Study Reveals Radiotherapy Benefits Persist for a Decade in Breast Cancer Patients A recent published study journal in the Lancet oncology states that providing radiotherapy after surgery could prevent breast cancer from returning in the same place for up to 10 years. This protective effect is limited after a decade, when the risk of cancer recurrence is similar to that in those who have not received radiotherapy. The findings provide a more complete picture of the long-term benefits of radiotherapy with breast cancer surgery, followed by radiotherapy which remains the standard care for women with early-stage breast cancer. Radiotherapy targets high doses of radiation to the breast to destroy any remaining cancer cells after removal of the tumour.The Scottish Breast Conservation Trial, led by the University of Edinburgh, looked at 585 women who received treatment for early-stage breast cancer in Scotland – half received radiotherapy and half did not. The average follow-up period for patients was 18 years, with some cases followed for more than three decades.After 10 years, 16 per cent of those who had radiotherapy had experienced the return of their cancer in the same location, compared with 36 per cent of those who did not have the treatment. Despite a reduction in cancer recurrence, survival rates did not improve with radiotherapy treatment. Average overall survival rates after 30 years were similar for those who received postoperative radiotherapy and those who did not – 19.2 years and 18.7 years, respectively. There were fewer deaths from breast cancer among those who received radiotherapy than those who did not – 37 per cent versus 46 per cent. By contrast, there were more deaths from other cancers in the group who received radiotherapy – 20 per cent versus 11 per cent.Based on the study findings, it can be concluded that radiotherapy for breast cancer provides substantial and sustained benefits, significantly reducing the risk of recurrence and mortality over a period of at least ten years. These long-term advantages underscore the importance of radiotherapy as a critical component of breast cancer treatment protocols, highlighting its role in improving patient outcomes and survival rates. The study's results support continued use and optimization of radiotherapy techniques to maximise its effectiveness for breast cancer patients.References: Reanalysis and results after 12 years of follow-up in a randomised clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med. 1995; 333: 1456-1461The global intake of sugar-sweetened beverages is rising among children and teenagers: Study A recent published study in the journal BMJ, A new global analysis of the dietary habits of children and adolescents from 185 countries revealed that youth, on average, consumed nearly 23% more sugar-sweetened beverages in 2018 compared to 1990. Overall, intakes were similar in boys and girls, but higher in teens, urban residents, and children of parents with lower levels of education.The study drew from the Global Dietary Database, a large comprehensive compilation of what people around the world eat or drink, to generate the first global estimates and trends of sugar-sweetened beverage intake in youth. These were defined as soda, juice drinks, energy drinks, sports drinks, and home-sweetened fruit drinks such as aguas frescas with added sugars and containing more than 50 kcal per 1 cup serving. The research team found that youth were drinking more and had nearly twice the overall intake of adults. Sugar-sweetened beverage intake among young people varied dramatically by region, averaging 3.6 servings per week globally and ranging from 1.3 servings per week in South Asia to 9.1 in Latin America and the Caribbean. The researchers found that children and teens in 56 countries, representing 238 million young people or 10% of the global youth population, averaged 7 or more servings per week.In recent years, many governments worldwide have been implementing measures such as soda taxes and restrictions on the sale of sugary drinks in schools to promote healthy dietary habits. These efforts are new and also face strong opposing forces such as aggressive industry marketing and the globalisation of the food sector.It is concluded that the intake of sugar-sweetened beverages (SSBs) is on the rise globally among children and teenagers, posing significant public health concerns. The increasing consumption of SSBs is associated with various adverse health outcomes, including obesity, type 2 diabetes, and dental cavities. The findings emphasise the urgent need for effective public health strategies and policies to reduce SSB consumption in young populations, such as educational campaigns, taxation, and restrictions on marketing targeted at children and adolescents. Addressing this growing trend is crucial for improving the long-term health and well-being of future generations.References: Wang Y, Lobstein T. Worldwide trends in childhood overweight and obesity. Int J Pediatr Obes 2006;1:11–25 [PubMed] [Google Scholar]Study reveals coronary atherosclerosis prevalent even in low-risk adults with normal cholesterol levelsIn a recent study published in the journal JACC Advances, researchers examined the presence of coronary atherosclerosis using coronary computed tomography angiography (CCTA) in asymptomatic adults without traditional risk factors based on their serum levels of low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol (non-HDL-C), and apolipoprotein B (apoB). They found that coronary atherosclerosis is common, and the prevalence increases with increasing levels of atherogenic lipoproteins, even in low-risk adults without traditional risk factors.Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of mortality worldwide, primarily due to coronary atherosclerosis, which begins early and progresses over time. Elevated LDL-C is a major contributor to ASCVD, and lowering LDL-C levels is essential for prevention. Traditionally, LDL-C levels of ≥160 mg/dL were considered elevated, while levels <100 mg/dL were deemed optimal. However, these thresholds may still be inadequate for preventing atherosclerosis or ASCVD.Data for the present study included a total of 1,033 participants aged 40–65 years. All participants were free of clinically symptomatic cardiovascular disease and were not undergoing lipid-lowering therapy. A subgroup of 184 participants with optimal risk factors was also identified. Individuals with high-risk conditions such as obesity, high creatinine levels, asthma, cancer, or pregnancy were excluded from the study. The median age of the participants was 51 years. Data on demographics, clinical history, and coronary computed tomography angiography (CCTA) imaging were collected. Coronary atherosclerosis was diagnosed using the Agatson method and classified according to the American Heart Association guidelines.The study cohort had median serum LDL-C, non-HDL-C, and apoB levels of 125, 144, and 94 mg/dL, respectively. A majority of the participants had a lower predicted 10-year ASCVD risk, with over 86% having <5% risk. Men showed a higher body mass index, atherogenic lipoprotein levels, and ASCVD risk compared to women.In conclusion, the study suggests that among asymptomatic, apparently healthy, middle-aged adults without traditional ASCVD risk factors, coronary atherosclerosis is common even at serum cholesterol levels considered to be normal. The condition's prevalence increases with higher LDL-C, non-HDL-C, and apoB. Despite this population's relatively infrequent high-risk plaque features, healthcare professionals should consider lowering serum atherogenic lipoproteins through diet, lifestyle changes, or medication to potentially prevent or delay coronary atherosclerosis and improve their health outcomes.References: Serum Lipoproteins are Associated with Coronary Atherosclerosis in Asymptomatic U.S. Adults Without Traditional Risk Factors. Faridi, K. et al., JACC Advances, 7_Part_1 (2024), DOI:10.1016/j.jacadv.2024.101049,https://www.jacc.org/doi/10.1016/j.jacadv.2024.101049Study reveals high blood sugar at stroke admission linked to poor prognosisThe study published in the journal Cardiovascular Diabetology States that Having higher than usual blood sugar levels at the time of hospital admission for an ischemic stroke significantly increases the risk of a poor functional prognosis or death within three months of the stroke. This is the main conclusion of a study by the Endocrinology and Nutrition Services and the Neurology Department of Hospital del Mar, with researchers from the hospital's Research Institute, the RICORS-ICTUS network, and the CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM). Inflammatory states in certain diseases can cause increased blood sugar levels, or hyperglycemia, which can influence prognosis. In ischemic stroke, elevated blood sugar levels are common but have not been thoroughly analysed. The Hospital del Mar study addresses this issue by reviewing data from 2,774 patients with ischemic stroke. The study considers blood sugar levels at the time of admission and compares them with each patient's usual levels. Additionally, variables such as age, diabetes, disability, stroke severity, and treatment received were taken into account.The study confirmed that elevated blood glucose levels at stroke admission are associated with worse functional outcomes and increased mortality three months post-stroke, independent of other factors. Even a modest 13% increase above usual glucose levels significantly worsens prognosis, regardless of baseline glucose levels. This association was also observed in patients with a history of diabetes, who comprised 35% of the study population.The study concluded that elevated blood sugar levels at the time of stroke admission are associated with a poorer prognosis. Higher admission glucose levels correlate with increased risk of adverse outcomes, including greater neurological impairment and reduced functional recovery. These findings have highlighted the importance of managing blood sugar levels promptly and effectively in stroke patients to improve overall outcomes and reduce long-term complications. Enhanced glycemic control during the acute phase of stroke may be crucial for optimising patient recovery and minimising disability.References: Climent, E., et al. (2024). Acute-to-chronic glycemic ratio as an outcome predictor in ischemic stroke in patients with and without diabetes mellitus. Cardiovascular Diabetology. doi.org/10.1186/s12933-024-02260-9.

