HHS Confirms DNA Testing of Migrant Families With Additional Details

 The US Department of Health and Human Services last week confirmed that it is DNA testing migrant families to help it meet court-mandated deadlines for reuniting children separated at the border from their parents.

An HHS spokesperson maintained that the government is only using DNA testing for the purpose of verifying parentage, but added without elaborating that HHS is not publicizing the contractor doing the testing “due to privacy and security.” According to the spokesperson, HHS has not consulted with the lab contractor to get permission to publicize this information.

Last week, following press reports that HHS was DNA testing migrant families separated at the border as a result of the Trump Administration’s “zero tolerance policy,” genetic ethicists and legal experts expressed concern about the government’s lack of transparency in terms of which lab was involved, the type of testing being performed, if the information would be used beyond family reunification purposes, and if the data were being saved in any kind of database.

Subsequently, HHS held a press conference and issued a statement that DNA testing was being done to “expedite verification of parentage” in light of a court order from Judge Dana Sabraw of Federal District Court in San Diego, requiring that the government reunite all children under age five with their parents by July 10 and older children by July 26.

HHS said in a statement that “a DNA test is done only when there is a specific parent-child relationship that needs to be validated. It will be used only for this purpose.”

HHS further noted that its Office of Refugee Resettlement (ORR) already uses DNA testing as a parentage verification tool in its Unaccompanied Alien Children program when proof cannot be provided with regular documentation — a scenario that may not be uncommon for refugees fleeing locales riddled with violence or ravaged by natural disasters.

According to an HHS spokesperson, organizations with grants from ORR to provide care to minors are collecting cheek swab samples from children, and Department of Homeland Security personnel or HHS-deployed field teams are collecting samples from the adults in the custody of US Immigration and Customs Enforcement (ICE). The samples are sent to an unnamed third party lab for analysis.

Although the government is not publicizing the lab doing testing, it has a number of options in this regard, including a commercial lab with AABB accreditation for kinship testing, a state lab, or one of the Federal Bureau of Investigation’s accredited labs.

Once testing is done, the lab electronically transmits the results to the incident management team at the securities operations center, which share them with grantees, and the information is used for verifying parentage. After the parent/child relationship is verified, HHS has instructed the testing contractor to destroy the samples and the results, according to the spokesperson.

In a statement, HHS estimated it has more than 11,800 minors in its custody, 80 percent of whom are male teens who have crossed the border unaccompanied by an adult. An audit identified that fewer than 3,000 of these minors currently in ORR’s care could have been separated from a parent.

On May 7, Attorney General Jeff Sessions announced the “zero tolerance policy,” stipulating that all who illegally cross the southwest border would be prosecuted for illegal entry, and as a result, when families are caught, children crossing with their parents are put in government custody as unaccompanied minors and the parents are sent to jail. Since this policy went into effect, the government estimates more than 2,300 children have been separated from their parents. However, the court order requires the government to also reunite children separated from parents before the policy went into effect.

Meanwhile, the government has asked the court to extend the reunification deadline for the estimated 101 children under age five. According to reports, the government’s usual record-keeping system for tracking children and their parents has been a bureaucratic mess. Some of the parents of the youngest detained children have already been deported or released and their whereabouts are unknown, according to US Department of Justice lawyers cited in a report.

HHS indicated that before releasing detained children from its care, it needs to properly vet the adults claiming to be their parents and ensure they’re telling the truth and don’t have criminal backgrounds. Although Trump Administration officials have indicated that child trafficking is a significant problem among those crossing the border illegally, experts GenomeWeb spoke to said while this does happen there aren’t good estimates of how big the problem is in the present situation.

“We are working with other federal agencies to perform background checks on purported parents,” the HHS spokesperson said. According to HHS, while working to reunite children under age 5 with their parents, ICE criminal background checks identified two “purported parents” with criminal histories, “including charges of child cruelty, rape, and kidnapping.”

https://bit.ly/2MZjRMC

Inhaled Heroin Tied to ‘Peculiar, Often Catastrophic’ Brain Damage

“Chasing the dragon” (CTD) — a method of inhaling heroin in which users heat heroin over aluminium foil with a lighter and then chase the fumes — is growing in popularity and may lead to “peculiar and often catastrophic brain complications,” new research shows.

