WASHINGTON — The nation’s top doctor said the United States is “falling short” in protecting the public health of children and adolescents from the impact of social media and firearm violence — and both are areas where he wants Congress to take additional action.

Surgeon General Vivek Murthy is no stranger to the task of influencing the federal government’s public health priorities and the nation’s understanding of the biggest public health issues.

Between his tenure as surgeon general in the Obama administration from December 2014 to April 2017 and his current role under President Joe Biden since March 2021, he’s had one of the longest careers as surgeon general since the 1950s — more than five and half years.

The surgeon general job has taken different forms over the years, with some physicians serving more as an advocate for healthy behavior and others pushing novel and sometimes controversial policy changes.

The late C. Everett Koop gained prominence in the Reagan administration for a surgeon general report recognizing that nicotine could be as addictive as cocaine and heroin and spearheading a mass mailing to all households educating about AIDS. Under President Bill Clinton, Joycelyn Elders was forced to resign over her comments on sex education.

Murthy has straddled that line, offering increasingly bold proposals in his effort to tackle the youth mental health and loneliness crisis.

“It became increasingly clear to me during my first term as surgeon general that the mental health challenges we faced were far bigger and deeper than we were acknowledging as a country and certainly than we were responding to,” Murthy said this week in an interview.

This year he has issued two calls to action — both met with mixed reception from industry and the broader health community — tackling the impact of social media on youth mental health and reducing the public health impact of firearm violence.

“Our most sacred responsibility as a society is to take care of our children, and when it comes to protecting them from the harms of social media and gun violence, we are falling short, and we’ve got to do better,” Murthy said. “The ripple effects are extraordinary for anyone who has had a child in their life.”

His priorities have shifted since his first Senate confirmation in 2014, and many of his ideas are shaped by the ongoing conversations with community members that he began having after taking the job. Some of those conversations inspired the first federal report on electronic cigarettes in 2016, he said.

Murthy joined the Biden administration in the middle of the COVID-19 pandemic. Even amid that crisis, he said he understood that loneliness and isolation from the pandemic could have wide-ranging mental health implications.

“We’ve got to approach these issues with the urgency that they deserve,” Murthy said. “Our problem is not a lack of good ideas, it’s the will to implement those ideas and to ultimately protect our kids.”

Social media

Murthy published an editorial in the The New York Times on June 17 calling for social media companies to use warning labels illustrating the adverse effects the platforms can have for youth. The call to action also advised Congress to take steps to reduce online harassment and exploitation of children and adolescents online and echoed an advisory he had issued the prior year.

His 2024 push ultimately came with congressional backing: The Senate passed its package of two children’s online safety bills last month, 91-3, despite some industry objections.

Numerous lawmakers have cited Murthy’s guidance and his op-ed in their support for the package and the need to take action. Murthy called the congressional action “really important steps forward,” but he cautioned against drawing early conclusions on the impact.

“History is full of well-intended measures that didn’t have the full impact that they needed to have,” he said. “Until we have data that shows us that the ultimate changes that are being made are resulting in a safe environment for our kids and technology that is safe for our children to use, then our job won’t be done.”

By contrast, the House has faced obstacles advancing its companion bills. The Energy and Commerce Committee canceled a June 27 markup of an online privacy bill after it received opposition from tech companies and some LGBTQ advocacy groups.

It’s unclear whether the House will take up the Senate version after the August recess, but Murthy stressed the urgency of the problem.

“I certainly would welcome the opportunity to keep working with legislators as they fashion solutions. With that said, what’s really important is time here,” he said.

But the surgeon general stopped short of saying whether he would advocate for House passage of the Senate-passed legislation.

“When legislators have questions and need technical assistance, you know, we’re always happy to help them,” he said, adding that he’s spoken to members of Congress from both chambers about his advisories and calls to action related to social media.

“It’s taken us long enough as a country to take the steps that we’ve already taken from a legislative perspective,” he said, “and we have to get the job done.”

Firearm violence

Murthy has likened strategies to mitigate the impact of gun violence to the adoption of seat belts and airbags in automobiles.

Both safety features were initially underused, and the automotive industry lobbied against requiring them. But both are now required under federal law and greatly reduce the risk of automobile fatalities.

“The political polarization that we see around gun violence often obscures how much agreement there is in the general public about measures that have to be taken,” said Murthy, who thinks people can unite around a shared concern about the mental and physical consequences of children whose families experience gun violence.

His office released an advisory and report on the public health threat of gun violence on June 25, shortly after calls from advocates on the issue.

According to the report, the federal government spent $878 million researching motor vehicle crashes in children and adolescents between 2008 and 2017. In that same period, the federal government spent $12 million on firearm injury prevention research — money spent through the National Institutes of Health and the National Institute of Justice.

“We have a long way to go for Congress to raise the level of funding for gun violence to what’s actually needed to help us understand more about the factors that are contributing to gun violence, understanding who is most deeply affected, to understanding what solutions work and are most effective, and hence need to be scaled up further,” Murthy said.

Congress allocated new funding specifically for gun violence research at the Centers for Disease Control and Prevention and the NIH for the first time in decades for fiscal 2020. Murthy said he was “encouraged to see Congress allocate some funding for gun violence research” but that the government was still “massively underfunding research” on the issue.

He said there’s a lot more that researchers still need to understand to ensure that gun violence prevention programs are effective.

“And all of that requires funds, funds that can’t be entirely provided at the scale that’s needed by the philanthropic sector, but that really need [the] government to step in,” he said.

But increasing federal funding for that research is likely a hard sell with lawmakers. The House and Senate have proposed vastly different topline numbers for Labor-HHS-Education spending in fiscal 2025, and the inclusion of any money for firearm violence-related research is a sticking point for some Republicans.

Congress did come together in 2022 on a bipartisan gun control and mental health law, the first such compromise since the assault weapons ban in 1994.

But smaller endeavors haven’t made headway.

Murthy sees the key to changing attitudes about funding this research as taking a cue from Congress’ speed and efficiency in passing broad COVID-19 relief in 2020.

“Congress moved during a complicated year to get resources to families and to communities and to put measures in place to help accelerate vaccine development,” he said. That, in combination with action in 2021, resulted in billions of dollars for schools to reopen safely.

“We can move when there is an urgent threat that we’re facing, and gun violence represents one of those threats,” Murthy said. “It may not feel as urgent, given how desensitized sometimes we become to stories about gun violence, but the truth is, the urgency is still there.”

