Loading
Taste Movie

Taste Movie 2015

Posts by hailong01

As clock ticks, Republicans try to move ahead on Obamacare repeal

WASHINGTON (Reuters) – The Trump administration and top U.S. Senate Republicans pushed on Tuesday for action on a bill to dismantle Obamacare, but time was running out and they were still hunting for the votes needed to pass their latest attempt to gut the 2010 healthcare law.

Vice President Mike Pence lunched with Republican lawmakers on Capitol Hill to urge them to approve the legislation introduced last week by Republican Senators Lindsey Graham and Bill Cassidy. Pence said President Donald Trump backs the bill.

“Now is the time. We have 12 days” to pass it, Pence said before the lunch.

Senate Majority Leader Mitch McConnell, who fell a single vote short of securing passage of another healthcare overhaul bill in July, said the Graham-Cassidy legislation “has a great deal of support,” but would not commit to bringing it to the Senate floor for consideration.

After Sept. 30, the last day of the fiscal year, procedural rules will make it much more difficult for Republicans. The bill after Oct. 1 would need 60 votes in the 100-seat Senate to be brought up for consideration, rather than a simple majority until the end of the month.

Despite controlling both chambers of Congress and the White House, Republicans this year have failed to make good on their seven-year effort to dismantle a law that was the top legislative achievement of Trump’s Democratic predecessor Barack Obama.

Having suffered the humiliating failure in July, Republican congressional leaders only want to hold a vote on legislation they know can pass.

“At the end of the day, I really believe we’re going to get 50 Republican votes,” Graham told reporters, but he would not say how many committed votes he has now in a Senate that his party controls 52-48.

Dismantling the Affordable Care Act, known informally as Obamacare, was a central campaign promise last year by Trump. Republicans call that law a government overreach into the healthcare system. Democrats point out that it has expanded health insurance coverage to some 20 million more people.

The new bill could give Republicans one last shot this year on healthcare.

It proposes to replace Obamacare with a system giving states money in block grants to run their own healthcare programs. It would allow states to opt out of certain Obamacare protections for consumers and waive regulations requiring insurers to cover certain health benefits. It also would end the Obamacare expansion of the Medicaid insurance program for the poor and disabled.

Sen. Lindsey Graham (R-SC), accompanied by Sen. John Barrasso (R-WY), and Senate Majority Leader Mitch McConnell, speaks with reporters following the party luncheons on Capitol Hill in Washington, U.S., September 19, 2017. REUTERS/Aaron P. Bernstein

“Similar to proposals that were considered in the Senate in July, we believe the Graham-Cassidy amendment would result in millions of Americans losing their health insurance coverage, destabilize health insurance markets, and decrease access to affordable coverage and care,” said James Madara, chief executive of the American Medical Association.

Senate Democratic Leader Chuck Schumer said Republicans were “grossly irresponsible” to consider the Cassidy-Graham legislation before getting a full assessment of its effects from the non-partisan Congressional Budget Office.

UNDECIDED SENATORS

Several Republicans, including the same three senators whose “no” votes blocked the earlier bill in July, are still undecided, including Graham’s close friend John McCain.

Slideshow (19 Images)

A bipartisan group of 10 governors wrote a letter to Senate leaders asking them not to consider the Cassidy-Graham bill, and instead urged support for bipartisan talks on healthcare legislation now going on in the Senate health committee.

Alaska Governor Bill Walker was among those who signed the letter. One of his state’s two senators, Republican Lisa Murkowski, is among those undecided on the Cassidy-Graham bill.

Meanwhile the clock is ticking. The Senate will not be in session Wednesday through Sunday. The Senate Finance Committee said it will hold a hearing on the bill next Monday.

Graham said House of Representatives Speaker Paul Ryan has told him that if the Senate passes the Cassidy-Graham bill, the House will, too.

Ryan has told McConnell that the separate bipartisan healthcare effort in the Senate that aims to protect some subsidies being paid to insurance companies to help people buy insurance policies would not be viable in the House, according to a source familiar with the discussion who asked not to be identified.

