Health – Dominican Today

Low vaccination rates trigger diphtheria and whooping cough

Santo Domingo, DR— Luz Herrera, former president of the Dominican Society of Pediatrics, described the increase in vaccine-preventable infectious diseases, such as whooping cough, diphtheria, tetanus, and meningococcal disease in non-neonatal children, as a “setback” and a “poor prognosis.”

Santo Domingo, DR— Luz Herrera, former president of the Dominican Society of Pediatrics, described the increase in vaccine-preventable infectious diseases, such as whooping cough, diphtheria, tetanus, and meningococcal disease in non-neonatal children, as a “setback” and a “poor prognosis.”

According to the Ministry of Public Health’s epidemiological bulletin for week 30, the country recorded 53 cases of diphtheria and one death; 21 cases of whooping cough and two deaths; and 13 cases of meningococcal disease, with six deaths.

Additionally, 17 cases of tetanus were reported, representing a 15% increase compared to the same week in 2024.

“It seems that the vaccination rate has decreased, and vaccine-preventable diseases have increased. That’s the answer I give to that. There’s a decrease in guidance and education for people. This means a setback for the health system,” Herrera said.

Vaccination schedule

Herrera explained that the national immunization schedule establishes that the first vaccine for newborns is BCG (against tuberculosis) and hepatitis B.

At two months, the rotavirus vaccine (which prevents severe diarrhea), IPV (against polio), and pneumococcal vaccine are administered.

The pentavalent vaccine, which prevents diphtheria, tetanus, and whooping cough, is then administered at two, four, and six months of age, along with the pneumococcal vaccine.

At twelve months, children should receive the seasonal influenza vaccine and the MMR vaccine, which prevents measles, rubella, and mumps. At the same age, another pneumococcal booster shot is given.

At age four, the infant receives a second polio booster and again the pentavalent vaccine.

“These diseases are more common in children under five. Anti-vaccine movements have increased, and because of this, authorities are neglecting them, so these numbers are only going to increase,” Herrera said.

He added that children receive a third booster shot of the diphtheria and tetanus vaccine between the ages of nine and fourteen.

In the case of pregnant women, Herrera indicated that they are also given a dose of the pentavalent vaccine and the seasonal flu vaccine in the first months of pregnancy.

Given the increase in these cases, the specialist recommended completing the Ministry of Public Health’s vaccination schedule, continuing to educate parents about the importance of vaccines, and ensuring that health centers continue administering them, as they prevent mortality and morbidity (the onset of diseases).

What are these diseases?

Diphtheria

It is a severe bacterial infection that affects the mucous membranes of the nose and throat. It is prevented with the DPT vaccine, included in the national immunization schedule. Its symptoms include sore throat, hoarseness, swollen glands, runny nose, fever, and fatigue.

Whooping cough

Also known as pertussis or whooping cough, it is a highly contagious respiratory illness. It primarily affects young children with severe coughing attacks that make breathing difficult. Its initial symptoms resemble a cold, but the cough becomes more intense and distinctive.

Meningococcal disease

It is a severe bacterial infection that can cause meningitis (affecting the brain and spinal cord) or sepsis. Symptoms include high fever, severe headache, stiff neck, and sometimes a rash.

Tetanus

It is a severe disease that affects the nervous system. It is acquired through contaminated wounds and, although it is not contagious between people, it is preventable with vaccination. Its symptoms include muscle stiffness and painful spasms.

4 weeks 1 day ago

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Health | NOW Grenada

The Battle of the Bulge in Grenada

“Research shows fasting for a certain number of hours each day or eating just one meal a couple of days a week may have health benefits”

View the full post The Battle of the Bulge in Grenada on NOW Grenada.

“Research shows fasting for a certain number of hours each day or eating just one meal a couple of days a week may have health benefits”

View the full post The Battle of the Bulge in Grenada on NOW Grenada.

1 month 15 hours ago

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Medical News, Health News Latest, Medical News Today - Medical Dialogues |

Orforglipron Shows Significant Weight Loss and Heart Health Benefits in Phase 3 Trial

In the 72-week phase 3 ATTAIN-1 trial, the once-daily oral GLP-1 receptor agonist orforglipron led to substantial weight loss and improved cardiovascular risk factors in 3,127 adults with obesity or

In the 72-week phase 3 ATTAIN-1 trial, the once-daily oral GLP-1 receptor agonist orforglipron led to substantial weight loss and improved cardiovascular risk factors in 3,127 adults with obesity or overweight with related medical issues, meeting its primary endpoint.

 At 72 weeks, all three doses of orforglipron, met the primary endpoint and all key secondary endpoints compared to placebo, delivering clinically meaningful weight loss as an adjunct to a healthy diet and physical activity. For the primary endpoint, orforglipron 36 mg, taken once per day without food and water restrictions, lowered weight by an average of 12.4% (27.3 lbs) compared to 0.9% (2.2 lbs) with placebo using the efficacy estimand.1=

"Obesity is one of the most pressing global health challenges of our time, driving global chronic disease burden and impacting more than one billion people worldwide," said Kenneth Custer, Ph.D., executive vice president and president of Lilly Cardiometabolic Health. "With orforglipron, we're working to transform obesity care by introducing a potential once-daily oral therapy that could support early intervention and long-term disease management, while offering a convenient alternative to injectable treatments. With these positive data in hand, we are now planning to submit orforglipron for regulatory review by year-end and are prepared for a global launch to address this urgent public health need."

In the ATTAIN-1 trial, orforglipron met the primary endpoint of superior body weight reduction compared to placebo. Participants taking the highest dose of orforglipron lost an average of 27.3 lbs (12.4%) at 72 weeks using the efficacy estimand. In a key secondary endpoint, 59.6% of participants taking the highest dose of orforglipron lost at least 10% of their body weight, while 39.6% lost at least 15% of their body weight. In addition to achieving significant weight loss, orforglipron was also associated with reductions in known markers of cardiovascular risk, including non-HDL cholesterol, triglycerides and systolic blood pressure in pooled analyses across all doses. In a pre-specified exploratory analysis, the highest dose of orforglipron reduced high-sensitivity C-reactive protein (hsCRP) levels by 47.7%.

iSuperiority test was adjusted for multiplicity.

For the treatment-regimen estimand, each dose of orforglipron led to statistically significant improvements across the primary and all key secondary endpoints.