Overall, intakes were similar in boys and girls, but higher in teens, urban residents, and children of parents with lower levels of education.The study drew from the Global Dietary Database, a large comprehensive compilation of what people around the world eat or drink, to generate the first global estimates and trends of sugar-sweetened beverage intake in youth. These were defined as soda, juice drinks, energy drinks, sports drinks, and home-sweetened fruit drinks such as aguas frescas with added sugars and containing more than 50 kcal per 1 cup serving. The research team found that youth were drinking more and had nearly twice the overall intake of adults. Sugar-sweetened beverage intake among young people varied dramatically by region, averaging 3.6 servings per week globally and ranging from 1.3 servings per week in South Asia to 9.1 in Latin America and the Caribbean. The researchers found that children and teens in 56 countries, representing 238 million young people or 10% of the global youth population, averaged 7 or more servings per week.In recent years, many governments worldwide have been implementing measures such as soda taxes and restrictions on the sale of sugary drinks in schools to promote healthy dietary habits. These efforts are new and also face strong opposing forces such as aggressive industry marketing and the globalisation of the food sector.It is concluded that the intake of sugar-sweetened beverages (SSBs) is on the rise globally among children and teenagers, posing significant public health concerns. The increasing consumption of SSBs is associated with various adverse health outcomes, including obesity, type 2 diabetes, and dental cavities. The findings emphasise the urgent need for effective public health strategies and policies to reduce SSB consumption in young populations, such as educational campaigns, taxation, and restrictions on marketing targeted at children and adolescents. Addressing this growing trend is crucial for improving the long-term health and well-being of future generations.References: Wang Y, Lobstein T. Worldwide trends in childhood overweight and obesity. Int J Pediatr Obes 2006;1:11–25 [PubMed] [Google Scholar]

After nearly a decade of keeping it under wraps, Olympic medalist Katie Ledecky has shared her POTS diagnosis with the world.

The athlete, who has won 14 Olympic medals for swimming, the most of any female Olympian, said she has POTS (postural orthostatic tachycardia syndrome).

In "Just Add Water: My Swimming Life," Ledecky's new memoir, which was published by Simon & Schuster in June, she wrote that the disease can cause "dizziness, fainting and exhaustion."

US OLYMPIAN SAMMY SULLIVAN SAYS ARMY SERVICE HELPED HER WIN BRONZE MEDAL FOR RUGBY

Here's more. 

POTS is a disturbance in the autonomic nervous system, which controls some of the normal regulatory functions of the body, according to Dr. Blair Grubb, a cardiologist and expert on POTS at The University of Toledo College of Medicine and Life Sciences.

"When the person stands, gravity will try to displace downward roughly 20% to 30% of the body's blood volume," he told Fox News Digital. 

In response to this displacement, the brain tells the heart to beat faster and more forcibly, and tells the blood vessels in the lower half of the body to tighten, or constrict, to three times the level they were previously, the doctor said.

"This allows for accumulation of much more blood than normal in the lower half of the body," Grubb said.

SLEEP DOCTORS SAY OLYMPIC ATHLETES' CARDBOARD BEDS COULD HAVE ‘DISASTROUS’ IMPACT

As more blood is displaced downward, the brain gets less and less oxygen. 

Ledecky discussed this effect in her book. She wrote, "I pool blood in the vessels below my heart when I stand. My body then releases extra norepinephrine or epinephrine, which adds additional stressors on my heart, making it beat faster."

Individuals with a genetic trait called Ehlers-Danlos syndrome (also known as joint hypermobility syndrome) appear to be more susceptible to developing this condition, according to Grubb. 

"However, POTS is frequently triggered by a viral infection, such as Epstein-Barr virus or COVID-19," he told Fox News Digital.

One of these infections can trigger an autoimmune response, in which the body's immune system attacks itself and produces antibodies that interfere with the ability of blood vessels to tighten, the doctor said.

