During the past thirty years, vaccines have experienced a renaissance. Advances in science, business, and distribution have transformed the field to the point where vaccines are recognized as a “best buy” in global health, a driver of pharmaceutical industry growth, and a key instrument of international development. With many new vaccines available and others on the horizon, the global community will need to explore new ways of ensuring access to vaccines in developing nations. So-called tiered pricing, which makes vaccines available at different prices for countries at different levels of economic development; innovative financing mechanisms such as advance market commitments or offers of long-term and high-volume contracts to vaccine producers; and technology transfers such as sharing intellectual property and production techniques among companies and countries can all play a part in bringing new life-saving vaccines for pneumonia, rotavirus, malaria, and other diseases to developing countries.

Despite decreasing demand for bypass surgery, 301 new cardiac surgery programs opened between 1993 and 2004. We used Medicare data to identify where the new programs opened and to assess their impact on access and efficiency. Forty-two percent of the new programs opened in communities that already had access to cardiac surgery, which suggests that their creation has led to a fight for shares of a shrinking market. New programs were much more likely to open in states that did not require them to show a certificate-of-need.

Overall, travel time to the nearest cardiac surgery program changed little, which suggests that these programs have done little to improve geographic access. The duplication of services that resulted in many areas may have engendered competition based on quality, price, or both, but it may also have increased surgical rates, with unknown results. We observe that certificate-of-need requirements may help avoid unnecessary duplication of services by preventing new programs from opening in close proximity to existing ones.

Washington Post

U.S., allies to release 60 million barrels from oil reserves – Steven Mufson and Zachary A. Goldfarb report that the U.S. will sell 30 million barrels from its Strategic Petroleum Reserve over the next 30 days to bring down oil prices and kick-start the economy, but some in Congress say the effect will be limited and that reserves should be held for energy emergencies

Targeted HIV-testing program finds 18,000 new patients – David Brown reports on a Centers for Disease Control and Prevention program that targeted 25 cities and states to identify persons with the HIV virus who did not know they had it; the CDC’s relaxation of testing rules paved the way for the program

Where are the new obesity drugs? – Ken Fujioka, a physician who treats obese patients, says the Food and Drug Administration’s standard for approving obesity drugs is too rigid because some risks are worth the benefit to obese patients who develop life-threatening conditions

How to hire a federal watchdog – Ian Ayres, a professor at Yale, suggests that to break the logjam in Congress over the Consumer Financial Protection Bureau, the president should appoint Elizabeth Warren under a recess appointment and simultaneously nominate Sarah Raskin who was recently confirmed as a Federal Reserve Board Governor

Michael Copps, the FCC’s voice for media democracy – Katrina vanden Heuvel highlights the latest crusade by Federal Communications Commissioner Copps to bring attention to the crisis in local news coverage which he says is a threat to democracy; Copps fought deregulation and consolidation, and is a “tenacious advocate for a public-interest approach to regulating the media” in her view

Petraeus calls CIA a “bargain” at confirmation hearing – Walter Pincus reports that nominee to head CIA, Gen. David Petraeus defended the agency’s annual budget of $6 billion at his confirmation hearing

New York Times

Consumer agency asks for definitions of nonbanks – The Consumer Financial Protection Bureau is asking for comments on non-banks that fall under its jurisdiction under the Dodd-Frank financial reform law, which defined them vaguely as larger market participants; the CFPB proposes that it regulate debt collection; consumer reporting; consumer credit and related activities; money transmitting, check cashing and related activities; prepaid cards; and debt relief services

F.T.C. is said near a move on Google – Edward Wyatt and Michael Helft report that the Federal Trade Commission is about to open an antitrust investigation of Google’s search functions and related advertising practices

Republican challenges administration on plans to override education law – Sam Dillon reports that Rep. John Kline (R-MN) the chairman of the House education committee announced plans to amend the No Child Left Behind law so that Education Secretary Duncan could no longer grant waivers to states of provisions of the law that are too difficult to meet

Wall Street Journal

Nuclear agency scientists blast bosses over Yucca decision – Ryan Tracy and Stephen Power report that scientists at the U.S. Nuclear Regulatory Commission who had worked for years on the now halted project to determine whether the Yucca Mountain nuclear waste disposal plan met NRC health and safety regulations criticized Gregory Jaczko, the NRC chairman and other senior NRC management for suppressing their views

In developed countries some parents have decided not to provide routine vaccinations for their children, while in many developing countries there are inadequate rates of vaccination for various reasons. The consequences for children, and members of the community in which they live, can be significant and even tragic. Although some parents may worry that vaccines will harm their child, there is a broader moral case for vaccination that parents and policy makers should consider. This case has four components: benefits and harms, best interests, community benefits, and justice. This moral case should be central to deliberations about vaccination by parents and policy makers.

