The pharmaceutical industry is a behemoth in the United States. In 2023, the 20 largest pharmaceutical companies had a market capitalization of $ 3.78 trillion dollars.[1] Pharma companies spent more than $15 million dollars in contributions through political action committees during the 2020 election cycle.[2] Analysts constantly see new avenues of generating revenues and profits for the industry including, most recently, obesity drugs which are predicted to become a $ 44 billion market by 2030, according to Bloomberg Intelligence.[3] Private equity has targeted elder and primary care for a ..read more

Climate change is undeniably a bleak story. Recent data–from the top of a remote volcanic mountain–show that carbon dioxide is accumulating in our atmosphere faster than ever. Its concentration has reached levels far beyond those in any other time of human existence. This bad news is balanced, however, against a highly-regarded good news report that fossil fuel emissions have plateaued in recent years. Public health professionals are used to this tug-of-war of data. We are optimists at heart who work daily against very strong headwinds to improve health worldwide. As a profession, we have suc ..read more

Food is life. A consistent, nutritious diet can improve overall health and protect against chronic conditions. But not everyone can access or afford a nutritious diet. In 2022, 1 in 8 households in the U.S. and 1 in 6 households with children were food insecure. Black and Latinx households experience more than double the rates of food insecurity than white households. And a February 2024 article in Medical Care found that among Virginia’s adult Medicaid population, members of color had almost twice the odds of unmet medical and social needs including food insecurity. Food insecurity has an adv ..read more

Research shows time and again that Black women are at least three times more likely to die from a pregnancy or childbirth-related cause than white women. Black infants are also over two times more likely than white babies to die before they turn one. Research also shows that people identifying as Black or African American prefer to see providers of their own race. And this racial concordance leads to better health outcomes. Yet, programs targeting race-based infant and maternal health disparities, including those increasing provider diversity, and therefore patient-provider racial concordance ..read more

I asked the question as a panelist at a health equity gathering, “Who does our health system serve?”. As a family medicine physician who sits perilously between patients and corporations (insurance, pharmaceutical, durable medical equipment, etc.), my answer was quite simple. Our health system serves the profit motives of those with hands in the jar. It feeds the pockets of those who scheme and strategize how to maximize profits. The health and health equity of the populace take a back seat to the money-making interests. I want to look at an example in our current landscape: Paxlovid. At the ..read more

Abortion Bans Are Driving Off Doctors and Closing Clinics, Putting Basic Health Care at Risk Interactive map available at The Guttmacher Institute The rush to ban abortion in some US states after the overturn of Roe v. Wade is resulting in a startling consequence that abortion opponents may not have considered: fewer medical services available for all women living in those states. Doctors are showing — through their words and actions — that they are reluctant to practice in places where making the best decision for a patient could result in huge fines or even a prison sentence. And when clin ..read more

After seemingly endless negative pregnancy tests and a few early losses after rounds of alternate fertility treatments, I felt that in-vitro fertilization (IVF) was my only hope of becoming a mother. As I saw others conceiving naturally, or succeeding relatively quickly with less invasive assisted methods, my longing and desperation for motherhood only grew. I frequently drove three hours to Philadelphia for specialized monitoring and checked my patient portal for time-sensitive updates on how my body was responding to medication. I was nauseous and lethargic after a successful egg retrieval s ..read more

For new readers, the editors and the majority of contributors to The Medical Care Blog recently authored and signed onto a special consensus statement about climate change, labeling it the “greatest threat” to global public health. As part of the plan to publish that statement, we also declared that the drivers and health risks of climate change would be a central topic of our blog for 2024. We have published calls for clinicians to act as activists for social change, in a post titled “Don’t ‘Stay in Your Lane’”. We also reviewed and summarized the American Public Health Association’s long hi ..read more

I am a health economist, trained to make sense of messy data. I generally work amidst a sea of numbers. But I’ve found that seeking out stories in health services research–those of doctors and patients–can help me anchor what’s truly important in research. These stories may also help researchers communicate the value of their work to others. For the past seven years, I’ve worked on several of Medicare’s primary care models. First, I worked on the Comprehensive Primary Care Plus Initiative (CPC+) and more recently on the Primary Care First and Making Care Primary models. These models all seek t ..read more

Patient-provider racial/ethnic concordance (i.e., physician and patient identify as the same race/ethnicity) has emerged as one key suggestion for mitigating healthcare disparities. Past research has underlined its benefits, including improved infant mortality and more appropriate prescription regimens. However, the sum of the evidence remains unclear and many facets of the patient-provider relationship have yet to be examined. From historical and practical perspectives, shared decision-making and doctors communicating treatment options are critical in improving healthcare trust and experience ..read more