Robotics in rural Alabama obstetrics care gets mixed reviews

36 of Alabama's 54 counties lack any obstetrics care.
(Photo by Volodymyr Hryshchenko, Unsplash)

People are conflicted about part of the Alabama Rural Health Transformation Program, which aims to add robotic ultrasound machines in rural areas of the state, reports Liz Carey for The Daily Yonder. Many experts agree that the state's biggest obstacles to ensuring healthy pregnancies, babies and moms is access.

Alabama has the highest maternal mortality rate in the U.S., with 41 of its 54 counties lacking labor and delivery services and 36 counties without any obstetrics care.

While the new robots address a lack of technical support in rural healthcare, the real issue, medical care access, isn't addressed by robot-providing ultrasounds, according to an OB/GYN in Jasper, Alabama.

“There may be a case where a mom may have low fluid, and that patient needs to go to a hospital,”  LoRissa Autery told Fox54 News. “But if you’re in a part of the county that doesn’t have a hospital that has obstetrical services, now you have to drive an hour to an hour and a half to receive those services from a physician that did not do the ultrasound.”

New technology can help provide access to care, but to do so, it requires basic healthcare infrastructure and reliable broadband internet access, Katy Kozhimannil, a professor and co-director of a rural health research center at the University of Minnesota, told the Yonder.

The Alabama's plan also outlines programs to supply emergency labor and delivery carts to rural hospitals, pair patients with specialty providers, and distribute equipment upgrades and minor building renovations, reports Carey.

Some state and federal officials have praised the plan, while others have given it mixed reviews, Carey adds.

When dialysis treatment centers close, rural patients have no choice but to drive further for care

After the Chadron dialysis center closed, Pieper's 
treatment travel time tripled. (KFF Health News photo)

Rural residents who require dialysis treatment to stay alive are having to drive longer distances for care as smaller hospitals and clinics shed unprofitable services to stay afloat, reports Ariella Zionts of KFF Health News.

When Chadron Hospital shuttered its dialysis center, which served Nebraska residents in the state's far western panhandle, Mark Pieper became one of the many displaced patients who would have to find another dialysis center for treatment.

Because the human body cannot survive without kidney-like functions that filter toxins, remove excess fluid and balance electrolytes, dialysis cannot be rescheduled or skipped. When faced with the closure of their dialysis center, renal patients like Pieper have two choices: Travel for treatment or die.

"Pieper eventually found treatment in Scottsbluff, which, with about 14,000 residents, is the biggest city in the rural Panhandle region," Zionts writes. "The hour-and-a-half drive will triple his time on the road to more than nine hours each week."

Chadron Hospital discontinued its dialysis service despite the $219 million in federal money Nebraska will receive this year from the Rural Health Transformation Program. But RHTP awards aren't meant to "help existing services stay afloat," Zionts explains. Instead, they are earmarked to help rural medical centers "explore new, creative ways to improve rural health." Only 15% of RHTP funds can be used to pay for patient care.

Chadron Hospital was "losing $1 million a year on its dialysis service due to low reimbursement rates that didn’t cover operational costs," Zionts reports. Nephrologist Mark Unruh said the "dialysis closure in Chadron reflects a wider trend of staffing and funding challenges."

Preventing kidney failure is one of the best ways rural areas can change what rural dialysis patients like Pieper are facing now, Unruh told KFF Health News. "He pointed to a tele-education program that helps primary care doctors in rural and other underserved areas prevent end-stage renal failure."

A startling look at the lack of dialysis treatment options for rural Americans experiencing kidney failure

For the roughly 240,000 rural Americans suffering from kidney failure, or End-Stage Renal Disease (ESRD), getting to a dialysis center that can deliver consistent, quality care is a struggle. The lack of reliable dialysis for rural ESRD patients has been exacerbated by too few providers within a drivable distance, with some rural residents facing travel across several counties to access dialysis.

The most common dialysis clinics near rural ESRD patients are often owned by DaVita, a "for-profit company with a documented history of kickbacks to doctors and involuntary patient discharges," reports Sarah Melotte of The Daily Yonder. Involuntary discharges are supposed to be extremely rare and regulated by the Centers for Medicare and Medicaid Services.

About 22.8 rural Americans – just over half of the total rural population – live in a county where either DaVita is the only clinic, or there is no clinic at all. (Map by Sarah Melotte, Daily Yonder, from CMS data)

In fact, for 6.1 million rural Americans, DaVita is the only Medicare-certified dialysis clinic in their county, according to Melotte's analysis of CMS data. Melotte reports. "Another 16.5 million rural Americans live in a county with no facility at all."

Overall, DaVita and its German competitor, Fresenius, "tend to have worse health outcomes compared to independent, non-profit clinics," Melotte writes. "Duke University’s research found that, after dialysis clinics were acquired by large, for-profit, companies, the likelihood of each patient being hospitalized each month increased by 4.5%."

