Health Train Express

Testing for Alzheimers and other Neurodegenerative Diseases

noreply@blogger.com (Gary M. Levin) — Sun, 05 Apr 2026 16:09:00 +0000

https://x.com/TheHillEvents/status/2040804775369846969?s=20

Instantaneous early diagnosis allow for planning.

Does your Surgeon Count his Cases? Why ?

noreply@blogger.com (Gary M. Levin) — Thu, 02 Apr 2026 17:32:00 +0000

Your surgeon has a number.

They may not tell you what it is.

But it exists.

It is the number of surgeries they need to do each month to hit their productivity target. The number that keeps their administrator happy. The number that justifies their salary or their partnership share or their bonus.

When you walk into their office with knee pain, you are not just a patient. You are a potential case. A potential number.

If your surgeon is three cases short this month, the recommendation might tilt toward surgery. If they are ahead, maybe they mention physical therapy first. You will never know which version of the conversation you got.

This is not because surgeons are bad people. Most are not. It is because the system creates pressure. And pressure shapes decisions in ways people do not even realize.

The surgeon who needs to hit 20 cases this month is not thinking "I should operate on this person to make my quota." They are thinking "this patient probably needs surgery." The bias is unconscious. The incentive is invisible. But it is there.

I do not have a number.

Nobody is tracking my cases. Nobody is comparing my productivity to a benchmark. Nobody is pressuring me to operate more.

When I tell you that you do not need surgery, it is because you do not need surgery. When I tell you that you do, it is because you do. The recommendation comes from the exam and the imaging and your goals. Not from a spreadsheet.

That is what independence gives you.

A surgeon who is not keeping score.

https://www.linkedin.com/posts/thomas-myers-md-b962a451_your-surgeon-has-a-number-they-may-not-activity-7440725085826646017-c006?utm_source=social_share_send&utm_medium=member_desktop_web&rcm=ACoAAAAqTbwBl7WHwBdULQ1iB1ThcCkr32EMVjE

3 D printed Middle Ear Ossicles

noreply@blogger.com (Gary M. Levin) — Thu, 02 Apr 2026 17:31:00 +0000

A little known African Otolaryngologist. Professor Mashudu Tshifularo, Head of Otorhinolaryngology at the University of Pretoria, performed the world's first middle ear transplant using 3D-printed titanium bones. March 2019. Steve Biko Academic Hospital.

He hadn't heard his daughter's voice in years. Then a South African surgeon did what no one had done before. Professor Mashudu Tshifularo, Head of Otorhinolaryngology at the University of Pretoria, performed the world's first middle ear transplant using 3D-printed titanium bones. March 2019. Steve Biko Academic Hospital. The patient was a 40-year-old man. A car accident had destroyed the three tiny bones that transmit sound — the hammer, anvil, and stirrup. For years, silence. After surgery, Thabo Moshiliwa heard immediately. Think about that. Not weeks of recovery. Not gradual improvement. Instant sound transmission. His first words: he could hear clearly again. The innovation that made it possible: ↳ Custom 3D-printed titanium ossicles — sized precisely for each patient ↳ Endoscopic surgery — minimally invasive, 90 minutes ↳ Reduced risk of facial nerve damage compared to traditional methods ↳ Faster recovery, less trauma A second patient that same week: born without fully formed middle ear bones. Congenital. Had never heard normally. The same implants worked. What stopped me: This wasn't developed in a billion-dollar lab in Boston or Zurich. It happened at a public hospital in Pretoria. Hundreds of inquiries have come from around the world since. Patients who had been told nothing could be done. The Multiplication Effect: 1 successful transplant = proof the method works 10 hospitals adopting 3D-printed ossicles = regional access to hearing restoration 100 countries with this capability = conductive hearing loss becomes treatable everywhere At scale = we stop asking who can afford to hear and start asking how we missed this for so long The shift isn't just surgical. It's about where innovation comes from — and who it reaches. What's one medical innovation you've seen come from a place no one expected, and why do you think geography still dictates who gets access to breakthrough care? Sources: University of Pretoria, Steve Biko Academic Hospital This is not a sponsored post. Please note: This is not intended as medical advice, diagnosis or treatment. Always check with a healthcare professional.

Periodic Therapeutic Phlebotomy Mitigates Systemic Aging Phenotypes by Promoting Bone Marrow Function - Cai - 2026 - Aging Cell - Wiley Online Library

noreply@blogger.com (Gary M. Levin) — Wed, 01 Apr 2026 17:08:00 +0000

Leach's may have worked...

Aging is the primary risk factor for numerous chronic diseases, making the identification of safe and effective anti-aging strategies a critical focus in biomedical research. Heterochronic parabiosis by blood exchange shows that the exchange interaction between young and old plasma can exert anti-aging effects through exchange of bloodborne factors. However, the limited plasma source greatly affects clinical translation. Here, we demonstrate that periodic therapeutic phlebotomy in D-galactose-induced aging models exerts significant and comprehensive anti-aging effects, which is reflected by a notable improvement in aging-associated behavioral deficits and neurogenesis, a significant decrease in the level of circulating senescence-associated secretory phenotypes, and an obvious mitigation of aging-associated structural degradation and molecular alterations within the muscle, bone, liver, kidney, and nervous systems. Mechanistically, periodic therapeutic phlebotomy induces bone marrow microenvironment restoration through functional rescue of mesenchymal stem cells and endothelial cells, thereby reestablishing balanced hematopoietic homeostasis. This hematopoietic revitalization subsequently drives systemic improvements in peripheral blood composition and function. In conclusion, our work provides preliminary evidence suggesting that periodic therapeutic phlebotomy exerts anti-aging effects by restoring bone marrow function and mitigating aging phenotypes, subsequently driving peripheral blood functional restoration. Given its technical simplicity and safety profile, this periodic therapeutic phlebotomy strategy will hold potential to pave the way for clinical translation.

Periodic Therapeutic Phlebotomy Mitigates Systemic Aging Phenotypes by Promoting Bone Marrow Function - Cai - 2026 - Aging Cell - Wiley Online Library

Health care is on hold for some older adults as they wait for Medicare

noreply@blogger.com (Gary M. Levin) — Tue, 24 Mar 2026 16:57:00 +0000

Waiting for Medicare: Steeper costs push some adults to delay care

AI Generated by USA TODAY

The end of expanded ACA subsidies has caused many adults in their 50s and early 60s to face sharply higher premiums, prompting them to delay essential medical procedures until they qualify for Medicare, which experts warn could increase health risks and future public costs.

John Galvin, 64, delayed a colonoscopy until turning 65 because his monthly Obamacare premium rose to $2,460 and his deductible was $2,700.

People with incomes above 400% of the federal poverty level (about $86,560 for a two‑person family) lost the pandemic‑era subsidies at the end of December 2025.

Adults ages 50‑64 make up roughly half of ACA enrollees, and many are seeing premium increases of up to threefold, sometimes amounting to a quarter of their income.

AARP reports that the ACA cut the uninsured rate for the 50‑64 age group in half and provided a safety net for those without employer coverage.

Jessica Schubel warned that delayed care will create pent‑up demand, forcing Medicare to spend significantly more when these individuals enroll at 65.

Health care is on hold for some older adults as they wait for Medicare

Cyberattack against Stryker highlights potential impacts of Iran war on healthcare industry

noreply@blogger.com (Gary M. Levin) — Mon, 23 Mar 2026 17:19:00 +0000

HEALTHCARE IS ON A WAR SETTING WITH IRAN

The cyberattack against medtech company Stryker isn’t quite like other major cybersecurity events we’ve seen in the healthcare industry in recent years. This attack is part of Iran’s response against the US to the war in the Middle East.

On March 11, an Iran-linked threat actor called Handala (suspected by Israeli cybersecurity experts to be tied to the Iranian Ministry of Intelligence and Security) disrupted Stryker’s internal Microsoft network, the company shared in a statement, prompting the company to initiate a cybersecurity “response plan” and an internal investigation, per a Securities and Exchange Commission filing.

But crucially, this could be also a sign of more to come within this war, cybersecurity experts have said.

“You can’t look at this cyberattack in a vacuum. It’s direct retaliation tied to the broader conflict with Iran,” Erik Pupo, director of commercial health IT advisory at tech consultancy Guidehouse, told us via email.

Stryker has maintained since the attack that its medical and surgical devices have not been impacted and there has been no sign of malware or ransomware that could impact USB flash drives for related products. Its 56,000 global employees were encouraged to keep company-issued devices turned off and disconnected from networks.

“Incidents like the recent attack on Stryker are a reminder that cyber conflict increasingly mirrors geopolitical tensions, where disruption is used as a signal of reach and capability, not just immediate impact,” Michael Smith, field chief technology officer at digital security company DigiCert, told Healthcare Brew via email.

Cyberattack against Stryker highlights potential impacts of Iran war on healthcare industry

Cost Concerns and Coverage Changes: A Follow-Up Survey of ACA Marketplace Enrollees | KFF

noreply@blogger.com (Gary M. Levin) — Thu, 19 Mar 2026 22:11:42 +0000

A little more than half of Affordable Care Act (ACA) marketplace enrollees reported cutting back on spending for food, clothing and other basic household items to afford health care, which has become more expensive.

In a new KFF poll released Thursday, 55 percent of returning ACA marketplace enrollees said they are already or are planning to cut back on food or basic household items so they can afford health care-related costs, with half of those surveyed saying their health care costs are “a lot” higher in 2026.

Roughly 4 in 10 survey participants said they have already or are planning to find an extra job or work additional hours because of higher health care spending. About the same amount of participants reported that their deductibles had gone up this year.

Among surveyed 2026 ACA marketplace enrollees, the vast majority — 78 percent — said they thought Congress did the wrong thing by letting the subsidies expire. Ninety-four percent of Democratic enrollees said it was wrong, while 58 percent of Republicans said the same.

About the Survey

At the end of 2025, despite a government shutdown over the policy, the enhanced premium tax credits expired, decreasing financial assistance for subsidized Marketplace enrollees and contributing to significant increases in the Affordable Care Act (ACA) Marketplace costs for most enrollees overall. Amid the debates leading up to the expiration, KFF conducted a probability-based survey of 1,350 adults covered by ACA Marketplace plans in late 2025 to better understand their worries about potential cost increases for their health coverage. Now—without the enhanced tax credits in place—KFF re-interviewed 1,117 individuals (more than 80% of the original sample) to learn how they are navigating these changes to the ACA Marketplace.

This report is based on all 2025 Marketplace enrollees who took the follow-up survey, including returning Marketplace enrollees1, those who have left the Marketplace entirely for another type of coverage, and those who are now uninsured.

About the Survey

Returning Marketplace Enrollees Are Paying More for Their 2026 ACA Coverage and Will Cut Back on Spending; Many Not Confident They Can Afford Premiums All Year

Percent of returning Marketplace enrollees who report each of the following:

Bar chart showing health care cost concerns among 2025 ACA Marketplace enrollees who still have Most 2025 Marketplace Enrollees Still Have Marketplace Coverage, Though One in Ten Are Now Uninsured

Current health insurance coverage for 2025 Marketplace enrollees:

Bar chart showing health insurance coverage type among 2025 Marketplace enrollees.

Marketplace coverage

69%

Same Marketplace plan

39%

Switched Marketplace plans

28%

Other type of coverage

22%

Medicaid

Non-Marketplace, purchased plan

Employer-sponsored insurance

Medicare

Insurance through parents

coverage.

Higher health care costs

Total who report higher health care costs

80%

Their costs are "a lot" higher

51%

Affordability concerns

Worried about affording costs for emergency care or hospitalizations

73%

Worried about affording costs for routine medical care

49%

Worried about affording costs for prescription drugs

45%

They are, or will be, cutting back on household spending to afford health care costs

55%

They are not confident they can afford their premium all year

17%

Note: Among 2025 Marketplace enrollees who still have Marketplace coverage. See topline for full question wording.

Some previous ACA Marketplace enrollees are now uninsured or have changed to a different Marketplace plan, citing costs as the major reason for that decision. One in ten (9%) 2025 Marketplace enrollees say they are now currently uninsured and three in ten (28%) say they switched to a different Marketplace plan. When asked the reasoning behind their change, a larger share say costs were the driver rather than changes to their health care needs. A 34-year-old man living in Texas put it this way, “The prices are simply too high. $800/month for the absolute cheapest plan for two people. Our income is $120k, so we don’t qualify for subsidies in Texas. I don’t think we could afford our mortgage if I had to pay for health insurance.”

Health care costs may be a deciding factor for ACA Marketplace enrollees in the 2026 midterm elections. With health care costs front and center for 2025 Marketplace enrollees, many who are registered to vote say that the cost of health care will have a major impact on their decision to vote (48%) and which party’s candidate they will support (49%) in the midterm elections. The issue currently resonates more with Democrats, who are more than twice as likely as Republicans to say health costs will play a major impact on their decision to vote in the 2026 midterms (67% vs. 27%) and on which candidate they decide to vote for (70% vs. 30%).

Cost Concerns and Coverage Changes: A Follow-Up Survey of ACA Marketplace Enrollees | KFF

Ue It or Lose IT

noreply@blogger.com (Gary M. Levin) — Mon, 09 Mar 2026 18:47:00 +0000

The brain is continuously producing new brain cells. If they are not used, they undergo atrophy.