Trump’s administration has repeatedly threatened to cut off payments made directly to insurers, called cost-sharing reductions, that help cover out-of-pocket medical expenses for low-income consumers. It faced a deadline on Wednesday to make the payments for the month of September, and insurers expected to receive the payments.

If the bill were to go through, it would likely affect revenue at most insurers, including small companies like Centene Corp and Molina Healthcare that focus on Medicaid, and larger more diversified companies like Anthem Inc, Aetna Inc and UnitedHealth Group, Wall Street analysts said.

Aetna shares were off 2.8 percent on Tuesday and UnitedHealth was down 2.3 percent while the stocks of hospital chains were also lower on the possibility of less government funding, including HCA Healthcare’s decline of 2 percent.

Additional reporting by Richard Cowan and Yasmeen Abutaleb in Washington and Caroline Humer in New York; Editing by Kevin Drawbaugh and Will Dunham

Our Standards:The Thomson Reuters Trust Principles.

'Shocking' disregard for safety in U.S. meningitis case -prosecutor

BOSTON (Reuters) – A federal prosecutor on Tuesday accused a Massachusetts pharmacist charged with murder for his role in a deadly 2012 U.S. meningitis outbreak of showing a “shocking” disregard for patients’ lives, while his lawyer argued the man was no killer.

Glenn Chin, a former supervisory pharmacist at New England Compounding Center, oversaw the production in filthy conditions of tainted steroids, Assistant U.S. Attorney George Varghese said at the start of the man’s trial in Boston federal court.

Those drugs led to an outbreak that sickened 778 people nationally, including 76 who died after being injected with steroids containing mold produced by the now-defunct Framingham, Massachusetts-based NECC, according to prosecutors.

Varghese told jurors that Chin, 49, recklessly failed to ensure the compounding pharmacy’s drugs were produced in sanitary conditions in order to keep up with demand from hospitals nationally for its products.

Varghese said Chin directed staff in NECC’s so-called clean rooms, where the medications were made, to skip cleaning despite the presence of insects, mice and mold.

“His actions demonstrated a shocking – a shocking – disregard for human life,” he said.

But Stephen Weymouth, a lawyer for Chin, said there was no proof he was guilty of second-degree murder.

Former New England Compounding Center supervisory pharmacist Glenn Chin enters the federal court in Boston, Massachusetts, U.S. September 15, 2017. Picture taken September 15, 2017. REUTERS/Nate Raymond

“He didn’t do anything to kill these people,” Weymouth said, urging jurors to look past the emotions the case raises.

Weymouth said blame instead lies with Barry Cadden, NECC’s co-founder and former president. Cadden was sentenced in June to nine years in prison after he was found guilty of racketeering and fraud charges but cleared of murder.

Slideshow (2 Images)

“He called all the shots, he told people what to do,” Weymouth said. “No one could tell Barry Cadden what to do.”

Chin and Cadden were among 14 people indicted in 2014 for their roles in the outbreak and the only two to be accused of second-degree murder over 25 deaths. The murder charges were brought under a racketeering law.

The outbreak led Congress in 2013 to pass a law that aimed to clarify the U.S. Food and Drug Administration’s ability to oversee large compounding pharmacies.

Chin faces other charges including mail fraud. He could be sentenced to life in prison if convicted of second-degree murder.

Lesser charges were filed against 12 other people. Three have pleaded guilty, while a federal judge dismissed charges against two defendants in October 2016. Charges remain pending against the other seven.

Reporting by Nate Raymond; Editing by Scott Malone and Marguerita Choy

Our Standards:The Thomson Reuters Trust Principles.

US Military surgeons in Afghanistan treat civilian injuries

(Reuters Health) – At U.S. military facilities in Afghanistan, roughly half of the surgeries done for local civilians during more than a decade of war have been for non-combat injuries and health problems, a recent study suggests.

From January 2002 through March 2013, a total of 5,786 local civilians underwent 9,428 surgical procedures at U.S. military treatment centers in Afghanistan, accounting for 37,121 inpatient hospital days, researchers report in JAMA Surgery.