©2024 CQ-Roll Call, Inc., All Rights Reserved. Visit cqrollcall.com. Distributed by Tribune Content Agency, LLC.

LOS ANGELES — Jonnae Thompson has felt for a long time that her dark brown skin and natural hair have made finding work in Hollywood especially hard.

“It’s like this negative connotation,” said the 37-year-old actress, singer, and stand-up comedian, who said she is often asked to audition for villainous roles such as a bully, drug dealer, or pimp.

Her quest for more equitable representation on the big screen isn’t just professionally exhausting. Thompson says anxiety about her skin complexion has affected her health.

“It definitely had a negative impact on my self-esteem,” she said. She recalls being called “charcoal” in kindergarten. “It was big, like, your skin is dark and that’s a problem.”

The term colorism — a form of prejudice and discrimination in which lighter skin is favored over darker skin — was popularized by author Alice Walker in her 1983 book “In Search of Our Mothers’ Gardens: Womanist Prose.”

Clinicians from various ethnic groups have recently begun to draw a direct line between colorism and poor health. A 2023 KFF survey found that, among Black and Hispanic adults, those with self-described darker skin tones reported more experiences with discrimination in daily life compared with those who have lighter skin tones. People who feel they experience daily discrimination can be at higher risk for depression, loneliness, increased alcohol and drug use, and anxiety, data shows.

And colorism can also lead to physical health concerns. Hair straighteners and skin lighteners commonly used by women of color, sometimes to conform to racialized beauty standards, increase their exposure to toxic chemicals, research shows.

Because of the potential health implications, the health care system should pay more attention to colorism, said Regina James, a child and adolescent psychiatrist who heads the American Psychiatric Association’s Division of Diversity and Health Equity.

“Skin color discrimination is so insidious it can literally get under your skin,” she said. “And consciously or subconsciously, it can contribute to low self-esteem and self-confidence, and even be detrimental to one’s mental health.”

Conversations about skin complexion can remain overlooked by mental health professionals who do not have expertise about or awareness of a person’s cultural context, if the conversations happen at all, said Usha Tummala-Narra, a clinical psychologist and professor in the Department of Counseling, Developmental, and Educational Psychology at Boston College.

“There’s no specific training on colorism. Many people are unaware that it exists,” Tummala-Narra said.

But the experience can negatively affect a person’s self-worth, relationships, sense of belonging, and dignity. “These are all really critically important things as human beings that we all need to secure to have good health, both physically and mentally,” she said.

The issue can emerge in childhood for Black and Indigenous people and other people of color, who must navigate fair skin often being seen as superior, a ramification of colonialization. Black children with the darkest complexions experience higher levels of depressive symptoms, found a 2020 study in the journal Society and Mental Health.

Shannon Brown, 34, a former college counselor from the Bronx, New York, who is Black, remembers being called “midnight” by classmates and having family members joke about his skin being difficult to light in family photos. “I’ve just kind of accepted it and try to find the humor in it,” he said. “I feel like most folks aren’t intentionally trying to hurt me, but the jokes get tiresome.”

Shakun Kaushal, a 26-year-old digital communications specialist at the Johns Hopkins Center for Gun Violence Solutions, is Indian American and has a “darker complexion.” She said that in Indian culture one might hear comments like, “Oh, she’s so light and beautiful.”

“I sometimes feel dismissed by people,” said Kaushal, who has searched for an Indian or Black therapist in hopes they might better relate to her lived experience. She believes conversations about colorism should be intergenerational, start early, and get introduced with great care.

“What you say to a child does affect them. They will remember, and it will impact how they feel about themselves and in their skin,” Kaushal said. “We must talk about it.”

The feeling of shame and embarrassment colorism produces in people is palpable and needs to be acknowledged in health care settings, said Roopal Kundu, a dermatologist who founded and directs the Northwestern Medicine Center for Ethnic Skin and Hair in Chicago. Kundu, who is of South Asian heritage, opened the center in 2005 and notes that some cases of diseases like psoriasis, skin cancer, and eczema get diagnosed later, or misdiagnosed, because they present differently on diverse skin tones.

“How can we really make sure, as a field, that we’re taking care of everybody?” she said. “Healthy skin is beautiful skin. And beauty is across every single skin tone that there is.”

Therapists, doctors, and other clinicians from diverse backgrounds say that, in addition to clinical approaches that incorporate cultural competence, more efforts are needed to diversify the pool of mental health practitioners and to collaborate between disciplines.

Without cultural awareness and sensitivity, “you’re not going to get all the information that you need to appropriately diagnose and treat someone,” James said.

Black people are more likely to report difficulty finding mental health providers who understand their background and experiences, a KFF survey found. At the same time, programs that bolster diversity, equity, and inclusion in medical schools are faltering in the wake of the 2023 Supreme Court decision outlawing affirmative action in higher education.

According to the Association of American Medical Colleges, in 2022, about 5% of active psychiatric physicians identified as Black, 16% as Asian, 6% as Hispanic, and fewer than 1% as American Indian or Alaska Native.

Thompson, Brown, and Kaushal all said they had never been treated by a therapist who looks like them.

Thompson, the L.A. comedian, said she drank bleach when she was 10 years old, thinking it would lighten her skin. Fortunately, it caused only nausea.

If she could speak to her younger self, she would say: “You’re beautiful. You’re brilliant.”

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(KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of KFF — the independent source for health policy research, polling and journalism.)

©2024 KFF Health News. Distributed by Tribune Content Agency, LLC.

A three-judge panel of the 1st District Court of Appeal overturned a 2023 decision by Leon County Circuit Judge John Cooper that said Moody had the power to enter settlements that effectively included trumping separate claims by local government agencies.

Wednesday’s ruling was a victory for the Sarasota County Public Hospital District, Lee Memorial Health System, the North Broward Hospital District, the South Broward Hospital District, Halifax Hospital Medical Center, the Miami-Dade County School Board and the Putnam County School Board. They have sought to pursue lawsuits to recover costs related to treating patients and educating children affected by the opioid epidemic.

All of the local agencies had sued drug distributors, manufacturers or pharmacies because of the epidemic.

