Category: Medical News

Genesis Whegelee (right, in vest) has been a community health worker for Last Mile Health in Rivercess County, Liberia, since 2018. He visits households to keep an eye on sick children, pregnant moms and anyone with a problem that needs diagnosing.

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Last Mile Health

In 2007, Dr. Raj Panjabi, a physician at Brigham and Women’s Hospital in Boston, traveled to Liberia, where he was born. He had just been married and brought the $6,000 he had raised from wedding guests to help co-found a health initiative to provide care to those who lived in the country’s most remote, inaccessible regions. The organization’s name, Last Mile Health (LMH), reflected its mission: the belief that no one should be beyond the reach of life-saving medical help.

Today, Last Mile Health is receiving an honor that comes with a $3 million gift. It’s the Conrad H. Hilton Humanitarian Prize, the world’s largest humanitarian award to a nonprofit group. It’s a resounding affirmation of how a group that started very small can go on to, according to the Hilton honor announcement, make extraordinary contributions toward alleviating human suffering.

Dr. Raj Panjabi started Last Mile Health with money donated by his wedding guests. His goal was to walk the last mile to bring healthcare to people in remote areas in Liberia, where he grew up.

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Last Mile Health

But how did they reach that last mile, when physicians, nurses and medical supplies were, if available at all, scarce and far away? By using community health workers.

These are individuals who typically have a primary school education. During their eight weeks of training, they learn to diagnose and treat preventable diseases in children, including malaria, pneumonia and diarrhea, as well as help pregnant mothers develop a birth plan to deliver in the clinics. The health workers are also trained to monitor any signs of new diseases or outbreaks. 

The initial $6,000 raised to start the organization served to pay the organization’s first 17 workers. Since then, the group has expanded its scope with funding from governments as well as philanthropic and nonprofit institutions. In 2010, LMH began caring for HIV/AIDS patients in 12 of Liberia’s 15 counties, partnering with the Government of Liberia and the Global Fund to Fight Aids, Tuberculosis and Malaria.

During the 2014-16 Ebola epidemic in Liberia, LMH trained more than 1,300 community health workers to help contain the outbreak’s spread. During the COVID-19 pandemic, LMH delivered 6.2 million pieces of personal protective equipment. Going door to door to persuade people to get vaccinated, they helped lead Liberia, one of the poorest countries in the world, to an 81% vaccination rate.

Today, LMH supports 20,000 community health workers helping 32 million people not only in Liberia but in Ethiopia, Malawi and Sierra Leone. The nonprofit group has helped design a digital training program as well.

But many people who live in remote areas struggle to find medical services, points out LMH chief executive officer Lisha McCormick.

Lisha McCormick is the chief executive officer of Last Mile Health. Approximately two billion people live in remote communities outside the reach of healthcare, she points out. The group’s goal is to bring healthcare to them.

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Last Mile Health

“Last Mile Health’s work feels especially pressing today,” Peter Laugharn, president and CEO of the Hilton Foundation, said in a statement. “Health systems in the hardest-to-reach regions still face enormous strain, and Last Mile Health has met that challenge head-on.”

Panjabi, who is now president emeritus of LMH, agrees.

“We are at an unprecedented moment in global health,” he says, citing projections that there could be millions more deaths by 2030 if current funding trends continue, with major reductions by the United States as well as some European countries. The projections come from a study published in Lancet , which found that U.S. foreign aid cuts in the year 2025 could lead to more than 14 million additional deaths globally by 2030, including more than 4.5 million children under five.

“Everyone wants to cut healthcare costs,” he continues. “We cannot cut funds without cutting care, unless you get ahead of the disease. One of the most effective ways to get ahead of disease is to detect it at the earliest possible time. And community health workers are part of the answer.”

Research exists to back the contention that beyond saving lives, community health workers also save money. A 2025 analysis of 255 studies published in SSRN, a platform for researchers from academia and, in this case, members of leading health groups like the Clinton initiative, found that more than 80% of the time, these professionals delivered care at a median cost of just $0.59 per person per year. “Overall, a decade of data shows that CHWs [community health workers] are a proven, cost-effective platform for primary health care,” the paper’s authors concluded.

That achievement is reflected in the experience of Genesis Whegelee, who has worked as a community health worker in Rivercess County, Liberia, since 2018.

“There was a lot of malaria, and we didn’t know why children were dying in the community,” he says. “Now everyone is getting [medical] attention.”

Whegelee is responsible for visiting 42 households — three a day in rotation –- to assess their healthcare needs. He carries a small bag of medications and what the group calls a “job aid” –- essentially a medical textbook he can consult as he tracks the health and well-being of each family.

These visits include checking to see if there are any ill children or newly pregnant women, along with education about mosquito nets and sanitation. They account for about four hours each day. He is on call at his home the rest of the day not only doing necessary planning and paperwork but also available for emergency calls and visits.

He tells of a mother who carried her 22-month old baby from her farm to his home for an emergency visit, crying that her child was dying. “The baby was weak and feverish,” Whegelee says. He gave the baby a sponge bath to bring down the fever and gave a rapid diagnostic test to see if the baby had malaria, which was the case. He then started the baby on two medications to treat it, one for malaria and the other to control the fever, and taught the mother how to continue the medication. He made follow-up visits to the child’s home every day for the next five days. If the child had not improved, Whegelee would have referred her to a clinic. But in this case, “the child was better, and the mother is so happy that whenever I visit now the mother gives me a hug,” Whegelee says.

Shortly before he spoke to NPR, Whegelee did have to take a child to a clinic. “The child was vomiting and had diarrhea and could not keep anything down. We were taught that is a dangerous sign. That cannot be treated at home. You cannot delay,” he says.

On another occasion, he had to persuade a pregnant woman that she should deliver the baby at the hospital rather than at home in case there were complications. At first the husband was skeptical; he thought people got sick at the hospital. Whegelee succeeded in convincing the dad as well as the mom. She had trusted his advice, and the father was happy. In the routine family visits that followed, he encouraged breastfeeding and vaccines for the baby.

Such stories give support to Panjabi’s belief that “The first line of contact to the health care system is often the community health worker, the neighbor trained to be one.”

As for the Hilton Foundation grant, he said, “We will put the money to work immediately in the countries we currently work in now,” with the goal of reaching 50 million people there by 2028. LMH will also continue to work with the continent-wide initiative it co-founded, Africa Frontline First, to introduce and implement community health worker programs to additional communities and countries.

“The community health worker model is not new, but LMH is helping professionalize them. They are not volunteers but front-line practitioners who provide diagnostic and curative services,” McCormick says. She, like Panjabi, is fond of saying “Illness is universal, and access to health care is not.” That is why LMH exists, she adds, “to put a health worker in reach of everyone, everywhere.”

Diane Cole writes for many publications, including The Wall Street Journal and The Washington Post. She is the author of the memoir After Great Pain: A New Life Emerges. Her website is DianeJoyceCole.com

The White Mesa Mill’s radioactive waste is stored in five tailings cells, which occupy 284 acres of land in Blanding, Utah, as shown overhead from a plane on March 22.

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WHITE MESA, Utah — On a hot April day, Malcolm Lehi maneuvered his Jeep Wrangler over a rough dirt road. He drove past junipers and sagebrush in search of Entrance Spring on land long connected to his tribe, the Ute Mountain Ute.

The cool, mossy spring lies just across the highway from White Mesa Mill, the nation’s only remaining conventional uranium mill, which produces yellowcake for nuclear power fuel.

For decades, the mill has sparked debate over whether radioactive contamination threatens human health by getting into the water and the air. Concerns run especially deep in the White Mesa Ute Community, where Lehi and about 200 members of his tribe live some 5 miles south of the facility.

State regulators and the company that owns the mill contend that any pollution associated with it is contained. That’s little consolation to nearby tribal members, who — aware of uranium’s deadly legacy across the Colorado Plateau — have raised questions about the potential spread of toxic waste. Many won’t drink the local water, relying on bottled water instead.

Now the tribe’s concerns have taken on new urgency as the U.S. pushes to revive domestic uranium production. A federal law, passed in 2024, bans imports of Russian uranium by 2028, increasing pressure to develop domestic fuel supplies. President Trump set a goal to quadruple U.S. nuclear energy capacity by 2050. He issued orders to prioritize mining on federal lands and fast-track approval of mining projects. The Velvet-Wood uranium mine in Utah, for instance, zipped through federal environmental review in 11 days, to the dismay of local tribes who were given one week to offer input.

Trump’s goal of quadrupling nuclear power capacity will be hard to meet, because it would require constructing more reactors — which are difficult to build and often meet local opposition, said David Hart, a senior fellow for climate and energy at the Council on Foreign Relations. But data centers and rising electricity demand have intensified interest in nuclear power as a low-carbon energy source, he said. And more states are opening the door to it.

So the effort to obtain the key ingredient, uranium, is underway.

Tension at the White Mesa Mill 

The White Mesa Mill, built in 1980 near what is now the Bears Ears National Monument in southeastern Utah, is a focal point of this latest uranium boom — and the tensions between local tribal concerns and national economic interests.

Increased demand draws a steady flow of trucks carrying uranium ore to the mill from regional mines, including one near the Grand Canyon where the Havasupai Tribe lives. That ore is trucked through the Navajo Nation. And the mill plans to expand its waste storage, as well.

A former tribal councilmember, Lehi is part of a growing opposition that includes members of the Havasupai and Navajo (Diné) tribes, who are now linked by the uranium trucking routes passing through their lands. The Havasupai and Ute Mountain Ute tribes share concerns that toxic wastewater from uranium mining and milling may move through the ground and poison drinking water for future generations.

Malcolm Lehi stands at Entrance Spring, where in the late 2000s elevated levels of radionuclides were linked to the nearby White Mesa Mill. The mill processes uranium ore from across the Southwest and radioactive waste from as far away as Estonia.

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Melissa Bailey/KFF Health News

A history of distrust

One spring morning in White Mesa, Yolanda Badback gazed out an open door not far from the highway and watched three uranium trucks drive by.

“There goes another one,” Badback said with a tone of exhaustion. She is a Ute Mountain Ute member and leader of the White Mesa Concerned Community advocacy group that has been fighting the mill.

The mill receives 10 to 15 trucks each weekday, said Curtis Moore, senior vice president of marketing and corporate development at Energy Fuels, which has owned the facility since 2012. The majority pass through White Mesa.

The mill’s business is picking up after a quiet 15 years, Moore said. The White Mesa Mill produced 1 million pounds of yellowcake last year; the company plans to more than double that this year, he said. The mill has also diversified into processing radioactive waste from as far away as Estonia and Japan, and received a $725 million conditional loan commitment from the Defense Department to scale up its domestic processing of rare earth elements.

The new rare earths business alone could create 100 permanent jobs, Moore said. About half of the mill’s 105 workers are Indigenous; Moore estimated that no more than two belong to the Ute Mountain Ute Tribe.

“When it comes to tribes in the area, I do very much understand their skepticism of uranium,” Moore said. “They’ve been lied to before.”

A uranium boom driven by the U.S. government from the 1940s through the 1980s, much of it concentrated around the Four Corners area of Arizona, New Mexico, Utah and Colorado, exposed miners to heightened rates of mortality from lung and other cancers. Federal reviews found that the miners, many of them Navajo (Diné), were not warned about radiation risks even after government scientists understood the dangers. Mining companies left behind thousands of abandoned waste sites that have leached contamination into surrounding soil and water, including over 500 spots on and near the Navajo Nation.

But Moore said things have changed a lot since the 1950s. He said workers today are exposed to 15% to 20% of allowable radiation limits, and outside the mill it’s “effectively zero.”

Government agencies and Energy Fuels officials have said there’s no evidence that the mill is affecting White Mesa’s drinking water supply, which comes from a deep aquifer protected by a thick rock barrier known as an aquitard.

“It really is the perfect site for a uranium mill,” Moore said.

Scott Clow, environmental programs director of the Ute Mountain Ute Tribe, said that deep aquifer does have quality issues — including arsenic, iron, and manganese — but the public drinking water is filtered and safe to drink.

Adam Wingate, uranium recovery manager at the Utah Department of Environmental Quality, said he understands why some residents are concerned. White Mesa is downslope in terms of underground water flow from the uranium mill.

If locals hear about the plume of contamination in a different, shallower aquifer beneath the mill — even if it’s not the source of their drinking water — and their own water tastes funny, “that’s a scary spot to be in,” he said. But based on available evidence, Wingate said, locals’ “health is not at risk because of the mill.”

Even so, Lehi and Badback said that the tap water smells of sulfur and has a milky color, and that people in White Mesa typically don’t drink it.

“I don’t trust it,” said Badback, whose family has been fighting the mill for decades. “My main goal is to shut the mill down.”

An annual spiritual walk and protest sponsored by Badback’s group has grown over the past decade amid deep distrust rooted in uranium mining’s history. Much of the opposition centers on the mill’s toxic waste, which is stored in five lined pits called tailings cells occupying 284 acres of land.

Badback vows to fight expansion plans that include new tailings cells located about a quarter-mile closer to the White Mesa community than the current ones. Moore said the cells will be triple-lined per modern standards.

“They want to expand south towards my reservation,” Badback said. “That’s the reason why I am standing up and doing whatever I can to stop that from happening.”

Concerns about air quality 

At a No Kings rally in March in Moab, about 80 miles north of White Mesa, Badback gave a speech and staffed a table offering T-shirts and information.

Yolanda Badback, whose family has been fighting the White Mesa Mill in southeastern Utah for decades, speaks at a No Kings rally in Moab, Utah, on March 28.

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Melissa Bailey/KFF Health News

“No Uranium,” the T-shirts read. “Protect White Mesa Ute Community.”

In 2021, her tribe passed a resolution stating that the White Mesa Mill “has had severe health impacts on the residents of White Mesa and should cease entirely.”

While their psychological stress is palpable, other health effects have been hard to prove.

A 2023 federal health assessment concluded that radiation levels measured at the tribe’s air monitor in the center of White Mesa between 2013 and 2019 were unlikely to harm human health. But the authors said they could not evaluate whether the mill’s radon emissions could affect bordering properties or residents. They recommended that the tribe collect air samples closer to the mill, during times of heightened mill activity.

In December 2021, the Environmental Protection Agency found the mill was violating the Clean Air Act by failing to cover one of its tailings cells with liquid to limit emissions of radon, a known cause of lung cancer. The EPA called the violation “egregious in nature and duration” and temporarily barred the mill from receiving waste from Superfund cleanup sites.

The mill corrected the problem, according to state regulators, and passed its latest air quality review in 2025.

Still, some White Mesa residents remain uneasy. Badback and Lehi complained of odors, which they attribute to the mill, that smell like chemicals or rotten eggs. She has raised concerns about air quality and rates of cancer and asthma, which are being explored by a University of Utah health survey.

Moore denied that any odors from the mill could be smelled beyond the mill parking lot.

Utah air quality officials said the state does not conduct ambient air monitoring in White Mesa and does not regulate odors.

Watching the water

That spring day, Lehi continued to look for Entrance Spring. On the horizon lay the silhouette of Sleeping Ute Mountain, a landmark of the Ute Mountain Ute Tribe, said to be the body of a great warrior god.

Along the way, Lehi pointed out a circle of stones that he thought looked like an ancestral burial site. After parking the Jeep, he walked down a faint trail through a lush grove of willows and found his way into a streambed that he reckoned would lead to the spring.

The tribe doesn’t rely on the spring for drinking water. But it’s one of the seeps and springs that the tribe, the state and the company monitor, because they offer clues to whether the mill’s waste ponds are leaking into a less protected aquifer.

In the late 2000s, an EPA report found elevated contamination by radionuclides — atoms that emit radiation as they decay — at Entrance Spring. EPA water samples found that uranium concentrations at times exceeded the federal drinking water standard. EPA and U.S. Geological Survey fieldwork suggested the uranium at Entrance Spring came not from leaking waste ponds but from dust that blew off the mill’s ore storage pads.

The latest tests from 2025 showed Entrance Spring had uranium levels at 22.5 micrograms per liter (µg/L) — within the federal drinking standard of 30 µg/L but still elevated.

Clow said the tribe continues to keep a close eye on the seeps and springs.

“We’re concerned about the pollution of those springs,” he said. “We are looking towards many generations in the future here.”

Clow is also closely watching the Burro Canyon Aquifer, which lies beneath the mill’s toxic waste cells and feeds the local springs. A plume of chloroform and another of nitrates already pollute the aquifer, said Wingate, with the state. He said Energy Fuels is pumping out the contamination.

When contaminants increase, it’s hard to prove whether they stemmed from natural causes or mill activity, since substances such as sulfate and manganese occur naturally in the local bedrock. So Clow, the company and state officials continually debate whether the tailings ponds are leaking.

What’s not in dispute is that the mill produces radioactive waste — and once that exists, it can linger for tens of thousands of years.

Lehi followed the stream to where it ends in a curved grotto — the site of Entrance Spring. Water oozed from a rock face into a pool, offering cool relief from the desert. Lehi looked around with wonder at the dripping green moss. A descendant of medicine men, Lehi said he feels a duty to protect the landscape as his ancestors did, even if the tribe doesn’t currently use this spring for drinking water.

 ”Water is life,” Lehi said, “because that’s where we all began.”

This article was supported by The Water Desk, an independent journalism initiative based at the University of Colorado-Boulder’s Center for Environmental Journalism.

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 — the independent source for health policy research, polling, and journalism.

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A few years ago, Niro Feliciano didn’t even have the time to grasp how busy she was. The mom of four was taking on more writing and speaking gigs on top of her work as a psychotherapist and a licensed clinical social worker.

“I remember sitting in my office. I had done eight sessions, several with adolescents. And I said, ‘When was the last time I spent 45 minutes listening to one of my kids?'” she says.

She realized that how she wanted to spend her time and how she was really spending it “were very much misaligned,” she says. “I did not see enough of a reflection of things that brought me joy and contentment.”

If your day leaves you no room to enjoy what matters, reevaluate where your time is going, says Feliciano, author of two self-help books, including This Book Won’t Make You Happy: Eight Keys to Finding True Contentment. 

Feliciano asks many of her own clients to do this, especially those who feel like they’re on a “hamster wheel and can never catch up,” she says. “Oftentimes, the things that are most important to them don’t have much of a place in their day-to-day schedule.”

To regain control of your time — and your life — try these exercises from Feliciano.

Do a time audit 

Make a list of the people and the activities that are the most important to you. It might be loved ones like your partner, your kids or your bestie, and hobbies like reading, working out or video-chatting with your long-distance friends. 

Then do a time inventory. Where is your time really going each day? Are the lists matching up? You might find that a lot of your day is spent on obligations, chores and time-sucking activities.

Then look for ways to make your lists reflect each other. Where can you carve out more space for your family? Or set aside a moment for reading?

“When your schedule begins to align with your values is when we begin to feel inner peace,” she says.

Cut back on the time-wasters 

To make more time, you’ll need to set some boundaries, Feliciano says. “What are you doing that makes you feel resentful, depleted, exhausted?” And what can you do to limit yourself from those activities?

Feliciano found that she was spending a lot of unnecessary time scrolling on social media — but that wasn’t on her list of priorities, so she cut back.

You may need to communicate with other people that you are taking a break. For example, you might tell your friend (who’s a bit of an energy vampire) that you’re pausing for a bit on weekly trivia.

Those who have your best interests in mind will understand. “The only people who will push back on your healthy boundaries are the people who benefited from you not having them,” Feliciano says.

Don’t overlook where you can gain time. Feliciano often has this conversation with mothers, “because they are doing so much for their children and partners,” she says. Enlist family members’ help with everyday tasks and chores. “That’s good for everyone on board.”

Learn to exist in the open space you’ve created 

Be purposeful with your newfound time, Feliciano says. Do something joyful. Catch up with an old friend. Start that project you’ve been meaning to get to. “If we think about those things prior to that moment, we’ll know how to fill it,” she says.

Get comfortable with being bored. “Do you have a few minutes where you can just be still and rest your body? Even doing nothing is OK,” she says.

And don’t forget: The impulse to be busier and busier can leave you in endless pursuit. “When your value and identity lie in acquisition and accomplishment, you will constantly be pursuing it,” she says. “It’s a cycle that you’re constantly going to be chasing unless you choose to get off it.”

This story was edited by Meghan Keane. The visual editor is CJ Riculan. The producer of the episode is Margaret Cirino. We’d love to hear from you. Leave us a voicemail at 202-216-9823, or email us at LifeKit@npr.org.

Listen to Life Kit on Apple Podcasts and Spotify, and sign up for our newsletter. Follow us on Instagram: @nprlifekit.

A child is prepped to receive an MMR vaccine at Lurie Children’s Primary Care in Chicago.

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Erin Hooley/Chicago Tribune

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President Trump signed an executive order Monday related to childhood vaccines in an Oval Office ceremony, flanked by top health officials and a conservative commentator who talked about her child and her current pregnancy. Those attendees called the move “historic” and “a big deal.”

But what’s different today when it comes to childhood vaccine policy in the U.S.? Not much. There’s no new research, no new vaccines available and no immediate change to insurance coverage or school requirements.

And so far, pediatrician Dr. Jennifer Shu in Atlanta says parents in her practice aren’t asking her about what the executive order means for their kids.

“At the very beginning, when the administration started making changes, people were concerned about — gosh, are we no longer going to have access to certain vaccines?,” she says. “But I’m not hearing that anymore.”

She says since some of the biggest swings from the White House – including an effort to reduce the number of federally-recommended vaccines for children – were blocked by courts and never took effect, “I’m feeling like a lot of parents are kind of wanting to see what the final result is before they get too concerned.”

Still, the potential for confusion is real, she says. Here are the answers to five questions parents might be having about the executive order.

1. Are the same shots still available?

“Yes — as of right now, yes,” Shu says. All of the shots in the childhood vaccine schedule backed by pediatricians are still available.

The Trump administration has tried — first through a panel of hand-picked advisors and then unilaterally — to change the list and timing of these vaccines, but has not been successful so far. The new executive order calls for certain things to be researched and reports to be written, but it makes no immediate changes.

All of that highlights the limits of the federal government in this area, says Jen Kates, senior vice president and director of the Global and Public Health Policy Program at the nonpartisan health research organization KFF.

“It’s up to states and individual parents,” she says. “States are going to make these decisions about school entry and then parents can make their own decisions about timing.” In fact, she explains, “in all states but five, parents can opt out of vaccines or they can get a nonmedical exemption.

“So parents actually have quite a bit of choice already, and nothing about this will diminish or expand their choice,” she adds.

2. Does this affect which vaccines are covered by insurance?

No, health insurance coverage is unchanged for all vaccines in the American Academy of Pediatrics’ vaccine schedule. Nearly all families can receive vaccinations with no copays, including families without health insurance.

In a statement from May, AHIP, the trade association that represents health insurance companies, said that health plans would cover vaccines recommended by the CDC through the end of 2027.

3. Why is this vaccine order happening now?

It’s not entirely clear why this executive order is being rolled out now, especially so close to the November midterms elections, since some Republican pollsters have warned vaccine changes are politically hazardous. The timing also intersects with the beginning of the school year.

At the signing, Trump seemed to indicate that his administration was making another move in this area because it matters a lot to him, and because past efforts have been blocked in the courts.

“I believed in this a long time,” Trump explained as he signed the executive order Monday. When vaccinating his own children, Trump told reporters, he made extra doctors’ appointments to spread out the number of shots they got at one time. “It’s inconvenient, it’s five stops, but it’s something that I think will have a huge impact on autism,” he added.

The executive order does not actually address autism and vaccines, but Trump made multiple references to it at the press conference, as did Health Secretary Robert F. Kennedy Jr., a longtime anti-vaccine activist. The links between autism and vaccines have been debunked by many studies.

“There’s nothing new,” Shu says. “Nothing has changed with the science.” She adds that the effort to change the vaccine schedule is “based on misinformation.”

4. What’s the idea behind spacing out children’s shots?

Shu says she does see families who ask about spacing out the vaccine schedule the way Trump describes doing with his own children.

“What I tell parents is that splitting the vaccines has not been studied — putting the vaccines together as scheduled has been proven to be safe and effective,” she says. “And sometimes combining vaccines at one visit may help some work better together.”

Spacing the vaccines out has downsides, she adds. “Splitting them up leaves a kid more vulnerable to certain infections if they get exposed before they’re fully protected by the vaccine, it means more visits to the doctor’s office, it means more time off that the parents take — things like that.”

5. Could the MMR shot be split into three shots?

Maybe, but it would take a while. The executive order calls for the measles, mumps and rubella vaccine to be divided into three separate shots, but right now separate shots for those vaccines are not available in the U.S. A White House official told reporters on background Monday that the administration would be working with private drugmakers to explore making those available.

“There’s no evidence whatsoever that that vaccine should be split, in fact, it raises all kinds of challenges and potential downsides,” Kates from KFF says. She points out that one of the complaints raised by Trump is that children get too many shots, yet this change would increase the numbers of shots for the same amount of protection.

Kates adds that Trump’s statements during the press conference about the dangers of the MMR shot could have a bigger impact on public health than the policy specifics of splitting up these vaccines. KFF polling shows most parents are supportive of vaccines, Kates says, but even a small group that becomes concerned or confused about vaccines can make a difference when it comes to public health.

“As we can see with the measles outbreak, as soon as you start to bring vaccine coverage down, even a slight amount, that is where you start to see breakthrough [infections] — that’s the risk here,” she says.

A midwife crisscrosses Alabama to care for pregnant women and deliver babies. It’s an important profession as maternity deserts expand across the U.S., according to the latest March of Dimes report.

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Maria Fabrizio/NPR

Nadia Gramby cherishes quiet moments with her baby girl River Emmanuel, who’s starting to talk. They exchange snuggles and baby coos each morning.

“Did you sleep well last night?” Gramby asks her little girl, who has dark curls and a big smile.

Besides being a mother of two and a wife, Gramby spends her days and many nights as a midwife caring for other moms and babies across Alabama where she lives and practices.

The kind of care Gramby offers is important because more than 52% of counties in the U.S. do not have hospital-based labor and delivery services, according to the latest March of Dimes “Nowhere to Go” report on maternity care deserts, out Tuesday. The 2026 report also finds one in three counties, or nearly 35%, are maternity care deserts, meaning they have no birthing facilities or obstetric clinicians.

Nadia Gramby spends her days and many nights as a midwife caring for other moms and babies across Alabama, where she lives and practices.

Nadia Gramby

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Nadia Gramby

“This goes beyond a mere inconvenience,” said Dr. Michael Warren, chief medical and health officer for the March of Dimes. “We know that those women who live in maternity care deserts are more likely to have bad outcomes when it comes to their pregnancies.”

More than 20,000 babies die before their first birthday every year in the U.S., according to the Centers for Disease Control and Prevention. And about 600 women a year don’t survive pregnancy-related complications.

The risks are heightened for women of color, according to the most recent maternal mortality data from the March of Dimes and the CDC. Rates of maternal death are significantly higher for Indigenous and Black women than for white women.

Miles for moms

On any given day, the midwife Gramby may drive hundreds of miles through cities and sprawling rural towns in Alabama, to help families bring new life into the world. She’s a licensed and certified professional midwife based in Chelsea, a suburb of Birmingham. Gramby says traveling long distances to support patients is worth every mile.

“It is an amazing joy to see families who feel safe,” she says with delight.

Nadia Gramby, her husband Shamar and their two kids, son Khalil and daughter River Emmanuel.

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Gramby family

Gramby drove 302 miles in one day recently to prenatal appointments in Anniston, Montgomery, Helena and Alabaster. When leaving home for a birth, she never knows exactly when she’ll return. She’s grateful for the support of her husband Shamar, who she considers a superdad.

Gramby, 41, founded her practice, Crown of Glory Birth Services, in 2018, partly to help meet the needs of women lacking care in maternity deserts. She supports families through pregnancy, labor, birth and the postpartum period after a woman gives birth.

Gramby is one of only about 1,200 Black midwives in the U.S., according to the American Midwifery Certification Board. Midwives are medically trained to perform many of the same functions and procedures as doctors when women are having babies in low-risk situations. Gramby says one main difference is that midwives are able to give more personalized care:

“It is about ‘How are you doing emotionally, spiritually, physically? What support do you have? Who’s around you that’s going to be with you throughout the pregnancy?'”

Midwives often provide services after birth that include holistic care and home visits.

“Who’s going to show up postpartum to cook you some food? To make sure you stay in the bed and you’re not doing too much postpartum,” said Gramby with a laugh.

Research shows midwife births lead to lower rates of both cesarean section and complications. Midwives deliver in hospitals alongside physicians, birth centers and at homes. They also frequently collaborate with doulas, who provide non-medical support.

Gramby recently started seeing clients in her new office in Birmingham. Until now, she exclusively visited women and families in their homes. The reason she still travels all those miles is to offer the home birth experience and serve communities without access to maternity care.

“Nowhere to Go”

In its new report, the March of Dimes says midwives play a critical role in expanding access to maternity care. The organization, which works to improve health outcomes for mothers and babies, releases the report every two years. It details the challenges millions of women and couples face in obtaining maternity care in their own communities.

The March of Dimes finds maternity care deserts exist in every region. The south and midwest have the highest proportion with 38.7% of counties; 26.4% of counties in the west; and 5.1% of counties in the northeast.

“Those counties are collectively home to 2.4 million women of reproductive age and they are counties where 150,000 births occur every year,” said Warren, noting that it can take three times longer, on average, to travel from impacted counties for appointments, treatment or emergencies. In 2024, one in four women didn’t receive prenatal care during their first trimester, the report says.

While the overall picture held mostly steady from the 2024 maternity care desert report, the organization’s leadership says the data remains distressing.

Barriers to maternity care

The March of Dimes says President Trump’s One Big Beautiful Bill Act passed by Congress last year creates additional barriers to accessing maternity care. The law significantly cuts Medicaid funding and did not extend tax credits that would have kept Affordable Care Act insurance premiums cheaper.

An obstetrics workforce shortage adds to concerns. And more than 500 hospitals closed maternity wards between 2010 and 2022, according to a study published in the medical research journal JAMA.

The problem affects women and families in rural and urban communities, and drives up infant mortality rates. Maine’s largest non-profit health system voted to close Lincoln Hospital’s labor and delivery unit in the rural coastal town of Damariscotta last week. Washington, D.C.’s largest hospital shuttered one of its two postpartum units last month.

The March of Dimes says closures usually involve a county’s only birthing facility.

“Unfortunately, in the United States, we live in a country that is among the most dangerous developed countries in the world for giving birth,” said Warren.

He worries especially about Black and brown mothers and babies, and the persistently higher risks they face.

“We’ve got to do better and it’s also not acceptable that what you look like and where you live determines your chance of survival,” Warren said. “Black and brown women and their babies suffer disproportionately in this country.”

Nadia Gramby is passionate about undoing those disparities.

“It’s really about the history of this country of how we, as Black women, have not been heard,” she said. “A lot of times, those Black moms are coming to me for care. One, because they want to be cared for by someone that looks like them, that has lived in the same culture as them, that understands their culture, that will respect them, that will hear them, that will not minimize their pain.”

Expanding access to care

The March of Dimes finds that progress in improving health outcomes for moms and babies has been made over the past 40 years, but slowly. The report says midwives are part of the solution and critical to expanding access to maternity care, especially in rural and under-resourced communities.

“Midwives are a very important part of this picture. They are a vital part of the maternity care team,” said Warren. “When we look at this challenge of maternity care deserts, we need to be leveraging every resource that we have to solve this problem.”

Midwives currently attend about 12% of births nationwide, according to the maternity care desert report. That’s an increase of four percent over the past decade. However, insurance policies can vary on how they cover midwifery care. And some state laws make it more difficult for midwives to practice. Midwives have filed lawsuits against several southern states.

In Alabama, they’re suing over restrictive licensing requirements. State health officials argue doctors should always be involved in the birthing process to protect health and safety. Those who challenge midwifery care question the safety of home births, particularly when emergencies arise.

The March of Dimes is advocating for policies to allow midwives to practice independently and prescribe medication. The group’s new report also calls for expanded hospital privileges for them.

Gramby is looking forward to finding more solutions to ensure mothers and babies get the care they need.

“We have some work to do. We have to acknowledge that what’s been happening is not working and then move forward with the plan of true collaboration,” she said. “I have tremendous hope for positive change.”

Gramby sees compassionate, thorough and accessible maternity care as a birthright.

President Trump speaks before signing an executive order that calls for changing the childhood vaccine schedule.

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Jim Watson/AFP via Getty Images

This is a developing story that will be updated.

President Trump signed another executive order aimed at trying to upend the way U.S. children are vaccinated against dangerous infectious diseases.

The new executive order, signed Monday afternoon in the Oval Office, calls for reducing the number of childhood vaccines recommended by the federal government.

It also calls for breaking up the shot known as the MMR, which is now given as a single vaccination for measles, mumps, rubella and chickenpox. The order advises breaking it up into separate shots.

The order also directs the Justice Department to pressure states to reduce the number of vaccines required for school.

The moves will likely be challenged in court, as previous similar attempts to change the childhood vaccination schedule have been.

At the signing ceremony, the president talked about vaccines needing to be studied in light of rising autism rates, a thoroughly studied and debunked theory.

The news was welcomed by vaccine critics and denounced by many public health experts.

Erica Carter of Sioux City, Iowa, says she enjoys her job as a finance manager for the Omaha Nation public school district in Nebraska, working to find grants and opportunities for low-income students. But when she learned her pay was too high for her to remain in an Iowa Medicaid program, Carter had to choose — leave the job or give up her benefits.

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Erica Carter is passionate about her job, and she has 7 acres of flowers and vegetables to show for it.

Carter’s specialty is reeling in grants to support students in the Omaha Nation school district, where she is a finance manager. One paid for the garden that sits next to the district’s campus. Another allowed the school system, in one of Nebraska’s lowest-income counties, to pay students to maintain it.

“They’re out in the sun. They’re watering plants,” she said. “It’s the first time they get a paycheck in their life.”

Carter, 41, is paralyzed from the chest down, an injury she’s lived with since a fall in her early 20s. It didn’t slow her down as she built her accounting career and got a master’s degree in human resource management.

But in November 2023, Carter — who lives in Sioux City, Iowa — got a letter from Iowa’s Department of Health and Human Services. It said that her income was too high for her to stay on Medicaid and that she might lose her benefits in two weeks if she didn’t take action.

States are scrambling to get ready for a new federal requirement to double-check that many people on Medicaid qualify for the benefit, by showing they are working, volunteering, or studying at least 80 hours per month. Politicians’ focus on requiring work has angered many people with disabilities who have Medicaid and say current policies that apply to them have the opposite effect — making them choose between working or receiving benefits.

“I have no options”

When Carter got the letter, she was making $110,000 a year, well above Iowa’s 2023 income limit for working people with disabilities: $36,450 for a household of one.

“I had no time at all to prepare,” she said. “I had a decision to make.”

At the time, Carter got her health coverage through Iowa’s Medicaid for Employed People With Disabilities, a “buy in” program that allows working disabled Iowans to pay a part of their income to the state to maintain access to Medicaid benefits. Forty-seven states offer Medicaid buy-in programs, but most restrict eligibility through limits on income and assets.

For years, disability rights advocates have pushed state legislatures to change the limits, arguing that they prevent people like Carter from accepting raises or building savings, for fear of losing crucial medical benefits. Massachusetts, Minnesota, New Jersey and Rhode Island have eliminated such limits over the past five years.

To keep her Medicaid coverage, Carter would’ve had to find a job paying her far less than she was making. Or she could drop her Medicaid coverage and enroll in the school district’s health plan. But that plan didn’t cover many of the disability-related expenses that Medicaid did.

Carter decided to keep her job and leave the Medicaid buy-in program. In the end, the decision felt like a no-brainer, she said.

“I like getting up and going to work every day, and I really like what I do,” she said. “Why would I throw that away?”

Erica Carter of Sioux City, Iowa, says she’s helped write grants for projects such as a student-run garden and a new playground for the Omaha Nation public school district in Nebraska. She chose to give up her Medicaid coverage rather than quit her job as a district finance manager when her income surpassed the allowed income cap.

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But it’s been hard on her finances. Carter said she now spends about $35,000 a year out of pocket for expenses her old plan covered, such as the nurse who visits her three times a week, modifications for her car and wheelchair repairs.

“I had the motors go out on my wheelchair,” she said. “So that was like $4,000 to fix.”

Over the next year, Carter picked up extra jobs and cashed in some of her retirement savings.

“I want to pay my own way. I don’t mind paying taxes,” she said. She doesn’t want to hide her income, either. “I just want an option,” she said. “I have no options right now.”

A program originally intended to encourage work

Congress approved the option for states to create Medicaid buy-in programs in the 1990s, intending to incentivize more people with disabilities to work. Iowa was one of the first states to adopt the program.

According to state data, 11,640 Iowans were participating in the buy-in program as of late January, or 1.7% of all Medicaid recipients in Iowa.

The income caps have inched up since Carter got her letter. Iowa’s limit, set at 250% of the federal poverty level, is $39,900 for a household of one this year.

The rules also restrict recipients from accumulating too much in assets. The current cap is $12,000 for an individual or $24,000 for a married couple, excluding some assets, such as a primary home or vehicle.

Carlyn Crowe, the public policy manager at the Iowa Developmental Disabilities Council, said the limits can prevent disabled Iowans from reaching their goals. “Work full-time and be able to buy a house, live in the community, buy a car,” she said. “Those limits placed on what they can earn and save are keeping them from doing that.”

Crowe’s organization, which has counterparts in every state, is federally funded and advocates for people with disabilities. In Iowa, such advocates have asked legislators to drop the hard limits on income and assets. Instead, they suggest that disabled Iowans pay 6% of their income to buy into the Medicaid program, an approach modeled after a 2024 Tennessee law that created a Medicaid buy-in program with no income and asset limits. (Tennessee is waiting on federal approval before starting its program.)

In recent years, these efforts have built bipartisan support and gained traction. An Iowa House committee unanimously advanced a bill in 2025 to remove the income and asset caps, but the bill died after failing to move forward during this spring’s legislative session.

Erica Carter makes her way through the cafeteria at the Omaha Nation Public Schools campus, where she works as a finance manager. Carter says she enjoys her job writing grants for one of Nebraska’s lowest-income school districts.

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State legislatures are now facing federal reductions in Medicaid spending estimated at more than $900 billion over 10 years, as part of the One Big Beautiful Bill Act.

Alice Burns, an associate director of KFF’s Program on Medicaid and the Uninsured, said the specific worry is that buy-in programs, though they’re a small part of the larger Medicaid system, could increase overall Medicaid spending if eligibility changes.

“The premiums charged in buy-in programs are nowhere near close to the expected costs of covering people,” Burns said. (KFF is a health policy research, polling, and news organization that includes KFF Health News.)

Focusing on initial cost increases is myopic, said Daniel Van Sant, the director of disability policy at The Harkin Institute at Iowa’s Drake University. More workers mean additional income tax revenue for states. It also enables some people with disabilities to earn enough to transition off other government assistance programs, such as the Supplemental Nutrition Assistance Program.

“Three, five, seven years from now, you may be recouping those expenses by having people be able to work their way off,” Van Sant said.

Falling through the cracks

Iowa lawmakers tried a more modest adjustment during this year’s legislative session. Instead of removing the income limit entirely, they introduced legislation that would raise the cap to 300% of the federal poverty level and exempt pension accounts and a spouse’s income, among other things, from the asset cap.

In the end, the provision was stripped from a wide-ranging public assistance bill. If it had passed, the new income limit would have been one of the highest in the country for a buy-in program, according to KFF.

Alex Watters, a former City Council member in Sioux City who was paralyzed from the chest down after a diving accident, told state lawmakers during a subcommittee hearing in February that the proposal was a step in the right direction, but not enough.

“I fear that we’re going to lose people to other states,” said Watters, who added that he was considering moving to Minnesota, which never had an income cap and eliminated asset caps for its Medicaid buy-in program in 2024.

Even if Iowa had raised its income limit, Carter would still have been ineligible.

Carter remains committed to her primary job at the school district. She plans to keep working there and taking on additional jobs, seven days a week, so she can pay for her medical needs and continue helping students.

This story comes from NPR’s health reporting partnership with Iowa Public Radio and KFF Health News.

The military plans to start screening service members for low testosterone, and social media is overflowing with claims about testosterone therapy.

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A few times, Dr. Jamin Brahmbhatt suspected he might have low testosterone.

But when he checked his numbers, he discovered they were entirely within a normal range.

“Turns out it was more so my sleep and stress and everything else,” says Brahmbhatt, a urologist at Orlando Health in Florida.

Brahmbhatt treats men with low testosterone every day — meaning he’s on the front lines of the current cultural fixation with testosterone.

Social media is overflowing with testosterone content, from fears of “low T” to “‘t-maxxing”‘ tutorials. Influential voices, including the podcaster Joe Rogan and Health Secretary Robert F. Kennedy Jr., are openly discussing their own use of testosterone therapy. And there’s a huge industry of online clinics that make it easy for anyone to get a prescription.

Brahmbhatt welcomes the increased attention to men’s health — and hormone replacement therapy specifically –– which he says has been “ignored” for too long.

But he also sees men who’ve spent hours in online forums like Reddit, convinced they need testosterone even before they’ve spoken to a doctor or had their levels tested. “Not every guy needs to be on it,” Brahmbhatt says.

“Testosterone has gotten a bad wrap because … you can walk into these clinics, go online, and get a prescription, they don’t do all the testing, they don’t do the follow up. That is the unsafe territory.”

What are the symptoms of low testosterone? 

Testosterone is a sex hormone, but its effects on physiology extends well beyond reproduction. It’s also involved in metabolism, bone health, muscle mass, red blood cell production and cognitive health.

Experts in the field emphasize that it’s a powerful indicator of overall health.

“When levels are low and men are symptomatic, it’s not just a testosterone issue, but a men’s health issue,” says Dr. Helen Bernie, director of Sexual and Reproductive Medicine at Indiana University.

Brahmbhatt says what’s challenging is symptoms of testosterone deficiency, technically known as “hypogonadism,” can easily be attributed to other causes. They include depressed mood, fatigue, reduced libido, weight gain and trouble concentrating.

The underlying causes for low testosterone vary.