“The distinct pharmacology of CTD correlates with its specific clinical and radiological features and prompts grave concern for potential morbidity and long-term disability costs,” write Vilakshan Alambyan, MD, from The Neurological Institute, University Hospitals Cleveland Medical Center in Ohio, and colleagues.

Roughly 2.4 million Americans are addicted to opioids and nearly 1 million abuse heroin, costing the US $51 billion annually. Inhaled heroin is approaching epidemic levels east of the Mississippi River as well as among urban young people. CTD is of particular concern because it is easier to administer and provides a greater high compared with injected heroin.

Alambyan and colleagues review the emerging role of inhaled heroin, specifically CTD, in the opioid epidemic in an article published online July 9 in JAMA Neurology.

They say CTD is associated with a “unique spectrum” of health outcomes, including an aggressive toxic leukoencephalopathy with pathognomonic neuropathologic features, along with sporadic instances of movement disorders and hydrocephalus.

For example, CTD led to spongiform leukoencephalopathy in 116 of 141 reported cases (82.3%), as compared with 25 cases (17.7%) arising from other forms of heroin inhalation (ie, sniffing, smoking, and snorting).

The literature suggests three distinct degrees of CTD clinical severity. Among 88 patients, 18 (21%) developed a mild syndrome consistent with inattentiveness, confusion, ataxia, and psychomotor symptoms; 46 (52%) exhibited moderate severity with corticospinal or extrapyramidal involvement and impaired alertness ranging from severe confusion to delirium; and 24 patients (27%) developed the most severe form involving generalized motor impairment, abulia without concomitant language disorders or apraxia, and noticeable alertness deficits.  Mild cases typically survive with minor sequelae, while moderate to severe presentations may deteriorate and lead to death.

As for treatment, preliminary evidence suggests a role for coenzyme Q10. For example, among nine patients with CTD administered coenzyme Q10, five improved to varying degrees, and four remained unchanged or deteriorated. Given its negligible adverse effect profile, Alambyan and colleagues recommend a coenzyme Q10 trial regimen of 300 mg four times a day in all patients meeting criteria for possible or probable CTD.

They propose the following clinical diagnostic criteria and categories for CTD leukoencephalopathy.

Inclusion criteria

1. Presence of a clinical syndrome suggestive of leukoencephalopathy

2. Positive results on heroin toxicologic testing

3. Confirmed report of CTD inhalation by the patient, his or her next of kin, or a witness

4. Supportive neuroimaging

5. Neuropathology findings consistent with spongiform leukoencephalopathy

Exclusion Criteria

1. Confirmed history of acute intoxication or exposure to a toxin other than heroin that is capable of producing a CTD-like outcome

2. Overt clinical picture suggesting an infectious, demyelinating, vascular, or paraneoplastic cause

3. Neuroimaging consistent with a predominantly cortical involvement along with sparing of subcortical areas and posterior fossa

Diagnostic Category

Definite CTD: Patient fulfills all the inclusion criteria

Probable CTD: Patient fulfills inclusion criteria 1 through 4

Possible CTD: Only inclusion criteria 1 through 3 are met, or criteria 1 through 4 are accompanied by confirmed polysubstance or polyroute heroin abuse

The investigators suggest establishing a case registry or database using these suggested criteria as a means to further clarify the syndrome. “However, clinical utility necessitates a permissive approach, where even a possible suspicion for CTD leukoencephalopathy should prompt appropriate therapy,” they advise.

This research had no commercial funding. The authors have disclosed no relevant financial relationships.

JAMA Neurol. Published online July 9, 2018. Abstract

https://wb.md/2J93hb3

OncoCyte Reports Encouraging New Study Results for Lung Cancer Blood Test

– Results suggest improved performance of next-generation test– Study results support move to new diagnostic testing platform– Significant development work required to fully validate this recent progress

OncoCyte Corporation(NYSE American:OCX), a developer of novel tests for early detection of cancer, today reported that its most recent study of clinical samples in the development of DetermaVu™, its lung cancer diagnostic blood test, has produced encouraging results. This study supports moving the test to a leading clinical diagnostic testing platform and indicates that the clinical performance of the test may be better than was previously expected.

The move to a leading diagnostic testing platform is expected to resolve the inconsistent data issues OncoCyte encountered with the diagnostic testing platform it had previously used in the development of DetermaVu™. OncoCyte believes that the precision of Next Generation Sequencing (NGS) platforms may increase test performance. In addition, the use of a NGS platform could allow for decentralized operations beyond OncoCyte’s CLIA lab, potentially enabling development of a CE marked kit product for distribution in Europe and other markets, if OncoCyte’s upcoming studies are successful.

