The full form of NEET UG is the National Eligibility cum Entrance
Test- Undergraduate, which is the main entrance exam for students seeking
admission to undergraduate medical programmes in India. It was introduced in
2013 by the Medical Council of India (MCI) and the Central Board of Secondary
Education (CBSE).

NEET UG replaced many medical entrance exams like the All India Pre-Medical Test (AIPMT) and
other state exams, streamlining the admission process and ensuring a more
transparent and standardized evaluation system.

Before NEET UG, each Indian state conducted its separate medical
entrance exams, resulting in varying eligibility criteria, syllabus, and
difficulty levels. As there was a lack of a uniform evaluation system, students
had to face stress and financial burden and give multiple examinations during
the same academic year. Therefore, NEET UG was introduced in 2013 to address
these problems.

After implementing
NEET UG, students are assessed on the same parameters, promoting
fairness and eliminating regional disparities. NEET UG has also helped decrease corruption and malpractices in the admission process.

NEET UG Exam Pattern:

NEET UG is an offline,
pen-and-paper-based examination which is conducted annually by the National
Testing Agency (NTA). The exam comprises of a single-question paper with 180
multiple-choice questions (MCQs) covering Physics, Chemistry, and Biology
(Botany and Zoology). The exam lasts 3 hours and 20 minutes and is held in
various languages, making it accessible to many students.

Each subject has two sections,
Section A has 35 questions, and Section B has 15 questions. Candidates can attempt
any 10 questions out of the 15 questions section.

No.

Subjects

Sections

No. of Questions

Marks- Each question carries 4 marks

Question Type

1.

Botany

Section A

35

140

MCQ

Section B

15

40

2.

Zoology

Section A

35

140

Section B

15

40

3.

Physics

Section A

35

140

Section B

15

40

4.

Chemistry

Section A

35

140

Section B

15

40

Total Marks

720

The test aims to assess a
candidate's understanding of concepts, problem-solving skills, and application
of knowledge in medical sciences.

In Section A MCQs- Each
correct answer is given four marks, while one mark is deducted for each wrong
answer and the unanswered question gets no marks.

In Section B MCQs: Candidates
need to attempt 10 out of the 15 questions. If a candidate
attempts more than 10 questions only the first 10 questions attempted are
considered while checking. There is no negative marking for section B. But, if any
discrepancy is found later on, this rule will be followed: Each correct answer
is given four marks, while one mark is deducted for each wrong answer, and the unanswered question gets no marks.

The duration of the exam is 03
hours and 20 minutes. PwBD candidates (those with physical limitations
affecting writing) are given compensatory time of one hour and five minutes,
irrespective of whether they used a scribe or not, for the three hours and
twenty minutes (03:20 hrs) duration of the examination.

NEET UG is held for admissions
to various medical courses like MBBS, BDS, BAMS, BSMS, BUMS, and BHMS. These
courses are offered by medical institutions that follow the norms, guidelines,
and regulations the relevant Regulatory Bodies set forth under the NCISM
Act, 2020 and NCH Act, 2020.

Languages offered for question paper:

The candidates can choose exam
question papers in 13 languages- English, Hindi, Odia, Punjabi, Tamil, Telugu,
Assamese, Bengali, Gujarati, Kannada, Malayalam, Marathi, and Urdu.

Candidates who opt to take the test in English, Hindi, or a
regional language will be given a test booklet with questions in English and
their chosen language. As an example, if an applicant selects Tamil, the test
booklet will have questions in Tamil, English, and Hindi. However, the English original of a test question shall be taken as the definitive and final version
if there is any ambiguity or doubt in the translation. The National Testing
Agency's (NTA) judgement shall be final and binding.

Benefits of NEET UG:

NEET UG has brought about
significant changes in the Indian undergraduate admission system. Some of the
key impacts include:

·
Standardization of Evaluation: NEET UG has standardized the
evaluation process, ensuring that students from different states are judged
fairly and equally.

·
Boost to Meritorious Students: NEET UG rewards students based on
merit rather than their state of origin or other discriminatory factors. As a
result, deserving candidates, regardless of their background, have a better
chance of securing seats in reputed medical colleges.

·
Curbing Commercialization of Education: The centralized nature of
NEET UG has significantly reduced the commercialization of medical education.
Earlier, private medical colleges used to conduct separate exams, leading to
exorbitant fees and rampant profiteering.

·
Strengthening Medical Infrastructure: With the elimination of
capitation fees and a more transparent admission process, NEET UG has helped in
attracting better talent to government medical colleges. This, in turn, has
strengthened the medical infrastructure of the country.

NEET UG Eligibility:

The candidate must be 17 years old at the time of admission or
will turn 17 on or before December 31st of the year they are admitted to the
first year of the undergraduate medical course.

The candidate must have a 10+2 or
equivalent diploma from a recognised board, with Physics,
Biology/Biotechnology, Chemistry, and English as core courses.

According to the Under Graduate Medical Education Board (UGMEB), NEET (UG) exam applicants have no upper age limit. This indicates that
there is no upper age limit on applicants for the exam and that candidates of
any age may do so.

For Overseas Citizens of India (OCI) applicants who wish to be
accepted into Indian medical or dental schools, they must also pass the NEET
(UG) exam.

NEET Syllabus:

The NEET (UG) syllabus is vast and comprehensive because it covers
topics in Biology (Botany and Zoology), Chemistry, and Physics. The aim of the
syllabus is to evaluate the candidate's knowledge of multiple issues as well as
their problem-solving skills. A general summary of the subjects covered in each
is given below:

Physics:

Current Electricity

Kinematics

Laws of Motion

Magnetic Effects of Current and Magnetism

Electromagnetic Induction and Alternating Currents

Electromagnetic Waves

Optics

Thermodynamics

The behaviorBehaviour of Perfect Gas and Kinetic Theory

Oscillations and Waves

Electrostatics

Dual Nature of Matter and Radiation

Atoms and Nuclei

Electronic Devices

Physical-world and measurement

Work, Energy, and Power

Properties of Bulk Matter

Chemistry:

Some Basic Concepts of Chemistry

Structure of Atom

Classification of Elements and Periodicity in Properties

Chemical Bonding and Molecular Structure

States of Matter: Gases and Liquids

Thermodynamics

Equilibrium

Redox Reactions

Hydrogen

Coordination Compounds

Haloalkanes and Haloarenes

Alcohols, Phenols, and Ethers

Aldehydes, Ketones, and Carboxylic Acids

Organic Compounds Containing Nitrogen

Biomolecules

Polymers

Chemistry in Everyday Life

s-Block Elements (Alkali and Alkaline earth metals)

Hydrocarbons

Environmental Chemistry

Solid State

Solutions

Electrochemistry

Chemical Kinetics

Surface Chemistry

General Principles and Processes of Isolation of Elements

p-Block Elements

d- and f-Block Elements

Some p-Block Elements

Organic Chemistry - Some Basic Principles and Techniques

Biology:

Diversity in Living World

Structural Organization in Animals and Plants

Cell Structure and Function

Plant Physiology

Human Physiology

Reproduction

Genetics and Evolution

Biology and Human Welfare

Biotechnology and Its Applications

Ecology and Environment

Exam Strategy:

In order to do well in the NEET UG exam,
candidates must deeply study each topic according to the NEET UG syllabus. They
should also concentrate on frequent practice, working on sample papers, and
taking mock exams to improve their time management and problem-solving skills.
Candidates can succeed in NEET UG and gain admission to top medical colleges by
following a well-structured study strategy and constantly trying.

Success in NEET UG mostly
depends on time management, consistent practice, and conceptual clarity. Many
candidates join coaching classes to gain advice and experienced mentoring. A
well-structured study strategy, commitment, and perseverance are necessary for
NEET preparation.

Counselling and Reservation:

Admissions to all seats of Undergraduate Medical/Dental Courses
for the NEET (UG) - 2023 followed the following specific quotas:

All India Quota Seats

State Government Quota Seats

Deemed Universities/Central Institutions/Universities

State or Management or Dental Colleges or any Private University
or NRI Quota Seats in Private Medical

Central Pool Quota Seats

All seats, which include NRI Quota and Management Quota, are in
private unaided/aided minority/non-minority medical colleges.

