HEALTH TRAIN EXPRESS
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I learned about a new acronym in medical terminology that I was not aware of before —MAID.
An interesting article about MAID, which stands for Medical Assistance in Dying, came out, specifically about a pod that’s been built in Switzerland, called the “Sarco Pod,” where ending one’s misery, so to speak, is made more comfortable, for lack of a better word.
The Sarco was inspired by UK man Tony Nicklinson who had locked-in syndrome. The lawyers of Tony approached Exit to ask if Philip Nitschke could invent a device that could be activated by the blink of an eye (this was the only movement Tony had). This got Philip thinking. Using his background in experimental physics, Philip set to work to create the Sarco. Sadly, Tony died before the project could be finished for him.
In the future, the blueprints for this Sarco Pod will be posted online, and you will apparently be able to 3-D print the machine wherever you are in the world and postulated that AI could assess whether you met the criteria to end your own life, versus having to go to a human doctor. Apparently, Switzerland is consistently thought of as the most libertarian of societies on Earth, according to the article byVox. It is ranked as the #1 country in theHuman Freedom Indexreport, put out by a libertarian think-tank Cato Report.
Apparently, demand is increasing for this practice, and only a few countries, including Canada, the Netherlands, Spain, and Belgium, allow it legally. What are your thoughts on assisted suicide?
The Peaceful Pill is available for those who want more information on euthanasia.
An online edition can be found here along with frequent updates We have an online live pain management conference coming up called New And Integrative Ways To Manage Pain, which will welcome a few palliative medicine docs. It will be interesting to visit this issue there and ask for everyone’s thoughts. Faculty at our event will includeDelia Chiaramonte, MD, MS(whose SoMeDocs podcast episode was among the favorites in 2024),
Research shows being constantly busy has major side effects — It permanently reduces your ability to think:
To protect our brains, according to science, it's necessary to balance intense focus with idleness.
However, in our fast-paced world, where every spare moment is filled with checking our phones, this reset is often neglected. This constant stimulation trains our brains to crave busyness, making it harder to disconnect. Neuroscientist Daniel Levitin highlights these concerns in his book,
The Organized Mind. He pointed out that information overload keeps us trapped in a cycle of noise, sapping both our willpower and creativity. Levitin explains that to prevent overload, we need to hit the reset button, which means carving space in our day for lying around, meditating, or staring off into nothing.
Too much information, and cognitive overload.
Our brain physiology regenerates during periods of sleep and rest. Sleep is essential for good health.
Brain chemical mediators, often referred to as neurotransmitters, are essential for communication between neurons and play crucial roles in regulating various physiological and psychological processes.
Key neurotransmitters:
Dopamine: Involved in reward, motivation, and motor control. Imbalances are linked to conditions like Parkinson's disease and schizophrenia.
Serotonin: Regulates mood, appetite, and sleep. Low levels are associated with depression and anxiety disorders.
Norepinephrine (Noradrenaline): Plays a role in arousal, alertness, and the stress response. It's important for mood regulation.
Acetylcholine: Involved in muscle activation, memory, and learning. Its deficiency is linked to Alzheimer's disease.
GABA (Gamma-Aminobutyric Acid): The primary inhibitory neurotransmitter in the brain, helping to regulate anxiety and prevent overstimulation.
Glutamate: The main excitatory neurotransmitter, crucial for learning and memory. Excessive levels can lead to neurotoxicity.
Endorphins: Peptides that act as natural painkillers and are involved in the reward system, often released during exercise or stress.
Oxytocin: Often called the "love hormone," it plays a role in social bonding, reproduction, and childbirth.
Histamine: Involved in immune responses and regulation of sleep-wake cycles.
These neurotransmitters work in complex networks, influencing mood, behavior, and cognitive functions.
Each of these substances exists in specific areas and cells of the brain. Neurotransmitters are a necessary chemical interaction between neurons (synapses)
(A synapse isthe space between two neurons where they communicate with each other)
Without rest, these compounds will not be regenerated. Sleep-deprived individuals lose the normal ability to think, or problem-solve. If extended it will lead to hallucinations, and disorientation.
