Waste Of The Day: Unused COVID Quarantine Pods

 by Jeremy Portnoy via RealClearInvestigations,

Topline: Nashville spent $1.2 million to buy 108 quarantine housing pods in 2021 during the Covid-19 pandemic, but the shelters were never used. Now the city plans to give 25 of them away to local nonprofits to be used as homeless shelters while covering the cost of renovating them.

Key facts: The combined municipality of Metropolitan Government of Nashville and Davidson County bought the pods using federal funds from the Centers for Disease Control and Prevention. Part of the $1.2 million price tag was for certified nursing assistants and 24-hour security at the pods — which was obviously unnecessary because the pods were never used, Nashville Scene reported.

Nashville started installing 25 of the quarantine pods in 2021 but could not use them until the Tennessee Fire Marshall’s Office gave its approval. The fire marshal told Nashville Scene they required a letter signed by an engineer declaring the pods were safe, but Nashville did not send the letter for almost a year.

The remaining 86 pods have been in storage in an unknown location. The Nashville Scene could not even confirm whether the pods are still in Tennessee.

Metro Nashville has been trying to find a way to repurpose the pods since 2023 and is currently accepting applications to give away the pods for homeless housing. The government will pay for the cost of transporting the pods, renovating them, buying replacement parts and installing thermal barriers.

Critics say the city is taking too long to put the pods into use, which were approved for use as homeless shelters in late 2024. Dede Byrd, a founding member of local nonprofit Reclaim Brookmeade Park, told FOX17 Nashville “It is unacceptable to me that it takes this long.”

Summary: Covid-related expenses cost the country more than enough without spending money on initiatives that did not even prevent the spread of disease, like Nashville’s unused quarantine pods.

The #WasteOfTheDay is brought to you by the forensic auditors at OpenTheBooks.com

https://www.zerohedge.com/political/waste-day-unused-covid-quarantine-pods

Homeowners Worried About Chemicals Being Spread In Sewage Fertilizer

 by Michael Clements via The Epoch Times (emphasis ours),

Rural landowners say America’s farms have become dumping grounds for sludge from the wastewater treatment plants of larger cities. They complain of foul odors, contaminated soil, health problems, and stormwater runoff contaminating streams, lakes, and groundwater with possibly dangerous chemicals.

A tractor spreads fertilizer on a field at a farm in Church Hill, Md., on March 20, 2025. Biosolids, or treated sewage sludge, are widely used in the United States as a soil amendment and fertilizer. But rural landowners and farmers are increasingly concerned about foul odors, soil contamination, health risks, and stormwater runoff carrying potentially dangerous chemicals into waterways. Jim Watson/AFP via Getty Images

The treated sewage sludge—known as “biosolids”— is the solid matter left from the wastewater treatment process. The sludge is removed from the bottom of the sewage plant tanks then treated to reduce pathogens for use as a soil amendment or fertilizer.

The biosolids industry promotes the treated sludge as an environmentally friendly way to recycle waste that would otherwise end up in a landfill while saving farmers money on fertilizer. Critics believe the less tangible costs of the sludge far outweigh any benefits.

Luther, Oklahoma, property owners Walt and Saundra Traywick, say they were first introduced to biosolids by a sickening stench outside their home in 2018. They say they have been dealing with the impact of the treated sewage and the PFAS chemicals they carry ever since then.

“It’s that rotting carcass smell, but more metallic,” Walt told The Epoch Times.

Saundra Traywick said a neighbor was spreading biosolids from wastewater treatment plants in Oklahoma City and Tulsa on his land. She and some of her neighbors were able to get the practice banned in their town of Luther. And the company spreading the materials agreed to include buffer zones around their work area.

The Traywick family, (L–R) Hannah, Walt, Elaine, and Saundra, pose on their donkey dairy farm in Luther, Okla., on April 9, 2025. The Traywicks, whose daughter Hannah has an autoimmune disorder, are pushing to ban biosolids in the state over health concerns posed by chemicals in the material. Michael Clements/The Epoch Times

But, when she contacted the cities to complain, she was told “you shouldn’t have moved here if you didn’t like it, because we’ve been doing this for 40 years.”

Using biosolids as fertilizer has been controversial since the early part of this decade when per- and polyfluoroalkyl substances (PFAS), also called forever chemicals, were found in the sludge. The state of Maine has banned the practice over public health and safety concerns.

PFAS are called “forever chemicals” because they don’t degrade easily and can remain in soil, air, water, plants and animals even years after exposure.

The controversy was further heightened when the new head of the Environmental Protection Agency (EPA) announced he was tapping the brakes on a regulatory process begun under former President Joe Biden.

On May 14, EPA Administrator Lee Zeldin said the agency is maintaining its current guidelines for levels of PFAS in drinking water.

The EPA set drinking water limits of 4 parts per trillion for Perfluorooctanoic acid (PFOA) and Perfluorooctanesulfonate (PFOS) in March 2023. The agency also proposed a non-enforceable Maximum Contaminant Level Goals of zero for the chemicals because “there is no dose below which either chemical is considered safe.”

The EPA is also extending the deadline for water utilities to comply with the guidelines from 2029 to 2031.

“[Extending the deadline] will support water systems across the country, including small systems in rural communities, as they work to address these contaminants. EPA will also continue to use its regulatory and enforcement tools to hold polluters accountable,” Zeldin stated in the press release.

It is up to each state to regulate the use of biosolids using the EPA regulations as a guide. Only the state of Maine bans the practice.

Julie Lay, of Guntersville, Alabama, said she got her own rude awakening in June 1019.

Environmental Protection Agency Administrator Lee Zeldin testifies before the House Subcommittee on Environment on Capitol Hill in Washington on May 20, 2025. In a May 14 announcement, Zeldin said the agency will keep its current guidelines for PFAS levels in drinking water. Madalina Vasiliu/The Epoch Times

That is when she and her family also noticed a bad smell coming from a neighbor’s property. The wife and mother had worked in agribusiness for years. She had never encountered an odor like the one surrounding her home.

“It was an awful smell,” her husband Keith told The Epoch Times.

As she researched the source of the odor, Lay found that state agencies and agricultural groups she thought would oppose spreading sewage on farms were supportive of the practice as a cost-effective alternative to commercial fertilizer.

She said the people she spoke with repeated the claim that the biosolids were “nutrient-rich” and beneficial to the soil. They shrugged off any possible danger because no one could say for certain there is a problem, Lay said.

She is concerned that by the time a solid link between biosolids and disease is found, the damage to the land and the people who eat the food grown on it will already be done.

“So they used the land as a guinea pig and they used all of us as guinea pigs,” she told The Epoch Times.

The EPA reports that PFAS are found in all 50 states.

The chemicals make their way from manufacturing plants, industrial sites, and military installations, to wastewater treatment plants where they mix with residential sewage and wastewater.

The chemical bond is so strong that they survive the wastewater treatment process and remain in the sludge that is eventually sold as fertilizer.

3M, one of the largest makers of PFAS, agreed to begin phasing the chemicals out in 2000. However, since the chemicals have been around since the 1940s, a majority of Americans have likely already been exposed, the EPA reported.

A 2016 study published by the Department of Health and Human Services found evidence that chemicals in the PFAS family could disrupt the human immune system. Research also shows possible links to cancer.

https://www.zerohedge.com/food/homeowners-worried-about-chemicals-being-spread-sewage-fertilizer

'US to drop guidance to limit alcohol to one or two drinks per day, sources say'

 U.S. Dietary Guidelines are expected to eliminate the long-standing recommendation that adults limit alcohol consumption to one or two drinks per day, according to three sources familiar with the matter, in what could be a major win for an industry threatened by heightened scrutiny of alcohol's health effects.

The updated Dietary Guidelines for Americans, which could be released as early as this month, are expected to include a brief statement encouraging Americans to drink in moderation or limit alcohol intake due to associated health risks, the sources said.

The guidelines are still under development and subject to change, two of the sources and a fourth individual familiar with the process said.

Currently, the recommendations advise limiting drinking to one serving or less per day for women and two or less for men, widely seen as a moderate level.

Similar guidelines exist in countries such as the United Kingdom, which advises limiting drinking to 14 units per week, while Canada, however, has adopted a more cautious stance, warning that health risks begin to increase after just two drinks per week.

Even moderate drinking is linked to some health risks, such as higher risk of breast cancer, though some studies have also found an association with possible health benefits, such as a lower risk of stroke.

The fourth source said that the scientific basis for recommending specific daily limits is limited, and the goal is to ensure the guidelines reflect only the most robust evidence.

The new guidelines, developed by the U.S. Department of Health and Human Services and the U.S. Department of Agriculture, are closely watched internationally and influence policies ranging from school lunch programs to medical advice. Neither department responded to requests for comment.

Health Secretary Robert F. Kennedy Jr., a known teetotaler, has remained largely silent on alcohol but has emphasised a focus on whole foods in the upcoming guidelines.

Some alcohol executives had feared a move towards tighter recommendations on alcohol intake as authorities like the World Health Organization upped their warnings about alcohol's health risks.

Former U.S. Surgeon General Vivek Murthy said alcohol consumption increases the risk of at least seven types of cancer and called for warning labels on alcoholic drinks.

Major industry players, including Diageo and Anheuser-Busch InBev, have lobbied lawmakers throughout the review process. Senate records show each company spent millions on lobbying efforts related to the guidelines and a range of other issues such as tax and trade in 2024 and 2025. Both companies declined to comment.

The new guidelines are set to move away from suggesting consumers limit alcohol consumption to a specific number of daily servings, according to the three sources, who asked not to be named in order to speak freely.

One person said the new alcohol-related recommendation will probably be limited to a sentence or two. Another said the existing numbers tied to moderate drinking could still appear in a longer appendix.

While industry representatives have lobbied lawmakers on the guidelines or how they should be decided, some officials and researchers advocated for tighter restrictions.

Reports intended to inform the guidelines have meanwhile drawn different conclusions about alcohol's health effects and the science around this.

'UNHELPFUL'

The guidelines, which are reviewed every five years, have advised drinking in moderation and defined that as no more than one drink per day for women and no more than two for men since 1990.

Eva Greenthal, a senior policy scientist at the Center for Science in the Public Interest, a non-profit focused on nutrition, health and food safety, said the more general language expected in the guidelines was "so vague as to be unhelpful".

Under such a change, the message that even moderate drinking can increase risks, especially for breast cancer, would get lost, she continued.

Two studies were produced to inform the development of the guidelines. The first found that moderate drinking was associated with increased risk of some cancers, but a decreased risk of dying from any cause and some cardiovascular problems like stroke.

The evidence for some other health impacts was insufficient to draw conclusions, it found.

The other report conversely found the risk of dying from alcohol use, including increased risk for seven cancers, begins at any or low levels of alcohol use and increases with higher consumption.

https://www.aol.com/news/exclusive-us-drop-guidance-limit-100739634.html

'Addiction to Screen Time Tied to Suicidality in U.S. Kids'

 

• Addictive screen use trajectories were associated with suicidal behaviors and ideation as well as worse mental health among U.S. kids in a large study.
• Increasing addictive use trajectories were associated with higher risks of suicide-related outcomes than low addictive use trajectories, and high addictive use trajectories for all screen types -- social media, mobile phones, and video games -- were associated with suicide-related outcomes.
• Compared with low addictive use trajectories, the high video game addictive use trajectory showed the largest relative difference in internalizing symptoms like anxiety and depression, and the increasing social media addictive use trajectory showed the largest relative difference in externalizing symptoms like aggression and rule-breaking.

Addictions to social media, mobile phones, and video games were associated with suicidal behaviors and ideation as well as worse mental health among U.S. kids, a cohort study suggested.

Addictive use as indicated by kids' self-reported compulsive use, difficulty disengaging, and distress when not using these technologies was common, with nearly one-third of participants scoring increasingly higher for addiction to social media or mobile phones beginning at age 11 years, Yunyu Xiao, PhD, of Weill Cornell Medicine/NewYork-Presbyterian in New York City, and colleagues reported in JAMAopens in a new tab or window.