In addition, the study incorporated newly discovered biomarkers into a new, next-generation version of DetermaVu™. These biomarkers appear to be more robust than those used in the earlier biomarker panel and may enhance the utility and accuracy of DetermaVu™. The use of the new biomarkers in combination with the existing Wistar biomarkers achieved encouraging results even without the inclusion of clinical data such as nodule size, while the original DetermaVu™ algorithm included nodule size as a contributing factor.

The study found that an enhanced algorithm incorporating the best-performing new biomarkers with the best-performing biomarkers used in previous DetermaVu™ studies yielded accuracy results (as measured by Area Under the Curve (AUC) data) equivalent or superior to results of previous studies using the earlier biomarker panel and algorithm. Because the error bar or potential range of results from the small sample set in the study is wide, these results must be confirmed in a larger sample set.

This most recent study was performed on two assay platforms, the Illumina Nova Seq 6000 and Thermo Fisher Chef-S5. DetermaVu™ ran successfully on both platforms. OncoCyte anticipates that the use of one of these widely commercialized diagnostic platforms will increase the likelihood that DetermaVu will offer the consistent and robust results necessary for product development and commercial operations.

“We are extremely pleased with the results of this study, which provide us with a new diagnostic testing platform and a route forward for the development of a next-generation DetermaVu™,” said William Annett, President and Chief Executive Officer.

Lyndal Hesterberg, Senior Vice President of Research and Development, stated, “The study results are very encouraging. Although further studies testing larger numbers of samples are necessary, it appears the addition of the new biomarkers in DetermaVu™ may enhance the accuracy of our diagnostic test.”

While these initial results are very encouraging, significant development work remains. OncoCyte will engage in a series of studies intended to retrain and validate the algorithm on the new platform. The company will further test its biomarkers on a broader set of clinical samples, with the goal of selecting the optimal biomarker panel and algorithm.

OncoCyte is currently in the process of moving to the new platform. Next, OncoCyte will perform a prospective, blinded R&D Validation Study on approximately 250 patients to assess the performance of the algorithm in a blinded set of clinical samples. If successful, the R&D Validation Study will be followed by an Analytical Validation Study in the Company’s CLIA laboratory. Finally, OncoCyte plans to conduct a Clinical Validation Study to confirm test performance. OncoCyte has collected all the samples it expects to require for the R&D Validation study.

With the necessary samples in hand, OncoCyte has expanded the R&D Validation study protocol to include a larger number of samples than were used in the comparable 2017 study. This larger sample set is intended to provide OncoCyte with a clearer picture of the potential accuracy of DetermaVu™, and more confidence in the results expected in the Clinical Validation Study that will follow. OncoCyte’s goal is to complete the expanded R&D Validation Study by the end of 2018 and to complete the Clinical Validation Study during the first half of 2019.

OncoCyte believes that it has the opportunity to create a highly accurate test which, if confirmed in a large clinical data set, could successfully address what it estimates could be a $4.7 billion annual market in the U.S. for confirmatory lung cancer liquid biopsy tests, depending on pricing, market penetration, and the availability of Medicare and private payer reimbursements.

https://bit.ly/2KKJfsT

FDA Grants Eagle 7 Year Orphan Drug Exclusivity for Lead Med

Eagle Pharmaceuticals, Inc. (Nasdaq: EGRX) (“Eagle” or the “Company”) announced today that the U.S. Food and Drug Administration (FDA) has granted seven years of orphan drug exclusivity (ODE) in the U.S., for BENDEKA™ (bendamustine hydrochloride injection, or bendamustine HCI), a liquid, low-volume (50 mL) and short-time 10-minute infusion formulation of bendamustine hydrochloride.

As a result, and consistent with the order issued by the U.S. District Court for the District of Columbia (the Court) on June 8, 2018, the FDA will not approve any drug applications referencing BENDEKA until the ODE expires in December 2022. Additionally, on July 7, 2018, the FDA filed a motion with the Court asking it to clarify that the order was not intended to affect applications referencing TREANDA^®. Eagle continues to believe that an appropriate application of ODE would first allow generic TREANDA entrants in December 2022, rather than November 2019, and expects to vigorously defend the scope of its exclusivity grant.

https://bit.ly/2u4ZyX6

BD Acquires TVA Medical to Advance Solutions for Chronic Kidney Disease

BD (Becton, Dickinson and Company) (NYSE: BDX), a leading global medical technology company, today announced it has completed the acquisition of TVA Medical, Inc., a company that develops minimally invasive vascular access solutions for patients with chronic kidney disease requiring hemodialysis.

