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Responding to a backlash from pain patients, the Centers for Disease Control and Prevention released updated guidelines Thursday that offer clinicians more flexibility in the way they prescribe opioids for short- and long-term pain. The new recommendations eliminate numerical dose limits and caps on length of treatment for chronic pain patients that had been suggested in the landmark 2016 version of the agency’s advice, which was aimed at curbing the liberal use of the medication and controlling a rampaging opioid epidemic. Those guidelines cautioned doctors that commencing opioid therapy was a momentous decision for patients. (Bernstein, 11/3)

The new guidance avoids strict figures on dosage and length of opioid prescriptions, recommends how and when to prescribe opioids, and describes harms and benefits. But the CDC emphasized the recommendations are voluntary and flexible and should not be used to support a one-size-fits-all policy. (Alltucker, 11/3)

A draft released in February received 5,500 public comments. Some modifications were made, but several main changes stayed in place, including: The CDC no longer suggests trying to limit opioid treatment for acute pain to three days; The agency is dropping the specific recommendation that doctors avoid increasing dosage to a level equivalent to 90 milligrams of morphine per day. (Stobbe, 11/3)

CDC officials say that doctors, insurers, pharmacies and regulators sometimes misapplied the older guidelines, causing some patients significant harm, including "untreated and undertreated pain, serious withdrawal symptoms, worsening pain outcomes, psychological distress, overdose, and [suicide]," according to the updated guidance. (Stone and Huang, 11/3)

The authors of the original guidelines warned in 2019 that their recommendations were being misapplied. And in a commentary also published Thursday, the authors wrote that they revised their recommendations because the original document was improperly cited as a justification for certain policies that restricted opioid access. (Joseph, 11/3)

Pfizer and BioNTech said Friday that the immune responses against Omicron BA.4/BA.5 subvariants were “substantially higher” in people who got its new bivalent booster compared with people who received the companies’ original Covid-19 vaccine. (Christensen, 11/4)

A month after vaccination, the new booster triggered a fourfold increase in omicron-blocking antibody levels against the BA.4/BA.5 version of omicron compared with the old booster in older adults. That is an advantage, but scientists have varying opinions on whether it will make a difference in whether people are likely to fall ill. (Johnson, 11/4)

The companies said that one month after getting the new booster, clinical trial participants over 55 had antibody levels that were 3.8 times as high as those who received the original booster. The number of participants in the study was small, with 36 people receiving the new booster and 40 receiving the old one. The control group included only older adults, and the findings so far are limited to one month after the shot. Results from a similar clinical trial by Moderna are expected soon. (LaFraniere, 11/4)

Fauci, in a radio interview Thursday, said the pandemic has clearly eased since last winter, but deaths, which average more than 2,600 per week, remain far too high. At the same time, the new omicron variants are knocking out key tools used to protect the most vulnerable. (Kimball, 11/3)

“Clearly, the unvaccinated are a threat to themselves,” said Dr. Jeffrey Shaman, an infectious disease specialist at Columbia University. As recently as August, their risk of dying of COVID-19 was six times higher than for people who were fully vaccinated and eight times higher than for people who were vaccinated and boosted, according to the Centers for Disease Control and Prevention. (Healy, 11/3)

The Omicron SARS-CoV-2 variant was likely transmitted through the floors and walls of a quarantine hotel in Taiwan in December 2021, adding to a large body of evidence that aerosol transmission plays a significant role in outbreaks and clusters, according to a report yesterday in Emerging Infectious Diseases. (11/3)

The state health department launched a new telehealth program Wednesday with the idea of providing Wisconsinites free access to prescription COVID-19 antiviral pills. (Shastri, 11/3)

The state is launching a telehealth program to expand access to Paxlovid for New Hampshire residents. The antiviral treatment reduces severe illness among people at high risk from COVID-19. (Cuno-Booth, 11/3)

Pfizer and BioNTech have launched a clinical trial on a vaccine targeting both COVID-19 and influenza, the companies announced Thursday. The phase 1 trial is being done in the United States with 180 participants between the ages of 18 and 64, with the first participant dosed this week, the companies said. The follow-up period for each participant will be six months. (Deliso, 11/3)

A preventive treatment for lower respiratory tract infections caused by RSV got the go ahead from the European Commission on Friday, according to one of the companies that make it. The treatment is the first of its kind to protect all infants in their first year of life. (Christensen, 11/4)