“The attorney general does not have the legal authority to unilaterally dismiss, for example, actual and individual damages incurred by the two school boards for increased harms and expenditures for compliance with federal law for special educational needs for disabled students — disabled allegedly by the actions of the opioid (industry) defendants that caused the students or their parents to become addicted to prescription opioids,” the appeals court ruling said. “And this is but one example. The special hospital districts also assert individual and actual damages separate from the general public for harms allegedly inflicted by the opioid defendants that caused these hospitals to have to provide specialized medical care for opioid-addicted and harmed patients. It is not within the attorney general’s power to make such decisions.”

Moody’s office entered into seven settlements with a variety of companies — with each of the settlements including a “release” of claims filed by local governments. Some settlements resulted from multi-state litigation — what is known as a global settlement — while others came as a result of a lawsuit that the attorney general’s office filed in Pasco County.

Moody in 2022 filed a lawsuit in Leon County circuit court against the hospital districts and school boards to try to prevent their claims against the industry. The lawsuit said Moody’s settlements would provide money for opioid treatment, prevention and recovery services and that money would go to communities throughout the state. But the hospital districts and school board argued that Moody did not have the authority to release their claims.

Cooper’s decision last year said the Legislature “specifically granted the attorney general authority to enforce consumer protection laws” and that Moody had the power to enter settlements that prevented separate claims.

“Allowing defendants (the hospital districts and school districts) to continue pursuing their subordinate opioid claims threatens Florida’s sovereign interest in vindicating its citizens’ rights — all of its citizens’ rights — when confronted with societal harms such as the opioid crisis,” Cooper wrote. “These are collective harms. They do not flow in an insular fashion to individual (political) subdivisions — the harms cross city and county lines. Indeed the opioid settlements consider the pervasive harms caused by the opioid crisis and apply a mixture of statewide and local solutions. … Defendants’ continued pursuit of their opioid claims in contravention of the opioid settlements jeopardizes the flow of tens of millions of dollars that will aid in the abatement of the opioid epidemic throughout the state of Florida.”

But the appeals-court ruling, written by Judge Brad Thomas and joined by Judges Ross Bilbrey and Thomas Winokur, said the Legislature has “assigned the rights of legal representation of claims to appellants (the hospital districts and school boards) themselves, not the attorney general.”

“In essence, the attorney general asserts the unilateral substantive authority to dispose of appellants’ claims on behalf of the people of Florida, notwithstanding the enactment of law assigning that authority to appellants,” the 19-page ruling said. “But the attorney general is the ‘chief state legal officer’ of the state, not the client. As the state’s chief legal officer, the attorney general has limited common-law authority … to litigate claims common to the state at large — and, of course, claims authorized by general law, and limited by that law — but not to control claims of appellants who assert unique and individual actual damages.”

The ruling also said Moody “argues unpersuasively that as the state’s chief legal officer, she may bar appellants from representing themselves, while simultaneously denying any interest in representing appellants. The attorney general argues that it is her prerogative to eliminate the value of appellant’s individual claims for harms caused by the opioid defendants, as a ‘bargaining chip’ to obtain this global financial settlement. Thus, the attorney general asserts that she may disavow these school boards’ and hospital districts’ actual damages for her own negotiating prerogatives.”

“No doubt the global settlement achieves many laudable goals,” the ruling added. “But it cannot deprive appellants of their legal rights to be made whole for their unique losses.”

LONDON (AP) — The World Health Organization has declared the mpox outbreaks in Congo and elsewhere in Africa a global emergency, with cases confirmed among children and adults in more than a dozen countries and a new form of the virus spreading. Few vaccine doses are available on the continent.

Earlier this week, the Africa Centers for Disease Control and Prevention announced that the mpox outbreaks were a public health emergency, with more than 500 deaths, and called for international help to stop the virus’ spread.

“This is something that should concern us all … The potential for further spread beyond Africa and beyond is very worrying,” said WHO director-general Tedros Adhanom Ghebreyesus.

The Africa CDC previously said that mpox, also known as monkeypox, has been detected in 13 countries this year, and that more than 96% of all cases and deaths are in Congo. Cases are up 160% and deaths are up 19% compared with the same period last year. So far, there have been more than 14,000 cases and 524 people have died.

“We are now in a situation where (mpox) poses a risk to many more neighbors in and around central Africa,” said Salim Abdool Karim, a South African infectious diseases expert who chairs the Africa CDC emergency group. He noted that the new version of mpox spreading from Congo appears to have a death rate of about 3-4%.

During the global 2022 mpox outbreak that affected more than 70 countries, fewer than 1% of people died.

Michael Marks, a professor of medicine at the London School of Hygiene and Tropical Medicine, said declaring the mpox outbreaks in Africa an emergency is warranted if that might lead to more support to contain them.

“It’s a failure of the global community that things had to get this bad to release the resources needed,” he said.

Officials at the Africa CDC said nearly 70% of cases in Congo are in children younger than 15, who also accounted for 85% of deaths.

Jacques Alonda, an epidemiologist working in Congo with international charities, said he and other experts were particularly worried about the spread of mpox in camps for refugees in the country’s conflict-ridden east.

“The worst case I’ve seen is that of a six-week-old baby who was just two weeks old when he contracted mpox,” Alonda said, adding the baby has been in their care for a month. “He got infected because hospital overcrowding meant he and his mother were forced to share a room with someone else who had the virus, which was undiagnosed.”

Save the Children said Congo’s health system already had been “collapsing” under the strain of malnutrition, measles and cholera.

WHO Director-General Tedros Adhanom Ghebreyesus said officials were facing several outbreaks of mpox outbreaks in various countries with “different modes of transmission and different levels of risk.”

The U.N. health agency said mpox was recently identified for the first time in four East African countries: Burundi, Kenya, Rwanda and Uganda. All of those outbreaks are linked to the one in Congo. In the Ivory Coast and South Africa, health authorities have reported outbreaks of a different and less dangerous version of mpox that spread worldwide in 2022.

Earlier this year, scientists reported the emergence of a new form of the deadlier form of mpox, which can kill up to 10% of people, in a Congolese mining town that they feared might spread more easily. Mpox mostly spreads via close contact with infected people, including through sex.

Unlike in previous mpox outbreaks, where lesions were mostly seen on the chest, hands and feet, the new form causes milder symptoms and lesions on the genitals. That makes it harder to spot, meaning people might also sicken others without knowing they’re infected.

In 2022, WHO declared mpox to be a global emergency after it spread to more than 70 countries that had not previously reported mpox, mostly affecting gay and bisexual men. Before that outbreak, the disease had mostly been seen in sporadic outbreaks in central and West Africa when people came into close contact with infected wild animals.