• Percent weight reduction: -7.5% (-7.8 kg; 17.2 lbs; 6 mg), -8.4% (-8.6 kg; 19.0 lbs; 12 mg), -11.2% (-11.3 kg; 25.0 lbs; 36 mg), -2.1% (-2.4 kg; 5.3 lbs; placebo)

• Percentage of participants achieving body weight reductions of ≥10%: 33.3% (6 mg), 40.0% (12 mg), 54.6% (36 mg), 12.9% (placebo)

• Percentage of participants achieving body weight reductions of ≥15%: 15.1% (6 mg), 20.3% (12 mg), 36.0% (36 mg), 5.9% (placebo)

The overall safety profile of orforglipron in ATTAIN-1 was consistent with the established GLP-1 receptor agonist class. The most commonly reported adverse events were gastrointestinal-related and generally mild-to-moderate in severity. The most common adverse events for participants treated with orforglipron (6 mg, 12 mg and 36 mg, respectively) were nausea (28.9%, 35.9% and 33.7%) vs. 10.4% with placebo, constipation (21.7%, 29.8% and 25.4%) vs. 9.3% with placebo, diarrhea (21.0%, 22.8% and 23.1%) vs. 9.6% with placebo, vomiting (13.0%, 21.4% and 24.0%) vs. 3.5% with placebo, and dyspepsia (13.0%, 16.2% and 14.1%) vs. 5.0% with placebo. Treatment discontinuation rates due to adverse events were 5.1% (6 mg), 7.7% (12 mg) and 10.3% (36 mg) for orforglipron vs. 2.6% with placebo. The overall treatment discontinuation rates were 21.9% (6 mg), 22.5% (12 mg) and 24.4% (36 mg) for orforglipron vs. 29.9% with placebo. No hepatic safety signal was observed.

The detailed ATTAIN-1 results will be presented next month at the European Association for the Study of Diabetes (EASD) Annual Meeting 2025 and published in a peer-reviewed journal. More results from the ATTAIN Phase 3 clinical trial program will be shared later this year, along with findings from the ACHIEVE Phase 3 clinical trial program evaluating orforglipron for adults with type 2 diabetes.

About orforglipron

Orforglipron (or-for-GLIP-ron) is an investigational, once-daily small molecule (non-peptide) oral glucagon-like peptide-1 receptor agonist that can be taken any time of the day without restrictions on food and water intake. Orforglipron was discovered by Chugai Pharmaceutical Co., Ltd. and licensed by Lilly in 2018. Chugai and Lilly published the preclinical pharmacology data of this molecule together. Lilly is running Phase 3 studies on orforglipron for the treatment of type 2 diabetes and for weight management in adults with obesity or overweight with at least one weight-related medical problem. It is also being studied as a potential treatment for obstructive sleep apnea (OSA) and hypertension in adults with obesity.

About ATTAIN-1 and ATTAIN clinical trial program

ATTAIN-1 (NCT05869903) is a Phase 3, 72-week, randomized, double-blind, placebo-controlled trial comparing the efficacy and safety of orforglipron 6 mg, 12 mg and 36 mg as monotherapy to placebo in adults with obesity, or overweight with at least one of the following comorbidities: hypertension, dyslipidemia, OSA or cardiovascular disease, who did not have diabetes. The trial randomized 3,127 participants across the U.S., Brazil, China, India, Japan, South Korea, Puerto Rico, Slovakia, Spain and Taiwan in 3:3:3:4 ratio to receive either 6 mg, 12 mg or 36 mg orforglipron or placebo.

The primary objective of the study was to demonstrate that orforglipron (6 mg, 12 mg, 36 mg) is superior to placebo in body weight reduction from baseline after 72 weeks in people with a BMI ≥30.0 kg/m² or a BMI ≥27.0 kg/m² with at least one weight-related comorbidity and a history of at least one self-reported unsuccessful dietary effort to lose body weight. All participants in the orforglipron treatment arms started the study at a dose of orforglipron 1 mg once-daily and then increased the dose in a step-wise approach at four-week intervals to their final randomized maintenance dose of 6 mg (via steps at 1 mg and 3 mg), 12 mg (via steps at 1 mg, 3 mg and 6 mg) or 36 mg (via steps at 1 mg, 3 mg, 6 mg, 12 mg and 24 mg). Dose reduction was only allowed for GI tolerability if other mitigations failed.

The ATTAIN Phase 3 global clinical development program for orforglipron has enrolled more than 4,500 people with obesity or overweight across two global registration trials. The program began in 2023 with additional results anticipated this year.

1 month 1 day ago

Medicine,Medicine News,Top Medical News,Latest Medical News

Health | NOW Grenada

Carnival message from Minister of Youth and Mental Health

“The highs of Carnival can sometimes mask deeper struggles. If you are feeling overwhelmed, anxious, or simply not yourself, please know that help is available. You are not alone”

1 month 1 day ago

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STAT

STAT+: Pharmalittle: We’re reading about Trump and drug prices, an FDA plan for U.S. manufacturing, and more

And so, another working week will soon draw to a close. Not a moment too soon, yes? This is, you may recall, our treasured signal to daydream about weekend plans. Our agenda is, so far, rather modest. We plan to catch up on our reading, promenade with the official mascots, and manicure the Pharmalot grounds.

We also plan to hold another listening party, where the rotation will likely include this, this, this, this and this. And what about you? As always, summer is moving by quickly, so perhaps this is an opportunity to enjoy the great outdoors. Beaches, lakes, and mountain trails are perennials, yes? You could also tend to your garden, visit the local library (your tax dollars at work), or perhaps take time to experiment with a recipe or two. Or you could simply plan the rest of your life. Well, whatever you do, have a grand time. But be safe. Enjoy, and see you soon. …

The Trump administration has been talking to drugmakers about ways to raise prices of medicines in Europe and elsewhere in order to cut drug costs in the United States, Reuters reports, citing a White House official and three pharmaceutical industry sources. U.S. officials told drug companies it would support their international negotiations with governments if they adopt “most favored nation” pricing under which U.S. drug costs match the lower rates offered to other wealthy countries. The Trump administration has asked some companies for ideas on raising prices abroad and has held multiple meetings over several months aimed at lowering U.S. prices without triggering cuts to research and development spending drugmakers insist would result. The previously unreported discussions reflect the challenges Trump faces to achieve that goal, and are the backdrop to the letters he sent last week to 17 major drugmakers, urging them to cut U.S. prices to match those paid overseas.