In the U.S. alone, there are more than 440,000 patients with End-Stage Renal Disease (ESRD) who are surviving on hemodialysisⁱ. The addition of TVA Medical enables BD to offer the everlinQ™ endoAVF System, a new endovascular arteriovenous (AV) fistula creation technology that adds to the company’s ESRD portfolio of dialysis catheters, drug coated balloons, standard angioplasty balloons and endovascular stent graft products. This technology will further improve BD’s ability to serve physicians and their patients by providing a minimally invasive option for creating critical AV fistulas (joining arteries to veins to create a circuit) for hemodialysis procedures.

“The addition of TVA Medical allows BD to provide another innovative device to physicians who treat patients suffering from chronic kidney disease requiring hemodialysis,” said Steve Williamson, worldwide president of Peripheral Intervention at BD. “This technology is highly complementary to our Peripheral Intervention offerings, and we will continue to bring new technologies to market that improve our category-leading ESRD portfolio. This is a great example of our continued strategy to use tuck-in acquisitions to advance category leadership.”

Hemodialysis, a form of treatment for kidney failure patients, is a procedure that removes wastes, salts, and fluid from a patient’s blood when the kidneys can no longer perform these functions. Vascular access is considered a “lifeline” for hemodialysis patients. Options for vascular access include central venous catheters, AV grafts and surgical AV fistulas. Surgical fistulas are currently the preferred vascular access option for hemodialysis patients, resulting in lower mortality rates, fewer infections and lower cost of dialysis delivery compared to central venous catheters^ii,iii,iv.

On June 22, the U.S. Food and Drug Administration (FDA) announced De Novo marketing authorization for the everlinQ endoAVF System. The system uses two, thin, flexible, magnetic catheters that are inserted into the ulnar artery and the ulnar vein in the arm through a small puncture. When placed close to each other, the magnets in each catheter attract, pulling the vessels together. After confirming alignment, an electrode from the venous catheter delivers radiofrequency energy to create the connection between the artery and vein. Embolization of the brachial vein is then recommended. The fistula is confirmed with an angiogram (X-ray image of the vascular system) to show that arterial blood is flowing to the low-pressure venous system. The procedure minimizes the amount of vessel and skin trauma compared to traditional fistula creation using open surgery. The everlinQ endoAVF System enables an additional AV fistula location for patients than what is typically done surgically. The device is already commercially available in Europe and Canada. For more information on the everlinQ endoAVF System, visit http://tvamedical.com/product/. The product name will be transitioned to WavelinQ™ EndoAVF System during integration.

“The FDA’s authorization and joining BD are the culmination of many years of hard work by a dedicated team of innovators at TVA Medical, and I’d like to thank them for their tireless efforts to get us to these important milestones,” said Adam L. Berman, co-founder of TVA Medical. “BD will enable us to deliver to physicians and patients what we believe is a highly-desirable and transformative endovascular technology as an integral part of a broader ESRD-focused portfolio of solutions. I look forward to the next chapter of our history as part of the BD family.”

This transaction is not expected to have a material impact on BD results for fiscal 2018 or 2019. Future results for TVA Medical will be reported under the Peripheral Intervention business within the Interventional Segment at BD. The company used cash on hand to finance the transaction. This transaction does not impact the company’s previously-communicated commitment to deleverage as part of the Bard acquisition. Terms of the transaction were not disclosed.

https://bit.ly/2NECMxl

Guideline Care Fails to Boost Survival in Younger Rectal Cancer Patients

Patients with rectal cancer who are younger than 50 do not have an overall survival benefit from National Comprehensive Cancer Network (NCCN) guideline-driven care, researchers found.

The results suggest, the investigators said, that early-onset stages II and III rectal cancer in this younger group may differ in epidemiology, biology, and response to therapy compared with in older patients.