AIIMS Institutes across India/JIPMER.

For successful candidates, the counselling for seats under 15% All
India Quota and 100%, which includes 85% of State quota seats of Central
Institutions- ABVIMS & RML Hospital/VMMC & Safdarjung Hospital/ESIC)/
Central Universities (including DU/BHU/AMU)/ AIIMS/ JIPMER, and Deemed
Universities, will be conducted by the DGHS/MCC for Undergraduate Medical/Dental
Courses.

For AFMC (Armed Forces Medical College), MCC handles the
registration process and forwards the registered candidates' data to AFMC
Authorities for admission.

Additionally, DU/BHU and other Universities may utilize the NEET
(UG) - 2023 scores for additional relevant courses they offer.

AACCC (Ayush Admissions Central Counselling Committee), which
falls under the Ministry of Ayush, will serve as the counselling authority for
the All-India Quota (AIQ) about BAMS (Bachelor of Ayurvedic Medicine and
Surgery), BUMS (Bachelor of Unani Medicine and Surgery), and BSMS (Bachelor of
Siddha Medicine and Surgery) courses under the National Commission for Indian
Systems of Medicine (NCISM) Act. AACCC will also counsel Bachelor of
Homeopathic Medicine and Surgery (BHMS) courses under the National Commission
for Homeopathy (NCH) Act.

Stepwise approach for taking the NEET UG exam:

Step 1: Eligibility and
Information- Check the eligibility criteria for the NEET (UG) - examination. Read the Information Bulletin and familiarize yourself with the
exam guidelines, instructions, and important dates. Regularly check the
official NEET website for updates and additional information.

Step 2: Registration- Visit the NEET (UG) official website and
register for the exam. Fill in personal details accurately, including name,
date of birth, gender, nationality, and identification information. Give a
valid mobile number and email address for communication purposes.

Step 3: Prepare Documents- Gather all necessary documents,
including photographs, signatures, thumb impressions, category certificates,
Class 10 and 12 certificates, and address proof. Ensure all documents are in
the specified format and within the specified size limits.

Step 4: Filling Application Form: Log in to the NEET (UG) website and complete the application form carefully. Enter educational details, including Class 10, 11, and 12
examinations. Provide information on the examination city choices, question
paper medium, and category details.

Step 5: Fee Payment- Pay the examination fee through online
payment options (Debit/Credit Card, Net-banking, UPI). Verify the payment
status and keep a copy of the fee payment confirmation.

Step 6: Check Application Status- After successful fee payment,
verify the status of the application form to ensure it is complete and
error-free. Rectify any discrepancies, if necessary, by contacting the
helpdesk.

Step 7: Download Admit Card- Download the Admit Card from the
official NEET (UG) website using login credentials. Verify all the
details written on the Admit Card, such as name, photograph, and examination
centre details. In case of any discrepancies, immediately contact the helpdesk.

Step 8: Exam Day Preparations- Prepare all required materials,
including Admit Card, identity proof, pen, etc., for the exam day.

Step 9: Exam Day- Reach the examination centre on time as per the
reporting time mentioned on the Admit Card. Follow all the examination
guidelines and instructions strictly during the exam.

Step 10: Post-Exam- Preserve the Admit Card and all necessary
documents for future reference and stay updated with the official NEET (UG) website for information on results and counselling.

KIDNEY stones can be incredibly painful and cause serious problems if not taken care of properly.

These little, hard mineral deposits form in the kidneys and can cause discomfort when passing through the urinary tract. The good news is that there are ways to prevent kidney stones and keep your kidneys healthy.

In this article we'll explore some practical steps you can take to lower your risk of developing kidney stones.

1.
Stay hydrated: The power of drinking water

One of the simplest and most effective ways to prevent kidney stones is to drink plenty of water. Keeping yourself well-hydrated helps dilute your urine, making it less likely for minerals to stick together and form stones in your kidneys. Doctors often suggest drinking around 8-10 glasses of water a day but remember, your specific needs might vary depending on factors like age, activity level, and the climate you live in.

2. Watch your diet

Making some changes to your diet can make a big difference in preventing kidney stones. Here are some key dietary tips:

a. Cut back on sodium

A diet high in sodium can increase the levels of calcium in your urine, which can lead to the formation of stones. So, try to limit your salt intake and steer clear of processed foods that are packed with sodium.

b. Be mindful of oxalate-rich foods

In certain foods is a substance called oxalate that can combine with calcium in your urine to form kidney stones. Foods that are high in oxalates — like spinach, beets, nuts, and chocolate — should be eaten in moderation.

c. Balance your calcium intake

It might seem counter-intuitive but cutting back on calcium won't necessarily prevent kidney stones — in fact, not getting enough calcium can actually increase your risk. It's all about getting the right amount, either through your diet or with the help of supplements, as advised by your health-care professional.

d. Enjoy citrus fruits: Citrate, which is found in citrus fruits like lemons and oranges, can be helpful in preventing kidney stone formation by stopping crystals from growing. So, go ahead and add some citrus fruits to your diet.

3. Keep animal protein in check

Eating too much animal protein, like red meat, can raise uric acid and calcium levels in your urine, making it more likely for kidney stones to form. A good idea is to have a balanced diet that includes lean proteins from different sources, like fish, poultry, and plant-based alternatives, for the sake of your kidney health.

4. Maintain a healthy weight

Being overweight or obese can increase your chances of getting kidney stones. By exercising regularly and eating a balanced diet you not only reduce the risk of kidney stones but also improve your overall health and well-being.

5. Be aware of medications

Some medications, such as diuretics and calcium-containing antacids, can contribute to kidney stone formation. It's essential to have a chat with your health-care professional about potential side effects and consider alternatives if necessary.

Taking care of your kidneys and preventing kidney stones involves making some lifestyle changes and being mindful of what you eat. Drinking plenty of water, watching your diet, moderating your animal protein intake, maintaining a healthy weight, and being aware of medications can go a long way in safeguarding your kidney health. Remember, personalised advice from health-care professionals is crucial, especially if you have a history of kidney stones or other kidney-related issues. By taking preventive measures you can lead a happier and healthier life, free from the discomfort of kidney stones.

Dr Jeremy Thomas is a consultant urologist. He works privately in Montego Bay, Savanna-la-Mar and Kingston, and publicly at Cornwall Regional Hospital. He may be contacted on Facebook and Instagram: @jthomasurology or by e-mail: jthomasurology@gmail.com

In the last 15 years since WHO's MPOWER tobacco control measures were introduced globally, smoking rates have fallen. Without this decline there would be an estimated 300 million more smokers in the world today.

The MPOWER interventions have been shown to save lives and reduce costs from averted healthcare expenditure. The first MPOWER report was launched in 2008 to promote government action on six tobacco control strategies in-line with the WHO FCTC to: Monitor tobacco use and prevention policies; protect people from tobacco smoke; offer help to quit tobacco use; warn people about the dangers of tobacco; enforce bans on tobacco advertising, promotion and sponsorship; and raise taxes on tobacco.

This WHO Report on the global tobacco epidemic, supported by Bloomberg Philanthropies, is focused on protecting the public from second-hand smoke, highlighting that almost 40 per cent of countries now have completely smoke-free indoor public places.

The report rates country progress in tobacco control and shows that two more countries, Mauritius and the Netherlands, have achieved best-practice level in all MPOWER measures, a feat that only Brazil and Türkiye had accomplished until now.

"These data show that slowly but surely, more and more people are being protected from the harms of tobacco by WHO's evidence-based best-practice policies," said Dr Tedros Adhanom Ghebreyesus, WHO director general. "I congratulate Mauritius on becoming the first country in Africa, and the Netherlands on becoming the first in the European Union to implement the full package of WHO tobacco control policies at the highest level. WHO stands ready to support all countries to follow their example and protect their people from this deadly scourge."

"With a strong political commitment, we have made great progress in tobacco control policies in Mauritius. Our country has adopted the MPOWER strategy and is moving resolutely towards a smoke-free country." stated Pravind Kumar Jugnauth​, prime minister, Republic of Mauritius.