Using a CMS dialysis facilities dataset, in 300 counties, 190 of which are non-metropolitan, or rural, "DaVita runs the only clinics in the county," according to Melotte's anaysis. "In rural counties, about 31% of clinics are owned by DaVita."

In some rural regions, the lack of dialysis centers is even more dire. "About 59% of rural counties don’t have a single Medicare-certified dialysis clinic," Melotte writes. "In places like rural Central Nebraska or Western Kansas, patients might be several counties away from the nearest clinic."

Tribal lands need broadband to improve health care access, but progress is slow

Shoshone-Bannock tribal lands are vast with a rocky terrain, which poses a challenge in building fiber-optic cable lines for high-speed internet to homes. (Photo by Sarah Jane Tribble, KFF Health News)

The lands of the Shoshone-Bannock Tribes in Idaho span seemingly endless miles. But the beauty of this vast tribal expanse comes with a cost: Profound broadband gaps that limit health care for Native Americans throughout the region. "Tribal members are historically underserved and, on average, live with the highest rates of chronic illnesses and die 6.5 years earlier than the average U.S. resident," reports Sarah Jane Tribble of KFF Health News.

Accessing medical treatment without broadband connectivity presents a range of challenges. Tribal members have to drive to medical appointments because telehealth isn't an option. "Tribal field nurses update charts in paper notebooks at patients’ homes, then drive back to the clinic to pull up records, send orders, or check prescriptions," Tribble writes. Getting care and medicine all takes longer.

All the while, millions in federal dollars have been set aside to address tribal broadband infrastructure. "Three years ago, the Shoshone-Bannock Tribes were awarded more than $22 million during the first round of the federal Tribal Broadband Connectivity Program," Tribble explains. "But tribes that were awarded millions in a second round of funding saw their payments held up under the Trump administration."

Shoshone-Bannock Tribes Broadband Infrastructure Deployment project
(Map by Lydia Zuraw and Sarah Jane Tribble, KFF Health News)

For some tribal members, waiting for fiber isn't an option. Instead, they pay for Starlink, which uses low-earth-orbit satellites and costs between $80 and $120 a month. "For 53-year-old Carol Cervantes Osborne, who lives with constant pain from severe rheumatoid arthritis, having internet is a necessity," Tribble explains. "She signed up for Starlink so that she can connect with doctors remotely through telehealth appointments." 

Despite the wait for broadband and the current lack of care access on their lands, tribal leaders say Starlink is too expensive for most of their members.

This year, the Shoshone-Bannock Tribes started work on their high-speed internet installation, but progress will be slow. "To build fiber-optic cables underground, the tribes must navigate lava rock and work with the Bureau of Indian Affairs to get permits," Tribble explains. "Eventually, the old radio station will be central to operations, with fiber-optic cable lines that web out over about 800 square miles to reach the reservation’s five district lodges."

Managing cattle manure can prevent antibiotic-resistant bacteria from contaminating crops, new study finds

Unmanaged cow manure can cause antibiotic-resistant bacteria
to proliferate. (Adobe Stock photo)

Manure and antibiotic management on cattle ranches can help prevent the growth of more antibiotic-resistant bacteria, a new study finds.

Researchers have uncovered substantial evidence that unmanaged livestock manure poses a global health risk by transmitting antibiotic-resistant genes (ARGs) when spread in fields or used to water crops.

When antibiotics are used to treat livestock, resistant bacteria and their resistance genes "can build up in cattle guts, which is then excreted into manure," reports Pragathi Ravi for Offrange. Antibiotic-resistant bacteria and their genes "reduce the effectiveness of critical medicines on humans." 

Giving farm animals antibiotics only when they are ill -- not as a way to promote growth -- is one way to prevent antibiotic-resistant bacteria and genes from multiplying, according to the World Health Organization. 

One problem with antibiotic-resistant bacteria or genes is that once they have sickened a human, there is no viable treatment. Ravi adds, "In 2021, a study published in The Lancet estimated that 4.71 million deaths were associated with antimicrobial resistance between 1990 and 2021."

Humans can become ill from contact with untreated manure or from ingesting food fertilized or watered with unprocessed manure that contains bacteria. Ravi explains, "Salmonella can grow inside a tomato, which means washing it externally is not going to help when the tomato is consumed raw."

Study researcher and professor Xun Qian told Ravi: "Livestock manure carries antibiotic resistance genes that can defeat every major class of antibiotics used in human medicine — including those considered ‘last resort.'" 

Implementing programs that support proper manure composting before it is applied to farmland can help prevent ARGs from spreading.