A bipartisan group of lawmakers introduced legislation to break up pharmacy-benefit managers, the drug middlemen that have now faced yearslong scrutiny from Congress and the Federal Trade Commission.
A Senate bill, sponsored by Sens.Elizabeth Warren(D., Mass.) andJosh Hawley(R., Mo.), would force companies that own health insurers or pharmacy-benefit managers to divest their pharmacy businesses within three years.
A companion bill, which sponsors say draws on a history of government prohibitions on joint ownership within industries, was also introduced in the House on Wednesday.
If passed, the legislation would be the most far-reaching intervention yet into the operations of pharmacy-benefit managers, known as PBMs, and their parent companies, cutting off a major source of revenue for the companies and frustration for patients.
Originally conceived as a means to reduce medication costs for patients, PBMs have grown to monopolize the prescription drug market. It is utilized by the giants of the healthcare industry.
The three biggest PBMs—CVS Health’s Caremark, Cigna’s Express Scripts, and UnitedHealthGroup’s OptumRx—belong to companies that own some of the country’s largest health insurers. They distribute some medicines through their own mail-order pharmacies. CVS also owns more than 9,000 retail pharmacy locations.
“PBMs have manipulated the market to enrich themselves—hiking up drug costs, cheating employers, and driving small pharmacies out of business,” Warren said. “My new bipartisan bill will untangle these conflicts of interest by reining in these middlemen.”
Hawley said the legislation “will stop the insurance companies and PBMs from gobbling up even more of American healthcare and charging American families more and more for less.”
“Any policies that would limit our ability to negotiate with drugmakers and pharmacies would ultimately increase the cost of medicine in the United States, and in many cases, serve as a handout to the pharmaceutical industry,” said a CVS Health spokesman.
PBMs are powerful players in the prescription drug business, influencing which medicines insurance plans will pay for and how much.
The assassination of United Health Care CEO Brian Thompson brought to the forefront the inequity of the health system.
We are deeply troubled by the response from UnitedHealth Group (UHC) in light of the tragic murder of our CEO. The lack of a compassionate and timely acknowledgment of this devastating event reflects a concerning insensitivity to the profound impact such a loss has on the organization, its employees, and the broader community.
In moments of crisis, leaders are called upon to demonstrate empathy and support for those affected. The absence of a clear message of condolences and solidarity not only undermines the morale of employees but also sends a troubling signal about the company’s values and commitment to its patients
We urge UHC to prioritize transparency, compassion, and support for its patients and employees during this challenging time. A thoughtful and sincere response is essential to foster a sense of unity and healing as we navigate the aftermath of this tragedy.
If you want to know more about research development in eye care, the latest developments that hold promise are listed.
Millions of people with age-related macular degeneration, glaucoma, or corneal disease are looking for advances.
When a patient hears the words glaucoma or macular degeneration the first question is, "Doctor will I go blind?"
Ophthalmologists have had treatments for glaucoma for several decades, including eye drops, laser treatments, and invasive surgeries. Treatment can be used when the glaucoma is monitored with intraocular pressure measurements, visual field testing, and examination of the optic nerve with photos and/or ocular coherence tomography. These are essential because glaucoma often has no symptoms, and must be monitored several times a year. In many cases, glaucoma progresses with 'normal IOP" Glaucoma, a complex optic neuropathy affecting approximately 80 million people worldwide, has limited treatment success with current options like eye drops, surgery, or laser therapy. Glaucoma specialists have been puzzled by this occurrence and now research scientists may have found other metabolic pathways that cause degeneration of nerves. Highlighting the disease’s complexity, Dr. Sophia Millington-Ward emphasized the urgent need for targeted therapies. The new gene therapy offers a potential breakthrough by enhancing mitochondrial activity, reducing harmful reactive oxygen species, and safeguarding RGCs. Professor Jane Farrar underscored the importance of broad therapies capable of treating large patient populations to offset high development costs.
Macular degeneration (edema) can develop in the macula, and treatments have been insufficient to treat it. Several treatments evolved and are used today.