Artificial Intelligence use decreases the use of many brain cells. This will reduce your capacity to think about problems.

Brain Cell Regeneration

Gregg Braden: We produce new brain cells until the day we die. However, you have 7-10 days to use them before the brain thinks you don’t need them and atrophy sets in.

Healthcare Trajectory--Rapid Fired Answers--Part 1

noreply@blogger.com (Gary M. Levin) — Sun, 08 Mar 2026 18:14:00 +0000

Sunday's Health Train is making many stops on our journey...Consider these a new bullet train.

INCREDIBLE: A team of renegade doctors has exposed 18 alternative cancer treatments the mainstream tried to bury. They defy Big Pharma’s narrative and put survival back in the hands of the people. These methods are backed by science, many are low-cost or even free, and they’re delivering results that terrify the medical cartels.

Cancer is fed by lies, and the hospitals profit from misery. But these 18 methods prove there’s another way.

Ketogenic Diet – Starves cancer cells of glucose, cutting off their lifeline. Patients report slowed growth, even remission.

Exercise – Activates immunity, destroys cancer cells, reduces inflammation, and restores strength.

Stress Reduction, Sleep, Sunshine – Stress fuels tumors. Deep sleep repairs, while sunlight boosts Vitamin D and immunity.

Vitamin D3 – Low levels linked to higher cancer risk. Supplementing blocks cell proliferation.

Propranolol – A heart drug that starves cancer cells of stress hormones they need to spread.

Melatonin – Not just for sleep. Shields healthy cells, boosts immunity, and kills cancer cells.

Metformin – A diabetes drug cutting off cancer’s sugar supply. Proven to slow tumor growth.

Curcumin/Nanocurcumin – Anti-inflammatory, anti-tumor, triggers cancer cell death.

Ivermectin – Demonized during COVID, now revealed to sabotage cancer cell survival.

Mebendazole/Fenbendazole/Albendazole – Anti-parasitic drugs that stop cancer cells from dividing.

Green Tea – EGCG compound blocks tumor growth and blood vessel formation.

Omega-3 Fatty Acids – Reduce inflammation, slash risks of breast, prostate, and colon cancers.

Berberine – Ancient plant compound, regulates sugar and kills cancer cells.

Statins – Cholesterol drugs with hidden anti-cancer effects.

Viagra, Cialis, Levitra – Blood flow enhancers making chemo deadlier against tumors.

Disulfiram – Alcoholism drug that destroys cancer’s survival pathways.

Ashwagandha – Ancient herb, cuts stress, boosts immunity, halts tumor growth.

Itraconazole – Antifungal that blocks cancer’s growth channels.

This isn’t speculation. These treatments are backed by research but buried to protect billion-dollar chemotherapy industries. The truth is being censored because a healed population doesn’t make money.

There are however no clinical rtrials and little interest by Pharma, because they are all readily available and not covered by health insurance

The world is waking up. The Deep State’s medical machine is cracking. These 18 therapies are weapons of survival, tools of liberation. Cancer was never just a disease—it was a business model. That business model is collapsing.

Take this seriously. Share this with those who need it most. This knowledge is power. This knowledge is life.

The American Medical Association represents less than 15% of practicing physicians.

It controls the CPT code system that governs how every physician in America gets paid.
It receives licensing fees from that system regardless of AMA membership.

It lobbies on behalf of positions most physicians actively oppose. It endorsed policies that accelerated consolidation, employment, and the commoditization of physician labor for decades.

The AMA doesn’t represent physicians.

It licenses the billing infrastructure they’re forced to use.

It controls the CPT code system that governs how every physician in America gets paid.

It receives licensing fees from that system regardless of AMA membership.

It lobbies on behalf of positions most physicians actively oppose. It endorsed policies that accelerated consolidation, employment, and the commoditization of physician labor for decades.

These are different things.
The conflation is not accidental.

“Is an AI doctor better than no doctor at all?”

It's the wrong question for a very real problem - healthcare access and capacity. That said, I think the medical training model gives us the best analogy for answering it anyway. Lemme explain...

Medical AI in its current form has "spikey" intelligence - just like a real medical student. Doctor-level quality at some things, but clearly not ready for autonomous patient care at others.

Think about what a medical student does well:

→ More time and patience to take complete medical histories

→ Can look up, synthesize, and summarize diagnosis and treatment plans

→ Often takes more comprehensive notes than their attending

But medical students lack the clinical judgment to connect the dots in every situation. They can't yet navigate the interprofessional complexity of real care. They struggle with the non-clinical dimensions of medicine that no textbook covers.

So what do we do? We let med students work autonomously on those tasks where they're spikey-good, but attendings maintain oversight and own ultimate responsibility for the patient.

We are at a similar stage with AI in healthcare right now.

AI is spikey. Incredibly good at specific tasks - in fact, better than physicians at some of them. It can research and synthesize clinical information faster than any human doctor alive.

Sure, AI hallucinates - but it never gets tired. Let's not forget: physicians make errors too, and more so when they're tired.

Over time, healthcare AI will get less spikey - not because the spikes disappear, but because it will grow more of them. It will reach "doctor-level" autonomy across more and more activities. At some point, for a large range of tasks, it may feel almost resident-like... fairly darn autonomous.

But full medical licensure for AI? Unlikely. Not because it won't have comparable technical skill, but because most people still want humans orchestrating AI, not the other way around (for safety, ethical, and just plain human reasons).

So in reality, the most likely path isn't a fully licensed AI doctor. It's a human physician orchestrating a team of highly skilled AI resident agents - each spikey-good at specific high-value tasks. The human owns liability and gains the leverage to care for more patients with the same time and effort.

Some patients - low-risk, routine - may interact primarily with AI (and this is already happening!). The doctor becomes the manager: watching for deviations, running quality checks, talking directly to the patients they're worried about.

The right question was never "is an AI doctor better than no doctor?"

Because the honest answer is: “yes, but only for specific tasks... which means it's not really a full AI doctor at all.”

So the better question is: how can AI give every clinician more leverage to care for more patients - without burning out the humans who hold the whole system together?

Robert Pearl, M.D.Robert Pearl, M.D.

Will generative AI replace the work of human clinicians?

In the three years since the public rollout of large language models, the official answer from healthcare leaders and technology companies has been the same: No. AI will assist doctors and nurses, but only clinicians can diagnose and treat diseases.

Three key pieces of evidence now reveal a different truth:

1️⃣ At Mass General Brigham, a generative AI system called "Care Connect" already takes patient histories, evaluates symptoms and proposes treatment plans before a clinician enters the conversation. Researchers studying more than 400 urgent-care visits at Cedars-Sinai recently found something surprising: The AI’s recommendations were rated optimal 77% of the time ... compared with 67% for physicians’ final decisions.

2️⃣ Meanwhile, with more than 230 million people asking ChatGPT health-related questions every week, major AI companies including Anthropic and Google are building secure repositories for medical records and wearable data. Meaning what? Big Tech is turning its eyes and its tools toward direct patient care, as well.

3️⃣ Utah is launching a pilot that allows generative AI to monitor chronic diseases and renew prescriptions WITHOUT human oversight.

Put these developments together, and the future of medicine starts to look very different than the present.

My take? Generative AI will not eliminate clinicians. But it will take on many of the tasks they perform today. And it will continue to reshape who does what in healthcare: handling routine problems, monitoring chronic disease and answering everyday medical questions.

In the same way many Americans now use an ATM and online banking rather than a bank teller, millions of patients will turn first to a generative AI application for medical advice.

Watch the video below for details and tell me what you think: Will generative AI continue to take on more clinical work or are we overestimating its role?

A History of Medicine, The Last 60 years

Why You Can't Find a Primary Care Doctor: Follow the Money Back to 1966

July 1,1966, I remember the date well.

It was the first day of my medical internship at Boston University Medical Center and the very same day the first Medicare patients were admitted to the hospital.

I thought I knew my path. Two years of training, my second at the Boston City Hospital, then off to the U.S. Navy as a Lieutenant under the Berry Plan. What I did not know was that I would have a front row seat to a 60-year “project” that would fundamentally transform American medicine.

The “Medical Arms Race”
It began with reimbursement.

When Medicare launched, hospitals were reimbursed based on their reported costs, including capital investments in equipment and facilities, plus a margin. Financial risk for adopting new technology was minimal. The predictable result was a “medical arms race.” Hospitals competed by acquiring advanced imaging, surgical suites, and specialized capabilities.

At the same time, the payment structure rewarded procedures more generously than cognitive care. Surgical and interventional services generated higher reimbursement than time spent diagnosing complex, chronic illness.
The incentives were clear.
Over time, those incentives shaped career decisions.

When I graduated from medical school, there were nineteen specialty boards and no subspecialty boards. Today, physicians choose from more than two dozen specialty boards and nearly ninety subspecialties.

That expansion did not happen by accident. It followed the money.

Current workforce trends tell the rest of the story. The majority of graduating internal medicine residents, 70% now choose hospitalist roles, 20% pursue subspecialty training and a small minority, 10% enter traditional outpatient general internal medicine.

We should not be surprised that it is difficult to find a primary care physician.

From the beginning, Medicare’s payment structure favored acute intervention over longitudinal cognitive care. Sixty years later, we have built a system that reflects those priorities, technologically advanced, procedurally sophisticated, and economically aligned toward intervention.

Preventive and diagnostic medicine, the slow work of thinking, listening, and managing complexity over time remains comparatively undervalued.

We did not lose our primary care foundation by accident.
We redesigned the incentives.
If we were building Medicare today, would we structure it the same way?

A Single 20g Dose of Creatine Increases Cognitive Processing Speed by 24.5% Within 3.5 Hours

A double-blind, placebo-controlled trial found that creatine rapidly enhanced brain bioenergetics and improved cognitive performance during sleep deprivation, with effects lasting up to nine hours.

Nicolas Hulscher, MPH

Feb 11, 2026

by Nicolas Hulscher, MPH

Creatine has long been regarded as just a muscle supplement — something for the gym that requires weeks of “loading” to saturate muscle stores. A recent randomized trial overturns that assumption.

In a randomized, double-blind, placebo-controlled crossover trial published in Scientific Reports, researchers gave healthy young adults a single high oral dose of creatine monohydrate (0.35 g/kg — roughly 20 grams for most adults) during 21 hours of sleep deprivation. They then tracked both cognitive performance and real-time brain energy metabolism using advanced MR spectroscopy.

The results were not subtle. At the first post-dose assessment — approximately 3.5 hours after ingestion — participants demonstrated a 24.5% improvement in numeric processing speed (p = 0.0003). When data were pooled across all three overnight assessments (0 a.m., 2 a.m., 4 a.m.), language processing speed improved by 29.1% — the largest cognitive gain observed in the trial. And the effect didn’t fade quickly. Improvements in processing speed and task performance persisted across the next two measurement points — extending roughly nine hours after ingestion.

Just as important, the cognitive findings were mirrored by measurable metabolic shifts inside the brain. Creatine increased cerebral total creatine levels, prevented the typical sleep deprivation–induced drop in the PCr/Pi ratio (a marker of cellular energy stress), stabilized brain pH, and reduced subjective fatigue compared to placebo. In other words, this wasn’t just a behavioral effect — spectroscopy confirmed that high-energy phosphate metabolism itself was altered. The brain’s ATP buffering system appeared more resilient under stress.

In conclusion, a single ~20g dose of creatine rapidly enhanced brain bioenergetics and significantly improved cognitive performance during sleep deprivation, with effects sustained for up to nine hours.

******************************************************************

America is facing a massive physician shortage.
But we aren't just losing doctors to burnout or long hours. We are actively driving our most experienced physicians out of medicine.
How? The endless, punishing cycle of Maintenance of Certification (MOC).
The AAMC projects a shortage of up to 86,000 physicians by 2036. At the same time, nearly half of practicing physicians are over 55.
We are on the verge of a massive retirement wave, and our current credentialing system is accelerating it.
Here is the reality on the ground: Doctors in their 50s and 60s, clinicians with decades of pristine practice, excellent patient outcomes, and countless hours of CME, are being handed the exact same recertification demands as a newly minted attending.
The rigid message the system sends.
"You are only as competent as your last exam score."
For thousands of mid-to-late-career physicians, this is the final straw. Layered on top of EMRs, prior authorizations, and state-specific mandates, the idea of paying exorbitant fees and taking another standardized test to "prove" their competence is insulting.
So, they quietly retire 5 to 10 years early.
The ripple effect is devastating:
📉 Hospitals spend up to $1M to replace a single experienced physician.
📉 Rural communities lose their only specialists, causing months-long delays for care.
📉 The medical field loses invaluable mentorship and clinical intuition that cannot be taught in a textbook.
To date, there is ZERO evidence linking MOC exams to workforce retention or patient safety. But there is massive evidence linking excessive administrative burden to early retirement.
We are draining the physician workforce with no measurable return.
It’s time for a structural realignment. We need a rational model that includes:
✅ Tiered maintenance by career stage
✅ Automatic CME integration to eliminate redundant systems
✅ Outcome-based accountability (real patient data, not online quizzes)
✅ A national credentialing platform for easier locums mobility
The greatest threat to patient safety isn’t a physician who skipped a multiple-choice quiz.
It is the empty exam room where no physician remains at all.
What has your experience been with MOC? Is it time to completely overhaul the board certification system?