Overall, 2,853 of these patients, or 49 percent, were treated for conditions that weren’t directly related to the war, the study found.

“We knew from personal experiences, shared anecdotes, and surveys of deployed personnel that a substantial amount of humanitarian care was being performed,” said senior study author Air Force Lieutenant Colonel Dr. Peter Learn, a researcher at Walter Reed National Military Medical Center in Bethesda, Maryland.

“Our study offers a much broader accounting and provides some indicators of resources expended,” Learn said by email. “It also uses the context of global burden of surgical disease to demonstrate how this care made an impact in a country that still faces substantial health challenges.”

For the study, researchers examined military data on noncombatant local patients over the age of 15 who underwent at least one surgical procedure.

A total of 2,933 procedures were classified as war-related because they dealt with injuries and conditions that occurred as a direct consequence of the conflict in Afghanistan, including both acute and chronic health issues.

Compared with patients who had war injuries, those treated for non-combat issues were generally older and had shorter hospital stays with fewer total procedures and lower death rates, the study found.

Traumatic injuries accounted for 2,762 surgical procedures, and these were often orthopedic cases involving fractures.

Many cases involved operations to treat common civilian health problems like hernia, cataracts, urinary obstruction or appendicitis.

One limitation of the study is that researchers lacked detailed data on the exact medical conditions patients had or the precise circumstances that brought them to the hospital.

Still, the results show military treatment facilities in Afghanistan provide a substantial amount of civilian care, said Army Colonel Dr. Mary Edwards, a researcher at San Antonio Military Medical Center on Fort Sam Houston in Texas, who wasn’t involved in the study.

Edwards said this report, and other data cited by the research team, “likely underestimate the total humanitarian care provided by the U.S. Military in Afghanistan during recent conflicts.”

Many surgeries unrelated to combat might have been necessary at least in part because local medical services were not readily available after years of war, she said.

“During times of war and civil unrest, accidental injury becomes more common, as normal public safety measures fail and the existing medical infrastructure of the local community becomes disrupted or overwhelmed,” Edwards said by email.

SOURCE: bit.ly/2xcXQpi JAMA Surgery, online September 13, 2017.

Our Standards:The Thomson Reuters Trust Principles.

Obamacare repeal must move quickly, says Senate's McConnell

WASHINGTON (Reuters) – The U.S. Senate’s top Republican on Tuesday urged quick action on a bill to repeal Obamacare but stopped short of promising to bring it to the Senate floor for a vote, as the clock ticks down on the latest attempt to kill the 2010 healthcare law.

Mitch McConnell, the Senate’s Republican leader, called the legislation drafted by senators Lindsey Graham and Bill Cassidy “an intriguing idea and one that has a great deal of support.”

Lawmakers should act because “our opportunity to do so may well pass us by if we don’t act soon,” McConnell said on the Senate floor.

The bill has revived a fight that many in Washington thought was over when an Obamacare repeal-and-replace bill flopped in the Senate in July, humiliating McConnell and President Donald Trump.

The latest measure has less than two weeks before procedural rules in the Senate make it much more difficult for the Republicans to do away with Obamacare.

The bill proposes replacing Obamacare with a system that would give states money in block grants to run their own healthcare programs and let them opt out of some Obamacare rules. Critics say it would bring deep cuts to the Medicaid program for the poor and higher insurance premiums for older people.

“Graham-Cassidy would be devastating for individuals with pre-existing conditions,” the Center for American Progress, a liberal think tank in Washington, said in a statement.

U.S. Senate Majority Leader Mitch McConnell (R-KY) faces reporters following a weekly lunch meeting with fellow Republicans on Capitol Hill in Washington, U.S., September 12, 2017. REUTERS/Joshua Roberts

McConnell stopped short of promising to bring the legislation to the Senate floor. But he said Republican lawmakers would continue to discuss it. He has been meeting with lawmakers to assess whether the bill has the votes to pass.

The proposal is the latest salvo in a long-running Republican war on Obamacare, and Graham and Cassidy say they are close to securing the votes needed for passage.