Western countries mostly shut down the spread of mpox with the help of vaccines and treatments, but very few of those have been available in Africa.

Marks of the London School of Hygiene and Tropical Medicine said that in the absence of mpox vaccines licensed in the West, officials could consider inoculating people against smallpox, a related disease. “We need a large supply of vaccine so that we can vaccinate populations most at risk,” he said, adding that would mean sex workers, children and adults living in outbreak regions.

Congolese authorities said they have asked for 4 million doses of mpox vaccine, Cris Kacita Osako, coordinator of Congo’s Monkeypox Response Committee, told The Associated Press. Osako said those would mostly be used for children under 18.

“The United States and Japan are the two countries that positioned themselves to give vaccines to our country,” Osako said.

Although WHO’s emergency declaration is meant to spur donor agencies and countries into action, the global response to previous emergency designations has been mixed.

Dr. Boghuma Titanji, an infectious diseases expert at Emory University, said the last WHO emergency declaration for mpox “did very little to move the needle” on getting things like diagnostic tests, medicines and vaccines to Africa.

“The world has a real opportunity here to act in a decisive manner and not repeat past mistakes, (but) that will take more than an (emergency) declaration,” Titanji said.

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Associated Press writers Gerald Imray in Cape Town, South Africa, Christina Malkia in Kinshasa, Congo and Mark Banchereau in Dakar, Senegal contributed to this report.

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

Election officials in Arizona and Missouri this week announced that abortion-rights supporters in their states had gathered enough petition signatures to put proposed amendments on the ballot enshrining abortion rights into their states’ constitutions.

The decisions mean voters in more than a half-dozen states will be deciding abortion measures this fall. The proposals are likely to drive up voter turnout, potentially affecting elections for president, Congress, governor and other state offices.

The U.S. Supreme Court removed the nationwide right to abortion with a 2022 ruling, which sparked a national push to have voters decide.

Since the decision, most Republican-controlled states have passed abortion restrictions, including 14 that ban it at every stage of pregnancy. Most Democratic-led states have laws or executive orders to protect access.

Voters in all seven states that have had abortion questions before voters since 2022 — California, Kansas, Kentucky, Michigan, Montana, Ohio and Vermont — have sided with abortion rights supporters.

What is on 2024 ballots?

MISSOURI

Missouri voters will decide whether to guarantee a right to abortion with a constitutional amendment that would reverse the state’s near-total ban.

The secretary of state’s office certified Tuesday that an initiative petition received more than enough signatures from registered voters to qualify for the general election. It will need approval from a majority of voters to become enshrined in the state constitution.

The Missouri ballot measure would create a right to abortion until a fetus could likely survive outside the womb without extraordinary medical measures, generally considered around 23 or 24 weeks into pregnancy. The ballot measure would allow abortions after fetal viability if a health care professional determines it’s necessary to protect the life or physical or mental health of the pregnant woman.

ARIZONA

Voters in Arizona will decide in November whether to amend the state constitution to add the right to an abortion up to about 24 weeks into pregnancy. The Arizona secretary of state’s office said Monday that it had certified enough signatures to put the measure on the ballot.

Under the proposed amendment, the state would not be able to ban abortion until the fetus is viable, with later abortions allowed to protect a woman’s physical or mental health. Opponents of the proposed amendment say it goes too far and could lead to unlimited and unregulated abortions in Arizona. Supporters say it would protect abortion access free from political interference.

Abortion is currently legal for the first 15 weeks of pregnancy in Arizona.

Notably, the informational pamphlet for voters who will decide the fate of the amendment can refer to a fetus as an “unborn human being” according to a ruling handed down by Arizona’s Supreme Court on Wednesday. It’s unclear, however, whether any specific language contained in the pamphlet will appear on the ballot.

COLORADO

Colorado’s top election official confirmed in May that a measure to enshrine abortion protections in the state constitution, along with requirements that Medicaid and private health insurers cover abortion, made the ballot for the fall election.

Supporters said they gathered nearly double the required number of signatures needed.

Amending the state constitution requires the support of 55% of voters.

Abortion is already legal at all stages of pregnancy in Colorado.

FLORIDA

The state Supreme Court ruled in April that a measure to legalize abortion until viability could go on the ballot despite a legal challenge from the state. Attorney General Ashley Moody had argued that there are differing views on the meaning of “viability” and that some key terms in the proposed measure are not properly defined.

To pass, the measure needs support from at least 60% of voters, a high threshold that supporters say they are hopeful of reaching after collecting nearly a million signatures on the petition to get it on the ballot.

Abortion is currently illegal in Florida after the first six weeks of pregnancy under a law that took effect May 1.

MARYLAND

Maryland voters also will be asked this year to enshrine the right to abortion in the state’s constitution. Abortion is already allowed in Maryland until viability.

NEVADA

The Nevada Secretary of State’s office announced in June that a ballot question to enshrine abortion rights in the state constitution has met all of the requirements to appear in front of voters in November.

Under the amendment, abortion access for the first 24 weeks of pregnancy — or later to protect the health of the pregnant person — would be protected. To change the constitution, voters would need to approve it in both 2024 and 2026.

Abortion up until viability is already allowed in the state under a law passed in 1990.

SOUTH DAKOTA

South Dakota voters will decide this fall on a constitutional amendment that would ban any restrictions on abortion in the first trimester of pregnancy. The measure would allow the state in the second trimester to “regulate the pregnant woman’s abortion decision and its effectuation only in ways that are reasonably related to the physical health of the pregnant woman.” An abortion ban would be allowed in the third trimester, as long as it included exceptions for the life and health of the woman.

Opponents have sued to try to take the initiative off the ballot.

What’s on the ballot in New York?

While not explicitly preserving a right to abortion, a reproductive rights question is on the ballot in New York. The measure would bar discrimination based on “pregnancy outcomes” and “reproductive healthcare,” along with sex, sexual orientation, gender identity, national origin and disability. Abortion is currently allowed in New York until fetal viability.

The question was on the ballot, then removed in May by a judge who found lawmakers missed a procedural step when they put it there. An appeals court reinstated it in June.

Where else could abortion be on the ballot in 2024?

MONTANA

Abortion rights proponents in Montana have proposed a constitutional amendment that would bar the government from denying the right to abortion before viability or when it is necessary to protect the life or health of the pregnant person.

After a legal battle over the ballot language, the Montana Supreme Court in April wrote its version of the language that would appear on the ballot if enough valid signatures are certified. Sponsors were required to submit about 60,000 signatures by June 21. They turned in nearly twice that many — about 117,000 — and backers have said counties have validated more than enough signatures. The secretary of state has until Aug. 22 to finalize the November ballot.

Abortion is already legal until viability in the state under a 1999 Montana Supreme Court opinion.

NEBRASKA

Competing abortion measures could be before voters in November after supporters of each said this month that they turned in far more signatures than the 123,000 required for ballot access.

One would enshrine in the state constitution the right to abortion until viability. Supporters said they submitted more than 207,000 signatures.

The other would write into the constitution the current law, which bars abortions after the first 12 weeks of pregnancy, with some exceptions. Its backers said they submitted more than 205,000 signatures.

The measure that gets the most votes will become part of the state constitution.

A Florida Atlantic University poll released Wednesday found both falling short of the 60% required for passage. A Suffolk University poll also found the abortion amendment short of hitting the threshold, and the marijuana question with slightly more than it needs.

Abortion: FAU found 56% of voters surveyed support and 21% oppose Amendment 4, which would enshrine abortion rights in the state Constitution. The Suffolk/USA TODAY/WSVN-Ch. 7 poll reported 58% support and 35% opposed.

Marijuana: FAU found 56% support and 29% oppose Amendment 3, which would legalize recreational marijuana for people age 21 and older. Suffolk reported 63% in favor and 33% opposed.

There are still more than enough voters who said they didn’t know — 23% on the abortion question and 15% on the marijuana question in the Florida Atlantic University poll — that passage is possible. Voters will be bombarded with extensive pro and con campaigns on both questions through the fall.

Conflicting polls

So how is it that two Florida polls released on the same day appear contradictory?

(A third Florida poll, released 16 days ago, had different results as well. A University of North Florida poll found greater support (69% to 23%) for the abortion rights amendment and for the marijuana referendum (64% to 31%).

It involves the nature of polling.

People who produce high-quality public opinion polls always point out that their surveys are snapshots of what people say at the time they’re asked. The timing of when polls are being taken — they describe it as being “in the field” — can make a difference.

Mainstreet Research for Florida Atlantic University’s PolCom Lab: 1,055 Florida registered voters, was conducted Aug. 10 and 11.

Suffolk University/USA TODAY/WSVN-Ch. 7: 500 likely Florida general election voters, was conducted between Aug. 7 and Aug. 11.

University of North Florida’s Public Opinion Research Lab: 774 registered voters, from July 24 to July 27.

In a statement about FAU’s results, political scientist Luzmarina Garcia noted the difference since its last poll on the amendments in the spring. “These results reflect a growing awareness of the constitutional amendments. In April, FAU polled on both initiatives and at that time these measures had 49% approval, which shows a gain of 7 (percentage points) over the last four months.”

The methods pollsters use can make a difference in the nature of the sample.

Pollsters use a range of techniques, some involving live callers to phone lines, others online surveys, others automated calls to phone lines and others use an online component. Sometimes they use a combination of methods to try to reach people, especially younger voters, who may be less inclined to answer their phones.

FAU’s survey used an online panel and automated phone calls to reach other voters.

Suffolk’s survey used live telephone interviews.

UNF’s survey used an online panel, in which voters were contacted by text message and asked to complete the survey, and from live callers.

Pollsters also make adjustments to weight the samples. If, for example, the survey doesn’t have enough people of a certain demographic group to reflect the total population, they’ll make a statistical adjustment so the total sample more accurately represents the entire population.

And polling isn’t precise. The margin of error indicates the range in which pollsters expect the results to be accurate most of the time.

Candidate A has 54% and Candidate B has 46% and the margin of error is plus or minus 5 percentage points, A and B could be tied at 50% each. Or, it could be 58-42.

The FAU poll has a margin of error equivalent to plus or minus 3 percentage points.

Suffolk said its margin of error was plus or minus 4 percentage points.

UNF reported a margin of error was plus or minus 5 percentage points.

The margin of error refers to the full poll. However, the margin of error for smaller groups, such as Republicans or Democrats, or men and women, would be higher because the sample sizes are smaller.

Abortion

The Florida Atlantic University poll found the abortion rights amendment is supported by a majority of every group surveyed — except Republicans.

Republicans were evenly divided, with 35% supporting and 35% opposing the amendment.

Democrats, with 80% in support and 8% opposed, favor the amendment more than any other group.

Independents are in favor, 59% to 15%.

Democrats were far more likely to have made up their minds. Just 12% of Democrats said they didn’t know how they would vote, compared to 27% of independents and 30% of Republicans.

Women were more likely than men to support the abortion rights amendment.

Women support it 59% to 19%, a 40-percentage point advantage.

Men support it 54% to 24%, a 30-point advantage.

And voters under age 50 were more likely to support the proposed amendment (62%) than voters 50 and older (52%.)

With Harris in race, poll shows closer contest in Florida. Trump now leads by 3 points.

Marijuana

The FAU survey shows a big age divide on the referendum that would allow recreational use of marijuana under state law by adults.

Voters younger than age 50 favor it, 69% to 20% — a difference of 49 percentage points, FAU reported.

Voters 50 and older support it more narrowly, 47% to 36%, a difference of 11 points.

There’s no difference based on gender, with 56% of men and 56% of women supporting legalization.

There is, however, a significant partisan divide.

Democrats favor the marijuana amendment 74% to 15%.

Independents favor it 63% to 22%.

Republican support is much lower at 37%, with 46% opposed.

“If they’re going to hit that 60%, the supporters of the amendment are probably going to have to reach a few more Republicans or have a particularly Democratic-leaning electorate, which sees a challenge in a presidential election year,” said Kevin Wagner, a Florida Atlantic University political scientist.

Wagner is also co-director of FAU’s PolCom Lab, a collaboration of the School of Communication and Multimedia Studies and Department of Political Science, which conducted the poll.

Anthony Man can be reached at aman@sunsentinel.com and can be found @browardpolitics on Bluesky, Threads, Facebook and Mastodon.

UPSIDE Foods, Inc., contends, in part, that the law violates a constitutional prohibition on favoring in-state businesses over out-of-state competitors.