Cardiology

UnitedHealthcare, the largest Medicare Advantage provider in the United States, is implementing a new policy on May 1, 2026, that will require patients to receive a primary care provider (PCP) referral before seeing a cardiologist. This affects all patients enrolled in the insurer’s HMO and HMO-point of service (POS) Medicare Advantage plans.

The policy, which also covers cardiothoracic surgeons, vascular surgeons and several other specialties, officially went into place on Jan. 1. However, UnitedHealthcare announced at the time it would not start denying claims due to a lack of a referral until May 1. Existing referral policies in California, Nevada and Texas mean that PCP referrals have already been required in those states for all of 2026.

There are several exceptions to this new rule, including cardiac rehabilitation, physical therapy, dialysis and various emergency room/urgent care services. Medical imaging provided by a radiologist is another key exception.

“The referral requirement for specialist visits reflects the core design of HMO plans, which emphasize primary care‑led coordination,” a UnitedHealthcare representative told Cardiovascular Business. “Stronger PCP engagement can support earlier diagnosis, better chronic condition management, and more proactive care—ultimately contributing to improved health outcomes.”

The representative also emphasized that these referrals are effective as soon as they are submitted by the PCP.

Industry reactions to the new policy

There is a fear among many specialists that this added step will result in elderly patients missing out on care altogether. Securing an approval can be confusing for some patients, for instance, especially if they previously did not need a PCP referral to see a specific specialist.

There are also concerns about asking PCPs to take on additional work at a time when burnout is already high and physician shortages are already a significant problem throughout the United States.

Amit J. Shanker, MD, chair of the Heart Rhythm Society (HRS) Health Policy Committee and a Heart Rhythm Advocates board member, pointed to this policy is part of an ongoing issue with Medicare Advantage plans.

“There is a growing trend of hospitals and health systems terminating contracts with Medicare Advantage due to persistent prior authorization denials and delayed reimbursement,” he told Cardiovascular Business. “Over the past three years, approximately 90 health systems have severed ties with some or all Medicare Advantage plans. When hospitals drop plans, patients may face restricted physician access or higher out-of-pocket costs. This recent additional provision (effective May 1) by UnitedHealthcare further increases the barrier to cardiology access for patients.”

Meanwhile, Wendell Potter, a former health insurance executive who became a whistleblower and now advocates for policy reform, wrote about this update at length online. He said requiring these PCP referrals could save UnitedHealthcare “millions, if not billions of dollars” by reducing specialist visits. He also noted that the insurance juggernaut has “doubled down” on its efforts to shed high-cost patients in the wake of the 2024 murder of CEO Brian Thompson, a moment some analysts predicted might result in “kinder, gentler” policies.

Click here for additional information about the referral requirements for UnitedHealthcare’s Medicare Advantage HMO and HMO-POS plans.

CVS bars transparency

This was on X from Insurance Oligopoly.

The amendment now classifies MAC lists, reimbursement rates, and pricing terms as “Confidential Caremark Information.” It also states that providers cannot disclose, publish, distribute, or share this information without CVS Caremark’s permission.

The Consolidated Appropriations Act (CAA) specifically addressed gag clauses that restrict transparency around healthcare pricing and contract terms.
Yet we continue to see language that appears designed to limit visibility into how drugs are priced and reimbursed.
If employers are fiduciaries under ERISA, how are they supposed to ensure prudent oversight when critical pricing information is treated as confidential? Transparency in healthcare cannot exist without seeing the actual data.

When will we ENFORCE laws, words passed to act like you worked for the American people means NOTHING! Enforce the laws in place!!!

My bill from my January total reverse shoulder replacement. A personal record. $226,000 in billed charges outpatient at University Community Hospital in Tampa. The doctors and staff were great, but this is absurd. Medicare paid $16,420. Works out to 7%
of billed charges. Medicare ignores all the nonsense of the bill and pay a bundled APC rate.

What if this was my pre-Medicare days and I was on Aetna? Deerhold Ltd.'s PRIZM shows a 33.9% of billed charges rate. It sounds like a great rate (66% discount) until you realize that's still $76,000. 460% of actual Medicare. Probably 300% of Medicare the way RBP vendors do it. My doctor would have received about $2K under Aetna. Doctors are not the problem.

All the transparency posts on this site are about professional fees. That's fine, but that's not where the money is. Why a not-for-profit hospital owned by the Adventists are charging 1200% of Medicare is another question.

The AHA board chairman's hospital sued patients 8,000 times in one year for unpaid bills.

The AHA board said nothing. Ask yourself: Who wins when the board chairman's hospital system sues thousands of vulnerable people for not being able to pay? The board chairman. And the AHA board knows it.
Ask yourself: Who loses? The patients. The credibility of the "nonprofit" label. Everyone except the cartel.
In life, we choose sides. Right is one side, and wrong is the other.

“The problem with what’s happening in healthcare is that it’s like a silent, slow apocalypse.”
— Dr. Linda Peeno in Suck It Up, Buttercup

Dr. Peeno is a physician and ethicist who became one of the most well-known whistleblowers on the managed care industry.

In 1996, she testified before the U.S. Congress and made a statement that stunned the room. She described denying a patient a life-saving heart transplant while working as a medical reviewer for an insurance company.

A decision driven by cost and the patient died.

Since then, she has spoken publicly about how systems built around financial incentives can quietly shape life-and-death decisions in healthcare.

She reflects that medical care is something every one of us will need.
We are imperfect.
We are vulnerable.
We are mortal.

That is why her description of our system as a “silent, slow apocalypse” is so alarming.

The erosion of trust, access, and moral clarity has been unfolding for decades, often out of sight.

It is no longer out of sight.

Healthcare should ultimately serve one purpose:
Caring for human beings when they need it most.

Are we willing to redesign the system so that purpose comes before profit?

A live Webinar Discussion. The Healthcare Reinvention Collaborative is hosting a live watch partyOn March 19, there will be a special screening of Suck It Up, Buttercup.
Learn more here: https://lnkd.in/gbsFDvzr

The Healthcare Reinvention Collaborative is hosting a live watch party, and we’d love to have you join us.
Register here: https://lnkd.in/gVMbXSmi

Join us for a powerful, special screening experience as we gather around this bold documentary examining the pressures, dysfunction, and human cost embedded in today’s healthcare system.

This is more than a film showing. It’s a shared moment of reflection and activation.

We Are Joining the Virtual Premiere Experience
The filmmakers are hosting simultaneous in-person and virtual screenings for this early release. HRC will join the virtual event, which has been intentionally designed so online participants receive a fully engaging experience.

Here’s what to expect:
🔸 Each audience will have its own dedicated MC to guide the experience and create space for engagement.
🔸 As attendees arrive, both audiences will view “red carpet–style” interviews with cast and crew.
🔸 The film will begin simultaneously for both groups.
🔸 After the screening, each audience will participate in its own facilitated Q&A discussion session.
🔸 Online participants will enjoy exclusive short interviews with cast and crew as they leave the in-person event, creating a special closing experience that feels intentional and dynamic.

J The film begins at 4:00 PM PT (7:00 PM ET).

About the Film
Suck It Up, Buttercup is an investigative, emotionally grounded documentary that examines corporate influence, systemic dysfunction, clinician burnout, and patient harm within U.S. healthcare while also spotlighting voices calling for change.

Why HRC Is Hosting This
At HRC, we believe meaningful reinvention begins with courageous truth-telling followed by connection, dialogue, and action. This evening creates space to:
🔸 Reflect on what we’re seeing and living
🔸 Deepen relationships across roles and sectors
🔸 Move from frustration to forward momentum
And join us the next day for a deeper conversation about what comes next.
Register here: https://lnkd.in/gkn2Kmbj

I HOPE YOU WILL JOIN US FOR A VERY INTERESTING DISCUSSION

MEDICAL NEGLIGENCE

Emergency departments are where medicine meets uncertainty. Decisions are made quickly, often with incomplete information, and the consequences of those decisions may only become clear much later.
A recent South African case, A.L.S v MEC for Health, Western Cape, provides a powerful teaching example for both doctors and lawyers.
The matter arose after a trauma patient presented to a public hospital emergency department with an injury involving the kidney and renal pelvis. The allegation was that the injury was not properly recognised at the time of the initial emergency assessment and that imaging and specialist management were delayed. By the time the injury was fully appreciated and reconstructive surgery attempted weeks later, the kidney could not be salvaged.
The claim was therefore framed in the familiar way: inadequate assessment, delayed diagnosis and delayed treatment. Proceedings were brought against the MEC for Health, Western Cape, reflecting the principle that the state carries vicarious liability for clinicians working in public hospitals.

The decisive issue at trial, however, was causation.

After hearing expert evidence, the court concluded that the plaintiff had not proven on a balance of probabilities that earlier diagnosis would have saved the kidney. Even if the injury had been recognised sooner, the evidence did not convincingly establish that the outcome would probably have been different. The claim was therefore dismissed.
Read the judgment here:
https://lnkd.in/gbhByqBR
For doctors, the lesson is simple but important: a poor outcome does not equal negligence.
For lawyers, the reminder is equally clear: medical negligence litigation often turns on causation rather than criticism of care.

Having spent many years working at the intersection of medicine and law, I am constantly reminded that emergency medicine happens in real time under pressure. Courts, by contrast, analyse those moments years later with the benefit of hindsight. Understanding that gap is essential if we are to learn from cases like this rather than simply litigate them.
— Dr/Adv Navin Naidoo
Medico-Legally Speaking

Leading Advanced Neurologic Care at Critical Moments |

noreply@blogger.com (Gary M. Levin) — Sat, 07 Mar 2026 01:12:00 +0000

WHAT ARE THE SIGNS OF A STROKE (CVA-CEREBROVASCULAR ACCIDENT)

Weakness of one side of the body or face

Sudden vertigo, or loss of balance

Loss of speech

Confusion

Stroke Centers of Excellence

For patients facing stroke, epilepsy, Parkinson’s disease or other complex neurologic conditions, timely access to specialized neurologic care can shape recovery, independence and quality of life.

Across Northern California, not-for-profit health system Sutter Health is expanding how advanced neurologic care is delivered – helping patients receive the right care, at the right time, close to home.

To highlight how this work reflects Sutter’s comprehensive, integrated approach to neuroscience care, this fact sheet was created to illustrate how the service line is advancing the future of neuroscience services through expanded access, innovation and clinical excellence. Click here to enlarge the document.

Innovation With Impact

Sutter continues advancing its award‑winning, high-quality neurologic care through systemwide efforts focused on improving the speed and precision of diagnoses and treatments, and the patient experience. The following reflect just some of those efforts:

AI-powered imaging to support earlier detection and faster triage of stroke, helping reduce diagnostic delays and improve care coordination across Sutter’s 17 certified stroke centers that collectively care for more than 6,000 stroke patients each year.
Expanded access advanced imaging for epileptic seizure detection, including new headset technology that brings outpatient brain monitoring to rural areas and hospitals without on‑site neurologic coverage.
Digital cognitive screening tools that help identify early signs of cognitive decline in older adults, supporting earlier diagnosis, care planning and easier access to specialty memory services, including care delivered through specialized sites like Sutter’s Ray Dolby Brain Health Center in San Francisco.
Advanced neurosurgical and brain‑stimulation therapies – from incisionless surgery and minimally invasive options such as focused ultrasound and laser ablation to deep brain stimulation and vagus nerve stimulation – providing a comprehensive array of surgical treatment options for brain tumors, refractory epilepsy, movement disorders, and improved motor recovery after stroke.

“These advances translate into meaningful, real‑world impact for our patients and their families,” said Dr. Shawn Kile, chair of Sutter’s Advanced Neuroscience Service Line. “They help people regain independence through prompt, coordinated care and return to daily activities they once thought were out of reach.”

Investments Built to LastFor patients facing stroke, epilepsy, Parkinson’s disease or other complex neurologic conditions, timely access to specialized neurologic care can shape recovery, independence and quality of life.

Innovation With Impact

AI-powered imaging to support earlier detection and faster triage of stroke, helping reduce diagnostic delays and improve care coordination across Sutter’s 17 certified stroke centers that collectively care for more than 6,000 stroke patients each year.
Expanded access advanced imaging for epileptic seizure detection, including new headset technology that brings outpatient brain monitoring to rural areas and hospitals without on‑site neurologic coverage.
Digital cognitive screening tools that help identify early signs of cognitive decline in older adults, supporting earlier diagnosis, care planning and easier access to specialty memory services, including care delivered through specialized sites like Sutter’s Ray Dolby Brain Health Center in San Francisco.
Advanced neurosurgical and brain‑stimulation therapies – from incisionless surgery and minimally invasive options such as focused ultrasound and laser ablation to deep brain stimulation and vagus nerve stimulation – providing a comprehensive array of surgical treatment options for brain tumors, refractory epilepsy, movement disorders, and improved motor recovery after stroke.

Investments Built to LastIf possible, look for a hospital that is well known for stroke care.

The "best" stroke care is highly time-dependent and follows a specialized continuum from emergency response to intensive rehabilitation. Major medical organizations, including the American Heart Association (AHA) and American Stroke Association (ASA), define the gold standard through specific certifications and clinical timelines.

1. Emergency Care: "Time is Brain"

The most critical factor in stroke care is speed. Immediate treatment at a Comprehensive Stroke Center is recommended for the most complex cases.