If Congress doesn't extend enhanced health care tax credits, 4 million rural Americans could face steep premium hikes

Average health care premium comparison before and after ACA credits for 10 'farm states.'
(Robert Woods Johnson Foundation graph)

Without the Affordable Care Act's enhanced tax credits, roughly four million rural Americans could see significant increases to their health care insurance premiums. Last year, the Health and Human Services reported that 17% of individuals who purchased insurance through the ACA marketplace were rural residents, reports Chris Clayton of Progressive Farmer.

While Washington lawmakers focus on eliminating programs that could use American tax dollars to pay for health insurance for illegal immigrants, "there is less talk about how much rural America relies on those tax credits," Clayton explains. "The tax credits have been a major driver for reducing the number of uninsured Americans."

In 2024, the Robert Wood Johnson Foundation reviewed "enrollment of Medicaid and marketplace policies in ten 'farm states,'" Clayton reports. "In that study, eight states -- all but Iowa and Kentucky -- showed more than 5% of residents were enrolled in ACA marketplace policies."

Without ACA enhanced tax credits, health insurance premiums may be out of reach for many rural Americans. According to the article, an individual making $35,000, with enhanced tax credits, would pay a health care premium of $1,033 per year. Without ACA credits, the premium jumps to $2,615 annually, representing a $1,582 increase.

"Overall, the enhanced tax credits saved rural enrollees an average of $890 per year, about 28% more than their urban counterparts," Clayton reports.

To avoid closures, mergers or reduced services, some rural hospitals are banding together

A mobile MRI machine services and costs can be
shared by a network of hospitals. (KFF Health photo)

A growing number of independent rural hospitals are joining networks that allow them to meet their community's health care needs without operating in the red or being pushed into a merger, reports Arielle Zionts of KFF Health News. While such medical networks have existed for decades, their popularity as a lifeline for rural hospitals is relatively new.

In North Dakota, 22 hospitals banded together to form the Rough Rider Network, which "used its members' combined patient rolls to negotiate better prices," Zionts writes. "The networks are an alternative to shutting down or reducing services, or to giving up local autonomy and joining a large hospital system."

The Rough Rider Network was formed with the help of an independent company, Cibolo, which worked on hospital partnerships. Zionts writes, "Cibolo Health has helped start networks in Minnesota, Nebraska, Montana, and Ohio."

Hospitals that team up with other hospitals can opt to share specialist providers, expensive diagnostic equipment, mobile clinic opportunities, and even "pool staffers for a network-wide employee health insurance plan," Zionts adds.

Rural health care providers are "increasingly interested in forming such networks, said Marnell Bradfield, executive director of the Community Care Alliance, a network of hospitals and independent primary care offices in rural western Colorado," Zionts reports. "About once a month, she said, she gets a call from health care leaders exploring similar networks and asking about her experience."

Banding together to keep small town hospitals open does more than provide nearby medical care for a community. It's also "beneficial for the economy of rural areas, where hospitals are often major employers," Zionts writes. "Some networks also invest in broadband, housing, and other community development projects that can help people stay healthy and access care."

Telemedicine provides abortion access for rural women in states where the procedure is restricted or banned

Graph by the Society of Family Planning (click to enlarge)

Women living in rural areas with abortion-restrictive state laws are using telehealth and doctors in other states to access abortion medications. State shield laws currently protect out-of-state medical professionals who prescribe abortion medications, but that protection may not remain a guarantee.

Asynchronous telemedicine abortion medication provision rates "were higher in states with abortion restrictions and poorer counties far from clinics," reports Rachael Robertson of MedPage Today. "Of the 118,338 medication abortion pill packs Aid Access provided over a 15-month period, 84% went to states with near-total restrictions or bans on telemedicine abortion," reported Abigail Aiken, PhD, at the University of Texas, in the Journal of the American Medical Association.

When the U.S. Supreme Court overturned Roe v. Wade in 2022, some states followed the decision with abortion bans; however, if the bans were meant to stop abortions, they had limited success. Robertson writes, "Some data suggest that abortion rates remained steady despite these challenges."

Aiken's research points to medication abortions and the shield law as a reason abortion rates remained level, even in states with the most stringent restrictions. Aiken explains, "One plausible contributor is the rise of online asynchronous telemedicine abortion services -- particularly those operating under shield laws, which allow U.S.-licensed clinicians to provide abortion medications to patients in ban states with protection from legal liability."

"Before Roe was overturned, telehealth only accounted for 4% of abortions; that has increased to 25% as of December 2024, and disproportionately to ban states, according to Society of Family Planning data," Robertson adds.

Shield law protections will be tested by a Texas lawsuit "against a New York physician operating a nonprofit delivering telemedicine abortion," Robertson reports. "In the past, states tended to honor and assist other states' law enforcement, but the post-Roe era is different."

Measles made its way back into the U.S., but new ways to prevent the disease may be on the horizon.