Centrist Sen. Joe Manchin (D-W.Va.) on Thursday called for a broad bipartisan deal to protect the solvency of Social Security, Medicare and Medicaid, popular programs that face serious funding issues over the next few decades. ... Manchin, who sank Biden’s ambitious $3 trillion Build Back Better agenda in December, has often talked about the financial challenges facing Social Security and Medicaid. (Bolton, 11/3)

Manchin said at a Fortune CEO conference he’d like to see bipartisan legislation over the next two years to deal with entitlement programs, which he said are facing “tremendous problems.”  Some of the trust funds that help support the programs could run out of money in the next 12 years, which would trigger cuts to benefits.  (Dennis, 11/3)

In a bipartisan letter sent Wednesday, 46 senators — from Sen. Rand Paul (R-Ky.) to Sen. Elizabeth Warren (D-Mass.) — asked leadership to address looming Medicare payment cuts to providers before the new year, when they would take effect. “It is essential in the coming weeks that we make sure providers have the resources they need to keep their doors open for seniors and families,” the senators wrote. The letter comes a day after the Centers for Medicare and Medicaid Services released its final rule confirming the cuts, which are required by law. (Payne and Mahr, 11/3)

In 2020, the North Carolina Hospital Association published an infographic that claimed its hospitals lost $3.1 billion by providing care to Medicare patients. But a report commissioned by State Treasurer Dale Folwell argues that most North Carolina hospitals did not lose money on Medicare. In fact, many of them profited, the report says. (Rosenbluth, 11/4)

On Tuesday, as millions of Americans cast their ballots in the 2022 midterms, the Supreme Court will hear oral arguments in what could be one of the most consequential health care cases in its history. The defendants in Health and Hospital Corporation of Marion County v. Talevski are asking the justices to fundamentally rework the Medicaid program, which provides health care to over 76 million low-income Americans. (Millhiser, 11/3)

Progressives have helped bring health coverage to tens of thousands of uninsured Americans with an exercise in direct democracy: They have persuaded voters to pass ballot measures expanding Medicaid in six states where Republican elected officials had long been standing in the way. Now comes the latest test of this ballot box strategy: South Dakota. (Stolberg, 11/3)

KHN: Centene Showers Politicians With Millions As It Courts Contracts And Settles Overbilling Allegations 

On Nov. 2, 2021, Nevada Gov. Steve Sisolak’s reelection campaign received 10 separate $10,000 contributions from what appeared to be unrelated health insurance plans from across the country. The Buckeye Community Health Plan of Ohio, Louisiana Healthcare Connections, and Peach State Health Plan of Georgia were among the companies that sent money to the Democrat, according to state campaign finance records, even though only one, SilverSummit Healthplan, provided insurance in the Silver State. But a thread connects the companies: Each is a subsidiary of Centene Corp., ranked 26th on the Fortune 500 list, and the nation’s largest private managed-care provider for Medicaid, the government insurance program for people with low incomes or disabilities. (Young, Miller and Grapevine, 11/4)

KHN: KHN’s ‘What The Health?’: ACA Open Enrollment Without The Drama

It’s open enrollment time for Affordable Care Act health coverage. And for the first time, people are enrolling with comparatively little controversy, as most Republicans have moved on from trying to repeal the law. On the campaign trail, meanwhile, Democrats are charging that if Republicans win majorities in the U.S. House or Senate, they will try to cut Social Security and Medicare. (11/3)

U.S. Rep. Henry Cuellar is accusing his Republican challenger, Cassy Garcia, of lying about her support for the Affordable Care Act — a law she once called a "train wreck" — as one of the most closely watched congressional races in the state has grown increasingly bitter in the final days before the midterms. (Wermund, 11/3)

Angry over the US Supreme Court’s reversal of Roe v. Wade in June, Deborah Willoughby wanted to do more than attend a rally or make a donation. So she sat down at her computer and placed an order for a pack of abortion pills from India sold under the brand name Unwanted. (Einhorn and Pandya, 11/3)

Stepping in to fill that demand are online pill brokers that are buying generic versions of the drugs in bulk from pharmacies in India, Russia, Mexico and Vietnam. The drugs are then shipped illegally to U.S. consumers at a significant markup -- 10 times the original cost or higher -- but still a fraction of the $400 to $500 price tag charged by many abortion clinics, advocates say. (Flaherty, 11/4)

An Indiana abortion provider who came under attack by the state attorney general has filed a lawsuit to block him from subpoenaing her patients' medical records – including those of a 10-year-old rape victim she treated. (McCammon, 11/3)