If approved, it would replace the 2010 Affordable Care Act, known informally as Obamacare, which Republicans have long seen as government overreach into the healthcare business.

Slideshow (14 Images)

Several Republicans – the same ones whose votes blocked repeal of Obamacare in July – are still undecided on the latest bill and time is running out.

A special parliamentary procedure that would allow the bill to move forward with only 51 votes will expire at the end of the month. After that, it would need 60 votes, like most Senate legislation. Republicans have a 52-vote Senate majority.

The Senate Finance Committee said it will hold a hearing on the bill next week.

If the Senate can pass the bill, “the hope would be that the House would take it up and pass it and the president sign it,” said John Cornyn, the No. 2 Senate Republican.

Senate Democratic Leader Chuck Schumer said Republicans were “grossly irresponsible” to consider legislation before even getting a full assessment of its impacts from the non-partisan Congressional Budget Office.

Additional reporting by Richard Cowan and Amanda Becker; Editing by Chizu Nomiyama and Alistair Bell

Our Standards:The Thomson Reuters Trust Principles.

Energy-efficient green buildings may emit hazardous chemicals

(Reuters Health) – Newly renovated low-income housing units in Boston earned awards for green design and building but flunked indoor air-quality tests, a new study shows.

Researchers found potentially carcinogenic levels of toxic chemicals in the remodeled homes before and after residents moved in. All of the 30 eco-friendly homes in the study had risky indoor air concentrations for at least one chemical.

“Even in green buildings, building materials contain chemicals that we’re concerned about from a health perspective,” said lead author Robin Dodson, a researcher at Silent Spring Institute in Newton, Massachusetts.

“We should not only think about the efficiency of the building but the health of the building,” she said in a phone interview.

The hazards seemed to come both from materials used to renovate the housing units as well as from occupants’ furnishings and personal-care products, the study found.

“Synthetic chemicals are ubiquitous in modern life,” said co-author Gary Adamkiewicz, an environmental health professor at Harvard T.H. Chan School of Public Health in Boston.

“They’re in new housing, old housing, green housing, conventional housing and high- and low-income housing,” he said by email.

As reported in Environment International, Dodson, Adamkiewicz and colleagues collected air and dust samples from 10 renovated units before occupancy and from 27 units one to nine months after residents moved in between July 2013 and January 2014.

By testing the homes before and after they were occupied, investigators were able to trace the presence of nearly 100 chemicals with known or suspected health concerns to the renovation, the residents or a combination.

Both before and after occupancy, all the tested units had indoor air concentrations of formaldehyde that exceeded the U.S. Environmental Protection Agency’s cancer-based screening level.

The researchers expected formaldehyde, which has been associated with allergy and asthma, might leach out of building materials, and they found evidence that it did. But because formaldehyde emissions remained high after occupancy, the research team suspected that residents also brought formaldehyde in personal-care products.

Researchers also believe that flame retardants, which are suspected of causing cancer and diminishing male fertility, had been added to the building insulation.

To their surprise, they found chemicals used in sunscreen, nail polish and perfumes being emitted from building materials, possibly because they had been added to paint or floor finishes, Dodson said.

Residents appear to have brought into the renovated homes a number of health-disturbing chemicals, including antimicrobials, flame retardants, plastics and fragrances.

Flame retardant BDE-47, which appeared after residents moved in, has been banned since 2005. Dodson assumes residents carried the compound into their homes, possibly in second-hand furniture.

Consumers could improve household air quality by using products free of fragrance and other seemingly innocuous but harmful ingredients, Dodson said. But the onus should not be on consumers, she said.

“Why are manufacturers even allowed to use these chemicals in their products?” she said.

Green building standards should be broadened to prohibit use of hazardous chemicals, she said.

Tom Lent, policy director of the nonprofit Healthy Building Network in Berkeley, California, said the study provides important clues about which hazardous chemicals are being released from building materials so that green buildings can be constructed to be both energy-efficient and healthy.

“There does not need to be a conflict,” Lent, who was not involved with the study, said in an email.