Increasingly addictive use trajectories for social media and mobile phones were associated with higher risks of suicide-related outcomes, as were high addictive use trajectories for all three screen types in the cohort of 4,285 kids age 10 years who were followed for 4 years.

Compared with low addictive use trajectories, the high video game addictive use trajectory showed the largest relative difference in internalizing symptoms like anxiety and depression, while the increasing social media addictive use trajectory showed the largest relative difference in externalizing symptoms like aggression and rule-breaking.

"While most existing research has focused on total screen timeopens in a new tab or window, emerging evidence suggests that addictive screen use may be a more salient risk factoropens in a new tab or window for suicidality and mental health in youths," Xiao and colleagues wrote. "Addictive use may vary by platform and follow distinct developmental trajectories. However, addictive use trajectories among youths have not been well characterized, and how they may relate to suicide-related and mental health outcomes remains largely unknown."

Indeed, the study's findings "suggest that addictive screen use is more strongly linked to negative mental health outcomes than screen time alone," wrote Jason Nagata, MD, MSc, of the University of California San Francisco, and colleagues in an accompanying editorialopens in a new tab or window. "These results emphasize the importance of addressing not just screen time but also addictive behaviors in adolescents."

High and/or increasing addictive screen use trajectories were common among study participants, who had a mean age of 10 years at baseline. Nearly one-third of kids had an increasing addictive use trajectory for social media or mobile phones beginning at 11 years of age. And about 41% of participants had a high addictive use trajectory for video games.

Notably, there were 30% to 40% of kids who "started with low addiction use and ended up with higher addiction use," Xiao told MedPage Today in emailed remarks. "[I]f you do not follow the kids over time, you would miss this substantial group that shifts from low risk to higher risk."

Overall, 5.1% of participants reported suicidal behaviors and 17.9% reported suicidal ideation at follow-up of 4 years. Child and parent reports over the prior year were assessed via the Kiddie Schedule for Affective Disorders and Schizophreniaopens in a new tab or window, which covers nine outcomes ranging from passive ideation to preparatory actions for imminent suicidal behavior and suicide attempt. For other mental health concerns, there were parent-reported internalizing and externalizing symptoms using the Child Behavior Checklistopens in a new tab or window.

For social media, patterns of use that peaked with high addictive use scores or that grew increasingly addictive were associated with significantly higher risk of suicidal behaviors (RR 2.39 and 2.14, respectively, P<0.001 for both) and of suicidal ideation (RR 1.51 and 1.46, P<0.001 for both) compared with the low addictive risk trajectory.

For mobile phones, the high addictive use trajectory was associated with higher risk of suicidal behaviors and suicidal ideation (RR 2.17 and 1.50, both P<0.001) than the low addictive use trajectory. And the increasing addictive use trajectory was modestly associated with a greater relative risk of suicidal ideation (RR 1.22, P<0.001).

As for video games, the high addictive use trajectory was associated with higher risk of suicidal behaviors (RR 1.54, P=0.004) and suicidal ideation (RR 1.53, P<0.001) than the low addictive risk trajectory.

Total screen time at baseline was not associated with suicidal behaviors or ideation or internalizing or externalizing symptoms, they found.

The study used data from the Adolescent Brain Cognitive Development (ABCD) study, with population-based samples from 21 sites across the U.S.

Limitations included the observational nature of the study and reliance on self-reported data, Xiao and colleagues noted. Also, the pandemic could have influenced screen time, the ABCD study did not assess multitasking across screen platforms, and 4-year follow-up data were not available for all participants.

Additionally, psychosocial and behavioral factors like bullying, adverse childhood experiences, and social determinants of health were not assessed, they noted.

Ultimately, "[n]ow that we know the addictive use pattern is so important," Xiao said, "we need to develop intervention strategies and test them in controlled clinical trials."

Disclosures

The study was supported by funding from the National Institute of Mental Health, the American Foundation for Suicide Prevention, and Google.

Xiao disclosed no relevant relationships with industry. A co-author of the study reported receipt of royalties for commercial use of the Columbia-Suicide Severity Rating Scale from the Research Foundation for Mental Hygiene and the Columbia Pathways App from Columbia University.

The editorialists did not report any relevant conflicts of interest.

Primary Source

JAMA

Source Reference: opens in a new tab or windowXiao Y, et al "Addictive screen use trajectories and suicidal behaviors, suicidal ideation, and mental health in US youths" JAMA 2025; DOI: 10.1001/jama.2025.7829.

Secondary Source

JAMA

Source Reference: opens in a new tab or windowNagata JM, et al "Beyond screen time -- Addictive screen use patterns and adolescent mental health" JAMA 2025; DOI: 10.1001/jama.2025.8135.

https://www.medpagetoday.com/pediatrics/generalpediatrics/116127

An instantaneous voice-synthesis neuroprosthesis

 

Maitreyee Wairagkar,
Nicholas S. Card,
Tyler Singer-Clark,
Xianda Hou,
Carrina Iacobacci,
Lee M. Miller,
Leigh R. Hochberg,
David M. Brandman &
Sergey D. Stavisky

Abstract

Brain–computer interfaces (BCIs) have the potential to restore communication for people who have lost the ability to speak owing to a neurological disease or injury. BCIs have been used to translate the neural correlates of attempted speech into text1,2,3. However, text communication fails to capture the nuances of human speech, such as prosody and immediately hearing one’s own voice. Here we demonstrate a brain-to-voice neuroprosthesis that instantaneously synthesizes voice with closed-loop audio feedback by decoding neural activity from 256 microelectrodes implanted into the ventral precentral gyrus of a man with amyotrophic lateral sclerosis and severe dysarthria. We overcame the challenge of lacking ground-truth speech for training the neural decoder and were able to accurately synthesize his voice. Along with phonemic content, we were also able to decode paralinguistic features from intracortical activity, enabling the participant to modulate his BCI-synthesized voice in real time to change intonation and sing short melodies. These results demonstrate the feasibility of enabling people with paralysis to speak intelligibly and expressively through a BCI.

https://www.nature.com/articles/s41586-025-09127-3

Dupilumab for Atopic Dermatitis Linked to Increased Risk of Psoriasis

 

• The use of dupilumab for the treatment of atopic dermatitis was associated with an increased risk of psoriasis compared with other systemic agents.
• The association between dupilumab and psoriasis was further supported by validation in patients with asthma without atopic dermatitis.
• This suggests that dupilumab may act as a trigger in promoting psoriasis.

The use of dupilumab (Dupixent) for the treatment of atopic dermatitis was associated with an increased risk of psoriasis compared with other systemic agents, according to a retrospective cohort study.

Among over 19,000 matched patients, the 3-year cumulative incidence of psoriasis was 2.86% with dupilumab versus 1.79% with other systemic agents (P<0.001), with a number needed to harm of 94, reported Chun-Ying Wu, MD, MPH, PhD, of National Yang Ming Chiao Tung University in Taipei, Taiwan, and colleagues in JAMA Dermatologyopens in a new tab or window

The dupilumab cohort had an increased risk for psoriasis (HR 1.58, 95% CI 1.25-1.99), although the risk for psoriatic arthritis (PsA) was not significant (HR 1.97, 95% CI 0.75-5.18).

Key findings of subgroup analyses included an observed increased psoriasis risk in patients without atopic comorbidities (HR 1.42, 95% CI 1.06-1.89) and those with pretreatment immunoglobulin E (IgE) levels less than 0.048 mg/dL (HR 1.59, 95% CI 1.26-2.01).

The association between dupilumab and psoriasis was further supported by validation in patients with asthma without atopic dermatitis (HR 2.13, 95% CI 1.38-3.31), the authors noted.

"Since psoriasis prevalence in general AD [atopic dermatitis] populations ranges from 0.3% to 12.6%, the dupilumab cohort's psoriasis rate, although higher than the control cohort, remained within this range," Wu and team wrote. "This suggests that dupilumab may act more as a trigger rather than a decisive factor in promoting psoriatic eruption in patients with AD."

"Recent proposals suggest that AD and psoriasis may exist on a spectrumopens in a new tab or window, with varying Th2-Th17 polarization associated with overlapping disease features," they explained. "Because IL [interleukin]-4 and IL-13 negatively regulate Th17 function, their blockade by dupilumab may skew immune responses toward Th17-driven inflammation, potentially triggering psoriasis."

