndrome,” after the city where almost all of the victims have been based, the illness consists of headaches, dizziness, trouble concentrating and then stumbling over words and facts, as my Post colleague Amanda Erickson reports.

The United States has gotten the CIA and FBI involved, but “we know very little about what’s happening or who’s behind it,” she adds.

The latest diagnosis brings the number of Canadian officers or family members affected up to 13. More than 20 Americans have also been affected.

“Doctors who’ve conducted brain scans of the victims say it looks as if they suffered a concussion without the preceding traumatic injury,” Erickson writes. “Some have posited that the assailants are using a ‘sonic weapon,’ but U.S. investigators have allegedly ruled out the possibility that the injuries were caused by the sounds themselves.”

It’s unclear who is behind the attack, though officials have a couple of suspects in mind, including “Cuban hard-liners loyal to Fidel Castro, acting covertly to try to disrupt the normalization of relations” who are likely to be working with another hostile government, and “prime suspects: China and Russia," my colleague writes. 

AGENCY ALERT

— The Trump administration has been promoting its private Medicare Advantage plans with emails touting the plans will offer stable costs and more benefits, the New York Times’s Robert Pear reports.

“The officials deny that they are steering patients to private plans, but the subject lines of recent emails read almost like advertisements,” Pear writes. “'Get more benefits for your money,’ says a message dated Oct. 25. ‘See if you can save money with Medicare Advantage,’ said another sent a week later.”

He notes the emails include fine print that say they were “created and distributed by the Centers for Medicare and Medicaid Services” for those who “signed up for emails from the Medicare team.” And CMS administrator Seema Verma insisted the agency is “not steering any Medicare beneficiary anywhere.”

But experts say the emails seem more like advertising than information from a government agency, according to Pear.

“Federal spending on Medicare Advantage will nearly triple in the coming decade, to $584 billion in 2028, from $210 billion this year, the Congressional Budget Office estimates,” he adds. And some Democrats are taking notice. Sens. Richard Blumenthal and Chris Murphy and Rep. Rosa L. DeLauro, all Democrats from Connecticut, sent a letter to the administration charging that government officials were “inappropriately working to steer Medicare beneficiaries to Medicare Advantage plans.”  

STATE SCAN

— The Legislative Black Caucus of Maryland is calling for increasing the age to buy tobacco products from 18 to 21 in the state, part of an effort in response to concerns about youth smoking and the impact smoking has on the African American community, my Post colleague Ovetta Wiggins reports.

“The decision for the caucus to include the anti-tobacco measure as part of its 2019 legislative priorities follows action taken by lawmakers in the District, New York City, California and Massachusetts in response to public health warnings about the effects of smoking and the increased popularity of e-cigarettes,” Wiggins writes. “The proposed legislation also comes on the heels of a recent announcement that the Food and Drug Administration will impose restrictions to block the sale of flavored e-cigarettes to those younger than 18 and to eventually ban menthol cigarettes and flavored cigars, which are especially popular among African American teenagers.”

Wiggins notes the caucus's chairman, Del. Darryl Barnes (D-Prince George's), said it’s the first year the caucus had made the legislation a priority. Maryland state Sen. Delores G. Kelley (D-Baltimore County) said she’s optimistic about the effort's success in part because several younger progressive lawmakers were elected in the midterms. “Certainly a bill like this, if it gets to the floor, it should have a better chance,” Kelley said. “We’re going to work it hard.”

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

TRUMP TEMPERATURE
Morning Mix
“Mission complete,” said Jim McGrath, the Bush spokesman who shared a photo of the service dog’s mournful stance.
Isaac Stanley-Becker
MEDICAL MISSIVES
Health
Normandy High School, the same school Mike Brown graduated from, was rocked by a HIV "outbreak" in the fall of 2008 when 50 students were exposed by the virus.
Amber Ferguson
The founder of Southwest Key made millions from housing migrant children. His nonprofit has stockpiled taxpayer dollars and possibly engaged in self-dealing with top executives.
The New York Times
DETROIT (AP) — Michigan clears a threshold this week as the first state in the Midwest to allow marijuana for more than just medical purposes. In the Nov. 6 election, voters by a wide margin endorsed recreational use by adults who are at least 21.
Associated Press
Health & Science
Social relationships can help reduce stress, increase happiness and bolster self-confidence.
Juli Fraga
INDUSTRY RX
Should the outbreak take hold in larger cities, the scale of the outbreak could tax the available supplies of an experimental vaccine.
Stat
OPIOID OPTICS
Two nurses overdosed and died in the past two years at the UT Southwestern Medical Center hospital where they worked.
Dallas Morning News
REPRODUCTIVE WARS
That's infuriated anti-abortion groups, who plan to take their fight to state legislatures and the courts.
Politico
DAYBOOK

Coming Up

  • The House Energy and Commerce Committee Subcommittee on Oversight and Investigations holds a hearing on "Examining the Availability of SAFE Kits at Hospitals in the United States" on Wednesday.
     
SUGAR RUSH
Tributes from journalists, friends and former administration officials pour in for President George H.W. Bush after his death:

In Buenos Aires, Trump and German Chancellor Angela Merkel spoke about the death of George H.W. Bush: