San Francisco Chronicle: Why Fatal Drug Overdoses Are Finally Declining In S.F. — And Elsewhere
San Francisco this week reported the lowest number of monthly drug overdose deaths in four years, continuing a sustained trend with 2024’s running total of fatalities down nearly a quarter compared to the same period last year. The trend — which local health officials called “remarkable” — echoes similarly promising national data, released by the U.S. Centers for Disease Control and Prevention this month, that show fatal overdoses are down almost 15% compared to 2023. Overdose deaths in California are down about 10%, according to the CDC data. The figures are provisional and compare the 12 months ending June 2024 to the 12 months ending June 2023. (Ho, 11/22)

The New York Times: Drug Overdose Deaths Are Declining Due To Changes In The Drug Supply 
After years of relentless rises in overdose deaths, the United States has seen a remarkable reversal. For seven straight months, according to federal data, drug fatalities have been declining. Expanded treatment, prevention and education efforts are playing a role, but drug policy experts believe there is another, surprising reason: changes in the drug supply itself, which are, in turn, influencing how people are using drugs. ... Some epidemiologists theorize that the growing prevalence of other drugs, sold on their own and also mixed in with fentanyl, is having an impact on how people use fentanyl itself. Fentanyl is now often diluted with xylazine, an animal tranquilizer that can cause horrific skin ulcers, which have even led to limb amputations. But drug policy experts said that xylazine, in some cases, might also be having a lifesaving effect. People addicted to fentanyl often need the drug numerous times a day. But xylazine can sedate users for hours. (Hoffman and Weiland, 11/21)

CNN: Less-Potent Fentanyl Pills May Be Playing A Role In Decrease Of US Overdose Deaths, DEA Says
The US Drug Enforcement Administration says that less fentanyl is present in the nation’s illicit pill supply and that is helping drive down overdose deaths in the United States. But experts say that there are limitations to this claim and that many other factors are probably playing a role. (McPhillips, 11/21)

CBS News: Drug "Several Times" Stronger Than Fentanyl Linked To California Overdose Death 
The U.S. Department of Justice's Los Angeles office filed charges in what could be the nation's first death-resulting criminal case involving a synthetic opioid that is possibly more dangerous than fentanyl. On Thursday, federal prosecutors announced the sole count of distribution of protonitazene resulting in death against 21-year-old Benjamin Anthony Collins, a resident of LA County. He faces a mandatory minimum sentence of 20 years in prison if convicted. The harshest possible punishment for this charge is life in prison. (Rodriguez, 11/21)  

The Mercury News: 23andMe, Tech Companies Disclose Hundreds Of Bay Area Job Cuts
23andMe has detailed its plans for Bay Area job cuts, while separate tech company cutbacks have helped to shove the technology industry’s current burst of layoffs past the 49,000 mark in the nine-county region. The most recent rounds of layoffs serve notice that the tech and biotech industries are still seeking ways to improve efficiencies even as they scout for new cutting-edge markets to harvest. (Avalos, 11/22)

Modern Healthcare: Hospital Fundraising Increases To Offset Lower Operating Margins
Nonprofit health systems, cancer centers and pediatric hospitals are increasingly depending on big donors to boost oncology, cardiology and other services. Many nonprofit providers have ramped up investment in fundraising campaigns, often targeting high-profile donors, as operating margins have been slow to recover in the wake of the COVID-19 pandemic. Philanthropy is poised to play a bigger role in those systems' finances as other sources of revenue wane and expenses remain relatively high, analysts and provider executives said. (Kacik, 11/21)

San Diego Union-Tribune: San Diego Biotech Halozyme Makes $2.1B Bid For German Drugmaker 
Halozyme Therapeutics, a San Diego-based biopharmaceutical company, has made a $2.1 billion bid to buy German drugmaker Evotec. (Rocha, 11/21)

Fresno Bee: Community Health Systems CEO That Oversaw Clovis Hospital Expansion Announces Retirement
Formerly known as Community Medical Centers, Community Health System is a private nonprofit that operates downtown Fresno’s Community Regional Medical Center, Clovis Community Medical Center and several other healthcare sites. (Montalvo, 11/21)

AS USA: Attorney General Nominee Pam Bondi’s Record Attacking The Affordable Care Act 
In 2018, in her capacity as Florida Attorney General, Pam Bondi signed onto a lawsuit brought to the Supreme Court by over a dozen Republican-led states to overturn the ACA. The group was only partially successful, as protections for those with preexisting conditions and the general framework were allowed to remain, but the court ruled that the individual mandate was unconstitutional. The mandate had fined taxpayers who failed to purchase insurance, which was designed to encourage healthy young people into the market. (Knorr-Evans, 11/22)

Politico: Trump Fills His Next Administration With Project 2025 Authors
Donald Trump spent his presidential campaign running from Project 2025. Now, he’s using it to stock his White House and administration. In recent days, Trump has tapped nearly a half-dozen Project 2025 authors and contributors, including Brendan Carr, who Trump picked this week to lead the FCC; former Rep. Pete Hoekstra, who got the nod for ambassador to Canada; and John Ratcliffe, who was tapped for director of the CIA. One of Trump’s first selections — Tom Homan as “border czar” — was also a Project 2025 contributor. (Wren, Bade, Ollstein and Allison, 11/21)

NPR: Foreign Nationals Propel U.S. Science. If Trump Limits Immigration Again, That Could Change
Foreign-born workers account for about half of the doctoral-level scientists and engineers working in the U.S. Many were initially hired under H-1B visas, which are granted to as many as 85,000 highly skilled specialists each year, allowing them to work in the U.S. for up to six years. But the incoming Trump administration has signaled that it will crack down on H-1B visas, which could make it harder for universities, research institutions, and tech firms in the U.S. to find enough highly educated workers. (Hamilton, 11/21)

The Washington Post: RFK Jr. Weighs Major Changes To How Medicare Pays Physicians 
Robert F. Kennedy Jr. and his advisers are considering an overhaul of Medicare’s decades-old payment formula, a bid to shift the health system’s incentives toward primary care and prevention, said four people who spoke on the condition of anonymity to discuss private deliberations. The discussions are in their early stages, the people said, and have involved a plan to review the thousands of billing codes that determine how much physicians get paid for performing procedures and services. (Diamond, 11/21)

The Hill: GOP Senators Warn Trump Against Aggressive Recess Appointment Move
Republican senators are pouring cold water on the idea that President-elect Trump could force the Senate into an extended recess next year so that he would be able to fill key positions in his Cabinet without going through the Senate confirmation process. Republican senators and aides say that Trump allies who claim that the incoming president would have power under Article II, Section 3 of the Constitution to force an extended recess don’t understand how Congress really works. (Bolton, 11/22)

Stateline: Expecting Challenges, Blue States Vow To Create ‘Firewall’ Of Abortion Protections
Officials in blue states are vowing to build a “firewall” of reproductive health protections as they anticipate federal and state attacks on abortion access under the Trump administration. “We’re going on offense,” Connecticut Attorney General William Tong, a Democrat, told Stateline. “We are in an unprecedented war on American women and patients. State attorneys general, particularly my colleagues and I who support abortion rights and reproductive freedom, have been building this firewall for some time now.” (Claire Vollers, 11/21)

The Hill: 2 House Republicans Seek To Stop IVF Expansion In Defense Bill
Two House Republicans, Reps. Matt Rosendale (Mont.) and Josh Brecheen (Okla.), are asking the leaders of the House and Senate Armed Services committees to not include provisions in the annual defense authorization bill that expand access to in vitro fertilization (IVF).The Thursday letter to the committee chairs and ranking members, first shared with The Hill, is an example of divisions that remain in the Republican Party amid threats to the fertility treatment. The topic came to the forefront after the Supreme Court overturned Roe v. Wade, spurred by social conservatives’ belief that life begins at conception — even as President-elect Trump and the majority of vocal Republicans say they support IVF. (Brooks, 11/21)

The Hill: Mark Milley Supports Women In Military Combat If They 'Meet The Standards'
Mark Milley, the former Joint Chiefs of Staff chairman, said that women should be actively deployed for military combat if they “meet the standards.” “Women have been in combat, and it doesn’t matter if that 762 hits you in the chest, no one gives a sh– if it’s a woman or guy who pulled the trigger,” he said during the National Security Innovation Forum on Wednesday. “If you meet the standards, our military must be and always should be a standard-based merit-based military, period, full stop. Doesn’t matter if you are white, black, a man, a woman, Catholic, Protestant,” he added. (Fields, 11/21)

The Hill: FDA Gives Green Light To PTSD Marijuana Study In Veterans
The Food and Drug Administration (FDA) this week authorized a long-delayed clinical trial to test whether smoking marijuana can be used to treat post-traumatic stress disorder (PTSD) in veterans. The trial, sponsored by the nonprofit Multidisciplinary Association for Psychedelic Studies (MAPS), has been blocked by the FDA since 2021. The agency had raised a variety of objections, including that allowing people to inhale high-potency cannabis was dangerous to their health.  (Weixel, 11/21)

The Mercury News: Bay Area Health Officials Plan For RSV, Flu, COVID And Trump Administration
With the holiday season upon us and families gathering for Thanksgiving, public health officials are preparing for the respiratory virus season to ramp up and for January — when Donald Trump will return to the White House. Several public health officials joined forces Thursday to discuss the importance and efficacy of routine vaccines, as flu and RSV start to increase nationally, with COVID almost certain to follow suit. (Rowan, 11/22)

The (Santa Rosa) Press Democrat: North Bay Gets Ready For Respiratory Virus Spread During Holidays 
As Sonoma and Napa county residents prepare for Thanksgiving travel and family gatherings, local infectious disease experts are encouraging them to take steps to reduce the spread of respiratory illnesses, including influenza, COVID-19 and respiratory syncytial virus. (Espinoza, 11/21)

The Hill: National COVID-19 Vaccination Rate Less Than 20 Percent: CDC Survey
Just 17.9 percent of U.S. adults have gotten a COVID-19 vaccine, and 34.7 percent have received an influenza vaccine during the 2024-25 respiratory disease season, according to a new report from the Centers for Disease Control and Prevention (CDC).  The report, published Thursday, notes that 35 percent of adults are open to receiving an influenza vaccine, 41 percent are willing to get a COVID-19 vaccine and 40 percent are open to getting a vaccine for RSV.  (O'Connell-Domenech, 11/21)

Los Angeles Times: Sun Valley Residents Endured A Methane Leak For Years. Now L.A. Will Pay Them $60 Million
For years, many residents in the working-class, mostly Latino communities of Sun Valley and Pacoima thought they were going crazy as doctors were unable to figure out why they were plagued with frequent headaches, nausea and nosebleeds. It turns out they were being gaslighted. Staff at the L.A. Department of Water and Power hid their knowledge of a long-standing methane gas leak at the utility’s Valley Generating Station for at least a year. Lawyers allege they hid it for several years. (Harter, 11/22)

East Bay Times: Phillips 66 Indicted On Charges It Dumped Tainted Water From California Refinery Into Sewer System 
Phillips 66, which last month announced plans to close its Los Angeles-area refineries by the end of 2025, was indicted Wednesday for allegedly discharging hundreds of thousands of gallons of industrial waste from its Carson oil refinery into the Los Angeles County sewer system during the pandemic, the U.S. Attorney’s Office said Thursday, Nov. 21. (Maio, 11/22)

The Oaklandside: Group Opposing OAK Airport Expansion Says Health Concerns Have Been Ignored
A group opposing the expansion of Oakland International Airport will descend on a meeting of Port of Oakland commissioners today to demand that they delay certification of the final environmental impact report. The Stop OAK Expansion Coalition, a group made up of residents and 80 grassroots organizations, says the report does not address a variety of environmental and health concerns. ... The airport sits on the western edge of East Oakland, a community that has historically been overburdened by environmental justice issues. East Oakland has some of the highest rates of asthma-related hospitalizations, with children under 5 facing the most visits. East Oakland residents have also been shown to have significantly lower life expectancy than their affluent neighbors. (Rhoades, 11/21)

USA Today: Byproduct Of Tap Water Purification Could Be Toxic, Study Says
Tap water for about 1 in 3 Americans could contain a byproduct from the decontamination process that may be toxic, according to a study published Thursday. For over a century, public water systems have used chemical compounds to kill pathogens that cause waterborne diseases such as cholera and typhoid fever, saving countless lives. This purification process has been carried out using chlorine. In the 1970s, researchers found chlorine could react to organic compounds in water to produce chemical reactions that cause cancer, low birth weight babies and miscarriages. (Cuevas, 11/21)

MedPage Today: Opioids Tied To Higher Dementia Risk, But Only After A Point
After a certain threshold, cumulative opioid use was associated with higher dementia risk, a study of adults over age 60 in Denmark showed. (George, 11/19)

Fox News: Popular Anxiety Drug, Clonazepam, Recalled Nationwide For ‘Possibly Life-Threatening’ Error
The anxiety-reducing drug, Clonazepam, has been recalled after a potentially "life-threatening" label mix-up, the Food and Drug Administration (FDA) said. According to a release from the federal agency, Endo Inc. announced a voluntary recall of 16 lots of Clonazepam Orally Disintegrating Tablets. The pharmaceutical company said the immediate recall came after it was discovered that 16 lots of the anxiety drug were mislabeled with the incorrect strength and National Drug Code (NDC) on them. The company said the labeling error was made by a third-party packager. (Rumpf-Whitten, 11/22)

Los Angeles Times: California Voters Approve Measure Aimed At Restricting AIDS Healthcare Foundation Spending 
California voters have approved Proposition 34, a measure from an apartment trade group that aimed to restrict spending by the AIDS Healthcare Foundation, which has bankrolled several rent control initiatives and criticized the measure as unconstitutional revenge. The Associated Press called the initiative Wednesday evening. According to the California Secretary of State, the measure is ahead 50.8% to 49.2%. (Khouri, 11/21)

The (Santa Rosa) Press Democrat: Santa Rosa Medical Center Evacuated After Floodwaters Strand 150 People 
Rising floodwaters stranded about 150 people at Sutter Medical Center on Airway Drive in Santa Rosa, submerging vehicles in the parking lot and cutting off access, said Santa Rosa Division Chief Fire Marshal Paul Lowenthal. (Armstrong, Atagi, and Smalstig, 11/21)

Capital & Main: Dismissive Doctors, Crowded Clinics And Memory Loss
The doctor wasn’t listening. A receptionist had accused her of making things up. The medicine in the chest patch she wore to maintain her cognition made her so nauseous that she went to the hospital. The Rev. Carolyn Habersham had a sermon to deliver at the end of that week, but her brain had been gradually deteriorating. That made the normal few hours of preparation stretch for days. Habersham said it was her week of revelation. (Sanchez-Tello, 11/19)

Los Angeles Times: Don't Cut Funding For A Game-Changing Healthcare Service 
Hospital-at-home's expansion during the COVID-19 pandemic benefitted many Americans. Congress can keep that progress going. (Ankit Mehta and Chrisanne Timpe, 11/22)

San Francisco Chronicle: Yes, We Can Save Dying California Community Hospitals. Here’s How
Once operated by an out-of-state order of nuns, St. Rose has been an independent nonprofit hospital since the early 2000s. That makes it an endangered species. In the past 10 years, 20 hospitals have closed in California. Rural and smaller stand-alone hospitals like St. Rose are most at risk. (Mark Friedman, 11/21)

Los Angeles Times: New California Rules Trade Short-Term Climate Gain For Long-Term Health And Safety
As long-serving members of the California Air Resources Board, we have prioritized environmental justice and community health, championing efforts to combat climate change. However, we believe state policies must thoughtfully address the consequences for communities least able to bear the associated costs. This concern applies to CARB’s newly adopted amendments to accelerate the Low Carbon Fuel Standard, or LCFS, which we opposed. The fuel standard program, established in 2011, aims to reduce greenhouse gas emissions from transportation by capping the carbon intensity of fuels. The current program mandates a 20% reduction in fuel carbon intensity by 2030. The proposed amendments push this to a 30% cut by 2030 and 90% by 2045. (Dean Florez and Diane Takvorian, 11/20)

Los Angeles Times: Wildfire Smoke Is Polluting California And Beyond. Here's How To Protect Yourself
The Santa Ana winds caused a massive wildfire this month in Ventura County, with stunning visuals of orange skies in Oxnard reminiscent of 2020 in the San Francisco Bay Area. Although the Mountain fire is now just about contained (as is the Sandy fire in Monterey County), it was the most destructive fire to hit Southern California in six years, polluting air past Ventura toward Santa Barbara and beyond. (Devabhaktuni Srikrishna, 11/21)

CalMatters: California Bird Flu Outbreak Warrants A Broader Look At The Risky Ways We Produce Food
As a physician, I am closely following a bird flu outbreak that is hitting our Central Valley dairy farms hard, especially since the California Department of Health reports at least 21 human cases. This number seems to increase each week in our state, which has more dairy cows than any other. Bird flu has spread to at least 291 dairy herds in California. (Seema Policepatil, 11/20)