Illustration of infectious diseases under a microscope
(Adobe Stock)

Once thought to be eliminated in the U.S., measles has returned, leaving its unpleasant symptoms and tell-tale itchy rash in its wake. With more people contracting and spreading the disease, ways to avoid or treat it have revived. "As vaccination rates fall and infections rise, scientists are racing to develop drugs they say could prevent or treat the disease in vulnerable and unvaccinated people," reports Dominique Mosbergen of The Wall Street Journal.

A little over 20 years ago, looking for ways to treat measles wasn't a consideration, but now some biotech companies and universities are working on measles prevention without the typical MMR vaccination. Mosbergen writes, "The drugs are still a ways from becoming available to patients but could offer alternatives to people who are immunocompromised, don’t respond to the measles vaccine or are vaccine skeptics."

Not all medical professionals see new measles treatments as a positive development because they could "further drive the drop in vaccination. Nationally, 92.5% of kindergartners received the measles, mumps and rubella . . . shot in the 2024-25 school year," the Journal reports. "In 2019-20, the vaccination rate was over 95%, which is the rate encouraged by health authorities to prevent community transmission of measles."

Invivyd, one of the companies working on a new measles treatment, uses measles "antibodies that are lab-made versions that can be delivered intravenously or as an injection and boost immunity immediately," Mosbergen explains. "They could benefit newborns and immunocompromised people who can’t be vaccinated, as well as the minority of people who don’t respond to the vaccine or whose immunity has waned."

Scientists haven't studied the measles virus as much as other communicable diseases because the vaccine was so effective, but to develop new treatments, researchers have "been forced to better understand measles," Mosbergen reports. "The body’s immune response to measles, for instance, hadn’t been well understood."

Upcoming 'Make America Healthy Again' report targeting farming chemicals is already under review

U.S. farmers apply almost 300 million pounds of
glyphosate, or Roundup, per year. (Adobe Stock photo)

U.S. Health and Human Services Secretary Robert F. Kennedy Jr. may want his "Make America Healthy Again" strategy to include rooting out farm herbicides and pesticides as a national health concern, but the idea is already facing pushback, report Kristina Peterson, Josh Dawsey and Liz Essley Whyte of The Wall Street Journal. "Some White House and agency officials are concerned the move would disrupt the food-supply chain."

Kennedy plans to use MAHA's May 22 report to push U.S. food producers away from heavy chemical use. "White House officials have raised concerns about the pesticide push and are closely reviewing the coming report," the Journal reports. Although President Trump committed to investigating pesticides during his campaign, where he will finally stand on the issue remains unclear.

The report will likely target glyphosate, the primary ingredient in Roundup, as an ongoing danger to human health; however, removing it from the U.S. food supply seems nearly impossible. Not only is glyphosate the world's most popular herbicide, "more than 90% of soybean, corn and cotton crops planted in the U.S. are genetically modified to withstand glyphosate-based weedkiller," the Journal reports. "American farmers apply almost 300 million pounds of glyphosate to their fields each year, according to data from the U.S. Geological Survey." 

The report is also expected to call out "atrazine, a herbicide used on grasses and corn, as a possible problematic toxin," Peterson, Dawsey and Whyte add. Between glyphosate and atrazine, glyphosate is more popular with farmers, and limiting its use could prove detrimental.

U.S. Rep. Andy Harris (Rep., Md.), during a Wednesday hearing, "told Kennedy that going after pesticides could hurt farmers," the Journal reports. "Kennedy said he shared that concern and that the government 'cannot be putting [farmers] out of business.'"

Comments by a White House spokesman depicted MAHA's first report as a foundational review that could guide further research into chronic health issues in the United States.

Forest plants and resources can help feed more marginalized people while supporting biodiversity conservation

Policies recognizing the value of
forests have multiple benefits.
(Photo by Ruta Celma, Unsplash)

The first humans didn’t have a Walmart or a convenience store, but they did have the forest, which has provided food, medicine and life since the dawn of time.

In an article for the Great Lakes Echo, Victoria Witke wrote that a “notable” number of people in the United States rely on “public forests for food and medicine.” Witke acknowledged that this is a low-cost option.

Jimmy Chamberlain, a researcher in a study conducted in the journal Trees, Forests and People, told Witke that, “policies should be created to recognize forest foods as valuable, thus supporting food production and biodiversity conservation.”

According to Witke's report, "A notable proportion of the U.S. population relies on public forests for food and medicine, but the forest products industry is 'not well served by institutions that set forest management policies,' according to a new study in the journal Trees, Forests and People."

 
Chamberlain said that if public land agencies don’t manage the plants and resources, there will be less food security for the people using them. However, “If we can begin to manage for food and medicine, then we meet the needs of a larger constituency. That constituency is typically economically marginalized – poor people.”

Not only would caring for the forest increase its value and help people, but it is also a meaningful practice that encourages giving care to what provides our resources and discourages greed.

Roger LaBine, of the Lac Vieux Desert Band, told Witke, "his tribe is taught that plants and animals sacrifice for humans, and it’s mankind’s responsibility to protect them."