However, "such an immune shift following dupilumab may not be straightforward in all patients," they added.

Danilo C. Del Campo, MD, of the Chicago Skin Clinic, told MedPage Today that "this immune shift from Th2 to Th17 dominance is certainly something we have seen in private practice, and it's encouraging to see it supported by a large, well-designed cohort study."

"That said, I do not see this as practice-changing at this point," he added. "Dupilumab remains an effective and well-tolerated option for many patients with moderate-to-severe atopic dermatitis. Awareness of this potential risk can help guide monitoring and patient counseling, particularly in those with a personal or family history of psoriasis."

Shoshana Marmon, MD, PhD, of New York Medical College in Valhalla, told MedPage Today that "the observed association between dupilumab and psoriasis in patients with asthma (but not atopic dermatitis) supports a likely drug-related trigger related to this shift in immune balance. While the absolute risk remains low, clinicians should be aware of this potential adverse effect, particularly in patients 60 years or older, without atopic comorbidities, or with lower baseline IgE levels."

"Though relatively rare, this paradoxical reaction highlights the need for increased clinical awareness when evaluating new-onset psoriasiform lesions in patients receiving dupilumab," she noted. "Clinicians should remain aware of this risk but balance it against dupilumab's strong efficacy in treating moderate-to-severe atopic dermatitis."

Observations of arthritis and enthesitis resembling PsA following dupilumab initiation also support a possible connection to a psoriatic disease phenotype, Wu and colleagues said. However, observational dataopens in a new tab or window link more than a quarter of musculoskeletal events to non-inflammatory causes; thus, "identifying the role of PsA in inflammatory cases remains challenging. As psoriatic skin lesions often precede PsA, patients may discontinue dupilumab after developing psoriasis, preventing further progression. If PsA occurs first, the absence of skin symptoms may lead to a missed diagnosis."

This population-based retrospective cohort study included adults with atopic dermatitis from the TriNetX Global Collaborative Network. Propensity score matching at a 1:1 ratio was based on age, sex, race, comorbidities, laboratory measurements, and prior medications.

Wu and colleagues analyzed 19,720 patients, 9,860 who were prescribed dupilumab and 9,860 who were prescribed other systemic agents (corticosteroids, methotrexate, cyclosporine, azathioprine, or mycophenolate mofetil). Mean age in both groups was 44.8, 55.2% were women, 50.2% were white, 18.2% were Black, and 10.2% were Asian.

Due to the observational nature of the study, the authors could only report an increased risk of psoriasis in patients receiving dupilumab without establishing causality, which was a limitation.

Disclosures

This work was supported in part by the National Science Technology Council of Taiwan and Taichung Veterans General Hospital.

The study authors had no disclosures.

Del Campo and Marmon had no disclosures.

Primary Source

JAMA Dermatology

Source Reference: opens in a new tab or windowLin T-L, et al "Psoriasis risk in patients with atopic dermatitis treated with dupilumab" JAMA Dermatol 2025; DOI: 10.1001/jamadermatol.2025.1578.

https://www.medpagetoday.com/dermatology/psoriasis/116153

'Oregon Law Aims to Curb Corporate Ownership in Healthcare'

 Oregon has enacted a law imposing stringent new regulations on corporate ownership of physician practices in the state.

SB 951opens in a new tab or window, signed into law by Gov. Tina Kotek (D) on June 9, aims to close a loophole in which corporations list physician owners on documentation in order to comply with state "corporate practice of medicine" (CPOM) laws -- but in reality, the physicians lack true control over the practice, according to a press releaseopens in a new tab or window.

"Back in 1947, we drew a clear line between who could own a clinic and who could practice medicine, because we understood that healthcare isn't just a business, it's personal," said Oregon Rep. Cyrus Javadi (R) in the press release, referring to the state's original CPOM law. "SB 951 updates that line for a world where private equity firms and management companies have figured out how to blur it."