Ischemic Stroke (Clots):
- Thrombolytic Therapy (tPA/TNK): The "gold standard" involves administering clot-busting medications within 3 to 4.5 hours of symptom onset to dissolve blockages.
- Mechanical Thrombectomy: For large blockages, specialists use a catheter to physically remove the clot, often effective up to 24 hours after onset in certain patients.
Hemorrhagic Stroke (Bleeding): Care focuses on controlling blood pressure, reversing blood thinners, and potentially performing surgery (like a craniotomy or aneurysm clipping) to relieve brain pressure.

2. Specialized Care Settings

Where a patient receives care significantly impacts recovery outcomes.

Comprehensive Stroke Centers (CSC): These facilities have the highest level of certification, with 24/7 access to advanced neurosurgery and specialized infrastructure.
Inpatient Rehabilitation Facilities (IRF): For recovery, the AHA/ASA recommends treatment in an inpatient rehab hospital rather than a skilled nursing facility whenever possible. These programs typically provide at least 3 hours of therapy per day, 5 days a week.

3. Comprehensive Rehabilitation Team

Effective care requires an interdisciplinary team to address physical, cognitive, and emotional needs:

Physiatrists & Neurologists: Specialized doctors who lead the medical and recovery plan.
Physical Therapy (PT): Focuses on mobility, balance, and motor-skill exercises.
Occupational Therapy (OT): Helps patients relearn daily living skills like dressing and bathing.
Speech-Language Pathology (SLP): Addresses communication disorders (aphasia) and swallowing issues (dysphagia).
Neuropsychology: Manages the emotional and cognitive changes, such as depression or memory loss, which are common post-stroke.

4. Post-Discharge & Prevention

Continued care focuses on preventing a second stroke, as 1 in 4 survivors will experience another within five years.

Medication Management: Strictly following regimens for blood pressure, cholesterol (often statins), and antiplatelet or anticoagulant agents.
Lifestyle Changes: Regular exercise, a healthy diet, and smoking cessation are essential for long-term health.
Support Systems: Peer support programs like Stroke Survivor 2 Survivor (SS2S) help navigate the transition from hospital to home.

This is for informational purposes only. For medical advice or diagnosis, consult a professional. AI responses may include mistakes. Learn more

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What are the best rehabilitation exercises for stroke recovery?

The best rehabilitation exercises for stroke recovery are those that are

repetitive, task-specific, and performed consistently to trigger neuroplasticity—the brain's ability to rewire itself.

1. Lower Body & Mobility (Gait Training)

Improving walking and leg strength is a top priority for regaining independence.

Seated Marching: Sit tall and alternate lifting knees toward the chest. This builds hip flexor strength for better foot clearance while walking.
Sit-to-Stands: Transition from a seated to a standing position without using your arms. This mimics daily movements and strengthens the quadriceps and glutes.
Ankle Dorsiflexion: Flex your foot upward toward your shin. This is critical for treating "foot drop" and preventing trips.
Flamingo Stands: Practice standing on one leg for 30 seconds while holding a stable surface for safety. This directly challenges and improves balance.

2. Upper Body & Arm Recovery

Exercises focus on regaining coordination and joint stability.

Tabletop Towel Slides: Place your hand on a towel and slide it forward, backward, or in circles. This improves shoulder and arm coordination through guided movement.
Wrist Curls: While resting your forearm on a table, slowly bend your wrist up and down. You can use a light water bottle for resistance.
Shoulder Openers: With elbows pinned to your sides, rotate your forearms outward like opening a door to improve range of motion.

3. Fine Motor Skills (Hand & Fingers)

Targeting small movements helps with tasks like buttoning shirts or using utensils.

Finger Tapping: Tap each finger to your thumb sequentially. Start slow and gradually increase speed to boost dexterity.
Coin Pickups: Practice picking up coins from a table and placing them in a cup to strengthen grip and hand-eye coordination.
Pen Spin: For more advanced recovery, practice rotating a pen between your fingers.

4. Core & Balance

A strong core is essential for postural stability and preventing falls.

Trunk Rotations: While seated, gently twist your torso from side to side to reduce stiffness and improve walking control.
Knee-to-Chest (Lying): While lying on your back, bring one knee toward your chest to engage abdominal muscles.
Bridges: Lie on your back with knees bent and feet flat; lift your hips toward the ceiling to strengthen the lower back and glutes.

5. Specialized & Cognitive Therapies

Mirror Therapy: Move your unaffected limb in front of a mirror so the brain "sees" the affected limb moving, which can help rewire motor pathways.
Constraint-Induced Movement Therapy (CIMT): Restricting the stronger limb to force the use of the affected side during daily tasks.
Cognitive Exercises: Jigsaw puzzles, Sudoku, and reading aloud help rebuild memory, problem-solving, and speech skills.

Note: Always consult a physical or occupational therapist to ensure exercises are performed safely and tailored to your specific stage of recovery.

This is for informational purposes only. For medical advice or diagnosis, consult a professional. AI responses may include mistakes.

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Leading Advanced Neurologic Care at Critical Moments | Vitals

Photobiomodulation to boost immune response

noreply@blogger.com (Gary M. Levin) — Fri, 06 Mar 2026 00:28:00 +0000

Pick the Red Light Neo

Full Body Red Light Enclosure

What if red light is the key to preventing aging in the immune system?

An unsolvable longevity health problem (so far) is that the thymus shrinks and declines with age, decreasing your overall immune response. The thymus is a small organ located just behind the breastbone where T cells are produced and mature.

T cells are a type of white blood cell that fight both infections (bacteria, viruses) and cancerous cells. The decline in response to pathogens means that the flu kills you when you’re old. Similarly, an inability to nip cancerous mutations in the bud means that cancer incidence increases dramatically with aging.

There are multiple types of T cells - some regulate the immune response and protect against autoimmune attacks, while others directly kill off cells that need to be removed.

Photobiomodulation - red light therapy - is one way to help boost T cell function in aging (or at any age). It is exactly what it sounds like: exposure to light in the red wavelengths at a strong intensity. And the clinical trials on it show that it can significantly improve immune function.

Mitochondria are the source of energy production in cells. Red light (specifically 630-670nm) and near-infrared light (NIR) enhance mitochondrial function by stimulating cytochrome c oxidase, a key enzyme in the electron transport chain. This process increases ATP production, boosts cellular metabolism, and reduces oxidative stress. It acts as a form of photobiomodulation that can improve cellular energy, accelerate tissue repair, and reduce inflammation.

Practical applications for enhancing mitochondrial function include:

1. Athletic Performance & Recovery

Reduced Muscle Soreness: Applying RLT before or after exercise can reduce delayed-onset muscle soreness (DOMS) by up to 50%.

Performance Boost: Pre-workout sessions may enhance muscle strength, endurance, and power output by providing extra cellular energy.

Faster Repair: Increased ATP speeds up the repair of micro-tears in muscle fibers and reduces inflammatory markers like creatine kinase.

2. Skin Health & Anti-Aging

Collagen Stimulation: Red light (around 660 nm) activates fibroblasts to produce collagen and elastin, improving skin elasticity and reducing wrinkles.

Wound Healing: Accelerated ATP production supports faster tissue regeneration for minor burns, scars, and post-surgical incisions.

Acne Management: Its anti-inflammatory properties help reduce the redness and swelling associated with breakouts.

3. Pain & Inflammation Management

Joint Relief: RLT is used to reduce pain and improve mobility in conditions like osteoarthritis, tendonitis, and chronic back pain.

Systemic Inflammation: Regular use can lower overall oxidative stress by boosting antioxidant enzymes like glutathione.

4. Metabolic & Cognitive Support

Blood Sugar Regulation: Recent studies suggest that applying red light (specifically 670 nm) can reduce blood glucose spikes after meals by increasing mitochondrial glucose demand.

Brain Health: Emerging research explores near-infrared light (NIR) for "brain fog," mood support, and neurodegenerative conditions like Parkinson’s by energizing neurons.

ubiehealth.com

5. Hair Regrowth

Follicle Activation: Consistent application to the scalp improves blood flow and energizes hair follicles, which can increase hair density in early stages of thinning.

Practical Implementation Tips

Consistency: Most benefits require 3–5 sessions per week over 4–12 weeks.

Wavelength Choice: Use ~660 nm for surface issues (skin) and ~850 nm for deeper issues (muscles/joints).

Session Length: Typical sessions last 10–20 minutes per targeted area.

Key Mechanisms and Effects:

Energy Production: Red light increases ATP production by facilitating the release of nitric oxide from mitochondria, which allows oxygen to bind to cytochrome c oxidase more efficiently.

Wavelength Precision: Wavelengths between 630-670nm are particularly effective at improving mitochondrial function and, in some studies, have reduced blood glucose levels.

Tissue Penetration: Long-wavelength red and NIR light (650–800 nm) can penetrate deep into biological tissues to boost mitochondrial activity.

Cellular Protection: This therapy has been shown to reduce the pace of cell death in the retina and improve visual function.

Clinical Applications: Studies indicate potential benefits in treating conditions like knee osteoarthritis, chronic joint pain, and enhancing muscle recovery.

The technique is often referred to as Low-Level Light Therapy (LLLT) or photobiomodulation.

Background terminology:

When looking at light therapy, the things to consider include wavelength, intensity, and time of exposure.

Wavelength: The color of the light - wavelength - is important for interacting with cytochrome c in the mitochondria to produce ATP. In the study on mitochondrial ATP production, the researchers used 810nm light. Other studies show that around 610 nm, 760 nm, and 820 nm have an effect.

Red light: 600-700 nm (visible), penetrates 1-2 cm

Near-infrared (NIR): 700-1100 nm (invisible)

800-850 nm penetrates 2-4 cm

1064 nm penetrates even deeper

Irradiance (power density): Studies measure this in different ways, which makes it confusing. But irradiance is power (usually mW) divided by area (usually in cm²).

Energy density (Fluence): This is the amount of light energy per unit area times the duration. It comes out to be Joules/cm² in terms of units and is usually in the range of 2-70 J/cm².

U-shaped curve: Some studies show that there is essentially a U-shaped curve in reference to the dose and response. Low levels aren’t going to do anything, too high of levels can be a negative — thus the need for the right wavelength, energy density, and duration. 1

Clinical trials, immune response:

Let’s take a look at what randomized clinical trials (most with sham control) show for photobiomodulation for immune-related conditions: 2

45%reduction in pain and stiffness for rheumatoid arthritis patients (810 nm wavelength, 10 J/cm², 3x weekly for 12 weeks)

65% faster wound healing for chronic wounds (660 nm wavelength, 4 J/cm², daily for 4 weeks)

40% reduction in asthma exacerbation and improved pulmonary function (904 nm wavelength , 6 J/cm², 2x weekly for 8 weeks)

55% improvement in psoriasis inflammation (633 nm wavelength, 12 J/cm², Daily for 8 weeks)

30% reduction in relapse rate for MS (670 nm, 5 J/cm², 3x weekly for 16 weeks)

30% reduction in ICU length of stay (635nm and 880 nm, 90-second intervals over thighs, legs, arms for 15 minutes)3

Mitochondrial health:

Mitochondria are the ‘powerhouse’ of the cells, supplying the ATP needed for most cellular reactions. Researchers in 2024 showed that light at specific wavelengths can enter the mitochondria and excite specific molecules in the electron transport chain to produce ATP directly. It’s not a huge amount (you still need to eat food), but it is a measurable increase. 4

In addition to producing ATP, photobiomodulation affects the mitochondrial production of reactive oxygen species (ROS). In cells, ROS needs to be at the right level. Excess ROS causes oxidative stress and can kill the cell, but a low level of ROS is needed as a signaling mechanism to promote antioxidant defense and immune activation. 5

Positive T cell changes:

Looking specifically at the changes in T cells, a study involving an animal model of COPD showed that photobiomodulation reduced inflammation in the lungs, reduced mucous, and improved bronchoconstriction. This was in conjunction with positive changes to CD4+ and CD8+ T cells. 6

In a mouse model of familial Alzheimer’s, researchers found that photobiomodulation promoted CD4+ T cells and a positive brain immune response.7

Rabbit trail: Making people smarter

While I had planned to write only about the immune modulating effects of photobiomodulation, I also wanted to mention that there are a bunch of new studies on photobiomodulation through the skull to improve memory and cognitive function.

Targeting the prefrontal cortex with a low-level laser on the forehead above the right eyebrow improved memory and cognition for 5 days.8

The military is also interested in photobiomodulation. A study using transcranial photobiomodulation (1,070 nm, 15 minutes) resulted in a decrease in anxiety, stress, and depression while simultaneously improving cognitive performance.

What to buy?

This is where a great article on photobiomodulation would hold all the answers and tell you the exact best product to buy. I don’t have all the answers.

If you belong to a gym or fitness center, check to see if they have full body red light therapy available. I know people that swear by the full body red lights.

If you have a red light or photobiomodulation device that you like and recommend, can you post it in the comments?

Photobiomodulation to boost immune response

Trump’s State of the Union: 6 healthcare takeaways - Becker's Payer Issues | Payer News

noreply@blogger.com (Gary M. Levin) — Wed, 25 Feb 2026 18:10:00 +0000

Truth or Lie?