It can be due to some rare medical conditions, like certain genetic disorders or disorders of the pituitary gland. Testosterone also gradually declines with age. But Bernie says there are often other contributing factors in younger and middle-aged men beyond aging, like obesity, diabetes, sleep apnea, drug use and smoking.

Calls for increased access to testosterone 

Testosterone therapy has long been overshadowed by doping scandals and concerns about anabolic steroids in sports and bodybuilding.

Increasingly, messaging from online clinics and influencers emphasizes wellness, athletic performance, longevity and improved focus.

Bernie says she worries about these claims.

“The goal of testosterone therapy isn’t peak performance,” says Bernie. “It’s not some drug to promise the fountain of youth. It is restoring normal physiology in men who have a true deficiency. I think it’s really important to separate marketing from actual medicine,” she adds.

The growing visibility of testosterone therapy reflects more than just a convergence of cultural forces and a booming market for these products — the Trump administration is making a concerted effort to expand access for men.

Under the Food and Drug Administration’s current criteria, testosterone therapy is only approved for men whose low levels can be traced to an identifiable medical condition. But the administration has signaled it wants to revise that so men with low testosterone — whatever the cause — can qualify for treatment, if they have low libido as a symptom.

The FDA wants to remove language from the drug label that explicitly states the safety and effectiveness for “age-related hypogonadism” had not been established.

Dr. Martin Miner, who co-directs the Men’s Health Center at the Miriam Hospital in Providence, Rhode Island, says the changes are long overdue.

“You wouldn’t treat a person with high blood pressure because it’s due to one cause and it’s not due to another,” he says. “You treat it because a person has symptoms. The same is true for low testosterone,” he says.

Miner is also president of the Androgen Society and has consulted for several companies that make testosterone.

He and other high-profile figures in the field are also calling on the administration to place testosterone in a less restrictive category of controlled substances (it’s currently listed alongside drugs like ketamine).

Others remain concerned about the direction the Trump administration is taking — and opening up even wider access to the drug.

“I think it is too soon,” says Dr. Steven Woloshin, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice at Geisel School of Medicine, who has testified in court against a drug company that makes testosterone.

“I think we really need to have a better handle on the long-term benefits and harms.”

The long-running debate around testosterone – and its safety

During the early 2000s, testosterone was one of the fastest-growing prescription drugs in the United States. Topical gels came onto the market, offering alternatives to injectables. Drug companies pushed disease awareness advertising around low testosterone.

But after data suggested testosterone increased the risk of heart attack and stroke, the FDA placed warnings on the products and requested the drug companies conduct a major safety study.

That trial — known as TRAVERSE — was published in 2023 in the New England Journal of Medicine. It did not find an increased risk of heart attack, stroke and other major cardiovascular events when compared to placebo, though it did raise some other concerns like a higher risk of fractures.

Doctor Steven Nissen, a cardiologist at the Cleveland Clinic who led the study, points out they used the drug in a very specific way: They gave it to middle and older-aged men in the form of a gel and ensured their testosterone levels did not go above normal.

“What we know is what we studied,” he says. “It was important to do that. But did our study answer all questions about the safety of testosterone? No, it did not.”

The findings were the main rationale for the FDA’s recent decision to remove the warning language around these cardiovascular risks from the products.

But Woloshin says doing so was premature because the study had a number of major limitations: The follow-up period was not long enough to understand potential harms — and testosterone levels in the blood were not raised as high as they typically are in clinical practice.

In his view, the benefits of testosterone therapy are often overstated, particularly in the realm of longevity, even though there are no well-controlled studies showing that.

Research does show an association between low levels of testosterone and a greater risk of dying from a variety of causes, but Woloshin says “that doesn’t mean giving someone a bunch of testosterone is going to change that.”

Who stands to benefit? 

Some of the strongest data on the benefits come from another trial published in 2016 in the New England Journal of Medicine.

That study of men 65 and older showed testosterone gel “improved libido considerably, sexual function considerably, energy a little bit, red blood count, bone density and strength,” says Dr. Peter Snyder, an endocrinologist at the University of Pennsylvania who led the trial.

“Now these benefits apply only to men who have low testosterone, unequivocally low testosterone,” he says. “The lower, the more likely are the benefits,” he says.

The guidelines from both the American Urological Association and the Endocrine Society say that testosterone therapy should only be recommended after identifying symptoms and consistently low levels based on two separate blood tests.

But research suggests that’s not necessarily happening, at least in the world of direct-to-consumer testosterone clinics. In fact, a study published in JAMA Internal Medicine in 2022 sent a secret shopper to seven of these clinics and found most were ready to prescribe, even though the patient in question had normal levels.

The biggest downside, especially for younger men, are the impacts on fertility. Testosterone therapy suppresses the body’s production of sperm, and can lead to permanent infertility.

Because low testosterone is often linked to other health problems, Bernie says lifestyle changes can be an alternative to treatment, but may not always be realistic.

“Think of the 60-year-old guy who’s got low testosterone, he’s tired, he’s overweight, he feels terrible. Now, I’m telling him, ‘Go to the gym, man, go work out!” she says. “Well, it’s kind of like pushing a huge boulder up and up a hill, right?

George Bove, 60, who lives outside Knoxville, Tenn., says he started testosterone therapy 15 years ago because he was constantly exhausted and couldn’t keep the weight off.

It took some time to figure out the right dose, but once he did, the weekly injections have changed his life.

“You stay awake a little bit longer. You got the energy to do things throughout the day instead of having to constantly retire to the couch to recharge your batteries,” he told NPR.

A chorus of influencers on social media in the MAHA and “trad wife” communities emphasize the downsides of hormonal birth control. Research shows few of them have medical expertise.

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Right after the Supreme Court overturned Roe v. Wade in 2022, there were many stories about how new state abortion bans were influencing people’s birth control decisions, especially by prompting people to use long-acting or permanent options.

Research shows that it wasn’t just anecdotal, the trend was real — more people got intrauterine devices and implants for birth control, and procedures like vasectomies and tubal ligation spiked.

These days, though, Dr. Caitlin Bernard, an OB-GYN in Indianapolis who helps lead a statewide free birth control program, says her patients aren’t talking much about the abortion ban that’s been in place in the state for years.

“This is just the normal status quo now,” says Bernard, who was involved in a high-profile abortion case soon after Roe was overturned. “Other things that help you decide whether or not to use contraception are more top of mind.”

Bernard says patients are questioning things like whether they would rather take a pill or have an IUD, and whether their insurance would cover both options. She also sees patients worried about finances in general and trying to avoid going to the doctor to steer clear of unexpected medical bills.

Contraception “maligned”

Bernard says there is one thing that is affecting her patient’s decision-making more nowadays: Social media, and the rise of “Make America Healthy Again” and “trad wife” influencers. Both deliver messages about hormonal birth control being bad for women.

These types of videos are all over social media. While research shows that hormonal birth control options are safe and that they’re effective at preventing pregnancy, many of these videos exaggerate potential side effects and minimize the downsides of non-hormonal birth control options. Most are posted by people who aren’t medical professionals.

“There is definitely a social media phenomenon of wellness influencers with non-evidence-based personal experiences that are just ricocheting through the stratosphere,” says Cynthia Harper, a contraception researcher at the University of California San Francisco. “That’s overlapping with ideology and policy that women are supposed to be at home having a lot of babies, young,” she says, referring to the pronatalist movement.

“These two things have come together and contraception has never been so maligned,” she says.

Harper adds that there are also political forces working against birth control access. The Trump administration has cut fundingfor reproductive health providers across the country, and for the health system more broadly. Harper says those things have an impact. “Everything I see points to lower access to contraception,” she says.

A twist after abortion bans: More abortions

Surprisingly, the number of abortions has actually gone up in the last few years as states have enacted bans.

Could it be that the cultural push against birth control is leading to more unplanned or unwanted pregnancies and therefore more abortions?

Harper thinks it’s an intriguing hypothesis. To test if out, you’d have to do a study to survey people accessing abortion, she says, “and ask if it was the restricted access to contraception that was the reason for the pregnancy that they’re seeking abortion care for.”

Brittni Frederiksen, a women’s health police researcher at the nonpartisan organization KFF, does not think that shifts in birth control use explains recent abortion numbers. “I actually think the number of abortions going up is likely just due to increased abortion accessibility, particularly with telehealth medication abortions,” she says.

In telehealth medication abortion, patients are able to get abortion pills from a pharmacy or in the mail after a telehealth visit. It has grown dramatically in popularity since becoming available during the COVID-19 pandemic. Right now, a high-profile legal case from Louisiana aims to remove that option for patients all over the country.

As for the effect abortion bans have had on birth control? Frederiksen points to the women’s health survey KFF conducts every two years that asks about birth control use.

“In 2024, 82% of sexually active reproductive age women were using contraception. 6% were not using contraception,” she says. The rest were pregnant, trying to get pregnant or unable to conceive.

KFF just fielded the survey again this year. “I have given a brief look at the 2026 data, and it looks like the shares using contraception are pretty similar,” she says.

Frederiksen says cultural attitudes towards birth control and political forces are changing, and funding cuts that affect access are happening, though perhaps in ways that aren’t visible in the data yet.

Marc Padeu, a painter from Cameroon, draws inspiration from Renaissance art brought into an African landscape. The above painting is title “Sous le poids de la coupe” — under the weight of the cup.

Copyright The Artist/Courtesy Larkin Durey

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Copyright The Artist/Courtesy Larkin Durey

Cameroonian painter Marc Padeu says that being an African artist means “being the heir to an extraordinarily rich history.” But he also says it can mean “living and working on a continent where artistic infrastructure is virtually nonexistent.”

Padeu’s work often takes inspiration from religious paintings from the European Renaissance –- but reimagines them, depicting people in Cameroon’s cocoa plantations. London gallery Larkin Durey is currently holding an exhibition of Padeu’s latest work.

Marc Padeu, a painter from Cameroon, has a new show at the London gallery
London gallery Larkin Durey.

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Courtesy of Larkin Durey

Oliver Durey, the gallery’s director, said: “Mark’s work is timeless. His visual style is simultaneously very contemporary but also deeply rooted in that old tradition –- so there is something extremely fresh about it.”

Padeu is from Bafang in the West Region of Cameroon and is part of the Bamileké ethnic group. The 36-year-old now lives in Yaoundé, the country’s political capital. In an interview with NPR, Padeu explained his art — and what inspires him.

Can you talk about why you meld classic Western paintings with African scenes?

I wouldn’t say that I’m trying to fuse Western painting with African scenes. For me, it’s more a question of placing images that everyone recognizes within a setting that is familiar to me. I grew up in Cameroon, surrounded by plantations, villages and people who make their living from the land. That’s the world I know best, so it’s only natural that this is the setting in which I want to tell these stories.

At one point, I asked myself why certain images seemed to belong exclusively to Europe. Why should the Nativity, the Last Supper or Christ in Gethsemane always be depicted with the same faces and the same landscapes? Yet what they convey goes far beyond any particular place or era. They speak of love, sacrifice, fear, hope, family. These are profoundly human, universal experiences.

How did you become an artist? 

It’s certainly down to genetics, first and foremost. My mother is a fashion designer. She doesn’t work much any more, but when I was younger, I used to see her fashion sketchbooks. So I inherited this talent from my mother. I was already drawing a lot at primary school and then at secondary school. I was the one who often helped teachers draw their demonstration sketches on the blackboard in front of my classmates. This often earned me a certain reputation at the various schools I attended.

Later on, I went on to study at the school of fine arts. I must say the timing was perfect in that respect. The very year I passed my A-levels, the Cameroonian government opened the country’s very first art schools. So I’m part of the very first ever intake of graduates from that school. It was a very traditional course, based mainly on the study of art history.

“La bague de Roxane” — Roxane’s ring — by Marc Padeu

Private Collection, USA/Image copyright of the artist, courtesy of Larkin Durey

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Private Collection, USA/Image copyright of the artist, courtesy of Larkin Durey

Is there one artist who inspired you most?

The African American painter Kerry James Marshall. Marshall was a significant discovery for me, not because I wanted to paint like him, but because he showed me that it was possible to reestablish Black bodies at the heart of the great tradition of painting. He never merely added Black figures to an art history that had already been written; he demonstrated that they were an integral part of it.

I do think, however, that our approaches subsequently take different directions. He is very interested in the social and political history of African American communities. My work is more permeated by philosophical and spiritual questions. I explore the major themes of existence: birth, sacrifice, death, hope, promise by embodying them in scenes from everyday life in Cameroon.

Is it right that you used to be a fresco painter in a church?

That’s right. I created a few murals in the churches of Nkongsamba, where I was studying at the school of fine arts. At first, it was just a part-time job to earn a bit of money. But the murals were so successful that I was very quickly inundated with commissions, mainly of religious murals. The churches commissioned me to paint scenes inspired by the Bible: episodes from the life of Christ, the Virgin Mary, the various apostles, angels and certain saints.

One evening, whilst I was still painting on the scaffolding inside the town’s grand cathedral, a few women from a prayer group entered the church and prostrated themselves before the still-unfinished mural. It gave me a very strange feeling. But above all, it was at that moment that I realized the power that images and representations can have.

“The Blue Man of Njombé,” by Marc Padeu

Private Collection, USA/Image copyright of the artist, courtesy of Larkin Durey

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Private Collection, USA/Image copyright of the artist, courtesy of Larkin Durey

I have read that you take inspiration from religious paintings from Europe, especially from the Renaissance era. 

Through constantly depicting these religious images, I began to take a deeper interest in them. I remember one in particular: The Coronation of the Virgin by Diego Velázquez. This painting, which I consider a masterpiece of composition, fascinated me to such an extent that I created my own reinterpretation, which I would call The Blue Virgin. The same is true of Caravaggio’s The Incredulity of Saint Thomas, which I reinterpreted as The Blue Man of Njombé.

Can you tell us a bit more about The Blue Virgin – with its depiction of a woman whose skin and clothing is blue? 

The Blue Virgin is one of the first works in which I sought to create a dialogue between Christian iconography and my own visual world. I depict a young African woman striking the serene, frontal pose of Renaissance Madonnas. Inspired by Diego Velázquez’s The Coronation of the Virgin, this is not a Virgin in the religious or devotional sense. Rather, she is a symbolic figure. She embodies motherhood, promise and a form of silent presence. By giving her the features of a young Cameroonian woman, I wanted to show that these foundational figures of art history can be reinvented through other faces, other stories and other places.

The luminous skull resting on the figure’s lap is undoubtedly the most important element in the painting. It refers to the memento mori {Latin for “remember you must die”] tradition, which features prominently in Western painting. In Christian iconography, the Virgin is often associated with the promise of life; here, that promise is set against the awareness of death. The color blue was not chosen here solely because it is traditionally the color of the Virgin Mary. It creates a sense of distance from reality. It distances the figure from the portrait, bringing it closer to the symbolic.

Can you explain how religion influences your work? Are you religious yourself?

My relationship with religion did not begin with the frescoes in churches. For as long as I can remember, my family has always been very religious. My mother is without a doubt the most devout person I know on this earth. This was already the case with my grandparents before her. My grandfather was a catechist [a teacher in the church]. However, I grew up caught between two spiritual traditions. My mother’s family are very devout Catholics. My father’s family, on the other hand, are not at all. They are animists [people who believe that animals, plants and various objects possess a spiritual essence] deeply rooted in the Bamiléké spiritual tradition. My father was, in fact, a member of a council that assists the village chief in making decisions for the community. So I have always navigated between these two spiritual traditions, as have most other Africans, for that matter.

How did you get the idea of putting classical figures in a clearly African setting –- and not a glamorous setting but a setting of people who farm for a living, which is hard work?

My aim here is not to rewrite the history of painting. Over the years I have spent studying classical painting, I very quickly realized that the major themes it explores — namely birth, death, sacrifice, promise, hope and so on — are by no means exclusively European. They are quite simply human and can therefore be embodied by Africans, and of course by Cameroonians.

Having grown up in an environment where working the land plays a central role, it therefore seemed entirely natural to me to place at the heart of my work these men, women and children whom I know well, and with whom I once shared the grueling daily life of the plantation. The idea is to portray them with the same nobility and dignity as the figures of the great masters. So, indirectly, it is my own story that I am telling. It is myself that I am painting.

Marc Padeu, “La Balançoire,”

Image copyright of the artist, courtesy of Larkin Durey

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Image copyright of the artist, courtesy of Larkin Durey

Your paintings feel very alive, like the people in them might move at any moment. Do you work from photographs or real life models?

My way of working is rather unusual — it’s very personal. In fact, a painting can take several months, or even much longer, to take shape in my mind before I even begin to paint. I live with that image for a while. I think about it constantly, I transform it in my mind, I imagine different compositions until everything starts to fall into place.

Once this vision becomes clearer, I look for people who can bring it to life. Sometimes these are close friends or family members, sometimes acquaintances and sometimes people I meet over time. I don’t work with professional models. I organize photo shoots, but I don’t necessarily ask them to strike a specific pose. Although nothing is left to chance, I prefer to suggest a situation or an emotion and let them express themselves naturally in front of the camera.

These photographs form my raw material. I sometimes take dozens, or even more, for a single painting. The figures are often photographed separately, at different times, sometimes several months apart. Then, in my studio, I reconstruct the scene entirely from scratch. I reposition the bodies, alter the gazes, the lighting, the colors and the proportions. A final composition may thus bring together references taken at moments far apart in time.

I like to let an image mature for a long time before bringing it to life on the canvas. It is often in this waiting that the work finds its true purpose.

What does it mean to be a Cameroonian artist -– an African artist –- in 2026?

That’s an excellent question. Being a Cameroonian or African artist in 2026 means, first and foremost, living and working on a continent where artistic infrastructure is virtually non-existent. We’re talking here about sub-Saharan Africa. This means that recognition very often comes from outside the continent. We find ourselves in a kind of paradox: We’re more visible in London, Berlin, Paris or New York than in Douala, Abidjan or Lagos. As African and Cameroonian artists, our careers therefore depend on an international ecosystem whose rules and contours we don’t always fully understand.

However, being an African artist, a Cameroonian artist, also means being the heir to an extraordinarily rich history. We come from great kingdoms, often with recognized artistic traditions. Kingdoms that have weathered major historical and painful events, namely: the various slave trades, colonization, the struggles for independence, the diversity of languages and the coexistence of ancestral practices with monotheistic religions imported from the West. All this heritage that already exists within us is very often reflected in the works we create.

However, we do not remain prisoners of this history. We do not paint to represent Africa or Cameroon to the world but to reveal the world from the perspective of Cameroon, of Africa.

“Memento vivere” — remember to live — by Marc Padeu.

Copyright The Artist/Courtesy Larkin Durey

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Copyright The Artist/Courtesy Larkin Durey

What advice do you have for other aspiring African artists?

First and foremost, I would tell them not to try to be “African artists” but simply to become artists. Much like a politician, one’s ethnic or geographical background cannot be a political platform. One’s background is therefore merely a starting point for a broader openness to the world.

I would encourage them to broaden their horizons further. To study their personal history and their origins in depth. To learn about the history of art and to take a serious interest in philosophy.

I’d also tell them not to be afraid of time. These days, everything pushes us to produce quickly, to be visible straight away. Personally, I don’t produce more than ten paintings a year, sometimes even fewer than seven. That suits me just fine. I’m constantly quite aware that I’ll be doing this all my life, so that drives me to find a creative rhythm that I can easily sustain, given the high standards it demands over the very long term.

Finally, I’d remind them that art isn’t just a profession, but a way of being, of existing in the world.

Are you ever asked if you are just imitating the great masters? Or trivializing these images by putting them in a cocoa plantation? 

To be honest, I have never asked myself the question in those terms. All artists draw inspiration from those who came before them. Manet drew inspiration from Titian, Picasso from Velázquez and so did Francis Bacon. For my part, I enter into a dialogue with these images because they form part of our shared heritage. I do not seek to copy them but to extend them through my own perspective.

As for the idea that I might trivialize these works by transposing them into a cocoa plantation, I actually believe quite the opposite. Biblical stories feature ordinary people: fishermen, shepherds, craftsmen. They do not take place in extraordinary settings but at the heart of everyday life. Ultimately, what could be more natural than to bring them back to life today amongst the men and women who work the land? For me, there is something profoundly noble in these ordinary gestures.

“La promesse et l’agneau” — the promise of the sheep — by Marc Padeu.

Copyright The Artist/Courtesy Larkin Durey

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Copyright The Artist/Courtesy Larkin Durey

In a world where prejudice sadly still flourishes, have you run into discrimination?

In all honesty, I don’t recall ever having personally been the victim of any form of discrimination. Perhaps I haven’t been paying close enough attention to have noticed it? Or perhaps philosophy really does help me a great deal in this regard. However, I think it would be very naïve to say that prejudice does not exist in the art world. It can be present there just as it is in other areas of life. However, it is essential not to build one’s career around it. If one makes prejudice the main subject of one’s work or narrative, one gives it a prominence it does not deserve.

I therefore believe that the best response to discrimination is not to confront it head-on or to deny it but rather to produce works that defy all the categories into which people might seek to pigeonhole them.

What is your dream for your work, and what would you like people to think when they see it? 

My professional dream hasn’t changed much since the days when I used to paint murals in churches. I simply hope that my work reaches as many people as possible around the world.

You know, the world is in a really difficult state. With all these conflicts and natural disasters, as an artist, I feel a humble duty to do my bit for a happier world. George Bernard Shaw said: “Without art, the brutality of reality would make the world unbearable.”

Marc Padeu: Memento Vivere is on view at the Larkin Durey gallery in London until August 14. The gallery regularly exhibits Padeu’s work.

A drug user uses a test strip on Aug. 22, 2018, in New York, to see if fentanyl has been added to heroin, which could increase the risk of overdose.

Bebeto Matthews/AP Photo

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Bebeto Matthews/AP Photo

Last year, Baltimore had three mass overdose incidents in the span of three months in its Penn North neighborhood.

In one incident, more than two dozen people were hospitalized after many were found unresponsive, lying in the streets or on sidewalks. No one died, but some came close.

Follow-up testing found that the street drugs contained high levels of N-methylclonazepam, a benzodiazepine that operates similarly to Xanax or Valium.

Like opioids, benzodiazepines suppress breathing. When they’re combined, the risk of overdose goes up. And benzodiazepines don’t respond to opioid overdose reversal drugs.

Afterward, the Baltimore Harm Reduction Coalition created test strips specifically for benzodiazepines. The group distributed them — along with test strips that identify other harmful adulterants, such as fentanyl, xylazine, and medetomidine — at clinics and neighborhood events.

The strips, available at no cost, can also be found in bars and spread out on street corners. People testing drugs mix a small amount with water and then dip a test strip into the liquid. The strip will change color if it identifies an adulterant.

“Nobody really knows what they’re getting whenever they’re getting stuff off of the street,” said Candy Kerr, a spokesperson for the coalition. “Having the test strips available for the general public gives them the option to move slower if they’re going to use whatever they’re going to use.”

But a new federal policy could make it harder for organizations such as Kerr’s to give out the test strips, and they’re worried that overdoses could increase.

In late April, the Substance Abuse and Mental Health Services Administration banned the use of federal grants for distributing strips to the public and for some other harm reduction practices that have been credited with saving lives. Test strips have been used for nearly 10 years to identify adulterants.

A box with free test strips for different types of adulterants sits outside the Chesapeake Detention Center in Baltimore. Many health advocacy groups try to give the strips to people when they are released from jail or prison, to avoid overdoses.

Scott Muacione
/WYPR

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Scott Muacione
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A letter sent to local health departments and nonprofits that provide addiction services explained that the Trump administration believes those harm reduction practices “facilitate illicit drug use and are incompatible with Federal laws.”

According to the letter, grants from the Department of Health and Human Services also cannot be used for programs that support the use of clean needles or drug paraphernalia such as pipes, or to fund a type of specialized hotline that people can call while taking drugs, so someone is aware and can call for help if they overdose.

The Trump administration wants to focus more on other techniques, such as giving out naloxone, an overdose reversal drug available as a nasal spray, according to Emily Hilliard, an HHS spokesperson.

“It is critical that federal funding provided by the American taxpayer goes to effective, common-sense solutions that have been proven to save lives and keep people out of an endless cycle of addiction and moves them into a life of recovery,” she said.

Baltimore Mayor Brandon Scott at a press conference after a mass overdose incident in Baltimore’s Penn North neighborhood in 2025.

Scott Maucione/WYPR

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Scott Maucione/WYPR

The new policy does not prohibit federal funds from being used to purchase test strips for use by law enforcement officers, public health officials, EMTs, or other medical professionals.

That creates an important exception for government agencies that test drugs and send out regular reports on what adulterants are saturating the drug supply in certain locations.

Still, Yngvild Olsen, who oversaw SAMHSA’s Center for Substance Abuse Treatment in the Biden and Trump administrations, says there is a substantial body of evidence that shows giving test strips to people who use drugs can change behavior.

“There’s some people deciding not to use the substances, some people deciding to reduce, to use less, or take other types of precautions, including naloxone, and making sure that there are people around that can actually then help in the case of an overdose,” Olsen said.

Naloxone, a nasal spray that can help reverse an opioid overdose, is spread out on a sidewalk for people to take, after a mass overdose incident in Baltimore’s Penn North neighborhood in 2025.

Scott Maucione/
WYPR
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Scott Maucione/
WYPR

Kerr said the best approach would be to continue to promote the use of test strips while also continuing to give out lifesaving medications like naloxone. She believes that working on all fronts has helped lead to Baltimore’s decline in overdose deaths, which havedropped more than 40% since 2023.

Under the new policy, nonprofits will still be able to hand out test strips, but they will have to find other funding for that work, which Kerr finds worrisome.

“We’ve been making these strides forward because we’ve had these things, because we’ve been funded,” she said. “We’re going to have to pull money from other places.”

To pay for the test strips, Kerr said, the Baltimore Harm Reduction Coalition will have to cut back on services such as giving out hygiene and wound care kits. But she said that option is better than risking another mass overdose in Baltimore — or allowing even just one preventable fatality.

This story comes from NPR’s health reporting partnership with WYPR and KFF Health News.

Kalshi and Polymarket say allowing people to bet on the outcomes of clinical trials and FDA drug approvals provides valuable information about drug development. But researchers warn the bets could incentivize insider trading and interfere with the integrity of the process.

Fred Tanneau/AFP via Getty Images

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Fred Tanneau/AFP via Getty Images

As a soon-to-be seventh grader, Joshua Pederson’s son is not exactly brimming with enthusiasm when he talks about the upcoming school year.

“The thing I’m looking forward to most in seventh grade is lunch, and the thing I’m looking forward to least is everything else,” said the 12-year-old.

Art is his passion, but he doesn’t take classes. He likes teaching himself.

“I like drawing scary stuff and robots,” he said. “Because I think scary stuff and robots are cool.”

Two years ago, his parents, who live in Boston, noticed a lump around his ribs that quickly spiraled into a nightmare scenario: It was cancer.

Pederson asked that his son’s name be withheld to discuss details of his medical condition.

After months of grueling chemotherapy and radiation, he was declared cancer-free last summer. Months later, however, the cancer returned. So Pederson entered his son into a clinical trial for a novel treatment.

That’s around the time Pederson read the news that prediction market sites Kalshi and Polymarket have begun allowing people to bet on the outcomes of clinical trials and whether the Food and Drug Administration will approve new medications.

“What seemed to be missed in the CEO statements was the fact that there were going to be patients on the other side of these bets,” said Pederson, who is a humanities professor at Boston University.

Bettors will make or lose money based on the success or failure of a clinical trial, a situation Pederson views as horrific.

“A clinical trial failing is a more sanitized euphemism for, people are going to suffer, people are going to die, people are going to have one fewer clinical option available to them in one of the most difficult medical situations of their entire life,” he said.

Researchers fear ‘undermining trial integrity’

Billions of dollars are traded every week on the lightly regulated prediction market sites, where users bet on everything from movie reviews to elections to conflicts in the Middle East. Clinical trials are just the latest area where the industry’s rapid growth is raising ethical questions.

Kalshi claims such bets will provide a new source of information about which drugs will get approved, and what clinical trials will show promising results, which the company says can help investors decide what new drugs to fund.

“If you want to ban profiting from the failure of clinical trials, you would start with the stock market, where the financial incentive for this type of profit is orders of magnitude larger,” said Kalshi spokesman Jack Such, pointing to stock market short sellers who have profited from clinical trial failures.

“While Kalshi and the stock market are the same in this regard, they do differ in one important way: the stock market doesn’t give any valuable information to researchers,” Such said.

Drug trial researchers, though, are far from convinced.

David Tsai, who runs clinical trials at a biotech company in the San Francisco Bay Area, started an online petition pushing for such betting to be banned, making the case that betting on drug trials “threatens the very foundation of trust and integrity in biotechnology.”

Tsai is concerned that the prospect of betting provides those involved with a clinical trial a reason to tamper with the results for a prediction market payout.

“If we were running a trial for an oncology drug that requires an infusion, a pharmacist who had placed a bet saying that it’s gonna work well, or doesn’t work well, could obviously adjust the infusion rate, could adjust the source temperature of the drug,” he said. “They could change any number of variables that could obviously have a direct impact [on] how the trial and the data and the patient safety would come out.”

Another skeptic is Nicholas Zaorsky, a professor of radiation oncology at the Mayo Clinic in Jacksonville, Fla., who has helped run clinical trials and agrees that prediction markets can interfere with the advancement of life-saving drugs.

“Prediction markets can be valuable in some settings because they aggregate information, but clinical trials are fundamentally different: investigators, coordinators, and sometimes even participants can directly influence aspects of the outcomes being wagered on,” Zaorsky said. “That creates financial incentives that risk undermining trial integrity.”

Patient’s father: People betting on trials are ‘distanced from the real cost’

Kalshi has tapped its own experts, including Anne Wojcicki, the founder of genetic testing company 23andMe, to vouch for the markets as a way of staying ahead of medical breakthroughs and for making clinical trials more accessible.

“Most patients don’t know about the choices available in clinical trials or which programs are most promising. The opportunity to have an open, transparent dataset about trial probabilities is extremely promising and empowering for people,” a white paper sponsored by Kalshi stated.

On Kalshi, users can currently bet on whether a weight-loss medication and a breast cancer treatment will be approved by federal regulators and on what date.

Polymarket, which declined to comment, is taking wagers on the approval of cancer treatments and whether the U.S. will allow Chinese peptides to be sold to Americans.

The possibility of insider trading, Kalshi argues, will be minimized by company safeguards verifying employment and tools to surveil for unusual market activity.

Indeed, prediction markets have helped identify insider traders in other markets, from President Trump’s teleprompter operator to former Congressman George Santos to a special forces soldier who was betting based on military intelligence about the toppling of Venezuelan leader Nicolás Maduro.

Given just how many people can be involved with clinical trials, Tsai thinks it might not be so easy to preemptively catch every bad actor.

Pederson is also skeptical. He argues the markets obscure the patients at the center of clinical trials, who have the most at stake from their outcomes.

“One of the things that has struck me about these platforms is that they’re flashy and they’re gamified in such a way that you’re often kind of distanced from the real cost,” he said.

Kalshi says it is offering bets on late-stage clinical trials where participants have already been chosen. And it says it won’t allow betting on markets where all trial subjects are minors. But that could change.

If it does, Pederson says wondering whether researchers in a trial could be motivated by prediction market profits will add to his anxieties — and to the burden his son is already carrying.

“The weight on him and what he’s being asked to do, and what he’s being asked to endure, is already so much,” Pederson said.

He hopes that Kalshi and Polymarket will stop letting speculators place bets that clinical trials won’t succeed.

Bettors, he argues, should not be rooting for an experimental medicine to fail just to earn a buck.

“It’s a dark idea,” he said. “It’s quite ghastly.”

A medical illustration depicts the Shigella bacteria, a leading cause of diarrheal disease.

Smith Collection/Gado via Getty Images

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Smith Collection/Gado via Getty Images

Diarrhea has been a headline story in the United States this summer, with thousands of cases of explosive diarrhea traced to Cyclospora from tainted lettuce –- and the first two deaths from the outbreak now confirmed in Michigan.

In other parts of the world, diarrhea is a constant — and deadly — threat. Over 1 million people die from diarrheal illness such as dysentery every year. Nearly half of them are children under age 5. Chad has the highest rate of childhood deaths: roughly 1 in 140 children under 5 die each year. 

In the world of public health, however, the disease often does not get the attention it deserves. It’s because of what researchers call the “poo taboo” –- people just aren’t comfortable talking about diarrhea.

Now a vaccine candidate offers a new hope.

“Rigorous” trial, “remarkable” response

The vaccine is called WRSs2 –- named after the Walter Reed Army Institute of Research. It was tested jointly at Cincinnati Children’s Hospital Medical Center and the Emory Vaccine Center’s Hope Clinic in Atlanta. The results, published in The Lancet Infectious Diseases this summer: It was 89% effective at preventing one of the leading causes of diarrheal deaths, shigellosis.

The study recruited 108 adults. Half received the vaccine — a weakened version of the shigella bacteria suspended in a liquid — almost like a yogurt. The dose is a tad less than a shot-glass worth taken twice a month apart. The other half got doses of salt water.

The weakened bacteria is strong enough to bring on an immune reaction but shouldn’t make anyone really sick, says Dr. Robert Frenck, a professor of pediatrics at Cincinnati Children’s and director of its Center for Vaccine Research, who co-led the trial.

Even though the number of trial participants were relatively small, that “rigorous” setup also makes the 89% figure harder to shrug off, says Dr. Kawsar Talaat, an infectious disease physician and vaccine scientist at the Johns Hopkins Bloomberg School of Public Health. Deliberate exposure is a brutal test — in this trial, 81% of the placebo group got sick, experiencing diarrhea and fever in some cases before receiving antibiotics.

“So the fact that the vaccine prevented almost 90% of the illness is really remarkable.” she says. “It’s the best efficacy we’ve ever seen.”

Talaat runs studies of her own but was not involved in this trial.

Frenck thanks the volunteers who contributed to the study. He says they were paid about $250 a day for roughly a week for the trial, and took a quiz ensuring they knew the risks. While it might not be for everyone, he says the volunteers made a swift and efficient trial possible rather than enrolling thousands and waiting for them to naturally get infected — and he notes their commitment is critical to the vaccine effort.

A scourge for children

“Throughout the world, diarrheal illness is the second leading cause of death of children,” Frenck says. “And Shigella is one of the more common causes of bacterial diarrhea.” It’s spread through contaminated food and water. Cases are more common in areas with poor sanitation.

The children who survive don’t always recover fully. Kids who get Shigella often slip off their growth curves and never quite catch up.

“If somebody develops Shigella, then they develop prolonged diarrhea, more hospitalization, more malnutrition and cognitive impairment,” says Dr. Jahangir Hossain of the Gambia Medical Research Council Unit at the London School of Hygiene & Tropical Medicine. The peak of risk, he says, arrives between 12 and 23 months of age.

Hossain has spent his career battling shigellosis cases since the 1990s, first in Bangladesh and now in West Africa. At the International Centre for Diarrhoeal Disease Research in Dhaka, where he started out, sometimes 800 diarrheal patients would come in a day, he says.

“A Shigella patient comes with bloody diarrhea. They develop fever, and abdominal pain,” he says. “Definitely it is emotional for every doctor facing a patient coming with Shigella and malnutrition.” Families often travel one to three hours to reach a clinic, he says, and the diagnostic labs that American hospitals take for granted mostly aren’t there. The treatment is antibiotics, but with resistance reaching over 80% for some antibiotics in some regions, efficacy can vary widely.

No Shigella vaccine has ever been licensed, despite more than 100 years of research. Prior candidates topped out well below WRSs2’s efficacy: one had 74% in young adults but no protection in younger children; an Israeli vaccine managed 28% overall; WRSs2’s precursor, WRSs1 had 40% and more side effects.

“It is very good efficacy,” Hossain says. “Usually WHO wants 60% efficacy and then it is fine — but it is 89% efficacy. It is a good hope.”

But he sounds a cautionary note about the study: “It is a small trial, and it is only the adult age group.” Hossain wants to see larger trials happen and see if it works in young children.

A timely trial

Dr. Hossain notes that the prospect of a vaccine is especially critical because increasing antibiotic resistance has complicated shigellosis treatment.

“The biggest problem is antimicrobial resistance,” Hossain says. “Usually we give antibiotics — ciprofloxacin, then azithromycin, and ceftriaxone — but sometimes it does not work. In some countries, especially in South Asia, even ceftriaxone is resistant.” Patients infected with antibiotic resistant Shigella, therefore, are often sick longer and are at higher risk of dying.

Talaat sees the same trend and highlights a precedent for what a vaccine can do about it. “As these organisms become harder and harder to treat, the need for a vaccine also increases,” she says. “We saw it with typhoid — there’s some typhoid that’s almost impossible to treat with antibiotics now.” She says if vaccines were to prevent the infection themselves, less antibiotics will be used which will in turn decrease the amount of resistant strains.

The vaccine is not side-effect free. Over half reported a headache and about 45% of recipients had some diarrhea after their dose. But no one was hospitalized from the vaccine. The authors called the safety profile acceptable while noting more work will be done to hone the vaccine’s safety-efficacy balance — vaccines often have a tradeoff of more side-effects with a higher dose for a stronger efficacy.

What’s next

WRSs2 is protective against a single species, Shigella sonnei. While one of the most common causes of diarrheal deaths, it’s part of a group of triggering bacteria.

“The holy grail — the thing that would be perfect — would be a vaccine that would control ETEC [enterotoxigenic E. coli], Campylobacter and Shigella,” Frenck says. “Then you’d be able to prevent all these with one or two administrations.”

Frenck imagines a combination vaccine that would protect against all the major bacterial causes of diarrheal deaths, albeit likely not cyclosporiasis.

There’s a practical reason for making it a combination vaccine too, Talaat says. “Kids get a lot of vaccines,” so Talaat says it’s easier to add one combination vaccine rather than several into the schedule — like the MMR or Tdap vaccine.

Hossain is more cautious about whether making it a combination will impede vaccine development.

“Combination is good — if it’s possible to make it in a realistic way,” he says. But he notes these vaccine trials have been ongoing for decades and worries if researchers “combine many serotypes and many pathogens together, it might be practically difficult.”

“We cannot delay — we need something immediately,” Hossain says.

Regardless of whether it is a combination vaccine or not, all agree the next step is making sure it works in children. The people who die of and are affected by shigellosis are overwhelmingly small children in the global south, who, the authors say, have poorer immunity than well-developed and nourished children. The paper — like Hossain — calls for trials in places where poor sanitation is a factor in high rates of diarrheal disease, targeting particularly young children next.

“The most important population for a potential Shigella vaccine would be children under 5,” Talaat says. “We want a vaccine that’s safe and effective in children as young as one year of age, or even younger.”

For Frenck, that’s the whole point. He says that vaccines are needed to achieve his goal of “really reducing deaths of children in the world.”

Sunnu Rebecca Choi for NPR

Dr. Mara Gordon, a family physician in Camden, N.J., answers reader health questions monthly. Send in your question to: thrive@npr.org.

Q: I am in perimenopause. I keep seeing posts all over social media talking up menopausal hormone therapy as cure-all. Should I be taking hormones? Should everyone? 

A: I’m not surprised that you’ve been hearing the hype. There’s been an explosion of menopause content from influencers, direct-to-consumer telehealth companies marketing to women in midlife, and new books and podcasts on the topic.

This is great news for women. Menopause has historically been under-studied and stigmatized, so I love seeing more open conversations about this stage of life. And the pendulum has swung on hormone therapy; medical groups now recommend it again for many patients, after years of cautioning against it.

It’s about time that women have access to treatments for the very real symptoms that can accompany menopause rather than being told to “deal with” their hot flashes or sleep disruption.

But I’m also seeing a lot of less-than-scientific misinformation out there that over-promises on what menopausal hormone therapy can do. There are also lots of less-than-ethical influencers who are looking to make a quick buck on unproven supplements and vitamins.

As I navigate the new focus on menopause care alongside my patients, I’ve realized how critical it is to separate the hype from the reality.

Here’s what the science says about menopausal hormone therapy — and what we don’t yet know.

For stories on the science of healthy living, subscribe to NPR’s Health newsletter.

What we mean when we say hormone therapy 

Two types of hormones tend to decline in female bodies as we age: estrogen and progesterone.

When doctors prescribe menopausal hormone therapy it’s typically either estrogen alone or estrogen plus a progestogen, a term that includes the progesterone naturally found in the body and the synthetic hormones that mimic it.

These medications come in many different formulations, including transdermal patches, pills, and vaginal creams and rings.

You can get systemic hormone therapy — that’s hormones that are absorbed throughout the body — or local therapy, like a vaginal estrogen that only affects the vulva. These treatments have different risks and benefits, and you might need different combinations of them depending on your symptoms.

Some doctors use testosterone to treat sexual dysfunction in women, but doctors generally don’t use the term menopausal hormone therapy when they’re talking about testosterone.

Why the pendulum has swung on hormone therapy

When I was in medical school in the 2010s, I learned that hormone therapy could be dangerous.

The idea came from the Women’s Health Initiative that followed thousands of women in midlife who were taking hormones throughout the 1990s and early 2000s. Researchers actually stopped it early because it seemed to show that hormone therapy increased risk of heart disease, breast cancer, stroke, and pulmonary embolism.

After this news, prescriptions for hormone therapy went down dramatically. In 1999-2000, 22% of American women over 40 were receiving menopausal hormone therapy, one study estimated. By 2010, researchers estimated that had dropped to just around 5% of women in that age group.

But then, researchers began to re-analyze data from the Women’s Health Initiative. The growing consensus is that menopausal hormone therapy is much safer than we thought for women in their late 40s and 50s.

Once that news started to spread — and go viral online — patient demand began to spike.

What symptoms are the hormones good at treating? 

The primary reason doctors recommend systemic hormone therapy is to treat what are called vasomotor symptoms of menopause, otherwise known as “hot flashes.”

Some researchers estimate that up to 80% of women in the menopausal transition have hot flashes — and they can really affect women’s quality of life. Some of my patients tell me that they disrupt their sleep, their ability to focus at work, and sometimes feel so distracting that they don’t want to leave the house.

