Science & Health

In February 2018 Melissa Hubbard underwent surgery to remove part of her colon. What she didn’t know until afterward was that her ovaries were removed as well.

Removing Hubbard’s ovaries had been recommended to Hubbard’s surgeon by her gynecologist to treat another painful condition that Hubbard was dealing with. But while the gynecologist had previously discussed the ovary surgery with her, Hubbard wasn’t ready to go forward with that procedure. She was unaware that the gynecologist had suggested it to the surgeon who was operating on her colon.

On Tuesday, the Wisconsin Supreme Court will hear oral arguments in a lawsuit that Hubbard has filed against the gynecologist, Dr. Carol Neuman. The lawsuit argues that Neuman’s recommendation to the surgeon without Hubbard’s knowledge was an act of medical negligence.

The lawsuit Hubbard filed against Neuman hasn’t gone to trial yet. The Ob/Gyn doctor, through her attorneys, argues that the lawsuit should be dismissed on summary judgment.

The lawsuit — and the doctor’s argument to throw it out — revolve around Wisconsin’s law that requires informed consent from patients for medical treatment.

Neuman’s lawyers argue that the doctor had no legal responsibility for Hubbard’s surgery under that law and no duty to tell Hubbard about what was merely Neuman’s recommendation to the surgeon, since Neuman didn’t perform the surgery herself.

A Rock County circuit judge disagreed with the doctor’s lawyers and rejected the summary judgment motion. The 4th District Wisconsin Court of Appeals upheld the circuit court’s refusal to dismiss the case. Now Neuman’s lawyers have asked the state Supreme Court to reverse those decisions.

Writing for a three-judge District 4 appeals court panel in March 2024, Judge Chris Taylor found that “the duty to inform a patient about ‘the availability of reasonable alternative medical modes of treatment and about the benefits and risks of these treatments’ applies to any physician who treats a patient, regardless of whether that physician actually performs the disclosed treatment options.”

According to the appeals court’s summary of the case, in 2018 Hubbard was in Neuman’s care for treatment of endometriosis — a condition in which the same sort of tissue that lines the inside of the uterus also grows outside the uterus. Endometriosis can cause pain as well as infertility, according to the Mayo Clinic.

In a medical note quoted in the original lawsuit, Neuman wrote that she told Hubbard she should consider having at least her left uterus tube and ovary removed, or both tubes and ovaries.

Those procedures would leave Hubbard unable to conceive a child, but Neuman wrote in her clinical note, “I believe her endometriosis is so severe she may need reproductive specialists to help her. She does not want to see them because her insurance does not cover this option.”

Hubbard did not agree to the removal of her reproductive organs, according to the lawsuit.

Neuman also referred Hubbard to a surgeon for a separate procedure: the removal of part of her colon due to a concern about cancer, according to Hubbard’s lawyer, Guy Fish of Milton.

Before the colon surgery, the doctor made a recommendation to the surgeon that he could remove Hubbard’s ovaries at the same time.

“Hubbard, prior to her surgery on February 13, 2018, at no time advised Neuman that she opted to have an ovary or ovaries be surgically removed” during the operation, however, according to Hubbard’s lawsuit.

Neuman and the surgeon, Dr. Michael McGauley, “engaged in pre-surgery discussions and planning … without including or briefing Hubbard,” the lawsuit states. At one point in their discussions, the plan was for Neuman to remove Hubbard’s tubes, ovaries and uterus, with McGauley performing the colon surgery in the same procedure.

Hubbard was not informed of those conversations, the lawsuit states. On the day that the surgery took place, McGauley performed the colon surgery and also removed Hubbard’s ovaries himself.

“Had Hubbard been apprised of Neuman’s pre-surgery recommendations to McGauley . . . Hubbard would have immediately cancelled the scheduled surgery for February 13, 2018 in order to consider all her options,” the lawsuit states.

Defending the motion to dismiss the case, Neuman’s lawyers have argued that a doctor’s recommendation to another doctor shouldn’t be subject to the state’s informed consent law.

“A recommendation is not an order or a prescription,” wrote Neuman’s legal team, from the Corneille Law Group in Madison, in a Supreme Court brief. The lawyers argued that not disclosing to Hubbard the recommendation Neuman made to the surgeon should not be treated as a violation of the state’s informed consent law.

“Treating physicians who discuss the patients’ care must be able to freely exchange their thoughts, opinions, advice and counsel without concern that they may each be liable for failing to disclose the content of those communications to the patient,” the brief for Neuman argues.

The brief asks the Supreme Court to send the case back to the Rock County circuit court with an order to dismiss the lawsuit.

But Hubbard’s lawyer argues that it’s in the interest of patients to encourage disclosure, including of communications among doctors.

“Doesn’t a treating physician more fully fulfill his/her duty by disclosing more pertinent medical information to the patient?” Fish asked in a brief to the high court.

The lower court also rejected the assertion that holding the gynecologist responsible for providing informed consent for her recommendation to the surgeon would squelch doctors from freely consulting one another.

In making their ruling, the appeals court judges focused on whether the state law would not apply to Neuman even assuming all of the factual allegations in the lawsuit were true.

The effect of Neuman’s recommendation — the loss of Hubbard’s ovaries without her knowledge ahead of time — was instrumental enough to consider Neuman a “treating physician,” even though she didn’t perform the surgery, the lower court judges wrote.

In making the recommendation to the surgeon, they wrote, Neuman arguably had a responsibility to disclose to the patient the risks of the procedure, the probabilities of success and any alternative treatments that might be available.

In short, they ruled, Neuman failed to make the case for dismissing the case outright.

Wisconsin Examiner is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Wisconsin Examiner maintains editorial independence. Contact Editor Ruth Conniff for questions: [email protected].

For her 14-year-old son’s whole life, Jessica Jackman’s main job has been caring for him.

That has meant constantly being by him to avoid falls, giving him seizure medication three-times daily to manage epilepsy, and carefully monitoring his food to avoid life-threatening risks of aspiration pneumonia.

For a few years, she’s been her son’s official paid caregiver through a new program that lets Idaho pay parents and spouses, instead of professional caregivers.

That program could end this month, as Idaho health officials say fraud and abuse have contributed to higher-than-expected program costs.

But Jackman and some disability advocates worry Idaho’s scarce direct care workforce — in relatively low-paid, demanding jobs that often require helping with day-to-day tasks like bathing — can’t meet kids’ needs.

“You’re opening up a lot of children and spouses to a higher incidence of hospitalization because people don’t understand the unique care that needs to happen for each person,” Jackman told the Idaho Capital Sun in an interview. “It can be a matter of life and death — and that’s not an exaggeration in our situation.”

The program, called Family and Personal Care Services, was federally approved during the COVID-19 pandemic to prevent COVID spread and address a direct care workforce shortage.

Even if the family caregiver program stopped, personal care services typically provided by direct care workers would remain, officials say.

If the federal Centers for Medicare and Medicaid Services approves, Idaho’s program could end Jan. 31.

If the federal Centers for Medicare and Medicaid Services approves, Idaho’s program could end Jan. 31. But the Idaho Department of Health and Welfare, in a letter sent Friday to providers, said Idaho didn’t yet have federal approval to end the program then and anticipated it didn’t have enough time to prepare for automatically changing authorizations on Feb. 1.

Spouses or parents can remain as direct care workers, the agency wrote in the letter, which the Sun obtained. But the letter asked stakeholders to encourage program participants with parent or spouse caregivers to “begin looking for alternative caregivers” and said the agency would notify providers when arrangements must be made.

Moves by the Idaho Legislature to reinstate the program aren’t expected until 2026 as officials work on safeguards, said Idaho Senate Health and Welfare Committee Chairwoman Juile VanOrden, R-Pingree.

“I don’t think we have any other programs in the state that supplement a salary … like this one does,” VanOrden told the Sun. “So it’s a unique program, and I think it has to have unique parameters around it.”

Idaho gives parents resources on how to continue care

When Idaho officials announced the move in November, they acknowledged many families correctly use the program and need it since they can’t find direct care workers. Officials pledged to help with resources and options.

The Idaho Department of Health and Welfare outlined available provider agencies in all counties through a directory, and worked with families on training other family members or family friends — but not a “legally responsible individual” like an aunt or grandparent — to become employed as direct care staff for family members, agency spokesperson Greg Stahl told the Sun in an email.

“Parents who want to continue to provide (personal care services) are encouraged to consider staying on as a direct care staff for another family in their community,” he said. “We also encourage families to look at receiving … services from multiple agencies if one agency alone is unable to meet all scheduled hours.”

Health and Welfare “is always available to work with families to problem solve if they are still having difficulty getting all … hours covered for their loved one and navigating any of these options,” he added.

Health agency continues pattern of putting disabled Idahoans at risk, disability group says

Disability Rights Idaho wrote in a public comment that Idaho’s waiver amendment to end the program “fails to provide sufficient assurances on how Idaho Medicaid will meet its obligation under Federal Medicaid law to assist families impacted by this program change and ensure a continuum of care.”

Referencing past watchdog reports that found shortcomings in Idaho health programs, Disability Rights Idaho officials wrote they are concerned the state health agency “continues to demonstrate a pattern or practice of inappropriate program management, oversight, and training which places Idahoans with disabilities, especially children, at risk for inadequate care and treatment, resulting in abuse, neglect, and exploitation.”