Diabetic macular edema (DME) is a complication of diabetes that affects the retina and can lead to vision loss. Treatments for DME aim to reduce swelling and improve vision. Here are the main treatment options:
Anti-VEGF Injections:
Medications such as ranibizumab (Lucentis), aflibercept (Eylea), and bevacizumab (Avastin) are injected into the eye to inhibit vascular endothelial growth factor (VEGF), which contributes to fluid leakage and swelling.
Steroid Injections:
Corticosteroids, like triamcinolone, can be injected into the eye to reduce inflammation and fluid accumulation.
Laser Therapy:
Focal Laser Treatment: Targets specific areas of the retina to reduce leaking blood vessels.
Panretinal Photocoagulation: A more extensive treatment that helps prevent further vision loss by treating the peripheral retina.
Intravitreal Implants:
Devices like the dexamethasone implant (Ozurdex) release steroids over time directly into the eye.
Control of Blood Sugar Levels:
Maintaining optimal blood glucose levels can help slow the progression of diabetic eye diseases.
Surgery:
In severe cases, surgical options such as vitrectomy may be considered to remove the vitreous gel that is pulling on the retina.
Lifestyle Modifications:
A healthy diet, regular exercise, and smoking cessation contribute to overall diabetes management and eye health.
New Experimental Drug Shows Promise in Treating Diabetic Macular Edema
macular edema
A recent study published in Nature Medicine reveals encouraging findings for a potential breakthrough in treating Diabetic Macular Edema (DME). The study highlights a novel class of therapeutics known as senolytics, which could revolutionize treatment outcomes with more effective and longer-lasting solutions.
• Effective in patients with poor responses to standard DME treatments.
• Offers potential for improved therapeutic outcomes in a condition that remains challenging to manage.
This innovative approach positions UBX1325 as a potential game-changer in managing DME, providing hope for patients with limited options and enhancing the future of ocular therapies.
Other areas for breakthrough basic science include genetic eye disease, and corneal degeneration,
However, the greatest challenge to stopping visual loss and/or blindness is in the social determination of health.
The poll revealed that nearly half of the respondents believe patient access to care is the primary issue, followed by regulatory hurdles, rapidly evolving technology, and education for new techniques.
Patient Access to Care: The Primary Challenge
Survey Result: 46% identified this as the top challenge.
Patient access to care is a cornerstone issue in ophthalmology, reflecting significant disparities that are deeply rooted in various socio-economic and geographical factors. The availability of ophthalmological services is unevenly distributed, with rural areas often facing critical shortages of specialists. This lack of access leads to delayed diagnoses and treatments, which can exacerbate conditions and contribute to preventable vision loss.
The World Health Organization (WHO) estimates that 2.2 billion people globally suffer from vision impairment, with nearly half of these cases being either preventable or untreated, highlighting the urgent need for more accessible care.
In the United States, the situation is further complicated by insurance coverage issues and the high costs associated with specialized eye care. According to the American Academy of Ophthalmology (AAO), millions of Americans lack adequate vision care, increasing the risk of preventable blindness and vision impairment. Addressing these issues requires comprehensive changes, including the expansion of telemedicine, increased funding for public health initiatives, and policy reforms aimed at making eye care more affordable and accessible to all populations.
The number of ophthalmology practices has been declining, which could impact patient access. Between 2015 and 2022, the number of ophthalmology practices in the U.S. decreased by 18%, from 7,149 to 5,890. This consolidation means fewer individual practices are available, potentially limiting access, especially in rural areas.
Regulatory Hurdles: A Barrier to Innovation
Survey Result: 22% saw this as a significant challenge.
Regulatory challenges represent another significant obstacle in the field of ophthalmology, particularly concerning the approval and deployment of new treatments and technologies.
The stringent requirements set by the U.S. Food and Drug Administration (FDA) and other global regulatory bodies, while essential for patient safety, often result in lengthy approval processes that can delay the availability of innovative therapies. These delays can be especially burdensome for smaller companies, which may lack the resources to navigate the complex regulatory landscape.