Systemic hormone therapy can help prevent fractures for those at high risk of osteoporosis. It also helps keep bones strong as women age, although most organizations don’t recommend it to be used only for this purpose. I think of bone loss prevention as a positive side effect of hormone therapy when I prescribe it for hot flashes, but it’s not clear that the benefits outweigh the risks for every single patient.

Hormone therapy is also used to treat premature menopause if a woman has had her ovaries removed.

Dryness and irritation in the vulva — known as the genitourinary syndrome of menopause — also often get better with hormone therapy. These symptoms often improve with an estrogen treatment in the vagina, such as a cream or a ring; systemic hormone therapy can help too.

And should I take them for heart health and longevity benefits? 

Hormone therapy can be life-changing for women experiencing hot flashes. But it’s not the fountain of youth, as many influencers seem to promise.

Most major medical organizations — including the U.S. Preventive Services Task Force, the American College of Obstetricians and Gynecologists, and the Menopause Society — do not recommend hormone therapy for longevity, heart health, or preventing chronic conditions, based on the data currently available. (It’s not recommended for youthful-looking skin and hair, another overly optimistic claim I’ve seen online!)

Still, there’s some genuine uncertainty about whether or not hormone therapy might help prevent heart disease.

“It’s really an unanswered question right now,” said Dr. Karen Adams, a professor of obstetrics and gynecology at Stanford, where she directs the Program in Menopause and Healthy Aging.

Adams says there is promising research that suggests that hormone therapy, when taken before age 60 or within ten years since menopause, might help prevent atherosclerosis, heart attacks, and strokes. But other studies show that hormone therapy — particularly when taken over age 60 — has no cardiovascular benefit at all or may even increase heart disease risk.

Essentially, researchers say that using hormone therapy right around the menopausal transition, usually in a woman’s early 50s, seems to be much safer than using it later in life.

The way that women take hormones seems to matter, too. Research generally shows that transdermal estrogen — delivered through a patch — is less likely to cause blood clots than oral estrogen.

So for patients in their late 40s and 50s with hot flashes or night sweats, Adams liberally prescribes hormone therapy unless patients have a clear medical reason not to. (More on that below!) But when it comes to heart health, she tends to focus on other prevention tools, like blood pressure management, cholesterol medications, nutrition, and exercise.

“I don’t say, ‘Here, take hormone therapy. It’s going to keep you from having a heart attack,'” Adams said. “We don’t have that data. And I don’t make that promise.”

Who should not take hormones 

There are definitely reasons to proceed with caution when it comes to menopausal hormone therapy.

Anyone who has had breast cancer, blood clots, or a heart attack or stroke should have an in-depth conversation with their doctor about it, because hormone therapy can make those conditions worse or increase the risk of them recurring.

If I saw a patient with one of those conditions who was experiencing hot flashes, I’d probably recommend they try a nonhormonal treatment option first. Certain types of antidepressants can reduce hot flash frequency and severity. If the antidepressants aren’t effective, women have several other options, including a medication called fezolinetant, which was approved by the Food and Drug Administration in 2023.

To help prevent loss of bone density in a patient who can’t take hormones, I’d recommend that old standby: exercise. Weight-bearing exercise is one of the most effective tools we have to help prevent osteoporosis.

A family history of breast cancer doesn’t mean a patient can’t consider hormone therapy. But it’s important to proceed with caution. In that scenario, I’d first do a formal breast cancer risk assessment and think about genetic testing for high-risk mutations.

If the patient really wanted to use hormone therapy, I’d recommend what professional prescribing guidelines suggest: Take the minimum dose of hormone therapy that effectively treats your symptoms for the shortest possible duration.

Ultimately, it’s about understanding your own values and preferences.

“I lay out the risks and benefits,” said Dr. Jessica Platt, a family physician in Massachusetts who focuses on women’s health and menopause care. “Giving people knowledge and also giving them patient autonomy.”

The bottom line 

Just because menopause hormone therapy is much safer than doctors believed in the 2000s doesn’t mean it’s a cure-all. Adams is concerned that some women might end up using a treatment that does more harm than good.

“When we just say this is the fountain of youth, people believe that. And women can be harmed by that,” Adams said.

In my own practice, I’ve come to realize there’s no one-size-fits-all answer.

Hormone therapy can really improve my patients’ quality of life. It’s gratifying when a patient comes to see me and says, “Thank you! My hot flashes are finally under control!”

But hormone therapy, unfortunately, does not fix every ailment the online influencers promise it will. It’s not right for everyone.

Ultimately, the decision to use hormone therapy should be a discussion between doctor and patient that takes into account the patient’s medical history, symptoms, and values.

Dr. Mara Gordon is a family physician in Camden, N.J. She writes the newsletter Your Doctor Friend. 

A new kind of flu vaccine made with mRNA technology will soon be available.

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Marco Bello/Bloomberg/Getty Images

For the latest stories on the science of healthy living, subscribe to NPR’s Health newsletter. 

The Food and Drug Administration approved Moderna’s mRNA-based vaccine against seasonal influenza for people 50 and older, the company said late Wednesday.

It’s the first approved vaccine for flu that uses the same technology as COVID-19 shots.

The vaccine is called mFLUSIVA, and Moderna says it will be available “in a few weeks” — in time for the 2026-2027 respiratory virus season in the U.S.

“The FDA approval of mFLUSIVA … demonstrates the continued strength and versatility of our mRNA platform,” said Stéphane Bancel, Moderna’s chief executive officer, in a statement. “Flu remains a significant public health challenge, and mFLUSIVA provides an important new option for America’s seniors. This approval also reflects the ongoing potential of our mRNA platform to help address important public health challenges through continued scientific innovation.”

Company research involving more than 40,000 people found that mFLUSIVA is safe and appears to produce stronger protection than traditional flu vaccines.

The FDA’s decision was being closely monitored because of the Trump administration’s hostility toward mRNA technology.

President Trump embraced mRNA technology during his first term to produce the COVID vaccines, an achievement widely praised as a medical triumph that saved millions of lives.

But the backlash against pandemic responses, including vaccine mandates, led to the vaccines and mRNA technology being vilified by some and becoming the focus of widespread misinformation.

Secretary of Health and Human Services, Robert F. Kennedy Jr., a long-time vaccine critic, has repeatedly condemned the vaccines.

The administration also slashed funding for mRNA vaccine research and curtailed access to the COVID vaccines.

The FDA initially refused to even consider reviewing Moderna’s mRNA flu shot. But the agency later relented because of backlash from the pharmaceutical industry and public health experts.

The agency convened a meeting of independent outside advisers in June to consider the vaccine. That panel voted unanimously to recommend the agency approve the new shot.

Many public health officials say the mRNA flu vaccine has other advantages as well.

mRNA vaccines, for example, can be updated and produced much more quickly than standard vaccines.

That could make the vaccine more useful when a new flu strain emerges unexpectedly, which occurred last flu season. It could be especially crucial if a very new flu virus evolves, triggering a flu pandemic.

“I think this is really a critical step forward in advancing influenza vaccine technology,” says Michael Osterholm, an infectious disease expert at the University of Minnesota.

Others agree.

“The FDA is signaling openness to this platform, which has been a controversy and an issue,” says Dr. Jeanne Marrazzo, chief executive officer of the Infectious Disease Society of America.

“It’s a really promising product that could set us up not only for improved response to a bad flu season but also to an improved response to any biological threats.”

But critics are disappointed by the decision.

“I really believe that this technology is just too new,” says Dr. Brian Hooker, the chief medical officer at Children’s Health Defense, an anti-vaccine group once headed by Kennedy. “There has not been the adequate level of study of the implications for, you know, literally everybody. I just feel like the train is leaving the station, and we’re not ready yet.”

Cambodia is the first country in Asia to meet the U.N. targets for controlling HIV. Above: A vendor in Phnom Penh sits by a banner marking World AIDS Day.

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Tang Chhin Sothy/AFP via Getty Images

Only 11 countries in the world can say this:

Ninety-five percent of people living there who are HIV positive know their status.

Ninety-five percent of HIV-positive people are taking medication that lowers the amount of the virus in their body.

And 95% of people on HIV medication have a viral load so low, they’re considered virally suppressed. This means they have an almost zero risk of passing HIV on to their partners.

In June, Cambodia became the first country in the Asia-Pacific region to reach this milestone, which the U.N. has set as a goal for every country to achieve by the year 2030. The 95-95-95 targets were called ambitious and daunting when UNAIDS set them in 2020.

But since then, 11 nations, most of which are in Africa, have achieved them. Denmark is the one European nation on the list.

Many Asian countries — including wealthy ones like Japan and South Korea — have struggled to make these gains, says Dr. Annette Sohn, director of amfAR’s TREAT Asia program, a network of clinics and researchers serving people with HIV.

“Sometimes people will think — why is it that we are not able to manage HIV control?” Sohn says. “The No. 1 challenge continues to be stigma.”

That stigma might be a feeling of shame that keeps a person from getting tested for HIV or from visiting a clinic for treatment.

People living with HIV also face discrimination, which can make navigating the healthcare system a struggle.

Sohn says this is how Cambodia succeeded: Advocates recognized that people seek healthcare where they feel accepted and used this strategy to save lives.

“I moved to the countryside … to die”

Sophal Seum is an advocate for people living with HIV. When he himself was infected in 2000, he lost his job after then-mandatory testing revealed his status. Today, he is on medication to control the virus. “I can survive,” he says, “because I have hope.”
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At the peak of the AIDS crisis, as many as 15,000 people in Cambodia were dying each year from a virus that had no cure and no vaccine. Before 1998, there was no medication to prevent HIV from destroying a patient’s immune system, leaving them vulnerable to infections and rare cancers.

“We heard it was a strange, deadly virus,” recalls Sophal Seum. “People were scared of HIV.”

The virus tore through brothels and nightclubs but quickly reached the general public. By 1999, about 2% of adults between the ages of 15 and 49 had contracted HIV. At the time, Seum was a young hotel worker near Angkor Wat, an ancient Hindu temple that attracts millions of visitors each year. He says he lost his job after testing positive for HIV in 2000 and struggled to find a new one. Many jobs at the time required blood tests, he says. The practice was banned in 2002.

“In 2006, I moved to the countryside — to die, you know,” Seum told NPR. His wife and children joined him.

But with medication, and the help of a program providing home-based care, Seum recovered. Today, he is a national advocate for people living with HIV. Seum organizes community meetings for people living with HIV, making sure their needs are met, and offers counseling, especially to young people.

“It’s not a full recovery, but I try to ride my bicycle to work,” he says. “I can survive, because I have hope.”

Cambodia had the political will

Cambodia’s HIV epidemic peaked in the late 1990s and early 2000s, when about 180,000 people had contracted the virus. Today, the national rate has dipped from more than 2% to below 0.5%, and the vast majority of Cambodia’s estimated 76,000 citizens living with HIV are on medication.

Chamreun Chob Sok is the executive director of KHANA, the Khmer HIV/AIDS NGO Alliance. It’s Cambodia’s largest network of nonprofits working to prevent HIV and support people living with the virus. Sok has worked on HIV prevention for almost the entirety of his career.

He says the country’s response succeeded thanks to three main factors.

First, Sok says, Cambodia had the political will to do this.

Cambodia is a constitutional monarchy. In the ’90s, both the king and the elected government wanted to prioritize HIV prevention efforts. In 1999, the country launched a public health campaign encouraging couples to use condoms 100% of the time, under the slogan “No condom, no sex.” During those early years, more than 80% of sex workers reported using condoms.

Later, in 2003, the Cambodian government made HIV medication free with an $11.2 million grant provided by the Global Fund. Based in Geneva, the international financing group provides grants to countries for HIV, tuberculosis and malaria relief. The United States is the fund’s largest donor.

Early programs in Cambodia focused on groups of people who had heightened rates of HIV: the military, police, garment factory workers and sex workers. As HIV rates shrank among the general population, Sok says, the epidemic became more concentrated among high-risk groups, who were harder to reach.

“What we call it now, is that Cambodia is under a concentrated epidemic. This means HIV transmission is occurring among a key and vulnerable population,” Sok says.

To tackle the concentrated epidemic, Cambodian community health workers had to get creative.

Sok’s perspective is that the best solutions are created by people with lived experience. Proudly, he lists off KHANA’s programs:

There is SmartGirl, an intervention organized by women who previously worked in nightclubs, bars or other places where sex work is common. (Sok prefers the term female entertainment worker in an effort to reduce stigma.) Through KHANA, the women organized HIV finger-prick testing drives in their former workplaces. Then, they offered counseling and helped women who were HIV positive get medical care and other support.

“They became lay counselors. They became the people who go and conduct outreach,” Sok says. “They’re run by themselves, reaching their peers.”

Men who sleep with men are another demographic with a high risk of HIV in Cambodia. Through KHANA, they created their own outreach, Sok says — including community hubs with coffee shops and internet access.

For a third project, transgender counselors created a program called Srey Sros: “Beautiful Woman” in the Khmer language, which signaled acceptance and safety.

“This is a way that can bring people to come to services early,” Sok says. “And importantly, they’re involved in ensuring the services are friendly.”

This focus on key populations — demographic groups with the highest rates of HIV, and the highest risk of contracting it — is considered a gold standard of epidemic control. However, after U.S. funding delays and cuts to global HIV prevention, these programs have been among the first on the chopping block in other countries.

“Life with HIV is possible”

Dalish Prum is a program manager for CPN+, a support network for people living with HIV. She herself is HIV positive, infected after being abducted and trafficked at age 15. Medication keeps the virus at undetectable levels. She counsels clients: Life with HIV is possible.
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Cambodia’s achievement also rests on the shoulders of people willing to tell their stories. Dalish Prum is a program manager and community health worker for CPN+, one of Cambodia’s largest support networks for people living with HIV.

When she was 15 years old, Prum was abducted and trafficked to the Thai border. Although she was quickly rescued, she fell sick months later. When she tested positive for HIV in 2003, she was still in high school.

“I cried almost every day for three years,” Prum recalls. “I thought I will die soon, I cannot learn, I cannot study, I cannot graduate or make a family.”

Prum drew strength from her supportive parents. She finished her studies and began working for HIV prevention programs, speaking at international conferences and becoming a leader in the country’s efforts. She fell in love, married and had a little girl in 2018.

Today, Prum takes medication to keep her HIV to undetectable levels in her body, preventing health complications. She says people living with HIV in Cambodia still face challenges, especially in healthcare settings. But the 95-95-95 achievement signals that the work she and her colleagues are doing makes a difference.

And this is what she often tells the clients she counsels: Life with HIV is possible.

“Honestly, please love yourself,” she says. “You have dignity.”

In bodycam footage released by the Milwaukie Police Department, 26-year-old Jean Descamps can be seen in a hospital bed at the Providence Milwaukie Hospital emergency room in Milwaukie, Ore., in December 2023. Soon after he was discharged by the hospital, Descamps died from drugs already in his system.

Milwaukie Police Department/Screenshot by NPR

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Milwaukie Police Department/Screenshot by NPR

On a cold December night in 2023, the staff at Providence Milwaukie Hospital in Milwaukie, Ore., called local police. They wanted help getting one of their patients, a 26-year-old man named Jean Descamps, out of the emergency room.

“He’s been evaluated medically. There’s no medical problems for him,” a member of the hospital team, who NPR has not been able to identify, told police. The moment was captured on an officer’s body camera.

Records show the hospital’s medical staff believed Descamps — emaciated, covered in feces, and often unresponsive — was experiencing symptoms of chronic street drug use, a leading cause of death for young Americans.

After Descamps arrived in an ambulance earlier that day, hospital staff cleaned him up and administered naloxone, a medication that reverses opioid overdoses. But now they wanted him gone. “He’s not thriving chronically, but there’s no medical reason for him to be here anymore,” one hospital staffer can be heard saying.

Video released by the Milwaukie Police Department shows Descamps sprawled in a hospital bed, his body limp, moaning and drooling, while medical staff stood nearby. After determining Descamps was too unwell to spend the night in jail, police officers challenged the hospital’s decision to discharge him.

“He can’t be on his own,” one officer said. “Why is he being released? We have no place to take him.”

“A bus station is fine,” a hospital worker replied. Another member of the hospital staff told police Descamps was faking the severity of his illness: “It’s not really a medical problem, it’s malingering.”

Officers eventually complied, rolling Descamps’ limp body in a wheelchair into the dark parking lot, where they covered him with a blanket against the winter cold. Police who gathered around Descamps can be heard voicing fear for his safety.

In video footage released by the Milwaukie Police Department, an officer can be seen rolling Descamps in a wheelchair to exit the hospital emergency room. “Do you feel at all comfortable with anything that’s going on right now?” one police officer asked. Another officer answered, “No.” 

Milwaukie Police Department/Screenshot by NPR

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Milwaukie Police Department/Screenshot by NPR

“Do you feel at all comfortable with anything that’s going on right now?” one police officer asked. Another officer answered, “No.” 

Their fears proved justified. A short time after being discharged, Descamps would be dead of an overdose from street drugs already in his system. A spokesman for Providence Milwaukie Hospital declined NPR’s repeated requests for an interview about Descamps’ case and didn’t respond to detailed questions about his treatment.

In a statement issued to the media after Descamps’ death, the hospital expressed regret and acknowledged the care he received was inadequate. “In this case, we fell short of our goal of providing safe, reliable, compassionate care to our patient,” it said.

But in interviews with more than a dozen doctors, scientists, federal officials and addiction activists, along with a review of research and government data, NPR found that what happened that night in Oregon is part of a troubling national pattern.

People with serious alcohol or drug addiction in the U.S. regularly go to doctor’s offices, clinics and hospitals, only to leave after receiving insufficient or no treatment, often with devastating consequences.

“I think we should be outraged every single time someone dies from any condition that has treatment available that someone isn’t getting,” said Dr. Judy Chertok, who treats addiction patients and teaches medicine at the University of Pennsylvania. “We would not allow, as a society, people with heart attacks to come to a hospital and not get appropriate treatment. This is as serious as that.”

Most addiction patients get little or no treatment

Chertok is among the growing number of critics who say efforts to bring addiction treatment into the mainstream of American medicine have fallen short.

Addiction is widespread in the U.S., affecting more than 40 million people, according to the latest federal data released last month. While drug overdose deaths have dropped in recent years, alcohol- and drug-related disorders still kill more than 250,000 people every year. Meanwhile, research shows alcohol-related deaths have doubled over the last 20 years, while nonfatal overdoses from fentanyl are rising.

Despite that toll, the federal data released last month shows that in 2025 more than 80% of people who need help get no medical treatment of any kind for their addiction.

“Much of what I do is scream back at that,” Chertok told NPR. “Many who ultimately die from their [addiction-related] illness have had significant contacts with healthcare and social services agencies in the few months leading up to their deaths.”

In the case of Jean Descamps on that winter night in Oregon, death came much faster, after Milwaukie police decided to transport him to an emergency behavioral health center in nearby Portland.

On the body camera recording, officers can be heard growing increasingly alarmed by his condition as he sat in the back of a police cruiser. “Hey Jean, hey Jean!” one officer shouted, after searching for signs Descamps was breathing. “Boy, I don’t know. Look at his eyes, I don’t know.”

In bodycam footage released by the Milwaukie Police Department, Descamps is seen in the hospital parking lot, unresponsive to surrounding officers.

Milwaukie Police Department/Screenshot by NPR

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Milwaukie Police Department/Screenshot by NPR

Efforts to revive Descamps failed. An investigation by a local prosecutor in Oregon found hospital staff failed to give him a toxicology test to evaluate drugs in his body before discharging him.

While this kind of catastrophic outcome is rarely caught on camera, federal data suggests similar moments may be common. One study by the Centers for Disease Control and Prevention found more than two-thirds of Americans who died from fatal overdoses in 2024 had “at least one potential opportunity for intervention” but didn’t receive help.

“When it comes to substance use disorder, we have not decided as a country this is an illness we actually can treat,” said Beth Meyerson, an expert on addiction care at the University of Arizona’s College of Nursing.

Addiction treatments are safe, effective — and rarely offered 

According to Meyerson, the problem isn’t just in hospital emergency rooms. It’s still the norm for doctors and nurses across U.S. healthcare settings to avoid treating patients with alcohol- and drug-related disorders.

“If I’m at my own general practitioner and it’s suddenly clear I’m addicted to an opioid, my doctor will likely send me somewhere else,” Meyerson said. “Versus [saying], I can treat that here, just like I can treat your diabetes or any other chronic disease you might have.”

This happens despite the fact that safe and affordable medications for treating the deadliest forms of addiction have been available to U.S. clinicians for decades. “We have good tools. Methadone and buprenorphine are gold standards,” Meyerson said. “Access to treatment would reduce opioid overdose by 60%. In some studies, I saw 80%.”

In 2022, Congress lowered regulatory barriers, making it far easier for nonspecialist clinicians to prescribe buprenorphine, a medication that reduces opioid cravings. But most doctors still don’t. It’s even rarer for doctors to offer naltrexone, a medication that helps patients by reducing the desire for alcohol.

Many doctors carry a strong bias against addiction patients

The obvious question is why? If addiction is common and deadly but treatments are available, why don’t more clinicians help these patients?

There’s consensus that this is, in part, a legacy of America’s drug war. Addictions are now considered treatable disorders, but for decades substance use was seen by many as a criminal or moral issue, with access to treatment often heavily regulated. Some forms of addiction still involve illegal drugs.

Research suggests this history led to fear and hostility in the general public and among medical professionals toward people with addiction. Chertok said despite efforts to change attitudes, many of her fellow doctors still view people experiencing these disorders with suspicion.

“I have observed or heard people talk about someone with addiction in the healthcare setting in a way that is not tolerated for any other group,” Chertok said. “It’s so jarring that that is accepted by so many.”

It may seem inconceivable, 30 years after the first wave of the opioid crisis made addiction a life-or-death issue for many families across the U.S., that the vast majority of clinicians still actively opt out of treating vulnerable patients because of personal bias.

A patient displays his Suboxone prescription following his appointment at the substance use disorders Bridge Clinic at Massachusetts General Hospital in Boston on April 27, 2018. The patient takes Suboxone, a medicine that contains buprenorphine and naloxone, to treat his substance use disorder.

Craig F. Walker/The Boston Globe via Getty Images

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Craig F. Walker/The Boston Globe via Getty Images

But studies show stigma among healthcare workers remains deep-rooted. One study published in the Annals of Internal Medicine in 2020 found only 1 in 5 American physicians “have interest in treating a patient with opioid use disorder.”

A report issued earlier this year by the American Medical Association, the nation’s leading physician trade group, identified stigma among health workers as a significant hurdle for patients needing treatment. Bias is so widespread that many doctors believe their patients will abuse addiction medications to get high, even though, for instance, studies show misuse of buprenorphine is rare.

“Forty-three percent of healthcare professionals believe medications for opioid use disorder substitute one drug for another,” said Robert DeForde, with a group called Shatterproof that conducted a survey of clinician attitudes in 2024.

DeForde’s organization works to convince doctors and nurses to treat people with addiction, conducting online training and in-person seminars. That work left DeForde convinced that bias in the medical community against this group of patients remains intense.

“They don’t want these people around them. They don’t think that the drugs that we have that are FDA-approved medications are really going to actually help the patient. That is what I would say is a fatal flaw in our system,” he said.

Will the next generation of doctors do better? Maybe not

While the AMA acknowledges that stigma affects clinician behavior and prescribing, the organization has long urged patience with the pace of reform and resisted efforts to mandate more rapid change.

“I think it’s going in the right direction,” said Dr. Bobby Mukkamala, who served as AMA president until June 2026 and currently leads the organization’s substance use task force. “Could it be going faster? Should it be going faster? Absolutely.”

In an interview with NPR, Mukkamala said he believes primary care doctors contributed to the decline in drug overdose deaths since 2023. But he also said many physicians are wary of treating addiction because they lack proper training and already feel overwhelmed by other duties.

In bodycam footage released by the Milwaukie Police Department, the Providence Milwaukie Hospital emergency room staff interacts with police officers the night Jean Descamps was discharged from the emergency room. “He can’t be on his own,” one officer said. “Why is he being released? Descamps died later that night from a street drug overdose. Staff members’ identities were blurred by the Milwaukie Police Department.

Milwaukie Police Department/Screenshot by NPR

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Milwaukie Police Department/Screenshot by NPR

“We know that we need to do this new thing that we are just gaining comfort with. But facing the headwinds of all the other things that we face as physicians, I think that’s a pretty understandable hurdle that we have to get over,” he said.

According to Mukkamala, those professional challenges heighten the personal unease some clinicians feel treating addiction patients. “There’s the emotional response from within that basically makes us say, ‘Yeah, but you know, it’s not something I’m comfortable with.’ That’s the stigma.”

Most experts interviewed for this story agree that some progress has been made. But not a single doctor, researcher, activist or federal official described the current level of addiction care as acceptable.

“What models can be developed to actually change the culture?” said Dr. Nora Volkow, who heads the U.S. government’s National Institute on Drug Addiction. “How do you embed the education and the training and the support systems in healthcare that will make clinicians feel more comfortable treating patients with substance use disorder?”

But despite the urgency of America’s addiction crisis — President Trump declared the opioid crisis a national public health emergency nearly a decade ago — most medical and nursing schools in the U.S. still don’t teach students how to care for patients with substance use disorders as a core part of their medical practice.

Meyerson at the University of Arizona College of Nursing thinks that has to change. “We will have to have very clear laws, policies, and frankly training practices and curriculum in medical school and nursing schools to really combat this,” she said.

“That guy does not need to be dead right now”

For now, experts say the results of poor addiction care are widespread, with few legal or professional consequences, even when patients with substance use disorders die. After Jean Descamps’ fatal overdose in December 2023, Providence Milwaukie Hospital promised to make immediate changes, including more careful evaluation of patients before discharge.

But a follow-up investigation by the Oregon Health Authority, made public in February 2024, found the facility was still discharging vulnerable patients, including those with severe addiction, without proper safeguards. The OHA warned of the “possibility that a similar event could occur.”

There’s no record that the hospital or its staff faced any kind of disciplinary action or sanction. Oregon officials say the facility is no longer under scrutiny. In a statement sent to NPR, Providence officials said they have enhanced staffing and “strengthened” procedures for caring for vulnerable patients.

The statement also said hospitals shouldn’t be held responsible for what happens to patients after they leave. “We do not have the capabilities nor the resources to manage the community needs once patients are discharged from our facilities,” it said.

Not everyone sees it that way. On the body camera recording, police officers who tried to save Descamps’ life can be heard voicing sorrow and anger at his lack of treatment. “That guy does not need to be dead right now,” one officer said. “Their mindset there [at the hospital] is ‘Oh, it’s just another tweaker.'”

Dr. Erica Schwartz, who appeared before the Senate Health, Education, Labor and Pensions Committee in July, was confirmed Wednesday as CDC director.

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Finn Gomez/Getty Images

The U.S. Senate confirmed Dr. Erica Schwartz as director of the Centers for Disease Control and Prevention, nearly a year after the last permanent director was fired in a dispute over vaccine policy with Health Secretary Robert F. Kennedy Jr.

The vote on Schwartz’s nomination was 51-44 in favor.

She will take command of a public health agency that has lost thousands of employees in the second Trump administration amid layoffs, resignations and leadership shakeups.

The CDC is currently responding to surges in measles cases, cyclosporiasis outbreaks and an Ebola outbreak in the Democratic Republic of the Congo and Uganda.

In a July confirmation hearing, Sen. Bill Cassidy led some Republicans in hard questions about vaccines and whether she would support their use if pressured by Kennedy.

Cassidy ultimately voted to advance her nomination out of the Health, Education, Labor and Pensions Committee after she allayed his concerns. He also voted in favor of confirmation.

“After speaking with Dr. Schwartz again after the hearing, reviewing the transcript and speaking to those who served with her and know her well, I’m confident that she knows what she is doing and will stand against those who do not,” Cassidy said on July 23.

Sen. Bernie Sanders, an independent from Vermont and ranking member on the health committee, voted against her advancement out of committee and against her nomination on the Senate floor Wednesday.

While Sanders said he was impressed by Schwartz’s credentials and service, he did not think she was prepared to stand up to Kennedy’s false statements on vaccines and other health topics.

“I think the American people are owed better than what President Trump has nominated,” Sanders said on July 30.

Dr. Demetre Daskalakis, a former CDC official who resigned last August, said Schwartz has her work cut out for her. “I really wish her luck in her new role,” he told NPR . “But I would also say, it’s not about the job, it’s about the public health mission. And that needs to be her focus.”

Back in the 1950s when Dr. Kelly Brownell was a young boy, snacking didn’t really exist.

“Children ate three meals and maybe one snack,” he says. And typically that snack occurred in one place: at home. “Nobody ate in their automobile. Maybe if you took a long trip, your parents would make sandwiches to bring along, but that would be about it,” says Brownell, who’s an emeritus professor of psychology at Duke University

Today kids’ eating patterns look strikingly different. Children eat, on average, about three snacks a day today, eight nationally representative surveys found. Children eat nearly everywhere they go, and a large portion of their snacks are ultraprocessed foods.

Many parts of kids’ lives have shifted since the mid 20th century. But, Brownell says, there’s a major driver that’s systematically reshaping families’ eating habits.

Earlier this year, he and his colleagues at Harvard University and the University of Michigan published extensive evidence in The Milbank Quarterly that the ultraprocessed food industry intentionally shifted the social norms around families’ eating habits. “So norm after norm after norm has been changed, and it doesn’t mean that things have changed in a positive way,” he says.

Many pediatricians, including the American Academy of Pediatricians, recommend toddlers to tweens eat about five times a day: three meals and about two snacks.

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But this advice doesn’t take into account the rise of ultraprocessed foods, says pediatrician Tamara Hannon at the Indiana University School of Medicine, who chairs the nutrition committee at the AAP. “The problem is what we know about child nutrition comes from studies with feeding kids no processed foods but fruits, vegetables, and whole foods. So foods that our grandmothers made,” she says. “So the ‘snacks’ in these studies are really not what we, in our culture, consider snacks,” Hannon adds.

It’s time, Brownell and Hannon say, for pediatricians and parents to push back against these industry practices.

A world designed to trigger continual snacking

Throughout the 20th century, the ultraprocessed food industry used a series of tactics to make snacking throughout the day not only acceptable but even expected, says Ashley Gearhardt, who’s a professor of psychology at the University of Michigan and contributed to the new study.

First off, the industry launched marketing campaigns, often targeted to children, to turn all contexts in which parents used to say, “No,” to eating into snacking zones. They sprinkled vending machines around communities – at schools, pools, parks and sporting events. They made ultraprocessed snacks available at gas stations, train stations and airports. “So now it’s not just cake at birthday parties anymore. It’s cake for breakfast; it’s cake in the car after you go to the gas station. It’s 24-7,” she says.

Second, big food companies added preservatives to snacks so they don’t spoil in your purse or in the car. They designed special packaging so snacks are convenient to carry around and quick to consume on-the-go. “That means you can have a purse full of snacks all the time that isn’t going to go bad,” Gearhardt says.

The result? “It has become so normal for children to constantly be snacking, snacking, snacking,” she says. “This new normal is certainly a huge benefit to the food industry.”

But it’s probably not beneficial for many children. Studies have found that large, high-calorie snacks are associated with obesity in children ages 2 to 5, as is the consumption of ultraprocessed foods, in general. These snacks account for about half of the added sugar children consume. They also boost children’s intake of saturated fat and sodium.

How to reset your child’s snacking habits

To fight back – and ensure your child receives the nutrients they need – researchers suggest these four new rules for the modern food world:

1. Cut out ultraprocessed snacks with high “total carbohydrate,” including crackers, pretzels, puffs and pea snacks

The problematic snacks aren’t just the ones with added sugar, Gearhardt says. Parents should also avoid packaged snacks with a high level of “total carbohydrate.” These foods often contain large amounts of refined starches from white flour, corn, peas and potatoes. In your body, these carbs act similar to the way sugar behaves.

“These carbs also spike your blood sugar, too,” she says. So two hours later, when their blood sugar crashes, kids want another high-carb snack. “These foods actually set kids up to be in this kind of craving and crashing cycle, as sugary foods do,” she says. “If the snack is delivering a high level of carbohydrate, be very skeptical,” Gearhardt adds.

Most of these snacks also have high levels of sodium, she adds. “In our research, we see that salt combined with a carbohydrate is one of the key ingredient combinations that makes you want to eat more and more and more.”

2. Realize that just because a child wants – or demands – a snack doesn’t mean they’re actually hungry

Big food companies have engineered ultraprocessed snacks to coax kids into eating even when they’re not truly hungry, Duke’s Kelly Brownell has found. “With these foods, their brains and guts don’t behave as they should,” he says. “Cues created by the food industry start to drive their eating instead of a biological need for food.”

“Then it’s very hard to distinguish whether kids are snacking because they’re physiologically hungry, or because the processed foods have set up biological cravings,” he adds. And these cravings can cause meltdowns and tantrums if they’re not addressed.

The solution? Wean kids off the processed snacks and onto whole foods. “So give them 75% of the processed snack and 25% slices of fruit at first,” Brownell explains. Then slowly over time, move to 50% fruit slices, then 25% and then zero. If the child turns down the whole food, then they’re not physiologically hungry, he says.

3. Focus on what kids are eating instead of how frequently they snack

In a recent study, the number of daily snacks didn’t correlate with a child’s risk for obesity or their diet quality, says Jennifer Orlet Fisher, who’s a behavioral nutritionist at Temple University. But something did matter: what caretakers offered children.

Orlet Fisher recommends sticking to whole and minimally processed foods for snacks, like produce, nuts, beans and dairy. When kids nibble on these foods, then snacking actually improves their diet. It increases their intake of often-missing vitamins and fibers, and it also helps kids develop a desire for and love of vegetables, Orlet Fisher says.

But just keep the portion size small, adds Dr. Tamara Hannon at the Indiana University School of Medicine. “Snacks are really a piece of fruit or a vegetable, maybe with some cheese, or a banana with some nuts,” she says. “They are a very small amount of food.”.

4. Stop carrying around ultraprocessed snacks

Children don’t need to eat everywhere they go, Gearhardt says. With food available in many locations, it trains children neurologically to crave and expect snacks throughout their daily routine. If you stop carrying around ultraprocessed snacks in your purse or backpack – and the snacks are truly not available – children will stop associating eating with your purse or backpack. Eventually they’re bodies and brains will adjust and stop expecting them.

Michaeleen Doucleff has a Ph.D. in chemistry and is a longtime science journalist (including previously for NPR). She is the author of the parenting book Dopamine Kids.

Cyclosporiasis is an intestinal illness caused by food or water contaminated with the parasite Cyclospora.

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Two people have died as part of the cyclosporiasis outbreak in Michigan, according to the state’s Department of Health and Human Services. These are the first reported deaths associated with cyclosporiasis since the outbreak began in May.

The department said in an update on its website Monday that “both individuals had significant underlying health conditions that may have been impacted by cyclosporiasis and dehydration.” No other information will be provided on those two cases, according to the department.

Cyclosporiasis usually isn’t fatal. The illness can last weeks and pass on its own. Symptoms include watery diarrhea, nausea and fatigue. Antibiotic treatment can help speed recovery.

The parasite Cyclospora makes its way into the human digestive system in food or water contaminated with human waste.

In Michigan and eight other states, contaminated iceberg lettuce from Taylor Farms in central Mexico has been linked as a source of the outbreak. That lettuce was recalled July 17.

Michigan’s case count of cyclosporiasis is up to 11,234 cases. As of July 30, there have been 193 reported hospitalizations there.

Nationally, the Centers for Disease Control and Prevention counts 6,707 confirmed cases as of July. The number is lower than what states collectively are reporting because of the time it takes for local health authorities to pass information to the federal level, and for federal officials to investigate and confirm.

The CDC and the Food and Drug Administration are investigating cases in 45 states. It’s the largest cyclosporiasis outbreak on record in the U.S.

Health officials recommend people follow standard food safety handling protocols to protect yourself from the parasite. Cooking fruits and vegetables to 158 F will also kill the parasite.

The popular and experimental drugs called peptides received unprecedented attention last month during a marathon hearing held by a panel that advises the Food and Drug Administration.

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The peptide saga has reached what could be its most confusing chapter — at least for consumers.

The popular — and experimental — drugs received unprecedented attention in late July during a marathon hearing held by a panel that advises the Food and Drug Administration.

The panel considered whether to back the production of seven different peptide therapies — and voted in favor of all but one — despite concerns raised by the agency’s own scientists.

These peptides include some of the most sought-after injectables, BPC-157, TB-500 and MOTS-c.

But that recommendation alone doesn’t change the status of these substances. It’s still illegal for pharmacies in the U.S. to make these compounds.

The FDA staff and leadership now need to review the data and decide whether compounding pharmacies in the U.S. should be allowed to make any of the seven peptides the panel considered.

It’s a regulatory nuance that Dr. Jessica Duncan, who spoke in favor of peptides at the FDA meeting, now finds herself explaining to patients who’ve seen the headlines and want to know when these therapies will be available.

“They are now even more curious,” says Duncan, chief medical officer for the telehealth company IVIM Health. “We tell them that the timeline is uncertain.”

What are the chances these peptides get the green light? 

There’s no guarantee, but it seems likely the FDA will move forward. The agency usually follows its advisory committees’ recommendations.

Plus, there’s high demand for these products — and Health Secretary Robert F. Kennedy Jr., whose agency oversees the FDA, has called to make them available.

Normally, the agency would move forward through its formal rulemaking process, which could take anywhere from several months to possibly over a year, says Jesse Dresser, a partner at the law firm Frier Levitt who represents compounding pharmacies and others in the industry.

“It would actually surprise me if this followed the traditional pathway of formal rulemaking,” Dresser told NPR. “Whatever options exist to make this a faster process, I think they are going to be leveraged.”

One likely scenario: The agency could green-light these peptides in the interim by placing them on what’s known as the “Category One list.”

That would give compounding pharmacies cover to begin making these products sooner, while the longer rulemaking process plays out.

“I do think that there is significant pressure here, but the FDA needs to follow the data,” says Ilisa Bernstein, a former FDA official and pharmacist who’s an expert on drug and pharmacy policy.

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Another route — one that would almost certainly result in a legal challenge — is that Kennedy could cite the dangers posed by the unregulated peptide market as a rationale to immediately place these on a list that OKs their compounding, says Dresser.

That authority is normally used to remove unsafe products from the market, not fast-track them. But “this is a unique scenario, unique product, unique industry and unique administration,” he says.

The agency could also buck the recommendations of the panel and decide not to change the status of these peptides. That would likely result in lawsuits from the industry, says Abha Kundi, an attorney at Aaron Fox Schiff who focuses on FDA regulatory law.

Though she adds that the agency is clearly “very attuned” to dealing with the real world landscape and the current availability of these products.

“In many ways, the toothpaste is out of the tube here. I think that is absolutely part of the calculus.”

Why have peptides become so controversial? 

Demand for them has leapfrogged well ahead of the evidence.

They are promoted widely in the wellness and longevity space and often taken together by injection as “stacks,” for injury recovery, muscle growth and fat loss, improving athletic performance, enhancing metabolism and more.

Unlike many of the GLP-1 weight-loss drugs — which are also synthetic peptides — none of the seven peptides under consideration has undergone the kind of large-scale, rigorous trials in humans that are necessary for drug approval.

But the gray market exploded several years ago, after the FDA placed many of them on a list that prohibited compounding pharmacies from making them due to safety concerns.

That dynamic has led to a dangerous situation. People are now obtaining these peptides from unvetted sources under the guise that they’re only being used for “research purposes” — not for human consumption.

“The gray market space is a lot seedier than what people think,” says Dr. Haleem Mohammed, chief medical officer for Gameday Men’s Health, which operates health clinics that offer hormone optimization and peptides. “That’s nowhere I want my patients getting their medications from.”

Mohammed was one of the FDA panelists who voted in favor of these peptides. Like others in the industry, he argues that the agency’s presentation during the meeting did not showcase the full breadth of evidence.

“This is not a rubber stamp,” he told NPR. “This is about moving towards a regulated pathway for peptides that patients are already using.”

The FDA’s scientists raised numerous concerns about the lack of published human data for all seven of the peptides and recommended against allowing for their production.

Even defining each substance proved difficult because the common name for a peptide can cover many compounds with quite different chemical compositions in the scientific literature, they said.

Legitimizing these peptides for compounding doesn’t require nearly the same degree of evidence as FDA drug approval, but the agency still has a “responsibility to ensure that there’s some level of safety before they become widely available,” explains Bernstein.

“Once the door is open, any pharmacy can compound these products,” she says. “So it could have a huge presence in the marketplace.”

If the FDA backs peptides, how will people get them?  

These drugs will require a prescription, but you probably won’t be able to pick them up from your local CVS or Walgreens anytime soon.

Instead, they’ll be available from compounding pharmacies, which prepare the drugs to order rather than manufacturing them the way a pharmaceutical factory would.

And it’s unlikely patients will be able to get any of these drugs immediately.

Pharmacies will need time to acquire the active ingredients so they can begin making them, says Scott Brunner, who leads the industry trade group, the Alliance for Pharmacy Compounding.

“It’s going to create some chaos,” he says. “It might take two months, it might take nine months, it depends on the substance.”

It won’t be difficult to find someone willing to prescribe them.

Major direct-to-consumer telehealth companies, med spas and high-end longevity medical practices alike are already marketing peptides and their potential.

But it’s likely that many doctors practicing in traditional medical settings will be more wary of prescribing them.

Various professional organizations offer training and certifications on peptide medicine; however, there are no widely accepted, evidence-based guidelines from major medical associations on how to use them.

“I think the commercial enthusiasm is outpacing clinical science here,” says Dr. Harmeet Narula, an endocrinologist at Banner Health in Arizona who regularly gets questions from his patients about peptides.

“It’s important for folks to know that what happened does not mean these drugs are FDA approved.”

Baby Ladoo’s grandmother, Hanifa, rocks the hammock where the 5-month-old stirs. His mother Mariam, 17, says her son was born prematurely at around seven months gestation. She couldn’t afford follow-up care, so she bought him home and is hoping for the best. About 1 in 4 babies in this fishing settlement of Rehri Goth are born prematurely, nearly double the national rate of 14% — and that’s one of the world’s highest. Scientists in a nearby university say they may have uncovered a bacteria that acts as an indicator of whether a women is likely to birth full term or pre-term.