1. What’s next after the enhanced ACA subsidy expiration

The failure to extend enhanced ACA subsidies motivated some lawmakers to spotlight affected constituents at the State of the Union. Sen. Tammy Duckworth, D-Ill., who boycotted the address, sent an Illinois man, whose premiums surged after the subsidies lapsed, as her guest.

Amid talks over the future of the subsidies earlier this year, President Trump pitched sending federal healthcare funds directly to consumers, bypassing insurers. A January healthcare policy framework did not provide specifics on how this plan would work.

“Since the passage of the ‘Unaffordable Care Act,’ sometimes referred to as Obamacare, big insurance companies got rich,” President Trump said. “It was meant for the insurance companies, not for the people.”

In January, President Trump floated plans to meet with 14 insurance companies to pressure them on pricing. While no such meeting has been publicly confirmed, five leading health insurance CEOs faced Congress that month, and House Republicans also subpoenaed eight insurers over ACA fraud concerns in February.

In response to the State of the Union, the Federation of American Hospitals echoed critiques of insurers.

“Across the country, American families continue to feel financial pressure, and we agree with the president’s call to lower the cost of healthcare for Americans,” the organization said in a statement shared with Becker’s. “It starts with demanding transparency from big insurers and addressing the rising out-of-pocket costs making it harder and harder for working families to make ends meet.”

2. TrumpRx moves forward

Originally intended to go live in January, the White House launched TrumpRx.gov — a federal direct-to-consumer platform offering discounted prescription drugs — Feb. 5. The administration had been negotiating most-favored-nation pricing agreements with pharmaceutical manufacturers to align U.S. prices for otherwise high-cost drugs with the lowest available in other developed nations. Currently, the website features 43 brand-name medications.

President Trump introduced Catherine Rayner, who he said was the first user of TrumpRx. She accessed an IVF drug on the site with roughly a $3,500 discount, according to the president. Fertility drugs on TrumpRx include Gonal-F, Ovidrel and Cetrotide. Based on the costs presented on the site, the president’s figure is likely based on multiple rounds of a drug.

The president also called on Congress to codify the most-favored-nation pricing structure into law.

3. ‘The war on fraud’ for Medicaid, a commitment to Medicare

At the end of 2025, the federal government froze all child care payments to Minnesota due to suspected fraud. UnitedHealth Group’s Optum has been auditing the state’s Medicaid program, recently flagging $52.3 million in direct recoveries from high-risk services over the span of 46 months. During his address, President Trump blamed the issues on “Somali pirates who ransacked Minnesota.”

Following concerns coming out of Minnesota, Texas Gov. Greg Abbott has been advocating for his own state to investigate its Medicaid program. President Trump accused California, Massachusetts and Maine of having dire fraud cases. He said Vice President J.D. Vance would lead “the war on fraud.”

The recent exposure of empty child care facilities which were receiving billions of dollars from Medicaid prompts an immediate revision of payment processes.

A solution would be to pay parents directly rather than sending lump sums to childcare facilities. Childcare benefits are slaved to income eligibility requirements for Medicaid. There is no reason to send them directly to childcare facilities. Childcare benefits could easily be added to an EBT card. The childcare benefit could easily be segregated in the EBT benefit.

Who is caring for Childcare?

Here are the specific sources and mechanisms for funding childcare:

Federal & State Government (Taxpayers): Child Care Aware® of America states that every state receives federal funds to support child care assistance programs, often known as vouchers or subsidies.

CalWORKs (California): The California Department of Social Services provides subsidized child care for TANF recipients, families transitioning off TANF, and other low-income families.

Alternative Payment Programs (CAPP): These programs use federal and state funds to provide vouchers for low-income families to pay for child care.

Head Start: Head Start programs provide federal funding for early education services for eligible families.

Tax Credits: The National Conference of State Legislatures notes that parents can receive help through the Child and Dependent Care Tax Credit, which is a tax incentive.

Local/County Funding: In some cases, county welfare departments and organizations like the Riverside County Office of Education administer these funds to ensure access to childcare.

California Department of Social Services (.gov)

In summary: All funding is from the Federal Government.

Our current system is byzantine and leaves open the ease of fraud.

Other news about fraud and abuse.

Buried in the news this week was that Conduent, the main processor for the Supplemental Nutrition Assistance Program (SNAP), which supports nearly 10 million cases monthly and processes over 1.5 billion EBT transactions annually, was hacked.

As if the SNAP/EBT system were not already a disaster, the implications of such a breach (of an unknown number) could be enormous. This should have been front-page news.

The company initially said about 4 million people in Texas were affected. That number has since jumped to 15.4 million, nearly half the state's population. Oregon's attorney general reported another 10.5 million impacted residents. Combined with other states issuing notifications, the total could reach into the dozens of millions.

The breach involved Ransomware. Conduent. has since secured its system

The stolen data includes names, Social Security numbers, medical information, and health insurance details. That combination is particularly dangerous because it can be used for identity theft, medical fraud, and highly targeted scams.Conduent processes data for large corporations, state agencies, and government healthcare programs. The company says its systems support services for more than 100 million people nationwide. However, it has not confirmed whether the breach affects that many individuals.

Trump’s State of the Union: 6 healthcare takeaways - Becker's Payer Issues | Payer News

BREAKING STUDY: MMR and MMRV Vaccines Linked to 2,657% More U.S. Deaths Than Measles Infection Since 1995

noreply@blogger.com (Gary M. Levin) — Tue, 24 Feb 2026 15:00:40 +0000

As time goes on. the statistics are in plain site.

For decades, Americans have been told that measles represents a grave and ongoing threat — and that MMR vaccination is one of the safest and most effective interventions in modern medicine. Pharma-captured mass media and public health agencies have centered almost exclusively on the minimal dangers of measles infection and ignored grieving parents whose children were injured or even killed by the shots. No proper attention has been paid to signals emerging within the federal government’s own vaccine safety database.

Now, our new McCullough Foundation study titled “Deaths Following MMR and MMRV Vaccination in the United States,” authored by Kirstin Cosgrove, Breanne Craven, Claire Rogers, John A. Catanzaro, Albert Benevides, M. Nathaniel Mead, Mila Radetich, Peter A. McCullough, and Nicolas Hulscher (myself), takes a comprehensive look at reported fatal outcomes following MMR and MMRV vaccination in the United States, doing the work that our public health agencies should have done many years ago.

After analyzing VAERS data through August 29, 2025, we identified a serious mortality safety signal following MMR/MMRV vaccination in the United States. What we observed was not a diffuse or randomly scattered pattern across age groups and time intervals. Instead, we found an alarming number of deaths among infants and toddlers within days of receiving MMR/MMRV vaccines, sharply clustered in the routine first-dose window.

This represents a 2,657% higher count of reported vaccine-associated deaths compared to measles deaths over the same period.

This is absolutely absurd. A vaccine should NEVER be deadlier than the disease.

Mortality Concentrated in the First-Dose Age Window

Among the 299 U.S. reports:

182 deaths (60.9%) occurred in children under age 2

156 deaths (52.2%) occurred between 1.0–1.5 years of age

That 1.0–1.5 year age band corresponds precisely to the routine 12–15 month first MMR dose.

Rather than a gradual distribution across childhood, we observed a sharp concentration during the narrow developmental window when the first dose is typically administered. The age clustering was pronounced and non-uniform.

Most Deaths Occurred Within 2 Weeks

Time-to-death analysis demonstrated a strongly front-loaded distribution:

120 deaths (40.1%) occurred within 7 days

158 deaths (52.8%) occurred within 14 days

Among first-week deaths with available age data, 68.6% occurred in children 1.0–1.5 years old, reinforcing the synchronization between age peak and immediate post-vaccination timing.

The highest concentration of deaths occurred in the immediate days following vaccination — not months or years later.

Majority Occurred During Multi-Vaccine Visits

We also examined concomitant vaccine exposure:

74.6% of deaths followed visits involving MMR/MMRV plus one or more additional vaccines

25.4% followed MMR/MMRV alone

Recurring Clinical Presentations

Clinical features preceding death showed recurring patterns:

24% SIDS or sudden unexplained death

15% fever

12% seizures

8% cardiac arrest

7% respiratory distress

3% encephalitis

Notably, 68% of SIDS cases occurred in the 1.0–1.5 year age group, mirroring the first-dose window.

Additionally:

23.7% involved emergency department visits

25.4% involved hospital admissions

Many cases involved documented acute clinical deterioration prior to death.

Taken together, these findings cannot be brushed aside as coincidence or statistical noise. The clustering across age, timing, vaccination context, and recurring clinical presentations forms a coherent and internally consistent signal of death within the federal reporting system itself.

As our study concluded:

We identified a serious mortality safety signal following MMR/MMRV vaccination in the United States. A substantial number of reported deaths were documented, with patterns demonstrating pronounced alignment across age, temporality, routine-dose timing, concomitant vaccine exposure, and recurring clinical presentations—including fever, seizures, SIDS, and cardiac arrest.

Reported deaths were predominantly concentrated in children under 2 years of age, and the majority occurred within the first 14 days following vaccination. The synchronization of age-specific clustering with immediate post-vaccination timing reflects a non-random pattern of mortality. This concern is further amplified by the stark contrast between reported vaccine-associated deaths and the exceedingly rare number of measles infection–associated deaths in the modern era.

The magnitude, concentration, and temporal proximity of these reports demand rigorous, transparent, and fully independent evaluation. Future research should prioritize active surveillance cohort studies, detailed autopsies with virologic testing, and record-linked datasets capable of assessing background mortality and determining causal relationships.

You can read the full study here: https://zenodo.org/records/18671462

Nicolas Hulscher, MPH

Epidemiologist and Foundation Administrator, McCullough Foundation

Support our mission: mcculloughfnd.org

ref: Hulscher et al. BREAKING STUDY: MMR and MMRV Vaccines Linked to 2,657% More U.S. Deaths Than Measles Infection Since 1995

noreply@blogger.com (Gary M. Levin) — Tue, 24 Feb 2026 02:49:00 +0000

Robert Redfield (2018–2021)

Former CDC does a 180 turn around. In 2020 he mandated the COVAX manufactured with mRNA.

Dr. Susan Monarez is the most recent former CDC Director, serving briefly in 2025 (July 31 – August 27) before being fired by HHS Secretary Robert F. Kennedy Jr. over disputes regarding vaccine approval and staff turnover. She was the first Senate-confirmed director to be ousted in this manner. Other notable recent former directors include Rochelle Walensky (2021–2023), Robert Redfield (2018–2021), and Tom Frieden (2009–2017).

Millions of US Medicare Advantage enrollees forced to switch plans, study finds | Reuters

noreply@blogger.com (Gary M. Levin) — Sat, 21 Feb 2026 17:10:00 +0000

Why Medicare Advantage plans are tanking. Denials for tests, care, surgery, narrow networks, Frequent changes in provider network. Providers often cancel MA contracts. Coverage us local. Out of network coverage has high deductibles. If you want an academic consult such as Mayo Clinic, Cleveland Clinic, UCLA, UCSF pay more. Some excellent institutions such as Johns Hopkins University have cancelled their contracts. MA plans often obfuscate their benefits. Most MA plans are for profit...They answer to CEO and shareholders....MA plans cook their books showing losses or break even numbers, all the while showing profits to potential investors. P+L

https://tipswatch.com/

2023/07/02/medicare-advantage-is-a-profit-machine-for-insurance-companies-study-finds/

Millions of US Medicare Advantage enrollees forced to switch plans, study finds | Reuters

In cancer science, many "discoveries" don't hold up | Reuters

noreply@blogger.com (Gary M. Levin) — Wed, 18 Feb 2026 17:44:00 +0000

What they are not telling you. The studies do not. stand up to being repeatable... An important fact in proving science.

In cancer science, many "discoveries" don't hold up | Reuters

Science is not "proven" in an absolute, final sense; rather, it is deemed reliable through the scientific method, which relies on falsifiable hypotheses, rigorous experimentation, and evidence. Theories are supported by consistent, reproducible results across many studies, building a consensus that represents the best current understanding of the natural world.

Evidence and Testing: Scientific ideas must be tested against the natural world, allowing for potential disproof (falsifiability).

Replication: An experiment must be repeatable by others to confirm the results, reducing errors or fraud.

Peer Review: Research is reviewed by independent experts, ensuring it meets scientific standards before publication.

Consensus: When many independent studies reach similar conclusions, confidence in the findings increases.

Progressive Refinement: Science is an ongoing process of updating theories as new, better evidence becomes available.

Instead of 100% proof, science provides overwhelming, verifiable evidence that makes certain theories highly reliable.

3. Repeatability & Peer Review

No single experiment "proves" a result. Science relies on a global community to verify findings:

Reproduction: Other independent scientists must be able to run the same experiment and get the same results.
Peer Review: Before research is published, experts in the field scrutinize the methods and data for flaws.
Consensus: When many different studies using different methods all point to the same conclusion, it becomes an "established fact" or "scientific consensus".

4. Self-Correction

Science is designed to be tentative. If new, better evidence comes along that contradicts a previous theory, the theory is updated or replaced. This is a feature, not a bug; it's how science gets closer and closer to a more accurate model of the universe.

The Shortcoming of Remote Monitoriing

noreply@blogger.com (Gary M. Levin) — Wed, 18 Feb 2026 00:21:00 +0000

Health tech keeps making the same mistake: it measures the right things but ignores the context that makes them meaningful.