For instance, the approval process for new ophthalmic drugs and devices can take years, often leading to significant delays in bringing potentially life-changing treatments to patients. This not only affects the patients who are waiting for advanced therapies but also stifles innovation in the field. Streamlining these regulatory processes, while maintaining high safety standards, could help accelerate the introduction of new treatments, ensuring that patients benefit from the latest advancements in ophthalmology.
Rapidly Evolving Technology: Keeping Pace with Progress
Survey Result: 20% of respondents cited this as a challenge.
The pace of technological advancement in ophthalmology is both a blessing and a challenge. On one hand, new diagnostic tools, surgical techniques, and treatment options are continually improving patient outcomes.
On the other hand, the rapid evolution of technology presents significant challenges for clinicians, who must constantly stay updated with the latest developments. Integrating these new technologies into everyday practice can be particularly daunting for smaller clinics or those in resource-limited settings.
Take, for example, the rise of artificial intelligence (AI) in ophthalmology. AI is increasingly being used to enhance diagnostic accuracy for conditions such as diabetic retinopathy and age-related macular degeneration (AMD). However, the implementation of AI and other cutting-edge technologies requires substantial investment in both hardware and training.
This creates a barrier for some practitioners, particularly those in smaller or rural practices, who may struggle to afford or effectively integrate these advancements into their workflows. Ensuring that all ophthalmologists have the resources and training necessary to utilize these technologies is crucial for maximizing their potential benefits to patients.
Education for New Techniques: The Need for Continuous Learning
Survey Result: 12% identified education as a key challenge.
The need for continuous education is paramount in ophthalmology, especially given the field's rapid advancements in medical techniques and technologies. Staying current with new procedures and treatment modalities can be challenging for practitioners, particularly those who manage busy practices or work in regions with limited access to advanced training programs. Ongoing professional development is essential to ensure that ophthalmologists can provide the highest standard of care to their patients.
Programs like the AAO's Ophthalmic Education initiative offer valuable resources for continuing education, yet disparities in access to these opportunities persist. The fast pace of innovation means that traditional educational models may need to evolve, offering more flexible and accessible training options that cater to the needs of a diverse range of practitioners. By prioritizing education and professional development, the ophthalmology community can better equip its members to adopt and implement new techniques, ultimately improving patient care across the board.
We find that, across HealthCare.gov insurers with complete data, nearly 17% of in-network claims were denied in 2021. Insurer denial rates varied widely around this average, ranging from 2% to 49%. CMS requires insurers to report the reasons for claims denials at the plan level. Of in-network claims, about 14% were denied because the claim was for an excluded service, 8% due to lack of preauthorization or referral, and only about 2% based on medical necessity. Most plan-reported denials (77%) were classified as ‘all other reasons.’
A claim file is a collection of the information your insurer used to decide whether it would pay for your medical treatment or services. Most people in the U.S. facing a denial have the right to request their claim file from their insurer. It can include internal correspondence, recordings of phone calls, case notes, medical records and other relevant information.
Information in your claim file can be critical when appealing denials. Some patients told us they received case notes showing that their insurer’s decision was the outcome of cost-cutting programs. Others have gotten denials overturned by obtaining recordings of phone calls where company staff introduced errors into their cases.
How This Works
Answer a few questions to generate a PDF of your claim file request letter.
Mail, fax or upload the completed letter to your health insurer.
Your claim file request should be fulfilled within 30 days.
If you agree to be contacted, we’ll email you later to see if you’ve received your file.
By law, health insurers’ responses should be timely and the records provided by the company should explain why they denied your claim or prior authorization request. However, ProPublica has found that some insurers don’t respond to claim file requests, or they do respond but send inaccurate or incomplete information. If this happens to you, see “I submitted my request but am having trouble getting my claim file.
What can I do now?”
You Have a Right to Know Why a Health Insurer Denied Your Claim. Some Insurers Still Won’t Tell You.
Federal regulations require insurers to promptly hand over records to patients facing claim denials. Some insurers only turned over their files after ProPublica reached out.
How hard can it get? Some insurers go the distance thinking the patient will give up trying to fight their denial of service.
Insurers Asking for Unnecessary Subpoenas or Court Orders
Cigna and Anthem told members that they would need to obtain a court order or subpoena to access their claim file records.