POTS can also occur on its own, without any obvious triggers.

A POTS patient’s symptoms will depend on how much blood is displaced downward, experts say.

"It can vary from mild cases where your heart races and you get a little dizzy upon standing, all the way to presenting as a disabling condition, disallowing patients from being upright," Valerie Iovine, PT, a physical therapist at Strive Physical Therapy in Philadelphia, told Fox News Digital.

"It can also change over the course of life, but can also change day to day or week to week."

The disorder’s name — postural orthostatic tachycardia syndrome — literally translates to "when you become more upright, your heart races," noted Iovine, who treats many patients with POTS and also has the disorder herself.

"The heart will flutter in an attempt to properly oxygenate the brain," she said. 

"But in addition to the dizziness, headaches, passing out or near passing out, many with this disorder don't realize that it can account for other issues, like temperature dysregulation, blood pressure dysregulation and GI dysfunction."

In more extreme cases, patients may have difficulty thinking, concentrating or remembering — sometimes called brain fog, according to Grubb.

WITH SOME OLYMPIC EVENTS POSTPONED, SEINE RIVER WATER QUALITY POSES CONCERNS

People may also experience blurred vision, black spots in their visual field, tunnel vision and headache. 

"Even greater displacement of blood can cause the individual to lose consciousness," Grubb said.

The primary treatment for POTS is increasing water and salt intake, Grubb said. 

"It is also important to recondition the patient through exercise, building the strength in their lower extremities," he said.

Some medications, such as midodrine and droxidopa — known as vasoconstrictors — can work to tighten blood vessels and increase blood return to the heart, according to Grubb. 

WHAT IS ANGELMAN SYNDROME? COLIN FARRELL’S SON IS LIVING WITH THIS RARE DISEASE

Still other drugs, such as fludrocortisone or desmopressin, work by increasing the volume of fluids available for the heart to pump. 

"Medications such as pyridostigmine facilitate nerve transmission and help the nervous system work more effectively to maintain normal vascular function," Grubb added.

Many often use the term "exercise intolerance" when describing symptoms of POTS, but Iovine said that "poorly prescribed and dosed exercise" is the problem.

"Exercise is the best management for POTS," she said.

"I would argue that for these patients, movement is medicine."

In her book, Ledecky noted that swimming can be an effective treatment for POTS, writing that "reclined aerobic exercise, such as swimming, and strengthening your core, can provide relief."

Seeking care from a cardiologist and a physical therapist is essential, according to Iovine.

The cardiologist can help to get vital signs like heart rate and blood pressure under control, she said, while a knowledgeable physical therapist can help to manage symptoms and increase upright tolerance. 

"Things like proper hydration, extra electrolytes, and being able to keep cool can also help manage symptoms," Iovine advised.

"The heat will make the blood vessels expand, making it harder to get the blood up the head against gravity," she said.

"POTS can be a challenge for anyone — from people with complicated pre-existing conditions, all the way to the top athletes, like Katie Ledecky," Iovine told Fox News Digital. 

The disease can often cause a flu-like feeling after exercise, something called post-exertional malaise/post-exertional symptom exacerbation (PEM/PESE). 

"This is when the autonomic nervous system can have a reflexive reaction to stress or exercise, either making existing symptoms worse or creating a new host of issues in people with POTS," Iovine said. 

"This can pose an issue in the sense of rigorous exercise for an Olympic athlete — or in other cases, exertion may be as simple as getting out of bed and walking to the kitchen."

POTS causes a "dynamic disability," Iovine noted.

"One day, it may allow you to swim like an Olympic athlete, and other days, [it will] have you stuck in bed or even in a wheelchair."

POTS is particularly challenging in athletic activities that involve frequent "start and stop" activities, such as basketball, volleyball, soccer and field hockey, added Grubb.

Both experts emphasized that POTS is a "real illness."

"People who were previously quite healthy develop severe limitations and disabilities," Grubb said.

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"They can experience disabling fatigue, exercise intolerance, heat intolerance, palpitations, lightheadedness, dizziness, fainting and brain fog."

Iovine said that due to the "invisibility" of the disease combined with the high heart rate and variability of presentations, it is often dismissed as a function of mental health.

"Patients are often turned away from proper care, made to believe it is all in their heads," she said.

"POTS is a very real condition, and the good news is that there are very real management strategies as well," Iovine went on.

For more Health articles, visit www.foxnews/health

While there is no cure for POTS, many patients are able to manage their symptoms and return to their daily activities.

Added Iovine, "Build up your care team and your confidence to advocate for your health and keep to your regimented routines for management."

A country’s economy grows and the standard of living of its residents is determined, in large measure, by the involvement, engagement and productivity of its workers. Workers who are engaged and producing at their optimum are workers who are healthy – emotionally and physically.

During this World Breastfeeding Week 2024, the Ministry of Labour, Social Security and Third Sector is happy to come alongside the Breastfeeding and Child Nutrition Foundation to remind us all of the importance of breastfeeding to workers, and to enterprise and national development.

Mothers who are able to breastfeed their children and are provided adequate facilities at work to express and store breast milk are generally more engaged, satisfied and committed workers. They are more inclined to get into and remain in formal employment. They are more likely to be advocates for the organisation.

Children who are breastfed are shown to be generally healthier and better-adjusted children. As adults, they have lower incidences of chronic, non-communicable diseases than other segments of the population. They are able to engage better, think more clearly, and therefore be more productive.

Let us join together to close the gap and support mothers who are able to breastfeed their children. Mothers benefit. Children benefit. Our communities benefit. Our nation benefits.

(Ministry of Labour, Social Security and Third Sector)

The post Closing the Gap Breasfeeding for all appeared first on Barbados Today.