Wearables collect time-stamped data from your body all day and all night. Heart rate variability, skin temperature, respiratory rate, sleep architecture. Every one of these signals follows a 24-hour circadian rhythm. A "low" HRV at 2pm means something completely different from the same reading at 2am. Your resting heart rate in the early evening isn't the same biological event as your resting heart rate during deep sleep.

But most wearables present these as flat scores against population averages, as if your biology were static. No wonder users report feeling anxious, confused, or pressured by numbers that fluctuate "without explanation." The fluctuations aren't random. They're circadian. The device just doesn't tell you that.

Now a new wave of wearables (Clair, Peri, Level Zero) is trying to estimate hormones, estrogen, progesterone, LH, cortisol, from these same proxy signals. The ambition is real. But here's what nobody in that conversation is saying: every proxy signal they're using is a downstream circadian biomarker, and the hormones they're estimating are themselves circadian outputs. Cortisol peaks about 30 minutes after waking. Progesterone rises are nocturnal. The LH surge has specific timing architecture.

Validating these estimates against a single morning blood draw is the wrong gold standard for a continuous monitor. You'd want concordance across the full 24-hour cycle.

A cortisol reading without circadian context is noise, not signal.

This connects to something I keep seeing in health AI research too. Most studies test whether AI can match a doctor's diagnostic accuracy using clean clinical vignettes. But that's answering a question nobody is actually asking. The real question is: when a scared, confused person types symptoms into ChatGPT at 2am, does that interaction lead to better decisions than what they would have done otherwise?

Same problem. Different domain. The technology works in controlled conditions. But health doesn't happen in controlled conditions. It happens at 2am, mid-cycle, post-travel, under stress, in bodies that run on clocks researchers keep forgetting to account for.

The next generation of health tech, whether wearables or AI, won't win by adding more sensors or more parameters. It will win by understanding context: biological timing, individual variation, and the messy reality of how humans actually live with their data.

Your body has a clock. Your health tools should know how to read it.

https://www.linkedin.com/posts/gillesfrydman_circadianhealth-wearables-digitalhealth-activity-7429141255684513792-QfAl?utm_source=social_share_send&utm_medium=member_desktop_web&rcm=ACoAAAAqTbwBl7WHwBdULQ1iB1ThcCkr32EMVjE

A Cure ffor Rural Health 2030 Bold Aim — Orchid Wellbeing-First Fellowship

noreply@blogger.com (Gary M. Levin) — Wed, 18 Feb 2026 00:21:00 +0000

Physician and Hospital shortage requires stakeholders to. take action to provide support services to rural residents.

By 2030, we seek to:

Inspire 100,000 stakeholders
Catalyze 1,000+ wellbeing-first jobs across a network of healthcare partners
Lead by example in 10 rural communities supporting over 20,000 patients

Orchid Wellbeing-First

People-first approach: care teams are valued, trusted, and empowered to prioritize patient and community needs.
Local decision-making: small, empowered teams guide care with focused, meaningful metrics.
Personalized care: builds strong relationships through longer, patient-focused visits. Care is guided by "what matters most" to patients.
Community integration: works collaboratively with local health and community partners.

A Decade of Transforming Rural Healthcare: Orchid’s Chapter One

In 2014, we launched Orchid Health with a courageous vision: to deliver healthcare to the people and places that needed it most. Our founding team saw firsthand the inequities straining Oregon’s rural communities—where nearly 40% of the state’s population lived without reliable access to quality, local healthcare.

Determined to disrupt an overly bureaucratic, profit-first system, we set out to create a transformative model built on relationships, joy in work, and health equity.

From the very beginning, we’ve held strong to the belief that supporting our communities starts with our own staff. A healthy community starts with a healthy health organization where caregivers are cared for and have the autonomy to do what they feel is best for their team and patients.

From Humble Beginnings to Trailblazing Change

Our team opened the first clinic in Oakridge, Oregon, a community where two rural clinics had closed in the previous decade. Orchid started to gain a reputation of rewriting the rules of healthcare with the introduction of hour-long new patient visits and 30-minute follow-ups. Over three short years, with unhurried, compassionate care, the Oakridge clinic team reduced emergency department utilization for Medicaid patients by 42%, proving that a relationship-based model can achieve meaningful outcomes.

Building on this success, we expanded our community footprint. By 2016, we launched the first hybrid school-based rural health clinic in Estacada, integrating medical and mental health services to serve the broader community and local high school students. Our innovative approach continued with the acquisition of the McKenzie River Clinic in 2020, rescuing a cornerstone of the community and one of the nation’s first certified Rural Health Clinics from closure. Even after the devastating Holiday Farm Fire later that year, our caregivers persisted, setting up a temporary clinic to ensure continuity of care.

A Wellbeing-First Operating Model

Orchid’s six thriving clinics now serve over 10,000 patients across Oregon, providing comprehensive care that includes same-day acute visits, behavioral health services, community health worker services, and chronic disease management.

Central to our successful operating model excellence is the happiness and autonomy of our caregivers.

Employees consistently praise Orchid’s supportive culture, where work-life balance, self-management, vulnerability, professional growth, and community engagement are celebrated. Nearly 30% of team members have advanced to new roles within the organization, and Orchid has maintained an industry-leading eNPS score three times the primary care average, ultimately leading to multiple awards and recognitions as a best place to work and healthiest workplace. Orchid’s turnover over the past three years has been about half of the industry average.

Universally, our Orchid teams are achieving a strong net operating margin, and a 9.5 out of 10 patient satisfaction rating. By focusing on the wellbeing of our caregivers and patients, we believe we’ve unlocked the key to delivering remarkable care and building a resilient organization.

Our clinics have earned four and five-star patient-centered primary care home (PCPCH) ratings—the highest recognition available in Oregon—while reducing emergency department utilization by 40% in the first three years of opening our first rural health clinic. With an eNPS score three times the primary care industry average and an impressive 90% employee retention rate in 2023, we are equally proud of our caregiver support.

Looking Ahead

Everyone at Orchid embraces a learning mindset, adapting to challenges and refining our model. Early experiments, like a direct primary care membership model, underscored the need for inclusivity and access. Today, Orchid contracts with most insurance providers to ensure no patient is turned away. We’re also at the forefront of value-based payment models, aligning financial incentives with patient outcomes.

Looking ahead, we aspire to expand our impact by sharing its proven approach. Plans are underway to establish a consulting arm to guide other healthcare organizations in adopting wellbeing-first principles. Additionally, Orchid recently spun off a new nonprofit arm, the Health Creation Network, to further its mission of health equity and innovation.

What started as a grassroots effort to address rural healthcare disparities has grown into a movement redefining community health. By focusing on relationships, challenging traditional power dynamics, and prioritizing the wellbeing of both caregivers and patients, Orchid Health is a beacon of hope for rural communities across Oregon.

As we enter our second decade, Orchid remains steadfast in its commitment to bringing care to where it’s needed most—proving that healthcare rooted in compassion, equity, and innovation can thrive.

Summary

There is little likelihood that new rural. hospitals will be built. Physician recruitment is difficult without hospital support, however Orcid health can provide support services for doctors who chose to practice in a rural setting.

Locum tenens

9 rural locations that desperately need locum tenens physicians

Apr 20, 2025

7 Min Read

Kathleen Stone

Locum tenens physicians are in demand across the country, from the largest cities to the smallest towns, but some locations have a greater need than others. Here are nine rural locations that are desperately in need of physicians. Our list is based on their scores as Healthcare Professional Shortage Areas (HPSAs) and number of open locum tenens jobs with the largest locum tenens agencies.

How to find a locums agency

1. New Mexico

Out of all the rural locations that need physicians, New Mexico tops the list with a HPSA score of 17.93 out of 25 for primary care and mental health. It’s one of the most rural states in the country, with a median county population density of just 7.1 people per square mile. In addition, New Mexico was ranked fourth in the nation for its poverty rate — 17.5% of New Mexico residents falling below the poverty line. This means that many New Mexico residents face two barriers to receiving healthcare: the physical barrier of a long drive to access care and the economic challenge of paying for it. Locum tenens physicians play a critical role in bringing healthcare to the people where they live through New Mexico’s rural clinics and hospitals.

2. Georgia

Georgia has the tricky combination of a growing population and a rural population. According to the American Medical Association, Georgia ranks 30th in the nation for physicians per capita. Since it’s growing quickly, the need for doctors is growing as well. To address that need, Augusta University has created a program that places medical students in 350 locations across Georgia to give them real-world experience. Its other aim is to introduce them to the more rural areas of the state. Like the other states on this list Georgia’s rural healthcare facilities need locum physicians to provide the coverage they need.

3. Missouri

Missouri's physician shortage continues to grow. The Institute for Public Health estimates that Missouri will need 687 additional physicians by 2030, which represents an 18% increase. Some of Missouri’s counties have been hit particularly hard by this shortage. For example, Osage County has a ratio of 13,688 people for every one physician. In comparison, the national average is 2300:1.

4. Arizona

Arizona only has 37% of the physicians it needs to care for its population. And with an aging population of patients and physicians, this need is likely to grow. Much like Georgia, Arizona also has a growing population; it’s home to two of the top four fastest growing cities, and Phoenix is the fastest-growing large city in the country. Locum tenens physicians are in high demand to keep up with the needs of the state’s growing population.

5. North Carolina

North Carolina is one of the top locations that need physicians because its population faces a variety of issues when it comes to healthcare. First, 20% of the population lives in a rural area. Plus, this rural population has risk factors that lead to lower income and a higher rate of health issues: They are older, poorer, and sicker than those living in urban areas. This means that this population needs extra medical care but has trouble accessing the caregivers who can provide it. Plus, they’re less likely to have health insurance, so it’s that much harder to get the necessary care.

6. Washington

Washington is home to four of the 15 U.S. counties with the highest physician shortages. This might come as a surprise considering the state is home to large cities like Seattle and Spokane, but healthcare tends to be concentrated in these areas, which makes it less accessible to Washington’s rural areas. By 2030, estimates find that the physician shortage in Washington will reach 6,037—and Washington citizens in rural and large areas will feel the effects.

7. Florida

In terms of the physician shortage, Florida makes Washington look better. By 2035, the Sunshine State will have a gap of nearly 17,000 physicians. Of these, 5,974 are primary care specialists, but Florida is also anticipating a shortage of 1,519 emergency department physicians, 654 anesthesiologists, 1,230 psychiatrists, and more. Florida and its sunny beaches are a perfect retirement set up, but as retirees and their doctors age, the demand for physicians will continue to grow and so will the need for locum physicians.

8. Texas

The Texas Department of State Health Services projects the shortage of physicians in Texas will nearly double by 2032. As of 2018, there was a shortage of 6,218 full-time equivalent physicians, but by 2032 that number will skyrocket to 10,330. Texas is the fastest-growing state in the country, and it has an aging population, which will drive the demand for healthcare providers higher and higher.

9. Oregon

Oregon anticipates a shortage of 1,174 physicians by 2030, and the rural areas of the state will once again be hit the hardest because of the concentration of people in urban areas like Portland. The Oregon Office of Rural Health is working to attract doctors to jobs in rural areas with special incentives, policy changes, and recruiting efforts.

The physician shortage is putting a strain on health systems across the country, and physicians interested in working locum tenens will continue to be in high demand, especially in rural locations. Doctors who are willing to take jobs in high-need areas can make a big difference in the lives of both their patients and the communities in which they live.

Locum tenens work in rural and underserved areas offers more than a change of scenery—it’s a chance to reconnect with purpose. Hear why emergency medicine physician Dr. Russ Reinbolt finds fulfillment working rural locums assignments:

VIDEO OF A LOCUM TENENS PHYSICIAN

2030 Bold Aim — Orchid Wellbeing-First Fellowship

The Recomended Daily Allowance for Vitamin D has been to low

noreply@blogger.com (Gary M. Levin) — Sun, 15 Feb 2026 23:11:00 +0000

What is Vitamin D ?