“We’re not looking to replace conventional meat, which will always have a place on our tables,” Uma Valeti, a cardiologist who founded UPSIDE in 2015, said during a conference call Tuesday with reporters. “We want to give consumers a choice, a choice so they can eat cultivated meat or conventional meat, any choice they can make in the future to keep up with the demand for meat that will double by 2050.”

The lawsuit, filed in the federal Northern District of Florida, names as defendants state Agriculture Commissioner Wilton Simpson, Attorney General Ashley Moody and four state attorneys. Simpson, a key supporter of the law, called the lawsuit “ridiculous” and said “lab-grown meat is not proven to be safe enough for consumers.”

“Food security is a matter of national security, and our farmers are the first line of defense,” Simpson said in a statement. “As Florida’s commissioner of agriculture, I will fight every day to protect a safe, affordable, and abundant food supply. States are the laboratory of democracy, and Florida has the right to not be a corporate guinea pig. Leave the Frankenmeat experiment to California.”

The Legislature this year approved the ban as part of a broader Department of Agriculture and Consumer Services bill (SB 1084), which Gov. Ron DeSantis signed on May 1. The lawsuit said Florida became the first state to ban the manufacture, distribution and sale of cultivated meat.

“In doing so, Florida did not cite concerns that cultivated meat is less healthy or safe than conventional meat,” said the lawsuit, filed by attorneys from the Institute for Justice legal organization. “Instead, Governor DeSantis announced that Florida was ‘fighting back’ against the ‘authoritarian goals’ of the ‘global elite,’ who he alleged would force consumers to eat cultivated meat. The governor also announced that the law was part of his administration’s ‘focus on investing in our local farmers and ranchers’ and an effort to ‘save our beef.’”

The U.S. Food and Drug Administration and the U.S. Department of Agriculture last year approved UPSIDE to manufacture and sell its products. Since then, the company has distributed cultivated chicken products, an alternative to plant-based meat alternatives, at restaurants and tasting events across the nation, including in Florida.

“Laws like this in Florida will absolutely make sure that this innovation will go outside the United States and make it very challenging for us to have food safety and food security in the future,” Valeti said.

Paul Sherman, an Institute for Justice senior attorney, said a motion for a preliminary injunction is pending. If approved, a preliminary injunction could allow UPSIDE to sell products in Florida while the lawsuit moves forward.

“The states simply do not have the power to wall themselves off from products that have been approved by the USDA and the FDA,” Sherman said, referring to the federal agencies. “And if consumers don’t like the idea of cultivated meat, there’s a simple solution. They don’t have to eat it. But they can’t make that decision for other consumers.”

The other defendants in the lawsuit are Jack Campbell, the state attorney in the 2nd Judicial Circuit, which includes Leon and surrounding counties; Bruce Bartlett, the state attorney in the 6th Judicial Circuit, which is made up of Pinellas and Pasco counties; Andrew Bain, the state attorney in the 9th Judicial Circuit, which is made of up Orange and Osceola counties; and Katherine Fernandez Rundle, the state attorney in the 11th Judicial Circuit in Miami-Dade County. They are defendants because they would be expected to enforce the law.

The law, in part, makes it a second-degree misdemeanor to sell or manufacture cultivated meat. The manufacturing process includes taking a small number of cultured cells from animals and growing them in controlled settings to make food.

The lawsuit contends Florida’s ban violates the Supremacy Clause in the U.S. Constitution by pre-empting federal laws regulating meat and poultry products and violates what is known as the “dormant” Commerce Clause by insulating Florida agriculture from out-of-state competition.

For example, the lawsuit pointed to March comments by House bill sponsor Rep. Danny Alvarez, a Hillsborough County Republican who said, “If you believe that we are doing this because we know that Florida’s agriculture can hold us down and provides plenty of safe, quality beef and agricultural products — you are absolutely correct.”

Alabama followed Florida in approving a similar law, which doesn’t go into effect until Oct. 1. Similar bans have been proposed in states including Kentucky, Iowa, Pennsylvania and Texas.

UPSIDE, which would like to distribute its poultry products at Miami Beach’s Art Basel event in December and the 2025 South Beach Food and Wine Festival, contends Florida’s ban has affected the company’s revenue, promotional opportunities and reputation.

DeSantis traveled to rural Hardee County in May to sign the measure with members of the cattle industry on hand. While behind a podium that featured a sign saying, “Save Our Beef,” DeSantis said the law would protect against “an ideological agenda that wants to finger agriculture as the problem.”

DeSantis also called the products “fake meat” and said Florida was pushing “back against the global elite’s plan to force the world to eat meat grown in a petri dish or bugs to achieve their authoritarian goals.”

The law doesn’t prohibit cultivated-meat research because of concerns that such a ban could affect Florida’s space industry, which is looking at cultivated meats for long-term space journeys.

“Star Wars” actor Daisy Ridley has been diagnosed with an autoimmune disorder that can come with serious consequences: heart failure, stroke and thinning bones, just to name a few. With more than 3.3 million Americans affected by the disease, she’s hardly alone.

The “Star Wars: The Force Awakens” star revealed during an interview with Women’s Health that she was diagnosed with Graves’ disease in September 2023. Ridley was suffering from bouts of hot flashes and fatigue after filming “Magpie.” That’s when her doctor encouraged her to see an endocrinologist.

“I thought, ‘Well, I’ve just played a really stressful role; presumably that’s why I feel poorly,’” she told the news outlet. It wasn’t.

Speaking to the specialist, she explained she had a racing heart rate, fatigue, hand tremors and was losing weight unexpectedly. “Tired but wired” is how the doctor explained the disease to her.

According to the National Institute of Diabetes and Digestive and Kidney Diseases, Graves’ disease is an autoimmune disorder that can cause hyperthyroidism. The thyroid, which lies near your voice box, creates hormones that control the body’s energy usage. That’s why an overactive thyroid can lead to a wide variety of health issues, including in the heart.

It affects roughly 1% of people in the United States and is responsible for 80% of all hyperthyroidism cases. The disorder is more common in women, people over 30, those with a family history of the disease and people with other autoimmune disorders.

Ridley — a native of Westminster, London — is 32 years old. In the U.K, as of October 2023, the disease affects up to 1.6% of women.

Common symptoms include weight loss (despite an increased appetite), irregular heartbeat, irritability, fatigue, muscle weakness and hand tremors. But more than a third of patients also develop an eye disease: Graves’ ophthalmopathy.

A result of the body’s immune system attacking the eye muscles, symptoms often include bulging, and irritated and puffy eyes, as well as blurred vision, light sensitivity and pain.