This clinic and other Planned Parenthood centers in Kansas have been doing their best to help by lengthening hours, hiring staff and flying in physicians. Still, they have only been able to take about 10% to 15% of the patients seeking abortions. “The ecosystem, it’s not even fragile. It’s broken,” said Emily Wales, president and CEO of Planned Parenthood Great Plains. “I think there’s a perception that if you are seeking care, you can find it somewhere. And that’s not true.” (Hollingsworth, 11/4)

When Brian Zahra learned that he had impregnated his 20-year-old girlfriend in May 1983, he grabbed the Yellow Pages, found an abortion clinic in the Detroit suburbs and made an appointment, the woman told NBC News in an interview last month. (Allen, 11/3)

“These anti-abortion campaigns ... are purposefully manipulating very vulnerable communities, those who are already disproportionately marginalized from accessing any form of health care,” said Aurea Bolaños Perea, strategic communications director at COLOR. (Rodriguez, 11/4)

Four days after the Supreme Court issued its decision that ended a federal right to an abortion, Kimberly Fleary took to TikTok to share what happened in the 12-hour shift she’d just finished. She’s a forensic nurse in San Antonio who specializes in working with victims of sexual violence. (Gilyard, 11/3)

Republican Sen. Lisa Murkowski said Thursday there is still a "long ways to go" to finding a bipartisan agreement on codifying abortion rights previously protected under Roe v. Wade. She added that she is "not in the camp that says it cannot be done." (Yilek, 11/3)

KHN: For Republican Candidates, Talk About Moms And Babies Is A Thorny Issue

A month before Election Day, as Republicans in Congress dodged questions about a proposal to ban abortions after 15 weeks of pregnancy, Sen. Chuck Grassley (R-Iowa) tweeted that he wanted to talk about moms and babies. Grassley, in the midst of what may be his closest race since becoming a senator in 1980, said he hears a lot about a lack of prenatal care in rural Iowa. He introduced his answer, called the Healthy Moms and Babies Act. “This bill will help fill those voids in rural America to make sure that we can deliver health care for high-risk pregnancies,” he said. (Huetteman, 11/4)

A few days a month, Dr. Esgar Guarín hits the road in his mobile vasectomy clinic, crisscrossing the Iowa heartland to reach patients throughout the state, sometimes traveling hundreds of miles from his Des Moines-area office. (Lourgos, 11/4)

When Tamiya Griffin was expecting her first child in 2014, she had what she thought was a straightforward plan: deliver at the hospital down the road, the same place her mother gave birth to her. But when Griffin, then a 22-year-old senior in college, went into labor a few weeks early, she had to undergo an emergency C-section. (Montague, 11/4)

The first new type of antibiotic developed in more than 20 years to treat urinary tract infections (UTIs) appears to be so effective that the pharmaceutical company stopped testing and will soon submit its data to the US Food and Drug Administration for approval. (Goodman, 11/3)

Two-thirds of 333 pharmacy owners and managers who responded at the end of October to a National Community Pharmacists Association survey about drug shortages said they were having difficulty getting the antibiotic. The liquid form of the drug has been in limited supply in the US since October, according to the Food and Drug Administration, and it’s also in shortage in other countries. (Swetlitz, 11/3)

Apellis Pharmaceuticals said Thursday that submission of additional clinical data to the Food and Drug Administration will delay the review of its experimental treatment for geographic atrophy — a chronic eye disease and a leading cause of blindness in older people. (Feuerstein, 11/3)

In the summer of 1955, an outbreak of polio hit the Boston area just months after a vaccine was approved, but not in time to stop the surge. More than 2,000 polio cases quickly overwhelmed the city’s pediatric units. At Children’s Hospital, the lines outside were so long that medical teams worked into the night with flashlights to evaluate children, some limp and feverish in their parents’ arms. Helping with the triage was a third-year resident, Samuel L. Katz. He had found his life’s work. (Murphy, 11/3)

Sen. Mark Warner (D-Va.), chairman of the Senate Intelligence Committee, released a report on Thursday outlining cybersecurity threats in the health care sector and ways the federal government can improve security standards in the industry. The report, which is divided into three sections, recommends that the federal government improve the country’s cybersecurity risk posture in the health care sector, help the private sector mitigate cyber threats and assist health care providers in responding and recovering from cyberattacks.  (Kagubare, 11/3)

For health systems and medical groups stepping up their defenses against an attack, here are top recommendations from cybersecurity experts for how to protect your organization. (Kelly, 11/1)