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REHRI GOTH, Pakistan –- The wind whips up sewage dried to a powder that’s been dumped for years onto an arid riverbed near the fishing settlement of Rehri Goth, on the outskirts of the Pakistani port city of Karachi. In an alley, a man squats over a pile of trash. He fishes out a battered peach and eats it.

It’s here that Sughran lives in a dusty compound with her extended family. She’s only got one name. She doesn’t know her age. Some dozen children mill about in tattered clothes. Five are hers. They’re the survivors.

On the day we meet, Sughran says it has been seven days since she buried her baby Gulshan. He was born at seven months gestation. She says when she felt her contractions quicken, her husband took her to a hospital miles away in Karachi. But she says they wouldn’t admit her because she wasn’t their patient. So she rushed to a local hospital, but it was closed for the night.

“So my family told me to go to another hospital,” she recalls. “I said that I would not go anywhere and decided to deliver the child at home.”

Baby Gulshan was cold by morning.

She buried him in the graveyard near his baby brother Roshan, who died last year. He was also preterm: Sughran says he was also born around 7-months gestation too. “One was alive for eight days, and the second was alive for two hours,” she laments.

While premature babies born in the West have an excellent chance of survival — particularly those born after 32 weeks gestation, or at around 8 months — it’s not the same in low-income countries. The World Health Organization says some half of all premature babies born in poor countries at around 32 weeks are likely to die. Many survivors suffer life-long impacts to their vision and hearing as well as learning problems.

The prematurity rate in Rehri Goth is among the highest in Pakistan: about one in four babies here are born early — before 37 weeks of gestation, according to Dr. Fyezah Jehan, chair of Paediatric Infectious Diseases at Agha Khan University in Karachi, who specializes in maternal health. That’s nearly double Pakistan’s nationwide average of just over 14% percent, already among the world’s highest.

It’s evident why women and girls in this community are having babies prematurely: They’re clearly malnourished. Other factors contribute to early birth, such as the extreme heat and poor sanitation.

Other countries do have the same conditions but prematurity rates aren’t as high as Pakistan’s, says Jehan. “So the question that naturally came to us was, why are the rates so high?”

Jehan says her department “got interested in the microbiome” –- the collection of all the microbes in a human body –- because “we are seeing more and more that the microbiome has a huge role in these adverse pregnancy outcomes.”

Microbes extract vital vitamins and other nutrients, teach the immune systems to recognize dangerous invaders and produce helpful anti-inflammatory compounds and chemicals that can stave off bugs that could make us sick.

The problem was, “we have several studies on the gut microbiome and pregnancy from Western populations, [but] we didn’t have any data from Pakistan.”

And that is key to trying to solve this prematurity puzzle, because a person’s microbiome is partly formed by their diet and local environment.

So Jehan’s team looked at the microbiome of Pakistani women who had just given birth –- by examining their stool. Her team selected 108 samples of feces collected from the area around Rehri Goth over the past two decades. About half were from women who had their babies to term. The other half had premature babies.

And “what we found was — there’s this one bacterium, Prevotella [copri], which was far less in women who had delivered pre-term compared to women who delivered term,” she says. “It was a eureka moment for us. We were like, oh, there is a bug, you know, which could potentially explain prematurity.”

She says so far, the initial study gives them “a signal of risk and a signal of understanding, but they’re by no means at a stage where we can translate it into policy.”

Jehan says her team is replicating the experiment in two different ways. One draws on samples drawn from a different area; the other uses stool samples extracted in different years.

Jehan says they’re also trying to cultivate the bacteria Prevotella copri in the lab. They hope to give it to at-risk pregnant women to see if it helps them get to term.

Dr. Vincent B. Young, an infectious disease physician at the University of Michigan Medical School, says Jehan’s team study is “not necessarily new,” but “it’s confirmatory in a different population than what’s been studied before. I think it adds to the idea that perhaps we can go ahead and intervene in the future.”

But Young cautions, even if Jehan’s team can give isolated Prevotella copri to at-risk pregnant women, it might not do anything. That’s because “association is not causation, right? That just because you see A and you see B, that doesn’t mean A causes B in any way, shape or form,” he says. “But it’s a strong association.”

And even if a lack of Prevotella copri is causing premature birth in some way, giving women more of it may not help. Young explains: “Maybe the reason it’s low is because something else is going on that’s suppressing the level of the Prevotella copri, and just giving more of it – well, that will get suppressed too.”

Young says the study may be useful in a different way — if a lack of Prevotella copri is associated with premature birth — that can be used as a way to identify at-risk women.

Jehan acknowledges there’s no silver bullet to prevent premature births. She says, “if you ask me, improve education and water and sanitation and half the problems will just disappear. What we are doing is really stopgap.”

But Jehan says donors are reluctant to undertake expensive, long-term work like sanitation or girls’ education, when local governments are widely perceived as corrupt. She says that’s why major donors would “rather fund the science” conducted in labs like hers.

A premature baby’s life

Back in Rehri Goth, it feels as if 17-year-old Mariam is fighting against the odds to keep her baby alive. Five-month-old Ladoo fusses in a hammock made from an old scarf. He was born prematurely at around 7 months, his mother says.

Baby Ladoo’s grandmother comforts the 5-month-old, who was born prematurely.

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“The doctor told us that we should take him to the hospital because he doubted whether he would survive.”

But Mariam says there was just no money. “We did not go anywhere, we returned home,” she says. Ladoo has been doing poorly since. “The illness never went away.”

His grandmother Hanifa lifts shirt to show us his stomach is swollen. They don’t know why it’s like that. Scars crisscross his bottom, from blisters that formed in the extreme heat. It was over 113 degrees here for weeks. She pulls out a tiny plastic bag of medicines they keep at the ready for Ladoo. “We are illiterate, and we don’t know which medicines are for which treatment,” his grandmother says.

Now, Ladoo is exposed to even more danger by another hazard many Pakistani women face: advice by health workers that is either ill-considered or so badly communicated that it becomes dangerous.

Mariam says when newborn baby Ladoo was suffering from diarrhea, “I was told not to breastfeed.”

She says she was told to give him formula instead, even though the water in Rehri Goth is unsanitary and dangerous for babies — even if boiled, according to the World Health Organization.

But Mariam can’t even afford formula, which sells for about $2.50 for a small packet in Rehri Goth. So “Right now, we do not have it, so he eats Cerelac.”

That’s a mix of rice powder, milk powder with vitamins and sugar made by the multinational Nestlé. A 25-gram packet, she says, costs the equivalent of 20 cents. The amount of sugar is not listed. It’s mixed with water and given to babies like formula — in a bottle.

The World Health Organization says Cerelac is not suitable as a sole diet for a child of any age. In response to NPR questions, the organization said in a statement that Cerelac “is not formulated to meet the nutritional needs of an infant. It is not sterile and may itself be the source of food-borne illness – even if it is prepared with clean drinking water.” The World Health Organization also said in the statement that the advice to withhold from breastfeeding for Ladoo was “certainly inappropriate and likely dangerous.”

The statement continued, “there are vanishingly few circumstances in which breastfeeding poses a greater danger to an infant’s health than replacement feeding.” That’s because breastmilk helps build a baby’s immunity against potentially deadly diseases.

Nestlé did not respond to detailed questions from NPR about whether it knew its product was being consumed as an alternative to baby formula in a community where women were deeply poor and largely illiterate.

Ladoo’s grandmother shoos away flies that have settled on his milk bottle and feeds the baby. She says, “We know this isn’t good for him but what can we do?”

She says, “We will do what we can to keep this boy alive.”

With additional reporting by Almas Kasmani

Cyclosporiasis is a parasitic illness caused by eating or drinking contaminated food or water.

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This summer, tiny Cyclospora parasites have wreaked havoc on the digestive systems of thousands of people in the U.S.

It’s the biggest outbreak of this parasite the U.S. has ever seen. In a July 28 update, the Centers for Disease Control and Prevention counted 45 states reporting cases of cyclosporiasis — the disease caused by the parasite.

Michigan is ground zero for cyclosporiasis, where more than 10,000 people have eaten something, likely lettuce, contaminated with microscopic pods containing Cyclospora parasites.

These parasites rely on the digestive tracts of humans — and only humans — to reproduce. To get there, they’ve likely been hitching rides on crops from places where the parasite is relatively common, to the unwitting mouths of hungry people across the U.S. Their complex biology contributes to why they’re so hard to kick, leading to infections that can last for weeks or months.

A lifecycle that requires the human gut

On the surface of an herb, vegetable or berry, Cyclospora parasites lie dormant in pods — called oocysts — that are virtually invisible to the human eye. “It would take about a hundred of them, linked end to end, to fit across the head of a pin,” says Vernon Carruthers, professor of microbiology and immunology at the University of Michigan Medical School.

Once swallowed by a human, the oocysts make their way down the esophagus, to the stomach and then the intestines. “The [oocysts] respond to signals in the gut, like body temperature, probably bile, digestive enzymes. This causes the parasites to be released,” Carruthers says.

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The parasites go straight for the lining of the small intestine, where they burrow in, taking over the cells to make copies of themselves. “These grow from just a few of the parasites we would take in, to millions of parasites replicating inside our intestinal cells,” Carruthers says.

After a while, some of those parasites begin to differentiate into egg- and sperm-like forms, which combine to form new microscopic oocysts — a process that can happen millions of times at the height of infection. “This is truly remarkable, given that the sperm must find the eggs inside infected cells that are blanketed by a mucus layer,” Carruthers says.

This whole process messes with the intestinal lining. “[The parasite is] entering those host cells, replicating in those cells, producing its life cycle within those cells. And that process eventually destroys the cells,” says Joel Barratt, a molecular parasitologist and associate professor at Emory University School of Medicine who used to lead a lab team at the CDC that responded to parasitic outbreaks.

Hardy pods in human excrement

As the parasites injure the cells lining the small intestine, they reduce nutrient absorption and lead to widespread damage, causing the hallmark symptoms of cyclosporiasis, such as nausea and diarrhea, Barratt says.

A single milliliter of that diarrhea can contain around a thousand of these parasitic pods, Carruthers says.

As far as scientists can tell, people only get sickened by Cyclospora when they inadvertently ingest these pods in food or water contaminated with traces of human waste.

But not when the waste is fresh. “When [the oocysts are] immediately shed, they’re not infectious,” Barratt says. “They have to sit out there in the environment and mature.”

The science isn’t clear on how long it takes for them to become infectious. It could be days or weeks; it may be affected by the seasons.

The parasite can enter the food system from tainted dirt or irrigation water, or germy hands handling the produce. It might be further spread by the industrial washing process, where many pieces of produce are rinsed in the same water.

The Cyclospora pods are hardy: They can remain viable in water or on crops, surviving chlorine, sunlight and cold temperatures.

Infections can linger

Inside the body, Cyclospora infections can last for weeks or months. “It’s much more complex than the typical viral stomach bug that you can pass in a day or two,” says Dr. Bobbi Pritt, a microbiologist at Mayo Clinic and director of its Clinical Parasitology Laboratory.

A combination of certain antibiotics — sold under the brand names Bactrim, Septra or Cotrim — can help by stopping the parasites from replicating and giving the immune system a better chance to clear them, Carruthers says.

Cyclosporiasis isn’t typically fatal, and people’s bodies seem to get better at fighting it off in places where the parasite is more common, including tropical and subtropical regions.

Where Cyclospora is endemic, studies have found that “it tends to be younger people who get the symptomatic infections; older people don’t tend to get symptomatic infections,” Carruthers says. “That would imply that you can build up some immunity to it, but that it may take several exposures to do that.”

It’s a “mystery” why this is a big outbreak year

In the U.S., Cyclospora has been causing more suffering in recent years.

Cyclosporiasis outbreaks detected in the U.S have been “up and down a little bit, kind of choppy,” after large outbreaks in 2018 and 2019, Barratt says. “But this year it’s just going straight through the roof.”

One major reason for cyclosporiasis outbreaks in the U.S. is the imported food supply. “We’re getting produce and other food materials from all around the world. Many of these are endemic countries where people don’t have access to good sanitary facilities,” Pritt says. Human waste containing Cyclospora “gets into the groundwater or it contaminates the plants that are being grown directly.”

Still, it’s a mystery why cyclosporiasis cases in the U.S. are so widespread this year. “It might just have been bad luck,” Pritt says, “with a large dose that was put into products that just happened to be high consumables,” destined for big chain restaurants like Taco Bell, whose shredded lettuce from Taylor Farms in central Mexico has been linked as one source of illnesses in a nine-state cluster. Taylor Farms voluntarily recalled that product on July 17.

Public health authorities are still working to figure out additional sources. In North Carolina’s outbreak, parsley and cilantro may be another culprit, according to the state health department.

In the meantime, health officials recommend washing and cooking fresh vegetables to cut your risk of a gut-busting infection.

Moderna will soon learn the regulatory fate of its mRNA-based flu shot.

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Health Secretary Robert F Kennedy Jr. has long questioned the value of mRNA vaccine technology. And soon the Food and Drug Administration will decide whether to approve a new kind of flu shot built on mRNA.

How the agency rules on the experimental vaccine made by Moderna has big implications for the future of mRNA research.

In February, Moderna president Stephen Hoge was at one of the company’s manufacturing sites, when the head of regulatory affairs, Charbel Haber, approached him.

Almost immediately Hoge knew something was wrong.

“Charbel came up to me and just had a very nervous look on his face,” he says. “And when your head of regulatory comes up and has a concerned look on … [his] face, you take it seriously.”

Moderna had just gotten a letter from the FDA. Hoge rushed with Haber to huddle with a few others in a nearby conference room.

“That’s where you pop it up on a screen and it hits you, you know, right in the face,” Hoge says.

The FDA said it would not review Moderna’s application for its mRNA flu shot, effectively rejecting it.

It was a shock. “We had talked to the FDA at every step along the way, including prior to filing,” he says. “And they had said, you can go forward and submit and we will conduct a review.”

An FDA decision that reverberated

Moderna went public with what happened. The news shook the pharmaceutical industry. There was an outcry over the FDA’s backtracking.

A little over a week later, the agency reconsidered and agreed to review the vaccine after Moderna promised to add a confirmatory study of the vaccine if it makes it to market. In June, a panel of advisers to the FDA recommended that the agency approve the vaccine.

The agency has a Wednesday deadline to make a decision. If the FDA gives it the green light, the Moderna vaccine would be the first mRNA-based flu shot to make it to market. But the FDA’s flip-flop in February has already had a chilling effect.

Rena Conti, a health economist at Boston University, says the industry and its investors will be watching closely because the U.S. market is where they make most of their money. They depend on the FDA to be consistent and fair.

“They don’t want to spend money if they don’t think there’s going to be a way to actually make money on the other end,” she says.

What’s more, the Department of Health and Human Services canceled nearly $500 million in mRNA vaccine research funding last summer.

In response to NPR’s questions about the administration’s actions on experimental mRNA vaccines, an HHS spokesman provided the following statement: “Under Secretary Kennedy’s leadership, HHS is advancing President Trump’s commitment to strengthen public health through gold-standard science, and FDA will continue applying rigorous, evidence-based standards to every product it reviews while supporting innovation that meets those standards.”

Investors in mRNA research are wary

But Hoge says Moderna is holding off on some planned mRNA research until the company knows how things will shake out.

In the world of mRNA, Moderna is a big fish and most of the rest are tiny biotechs with 20 or 30 employees, says Jeff Coller, a professor at Johns Hopkins University who has studied mRNA technology for decades.

“When you see the FDA rejecting a product that comes from Moderna, why is it that my little company would be able to push through?” he says.

Coller says the FDA’s actions combined with the HHS funding cuts spooked the venture capital firms that backed many of the smaller biotechs working on mRNA therapies for conditions ranging from Lyme disease to rare cancers.

That matters to people like 69-year-old Janusz Racz, a retired computer scientist who lives in London. When his doctors found inoperable Stage 3 lung cancer two years ago, it was a surprise.

He’s a runner and sailor and had no symptoms, but the tumor was the size of a golf ball. If he did nothing, his doctors told him he would be dead in a matter of months.

Racz got into a clinical trial in London, where he lives, that made him the first person in the U.K. to receive an mRNA vaccine made by BioNTech, Pfizer’s partner on the first vaccine against COVID-19.

“I decided just to participate because I saw that was a big chance.” he says. “And also, as a scientist … I wanted to participate in such a program to give other patients a hope.”

After a year of regular vaccinations, the cancer is gone. He’s making plans for the future while the study continues for other patients.

But he’s watched as the Trump administration and Health Secretary Robert F. Kennedy Jr. have taken aim at mRNA vaccines.

Racz is a U.S. citizen, so he says he wrote Kennedy a letter.

“I told him my story,” he says. “And this is a new hope for people, for millions of people. And they cut off the hope.”

He says Kennedy never wrote back.

Pooja Gawali and her family left the tin shack in which they’d live and moved into a new apartment building. She helped design their unit, which, she says, gives her much needed privacy and the space to take on a hobby. Her sewing machine occupies pride of place in her living room. The construction project has won an award for its innovative spirit.

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Viraj Nayar for NPR

Pooja Gawali used to live in a one-room home with no indoor plumbing. The walls were tin sheets. The roof leaked when it rained. The 32-year-old shared the cramped space with her husband, her in-laws and her husband’s two brothers.

She never knew what it meant to truly relax, she says. The lack of privacy in her home meant that she always had to always be on alert — conscious of how she sat or behaved.

That’s not uncommon in Sanjaynagar, a crowded slum in the western Indian state of Maharashtra where she lives. On mud lanes slick with goat droppings, homes press against each other. Around 900 people are squeezed into 206 metal shacks.

Today, things are very different for Gawali. In 2022, she moved into an apartment on the second floor of a newly constructed three-story building with 33 units that houses not just her own family but 30 other families from her slum neighborhood. One brother-in-law lives in the apartment below hers; the other in one above. When their home was being built, the family had a request — they wanted their apartments to be connected through an inner flight of stairs. They got that wish –- and more.

“I relish the privacy I have now,” she says. “It’s a joy to be able to live freely. We’re still a tight-knit family, but life is so much easier when everyone has their own space.”

Residents have named the three-story building Swapnapurti — Marathi for “a dream fulfilled.” It’s easy to see why. Each unit has its own living room, a single bedroom, a kitchen, bathroom with running water and balcony. Green plants and benches line the central courtyard. Bamboo screens along the walls  provide natural shade and ventilation.

Children relax outside the newly constructed apartment building.

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Viraj Nayar for NPR

And it’s noticeably cooler. The architects used building materials like bricks made of crushed sand and ash residue that have been found to be effective insulators, deflecting heat.

A revolutionary design initiative called the Sanjaynagar Redevelopment Project is transforming the slum where Gawali lived in stages. It’s a partnership between the local government, charitable donors, nonprofits and family members. Each participating family pays 10% of the costs of construction — roughly $1,000 for a 300-square-foot  apartment —which they fund by taking out low-interest housing loans provided by the social lending platform Rang De. Rang De offers peer-to-peer lending, a financial method that connects individual borrowers directly with individual lenders, bypassing traditional banks. The federal government’s low-cost housing scheme, called the PMAY, contributes $2,500 and philanthropic donors such as the U.S.-based Currystone Foundation contributed the rest.

Even in these early stages, the project is generating praise, winning the Silver at this year’s World Habitat Awards for innovative and sustainable housing projects.

Francesca Lionetti, an expert on housing rights at UN-Habitat, which co-runs the awards, says: “The fact it is community-led means there is a lot of attention on communal areas and social services. It’s showing a path for other communities in India and in other parts of the world.”

Sandhya Janardhan, an architect with the Community Design Agency, the nonprofit that helped redesign the houses, says the project focuses on the design details alongside the deep bonds the community shares.

Sandhya Janardhan, an architect at Community Design Agency, has been instrumental in this project. Here, she is photographed in a balvadi in the heart of the slum — one of seven community recreational centers set up by the state government. It’s a place for children to gather after school, for play and for creating art.

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Viraj Nayar for NPR

“All the apartments are built around a central courtyard,” says Janardhan. “This is a shared space for children to play, with benches where residents can sit and rest, and where community events can be held. The apartments are flanked by wide corridors that bring light and fresh air into the building.”

A sanctuary in the slums

No one was certain this project would succeed. That’s because the organizers had to persuade families to leave the only homes they knew and move into temporary accommodations based on a promise that they would one day return to something better. Their wait spanned three years while their old houses were torn down and rebuilt.

That leap of faith was possible largely because of Snehalaya, a local nonprofit. Snehalaya had been working in the community for years before redevelopment began. Since 2004, the group has run a learning center for children, raised awareness about drug and alcohol abuse and brought doctors and mobile clinics into this neighborhood with very few basic services.

A bird’s eye view of the Sanjaynagar slum in the city of Ahmednagar. The terrace of the new apartment building is visible. Roughly 900 people live in 206 metal shacks or dwelling units.

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Viraj Nayar for NPR

Over time, this sustained presence built deep trust with residents. When redevelopment was proposed, Snehalaya became an important voice, helping families understand the plans, express concerns and prepare for temporary relocation.

Hanif Shaik, a director of education projects at Snehalaya, says the idea began on a motorbike ride through the community in 2016. He wanted to show Janardhan, the architect, around a balvadi in the heart of the slum. It’s one of seven community recreational centers set up by the state government and run by Snehalaya — a place for children to gather after school to play and to create art.

“Slums are easy ground for the spread of addiction, violence and child labor,” says Shaik. “We noted that a lot of these troubles came from the living conditions — dark, dingy homes and no personal space.” It was easy for arguments to break out in these tight spaces; the threat of violence was always imminent. A balvadi provided a safe space but was not really a solution.

Shaik and Janardhan had an inspiration — if they could work together to redesign the slum, it could do a world of good.

They solicited donors. They got the consent of residents. And in 2017, the real work began. “We submitted a proposal [to the local government] to redevelop the slum in the city of Ahmednagar together,” Janardhan says.

A gazillion meetings

The local government provided land, temporary water supply, electricity and sanitation for makeshift camps.

“We gave the residents materials [like corrugated tin sheets, metal scraps and plaster] to create new shacks while their homes were being rebuilt,” says Janardhan.

Snehalaya reached out to a younger generation of slum residents to explain the nitty-gritty details to the others and to help with paperwork. “They played a vital role,” says Shaik.

Anjali Naydu (right) sits with her mother outside her home in the Sanjaynagar slums. Her family is waiting for construction to begin on a new apartment building in which they’ll live. As a community representative, Naydu had meeting after meeting with the members of the community to get them to support the redesign project.

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Viraj Nayar for NPR

Anjali Naydu, who’s 30, is one such representative. She’s been working with Snehalaya for the last 6 years. Her family, including her parents and five aunts, will soon begin the process of moving out. The single room home where she grew up in the middle of the slum is small, but cheery — one exterior wall is painted bright pink. Potted plants line a shelf above the entrance. Sometimes, her mother and father move their bed outdoors so they can have more room. 

“At first, it was hard,” she says of the relocation process. “We had to have meeting after meeting. When we first started work, many people just couldn’t believe that someone would go to all this trouble to make their homes and their lives better.”

Trained as a bedside nurse, Suryavanshi, 26, who is on a break from work to raise her child, serves as a community representative for the project as well.

Pooja Suryavanshi and her child, Rudransh, outside their home in Sanjaynagar.

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Viraj Nayar for NPR

“People have lived here for years, so of course, even if our homes aren’t perfect, there’s an emotional attachment,” she says. “But they’re also happy to move into proper homes. We told them: you have choices. You can choose your building, decide where exactly you want to live within it and even choose your neighbors and be involved in designing your home.”

For many residents living in cramped rooms with adult sons, daughters-in-law and grandchildren, the prospect of additional privacy was attractive. “For example, if there are parents and three grown sons in one slum home, each son can get a separate unit without paying extra costs,” says Naydu. “Slowly, people began to believe in the project. Many volunteered to give it a try.”

After several meetings, a slum committee and eight housing cooperative societies [a collective body of residents who will own, manage, and govern the new housing] were instituted to ensure that the interests of different groups were represented across the project.

“We often forget that slums possess high levels of social capital,” says Janardhan. “These are networks built over the years on trust and solidarity.” For instance, neighbors rely on each other for mutual support during tough times or for childcare. Many NGOs offer free services, like breast cancer checkups, dental checkups, medical outreach for the community.

“Most low-income re-housing programs [in India] displace residents completely from where they’ve lived, moving them to an entirely new location, and they stand to lose all of that. We didn’t want that to happen,” she says.

A “dream fulfilled”

Savitha Yadava is a 42-year-old widow. After her husband passed away several years ago, she could no longer even afford to live in the Sanjaynagar slum. She moved back to her native village with her three children — a son and two daughters. To provide for them, she worked long hours as a farmer.

Savitha Yadava and her daughter, Poonam, 19, pose in their living room of their new apartment. There’s a small shrine in one corner. Decorating her home has become a passion, she says.

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Viraj Nayar for NPR

When the redevelopment project began her in-laws urged her to come back. They said their two sons were eligible for two housing units and though Yadava had lost her husband, they wanted her to bring the kids back to Sanjaynagar and move into the new unit with them..

The decision to return changed their lives, she says. With better lighting, and a home that did not fill up with mud and water during every monsoon, her children began to perform well in school. Her son, who lives with them, had access to better paying job opportunities in the city. Yadava takes pride in decorating her home. “I really enjoy it,” she says. From her son’s income, she’s changed the flooring from cement to gleaming white tiles, added plenty of new wardrobes, a television and a small altar in the corner of the living room. Her college-going daughter Sonali, who is good at art, painted murals on the walls.

As residents have watched the first few families move into the newly designed homes –- and seen how their lives have changed as a result –- interest in the project has grown.

The government could cause some delays. With an ongoing overhaul of housing laws, legal and policy changes are expected. As a result, philanthropic support will likely be paused till the new policy takes effect.

But the project is going to move forward –- and will be “be more cost-effective and self-reliant, ” says Janardhan. For many families still waiting to move in, this has sparked hope. Pooja Suryavanshi’s toddler son is playing with his kittens on the chipped cement floor of their kitchen. “I dream of the day he will grow up in a home with sturdy walls that keep out the wind and rain, and with the possibility of a more secure future,” she says.

Kamala Thiagarajan is a freelance journalist based in Madurai, Southern India. She reports on global health, science and development and has been published in The New York Times, The British Medical Journal, the BBC, The Guardian and other outlets. You can find her on X @kamal_t

Linda Kim, a nurse at the Washtenaw County Health Department in Michigan, has been helping to investigate more than 900 cases of cyclosporiasis locally. Foodborne illnesses are some of the most complex public health investigations, especially with the Cyclospora parasite. That’s because symptoms may not appear for up to two weeks after someone’s eaten contaminated food.

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Kate Wells
/KFF Health News

More than 900 people in Washtenaw County, Michigan have been sickened with cyclosporiasis since mid-June. Linda Kim, a public health nurse, has spoken to more than 100 of them.

Almost everyone’s said the same thing: It’s excruciating, and one of the worst illnesses they’ve experienced.

But on a Wednesday in July, she called one man who said he wouldn’t mind having it again, actually.

“You’re enjoying the weight loss?” Kim said, laughing as she took notes in a small conference room at the Washtenaw County Health Department building, just outside Ann Arbor. “Well, I’m glad to hear that. At least you got something good out of it!”

From one crisis to the next 

Normally, Kim’s supposed to be working downstairs in the clinic, where families wait in the gray plastic chairs in the lobby for free or low-cost immunizations. But she hasn’t been there in months.

In March, Kim was transferred to a different department to help deal with a local measles outbreak that sickened seven people in the county, five of them children. It was an all-hands-on-deck situation; everyone worked overtime. The state issued an advisory urging families in Washtenaw and surrounding counties to get their babies 6 months or older vaccinated ahead of schedule, if possible.

Those contact-tracing calls for measles could be contentious, Kim said. People were suspicious, asking her how she knew they had tested positive, or why they should give her any information.

“People were like, ‘Oh, you’re just trying to restrict my life,’ or ‘You’re just trying to get information out of me and get me in trouble,'” she said. “It’s like, no, we’re actually not doing that at all.”

Public health nurse Linda Kim also did contact tracing during a measles outbreak in Washtenaw County, Mich. She says the cyclosporiasis patients have been much more forthcoming, even volunteering intimate details about their distressing gastrointestinal symptoms. In contrast, some of the people she called regarding measles were more suspicious about her questions and her reasons for trying to track exposures.

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Kate Wells/KFF Health News

As she tried to explain to them, tracing the spread of the highly contagious virus and publicizing possible exposure sites was an effort to “keep it contained, so it doesn’t become something huge.”

The county’s measles outbreak ended in late May. Then in June, reports of cyclosporiasis cases started pouring in: more than 10,000 so far in Michigan.

The cyclosporiasis surveillance has been different, Kim says. Now, people seem eager to divulge even the most graphic details of their illness, such as “pooping their beds, and, like, putting down towels and it’s not enough.”

Since she’s a nurse, such confessions don’t faze her, Kim said. Still, they have hundreds of these calls to make, so they try to keep each conversation to under an hour.

Before reports of cyclosporiasis cases started pouring in this summer, Washtenaw County Health Department staff in Michigan were working to contain a measles outbreak with contact tracing and testing. The county’s outbreak ended in May.

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Kate Wells/KFF Health News

But foodborne illness investigations are complex. Especially for this parasite, Cyclospora. Symptoms can take as long as two weeks to appear after people have eaten contaminated food. And no one remembers what they ate two weeks ago, public health staffers said.
 
The interview process can be extremely detailed. Kim and her colleagues ask people to pull up their restaurant receipts, scroll through purchases on their grocery store apps, even try to recall details such as the exact brand of bagged salad mix they bought, or the type of taco they got at Taco Bell.

“Is that the crunchy one or the soft one?” Kim asked on a recent call, typing on a laptop decorated with cat and vaccine-themed stickers.

Tracing the sources of outbreaks amid funding cuts

Kim has been working with the health department for two years, a period defined by federal funding cuts.

Laina Stebbins, a spokesperson for the Michigan Department of Health and Human Services, said the Trump administration’s sweeping cuts to public health grants eliminated a contract between the state health department and 44 of the state’s 45 local departments that funded 123 full-time employees.

Those cuts also impacted the state’s disease surveillance labs, “reducing funding for equipment maintenance contracts, data modernization and the ability to innovate laboratory processes during emerging disease response,” Stebbins said.

Some of that funding was restored after Michigan won a temporary restraining order against the Trump administration. But Washtenaw’s health department still had to scale back some disease surveillance and outbreak response work. Currently, employees who leave or retire aren’t replaced, except for those on the nursing team, which is hiring but still understaffed.

Staff at the Washtenaw County Health Department in Ypsilanti, Michigan, work to trace the source of the outbreak by conducting detailed, often lengthy interviews with hundreds of people.

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Kate Wells/KFF Health News

The county’s Health Equity Council, which aims to reduce health disparities, including in mental health, was also shuttered suddenly in early 2025. Nearly a year later, it resumed its work, with funding at least through this September.

An employee from the Centers for Disease Control and Prevention had been stationed at the department. During the funding chaos, the worker was fired, then rehired, then furloughed.

A frustrating federal response 

The federal response to cyclosporiasis has felt frustratingly slow, according to Christina Zilke, a nursing supervisor at the Washtenaw health department.

“It took them forever to say that this was lettuce, and fast food restaurants were taking it off the shelves before the CDC ever said what it was,” she said.

It’s not unusual for it to take a long time to identify a specific source for cyclosporiasis — if it’s identified at all, said Gwen Biggerstaff, Deputy Director of the CDC’s Division of Foodborne, Waterborne, and Environmental Diseases during a July 14 press call. That’s partly due to the lag time between exposure and the appearance of symptoms, and the complexity of tracing this particular parasite.

Meanwhile, Zilke’s been stocking the coffee station and bringing in pizza, trying to keep up staff morale. It’s not a reward, she said. “It’s more like, ‘Here’s some food for survival. Here’s a break so you don’t quit.'”

Linda Kim, for her part, remains enthusiastic about the job, but says it’s been a surreal introduction to a public health career: First measles, now Cyclospora.

“If nationally they don’t know what’s going on, how are we locally expected to know what’s going on?” she said. “And also just frustrating to be like, ‘Wow, I don’t think even our government knows how important public health is.'”

But there’s no time to dwell. She has to move on to the next call, as soon as she can wrap up this one. She gives each person her work number, so people can call or text with any follow-up questions.

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 — the independent source for health policy research, polling, and journalism.

What it’s like on the on the frontlines of the public health investigation into cyclosporiasis, in Washtenaw County, Michigan, which just finished with a measles outbreak. Now it’s dealing about 50 confirmed cases/day of cyclosporiasis, all of which need to be extensively documented (contact tracers reach out to the patient or families go over with them weeks of remembering where they ate, their grocery lists, shopper cards, grocery store receipts, etc.). The county itself is having to patch together funding and staff to try to handle all of it. Funding issues: state gave the county money for the measles surge, but it only lasted a few weeks and the needs went on longer. During the measles surge, they had to pull staff off of other jobs, like doing immunizations, to deal with measles. Now the county has to keep those staff on crisis-mode to deal with cyclosporiasis. Kate Wells, KFF Health News. Editor: Carrie Feibel

It’s so hot in Germany this summer that Cologne started a “Cooling Cologne” initiative: Chilled groundwater is dispersed through fine-mist sprays connected to fire hoses.

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Kadir Ilboga/Anadolu via Getty Images

In a summer of extreme heat, we asked our NPR readers to share the ways they keep cool without relying on air conditioning. The responses were practical, personal and inventive — shaped by childhoods without AC, long workdays outdoors and family traditions passed down through generations. From rural Minnesota porches to Syrian balconies, here are some of the strategies they swear by.

Cooling with water

Bridgit Jordan of Minneapolis says she goes swimming in the afternoon and stays in her wet swimsuit for the rest of the evening. “Combined with a fan, this keeps me cool,” she writes.

Olivier El Mekki, of Dijon, France, treats his bathtub as a personal plunge pool, filling it with fresh water for a day or two. “When I feel hot, I bathe in it for one or two minutes,” he says. “When I get out of the bathtub, I can feel the air is hot, but not me.” The inspiration? Cows. “In summer, if there is a tree and some water in their field, you will find them in the shadow of that tree, frequently going to bathe in that water,” he says.

Growing up in Syria, Amber Thompson remembers cooling off with well-timed showers. “In extreme heat, I used to take a cool shower in the middle of the night before going back to sleep,” she says.

Elizabeth Tillinghast, who grew up in Vermont, writes: “Our mother always told us to hold our wrists under cold running water. The many arteries and veins there would rapidly transport the cooled blood throughout our bodies.”

Playing with water

Ezra Musselman, who grew up with no plumbing in southeast Minnesota, recalls cold well water that “would take your breath away” as he and his brothers sprayed each other with squirt bottles and water pistols.

Dayton Bradford reports “no shortage of swimming holes” near his childhood home in southeast Tennessee.

And Barbara Wunder McAslan of Florida found her own solution while mowing her grandmother’s yard: “I brought a pink, inflatable kiddie pool, filled it up and plopped down in it like a whale in a bathtub.”

Fans and airflow

Diane Hinkle of Tennessee grew up before air conditioning was common. Her family used a box fan in an upstairs window to pull in cool night air. “About 7 a.m. we would close all windows to keep the cool air inside for as long as possible.”

Chaudhry Awais Ahmed of Rawalpindi in Punjab, Pakistan, uses a damp towel to turn a pedestal fan into an evaporative cooler. “As the fan pulls air from behind, a good portion of that air passes through the wet towel,” he explains. “The evaporation cools the air and adds a bit of humidity.”

Cool fashion tricks

Mary Richardson of Los Angeles suggests wearing a headband filled with ice cubes. And it’s a two-for-one: “This also helps with migraines,” she says.

“We have gel scarves that tie around the neck,” says Amy Barlow Liberatore of Platteville, Wis. “Cotton scarf encasing a tiny bundle of beads. I soak it overnight until the bundle puffs up, then I tie it around my neck. It keeps me cool all day.”

May Bolden of Tallahassee, Fla., says her husband, who owns a landscaping business, cools off by using ice vests she found on Amazon. “They have insertable ice packs that he changes throughout the day as they melt. He freezes the packs the night before and keeps the replacements in a cooler in his truck.”

Kimberly Wasylina of Texas says she cools her face and neck on sweltering days by rolling up a wet washcloth with ice cubes and slipping it into a baggie. “It’s best if you have a fanny pack strapped to you so you can pack it,” she writes.

And Pat Manly, who worked in construction during Arizona summers, learned from co-workers to dunk his shirt in a 5‑gallon bucket of water. “In 120‑degree heat and direct sun, you’ll stay nice and cool for about 30 minutes,” he writes. But he notes it didn’t work in humid New Hampshire, where he resorted to tucking frozen water bottles under his armpits.

Don’t forget your furry friends

Joan Sheehan of Sacramento, Calif., uses cold packs to cool her pets. “My cat would sit by the freezer and meow for me to get it out,” she writes.

Shade, structures and the outdoors

Jim Gillen of Portland, Ore., recommends minimizing hardscapes — replacing concrete with trees, garden beds and gravel. He recalls families once sleeping in a city park to escape the heat and suggests sleeping on a deck or in the yard as a good (and possibly fun) alternative.

Gina L. Freeman found relief through awnings. Her 1939 home’s bedroom stayed cooler because of an overhang, then she added a canvas awning and blackout curtains to the living room.

Amber Thompson’s childhood in Syria also involved structural cooling: removing carpets for the season, sleeping on balconies and tile floors. “My little brother slept on the marble floor!” she writes.

And Musselman, from Minnesota, even shares some fond memories of sweltering summers:

“The nights were spent sleeping outside on the porch. As we got older and more brave, we moved from the porch to a yellow-and-green tent that was roomy enough for three brothers (plus a cousin on occasion). With the crickets, owls, coyote and whippoorwill, the nights were alive. Watching the moon and stars on a hot summer evening is something that has never been forgotten.”

Timothy Herman leaves a senior center in Curtis, Nebraska. The state is the first in the nation to roll out work requirements for Medicaid, which President Trump created in his 2025 big budget law.

Rebecca S. Gratz for The Washington Post/Getty Images

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Rebecca S. Gratz for The Washington Post/Getty Images

On Saturday, Nebraska will become the first state to remove people from Medicaid for failing to meet new work requirements signed into law by President Trump.

The state’s Medicaid Director Drew Gonshorowski told Tradeoffs in an interview that roughly 200 Nebraskans will lose their coverage on Aug. 1. “We’ve ensured that we have extra steps in place making sure we review any denial multiple times before it goes out the door,” he said. “We don’t want folks falling through the cracks on this.”

Under new federal rules, about 20 million people in 44 states will need to work or volunteer 80 hours per month, attend school or participate in job training to keep their Medicaid benefits. People with disabilities or serious illness, parents of young children, caregivers and other select groups are exempt.

Trump’s big budget law, signed last year, created the work requirements. States must implement them by Jan. 1, but Gonshorowski said Nebraska decided to launch months early in part because he believes these new rules will help people move toward economic stability.

“It is an opportunity to build something that can reach out a hand to our membership,” he said. “Why wait?”

Gonshorowski and other supporters of work requirements argue the policy will help push people out of poverty and save the federal government $325 billion over 10 years.

Opponents point to research that found previous work requirement policies did not lead to more people getting jobs, and many people who lost coverage were either unaware of the rules or stymied by paperwork. Recent estimates vary on how many people will lose coverage as a result of the new requirements — ranging from as few as 3 million to as many as 8.6 million by 2028. That includes an estimated 30,000 people in Nebraska.

In a wide-ranging interview with Tradeoffs, Gonshorowski said Nebraska is well-positioned to take the lead on the biggest change to Medicaid since the Affordable Care Act because it runs its own eligibility system. The state can confirm the compliance of about three-quarters of people subject to work requirements without asking them for additional information, he said.

“I can get on the system, I can make a little request and … without reaching out to the member, we can confirm that they’re compliant with work requirements,” Gonshorowski said.

He added that Nebraska also benefits from its small size and number of people subject to work requirements — about 70,000. “We’re a small state,” he said. “We can really have a hands-on process early on to ensure that all of these decisions are correct.”

The state sent out tens of thousands of letters, text messages and emails, and aired radio and TV ads informing residents of the new requirements. But advocates like Amy Behnke, who leads the Health Center Association of Nebraska, said the state’s notices were confusing and left many low-income people uncertain if the new rules apply to them.

Tradeoffs tested Nebraska’s Medicaid help line and ran into long waits, a dropped call and problems getting through to the Spanish-language line. Nebraska officials said their average wait time is 10 minutes, and Gonshorowski said his team is meeting on a near-weekly basis with federal officials to make improvements to the state’s outreach and communication efforts.

As people begin to lose coverage on Aug. 1, Gonshorowski said he will be watching the number of people who appeal and ask for Medicaid fair hearings to challenge their termination.

“I view this as the ultimate bellwether on whether or not you got your process right on implementation,” Gonshorowski said. “You can imagine a world where a state gets that very wrong because you missed that they had a disability, or you missed that they had earned income every month. That’s the thing that keeps me up at night. That is the one scary number.”

Gonshorowski said his team is working closely with the state’s labor department to connect people who lose coverage with job opportunities.

“We have this new data stream in our program,” Gonshorowski said. “I think that amidst all this controversy, one of those great opportunities in this implementation is for states to use that data for good, too.”

An ad from Rep. David Valadao, R-Calif., highlights affordability challenges for healthcare.

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Republicans campaigning in swing districts are running ads about healthcare after facing criticism of the cuts in the One Big Beautiful Bill Act. Many of these ads target voters over 35 years old and focus on three topics: Medicaid fraud, rural hospitals and affordability.

An NPR analysis looked at video ads on YouTube that ran this midterm cycle, many of which mirror ads on other digital platforms and on television. The analysis includes advertising for candidates in races that are toss-ups or leaning toward one party or the other, as rated by the Cook Political Report.

This is a shift for the Republican Party. Jonathan Oberlander, a healthcare policy expert at the University of North Carolina, said repealing the Affordable Care Act (ACA), commonly called Obamacare, was “target No. 1” for Republican lawmakers after Trump was first elected in 2016. When the Senate failed to repeal the legislation, there was still major backlash against Republicans for attempting to do so in the midterms.