We also hope to hold another listening party, where the rotation will likely feature this, this, this, and this. And what about you? This is a grand time to enjoy the great outdoors. Beaches and lakes are beckoning. City streets want to be strolled. And woods are inviting the adventurous for long mysterious walks. Take your pick. Or you could simply hide indoors and binge-watch something on the telly. Well, whatever you do, have a grand time. But be safe. Enjoy, and see you soon. …

A U.S. court tossed a U.S. Chamber of Commerce lawsuit challenging the Medicare Drug Price Negotiation Program established through the Inflation Reduction Act, with a judge finding that several plaintiffs in the suit lacked standing, STAT reports. U.S. District Judge Michael Newman for the Southern District of Ohio found that the Chamber’s argument it could sue on behalf of its members through associational standing was incorrect. The plaintiffs argued they could sue on behalf of pharmaceutical companies that are members of the organization — in this case, AbbVie and its subsidiary Pharmacyclics. Pharmacyclics is based in California, and AbbVie operates in Illinois, California, Massachusetts, and Washington, D.C., but the suit was filed with a local Chamber chapter in Dayton, Ohio.

California lawmakers are making a last-minute push before adjourning to restrain pharmacy benefit managers against the background of a national effort to rein in prescription drug prices, Bloomberg Law writes. Proponents of the bill, led by pharmacists, argue SB 966 would help place needed safeguards on the middlemen who negotiate with drug manufacturers and manage prescription benefits for employers. The bill would require PBMs to be licensed. Supporters say the companies have undermined competition and are financially squeezing smaller pharmacies. The effort comes as lawmakers in 41 states have filed more than 170 related bills this year to regulate PBMs.

Continue to STAT+ to read the full story…

Guyana has almost eliminated filariasis, widely known locally as ‘big foot’, with remaining work to be done in only two of the ten administrative regions, Health Minister Dr Frank Anthony said, even as the United States Agency for International Development (USAID) and the Pan-American Health Organisation (PAHO) announced a new package of assistance to fight ...

The Host

Julie Rovner
KFF Health News

@jrovner

Read Julie's stories.

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

Minnesota Gov. Tim Walz is Vice President Kamala Harris’ choice of running mate. Walz — also a former U.S. congressman, high school teacher, and member of the National Guard — has a folksy, Midwestern affect and a liberal record. He has signed bills expanding abortion rights and medical care for transgender people as governor and represented a swing district in the House of Representatives.

Meanwhile, the number of abortions taking place in the U.S. since the overturn of Roe v. Wade continued to rise into early this year, according to a new study. That is frustrating abortion opponents, who are seeking more ways to bring the numbers down, even if it means barring pregnant women from traveling to other states.

This week’s panelists are Julie Rovner of KFF Health News, Sandhya Raman of CQ Roll Call, and Shefali Luthra of The 19th.

Panelists

Shefali Luthra
The 19th

@shefalil

Read Shefali's stories.

Sandhya Raman
CQ Roll Call

@SandhyaWrites

Read Sandhya's stories.

Among the takeaways from this week’s episode:

• Walz has been active on health issues, including capping insulin prices, codifying access to abortion and gender-affirming care, and supporting veterans’ health, as well as challenging hospital consolidation efforts. In fact, the similarities between him and Harris highlight unity among Democrats on key health issues.
• Meanwhile, the GOP vice presidential nominee, Sen. JD Vance of Ohio, said in an interview that reforming the Affordable Care Act would still be on the table if Trump were reelected, though he did not elaborate. The lack of specificity in the GOP’s plans leaves a lot unknown about what a second Trump administration would do with health policy.
• A recent report shows the number of abortions continued to rise amid restrictions. How? Telehealth is a major reason for the trend. And a separate report shows hundreds of millions in taxpayer dollars have been funneled to crisis pregnancy centers since the overturn of Roe v. Wade, reflecting an effort in conservative state legislatures to steer funding to centers that discourage abortion.
• And Congress has departed for its August recess without funding the federal government, again. Those eyeing other must-pass legislation, such as extended telehealth flexibilities and pharmacy benefit manager reform, are banking on the lame-duck session after the election.

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

Julie Rovner: JAMA Internal Medicine’s “Health, Access to Care, and Financial Barriers to Care Among People Incarcerated in US Prisons,” by Emily Lupton Lupez; Steffie Woolhandler; David U. Himmelstein; et al.

Shefali Luthra: KFF Health News’ “Inside Project 2025: Former Trump Official Outlines Hard Right Turn Against Abortion,” by Stephanie Armour.

Sandhya Raman: The War Horse’s “‘I Had a Body Part Repossessed’: Post-9/11 Amputee Vets Say VA Care Is Failing Them,” by Hope Hodge Seck.

Also mentioned on this week’s podcast:

• ProPublica’s “Texas Sends Millions to Crisis Pregnancy Centers. It’s Meant To Help Needy Families, But No One Knows if It Works,” by Cassandra Jaramillo, Jeremy Kohler, and Sophie Chou, ProPublica, and Jessica Kegu, CBS News.
• Vox’s “Free Medical School Won’t Solve the Doctor Shortage,” by Dylan Scott.
• Stat’s “How UnitedHealth Turned a Questionable Artery-Screening Program Into a Gold Mine,” by Casey Ross, Lizzy Lawrence, Bob Herman, and Tara Bannow.
• The Wall Street Journal’s “The One-Hour Nurse Visits That Let Insurers Collect $15 Billion From Medicare,” by Anna Wilde Mathews, Christopher Weaver, Tom McGinty, and Mark Maremont.

click to open the transcript

Transcript: The Walz Record

KFF Health News’ ‘What the Health?’ Episode Title: ‘The Walz Record’Episode Number: 359Published: Aug. 8, 2024

[Editor’s note: This transcript was generated using both transcription software and a human’s light touch. It has been edited for style and clarity.] 

Julie Rovner: Hello, and welcome back to “What the Health?” I’m Julie Rovner, chief Washington correspondent for KFF Health News, and I’m joined by some of the best and smartest health reporters in Washington. We’re taping this week on Thursday, Aug. 8, at 10 a.m. As always, news happens fast and things might’ve changed by the time you hear this, so here we go.

We are joined today via videoconference by Sandhya Raman of CQ Roll Call.

Sandhya Raman: Good morning.

Rovner: And Shefali Luthra of The 19th.

Shefali Luthra: Hello.

Rovner: No interview this week, but plenty of news for a hot summer week so we will get right to it. So for the second time in three weeks, we have a new vice-presidential nominee to talk about. Newly minted Democratic nominee Vice President Kamala Harris has chosen former congressman and current Minnesota Gov. Tim Walz to be her running mate. What do we know about Walz’s record on health care?