The U.S. Food and Drug Administration announced a program to make it easier for drug companies to set up manufacturing facilities in the U.S. and reduce the country’s reliance on imported medicines, Pharmaphorum notes. The regulator revealed FDA PreCheck, a two-phase approach to getting approval for new production sites. The first promises to provide quicker responses from the agency on start-up tasks like facility design, construction, and pre-production. The second phase is based on a pledge by the FDA to “streamline” the chemistry, manufacturing, and controls section of new facility applications with the help of “pre-application meetings and early feedback.” The move ties in with President Trump’s ongoing campaign to drive medicines manufacturing to the U.S. from overseas, a push that has already resulted in big investment commitments from a string of companies, including AstraZeneca, AbbVie, Roche, Novartis, Eli Lilly, and Johnson & Johnson. The FDA plans to hold a public meeting on September 30 to discuss the new program.

Continue to STAT+ to read the full story…

1 month 1 day ago

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News Archives - Healthy Caribbean Coalition

Virtual Veranduh Chat – Prioritizing Breastfeeding: Policy to Practice

Virtual Veranduh Chat – Prioritizing Breastfeeding: Policy to Practice

On Thursday 7 August 2025, the Healthy Caribbean Coalition and Healthy Caribbean Youth in partnership with the Breastfeeding and Child Nutrition Foundation hosted a Virtual Veranduh Chat, the subject for discussion was Prioritizing Breastfeeding: Policy to Practice.

Virtual Veranduh Chat – Prioritizing Breastfeeding: Policy to Practice

On Thursday 7 August 2025, the Healthy Caribbean Coalition and Healthy Caribbean Youth in partnership with the Breastfeeding and Child Nutrition Foundation hosted a Virtual Veranduh Chat, the subject for discussion was Prioritizing Breastfeeding: Policy to Practice.

The panellists and participants discussed the following:

  • Promoting breastfeeding and breast milk as primary nutrition for newborns.
  • The impact of digital marketing on breastfeeding and child development.
  • Breastfeeding best practices across the region and solutions to potential implementation barriers.

Panellists

The post Virtual Veranduh Chat – Prioritizing Breastfeeding: Policy to Practice appeared first on Healthy Caribbean Coalition.

1 month 1 day ago

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KFF Health News

KFF Health News' 'What the Health?': Kennedy Cancels Vaccine Funding

The Host

Emmarie Huetteman
KFF Health News

The Host

Emmarie Huetteman
KFF Health News

Emmarie Huetteman, senior editor, oversees a team of Washington reporters, as well as “Bill of the Month” and KFF Health News’ “What the Health?” She previously spent more than a decade reporting on the federal government, most recently covering surprise medical bills, drug pricing reform, and other health policy debates in Washington and on the campaign trail. 

Health and Human Services Secretary Robert F. Kennedy Jr.’s announcement that the federal government will cancel nearly $500 million in mRNA research funding is unnerving not only for those who develop vaccines, but also for public health experts who see the technology behind the first covid-19 shots as the nation’s best hope to combat a future pandemic.

And President Donald Trump is demanding that major pharmaceutical companies offer many American patients the same prices available to patients overseas. It isn’t the first time he’s made such threats, and drugmakers — who scored a couple of wins against Medicare negotiations in the president’s tax and spending law — are unlikely to volunteer to drop their prices.

This week’s panelists are Emmarie Huetteman of KFF Health News, Sarah Karlin-Smith of the Pink Sheet, Sandhya Raman of CQ Roll Call, and Lauren Weber of The Washington Post.

Panelists

Sarah Karlin-Smith
Pink Sheet


@SarahKarlin


@sarahkarlin-smith.bsky.social


Read Sarah's stories.

Sandhya Raman
CQ Roll Call


@SandhyaWrites


@SandhyaWrites.bsky.social


Read Sandhya's stories.

Lauren Weber
The Washington Post


@LaurenWeberHP


Read Lauren's stories.

Among the takeaways from this week’s episode:

  • Explaining the decision to cancel some mRNA vaccine funding, a priority for vaccine critics, Kennedy falsely claimed that the technology is ineffective against respiratory illnesses. Researchers have been making headway into mRNA vaccines for maladies such as bird flu and even cancer, and the Trump administration’s opposition to backing vaccine development weakens the prospects for future breakthroughs.
  • Trump’s insistence that big-name drugmakers voluntarily lower their prices underscores how few tools the presidency has to deliver results on this important pocketbook issue for many Americans. Medicare’s ability to negotiate drug prices took a hit under Trump’s big tax-and-spending law, which included two provisions advocated by the pharmaceutical industry that would delay or exclude some expensive drugs from the dealmaking process.
  • A year after Trump promised on the campaign trail to secure coverage of in vitro fertilization, the White House reportedly is not planning to compel insurers to pay for those pricey reproductive services — a change that would require an act of Congress and could raise costs overall.
  • And with Congress back home for its August recess and a late September deadline looming, the annual government funding process is in progress — but unlikely to resolve quickly or cleanly. Senate appropriators are further along in their work than usual, but the House of Representatives has yet to release its version, which is expected to cut deeper and hit social issues like abortion harder.

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

Emmarie Huetteman: KFF Health News’ “New Medicaid Federal Work Requirements Mean Less Leeway for States,” by Katheryn Houghton and Bram Sable-Smith. 

Sarah Karlin-Smith: Slate’s “Confessions of a Welfare Queen,” by Maria Kefalas. 

Sandhya Raman: CQ Roll Call’s “Sweden’s Push for Smokeless Products Leads Some To Wonder About Risks,” by Sandhya Raman. 

Lauren Weber: The New York Times’ “‘Hot Wasps’ Found at Nuclear Facility in South Carolina,” by Emily Anthes. 

Also mentioned in this week’s podcast:

click to open the transcript

Transcript: Kennedy Cancels Vaccine Funding

[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.] 

Emmarie Huetteman: Hello, and welcome back to “What the Health?” I’m Emmarie Huetteman, a senior editor 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. 7, at 10 a.m. As always, news happens fast, and things might have changed by the time you hear this. Here we go. 

Today, we’re joined via video conference by Lauren Weber of The Washington Post. 

Lauren Weber: Hey, everybody. 

Huetteman: Sandhya Raman of CQ Roll Call. 