In the study, published online in Cancer, Andrew Kolarich of the University of Florida College of Medicine in Gainesville, and colleagues noted that because current NCCN guidelines for treating rectal cancer are based primarily on trials or databases with older patients, the team wanted to see how those treatment guidelines affected survival patterns in patients younger than 50.

As Conor Delaney, MD, PhD, chair of the Digestive Disease and Surgery Institute at the Cleveland Clinic, recently told MedPage Today, studies have shown that the incidence of colon and rectal cancer among younger patients has been increasing.

Kolarich et al performed a retrospective review of the National Cancer Data Base (NCDB), analyzing patients treated with curative-intent transabdominal resections with negative surgical margins for stages I to III rectal cancer between 2004 and 2014.

A total of 43,106 patients were included in the analysis, with outcomes and overall survival for patients under and over age 50 compared by subgroups based on NCCN guideline-driven care. About 21% of patients (9,126) were younger than 50, which is younger than the age at which the guidelines recommend screening should begin.

The researchers found that while patients younger than 50 showed a survival benefit from NCCN guideline-drive care for stage I disease, no such survival benefit was demonstrated when the guidelines were followed for stages II and III disease.

“These data may help to stimulate future trial proposals to investigate the possibility of the exclusion or selective use of adjuvant therapies for stage II and III disease in the younger cohort to help to decrease treatment toxicity,” Kolarich et al wrote.

They also found key differences between younger and older rectal cancer patients. For example, younger patients were more likely to be female, minorities, and uninsured. They were also more likely to be diagnosed at a higher stage and have poor tumor differentiation and other histological features associated with worse outcomes — data that could provide physicians with the ability to provide prognoses tailored to younger populations.

In an editorial accompanying the study, titled “Rectal Cancer in Young Patients: Time to Take Notice,” Matthew F. Kalady, MD, of the Cleveland Clinic, said the researchers should be applauded for continuing the conversation about young patients with rectal cancer.

“This article should open the eyes of physicians treating rectal cancer and of those making treatment guideline recommendations and screening policies,” he wrote. “The alarming trend of increased colorectal cancer in the young population should make us stand up and take notice. We need to evaluate why this is happening and explore the unique characteristics that define this population and potential differences in comparison with older age rectal cancers.”

Still, there are several limitations to studies based on data in large administrative data bases such as the NCDB, Kalady pointed out: For example, half of all patients with rectal cancer were excluded from the analysis by Kolarich et al because of missing data, and even for those patients included in the study, key variables such as tumor location, clinical circumferential margin, the number of lymph nodes evaluated, and the quality of the surgical specimen, were unavailable.

Delaney, who was not involved in the study, echoed Kalady in noting that the researchers focused on a population that in the past has not been well studied. “I think the most important thing about this paper is that it’s highlighting the frequency — and problems — in younger people getting rectal cancer,” Delaney said. “Overall we have done pretty well in the last couple of decades, and survival has improved for colorectal cancer. But it’s clear that the frequency of colorectal cancer in younger people is increasing.”

Delaney also pointed out that the American Cancer Society recently updated its colorectal screening guidelines to reflect the fact that the numbers are showing that new cases of colorectal cancer are occurring at an increasing rate among younger adults.

“[The thinking] used to be that screening should start with patients over 50 years of age. As a professional group we’ve made the recommendation that this age group should be dropped to 45. Screening now is recommended for all people over the age of 45, and [even younger if there is] a family history of colorectal cancer.

“That’s not enough – all of us who do a lot of this have many patients much younger than 45 who have rectal or colon cancer,” Delaney added. “The other important message for the public is to remind them that if they have symptoms, they have to be investigated.”

Kolarich reported having no conflicts of interest; one co-author reported financial relationships with Merck and Bayer for work outside of the study, as well as institutional research support from Incyte, Bristol-Myers Squibb, Bayer, Merck, NewLink, AstraZeneca/Med-Immune, and Tesaro.

Kalady reported having no conflicts of interest.

• Primary Source

  Cancer

  Source Reference: Kolarich A, et al “Rectal cancer patients younger than 50 years lack a survival benefit from NCCN guideline-directed treatment for stage II and III disease” Cancer 2018; DOI: 10.1002/cncr.31527.

• Secondary Source

  Cancer

  Source Reference: Kalady M “Rectal cancer in young patients: Time to take notice” Cancer 2018; DOI: 10.1002/cncr.31524.

https://bit.ly/2J9dnbA

Azar Calls for Changes in 340B Drug Pricing Program

Health and Human Services Secretary Alex Azar continued his campaign against high drug prices on Monday, calling for more oversight of hospitals that get drug discounts under the federal 340B program because they serve many uninsured and low-income patients.