“[The repeal is] probably one of the factors that led them to lose their majority in the House,” he said of the 2018 midterm election, where Democrats won a decisive majority. “It was extraordinarily unpopular, the least popular major legislation of the past 40 years.”

With the passing of the One Big Beautiful Bill Act last year, there are now stiffer requirements for insurance and reduced funding for state programs. About 10 million fewer people are expected to have health insurance in 2034, according to a report by the Congressional Budget Office.

There were about 3 million fewer people enrolled through the health insurance exchanges in early 2026 than when the bill passed, according to the Centers for Medicare & Medicaid.

Since then, Republicans have failed to recover on the issue, with only a third of total voters approving of the Trump administration’s handling of the cost of healthcare, according to KFF’s most recent poll on the issue from April.

Republican candidates are addressing the unpopular reforms early, according to Daniel Hopkins, a professor of political science at the University of Pennsylvania.

“[Congressional Republicans] know that that’s going to be a potent line of attack from their challengers and they have to get in front of it and defend it,” he said.

Reforming Medicaid as a strength 

Rep. Mike Lawler, a Republican running for reelection in a toss-up seat in New York, ran ads on reforming Medicaid, saying the law — which he voted for — reduced the number of able-bodied individuals in the program. He’s also raised the false claim that undocumented immigrants can no longer receive benefits (they are not under a “qualified status” to receive benefits), a topic that plays well with the Republican base.

Focusing on reform plays into a strength of the Republican Party. According to KFF, Republicans outperform Democrats on “addressing fraud and waste in government health care programs” when respondents rated which party they trust more in different areas of healthcare policy.

“What Republican voters want to see from their lawmakers is changes to the Medicaid program,” Ashley Kirzinger, the director of survey methodology at KFF, said.

“They don’t want the program to go away, but they want it to reduce fraud so that the program is more sustainable.”

Notably, around a third of independent voters consistently said they don’t trust either party on addressing costs of healthcare, prescription drugs, keeping corporate interests out of medical care or addressing fraud and waste.

Funds into rural hospitals

Rural hospitals have the highest risk, because they rely on funding that was part of Medicaid expansion in the ACA. Many counties in Lawler’s home state are already in a healthcare crisis, according to a report from the New York State Comptroller last year.

In response to criticism over cuts to rural hospitals, Congress included the Rural Healthcare Transformation Act (RHTA), co-sponsored by Lawler, in the One Big Beautiful Bill Act. The $50 billion in funding from the RHTA doesn’t offset the $137 billion in Medicaid cuts that would directly affect rural areas, though, according to an analysis by KFF.

There’s also an expected gap in implementation, with the threat of “clawbacks,” where money is taken back if states don’t meet outcomes. This is causing states to take a cautious approach to rolling out the programs. Lara Kassel, coordinator for Medicaid Matters in New York, sees a waiting period in coverage for those removed from Medicaid who are waiting for funding from the RHTA.

“It’s an undertaking similar to [other programs] where you have to set up a program, rules, have people apply, and then allocate the money,” she said.

Republicans are trying to take control of the narrative. Maine Sen. Susan Collins has released a series of ads mentioning that she directed $190 million in funds for rural hospitals in Maine.

More than 60% of Maine’s hospitals are in rural areas, one of the highest rates in the country. Medicaid is crucial in keeping rural hospitals operating, covering essential services such as discharges and births. With more than 4 in 10 hospitals in debt, cuts would have major consequences for these facilities.

“They’re sources of safety, economic prosperity and jobs,” KFF’s Kirzinger said. “People in rural areas have a really strong connection to their hospital.”

Making healthcare affordable 

More than half of Americans say that healthcare costs are a high worry for them when voting, according to KFF, and Republican candidates are positioning themselves as fixers.

“Democratic lawmakers were more trusted on healthcare, and Republican lawmakers were more trusted on the economy, so what happens when it’s an economic healthcare issue?” Kirzinger said. “There is an opportunity to gain that lane and be the party that people trust.”

Three Republicans, Rep. Ashley Hinson, who is running for U.S. Senate in Iowa, and Reps. Mariannette Miller-Meeks, also of Iowa, and David Valadao, of California, who are both running for reelection in their districts, have made healthcare affordability part of their campaign messaging. All three are running in states or districts that have shifted away from Republicans in the past year (though Valadao’s district was also redrawn in California’s redistricting last year), according to the Cook Political Report. Miller-Meeks and Valadao are running in districts now seen as toss-ups.

Hinson and Miller-Meeks directed blame for medical costs toward insurance and pharmaceutical companies, organizations with historically low approval ratings. Hinson pointed to working with Trump to lower healthcare costs, while Miller-Meeks, a medical doctor, highlighted her expertise in challenging pharmaceutical companies.

In California, Rep. Valadao ran ads promising to lower costs and protect Medicare and Medicaid. Valadao voted for the OBBBA.

A report by the Urban Institute shows that ACA premiums have risen nationwide 21.7% between 2025 and 2026. Healthcare policy expert Jonathan Oberlander says this is linked to the Trump administration’s hands-off approach toward the healthcare industry.

“[Republican] policy, both on the One Big Beautiful Bill and not renewing the enhanced subsidies and rules and regulations, has been to make it harder for people to get health insurance coverage through the Affordable Care Act and through Medicaid,” he said. “When you take Medicaid away from people, when you take those enhanced subsidies away, it really increases the costs that they face.”

Looking forward

The majority of the changes and cuts enacted in the One Big Beautiful Bill are expected to go into effect after the midterm elections. While some healthcare cuts have already gone into effect, such as the removal of ACA premium tax credits, many other requirements will begin next year, such as frequent redeterminations of eligibility and work requirements, according to Medicaid Matters’ Lara Kassel.

Key changes, like the reduction of Medicaid funding, don’t occur until after this year’s midterms, so candidates see this as an opportunity to emphasize other, popular parts of the law, like tax cuts. Still, Republican lawmakers are laying the groundwork for blame if the opposing party gains power in the future, according to political scientist Daniel Hopkins.

“Some of the key changes, for instance, [like] the reductions in Medicaid funding, are scheduled to kick in years down the road,” he said. “That time disconnect makes it really hard for voters to tangibly feel and react to changes that are in the future.”

That delay will likely set up healthcare to be a top issue for the 2028 election, where Democrats are expected to attack Republicans on the fallout and both parties will have open primaries for the presidency.

“That phasing provides a bit of a buffer for Republicans from the political pain of these cuts,” Oberlander predicted. “[The healthcare cuts will] be fully exposed in 2028.”

Anthony Fauci, former director of the National Institute of Allergy and Infectious Diseases, during a Senate Homeland Security and Governmental Affairs Committee hearing in Washington, D.C. Experts worry that the pursuit of Fauci is helping to create a “chilling effect” on public health staffing and infrastructure in the U.S.

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For almost three hours on Wednesday morning, Dr. Anthony Fauci sat before the Senate Committee on Homeland Security and Governmental Affairs and declined to answer questions about the origins of the COVID-19 pandemic.

Instead, he invoked his Fifth Amendment right more than a hundred times — which later led Sen. Rand Paul, R-Ky., to say he would push to hold Fauci in contempt of Congress next week.

These moves have once again foregrounded Paul’s unproven claims that the SARS-Cov-2 virus came from a lab leak and that Fauci covered it up — a charge the scientist has vociferously denied. But the renewed attacks on Fauci, once the nation’s leading infectious disease expert, have caused Democrats, health workers and researchers to worry that these events may further erode public health staffing and infrastructure in the U.S.

“These firings and these cuts — they’re creating a chilling effect, honestly,” Andy Kim, D-N.J., said at the hearing, while also thanking Fauci and decrying what he called the demonization of public servants. “A chilling effect for the next generation of people who might consider stepping up to serve our nation, to be the next generation of researchers who now are wondering whether or not this is the right thing for them to do at a time when they see some of their colleagues, or those that they looked up to, being attacked.”

Other public health professionals agree that what played out on Capitol Hill earlier this week is part of a larger corrosion of the field to which they’ve dedicated their lives, endangering its future and undermining health outcomes in the U.S.

“I thought that we were healing as a country around COVID-19,” says epidemiologist Katelyn Jetelina. “I think what yesterday did was open some really deep wounds.”

Health freedom

During the pandemic, there was a surge in people asserting their right to reject various medical treatments and public health interventions. It’s a movement that’s often called health freedom.

“People were rejecting things like schools demanding that children be vaccinated for COVID before they return to school,” says Nicole Huberfeld, a professor of health law at Boston University. But those claims, she says, were not based on empirical evidence. “Rather, they were rooted in often religious or moral objections to vaccination.”

There were other pandemic policies that became increasingly unpopular — masking, social distancing, and school and work closures. People may have accepted these restrictions initially, but “that moment wasn’t long-lived in part because there was fairly swift pushback from the top during the first Trump administration,” says Huberfeld.

She says interest in ‘health freedom’ sloped downward during Biden’s presidency but it has spiked again during the second Trump administration. “I think it’s because people take their signals from the leaders that speak to them,” she says. And at this week’s hearing, Huberfeld says Republican lawmakers may have been speaking as much to members of their base as they were to Fauci.

But in her view, such attacks on the man who once helped lead the federal COVID-19 response, combined with a hollowing out of agencies like the U.S. Department of Health and Human Services, add up to a broader assault on the people and programs that keep Americans healthy.

“I think these hearings play into a larger picture,” says Huberfeld, “which is that the field of public health has been devalued significantly by leadership right now. And that devaluing will make it much harder to do the work of public health and it will make it so that the public doesn’t trust public health professionals.”

Dr. Georges Benjamin, the head of the American Public Health Association, says the consequences of that erosion are already apparent. “We are less healthy,” he says. “We’ve seen it every day, right? This inability to respond effectively to hantavirus, measles, cyclospora.”

The results can quickly become dire — especially, states Huberfeld, now that this scenario is compounded by recent sweeping cuts and changes to health care. “I do think there will be more illness and injury, which leads to preventable death,” she says.

Problems in the pipeline

Benjamin argues that public health professionals need to be able to provide educated and evidence-based information to lawmakers and other officials. But he worries that this week’s hearing and the political challenges that Fauci continues to face are likely to be intimidating.

“If you’re going to be threatened by members of Congress, you’re going to be a lot less willing to be frank and speak truth to power and give people the information that they desperately need to make decisions,” he says. “We can’t be tainted by a fear that if we say something, they’ll do something to destroy our careers and maybe put our lives at risk.”

Jetelina, who’s also an adjunct professor at the Yale School of Public Health, is concerned about the public health pipeline more broadly. She’s witnessed enrollment numbers drop and she’s had conversations with her students about their concerns about what a future in the profession might look like.

“We’re just scientists,” she says. “We are never supposed to be on TV and getting croissants thrown at us and death threats. It’s a whole new level of risk, and with risk comes really real calculations that people need to make.”

Jetelina believes that the current environment is forcing individuals to make difficult decisions about what to do professionally, especially in light of what happened to Fauci this week. “If you see someone like this — a public servant for the past 50 years — be just completely vilified,” she says, “it makes me wonder about the next emergency. Like, do I want to raise my hand and put my neck out there?”

In terms of how to move past this moment of mistrust and antagonism, Jetelina argues that the next step is to develop systems where health professionals and the public are engaging in conversation, “where we actually listen to the questions, concerns and confusion around health topics on the ground and then integrate that not only into communications but into operations,” she says. “People are demanding a far more participatory approach.”

And she wants to see something akin to a 9/11 Commission for COVID-19 to figure out “what we got wrong, what we got right and how are you going to fix it for the future.”

There’s no time to waste, says Benjamin, since questioning the legitimacy of science “makes us less healthy as a nation,” more vulnerable to current pathogens and future pandemics, and interferes with the essential objective of the field — treating and healing communities.

NPR journalist Manoush Zomorodi and her latest book, Body Electric: The Hidden Health Costs of the Digital Age and New Science to Reclaim Your Well-Being.

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Flatiron Books/Tory Williams/NPR

The internet at my apartment went out last Saturday. For three full days!

I’m used to having several spigots of information turned on — and drinking from them all at once. The TV, the laptop, the phone and even my tablet, if I was feeling extra thirsty.

It felt terrible.

So you know what I did? I pulled one of my Shakespeare books off the shelf and started re-reading Othello. Because I wasn’t trying to use all my devices at once, I was able to relax and focus.

I’m used to “media multitasking,” a term I learned from TED Radio Hour host Manoush Zomorodi, that describes double- or triple-screening devices. But when you’re consuming too much information, it can be hard to take anything in. And you end up feeling tired and overwhelmed.

Zomorodi talks about how digital habits like this one can drain our attention and energy in Body Electric: The Hidden Health Costs of the Digital Age and New Science to Reclaim Your Well-Being, published in May. Co-authored with behavioral medicine scientist Keith Diaz, the book looks at the physiological effects of our digital lives and offers evidence-backed strategies to combat them.

Zomorodi, who also hosted the NPR podcast Body Electric, talks to Life Kit about the science of information overload. This interview has been edited for length and clarity.

What happens in our bodies when we multitask?

Every time you switch a task, you use glucose. And every time you use glucose in your brain, you’re burning through a finite amount of it, as well as the oxygen it takes to burn it.

Your brain has the ability to clear out the CO2 that’s the remnants from burning all that glucose and oxygen. But at a certain point, it starts to build up if you overload yourself. So that is when you start to feel tired and foggy, mentally fatigued, maybe even feel it in your body.

If you’re multitasking, do the opposite — single-task. One thing at a time, all the way through. Then take a break. Then tackle the next task.

What is the best way to regain focus? 

Take a break, move. Not take a break on your phone, because that’s burning glucose again. Literally get up and walk around the room. That stimulates your muscles. Your muscles can then pump in more blood, which has oxygen and glucose, back up to your brain.

That moment in the afternoon where you’re like, “Oh, I just need chocolate so bad,” well, of course you do. Literally you are light on glucose in your brain. That makes total sense. But if you take a walk, you will refresh your cognitive capacity and protect your physical health as well.

There’s a chapter of the book where you talk about information overload. That feels important to me in my personal life, because I feel like I’m almost getting sick on information. How would you define it? 

It is infomania, a compulsion to take in more information. Sure, I could read all these things, but then do I remember what I’ve read? Am I processing [the information] in a way that’s getting stored in my memory?

No, because I’m not a computer. My brain is not infinite with RAM. We need to be smarter about how we take in [information], how we synthesize it and what our expectations are in terms of using all of it.

What are the symptoms of information overload? 

There was a podcast I did where we asked people what their symptoms were, and some of the things they mentioned were the eye twitch and the inability to sleep because you’ve been looking at screens for so long that you can’t settle down. Also, feeling like you can’t concentrate.

I’ve spoken to researchers, like Gloria Mark at University of California, Irvine, who have studied how we switch our attention. One of the things she has seen is that if you’ve spent an hour switching from screen to screen, checking X, then Instagram and going over to email, even if in the next hour everything calms down and you want to sit down with a single article, you will start switching tasks yourself.

So even if nobody else is interrupting you, you will start interrupting yourself. You will start trying to get information in different ways. It takes time to get into the rhythm that is required for reading something carefully and cautiously.

How do we try to not interrupt ourselves? 

If you catch yourself self-interrupting, have a plan ready. Decide ahead of time how you’ll respond, so your brain reaches for that instead of the phone. I try to have my calendar filled with things that need to be done, not because I like to be busy, but because, that way, I don’t have to think throughout the day.

How do you prevent information overload? 

Think of [yourself] as an information athlete with information goals.

Switching context is an emotional roller coaster and it’s exhausting. It’s burning through your cognitive resources fast.

So think about it this way: What is it that you want to get out of the time with your phone? If you are looking for something for dinner, great. That’s your goal. Then once you’ve achieved [that goal], stop.

Your turn: Did you try any tips from this interview?

Zomorodi would like to hear from you. Did you try setting an information goal to cope with information overload? Make a plan to help reduce self-interruption? Regain focus by taking a break? Email us at lifekit@npr.org with the subject line “To Manoush.” We’ll send her your responses.

The story was edited by Meghan Keane. The visual editor is CJ Riculan. We’d love to hear from you. Leave us a voicemail at 202-216-9823, or email us at LifeKit@npr.org.

Listen to Life Kit on Apple Podcasts and Spotify, and sign up for our newsletter. Follow us on Instagram: @nprlifekit.

Pediatrician John Snyder gives vaccine information to Tenzin Dekey, who had brought her 1-year-old son to Amherst Pediatrics for an annual exam. She accepted the vaccines that Snyder recommended.

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Karen Brown/New England Public Media

Dr. John Snyder, in Amherst, Mass., has been practicing pediatrics for 30 years. Whenever he wanted to find the most up-to-date research on treating young patients, he would turn to the Centers for Disease Control and Prevention.

If he wanted to learn more about an outbreak of measles or hantavirus, he would pore over the weekly CDC report that came by email.

If a patient’s family was traveling to Africa or Asia, he would check the latest CDC vaccine recommendations for overseas travel.

And if family members at his practice in Amherst, Mass., expressed worries about potential side effects from a shot, he could always send them to the CDC’s website to bolster his argument to get the immunization.

Public trust in the CDC has hit bumps in the road during infectious disease outbreaks, but for medical professionals, Snyder said, “the CDC used to be, worldwide, the most trusted source of information pertaining to public health and infectious disease.”

Yet even doctors began losing trust, Snyder said, after Donald Trump was elected president again. Trump quickly tapped longtime anti-vaccine activist Robert F. Kennedy Jr. as his nominee to lead the Department of Health and Human Services, which oversees the CDC.

John Snyder is a pediatrician at Amherst Pediatrics in Amherst, Massachusetts.

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Within months of his confirmation as secretary, Kennedy had dismissed every member of the CDC’s vaccine advisory board and replaced them with new appointees, some of them prominent vaccine skeptics.

“It turned into a completely unreputable source of information,” Snyder said.

This rupture of scientific trust in the CDC has put many pediatricians like Snyder in a bind, as they no longer turn to the United States’ preeminent public health agency and instead search for ways to fill the information gap. Some doctors are launching their own vaccine education efforts, sometimes in collaboration with local public health departments.

On Jan. 5, the CDC removed some vaccines from the recommended vaccine schedule for all children — against the advice of major medical groups like the American Academy of Pediatrics.

The number of recommended vaccines shrank as the agency dropped vaccines for rotavirus, COVID-19, influenza, hepatitis A, hepatitis B and meningococcal disease from the list.

The agency did not respond to a request for comment for this story.

In March, after medical groups sued, a federal judge ordered the Trump administration to revert to the previous guidelines. The administration has appealed the judge’s decision.

A “shocking” thing to tell patients

The back-and-forth “creates a whole bunch of confusion in the public,” Snyder said. “And it’s very confusing even for healthcare providers.”

So he’s trying to be clear to patients about what the evidence shows, even if that means going against the federal government. His practice, Amherst Pediatrics, changed its website to say: “The CDC is no longer considered to be a reliable or legitimate source of information.”

“It’s shocking that we have to say that,” Snyder said. Instead, the site directs families to get information from their own doctor, the state of Massachusetts, or nongovernmental medical organizations including the AAP.

The independent health website Valley Vax is advertised on the sides of buses in Western Massachusetts.

Kiko Malin

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Kiko Malin

In the exam room, Snyder is having more tense conversations with families. He said some parents are explicit that they want to hew to what the CDC recommends. “Even if they don’t say that, we have definitely seen increasing hesitancy and questions,” he said. “All of that interferes with us protecting children.”

On a spring afternoon, several of Snyder’s young patients came into Amherst Pediatrics for routine visits.

“Let’s talk about vaccines,” Snyder said to one mother, Tenzin Dekey, who was there with her 1-year-old. Snyder explained that her son was due for the MMR vaccine, which protects against measles, mumps, and rubella, in addition to the chickenpox vaccine.

“So that’s four shots, two in each leg,” he said, as he handed Dekey CDC information sheets about the vaccines. She glanced at them and agreed to the shots.

Ironically, the information sheets are stamped with the CDC’s logo — as required by law — even though Amherst Pediatrics has explicitly directed patients away from the CDC. Snyder said he hates that disconnect.

“This has been a source of heated discussion,” he said. “How can we be saying, ‘Do not trust the CDC when it comes to vaccines,’ yet here is the information we’re giving our own patients when they’re in the office about vaccines?”

Another mother brought her 14-year-old son for his annual physical. She asked to be identified by only her first name, Melissa, so she could freely discuss her family’s private health issues.

The storeroom of childhood vaccines at Amherst Pediatrics.

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Karen Brown/New England Public Media

Snyder recommended the HPV vaccine, which helps prevent some cancers. Although Melissa had refused the HPV vaccine in a previous visit, this time she left the decision up to her son. He agreed to it. But for other vaccines, she wouldn’t budge.

“I’m a hard ‘no’ on the covid,” she told Snyder.

“We could talk about that if you want,” he suggested.

“I don’t need to talk about it,” she replied.

After the appointment, Melissa said she just doesn’t know whom to trust anymore when it comes to vaccine safety. She used to get information from the CDC but no longer does.

“I worry that it’s been politicized a lot, and I don’t like politics,” she said. “Now I prefer to hear things from people, healthcare professionals.”

Such distrust and confusion inspired Snyder to join an independent vaccine information campaign, along with other pediatric practices and health departments in the Connecticut River Valley of Western Massachusetts.

New coalition launches new website

The campaign’s website, which is promoted in Snyder’s waiting room, is called Valley Vax. It sidesteps the CDC and highlights advice from local doctors and national medical groups, including the AAP.

Valley Vax bought ads on the sides of buses in Western Massachusetts to promote the site, with the faces and testimonials of local doctors including Snyder.

“We wanted something that felt familiar and appealing and that they might be more likely to trust,” said Kiko Malin, director of Amherst’s public health department, who coordinates the Valley Vax effort.

She said the organizers decided not to criticize the CDC outright.

“Some information from the CDC is reasonable. Like they are doing a good job of tracking influenza-like illness rates in the country,” Malin said. “It’s important not to discount an organization completely.”

Still, she said it’s the first time she’s had to contradict health information from the CDC. “That’s not a comfortable place to be in at all,” she said.

Other health leaders are also banding together to get out evidence-based information. At the state level, California, Hawai’i, Oregon, and Washington — frustrated with the CDC — operate the West Coast Health Alliance to “ensure the public has access to credible information.” And governors of 14 states and Guam set up the Governors Public Health Alliance in response to declining trust in federal health agencies.

Locally, some public health departments are partnering with community leaders to reach people who have stopped listening to government institutions but “do have strong connections within their faith community or do have strong connections within their neighborhood,” said Adriane Casalotti, a spokesperson for the National Association of County and City Health Officials.

Like Amherst, many local health departments now direct people to professional medical organizations instead of the CDC, Casalotti said, because advice from those groups may change slightly as the science evolves, but it’s unlikely to change with each lawsuit against the government.

This story comes from NPR’s health reporting partnership with New England Public Media and KFF Health News.

Angie Lowery grows squash, onions, potatoes, and other produce in her backyard garden in Robeson County, North Carolina. She’s tried to improve her health to be able to be there for her grandchildren.

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Andrew Jones/KFF Health News

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LUMBERTON, N.C. — Soybean fields surround Angie Lowery’s home on a plot of rural land in southeastern North Carolina’s Robeson County. Dozens of antique gas station signs, 20 feet tall, dominate her front yard. A framed re-creation of The Last Supper, Lone Ranger posters, and a 3-foot-wide tobacco harvesting basket adorn the walls of her home. A collector, Lowery over the years has amassed remnants of her region’s past.

But behind the house, the 44-year-old’s backyard garden showcases her goals for the future, one that involves a long, healthy life with her kids: collard greens, bell peppers, onions, tomatoes, red and white potatoes, kale.

Angie Lowery’s front yard in rural southeastern North Carolina hosts a small forest of antique gas station signs.

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Andrew Jones/KFF Health News

Like Lowery, many in the small towns of Lumberton and nearby Pembroke are citizens of the Lumbee Tribe who have dealt with heart conditions. The mother of four struggled with obesity and had to take insulin pills and shots daily. But when her first grandchild was born, in 2024, Lowery imagined her own life ending the way her biological father’s did: Daily insulin shots for diabetes. Kidney dialysis treatments at home. Dead of a heart attack at 63. She wanted her grandkids to remember her.

“If I don’t get this weight off me, if I don’t change my eating habits, it’s going to take me over,” she recalled thinking.

So, she expanded her garden. She cut fatty foods and sugary drinks out of her diet, stopped eating fried and fast food, and started moving more. She lost 120 pounds in two years and weaned herself off the daily insulin pills.

The Lumbee Tribe of North Carolina late last year became the 575th tribe to secure federal recognition as a sovereign nation, a milestone that leaders and citizens celebrated in tears. The designation provides federal funding for an array of services, including for healthcare. John Lowery, chairman of the tribe and a state representative, declared that “the biggest benefit” would be access to the Indian Health Service — its clinics and hospitals, as well as funding that it could provide for the tribe to create its own health system.

But Lumbee researchers and healthcare providers say that money won’t be enough. For decades, IHS has been chronically underfunded, with the agency’s budget workgroup estimating that it’s nearly $55 billion short of what it needs this year. And that was before the Trump administration’s cuts to other federal agencies further pinched IHS. Slashes to the Centers for Disease Control and Prevention last year initially included laying off nearly 1,000 IHS employees, and President Donald Trump’s proposed 2027 budget cuts more than $150 million for a program to address diabetes in Native American tribes.

The nearest IHS facility is more than a two-hour drive to another state for most of the 55,000 Lumbee citizens in Robeson County. The county is one of the poorest in the U.S. and has some of the worst health outcomes.

The Congressional Budget Office in 2022 estimated that the tribe could increase IHS spending by $247 million over four years.

The tribe will have to rely on other revenue sources that are now allowed through recognition, such as a casino, to reverse the health disparities their people have faced for decades, Lumbee researchers said.

“None of us can depend on IHS alone, because we just don’t have the resources within that system,” said Donald Warne, a physician, a researcher at the Johns Hopkins Center for Indigenous Health, and a member of the Oglala Lakota tribe. “But it’s a great starting point.”

The IHS did not respond to questions about plans for the tribe’s health system. Tribe chairman John Lowery did not respond to requests for an interview or a list of questions, but he said on a June podcast that he expected healthcare to be the largest portion of the tribe’s budget.

‘Not just statistics’

Eighteen years ago, Andrea Blackburn, a doctor in Lumberton and a citizen of the tribe, was working at a nearby medical center. There, she said, she was taught that patients with certain last names “are often referred directly to cardiac catheterization,” a procedure to diagnose or treat heart conditions.

Blackburn said she realized that common Lumbee surnames carried an expectation of disease.

“Nearly two decades later, I can tell you that reality has not changed,” she told assembled tribal leadership and citizens at a public hearing.

Robeson County’s rates of heart disease, diabetes, and substance use disorder continue to rank among the highest in the state, Blackburn noted. In 2025, more than half of the county’s residents were Medicaid enrollees, the highest percentage of all counties in the state.

“But these are not just statistics to me,” she said. “These are my patients. These are our families.”

For Angie Lowery, breaking free from those statistics meant taking her health into her own hands.

She hopes a healthy diet is the answer to breaking her family’s cycle and living long enough to form relationships with her grandkids. And she brought the rest of the family with her. Her teenage daughter lost about 35 pounds. Two of her other children are now “health fanatics,” Lowery said.

Her granddaughter will be 2 in November. One Sunday morning in March, Lowery served up macaroni, cauliflower, and chickpeas for her as they spent the day together.

Lowery had supported building a casino, believing it would provide better education, infrastructure, and healthcare for her family.

“That vote, I’m thinking of my children’s future,” she said.

Casino dreams in limbo

Tribal citizens are deeply divided over how to reverse decades of economic decline that have led to poor living conditions, unaffordable health services, and chronic disease.

Four months after Trump signed the Lumbee Fairness Act — declaring “I love the Lumbee Tribe” — tribal leaders gathered at a business meeting to take the first steps toward building a casino and establishing gaming as a new revenue source. Hundreds of federally recognized tribes across 29 states have used gaming as a source of revenue, bringing in $43.9 billion in fiscal year 2024, according to the latest report from the National Indian Gaming Commission.

The Lumbee Tribe government offices and citizen housing in Pembroke, North Carolina, stand amid long stretches of agricultural countryside.

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The approach has been popular among tribal nations looking for more dollars to build up healthcare. The Choctaw Nation of Oklahoma in 1999 became the first tribe to build its own hospital, using roughly $25 million in gaming money, and the Eastern Band of Cherokee Indians in western North Carolina funded its own hospital in 2015 mostly with $82 million in gaming funds.

But the Lumbee Tribe’s effort to establish a casino collapsed in June.

More than 60% of voters rejected a Lumbee constitutional amendment that would have allowed tribal leaders to create infrastructure needed for a gaming business. Tribal chairman Lowery said on Facebook that he doesn’t plan on bringing back the initiative now that it was rejected “by the majority of Lumbee voters.” His term as chairman ends in two years.

Other funding sources to provide health services for the tribe could include gas stations or hotels, he said in a call with citizens before the vote.

Lumbee and other Native health researchers said they believe a twofold system — using IHS money and additional revenue — is necessary. Funds from gaming could compensate for what IHS can’t support.

Casinos’ impact on tribal health has been debated in research for decades. Studies show that the money from gaming helps tribes build more facilities, hire more doctors, and improve social services, but unhealthy substance use and smoking increase.

“There’s going to be negative impacts,” Brittany Locklear, a social work professor at the University of North Carolina and citizen of the Lumbee Tribe, said at a June panel discussion on gaming.

Ronny Bell, 62, a Lumbee citizen and a researcher studying Native health at UNC, said the community has felt ripple effects from systemic racism, having not been acknowledged as a tribal nation for so long, and the economic downturn following the loss of Robeson County’s manufacturing and tobacco jobs.

That history plays a part in the health statistics in Robeson today, Bell said. But with federal recognition, he said, the Lumbee people have achieved a victory they’ve fought for since 1888.

“I think about the resilience of the Lumbee people and how they’ve gone through this 100-plus-year fight for federal recognition,” Bell said. “I sort of see that as a continuation of this resilience, and how now we have this opportunity with federal recognition to bring in resources to help address those issues.”

Resolution and uncertainty

Jada Brooks, a Lumbee citizen and UNC researcher who studies Indigenous health and lives in Robeson County, is conducting a study about heart health among Lumbee women. The initiative includes classes in which Lumbee women ages 18 to 50 signed up to discuss their health. That’s where she met Angie Lowery, who talked about her lifestyle changes with the group.

“I was just floored by, like, just the extent to which she went,” Brooks said.

She and other Lumbee researchers said federal recognition allows Lumbee citizens to be set apart in census data, paving a way to get clear information on heart health, cancer rates, diabetes diagnoses, and mental health risks.

“There’s challenges in even understanding the nuances of these complex health disparities, because a lot of data isn’t out there,” said Ryan Dial, a public health researcher at UNC and a member of the Lumbee Tribe.

But access and confidence may be the biggest barriers Lumbee people will have to overcome, Brooks said.

“I think what really matters is people feeling like they can trust the healthcare system.”

Brooks said she worried that a casino would encourage bad health habits, such as smoking and drinking.

“Let’s not create more problems for ourselves than we already have,” she said. She voted against the casino.

Like others in the tribe, Angie Lowery believes in her people’s power to help themselves, regardless of whether government steps in to help.

“Just because we’re federally recognized don’t mean that the doors are going to open up and money’s going to fall through the door like dirt,” she said.

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 — the independent source for health policy research, polling, and journalism.

Members of the Wuhan Hygiene Emergency Response Team leave the shuttered Huanan Seafood Wholesale Market in the city of Wuhan, in Hubei, Province on January 11, 2020. Investigations of the origin of COVID-19 have centered on the animals sold at the market.

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Sen. Rand Paul, R-Ky., faced off with leading COVID-era infectious diseases specialist Dr. Anthony Fauci during a Senate hearing today, bringing renewed attention to ongoing debates about the origins of the coronavirus that caused the pandemic.

Fauci, who directed the National Institute of Allergy and Infectious Diseases from 1984 to 2022, has long supported the theory that the virus jumped from animals to humans.

Paul and the Trump administration say that the virus leaked from a Chinese laboratory, either accidentally or intentionally. In 2025, the Trump administration took down some government websites providing COVID-19 information and replaced them with a page called “LAB LEAK: The True Origins of COVID-19,” dedicated to the controversial theory.

The lab in question, the Wuhan Institute of Virology, is located in the city where the first cases of COVID were recorded.

What does the evidence show?

Supporters of what’s now known as the “lab leak” theory note that the analysis of the virus by scientists relied on incomplete data provided by the Chinese government. They also point to the lack of a smoking gun in previous analyses — an animal infected with SARS-CoV-2, the virus that causes COVID-19, at a market in Wuhan, China.

Some U.S. intelligence agencies have also expressed a low-to-moderate degree of confidence in the accidental lab leak theory.

But virologists who study pandemic origins are much less divided than the U.S. intelligence community. They say there is “very convincing” data and “overwhelming evidence” pointing to an animal origin.

In a report issued in June 2025, the World Health Organization stated: “the weight of available evidence … suggests zoonotic spillover … either directly from bats or through an intermediate host.”

That conclusion was based on three years of research by the 27 members of The WHO Scientific Advisory Group for the Origins of Novel Pathogens.

NPR’s reporting has supported that theory.

A 2024 study in the peer-reviewed journal Cell found multiple lines of evidence showing the virus spilled over from wild animals to humans.

The authors of the study, a team of scientists that includes prominent names such as Michael Worobey and Angela Rasmussen, say the analysis shows with unprecedented granularity that coronavirus-susceptible wildlife and the SARS-CoV-2 virus were mingling, along with human beings, in a very specific part of the wet market in Wuhan.

In two extensive, peer-reviewed studies published in the journal Science in 2022, researchers looked at the distribution of the earliest known cases and found that they formed a bull’s-eye centered at the wet market. If the outbreak had started at the lab, researchers argue cases would’ve spread out from there.

Worobey, an evolutionary biologist who worked on the Science and Cell papers and was at the forefront of the pandemic-origins research, spoke to NPR in 2022 about the data.

“It’s absurd how strong the geographical association is [to the market],” he told NPR.

Worobey said that the likelihood of a coincidence — wherein the virus did come from a lab, even though the first cluster of COVID-19 cases occurred at the market — was “1 in 10,000.”

“The evidence is amongst the best we have for any emerging virus,” he said. “It’s important to note we haven’t found a related virus from the intermediate host. But we have a bunch of other evidence.”

Preparing for the future 

Many scientists still express the need to keep an open mind if new information about the pandemic’s origins surfaces.

In the WHO’s 2025 report, the authors note ongoing uncertainty about the pandemic’s origins. They wrote that much of the information needed to assess the lab leak theory had not been made available to them.

“While a zoonotic origin with spillover from animals to humans is currently considered the best supported hypothesis by the available scientific data, until requests for further information are met or more scientific data becomes available, the origins of SARS-CoV-2 and how it entered the human population will remain inconclusive,” the report states.

WHO director-general Tedros Adhanom Ghebreyesus offered this perspective: “As things stand, all hypotheses must remain on the table, including zoonotic spillover and lab leak. We continue to appeal to China and any other country that has information about the origins of COVID-19 to share that information openly, in the interests of protecting the world from future pandemics.”

That call for a forward-looking perspective has been echoed by many in the scientific community.

“In my view it’s important to keep investigating this question with an open mind while also proactively taking steps to minimize the risks of both future research-related and zoonotic outbreaks,” evolutionary virologist Jesse Bloom wrote in an email to NPR.

Some scientists, including Felicia Goodrum, a virologist at Dartmouth College, are concerned Sen. Paul’s ongoing focus on the pandemic’s origins, particularly Fauci’s personal notes, may erode public trust in research.

She believes the goal is “to sow distrust in science and scientists,” Goodrum said to NPR on Monday from the American Society for Virology meeting in Minneapolis.

She says many virologists are concerned that funding cuts and the ongoing tension regarding the pandemic’s origins are already hindering research focused on preventing the next pandemic.

“We are less safe. We are less prepared for a pandemic right now than we were in 2019,” says Goodrum. “And this is terrifying to all of us.”

Premiums for Medicare Part D drug coverage could rise next year because subsidies to insurers are set to end.

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The Trump administration is ending subsidies that helped keep costs down for Medicare drug coverage. The change could mean higher Medicare Part D premiums for millions of beneficiaries in 2027.

Under the Inflation Reduction Act of 2022, Medicare patients’ out-of-pocket drug spending was capped at $2,000 starting in 2025, and it changed the way insurers pay for drugs.

That meant that while seniors would have to pay less at the pharmacy counter and therefore have easier access to expensive prescription drugs, insurers would be on the hook for more of the bill.

At first, insurers didn’t know how much more they’d be spending — or how high to set premiums. To ease the transition for insurers, the Biden administration created temporary subsidies to stabilize premiums through what’s called a demonstration project.

The subsidies were expected to last through 2027, but they’re ending a year early.

Dr. Mehmet Oz, who oversees the Centers for Medicare and Medicaid, made the announcement on the social media platform X. “The Biden admin gave BILLIONS of taxpayer money DIRECTLY to Big Insurance Companies,” he wrote. “This is unacceptable.”

CMS estimated that the subsidies would cost $9.8 billion in 2025 and 2026, according to a report by the Government Accountability Office published in February. About 23 million people were enrolled in standalone Medicare Part D drug plans in 2025, according to the report.

Oz went on to say that the subsidies are no longer needed, adding that most people with Medicare will pay less than $10 more in premiums next year.

But it could be more than that, says Juliette Cubanski, vice president and director of the Program on Medicare Policy at KFF, the nonpartisan research organization. This year, the subsidies reduced the average drug plan premium by $16.

“That might not sound like a lot of money to some people,” she says. “To put it in context, the average premium now for drug coverage through standalone plans is $36. So people might have had to pay nearly 50% more for drug coverage this year without this demonstration.”

She says until CMS releases more information in the fall, it’s hard to know exactly how much more money seniors will have to spend.

Stacie Dusetzina, a professor of health policy at the Vanderbilt University School of Medicine, says while the subsidies were never meant to be permanent, ending them now is concerning.

The subsidies have been most helpful for standalone Medicare drug plans rather than Medicare Advantage plans, which have more flexibility to keep premiums low. As a result, removing the subsidies will affect people with traditional Medicare plans the most, she says.

“Project 2025 was pretty blunt about wanting to push more people into Medicare Advantage,” she says, referring to the Heritage Foundation’s blueprint for a second Trump presidency. “One way to really accelerate that is to make it very expensive to stay in traditional Medicare.”

To avoid the higher premiums for drug coverage, patients may move away from traditional Medicare plans and toward Medicare Advantage plans. While Medicare Advantage may have lower premiums, she says there are tradeoffs, including a more limited network of providers and hospitals that accept Medicare Advantage.

“That also requires you to think pretty far in advance about your long-term health needs,” Dusetzina says.

Sen. Rand Paul (R-KY) questions Dr. Anthony Fauci during a Senate committee hearing about the federal response to monkeypox in September 2022. Fauci is set to appear before a different Senate committee on Wednesday to answer questions about the origins of COVID-19.

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Newly released diary entries Republican lawmakers say were written by Dr. Anthony Fauci – the country’s leading infectious disease specialist during the COVID-19 pandemic – chronicle Fauci’s daily life between December 2019 and December 2022.

The over 1,100 pages of entries span the final years of his tenure as director of the National Institute of Allergy and Infectious Diseases (NIAID). He retired in December 2022.

Sen. Rand Paul, R-Ky., posted the documents over the weekend, took them down on Monday evening and reposted them by Tuesday morning with redactions. Paul also released a 465-page “prequel,” a collection of Fauci documents including records and email exchanges from 2001 to 2015.

This was all in advance of Wednesday’s Senate hearing, where Fauci will testify.

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Debate that won’t abate

The hearing follows years of debate about the pandemic’s origins, and whether the virus that causes COVID-19 emerged from a Chinese laboratory.

Paul chairs the Senate Homeland Security and Governmental Affairs Committee, and subpoenaed Fauci as the latest move in the pair’s public disagreement about the origins of coronavirus.

In a thread on X over the weekend, Paul wrote that the diary entries show what Fauci “wrote privately and what he told the country are two different stories.”

A spokesperson for Fauci sent a document fact-checking Paul’s claims and a letter written by Fauci’s legal team to Paul last month. In that letter, Fauci’s lawyers wrote Paul was waging a “years-long public crusade” against Fauci.

“You are single-mindedly fixating on seeing Dr. Fauci prosecuted for imaginary crimes, and you are so invested in that outcome that you have created a personal brand around it,” says the letter, which NPR reviewed.

Paul did not respond to NPR’s requests for comment in time for publication. It is also unclear how Paul obtained the Fauci diary documents, though a video posted Tuesday on X by Health Secretary Robert F. Kennedy Jr. mentions digging them “out of 11 separate servers.”

What Fauci’s notes reveal

At first glance, Fauci’s notes show him dealing with his increasing fame: including references to new security details, police guarding his home, celebrity encounters and “becoming an international celebrity” himself. The notes have the sentence fragments and typos of someone quickly recording their thoughts.

“Big front page article abut me appeared in the Washington Post,” Fauci writes on May 21, 2020. “Very flattering. The situation with my national and international fame is explosive and really unimaginable. It is not hyperbole to say that today I am the most famous and talked about person in the country and one of the most recognizable peson in the world.”

But the entries also show Fauci reacting with increasing alarm to case counts and the death toll and wrestling with questions about how the virus spread.

Consensus for natural origin

The current scientific consensus is that the virus is likely natural in origin. That means many scientists think the available data suggests COVID-19 started when someone in China was infected by an animal carrying the virus.

However, another theory popular with some researchers and President Donald Trump suggests SARS-CoV-2, the virus which causes COVID-19, spread from a Chinese government lab in Wuhan that was working with bat coronaviruses.

Paul alleges Fauci’s notes show he covered up evidence supporting this “lab leak” theory.

On Paul’s website, he points to Fauci’s entry from Feb. 1, 2020, detailing a conference call between Fauci and prominent scientists.