Washington Post

Lessons from the Gates war room – Greg Jaffe examines the tenure of outgoing Defense Secretary Robert Gates, who marshaled his years of Washington experience under 8 presidents to become a successful Pentagon chief in time of war, and who says he had no time to be a “visionary”

Supreme Court to hear FCC challenge – Cecelia Kang reports that the Supreme Court will hear a case challenging the Federal Communications Commission’s “decency” rules on the grounds that they violate First Amendment free speech rights; the rules prohibit “indecent” speech such as nudity and curse words on TV between 6 a.m. and 10 p.m. when children could be watching, and violations could result in fines or revocation of broadcast licenses

Which Petraeus will arrive at the CIA: The officer or the gentleman? – Walter Pincus considers Gen. Petraeus’s testimony at his confirmation hearing to be CIA chief and on his preparation for the transition from revered military leader to head of a civilian agency

Obama enters debt talks – Paul Kane and Rosalind S. Helderman report on the president’s one-on-one meetings with the Senate Majority and Minority leaders to jump-start negotiations on the debt, which will reach its limit in 6 weeks; Republicans are holding out for more than the $1.3 trillion in cuts in government spending that the administration has proposed

FCC dodges answers on wireless industry competition – Cecelia Kang reports that the Federal Communications Commission sidestepped the question of whether the wireless industry is competitive in its 15^th annual report on the state of the industry; the issue is critical to regulators’ consideration of the merger of wireless giants AT&T and T-Mobile

FCC’s net neutrality rules about to be official, and invite lawsuits – Cecelia Kang reports that the Federal Communications Commission will finally submit its net neutrality rules, which it approved last December to the Office of Management and Budget, one of the final steps in implementing the open Internet requirements

Human trafficking: A scourge needs greater attention – The Post says the U.S. and other countries need to step-up efforts to eliminate human trafficking following release of the State Department’s annual “Trafficking in Persons” report

New York Times

Nuclear plant’s vital equipment dry, officials say – Matthew L. Wald reports on the tour by the head of the Nuclear Regulatory Commission, Gregory B. Jaczko of the Fort Calhoun nuclear plant north of Omaha, Nebraska, which is threatened by flooding

Los Alamos laboratory is on alert for a wildfire – Kirk Johnson reports on a wildfire near the military’s nuclear research facility that led to evacuation of the town of Los Alamos; officials say nuclear materials are safely stored

Wall Street Journal

U.S. endorses Lagarde for IMF – Sudeep Reddy reports on Treasury Secretary Geithner’s announcement that the U.S. is supporting the candidacy of French Finance Minister Christine Lagarde to head the International Monetary Fund, giving Lagarde a majority of votes of IMF member nations

Senator blocks NRC Commissioner Ostendorff’s bid for 2^nd term – Stephen Power and Corey Boles report that Senator Bernie Sanders (I-Vt) is holding up the nomination because of Ostendorff’s intervention in a decision by Vermont to prohibit Entergy Corp. from managing the Vermont Yankee nuclear plant; meanwhile, Republicans are calling for the resignation of NRC chairman Gregory Jaczko based on a report of his withholding information from other commissioners

Traditional methods of projecting population health statistics, such as estimating future death rates, can give inaccurate results and lead to inferior or even poor policy decisions. A new “three-dimensional” method of forecasting vital health statistics is more accurate because it takes into account the delayed effects of the health risks being accumulated by today’s younger generations. Applying this forecasting technique to the US obesity epidemic suggests that future death rates and health care expenditures could be far worse than currently anticipated. We suggest that public policy makers adopt this more robust forecasting tool and redouble efforts to develop and implement effective obesity-related prevention programs and interventions.