Sandhya Raman: Good morning. 

Huetteman: And Sarah Karlin-Smith of the Pink Sheet. 

Sarah Karlin-Smith: Hi, everybody. 

Huetteman: It’s August, and here in the nation’s capital that means Congress has flown the coop, and a lot of the federal city has gone with them. No interview this week. And you may be wondering why you’re hearing my voice instead of the incomparable Julie Rovner. Julie’s out this week having surgery to repair her broken wrist. Good news: She’s on the mend and she’ll be back in your podcast feed very soon. Get well soon, Julie. Let’s get to the news. 

On Tuesday, the Trump administration announced that the secretary of Health and Human Services, Robert F. Kennedy Jr., has canceled almost $500 million in federal grants and contracts to develop mRNA vaccines. That technology, of course, was responsible for the first covid vaccines, and researchers have been working on new ways to use mRNA, including against bird flu and even cancer. But in explaining his decision, Kennedy made false claims about mRNA vaccines, including that they do not protect against respiratory illnesses. Kennedy’s opposition to the covid vaccine, in particular, is well-documented. But before becoming health secretary, he advocated for federal officials to revoke approval for mRNA-based covid shots. 

Sarah, you’re our pharmaceutical industry expert. What will this mean for vaccine development? Without this government funding, can that research continue? 

Karlin-Smith: I think people are really concerned, particularly about the speed of vaccine development for pandemic situations. That’s a classic market failure in that companies aren’t that incentivized to work on developing products for hypothetical situations that may never come to pass, but we obviously want to be prepared for strains of the flu that can be particularly harmful and stuff. So I think that’s where people are really concerned. 

I think, in general, this is just another mark in some of the vaccine actions that have taken place since this administration took over that makes people a little more nervous about just investing in the vaccine field, whether it’s mRNA or vaccines in general. FDA has made some unusual decisions around the indications for covid vaccines moving forward. The [Centers for Disease Control and Prevention’s] whole [Advisory Committee on Immunization Practices] has changed. So I do think there’s broader concern beyond the mRNA vaccines and our need to have this technology to really prepare for a pandemic about how confident industry will be in the places they normally would invest money on their own. 

Huetteman: Lauren, you had a story yesterday about how Kennedy’s decision is intensifying concerns about our ability to fight future pandemics. Can you tell us what you’re hearing from public health experts? 

Weber: Yeah. We spoke to a number of public health experts and vaccine experts, mRNA experts, who said, Look, this is the technology that you want to be spry, to be able to alter something, to fight potentially a bird flu. It’s also used in revolutionary ways to fight maybe even cancer here in the future. There’s a lot of fear about how this could have a chilling effect, as Sarah was pointing out, on the development pipeline and what that means in a pandemic situation. 

I do think it’s important to note that just this morning, Trump was asked about this and said he was going to have a meeting on it at noon. Not sure exactly what that means, but potentially that could be something. Robert Malone, who’s an ACIP member, sent out an email trying to rally MAHA [“Make America Healthy Again”] supporters to make sure that they backed up Kennedy’s decision. 

I think it’s also important to take a step back and look at Kennedy’s past remarks on mRNA, as you alluded to. This is a man who falsely called the covid vaccine “the deadliest ever made.” He’s described it as a poison in the past. Some anti-vaccine factions of MAHA have really been pushing to try and limit access to mRNA technology. You’ve seen this also in some Republican and far-right states, that are more right. You’ve seen some legislation suggested to remove access to mRNA technology. There’s a big question among some of the folks we talked to on if this is a bit of a signal to the base. 

Karlin-Smith: I was going to say, ironically, the mRNA vaccines was probably the biggest success of the Trump administration’s first term in office. He was instrumental in spearheading the fast development of the vaccines for covid. 

Huetteman: Right, Operation Warp Speed. Interesting how far we’ve come. To be clear, this isn’t all of the government’s mRNA contracts, right? This is just a piece of the research funding? 

Karlin-Smith: This is a piece of it coming through BARDA [the Biomedical Advanced Research and Development Authority], which is particularly designed to help fill those market gaps in pandemic preparedness, but they’ve also cut other mRNA vaccine contracts previously in this administration, including a big one around bird flu, which people are concerned about right now. I’ve even seen some media reports where people, researchers in the cancer but mRNA space, were concerned about grants just being flagged just because they had the terminology. It’s not everything, but I think there’s certainly fears that this is just a step in a bigger process that is problematic. 

Huetteman: Absolutely. We’ll be keeping an eye on that. And vaccine contracts aren’t the only thing that President Trump’s team is undoing this week. Under a new federal rule, VA hospitals would no longer be able to perform abortions in cases of rape, incest, or health endangerment. You may remember that the Biden administration introduced that policy at the Department of Veterans Affairs in 2022, after the Supreme Court ended the constitutional right to an abortion. The policy has allowed veterans and their relatives to obtain abortion services even while they are stationed in states with restrictions. 

Meanwhile, lots of news to get to this week. In prescription drug news, late last week, President Donald Trump sent letters to more than a dozen drugmakers insisting that they drop their prices within 60 days. Specifically, the president demanded that pharmaceutical companies offer many American patients the same prices that drugmakers charge abroad. Over the weekend, Trump told reporters that his administration is dramatically lowering drug prices, “up to 1,500%,” he said — which, well, I think that technically means the drugmaker would pay you

Anyway, Trump told drugmakers that if they don’t lower drug prices, “We will deploy every tool in our arsenal.” What can the president do to force drugmakers to comply? 

Karlin-Smith: I think, in some ways, he doesn’t have as many tools in the toolbox as he probably would like to think. At least, not ones that are making the industry particularly fearful right now. He doesn’t have the power to just issue a regulation saying, “The Medicare-Medicaid reimbursement rates are tied to the rates countries are paying abroad.” That would have to be through legislation. And I think there are reasons that both Republicans and Democrats don’t really like this most-favored-nation approach to drug pricing. There is some sort of limited authority for them to do a demonstration project through CMS’ [Centers for Medicare & Medicaid Services’] Medicare-Medicaid Innovation Center. They could come up with a test of this in some kind of limited area. They tried to start implementing that [in] his last term and they got scuttled by lawsuits, so we’ll see if they have a way to avoid that problem this time. 