In his notes, Fauci writes “there was not total agreement” about the virus’ origins during the call.

Later in his entries, however, Fauci writes he “is almost certain that the virus evolved naturally from a species jump, even though… I keep an open mind about the possibility of a lab leak,” and “that just because two alternatives are possible that does not mean that they are equally probable.”

Many scientists say this thought process reflects how their consensus changed as the understanding of COVID-19 evolved.

Felicia Goodrum, a virologist at Dartmouth College who spoke to NPR on Monday from the American Society for Virology meeting in Minneapolis, says the questions in the early days of the pandemic about the lab leak were “normal scientific questioning,” when scientists knew very little about how the virus spread.

“I think that’s what we acknowledge that Fauci was doing, that there’s of course a plethora of unanswered questions,” she said of the early days of the pandemic. Now, though, she says those questions are presented as “some sort of signal of guilt that they knew that this was happening.”

Gigi Gronvall, a biosecurity expert and immunologist, similarly says these kinds of questions are part of scientific exploration.

“It’s not unusual that people would be entertaining a variety of opinions or thinking about a lot of different theories and holes in their theories as they go forward,” she says. “That’s kind of what science is all about.”

The ‘lab leak’ theory and ‘gain-of-function’ controversy 

The focus of the lab leak theory is the Wuhan Institute of Virology in China.

Part of the ongoing controversy has been whether a U.S. nonprofit helped the Wuhan Institute facilitate what’s known as “gain-of-function” research that some believe led to the pandemic.

This kind of research involves experimenting with viruses and other pathogens in ways that give them new abilities. Often, this can help researchers better understand how the viruses work, or how they might become more dangerous or transmissible. The field has long been controversial because of the potential for dangerous pathogens to spill out of labs and cause a pandemic.

The group in question was a U.S. nonprofit called EcoHealth Alliance that researched bat coronaviruses. This included a years-long project in China, which EcoHealth ran in collaboration with the Wuhan Institute of Virology.

At the end of April 2020, the U.S. government stopped funding the project.

Many experts disagreed with the decision, saying that work was vital to preventing the next major coronavirus outbreak. The nonprofit’s president at the time, Dr. Peter Daszak, said terminating coronavirus research posed a threat to national security and public health.

In January 2025, the U.S. Department of Health and Human Services (HHS) cut off all funding for EcoHealth and Daszak.

President Trump also restricted funding for gain-of-function research with an Executive Order in May 2025, and on Tuesday the U.S. Department of Health and Human Services (HHS) released a policy it says will establish more oversight for this kind of research.

What does the evidence say? 

The Trump administration advanced the theory that the pandemic was caused by the virus escaping the Wuhan Institute of Virology. Leaked cables from the State Department raised concerns about safety protocols at the Wuhan lab.

But as information evolved, scientists cast doubt on what came to be known as the lab leak theory. NPR’s Geoff Brumfiel and Emily Kwong spoke to 10 leading scientists in 2020 who all believed the virus spread from animals to humans. They said their analyses of the virus showed no signs of human genetic modification, and that it infected people in a way scientists had never seen before — making laboratory engineering unlikely.

The following year, in February 2021, a joint investigation between China and the World Health Organization (WHO) similarly concluded that COVID-19 likely started in bats and made its way into humans via another animal.

At the time, however, the WHO Director-General Dr. Tedros Adhanom Ghebreyesus criticized the report, saying the team hadn’t done enough work to completely rule out the lab leak theory.

U.S. government agencies continued to investigate the pandemic’s origins in the following years.

In August 2021, U.S. intelligence agencies failed to reach a firm conclusion — and remained divided on the origins of COVID-19.

In 2023, the U.S. Department of Energy concluded, “with low confidence,” COVID-19 originated from a lab leak. This was in direct conflict with many scientists who study the origins of pandemics, who said much of the evidence still pointed to a natural origin.

A Republican-led Select Subcommittee on the Coronavirus Pandemic concluded in December 2024 that a lab leak was the most likely explanation for SARS-CoV-2. They also suggested NIH funds contributed to gain-of-function research at the Wuhan Institute of Virology.

A plea for open minds and preparation

Some scientists say there is simply not enough information to make a firm conclusion about how the outbreak began.

“In my view it’s important to keep investigating this question with an open mind while also proactively taking steps to minimize the risks of both future research-related and zoonotic outbreaks,” evolutionary virologist Jesse Bloom wrote in an email to NPR.

Goodrum says the focus on Fauci’s stance may erode public trust in research.

“I think they’re trying to sow distrust in science and scientists,” she says.

She says many virologists are concerned that funding cuts and the ongoing tension regarding the pandemic’s origins are already hindering research focused on preventing the next pandemic.

“We are less safe. We are less prepared for a pandemic right now than we were in 2019,” says Goodrum. “And this is terrifying to all of us.”

Joseph Kim contributed to this report.

Protesters gather at the opening ceremony of the 26th International AIDS Conference in Rio de Janeiro, Brazil, on Monday.

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“Rethink. Rebuild. Rise.”

That’s the theme of this year’s International AIDS conference, which began this week in Rio de Janeiro.

“Rethink” is perhaps an understatement.

This year, there are encouraging signs regarding the ongoing epidemic — even though 1.2 million people acquired the virus in 2025, the number of AIDS-related deaths was 547,000, the lowest number in 30 years.

Yet the fate of the global campaign to end AIDS as a public health threat by 2030 is now in doubt, as the Trump administration’s aid cuts have taken a tremendous toll.

“The question is no longer whether [we] can end AIDS, the question is whether we choose to end AIDS,” Winnie Byanyima, the executive director of the agency UNAIDS, said at a press conference on Monday. “When prevention disappears, infections rise. When treatment is interrupted, people die.”

“The HIV pandemic is not over,” she said. “Without urgent action, it could resurge.”

Even the future of her agency, which leads the global effort to conquer the disease, is uncertain.  The U.N. secretary-general proposed sunsetting the organization by year’s end as part of an effort to shrink the U.N. system. After pushback, a final decision has not yet been made.

Against this uncertain backdrop, the some 6,000 HIV researchers, professionals and activists at the conference are indeed rethinking: How do they address the funding disruptions and cuts by the United States, the single-largest funder of global HIV/AIDS programming, whose $6.7 billion support dropped to $4.6 billion last year? How do they respond to new research that points up deep disparities in who has access to care — and ensure that new medications for people living with HIV, which have shown great promise in trials, reach everyone in need?

“The last year has been a year of mixed feelings,” Dr. Kenneth Ngure, a public health expert and president-elect of the International AIDS Society, told NPR. “We have had very good scientific advances of the new products, yet the funding cuts have also taken us back.”

A focus on PEPFAR

Over the five days of the conference, the focus will be on the impact of cuts to the President’s Emergency Plan for AIDS Relief (PEPFAR), the acclaimed program launched by President George W. Bush.

The Trump administration slashed 30% of PEPFAR’s $4.7 million funding last year. Congress attempted to reinstate the funding to previous levels, but the State Department, which runs PEPFAR, only reported spending 70% of available funds.

A shuttered clinic in Kitwe, Zambia, that had been funded by the U.S. foreign aid agency USAID. The clinic provided free HIV medications and treatment to the community until it was suddenly closed in January 2025 after the Trump administration halted the vast majority of U.S. foreign assistance in light of their America First agenda.

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After this year’s back-and-forth, another funding milestone looms: The Trump administration has announced it will permanently cease PEPFAR funding by early 2027.

As the conference kicks off, new surveys of PEPFAR grantees are being shared, indicating the impact of these cuts and delays.

The nonprofit amfAR, devoted to AIDS research, education and prevention, will present the results of its survey of recipients of PEPFAR funding conducted between November 2025 and April 2026.

Among the findings:

Most organizations reported scaling back services in response to the cuts and restrictions on the usage of their funding.

A total of 1,714 clinics, drop-in centers and other providers shut down.

Community-based programs were more affected than those provided by large international aid groups.

Prevention programs aimed at men who have sex with men, transgender people, sex workers and people who inject drugs were hard-hit.

“The PEPFAR that survived is not necessarily the PEPFAR that existed before,” says Elise Lankiewicz, a policy associate for amfAR.

Asked to respond to these findings, the State Department sent a statement to NPR saying that it could not verify the amfAR report but called its methodology “flawed.”

The statement further noted that the Trump administration has “strengthened PEPFAR through clear strategic direction.”

Also on the agenda: New treatments

The week’s conference will also include presentations on successes, including trials of two HIV medications: A twice-yearly injection and a weekly pill.

Over the course of a year, the trials showed that lenacapavir injections had “superior efficacy” in preventing HIV transmission compared to daily oral medications, the researchers wrote. The weekly pills were also shown to be just as effective as a daily dose and had relatively few side effects.

These options make it easier for people living with HIV to keep their viral load suppressed to a level that is undetectable, protecting their health and preventing them from passing HIV on to their partners. The medications can also be used preventively, for people at a high risk of contracting HIV.

Yet the funding cuts could keep this medication out of reach for many people living with HIV, says Dr. Kenneth Ngure of the International AIDS Society.

“We are not too sure whether these products will be able to be scaled up, and whether they are going to reach the people who need them most,” he says.

Dr. Anthony Fauci, former Director of the National Institute of Allergy and Infectious Diseases, testifies before the House Oversight and Accountability Committee Select Subcommittee on the Coronavirus Pandemic on June 03, 2024 in Washington, DC. Fauci is expected to appear before the Senate Homeland Security and Governmental Affairs Committee on July 29, 2026.

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Sen. Rand Paul, R-Ky., published a tranche of diary entries over the weekend made by Dr. Anthony Fauci during the COVID-19 pandemic. The 1,141-page document, which was released over the weekend and was no longer available on the website on Monday, came ahead of Fauci’s appearance before a Senate committee on Wednesday. The entries, and Paul’s commentary on them, highlight the disagreement between the former director of the National Institute of Allergy and Infectious Diseases (NIAID) and some politicians over the origins of the coronavirus.

Paul and Fauci — who served as a key member of the White House’s Coronavirus Task Force — have disagreed publicly for years over how the pandemic began. Even after Fauci stepped down from his position at NIAID at the end of 2022, Paul has continued to conduct an “investigation into the origins of COVID-19 and risky taxpayer-funded life sciences research.”

On Saturday afternoon, as part of this ongoing inquiry, Paul published a thread on X describing the release of a string of what he called diary entries made by Fauci from December 2019 through December 2022. Paul commented on X at the start of the posts, “What [Fauci] wrote privately and what he told the country are two different stories.”

Fauci and Paul did not respond to an NPR request for comment prior to publication.

Felicia Goodrum, a virologist at Dartmouth College who spoke to NPR from the American Society for Virology meeting in Minneapolis, says that it’s possible that Fauci may have been less certain in private with his colleagues as they were racing to learn about the new virus than he was in public where he had to assure a population that was panicking over the rapidly emerging pandemic.

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This thread emerges ahead of a scheduled hearing on Wednesday before the Senate Homeland Security and Governmental Affairs Committee, which Paul chairs. Paul unilaterally subpoenaed Fauci to testify after he said that Fauci notified the committee that he wouldn’t appear voluntarily. Lawmakers are expected to question Fauci about what he knew and didn’t know as the pandemic was unfolding.

What is Rand Paul looking to hear from Anthony Fauci?

For years, Paul and Fauci have differed over the origins of SARS-CoV-2, the virus that causes COVID-19. Fauci has asserted that the scientific evidence points to a spillover — whereby the virus would have found its way from an animal into its first human host, and then spread at that point from human to human.

Proponents of this theory point to the wet market in Wuhan where potentially infected animals were waiting to be sold. “There’s very good evidence that there are two lineages [of SARS-CoV-2] that emerged,” according to Goodrum. “Both of those lineages were present at the market, and susceptible animals were present at the market.”

Goodrum says the market was cleared before it was possible to take any samples. However, she says the genetic data “maps all initial cases to that market” and “none to, for example, the Wuhan Institute of Virology, where they have accused the virus of having been created or released.”

Most scientists in the virology community share this view, according to a survey published in February 2024 by the Global Catastrophic Risk Institute, a nonpartisan U.S.-based think tank that studies potentially catastrophic events.

Paul has advocated for an alternative explanation. He says the possibility that the virus was engineered in a lab should not be discounted. Two years ago during a full Senate committee hearing, Paul said, “Do we know for certain it came from the lab? No, but there’s a preponderance of evidence indicating that it may have come from the lab.”

In late 2024, the Republican-led Select Subcommittee on the Coronavirus Pandemic published their final report that concluded a lab leak was the most likely explanation for the origins of SARS-CoV-2. They suggested that funds from the NIH may have helped support research by the Wuhan Institute of Virology to make a more potent or transmissible virus. Such viral enhancement is called gain of function.

But Robert Garry, a virologist at Tulane University, says he disputes this line of reasoning because there is “no actual evidence for it.” And he says that no one, including the Wuhan Institute of Virology, had a precursor virus similar enough to SARS-CoV-2 to create the pathogen that ultimately caused the pandemic.

Still, Paul suggests that Fauci, his colleagues, and certain federal agencies may have covered up any evidence to support the lab leak theory. In his view, he said in that same statement, they “withheld and continue to conceal crucial information from both Congress and the public.”

As noted, NPR reached out to Fauci about Paul’s comments, but did not receive a response before publication.

What does Paul say these newly published diary entries reveal?

In his posts on X, Paul highlights a few select excerpts from Fauci’s notes. For instance, he points to an entry on Jan. 26, 2020, not quite two months before the World Health Organization declared a global pandemic, where Fauci writes, “the first infection was in early December and was not connected to the market. … Now we know the market was not the source, it was the amplifier.”

Paul notes in his post, “The wet market was already off the table in [Fauci’s] own private notes.”

But in that same journal entry, Fauci adds, “Having said that, somewhere the virus jumped from animals to humans.”

Not quite a week later, in an entry penned on Feb. 1, 2020, Fauci listed the dozen researchers who participated in a conference call debating the origins of COVID-19. Specifically, they were talking about the plausibility that a key part of the SARS-CoV-2 genome could have evolved naturally.

According to his notes, only two of the scientists voiced support for a natural origin of SARS-CoV-2. “The rest felt that deliberate insertion was possible,” he wrote, referring to the hypothesis that the virus was engineered in a lab.

In response to that passage, Paul wrote on X, “This was never a 50/50 room,” suggesting that early scientific consensus considered a lab leak possible.

But Goodrum says that this meeting took place very early on, when scientists did not have as much data as they would later. The virologist points out that science is iterative and takes time to play out. What some of those scientists believed at the start gave way to a different consensus as more evidence emerged.

“We make the best conclusions we have with the data we have at the time, but then you’re going to keep working,” she says. “And then you’re going to ultimately revise the original conclusions that you made. You will change your mind. That’s absolutely fundamental to the way science is done. And it’s something that Fauci wasn’t really given any latitude to do.”

Goodrum adds that it’s possible that Fauci may have been less certain in private with his colleagues as they were racing to learn about the new virus than he was in public where he had to assure a public panicking over the rapidly emerging pandemic.

What happens next?

Fauci and Paul will again face off publicly on Wednesday when he testifies before the senator’s committee. Paul is likely to ask Fauci about the contents of his notes and the specific lines of concern that he identified in his thread on X.

Fauci may respond to the questions as he has before, describing his thought process and that of his colleagues at different points throughout the pandemic.

Previously, Fauci has expressed disinterest in questions about unproven claims regarding the pandemic. On Aug. 24, 2021, he wrote in his diary, “More conspiracy theory like letters keep coming in from congressmen and senators trying to link us to the origin of COVID-19. This is an amazing and unbelievable waste of our time.”

But in his thread over the weekend, Paul argued this wasn’t a waste at all. Rather, “it’s oversight.”

Aerial view of historic row houses in the Riverside neighborhood of Baltimore, Maryland.

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In March in a McDonald’s parking lot off a busy Baltimore street, mental health clinician Michala Williams met a 38-year-old woman in a car.

“So, you called the police for help?” Williams asked the woman, who was sobbing uncontrollably and said she sometimes thinks about harming herself.

She told Williams she has children ranging from age 2 to 22, she was dealing with health issues, and that her fiancé had recently been jailed. She felt so overwhelmed she couldn’t eat.

The woman, who asked not to be named so that she could freely discuss her mental health, explained she’d tried to get help the previous month by driving to the hospital but got pulled over on the way because her car registration had expired.

“I don’t care if I get pulled over,” she said. “But I was saying, ‘I don’t know what to do. I just want to go to the hospital.'”

The officer arrested her for acting erratically, so instead of going to the hospital she went to jail.

“I had to sit inside of a cold cell. I couldn’t use the bathroom or anything,” the woman said.

On the day she met Williams, she’d decided to call 911. The dispatcher recognized the woman didn’t need a police response but instead needed one of Baltimore’s mobile crisis teams, which send a clinician and a peer counselor to meet people in mental health distress.

By the end of an hourlong conversation, Williams set the woman up with referrals to a psychiatrist, a therapist, legal help, and a case manager to determine if her child with autism was eligible for government services.

Dispatchers take calls for mental health crises at the Behavioral Health System Baltimore office. They can send out a mobile response team to help people who are experiencing distress, but don’t need police intervention.

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“She’s been through a lot of trauma, and no one is going to deny that,” Williams said. “But I now have to take all of that and decide, ‘OK, here’s steps 1, 2, and 3,’ because we got to find a little bit of sliver of something to give her some hope that there’s help out here.”

Problem solving 24/7, without badges, guns or handcuffs

For years, the mobile crisis teams, which are overseen by Behavioral Health System Baltimore, a nonprofit that acts as the city’s mental health department, have diverted calls from police to mental health professionals. However, the units have a limited scope, focused on people in mental health crises.

Now Baltimore is tapping into some of the roughly $400 million it has received from opioid-related legal settlements to build out a broader service to operate around the clock and respond to other kinds of crises when police aren’t needed.

Baltimore logged 1.68 million calls to 911 in 2024, but tens of thousands of them didn’t require traditional emergency services, like police, firefighters, or EMTs, according to Tahir Duckett, an expert in community safety at Georgetown Law.

Instead, the calls were about, for example, a homeless person who fell asleep in a store, a person who seemed confused in a public park, and someone who was yelling at passersby on the street.

Such calls “don’t require a badge, a gun, and handcuffs to resolve,” Duckett said.

Often those people end up in jail instead of getting the help they need, he said.

A study recently found that when a non-law enforcement team responded to 911 calls in Durham, North Carolina, it resulted in fewer arrests than when police responded — especially for callers who were Black, men, or ages 25-39.

Police responses can also lead to trauma for that person or a less satisfactory outcome than another community service response would produce, Duckett said.

The idea behind the Baltimore mobile crisis teams — and the new service — is to find out what people in crisis may need and how to connect them to those resources instead of arresting them.

How a legal windfall will pay for expanded 911

From 2021 to 2025, Baltimore’s homicide rate decreased by 60%, setting records for the drop in violence. But at the same time, drug overdoses made national records, as about 1,000 people here died of an overdose each year from 2020 to 2023.

In 2018, Baltimore opted out of a global settlement that other jurisdictions made with opioid makers and distributors and instead sued them independently.

As these opioid-related lawsuits settled, city officials decided that the settlement awards it receives must be spent on drug-related harms — or on services that help prevent addiction such as housing support, healthcare, and education.

One new program seeks to directly address overdoses by placing boxes of the overdose reversal drug naloxone at every subway stop.

Expanding 911 services is part of a larger strategy to beef up city services, with $15 million in settlement funds allocated so far, according to Sara Whaley, Baltimore’s director of overdose response.

Whaley hopes the expansion will help the city think differently about how it responds to residents in crisis — regardless of why they’re calling 911.

She views the calls as an opportunity to help solve a problem rather than be punitive. “What are the wraparound services and support that can help prevent them from being involved in this, in that emergency system?” she said.

For example, the person falling asleep in a store may need connection to community housing. The goal is to reduce violence, get people proper resources, and avoid the cycle of incarcerating people dealing with poverty, addiction, and mental health.

‘The right response at the right time’

Rebecca Neusteter, executive director of the Health Lab at the University of Chicago, studies the impacts of services like these. She said they offer peace of mind for callers that “they’re going to be met with the right response at the right time.”

“We also see responders themselves feeling like they have a better toolbox in their ability to pursue actual resolution to these calls,” she said.

To expand its system, Baltimore looked to cities — including Durham — that have adopted similar models to reroute callers who don’t need emergency responders.

Durham’s diversion program is called the Holistic Empathetic Assistance Response Team, or HEART. The program estimates it has diverted more than 12,000 calls in four years. It said police backup was needed for only 0.02% of those calls and that response times have improved for all types of 911 calls.

Durham has collected descriptions of the HEART calls, showing that nonpolice responders in Durham have helped with everything from finding housing for a woman fleeing domestic violence to setting up medical appointments for a homeless veteran.

In one case, a hotel manager called 911 asking for help finding a blind man housing for the night, since the hotel didn’t have accessible rooms available. The HEART responders booked him a room and the next day provided a ride to meet with an organization that could help secure housing.

This story comes from NPR’s health reporting partnership with WYPR and KFF Health News.

School used to be pretty easy for Kate Jarvis when she was a little girl, back in the 1980s. She was a straight-A student, creative, and so organized that she’d even prep her toothbrush with toothpaste each night before school. She says her mother used to call her “bright-eyed and bushy tailed.”

Then puberty hit, and everything started to fall apart. She found it harder to focus in school, and her grades slipped. “It really hit my self-esteem badly. I felt pretty awful about myself,” she says.

In high school, she was diagnosed with anxiety and depression. She struggled to fit in. She says it stung when teachers would write comments like, “Kate has so much potential, if only she’d apply herself.”

“So it felt like character flaws rather than what it really was, which was undiagnosed ADHD,” says Jarvis, who didn’t get a diagnosis until her late 30s.

Kate Jarvis says that her diagnosis of ADHD in her 30s felt revolutionary. “Something I had been wrestling with for 25 years had a name, causes, symptoms and effects.” However, the diagnosis came with challenges as well. “Just because you know what something is, doesn’t mean you can immediately fix it. And that’s what I felt – like I needed to fix myself.”

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Researchers say Jarvis’ story is pretty common. For decades, ADHD, or attention deficit hyperactivity disorder, was considered a childhood disease that mostly affected boys – and boys were the focus of most research, says Julia Schechter, a clinical psychologist and co-director of the Duke Center for Girls and Women with ADHD. But ADHD often manifests differently in girls.

“They’re more likely to appear distracted, disorganized, kind of have their head in the clouds rather than show that overt, hyperactive or impulsive behavior that can disrupt a classroom,” Schechter says.

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She says those symptoms in girls are easier to miss. That’s one reason why girls tend to get diagnosed years later than boys, often not until adulthood. Instead, women will spend years wondering what’s wrong with them, being treated for anxiety or depression without addressing the underlying cause.

“Sometimes those conditions are truly present,” Schechter says. “Other times they’re secondary to years of undiagnosed and untreated ADHD.”

The heavy health cost of missed treatment

There is a cost to those years of missed treatment. ADHD is a neurodevelopmental condition that influences many aspects of a person’s life and can bring challenges with social relationships, impulse control and low self-esteem.

“For women, the risks are even more striking,” Schechter says. “So compared to girls and women without ADHD, those with ADHD have more problems with friendships. They’re more likely to experience abuse by romantic partners, more likely to have a teen pregnancy compared to boys and men with ADHD.” They’re also more likely to have feelings of worthlessness and self-harm or attempt suicide.

And there are other health risks for women, including a higher incidence of obesity, eating disorders, type 2 diabetes and cardiovascular disease than their peers without the condition, says Dr. Patricia Quinn, a developmental pediatrician who has specialized in ADHD in women and girls for decades. She says several factors linked to ADHD can contribute to these risks. They include impulsivity, trouble sleeping, an inability to maintain healthy routines, the chronic stress of living with unmanaged symptoms and poor food choices driven by the need to seek dopamine.

Last year, a large study from the UK found women with ADHD die on average nearly nine years earlier than their peers without the disorder – and two years earlier than men with ADHD. Yet many people don’t realize just how serious ADHD can be.

“It’s not just an excuse for ‘why I’m always late for work,'” Quinn says. “It’s a significant problem in their lives.”

In recent years, growing recognition of gender differences in ADHD has helped lead to a surge in diagnoses among adult women – nearly 7 million women in the U.S. had the diagnosis as of 2023, according to federal data analyzed by the nonprofit Children and Adults with Attention-Deficit/Hyperactivity Disorder, or CHADD. While boys are still diagnosed at roughly 2 to 3 times the rate of girls, those disparities even out in adulthood.

A breaking point in midlife

Often, women can spend years masking their symptoms, says Ellen Littman, a clinical psychologist who specializes in women with ADHD. But when life gets more complex, their compensation systems can crumble.

“And it just reaches a critical mass point of, ‘I can’t manage all of this,'” Littman says.

For Amy Reyer, that breaking point came at age 48. She was caring for two teens and aging parents, and had a demanding job that had her constantly on call.

“I was holding it together, as I’d learned to do, but a lot was breaking down,” Reyer says.

Reyer says her whole life, she’d struggled with focus and anxiety. She felt like she always had to work three times as hard as her peers to get things done.

Amy Reyer in her sophomore year at Sidwell Friends School. “I just assumed that everything I was going to do was going to be really, really difficult – and more difficult for me,” Reyer says. “But I didn’t know why at that time until I was diagnosed.”

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“I spent most of my life trying to prove that I wasn’t defective,” she says.

“I just assumed that everything I was going to do was going to be really, really difficult – and more difficult for me. But I didn’t know why at that time until I was diagnosed.”

Still, she’d managed to earn a doctorate and had a successful career in media. Then perimenopause hit, and it all became too much. “I was pretty overwhelmed and I wasn’t sleeping,” Reyer says.

Emerging evidence suggests fluctuations in estrogen levels can exacerbate symptoms of ADHD, and perimenopause might be a particularly vulnerable time. Research suggests women with ADHD enter perimenopause years earlier than those without the disorder and experience more severe symptoms during this menopausal transition.

One survey of more than 3,000 women with ADHD found the vast majority had been diagnosed for the first time during the menopausal years. “The big, big shift was brain fog and executive functioning problems during the menopausal years,” says Jeanette Wasserstein, a neuropsychologist who conducted the survey. She specializes in ADHD and is on the faculty at the Icahn School of Medicine at Mount Sinai.

Amy Reyer started treatment for ADHD after being diagnosed in her late 40s.

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Reyer says she’d first suspected she had ADHD after her son was diagnosed, because the disorder is highly genetic. She says when she was diagnosed in her late 40s, it changed her life because it led to treatment. Once she found an ADHD medication that worked for her, it was like a lightbulb came on.

“I remember just saying to myself, ‘Oh my God, this must be what normal feels like,'” she says.

Treatment beyond medication

Medication is just one part of treatment. Dr. Patricia Quinn, who recently released a guide for clinicians to treat ADHD in women, says for women in perimenopause, hormone replacement therapy can also be helpful. And because so many women have dealt with a lifetime of demoralization and shame, she says therapy – especially cognitive behavioral therapy – is also key, “because you need to rewrite all those scripts that are going on in your head.”

Psychologist Ellen Littman says in her practice, the focus is on helping women reframe their understanding of themselves “from ‘I’m a broken loser and I’m useless’ to helping them see themselves through the lens of this neurological information. And it changes their self-esteem and their ability to be effective in their lives and more confident as a parent and a partner.”

Lifestyle changes like exercise, meditation and a healthy diet can also help, says Kathleen Nadeau, a clinical psychologist in Maryland who’s been working with women and girls with ADHD for more than four decades. She says she encourages patients to find environments that play to their strengths – which can sometimes mean career changes.

“The metaphor I use is to plant yourself in the right garden, where the things that you’re good at can be nourished and expanded,” Nadeau says. “And the things that you struggle with are not what is emphasized in terms of what you’re supposed to do every day.”

Learning to thrive 

Ruth Danoff says getting an ADHD diagnosis at age 50 led to a process of understanding her life – her inability to focus and do well in school as a child despite being told she was bright, the years of struggling with “big emotions” and feeling overwhelmed.

It also ultimately led to a new professional path. After spending her whole career in administrative support jobs where she says she was consistently “dinged for not paying enough attention to detail,” now, at age 65, she’s become an entrepreneur and advocate for other women with ADHD. She serves on the community advisory council at the Duke Center for Girls and Women with ADHD .

Ruth Danoff, here in Carolina Beach, N.C., was diagnosed with ADHD at 50 and says it changed her life. The diagnosis put into perspective her childhood and led to a career change.

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“My mission in life is that I don’t want any woman to go through what I went through,” Danoff says. “And if I can help just one woman, that’s the best feeling in the world.”

Kate Jarvis says seeking a diagnosis, no matter your age, is worth it. After feeling like she didn’t quite measure up for so long, getting diagnosed with ADHD as an adult led her to medication and therapy, and ultimately, self-acceptance.

“There is so much joy waiting on the other side,” she says. “There’s so much joy.”

Hundreds of people gather in Abuja, the capital of Nigeria, to mark World Cancer Day on February 7, marching to raise awareness about cancer and the importance of early diagnosis. The World Health Organization cites Nigeria as a country with a rapidly rising number of cancer cases.

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When Titilayo found a lump in her left breast, it felt like a death sentence.

“My world was crumbling,” she says. “I had no hope, I had no life.”

Titilayo — who asked NPR to only share her first name in order to speak openly about her cancer and its impact on her life — lives in a small city in southern Nigeria. To find out if the lump was malignant, she had to wait for weeks for a biopsy sample to be sent to Abuja, Nigeria’s capital city.

When she got the news that the lump was cancerous, the doctor recommended that she undergo a mastectomy and multiple rounds of chemotherapy.

But the chemotherapy infusions she needed weren’t always available where she lived, requiring her to find them in another state and bring them to the hospital.

“The burden of getting the chemotherapy drugs — the burden was on me,” Titilayo recalls.

But her three daughters were young. They needed her. So she decided that whatever happened, she would pursue treatment.

“If I die of this thing, who would be able to care for my children?” Titilayo says. “I discovered that my life is worth fighting for.”

One in five people alive today will face cancer in their lifetime. But while cancer treatments and survival rates are improving in wealthy countries, that’s not the case in places where the rate of cancer diagnosis is rising the fastest.

The World Health Organization projects that by 2050, cases of cancer in sub-Saharan Africa will more than double; the highest rate of increase predicted in WHO’s six designated regions. The Eastern Mediterranean region, which includes much of northern Africa and the Gulf, is a close second.

Cancer predictions

In Abuja, radiation oncologist Dr. Basira Hanafi Lawal sees this firsthand.

“We’re wondering, are we creating more awareness for people and that’s why they’re coming in, or are the numbers just increasing?” she says.

Lawal points to several possible risk factors for a rise in cases: Nigeria’s older population is growing. And more people are drinking alcohol, smoking tobacco and living urban, sedentary lifestyles, she says.

She’s seeing a lot of patients coming in at early stages. She credits that to preventive screening and public awareness campaigns championed by nonprofits and religious groups.

There’s another trendline as well — patients who delay coming in until their symptoms are so severe they can’t be ignored. “It’s really heartbreaking,” Lawal says. “Especially at the later stages – what do you do for them? And they ask you — what do I do?”

She estimates that 70% of her patients are diagnosed at stage 3 or 4 – when tumors have spread from the original site into surrounding tissues, lymph nodes or even other organs.

Then there are the cases that don’t fit the patterns she’d expect. As in other parts of the world, colorectal cancer, associated with older individuals in the past, has become more common in youth. She recalls a 19-year-old diagnosed with this cancer.

Waiting room crowds

For all these patients, just finding a cancer doc can be daunting. Lawal is one of about 80 oncologists in a healthcare system that supports 242 million people. (For comparison, there are approximately 27,500 oncologists in the United States for a population of 340 million). It’s not uncommon for doctors to receive their training in Nigeria but move abroad for jobs elsewhere. And although more than half of cancer patients globally need radiation, there are only 15 radiation centers in Nigeria.

So when Lawal gets to work, she says she often sees a crowd of patients waiting.

“Sometimes you have patients traveling, maybe eight hours,” she says. “There are still a lot of areas and regions that are without radiotherapy centers, so the access is going to be quite limited.”

The WHO report shows that cancer patients in Nigeria are also disproportionately likely to be required to pay for their care. In 2022, patients were responsible for more than 80% of cancer care costs in Nigeria, according to data from WHO’s Global Health Expenditure Database.

Abigail Simon-Hart is all too familiar with these discouraging trends. She’s a Nigerian breast cancer survivor and advocate, who is credited as a reviewer in the WHO report.

“A lot of times, people present late. Sometimes they’ve detected it earlier and they don’t know where to go. Sometimes they know where to go but they don’t have the money,” she says.

Many health insurance plans in Nigeria do not include comprehensive cancer care, forcing many families to pay for their care out-of-pocket. Local crowdfunding websites are full of posts from cancer patients, trying to raise money for surgery and medications. That financial burden is felt not only in Nigeria, but across the low- and-middle income countries where the WHO expects to see the highest increases in cancer rates.

“I’ve seen people sell everything they have and still lose their loved ones,” Simon-Hart says. “It’s a very huge burden on the average family.”

“We have to go through loans — bank loans, to take loans from our workplace or to solicit funds from friends and family,” says Regina Fisayo Akinola, a breast cancer survivor and advocate in Ado Ekiti, Nigeria.

Akinola completed a round of treatment in 2014 and another in 2020, when she discovered another tumor in her right breast. She regularly encourages others to get regular mammograms to detect breast cancer as early as possible. She attributes her survival to this awareness and the support of her family.

But Akinola says that other patients aren’t as fortunate, with friends and loved ones abandoning them.

“They will look and say oh, this person will soon pass away. There’s no reason to waste their time or money on them. They cannot last,” Akinola says.

For some, these challenges are enough to make the decision to stop treatment entirely.

“We are not dying because our cancer is worse. It’s because our system fails us,” says Ethel Olomu, a breast cancer survivor from Rivers State, in southern Nigeria.

All of these factors reduce the likelihood that an average cancer patient in Nigeria survives after their diagnosis. In data compiled by the WHO’s Global Health Observatory from the years 2017-2021, just 28% of women diagnosed with breast cancer in Nigeria were still alive, five years later. The global median rate was 78%.

Feeling alone

During treatment and even afterwards, many survivors recount social isolation and even rejection from their partners and the community.

“I lost my hair, and my eyebrows, my skin changed — and people would say, ‘oh, you look like a witch,’ ” recalls Olomu, who was diagnosed with stage 4 breast cancer at the age of 31. “Because people didn’t know that this is how cancer [treatment] works.”

Olumu did not have a family history of cancer. After her diagnosis, her doctor taught her about the illness and what to expect during treatment. He even shared his personal contact information so she could ask questions about her symptoms at any time.

This inspired Olumu to create the Engraced Life Foundation, to support cancer survivors after treatment and to advocate for change. A support group for women in Rivers State includes more than 200 people, she said.

“And we share everything,” Olomu says. “It was founded out of a gap I lived through myself.”

The Nigerian government has set a goal of reducing cases of cancer by 30% by 2030. In 2020, it established the Nigerian Cancer Health Fund to help low-income patients. And leaders are working with international organizations to improve access to cancer care — including purchasing additional radiation machines to install in local hospitals.

“The government is actually investing in the infrastructure that’s highly costly,” says Jennifer Dent, CEO of BIO Ventures for Global Health, a non-profit organization that works with companies and governments in low and middle income countries to improve access to cancer treatment.

Another focus is on prevention.

For example — a vaccine against human papillomavirus, or HPV, can prevent cervical cancer, which is one of the most common cancers diagnosed in Nigeria, Kenya and other African countries. In 2019, Kenya added the HPV vaccine to its routine immunization program. In 2023, Nigeria followed suit.

“There’s a lot of mistrust in vaccines in Nigeria, but there’s some highly influential champions for cervical cancer in the country that I think are doing phenomenal work in driving public awareness,” Dent says.

In another project in Cote d’Ivoire, BIO Ventures helped create a public awareness campaign with video advertisements on commuter buses, encouraging men to get regular screenings for prostate cancer. Steps like these, Dent says, can help countries prepare for a future where cancer diagnoses are increasingly common.

An optimistic outlook

Titilayo, the mother of three, says she hopes to inspire others to watch for early signs of cancer, and to pursue treatment if diagnosed. She says it isn’t an easy task; cancer survivors in her community face stigma, gossip and rejection, especially if they have undergone a mastectomy. Others face financial hardship and difficulty returning to work.

But she now shows no evidence of disease. Her girls are older and she is optimistic about the future.

“I still insist that my life is worth more than any trauma or emotional issue,” Titilayo says. She wants to make sure the women around her feel the same.

Zubedah Hassan, 32, at home in Kibera. She works as a champion for the Stop Sex for Water program, encouraging women and girls to speak out if they face sexual violence from water vendors or are groped or peeped on in public bathrooms. “The main problem is poverty,” she says. “A girl tries to save money on water by doing favors for a vendor. Another challenge is drought. You find schoolchildren waking up very early to go and look for water and being raped along the small paths they take.”

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Early one morning, Saly Amutwayi unlocks the door to her small hair salon. Inside, the walls are painted a faded blue, with posters of braided hairstyles curled at the edges.

The salon is in Kibera, the African continent’s largest slum, just a few miles from central Nairobi, Kenya’s capital and largest city.

Before clients arrive, Amutwayi speaks quietly with her friend Mariam Hassan. Like many women in Kibera, they are responsible for collecting water for their households — a task that can take hours each day. And like many women in Kibera, both say they have experienced sexual violence while trying to get it.

“When there is no water,” Amutwayi says, “everything becomes dangerous.”

In Kenya’s informal settlements — densely populated neighborhoods where residents have no legal title to the land they live on, and which the state has largely left without formal infrastructure like piped water — residents rely on private vendors who control access to water and set prices. Rights groups say that in places like Kibera, this dependence has created conditions in which women who cannot afford water face harassment, assault or coercion — including pressure to exchange sex for water, a practice known as “sextortion.”

Saly Amutwayi styles Mariam Hassan’s hair. Both women have faced sexual assault as they tried to purchase water from a vendor. Hassan worries for her young daughter: “My baby girl is 8 years old. I will not send her to get water in the evening because of the experiences I have had.” She hopes education will help their children and other young women in Kibera, a slum neighborhood in Nairobi, Kenya: “Our parents never taught us about sexual harassment, but we are teaching our young girls.” Amutwayi wants to see men included in the conversations around sexual violence: “The boys need classes. All these lessons, most women understand, but men need to learn.”

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After more than a decade of advocacy led by Kenyan water-sector groups, the issue reached Parliament in 2024. It was the first time lawmakers took up the issue. Campaigners describe it as a breakthrough for a form of gender-based violence that has long gone unaddressed.

A basic need — and a daily risk

Kenya’s Constitution guarantees access to clean and safe water. But in Kibera, public water pipes rarely reach individual households. Instead, residents buy water by the jerrycan, yellow plastic containers that hold about a quarter-gallon, from kiosks, street carts or storage tanks, often at prices that fluctuate and can strain household budgets.

Billy Misuga, 25, works at a government-sponsored water kiosk in Kibera. “People are fighting for water. I let them fill even if they don’t pay,” he says.

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Nick Parisse for NPR

Water becomes scarcer and more expensive during shortages, which have become more frequent amid prolonged drought. Women who have experienced sexual violence in their efforts to obtain water and the advocates who work with them say that is when the risk of harassment and sexual violence increases.

During one such shortage, Amutwayi went to buy water from a vendor point on the street but did not have enough money to pay the full price. She says three men selling water began making comments about her appearance and then tried to force her into a nearby alley. She screamed, and neighbors intervened.

Amutwayi did not report the incident to police. The people who came to help, she says, told her to leave it, that since nothing had ultimately happened there was no report to file. “Nobody here has been held to justice,” she says in retrospect.

Hassan describes a similar experience. A man at the water line offered to take her somewhere with shorter queues, she says. She followed him, but he led her to his home instead, got her inside, and tried to rape her. She says she escaped after neighbors heard her screams.

Both women say the fear has stayed with them. “I only told my brother,” Hassan says. “I feared sharing it with my mother.”

When water comes with strings attached

Local organizations say these accounts are not unusual.

The Kenya Water and Sanitation Civil Society Network, known as KEWASNET, runs a program called Stop Sex for Water. Launched in 2014, the program supports survivors and documents abuse linked to water access in informal settlements. Staff members say they receive frequent reports of sexual harassment, attempted rape and coercion related to water collection.

Women use public toilets during the day, but these facilities may lack privacy and safety measures, such as locks and lighting. At night, concerned about the threat of sexual violence, they may opt to use buckets or “flying toilets” — human waste put in plastic bags and thrown outside.

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In many cases, advocates say, women who cannot afford water are pressured to provide sex instead.

“We are educating women to seek justice,” says Susie Njeri, 32, who is a champion for the Stop Sex for Water program, a nonprofit initiative to address sexual exploitation and violence related to efforts to obtain water in the slum community of Kibera, where the need for water creates a power dynamic that leaves women vulnerable to sextortion. Drought is exacerbating the problem, she says. “Because of the drought, water deliveries are more sporadic. You have to use your body to get ahead in line or to get more water.”

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“Sextortion thrives where services are scarce and accountability is weak,” says Joan Kones, a project lead at KEWASNET. “Water is a basic need. When access depends on informal systems, people become vulnerable to exploitation.”

Why reporting is rare

Malesi Shivaji, CEO of KEWASNET, says that many survivors do not report abuse to police. In interviews, women and the advocates who work with them cited fear of retaliation, social stigma and a widespread belief that authorities will not act. Shivaji says water-related sex crimes “are part of the culture of survival in Kibera. It’s so normalized that even survivors say they’ll be perceived as villains if they talk about what happened to them.”

Judith Shitabule, a community health promoter who works with survivors of gender-based violence in Kibera, says many women feel trapped by circumstance. “They wake up very early to look for water,” she says. “They still have to cook, clean and bathe their children. When they cannot pay, they are pressured in other ways.”

Posters, campaigns and educational meetings in Kibera encourage women and girls to report sexual harassment or assault.