But the conflict between energy-efficient building and the need to reduce toxic indoor air emissions has existed for 15 years, Asa Bradman said by email. Bradman, associate director of the Center for Environmental Research and Children’s Health at the University of California, Berkeley, was not involved with the study.

Adamkiewicz recently completed another study that suggests green buildings can be healthy, or at least healthier, he said.

He studied families who moved from old, conventional housing to new, green public housing units in Boston. The new buildings were designed to save energy and reduce exposures to indoor pollutants.

In the green units, adults wheezed and coughed less and suffered fewer headaches, he found, and children missed fewer school days and had fewer asthma attacks and hospitalizations.

SOURCE: bit.ly/2wZx8zN Environment International, online September 12, 2017.

Our Standards:The Thomson Reuters Trust Principles.

Obamacare repeal must move quickly, says U.S. Senate's McConnell

WASHINGTON (Reuters) – The U.S. Senate’s top Republican on Tuesday urged quick action on a bill to repeal Obamacare but stopped short of promising to bring it to the Senate floor for a vote, as the clock ticks down on the latest attempt to kill the 2010 healthcare law.

Mitch McConnell, the Senate’s Republican leader, called the legislation drafted by senators Lindsey Graham and Bill Cassidy “an intriguing idea and one that has a great deal of support.”

Lawmakers should act because “our opportunity to do so may well pass us by if we don’t act soon,” McConnell said on the Senate floor.

The bill has revived a fight that many in Washington thought was over when an Obamacare repeal-and-replace bill flopped in the Senate in July, humiliating McConnell and President Donald Trump.

The latest measure has less than two weeks before procedural rules in the Senate make it much more difficult for the Republicans to do away with Obamacare.

The bill proposes replacing Obamacare with a system that would give states money in block grants to run their own healthcare programs and let them opt out of some Obamacare rules. Critics say it would bring deep cuts to the Medicaid program for the poor and higher insurance premiums for older people.

“Graham-Cassidy would be devastating for individuals with pre-existing conditions,” the Center for American Progress, a liberal think tank in Washington, said in a statement.

McConnell stopped short of promising to bring the legislation to the Senate floor. But he said Republican lawmakers would continue to discuss it. He has been meeting with lawmakers to assess whether the bill has the votes to pass.

The proposal is the latest salvo in a long-running Republican war on Obamacare, and Graham and Cassidy say they are close to securing the votes needed for passage.

If approved, it would replace the 2010 Affordable Care Act, known informally as Obamacare, which Republicans have long seen as government overreach into the healthcare business.

Several Republicans – the same ones whose votes blocked repeal of Obamacare in July – are still undecided on the latest bill and time is running out.

A special parliamentary procedure that would allow the bill to move forward with only 51 votes will expire at the end of the month. After that, it would need 60 votes, like most Senate legislation. Republicans have a 52-vote Senate majority.

The Senate Finance Committee said it will hold a hearing on the bill next week.

If the Senate can pass the bill, “the hope would be that the House would take it up and pass it and the president sign it,” said John Cornyn, the No. 2 Senate Republican.

Senate Democratic Leader Chuck Schumer said Republicans were “grossly irresponsible” to consider legislation before even getting a full assessment of its impacts from the non-partisan Congressional Budget Office.

Additional reporting by Richard Cowan and Amanda Becker; Editing by Chizu Nomiyama and Alistair Bell

Our Standards:The Thomson Reuters Trust Principles.

U.S. Senate's McConnell urges quick action on Obamacare repeal bill

WASHINGTON (Reuters) – U.S. Senate Majority Leader Mitch McConnell on Tuesday urged quick action on a recently introduced bill to repeal Obamacare and said it had a lot of support.

The legislation by Senators Lindsey Graham and Bill Cassidy is “an intriguing idea and one that has a great deal of support,” McConnell, a Republican, told the Senate. Lawmakers should act, because we know that “our opportunity to do so may well pass us by if we don’t act soon,” he said.

The bill would replace Obamacare with a system that would give states money in block grants to run their own healthcare programs.