Pfizer Inc. announced today that the U.S. Food and Drug Administration (FDA) has accepted Pfizer’s filing for standard review of axitinib for patients with advanced renal cell carcinoma (RCC). This submission was based on Phase 3 data from the AXIS 1032 trial, comparing axitinib with sorafenib in patients with previously treated advanced RCC, which Pfizer recently presented at the 47th Annual Meeting of the American Society of Clinical Oncology (ASCO).

As indicated by the recent roll out of the House Republican budget strategy, the gloves are off in the battle to define the country’s spending priorities in the run-up to the November elections. But neither party adequately addresses the largest item in the discretionary budget: the Pentagon.

The Obama Administration’s approach to curbing runaway defense spending has been far too timid, while Republicans – from Paul Ryan to Mitt Romney – actually want to increase spending substantially beyond current levels.

A key player in this debate is the defense industry, which is pulling out all the stops to get the Pentagon a free pass from future budget cutting. The industry’s main trade group, the Aerospace Industries Association, has financed two studies raising the specter of a million jobs lost from planned Pentagon cuts.

Washington Post

As Justice Department investigates shooting of Florida teen, doubts arise about federal charges [Justice Department, FBI] — Sari Horwitz reports that while the Justice Department and FBI have opened an investigation into the Floritda community watch incident that left a black teenager slain, it’s unlikely that the federal forces will be able to charge the perpetrator with charges

Obama’s evolution: Behind the failed ‘grand bargain’ on the debt [President Obama, federal debt debate] — Peter Wallsten, Lori Montgomery, and Scott Wilson profile the 2011 struggle between the White House and Republican lawmakers over the federal debt

U.S. general suggests Afghan force should stay level after ’12 drawdown [General John Allen, Afghanistan] — Karen DeYoung reports that General John R. Allen, the top U.S. commander in Afghanistan, doesn’t expect another drawdown of troops for a while after this year’s scheduled withdraw of 23,000 U.S. troops

Idled nuclear driver for government still collecting paycheck [federal workforce] — Lisa Rein recounts the tale of Stephen Patrick, an Energy Department employee — hired to drive nuclear materials around the country to support the U.S. stockpile — who still receives a paycheck from the U.S. (as he’s still technically in the workforce) despite having been suspended from his job in 2007 for breaking the agency’s overnight-rest rules

NRC seeks public comment on proposed order [Nuclear Regulatory Commission] — Timothy R. Smith reports that the Nuclear Regulatory Commission is seeking public comment on a proposed government order to require nuclear plants to maintain functions despite loss of electric grid or energy generators — part of a government effort to prepare America’s nuclear reactors for a natural disaster

New York Times

Supreme Court revisits issue of harsh sentences for juveniles [Supreme Court, criminal justice] — Adam Liptak reports that the Supreme Court seems willing to limit the harsh punishments that are imposed on juvenile offenders

Justices limit suits filed over Family Leave Act violations [Supreme Court, Family Leave Act] — Adam Liptak reports that the Supreme Court has decided — in a 5-to-4 vote split along ideological lines — that state workers may not sue their employers for money for violating a part of the federal Family and Medical Leave Act

Wall Street Journal

Bernanke goes back to school [Federal Reserve, Ben Bernanke] — Jon Hilsenrath and Kristina Peterson report that Federal Reserve Chairman Ben Bernanke suggested that he’s in no real hurry to raise interest rates

Weak schools said to imperil security [Council on Foreign Relations, U.S. schools] — Jason Dean reports that the Council on Foreign Relations has concluded that U.S. schooling is a national security risk — failing to produce adults with the necessary math, science, and language skill snecessary to ensure American leadership in the 21st century

Soldier sentenced in kickback case [defense contracting] — Joel Millman reports that Sergeant Terry Hall is the latest U.S. soldier to be sentenced in a multi-million-dollar defense-contracting scandal at a base in Kuwait, where millions of dollars in bribes and kickbacks from defense contractors were solicited

The National Transportation Safety Board is urging Michigan not to repeal a state law that requires motorcycle drivers to wear helmets. The State Senate had previously passed such laws only to have them vetoed by Michigan Democratic Governor Jennifer Granholm. New GOP Governor Rick Snyder is more receptive to getting rid of the safety measure.