Healthcare organizations are deploying more biomedical and Internet of Medical Things devices, which increase IT complexity and create more attack vectors for bad actors to target. (Scott, 11/1)

An appeals court Wednesday rejected an attempt by employees of Ascension St. Vincent’s hospital to shield text messages from being disclosed in a medical malpractice case against a former physician at the Jacksonville medical center. (11/3)

KHN: Hospital Giant HCA Fends Off Accusations Of Questionable Inpatient Admissions 

Jennifer Smithfield felt weak and still had trouble breathing in February after nearly two weeks with covid-19. It was a Sunday, and her doctor’s office was closed. So her primary care physician suggested going to an emergency room to be safe. Smithfield went to HCA Healthcare’s flagship hospital, near its corporate headquarters in Nashville, Tennessee, and thought she would be checked out and sent home. But that’s not what happened. (Farmer, 11/4)

Nearly a half million dollars of new federal funding will be used to expand access to critically needed health services for Boston residents who struggle with homelessness, addiction, and, too often, racism, Mayor Michelle Wu said Thursday. (Lazar, 11/3)

Deaths caused by alcohol use in the United States spiked during the Covid-19 pandemic, killing more than 49,000 people in 2020, according to data published Friday by the US Centers for Disease Control and Prevention. The alcohol-induced death rate has been steadily increasing in recent decades, but it jumped 26% between 2019 and 2020 – making nearly the same climb in one year as over the decade before. In 2020, alcohol caused 13 deaths for every 100,000 people, up from 10.4 deaths for every 100,000 people in 2019. (McPhillips, 11/4)

Alcohol-related deaths rose by 26% from 2019 to 2020, a new report published Friday by the Centers for Disease Control and Prevention finds. The increase was even sharper among women ages 35 to 44, going up by 42% from 2019 to 2020. (Edwards, 11/4)

When most people think of a stroke patient, they often picture someone over 65. But experts say the rate of strokes is increasing among young people, and a new study suggests alcohol consumption may have something to do with it. (Rodriguez, 11/3)

On Nov. 3, Pennsylvania Gov. Tom Wolf approved House Bill 1393, which decriminalizes fentanyl test strips. The bill amends the Controlled Substance, Drug, Device and Cosmetic Act of 1972 to no longer define fentanyl test strips as drug paraphernalia, a release from the Department of Drug and Alcohol Programs and the Department of Health explained. (Van Etten, 11/3)

A group of the country's leading maternal health doctors is threatening legal action against the Texas Department of Health and Human Services over its delayed release of a long-awaited report on pregnancy-related deaths. (Blackman and Gill, 11/3)

A Santa Clara County resident died from West Nile virus after a long illness, according to the Public Health Department.While the death was recorded in the county, the person contracted the virus in Contra Costa County, the department said in a statement to the Bay Area News Group on Thursday. (Green, 11/3)

North Carolina’s health agency is weighing whether to challenge a judge’s order demanding that the state ramp up services for people with intellectual and development disabilities to allow more of them to live at home or in their communities. In 2020, Superior Court Judge Allen Baddour ruled that too many such people were forced to live in institutions in violation of state law. (Robertson, 11/3)

A Louisiana prison’s treatment of its mentally ill prisoners — including inadequate care, incomplete medical records and prolonged stints in solitary confinement — violates federal law and the Constitution, a federal judge has ruled. (McGill, 11/3)

As the health and safety of trans and queer youth are jeopardized across the country, there were a few minutes of hope on Wednesday in Boston when Adm. Rachel Levine, the assistant secretary for health at the Department of Health and Human Services and first transgender federal official confirmed by the U.S. Senate, visited the Boston Alliance of LGBTQ+ Youth. (Gaffney, 11/4)

Medical boards appointed by governors in some red states may be opening a new front in the ongoing political battle over government restrictions on gender-affirming care. (Gonzalez, 11/4)

It’s been an election cycle packed with misinformation and conspiracy theories. So why do so many people believe the lies? Blame the brain. Misinformation is more likely to be believed, remembered and later recalled — even after we learn that it was false. (Sima, 11/3)

From CRISPR to gene therapy, the biggest looming problem is that we will simply become lost and confused as to what works and what doesn’t. (Herper, 11/3)

Walk down two flights of stairs, accessed through the back entrance of the James Hunt Funeral Home in Asbury Park, N.J., and you reach a white-walled, linoleum-floored, fluorescently-lit room. On a recent Tuesday evening, Shawn’te Harvell walked down the steps and into the room, where two bodies, covered in white cloth, lay on gurneys. (Whang, 11/1)