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Shitabule says her work focuses on counseling and helping women understand their rights. “We tell them they can say no,” she says. “But saying no is very hard when your family needs water.”

 A broader problem of scarcity

The situation in Kibera reflects a national challenge. According to Water.org, roughly 19 million people, about a third of Kenya’s population, lack reliable access to clean water, with the largest gaps in rural areas and urban informal settlements.

In Kibera, residents told us supply is unpredictable and prices vary widely. During shortages, they say, vendors may ration water or stop selling it temporarily, forcing families to wait for hours or walk long distances in search of another source.

International research and rights organizations, including the U.N. Human Rights Office, the Brookings Institution and Transparency International, say this system concentrates power in the hands of those who control supply, creating conditions in which abuse can occur.

“When water is treated as a commodity rather than a public service,” Kones says, “it opens the door to exploitation.”

Lawmakers consider a response

Inside Parliament, the issue has been raised but not resolved.

Kenya has no specific law against sextortion. In 2024, Nairobi lawmaker Esther Passaris petitioned Parliament to create one, on behalf of citizens and with the backing of water-sector advocates. Several lawmakers spoke to it, describing how women are coerced as they try to get water.

Kibera is walled off from the rest of Nairobi, blocking its population from basic public services, such as a supply of clean water.

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Nick Parisse for NPR

In October 2025, a parliamentary committee turned the petition down. A new law was unnecessary, it said, because the conduct could already be charged under the Sexual Offences Act, which covers people who hold public office or authority over someone in their custody or care, such as police, prison officers, and hospital and school staff.

But it cannot be used to charge an informal vendor who controls the water supply in a place like Kibera and demands sex for it.

Advocates have not dropped the issue. They are pressing Parliament to take it up again. A law alone would not be enough, they say. Without training for the police and courts, and investment in water, the conditions behind the abuse would remain.

“Passing a law would not be the success,” Shivaji says. “Success is when this stops happening.”

The power of the cartels

Wycliffe Otiala is the leader of a water cartel, one of 30 that operate a large-scale water distribution network throughout Kibera. “We sell 60,000 liters a week.”

These groups are referred to as cartels by the local community, by Kenyan journalists and by academic researchers.

Wycliffe Otiala is part of a water cartel in Kibera that dispenses water for a fee. He’s pictured here by one of his water tanks. The cartels, he says, dispense their own form of justice: “In case of any problems, you have to sort it out with our guys, or your life is in danger. The police don’t do anything. They fear us.”

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Nick Parisse for NPR

Otiala’s cartel pulls water from different pipelines and distributes it to vendors, some of whom have kiosks while others sell from carts on the streets. “In other parts of the city, they receive water every day,” says Otiala. “Here in Kibera, we don’t get enough. The government is unfair.” While Nairobi Water pipes and delivers water to wealthy and middle-class neighborhoods, Kibera and other informal settlements all report the same problem.

Otiala explains that the cartels tap into municipal pipes by paying off the people who run the water system. “There are people who work in the piped system who know that we do this. We pay them and they let us take the water,” he says. “The police do nothing, because if they cut the supply, the community will have no water.” Asked whether his vendors attack women who cannot pay, he does not deny it. “Yes, of course,” he says. “That is the job. We know they do that. It is a business.”

A member of a water cartel in the slum community of Kibera, hammer in hand, cuts into a municipal water pipe to siphon off water illicitly. That water is then sold to residents who aren’t able to get government-supplied water.

Nick Parisse

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Nick Parisse

Otiala was speaking on a roadside where his team was laying pipe for a new tap connection. Nearby, Peter Munyao, a Kibera resident of more than 20 years, runs a public toilet in the Lindi ward, next to a water selling point. He confirms the power the cartels hold. “People have been crying for water,” he says. “Many regimes have turned a deaf ear to us residents. That is why the cartels rose up to fill the gap.”

Otiala says the cartels handle disputes themselves, and that the police stay out of their way. “In case of any problems, you have to sort it out with our guys,” he says, meaning through the cartel rather than the authorities. He claims the police do not interfere with the group’s operations.

Kenyans rank the police as the country’s most corrupt institution. A 2025 national survey by the Ethics and Anti-Corruption Commission, which polled more than 16,000 people across all 47 counties, put the police at the top, named by nearly half of those surveyed. (See pages 104-105.)

In Makina, a neighborhood in Kibera, shoes hang from power lines. Residents say each pair represents a person killed by community gangs.

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Raul Roman for NPR

The National Police Service, the Independent Policing Oversight Authority, the Ministry of Interior and the Ethics and Anti-Corruption Commission were each contacted for comment. None responded.

The vulnerability of trans people

Water scarcity also affects other marginalized groups.

A transgender man living in Kibera who asked not to be identified by name, fearing for his safety, says he routinely faces harassment when trying to access water and sanitation facilities. Vendors and other residents, he says, sometimes refuse to serve him altogether.

A transgender man living in Kibera; he asked that his name not be used because of fears for his safety. “I began my transition when I was 12 years old,” he says. He says he faces verbal abuse: “When you go to the toilet, people ask ‘Are you a woman or a man?'” He says he will stand in line for up to two hours to buy water from a vendor, only to be told “there is no water for people like you.” When that happens, he says, “I pay someone to stand in line and get water for me.”

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Nick Parisse for NPR

“They tell me there is no water for people like you,” he says. After waiting hours in line, he is sometimes forced to pay someone else to collect water on his behalf.

“It’s hard being transgender here,” he says. “You are denied even the basics.”

His account is not unique. He describes a transgender woman who was refused water, then surrounded by men who stripped and beat her. She was contacted but declined to be interviewed.

Human rights and water organizations, including the U.N. Human Rights Office and WaterAid, have documented that transgender people face heightened barriers to water and sanitation, including discrimination and a greater risk of violence.

Living with the fear — and hoping for change

Hassan worries about her 8-year-old daughter. “I will not send her to fetch water in the evening,” she says. “Because of what I went through.”

Saly Amutwayi still spends hours each week filling jerrycans. She avoids the vendors who attacked her, walking 300 feet or so farther to buy from others, though she says she still sees them near her house. At the water points, men offer to carry her cans for a few shillings, but some, she says, want sex instead. When she tries to pay, “they laugh and say, ‘You don’t know what I want.'”

Mariam Hassan holds onto hope. “What gives me joy is how I raise my daughter,” she says. “My dream is that she gets an education and does not have to live like this.”

This investigation is part of a larger project on the impact of water scarcity on women across Kenya, titled Pipe Dreams, recently published as a book by FotoEvidence. The project was carried out by a collaborative team of 25, more than half of them Kenyan.

Raul Roman is the founder of DAWNING, a research nonprofit that creates new knowledge on environmental and social challenges across the globe. He directed the Pipe Dreams effort.

Rafe H. Andrews and Camille Sachs were part of the DAWNING investigative team for Pipe Dreams.

A health worker measures the blood pressure of a woman at Penda Health Clinic Umoja II in Nairobi, Kenya, where researchers have tested an AI tool that can check out the notes taken by clinicians.

Patrick Meinhardt/AFP/via Getty Images

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Patrick Meinhardt/AFP/via Getty Images

A 4-month-old boy comes into the clinic with a fever and a stuffy nose. Vyonne Njeri thinks it’s just a cold. Then a yellow box pops up on her computer telling her to check his heart — because his heart rate is elevated. Njeri is a registered clinical officer in Nairobi, Kenya; she sees patients on her own like a nurse practitioner. When she listens with a stethoscope she hears a whoosh — a sign that the infant could have a congenital heart defect. 

“That’s something I would have missed on any other day,” Njeri says of the visit a few months ago. “That child would have just gone home.” She credits an AI tool that double checks her work for helping her. Njeri referred him to a specialist who confirmed the diagnosis and started him on medications; the child may have to undergo surgery.

The tool, called AI Consult, was tested in a randomized trial of nearly 10,000 patient encounters across 16 Kenyan primary clinics operated by Penda Health, and the results were published this summer in Nature Medicine. Half the clinical officers typed their notes into a computer with OpenAI’s GPT-4o checking their electronic notes in the background.

GPT-4o is a large language model, or LLM — the kind of AI that powers chatbots like ChatGPT. They’ve been trained on much of the internet and can generate text in response to instructions.

The other half used a computer for note-taking without the AI tool.

Here’s how the AI program works. It provides three prompts — green, yellow and red, like a traffic light. The AI looks for possible problems in a patient’s care or gaps in the notes. Green means everything is OK. Yellow means “click me” — the AI found a small problem in the notes and offers some guidance. Red pops up if the AI finds a critical concern based on the notes and alerts the clinician, who may need to act promptly.

For Njeri, these interventions offered welcome feedback: “You need to check on that” or “you’re on the right track.”

An independent panel of six Kenyan family physicians graded the notes. They judged that clinicians for whom AI Consult served as what Njeri calls a “second pair of eyes” produced better diagnoses and treatment plans.

And it cost 4 cents per patient.

The study captures both the potential of AI to improve healthcare and also the challenge of proving it.

But although health workers found this AI checkup helpful, the question of patient benefit was left unanswered. The study did not find evidence of improved outcomes.

There was a 23% decrease in treatment failures such as death or unresolved symptoms, but the decrease was not statistically significant because the number of such cases was low to start with.

Treatment failures “are just too rare in primary care,” says Dr. Bilal Mateen, a co-author of the study and chief AI officer at PATH, the global health nonprofit that sponsored the trial. A trial would need about 139,000 people to detect a meaningful difference, he says.

The trial was funded by the Gates Foundation, which provides financial support to NPR for its global health team; NPR is solely responsible for all content.

Nonetheless, in the continuing exploration of the role that AI can play in medical care, particularly in lower-resource countries — there is praise for the study. Dr. Jonathan Chen, an associate professor of medicine and biomedical data science at Stanford University, who was not involved with the study, says, “this is an important study as it goes beyond just running simulated test[s] with AI systems.” The study is among the first trials to compare the role of this type of AI’s potential as an aid to primary care.

Mateen says that prompting healthcare providers with what he calls “information-as-an-intervention” will have an “important incremental effect.”

Njeri shares that sentiment: “It helps us remember protocols and new guidelines,” she says. In a country where health resources are not comparable to wealthier nations, she says her team may see five or six patients an hour with a wide range of conditions — often without specialists for backup. “Having this tool really adds value,” she says.

As for the AI recommendations, Njeri says she finds them helpful about half the time — the other half the recommendations aren’t as helpful but they are seldom wrong.

“But I still feel it’s nice to have it — to give you that second thumbs-up or thumbs-down, like having a superior who says, ‘you could do better there’ or ‘you’re doing okay,'” she says. Most of the AI’s recommendations were rated safe and appropriate by the expert panel.

Mateen says he is working toward implementing the tool globally.

The paper did not look into whether AI could increase access to care, but Chen is most excited about that possibility. As AI gets better, he says it could in fact create a draft for the healthcare worker’s notes for editing — which could enable them to save time so they could see more patients. Or the AI tool could even interact with patients themselves.

He says, “timely and consistent access to medical care” is where AI may have the biggest impact.

Mateen says he is working toward bringing this tool to healthcare systems around the globe. But there are still concerns about fledgling AI tools. Healthcare AI researcher Dr. Nicholas Okumu, an orthopedic surgeon with Kenyatta National Hospital who wasn’t involved with the study, worries new AI systems could make mistakes or give bad advice, leading to grave errors. He warns “even AI that’s approved can still cause harm, so oversight has to stay active.” 

Relatives of Vanisa Anifa, a 6-month-old orphaned girl who died of Ebola, attend her burial, in Bunia, Congo, Friday, June 19, 2026.

Moses Sawasawa/AP

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Moses Sawasawa/AP

KINSHASA, Democratic Republic of Congo—More than 1,000 people have died of Ebola in eastern Democratic Republic of Congo, according to official figures released Thursday, with the outbreak showing no sign of slowing.

Health workers have recorded 2,536 cases of Ebola, as well as 1,033 deaths, since the conflict-torn central African nation declared an epidemic May 15.

Congolese Prime Minister Judith Suminwa will travel to the Ebola hotspots in the east of the country Thursday to “assess the realities on the ground,” the government stated, accompanied by officials from the US and the United Nations.

Health responders say the conditions on the ground are dire, with fragile hospitals overwhelmed and health responders struggling to catch up to the scale of the epidemic.

The situation is “worsening day by day,” Amadou Bocoum, the Congo director for the aid organization CARE International, told NPR. He pointed to deficiencies in contact tracing, funding and a rapid geographic expansion of the disease.

Aid workers are in a race against time to try to bring the situation under control before it spirals further.

Ebola is now spreading in eastern Congo at the fastest rate on record. According to the World Health Organization (WHO), it took 10 months to reach 2,000 confirmed cases during Congo’s 2018-2019 outbreak, compared to just two months for the current epidemic.

Other complications abound. Armed conflict has plagued the epicenter of the outbreak, Ituri province, for more than 30 years, and more than 900,000 people there live in displacement camps.

One of the mainstays of the local economy is also artisanal gold mining — which attracts informal workers who are highly mobile, and therefore likely to spread Ebola quickly if infected.

Funding is also a problem, as the severely degraded local health system in eastern Congo, as well as NGOs, struggles to cope as Ebola spreads in remote rural areas. In mid-July, the WHO said its joint $518 million plan to fight the disease, with the Africa Centers for Disease Control, faced a funding shortfall of over $400 million.

On the ground, many doctors say that they go without pay too. Health workers in Ituri went on a brief strike this month, for example, walking off Ebola wards and in some instances, burning tires in front of health centers, to protest alleged lack of payment and poor working conditions.

“We cannot continue responding to the epidemic with the same limited resources while it continues to outpace us,” said Trish Newport, an emergency program manager for Doctors Without Borders (MSF) in a statement this week.

MSF, as well as other aid organizations involved in the response, has also warned that many Ebola treatment centers are operating at full capacity. One consequence is that people suffering from Ebola must often wait at home until a bed becomes available, risking infecting others.

Complicating the response even more, Ebola has also spread farther from Ituri in recent weeks.

The Congolese government confirmed this month that Ebola had reached the provinces of Tshopo and Haut-Uele. Tshopo is a particular concern. According to official figures, four people have died of Ebola in its capital Kisangani, a major trading center of over 1 million people, with direct links to Congo’s capital Kinshasa.

Bocoum, the CARE International director, said that funding needed to be scaled up. “If nothing is done, it is unlikely that the situation will be controlled,” he said.

Health investigators in the Democratic Republic of Congo interview individuals as part of their contact tracing — seeking to find those who came into contact with people infected with Ebola.

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Michel Lunanga/Getty Images

The key to ending any infectious disease outbreak, especially one for which there’s no approved vaccine, like the ongoing Ebola outbreak in the Democratic Republic of Congo, is getting slightly ahead of the virus.

To do that, health officials need to quickly identify the possible routes a virus might spread, a practice known as contact tracing, says Armand Sprecher, an infectious diseases physician with Doctors Without Borders.

“We find a sick person and say, ‘Who was in contact with that sick person? Who took care of them? Who did their laundry, who touched them? Or who went to a burial where somebody had died of this?'” he says.

Spread by bodily fluids, the virus can only travel to these contacts. Identifying them all quickly, informing them of their exposure and keeping tabs on them can help prevent them from spreading the virus to others and get care faster if they develop symptoms. “It’s labor-intensive, but if you can do it well, you’ve got a really good handle on the outbreak,” says Sprecher.

Health officials do not have a good handle on the current outbreak.

Just over two months in, over 1,000 people have died, and more than 2,400 people have been sickened by the virus. Daily case counts show no signs of slowing down. Perhaps most concerningly, more than 80% of new cases are popping up outside of known contacts.

“That is an alarm bell for me,” says Nahid Bhadelia, an infectious disease physician at Boston University who has worked on previous Ebola responses. “It means that a lot more people have this disease than we think, and contact tracing is not keeping up.”

That high percentage could stem from the inability to trace all contacts of cases, giving them only a partial view of known transmission chains.

The outbreak is centered in a region with a lot of transient workers and ongoing conflict, which can make it difficult to track down everyone who comes into contact with a known case. More contact tracers would help, and the World Health Organization (WHO) announced that 21,000 community workers are being trained right now.

But it’s also likely that entire chains of transmission are occurring outside the view of health officials before a very sick — or dead — person gets on their radar. “There’s probably a lot more cases that we’re missing,” says Bhadelia. “This means people are presenting much later to care, which means their survival rates could be lower.”

Many people aren’t coming to clinics at all. Roughly two-thirds of deaths occur outside of the health system, according to WHO.

“There are still lots of people with symptoms that could be consistent with a concern for an Ebola diagnosis that are going ‘underground,'” says Boghuma Titanji, an infectious disease physician at Emory University. Instead, she says they may be seeking care with traditional healers, staying home with family or unable to access — or even purposefully avoiding — treatment centers.

“It’s important to remember that there’s a lot of stigma associated with Ebola,” she says. And where this outbreak is unfolding, there’s “lots of mistrust toward the medical science and the people who are investigating the outbreak.”

The fact that so much sickness and death is happening in the dark, outside the view of health officials and clinicians, has made responding harder, says Titanji. “I view it as just seeing the tip of the iceberg, but not being able to see just how big that iceberg is because we just don’t have the lens that allows us to see that.”

Improving that view, in part, will require building trust with affected communities. That’s hard work, says Bhadelia, but some recent good news in the response could help — the start of clinical trials for treatments and a drug that could protect exposed people from getting sick.

“I think that you can build trust by providing better care,” says Bhadelia, “and that better care can, of course, be access to potentially promising treatments.”

Access to these therapies is still quite limited, since they’re only available through clinical trials. But Bhadelia hopes that over time, the prospect of receiving better care or a drug that could prevent disease after an exposure could attract more people to seek help through clinics or contact tracers. Ultimately, she says that’s what’s needed to reduce the toll of this outbreak and get it under control.

For most people, knowledge of what life on the job is like for healthcare workers comes primarily from two limited vantage points: watching television shows and experiencing their own patient care.

The same is true even for many people who eventually become doctors and nurses, as Grace Farris reminds us early on in her sensitive, energetic graphic memoir, See One, Do One, Teach One: The Art of Becoming a Doctor. “Before I started medical school,” she writes, “I was completely unprepared.” But, as she shows in her new book, once someone has switched over to becoming a professional healthcare worker, a whole new set of issues presents itself. At that point, it can be difficult to toggle from patient to patient –- and to remember what it was even like to be the person receiving care.

From See One, Do One, Teach One: The Art of Becoming a Doctor: A Graphic Memoir by Grace Farris MD

W. W. Norton & Company

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W. W. Norton & Company

In 2012, not too long after Farris completes her residency, she gives birth to her first child at a hospital in Boston where she works. Her years in medical school and after have already acquainted her with all parts of the birthing process, and her labor does not involve serious complications – but she still experiences a state of shock afterwards. She observes: “Becoming a patient made me want to rethink everything and reconsider my medical training. What had just happened?”

Farris, whose bio gives equal weight to her impressive accomplishments as both doctor and artist, skillfully guides readers on her long and winding medical school journey. While most people recognize that this process takes years and involves various stages, public knowledge of specifics is often oversimplified, overdramatized, or simply left mysterious. Farris brings readers behind the scenes, to help them develop a better understanding of all aspects of the experience — from anxiety over student loans and persistent bouts of impostor syndrome to friendships forged under stressful circumstances and the impossibility of a work-personal life balance. She takes us with her into her first-year anatomy class, where things go along relatively smoothly until, late in the semester, the bone saw is taken out. One of the students goes down, and the professor, without missing a beat, tells the class this is a “typical reaction.” In another scene, Farris describes how medical students end up needing to learn more than 10,000 new words over the course of a year. In a series of illustrated flashcards depicting some of these new words and their meanings (“Necrosis,” “Apoptosis”), we get a sense of just how intricate and overwhelming such an endeavor might feel.

From See One, Do One, Teach One: The Art of Becoming a Doctor: A Graphic Memoir by Grace Farris MD

W. W. Norton & Company

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W. W. Norton & Company

Farris has a knack for breaking down the complexities of the medical school journey to make them accessible and direct, as in a full-page diagram she includes early on, titled, “The Path to Becoming a Doctor.” Here, she maps out the assorted typical stages, from preclinical and clinical years to residency, fellowship, and attending. She plays with visual metaphors, too, throughout, in order to give a sense of the texture of certain feelings and experiences. Working in the emergency room for the first time during her internal medicine clerkship feels like encountering a tsunami, as classroom knowledge and limited clinical experiences are suddenly, and forcefully, put to the test. And later, when she’s doing her medical internship, she suddenly begins to feel less like an impostor, likening the change to the slow, observable transformation of seasons. This reflective occasion is illustrated in a pair of bright images, a landscape of sturdy trees studded with golden leaves.

Farris’ depictions – drawn in a loose, minimal style with a bright, colorful palette – offer generalities that seem relatable for those who have attended med school. They also contain peculiarities specific to her own personal history. Throughout her initial years of med school, even well into her clinical years, she does not know what type of medicine she wants to pursue. We act as witness as she comes to recognize the specializations that are definitely not for her (surgery, pediatrics), and those that could be (psychiatry, internal medicine). For Farris, it’s a slow, anxiety-provoking, and ultimately fulfilling journey to figuring it all out.

Some of the most charming moments in the book occur when Farris recognizes how her artistic interests and her medical pursuits overlap. It’s in dissecting an ear and encountering the tiniest bone in the human body that Farris undergoes a “turning point”: “The tiny stapes was a miracle.” Her artistic skills and sensitivities come into play at various stages of the learning process, like as a way to help her get better acquainted with human anatomy and also when she realizes that it helps to sketch and diagram the various materials that need to be memorized. The title of the book comes from a phrase one of her surgical rotation supervisors passes along, “a classic expression in medicine.” The surgeon asks Farris to watch as the surgical site is sewn up, so she can do this final step of the procedure on her own next time around. “How on earth could I ever teach one?” Farris wonders of the final step in the phrase, after she watches and then attempts the skill on her own.

See One, Do One, Teach One joins a growing body of work often referred to as Graphic Medicine, the community and practice of using comics and illustration to support healthcare workers and patients in their efforts to tell stories that speak to all kinds of experiences. If it’s too easy to forget — or too difficult to envision — what it’s like to be a medical student, healthcare worker, or even a patient in certain situations, books like Farris’ are an effective teaching tool. They offer an important, powerful way to bridge that gap.

Purchase BookSee One, Do One, Teach One by Grace Farris MD

A 4-month-old boy comes into the clinic with a fever and a stuffy nose. Vyonne Njeri thinks it’s just a cold. Then a yellow box pops up on her computer telling her to check his heart — because his heart rate is elevated. Njeri is a registered clinical officer in Nairobi, Kenya; she sees patients on her own like a nurse practitioner. When she listens with a stethoscope she hears a whoosh — a sign that the infant could have a congenital heart defect. 

“That’s something I would have missed on any other day,” Njeri says of the visit a few months ago. “That child would have just gone home.” She credits an AI tool that double checks her work for helping her. Njeri referred him to a specialist who confirmed the diagnosis and started him on medications; the child may have to undergo surgery.

The tool, called AI Consult, was tested in a randomized trial of nearly 10,000 patient encounters across 16 Kenyan primary clinics operated by Penda Health, and the results were published this summer in Nature Medicine. Half the clinical officers typed their notes into a computer with OpenAI’s GPT-4o checking their electronic notes in the background.

GPT-4o is a large language model, or LLM — the kind of AI that powers chatbots like ChatGPT. They’ve been trained on much of the internet and can generate text in response to instructions.

The other half used a computer for note-taking without the AI tool.

Here’s how the AI program works. It provides three prompts — green, yellow and red, like a traffic light. The AI looks for possible problems in a patient’s care or gaps in the notes. Green means everything is OK. Yellow means “click me” — the AI found a small problem in the notes and offers some guidance. Red pops up if the AI finds a critical concern based on the notes and alerts the clinician, who may need to act promptly.

For Njeri, these interventions offered welcome feedback: “You need to check on that” or “you’re on the right track.”

An independent panel of six Kenyan family physicians graded the notes. They judged that clinicians for whom AI Consult served as what Njeri calls a “second pair of eyes” produced better diagnoses and treatment plans.

And it cost 4 cents per patient.

The study captures both the potential of AI to improve healthcare and also the challenge of proving it.

But although health workers found this AI checkup helpful, the question of patient benefit was left unanswered. The study did not find evidence of improved outcomes.

There was a 23% decrease in treatment failures such as death or unresolved symptoms, but the decrease was not statistically significant because the number of such cases was low to start with.

Treatment failures “are just too rare in primary care,” says Dr. Bilal Mateen, a co-author of the study and chief AI officer at PATH, the global health nonprofit that sponsored the trial. A trial would need about 139,000 people to detect a meaningful difference, he says.

The trial was funded by the Gates Foundation, which provides financial support to NPR for its global health team; NPR is solely responsible for all content.

Nonetheless, in the continuing exploration of the role that AI can play in medical care, particularly in lower-resource countries — there is praise for the study. Dr. Jonathan Chen, an associate professor of medicine and biomedical data science at Stanford University, who was not involved with the study, says, “this is an important study as it goes beyond just running simulated test[s] with AI systems.” The study is among the first trials to compare the role of this type of AI’s potential as an aid to primary care.

Mateen says that prompting healthcare providers with what he calls “information-as-an-intervention” will have an “important incremental effect.”

Njeri shares that sentiment: “It helps us remember protocols and new guidelines,” she says. In a country where health resources are not comparable to wealthier nations, she says her team may see five or six patients an hour with a wide range of conditions — often without specialists for backup. “Having this tool really adds value,” she says.

As for the AI recommendations, Njeri says she finds them helpful about half the time — the other half the recommendations aren’t as helpful but they are seldom wrong.

“But I still feel it’s nice to have it — to give you that second thumbs-up or thumbs-down, like having a superior who says, ‘you could do better there’ or ‘you’re doing okay,'” she says. Most of the AI’s recommendations were rated safe and appropriate by the expert panel.

Mateen says he is working toward implementing the tool globally.

The paper did not look into whether AI could increase access to care, but Chen is most excited about that possibility. As AI gets better, he says it could in fact create a draft for the healthcare worker’s notes for editing — which could enable them to save time so they could see more patients. Or the AI tool could even interact with patients themselves.

He says, “timely and consistent access to medical care” is where AI may have the biggest impact.

Mateen says he is working toward bringing this tool to healthcare systems around the globe. But there are still concerns about fledgling AI tools. Healthcare AI researcher Dr. Nicholas Okumu, an orthopedic surgeon with Kenyatta National Hospital who wasn’t involved with the study, worries new AI systems could make mistakes or give bad advice, leading to grave errors. He warns “even AI that’s approved can still cause harm, so oversight has to stay active.” 

A panel of advisers to the Food and Drug Administration will vote on recommendations for seven popular peptides.

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Sarah Silbiger/Getty Images

For the latest stories on the science of healthy living, subscribe to NPR’s Health newsletter. 

A slate of experimental peptide therapies are under scrutiny today in what marks the beginning of a two-day meeting to help determine whether the compounds will become available from specialized pharmacies.

The panel of advisers to the Food and Drug Administration is considering the evidence for seven compounds including some of the most sought-after: TB-500, BPC-157 and MOTs-C.

None of them has undergone the kind of large-scale trials to establish safety and effectiveness that are required for FDA drug approvals.

And yet the therapies have attracted enormous attention in the wellness space. They’re promoted for injury recovery, muscle growth and fat loss, skin health, enhancing metabolism and more.

Proponents argue that the current Biden-era restrictions on compounding of the substances — due to safety concerns and a lack of data — have fueled a risky gray market of overseas suppliers.

The meeting represents yet another tension point between Health Secretary Robert F. Kennedy Jr.’s Make America Healthy Again agenda and the traditional medical and scientific establishment.

Kennedy has publicly advocated for lifting restrictions on peptides and talked up their benefits.

Meanwhile, FDA scientists are recommending against giving compounding pharmacies the go-ahead to produce any of the seven peptides under consideration. In a review of the evidence, they repeatedly note the data comes primarily from preclinical work involving animals — and is quite limited for humans.

Peptides are strings of amino acids — smaller than a protein — that often act as signaling molecules in our bodies and carry out many critical functions.

They can be synthesized and delivered as drugs, often by injection. Some of those, like insulin, are naturally occurring in the body. Others are modified versions, as with the blockbuster GLP-1 obesity drugs.

For example, BPC-157 is based on a peptide found in human stomach juices, while TB-500 is related to a molecule found in many types of cells, called thymosin beta-4.

In June, the FDA overhauled the roster for the advisory committee. Many of the new members have ties to the peptide industry. Earlier this week, the agency made further changes, adding a handful of temporary voting members, largely from academic institutions.

The FDA committee is tasked with reviewing data that supports using these peptides for specific conditions, including migraines, ulcerative colitis, opioid withdrawal and wound healing. However, if the FDA ultimately reclassifies them, clinicians would have discretion to write prescriptions outside of those narrow indications.

The agenda for Thursday includes votes on four compounds: BPC-157, KPV, TB-500 and MOTs-C. On Friday, the panel will review three other peptides: Emideltide, Epitalon and Semax.

The committee will discuss each peptide one by one and vote on recommendations throughout the day, though FDA leadership makes the final call on whether to green-light the products.

University of Cambridge professor Elizabeth Murchison and Peter Emerson of the Vermont Fish & Wildlife Department scoop up catfish for testing in Newport, VT. Emerson was one of the researchers to publish a new paper in the journal Nature describing the first known transmissible cancer in fish.

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Every year, the Vermont Fish & Wildlife Department conducts a fish census in Lake Memphremagog, which straddles northern Vermont and the Canadian province of Quebec. In 2013, the team was startled by some of the brown bullhead catfish they were finding in the lake. The fish were marred by unsettling dark streaks.

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“It looks like black tar on the skin — not very pretty,” says Peter Emerson, a fish biologist with the department who has participated in the census since 2009. “You can tell it doesn’t help the fish cause they’re inside the mouth, they’re on the fins.” Sometimes the dark marks are on the lips or the gills or even covering the fish’s eyes.

Just over a quarter of the catfish had the black blotches. Anglers had noticed them the year prior, but before that there had been nothing. “They arrived very suddenly,” Emerson says.

In a paper published on Wednesday in Nature, Emerson and his colleagues report that these inky blemishes are a kind of transmissible skin cancer — one that appears to spread from catfish to catfish.

“It is the infectious agent itself,” says Julie Dragon, a data scientist at the University of Vermont and a co-author on the study. “Those cells can somehow escape the host, maybe live in the environment — the aquatic environment — and then infect a new host.”

Beyond this lake, Dragon believes these catfish may hold clues about how tumors spread throughout our own bodies. “We still don’t really understand this event where a cell leaves the tumor, moves through the bloodstream, gets into a new organ,” she says. In the catfish, “it might have some of the same processes going on that allow these cells to invade a new host, avoid the immune system and then establish themselves.”

A fishy mystery

Shortly after the sinister lesions first surfaced, the Vermont Fish & Wildlife Department worked with researchers to determine that they were melanomas.

They found this to be odd since catfish don’t usually spend much time at the surface where they would be exposed to the potentially damaging UV rays of the sun. Emerson and his colleagues thought maybe the melanoma was being caused by a chemical or pollutant leaching into the lake. (After all, the Coventry Landfill sits nearby.) So they looked for toxins in the bodies of the fish. fishes’ bodies.

“But it turns out, as we did the studies, they don’t have much of that at all,” says Emerson.

This is when the team reached out to Dragon. She started by looking to see whether there might be a virus responsible for the cancers, but she found no evidence.

“Over time, genome sequencing got cheaper and easier to do,” she says, “so we recommended whole genome sequencing of the fish and the tumors.”

A tumor usually erupts because something goes awry in the cells of the host organism. This means that a tumor tends to resemble its host genetically.

This wasn’t the case for these catfish, however. “These tumors were very different from the host fish that they came from,” says Dragon, “which is not what we expected or what anyone would expect.”

Instead, the tumors’ genetics resembled one another quite closely, suggesting to Dragon that these cancers were clones that arose in a fish some time ago and have been spreading from catfish to catfish ever since.

A cancer with “a life of its own”

Transmissible cancer has been identified in only a handful of animals so far, including Tasmanian devils, dogs, certain molluscs — and now fish, it seems.

Dragon and her colleagues aren’t sure how the catfish are infecting one another, but they suspect it may happen during spawning. First, they don’t observe the melanoma in young fish.

Second, “they aggregate into these big clusters, flop around on top of each other, and they have these spines behind their pectoral fins that are pretty sharp,” says Dragon. “And we think that they actually scratch accidentally each other, and that is one potential avenue for the cancer cells to invade a new host.”

This is in part what Dragon will consider next, alongside whether there’s something environmental or viral depressing the catfish immune systems. Today, 30% on average have the melanoma throughout the lake on both the U.S. and Canadian sides, though Dragon says, “they do appear to be able to live with these tumors for some time.”

“Normally, cancers are sort of a dead end,” says Vincent Lynch, an evolutionary biologist at the University at Buffalo who wasn’t involved in the research. “When the host dies — when the person with the cancer dies — so does the cancer.”

This means that it would be advantageous to the cancer to be able to escape and invade another host to stay alive. “The cancer wants to survive,” says Lynch. “Now it’s got a life of its own.”

He adds that these catfish may be useful in the lab to study how cancers metastasize and migrate within our own bodies. “It could tell us something about how metastases evolve and originate within an individual,” he says. “If you could stop that from happening, then you can actually stop people from dying of cancer.”

This is likely a ways off, though.

In the meantime, the researchers will be studying catfish melanomas that have surfaced in lakes and ponds elsewhere. For instance, this particular melanoma may have first been documented by Henry David Thoreau who observed a catfish in a tributary of the Concord River in Massachusetts “with an inky-black kind of leprosy, like a crustaceous lichen.”

The authors of this study argue that it’s worth considering whether transmissible cancers are perhaps more common than we once thought.

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Seven years ago, The New Yorker staff writer Jia Tolentino is widely credited with coining the term “Instagram face” to describe a beauty standard that she noticed emerging on social media among white female influencers.

“The face looked like the beauty filters that Snapchat and Instagram provided to kind of lift your cheeks, and plump your lips, and make your eyes bigger, and make your chin a little more heart-shaped,” Tolentino says. “It was the kind of … Kim Kardashian looks, like Kendall Jenner looks, like Bella Hadid looks, like Emily Ratajkowski.”

Now, in her latest New Yorker piece, Tolentino argues that social media optimization of Instagram face has trickled down, resulting in a proliferation of plastic surgery and cosmetic procedures among young people chasing an AI-based beauty standard.

“The drive toward optimization that has encompassed and driven every tech industry, all of Silicon Valley, for the last 25 years, it’s really come to roost in our faces and bodies and souls,” she says.

Tolentino argues that what’s changing isn’t just our appearance, it’s our relationship to reality. She notes that procedures like Botox and fillers, once associated with middle age, are now becoming popular for teenagers and young adults, with plastic surgeons reporting a significant uptick of patients under 30, and men and boys engaging in “looksmaxxing.”

When every face can be optimized, filtered or surgically refined, Tolentino says the face itself begins to lose its status as evidence of a life lived. While she doesn’t think there is anything immoral or wrong about changing your looks, she worries about the messages young women and girls are getting from the online world.

“If you are a young woman and you are interfacing with the internet, there is essentially no system that will tell you, ‘Your face is good as it is.’ And there is no end to the systems that will say, ‘Improve it, perfect it,'” she says. “Our imperfection … that’s the best thing about us. That’s what makes us actually human.”

Tolentino is the author of the best-selling essay collection Trick Mirror.

Interview highlights

On how Instagram face derives from different ethnicities 

Jia Tolentino is a staff writer for The New Yorker.

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Elena Mudd

I talked to a celebrity makeup artist who described it. He said there’s a South Asian influence with the brows and eye shape, an African American influence with the lip, a Caucasian nose, a cheek structure that’s predominantly Native American and Middle Eastern. And that, 10 years later, has resulted when you ask AI to generate an image, let’s say, of a beautiful woman, they are almost exclusively white, thin, young, but they have those features. And so there’s this erasure of other forms of faces, certainly other forms of beauty. There’s this near total erasure based on what the AI, just scraping Instagram, scraping faces, scraping the kind of racial hierarchies and preferences that are built into every system in our country.

On Instagram face trickling down from celebrities and influencers to the general population

This began as kind of niche behavior among the professionally beautiful, the wealthy and famous. But the desire trickles down because those faces are necessarily visually overrepresented. And what those women do becomes, trickles into the desire for the general population. …

If you are on social media, you see the way that people’s faces have become uncanny.

Jia Tolentino

If you are on social media, you see the way that people’s faces have become uncanny. The foreheads are freezing. The lips are plump. … Instagram face has kind of trickled down to the general population. You can get it at your local strip mall, basically anywhere you are in the U.S., and people certainly do.

On young women and girls doing anti-aging procedures 

There was a 12-year-old that went viral on TikTok for her anti-aging skin routine. If you look on non-visual forms of social media like on Reddit, or on Twitter, on any place, you’ll find teenagers wondering, “Should I start getting Botox? I’m 18, like I’m starting to see signs of aging.” You will have 20-somethings wondering if they should get a facelift because they think they have jowls.

On so-called “Mar-a-Lago face“

If you have observed the faces of the women of the second Trump administration, this is Mar-a-Lago face. It’s kind of like Instagram face. It’s as if the Kardashian-esque beauty standard of 2016 has ported itself 10 years later, to the seat of American power and added quite a lot of makeup to it. It’s what plastic surgery used to be, where it flaunts itself, where it kind of flaunts its lack of relationship to human reality, which I find kind of funny and I find almost quaint.

There’s a way in which it mirrors the actual political policy of the Trump administration, where power is displayed in proudly disconnecting from reality altogether. … It’s saying that what is given, what is human, doesn’t matter, I’m gonna slash it to bits and put some gold and lipstick on it. It’s the equivalent of the Trump ballroom, basically, in human face form. … This is certainly not a new observation, but it’s very interesting to watch people that are very much against trans health care, gender-affirming medical care, display a beauty look that is nothing if not gender-affirming. It’s fundamentally gender-affirming surgery like much plastic surgery is.

On parenting her daughter in this culture of plastic surgery and anti-aging intervention 

I think about my own behavior as the only thing I can really control. I want her to see me valorizing the human and not trying to improve and protect and beautify myself and my life in a way where it seems like that’s a priority. … I never want her to see within me that the purpose of being a woman is to be as beautiful as possible all the time and to never look old, to never change, to always look like I did when I was 26. … I hope I can hold myself to that, for her sake.

Monique Nazareth and Nico Gonzalez Wisler produced and edited this interview for broadcast. Bridget Bentz, Molly Seavy-Nesper and Beth Novey adapted it for the web.

In this image taken from video, an IV infusion is administered at Pure Alchemy Wellness in Chula Vista, Calif., in November 2025.

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It’s a big week for the peptide industry, and the growing number of Americans who’ve come to embrace the therapies touted for wellness and longevity.

The Food and Drug Administration is convening a panel of outside experts for a two-day meeting starting Thursday to make recommendations on whether compounding pharmacies should be allowed to make some of the most popular injectable peptides.

The gathering of the Pharmacy Compounding Advisory Committee is slated to begin early Thursday morning and stretch until Friday afternoon.

The group will review the evidence for seven compounds, including some of the most sought-after injectables: TB-500, BPC-157 and MOTs-C.

None of them have undergone the kind of large-scale trials to establish safety and effectiveness that are required for FDA drug approvals.

“I see it as very risky,” says Paul Knoepfler, a cell and molecular biologist at University of California, Davis who has tracked the upsurge in demand for these peptides, “These are drugs and they haven’t been scientifically proven.“

Peptide adoption hasn’t waited for the science

And yet the therapies have attracted enormous attention in the wellness space, where they’re promoted for injury recovery, muscle growth and fat loss, skin health, metabolism and more.

Major direct-to-consumer telehealth companies, med spas and high-end longevity medical practices alike are marketing peptides and their potential.

Proponents argue that the current Biden-era restrictions on compounding of the substances – due to safety concerns and a lack of data — have fueled a grey market of overseas suppliers, raising safety concerns as Americans inject themselves with unvetted substances.

It’s a message that industry groups are pushing heavily ahead of this week’s meeting.

“When peptides were pulled from the regulated compounding pharmacies, demand didn’t go away. It went into the underground,” Gary Brecka, a popular podcaster and wellness influencer whose company markets peptides, told reporters during a briefing held by the American Academy of Peptide Medicine, a professional society that formed earlier this year and is advocating for regulatory changes.

“This is not a question of whether Americans will use peptides,” he added.

Peptides are strings of amino acids — smaller than a protein — that often act as signaling molecules in our bodies and carry out many critical functions. They can be synthesized and delivered as drugs. Some of those like insulin are naturally occurring in the body. Others are modified versions, as with many of the blockbuster GLP-1 weight loss drugs.

For example, BPC-157 is based on a peptide found in human stomach juices, while TB-500 is related to a molecule found in many types of cells, called thymosin beta-4.

An influential peptide advocate at the top

The upcoming meeting represents yet another tension point between Health Secretary Robert F Kennedy Jr.’s Make America Healthy Again agenda and the traditional medical and scientific establishment.

Kennedy has publicly advocated for lifting restrictions on peptides and talked up their benefits.

In June, the FDA overhauled the roster for the advisory committee. Many of the new members have ties to the peptide industry. Some work for compounding pharmacies or clinics that offer them.

On Tuesday, the agency made further additions, adding a handful of temporary voting members, largely from academic institutions who were designated as having expertise in specific peptides.

FDA officials did not immediately respond to NPR’s inquiry about why it had made the changes.

Meanwhile, the FDA’s own career scientists are recommending against giving compounding pharmacies the green light to produce any of the seven peptides under consideration.

Sparse clinical evidence versus real-world experience

In a review of the evidence posted ahead of the meeting, they repeatedly note the data comes primarily from preclinical work involving animals — and is quite limited for humans.

For example, there weren’t any human clinical studies identified for TB-500. In the case of another compound, Semax, the available evidence “does not establish effectiveness,” the document states.

Medical providers should be honest about the “relatively sparse clinical evidence for these peptides,” says Dr. Anant Vinjamoori, chief medical officer of Hims & Hers, which plans to offer the peptides if the FDA does reclassify them.