Reporting by Susan Cornwell; Editing by Chizu Nomiyama

Our Standards:The Thomson Reuters Trust Principles.

Unbudgeted: How the opioid crisis is blowing a hole in small-town America's finances

INDIANA, Pa./CHILLICOTHE, Ohio (Reuters) – As deaths mount in America’s opioid crisis, communities on the front lines face a hidden toll: the financial cost.

Ross County, a largely rural region of 77,000 people an hour south of Columbus, Ohio, is wrestling with an explosion in opioid-related deaths – 44 last year compared to 19 in 2009. The drug addiction epidemic is shattering not just lives but also stressing the county budget.

About 75 percent of the 200 children placed into state care in the county have parents with opioid addictions, up from about 40 percent five years ago, local officials say. Their care is more expensive because they need specialist counseling, longer stays and therapy.

That has caused a near doubling in the county’s child services budget to almost $ 2.4 million from $ 1.3 million, said Doug Corcoran, a county commissioner.

For a county with a general fund of just $ 23 million, that is a big financial burden, Corcoran said. He and his colleagues are now exploring what they might cut to pay for the growing costs of the epidemic, such as youth programs and economic development schemes.

“There’s very little discretionary spending in our budget to cut. It’s really tough,” Corcoran said.

Cities, towns and counties across the United States are struggling to deal with the financial costs of a drug addiction epidemic that killed 33,000 people in 2015 alone, data and interviews with more than two dozen local officials and county budget professionals shows. (For graphics on the opioid crisis click here: tmsnrt.rs/2hO4YC7)

The interviews and data provide one of the first glimpses into the financial impact on local governments but it is far from complete because there is no central database collating information from counties and states. So, the true scale is still mostly hidden from view.

Opioids, primarily prescription painkillers, heroin and fentanyl – a drug 50 to 100 times more powerful than morphine – are fueling the drug overdoses.

President Donald Trump last month called the epidemic a “national emergency” but has not yet made an official national emergency declaration. Such a move would give states access to federal funds to fight it.

BUILDING A PICTURE

Counties grappling with rising overdoses face higher costs in emergency call volumes, medical examiner and coroner bills, and overcrowded jails and courtrooms, said Matt Chase, executive director of the National Association of Counties, which represents 3,069 county and local governments.

At his group’s July annual meeting, a presentation where county officials shared tips on tackling the opioid crisis, and the budget problems the crisis is triggering, played to a packed room, Chase said.

The organization is in the early stage of collecting information to build a more complete picture of the financial impact of the crisis on county budgets, Chase said.

Indiana County, Pennsylvania, a mountainous, predominantly rural region, provides a snapshot of how the crisis is stressing local services and budgets.

Its county seat, the borough of Indiana, is home to a modern college campus and a main street lined by restaurants and American flags. Yet beneath its outward tranquility, the opioid epidemic is everywhere, said David Rostis, an undercover detective and head of the county’s drug task force.

On a recent ride-along in Rostis’ car, he points to a building where a doctor used to sell opioid prescriptions for sex; a large, affluent home where a teenager died of an overdose; a trail where a drug-related killing recently occurred; and the local gas station where a woman recently overdosed and died in her car while people passed by.

In 2016, the county’s drug overdose death rate was 50.6 deaths per 100,000, compared to the state average of 36.5.

Autopsy and toxicology costs there have nearly doubled in six years, from about $ 89,000 in 2010 to $ 165,000 in 2016, county data shows.

Court costs are soaring, mainly because of the expense of prosecuting opioid-related crimes and providing accused with a public defender, local officials say.

The county is using contingency funds to pay for the added coroner costs, said Mike Baker, the county’s top government official. Last year, the county drew $ 63,000 from those funds, up from $ 19,000 in 2014, he said. In 2014, the county saw 10 drug-related deaths. In 2016, the number had grown to 53.

In Mercer County, West Virginia, 300 miles (483 km) to the south of Indiana County, opioid-related jail costs are carving into the small annual budget of $ 12 million for the community of 62,000 people.