Rural pharmacies have been forced into closure for years; now bigger chains are shuttering stores

A Walgreens pharmacy in Murphy, North Carolina,
pop. 1,600. (Wikipedia photo)

 

Over the past decade, rural, independent pharmacies faced shrinking profits and many closed. But now, even big chains are struggling to keep the current drugstore model profitable, reports Nathaniel Meyersohn of CNN News. "CVS is closing 900 stores. Walgreens announced it plans to close 1,200 stores, meaning 1 in 7 will disappear. . . .They are now shutting down because of shifting consumer habits, competition and changes in the pharmacy industry."

Both independent and larger drugstore chains blame some of their financial decline on pharmacy benefit managers, or PBMs, which negotiate rebates from drug manufacturers to insurers. "PBMs have been cutting reimbursement rates to boost their own profits, Elizabeth Anderson, an analyst at Evercore IRI," told CNN. "The pharmacy industry has complained that PBMs have too much control and can squeeze pharmacies. PBMs argue that they help keep drug prices down by negotiating with drug makers."

Walgreens added primary care clinics to try and bolster its bottom line, but the venture was unsuccessful. "Walgreens took a $5.2 billion stake in VillageMD, a primary care network, in 2021. But VillageMD has not been profitable for Walgreens, and Walgreens has tried to cut costs," Meyersohn writes. "The chain has been closing VillageMD locations and said over the summer it will divest from the company."

When the past 20 years of pharmacy availability for Americans is scrutinized, rural residents usually end up with fewer options and a longer drive for medication treatment, but the same can be true for poorer neighborhoods. Meyersohn reports, "Roughly one out of every eight pharmacies closed between 2009 and 2015, which disproportionately affected independent pharmacies and low-income neighborhoods, according to a study published in the Journal of the American Medical Association."

Opinion: Appalachian 'diggers' are not the main cause of wild ginseng's decline, but they could be part of the solution

Wild ginseng plants (Va. Ag photo)

Appalachian "diggers" have harvested wild ginseng roots for medicine or sale since the late 1700s, but recently, wild ginseng populations have shrunk and Appalachian diggers have been accused of overharvesting the plant and put under governmental scrutiny. In her opinion for The Conversation, Justine Law, an ecology and environmental studies professor, maintains that local harvesters are not to blame for wild ginseng's decline, but they can be part of the solution.

"I’m an environmental geographer who studies rural livelihoods and conservation in North American forests. As I see it, large-scale threats to ginseng, including mining and climate change, are bigger concerns than small-scale harvesting by negligent diggers. I believe many diggers can be valuable conservation partners," Law writes. "Ginseng was listed in Appendix II of the Convention on International Trade in Endangered Species of Wild Fauna and Flora in 1975. This indicated that the plant was not threatened at the time. . . .Today, ginseng is classified as vulnerable in 13 of the 19 states that allow its harvest and sale, subject to state regulations."

The tap roots of wild ginseng plants will fetch thousands of dollars per pound in Asian markets as well as hefty prices in the United States. As the wild ginseng populations declined, "state and federal agencies have tightened ginseng regulations and ramped up enforcement," Law explains. "In 2018, West Virginia increased fines for illegal ginseng harvesting from . . . $100 to between $500 and $1,000 for a first offense. That same year, Ohio began using K-9 dogs to detect ginseng held by people suspected of illegal digging."

Historically, wild ginseng diggers have been blamed for the plant's scarcity since the late 1800s. Law writes, "But diggers are not, and never have been, the only reason for small ginseng populations. Starting in the late 1800s, forests across virtually all of the eastern United States were logged for farming, fuel, and industry."

Most local diggers know the plant's needs for continued growth and harvest it with that in mind. "I have interviewed dozens of ginseng diggers. Nearly all of them harvest only a portion of the plants in a patch, and they will wait until a plant’s berries are ripe before they dig it up and replant the berries," Law adds. "Other researchers have also highlighted diggers’ conservation practices, the complex pressures on ginseng populations and the injustice of excluding Appalachians from their historical forest commons. Still, the 'crooked digger' narrative persists."

Opening up opportunities to Appalachian ginseng harvesters could also help the plant thrive. Law explains, "There’s already a robust movement to plant ginseng seeds under existing forest canopy on private land, but most diggers don’t own land. A complementary effort might distribute seeds to them for planting in designated zones. . . . Participating could be a way to earn ginseng harvesting permits in state or national forests."

To find out more about wild ginseng's history in Appalachia, click here. Watch the video below for a more global view of the plant's history.