“This is completely unheard of,” said Wells Wilkinson, a senior attorney with the nonprofit legal group Public Health Advocates which regularly files these requests. “It also sounds completely illegal. The consumer has the right to any information used by the health plan in the context of the denial.”
On July 12, Lisa Kays, a Maryland resident, asked Cigna for phone call records related to its decision to deny coverage for her 4-year-old son’s speech therapy. “We couldn’t afford to just give up,” Kays said.
In September, Cigna sent her a letter saying she would need to submit a subpoena to get any transcripts or recordings.
After ProPublica inquired, the company sent Kays partial transcripts of the calls. It also reimbursed her for some of the previously denied coverage. She is still waiting for the recordings.
Is there an optimum amount of exercise to prevent heart disease?
Question Does age modify the associations between physical activity and all-cause mortality?
Across all age groups, a dose-response (the more, the better) of physical activity association with reduced all-cause mortality in >2 million individuals with 11-year follow-up
Discussion
In this cohort study with a pooled analysis of more than 2 million adults, we observed that age somewhat modifies the association between meeting the PA recommendations and all-cause mortality. This age-dependent association showed a distinct pattern compared with those observed for other modifiable health factors. Although the mortality risk reduction associated with meeting the PA recommendations either remained stable or slightly increased with age, the benefits related to other health factors diminished as age advanced.
Overall, previous evidence35-41 indicates that the impact of certain modifiable health factors on mortality risk diminishes with age, indicating that their relative importance is lower among older adults compared with younger individuals. This observation could be attributed to selection bias, suggesting that individuals who are biologically more vulnerable to the adverse effects of risk factors may die earlier, leaving a population of older adults who are inherently less susceptible (ie, survivors), thereby decreasing the apparent association between these risk factors and mortality with advancing age. Conversely, extensive research within prospective cohorts that include a large proportion of older adults has consistently highlighted PA as a crucial determinant for enhancing survival later in life.23,42 Furthermore, stratified analyses from these studies have revealed age-dependent associations between PA and mortality. For example, Arem et al23 pooled data from 6 Western cohorts (5 from the US and 1 from Sweden) as part of the National Cancer Institute Cohort Consortium, encompassing 661 137 men and women with a median age of 62 years (range, 21-98 years), and identified a significant interaction (P < .001) across 4 age groups (ie, <50, 50-59, 60-69, and ≥70 years). Similarly, Liu et al42 analyzed data from 467 729 adults across 9 Asian cohorts within the Asia Cohort Consortium, with a mean age of 55 years (range, 48-60 years), and observed that the association between PA and mortality was more pronounced among older participants (≥65 years) compared with younger ones (<55 years and 55-64 years) at baseline (P for interaction = .04).
Differences in the association between PA, as measured in MET-hours per week, and mortality risk became notably more pronounced between younger and older age groups, particularly beyond the 15 MET-hours per week threshold but taking into account that any amount of PA was better than none. Yet, on average, only 25% of adults participate in PA exceeding this level, with engagement in such activities sharply declining from the age of 60 years onward. Consequently, if a larger fraction of older adults were engaged in PA levels beyond 15 MET hours per week, a more substantial reduction in mortality risk could potentially be observed. Several factors contribute to why the mortality benefits of PA may be similar or even greater for older compared with younger adults. First, PA is more associated with certain causes of death,1,13 mainly those affecting the circulatory system,43,44, and heart disease remains the leading cause of death in the elderly.9-12 Second, aging is accompanied by a decline in task performance, mobility, fitness levels, coordination, and exercise economy, suggesting that older adults may reap substantial benefits from PA at lower levels of intensity owing to their reduced capacity for physical exertion.45,46 Third, ample evidence supports PA’s role in mitigating major aging hallmarks, such as genomic instability and mitochondrial dysfunction, thereby underscoring its preventative potential against the physiological processes of aging.47 Fourth, PA is instrumental in slowing the progression of functional impairments and frailty, which are critical factors associated with unhealthy aging and increased mortality risk, by counteracting the decline in physiological reserve and heightened vulnerability to stressors seen in old age. However, the greater association observed in older age groups might also reflect the capacity for doing PA (often considered a vital sign of health at advanced ages), with the somewhat increased association possibly attributable to more residual confounding by health status.33
Global and other PA guidelines do not differentiate recommendations by age; the advised amounts of PA for younger, middle-aged, and older adults are uniformly the same.13 Systematic reviews underpinning these recommendations have consistently demonstrated that meeting these PA levels is associated with a 20% to 30% reduction in mortality risk compared with individuals who do not meet these criteria. Our study introduces new insights, further affirming that the mortality benefits associated with PA not only persist across different age groups but may also slightly enhance with age. From a public health viewpoint, it is crucial to communicate to adults that engaging in an adequate amount of PA remains critically important throughout the lifespan, gaining even greater importance as one ages. Policy actions must be addressed to facilitate and promote desired amounts of PA that can promote PA engagement and sustainability at all stages of adult life. Our results also lend support for the current PA guidelines where adults of all ages are recommended the same amount of PA.