But the ironic thing is that when the administration issued this executive order in May calling for this most-favored-nation pricing, he set this 30-day-ish deadline of saying, OK, we’ll tell you what prices we want, you guys lower them. If not, we’re going to do rulemaking. One thing that came up when he issued this letter, these letters on Friday, giving industry another 60 days is, Well, why are they not just going through with some kind of rulemaking or next steps? It almost seemed to some people like almost a more muted threat because they haven’t done the follow-through yet or come up with what the follow-through is here.  

Huetteman: Now, where is the Medicare’s drug negotiation ability in this equation? Why isn’t the president doing more to leverage Medicare’s power to negotiate at this point? 

Weber: Well, that’s really interesting because in the “Big, Beautiful Bill,” there were two provisions that a lot of people missed that limited the ability to negotiate on some key drugs, which has been estimated to likely cost the American taxpayer and the government billions of dollars over the next couple years. 

Huetteman: Yeah, the CBO says that those changes will cost Medicare at least $5 billion in missed savings over 10 years. 

Weber: Yes, that’s what’s called effective lobbying. Essentially, what happened is some pharma companies were able to tuck in provisions that key drugs, I think it was Keytruda, I’m not sure if I’m pronouncing that right, or Keytruda, which is used to treat cancer, it’s a drug by Merck. It had $17.9 billion in U.S. sales in 2024. That’s the kind of drug that they won’t be able to negotiate prices on for a bit.  

Huetteman: Yeah, that’s right. Of course, that also means that Medicare patients will be subject to paying their percentage of those higher prices as well. On top of talking about this CBO score there, we’re talking about drug prices that real people are paying for their expensive cancer drugs right now. I guess I’m curious why Trump isn’t using the negotiation process in order to lower those drug prices? 

Raman: I would add that something that makes this more difficult is that Trump has been very back-and-forth about a lot of his opinions on different things that he’s going to do throughout the last several months in this process. Even if you look at something like how we would deal with tariffs on the pharmaceutical industry, we’ve been a little bit all over the place. I think even if he’s not demonstrating the clear idea of which way he’d want to go, it makes it a little bit harder for the regulators, whether it would be in Congress or through the FDA, to do anything, given that he’s been changing a lot what he’s hinting at wanting to do.  

Huetteman: Yeah, that’s right. Actually, Sarah, you brought up the CMS innovation option. There’s a story out about this this week. The Washington Post reports that the Trump administration is considering using that center to do a pilot project to expand access to GLP-1 drugs for weight loss purposes by allowing state Medicaid and Medicare Part D plans to cover them. 

Now, insurance premiums are slated to go way up next year. If I’m not mistaken, the cost of covering GLP-1 drugs is one reason that insurers have cited for those premium hikes. If this happens, can we expect that the cost of those drugs would strain state and federal budgets? 

Karlin-Smith: Actually, one I guess positive thing is that some GLP-1 drugs are slated to be subject to negotiation through the IRA [Inflation Reduction Act] program next year, so that there’s maybe positive news around the prices of those going down. Again, that’s obviously only for Medicare. But the problem on the back end is that, based on law, Medicare is not allowed in Part D to cover drugs for weight loss. 

The Biden administration had tried through rulemaking to make an argument that weight loss drugs and drugs that treat obesity are two different things, hearkening back to — when that law was written we really didn’t understand obesity as a disease process and all the health problems it has on your body. We thought of weight loss as more of a cosmetic thing. The Trump administration actually pulled that rule, so this would be a much more small step in the direction of trying to get coverage. The report says it would be a “voluntary demo.” 

The biggest question in my mind, which is again, knowing that these drugs, even with cheaper prices, would likely raise costs, is what is the incentive for health plans to voluntarily want to participate in this? What would the government have to do to incentivize this? Without some sort of push there for states and for Medicare Part D plans, I’m not sure the private plans are just going to pick up these products given the amount of people that would qualify for them. I think we need a lot more details from the Trump administration to know if they can actually make this feasible. 

Weber: I just find this to be such a fascinating move considering [CMS Administrator Mehmet] Oz and Kennedy have such different opinions about weight loss drugs, as does MAHA as a whole. We at The Washington Post had reported previously that Oz does have financial ties to Ozempic through his show — they had to run a sponsored ad to some extent — and also through other means. It’s fascinating to see that clearly this is going forward, despite Kennedy having said repeatedly, often, constantly that he does not want to pay for these drugs, that he thinks other interventions, healthy diet and lifestyle, should be implemented. Which Oz has also really promoted as well. So fascinating to see how this experiment plays out. I agree with Sarah; I’m not sure where the incentives are, considering the cost that this will be to see it play out. 

Huetteman: And one year after Trump promised coverage for in vitro fertilization services on the campaign trail, The Washington Post reports that the White House does not plan to require health insurers to cover IVF. The president had said that “if he were elected, the government would either pay for IVF services itself or require insurance companies to do it.” 

What’s standing in the way here? What’s involved in making something an essential health benefit? 

Raman: I think this whole process has been interesting. In February, Trump had put out an executive order directing his administration to come up ways to reduce the out-of-pocket costs for IVF. At the time, it’s pretty vague in terms of what that would entail. After the deadline passed, in part, I think a lot of people weren’t surprised because a) IVF is very expensive. And b) I think there are a lot of complicated nuances to some of his base and whether or not they fully support IVF. We had a lot of this last year, with people saying that they support it, but then also some of the folks that are more pro-life have some stipulations about not wanting embryos destroyed. It just complicated that some of the people that were talking to him about some of the other abortion-related issues were not on board with all of the IVF things. I think that has played definitely a factor in what they’re going to do with this. 

But it’s also a hard thing to do, to just make this something that — even with prescription drugs, reducing the costs of those is not simple. In order for them to make it an essential health benefit, I think, is also more complicated given the issues that we’ve been having with preventative care, and just the concerns about the [U.S. Preventive Services Task Force] getting removed and what that’ll do to different things that are covered. It’s complicated and I wouldn’t really see this changing on IVF in the near future, at least from the executive level. 

Karlin-Smith: It needs to go through Congress to be an essential health benefit. I think there’s a theme in some of the topics we’re coming up to today where Trump is clearly coming up to the limits of his bully power and his threats of negotiation. I think Martin Makary, the head of the FDA, said, “You get more bees with honey.” Well, unfortunately, sometimes it’s just not enough to attract these industries to make major changes. 