Explanation of the Pandemic of Vitamin D Deficiency: Only 20% of our vitamin D reserve is meant to come from the diet. The remaining 80% is expected to be produced in our skin from the UV-B of the sun. In contrast to the context of the recommendations of the 1960s of 4000 to 5000 IU/d to avoid rickets, our diet today is poor in wild fish (×10 richer in vitamin D), wild eggs, and fresh milk. Children are playing and people are working indoors all day long, and powerful sunprotective cosmetics are used to prevent melanoma. Even sunny countries such as Greece present a high prevalence of vitamin D deficiency, as the angle of the sun rays from autumn to spring do not result in sufficient vitamin D production with usual sun exposure.; Optimal Vitamin D Supplementation; With the target for vitamin D set at 100 nmol/L, the dose, frequency, and duration of supplementation will be important factors for healthy subjects committed to optimizing their nutritional status.; Since in the case of vitamin D, serum levels depend on dietary intake (20%) and sun exposure (80%), a practical approach would be to recommend at least the three-fourths of the upper tolerable dose proposed by the Endocrine Society to be taken as a supplement all year long except for circumstances such as vacations in which one engages in sunbathing. This could translate to, for instance, 1000 IU for children <1 year on enriched formula and 1500 IU for those older than 6 months who are breastfed, 3000 IU for children >1 year of age, and up to 8000 IU for young adults and thereafter, with non-pediatric doses adapted to the body mass index with the target set to 100 nmol/L instead of 50 nmol/L. More importantly, according to the Endocrine Society’s clinical practice guidelines, doses up to 1000 IU/d for infants up to 6 months, 1500 IU/d for infants from 6 months to 1 year, 2500 IU/d for children aged 1-3 years, 3000 IU/d for children aged 4-8 years, and 4000 IU/d for everyone over 8 years can be given safely without medical supervision just to prevent vitamin D deficiency, while higher doses may be needed to correct hypovitaminosis D.; Importance of Vitamin D Supplementation; Such a strategy relies on adequate supplementation among pregnant and lactating women, and on timely supplementation of every newborn before seroconversion towards autoimmune targets occurs. The benefits for individuals’ general health status, apart from the obvious gains in skeletal health, cannot be fully foreseen, but may very well be surprisingly greater than expected given the impact of vitamin D deficiency on metabolic syndrome itself. Improvements in vitamin D status may help reduce the public health burden of metabolic syndrome and of potential subsequent health conditions, including type 2 diabetes and cardiovascular disease.; Other considerations; CONCLUSION; Unfortunately, medicine took a very long time to realize that vitamin D is not simply a vitamin that prevents rickets. For that purpose, 400-600 IU/d may be enough. However, we know today that vitamin D is a powerful nuclear receptor-activating hormone of critical importance, especially to the immune system. With the available data mentioned above, the proposed doses would probably suffice to maintain vitamin D levels around or over 75-100 nmol/L, with practically zero risk of toxicity. Undeniably, further studies are needed to clarify the optimal supplementation of vitamin D, although it is uncertain whether a universal recommended dietary allowance is feasible. Meanwhile, actions are urgently needed to protect the global population from the threats posed by vitamin D deficiency.

Vitamin D RDAs—A Promising Public Health Goal for MAHA

Acute management of measles: A systematic review of therapeutic strategies -

noreply@blogger.com (Gary M. Levin) — Thu, 12 Feb 2026 01:01:00 +0000

Current medical practice to prevent Measle is vaccination. There is no evidence that autism is caused by vaccination.

Measles is highly infectious and is often not recognized until a rash appears. Transmission often occurs early in the disease and prior to a visible rash.

There are accepted for patients already ill with Measles.

Acute management of measles: A systematic review of therapeutic strategies

Measles remains one of the most contagious viral infections, and its resurgence due to declining global vaccination coverage has renewed interest in therapeutic and preventive strategies. This systematic review analyzes current and emerging acute therapies and their relationship to measles virology and clinical outcomes. A systematic search of PubMed, Scopus, Web of Science, China National Knowledge Infrastructure and Google Scholar (1990–2025) was conducted using predefined inclusion and exclusion criteria to identify clinical studies on acute measles treatment. Despite being used off-label, ribavirin and interferon-α have demonstrated reductions in severity and complications in small clinical trials and case reports. Vitamin A supplementation remains the only widely recommended therapy with strong evidence for reducing morbidity and mortality, particularly in children with deficiency. Traditional Chinese medications such as Tanreqing and Xiyanping show symptomatic improvement but require mechanistic validation. Investigational therapeutics, including polymerase inhibitors such as ERDRP-0519, monoclonal antibodies targeting the fusion protein, and antiviral candidates such as remdesivir, offer promising future options. While vaccination remains essential, adjunctive therapies provide additional tools to reduce complications in under-vaccinated populations.

Measles is one of the world's most contagious viral diseases, with an estimated basic reproduction number (R0) of 12–18, the highest among human pathogens (Guerra et al., 2017). Despite the availability of a safe and effective vaccine for decades (Van Boven et al., 2010), measles cases have surged in recent years (Bednarczyk and Sundaram, 2025). In 2023 alone, over 10.3 million cases and 107,000 deaths were reported worldwide, representing a 21% increase over the previous year and reversing years of progress toward measles elimination (WHOa), (WHOb). Multiple factors are contributing to this resurgence, including vaccine hesitancy, healthcare system disruptions caused by the COVID-19 pandemic, and disparities in vaccine access across regions (The State of the World, 2023). The World Health Organization and UNICEF reported that 22 million children missed their first measles-containing vaccine dose in 2022, the highest number since 2008, leaving millions susceptible to outbreaks (The State of the World, 2023). In the United States, the CDC recorded 285 confirmed cases in the first half of 2024, nearly five times the 58 cases reported in all of 2023, with 40% requiring hospitalization, often in unvaccinated children under five years of age (Measles Cases and Outbreaks). As of November 26, 2025, the US has reported 1798 confirmed cases in 2025 across 43 jurisdictions, with 46 outbreaks and 3 deaths, marking the highest annual total since the elimination status in 2000 (Measles Cases and Outbreaks). Preliminary global data for 2025 indicate continued surges, with over 196,270 suspected and confirmed cases reported as of May 2025 (WHOa). These trends underscore the urgency of strengthening immunization programs and improving vaccine equity. They also highlight the need for additional strategies, including research into acute therapeutics, to protect under-vaccinated populations during outbreaks and reduce measles-related complications and deaths.

2. Systematic review methods

A systematic search was performed across PubMed, Scopus, Web of Science, China National Knowledge Infrastructure (CNKI), and Google Scholar for studies published between 1990 and 2025. Clinical trials, observational studies, case series and preclinical studies related to the acute treatment of measles infection were eligible for inclusion. Studies were excluded if they lacked therapeutic outcome data, did not pertain to acute measles infection, or were not peer-reviewed. Only literature with extractable clinical or mechanistic outcomes was included to ensure transparency and reproducibility.

Detailed inclusion and exclusion criteria are summarized in Table 1. The study selection process followed PRISMA 2020 guidelines, as illustrated in Fig. 1.

The search revealed ten articles on treatments for acute measles (Supplementary Table 1), six of these being clinical trials (Table 2), and four being preclinical studies (Supplementary Table 1).

Acute management of measles: A systematic review of therapeutic strategies - ScienceDirect

2,000 Surgeries/year. What is the cost?

noreply@blogger.com (Gary M. Levin) — Wed, 11 Feb 2026 22:03:00 +0000

2k+ surgeries a year sounds impressive.
Until you do the math.
That's 8 surgeries a day.
Every single day.
No vacations.
No slow weeks.
No time to breathe.
So when does that surgeon actually talk to you?
When do they sit down and examine your knee with their hands?
When do they compare it to your other knee?
When do they review your MRI themselves instead of skimming a radiologist's report between cases?

They don't.
Their PA does your intake.
Their medical assistant handles your pre-op questions.
Their nurse returns your calls.
You meet the surgeon for five minutes in a rushed appointment where they confirm what their staff already told you.
Then you're unconscious on a table with someone you barely know cutting into your body.
And when something goes wrong?
You're calling an office full of people who weren't in the room.
The surgeon is already eight cases deep into the next day.
You're yesterday's problem.
This isn't bad luck.
This is the system working exactly as designed.
Surgeons are paid by volume.
Insurance reimbursements keep dropping every year.
The only way to maintain revenue is to do more cases in less time.
So that's what they do.
They optimize for throughput.
They hire staff to handle everything except the 45 minutes they spend in the OR.
And here's the part that should make you angry: the incentive structure actually rewards bad outcomes.
A surgeon who rushes a case and causes a complication gets to operate on you again.
Bills insurance again.
Gets paid again.
There's no penalty for sloppy work.
There's a financial reward.
The nurses know this.
The PAs know this.
The surgical techs who hand instruments to these guys every day know this.
They see the wounds closed too fast.
The corners cut.
The patients who come back six months later for revision surgery that shouldn't have been necessary.
High volume is not high quality.
High volume is a business model.
You deserve a surgeon who knows your name. Who examined you with their own hands. Who will answer the phone when something doesn't feel right.That surgeon doesn't exist at 2000 cases a year. It's physically impossible to provide that level of care at that pace.
Do the math.

Then choose accordingly.

surgeons

Big Pharma pushes pricey scripts for brain fog, low energy, ED, and falling testosterone.

noreply@blogger.com (Gary M. Levin) — Wed, 11 Feb 2026 17:38:00 +0000

Big Pharma pushes pricey scripts for brain fog, low energy, ED, and falling testosterone. Yet a proven amino acid that sharpens focus, supports sexual health, and boosts fat burning is ignored. It’s Acetyl-L-Carnitine. Here’s how it helps men: 1. While Big Pharma gets rich by pushing meds that mask symptoms and testosterone replacement therapy with serious side effects, they ignore the root cause of male decline: failing cellular energy. Acetyl L-Carnitine is your body’s own transport system for turning fat into fuel at the cellular level. No patents, no side effects, just pure, clean energy. 2. What is Acetyl L-Carnitine? It’s a specialized form of the amino acid L-Carnitine that can cross the blood-brain barrier. It’s essential for creating energy in your mitochondria—the power plants of your cells. Think of it as the spark plug for your body’s engine. 3. What they won’t tell you: Your energy, your focus, and your metabolism all depend on mitochondrial health. As men age, mitochondrial function declines. This leads to fatigue, brain fog, weight gain, and low testosterone. Acetyl L-Carnitine directly supports your mitochondria, helping you fight back against age-related decline. 4. Benefits that matter for men in their 30s, 40s and 50s: - Promotes healthy testosterone levels - Supports sexual health & performance - Boosts cellular energy production - Enhances mental clarity and focus - Supports your body’s ability to burn fat for fuel - Aids in exercise performance and recovery If you want a top-tier Acetyl L-Carnitine, this is the one I trust. 1000mg per serving, third-party tested: amazon.com/dp/B06XSHQ11M? 5. Fight back against “male menopause”: As men age, testosterone levels naturally decline, leading to fatigue, mood swings, and reduced vitality. Acetyl L-Carnitine supports healthy testosterone levels and overall hormonal balance, helping you feel like yourself again. 6. Reclaim your physique: You can’t out-train a broken metabolism. Acetyl L-Carnitine helps your body become more efficient at burning fat for energy. This not only helps with weight management but also provides a clean, sustained energy source for your workouts and your day. 7. Your brain is starving for energy: Brain fog isn’t a character flaw; it’s an energy crisis. Acetyl L-Carnitine crosses the blood-brain barrier to directly fuel your brain cells, enhancing focus, memory, and cognitive function. It’s like a high-octane fuel for your mind. 8. Perform at your peak: Whether it’s in the gym, the boardroom, or the bedroom, you need energy and focus to perform. Acetyl L-Carnitine supports both, giving you the edge you need to succeed in every area of your life. 9. How to use it right: 1000mg daily with food. Take it consistently for at least 8-12 weeks to experience the full benefits. Combine it with a clean diet and regular exercise for maximum impact. 10. The Reality Check: Big Pharma's testosterone replacement comes with prostate enlargement risks and lifelong dependency. Acetyl L-Carnitine works WITH your body's natural energy systems to create real, sustainable energy and well-being. Here's the same maximum-strength Acetyl L-Carnitine formula I trust. 1000mg per serving, 200 veggie capsules: amazon.com/dp/B06XSHQ11M? Transparency note: This post contains affiliate links; I may earn a commission at no extra cost to you. This is for educational purposes and is not medical advice. Always consult a healthcare professional before changing your routine. Bottom line: Your vitality as a man is tied to your cellular energy. Support your mitochondria, and you support your strength, your mind, and your performance. Ignore it, and you’re just managing decline. If this helped you, share it. Follow

@JakePearson303

for more practical health advice for men. Repost so more men can reclaim their edge.

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Hospitals and insurers are fighting over money, leaving patients in the lurch

noreply@blogger.com (Gary M. Levin) — Wed, 11 Feb 2026 17:02:00 +0000

A contract fight between Mount Sinai Health System in New York City, where she gets care, and Anthem Blue Cross Blue Shield, whose network her insurance uses, has cast doubt on whether she’ll be able to get it on time.

Some hospitals go out of network to provide expertise when it is unavailable in their facility

The dispute is about money: Mount Sinai says Anthem owes it more than $450 million in unpaid claims, while Anthem says Mount Sinai is demanding a 50% rate increase. Mount Sinai’s physicians went out of network for most Anthem plans on Jan. 1 after the two sides failed to reach a deal, though its hospitals and facilities remain in network until March 1. Roughly 200,000 Mount Sinai patients have Anthem coverage, according to the hospital system.

If you are receiving an ongoing course of treatment, you have the right to continue receiving services at the same cost sharing amount, for 90 days or through the end of postpartum care. Specifically, you can continue treatment with your provider if you are any of the following: seeing your provider for a serious and complex condition (either acute or chronic), and if the treatment would prevent serious harm

undergoing a course of inpatient treatment, scheduled for nonelective surgery

pregnant and receiving treatment for pregnancy, or receiving postpartum care

receiving treatment for a terminal illness

Hospitals and insurers regularly renegotiate rates, but those discussions are usually handled behind closed doors and are typically resolved before patients feel an impact.

But in recent years, many negotiations have become more fraught, often spilling out into public view as both sides put out statements defending their position. When that happens, it’s usually a bad sign for patients.

Jason Buxbaum, a researcher at Brown University, has been tracking disputes between hospitals and insurers since 2021. From June of that year through May 2025, about 1 in 5 hospitals had at least one public dispute with an insurance company, according to Buxbaum’s preliminary findings. About 8% of the hospitals went out of network for the insurance company they were negotiating with, at least for a time. In total, roughly 500 to 600 public disputes between hospitals and insurers occur each year.