Even with the recently reported 10% growth in Idaho’s direct care workforce, the disability advocates wrote it’s unclear if there will be enough providers to serve children.

After submitting that public comment on Dec. 4, Disability Rights Idaho Executive Director Amy Cunningham told the Sun the organization heard from a parent who couldn’t find a direct care worker for their child after contacting 50 agencies.

The organization, Cunningham said, “is at a loss for understanding how Idaho Medicaid meets its obligations to Medicaid eligible children.”

In a 2022 report, the National Council on Disability recommended federal flexibilities that let Medicaid programs pay family members as caregivers remain permanently.

The American Academy of Pediatrics endorsed family caregiver programs for children with special health needs. A 2023 study found Colorado’s paid family caregiver program for children showed promise for other states to draw on, but needed more study and improvements.

How one parent became an advocate for family disability caregiver program

After he had brain cancer at 14 months old, Nathan Hill’s oldest son is physically and developmentally disabled.

The 15 year-old breathes through a tracheostomy tube, eats through a gastronomy tube and sleeps with a ventilator, Hill told the Sun in an interview.

For years, Hill said he’s been dealing with constant nurse shortages. And he’s been telling Idaho Medicaid it needs to pay parents to care for their kids with disabilities.

When new caregivers start, parents often spend a couple weeks training them, he said. That’s about how long some caregivers stay, he said.

“It’s not that we don’t want to do it. We love our children and our spouses,” Hill said. “It’s just that there’s nobody else to do it.”

“We are in this downward spiral of poverty. Because you’re always pulled away (from your career). And you’re filling in these shoes that the state would be paying somebody to fill, but there’s nobody to fill them,” he said.

In early 2023, Hill started advocating.

Advocates say officials didn’t notify work group of concerns before seeking program’s end

Before announcing the program’s potential end, Hill said state health officials told a work group for the program they wanted to make the family caregiver program permanent.

“At no point,” he said, “did they bring to the table their concerns.”

The work group needs to hear that, he said, to look at existing safeguards and plan out future measures to avoid fraud.

Asked why Health and Welfare didn’t notify the work group about fraud concerns before announcing the program’s planned end, Stahl said the agency hoped “this flexibility would work long-term and did not anticipate the unfortunate issues that have arisen over the last year.”

“Given active fraud and abuse investigations and time needed to confirm suspected trends, we were unable to share this information until we determined the full scope of the issues,” he said. “When we identified the significant number of issues and that some crossed over into health and safety concerns as well, we determined more extensive action was needed.”

Stahl also said because of a new law requiring legislative approval for Medicaid waivers, the agency believed adding more safeguards would’ve required legislative approval in 2025.

“The current structure to allow for parents and spouses as paid caregivers does not provide the appropriate level of oversight given the significant growth in the number of families” that applied, Stahl said. “This poses significant health and safety risks to participants being served in addition to fraud and abuse of the program; we are required to take swift action to address these issues.”

While alleged fraud is under investigation, officials release little information

In response to one public records request seeking program data by a community member, the agency replied the request would cost $12,150 to fulfill. In response to a separate request for information about fraud and abuse claims, the agency said it didn’t have such records — but offered a three-page explanation of fraud allegations that the agency said wasn’t legally required.

The agency shared that letter with the Sun.

Twenty-two personal care agencies were being audited by a health agency unit, the letter read, for “ineligible payments to legally responsible individuals,” which refers to family members eligible to be paid caregivers under the program.

But Hill said those provider agencies were actually being audited for a billing issue that he says stems from Health and Welfare not adequately notifying agencies that family caregivers couldn’t be paid for providing homemaker services, such as preparing meals or doing laundry, to adults with disabilities, but that outside direct caregivers could.

The agency wrote it couldn’t speak to the status of cases being handled by the Attorney General’s Office, but said “so far, no criminal charges have been filed.”

The records request response letter provided by the agency was partly redacted. But it appears to be dated as early as Nov. 14, according to a copy of a similar, unredacted letter the Sun obtained.

Health and Welfare wouldn’t tell the Sun how many cases of program fraud and abuse it notified law enforcement of, saying it couldn’t comment on pending investigations. But asked if charges were filed or if the agency alleges illegal use, Stahl said “fraud and abuse of this benefit has been confirmed.”

Some families didn’t want outside caregivers

Jackman’s son is non-verbal, she said, but uses a device to help communicate and gives cues through his body language.

“I know exactly what he needs,” Jackman said.

She cared for him without pay until a few years ago, when she signed up as a paid family caregiver, after learning about the program from parents who went to the same clinic as her son.

But even if she’d known her son would qualify for an outside caregiver, Jackman doesn’t think she would’ve used one. Partly because bringing another person in the house risks her son developing an infection or needing hospitalization, since he’s immunocompromised.

Her son, she said, sometimes has seizures severe enough that an ambulance must visit.

Working with a direct care agency as a paid caregiver has helped to have people to consult on her son’s needs, she said.

But she’s heard it’d be difficult to find an outside caregiver to provide the level of care her son needs.

“You can’t learn these skills in school. It’s … hands-on learning,” Jackman said. “In fact, I have RNs that refer to me: ‘How do you care for this?’”

To Hill, a lot of what health officials outlined as fraud concerns weren’t “so much fraud, as it is a lack of educating.”

The program’s recent rapid enrollment growth doesn’t appear unusual, he said.

In 2015, fewer than 500 families were enrolled in Idaho’s professional caregiver program, according to Health and Welfare.

Hill thinks enrollment was low then because many families just gave up on the program — out of frustration with caregiver staffing shortages.

That’s what he did.

“We didn’t want anything to do with it,” Hill said, “because I don’t want somebody being paid 13-bucks an hour, coming in off the street, who doesn’t really care, and who I spend two weeks training, and who stays for two weeks, and then I’m down again for however long. And then I go through the next one and the next one. All the while, my son’s dignity is stripped.”

Over 1,100 enrollees, as of November, is less than what he’d expect across Idaho’s professional and family caregiver programs, since research finds at least .67% of kids are medically complex but population estimates show over 460,000 Idahoans are minors.

For the past five years that Hill has been a paid caregiver, he said his son has had no hospitalizations.

As program’s potential end nears, families prepare for ‘impossible juggle’

Citing growing costs, Idaho seeks to end parental disability care worker program

VanOrden, who chairs the Senate Health and Welfare Committee, said she doesn’t expect the Legislature to reinstate the program this year.

“I feel like I need time to get some data in place and actually to make a case to my colleagues here for bringing the program back and making sure that we have safeguards in place that they’re comfortable with. That will be a checks and balances for this program, because I think there wasn’t anything in there,” the senator told the Sun in an interview last week.

She also said she’d heard of state efforts to boost training for direct care workers, and she’s involved in conversations to ensure state-appropriated raises go to them.

If the program ends, Jackman said her mom can handle some of her son’s care hours as a direct care worker. Her older son may be able to help, too.

But since her mom physically can’t provide all the care her son needs, Jackman said she’d still be around.

“None of this will allow me to work outside of the home, or replace the needed hours,” she said.

If the program ends, Hill said he will keep working toward a permanent program.

But for his family, he said, “we will have to figure out how to do that impossible juggle.”

Idaho Capital Sun is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Idaho Capital Sun maintains editorial independence. Contact Editor Christina Lords for questions: [email protected].

Under President Joe Biden, enrollment in Medicaid hit a record high and the uninsured rate reached a record low.

Donald Trump’s return to the White House — along with a GOP-controlled Senate and House of Representatives — is expected to change that.

Republicans in Washington say they plan to use funding cuts and regulatory changes to dramatically shrink Medicaid, the nearly $900-billion-a-year government health insurance program that, along with the related Children’s Health Insurance Program, serves about 79 million mostly low-income or disabled Americans.

The proposals include rolling back the Affordable Care Act’s expansion of Medicaid, which over the last 11 years added about 20 million low-income adults to its rolls. Trump has said he wants to drastically cut government spending, which may be necessary for Republicans to extend 2017 tax cuts that expire at the end of this year.

Trump made little mention of Medicaid during the 2024 campaign. The first Trump administration approved work requirements in several states, though only Arkansas implemented theirs before a federal judge said it violated the law. The first Trump administration also sought to block grant funding to states.

House Budget Committee Chair Jodey Arrington (R-Texas) told KFF Health News that Medicaid and other federal entitlement programs need major changes to help cut the federal debt. “Without them, we will watch this country sadly enter into fiscal collapse.”

Rep. Chip Roy (R-Texas), a member of the Budget Committee, said Congress needs to explore cutting federal spending on Medicaid.

“You need wholesale reform on the health care front, which can include undoing a lot of the damage being done by the ACA and Obamacare,” Roy said. “Frankly, we could end up providing better service if we do it the right way.”

Advocates for poor people fear GOP funding cuts will leave more Americans without insurance, making it harder for them to get care.

“Medicaid is an obvious target for huge cuts,” said Joan Alker, executive director of Georgetown University’s Center for Children and Families. “An existential fight about Medicaid’s future likely lies ahead.”

Medicaid, which turns 60 in July, is nearing the end of a disruptive period, after covid pandemic-era coverage protections expired in 2023 and all enrollees had to prove they still qualified. More than 25 million people lost coverage over the 18 months after the “unwinding” began, though it has not notably increased the number of people without insurance, according to the latest census data.

The unwinding’s disruptions could pale in comparison to what happens in the next four years, said Matt Salo, former executive director and founder of the National Association of Medicaid Directors. “What we are going to see is an even bigger seismic shift in who Medicaid covers and how it operates,” he said.

