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Good morning! I’m David Ovalle, a health writer covering addiction and drugs. This week, I’ve traded in balmy Miami for the arctic swamplands of D.C. More on that later, but first, if you’ve got tips, email me at <a href="mailto:david.ovalle@washpost.com" target=_blank>david.ovalle@washpost.com</a>.

Today’s edition: Potential conflicts of interest could complicate the confirmation of President-elect Donald Trump’s pick to run Medicare and Medicaid. What you need to know about the Florida sheriff tapped to lead the Drug Enforcement Administration in the incoming administration. But first …

The Supreme Court is set to consider vape regulations

Katherine Frey

On tap today: The Supreme Court is <a href="https://www.washingtonpost.com/health/2024/12/01/flavored-vapes-supreme-court-fda/" target=_blank>scheduled to hear oral arguments</a> over how the Food and Drug Administration regulates e-cigarettes, Rachel Roubein and I report for The Post.

The justices will review a lower-court ruling that the FDA acted in an “arbitrary and capricious” way when it denied two vape companies authorization to market products with sweet flavors like killer kustard, strawberry parfait and iced pineapple express.

The FDA wants to reverse a decision by the U.S. Court of Appeals for the 5th Circuit, which ruled that the agency shifted its scientific goal posts by abruptly requiring long-term studies about flavored vapes compared with tobacco-flavored varieties and instituting what amounted to a blanket ban.

Legal experts regard the case as a major test of the agency’s authority under the 2009 <a href="https://www.fda.gov/tobacco-products/rules-regulations-and-guidance-related-tobacco-products/family-smoking-prevention-and-tobacco-control-act-overview" target="_blank">Family Smoking Prevention and Tobacco Control Act</a>. The famously conservative 5th Circuit is known for rulings limiting the power of federal regulatory agencies.

The FDA had been overwhelmed by millions of applications for new tobacco products including some products such as e-cigarettes that rely on largely the same evidence in seeking authorization to market tens of thousands of similar products. The agency has rejected more than a million sweet and fruity vaping products.

A ruling against the FDA could upend how the agency considers applications. “It would be a gift to Big Tobacco and unleash a wave of youth tobacco addiction,” Sen. Dick Durbin (D-Illinois) said in a statement to The Post.

The legal fight highlights an enduring public health conundrum: how to keep kids away from sweet-flavored, addictive vapes, while giving adult smokers better options to help them quit cigarettes.

The agency <a href="https://www.fda.gov/media/159410/download" target=_blank>has said</a> addictive nicotine from vapes can adversely influence the development of adolescent brains, affecting attention, learning and memory, and their use may be associated with asthma, chronic bronchitis and emphysema.

But the vaping industry <a href="https://www.supremecourt.gov/DocketPDF/23/23-1038/328382/20241015192529258_White%20Lion%20SCOTUS%20Amicus%20CMSA%2010.15.24-served.pdf" target="_blank">contends</a> that the FDA’s approach deprives “millions of adult smokers access to products that even the agency concedes could benefit them.” Vape supporters point to an <a href="https://www.washingtonpost.com/health/2024/09/05/youth-e-cigarette-use-vaping-decline/" target="_blank">annual federal survey</a> showing a dramatic decline in e-cigarette use by teenagers since 2019 as evidence that e-cigarettes do not pose a problem of epidemic proportions.

FDA product denials reflect a broader stubbornness — rooted in suspicion of Big Tobacco — by public health officials and researchers to accept evidence that the products are not as harmful as once believed, said Jasjit S. Ahluwalia, a researcher at Brown University’s School of Public Health. Research has shown e-cigarettes <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa1808779" target=_blank>work better</a> than nicotine patches and as well as <a href="https://pubmed.ncbi.nlm.nih.gov/38884987/" target=_blank>certain prescription medications</a> in helping people quit cigarettes, Ahluwalia said.

“Let’s be very clear — they are dramatically safer than cigarettes,” Ahluwalia said.

I’ll be in the DMV to cover a preliminary DEA administrative hearing Monday on the Biden administration’s plans to <a href="https://www.washingtonpost.com/health/2024/04/30/marijuana-restrictions-loosen/" target=_blank>loosen federal restrictions on marijuana</a>.