Yes, they’ve gotten some sort of minor concessions, I think. I know they would like to think they’re transformative, but I think a lot of what they’ve gotten voluntarily is pretty minor, in terms of both health impact, and also how much it harms industry in terms of, like, food dyes. Or even the insurance companies saying, Oh, sure, we’ll do better on not going crazy on prior authorization

I think Trump now has to actually double-down and work with policymakers on rule writing, or work with Congress. It’s more complicated, especially again, as Sandhya said, IVF is something that’s complicated for his base to support. 

Huetteman: That’s right. This all came out of the blowback about how far towards banning abortion the country was going to go under Trump. This was a way to say, We’re preserving some parts of the reproductive health that are really important to people in our base, right?  

Raman: Yet even when Congress has tried to look at any of the IVF legislation in the past, it’s fallen on party lines. There have been ones that have been more messaging on either side. I think the closest we’ve gotten is that, on the defense side, trying to consider measures there for folks with Tricare, but it’s difficult to get folks on board with things like this through Congress. 

Huetteman: Well, speaking of Congress, Congress has left the building. August recess has begun and lawmakers are back home. Say, how is that government funding coming along. Sandhya?  

Raman: I think we’re in a similar place to many years in that it’s August, they’re out. We need government funding by the end of September, and we’re nowhere close to getting that. I would say on the plus side, the Senate is further along than they usually are. Before they left, they did mark up the Labor, HHS, Education funding bill, and that was overwhelmingly bipartisan. It included some money that would be a boost for NIH [the National Institutes of Health], which I know was a big concern for a lot of folks given what was in the White House proposal. It maintains funding for some of the programs that would be cut under the White House, things like Title X, Ryan White HIV. It also has a little bit of a pushback on making sure that the agencies continue the staffing to keep up some of their statutory duties.  

But again, it’s just the Senate. The House has not put out their bill. I would expect theirs to be a bit more conservative, given that the head of the Appropriations Committee in the Senate is Susan Collins, who’s been a little bit more moderate. The House is expected to release theirs and mark up theirs right after they get back. They meant to do it before recess but got pushed back because of reconciliation and that changing their schedule. 

It depends what they say in theirs and how much difference there is. I would expect there to be a lot of differences. It seems like we’re headed toward the usual of at least some sort of temporary spending to kick it down the line. Whether or not that ends up being a year again, like we did this year, or a short-term thing, we’re not sure yet. It depends on where we are in September.  

Huetteman: Right. And possibly preceded by a lot of fighting over social issues that get thrown into the health bill, and fights over the actual funding levels, if I had to guess, based on how House lawmakers have been talking about it so far.  

Raman: Oh, no. I think just the fact that we had such a big rescissions debate this year and the fact that we might do that again, it has definitely left a sour taste for a lot of Democrats who are worried that if whatever they vote for here might just get clawed back later on down the line. That’ll be another thorn in it.  

Huetteman: Awesome. Well, thanks for that take. That’s this week’s news. Now it’s time for our extra-credits segment. That’s where we each recognize a story we read this week that we think you should read, too. Don’t worry if you miss it; we’ll put the links in our show notes on your phone or other mobile device.  

Lauren, why don’t you go first this week?  

Weber: I have a doozy of a story from The New York Times titled “‘Hot Wasps’ Found at Nuclear Facility in South Carolina,” by Emily Anthes. Yeah, it’s the stuff of nightmares. It’s all about how wasps became radioactive — four wasps’ nests near a South Carolina nuclear facility.  

Huetteman: Yikes.  

Weber: If this gave you bad dreams, it definitely did for me. Essentially, what some of the researchers have posited is that wasps could have burrowed in some sort of bad wood or wood that was contaminated or other parts of the area that are contaminated. But this idea that it sounds like something out of Chernobyl, or something like that. But this idea that in the U.S., you could have a nuclear facility that is potentially transforming some of the near-wildlife is concerning in terms of cleanup efforts, and also concerning in terms of contamination control. Clearly, there’s more that needs to be dug into there. Hopefully everyone sleeps after hearing about this.  

Huetteman: Woof, yeah. I might need to take an Ambien tonight. Sandhya, how about you go next?  

Raman: My extra credit is from me in Roll Call. It’s my last dispatch from my reporting trip in Sweden earlier this year. And it’s called “Sweden’s Push for Smokeless Products Leads Some To Wonder About Risks.” It looks a little bit at some of the public health impacts as Sweden has really tried to reduce their smoking rate to become smoke-free. The U.S. is also at a low from smoking. Some of the things that public health experts are thinking about as people shift to other products and how they’re able to message to the remaining smokers that are not willing to give that up still.  

Huetteman: Awesome. Thanks for telling us about your work there. And Sarah?  

Karlin-Smith: I looked at a story from Slate, “Confessions of a Welfare Queen: I Study Poverty for a Living, and I Never Thought I’d Need Medicaid. Then My Child Was Diagnosed With a Terminal Illness,” by Maria Kefalas. It’s a personal story from a mother whose family needed Medicaid when their young child was diagnosed with an illness that was going to severely require intense medical care and limit her lifespan. They were able to take advantage of what are known as “Katie Beckett waivers” that were instituted by Ronald Reagan to allow states to voluntarily allow higher income requirements so that people could get Medicaid and care for their children at home. The original girl it was named for was otherwise basically going to be stuck living her life, and she lived until 34, in a hospital.  

The purpose of the story is really to point out that now that the “Big, Beautiful Bill” has passed and there are $1 trillion in spending cuts to Medicaid, that these are some of the sorts of people and programs, because it is not a mandatory program, that may unfortunately be on the first for the chopping block. I think the piece does a good job of pointing out, while there’s been a lot of rhetoric around the people who are going to get hurt by this are people that are not working or somehow abusing the system, and the mother does a pretty good job of talking about how both she and her husband continue to work. Most of the families that need this program, to the extent they can, want to keep working. You just get a really human picture of the type of people that are at risk of losing services.  

Huetteman: Yeah, for sure. It’s a really illuminating story. Thanks for talking about it. My extra credit this week is from my colleagues here at KFF Health News. The headline is “New Medicaid Federal Work Requirements Mean Less Leeway for States.” It’s by Katheryn Houghton and Bram Sable-Smith. 

They report that at least 14 states are in progress designing their own work requirement programs. But now, with the passage of Trump’s law last month, which institutes federal work requirements, those states must make sure that their programs meet federal standards. In some cases, the states are actually going even further than federal requirements, my colleagues report. For instance, Arizona state law would institute a five-year lifetime limit on Medicaid coverage for “able-bodied adults.” 