But Salo said any efforts to shrink the program will face pushback.

“A lot of powerful entities — state governments, managed-care organizations, long-term care providers, and everyone under the sun who wants to do well by doing good — wants to see Medicaid work efficiently and be adequately funded,” he said. “And they will be highly motivated to push back on something they see as draconian cuts, because it could affect their business model.”

The GOP is looking at several tactics to reduce the size of Medicaid:

• Shifting to block grants. Switching to annual block grants could lower federal funding for states to operate the program while giving states more discretion over how to spend the money. Currently, the government matches a certain percentage of state spending each year with no cap. Republican presidents since Ronald Reagan have sought to block-grant Medicaid with no success. Arrington said he favors ending the open-ended federal funding to states and replacing it with a set annual amount based on how many people each state has in the program.
• Cutting ACA Medicaid funding. The ACA provided financing to cover, through Medicaid, Americans with incomes up to 138% of the federal poverty level, or $20,783 for an individual last year. The federal government pays 90% of the cost for adults covered through the law’s Medicaid expansion, which 40 states and Washington, D.C., have adopted. The GOP may try to lower that funding to the same match rate the feds pay states for everyone else in the program, which averages about 60%. “We should absolutely note that we are subsidizing the healthy, able-bodied Medicaid expansion population at a higher rate than we do the poorest and sickest among us, which was the original intent of the program,” Arrington said. “That’s not right.”
• Lowering federal matching funds. Since Medicaid began, the federal match rate has been based on the relative wealth of a state’s population, with poorer states receiving a higher rate and no state receiving less than a 50% match. Ten states get the base rate — all but two are Democratic-run states, including New York and California. The GOP may seek to cut the base rate to 40% or less.
• Adding work requirements. During the first Trump term, federal courts ruled that Medicaid law doesn’t allow coverage to be conditioned on enrollees’ working or seeking jobs. But the GOP may try again. “If we can get strict work requirements on able-bodied adults, that can be a huge cost savings by itself,” Rep. Tom McClintock (R-Calif.) told KFF Health News. Because most Medicaid enrollees already work, go to school, or serve as caregivers, critics say such a requirement would simply add red tape to obtaining coverage, with little impact on employment.
• Placing enrollment hurdles. About 10 states offer some populations what’s called continuous eligibility, whereby people stay enrolled for years without having to renew their coverage. That policy’s been shown to prevent enrollees from falling out of the program for short periods because of hardships or paperwork problems, which can lead to surprise medical bills and debt. The Trump administration could seek to repeal waivers that allow states to grant multiyear continuous eligibility, which would require people in those states to reapply for coverage annually.

If the GOP’s plans to shrink Medicaid are realized, Democrats and health experts say, low-income people forced to buy private insurance would face challenges paying monthly premiums and the large copayments and deductibles common to commercial plans that typically don’t exist in Medicaid.

The Paragon Health Institute, a leading conservative think tank run by former Trump adviser Brian Blase, has issued reports saying the billions in extra money states took to expand Medicaid under the ACA has been a boon to private insurers that manage the program and relatively wealthier people it says shouldn’t be enrolled.

Josh Archambault, a senior fellow with the conservative Cicero Institute, said he hopes the Trump administration holds states accountable for overpaying providers and enrolling people in Medicaid who are not eligible. Conservatives have cited CMS reports saying states improperly pay Medicaid providers billions of dollars a year, though the federal government notes that is mostly due to lack of documentation.

He said the GOP will look to scale back Medicaid to its “traditional” populations of children, pregnant women, and people with disabilities. “We need to rebalance the program that most people think is underperforming,” he said. Most Americans, including large majorities of both Republicans and Democrats, view the program favorably, according to polls.

Subscribe to KFF Health News' free Morning Briefing.

This article first appeared on KFF Health News and is republished here under a Creative Commons license.

The "winners" of the annual Shkreli Awards—named after notorious "pharma bro" Martin Shkreli and given to the 10 "worst examples of profiteering and dysfunction in healthcare"—include a Texas medical school that sold body parts of deceased people without relatives' consent, an alleged multibillion-dollar catheter scam, an oncologist who subjected patients to unnecessary cancer treatments, and a "monster monopoly" insurer.

The Shkreli Awards, now in their eighth year, are given annually by the Lown Institute, a Massachusetts-based think tank "advocating bold ideas for a just and caring system for health." A panel of 20 expert judges—who include physicians, professors, activists, and others—determine the winners.

This year's awardees are:

10: The University of North Texas Health Science Center "dissected and distributed unclaimed bodies without properly seeking consent from the deceased or their families" and supplied the parts "to medical students as well as major for-profit ventures like Medtronic and Johnson & Johnson," reporting revealed.

9: Baby tongue-tie cutting procedures are "being touted as a cure for everything from breastfeeding difficulties to sleep apnea, scoliosis, and even constipation"—despite any conclusive evidence that the procedure is effective.

8: Zynex Medical is a company facing scrutiny for its billing practices related to nerve stimulation devices used for pain management.

7: Insurance giant Cigna is under fire for billing a family nearly $100,000 for an infant's medevac flight.

6: Seven suppliers allegedly ran a multibillion-dollar urinary catheter billing scam that affected hundreds of thousands of Medicare patients.

5: Memorial Medical Center in Las Cruces, New Mexico allegedly refused cancer treatment "to patients or demanding upfront payments, even from those with insurance."

4: Dr. Thomas C. Weiner is a Montana oncologist who allegedly "subjected a patient to unnecessary cancer treatments for over a decade," provided "disturbingly high doses of barbiturates to facilitate death in seriously ill patients, when those patients may not have actually been close to death," and "prescribed high doses of opioids to patients that did not need them." Weiner denies any wrongdoing.

3: Pharma giant Amgen was accused of pushing 960-milligram doses of its highly toxic cancer drug Lumakras, when "a lower 240mg dose offers similar efficacy with reduced toxicity"—but costs $180,000 less per patient annually at the lower dose.

2: UnitedHealth allegedly exploited "its vast physician network to maximize profits, often at the expense of patients and clinicians," including by pressuring doctors "to reduce time with patients and to practice aggressive medical coding tactics that make patients seem as sick as possible" in order to earn higher reimbursements from the federal government."

1: Steward Health Care CEO Dr. Ralph de la Torre was accused of orchestrating "a dramatic healthcare debacle by prioritizing private equity profits over patient care" amid "debt and sale-leaseback schemes" and a bankruptcy that "left hospitals gutted, employees laid off, and communities underserved" as he reportedly walked away "with more than $250 million over the last four years as hospitals tanked."

"All these stories paint a picture of a healthcare industry in desperate need of transformation," Lown Institute president Dr. Vikas Saini said during the award ceremony, according toThe Guardian.

"Doing these awards every year shows us that this is nothing new," he added. "We're hoping that these stories illuminate what changes are needed."

The latest Shkreli Awards came just weeks after the brazen assassination of Brian Thompson, CEO of UnitedHealth subsidiary UnitedHealthcare. Although alleged gunman Luigi Mangione has pleaded not guilty, his reported manifesto—which rails against insurance industry greed—resonated with people across the country and sparked discussions about the for-profit healthcare system.

Maryland has recorded its first case of bird flu in more than a year, after the virus was confirmed at a Caroline County farm through “routine sampling of a broiler operation,” according to a statement Friday from the Maryland Department of Agriculture.

It comes after the Highly Pathogenic Avian Influenza A(H5N1) virus was detected recently on two farms in Kent County, Delaware, the department said.

“This marks the first case of H5N1 at a Maryland commercial poultry operation since 2023 and the third commercial operation in the Delmarva region in the last 30 days when two Kent County, DE returned positive results,” the agency said Friday.

State officials have quarantined the affected properties, which are undergoing “depopulation” procedures – meaning chickens, usually thousands, will be killed in order to prevent the spread of the disease.That’s important, say state officials, public health researchers and farmers’ representatives, as bird flu has the potential to evolve into a harder-to-manage virus that, in the worst case, could lead to another pandemic.

The last time a commercial chicken farm in Maryland had a bird flu outbreak was in November 2023, also in Caroline County, according to data from the U.S. Department of Agriculture.

The Delmarva Chicken Association, a trade association for chicken farmers in Delaware, Virginia and Maryland, said in an email Wednesday, before the latest Maryland case was detected, that whenever H5N1 is detected on a chicken farm, “the chickens on the farm are depopulated to prevent the spread of the disease from farm to farm.”

Legionella cleared from last two affected state buildings; union calls for more water testing

Health officials said bird flu is not currently a major public health concern for the most people, either in the food supply or as a potential ailment. But they have been watching it more closely, as there have been cases where it spread from birds to mammals and recently led to the death of a backyard chicken farmer in Louisiana, the first U.S. death of a person from contracting H5N1.

“The risk is still low to everybody. Our food supply in terms of eggs and poultry are safe, because these infected animals never make it into the food supply,” said Andrew Pekosz, a professor and virologist at Johns Hopkins Bloomberg School of Public Health.

“They shouldn’t be overly concerned at this point in this time with these infections, but it’s very sobering to public health officials and virologists like myself,” he said.

Pekosz said researchers are monitoring bird flu closely for signs that it could develop into the next pandemic.

“It’s something that we’re trying to prepare for,” Pekosz said. “We know that H5N1 has signatures that would classify it as a virus that could cause a pandemic, were it to infect and start to spread among humans.”