But Monday’s hearing in Arlington isn’t the main show. That will happen early next year when the DEA administrative court is expected to hear testimony on pros and cons of the measure, which won’t legalize marijuana but could accelerate cannabis research and help struggling pot companies.

Last week, a judge denied an <a href="https://www.washingtonpost.com/health/2024/11/19/marijuana-reclassification-dea/" target=_blank>unusual request</a> to boot the DEA from its own hearing. Administrative Law Judge John J. Mulrooney II ruled that he didn’t have legal authority to do so but also chided the agency for how it responded to claims it improperly communicated with a prominent antimarijuana organization.

Why it matters: The judge will eventually recommend whether the proposal to reclassify marijuana is appropriate, a decision that could figure into possible lawsuits seeking to stop the move.

Oz’s past business ties spark concerns about conflicts of interest

Shuran Huang

Potential <a href="https://www.washingtonpost.com/health/2024/12/02/dr-oz-medicare-medicaid-ozempic-conflicts/" target=_blank>conflicts of interest</a> could complicate President-elect Donald Trump’s selection of Mehmet Oz to run the Centers for Medicare and Medicaid Services, The Post’s Desmond Butler, Lauren Weber and Caitlin Gilbert report.

Zooming in on weight loss: In 2019, Oz promoted Ozempic on his eponymous show in a segment sponsored by the drug’s manufacturer, Novo Nordisk. The Danish company was also a <a href="https://about.sharecare.com/wp-content/uploads/2021/02/Sharecare-Investor-Roadshow-Presentation.pdf" target=_blank>key marketing client</a> of Sharecare, the digital health platform the heart surgeon co-founded in 2009, according to a 2021 <a href="https://about.sharecare.com/wp-content/uploads/2021/02/Sharecare-Investor-Roadshow-Presentation.pdf" target=_blank>investor presentation</a> by Sharecare.

Since 2021, Oz has discussed the benefits of weight-loss drugs at least five times across his personal social media, website and TV show, according to a Post review. He has also touted other products, such as a collagen supplement to combat sagging facial skin known as “Ozempic face.”

Why it matters: If confirmed, Oz would oversee two of the largest taxpayer-funded programs just as pharmaceutical companies lobby the government to expand Medicare and Medicaid coverage for weight-loss drugs, as the <a href="https://www.washingtonpost.com/health/2024/11/26/ozempic-wegovy-medicare-medicaid-weight-loss-drugs/" target=_blank>Biden administration proposed last week</a>.

Critics of Oz’s <a href="https://www.washingtonpost.com/health/2024/11/19/dr-oz-medicare-medicaid-obamacare-trump/" target=_blank>pending nomination</a> argue that his personal finances and long television career — where he often mixed entertainment with medicine and product placements, sometimes without clear boundaries or sound science — could create other potential conflicts of interest.

What they’re saying: Novo Nordisk spokeswoman Liz Skrbkova said that while the company worked with Oz’s show to sponsor the paid advertising segment in 2019, it does not have an ongoing relationship with Oz; nor does it have a relationship with Sharecare, where Novo Nordisk had previously purchased media advertising. Brian Hughes, spokesman for the Trump-Vance transition, said, “All nominees and appointees will comply with the ethical obligations of their respective agencies.”

I’ve been to a lot of American Heart Association meetings — there is rarely a standing room crowd! But that happened in Philly this weekend when the AHA discussed a new study that showed for the first time that the diabetes and weightless drug Wegovy also reduced the chance of major heart problems by a whopping 20%! This is great news—now the question is how we, as a nation, can make these medications more affordable. #mehmetoz #droz #healthcare #wegovy #wegovyweightloss #wegovyshot #weightloss #americanheartassociation #healthcare 

Oz isn’t the only influencer in Trump’s orbit. Several members of the incoming administration are <a href="https://www.washingtonpost.com/technology/2024/12/01/trump-social-media-influencer-cabinet/" target=_blank>blending politics with their personal brands</a> to sell products online, our colleague Drew Harwell reports.