Medicare will save billions from its first-ever drug price negotiations with pharmaceutical companies

The negotiated prices will apply in 2026.
(Adobe Stock photo)

The first-ever talks between Medicare and pharmaceutical companies have yielded some positive change for Medicare expenditures, but how much older Americans will save remains uncertain. "The federal government released the new prices it will pay for 10 prescription drugs," reports Jared S. Hopkins of The Wall Street Journal. "The drugs, for serious conditions including cancer, diabetes and blood clots cost the government more than $50 billion a year altogether. . . . [But] they might not translate into much savings for many seniors."

The talks were Medicare's first foray using its massive consumer base to tamp down drug prices. "Lowering drug prices through negotiations is a milestone in years of efforts to give Medicare, the country’s biggest purchaser of prescription medicines, a power that private health plans have long deployed to keep a lid on rising drug costs," Hopkins explains. "It follows other new government measures tackling high drug prices, such as a $35 cap on how much Medicare members pay out of pocket for insulin."

Here are a few of the newly negotiated drug prices for a month’s supply compared to Medicare's 2023 list price for a 30-day supply. To read the full list, click here.

Eliquis, a blood thinner from Bristol-Myers Squibb and Pfizer: $231, down from $521;
Enbrel, an arthritis drug from Amgen: $2,355, down from $7,106;
Jardiance, a diabetes drug from Eli Lilly and Boehringer Ingelheim: $197, down from $573;
Stelara, a psoriasis drug from J&J: $4,695, down from $13,836;
Xarelto, a blood thinner from J&J: $197, down from $517.

Medicare's new prices will start in 2026. Anna Anderson-Cook and Richard G. Frank of Brookings report, "Using publicly-available data, estimate savings consistent with CMS reporting, find that 51.4% of the estimated savings ($3.28 billion) is accounted for by 3 drugs. Penn reports, "The negotiations will save nearly $100 billion by 2031, the Congressional Budget Office estimated."

Health advocates use produce 'prescriptions' to treat diet-related problems; funding can be a barrier

Nutritionist Shelby Ballinger teaches cooking classes
for Delta Produce RX participants. (RHIhub photo)

Community health advocates in pockets across the U.S. are helping rural community members access fresh produce with healthy food "prescriptions," which treat diet-related health problems.

In Leland, Mississippi, a program called Delta Produce RX serves more than "100 patients of Leland Medical Clinic who receive a monthly $80 credit reserved for the purchase of fresh produce at the Leland Stop N Shop," reports Brendan Stermer of Rural Health Information Hub. "The program is reserved for low-income individuals who suffer from diet-related chronic health conditions. Participants also attend cooking classes, meet with a nutritionist, and receive a membership to the local wellness center."

Leland's program began in 2020 and is run by Delta Health Alliance, a nonprofit healthcare and social service organization, and administered through grant dollars. Shelby Ballinger, a Delta Produce RX program manager and a nutritionist, told Stermer, "It kind of exploded. Word of mouth has gotten around our community, so I get a lot of calls from patients and community members who are interested in the program."

While some might say giving food to address diet-related problems is common sense, it has not been the norm. But the idea is gaining momentum. "According to a 2021 report commissioned by the nonprofit Wholesome Wave, 108 new 'produce prescription' programs launched in the U.S. between 2010 and 2020," Stermer writes. The Wholesome Wave report also "noted an 'unequal distribution of programs,' with the model experiencing 'strong growth on the coasts and within Midwestern urban cities.' Produce prescription programs are still uncommon in rural areas like the Mississippi Delta, where rates of food insecurity and diet-related disease are the highest."

As more programs have opened, more studies show the health benefits and cost savings they offer. Stermer reports, "New research from Tufts University supports the model's effectiveness at improving food security and various health metrics associated with diet-related disease. According to another recent Tufts University study, widespread implementation could facilitate long-term healthcare cost savings of $39.6 billion over 25 years."

Despite the concept's success, funding remains uncertain. Melissa Akers, manager of the Food Policy, Health, and Hunger Research Program at the University of California San Francisco Center for Vulnerable Populations, told Stermer, "Sustainable funding is still tricky." Stermer adds, "Akers [has] interviewed over a dozen 'key informants' working with rural produce prescription programs across the country. Funding came up frequently as the most significant barrier to program growth."

For more on starting a produce RX, Akers co-authored the Rural Produce Prescription Toolkit, which offers nuts and bolts for funding, launching and sustaining a rural produce-for-health program in your town.

Opinion: Recruiting physicians to rural areas needs to show what communities offer, which goes far beyond money

Rural medicine is often more about relationships than diagnoses,
which is a hard concept to incentivize. (UIC photo)

Student loan reductions and payoffs have not enticed enough graduating doctors to move into rural areas. But when medical providers experience working in less populated places, they often find smaller communities have so much more to offer, writes Arjun V.K. Sharma in his essay for Undark. "Strategies to attract doctors to rural areas can take many forms, but it is hard to imagine any being successful without the doctor seeing the benefits of the community in which they reside."