Bird flu has been around for many years, but has been of particular interest within the past two years as more migratory birds have been infected than in previous years, and more cases of bird flu are being detected in mammals

“From a public health perspective, the issue is every time this virus sees a mammal, it has the potential to pick up mutations to make it better able to replicate in mammals, and as it does that, it will also pick up mutations that will probably make it better at infecting humans,” Pekosz said. “That’s when it becomes a real pandemic threat.”

At the moment, however, the threat to the general public is still low. Those most at risk are workers on chicken farms or those who work with backyard flocks. Pekosz said those handling birds or responsible for depopulation should adhere to already established biosecurity measures, which include wearing protective gear and washing hands when exposed to flocks.

“This is one of those things where the general public is relatively safe – it’s an example of how the system worked in terms of detecting these viruses early,” Pekosz said.

The Delmarva Chicken Association said that broiler chickens, those raised for meat production, are routinely tested for bird flu before slaughter.

“It’s also important to note that on Delmarva, every broiler chicken flock is tested for HPAI before harvesting – so there is constant HPAI testing happening even when there is no active HPAI situation in the region,” the association said in a recent email. “That’s done to ensure that only healthy broiler chickens enter the food supply.”

Should bird flu develop into a full-fledged pandemic, Pekosz noted that scientists know much more about how H5N1 works than they did when COVID-19 first arrived a few years back.

“We’re actually much better prepared … We have some sense of how it’s spreading,” he said. Pekosz added that there is currently a H5N1 vaccine under development, and that some antiviral treatments for seasonal influenza also work on H5N1.

“When SARS‑CoV‑2 first emerged, we knew nothing about it — we had to go from zero up to some level of understanding and response,” Pekosz said. “We’re not starting from zero here. We’re fairly well prepared. It’s really more of a matter of how efficiently we can roll out responses to H5N1.”

Maryland Matters is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Maryland Matters maintains editorial independence. Contact Editor Steve Crane for questions: [email protected].

The Georgia Department of Agriculture announced it had detected a case of Highly Pathogenic Avian Influenza, sometimes called bird flu, in a small, backyard flock of chickens and ducks in Clayton County. This is the fourth detection of HPAI in Georgia since a nationwide outbreak began in February 2022, according to the department.

The illness is a highly contagious viral disease that can decimate flocks of birds, both domestic and wild, and can sometimes spread to mammals, including humans. As of Jan. 6, there have been 66 confirmed human cases of H5N1 bird flu in the U.S., including one case in Louisiana in which a patient died.

The Centers for Disease Control and Prevention is also tracking an outbreak of bird flu in dairy cows in 16 states, not including Georgia. At least 40 humans have contracted the disease from cows, in what the CDC calls the first instance of likely mammal-to-human spread. No human-to-human spread has been identified.

When a sick bird is detected, the entire flock is euthanized, which can be economically devastating for commercial farmers with large numbers of birds, and the outbreak has been blamed for contributing to higher prices for eggs, poultry and dairy.

“As the ongoing, nationwide HPAI outbreak continues, implementing and maintaining strict biosecurity measures has never been more important,” said Georgia Agriculture Commissioner Tyler Harper. “To date, the ongoing outbreak has impacted more than 133 million birds nationwide and less than .025% of those birds have been from Georgia, the nation’s top poultry producer – that speaks to the effectiveness of biosecurity and the importance of the work our animal health professionals and poultry producers are doing every single day to ensure the safety of their animals, employees, and operations.”

After confirming the presence of HPAI from a dead bird Wednesday, workers from the Georgia Department of Agriculture visited the affected premises on Thursday to “complete depopulation, cleaning & disinfection and disposal operations,” the department said in a release.

The department said the flock was in a residential neighborhood near a lake that is frequented by wild birds, particularly waterfowl which are known carriers of HPAI.

The department believes transmission most likely came from the wild birds or from viral material they shed into the environment. The department noted there are no commercial poultry or dairy cattle operations within six miles of the affected flock.

The Department of Agriculture encourages owners of poultry flocks to closely observe their birds and report a sudden increase in the number of sick birds or bird deaths to the Avian Influenza Hotline at 770-766-6850.

Georgia Recorder is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Georgia Recorder maintains editorial independence. Contact Editor John McCosh for questions: [email protected].

"Will this be the event that finally wakes everyone up?" wondered climate scientist Peter Kalmus on Thursday, with Los Angeles in its third day of multiple fires consuming large swaths in and around the city, forcing residents to flee and leaving destruction in their wake.

Late Thursday, the Los Angeles Times, citing officials, reported that at least 10 people have been killed by the blazes and upward of 9,000 homes, businesses, and other buildings appear to have been destroyed or damages in the two largest fires, the Palisades and Eaton fires.

The fires, now in their fourth day and still largely not contained, could be "at least collectively, the costliest wildfire disaster in American history," Daniel Swain, a climate scientist at the University of California, Los Angeles told the LA Times.

AccuWeather, a weather data and news company, on Thursday estimated damage and economic losses from the fires at $135-150 billion. A JPMorgan analyst, Jimmy Bhullar, gave a smaller figure to The Wall Street Journal on Thursday. He said that losses from the fires are pegged "close to $50 billion."

AccuWeather chief meterologist Jonathan Porter said that "fast-moving, wind-driven infernos" have spawned "one of the costliest wildfire disasters in modern U.S. history."

"To put this into perspective, the total damage and economic loss from this wildfire disaster could reach nearly 4% of the annual GDP of the state of California," Porter said.

For comparison, Hurricane Katrina, which devastated parts of the American South including New Orleans in 2005, cost $101 billion in 2023 dollars, according to the Insurance Information Institute, citing numbers from the insurance company Aon (other sources have put the cost of Hurricane Katrina at higher).

All told, the California Department of Forestry and Fire Protection counts five "currently active incidents" of fires burning in Los Angeles County. The Palisades Fire, which has so far burned over 20,000 acres, is 8% contained, and the Eaton Fire, which has burned more than 13,000 acres, is 3% contained. The Kenneth Fire, which has grown to 1,000 acres, is 35% contained. Two smaller fires, the Hurst Fire and the Lidia Fire, are 37% and 75% contained, respectively.

One homeowner in the Pacific Palisades remarked that his neighborhood "looks like Berlin—or it looks like some part of World War II...Everything is burned down. It’s just terrible."

The fire are also expected to deepen California's insurance crisis. San Francisco Chroniclereporting from last summer on data from 10 of the largest insurance companies revealed that more than 100,000 Californians lost their home insurance between 2019 and 2024. Insurance companies "overwhelmingly cited" wildfire risk as the reason for rolling back coverage.

California Insurance Commissioner Ricardo Lara on Thursday issued a one-year moratorium on homeowners insurance nonrenewals and cancellations for ZIP codes impacted by the fires.

Some Democratic lawmakers and other critics of congressional Republicans on Friday pointed to a document obtained by Politico as just the latest evidence that the looming GOP trifecta at the federal level poses a threat to working families nationwide.

"Americans: We just want higher wages and lower costs. Republicans: We are going to take away your healthcare," Rep. Pramila Jayapal (D-Wash.), chair emeritus of the Congressional Progressive Caucus, said in response to the reporting, which came as Republicans have taken control of both chambers of Congress and prepare for President-elect Donald Trump's inauguration in just over a week.

The one-page list originated from the House Budget Committee, chaired by Rep. Jodey Arrington (R-Texas), Politico reported, citing five unnamed sources. One of them explained that the "document is not intended to serve as a proposal, but instead as a menu of potential spending reductions for members to consider."

The document lists various policies that it claims would collectively cut up to $5.7 trillion. Republicans have been discussing how to offset the high costs of top priorities—specifically, Trump's immigration policies and plans for tax cuts that critics warn would largely benefit the wealthy, like the law he signed in 2017.

"In order to make his rich, billionaire buddies richer, Trump wants to kick millions off healthcare coverage and starve families. How does this help working families thrive?"

The policies are divided into eight sections, with headings that critics called "dystopian" and "Orwellian." The first calls for repealing "major" health rules from outgoing President Joe Biden's administration, which would supposedly cut $420 billion. The second section takes aim at Medicare, the federal health program for seniors, proposing policies that would cut $479 billion.

A large share of the potential cuts would come from section three, which lists seven potential changes to Medicaid, a program that provides health coverage to low-income people. The policies include per capita caps, work requirements, and lowering the federal medical assistance percentages (FMAP) floor.

"In order to make his rich, billionaire buddies richer, Trump wants to kick millions off healthcare coverage and starve families. How does this help working families thrive?" Michigan state Rep. Carrie Rheingans (D-47) asked on social media. "In this leaked list of cuts, 'lower FMAP floor' for Medicaid means states pay a higher proportion of Medicaid costs for enrollees—this just shoves [federal] costs to states so billionaires get more yacht money."

Section four of the document calls for "reimagining" the Affordable Care Act (ACA) to cut $151 billion, with changes that include repealing the Prevention and Public Health Fund, limiting eligibility based on citizenship status, and reclaiming $46 billion from subsidies set to expire at the end of the year.

The fifth section lays out $347 billion in cuts by "ending cradle-to-grave dependence," targeting initiatives including Temporary Assistance for Needy Families (TANF) and Supplemental Nutrition Assistance Program (SNAP), often called food stamps.