Just weeks before being tapped to lead the federal health department, Robert F. Kennedy Jr. posted a sponsored video for Boxbollen, a $29.99 at-home boxing game, calling it “the ideal stocking stuffer.” The now-deleted video, which drew a million views in 30 minutes, failed to disclose it was an ad, violating federal rules.

Boxbollen co-founder Jacob Eriksson said Kennedy was chosen for his fitness at age 70 and views on health and clean eating, not his politics. Kennedy has gained millions of followers with extreme health claims, including calling the <a href="https://www.washingtonpost.com/coronavirus/" target="_blank" class="contextual_link">coronavirus</a> vaccine a “<a href="https://x.com/RobertKennedyJr/status/1602383185278640129" target=_blank>crime against humanity</a>.”

Trump taps Florida sheriff as DEA administrator

James Borchuck

Hillsborough County Sheriff Chad Chronister <a href="https://www.washingtonpost.com/politics/2024/11/30/chad-chronister-dea-administrator-trump/" target=_blank>has been selected</a> to lead the DEA in the incoming Trump administration, replacing Anne Milgram, David and The Post’s Anumita Kaur report.

Trump <a href="https://truthsocial.com/@realDonaldTrump/posts/113574561799756610" target=_blank>announced the pick</a> on Truth Social on Saturday, writing that Chronister will work with the attorney general to “secure the Border, stop the flow of Fentanyl” and “SAVE LIVES.” The Florida sheriff has had limited national exposure but has three decades of law enforcement experience.

Why it matters: If the Senate confirms Chronister, he will inherit an agency tasked with dismantling domestic and international drug trafficking organizations flooding the streets with cocaine, methamphetamine, fentanyl and a panoply of <a href="https://www.washingtonpost.com/health/2023/12/10/nitazenes-opioid-stronger-than-fentanyl/?itid=lk_inline_manual_18" target=_blank>synthetic drugs</a>.

Fentanyl, primarily manufactured in Mexico with chemicals from China, remains the leading driver of overdose deaths. However, U.S. officials and experts credit enforcement efforts, changes in drug supply and an increased focus on public health measures with a <a href="https://www.usatoday.com/story/opinion/2024/11/26/dea-drug-deaths-fentanyl-mexican-cartels/75487168007/" target=_blank>sharp decline</a> in deaths this year.

Scott Gottlieb, who led the FDA during the first Trump administration, warned Friday that Kennedy could <a href="https://www.washingtonpost.com/health/2024/11/29/scott-gottlieb-trump-rfk-hhs/" target=_blank>“cost lives” if confirmed as the next secretary of Health and Human Services</a>, our colleague Dan Diamond reports.

“You’re going to see measles, mumps and rubella vaccination rates go down,” Gottlieb <a href="https://www.cnbc.com/video/2024/11/29/deep-concerns-with-rfks-intentions-for-core-public-health-protections-former-fda-commissioner.html" target=_blank>said on CNBC</a>, referencing Kennedy’s longtime criticism of federal recommendations for <a href="https://www.cdc.gov/vaccines/imz-schedules/child-easyread.html" target=_blank>childhood immunizations</a>. He warned that the nation is approaching a “tipping point” in which <a href="https://www.washingtonpost.com/health/2023/11/09/kindergarten-vaccine-exemptions-cdc-data/?itid=lk_inline_manual_4" target=_blank>further declines</a> in childhood vaccination rates could lead to measles outbreaks and deaths.

On our radar: The Senate is expected to review Kennedy’s nomination early next year. While many Democrats and some Republicans have voiced concerns about his views on vaccines and other positions, <a href="https://www.washingtonpost.com/health/2024/11/20/rfk-senators-vaccines-abortion-agriculture/?itid=lk_inline_manual_16" target=_blank>they haven’t ruled out supporting him</a>.

Gottlieb said he’s been <a href="https://www.washingtonpost.com/health/2024/11/20/rfk-senators-vaccines-abortion-agriculture?itid=lk_inline_manual_7" target=_blank>urging senators not to confirm Kennedy</a> but didn’t name specific lawmakers. He noted that Kennedy has “smart people” around him who could take <a href="https://www.washingtonpost.com/health/2024/11/08/rfk-jr-vaccines-fda-trump-health-policy/?itid=lk_inline_manual_7" target=_blank>immediate steps to affect Americans’ access to vaccines</a>, such as changing federal vaccine recommendations.