Baking Soda Exposed: Big Pharma’s $1B Secret Weapon?
Baking soda, a common household staple, has long been recognized for its versatile applications. However, its significance in the pharmaceutical industry goes far beyond simple household uses. This humble compound, scientifically known as sodium bicarbonate, has emerged as a critical ingredient that is reshaping pharmaceutical research, drug formulation, and healthcare solutions.
Pharmaceutical Applications: More Than Meets the Eye
Pharmaceutical-grade sodium bicarbonate is a far cry from the baking soda sitting in your kitchen pantry. As an active pharmaceutical ingredient (API) and excipient, it plays a pivotal role in drug development and manufacturing. Its primary functions include:
Acting as a pH buffering agent
Serving as a systemic alkalizer
Facilitating topical cleansing solutions
Contributing to the creation of effervescent tablets
One of the most fascinating aspects of sodium bicarbonate is its ability to enhance drug performance. Researchers have discovered that this compound can significantly improve the efficacy of antibiotics, potentially revolutionizing treatment protocols for various infections.
Beyond Pharmaceuticals: Personal Care and Cosmetics
The versatility of sodium bicarbonate extends beyond pharmaceutical applications. Major companies like Proctor and Gamble and Church and Dwight Co. Inc. have integrated this compound into personal care products. Its ability to maintain pH balance and serve as a gentle abrasive makes it a valuable ingredient in:
Toothpaste formulations
Hair care products
Skincare solutions
Cosmetic preparations
The Future of Sodium Bicarbonate in Healthcare
As medical research continues to evolve, sodium bicarbonate stands at the forefront of innovative healthcare solutions. Its potential to enhance antibiotic effectiveness, improve drug delivery mechanisms, and support various therapeutic interventions makes it a compound of immense interest.
Emerging studies suggest that sodium bicarbonate could play a crucial role in developing more targeted and effective treatments. Its ability to modulate pH levels and interact with various biological systems positions it as a potentially transformative ingredient in future pharmaceutical developments.
1. Purity
Pharmaceutical Grade: Contains at least 99% sodium bicarbonate and is free from contaminants. It is specifically manufactured to meet strict purity standards.
Food Grade: Also has high purity but may contain more impurities than pharmaceutical grade. It is still safe for consumption but not held to the same stringent standards.
TV’s Dr. Oz Invested in Businesses Regulated by Agency Trump Wants Him To Lead
Darius Tahir
President-elect Donald Trump’s choice to run the sprawling government agency that administers Medicare, Medicaid, and the Affordable Care Act marketplace — celebrity doctor Mehmet Oz — recently held broad investments in health care, tech, and food companies that would pose significant conflicts of interest.
Oz’s holdings, some shared with family, included a stake in UnitedHealth Group worth as much as $600,000, as well as shares of pharmaceutical firms and tech companies with business in the healthcare sector, such as Amazon. Collectively, Oz’s investments total tens of millions of dollars, according to financial disclosures he filed during his failed 2022 run for a Pennsylvania U.S. Senate seat.