Maarten van Ooijen, state secretary for health, welfare and sports for the Netherlands, said, "Civil society organisations, health experts and medical professionals are strong driving forces behind everything that we are achieving with regard to tobacco control in the Netherlands. They deserve the primary credits for the praise that our country receives from the World Health Organization. Although we are making progress in reducing smoking prevalence and improving our tobacco control policy, we also still have a long way to go. Together we will keep fighting for a smoke-free generation by 2040!"

Smoke-free public spaces is just one policy in the set of effective tobacco control measures, MPOWER, to help countries implement the WHO Framework Convention on Tobacco Control and curb the tobacco epidemic.

Smoke-free environments help people breathe clean air, shield the public from deadly second-hand smoke, motivate people to quit, denormalise smoking and help prevent young people from ever starting to smoke or use e-cigarettes.

"While smoking rates have been going down, tobacco is still the leading cause of preventable death in the world — largely due to relentless marketing campaigns by the tobacco industry," said Michael R Bloomberg, WHO Global ambassador for non-communicable diseases and injuries and founder of Bloomberg Philanthropies. "As this report shows, our work is making a big difference, but much more remains to be done. By helping more countries implement smart policies, backed by public opinion and science, we'll be able to improve public health and save millions of more lives."

Eight countries are just one MPOWER policy away from joining the leaders in tobacco control: Ethiopia, Iran, Ireland, Jordan, Madagascar, Mexico, New Zealand, and Spain.

There is still much work to be done, 44 countries remain unprotected by any of WHO's MPOWER measures and 53 countries still do not have complete smoking bans in healthcare facilities. Meanwhile, only about half of countries have smoke-free private workplaces and restaurants.

"WHO urges all countries to put in place all of the MPOWER measures at best-practice level to fight the tobacco epidemic, which kills 8.7 million people globally, and push back against the tobacco and nicotine industries, who lobby against these public health measures," said Dr Ruediger Krech, WHO, director for health promotion.

Around 1.3 million people die from second-hand smoke every year. All of these deaths are entirely preventable. People exposed to second-hand tobacco smoke are at risk of dying from heart disease, stroke, respiratory diseases, type two diabetes and cancers.

This report demonstrates that all countries irrespective of income levels can drive down the demand for deadly tobacco, achieve major wins for public health and save economies billions of dollars in health care and productivity costs.

The post The Universe has given us our assignment, it’s time for divine alignment first appeared on Toronto Caribbean Newspaper.

The Host

Julie Rovner
KFF Health News

@jrovner

Read Julie's stories.

Julie Rovner is chief Washington correspondent and host of KFF Health News’ weekly health policy news podcast, “What the Health?” A noted expert on health policy issues, Julie is the author of the critically praised reference book “Health Care Politics and Policy A to Z,” now in its third edition.

Congress has left for its annual August recess, but lawmakers have a long to-do list waiting when they return — and only a handful of legislative days to fund the government before the Oct. 1 start of the new fiscal year.

Meanwhile, Republican presidential candidates who are not named Donald J. Trump are preparing for their first televised debate and making interesting promises about health care.

This week’s panelists are Julie Rovner of KFF Health News, Alice Miranda Ollstein of Politico, Sandhya Raman of CQ Roll Call, and Lauren Weber of The Washington Post.

Panelists

Alice Miranda Ollstein
Politico

@AliceOllstein

Read Alice's stories

Sandhya Raman
CQ Roll Call

@SandhyaWrites

Read Sandhya's stories

Lauren Weber
The Washington Post

@LaurenWeberHP

Read Lauren's stories

Among the takeaways from this week’s episode:

• Work has paused on Capitol Hill. Among other items of unfinished business, lawmakers returning next month will have to pass at least a short-term spending bill — or soon face a government shutdown with implications for health programs and much, much more. Authorizations are also on the agenda, with programs like community health centers on the line. But the path to passage winds through a social issues minefield, owing to conservative House Republicans who have inserted measures targeting abortion access and gender-affirming care for transgender people.
• Access to women’s health care in the United States is worsening, with maternal health deserts popping up around the nation even in the years before the overturn of Roe v. Wade. Some states in particular have seen a huge decline in the number of maternal health providers, including the closures of obstetric wards. The fact that more people are living in counties with no maternal health providers is troubling news for a nation experiencing a maternal mortality crisis.
• State medical boards across the country have disciplined fewer than two dozen providers reported for spreading covid-19 misinformation, according to a new investigation by The Washington Post. The paucity of punishments demonstrates how ill-equipped such boards are to address the serious problem of health misinformation.
• On the 2024 presidential campaign trail, Republican candidates like Gov. Ron DeSantis of Florida are signaling that re-litigating the covid pandemic is part of their playbook — but do voters still care that strongly about vaccine mandates and business shutdowns?
• And the National Institutes of Health has moved to officially study long covid, a little-understood condition that impacts the lives of many Americans.

Also this week, Rovner interviews KFF Health News senior correspondent Phil Galewitz, who reported the latest KFF Health News-NPR “Bill of the Month” installment, about how a bill that should never have been sent created headaches for one patient. If you have an outrageous medical bill you’d like to share with us, you can do that here.

Plus, for “extra credit,” the panelists suggest health policy stories they read this week that they think you should read, too:

Julie Rovner: Stat’s “Henrietta Lacks Settlement Hailed by Experts as Step Toward Correcting Medicine’s Racist History,” by Annalisa Merelli.

Alice Miranda Ollstein: The Tampa Bay Times’ “Florida Veered From Norms to Strip Transgender Care From Medicaid, Records Show,” by Emily L. Mahoney and Romy Ellenbogen.

Sandhya Raman: KFF Health News’ “Black Women Weigh Emerging Risks of ‘Creamy Crack’ Hair Straighteners,” by Ronnie Cohen.

Lauren Weber: Politico’s “CDC Investigators Find More TB Infections Linked to Bone Graft Materials,” by Alice Miranda Ollstein and Lauren Gardner.

Also mentioned in this week’s episode:

• The Washington Post’s “Doctors Who Put Lives at Risk With Covid Misinformation Rarely Punished,” by Lena H. Sun, Lauren Weber, and Hayden Godfrey.
• Roll Call’s “Health Deadlines Pile Up as Congress Adjourns for August,” by Lauren Clason, Ariel Cohen, Jessie Hellmann, and Sandhya Raman.
• Slate’s “How Meta Created a Wild West for Abortion Misinformation,” by Jennifer Neda John.
• Politico’s “‘It’s a Crisis’: Maternal Health Care Disappears for Millions,” by Alice Miranda Ollstein and Megan Messerly.

click to open the transcript

Transcript: Congress Is Out. The Presidential Campaign Is In.

KFF Health News’ ‘What the Health?’Episode Title: Congress Is Out. The Presidential Campaign Is In.Episode Number: 308Published: Aug. 3, 2023

[Editor’s note: This transcript, generated using transcription software, has been edited for style and clarity.]

Julie Rovner: Hello and welcome back to “What the Health?” I’m Julie Rovner, chief Washington correspondent for KFF Health News, and I’m joined by some of the best and smartest health reporters in Washington. We’re taping this week on Thursday, Aug. 3, at 10 a.m. As always, news happens fast, and things might have changed by the time you hear this. So here we go. We are joined today via video conference by Alice Ollstein, of Politico.

Ollstein: Good morning.

Rovner: Lauren Weber, The Washington Post.

Lauren Weber: Hello, hello.

Rovner: And Sandhya Raman, of CQ Roll Call.

Sandhya Raman: Good morning.

Rovner: Later in this episode we’ll have my interview with my KFF Health News colleague Phil Galewitz, who wrote the latest “Bill of the Month” for KFF Health News and NPR. This month’s patient never should have gotten a bill for his care, but he and his family ended up with a giant mess nonetheless. But first, this week’s news. It is officially August. Congress is gone until September, which makes it a good time to take stock of what has and hasn’t been accomplished on the health agenda and what might feasibly get done this fall, which is always shorter than you think. The biggest outstanding issue, literally and figuratively, is the spending bill for the Department of Health and Human Services. When Congress comes back, members theoretically only have 11 legislative days before Oct. 1, when the new fiscal year begins. And if Congress doesn’t complete work on the spending bill, which has yet to come to the House or Senate floor or even get out of the House Appropriations Committee, a lot of Health and Human Services programs could shut down unless Congress passes a temporary bill to keep them open. Sandhya, right now everything kind of points to an Oct. 1 shutdown, or am I missing something?