Government officials, public policy writers and community planners would do well to look at what it takes for a resident to opt to live in a rural location. Sharma explains: "Often, it is interminably fraught — already hard work is made harder, significant others are uprooted, and certain city comforts and sensibilities may be sacrificed. Physicians, then, must rely on forces internally summoned — autonomy, altruism, competence — to propel them forward. These qualities are harder to define and measure, which make them difficult to meaningfully pin to any reward."

"When I left the city for work in a rural hospital, I put those virtues to the test. I was unsettled, initially wading through the steady stream of 'hellos,' 'good mornings,' and 'good nights' from passersby in the corridor, and unsure of how to interact with psychiatric patients who ran a café near their small ward to ease their transition to the world outside," Sharma writes. "And I was uneasy, at times, with the care we provided — even if patients were appreciative of what they received. The same decisions we fashioned in the city — to get antibiotics delivered at home or to get a surgeon to clear out an abscess — came together with fewer resources, and with doctors stretched hundreds of miles apart."

Rural settings offer a space where all people intermingle and get to know each other. And the closeness of being together while all others are miles away "lent a power to something decidedly tangible. Interactions with patients had an unflinching honesty and tenderness about them," Sharma adds. "One morning, an older man with anxiety was referred from the emergency department to a senior physician. They ran into each other at the grocery store and at local hockey games; living down the street, the physician would often check in on him."

Sharma writes. "A connection to a rural identity could be bought with incentives, or it could be learned. . . . It could be lived through simple and heartfelt things: a teary 'thank you,' a firm handshake, or the question, over and again, from patients of your plans to stay. These gestures don’t absolve the system of its responsibility to make positive reforms. But they affirm value and purpose of work that, whittled down by staffing shortages and burnout, can still impact lives our society willfully neglects."

Out-of-pocket prescription expenses can be painful -- here are some steps to control costs

Retail drug prices vary. Shopping around can
save money. (Photo by Jake Dockins, WSJ)

Ringing in the new year can mean the costly reset of health insurance deductibles, but understanding new caps and limits on prescriptions can make out-of-pocket expenses more manageable. "The Inflation Reduction Act of 2022 contained some of the most sweeping drug-price provisions ever enacted," reports Peter Loftus of The Wall Street Journal. Beyond the law's changes, there are several steps people can take to "put a lid on drug costs."

Beginning in 2023, insulin costs were capped at $35 per month for Medicare recipients. Loftus explains, "You can check the websites of the three main insulin manufacturers — Eli Lilly, Novo Nordisk and Sanofi — to see if the price of your insulin is being cut." If you carry private insurance, the cap does not apply.

The reduction act also "expanded the list of vaccines that seniors enrolled in Medicare Part D can receive at no cost," Loftus reports. Details are available here.

Check with your provider to see if swapping out your costly brand-name drug for a generic is an option. Loftus adds, "There's also a newer category of drugs called biosimilars, which are close copies of brand-name biologic drugs such as Humira, the high-selling drug for autoimmune diseases. . . . Here is the growing list of approved biosimilars."

Take time to compare costs. "Prices for the same drug can vary widely depending on where you buy it," Loftus writes. "For generics, check out the growing number of online discount prescription services. The Mark Cuban Cost Plus Drug Co. offers generic drugs at a 15% markup plus pharmacy and shipping fees by cutting out pharmacy middlemen and negotiating directly with manufacturers. Amazon.com offers various pharmacy services, including one that provides eligible medications for $5 a month, found here."

To read about when to consider skipping insurance and to find links to more savings options, you can read Loftus's full article here.

2023 was a tough year in many ways, but saw significant positive developments in science and medicine

The first pill to treat postpartum depression was
approved in 2023. (Photo by Hollie Santos, Unsplash)

Despite wars, the most mass killings since 2006, and the hottest average temperatures in human history, "2023 also was a year with significant positive developments, including in scientific research and medicine," report Victoria Bisset and other Washington Post staff members. Not only does some good news about the past year provide comfort, the Post points out that "research has indicated that uplifting news can provide an emotional buffer against distressing news and feelings of hopelessness — and even encourage optimism or action." Here are some things the Post listed:

The World Health Organization approved a new malaria vaccine that has been shown to be much more effective than the only previous vaccine against the potentially deadly disease. The U.S. has about 2,000 cases of malaria each year, most of them contracted in other nations.

The Food and Drug Administration approved the first pill to treat postpartum depression, which affects up to one in five women who can "experience intense hopelessness and, in rare cases, psychosis — and it can last for years," the Post notes. "The new drug is taken once a day for two weeks and, unlike the existing treatment of an IV injection that may take as long as 60 hours to administer in a health-care setting, it can be taken at home."

The FDA also approved two gene-therapy treatments for sickle-cell disease, "a rare and debilitating condition that affects around 100,000 Americans, most of them Black. The disease causes extreme, constant pain and can drastically cut the life span of those affected," the Post notes. "Both are intensive, expensive procedures — and require chemotherapy, which has significant side effects. But patients who have received the treatments have spoken of its profoundly beneficial impact on their lives."