OK, that’s this week’s show. Thanks as always to our producer-engineer, Francis Ying, and to Stephanie Stapleton, our editor this week. If you enjoyed the podcast, you can subscribe wherever you get your podcasts. We’d appreciate it if you left a review; that helps other people find us, too. Also, as always, you can email us your comments or questions. We’re at whatthehealth@kff.org. Or you can find me on LinkedIn. Where are you guys these days? Sandhya?  

Raman: I’m on X and Bluesky @SandhyaWrites.  

Huetteman: Sarah?  

Karlin-Smith: A little bit of everywhere, but X, Bluesky, LinkedIn @SarahKarlin or @sarahkarlin-smith.  

Huetteman: And Lauren?  

Weber: I’m at X and Bluesky @laurenweberhp. Yes, the HP is for “health policy.” 

Huetteman: We’ll be back in your feed next week. Until then, be healthy. 

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Health – Dominican Today

Dominican researchers achieve breakthrough in garlic cultivation

Santo Domingo.- The Institute for Innovation in Biotechnology and Industry (IIBI) and ISA University have made a major breakthrough in garlic cultivation in the Dominican Republic.

Santo Domingo.- The Institute for Innovation in Biotechnology and Industry (IIBI) and ISA University have made a major breakthrough in garlic cultivation in the Dominican Republic. With funding from MESCYT through FONDOCYT, researchers identified 13 high-quality garlic genotypes grown in Constanza, which show strong nutritional and pharmaceutical potential and are competitive by international standards.

The study enables the production of virus-free, bioactive-rich seeds suitable for export and industrial use. Chemical analysis revealed high levels of beneficial compounds such as allicin, antioxidants, flavonoids, and phenols in some local varieties, paving the way for the creation of value-added products like garlic extracts, powders, and nutraceutical capsules.

This innovation is expected to benefit small and medium-sized producers by improving crop yields and profitability, while also providing the food and health industries with certified, high-quality ingredients. The project strengthens national capacity in plant biotechnology and highlights how applied science can drive sustainable agricultural and industrial development.

1 month 2 days ago

Health

Health – Dominican Today

Dominican Republic sets roadmap to improve water and sanitation in health centers

Santo Domingo.- The Dominican Republic’s Ministry of Health, UNICEF, and the Water Cabinet have signed a joint declaration to improve access to safe water, sanitation, and hygiene (WASH) in health centers across the country.

Santo Domingo.- The Dominican Republic’s Ministry of Health, UNICEF, and the Water Cabinet have signed a joint declaration to improve access to safe water, sanitation, and hygiene (WASH) in health centers across the country. This initiative aims to ensure quality and resilient health services by integrating water quality standards into the planning, construction, and maintenance of healthcare facilities.

The action plan, developed through a detailed “bottleneck analysis” supported by UNICEF and international experts, identified key obstacles and proposed sustainable solutions. Institutions like INAPA, the National Health Service, and the Water and Sewerage Corporations committed to implementing these actions within their operational plans.

The plan responds to alarming data showing that only 28.5% of Dominican households have regular access to water, a problem that also affects health centers. The initiative prioritizes vulnerable communities and emphasizes that safe water is a basic human right essential for public health and climate resilience.

1 month 2 days ago

Health

PAHO/WHO | Pan American Health Organization

La OMS designa nuevas autoridades para su inclusión en la lista de autoridades catalogadas por la OMS, lo que refuerza el acceso mundial a productos médicos de calidad garantizada

WHO designates new WHO-Listed Authorities, strengthening global access to quality-assured medical products

Cristina Mitchell

7 Aug 2025

WHO designates new WHO-Listed Authorities, strengthening global access to quality-assured medical products

Cristina Mitchell

7 Aug 2025

1 month 2 days ago

PAHO/WHO | Pan American Health Organization

On World Breastfeeding Week, countries urged to invest in health systems and support breastfeeding mothers

On World Breastfeeding Week, countries urged to invest in health systems and support breastfeeding mothers

Oscar Reyes

6 Aug 2025

On World Breastfeeding Week, countries urged to invest in health systems and support breastfeeding mothers

Oscar Reyes

6 Aug 2025

1 month 3 days ago

PAHO/WHO | Pan American Health Organization

PAHO presents its 2024 country reports, highlighting concrete results of its technical cooperation in health in the Americas

PAHO presents its 2024 country reports, highlighting concrete results of its technical cooperation in health in the Americas

Oscar Reyes

6 Aug 2025

PAHO presents its 2024 country reports, highlighting concrete results of its technical cooperation in health in the Americas

Oscar Reyes

6 Aug 2025

1 month 3 days ago

Health | NOW Grenada

Grenada welcomes Nigerian medical team

“The medical team, deployed through the Nigerian Technical Aid Corps (NTAC), includes 2 nephrologists, 2 anesthesiologists, and one orthopaedic specialist”

View the full post Grenada welcomes Nigerian medical team on NOW Grenada.

“The medical team, deployed through the Nigerian Technical Aid Corps (NTAC), includes 2 nephrologists, 2 anesthesiologists, and one orthopaedic specialist”

View the full post Grenada welcomes Nigerian medical team on NOW Grenada.

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Health, Politics, PRESS RELEASE, actif, africaribbean trade and investment forum, genral hospital, joseph andall, ministry of foreign affairs, Ministry of Health, nigeria, nigerian technical aid corps, ntac, philip telesford, yusuf buba yakub

Health – Dominican Today

Dominican Republic to host international health and wellness tourism congress

Santo Domingo.- The Dominican Republic will host the Seventh International Congress on Health and Wellness Tourism from October 22 to 23, bringing together experts from the United States, Colombia, Chile, Ecuador, and Argentina. Notable participants include the president and CEO of Mass General Brigham, a major U.S. medical institution.

Santo Domingo.- The Dominican Republic will host the Seventh International Congress on Health and Wellness Tourism from October 22 to 23, bringing together experts from the United States, Colombia, Chile, Ecuador, and Argentina. Notable participants include the president and CEO of Mass General Brigham, a major U.S. medical institution.

The event will convene leaders from the healthcare, tourism, finance, government, and technology sectors to explore global trends, innovations, regulatory issues, and investment opportunities in the industry. The Dominican Republic currently ranks as the top destination in the Caribbean and second in Latin America on the Medical Tourism Index.