Raman: Yeah, I think at this point we’re looking at either a shutdown or just, like, a continuing resolution, just kicking the can a little bit down the road and giving them some more time. So right before Congress left, the Senate did advance, in the Appropriations Committee, their spending bill for [the departments of] Labor, HHS, and Education. And that means that all 12 of theirs have gotten at least that far, through the Senate Appropriations Committee, but they would still need to come to the floor, and it doesn’t mean that the House is going to agree to any of that. And the House is a lot further behind in that the only markup they’ve had on the HHS bill is on the subcommittee level. It’s not even at the House Appropriations level. And you can kind of see the tea leaves in that they were trying to get the agriculture bill done before they left, which has all the FDA money in it, and they didn’t end up bringing it to the floor because they didn’t think they would have the votes to pass it. So I think that we’re going to need some time, given that I don’t think that, even though the Senate bills have been bipartisan so far, that they’re going to be eager to jump on those.

Rovner: Every year when there’s a change in leadership in either the House or the Senate, they vow, “This is the year we’re not going to do a big omnibus spending bill. We’re going to do all 12 appropriations separately, and we’re going to run them through the House and the Senate floors, and we’re going to have a conference.” And it hasn’t happened in more than 20 years now. And there’s clearly no reason to think it’s going to happen this year, right?

Ollstein: And one of the biggest sticking points: There are the fights that happen every single year over things like the Hyde Amendment, which prevents federal spending on abortion, but that has spread to almost every single appropriations bill. There are anti-abortion budget riders. There are anti-trans health care budget riders. There are all kinds of things tucked in there that Democrats say they will oppose and that the Senate bills don’t have. But, you know, you have this disconnect where there are plenty of House members who would be completely fine with a shutdown; they’ve said publicly that they think that would not be so bad.

Rovner: You have to say it wouldn’t be as bad as letting the debt ceiling get breached.

Ollstein: Right, right, right, right. Whereas Democrats are very much saying it would be horrible to have a shutdown. And so I was talking to some Democratic House members who say that people are really torn between the pressure to make a deal to keep the government open and the pressure to oppose all of these conservative budget riders. And that tension is going to really come into play in the fall.

Rovner: Yeah. Alice, you wrote a wonderful story on all the abortion fights in all these different bills, and I just had sort of deja vu to the ’90s. If you were following abortion, you had to keep track of obviously the ag bill with FDA in it, HHS bill, and the Department of Justice bill because of abortion in prisons, and the defense bill because of, you know, abortions for servicewomen. I mean, we basically had some kind of abortion fight in more than half of the appropriations bills. So we’re coming back to that right now. Well, there are also lots of programs whose authorizations expire Oct. 1. That’s not the same as the appropriations bills that we’ve just been talking about. Without appropriations, programs have to shut down, at least temporarily. Authorizations, though, can lapse as long as the programs are funded through the appropriations. But it’s still nice to, you know, get your work done on time. Some of the big programs Congress is working on include renewing authority for community health centers, for pandemic preparedness programs, for a big group of graduate medical education programs. What’s the fall outlook for those authorizations?

Raman: So I think part of it is tied into what we see with appropriations, because a lot of these programs — even if they come to an agreement, it’s likely to ride on whatever big spending bill we have next, whether that’s a continuing resolution, whether that’s an omnibus or anything like that. So if we end up seeing some sort of continuing resolution, which is looking likely, a lot of these are going to be short-term, maybe extended if they have an agreement there, which is what they traditionally do, and then something longer — the next vehicle that pops up, the next one, or sometimes they even get a one-year, even if there is agreement, just because this is what Congress does. So some of them, I think, are looking more promising than others. We’ve seen things kind of happen with some of the graduate medical education, the [National] Health Service Corps, like those have kind of come to some sort of agreement, but —

Rovner: And those are typically bipartisan programs.

Raman: Yeah, but then others are not as far along and will take time. I mean, the process to even do like the SUPPORT [for Patients and Communities] Act, which was a 2018 law that had a bunch of different opioid provisions in it, that was bipartisan, got through: I mean, we’ve been marked up in [the] Energy and Commerce [Committee] in the House, and the Senate has not done a markup; they just have a bill that has come out so far. And so getting that done before the Sept. 30 deadline is tricky. There are some that are a little bit more partisan that I think would be more difficult to get done. I mean, the Children’s Hospitals Graduate Medical Education has been a little bit derailed over, like, political back-and-forth over policies for transgender children. And so I think even some things that have been more easy to get across the finish line in the past are having factors that are weighing them down. So a lot of these are a question mark. Yeah.

Rovner: So that was originally a Republican program. I remember when it was created because Medicare funds most of the graduate medical education, but obviously there’s not a lot of Medicare beneficiaries who are children, so they had been left out and this is their own program. But I always get at this point to share my favorite piece of trivia about authorizations versus appropriations, which is that the federal family planning program, Title X [“ten”], has not been reauthorized since 1984. Congress has tried any number of times and has failed. It continues to get funded, but it has literally been operating without authorization for all of those years. Well, one more important authorization that’s not part of the Department of Health and Human Services but is part of health care is PEPFAR [the United States President’s Emergency Plan for AIDS Relief], the very successful international AIDS and HIV program begun under President George W. Bush 20 years ago this year. But this time around, the bipartisanly popular program is hung up over — what else? — abortion. Alice, you wrote about this. I mean, PEPFAR, this is really a Republican-backed program.

Ollstein: Yes. It was created by George W. Bush and has had bipartisan support for most of its life. It’s credited with saving the lives of tens of millions of people. Few programs can say that, of any kind. And millions of people are depending on it right now for access to medications around the world. So Republicans are saying that they won’t support reauthorizing it but they will keep it funded through appropriations, just like you were talking about, keep it sort of limping along on a one-year budget, with language restoring the Trump-era restrictions on the program. So, of course, for the entirety of the program, money has not gone to providing abortions, but this expands that and says money can’t go to any organization that, you know, uses other money to provide abortions or even an organization that gives money to another organization and that subsequent organization does abortions. And so this really has been tough for the program in the last few years. And independent experts are telling me that not reauthorizing it, yes, it wouldn’t shut down the program, but they worry it would send a signal to other countries that this is not something the U.S. is really invested in going forward and it would lead other people to cutting their contributions.

Rovner: Yeah, I mean, in addition to saving millions of lives or tens of millions of lives, this has been an important piece of international diplomacy, particularly in Africa, right?

Ollstein: Right. And that was the point Sen. [Bob] Menendez [(D-N.J.)], who had wanted a full five-year reauthorization attached to the NDAA [National Defense Authorization Act], which he said his Republican colleagues killed — he made that exact point.

Rovner: The defense authorization bill.

Ollstein: Exactly, yes. They were trying that as a workaround to get it reauthorized. And it didn’t work because of GOP opposition. But Menendez was saying, you know, this will only empower countries like China that have been trying to make inroads in Africa with philanthropic work and reduce the influence of the U.S. The geopolitics are definitely on people’s mind as well as the basic humanitarian value.

Rovner: So it’s going to be a busy fall. Well, while we are on the subject of reproductive health, the problem of getting maternal health care here in the U.S. is growing, according to a new study from the March of Dimes. We are the country that already has the worst record for maternal mortality in the developed world. Yay, us. How much worse has it gotten?

Ollstein: It’s gotten a lot worse. So in just one year, between 2019 and 2020, there was a 4% decline in the number of hospitals that have birthing services, OB [obstetrics] wards. And 4% may not sound like a lot, but it’s not evenly distributed; that’s just the national average. Some states had a nearly 25% decline. And like you said, you know, we’re already doing so much worse than other countries with maternal mortality. And this just means millions of more people than before are living in a county that has zero hospitals, zero OB-GYNs, zero maternal health care providers — and then a lot of those same places, these same states and counties, also have really high rates of chronic health conditions that are contributors to maternal mortality. And so all of this is coming as births are expected to go up because of abortion bans. This data was from before Dobbs [v. Jackson Women’s Health Organization, the 2022 Supreme Court ruling overturning the nationwide right to abortion], so we don’t know yet what’s going to happen, but the expectation is that births will go up. And at the same time, there’s just fewer care providers to meet that need.