Section six claims "reversing Biden climate policies" would cut $468 billion: $300 billion by discontinuing some provisions from the 2021 bipartisan infrastructure legislation, $112 billion by rolling back electric vehicle policies, and $56 billion by repealing green energy grants from the Inflation Reduction Act (IRA).

The seventh section is a catchall, listing up to $1 trillion in potential cuts through moves that include ending student debt forgiveness, restricting emergency spending, and reforming federal employee benefits. Section eight identifies up to $527 in potential tax offsets from requiring Social Security numbers for the child tax credit and green energy credits.

House Speaker Mike Johnson (R-La.), who recently agreed to use the budget reconciliation process to cut $2.5 trillion, "can't afford any Republican defections if he wants to pass a package on party lines," Politico reported. "Even proposed cuts to green energy tax credits, worth as much as $500 billion, could be tricky—as the document notes, they depend 'on political viability.' Already 18 House Republicans—14 of whom won reelection in November—warned Johnson against prematurely repealing some of the IRA's energy tax credits, which are funding multiple manufacturing projects in GOP districts."

Sharing the report on social media Friday, Rep. Nydia Velázquez (D-N.Y.) stressed that "Republicans want to cut vital food and healthcare support programs to pay for a tax cut for billionaires and large corporations. The GOP wants working families to pay for their billionaire handouts."

In states where both medical and recreational marijuana are legal, fewer patients are filling prescriptions for medications used to treat anxiety. That is the key finding of my recent study, published in the journal JAMA Network Open.

Scientists have long puzzled over how pterosaurs became the first vertebrates to master flight. Some pterosaur species, such as the Quetzalcoatlus were the largest known animals to ever take to the skies, with wingspans of over ten meters (on par with military aircraft like the Spitfire). My team’s new study may help solve the evolutionary mystery, revealing how a vane on the tip of their tails may have helped these ancient animals fly more efficiently.

The U.S. district judge in Cleveland, Ohio handling a galaxy of claims stemming from the prescription opioid epidemic on Monday reiterated his belief that powerful drug middlemen are trying to stall cases against them.

One maneuver, he said, “borders on frivolous.” That’s not something lawyers want to hear from a judge in a case where $41 billion in settlements have already been awarded — and billions of their clients’ dollars are potentially at stake.

More than a half-million Americans have died from opioid overdoses since 1999, and the lives of countless more have been shattered.

Overprescription of opioids was a major cause of the epidemic. Wealthy interests made billions, while many ignored evidence that what they were doing was devastating Americans, their families, and their communities.

Since 2017, U.S. District Judge Dan Aaron Polster has been working to consolidate more than 2,000 claims in his Cleveland federal court. They were filed by towns, cities, counties, and Indian tribes against those behind the the flood of opioid pills: doctors who prescribed them, companies that made them, wholesalers that distributed them, pharmacies that sold them, and the pharmacy middlemen that facilitated the transactions.

So far, cases have been consolidated and settlements reached with wholesalers such as Dublin-based Cardinal Health. Manufacturers such as Teva, Allergan, and Janssen Pharmaceuticals also have settled.

In addition, pharmacy chains CVS, Walgreens, and Walmart have agreed to pay a combined $13.1 billion to settle claims that their negligent conduct fueled the scourge.

But when it comes to middlemen known as pharmacy benefit managers, lawyers are still in the process of deciding which of about 80 cases against them should be considered first. So any settlements might be far off.

The three largest middlemen — CVS Caremark, OptumRx, and Express Scripts — work on behalf of insurers to facilitate drug transactions. They negotiate rebates from drugmakers, they create pharmacy networks, and they determine reimbursements and reconcile claims.

Also known as PBMs, the big-three benefit managers control access to roughly 80% of insured Americans. They hold enormous sway over drugmakers because they decide on behalf of insurers which drugs to cover and which of those to give the most preferential treatment, often by not requiring a copayment.

To get preferential treatment — and thus sell more of their products — drugmakers pay PBMs huge rebates and fees. The system is far from transparent, but the PBMs pass a portion of that money along to their clients and keep a portion themselves.

Federal regulators have accused the big PBMs, each part of a massive health conglomerate, of using the system to push up rebates, list prices of drugs and out-of-pocket costs for patients, some of whom are among the least able to afford them.

Two recent journalistic investigations showed how opioid makers used the system of rebates and fees to get PBMs to do their bidding.

In October, Barron’s reported that between 2016 and 2017 oxycontin maker Purdue Pharma paid $400 million in rebates and fees to the big three PBMs. The story detailed a consultant’s report saying that Purdue officials knew that big rebates were key to keep the PBMs covering their products.

In 2020, Purdue pleaded guilty to several charges, including misleading the DEA as it marketed opioids to entities it had reason to believe were selling them illicitly, and to paying doctors kickbacks to write more opioid prescriptions. The company also agreed to pay $8.6 billion.

In December, the New York Times reported that the PBMs avoided or delayed putting limits on their opioid coverage in exchange for greater rebates and fees from the companies that made them. The foot dragging continued even as some executives pleaded for more responsible conduct, the story said.

As litigation against the PBMs proceeds in Cleveland, the companies are trying to avoid turning over personnel records of company officials before they sit for depositions in the case. The PBMs have asked Judge Polster to delay an order to turn over the records pending an emergency appeal to the 6th U.S. Circuit Court of Appeals in Cincinnati.

In an amended order filed on Monday, the judge wasn’t having any of it.

He noted that personnel records had been turned over in earlier parts of the multidistrict litigation, and that the PDM defendants were free to request the personnel records of anyone they planned to depose.

Polster also wrote that “this Court has long stated” that the PBMs could redact items such as addresses, phone numbers and medical history that the PBMs said they wanted to protect. Then he accused them of blatantly trying to stall.

“Ultimately, the PBMs’ request for emergency intervention by the Sixth Circuit regarding an everyday discovery matter borders on frivolous,” he wrote. “The Court believes the PBMs are wasting this Court’s and the Sixth Circuit’s time with a mandamus petition regarding the discoverability of current and former employees’ work background regarding compensation, discipline and commendations, job history, and so on.”

Ohio Capital Journal is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Ohio Capital Journal maintains editorial independence. Contact Editor David Dewitt for questions: [email protected].

A month after the killing of UnitedHealthcare CEO Brian Thompson prompted many Americans to share personal horror stories of the company's coverage denials and other practices, a doctor in Austin, Texas on Wednesday shared her own experience that she said exemplified how the for-profit health system "just keeps getting worse."

In a video posted to TikTok, Dr. Elisabeth Potter said she recently received an unprecedented phone call from UnitedHealthcare about a patient—one who was already under anesthesia and having surgery.

Potter, a plastic surgeon who specializes in reconstructive surgery for breast cancer patients who have had mastectomies, said she was performing a bilateral deep inferior epigastric perforator [DIEP} surgery when UnitedHealthcare called her in the operating room.

The call was urgent, she was told, and needed to be returned right away.

"So I scrubbed out of my case and I called UnitedHealthcare, and the gentleman said he needed some information about her," said Potter. "Wanted to know her diagnosis and whether her inpatient stay should be justified."

Potter found that the person calling wasn't aware that the patient whose care he was questioning had breast cancer and was in the operating room—that information was known by "a different department" at UnitedHealthcare.

Potter's account, said Nidhi Hegde, managing director at the American Economic Liberties Project, was "another horror story from a doctor dealing with United Healthcare's terrible authorization process."

"Ridiculous that doctors/nurses are spending time explaining their work to an insurance company instead of being able to focus on care," said Hegde.

As Common Dreams reported last month, cancer patients have become disproportionately affected by "prior authorizations" demanded by for-profit health insurers, which require doctors to get approval for treatments. Prior authorization can delay lifesaving care and one survey of oncologists in 2022 found that patients experienced "disease progression" 80% of the time an insurance company's bureaucratic requirements delayed their treatment.

Potter had to inform the UnitedHealthcare staffer that the company had already given her approval for the surgery.

She said she told him, "I need to go back and be with my patient now" and was able to continue the procedure.

"But it's out of control," she said. "Insurance is out of control. I have no other words."

Even before Thompson's killing, UnitedHealthcare has garnered outrage for the numerous methods it uses to deny healthcare coverage to patients.

A Senate investigation found the company intentionally denied claims submitted by nursing home patients who suffered strokes and falls, in order to increase profits. The company also faces a class-action lawsuit for using an AI algorithm with a 90% error rate to deny coverage to senior citizens with Medicare Advantage plans,

In December, ProPublica published an investigation that found the company is one of several insurers who repeatedly relied on the advice of company doctors who have wrongly recommended denying care.

In a follow-up video, Potter said on Wednesday that insurance companies have created "a fear-based system where, if an insurance company calls me and says I've got to call them right back, I'm afraid they're not going to pay for my patient's surgery, that patient is going to get stuck with a bill."

Potter toldNewsweek that the experience confirmed for her that "there is no room in healthcare where the pressure of insurance isn't felt by both patients and doctors. Not even the operating room."

UnitedHealthcare suggested in a comment to Newsweek that it did not call Potter during surgery, saying, "There are no insurance related circumstances that would require a physician to step out of surgery and it would create potential safety risks if they were to do so. We did not ask nor would ever expect a physician to interrupt patient care to answer a call and we will be following up with the provider and hospital to understand why these unorthodox actions were taken."

Potter joined many Americans in speaking out against the for-profit health insurance system in the days after Thompson's killing, offering a doctor's perspective.