“Researchers aren’t sure why some people develop autoimmune disorders such as Graves’ disease,” the institute reported. “These disorders probably develop from a combination of genes and an outside trigger, such as a virus.”

“With Graves’ disease, your immune system makes an antibody called thyroid-stimulating immunoglobulin (TSI) that attaches to your thyroid cells,” the NIDDK continued. “TSI acts like thyroid-stimulating hormone (TSH), a hormone made in your pituitary gland that tells your thyroid how much thyroid hormone to make. TSI causes your thyroid to make too much thyroid hormone.”

Treatments for Graves’ disease include radioiodine therapy and surgery, though medication is sometimes sufficient.

Already suffering from endometriosis and polycystic ovarian syndrome, the Hollywood star is still in high spirits, and she encouraged other women suffering to come forward.

“We all read the stats about women being undiagnosed or underdiagnosed and sort of coming to terms with saying, ‘I really, actually don’t feel good’ and not going, ‘I’m fine, I’m fine, I’m fine, I’m fine.’ It’s just normalized to not feel good,” she said.

“In the grand scheme of things, it’s much less severe than what a lot of people go through,” she later added. “Even if you can deal with it, you shouldn’t have to. If there’s a problem, you shouldn’t have to just (suffer through it).”

©2024 The Atlanta Journal-Constitution. Visit at ajc.com. Distributed by Tribune Content Agency, LLC.

Oliver Lackey opened a pharmacy in his hometown of Fairview, Oklahoma, so he could “provide the best patient care.” He set up shop a decade ago in the local grocery store with “zero prescriptions.” Before long, business took off — yet he was still struggling.

“I was getting more patients and was filling more prescriptions,” Lackey told Stateline. “But as I grew in revenues, my reimbursement from the insurance companies and PBMs every year was getting worse.”

PBMs are pharmacy benefit managers, the intermediaries in the drug supply chain that manage prescription drugs for health plans. PBMs determine which drugs are available under a person’s insurance plan, set copayments and decide how much pharmacies must pay to acquire drugs.

PBMs argue that they use their bargaining power to negotiate lower drug prices for consumers and pharmacists. But critics say PBMs, some of which are owned by the largest health care corporations in the nation, engage in anticompetitive practices that lead to higher prices and drive independent pharmacies like Lackey’s out of business.

In recent years, all 50 states have enacted laws designed to lower prescription drug costs by curbing the power of PBMs, according to the National Academy for State Health Policy, a nonpartisan research group. But thanks to a 50-year-old federal law called the Employee Retirement Income Security Act, better known as ERISA, almost none of those measures applies to the 65% of Americans who work for large employers that cover their workers through so-called self-funded health care plans.

That could change if the U.S. Supreme Court upholds a PBM law enacted by Lackey’s home state of Oklahoma.

Five years ago, Oklahoma tried to rein in PBMs by approving a measure barring them from forcing pharmacies to pay certain fees or requiring patients to use PBM-owned or -affiliated pharmacies. The law also prohibited PBMs from giving more generous reimbursements to their own pharmacies or arbitrarily booting pharmacies from their preferred networks.

It was “the most aggressive, broadest PBM enforcement legislation in the country,” Oklahoma Insurance Commissioner Glen Mulready, a Republican, told Stateline. “And it was immediately challenged.”

The Pharmaceutical Care Management Association, a trade association representing PBMs, sued to invalidate the law. In August of last year, the 10th U.S. Circuit Court of Appeals ruled that ERISA, the federal law, prevented Oklahoma from applying much of its law to self-funded health care plans.

Greg Lopes, the trade group’s vice president of public affairs, said the Oklahoma law “would raise costs for health plans and consumers in the state.”

“Oklahoma’s law would devastate employer, union, and Medicare plan sponsors as well as hundreds of thousands of their beneficiaries, who would experience higher costs and reduced benefits,” Lopes said in an email.

But in May, the state pushed back: Oklahoma appealed to the U.S. Supreme Court to reverse the decision. In June, 32 state attorneys general and five pharmacist trade groups joined the lawsuit.

The Supreme Court hasn’t decided whether to take the case. If the high court eventually rules in favor of Oklahoma, legal experts say, it could establish an important precedent by allowing states to regulate the health plans that provide coverage to the majority of Americans, instead of being limited to regulating individual and group health plans and Medicaid programs.

But if the high court declines to hear the case or rules against Oklahoma, states will continue to have a hard time applying any state regulations to self-funded plans.

Whatever the outcome, it will come too late for Oliver Lackey. He was in business for six years but had to shutter his pharmacy in 2020, he said, because PBMs weren’t paying him enough for the drugs he was selling. He now works as the pharmacy director for the nonprofit Great Salt Plains Health Center, which serves patients in five Oklahoma locations.

“I had lots of patients who, when I announced that I was closing, came in crying,” he said. “It was a really tough time to go through that, because you’re essentially telling your family or your patients that you can’t afford to take care of them anymore.”

Origins of the law

The goal of ERISA, which President Gerald Ford signed into law in 1974, is to protect participants in employer-sponsored retirement and health plans by setting uniform standards for how the plans operate. The rules are designed to ensure that plan administrators run them in the interest of participants and beneficiaries, solely to provide benefits and cover expenses.

Congress approved ERISA in response to high-profile cases of underfunding and fraud in pension plans, said Elizabeth McCuskey, a professor of health law policy and management at the Boston University School of Public Health and School of Law.

“They made a lot of protections for employees, to make sure that the benefits promised to them by their employers were not being fraudulently reduced or squandered,” McCuskey said.

Under ERISA, large employers with thousands of employees in multiple states must abide by a single set of federal standards in their retirement and health benefits, rather than having to follow many different sets of state rules.

“Companies want to offer benefits, and they want to offer very good health plans for their employees,” said James Gelfand, president of the ERISA Industry Committee, a trade group representing large employers covered by the law. “However, it would not be possible to do that if they had to follow different rules in every state, every city or every municipality.”

Having to follow state-specific regulations — such as the ones in the Oklahoma law — likely would make it more expensive for large employers to provide health care coverage to their employees, Gelfand said. In response, he suggested, employers might stop offering certain benefits.

“We’ve also said to states, you know, if you pass a law that violates federal law, we will consider legal action, because our companies are not going to be able to offer benefits if they have to have a different plan in California and Texas and Maryland and Massachusetts,” he said.