Rovner: And we also know that in the states with bans, we’re starting to see providers either leave or not go there to train in the first place, which is just going to make the whole thing worse. This week the action is going on in a couple of Midwestern states, Indiana and Ohio, I guess both of which have bans, and one of which is in force and one of which isn’t. Where are we with Indiana and Ohio? I know it changes from hour to hour.

Ollstein: So Ohio’s ban is still enjoined, so that means abortion is still legal in Ohio. The development was about this upcoming vote, and there are two upcoming votes. This is kind of wonky, but the upcoming vote that’s happening in less than a week is whether to make ballot initiatives in general harder to pass, to raise the threshold from 50 to 60%. And that’s explicitly intended to thwart the fall vote on legalizing abortion in the state and putting something in the state constitution that supports it.

Rovner: Which, coincidentally, polls show has about like 56, 57% support, right? So 60% would make it more likely to fail.

Ollstein: Right. Right. That’s coming up. But for now, because of a court injunction, abortion remains legal and the ban is not enforced.

Rovner: And Indiana, which had a very stringent ban that was about to go into effect?

Ollstein: Sandhya, do you want to?

Raman: Oh, yeah. I was just going to add to Ohio first that, as of this morning, the voter turnout for the Ohio election next week is super high. It was, like, over 380,000 people have already cast their ballot, and that was higher than, I guess, you know, when they had, like, [a] competitive Senate primary before. And so it will definitely be something to watch. I mean, we don’t know if the voter turnout is high one way or the other, but I just thought that was really interesting. But with Indiana, their abortion ban was supposed to take effect on Tuesday and then it was halted by another lawsuit, and they were the state that was the first one to pass a post-Dobbs, new abortion ban last year. So it’s, like, another sticking point in that a lot of the bans that have gone into effect are older laws or things that have been unblocked in court.

Rovner: So, yes, it really does depend on the day. I guess I read that a bunch of clinics that had been providing abortion have stopped, even though the ban is, at least for the moment, on hold. So rather typically around the country, you literally have to go day by day to figure out what is allowed and what is not. All right. Well, let us turn now to a segment I’m calling “Myths and Disinformation” this week. Lauren, I was so glad you could join us this week because you and a couple of your colleagues at the Post have a new investigation into how doctors who were peddling bad and often dangerous information during the pandemic were called to account. Spoiler: Not a lot of them were, right?

Weber: Yeah, I was going to say spoiler alert that not a lot of them were called to account. So essentially my colleagues Lena Sun, Hayden Godfrey, and I reviewed the records from all 50 states’ various medical boards, both MD boards and osteopathic boards, to see who actually had been punished for spreading covid misinformation or for practicing in a way that is misinformation-related. And despite discovering from our various records requests over hundreds of complaints for doctors that asked patients to remove masks or told them the vaccines were full of metal or told them not to get a vaccine or a various number of the —or prescribed ivermectin or hydroxychloroquine — only 20 doctors have been disciplined, and we are three and a half years into covid. And you know, what our investigation found is something that everyone on this panel has known for quite some time. But state medical boards are historically weak, underfunded, and are very ill-equipped in the social media age, where misinformation is a deluge, to really step into that breach. And what our investigation essentially found is that they’ve really failed to stop doctors that are spreading misinformation or, you know, prescribing drugs that are not deemed the consensus around the standard of care.

Rovner: So everybody says, oh, well, this is up to medical boards in every state, and they keep doctors honest and keep them on the straight and narrow and sanction them when they do wrong things. That’s not been true for a long time. And I guess now it’s still not true, right?

Weber: Yeah, exactly. And it’s really interesting. And this came up, too, in the case in Idaho for abortion, you see a lot of misinformation folks cite free speech in their ability to practice medicine. It’s actually — you know, it makes it difficult to discipline people because it is being able to prescribe things off-label, or your medical judgment is not something people — medical boards are loath to discipline over, and for good reason. You understand why that may be, but in the case of covid, where this has continued and, you know, treatments like hydroxychloroquine or ivermectin have been deemed outside of the standard of care, it is very surprising that we’ve seen such a low number of disciplinary actions taken. It really goes to show that the boards are not equipped to kind of step into this breach as misinformation has flooded the zone.

Rovner: Well, meanwhile, abortion rights groups are getting frustrated with Meta, Facebook’s parent company, over its inconsistent moderation of information about abortion and reproductive health. It reminds me of some years ago when public libraries would try to limit internet search terms to keep people away from online porn but ended up barring people from searching about breast cancer because it had the word “breast” in it. So this isn’t something that’s new. In fact, going back decades, anti-abortion groups used to advertise their crisis pregnancy centers, which don’t offer abortion but sound like they do, in the yellow pages of the phone book. And kids, ask your parents what a Yellow Pages was. But social media algorithms have the ability to determine what information a lot more people see or don’t see. This one looks pretty hard to resolve. I know that, unlike Twitter, Facebook is trying here, but this is going to be difficult, yes?

Weber: Yeah, I would say it’s a really hard — you know, it’s interesting that the article in particular that you’re talking about, there were two different camps opposed that were saying abortion is killing the unborn child versus you’re killing people if they have an abortion. And both of those got sanctioned by Facebook because it had the word kill in it. And so what we’re going to see is how they come down on this information. But in a world where you see misinformation — in [Judge Matthew] Kacsmaryk’s circuit [district] court ruling, you know, it’s kind of hard to see how this is going to be resolved by Facebook. I do not envy them in this task. I don’t really know how you would come down on this and how you would comprehensively evaluate all of these posts in a fair manner that is respective of free speech. And like you said, Julie, you know, a lot of times it leads to unintended consequences when you try and restrict posts like this on all sides. And there are some smart people that are trying to advise in the correct way, but we’ll see what happens.

Rovner: Yeah, it is not easy. Speaking of mis- and disinformation and real information, we’re going to move to the campaign trail, because it’s only August of an odd-numbered year but the 2024 presidential campaign is in full swing, with the first Republican candidate debate later this month. And while health care, specifically the desire to repeal the Affordable Care Act, is far from the rallying cry for Republicans that it has been in the last couple of presidential campaigns, we are seeing some interesting stances and comments from candidates who are not named Donald Trump. We will start with the candidate who’s running second in the Republican primary polls. That would be Florida Gov. Ron DeSantis, whose campaign launch has been anything but smooth. DeSantis, perhaps looking for some publicity, raised some eyebrows last week when he suggested on a conservative podcast that, if elected, he might install Democratic presidential candidate and known anti-vaxxer Robert F. Kennedy Jr. at the CDC [Centers for Disease Control and Prevention] or the FDA. DeSantis has been trying to stake out kind of a middle ground on his vaccine position. He’s not outright anti-vax, but he doesn’t support mandates and he’s kind of hot and cold on supporting vaccines in general. I don’t see how this would actually win him love on either side. I mean, he actually said that they would sic RFK Jr. on the CDC or the FDA.

Weber: I got to say, I find it fascinating. I mean, look, RFK Jr. has a cult following. And I think if anything, it speaks to the fact that Republicans are very much anti-vaccine mandate, anti-government shutdown, all things that RFK says all the time. And DeSantis did walk it back and said he would put him on a committee because, you know, we wouldn’t want a Democrat actually running these things. But I think really what this episode shows is the salience that words like the CDC, and we’ll talk later about the FDA — you know, the American voting public cares about these things now. They know what these agencies are, and they have strong feelings. They blame them for pandemic policies. And I think it just goes to show that relitigating the pandemic and different people’s versions of how they believe the pandemic went is really going to be a constant in this political run-up to 2024.

Ollstein: While I agree with that, I also think it is maybe not as salient as DeSantis was hoping it would be. I mean, he really has formed his candidacy on his governorship during the pandemic, and it doesn’t seem to be breaking through. He’s still just miles and miles and miles behind Trump. And depending on the polls, some of these people with way less of a platform than the governor of Florida are doing quite well. And so I think that people do have strong feelings about vaccine mandates and mask mandates and school closures and all of that, but not nearly as strong as a year ago. So I think that he maybe isn’t getting the juice from saying a lot of these things that he was hoping he would.