The Biden administration has <a href="https://www.washingtonpost.com/health/2024/11/27/1-800-medicare-call-center-maximus-contract-biden/?itid=lk_inline_manual_70" target=_blank>abandoned its efforts</a> to rebid a $6.6 billion contract to operate call centers for Medicare and the Affordable Care Act, resolving a dispute that became <a href="https://www.washingtonpost.com/health/2024/06/28/medicare-hotline-contract-hhs-maximus/?itid=lk_inline_manual_2&itid=lk_inline_manual_70" target=_blank>tangled in election-year politics</a> and Republican accusations of undue influence by labor unions, Dan reports.

Insurance companies <a href="https://www.washingtonpost.com/health/2024/11/29/prep-insurance-coverage-issues-hiv-mistr/#?itid=lk_inline_manual_71" target=_blank>are skirting federal rules</a> requiring them to cover pre-exposure prophylaxis treatment without cost-sharing, forcing patients to shell out hundreds of dollars each year for drugs that reduce their risk of contracting HIV, The Post’s Fenit Nirappil reports.

The Centers for Disease Control and Prevention <a href="https://www.cdc.gov/media/releases/2024/a1129-salmonella-outbreak.html" target=_blank>is warning</a> about a salmonella outbreak linked to cucumbers that has sickened 68 people across 19 states. Produce grown in Sonora, Mexico, by Agrotato S.A. may be the culprit, according to the agency.

📅 Welcome back! The Senate returns today, with the House set to reconvene tomorrow for a three-week sprint ahead of the year-end recess. Here’s what we’re watching:

On Wednesday: The House select subcommittee on the coronavirus pandemic <a href="https://x.com/COVIDSelect/status/1861848345523667445" target=_blank>will markup</a> its final report, outlining key lessons learned and recommendations for the future after two years of investigations.

On Thursday: The Senate health committee <a href="https://www.help.senate.gov/hearings/what-is-the-fda-doing-to-reduce-the-diabetes-and-obesity-epidemics-in-america-and-take-on-the-greed-of-the-food-and-beverage-industry" target="_blank">will review</a> the FDA’s efforts to combat diabetes and obesity through the food and beverage industries; a Senate Environment and Public Works subcommittee <a href="https://www.epw.senate.gov/public/index.cfm/hearings?ID=D93694BC-7534-4AEF-A435-A7CDBB6013DC" target="_blank">will discuss</a> the public health effects of “forever chemicals.”

At the Supreme Court, the justices will hear oral arguments in a case <a href="https://www.washingtonpost.com/politics/2024/06/24/scotus-trans-minors-gender-care/" target=_blank>challenging the constitutionality</a> of Tennessee’s ban on gender-affirming care for minors.

<a href="https://www.washingtonpost.com/health/2024/11/29/prep-insurance-coverage-issues-hiv-mistr/#" target=_blank>HIV prevention pills should be free, but insurers are still charging (By Fenit Nirappil | The Washington Post)</a>

<a href="https://www.nytimes.com/2024/11/29/health/trump-nursing-homes-staff-mandates.html" target="_blank">Nursing home industry wants Trump to rescind staffing mandate (By Jordan Rau | The New York Times)</a>

<a href="https://apnews.com/article/massachusetts-generational-tobacco-ban-c8f18b1a30e65df8f04e28a33eb259ea" target=_blank>Massachusetts lawmakers push for an effort to ban all tobacco sales over time (By Steve Leblanc | The Associated Press)</a>

Thanks for reading! Not a subscriber? <a href="https://www.washingtonpost.com/newsletters/the-health-202/" target=_blank>Sign up here.</a>

David Ovalle

American University, BA in journalism

McKenzie Beard is a researcher for The Health 202, a morning newsletter and daily guide to Washington's health-care policy debate. She started at the Post as an American University practicum student on the investigative desk in 2021 and has previously reported for Voice of America and Teen Vogue.

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