This naive, safety-first blogger mistakenly presumed that all states required cyclists (including bicyclists) to wear helmets. But only 20 states have laws requiring all motorcyclists to wear helmets. Illinois is one of three states, along with Iowa and New Hampshire, to have no motorcycle helmet-use law on the books whatsoever.

Federal authorities have recently signaled that they would consider delaying some aspects of implementation of the newest version of the International Classification of Diseases, known as ICD-10-CM, a coding system used to define health care charges and diagnoses. Some industry groups have reacted with dismay, and many providers with relief. We are concerned that adopting this new classification system for reimbursement will be disruptive and costly and will offer no material improvement over the current system. Because the health care community is also working to integrate health information technology and federal meaningful-use specifications that require the adoption of other complex coding standardization systems (such as the system called SNOMED CT), we recommend that the Centers for Medicare and Medicaid Services consider delaying the adoption of ICD-10-CM. Policy makers should also begin planning now for ways to make the coming transition to ICD-11 as tolerable as possible for the health care and payment community.

Washington Post

Afghanistan poppy killers get scrutiny absent in prior contracts – Michelle Jamrisko reports that U.S. contractors, including DynCorp International, Lockheed Martin and Raytheon among others, with almost $2 billion worth of counter-narcotics business in Afghanistan, will face more scrutiny than they faced for similar work in Latin America over the past decade, which was marked by inadequate competition and little oversight

Obama’s Afghanistan plan gets mixed reviews from grunts at Fort Campbell – Kevin Sieff reports from Tennessee’s Fort Campbell military base to reflect the negative, dismissive view of President Obama’s recent announcement of a major phaseout of troops in Afghanistan

A new way of thinking as sea levels rise – Darryl Frears reports that as fears over rising sea level loom in Virginia Beach — where water is expected to rise 14 to 17 inches in the next century — the Environmental Protection Agency is advising against seawalls and dikes, and urging residents to accept rising sea levels as inevitable

New York Times

Behind veneer, doubt on future of natural gas – Ian Urbana reports that disagreements abound among the United States Energy Information Administration, where some are convinced of natural gas’s prosperous future, but others are skeptical, wary of how this bubble might burst as the housing and technology bubbles did, and concerned about how much natural gas can affordably be extracted

U.S. plans stealth survey on access to doctors – Robert Pear reports that the Obama Administration plans to deploy “mystery shoppers” to gauge general access to primary care doctors, judging how difficult it is for people to get care when they need it

U.S. to provide guidelines to bolster computer security – Riva Richmond reports that the Homeland Security Department will soon release a new system of guidance intended to help make the software behind such services as Web sites and power grids less susceptible to hacking; the guidelines will include a list of the top 25 programming errors that most clearly enable serious attacks

Wall Street Journal

Your mileage may vary – Josh Mitchell and Sharon Terlep reports that the Obama administration may soon require automakers to just about double the average fuel economy of their car and light truck fleets, to 56.2 miles per gallon by 2025

Showdown over use of cancer-drug Avastin – Alicia Mundy reports that Food and Drug Administration scientists are fighting to have their decision to revoke cancer drug Avastin accelerated approval for breast cancer upheld

Biden pushes debt-reduction plan – AP reports that Vice President Joe Biden took a stance against Republican and their attempts at lowering the national debt limit, saying that their approach would only benefit the wealthy

Governments constantly face the challenge of determining how much they should spend to prevent premature deaths and suffering in their populations. In this article we explore the benefits of expanding the delivery of life-saving vaccines in seventy-two low- and middle-income countries, which we estimate would prevent the deaths of 6.4 million children between 2011 and 2020.  Present the economic benefits of vaccines by using a “value of statistical life” approach, which is based on individuals’ perceptions regarding the trade-off between income and increased risk of mortality. Our analysis shows that the vaccine expansion described above corresponds to $231 billion (uncertainty range: $116–$614 billion) in the value of statistical lives saved. This analysis complements results from analyses based on other techniques and is the first of its kind for immunizations in the world’s poorest countries. It highlights the major economic benefits made possible by improving vaccine coverage.

The program of US foreign assistance to advance health and health care in developing countries survived the 2011 budget battles, but it continues to face other challenges.