Rovner: Well, speaking of candidates who have less of a platform and yet seem to be making inroads — long shot but picking-up-momentum candidate Vivek Ramaswamy, who actually does know something about health policy, as the founder of a biotech firm, has vowed to, quote, “expose and [to] ultimately gut” the FDA. Now, he is a former libertarian rapper, so it is not a shock that he opposes most federal regulatory entities. But I wonder how even Republican voters would feel about actually gutting the FDA. It’s one thing — Alice, you were talking about feelings about the pandemic, but the FDA obviously does a lot more things than just deal with masks and covid vaccines. I mean, is there really a Republican constituency for wiping out the federal regulatory mechanism?

Ollstein: I mean, there at least seems to be at the state level in some states. We’ve talked so much about how GOP lawmakers have voted to roll back public health powers in a bunch of states because of covid. But it’s set to have implications way beyond covid and limit public health workers’ ability to respond to foodborne outbreaks and other things — things in the water, things in the air. So you could see that skepticism and desire to strip the government of its public health powers at the federal level as well.

Rovner: And, Lauren, you’ve been looking at this at the state level, too, right, sort of the slow decline of trust in public health, or maybe not-so-slow decline of trust in public health.

Weber: Yeah. I mean, you know, I found this February, 30 states have passed laws that have rolled back public health powers. There’s litigation at the federal level that has really stripped a lot of executive power for the public health system. As we know, public health leaders on the ground have resigned, quit, or been fired in droves due to political pushback. There’s a lot of concern among the public health community and the folks that I talk to constantly that we have seen just a massive hollowing-out of the workforce that will be impossible to replace. And so I think you’re seeing, you know, kind of as we’ve talked about, how I think this is a talking point among Republican candidates, to kind of bash these government agencies because it’s something that is appealing to people that are irritated over these deals.

Raman: Like, if you look at his comments about this, does this really hold up to the scrutiny? I mean, FDA is not the one that would mandate vaccines, mandate mask-wearing. They don’t set prices. None of that is under their jurisdiction. And, you know, you can assume that he knows this given his background, but I think it just kind of goes with some of his other comments about, you know, defunding a lot of the other agencies that he’s made. So I think some of this also just banks on people maybe not knowing, you know, what falls under what bucket. And it just might be an easy punching bag to lump it in together if the people aren’t aware of what falls under CDC versus FDA or any other agency or state-level.

Rovner: And he’s one of those people that just seems very sure of himself, even when what he’s saying isn’t necessarily true. And the very-sure-of-himself part seems to appeal to voters. But I want to go back to DeSantis just one more time. But before we’re done, speaking of trying to have it both ways, DeSantis stepped into a bees’ nest on abortion, of all things. This is the governor who signed a six-week abortion ban bill in Florida, but he kind of hemmed and hawed about saying whether he would support a national abortion ban. So that won him a firm rebuke from the Susan B Anthony List, which is a pretty powerful political arm of conservative Republicans. Does DeSantis really think he can sustain a position like this, where you can really say, “We only want states to deal with this and we don’t really want it to be at the federal government”? I mean, that was sort of the Supreme Court’s argument. But I think that there’s a lot of grassroots Republicans who would like to not have to fight this state by state and would like to see a national ban.

Ollstein: Yes, the major anti-abortion groups have said that that, you know, “leave it to the states” is not an answer they will accept and they will continue to put the pressure on candidates. Their argument is that, you know, because of things like the appropriations process and because of things like access via Medicaid — [that] is a fight and access in prisons is a fight and access for — you know, their argument is the federal government is already involved in abortion, so you should support the federal government getting involved in banning abortion.

Rovner: Which is kind of true. I mean, the part about the federal government already being heavily involved in abortion.

Ollstein: Sure. Do with that what you will. But candidates keep falling into this same trap. I mean, you had Nikki Haley, who is not polling very well at the moment — she held a whole event with Susan B. Anthony List that they hyped, and she said she would lay out her plan for abortion and there were, like, no specifics whatsoever. And then the group said, “Oh, she assured us she supports a national ban,” but then she said she didn’t. And this is going to continue to be a fight. I think really Mike Pence is the one who is most firm in saying, “Yeah, I support a national ban.”

Rovner: Yeah, and he’s been consistent his entire career, when he was in the House and when he was governor.

Ollstein: He is also not polling very well, I will note.

Rovner: Yes, that’s true. Fair point. We will obviously continue to talk about things on the campaign trail as we move along the campaign trail. Well, finally this week, I want to talk about covid, which we haven’t done for a while. It is still around, and cases, while still low, are on the upswing at the moment. But the news this week is that after almost three years, the National Institutes of Health is finally acting on directions from Congress to get moving on efforts to study and treat so-called long covid, which as many as 10% of patients end up with after having the virus. The long covid community, which could be several million people, have been agitating for scientists to take their symptoms more seriously and do more work in the research realm. Now, NIH has finally created an Office of Long COVID [Research and Practice], albeit with only two full-time staffers to start with. It’s also started enrolling an estimated 24,000 people in several clinical trials to test things like a longer course of the drug Paxlovid. But patient groups say it’s still way too little for what’s a serious and growing more widespread ailment. Why is this all taking so long? I mean, we have a Democratic administration. One would think that they would be anxious to do this.

Weber: I mean, I think if you look at it, there was over a billion dollars allocated to this. I mean, I don’t know why it’s taking so long, Julie. I think a lot of advocates are asking the same question and really beating the drum around that — and especially if you look at things that are named Operation Warp Speed or, you know, other covid treatments, vaccine, other things that were able to move at a much quicker pace and get done in a much quicker time frame — I think there’s a lot of agitation among what could be a very large group of people that their concerns and quality of life and some of these horrible symptoms are not being addressed. And as you noted, I think it’s very fascinating there are only two full-time staffers. I’ll be curious to see if this continues to change, but historically, it hasn’t been very promising.

Rovner: This is not new that Congress will direct, particularly the NIH, to study something that NIH just doesn’t seem prepared to study. Of course, as we know, there’s no NIH director at the moment. We’ve talked about the fact that nominee is being blocked by Democrat Bernie Sanders. But still, I mean, this is something — and I think Congress wants NIH to do because so many of their constituents are coming to them and saying, “We have this problem; please go out and study it.” And yet the federal scientists don’t seem to know really what to do.

Weber: Well, and there was a congressman, I don’t remember his name, but someone on this panel probably does, who said he was retiring because he has long covid, and I think he has colleagues that also have long covid. So, I mean, I think that probably helped get them a fair amount of cash. But as you said, the delivery mechanism on getting clinical trials rolling has really not been there.

Rovner: Well, we will keep an eye on this, too. That is this week’s news. Now we will play my interview with KFF Health News’ Phil Galewitz, and then we will come back with our extra credits. We are pleased to welcome back to the podcast my colleague Phil Galewitz, who reported and wrote the latest KFF Health News-NPR “Bill of the Month” story. Phil, thanks for being here.

Phil Galewitz: Nice to be back.

Rovner: So, this month’s patient was well covered by insurance and, to cut to the chase, shouldn’t have paid anything for a surgery he had in 2021. Tell us who he is and what kind of care he got.

Galewitz: Thomas Greene had complications from diabetes, and he had to get some clogged arteries cleared out in his leg to treat something called peripheral artery disease. So he went to the hospital in 2021 for the procedure. He recovered pretty well. He had some other health issues, but he recovered fine from the procedure. The issue then came when the bills started coming in.

Rovner: And Mr. Greene has both Medicare and a supplemental Medigap policy, which should have brought his out-of-pocket cost to zero. But that’s not what happened. What did happen?

Galewitz: Yes, the Greenes, because of their good insurance, were used to whenever they got health care, that they did not have any out-of-pocket expenses. But this time, about a year later, or over a year, after the procedure, they suddenly started getting some letters from collection agencies who were looking to collect bills for about $3,000 for anesthesia.

Rovner: So, just the anesthesia part.

Galewitz: It was just the anesthesia. The hospital was fine. The surgeon who did the procedure was fine, but the anesthesiologist, who they were not even familiar with, started sending them bills through a collection agency, and they were perplexed about what was going on. And they tried to reach out and call and find out what was happening, why they were getting bills. And they said they were getting a runaround and couldn’t really get a clear answer.

Rovner: They went for help, too, and the people who were helping them had trouble getting answers.