“People start planning and they realize, ‘Holy cow, there are so many decisions to be made,’” said Mr. Fogarty, who organized a three-day “Before I Die” festival in the Dayton, Ohio, area last weekend. The festival included a Day of the Dead-themed dinner at a cemetery, screenings of death-themed movies including “Coco” from Walt Disney Co.’s Pixar and a death cafe, where people could converse about mortality. (Mosbergen, 11/3)

Is stress contagious? Yes, says neuroscientist Tony W. Buchanan, a professor at St. Louis University. In 2010, he measured the response of people who were simply observing stress in others. Now, more researchers are investigating whether this contagiousness is something seen across the animal kingdom. (Sand, 10/30)

A treatment may help those with chronic nightmares. The experimental method, which combined an established treatment — imagery rehearsal therapy — with a sound, led to fewer nightmares among participants for as long as three months afterward, a study showed. (Cimons, 10/28)

“The Age of Roe,” a new exhibition at Harvard’s Schlesinger Library for the History of Women, aims to break down any simple understanding of how the Supreme Court’s 1973 decision in Roe v. Wade has shaped America. The show, in the works since 2020, was originally going to be called “Roe at 50.” (Schuessler, 11/2)

Chris Bahl is a self-proclaimed protein geek. He’s spent the better part of 10 years studying the intricate structures of proteins — complex molecular machines responsible for nearly all facets of life, from metabolism to movement. His goal was to create completely synthetic proteins using computer programs, and to open up a new avenue for making medicines. (Cross, 11/3)

More than four months after devastating monsoon floods began in Pakistan, at least 1,500 people have died, and the waters that inundated nearly the entire country have yet to recede. This ongoing emergency is causing illness and communicable disease to spread, and these effects are likely to be much more deadly than the initial catastrophe. (Biba, 10/24)

Space poses some massive dangers for humans, from black holes to the heat death of the universe. But as humanity considers long-haul space travel, there are other, smaller potential hazards that some researchers say may deserve more attention: microbes from Earth. (Johnson, 11/2)

My daughter was a high school senior when I first caught her skipping respiratory therapy. (Abby Alten Schwartz, 11/3)

"Mommy. Daddy. I can’t breathe.” Waking up to those words is terrifying for any parent. For me as a pediatric emergency physician, it was especially scary coming from my 8-year-old son while on a trip in rural New York, hours from a specialized pediatric emergency department dedicated to the care of children. (Marc Auerbach, 11/3)

The reality is for more than 50 years, the home care industry has stood at the ready, but only in the past three years has it become abundantly clear that home-based health care clinicians are integral to how this country can meet the increase in health care demand. (Jennifer Sheets, 11/3)

Medical practitioners and public health officials work within boundaries that, when crossed by others, can harm the people they are entrusted to protect. When these red lines are crossed, the medical and scientific community can — and should — speak out against it. (Scott Rivkees, 11/4)

The Department of Health and Human Services has proposed a rule to prohibit clinical algorithms from discriminating against individuals based on race, color, national origin, sex, age, or disability. It is an important step toward addressing an urgent issue. (Ashley Beecy, Steve Miff and Karandeep Singh, 11/3)

Another fall season, another virus in the news: The respiratory syncytial virus, commonly known as RSV, is filling up emergency rooms and hospital beds in many parts of the country. (Saad B. Omer, 11/4)

Over the past several months, many readers have asked a version of this question: Should they continue to ask that everyone gathering with them be vaccinated and perhaps even up-to-date with their booster shots? (Leana S. Wen, 11/3)

The journal Nature published today global consensus recommendations to end Covid-19 as a public health threat. It took a panel of almost 400 independent-thinking scientists, doctors, and representatives of community groups from more than 100 countries (we were among the co-chairs) some 14 months to develop and agree on these recommendations. (Jeffrey V. Lazarus, Adeeba Kamarulzaman and Agnes Binagwaho, 11/3)

Healthcare can be expensive, so picking the right insurance plan that meets your individual or family needs can be critical to maintaining a balanced budget. (Doug Haaland, 11/3)

The open enrollment season for health insurance is gearing up at a time when more people in the United States have health insurance than ever before. Yet millions of Americans who enroll this fall still won’t be able to easily afford the health care they need or will be hit with medical bills they can’t pay. (David Blumenthal and Sara Collins, 11/4)