Fifty percent of college students who drink report alcohol-induced blackouts, and alcohol abusers in general put a heavy burden on the medical care system. Using data drawn from a randomized, controlled alcohol intervention trial at five university sites, our study quantified the costs of visits to emergency departments by college students who experienced blackouts from drinking alcohol. Of 954 students in the study, 52 percent of males and 50 percent of females at the outset of the study had experienced an alcohol-induced blackout in the past year.

Of 404 emergency department visits among the study participants over a two-year observation period, about one in eight were associated with blackout drinking. Injuries ranged from broken bones to head and brain injuries requiring computed tomography. We calculate that on a large university campus having more than 40,000 students, blackout-associated emergency department visit costs would range from $469,000 to $546,000 per year. Conclude that blackouts are a strong predictor of emergency department visits for college drinkers and that prevention efforts aimed at students with a history of blackouts might reduce injuries and emergency department costs.

Washington Post

Federal agencies to open investigation into black teen’s death [Justice Dept. Civil Rights Division, FBI] – Sandhya Someshekhar reports that the Justice Department will investigate the shooting death of a black teenager in Florida by a neighborhood watch who claims he shot the unarmed youth in self-defense; federal authorities are pursuing the case after a public outcry over the local police department’s failure to arrest the shooter

IRS employee-screening records found lacking [Treasury Dept., IRS, Office of Personnel Management] – Eric Yoder reports that the Internal Revenue Service often hires employees without completing the “rigorous” background investigation required for its employees who are responsible for handling sensitive information; records of fingerprint checks against FBI records and the applicant’s history of paying taxes are often missing, according to a Treasury Department Inspector General report

U.S. commander in Afghanistan to appear before wary Congress [Pentagon, Gen. John Allen, commander of U.S. and NATO forces in Afghanistan] – Ernesto Londoño and Richard Leiby preview the congressional testimony of Gen. John Allen, commander of U.S. and NATO forces in Afghanistan, who will be grilled about U.S. plans for withdrawal from the region at a time when relations with the Afghan government are at a new low and discussions with the Taliban have broken off

New York Times

Use of ‘conflict minerals’ gets more scrutiny from U.S. [Securities and Exchange Commission, United States office of Global Witness] – Edward Wyatt reports that the electronic manufacturing industry is worried about an obscure provision of the Dodd-Frank financial reform law that requires publicly traded companies to trace certain minerals used in their products and to report to shareholders and the Securities and Exchange Commission whether their mineral supply comes from the Democratic Republic of Congo — where brutal militias are financing themselves with the profits from the sale of those minerals; following voluminous comments on how to implement the law, and heavy lobbying, the SEC chair said the agency will issue a rule in a couple of months

U.S. war game sees peril of Israel strike against Iran [Pentagon, Central Command, Iran, Israel] – Mark Mazzetti and Thom Shanker report that the U.S. military conducted a simulated war game called “Internal Look” to determine the effect of an Israeli attack on Iranian nuclear facilities for the U.S., which would likely become involved in such as conflict, and concluded that an Israeli first strike would have “dire consequences” for the region and the U.S., although military specialists note that it is impossible to predict Iran’s response

Wall Street Journal

U.S. energy-efficiency program falls short, report says [Energy Dept.] – Ryan Tracy reports that a House Oversight and Government Reform Committee report sharply criticizes the Energy Department weatherization program as poorly managed and ineffective

Fed choices offer steady path [Federal Reserve] – Kristina Peterson reports on two nominees to the Federal Reserve Board — Democrat Jeremy Stein, a Harvard professor of economics, and Republican Jerome Powell, a former private-equity executive — neither of whom has sparked opposition

Court upholds graphic tobacco labels [Food and Drug Administration, tobacco] – Jennifer Corbett Dooren reports that the Sixth Circuit Court of Appeals agreed with a lower court that the Food and Drug Administration had the authority to require graphic images on tobacco packages warning of its health effects as part of its authority to regulate tobacco products under a 2009 law, and the court rejected tobacco companies’ claim that such ads violate their free speech rights; the D.C. Circuit will review a lower court decision in its jurisdiction that came to the opposite result, and the Supreme Court is likely to ultimately decide the matter