1 month 3 days ago

Health

Medical News, Health News Latest, Medical News Today - Medical Dialogues |

Medical Bulletin 06/August/2025

Here are the top medical news for the day:

This Brain Hormone May Control Blood Sugar Without Insulin

Here are the top medical news for the day:

This Brain Hormone May Control Blood Sugar Without Insulin

An analysis published in The Journal of Clinical Investigation has revealed new insights into how the hormone leptin might be used to manage diabetic ketoacidosis (DKA), a serious and potentially fatal complication of type 1 diabetes. The research, based on over a decade of findings including work from UW Medicine, shows that leptin may help regulate blood sugar levels even in the absence of insulin—challenging long-standing beliefs in diabetes care.

Diabetic ketoacidosis occurs when the body lacks insulin and begins breaking down fat for energy, leading to a dangerous buildup of glucose and ketoacids in the bloodstream. Traditionally, insulin has been the only effective treatment. However, this new analysis points to the brain—and specifically, the hormone leptin—as a key regulator in this process.

Leptin, produced by fat cells and transported to the brain, plays a role in controlling appetite and energy balance. According to senior author Dr. Michael Schwartz, professor of medicine at the University of Washington School of Medicine, when insulin is absent, "the brain gets the message that the body is out of fuel, even if it's not. This information is being communicated in part by a low blood level of the hormone leptin."

Schwartz and his team first explored this idea in 2011 by injecting leptin directly into the brains of rats and mice with type 1 diabetes. Surprisingly, within four days, their blood sugar and ketone levels normalized, despite having virtually no insulin. "I think the most amazing thing is that the blood sugars just didn't come down, but that the levels stayed down," said Schwartz.

At the time, the discovery was largely overlooked. Now, with a deeper understanding of the mechanism, Schwartz plans to seek FDA approval for human trials. If successful, this could lead to a paradigm shift in how type 1 diabetes is treated—potentially without insulin.

The findings suggest the brain, not just the pancreas, could be a key target in future diabetes therapies, offering hope for millions worldwide.

Reference: https://newsroom.uw.edu/news-releases/brain-might-become-target-of-new-t...

Adults Born Preterm Face Higher Risk of Chronic Diseases: Study Finds

The longest-running U.S. study on preterm birth has found that being born early can have lasting health consequences well into adulthood—affecting everything from heart health to mental wellbeing. The findings, published in the Journal of the American Medical Association (JAMA), highlight the urgent need to include birth history in adult medical records and develop long-term clinical guidelines for individuals born preterm.

The research, led by University of Rhode Island College of Nursing Professor Amy D’Agata, continues work that began in the 1980s with a cohort of infants born preterm at Women & Infants Hospital. The longitudinal study has followed 215 participants, including both preterm (born between 22 to 36 weeks of gestation) and full-term infants.

As these individuals approach their 40s, the data reveal clear health disparities between those born preterm and their full-term peers. According to D’Agata, preterm individuals are showing higher rates of high blood pressure, elevated cholesterol, abdominal fat, and reduced bone density. Psychologically, they are more prone to internalizing stress, which manifests as higher levels of anxiety and depression.

“Preterm birth is not just a neonatal issue. It, in fact, is a lifelong condition,” said D’Agata. “We are now realizing that there is a very strong link between what happens to you early in life and later health outcomes.”

One critical finding is the lack of birth history documentation in adult healthcare. Many clinicians are unaware if a patient was born preterm, making it harder to assess risk for chronic conditions. D’Agata is calling for birth history to be a standard part of adult medical intake and for targeted screening guidelines to be developed.

“We believe a paradigm shift is needed in health care that recognizes preterm birth as a chronic condition requiring lifelong monitoring and support,” she emphasized.

This research is helping reshape how medicine views early birth—not as a one-time event, but a factor with lifelong implications.

Reference: D’Agata AL, Eaton C, Smith T, et al. Psychological and Physical Health of a Preterm Birth Cohort at Age 35 Years. JAMA Netw Open. 2025;8(7):e2522599. doi:10.1001/jamanetworkopen.2025.22599

Study Reveals Social Factors that May Triple the Risk of Long Covid

A new nationwide study led by investigators at Mass General Brigham has revealed that social risk factors such as financial hardship, food insecurity, and limited access to healthcare are significantly associated with a higher risk of developing long COVID. The findings, published in the Annals of Internal Medicine, offer vital insights into the long-term impact of the COVID-19 pandemic and underscore the need to address social determinants of health in efforts to combat long COVID.

Long COVID refers to a broad spectrum of symptoms that persist for three months or more following a SARS-CoV-2 infection. While scientific understanding of the condition has grown through the National Institutes of Health’s RECOVER (Researching COVID to Enhance Recovery) Initiative, the influence of social factors has remained less clear—until now.

To better understand this relationship, researchers analyzed data from 3,700 participants in the RECOVER-Adult cohort. These individuals had contracted COVID-19 during the Omicron

variant surge and completed comprehensive surveys at the time of infection and again six months later to assess for long COVID symptoms. Participants came from 33 states, Washington, D.C., and Puerto Rico, and enrolled between October 2021 and November 2023.

The researchers assessed four major categories of social risk: economic instability, education and language barriers, healthcare access and quality, and lack of community support. They also used ZIP code-level data to measure factors like household crowding.

After accounting for variables such as vaccination status, hospitalization, age, sex, and race, the study found that nearly all individual-level social risk factors were strongly associated with a two- to three-fold increase in the likelihood of developing long COVID. Living in more crowded areas further raised the risk. The burden of these risk factors was higher among racially and ethnically minoritized groups, but their impact on long COVID risk was consistent across all racial categories.

"While rates of COVID-19 have decreased, long COVID is a chronic disease that many people still suffer from," said senior author Dr. Elizabeth Karlson. "Future interventions must address these factors to effectively reduce adverse outcomes among people with high burden of social risk factors."

Researchers plan to expand the study to assess whether these trends hold for children and explore long COVID symptoms lasting a year or more.

References: Candace H. Feldman, Leah Santacroce, Ingrid V. Bassett, et al. Social Determinants of Health and Risk for Long COVID in the U.S. RECOVER-Adult Cohort. Ann Intern Med. [Epub 29 July 2025]. doi:10.7326/ANNALS-24-01971

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