Raman: We know a lot. I think it’s easier to draw from his record compared to JD Vance, who was only elected for the first time in 2022. Tim Walz has had six terms in the House. He’s on his second term as governor. And from that you can see what his priorities are, how he’s drawn from his personal experience and the things that he’s been doing that are very in line with what either Biden and Harris or just Harris have done. When we had Biden, we hear a lot of talk about capping insulin costs, and that’s something that Walz signed a Minnesota bill for a few years ago. And he’s also been very active in reproductive health issues. He signed a couple abortion-related laws last year. That’s been a key focus of the Harris and Biden-Harris campaigns. He’s been active in talking about IVF and how his family has used that, also pretty in line with that.

Rovner: I love that he had a daughter using IVF, whose name is Hope.

Raman: Yeah, yeah.

Rovner: Very Midwestern.

Raman: Yes, and I think he’s also been pretty active on some of the veterans’ issues as a former member of the Army National Guard for several years. And just some of the education and health issues as a former teacher. And he signed legislation related to gender-affirming care as governor. So I think we have a pretty good idea of the types of things that he’d be interested in if they were elected.

Luthra: And I think what’s striking as well is how in line he seems to be on so many policy fronts to what we know the vice president and, frankly, what we know about the other people who were in contention for the vice-presidential nomination. And what I think that tells us is how unified a lot of the party is right now on health care and health policy issues in general. I was pretty struck by how quickly we got reactions from both pro-abortion rights groups and anti-abortion rights groups. As soon as the news came, SBA [Susan B. Anthony] Pro-Life America, one of the biggest anti-abortion groups, is quick to say this is the most pro-abortion ticket in history. They might be right.

Rovner: I was going to say it’s probably true.

Luthra: Yeah. And they could have said that about any Harris, et cetera, ticket, whether that was Walz, whether that was [Pennsylvania Gov. Josh] Shapiro, whether that was someone else from her reported list of finalists. And at the same time, what we saw from abortion rights advocates is they’re equally thrilled about this because they look at Walz as an ally. They look at the work that was done in Minnesota around getting rid of abortion bans; codifying abortion rights in the state constitution; limiting requirements like the 24-hour waiting period: That is gone in the state. And passing a shield law.

All of that underscores that he’s very in line with the vice president. I think what’s worth asking ourselves is how much does that matter when we have someone like Kamala Harris who is very interested in these issues. And in a way, we know far less about JD Vance. But whatever we could find out about him probably matters a lot more because Donald Trump has never shown much interest in health care or health policy. So if we did get a Trump-Vance ticket, it feels like there is a real possibility we’d have a lot more Vance influence in this area as opposed to Walz in a Harris-Walz administration.

Rovner: Which we’ll get to in a second. Just something that jumped out at me when I was researching this is that there’d been much made about the fact that Harris is the first presidential candidate who’s actually visited an abortion clinic. Well, so has Walz. So we’ve now got a presidential candidate and a vice-presidential candidate who have visited an abortion clinic. And I’m thinking even 15, 20 years ago on a Democratic ticket, how much the world has changed since the fall of Roe [v. Wade], that that never would’ve been something that anybody would’ve wanted to advertise. I think it speaks volumes as to really how big reproductive health is going to be going forward in this campaign.

Raman: They went together when they visited a clinic together in St. Paul [Minnesota] earlier. So I think that speaks to it, too, that it is a very important issue for both of them and that it is definitely going to be something the other side is going to really seize on and a point of distinction.

Rovner: Meanwhile, as Shefali alluded to, the Republicans continue to bob and weave on health care issues. Republican vice presidential nominee JD Vance told the news site Notice earlier this week that the ACA [Affordable Care Act] is indeed on the agenda for a second Trump administration, although he didn’t say exactly how. “I think we’re definitely going to have to fix the health care problem in this country,” was his exact quote. Any hints to what that might entail?

Raman: Honestly, no. I think that everything that we’ve heard so far has really just put multiple things up on the table without giving any specifics. Is the ACA repeal-and-replace still on the table? It depends on do we have a majority, do we have a minority, in Congress? And what would that even entail given that we had the whole thing in 2017 where it didn’t work out for them? And Trump has hinted back and forth and not been very clear, so we’re still not sure without more clarity from them.

Rovner: The rest of what JD Vance said was “Obamacare is still too expensive and a lot of people can’t afford it, and if they can’t afford it, they don’t get high-quality care, and we’re going to give them high-quality care.” And my thought was, that would be great. How on earth do you plan to make Obamacare less expensive and care higher quality? That seems like a rather tall order, but a great goal.

Luthra: And realistically, right? We don’t have, as Sandhya pointed out, a real record for JD Vance to look at. We do have a record for Donald Trump, but we don’t have statements of principle or value that we can really attribute to him. We don’t know what he really would do because we don’t know what he believes in. And that, I think, is why we put so much attention in the press. And why we’ve seen Democrats put so much attention on what Republican think tanks are talking about. And what the people who would staff those administrations would say. That is why something like Project 2025 merits so much scrutiny because those are the people who will be in power in institutions of government and potentially interpreting these kinds of vague sentences into actual policy that touches our lives.

Rovner: We don’t know very much of what Donald Trump really thinks about health care because he wants it that way. He wants to keep all of his options open. But one of the things that we do know is that he’s repeatedly promised not to touch Social Security or Medicare, the so-called third rails of American politics. He has specifically declined, however, to include Medicaid on that list of things that he won’t touch. And now we’re reading various proposals — as you mentioned, from Project 2025 to the Paragon Institute, which is run by a former Trump official — that are proposing various ways to scale back Medicaid, particularly federal Medicaid spending, possibly dramatically. Did they not learn from the 2017 repeal-and-replace fight that Medicaid, now that it covers like 90 million people, is kind of pretty popular?

Raman: I think that even after that, we’ve had so many times that we’ve seen in that administration trying to modify the ways that they can with Medicaid. We had the try to push for block grant proposals multiple times. We’ve had the work requirements try to come to fruition in multiple states before being struck down by the courts. And those things are still pretty popular if you look at the documents put out by a lot of these think tanks as something that could be brought up again. Including pulling back on expansion as a way that they see as really reducing federal spending, especially as they’re trying to reduce the national debt and just bring down costs in general.