Essentially, the law establishesopens in a new tab or window a clear rule that management service organizations (MSOs), which deal with the non-clinical aspects of medical practices, cannot own a majority of shares in a healthcare facility or collectively control such a facility with a physician who is also involved with the MSO as a shareholder, director, member, manager, officer, or employee.

Corporations often use MSOs as a way to skirt the boundaries established by CPOM restrictions, according to Robert McNamara, MD, an emergency physician who has long criticized the corporate takeover of medicine.

As the first and only law of its kind in the country, Oregon's legislation is quite significant, McNamara told MedPage Today. While there are laws in some states that require the attorney general to review private equity purchases of hospitals, he said, SB 951 goes much further. It's an important step toward regulating corporate ownership of physician practices in that it directly aims to end the "friendly physician model, where a physician who didn't even practice in the hospital, sometimes not even the state, would be the 'owner' of the professional corporation," McNamara said.

That outside company then takes control of the healthcare facility, siphoning off revenue and taking away control from a business that is no longer locally owned, he said. "We need to make sure that our healthcare providers and our delivery system stays local and is controlled locally," Kotek said during a press briefing on the law last week, according to the Oregon Capital Chronicleopens in a new tab or window.

McNamara noted that the American Academy of Emergency Medicine (AAEM) sued Envision Healthcareopens in a new tab or window in 2021 for engaging in such a practice in California. AAEM went to court to show that Envision's management "was just a scheme to skirt the intent of the prohibition on the corporate practice of medicine," McNamara said, noting that Envision eventually withdrew from the state.

SB 951 is, in part, a reaction to a 2020 takeover of Oregon Medical Group by UnitedHealth Group's Optum unit, Rep. Lisa Fragala (D) said in the press release. Dozens of doctors left after Optum required them to sign non-compete contracts, according to news reportsopens in a new tab or window, leaving thousands of patients without healthcare. Optum later reversed course after pressure from lawmakers, according to reports.

The law doesn't go into effect immediately, and allows a 3-year adjustment period for clinics to comply with the restrictions, reports stated.

Oregon's move comes as physicians increasingly rally against corporate influence in medicine, particularly when it comes to private equityopens in a new tab or window involvement. In addition, more physicians -- not just residents and fellows -- are unionizingopens in a new tab or window than ever before.

"Most people think having your doctor employed by an insurance company isn't a good idea," McNamara said, because that doctor will have a conflict-of-interest between the health of patients and company profits.

There are a number of problems with the corporate onwership of medical practices, Adam Brown, MD, MBA, said in an email to MedPage Today, including "rising costs, declining quality of care, and increasing rates of burnout among clinicians."

Brown added that while SB 951 is a step forward, it's important not to ignore vertically integrated payers and consolidated hospital systems as well. "If reform efforts concentrate solely on one sector while allowing others to continue unchecked," Brown said, "we risk tipping the balance further in favor of these powerful institutions."

In his view, federal agencies like CMS and the Federal Trade Commission need to "establish clearer guardrails to limit excessive vertical integration between insurers and providers."

The situation has worsened over recent years, Gary Price, MD, president of Physicians Foundation, a national nonprofit, told MedPage Today. "We're now in a situation where roughly 80% of physicians are employed by some sort of larger entity," Price said.

Competing interests at work in the exam room, he added, "involves all sorts of things, from transparency, as far as the patient knowing who's really deciding about care decisions, but also the ethical implications for the physician and the frustration of the environment, adding to what's already a crisis in physician well being."

McNamara said he hopes the Oregon bill will set a precedent and spread to other states.

But not everyone was sold on it. Ryan Grimm, president of the Oregon Ambulatory Surgery Center Association, testifiedopens in a new tab or window during a hearing on the bill that a broad mix of ownership models benefits consumers.

Grimm's three main concerns with SB 951 were that it will prohibit attracting physicians incentivized by an ownership stake in a healthcare facility, drive management companies away from Oregon, and leave physician-owned clinics with the sole option of selling to a hospital as a means of investment.

The law, he said, "could lead to clinic closures, challenges recruiting new physicians to Oregon, and higher healthcare costs for consumers."

https://www.medpagetoday.com/publichealthpolicy/workforce/116130