At the time ERISA was approved, McCuskey explained, the main concern was pensions, not health care plans. “But it has this tradeoff,” she added, because “the thing that states want and need to regulate over the past 50 years has been their health care markets.”

Legal confusion

ERISA can be triggered fairly easily, so states must be careful when they try to regulate their health care markets, according to Joanne Roskey, an attorney at Miller & Chevalier, where she specializes in ERISA cases. As a result, their legislative efforts typically don’t apply to the nearly two-thirds of people enrolled in self-funded plans.

In 2020, the U.S. Supreme Court opened the door to at least some state regulation of PBMs in self-funded plans when it upheld a more limited Arkansas law. But the constant threat of ERISA-related lawsuits makes it challenging for legislators to do more to curb prescription drug costs, an issue that ranks high on voters’ lists of concerns, experts said.

“It’s so broad, and it’s so muddled, and there’s billions of dollars at stake,” Boston University’s McCuskey said.

McCuskey and other legal experts say a ruling on the Oklahoma case could clear the way for more action. Mulready, the state’s insurance commissioner, hopes they are right.

“We just need clarity on the issue,” he said. “That’s what’s needed by lots of folks across the country as they’re watching this or have watched this play out.”

Stateline is part of States Newsroom, a national nonprofit news organization focused on state policy.

©2024 States Newsroom. Visit at stateline.org. Distributed by Tribune Content Agency, LLC.

NEW ORLEANS (AP) — President Joe Biden is zeroing in on the policy goals closest to his heart now that he’s no longer seeking a second term, visiting New Orleans on Tuesday to promote his administration’s “moonshot” initiative aiming to dramatically reduce cancer deaths.

The president and first lady Jill Biden toured medical facilities that receive federal funding to investigate cancer treatments at Tulane University. Researchers used a piece of raw meat to demonstrate how they are working to improve scanning technology to quickly distinguish between healthy and cancerous cells during surgeries.

The Bidens then championed the announcement of $150 million in awards from the Advanced Research Projects Agency for Health. Those will support eight teams of researchers around the country working on ways to help surgeons more successfully remove tumors from people with cancer. It brings the total amount awarded by the agency to develop breakthrough treatments for cancers to $400 million.

Cancer surgery “takes the best surgeons and takes its toll on families,” Biden said. He said the demonstration of cutting-edge technology he witnessed would offer doctors a way to visualize tumors in real time, reducing the need for follow-on surgeries.

“We’re moving quickly because we know that all families touched by cancer are in a race against time,” Biden said.

The teams receiving awards include ones from Tulane, Dartmouth College, Johns Hopkins University, Rice University, the University of California, San Francisco, the University of Illinois Urbana-Champaign, the University of Washington and Cision Vision in Mountain View, California.

Before he leaves office in January, Biden hopes to move the U.S. closer to the goal he set in 2022 to cut U.S. cancer fatalities by 50% over the next 25 years, and to improve the lives of caregivers and those suffering from cancer.

“I’m a congenital optimist about what Americans can do,” Biden said. “There’s so much that we’re doing. It matters”

Experts say the objective is attainable — with adequate investments.

“We’re curing people of diseases that we previously thought were absolutely intractable and not survivable,” said Karen Knudsen, CEO of the American Cancer Society and the American Cancer Society Cancer Action Network.

Cancer is the second-highest killer of people in the U.S. after heart disease. This year alone, the American Cancer Society estimates that 2 million new cases will be diagnosed and 611,720 people will die of cancer diseases.

Still, “if all innovation ended today and we could just get people access to the innovations that we know about right now, we think we could reduce cancer mortality by another 20 to 30%,” Knudsen said.

The issue is personal enough for Biden that, in his recent Oval Office address about bowing out of the 2024 campaign, the president promised to keep fighting for “my cancer moonshot so we can end cancer as we know it.”

“Because we can do it,” Biden said then.

He said in that speech that the initiative would be a priority of his final months in office, along with working to strengthen the economy and defend abortion rights, protecting children from gun violence and making changes to the Supreme Court, which he called “extreme” in its current makeup during a recent event.

Both the president and first lady have had lesions removed from their skin in the past that were determined to be basal cell carcinoma, a common and easily treated form of cancer. In 2015, their eldest son, Beau, died of an aggressive brain cancer at age 46.

“It’s not just personal,” Biden said Tuesday. “It’s about what’s possible.”

The president’s public schedule has been much quieter since he left the race and endorsed Vice President Kamala Harris, making Tuesday’s trip stand out.

Advocates have praised Biden for keeping the spotlight on cancer, bringing stakeholders together and gathering commitments from private companies, nonprofit organizations and patient groups.

They say that the extra attention the administration has paid has put the nation on track to cut cancer death rates by at least half, preventing more than 4 million deaths from the disease, by 2047. It has done so by bolstering access to cancer treatments and reminding people of the importance of screening, which hit a setback during the coronavirus pandemic.

“President Biden’s passion and commitment to this effort has made monumental differences for the entire cancer community, including those who are suffering from cancer,” said Jon Retzlaff, the chief policy officer at the American Association for Cancer Research.

Looking ahead, Retzlaff said, “The No. 1 thing is for us to see robust, sustained and predictable annual funding support for the National Institutes of Health. And, if we see that through NIH and through the National Cancer Institute, the programs that have been created through the cancer moonshot will be allowed to continue.”

Initiatives under Biden include changes that make screening and cancer care more accessible to more people, said Knudsen, with the American Cancer Society.

For instance, Medicare has started to pay for follow-up colonoscopies if a stool-based test suggests cancer, she said, and Medicare will now pay for navigation services to guide patients through the maze of their cancer care.

“You’ve already paid for the cancer research. You’ve already paid for the innovation. Now let’s get it to people,” Knudsen said.

She also said she’d like to see the next administration pursue a ban on menthol-flavored cigarettes, which she said could save 654,000 lives over the next 40 years.

Scientists now understand that cancer is not a single disease, but hundreds of diseases that respond differently to different treatments. Some cancers have biomarkers that can be targeted by existing drugs that will slow a tumor’s growth. Many more targets await discovery.

“We hope that the next administration, whoever it may be, will continue to keep the focus and emphasis on our national commitment to end cancer as we know it,” said Dr. Crystal Denlinger, CEO of the National Comprehensive Cancer Network, a group of elite cancer centers.

___

Johnson reported from Washington state.