Galewitz: Yes. They went to some organizations within Pennsylvania that specialize in helping seniors with their medical bills, and even them couldn’t get any clear answers. And then thankfully, they kept pushing and kept pushing, and they were able to get another advocacy group to work on their behalf, who talked to this organization called the North American Partners in Anesthesia, which is a large anesthesia group, to stop sending them bills, and thankfully, the bills have stopped coming. They did not pay anything, but they were worried about that this was going to affect your credit.

Rovner: So what did happen? How did they end up with these bills that they shouldn’t have had?

Galewitz: It’s still a mystery. North American would not talk to us, KFF Health News, to give us answers, and they don’t really have a clear answer. By law, providers are supposed to bill Medicare within one year to have their claims paid. In this case, the records that the Greenes have show that the bills to the claims to Medicare were sent in after a year, and that because of that, Medicare clearly marked down and said these bills are after a year, we’re not paying anything, and the patient owes zero. And when a patient gets a notice from Medicare saying, “You owe zero,” that’s supposed to be it. You don’t owe anything. No matter what letters you get from the provider, you’re not supposed to pay anything. But in this case the provider continued to bill and continued to send collection agencies after the patient. And they were perplexed.

Rovner: And just to be clear, when they billed this supplemental policy, the supplemental policy has to deny it if Medicare denied it, right?

Galewitz: Right. Humana was their supplemental provider, and that was actually the answer from Humana. If Medicare is not covering it, then we’re not going to cover it.

Rovner: So, in the meantime, even if you get one of these bills and you know that you don’t owe anything but there are collection letters coming, you do need to do something, right?

Galewitz: Yes. You should open your mail. The Greenes did say at one point they think they may have gotten some letters earlier from the anesthesia group and they may not have opened them. Because they didn’t expect any bills, they didn’t open them. The lesson is open your mail. Even if you think you shouldn’t get any bill, you should at least know ahead of time that you may be able to stave off problems down the road. So always open your mail, and then you may be able to handle the problem earlier on. So they may have stopped some of the collections. But again, they were covered. They reached out. They tried to do everything that they can within their realm, and they struggled. They’re feeling OK now. They never got a letter from North American saying, “Hey, we apologize,” or, “You’re in the clear.” They’ve just stopped getting bills. And it’s been since last year that they’ve gotten a bill, so they feel like they should be OK.

Rovner: And just the one little quirk also of this story is that it looked like the anesthesia group overbilled, right?

Galewitz: There was a question on the bills, on the claims, that it appeared that an anesthesiologist and a nurse anesthetist both billed Medicare for the exact same time, though it could be that maybe there was both, that one assisted the other. This was not a complex procedure. So there were questions about that. But it would be unusual that they would both bill for the exact same time period. And so there’s a question if they were double billing; it could not have been. North American would not answer our question.

Rovner: Well, so we have discovered another thing that, even if you don’t necessarily get answers, it appears that they got their problem solved, right?

Galewitz: Yes.

Rovner: OK. Phil, Galewitz, thank you very much.

Galewitz: Thank you.

Rovner: OK. We are back and it’s time for our extra credit segment. That’s when we each recommend a story we read this week we think you should read too. As always, don’t worry if you miss it. We’ll post the links on the podcast page at kffhealthnews.org and in our show notes on your phone or other mobile device. Alice, why don’t you go first this week?

Ollstein: Sure. Staying on the DeSantis train, I have a piece from the Tampa Bay Times called “Florida Veered From Norms to Strip Transgender Care From Medicaid, Records Show.” And this came out of a lawsuit that was challenging the state’s decision to strip Medicaid coverage of gender-affirming care, not just for children, but for adults as well. So what came out in discovery in the lawsuit was that the state did just all of these really unusual things. And the judge thought it showed a political motivation rather than, you know, a serious health care motivation for doing this. They paid all of these outside contractors with dubious backgrounds to be part of this effort. They came up with a slogan for the report, which is completely unusual. And the reporters found that staffers who supported defunding gender-affirming care got huge raises, and people who were not supportive of it did not. So, really good accountability reporting, and it seems to have played out in court as well.

Rovner: Yeah, quite a story. Sandhya.

Raman: My extra credit this week is called “Black Women Weigh Emerging Risks of ‘Creamy Crack’ Hair Straighteners.” And it’s from Ronnie Cohen for KFF Health News and on BET. The story takes a look at the messaging and awareness related to increasing health risks that people are worried about related to relaxers or, you know, chemically straightened hair. And it’s something that is especially popular among Black women. I think it was really interesting that only about half of states have anti-hair-discrimination laws, and so a lot of women might be more eager to get their hair chemically straightened for various reasons, workplace or things like that. And there’s not a ton of research.

Rovner: Right. It’s not just that they think it looks better.

Raman: No, no. And there’s not a ton of research on the cancer risk, but personal care products like hair relaxers don’t have the same kind of approval process through the FDA as food and drugs. So, it just takes a look at some of the different things there and what different providers are kind of considering and watching out for.

Rovner: Yeah, it’s really kind of scary. Lauren.

Weber: I actually flagged one of Alice’s stories, which is, “CDC Investigators Find More TB Infections Linked to Bone Graft Materials,” and it details how a bunch of patients have tested positive for tuberculosis after receiving bone grafts. And one of them has died. And there’s 36 more that are being treated for tuberculosis. And I find this fascinating because I find the coverage of tuberculosis in this country totally not where it should be. I mean, TB is — there are a lot of cases in the U.S. It’s a highly infectious — I mean, not a lot; there’s like 10,000 — but there’s a lot more than people realize. And it can be latent and lie in wait and, you know, to have some sort of medical procedure and then find out that whatever was implanted in you has given you a very dangerous, highly infectious disease that could result in you having to quarantine for months, depending on what it is, is really alarming. And there’s a lot of accountability follow-up questions on this for the FDA, these bone graft companies. And it gets at, do we want to gut the FDA, that is hopefully trying to stop things like this, even if it’s not preventing it here? It just leads to a lot of accountability questions that I think are quite fascinating.

Rovner: Yeah, a lot a lot of things that people have not thought about. Well, my story this week is from Stat, but it’s not so much a story as it is an event. Aug. 1 would have been the 103rd birthday of Henrietta Lacks, who longtime listeners to the podcast will remember we talked about a few years back when the book about her life, “The Immortal Life of Henrietta Lacks,” was made into a movie. For those of you without such long memories, Henrietta Lacks was an African American woman from Baltimore who was admitted to Johns Hopkins Hospital for cervical cancer in 1951. She died later that year at age 31. But the doctors who treated her also harvested cells without her knowledge or permission that turned out to be the first-ever self-perpetuating cell line. So HeLa cells, as they are called, for Henrietta Lacks, have been used in more than 75,000 different studies since then and have led to the development of such breakthroughs as the polio vaccine, treatments for cancer, and even the mapping of the human genome. While Hopkins has given the cells away for free to researchers, many of the companies that have used them have developed products that have made them, the companies, very rich. But until this week, no one in Henrietta Lacks’ family ever profited from the enormous contribution that she made to medical science. This week, the family’s lawyers reached a confidential but presumably significant settlement with one of those companies, Thermo Fisher, which makes a wide range of scientific supplies. But this is not just about justice for the family of Henrietta Lacks; it’s about starting to recognize and atone for unethical medical research over many, many years, particularly on African Americans. A good birthday present indeed. OK, that is our show for this week. As always, if you enjoy the podcast, you can subscribe wherever you get your podcasts. We’d appreciate it if you left us a review; that helps other people find us too. Special thanks, as always, to our producer, Francis Ying. Also as always, you can email us your comments or questions. We’re at whatthehealth@kff.org. Or you can still tweet me. I’m @jrovner. Sandhya.

Raman: I’m @SandhyaWrites.

Rovner: Lauren.

Weber: @LaurenWeberHP.

Rovner: Alice.

Ollstein: @AliceOllstein.

Rovner: We will be back in your feed next week. Until then, be healthy.

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USA: A recent study has found surgical approaches (microsurgery, embolization, radiosurgery) to be safe and effective for the treatment of selected patients with unruptured arteriovenous malformation (AVM). 

The analysis, presented at the Society of NeuroInterventional Surgery’s (SNIS) 20th Annual Meeting, is contrary to the results of a seminal study in the field. 