Trump said Tuesday he would nominate Oz as administrator of the Centers for Medicare & Medicaid Services. The agency’s scope is huge: CMS oversees coverage for more than 160 million Americans, nearly half the population. Medicare alone accounts for approximately $1 trillion in annual spending, with over 67 million enrollees.
UnitedHealth Group is one of the largest healthcare companies in the nation and arguably the most important business partner of CMS, through which it is the leading provider of commercial health plans available to Medicare beneficiaries.
UnitedHealth also offers managed-care plans under Medicaid, the joint state-federal program for low-income people, and sells plans on government-run marketplaces set up via the Affordable Care Act. Oz also had smaller stakes in CVS Health, which now includes the insurer Aetna, and in the insurer Cigna.
It’s not clear if Oz, a heart surgeon by training, still holds investments in healthcare companies, or if he would divest his shares or otherwise seek to mitigate conflicts of interest should he be confirmed by the Senate. Reached by phone on Wednesday, he said he was in a Zoom meeting and declined to comment. An assistant did not reply to an email message with detailed questions.
“It’s obvious that over the years he’s cultivated an interest in the pharmaceutical industry and the insurance industry,” said Peter Lurie, president of the Center for Science in the Public Interest, a watchdog group. “That raises a question of whether he can be trusted to act on behalf of the American people.” (The publisher of KFF Health News, David Rousseau, is on the CSPI board.)
Oz used his TikTok page on multiple occasions in November to praise Trump and Robert F. Kennedy Jr., including their efforts to take on the “illness-industrial complex,” and he slammed “so-called experts like the big medical societies” for dishing out what he called bad nutritional advice. Oz’s positions on health policy have been chameleonic; in 2010, he cut an ad urging Californians to sign up for insurance under President Barack Obama’s Affordable Care Act, telling viewers they had a “historic opportunity.”
Oz’s 2022 financial disclosures show that the television star invested a substantial part of his wealth in healthcare and food firms. Were he confirmed to run CMS, his job would involve interacting with giants of the industry that have contributed to his wealth.
Given the breadth of his investments, it would be difficult for Oz to recuse himself from matters affecting his assets, if he still holds them. “He could spend his time in a rocking chair” if that happened, Lurie said.
In the past, nominees for government positions with similar potential conflicts of interest have chosen to sell the assets or otherwise divest themselves. For instance, Treasury Secretary Janet Yellen and Attorney General Merrick Garland agreed to divest their holdings in relevant, publicly traded companies when they joined the Biden administration.
Trump, however, declined in his first term to relinquish control of his own companies and other assets while in office, and he isn’t expected to do so in his second term. He has not publicly indicated concern about his subordinates’ financial holdings.
CMS’ main job is to administer Medicare. About half of new enrollees now choose Medicare Advantage, in which commercial insurers provide their health coverage, instead of the traditional, government-run program, according to an analysis from KFF, a health information nonprofit that includes KFF Health News.
Proponents of Medicare Advantage say the private plans offer more compelling services than the government and better manage the costs of care. Critics note that Medicare Advantage plans have a long history of costing taxpayers more than the traditional program.
UnitedHealth, CVS, and Cigna are all substantial players in the Medicare Advantage market. It’s not always a good relationship with the government. The Department of Justice filed a 2017 complaint against UnitedHealth alleging the company used false information to inflate charges to the government. The case is ongoing.
Oz is an enthusiastic proponent of Medicare Advantage. In 2020, he proposed offering Medicare Advantage to all; during his Senate run, he offered a more general pledge to expand those plans. After Trump announced Oz’s nomination for CMS, Jeffrey Singer, a senior fellow at the libertarian-leaning Cato Institute, said he was “uncertain about Dr. Oz’s familiarity with health care financing and economics.”
Singer said Oz’s Medicare Advantage proposal could require large new taxes — perhaps a 20% payroll tax — to implement.
Oz has gotten a mixed reception from elsewhere in Washington. Pennsylvania Sen. John Fetterman, the Democrat who defeated Oz in 2022, signaled he’d potentially support his appointment to CMS. “If Dr. Oz is about protecting and preserving Medicare and Medicaid, I’m voting for the dude,” he said on the social platform X.