The county’s jail expenses are on course to increase by $ 100,000 this year, compared to 2015. The county pays $ 48.50 per inmate per day to the jail, and this year the jail is on course to have over 2,000 more “inmate days” compared to 2015, according to county data.

“At least 90 percent of those extra jail costs are opioid-related,” said Greg Puckett, a county commissioner who sits on a national county opioid task force. “We spend more in one month on our jail bill than we spend per month on economic development, our health department and our emergency services combined.”

West Virginia has been on the front line of the opioid crisis. In 2015, the state led the nation in drug overdose death rates for the third consecutive year. Preliminary numbers for 2016 recorded 883 drug overdose deaths, with 755 involving at least one opioid, up from 629 total deaths in 2014.

AUTOPSIES INC.

Few know the opioid crisis like the father-son duo Sidney and Curtis Goldblatt. The pair run two companies, ForensicDx for autopsies and MolecularDx for drug testing, out of Windber, Pennsylvania. Together they conduct autopsies for 10 Pennsylvania counties, including Indiana, charging between $ 2,000 and $ 3,000 per body.

In 2014, overdoses represented about 40 percent of the deaths they handled, the Goldblatts said. Last year, that shot up to 62 percent. Goldblatt senior has been performing autopsies for 50 years and says he has never seen anything on the scale of the current epidemic. When he started, a drug overdose was rare.

The pair opened ForensicDx in 2014 with a staff of three, serving only three counties. That’s grown to seven staff and 10 counties, mainly to meet demand from drug-related deaths, the Goldblatts said.

Indiana County’s ambulance service is also under financial stress because of the opioid crisis. The county’s primary ambulance provider, Citizens’ Ambulance Service, has lost more than $ 100,000 since 2016 alone on opioid calls, said Randy Thomas, director of operations.

The non-profit is reimbursed only if an opioid overdose patient is transported to the hospital. It doesn’t get paid for successfully treating people who have overdosed but then refuse to go to the hospital, Thomas said.

People brought back from the brink of death after a dose of the life-saving drug naloxone, also known as Narcan, often awake angry and combative and refuse hospitalization, Thomas said.

As costs related to the opioid epidemic increase, Indiana County commissioner Baker isn’t sure what will happen next. Unless the state or federal government intervene, the county will have to either cut services or increase taxes, Baker said.

“This has introduced an entirely different metric, an entirely different level of unpredictability in budgeting,” he said.

For all the budget problems Baker faces because of the crisis, the human toll is what distresses him most. Last fall, Baker’s nephew died of a fentanyl overdose. He was 23. Talking about his nephew’s death, Baker pauses to collect his thoughts.

”It is a most painful and difficult experience and I wouldn’t wish it on anyone in the world,” he said.

Editing by Jason Szep and Ross Colvin

Our Standards:The Thomson Reuters Trust Principles.

GlaxoSmithKline breathes easier as U.S. approves triple lung drug

LONDON (Reuters) – U.S. regulators have approved GlaxoSmithKline’s three-in-one inhaler for chronic lung disease, a key new product for the group as it strives to keep its lead in respiratory medicine despite falling sales of the older drug Advair.

Trelegy Ellipta is the first once-daily triple medicine for chronic obstructive pulmonary disease (COPD), putting Britain’s biggest drugmaker ahead of rivals such as AstraZeneca and Novartis .

Last week, the inhaler, which GSK developed with Innoviva, also won a recommendation for approval from the European Medicines Agency.

Chief Executive Emma Walmsley sees the triple lung drug as one of three “critical” launches as GSK seeks to fill a revenue gap left by falling sales of Advair, which is expected to face U.S. generic competition sometime next year.

Its two other key new products are Shingrix, a shingles vaccine that was unanimously recommended for approval by a U.S. Food and Drug Administration (FDA) advisory panel last week, and a novel dual-drug regimen for HIV.

GSK estimates about a quarter of COPD patients are already using three drugs to control their lung disease, suggesting plentiful demand for more intensive treatment.

Such patients will now get all three medicines in one easy-to-use inhaler, although how exactly that will translate into overall sales is less easy to calculate.