Scientists made progress in understanding dementia, the Post reports. One study "suggested that lifestyle habits, including regular mental and physical activity, eating a healthful diet, and regular social contact were linked with a slower rate of memory decline," the Post reports. "Another found that living in areas with more natural green spaces was associated with lower rates of hospital admissions for diseases including dementia, while separate research indicated that the use of hearing aids could cut the risk of cognitive decline by nearly half."

Meanwhile, the FDA approved, for the first time, a drug that modestly slows Alzheimer’s disease. While difficult questions about safety, effectiveness and cost remain, many neurologists say that having a drug that slows Alzheimer’s is nonetheless a milestone after years of failed trials.

As states receive more than $50 billion in opioid settlement money, companies are competing to get some of the funding

Caution is advised with settlement money.
(Photo by JP Valery, Unsplash)

Money from opioid settlements began to hit state coffers in November, and now a long line of companies and service providers want to help states spend it. Experts are urging caution, reports Aneri Pattani KFF Health News. Marketing pitches for everything from funding new psychedelic research to providing law enforcement with lassos instead of tasers have been flooding state and local officials in charge of distributing the more than $50 billion in settlement funds.

The billions in payments were intended as a punishment and warning to drug companies whose aggressive, harmful and often dishonest marketing practices "fueled an epidemic that progressed to heroin and fentanyl and has killed more than half a million Americans," Pattani explains. "The settlement money, arriving over nearly two decades, is meant to remediate the effects of that corporate behavior."

But as the dollars began to flow to states in early November, "a swarm of private, public, nonprofit, and for-profit entities began eyeing the gold rush," Pattani writes. "Some people fear that corporations, in particular — with their flashy products, robust marketing budgets, and hunger for profits — will now gobble up the windfall meant to rectify it."

JK Costello, director of behavioral health consulting for the Steadman Group, a firm that is being paid to help local governments administer the settlements in Colorado, Kansas, Oregon and Virginia, "receives multiple emails a week from businesses and nonprofits seeking guidance on how to apply for the funds," Pattani adds. "To keep up with the influx, he has developed a standard response: 'Thanks, but we can't respond to individual requests, so here's a link to your locality's website, public meeting schedule, or application portal.'"

KFF Health News "obtained email records in eight states that show health departments, sheriffs' offices, and councils overseeing settlement funds are receiving a similar deluge of messages," Pattani reports. "In the emails, marketing specialists offer phone calls, informational presentations, and meetings with their companies. Alabama Attorney General Steve Marshall recently sent a letter reminding local officials and vet organizations to reach out.

While some private sector companies will be partners, "the key, agree public health and policy experts, is to critically evaluate products or services to see if they are necessary, evidence-based, and sustainable — instead of flocking to companies with the best marketing," Pattani reports. "And, ultimately, failure to do due diligence could leave some jurisdictions holding an empty bag."

More than $1 billion in medical debt abolished for Appalachians by RIP Medical Debt organization

A national nonprofit announced recently that it has abolished more than $1 billion in medical debt for people in the Appalachian region. RIP Medical Debt, a nonprofit "that raises funds from donors and uses them to acquire and abolish medical debt for people who are financially burdened" has a program that focuses specifically on people in Appalachia, "one of the poorest and least healthy areas of the U.S.," according to information from the organization.

The region's campaign to wipe out medical debt began in 2019 "with the generous support of two families with ties to the region – Jim and Sharen Branscome and Bill Bishop and Julie Ardery – whose donation wiped out $10 million of medical debt for 10,000 individuals in Appalachia. The Branscome's ongoing fundraising has played a major role in reaching the 1 billion dollar milestone." Read more about that donation and the funders' connection to the area here.

According to the organization, Appalachia comprises 423 counties across 13 states and spans 206,000 square miles, from southern New York to northern Mississippi. The region is home to 26.3 million residents. "While it has made progress in recent years, it still lags behind the nation in key socioeconomic indicators. Just under 1 in 7 people in Appalachia are in poverty, and approximately 2.2 million people are uninsured. With higher debt burdens than other parts of rural America, nearly 1 in 4 Appalachians have medical debt in collections."

RIP Medical Debt works nationally to relieve people of medical debt, which in turn helps individuals "enhance their economic opportunities and enable them to live healthier lives. RIP’s criteria for debt relief are those individuals who are four times or below the federal poverty level or those with medical debt that is 5% or more of their gross annual income. Medical debt relief cannot be requested . . . ."

Since RIP Medical Debt's inception in 2014, "more than $10.4 billion of medical debt has been abolished, helping more than 7 million people. Medical debt often results from unplanned, unexpected illnesses and accidents. About one-third of U.S. adults have difficulty covering unexpected health care bills."