“By one estimate, discounted purchases under 340B totaled $16 billion in 2016 — a fourfold increase just since 2009,” Azar said at the annual meeting of 340B Health, a trade group for 340B hospitals. “Government programs can grow pretty fast, but they usually don’t grow that fast.”

“This growth has occurred without any increase in statutory oversight,” he continued. “HHS works hard within the powers we have to oversee the program. But a comprehensive system for reporting on the distribution and use of the program’s benefits does not exist … The current nature of 340B is such that it is quite possible for the program’s benefits to be diverted to unintended purposes, unrelated to supporting care for low-income patients.”

For example, Azar said, “the acquisition of outpatient clinics by 340B entities has meant that a Medicare patient could pay cost-sharing on the full price of a Part B drug administered in their doctor’s office, while the doctor’s office gets the drug at a large discount that will never be known to the patient, was never intended to support care for that kind of patient, and may not be used to support care for low-income patients at all. Indeed, the discount may be so steep that the patient’s cost-sharing is greater than the price their doctor paid for the drug.”

He called for two kinds of reforms for the 340B pricing program: “greater transparency surrounding how these discounts are being used, and reforms to reduce the gap between discounted prices and the reimbursement provided, particularly by government programs.”

“We believe changes along these lines are essential to the future of the 340B program,” Azar added. “Leaving a program as it is, within the rapidly changing context of healthcare, quickly renders it outdated.”

Maureen Testoni, 340B Health’s interim president and CEO, seemed taken aback by Azar’s remarks when she spoke after Azar left the lectern. “I credit the secretary with coming here,” she said. “It certainly gives me my marching orders going forward; we have a lot of work to do.”

“They came out with their blueprint and they are obviously concerned about an impact the 340B program may be having on the market and how the 340B dollars are being used,” Testoni told MedPage Today in a meeting with reporters afterward, with a media relations representative present. “Incumbent on us from the provider community to make that clear and educate the administration and members of Congress on how valuable the program is — the fact that they do so much more uncompensated care than other types of hospitals and see so many more Medicaid patients. We’re worried that is getting lost and we really need to make sure we get that out.”

“What’s not getting as much attention is all this publicly available data on how much uncompensated care 340 B hospitals provide,” said Testoni. “[If you compare] how much is being spent on [the 340B] discount compared to how much uncompensated care 340B hospitals provide, it’s just a fraction.”

Azar’s remarks came only a few days after a report from the Government Accountability Office (GAO) faulted the Health Resources and Services Administration (HRSA) for lax oversight of 340B contract pharmacies — mainly retail and independent pharmacies that 340B hospitals contract with to provide drugs to patients.

The GAO listed three main problems with HRSA’s work: lack of data on how many contract pharmacies are participating in the program; weaknesses in the audit process; and lack of specific guidance for the providers involved.

“As currently structured, weaknesses in HRSA’s oversight impede its ability to ensure compliance with 340B program requirements at contract pharmacies,” the report’s authors concluded. “As the 340B program continues to grow, it is essential that HRSA address these shortcomings.”

Azar didn’t just aim his remarks at 340B hospitals; he also repeated his criticism that pharmaceutical manufacturers weren’t taking seriously the administration’s call to lower their prices. “The drug companies that recently increased prices will be remembered for creating a tipping point in U.S. drug pricing policy. As you may have recently seen on Twitter, the President’s noticed, I’ve noticed, and, more importantly, the American people have noticed. Change is coming to prescription drug pricing, whether it’s painful or not for pharmaceutical companies.”

Azar was referring to a tweet from President Trump, which called out Pfizer and other companies for raising their prices. “Pfizer & others should be ashamed that they have raised drug prices for no reason,” Trump tweeted early Monday afternoon. “They are merely taking advantage of the poor & others unable to defend themselves, while at the same time giving bargain basement prices to other countries in Europe & elsewhere. We will respond!”

At the end of May, Trump predicted that “people will see for the first time ever in this country a major drop in the cost of prescription drugs … I think we’re going to have some big news … Some of the big drug companies are going to announce voluntary massive drops in prices.” No such decreases have yet occurred.

https://bit.ly/2zreJiw