The new product is likely to be attractive in some markets, since it will reduce co-payments for patients by offering a single prescription, but GSK will inevitably cannibalize sales of some of its other drugs.

At the same time, prices for inhaled respiratory medicines are continuing to decline due to increased competition.

Still, by launching Trelegy Ellipta before generic Advair hits the U.S. market, GSK will have more breathing space to switch patients to the newer product, Berenberg analysts said in a note.

GSK, whose shares were little changed in early trade on Tuesday following overnight news of the FDA approval, said it would make Trelegy Ellipta available in the United States “shortly”.

The GSK inhaler combines the drugs fluticasone furoate, umeclidinium and vilanterol, offering three different mechanisms to help open airways of patients with severe COPD. The drug is not indicated for asthma.

GSK has been the respiratory market world leader since launching its Ventolin inhaler in 1969 and Walmsley, who took over as CEO in April, has made lung disease a continuing priority for the years ahead.

In July, she announced plans to narrow the focus of the group’s drug research and allocate 80 percent of its R&D budget to respiratory and HIV/infectious diseases, along with two other potential areas of oncology and immuno-inflammation.

Additional reporting by Rama Venkat Raman in Bengaluru; Editing by Leslie Adler and Louise Heavens

Our Standards:The Thomson Reuters Trust Principles.

U.S. AIDS strategy to focus on 13 countries close to controlling epidemic

(Reuters) – The United States will concentrate its resources on 13 countries with high levels of HIV that have the best chance of controlling the AIDS epidemic under a strategy unveiled on Tuesday.

U.S. Secretary of State Rex Tillerson outlined the priorities of the President’s Emergency Plan for AIDS Relief or PEPFAR, a cornerstone of U.S. global health assistance, which supports HIV/AIDS treatment, testing and counseling for millions of people worldwide.

President Donald Trump’s administration requested the program be cut by $ 1 billion earlier this year but the Senate Appropriations Committee voted last week to keep funding largely unchanged at roughly $ 6 billion.

“The Trump Administration remains deeply committed to the global HIV/AIDS response and to demonstrating clear outcomes and impact for every U.S. dollar spent,” Tillerson said in the report.

The administration did not disclose which programs were being cut, but the State Department has stressed that it will continue offering treatment to people who are already receiving it.

PEPFAR will continue to operate programs in more than 50 countries. To maximize its impact, however, it will focus much of its efforts on 13 countries that are nearing epidemic control – the point where there are more deaths each year from AIDS than there are new HIV infections.

FILE PHOTO: Secretary of State Rex Tillerson arrives for a meeting at the Palace Hotel during the United Nations General Assembly in New York City, U.S. September 18, 2017. REUTERS/Stephanie Keith

Those countries include Kenya, Zambia, United Republic of Tanzania, Uganda, Zimbabwe, Malawi, Lesotho, Ivory Coast, Botswana, Namibia, Swaziland, Haiti and Rwanda.

“We’ve really focused on accelerating in these countries that we can get over the finish line, together with communities and governments,” Ambassador Deborah Birx, the U.S. global AIDS coordinator, said in a telephone interview.

The work would be done in collaboration with the Global Fund to Fight AIDS, Tuberculosis and Malaria, UNAIDS, and others.

Five of the target countries – Lesotho, Swaziland, Malawi, Zambia and Zimbabwe – are already nearing control of their HIV epidemics, based on national surveys from the Centers for Disease Control and Prevention, Columbia University and local governmental and non-governmental partners.

Last May, Republicans balked at the Trump administration’s proposed $ 5 billion budget for PEPFAR, a $ 1 billion cut from the current budget of $ 6 billion.

The Bill and Melinda Gates Foundation last week warned that even modest cuts in HIV/AIDS funding could reverse dramatic gains in curbing the global AIDS epidemic.

In the past five or six years, presidents have proposed PEPFAR cuts and Congress, which controls the budget, has restored the funding, Birx said.

Reporting by Julie Steenhuysen; Editing by Lisa Shumaker

Our Standards:The Thomson Reuters Trust Principles.