Rovner: Pulling back on the federal match for expansion, more to the point.

Raman: Because Medicaid expansion is largely funded by the federal government. And so I think those are things that we could see given the history and the people that are working in those places and their connections to the former administration.

Luthra: And I do think it’s worth noting that Trump has said right now that he would not want to touch Social Security or Medicare. I think we can also put a few grains of salt, maybe some more salt, in there, because that is also what he said when he ran for president in 2016. And again, that isn’t really what he was as committed to as president. It was: What does [House Speaker] Paul Ryan want to do? What will I be willing to negotiate on? And with Trump in particular, there is such a distinction between knowing what is politically pragmatic to say in a campaign versus what is on the table as an administration, that I just think that it is incumbent on all of us to not take that with too much credibility, just in this very specific case.

Rovner: And also Social Security and Medicare sometimes need touching, saying that you’re not going to touch, leaving them on autopilot, is not a very responsible public policy. You actually do have to get under the hood occasionally and do things to these programs. But before we get to that, I want to talk a little bit more about abortion. This week, the Society of Family Planning, which is tracking the number of abortions around the U.S. in the wake of the Dobbs [v. Jackson Women’s Health Organization] ruling, reported that the volume of abortions continues to increase despite complete bans in 14 states and near-bans in several others. Shefali, how is this happening? Why is the number of abortions going up? One would think it would be going down.

Luthra: I think these numbers are really striking. They show a continuation of a trend, which is largely this increase in telehealth. More people getting abortion through, in some cases, shield law provision, living in states like Texas and getting pills mailed to them from doctors in New York. Or the fact that it is simply easier to get an abortion if you live in a state with abortion protections because telehealth is much more available right now. The numbers also do show more in-clinic care because people are traveling and overcoming great distances to get abortion.

One thing that I think is really important and that the authors had noted when this came out was these go through March. And on May 1, Florida’s abortion ban took effect, and that is one of the biggest abortion bans that we have seen since the Dobbs decision. And I think it will be really interesting to see whether the trend that we have been observing for quite some time — this steady increase and, in particular, growth of telehealth and continued travel — if that remains possible and viable when you lose a state with as many clinics and as many people as Florida had had.

Rovner: I saw Stephen Miller, the Trump adviser, on TV last night talking about “There will be no national abortion ban under Donald Trump,” which is a whole other discussion. But these numbers, and continuing to go up, must be making the anti-abortion movement crazy.

Luthra: They are losing their minds. They are deeply frustrated on two levels. They’re very concerned that people are finding ways to travel. That is not something they hoped for. And they are very concerned about telehealth in particular. And what they keep saying is they want to find some kind of legal strategy to challenge the shield law provision, but they haven’t quite figured out how. There is real talk in Texas among some of the anti-abortion activists. They’re trying to see is there a way we could pass legislation in a future session to perhaps ban internet providers from showing the websites that allow you to order medication abortion.

Something like that. All of this would be fought through the courts. All of this would be heavily litigated. But it is their No. 1 priority because it is an existential threat to abortion bans. Obviously, they are waiting to see what happens in the presidential election because if you do have an administration that is willing to restrict the ability to mail mifepristone through rehabilitating the Comstock Act — not passing a national abortion ban, but using older laws on the books — then that does some of the job for them and could very significantly put a dent in or even halt this trend.

Rovner: Well, speaking of the abortion pill, we’re seeing pressure campaigns from both sides now aimed at some of the big corporations, including Costco and Walmart, that could start selling the abortion pill in their brick-and-mortar pharmacies. This is something that the Food and Drug Administration, at least, started to make easier earlier in the Biden administration. Now we have institutional investors from blue states pushing companies to carry the drug to make it more available, or else they will divest their very large stock holdings. While we have institutional investors that represent anti-abortion groups, like the American Family Association, who are threatening to divest if the companies do start selling the abortion pills, I would not like to be on the board of any one of these big corporations right now. This seems like a rather uncomfortable place for them to be.

Luthra: Yeah, and none of this is surprising. Alice Ollstein, regular contributor to this podcast, broke a really great story, gosh, a year and a half ago now, when we saw that even CVS and Walgreens, for a time, didn’t want to distribute mifepristone in states where abortion was legal, but there were threats of litigation from attorneys general. And that has changed. The story points out that we have CVS and Walgreens carrying these pills and distributing them. But a lot of people do get medication from Costco. A lot of people do get medication from Walmart. What we’ll see is that this is just another way in which the fight over abortion, which has real meaning for so many people, just continues to play out in the corporate sector. It is something that has been true since Dobbs happened. It is just another sign of how much people care about this and the money behind it and the chaotic nature of banning a procedure in some states and heavily stigmatizing it even in others.

Rovner: The ripple effect of the Dobbs decision. I really do think the Supreme Court had no great appreciation for just how far into other facets of American life this was going to spread, which it definitely is. Well, even as abortions are going up, states with abortion bans are spending increasing amounts of taxpayer money on anti-abortion crisis pregnancy centers that try to talk pregnant people out of terminating their pregnancies. This is flying under the radar, I feel like. We’ve seen these crisis pregnancy centers have been around for a very long time, but what we haven’t seen is the amount of money that states are now saying, “Well see, we care about pregnant women, even though we’re banning abortion, because we’re giving all this money to these crisis pregnancy centers.”

Luthra: And I was pretty struck by just how much money we have seen states put into these centers since the Dobbs decision. The report that you highlight, Julie, found that it was almost $500 million across all these states has gone in since 2022. That’s almost half a billion dollars going into these centers. And you’re right that they do fly, in some ways, under the radar. And part of that is because it is very hard to know how they spend that money. They have very, very little accountability built in place. They are not regulated the way that health care systems are. That also means if you’re a patient and you go there for seeking health care, you are not protected by HIPAA necessarily. And you often will get “care” that can be inaccurate or misleading because, fundamentally, these institutions exist to try and deter people from getting abortions, from … staying pregnant and having children.