"I want you to know that insurance companies are affecting the kind of care that you're getting, because they're applying pressures to physicians through their policymaking," said Potter in one video posted on TikTok. "This is a dark, dark time for healthcare, and we have to fix this or we're gonna go down a path that we can't get back from."

More than 4.6 million Florida residents enrolled in an Obamacare plan through the “Marketplace” for 2025 health insurance coverage.

Data released by the Centers for Medicare & Medicaid Services show that 4,633,650 residents signed up for insurance coverage through the Marketplace by the end of 2024.

Nationally, CMS reports that 23.6 million people enrolled for 2025 coverage, including 3.2 million new consumers. Total enrollment is record-breaking, CMS said in a statement.

Four insurance companies and 12 health maintenance organizations (HMOs) are participating in the Florida Marketplace, the Florida Office of Insurance Regulation website shows. HMO coverage is regional and people must live in the area an HMO is authorized to operate in to enroll in the managed care plan.

The Marketplace is a centerpiece of the Affordable Care Act, often referred to as Obamacare. President-elect Donald Trump has vowed to repeal the program but has offered no details.

“The Affordable Care Act health insurance marketplace and reforms have proven to be successful and critically important for millions of Americans and their families,” Health and Human Services (HHS) Secretary Xavier Becerra said in a prepared statement. “Every American should have access to quality, affordable health care — and thanks to the ACA, they do. The Affordable Care Act now stands along with Medicare, Medicaid, and Social Security as one of the most consequential social programs in the history of our nation.”

The CMS data does not show how many of the Florida consumers are new enrollees versus returning customers. But with 4,633,650 people enrolled, the data show that Florida leads the nation in enrollment. Rounding out the top three states for the most enrollment is Texas and California with 3,861,244 and 1,895,558 enrollees, respectively.

“Help is still available”

“We can’t lose sight of what’s behind our tremendous, record-setting progress: Millions of individuals and families who now have a critical connection to the lifeline of health care coverage,” said CMS Administrator Chiquita Brooks-LaSure. “To the millions more who may still need coverage: Don’t delay. Help is still available, including tax credits that have made coverage more accessible by reducing the barrier posed by high costs.”

Open enrollment for 2025 health insurance coverage began Nov. 1 and runs through Jan. 15. Health insurance coverage took effect Jan. 1 for consumers who enrolled by Dec. 15. Health insurance coverage takes effect Feb. 1 for those who enroll by Jan. 15.

Although Republicans in Florida have not expanded Medicaid to lower-income childless adults as the ACA allows, the federal health law is popular with residents who annually have flocked to the marketplace for health coverage. President-elect Donald Trump has promised to repeal the ACA but has provided no details.

“Nearly 24 million people, a record number, have signed up for Marketplace coverage — and the Open Enrollment Period is not over yet. The Affordable Care Act health insurance marketplace and reforms have proven to be successful and critically important for millions of Americans and their families,” said Becerra.

Florida Phoenix is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Florida Phoenix maintains editorial independence. Contact Editor Michael Moline for questions: [email protected].

Powerful Santa Ana winds, near hurricane strength at times, swept down the mountains outside Los Angeles and pushed wildfires into several neighborhoods starting Jan. 7, 2025. Over 1,000 stuctures, mostly homes, had burned and at least five people had died by Jan. 8. Officials urged more than 100,000 residents to evacuate, but with the winds so strong, there was little firefighters could do to control the flames.

Jon Keeley, a research ecologist in California with the U.S. Geological Survey and adjunct professor at UCLA, explains what causes extreme winds like this in Southern California, and why they create such a serious fire risk.

What causes the Santa Ana winds?

The Santa Ana winds are dry, powerful winds that blow down the mountains toward the Southern California coast.

The region sees about 10 Santa Ana wind events a year on average, typically occurring from fall into January. When conditions are dry, as they are right now, these winds can become a severe fire hazard.

Santa Ana winds blow down the mountains toward the coast, drying and warming as they descend. USGS

The Santa Ana winds occur when there is high pressure to the east, in the Great Basin, and a low-pressure system off the coast. Air masses move from high pressure to low pressure, and the more extreme the difference in the pressure, the faster the winds blow.

Topography also plays a role.

As the winds rush downslope from the top of the San Gabriel Mountains, they become drier and hotter. That’s a function of the physics of air masses. By the time the winds get to the point where the Eaton Fire broke out in Altadena on Jan. 7, it’s not uncommon for them to have less than 5% relative humidity, meaning essentially no moisture at all.

Canyons also channel the winds. I used to live in the Altadena area, and we would get days during Santa Ana wind events when the wind wasn’t present at all where we lived, but, a few blocks away, the wind was extremely strong.

These strong, dry winds are often around 30 to 40 mph. But they can be stronger. The winds in early January 2025 were reported to have reached 60 to 70 mph.

Why was the fire risk so high this time?

Typically, Southern California has enough rain by now that the vegetation is moist and doesn’t readily burn. A study a few years ago showed that autumn moisture reduces the risk of Santa Ana wind-driven fires.

This year, however, Southern California has very dry conditions, with very little moisture over the past several months. With these extreme winds, we have the perfect storm for severe fires.

Dark smoke from the fires was evident from the Santa Monica, Calif., pier on Jan. 8, 2025. AP Photo/Richard Vogel

It’s very hard to extinguish a fire under these conditions. The firefighters in the area will tell you, if there’s a Santa Ana wind-driven fire, they will evacuate people ahead of the fire front and control the edges – but when the wind is blowing like this, there’s very little chance of stopping it until the wind subsides.

Other states have seen similar fires driven by strong downslope winds. During the Chimney Tops 2 Fire in Tennessee in November 2016, strong downslope winds spread the flames into homes in Gatlinburg, killing 14 people and burning more than 2,500 homes. Boulder County, Colorado, lost about 1,000 homes when powerful winds coming down the mountains there spread the Marshall Fire in December 2021.

Have the Santa Ana winds changed over time?

Santa Ana wind events aren’t new, but we’re seeing them more often this time of year.

My colleagues and I recently published a paper comparing 71 years of Santa Ana wind events, starting in 1948. We found about the same amount of overall Santa Ana wind activity, but the timing is shifting from fewer events in September and more in December and January. Due to well-documented trends in climate change, it is tempting to ascribe this to global warming, but as yet there is no substantial evidence of this.

California is seeing more destructive fires than we saw in the past. That’s driven not just by changes in the climate and the winds, but also by population growth.

More people now live in and at the edges of wildland areas, and the power grid has expanded with them. That creates more opportunities for fires to start. In extreme weather, power lines face a higher risk of falling or being hit by tree branches and sparking a fire. The area burnt because of fires related to power lines has greatly expanded; today it is the major ignition source for destructive fires in Southern California.

Dogs have lived alongside humans for thousands of years. They have been used to hunt, guard, herd and perform many other tasks, but today they mainly act as companions. While their lives today may seem easy compared with their ancestors, they still face many stresses – including visits to the vet.

Since it was started in 2013 by the charity Alcohol Change UK, the Dry January challenge has significantly grown in popularity, becoming a very popular new year’s resolution. In 2023, 175,000 people officially signed up to take on the challenge of going alcohol-free for the entire month of January – and it’s likely many more will have done it unofficially.

Taking a month-long break from alcohol can have many benefits. And these benefits appear pretty quickly – across various aspects of health and wellbeing.

At the biological level, one month of abstinence is associated with reductions in liver fat, blood glucose and blood cholesterol.

A month of abstaining from alcohol can also have a range of psychological benefits, as found in one study on the Dry January challenge that I conducted with Alcohol Change UK.

The study looked at 4,232 adults who had signed up to participate in Dry January. Participants were surveyed just before the start of the challenge, with follow-up surveys conducted in the first week of February.

One of the key benefits of doing the Dry January challenge was better sleep. Over half of participants (56%) said their sleep quality was better by the end of the month.

Although many people believe alcohol facilitates sleep, alcohol use is actually shown to impair sleep quality and the amount of dream sleep a person gets. This can affect memory and concentration. Alcohol use can also make sleep apnoea worse.

It’s no wonder then that giving up alcohol – even temporarily – can benefit sleep quality. And alongside better sleep, 52% of the Dry January participants surveyed reported having more energy, while 50% said they had better overall health. In addition, 63% of participants reported Dry January helped with saving money.

In a subsequent study of 1,192 Dry January participants followed-up over six months, my co-author and I used validated questionnaires to assess psychological wellbeing and self-efficacy (a sense of being able to take on challenges). The study found significant improvements in both. That study also found that people who completed Dry January felt more in control of their drinking.

These benefits were found among all participants, but were more apparent in those who stayed dry for the whole month. But people who cannot commit to a full month may still benefit from abstaining even for a shorter time.

My co-author and I have also conducted a parallel study of the general population to compare people who were participating in the Dry January challenge to people not trying to change their drinking. The positive changes experienced by Dry January participants were not seen in the general population. This indicated that the positive, changes we saw were the result of participating in Dry January, and not due to seasonal variation in drinking or wellbeing.

Around half of the people who undertake Dry January return to their previous drinking levels – but feel they have a greater sense of control over it. Around 40% choose to make broader changes to their drinking – either by drinking on fewer days per week or drinking less on the days they do drink.