“This has accelerated in recent years,” he said. “There’s definitely a potential for folks to get screwed over.”

The disputes have played out with some of the biggest names in health care. Insurance giant UnitedHealthcare warned members could lose in-network access at NewYork-Presbyterian unless the two sides reached an agreement. The insurer also missed a June 30 deadline with Memorial Sloan Kettering Cancer Center, though a deal was reached the next day. In Southeast Texas, Memorial Hermann Health System and Blue Cross Blue Shield of Texas are currently in contract talks for commercial plans, with an April 1 deadline; Memorial Hermann ended its relationship with the insurer for Medicare Advantage plans on Jan. 1. Last year, Duke Health said it would leave Aetna’s network if it didn’t reach a deal — which it ultimately did weeks later.

Leemore Dafny, a professor of public policy at the Harvard Kennedy School, said rising health care costs are a major reason these disputes are becoming more common.

According to the American Hospital Association, an industry trade group, total hospital expenses grew 5.1% in 2024, significantly outpacing the overall inflation rate of 2.9%. It slowed in 2025, although it remains elevated, the group said.

“Hospital prices have grown tremendously,” Dafny said. “So you can imagine that the pushback from insurers against requests or demands for payment increases is going to be pretty fixed.”

Insurers have tried to use tools like prior authorization and claim denials to tamp down on health care costs — but have faced growing public blowback over it, Dafny said. Now, she said, many insurers see contract negotiations as one of the few levers they have left.

“So what’s left is let’s try to pay less for things or let’s actually try to potentially exclude high cost providers altogether,” she said. “ It’s [the] job as an insurer to provide access to high quality care and try to keep it affordable. And that might mean not rolling over every time a provider demands a price increase, even if the provider is dealing with rising prices itself.”

Buxbaum said that another factor in the growing number of disputes is recent federal transparency rules that force hospitals and insurers to reveal more about what they charge — and what they’re paid. In the past, hospitals often had a rough sense of what rate a nearby health system was getting from the insurer, but didn’t know for sure, he said.

“Now nobody wants to be the worst paid on the block,” he said.

Dafny said the problem is likely to grow, especially for Medicare Advantage, which now covers well over half of people on Medicare. Medicare Advantage is run by private insurers, rather than the government.

Unlike traditional Medicare — where patients can generally see any provider who accepts it — Medicare Advantage plans typically rely on a smaller network of doctors and hospitals.

“There’s no question that these processes slow things down and people suffer,” she said.

Brent Estes, the chief managed care officer at Mount Sinai and the lead negotiator in the Anthem dispute, said the hospital system is standing its ground. Mount Sinai is open to hammering out a new contract with Anthem — if the insurer is willing to meet its terms.

“It’s not like we can get paid the same forever,” Estes said. “We feel like we’re substantially lower in terms of our payment rates than our academic peers, which puts us in a difficult position to compete in the market in the long run.”

In an emailed statement, an Anthem spokesperson said the insurer’s sticking point is cost.

“Mount Sinai is seeking price increases and the removal of patient overbilling protections that would drive healthcare costs up by as much as 50 percent by 2028 — far outpacing inflation,” the statement read. “Those costs would ultimately be paid by patients, unions, employers, and governments.”

Insurers often pass responsibility to a third party The spokesperson said Anthem doesn’t have the authority to grant Reichel so-called continuity of care approval. (Reichel’s insurance is administered by International Benefits Administrators, a third party group that uses Anthem’s provider network.) The exception can allow patients to keep seeing their doctors temporarily even after they go out of network.

"Deny and Delay" a statemend given by the alleged murderer of Brian Thompson, CEO of United Health Group.

Hospitals and insurers are fighting over money, leaving patients in the lurch

Physicians Are Not Providers: The Ethical Significance of Names in Health Care: A Policy Paper From the American College of Physicians | Annals of Internal Medicine

noreply@blogger.com (Gary M. Levin) — Wed, 11 Feb 2026 15:36:00 +0000

Physicians Are Not Providers: The Ethical Significance of Names in Health Care: A Policy Paper From the American College of PhysiciansFREE

Authors: Lois Snyder Sulmasy, JD, and Jan K. Carney, MD, MPH 0000-0002-3822-0303, for the ACP Ethics, Professionalism and Human Rights CommitteeAuthor, Article, & Disclosure Information

Publication: Annals of Internal Medicine

https://doi.org/10.7326/ANNALS-25-03852

PDF/EPUB

Abstract

More than 25 years ago, Pellegrino and Relman noted the increasing commercialization of the learned professions, anticipating what many physicians are increasingly experiencing today: an impairment of their ability to practice in accordance with standards of medical ethics and professionalism. These hurdles to the physician’s ability to do right by the patient contribute to what leaders in medicine and the American College of Physicians have called deprofessionalization. An example is the use of the term provider to describe physicians and other health professionals. The use of this terminology has been reviewed in medical journal articles but has not been adequately explored as a matter of ethics and professionalism. Through that lens, this paper examines the trends, significance, and implications for patients, physicians, and health care of the use of the term provider.

What’s in a name? That which we call a rose
By any other name would smell as sweet…
—William Shakespeare, Romeo and Juliet (1)

With apologies to Shakespeare, names are important. In health care, they can have ethical significance.

The American College of Physicians (ACP) is concerned about the use of the term provider to describe physicians. Medical journal articles have criticized the term as deemphasizing professional identity, with particular negative ramifications for primary care because differences in training and expertise among clinicians are not recognized; others have found it to be ambiguous and disrespectful (2–5). Yet the use of provider has not been adequately examined as an ethical matter.

The word provider represents one of many challenges to ethics and professionalism posed by corporatization, commercialization, and physician employment, among other aspects of today’s practice environment (6–8). The issues are not new. From Galen to Paracelsus to Sir William Osler, distinguishing the patient–physician relationship from commercial transactions has been critical. As Osler said, “The practice of medicine is an art, not a trade; a calling, not a business…” (9).

It is also essential to consider the use of the term provider given changes in health care delivery over time. Changing societal and cultural expectations are embedded in physicians’ roles and the context of care, such as challenges posed by electronic health records and technological advances. Civil rights and consumer movements (8) have stimulated greater patient engagement, especially in medical decision making, and led to increased self-management by patients.

In 1980, Relman described the rise of the “medical-industrial complex” (10); in 1999, Pellegrino and Relman examined the increasing commercialization of the learned professions (11). They anticipated what many clinicians experience today: deprofessionalization, an impairment of the ability to practice according to the precepts of ethics and professionalism (7, 11). Has language helped cause these shifts, is language a result of them, or are both true? This paper examines trends and implications for patients, physicians, and health care of the term provider from the perspective of medical ethics and professionalism.

Methods

This paper was developed on behalf of the ACP Ethics, Professionalism and Human Rights Committee (EPHRC). Committee members abide by the ACP’s conflict-of-interest policy and procedures; appointment to the EPHRC and its procedures are governed by the ACP’s bylaws. Following environmental assessment to determine the scope of issues and literature reviews, the EPHRC evaluated and discussed drafts of the paper; it was then reviewed by the ACP Board of Governors, Board of Regents, Council of Early Career Physicians, Council of Resident/Fellow Members, Council of Student Members, and other committees and experts and was revised to incorporate comments from these groups and individuals. The ACP Board of Regents approved the paper on 26 July 2025.

Origins of Words Associated With Care

Paydarfar and Schwartz trace the origin of the use of the word provider to Medicare and Medicaid law (1965), which refers to “any provider of services” (2). They found it to be a “peculiar descriptor” when applied to physicians given its common use to describe suppliers delivering products and services to markets. Goroll describes the use of provider for hospitals or networks referring to institutions or insurers (3) but not for human-to-human relationships and interactions. Use of provider before the 1960s has been historically contested (12), but the term has clearly evolved to encompass diverse types of clinicians.

Medical care is not a mere service. This is especially apparent in the origins of words associated with care. The Oxford English Dictionary defines the origins of the terms patient, physician, and medicine. Patient is from the Latin patiens, for one who suffers. This word refers to the vulnerability often brought on by illness. Doctor comes from the Latin docere (“to teach”). Physick originally meant medical treatment or remedy; one who practiced physick was a physician. By the 18th century, physic referred to the practice of medicine. Compassion comes from the Latin compassio, meaning “to suffer with.” Compassion is essential to the patient–physician relationship; it is not just empathy or kindness but refers to supporting the patient in need and acting with and for the patient. These words help convey the significance of what is at stake in medical care.

The Implications of Language for Care and for Ethics and Professionalism

Language has myriad implications for health care as well as for ethics and professionalism. First, the current use of provider in reference to institutions, insurers, physicians, nurses, physician assistants, and other clinicians lumps impersonal entities in with humans and obscures differences in clinical training and expertise (3). For patients, who need to be aware of the important and different roles of health care team members, such distinctions may not be transparent.

Second, the duties of physicians differ from those of individuals and entities who deliver commercial and other services. The physician’s ethical responsibilities are primary when delivering patient care—arising from the patient’s experience of illness—and inform the nature of medical decisions in the context of diagnosing and treating illness and preventing disease (13). The patient–physician interaction focuses on maintaining or improving the health of the patient. This partnership is not transactional but rather relational, with the patient seeking care from a physician who is trained to help and bound by ethical duties to do so.

Patients are not mere consumers; they have dignity and individual needs. The physician must act in the patient’s best interests (the ethical principle of beneficence, promoting the good of the patient), even when it is counter to the physician’s own interests or conflicts. The physician must avoid doing harm (the duty of nonmaleficence), such as unnecessary tests and procedures; respect patient autonomy; and consider issues of justice, such as equity and the responsible stewardship of resources (8).

Third, use of the term provider undermines ethics and professionalism. Medicine is dedicated to serving others whose trust must be earned. As quoted in the ACP Ethics Manual, Francis Peabody said that medicine is not “a trade to be learned, but a profession to be entered” (8), with publicly declared values (in Latin, the “profess” in “profession”) and ethical duties to uphold. The professional prerogatives and rights that society grants to physicians include expectations that physicians will use their role to benefit patients. Physicians are accountable to the public for their professional actions (8). The mission of hospitals was once aligned with and supported the ethical duties of physicians to serve the needs of patients first and to avoid commercialism (14), but that role has often been compromised. Admittedly, professionalism and commerce coexist in medicine to advance clinical practice and research; it becomes problematic when underlying motivations are economic and not ethical (14). Today, commerce and professionalism are imbalanced, with the forces of commercialism growing (7).

The term profession is often used loosely. But medicine is a learned profession, of which there are only a few (15); it requires “educational breadth,” dedication to service, and putting patient care above self-interest to fulfill a “fundamental human need.” Altruism and the desire to help people need to be fundamental motivators in this ethical endeavor that is committed to the welfare of patients (15).

A physician should be a trusted confidant, counselor, advocate, and partner in times of need. Since Hippocrates, physicians have committed to putting the interests of patients first, utilizing their extensive knowledge, training, and experience to benefit patients and help keep them from harm. In contrast, providers provide. Business transactions need not focus on values or consider the interests of consumers before those of stockholders and owners.

Fourth, language not only affects the perception and value attributed to what is being provided but can also alter one’s professional sense of self and influence behavior (2, 16). Communication and language are key. To quote Robert M. McLean, MD, former president of ACP, “Patients share things with us that they share with nobody else, including close family” (17). Language should focus on “health and not healthcare, on relationships and not transactions, and on people and not products” (18). Terms such as “covered lives,” patient “leakage,” and others that focus on the “healthcare industry” undermine the physician’s role and should be avoided. Health care should be 2 words: health (including the opportunity for its fulfillment for all [19]) and care (attending to patients).

Recommendation

Language in health care has ethical and practical implications. Physicians should be referred to as physicians, not providers. Also, when describing professionals with varied credentials who care for patients, the terms clinicians or health care professionals, not providers, should be used.

Conclusion

ACP supports transformative changes to promote quality and access to health care. This objective needs to uphold the ethics of the patient–physician relationship, which is fundamental to the practice of medicine. The words physician and provider are not interchangeable. Provider undermines the physician’s ethical obligations, clinical integrity, and accountability, as well as trust in the patient–physician relationship. The term should not be used to describe physicians, nor should physicians use it to describe themselves, their team members, or their trainees.

Patients still want trusted, compassionate relationships and care by humanistic physicians who exercise independent clinical judgment and profess to heal when possible and to comfort always. Physicians should strive to fulfill these expectations, and language should recognize and support their individual and collective ethical responsibilities to serve patients.

References

Shakespeare W. Romeo and Juliet. Act 2, scene 2, lines 43-44. Dover Publications; 2014.

Physicians Are Not Providers: The Ethical Significance of Names in Health Care: A Policy Paper From the American College of Physicians | Annals of Internal Medicine

THE MEASLES EPIDEMIC

noreply@blogger.com (Gary M. Levin) — Wed, 11 Feb 2026 15:23:00 +0000

VACCINATE YOUR CHILDREN TODAY.

Measles, a disease that was wiped out returns with a vengeance. Measles can cause encephalitis with permanet long term brain damage.

https://x.com/Reuters/status/2021603900713767159?s=20