I do think that we will see more and more of this happen, and in some ways Republicans have been very overt about that. This was the focus of the March for Life. We saw a bunch of bills in Congress that Republicans put forth talking very specifically about federal funding for anti-abortion centers. This was the biggest trend we saw in statehouses this year when it came to abortion, was passing bills that would add more funding to anti-abortion centers. It’s one area where they feel like the political consequences are far less than bans because bans are unpopular and people don’t fully understand and know what these are. And so they’re not going to get as upset with you when they hear, “Oh, you put more money into these places that are supposed to help pregnant people.” Even though the reality is we don’t actually have any metrics or data that show that they do, and we do have a lot of journalism that shows that they mislead people.

Rovner: Yeah. I will put the link back to the good investigation that ProPublica did that we talked about a couple of weeks ago about how all the money in Texas is impossible to track, basically. All right, well, the Senate last week followed the House’s lead and recessed until early September, which leaves them just a few legislative days when they get back to either finish up all 12 of the regular spending bills — spoiler, that is not going to happen — or else pass some sort-of continuing resolution to keep the government open after the Oct. 1 start of fiscal 2025. Sandhya, they went into this — we’ve said this before — with so much optimism from the Republicans: “We’re going to get these all done before Oct. 1.” Where are we?

Raman: So, at this point, we’ve gotten some work done, but it’s very unlikely we would have things done before the end of September. So the House was on track initially to vote on the House floor on their Labor HHS [Health and Human Services] spending bill, but it got derailed after there were some issues with another bill, the energy-water bill, and after they’d fallen short on their legislative branch spending bill, they recessed early.

Rovner: We should point out that while “Labor-H” is always hard to pass, those other ones tend not to be … those are ones that usually go through.

Raman: Yeah, Labor H generally is done near the end of the whole slate just because it is notoriously one of the trickier ones to get all the agreement on. And it is the biggest nondefense spending bill. So it takes longer, and so less far along on the progress with that, and we’re in August recess, both chambers are out. We won’t see any progress until September. Before the Senate left, they did advance their spending bill on the committee level. That went a lot differently than the House’s markup. So we had three people opposed, but everyone else was pretty much in agreement. A lot less eventful. It wasn’t focused on amendment debate and it was bipartisan, which is a big thing.

So we will see it when they come back, if they gravitate a little bit more towards this, if they’re shifting a little bit in between the two bills. But I think another thing to keep in mind is they have so little time this year to get so much done. They have so much recess this year for the election that it really puts a crunch on their timeline. And then there are certain people advocating that if this person wins, if that person wins, should we do a shorter-term plan spending bill so that we can get our priorities in if this party’s in control, this party has more control. So it’s a difficult situation.

Rovner: Yeah. Here we are basically heading into the home stretch for the spending bills with a gigantic question mark. As usual. Every year they say, “This won’t happen next year.” Every year this happens next year. Well, meanwhile, this is our midyear reminder that Congress also has to pass a bunch of other bills to do things like preventing some pretty big cuts to Medicare physician pay, to keep community health centers and safety-net hospitals up and running, and they have to do all this by the end of the year. I assume we’re still looking at a postelection, lame-duck session to try to wrap everything together.

Raman: I think that’s what we’re looking at. The big priority is going to be to get the government funded. And I think. as with previous years, will we get some of these other things tacked onto there? Will we get extension of telehealth flexibilities or some of the PBM [pharmacy benefit manager] reform or some of the other things that we’ve been discussing at the committee level and hoping to get across the finish line? But it’s really difficult, I think, to get some of those things done until we have this broader package. And I think it’s important that some of the times when we get the broader package, it can help pay for other of the programs that we’ve been considering at the committee level.

Rovner: That was just what I was going to say. The PBM reform, in particular, saves money. Gee, you can prevent the physician pay cut and fund community health centers.

Raman: Yeah. So I think a lot of it will depend on how quickly they’re able to get to an agreement. And if you look at the differences between the House and the Senate bills, it’s billions of dollars. I think just on health spending, it was like almost a $16 billion difference in the top line number between the bills. So getting to some sort of middle ground is going to take some time to get there.

Rovner: Well, before we leave the Hill for the rest of the summer, the Senate Health, Education, Labor, and Pensions Committee, where Democrats and Republicans have not always seen eye to eye under Chairman Bernie Sanders, actually came together last month to open an investigation into, and issue a subpoena to, the CEO of Steward Health Care. You may remember we talked about Steward back in May. It’s a Dallas-based, physician-owned hospital group that was sold to a private equity firm, which promptly sold the real estate the hospitals were sitting on, forcing them to then pay rent. Then the private equity group basically cashed out. And now the hospitals are floundering financially, which is threatening patient care in several states. This is the first time the committee has issued a subpoena since 1981. I did not know that before this week. And it’s kind of a big deal. This is the first, I think, I feel like, big investigation, at least among this committee, about the consequences of private equity in health care.

Raman: Yeah, I would say that, and especially because this is bipartisan. And I think there have been so many bipartisan issues over the past couple of years that it has been difficult to get the chairman and the ranking member to see eye to eye on or to prioritize in the same order. And so I really do think it is a big deal to be able to issue that subpoena and have the CEO come in in September.

Rovner: Yeah, this will be interesting. [Sen.] Bernie Sanders made a big point of dragging up some of the drug company CEOs who said pretty much what we expected them to say. But this is a little bit of a different situation and there’s a bunch of senators from both parties who have hospitals in their states that are now being threatened by the bankruptcy of Steward Health Care, so we’ll see how that goes. Speaking of profiteering in health care, we have two really excellent stories this week on pretty much the same subject: Stat News as part of its continuing investigation into the way UnitedHealthcare is squeezing extra money out of the Medicare program, particularly the Medicare Advantage program, has a piece on the use of a questionable test that’s used to diagnose peripheral artery disease, which can dramatically increase the Medicare Advantage payment for a patient who has it, just kind of coincidentally.

Along similar lines, The Wall Street Journal has a story looking at how not just United, but other major Medicare Advantage insurers, including Humana and Aetna, are using the same test, often provided during a “free home visit” by a nurse practitioner, and scoring those very same extra Medicare Advantage payments. Now, I’m old enough to remember when the biggest knock on Medicare Advantage was that, because it had fixed payments, it gave insurers an incentive to skimp on care. So we had lots of patients who couldn’t get care that they needed. Now that the payments are risk-adjusted, there’s an incentive for insurers to give too much care, or at least to suggest that patients need more care than they do; like that maybe they have peripheral artery disease when they don’t, really. Are there any suggestions floating around how to fix this? Shefali, you were alluding to this, that Medicare Advantage, in particular, can be a little bit of a sinkhole for federal funds.