Tips for taking part

People who sign up for Alcohol Change UK’s Dry January challenge and those who engage with the campaign’s supporting materials are twice as likely to complete the challenge than those who try to go it alone. This may be because they have access to an online community of other participants who share tips for managing temptation and cravings. They also receive feedback on their achievements, and motivation to continue. Other studies have shown that having social support can help people to reduce alcohol use.

If you’re attempting to have a dry January, try to minimise opportunities to drink. For example, it may help not to have alcohol at home. If you do go out with friends to a restaurant or the pub, try planning ahead and work out what you will drink instead of what you usually order. Planning how to politely refuse offers of drinks may also help.

If you think it will be difficult to manage social pressure or expectations to drink, consider socialising in alcohol-free places and times. You could meet in a café rather than a pub or bar, or meet on Saturday morning rather than Saturday night.

Some people benefit from pairing up with another person: buddy systems can work, but may not be for everyone.

Dry January may not be appealing to all drinkers. It’s also not appropriate for those who experience alcohol dependence of addiction, and may need specialist support. But for many people who are motivated to change their drinking, it can be effective – and comes with numerous physical and psychological health benefits.

Richard de Visser, Professor of Health Psychology, Brighton and Sussex Medical School, University of Sussex

This article is republished from The Conversation under a Creative Commons license. Read the original article.

In a groundbreaking medical achievement in the UK, a 32-year-old woman from Manchester has undergone the country’s first liver transplant for advanced bowel cancer.

Bianca Perea was diagnosed with stage four bowel cancer in November 2021, with the disease having spread to all eight segments of her liver. Initially given a bleak prognosis, she responded really well to rounds of drug-based treatment. Yet despite the promising response, the disease still remained in her liver. Because the cancer was so widespread, only a transplant would be able to remove the disease.

Perea’s liver transplant was performed in the summer of 2024. She has remained cancer-free since then.

Although transplantation is more commonplace in treating primary liver cancers, Perea’s case adds to a growing body of research showing the procedure can benefit patients with advanced bowel cancer.

Bowel cancer (also known as colorectal cancer) is the fourth most common cancer in the UK. It accounts for 11% of all new cancer cases.

The disease can be particularly challenging to treat, especially when diagnosed at an advanced stage – even despite recent developments in immunotherapy. This is because bowel cancer often spreads to the liver – which complicates treatment options and can usually mean the disease is no longer curable.

The standard treatment approach for bowel cancer typically involves a combination of surgery to remove any tumours, alongside chemotherapy or radiation therapy. What treatment a patient receives will depend on the stage and location of the cancer.

For patients with advanced bowel cancer that has spread to the liver, treatment becomes even more complex. While cancer drugs and surgery often work, the disease usually comes back. And though liver surgery is possible in these cases, sometimes the disease is in areas of the liver too risky to surgically remove – or the cancer is too widespread, making it impossible to remove all the tumours while leaving enough healthy liver tissue. In such cases, the goal of treatment shifts from cure to managing symptoms and prolonging the person’s life.

If bowel cancer spreads to the liver, it complicates treatment. ALIOUI MA/ Shutterstock

But a transplant would be able to overcome these limitations. By replacing the entire liver, it effectively removes all cancerous tissue from the organ.

Research also suggests that the immune response triggered by the transplant may even help combat remaining cancer cells in the body – although the mechanism that causes this to happen is not fully understood.

Survival outcomes

It’s important to point out here that Perea’s success was likely due to a combination of treatments – including targeted drug therapy, chemotherapy and surgery to remove the primary bowel tumour before the transplant. She will now need to be monitored closely – including for the possibility of recurrence. It’s always possible that microscopic cancer cells we cannot see have been left behind. Patients such as Perea will need life-long immunosuppression drugs to ensure she doesn’t reject the transplant.

Still, Perea is not the first case of a liver transplant successfully curing bowel cancer in a patient. The body of evidence so far consistently shows liver transplantation, when used alone or with drug treatment (such as chemotherapy), improves five-year survival rates in bowel cancer patients compared to when only standard methods are used.

For example, one study from Norway showed a 60% to 83% five-year survival rate in patients who underwent a liver transplant for advanced bowel cancer that had spread to their liver.

A US study, conducted in similar bowel cancer patients, found that 91% of those who had received a liver transplant had survived when followed up three years later. In comparison, patients who’d opted to use only standard treatment methods had a 73% survival rate at follow-up.

Just as was the case with Perea, these studies all emphasise the importance of using a multi-faceted approach to manage bowel cancer. Most patients received additional anti-cancer drugs (including chemotherapy) before and after transplantation. More trials will now be needed to confirm the benefits of this treatment technique in a larger cohort.

It’s also important to note that this treatment is probably only suitable for a small percentage of patients – about 2% of those whose bowel cancer has spread to their liver. Strict selection criteria will be necessary to ensure the best outcomes.

We also need more data on long-term survival rates and quality of life for patients who undergo liver transplants for bowel cancer. Trials comparing liver transplantation to other advanced treatments are necessary to confirm its benefits. The ethical implications of using livers for cancer patients also needs to be carefully considered given the scarcity of donor organs.

The five-year survival rate for all stages of bowel cancer in the UK is currently a little over 50%. This highlights the need for more effective treatment options, particularly for advanced cases. Liver transplantation may be one potentially curative option in such instances.

Bianca Perea’s recent success represents a significant breakthrough. This will hopefully prompt much-needed research in the area so the technique can become a more widely adopted treatment strategy in the future for those who will most benefit.

Justin Stebbing, Professor of Biomedical Sciences, Anglia Ruskin University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Republican proposals to impose a per person cap on federal Medicaid funding or turn the government health insurance program for lower-income Americans into a block grant would leave millions of people without coverage or care, according to an analysis published Tuesday.

The Center on Budget and Policy Priorities (CBPP), a progressive think tank, examined GOP policy proposals including the per capita funding cap and making Medicaid a block grant and found that such policies "would dramatically change Medicaid's funding structure, deeply cut federal funding, and shift costs and financial risks to states."

"Faced with large and growing reductions in federal funding, states would cut eligibility and benefits, leaving millions of people without health coverage and access to needed care," CBPP added.

According to the analysis:

Many of those losing Medicaid coverage would be left unable to afford lifesaving medications, treatment to manage chronic conditions like cardiovascular disease and liver disease, and care for acute illnesses. People with cancer would be diagnosed at later stages and face a higher likelihood of death, and families would have more medical debt and less financial security. A large body of research shows that Medicaid improves health outcomes, prevents premature deaths, and reduces medical debt and the likelihood of catastrophic medical costs.

"Before resurrecting harmful per capita cap proposals, policymakers should consider how similar past proposals would have impacted states' budgets and thus their ability to support Medicaid enrollees," CBPP advised.

The analysis comes as Republicans—who control both houses of Congress and, starting on January 20, the White House as President-elect Donald Trump takes office—pursue a massive tax cut that would be funded in part by cutting social programs including Medicaid. GOP lawmakers are also considering work requirements for Medicaid recipients in order to help pay for the tax cut, which critics argue would primarily benefit rich people and corporations.

According to a 2024 report by the National Association of State Budget Offices, Medicaid—which, along with the related Children's Health Insurance Program, serves nearly 80 million U.S. adults and minors with limited income and resources—makes up more than half of all federal funding for states.

Total Medicaid spending was approximately $860 billion for fiscal year 2023, with the federal government contributing around 70% of the funds. The CBPP analysis notes that "under a per capita cap, states would get additional funding as the number of enrollees increased, but if the caps were set at an insufficient level, the state's funding shortfall would grow as more people enrolled."

The report also says that "the design of per capita caps can expose states to cuts even if spending falls below caps for some eligibility groups, and even if spending growth falls below the cap on average over time. And as the caps would be permanent, the size of the cuts and the number of states affected would continue growing over time. These losses in federal support would impose significant strain on states and put millions of people at risk of losing benefits and coverage."

Under a block grant, "the funding shortfall would be even worse since federal funding wouldn't change in response to enrollment increases," the analysis states.

"In short, recent proposals for a per capita cap or block grant would cause people to lose health coverage and benefits, shift costs and risks to states, and destabilize healthcare providers," the publication concludes. "The federal funding cuts to states would be large and unpredictable. Restructuring Medicaid's financing would also make the program highly vulnerable to future cuts, as it would impose a funding formula that could be easily ratcheted down further—for example, by setting the cap or its growth rate even lower. Policymakers should reject proposals for per capita caps and block grants and instead retain the current federal-state financial partnership."

The Louisiana patient who contracted what officials said was the nation’s first “severe” case of avian influenza has died, the state health department said Monday.

The person who contracted the H5N1 strain of highly pathogenic bird flu in southwest Louisiana had been hospitalized since mid-December. The patient was over age 65 and had an underlying medical condition, according to the Louisiana Department of Health. They contracted the virus from exposure to a combination of a non-commercial backyard flock and wild birds, officials have said.

State health workers have conducted an “extensive public health investigation” and identified no additional H5N1 cases nor evidence of person-to-person transmission, LDH said in a news release. The patient has been the only human case of H5N1 reported in Louisiana.

The state Department of Agriculture and Forestry has confirmed the presence of H5N1 in two “backyard flocks” in the state, one in Northwest Louisiana and another in Southwest Louisiana.

There have been 66 human cases of avian influenza confirmed in a total of 10 states, according to the U.S. Centers for Disease Control and Prevention. California has the most cases with 37, followed by Washington with 11 and Colorado with 10.