Oz’s investments in companies doing business with the federal government don’t end with big insurers. He and his family also hold hospital stocks, according to his 2022 disclosure, as well as a stake in Amazon worth as much as nearly $2.4 million. (Candidates for federal office are required to disclose a broad range of values for their holdings, not a specific figure.)
Amazon operates an internet pharmacy, and the company announced in June that its subscription service is available to Medicare enrollees. It also owns a primary care service, One Medical, that accepts Medicare and “select” Medicare Advantage plans.
Oz was also directly invested in several large pharmaceutical companies and, through investments in venture capital funds, indirectly invested in other biotech and vaccine firms. Big Pharma has been a frequent target of criticism and sometimes conspiracy theories from Trump and his allies. Kennedy, whom Trump has said he’ll nominate to be Health and Human Services secretary, is a longtime anti-vaccine activist.
During the Biden administration, Congress gave Medicare authority to negotiate with drug companies over their prices. CMS initially selected 10 drugs. Those drugs collectively accounted for $50.5 billion in spending between June 1, 2022, and May 31, 2023, under Medicare’s Part D prescription drug benefit.
At least four of those 10 medications are manufactured by companies in which Oz held stock, worth as much as about $50,000.
Oz may gain or lose financially from other Trump administration proposals.
For example, as of 2022, Oz held investments worth as much as $6 million in fertility treatment providers. To counter fears that politicians who oppose abortion would ban in vitro fertilization, Trump floated during his campaign making in vitro fertilization treatment free. It’s unclear whether the government would pay for the services.
In his TikTok videos from earlier in November, Oz echoed attacks on the food industry by Kennedy and other figures in his “Make America Healthy Again” movement. They blame processed foods and underregulation of the industry for the poor health of many Americans, concerns shared by many Democrats and more mainstream experts.
But in 2022, Oz owned stakes worth as much as $80,000 in Domino’s Pizza, Pepsi, and US Foods, as well as more substantial investments in other parts of the food chain, including cattle; Oz reported investments worth as much as $5.5 million in a farm and livestock, as well as a stake in a dairy-free milk startup. He was also indirectly invested in the restaurant chain Epic Burger.
One of his largest investments was in the Pennsylvania-based convenience store chain Wawa, which sells fast food and all manner of ultra-processed snacks. Oz and his wife reported a stake in the company, beloved by many Pennsylvanians, worth as much as $30 million.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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This article first appeared on KFF Health News and is republished here under a Creative Commons license.
The task of seeking care in a foreign country has been simplified by JetPatient
Medical tourism refers to traveling to another country for medical care. This phenomenon has grown significantly over the years due to several factors:
Reasons for Medical Tourism
Cost Savings: Medical procedures can be significantly cheaper in certain countries, even after accounting for travel expenses.
Quality of Care: Many countries offer high-quality healthcare services, with well-trained doctors and modern facilities.
Availability of Treatments:
Some treatments may not be available or may have long waiting lists in a patient's home country.
Privacy and Confidentiality:
Patients may seek procedures in other countries to maintain privacy regarding sensitive health issues.
Combining Treatment with Travel:
Many patients take the opportunity to explore a new country while receiving medical care.
Common Destinations
India: Known for cardiac surgery, orthopedic procedures, and alternative medicine like Ayurveda.
Thailand: Popular for cosmetic surgery and wellness retreats.
Mexico: Often chosen for dental work and weight loss surgeries.
Costa Rica: Renowned for dental and orthopedic procedures.
Types of Treatments Sought
Cosmetic Surgery
Dental Procedures
Fertility Treatments
Orthopedic Surgery
Cardiac Surgery
Research: Patients should thoroughly research hospitals and doctors.
Accreditation: Check if the facility is accredited by international standards (e.g., JCI).
Legal and Ethical Concerns: Understand the laws and regulations regarding medical practices in the destination country.
Post-operative Care: Consider how post-operative care will be managed after returning home.
Conclusion
Medical tourism can offer significant benefits, but it requires careful planning and consideration to ensure safety and success.
