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In a First, New England Journal of Medicine Joins Never-Trumpers

Throughout its 208-year history, The New England Journal of Medicine has remained staunchly nonpartisan. The world’s most prestigious medical journal has never supported or condemned a political candidate.

Until now.

In an editorial signed by 34 editors who are United States citizens (one editor is not) and published on Wednesday, the journal said the Trump administration had responded so poorly to the coronavirus pandemic that they “have taken a crisis and turned it into a tragedy.”

The journal did not explicitly endorse former Joseph R. Biden Jr., the Democratic nominee, but that was the only possible inference, other scientists noted.

The editor in chief, Dr. Eric Rubin, said the scathing editorial was one of only four in the journal’s history that were signed by all of the editors. The N.E.J.M.’s editors join those of another influential journal, Scientific American, who last month endorsed Mr. Biden, the former vice president.

The political leadership has failed Americans in many ways that contrast vividly with responses from leaders in other countries, the N.E.J.M. said.

In the United States, the journal said, there was too little testing for the virus, especially early on. There was too little protective equipment, and a lack of national leadership on important measures like mask wearing, social distancing, quarantine and isolation.

There were attempts to politicize and undermine the Food and Drug Administration, the National Institutes of Health and the Centers for Disease Control and Prevention, the journal noted.

As a result, the United States has had tens of thousands of “excess” deaths — those caused both directly and indirectly by the pandemic — as well as immense economic pain and an increase in social inequality as the virus hit disadvantaged communities hardest.

The editorial castigated the Trump administration’s rejection of science, writing, “Instead of relying on expertise, the administration has turned to uninformed ‘opinion leaders’ and charlatans who obscure the truth and facilitate the promulgation of outright lies.”

The uncharacteristically pungent editorial called for change: “When it comes to the response to the largest public health crisis of our time, our current political leaders have demonstrated that they are dangerously incompetent. We should not abet them and enable the deaths of thousands more Americans by allowing them to keep their jobs.”

Scientific American, too, had never before endorsed a political candidate. “The pandemic would strain any nation and system, but Trump’s rejection of evidence and public health measures have been catastrophic,” the journal’s editors said.

The N.E.J.M., like all medical journals these days, is deluged with papers on the coronavirus and the illness it causes, Covid-19. Editors have struggled to reconcile efforts to insist on quality with a constant barrage of misinformation and misleading statements from the administration, said Dr. Clifford Rosen, associate editor of the journal and an endocrinologist at Tufts University in Medford, Mass.

“Our mission is to promote the best science and also to educate,” Dr. Rosen said. “We were seeing anti-science and poor leadership.”

Mounting public health failures and misinformation had eventually taken a

BITTER MEDICINE | Columns | The Journal Gazette

The COVID-19 pandemic rages on, half a million Hoosiers are out of work, and Indianapolis-based Eli Lilly has chosen this moment in history to end the company’s participation in the 340B Drug Pricing Program that provides affordable prescription drugs to low-income residents.

What was Lilly thinking? It’s hard to tell – the company didn’t respond to multiple requests for interviews.

But the medical professionals who are trying desperately to keep the poorest people in the country healthy say the company is attempting to recoup some of its profits from independent pharmacies, which sometimes offer their own discounts. They accuse drug manufacturers threatening to exit the 340B program of courting potential disaster.

The 340B program allows health centers to buy prescription drugs at discounted prices, at a time when the country’s health care system is struggling to provide basic care for patients with chronic conditions who need vital outpatient treatment.

The threatened end of 340B most severely affects community “safety net” health centers, including Fort Wayne’s Neighborhood Health Clinics Inc., which provide primary health care to vulnerable people regardless of their ability to pay.

Many area hospitals may also lose their access to affordable drugs. Tami Brigle, public relations manager at Parkview Health, said 340B programs are in place to serve low-income patients at Parkview Regional Medical Center, Parkview Randallia, Parkview Behavioral Health Center, and at Parkview hospitals in LaGrange and Wabash.

Neighborhood Health Clinics President and CEO Angie Zaegel worries that the effective end of 340B support from Lilly and other manufacturers will make it impossible for the center to provide affordable prescription drugs to low-income northeast Indiana residents.

She said Neighborhood Health Clinics keep careful records of the drugs they prescribe, and their sources.

“We’re a much smaller fish,” Zaegel said. “We’re a qualified health center. This is the only way we’re able to provide our patients with affordable medicines to keep them healthy. We’re closely monitoring this, and trying to understand the overall impact, which we see as a threat to the 340B program. We rely on contracted pharmacy relationships. I’m not sure how we’ll help our patients get access to affordable drugs.”

“Angie is not alone,” said Drew Thomas, finance and operations manager for the Indiana Primary Health Care Association. “We represent 36 primary health centers in Indiana that treat 600,000 Hoosiers, and a vast majority of these clinics have 340B programs.”

Created by Congress in 1992, and representing less than 3% of total U.S. drug sales, the 340B program allows basic health care centers to stretch the federal funding they receive, and provide care to more people.

Hospitals and health clinics such as Neighborhood Health Clinics use their savings to fund specialty clinics that treat patients with specific conditions like diabetes.

The 340B program has also been an important tool for stretching federal grants to help combat the opioid epidemic, which has ravaged urban and rural communities alike.

Pharmacies first

Lilly’s move is not the first time the hammer has dropped on 340B.

In 2018, the