H5N1 infects birds and poultry. It can be passed on to humans who work in close contact with sick and dead birds. Human cases reported in other states have mostly been linked to dairy workers where the virus has been spread to cattle.

The virus can cause severe breathing problems and death in birds. Similar, severe flu-like symptoms can appear in humans, though the risk for public health is considered generally low.

Nearly 13 people out every 100,000 in Louisiana died annually from flu-related illnesses from 2018-22, based on the most recent figures available from the National Center for Health Statistics. That rate has decreased every year since 2020.

More than 12,400 persons in the U.S. who believed they were exposed to avian influenza have been monitored, according to the Centers for Disease Control and Prevention. Of that number, 560 have been tested for H5NI, resulting in confirmation of the 63 cases.

State health officials say the best way for families to protect themselves from H5N1 is to avoid sources of exposure, such as direct contact with wild birds or other animals that might be infected.

Experts also advise against eating uncooked or undercooked food. Cooking poultry, eggs and other animal products to the proper temperature helps lower the risk from any possible contaminants.

For anyone who works on poultry or dairy farms, health officials suggest talking to a health care provider about getting a seasonal flu vaccination. It will not prevent infection with avian influenza viruses, but it can reduce the risk of coinfection with avian and flu viruses.

Sick birds or animals should be reported to the U.S. Department of Agriculture at 1-866-536-7593 or the Louisiana Department of Agriculture and Forestry Diagnostic Lab at 318-927-3441.

Persons who suspect they were exposed to sick or dead birds or other animals or work on a farm where avian influenza has been detected should watch for respiratory symptoms or conjunctivitis (pink eye).

If you develop such symptoms within 10 days after exposure to sick or dead animals, officials urge you to tell your health care provider you have been in contact with sick animals and are concerned about avian influenza. This information will help them give you appropriate advice on testing and treatment.

Anyone who suspects they are infected with avian flu should stay away from others while symptomatic.

This is a developing story

Louisiana Illuminator is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Louisiana Illuminator maintains editorial independence. Contact Editor Greg LaRose for questions: [email protected].

Cannabis, cocaine and heroin have interesting life stories and long rap sheets. We might know them today as illicit drugs, but each was once legal.

Then things changed. Racism and politics played a part in how we viewed them. We also learned more about their impact on health. Over time, they were declared illegal.

But decades later, these drugs and their derivatives are being used legally, for medical purposes.

Here’s how we ended up outlawing cannabis, cocaine and heroin, and what happened next.

Cannabis, religion and racism

Cannabis plants originated in central Asia, spread to North Africa, and then to the Americas. People grew cannabis for its hemp fibre, used to make ropes and sacks. But it also had other properties. Like many other ancient medical discoveries, it all started with religion.

Cannabis is mentioned in the Hindu texts known as the Vedas (1700-1100 BCE) as a sacred, feel-good plant. Cannabis or bhang is still used ritually in India today during festivals such as Shivratri and Holi.

From the late 1700s, the British in India started taxing cannabis products. They also noticed a high rate of “Indian hemp insanity” – including what we’d now recognise as psychosis – in the colony. By the late 1800s, a British government investigation found only heavy cannabis use seemed to affect people’s mental health.

This drug bottle from the United States contains cannabis tincture. Wikimedia

In the 1880s, cannabis was used therapeutically in the United States to treat tetanus, migraine and “insane delirium”. But not everyone agreed on (or even knew) the best dose. Local producers simply mixed up what they had into a tincture – soaking cannabis leaves and buds in alcohol to extract essential oils – and hoped for the best.

So how did cannabis go from a slightly useless legal drug to a social menace?

Some of it was from genuine health concerns about what was added to people’s food, drink and medicine.

In 1908 in Australia, New South Wales listed cannabis as an ingredient that could “adulterate” food and drink (along with opium, cocaine and chloroform). To sell the product legally, you had to tell the customers it contained cannabis.

Some of it was international politics. Moves to control cannabis use began in 1912 with the world’s first treaty against drug trafficking. The US and Italy both wanted cannabis included, but this didn’t happen until until 1925.

Some of it was racism. The word marihuanais Spanish for cannabis (later Anglicised to marijuana) and the drug became associated with poor migrants. In 1915, El Paso, Texas, on the Mexican border, was the first US municipality to ban the non-medical cannabis trade.

By the late 1930s, cannabis was firmly entrenched as a public menace and drug laws had been introduced across much of the US, Europe and (less quickly) Australia to prohibit its use. Cannabis was now a “poison” regulated alongside cocaine and opiates.

The 1936 movie Reefer Madness fuelled cannabis paranoia. Motion Picture Ventures/Wikimedia Commons

The 1936 movie Reefer Madness was a high point of cannabis paranoia. Cannabis smoking was also part of other “suspect” new subcultures such as Black jazz, the 1950s Beatnik movement and US service personnel returning from Vietnam.

Today recreational cannabis use is associated with physical and mental harm. In the short term, it impairs your functioning, including your ability to learn, drive and pay attention. In the long term, harms include increasing the risk of psychosis.

But what about cannabis as a medicine? Since the 1980s there has been a change in mood towards experimenting with cannabis as a therapeutic drug. Medicinal cannabis products are those that contain cannabidiol (CBD) or tetrahydrocannabinol (THC). Today in Australia and some other countries, these can be prescribed by certain doctors to treat conditions when other medicines do not work.

Medicinal cannabis has been touted as a treatment for some chronic conditions such as cancer pain and multiple sclerosis. But it’s not clear yet whether it’s effective for the range of chronic diseases it’s prescribed for. However, it does seem to improve the quality of life for people with some serious or terminal illnesses who are using other prescription drugs.

Cocaine, tonics and addiction

Several different species of the coca plant grow across Bolivia, Peru and Colombia. For centuries, local people chewed coca leaves or made them into a mildly stimulant tea. Coca and ayahuasca (a plant-based psychedelic) were also possibly used to sedate people before Inca human sacrifice.

In 1860, German scientist Albert Niemann (1834-1861) isolated the alkaloid we now call “cocaine” from coca leaves. Niemann noticed that applying it to the tongue made it feel numb.

But because effective anaesthetics such as ether and nitrous oxide had already been discovered, cocaine was mostly used instead in tonics and patent medicines.

Hall’s Coca Wine was made from the leaves of the coca plant. Stephen Smith & Co/Wellcome Collection, CC BY

Perhaps the most famous example was Coca-Cola, which contained cocaine when it was launched in 1886. But cocaine was used earlier, in 1860s Italy, in a drink called Vin Mariani – Pope Leo XIII was a fan.

With cocaine-based products easily available, it quickly became a drug of addiction.

Cocaine remained popular in the entertainment industry. Fictional detective Sherlock Holmes injected it, American actor Tallulah Bankhead swore by it, and novelist Agatha Christie used cocaine to kill off some of her characters.

In 1914, cocaine possession was made illegal in the US. After the hippy era of the 1960s and 1970s, cocaine became the “it” drug of the yuppie 1980s. “Crack” cocaine also destroyed mostly Black American urban communities.

Cocaine use is now associated with physical and mental harms. In the short and long term, it can cause problems with your heart and blood pressure and cause organ damage. At its worst, it can kill you. Right now, illegal cocaine production and use is also surging across the globe.

But cocaine was always legal for medical and surgical use, most commonly in the form of cocaine hydrochloride. As well as acting as a painkiller, it’s a vasoconstrictor – it tightens blood vessels and reduces bleeding. So it’s still used in some types of surgery.

Heroin, coughing and overdoses

Opium has been used for pain relief ever since people worked out how to harvest the sap of the opium poppy. By the 19th century, addictive and potentially lethal opium-based products such as laudanum were widely available across the United Kingdom, Europe and the US. Opium addiction was also a real problem.

Because of this, scientists were looking for safe and effective alternatives for pain relief and to help people cure their addictions.

In 1874, English chemist Charles Romley Alder Wright (1844-1894) created diacetylmorphine (also known as diamorphine). Drug firm Bayer thought it might be useful in cough medicines, gave it the brand name Heroin and put it on the market in 1898. It made chest infections worse.

Allenburys Throat Pastilles contained heroin and cocaine. Seth Anderson/Flickr, CC BY-NC

Although diamorphine was created with good intentions, this opiate was highly addictive. Shortly after it came on the market, it became clear that it was every bit as addictive as other opiates. This coincided with international moves to shut down the trade in non-medical opiates due to their devastating effect on China and other Asian countries.

Like cannabis, heroin quickly developed radical chic. The mafia trafficked into the US and it became popular in the Harlem jazz scene, beatniks embraced it and US servicemen came back from Vietnam addicted to it. Heroin also helped kill US singers Janis Joplin and Jim Morrison.

Today, we know heroin use and addiction contributes to a range of physical and mental health problems, as well as death from overdose.

However, heroin-related harm is now being outpaced by powerful synthetic opioids such as oxycodone, fentanyl, and the nitazene group of drugs. In Australia, there were more deaths and hospital admissions from prescription opiate overdoses than from heroin overdoses.

In a nutshell

Not all medicines have a squeaky-clean history. And not all illicit drugs have always been illegal.

Drugs’ legal status and how they’re used are shaped by factors such as politics, racism and social norms of the day, as well as their impact on health.

Philippa Martyr, Lecturer, Pharmacology, Women's Health, School of Biomedical Sciences, The University of Western Australia

This article is republished from The Conversation under a Creative Commons license. Read the original article.