AVMs are tangled blood vessels with abnormal connections between arteries and veins, bypassing the capillary system, and they are most commonly found in the brain and spinal cord. Untreated, these vessels can weaken and rupture, causing brain haemorrhage, stroke, brain damage, and death. However, treating unruptured AVMs has been controversial because of the risk of complications-including stroke and death-brain arteriovenous malformation from AVM surgery.

In 2014, a long-term study evaluating patients across nine countries, “A Randomized Trial of Unruptured Brain Arteriovenous Malformations (ARUBA),” suggested that it’s safer to avoid surgery for people with unruptured AVMs, and alternatively, the management should be focused on treating AVM symptoms (including headaches and seizures). However, new research notes that the limitations of the ARUBA study’s results make it less generalizable to determine the guideline for treating individuals with unruptured AVMs and that neuro interventionalists and neurosurgeons can surgically treat unruptured AVMs successfully for carefully selected patients.

A new collaborative study, “Treatment Outcomes for ARUBA-Eligible Brain Arteriovenous Malformations: A Comparison of Real-World Data from the NVQI-QOD AVM Registry to the ARUBA Trial,” led by a team from Cleveland Clinic, reviewed patient information from hospitals and surgical centres around the U.S. using the Neurovascular Quality Initiative Quality Outcomes Database, on which SNIS collaborates.

“We performed a retrospective analysis of prospectively collected data of ARUBA-eligible patients, who underwent intervention at 18 participating centers,” said Nina Moore, MD, senior author of the study, researcher, and neurosurgeon at the Cleveland Clinic. “Our results suggest that intervention for unruptured brain AVMs at comprehensive stroke centres across the United States is safe and effective.”

The study authors specifically analyzed records for 173 patients who are ARUBA-eligible with similar demographics and characteristics of the AVMs, finding that more patients survived and thrived after AVM surgery than in the ARUBA study. For example, only 8.7% of surgically treated patients from this study experienced death or stroke, compared to 30.7% in the ARUBA trial. In addition, only 25.4% of patients from the database experienced post-surgery physical impairment, compared to 46.2% in the ARUBA trial. The study authors also didn’t find a difference in the risk of stroke and/or death among the surgical modalities used. As a result, the study authors suggest that comprehensive stroke centres across the United States would be able to safely surgically treat unruptured AVMs.

“Seeing through this data that neuro interventionalists and neurosurgeons can safely treat unruptured brain AVMs via different surgical modalities is very encouraging,” said Anas Alrohimi, MD, PhD, primary author, and neuroendovascular surgery fellow at the Cleveland Clinic. “In this constantly evolving field, it is crucial we continue to investigate new procedures that impact the patient’s outcomes. It’s exciting to open up opportunities to manage this potentially deadly condition and improve patients’ quality of life.”

Medicare and Medicaid patients will make up 92% of the market for lecanemab, according to Eisai Co., which sells the drug under the brand name Leqembi. In addition to the company’s $26,500 annual price tag for the drug, treatment could cost U.S. taxpayers $82,500 per patient per year, on average, for genetic tests and frequent brain scans, safety monitoring, and other care, according to estimates from the Institute for Clinical and Economic Review, or ICER. The FDA gave the drug full approval July 6. About 1 million Alzheimer’s patients in the U.S. could qualify to use it.

Patients with early Alzheimer’s disease who took lecanemab in a major clinical trial declined an average of five months slower than other subjects over an 18-month period, but many suffered brain swelling and bleeding. Although those side effects usually resolved without obvious harm, they apparently caused three deaths. The great expense of the drug and its treatment raises questions about how it will be paid for, and who will benefit.

“In the history of science, it’s a significant achievement to slightly slow down progression of dementia,” said John Mafi, a researcher and associate professor of medicine at the David Geffen School of Medicine at UCLA. “But the actual practical benefits to patients are very marginal, and there is a real risk and a real cost.”

To qualify for Leqembi, patients must undergo a PET scan that looks for amyloid plaques, the protein clumps that clog the brains of many Alzheimer’s patients. About 1 in 5 patients who took Leqembi in the major clinical test of the drug developed brain hemorrhaging or swelling, a risk that requires those taking the drug to undergo frequent medical checkups and brain scans called MRIs.

In anticipation of additional costs from the Leqembi drug class, the Centers for Medicare & Medicaid Services in 2021 increased monthly premiums for Medicare patients by 15%, and premiums may rise again in 2024 after a slight decline this year.

Such increases can be a significant burden for many of the 62 million Medicare subscribers who live on fixed incomes. “Real people will be affected,” Mafi said. He contributed to a study that estimated lecanemab and related care would cost Medicare $2 billion to $5 billion a year, making it one of the most expensive taxpayer-funded treatments.

In its analysis, ICER suggested that Leqembi could be cost-effective at an annual price of $8,900 to $21,500. In an interview, David Rind, ICER’s chief medical officer, said $10,000 to $15,000 a year would be reasonable. “Above that range doesn’t seem like a good place,” he said.

Whatever its price, patients may be delayed getting access to Leqembi because of the relative shortage of specialists capable of managing the drug, which will require genetic and neuropsychological testing as well as the PET scan to confirm a patient’s eligibility. A similar drug, Eli Lilly’s donanemab, is likely to win FDA approval this year.

Already there are long waits for the testing needed to assess dementia, Mafi said, noting that one of his patients with mild cognitive impairment had to wait eight months for an evaluation.

Such testing is not readily at hand because of the paucity of effective treatment for Alzheimer’s, which has helped to make geriatrics a relatively unappealing specialty. The United States has about a third as many dementia specialists per capita as Germany, and about half as many as Italy.

“Time is of the essence” for the neuropsychological testing, Mafi said, because once a patient’s cognitive ability declines below a certain threshold, they become ineligible for treatment with the drug, which was tested only in patients in the earliest stages of the disease.

Mafi’s study estimates that patients without supplemental Medicare coverage will have to pay about $6,600 out-of-pocket for each year of treatment. That could put it out of reach for many of the 1 in 7 “dual eligible” Medicare beneficiaries whose income is low enough to simultaneously qualify them for state Medicaid programs. Those programs are responsible for about 20% of physician bills for drug infusions, but they don’t always cover the full amount.

Some practitioners, such as cancer centers, cover their Medicaid losses by receiving higher rates for privately insured patients. But since almost all lecanemab patients are likely to be on government insurance, that “cross-subsidization” is less of an option, said Soeren Mattke, director of the Center for Improving Chronic Illness Care at the University of Southern California.

This poses a serious health equity issue because “dual eligibles are low-income patients with limited opportunities and education, and at higher risk of chronic illnesses including dementia,” Mattke said in an interview. Yet many doctors may not be willing to treat them, he said. “The idea of denying access to this group is just appalling.”

Eisai spokesperson Libby Holman said the company was reaching out to specialists and primary care physicians to make them aware of the drug, and that reimbursement options were improving. Eisai will provide the drug at no cost to patients in financial need, she said, and its “patient navigators” can help lock down insurance coverage.

“A lot of clinicians are excited about the drug, and patients are hearing about it,” said David Moss, chief financial officer of INmune Bio, a company that has another Alzheimer’s drug in development. “It’s a money center for infusion centers and MRI operators. It provides reasons for patients to come into the office, which is a billing thing.”

Outstanding doubts about Leqembi and related drugs have given urgency to efforts to monitor patient experiences. CMS is requiring Leqembi patients to be entered into a registry that tracks their outcomes. The agency has established a registry, but the Alzheimer’s Association, the leading advocacy group for dementia patients, is funding its own database to track those being treated, offering physician practices $2,500 to join it and up to $300 per patient visit.

In a letter to CMS on July 27, a group of policy experts said CMS should ensure that any and all Leqembi registries create and share data detailed enough for researchers and FDA safety teams to obtain a clear picture of the drug’s real-world profile.

The anti-amyloid drugs like lecanemab have created a polarized environment in medicine between those who think the drugs are a dangerous waste of money and those who believe they are a brilliant first step to a cure, said ICER’s Rind, who thinks lecanemab has modest benefits.

“People are as dug in on this as almost anything I’ve ever seen in medicine,” he said. “I don’t think it’s healthy.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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