Luthra: I think this is something that we have struggled with for a long time, right. And I think I was always thrilled to see a Bob Herman byline and we get another one on this Stat story. And one thing that he has written about so compellingly is that the sheer power that health care providers have. And I think we just can’t really ignore the role that they play then in being able to get all of this federal money into their system for things that we don’t necessarily need. And that’s not an easy thing to address politically because people like their hospitals. And even when you hear from lawmakers who want to talk about better regulation of hospitals, they really only talk about for-profit hospitals. Even though if you were to go to a for-profit or not-for-profit, you might see some similarities in how they approach what they bill for. And this is something that we haven’t figured out a good solution to because of how our politics work. But I’m really grateful that we get more reporting like this that helps remind us just how skewed the incentives are in our system.

Rovner: Yeah, it’s hard to blame them. These are for-profit companies that have shareholders, and their job is to figure out how to make money for their shareholders. And they do it extremely well. But the money that they’re making is coming from U.S. taxpayers, and there are patients who are caught in the middle. It’s been a thorny issue. This has been what we’ve been fighting about with Medicare for Medicare’s entire 59 years of its existence. So that will continue while we try to figure out everything else, like making this year’s budget work. Finally this week, we reported in July how Michael Bloomberg gave his alma mater, Johns Hopkins University, another billion dollars that will, among other things, eliminate medical school tuition for most of its student body. We pointed out at the time that the schools that have gone tuition-free have not actually succeeded either in getting more students to go into primary care.

There’s the concern that if you have a lot of debt, you’re going to want to go into a specialty to pay it off. Nor has it enabled more students of color to become doctors. So now Bloomberg is making his philanthropy a little bit more direct. He’s giving a combined $600 million to the four historically Black colleges and universities that have their own medical schools, including Howard [University] here in D.C., in hopes of more directly addressing equity issues that go along with patients not being able to get culturally sensitive care. HBCUs educate the vast majority of the nation’s Black doctors, so is this finally a step in the right direction with the medical education and health equity?

Raman: I would argue it is. Like you said, if you look at the data, the American Association of Medical Colleges [Association of American Medical Colleges] said half of Black doctors graduate from one of these schools. And that could really increase some of the uptake of preventative care and trust in medicine in the Black community who, I think they’ve done some polling, that are more comfortable a lot of times with other Black doctors. And I think that another point was the money is also starting another medical school to increase that pipeline as well. And that is another big thing where it’s broadening the pipeline, but also just really feeding into these goals, should be big over time.

Rovner: A continuing effort, I think there. All right, well, that is the news for this week. It’s time for our extra-credit segment. That’s when we each recommend a story we read this week we think you should read, too. As always, don’t worry if you miss it. We will post the links on the podcast page at kffhealthnews.org and in our show notes on your phone or other mobile device. Sandhya, you got yours picked first this week. Why don’t you tell us about your extra credit?

Raman: So I chose, “‘I Had a Body Part Repossessed’: Post-9/11 Amputee Vets Say VA Care Is Failing Them.” And it’s by Hope Hodge Seck at The War Horse. And it is just a really excellent piece looking at some of the concerns that amputee vets have been having and what the shortcomings are in the care from the VA [U.S. Department of Veterans Affairs], not having bills paid for some of the prosthetics or just delays in receiving them. And one interesting issue that was brought up there is that VA care for post-9/11 amputee veterans doesn’t take into account some of the needs for that population. They’re very different from maybe the needs of senior veterans. And it goes into more about how Capitol Hill is hearing some of these concerns. But read the story and learn more.

Rovner: Shefali?

Luthra: This is from KFF Health News. It is by Stephanie Armour. It is on a topic we discussed earlier on this podcast. The headline is “Inside Project 2025: Former Trump Official Outlines Hard Right Turn Against Abortion.” And what I love about this piece is it does a great job going into detail about the reproductive health ideas and agenda that is outlined in Project 2025. But I also really love that it ties that to the people who are involved in Trump World. Right? And it talks about who are the people who wrote this. Roger Severino, obviously a huge name, very anti-abortion, was involved in Trump’s HHS when he was president last time, and …

Rovner: Did the Office for Civil Rights.

Luthra: Exactly, which has huge implications for abortion policy and reproductive health policy. And I think that Stephanie does a really great job of getting into the political back and forth that has emerged over Project 2025, in which Trump himself has tried to distance himself from the document, from what it outlines and what it says. But that doesn’t really stand up to scrutiny when we look at the authors because it is largely people who have worked for Trump, have advised him, and are likely to have influential roles coming forward. There’s also some ties between JD Vance and the folks at [The] Heritage [Foundation] and Project 2025 that really solidifies the notion that this is something that could be very influential in dictating what our country would look like under a Trump-Vance presidency. And I appreciate Stephanie’s work in clarifying what it says.

Rovner: Yeah, it’s a really good story. Well, my extra credit this week is a study in JAMA Internal Medicine. It’s from the Cambridge [Health] Alliance at Harvard and is called “Health, Access to Care, and Financial Barriers to Care Among People Incarcerated in US Prisons.” And it looks at something that I didn’t even know existed: copays required in prisons for prison inmates in order to obtain medical care. The study found, not surprisingly, that copays can be equal to more than a week’s wage for some inmates, who often make just pennies an hour for the work that they do behind bars. And that many inmates end up going without needed care because they can’t afford said copays.

It’s pretty eye-opening and I hope it gets some attention. OK, that is our show. As always, if you enjoy the podcast, you can subscribe wherever you get your podcasts. We’d appreciate it if you left us a review; that helps other people find us, too. Special thanks as always to our technical guru, Francis Ying, and our editor, Emmarie Huetteman. As always, you can email us your comments or questions; we’re at whatthehealth@kff.org. Or you can still find me at X, I’m @jrovner. Sandhya?

Raman: @SandhyaWrites.

Rovner: Shefali?

Luthra: @shefalil.

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

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