“At this point, we do have experience that’s accumulated across close to a decade — thousands of physicians, close to millions of patients — that seems to indicate these peptides can be beneficial to promote health,” he adds.

The FDA committee is tasked with reviewing data that supports using these peptides for specific conditions, including migraines, ulcerative colitis, opioid withdrawal and wound healing. However, if the FDA ultimately reclassifies them, clinicians would have discretion to write prescriptions outside of those narrow indications.

While compounding pharmacies can “undoubtedly make better versions of these peptides,” UC Davis’ Knoepfler says, that doesn’t resolve concerns peptides, especially if taken at the wrong dose, could inadvertently promote cancer growth or trigger a dangerous immune response.

But he also worries about the prospect of FDA leadership going against the advice of its own internal scientists.

“I think that’s not good for the FDA,” he says. ” I think that undermines their authority and consistency.”

Cody Coughenour of Port Angeles, Wash. is a beneficiary of a bipartisan policy experiment that allowed him to receive Medicaid before being released from incarceration.

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Cody Coughenour landed in jail at least half a dozen times by the time he was 47 years old. First, it was crimes related to his alcohol addiction. Then, when he was 26 years old, his mother died of a meth-induced heart attack.

The overwhelming grief led him to the same methamphetamines that killed his mother.

“What people are running away from, that’s what they’re going to run into,” he said.

Each time Coughenour got out of jail in Washington state, the list of things he was supposed to do to get back on his feet felt overwhelming. He knew that addiction treatment and therapy should be near the top.

But to pay for that care, he needed health insurance.

When he would get released, his jailers would hand him a phone number to call to get onto Medicaid, the public health insurance program for low-income and disabled Americans. It would either go to voicemail, Coughenour said, or he’d be placed on a long hold. That delay was enough to send him straight to his dealer’s house — and eventually back to jail.

December 2025 was different. Coughenour left jail with medications for his anxiety, his Medicaid card in hand and appointments already on the calendar.

“We went straight to the treatment facilities,” he said.

Cody Coughenour, at home in his bedroom, holds his health insurance card. It’s made his most recent release from jail different than other times he was incarcerated and released.

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Ramon Dompor for Tradeoffs

A large experiment

Coughenour’s experience is one example of a much larger experiment unfolding across the country. Some states are turning Medicaid on before some people leave jail or prison, with the goal of making sure they have a better chance of staying out of jail and staying alive.

But just as 19 states race to build these programs, Medicaid itself is changing.

H.R. 1, the sweeping federal budget law passed last year that’s also known as the One Big Beautiful Bill law, is forcing state Medicaid agencies to implement work requirements, tighter eligibility checks and budget cuts. At the same time, the Trump administration is scrutinizing how much these “reentry programs” cost and what services they cover.

The result is a new test for a rare bipartisan Medicaid initiative: How much of a bridge from incarceration to care can states still build in a narrower Medicaid program?

Elevated risk of death after incarceration

For decades, federal Medicaid dollars were prohibited from paying for most health care provided to people while they were incarcerated. Instead, that cost was paid by the counties and states.

But health care behind bars is often underfunded and inadequate. Courts have ordered improvements in roughly half of state prison systems.

Many people leave incarceration with untreated mental illness, substance use disorders, chronic disease and few easy ways to connect to care once they return to the community. Research shows that they face sharply elevated risks of death in the first weeks after release, particularly from overdose.

In 2018, Congress directed federal health officials to work with states on ways to improve care for people leaving prison and jail. States started requesting waivers to allow them to cover certain services 30-90 days before release, and the Biden administration gave 19 states permission to move forward, with eight additional states and Washington D.C. also seeking approval.

In the four states — California, Washington, Montana and New Hampshire — that have started providing Medicaid coverage to people inside, tens of thousands of people are now being screened for substance use disorder, provided medications and connected to care before release, among other services.

It’s too soon to know whether these efforts are reducing deaths or emergency room visits, though state officials in Washington say people who have received Medicaid before release have been less likely to return to jail or prison.

What is clear is that bringing Medicaid behind bars takes a lot of work. It took several years for officials in these states to build new systems, win buy-in from local jail operators and figure out how to integrate the worlds of Medicaid and incarceration.

“What we really needed was a translator between the Medicaid agency and the jails,” said Marc Stern, a Washington doctor who has spent 25 years working inside prisons and jails. “Because Medicaid doesn’t speak jail, and jail doesn’t speak Medicaid.”

Now, some Medicaid agencies say federal changes are making it impossible for them to replicate those efforts in their states.

Trump’s cuts force some states to pull back

Advocates and policy experts who are assisting states with implementing this experiment say most are still moving forward with their plans for now. But at least three states — Oregon, Rhode Island and Michigan — have paused their work as a result of the OBBB.

Oregon Medicaid Director Emma Sandoe said bringing Medicaid behind bars fit squarely with her state’s long-standing push to expand health coverage. But the OBBB has forced Oregon to focus on other urgent tasks, such as implementing new work requirements and more frequent eligibility checks. Sandoe said the state still wants to get Medicaid into jails and prisons, but it will have to wait.

“What physically can be done with the amount of time, with the amount of resources available, is limited,” Sandoe said.

Rhode Island and Michigan cited insufficient funding in their decisions. In rescinding its application in December 2025, Michigan officials wrote, “This initiative will be archived and considered for future efforts to support reentry populations.”

Louisiana offers clues to Trump vision for Medicaid behind bars

States pursuing this work are expected, under guidance from the Centers for Medicare and Medicaid Services, to provide people with at least addiction treatment, medications pre-release and someone to help them get care once they are out. Some states approved by the Biden administration went further — offering the full Medicaid benefits that someone in the community would receive.

Federal officials seem to be encouraging a more narrow approach now.

In April, officials from Louisiana and the Trump administration announced that Louisiana would be the next state approved to bring Medicaid into jails and prisons — and the first to be cleared under President Trump.

Louisiana Deputy Medicaid Director Pete Croughan said the state’s proposal went through an “intensive delete process” as federal officials pushed Louisiana to cover only the services the state saw as most essential. To get a thumbs up from the Trump administration, Louisiana limited the services it would pay for to mental health care, medications for addiction treatment, infectious disease screening and medical equipment like wheelchairs.

Croughton said Louisiana scaled back its plans to have Medicaid pay for primary care services inside jails and prisons. Instead of having people see a primary care provider before release, the state now plans to introduce them to a clinician they can see once they are out.

“There’s definitely evidence that folks with untreated mental health and addiction issues are more likely to die. So we have to solve for that,” Croughan said. “I don’t know that there’s evidence for that for someone with untreated knee pain.”

Louisiana also asked for less federal funding to help cover startup costs, including new staffing and technology. Instead, the state plans to use money it will receive from the new Rural Health Transformation Fund and another existing federal funding source.

Federal health officials declined to say whether other states must follow Louisiana’s approach to receive approval going forward. A spokesperson for the Centers for Medicare and Medicaid Services said in a statement, “The agency understands that states may face varying challenges during implementation, and CMS remains committed to supporting all states throughout this process.”

Experts worry that narrower programs could be less effective

Lauren Brinkley-Rubinstein, a professor at Duke University who studies the health impacts of incarceration, said the services Louisiana plans to offer — especially medications for opioid use disorder — are the most impactful for keeping people alive.

But she said many people leaving incarceration have multiple chronic illnesses that have often been inadequately cared for inside. Under Louisiana’s plan, newly released individuals will have to find care for those conditions on their own — on top of needing to find housing, food and employment.

Cody Coughenour said participating in mental health programs has allowed him to be more present in his teenage daughter’s life.

Ramon Dompor for Tradeoffs

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Ramon Dompor for Tradeoffs

“Going to the doctor and refilling that prescription is just never going to rank higher than those other things,” she said. “It makes it more likely that they are going to come back through the [jail or prison] door.”

That was Cody Coughenour’s experience every other time he left jail. But after Washington state got him on Medicaid before his most recent release, it’s been a different story.

He’s been sober and in therapy since he got out in December. He’s working and going to school to become a phlebotomist.

Most importantly to Coughenour, the stability has opened the door to something he had missed out on for years: time with his teenage daughter.

“We baked cookies together,” Coughenour said, recalling an afternoon a few months after he got out of jail. “She hugged me, and she cried.”

Cody Coughenhour crosses the street in front of a bowling alley in Port Angeles, Wash. Several members of his sober support group joined him for bowling to celebrate his nine months of sobriety in June 2026.

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Reporting for this story was supported, in part, by the philanthropy Arnold Ventures.

Julie Wernau is a reporter for Tradeoffs, a nonprofit news organization that covers healthcare’s toughest choices. You can sign up for Tradeoffs’ weekly newsletter to get the latest stories in your inbox each Thursday morning.

A new study from West Health-Gallup Center on Healthcare in America finds “job lock” is even more prevalent for people with chronic conditions, 41% of whom report staying in a job to keep health insurance.

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Why do some people stay in terrible, horrible, no good, very bad jobs?

A new report finds that nearly a quarter of workers who get health insurance through their jobs report staying in unwanted jobs for health insurance — a figure that’s risen dramatically in the last five years.

The survey from West Health-Gallup Center on Healthcare in America finds that approximately 23 million adults are in what the report authors call “job lock.” In 2021, 16% of those surveyed were in job lock.

“Anybody having to stay in a job just to keep their health insurance, knowing that they want to leave, is crazy,” says Ellyn Maese, a research director for the center, a partnership between Gallup and West Health. “That is a concerning figure, even if it’s 10%. But when we’re seeing it rise to 1 in 4 employees, that’s pretty serious.”

The numbers are higher for people who are ill. Of working adults with three or more chronic health conditions, the report found that 41% were staying in their jobs for health insurance.

This comes at a time when concerns about healthcare costs have been climbing. An April poll from the health research organization KFF found nearly two-thirds of adults are anxious about affording healthcare — tied for first with concerns about affording gas and transportation.

“Healthcare tops the list of economic worries right now,” says Larry Levitt, executive vice president for health policy at KFF. “So it stands to reason that people would be concerned about leaving an unwanted job for fear of losing their health insurance.”

Levitt was not involved in the new study from West Health-Gallup and says it fits with the picture KFF polls have found.

The findings from the survey released Wednesday may be compounded by pessimism about the job market, Maese says. A May Gallup poll found that just 28% of U.S. workers said it is a good time to find a job, the lowest it’s been since 2013.

The economic effects

The consequences may extend beyond employees’ discontent.

Unhappy employees are less effective, Maese explains, and that’s bad for the U.S. economy at large. “Leaving, moving, becoming entrepreneurs,” she says, is “what we need to see for our economy to really thrive.”

To that end, recent changes in the Affordable Care Act may have been unhelpful. In 2021, Congress increased financial assistance to middle income people buying their own insurance through the ACA marketplaces. When Congress let these subsidies expire in 2025, that help for would-be entrepreneurs evaporated. Levitt says the expiration of the ACA subsidies has contributed to increased costs, and U.S. workers being stuck in jobs they might otherwise quit.

Michael Cannon, director of health policy studies at the Cato Institute, a libertarian think tank, agrees this is a problem.

“Everyone acknowledges that job lock is real,” he says.

“Whether the extent of job lock is 8%, 24%, or something else,” Cannon says, “favoring employer-sponsored health insurance creates coverage gaps, reduces income mobility, and is crying out for reform.”

Cannon would prefer insurance coverage that belongs to individuals rather than their jobs — insurance purchased by consumers that would be stable as they change jobs.

Maese is especially concerned about the middle class — workers who are “stuck in the middle, where they don’t really qualify for assistance,” she says, “but they also don’t make enough to be able to catch up with the rising costs of healthcare.”

A policy change, such as bringing back ACA subsidies, Maese says, is needed to course correct.

On the other hand, Cannon has long been a vocal critic of the ACA. He advocates for an efficient free market option that would “let consumers control their health insurance dollars and choose their own health plan.” He’s for expanding HSA options.

Yet both Maese and Cannon agree that reform is needed.

“For 100 years,” Cannon says, “Congress has effectively penalized workers unless they enroll in health insurance that disappears when your job does.”

Research into any health benefits of avocado oil lags behind the studies of other oils, such as olive and seed oils.

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Avocado oil is having a moment. Browse the aisles of the grocery store and you’ll find packaged goods like chips, salad dressings and mayonnaise, all boasting that they’re made with avocado oil. But a new study finds that consumers who are paying a premium for these foods are probably not getting what they think they’re buying.

And at a time when consumer interest in avocado oil is growing because of its perceived health benefits, the findings add to evidence of widespread fraud in the industry.

“If you’re buying avocado oil products, it’s very likely that you’re not getting what you’re paying for,” says Selina Wang, a professor of food science at University of California, Davis and the lead author of the study, which appears in the journal Applied Food Research.

In the study, Wang and her colleagues purchased 54 products that listed avocado oil as the only oil used and submitted them to chemical analysis. The vast majority – 89% – showed signs of being adulterated with other, cheaper oils, such as soybean oil. She says one sample appeared to have basically no avocado oil in it. And price did not correlate with the authenticity of the oil. (UC Davis has posted the full list of products tested and the results.)

For comparison’s sake, the researchers also tested 20 different packaged foods made with olive oil – and only one appeared to show signs of adulteration.

“So this is largely an avocado oil product problem,” Wang says.

It’s not just packaged foods

She says the findings were disappointing, but not surprising given her past research. In 2020 and 2023, she published studies which found that the bulk of commercially bottled avocado oils were either rancid, meaning they have started to oxidize, or they were adulterated with other oils.

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Since then, a slew of new packaged food products labeled as being made with avocado oil have hit the market. That got her curious about the authenticity of the oil in them, she says, because “I didn’t think we had this much avocado oil to go around.”

She says the new findings are especially disheartening because avocado oil and products made with it are often significantly more expensive than those made with olive oil and other vegetable oils.

The avocado oil health halo

One reason behind the growing interest in avocado oil and products made with it is because it’s often seen as a healthier alternative to seed oils, such as canola, soybean and safflower, says Sarah Berry, a professor of nutrition at King’s College London, who has studied the interplay between dietary fats and health. Many nutrition researchers say seed oils have been unfairly maligned.

Berry says while avocado oil is indeed a healthy choice, “where I struggle is the health halo that it’s been given.”

She says that there’s plenty of research showing the health benefits of eating avocados, but there’s not a lot of direct evidence on avocado oil.

On the other hand, “we have decades of data showing that extra virgin olive oil is healthy. We have decades of data showing that most seed oils are healthy, whether it’s canola oil, sunflower seed oil or soybean oil,” Berry says.

Given all that, Berry says it’s hard for her to justify paying a markup for products made with avocado oil.

Teresa Fung, an adjunct professor of nutrition at Harvard T.H. Chan School of Public Health, agrees. “I would rather eat the avocado instead,” she says.

Incentives to adulterate

Of course, avocados themselves can be expensive, and they don’t yield a whole lot of oil, says Wayne Adams, CEO of the Adams Group, which refines avocado oil in the U.S. and sells it under the brand name Marianne’s. That’s one big reason why avocado oil tends to be so pricey. Meanwhile, seed oils are so much cheaper.

“You just find people that look at the economic difference and they just see the incentive to adulterate,” Wayne says. He’d like to see more regulatory action on the issue of adulterated oil in the industry. Ultimately he says, that would help his business not get undercut by cheaters.

Adulteration of premium cooking oils to maximize profits has been going on for decades, says Eric Decker, a food science professor at the University of Massachusetts Amherst whose research focuses on fats and oils.

“For a period of time, olive oil would be adulterated with hazelnut oil because their fatty acid compositions were very similar,” Decker notes. “But then hazelnut wholesale became very expensive.”

Decker, Adams and Wang all say it’s not clear where in the supply chain the adulteration may be taking place. But Wang says she hopes her findings help spur the industry to act.

In fact, Wang first made headlines a decade and a half ago with a study that found many imported extra-virgin olive oils failed to meet quality and purity standards. Those findings brought attention to the problem and since then, testing indicates there’s been a lot of improvement in the olive industry, Wang says.

In a statement to NPR, the board members of the Avocado Oil Manufacturers Association – Enrique García Gavira, Miraj Shah and Lia Bijnsdorp – said the international group was founded last year precisely to address these authenticity challenges in their young, rapidly growing industry.

“We are learning from olive oil, which faced similar problems until the creation of an international council and shared standards helped restore consumer confidence,” the group said. “Avocado oil must follow the same path, and that journey is now underway.”

Nursing student Amiri Saadiq (left) talks with classmate Ethan Stinson in the simulation suite at the University of Alabama at Birmingham School of Nursing. Through clinical rotations, Saadiq has found that the work suits his disposition. “I think I’m pretty personable for the most part,” he says.

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Men are largely missing out on one of the hottest professions in the U.S. right now: nursing.

For registered nurses alone, the Labor Department projects there will be 189,000 job openings each year for the next decade. But only 1 in 8 nurses are men.

There have long been efforts to rewrite the script around nursing — to push back on the idea that it’s women’s work. Now, the economy is helping, too.

With diminishing opportunities in male-dominated industries like manufacturing and software engineering, nursing has emerged as a stable alternative and a solid pathway to a middle-class life.

Nursing students at the University of Alabama at Birmingham are already experiencing what it’s like to be in demand.

Ethan Stinson chose to go into nursing his first year of college, drawn by the job security. He’s headed for a job in a hospital psychiatric unit. “I think I’m pretty calm under stress,” he says.

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Ethan Stinson will graduate next month and go straight into a job in the psychiatric unit at the university hospital.

“I feel like it’s really easy to get a psych job if you’re a nurse,” he says. “They’re hunting people all the time.”

His classmate Hatim Nasser, whose family had wanted him to study computer science, has a job lined up in the university hospital’s heart and lung transplant intensive care unit.

At a time when many of their peers are unsure of what’s next, the students are happy their skills are in demand.

“We’re grateful for it,” Nasser says.

Hatim Nasser practices putting on a sterile gown for surgery. He started out studying computer science but hated it. He switched to nursing because he wanted to be able to help people. “Just caring for them and helping them feel comfortable,” he says.

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A nursing school in the South leads the way

No doubt, stereotypes about men in nursing still abound. But slowly, they’re being eroded.

At the University of Alabama at Birmingham, close to 1 in 6 nursing students are men, outpacing the national average. And nearly 1 in 5 faculty are men. In some specialties within the university hospital, male nurses are nearly as common as female nurses.

“I don’t really feel like nursing isn’t for men or anything like that. When I go to the hospital, I see guys all the time,” says nursing student Amiri Saadiq, who’s headed for a job in the bone marrow transplant intensive care unit.

For years, the nursing school has been intentional about creating a welcoming environment for men. It features male students on all its marketing materials. It sends male and female nurses into high schools to recruit students. There’s an employee resource group for men in nursing at the university hospital.

Professor Curry Bordelon says all of this makes a difference.

“We’re never going to flip the entire iceberg. But I can get one little ice cube at a time out of it,” he says. “And when you do that, you’re opening up that opportunity for change.”

Nursing student Connor Aderholt speaks with professors Curry Bordelon (center) and Gregory Eagerton (right). Bordelon believes increasing the share of male nurses will lead to better health outcomes for men. “Patients respond when they see people caring for them that look like them,” he says.

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A different landscape in the 1990s

Things were very different three decades ago when Bordelon was getting his start in what he calls “small-town Louisiana.”

Men made up only 4% of nurses back then. Bordelon first learned about nursing through his aunt, who was a nurse. He was her practice patient.

Out of high school, he worked as a volunteer firefighter and found himself drawn to the medical calls.

From there, he enrolled in a nursing program at a local community college. He remembers his first day, looking around. There were about 90 students in his first class. Just three of them were men. He recalls the instructor telling the guys that the only reason they were there was to satisfy a quota.

“That, to me, was sort of a wake-up,” he says. “It was a — ‘I want to find my right fit where I can strive.'”

Getting help from someone who looks like you

Bordelon found a more welcoming environment at a different nursing school. Then, he found his calling: working in a neonatal intensive care unit (NICU), where male nurses are extremely rare.

He says fathers in the NICU would sometimes get defensive when they saw him talking to their wives about breastfeeding. But he made a point to include them, too.

“‘I’m here to support the entire family unit,'” he says he would tell them. “‘Which means — Dad, would you like to do skin-to-skin?'”

That simple action — holding a baby to one’s bare chest — is incredibly important for the baby’s long-term success, Bordelon says. Not to mention, it prepares fathers for the transition home.

Bordelon is certain that having more male nurses everywhere could improve health outcomes. Studies have found that patients respond better to healthcare providers who look like them.

Nicholas Seay has found that Black male patients feel more at ease with him than other hospital staff. “It’s a cool experience to see how my patient will talk to me differently from the nurse that I’m following,” he says.

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Nursing student Nicholas Seay, who is Black, has already experienced this during his clinical rotations. He finds older Black men often look relieved when he walks into the room. At times, they seem more at ease talking with him than with the nurse he’s shadowing.

“I think they’re happy to see [a] familiar face,” he says.

Seay has also experienced the opposite: female patients who are not comfortable with him at their bedside. In those situations, he steps aside.

“If I was a woman, I don’t know if I’d want a male student in the room either, so I really can’t be mad,” he says.

“Permission” to be in nursing

Even in the cocoon of the university setting, stereotypes persist.

For one, male nurses are often mistaken for doctors. Chris Jones, a graduate student pursuing a dual master’s degree in nursing and business administration, says it happens when he enters patients’ rooms, as well as elsewhere in the hospital.

“They would give me the resident discount in the cafeteria, and it’s a good discount,” he says with a laugh. “I’ve had to correct them.”

Graduate student Chris Jones says nursing isn’t marketed to men as an option. “They’re not shown that it’s an opportunity for them,” he says.

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And because nursing requires patience and compassion — traits traditionally seen as feminine — there are people who assume all male nurses are gay.

Bordelon knows persistent stereotyping gives some men pause.

“A lot of times, men need permission to be in the nursing field,” he says.

He’s happy that popular shows like The Pitt depict men in all kinds of healthcare roles, including nursing. And, he says, the fact that the jobs pay well doesn’t hurt. The national median wage for registered nurses tops $90,000 a year.

Jones, who was the first in his family to go to college, says one reason he became a nurse was so that he’d be able to take care of himself.

“And if I wanted to start a family one day, too, that I could do that as well,” he says.

Adjunct instructor Steven Parsons says advanced technology used in surgery is helping to draw more men into nursing. “They almost have to be a biomedical engineer because they’re dealing with robots and all kinds of equipment,” he says.

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In recent years, nursing has become more technologically advanced, another draw for men, says Steven Parsons, a cardiovascular operating room nurse and adjunct instructor at the University of Alabama at Birmingham.

Robots are frequently used in lung surgery and sometimes in heart surgery, he says. A robotics team that he was a part of was majority male.

“You’ve got guys that are kind of interested in that mechanical stuff,” he says.

Still, for others, the motivation for going into nursing is personal. Connor Aderholt, a former college baseball player, says he and his brother both decided to pursue careers in nursing after observing the compassionate care their grandmother received after a stroke.

“In that vulnerable moment — in our family’s vulnerable moment — it made me realize, this is what I want to do, to deal with these tough situations that people have to deal with,” says Aderholt. “To be that calm in the storm for other people.”

Connor Aderholt decided to pursue nursing after observing the care his grandmother received following a stroke. “It made me realize, this is what I want to do,” he says.

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Moving the needle faster

This fall, Bordelon will assume leadership of the American Association for Men in Nursing, a national advocacy group. He knows there’s still much to tackle.

“Will we ever be 100% gender neutral? I don’t know that,” Bordelon says. “Can we help move the needle a little faster? Sure, there’s opportunities for that.”

He and a colleague at Purdue University School of Nursing recently scored a big win: getting men’s health officially designated as a nursing specialty. Beyond urological issues, Bordelon argues, there are many other factors that drive a shorter life expectancy for men.

“We have women’s health nurse practitioners. We potentially could have men’s health nurse practitioners,” Bordelon says. “That’s our dream. That’s our goal.”

NPR’s Life Kit breaks down what you really need to know about skincare.

Transcript

ADRIAN MA, HOST:

Before you step into the summer sun, you probably know to put on a little SPF. But say you want to go beyond that. What else do you need to know to protect your skin? Online, there are thousands of products and endless advice videos which can make skin care seem really complicated. The good news, though, is that it doesn’t have to be. From NPR’s Life Kit podcast, journalist Kelle Walsh explains the science of healthy skin.

KELLE WALSH: According to dermatologists, taking care of your skin isn’t difficult.

MICHELLE HENRY: You know, the fundamentals of skin care are very simple. Good quality products. You don’t need 20 of them. You need – consistency is more than having 25 products. Find a regimen that works with your skin type. Stick to it, right?

WALSH: That’s Michelle Henry, a dermatologist and surgeon who teaches at Weill Cornell Medical College in New York. She points to skin’s primary function as a barrier that protects us from external harm. It’s also essential for things like temperature regulation and vitamin D production. Maintaining skin health really is about keeping that barrier intact, and it’s pretty straightforward.

SARANYA WYLES: From a skin health standpoint, it’s really two key ingredients we’re talking about. This – you just have to keep your skin moisturized, and you have to keep your skin protected from UV with sunscreen.

WALSH: That’s Mayo Clinic dermatologist and researcher Saranya Wyles. Sun protection also includes clothing, hats and avoiding the strongest UV rays during the day. Also useful, say experts, a gentle cleanser, something that won’t strip skin’s natural oils. Besides those three core products, experts say there are a few ingredients that while not essential are considered nice-to-haves, like antioxidants.

KELLY DOBOS: Antioxidants go hand in hand with sunscreen.

WALSH: That’s cosmetic chemist Kelly Dobos, who teaches at the University of Cincinnati. She explains that UV damage, along with pollution, can cause skin to generate free radicals – unstable molecules that can damage DNA, proteins and the natural oils that help protect that skin barrier.

DOBOS: A topical antioxidant is going to help neutralize those free radicals.

WALSH: She says to look for ingredients like vitamin C and E, green tea and niacinamide in moisturizers and standalone serums. Exfoliants are another helpful ingredient, experts say. Alpha hydroxy acids like glycolic or lactic acid can help skin shed old cells more evenly, bringing new ones to the surface. This is a process that happens naturally, but slows down as we age, says Dr. Wyles, making skin drier and more vulnerable.

WYLES: So when you’re younger, your skin just has an innate reparative, regenerative capacity that’s just functioning at a very high level.

WALSH: Experts say that as these products and ingredients support the health of your skin, they can also make it look brighter, more even and possibly with fewer visible lines. But they aren’t going to turn back the hands of time, says Dr. Henry.

HENRY: So there’s just a limit to what skin care can do.

WALSH: If your goal is to reduce deep wrinkles, loose skin or lots of hyperpigmentation, Henry says, there are cosmetic medical treatments that can help. Things like prescription retinoids or lasers are common. You can see a dermatologist for these treatments.

As for what’s possible at home, helping your skin be healthy and look that way is definitely in the realm of over-the-counter skin care. Beyond that, manage your expectations. All those products with sciencey-sounding (ph) or just bizarre ingredients and the multi-step routines…

HENRY: In many ways, it’s a marketing tool for this, like, aesthetic ideal that is just basically made up. Just because you don’t have wrinkle-free, rosy skin does not mean it’s not healthy. Healthy skin is comfortable, functional skin, frankly, right? And the good thing is that, for the most part, healthy skin does look beautiful.

WALSH: For NPR News, I’m Kelle Walsh.

MA: Want more skin care tips from Life Kit? Sign up for their one-week newsletter series at npr.org/skincare.

(SOUNDBITE OF MUSIC)

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Sales of avocado oil and products made with it are booming as consumers willingly pay a premium, drawn by the oil’s health halo. New research finds many products actually contain other, cheaper oils.

Transcript

MICHEL MARTIN, HOST:

Avocado oil is having a moment. Consumers are often paying extra for it and products made with it because they think avocado oil is healthier than other oils. A new study looked into how much avocado oil is really in packaged foods that have it on the label, NPR’s Maria Godoy reports.

MARIA GODOY, BYLINE: Browse the aisles of the grocery store and you’ll find chips, salad dressings and mayonnaise all boasting that they’re made with avocado oil. But when Selina Wang noticed this trend, she was puzzled.

SELINA WANG: I didn’t think we have this much avocado oil to go around. So I became curious about the purity of them.

GODOY: Wang is a food science professor at UC Davis and an expert on cooking oils. To find out if these products really contained what they said, she and her colleagues bought a slew of them and extracted their oil. While these foods listed avocado oil as the only oil used, chemical analysis revealed a different story.

WANG: Out of the 54 avocado oil products, 89% were inconsistent with authentic avocado oil.

GODOY: In other words, they showed signs of being adulterated with other, cheaper oils like soybean oil. One sample appeared to have basically no avocado oil in it. For comparison’s sake, the researchers also tested 20 different packaged foods made with olive oil and only one appeared to show signs of adulteration.

WANG: So this is largely an avocado oil product problem.

GODOY: Wang says the findings, which appear in the journal Applied Food Research, were disappointing but not surprising. Her previous research has found that the vast majority of commercially bottled avocado oils were either no longer fresh, or they were adulterated with other oils. Wang says that’s disheartening because avocado oil products are often significantly more expensive than those made with olive oil and other vegetable oils.

WANG: If you’re buying avocado oil products, it’s very likely that you’re not getting what you’re paying for.

GODOY: Sarah Berry is a professor of nutrition at King’s College London. She notes that in recent years, avocado oil has grown in popularity because it’s seen as a healthier alternative to seed oils. She says, while avocado oil is indeed a healthy choice…

SARAH BERRY: Where I struggle is the health halo that it’s been given.

GODOY: She says that while there’s plenty of research showing the health benefits of eating whole avocados, there’s really not a lot of direct evidence on avocado oil. On the other hand?

BERRY: We have decades of data showing that extra virgin olive oil is healthy. We have decades of data showing that most seed oils are healthy, whether it’s canola oil, sunflower seed oil or soybean oil.

GODOY: Given all that, Berry says it’s hard for her to justify paying a markup for products made with avocado oil. One big reason for that premium price is that avocados are expensive to begin with. And they don’t yield a whole lot of oil, says Wayne Adams. He’s CEO of the Adams Group, which refines avocado oil in the U.S. and sells it under the brand name Marianne’s. Meanwhile, he says, seed oils are so much cheaper.

WAYNE ADAMS: You just find people that look at the economic difference, and they just see the incentive to adulterate.

GODOY: He’d like to see more regulatory action on the issue of adulterated oil in the industry. Ultimately, he says, that would help his business not get undercut by cheaters and help consumers, too.

Maria Godoy, NPR News.

(SOUNDBITE OF HOT SUGAR’S “THE GIRL WHO STOLE MY TAMAGOTCHI”)

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Accuracy and availability of NPR transcripts may vary. Transcript text may be revised to correct errors or match updates to audio. Audio on npr.org may be edited after its original broadcast or publication. The authoritative record of NPR’s programming is the audio record.

Cyclosporiasis is a foodborne illness caused by contaminated food or water carrying the Cyclospora parasite. FDA officials have yet to figure out the source of the outbreak that the CDC says has sicked more than 1,600 people this summer.

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The source of the Cyclospora illness outbreak remains unknown, after the Food and Drug Administration announced Sunday that a previous test identifying the parasite in a sample of lettuce from Taylor Farms de Mexico was not actually contaminated with Cyclospora.

The agency reviewed the results and said in a statement it “concluded that the finding does not represent true amplification and should be considered a false positive.”

On social media, however, the FDA clarified that “this false-positive lab sample DOES NOT change the basis for FDA’s ongoing outbreak investigation or the overwhelming epidemiological data supporting the current voluntary recall by Taylor Farms.”

The FDA’s recommendation is still not to eat iceberg lettuce grown or processed by Taylor Farms in Mexico. The products were sold at Taco Bells in five states: Indiana, Kentucky, Michigan, Ohio and West Virginia, and Taco Bell has said they are no longer using that lettuce. Iceberg lettuce products were also distributed in 27 states and Walmart stores in 15 states. Health officials recommend discarding any recalled iceberg lettuce distributed by Taylor Fresh Foods.

That recommendation is based on interviews done with sick people, many of whom had eaten at Taco Bell that included the lettuce.

The FDA is continuing to test lettuce samples, and says it’s also testing produce at the southern border to check for Cyclospora. But so far none of this has turned up any positives.

There are now over 1,600 confirmed cases of diarrhea caused by this water and food-borne parasite and a growing number of suspected cases in the thousands. Ninety-four people have been hospitalized. There have been no deaths reported.

Taylor Farms said in a statement that the FDA apologized emphasizing that “FDA has not identified a single positive product test result for Cyclospora.” On July 17, the company did voluntarily recall all iceberg lettuce grown and processed in central Mexico and on Monday clarified that they are, “no longer sourcing iceberg lettuce grown in central Mexico for the remainder of the growing season” and are working closely with public health officials.

The parasite causes diarrhea, fatigue and nausea. To reduce the likelihood of infection from the parasite, health officials recommend cooking produce to 158 F. Washing produce thoroughly with water can help reduce the risk of cyclosporiasis.

But some experts note that while cyclosporiasis cases are on track to break records this year, it is common to see several cases every summer.

Identifying the source quickly certainly would help contain an outbreak — and perhaps save people from getting sick weeks down the line. But Donald Schaffner, a microbiologist at Rutgers University, says these are often separate and unrelated clusters.

“Just because you’re sick with Cyclospora right now doesn’t mean that you’re part of this cluster of cases that have an epicenter in Michigan and Ohio,” he says. Every summer since the 1990s there have been several cyclosporasis outbreaks, though none as significant in size as this one. There are many potential sources of Cyclospora, and they don’t necessarily share a common source, he says. “Sometimes we can figure out what’s causing it, and sometimes we can’t.”

So that’s why we’re in limbo, he says.

He also points out that sometimes people are exposed to the parasite from other ways besides food. The parasite could be in water that you drink or swim in, or water that may have been used on a batch of lettuce.

Shireen Rizvi is a professor of psychiatry and behavioral sciences and co-wrote the book Real Skills for Real Life: A DBT Guide to Navigating Stress, Emotions, and Relationships.

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Think about the last time you were distressed. How did you cope?

Did you lash out at someone? Drink alcohol? Pretend like it never happened?

There are healthier ways to deal with the pain. “Those behaviors are the result of not knowing how to tolerate what feels intolerable,” says Shireen Rizvi, a professor of psychiatry and behavioral sciences at Montefiore Medical Center. “In those moments, we have to learn how to accept the distress and respond in a more effective way.”

She explains how to do just that in her book Real Skills for Real Life: A DBT Guide to Navigating Stress, Emotions, and Relationships, published earlier this year.

She and co-author Jesse Finkelstein, a clinical psychologist, use engaging diagrams and illustrations to teach skills rooted in dialectical behavior therapy (DBT), a form of therapy that helps people manage difficult emotions. There’s a decision tree on how to use DBT skills to resolve conflict, for example, and an infographic on how to practice mindfulness.

DBT was first developed by psychologist Marsha Linehan in the 1980s to treat borderline personality disorder. Since then, many studies have shown that “DBT skills are helpful for lots of different people with many different types of problems,” write Rizvi and Finkelstein in their book — not just for those with complex mental health issues.

TIP: What to do when you’re so distressed you can’t think straight 

Rizvi, a board-certified DBT therapist, shares a set of techniques from her book called TIP. The acronym stands for temperature, intense exercise, paced breathing and paired muscle relaxation.

You can use these four distinct skills in moments when you’re so distressed that you can’t think straight, she says. For example, if you get in a big fight with your partner, or if you’re dealing with a big life event like illness or death.

TIP can quickly bring down the level of emotional intensity from extreme to moderate. They can “help you go from, say, a 100 to an 80 on a scale from zero to 100,” Rizvi says. Then when you’re at an 80, you’ll have more clarity to do something else to help yourself.

T: Lower your temperature  

How to do it: Fill a large kitchen bowl with cold water and ice, take a deep breath, and plunge your face, eyes and temples into the water while holding your breath. Stay there for as long as possible, Rizvi says.

Why it works: It triggers the mammalian dive reflex, which happens when mammals are submerged in cold water, Rizvi says. It increases the likelihood of survival by slowing down your heart rate and respiratory rate. “Those are things we also need [our bodies to do] when we are in high degrees of distress.”

Rizvi does not recommend this maneuver for those with a heart condition or those taking beta blockers. “A sudden decrease in heart rate could obviously be a problem,” she says. But if you don’t have those conditions, it’s worth a try.

I: Do some intense exercise

How to do it: Do anything that can get your heart rate up quickly, Rizvi says. Run up the stairs, do some jumping jacks or pushups. Sustain that movement for 30 seconds or longer.

Why it works: The idea behind this skill is “almost paradoxical,” she says. “In that moment of high agitation, you’re revving yourself up.” Then, when you stop the exercise, your heart rate decreases, making you feel calmer — and your endorphins kick in.

P: Try some paced breathing 

How to do it: Make your exhale longer than your inhale, Rizvi says. Breathe in for a count of four, then breathe out for a count of six.

Why it works: When we’re distressed, we tend to breathe from our chest, “which is more like hyperventilating, the opposite of relaxing,” Rizvi says. Paced breathing can slow down your heart rate and lower emotional intensity.

P: Practice paired muscle relaxation 

How to do it: Go through your body, muscle group by muscle group, and tense the muscles as tight as you can — then release them. Breathe in as you clench your body. Then, as you breathe out, say or think of a word that you associate with relaxation, like “relax” or “calm,” as you unclench. That’s the “paired” part of the exercise, Rizvi says.

Why it works: “The idea is that if you tense your muscles as hard as you can, then relax, you get a greater sense of relaxation than if you just try to relax without tensing the muscle first,” she says.

Intense moments don’t last forever

One of the biggest things people get wrong about distress is that they have to get rid of the feeling right away or it will last forever, Rizvi says.

But it doesn’t, she says. “One thing we want people to learn is that whatever it is you’re feeling, no matter how intense, no matter how awful it feels in this moment, it will pass.”

The story was edited by Meghan Keane. The visual editor is CJ Riculan. We’d love to hear from you. Leave us a voicemail at 202-216-9823, or email us at LifeKit@npr.org.

Listen to Life Kit on Apple Podcasts and Spotify, and sign up for our newsletter. Follow us on Instagram: @nprlifekit.

Health workers tend to an Ebola patient at the Rwampara Treatment Center in Ituri, Congo, Thursday, June 18, 2026.

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BUNIA, Congo — At least 930 people have died in Congo’s Ebola outbreak, the country’s Ministry of Health said Monday, with 37 new deaths recorded in a 24-hour span Friday into Saturday, one of the highest totals.

The deaths were recorded out of the 2,344 cases confirmed as of Saturday, the health ministry said.

The Ebola outbreak that was declared in eastern Congo on May 15 is the fastest-growing Ebola outbreak on record. The Bundibugyo virus responsible for the outbreak is less common than others that cause Ebola disease, and there is no approved vaccine or treatment.

Ebola is highly contagious and can be transmitted to people from wild animals. It spreads in the human population through contact with bodily fluids such as vomit, blood or semen, and with contaminated surfaces and materials such as bedding and clothing. The disease is rare but severe and often fatal.

The surge in deaths comes as safety fears have restricted the response in the worst-affected province of Ituri. A total of five provinces have been affected, all in the eastern region where rebel violence is rampant.

At least 12 attacks — mostly fueled by skepticism and rumors — have been recorded against health facilities and teams since the outbreak was declared in mid-May, authorities said Saturday. Many health workers meanwhile have walked off their jobs as they protest lack of payment.

At least 36 health workers infected with the virus have died.

The World Health Organization last week expressed concerns that 80% of new Ebola cases were emerging from unknown chains of transmission, a sign the outbreak is spreading faster than health officials can track despite an expanding response.

Congo’s Health Ministry said in its latest update that 724 patients are currently in isolation and in hospitals, and that it is intensifying response efforts in affected health zones.

“Patient care and support capacities are consolidating, with 22 new recoveries recorded in 24 hours,” the ministry said.

Marie Noon at her home in Brighton, Michigan, with her dog, Ziggy. Despite being eligible for Medicaid, Marie was denied coverage in 2025 because of an error with the state’s benefits system. It took months of pushback before the state reversed its mistake. Even as a “tech-savvy” former bank manager, Marie says, she wanted to give up several times along the way.

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Marie Noon takes eight medications a day. One keeps her heart rate from spiking to avoid a stroke. One prevents debilitating headaches. Another ensures she doesn’t retain excess fluid.

More than a decade ago, Noon said, she was diagnosed with adult-onset Still’s disease, a rare type of inflammatory arthritis that can cause rashes, debilitating pain, and fevers. The disease upended her life.

She had been living a typical suburban life in Michigan, shuttling her two kids to activities like cheerleading, choir practice, and track. She was active in the PTA. She managed a bank.

She went from that to crawling to the bathroom because she was in so much pain, “just crying all day long” from being so sick.

Noon, who is 48 and disabled, said she couldn’t work for eight years — a time marked by hospital stays that stretched for weeks.

“I honestly thought I was going to die,” Noon said.

So it was a shock when Michigan denied her application for Medicaid benefits last year after she lost private insurance. Worse yet, it came down to an IT error, according to an attorney who helped Noon overturn the denial.

“I can’t afford my medical care. I have to have insurance,” said Noon, who has returned to working.

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Deloitte, a multibillion-dollar global consulting firm, has operated Michigan’s Medicaid eligibility system under contracts worth roughly $768 million since 2006, according to contracts reviewed by KFF Health News. Nationwide, Deloitte dominates this important slice of government business: At least 25 states have awarded the company contracts to build or run computer systems that control access to safety net benefits such as Medicaid.

Michigan’s system has incorrectly directed people with disabilities into skimpier benefits that cover limited care or denied coverage completely, a KFF Health News investigation found. Similar problems were at the center of a class-action suit in Tennessee , court documents show, and have occurred in Texas, according to interviews and state records.

This KFF Health News investigation is based on statements from state officials, emails obtained through public records requests, state government communications sent to Medicaid enrollees and applicants, and interviews with attorneys and patients or their caregivers.

In an emailed statement, Deloitte spokesperson Karen Walsh said it found “no system anomalies causing routine denials of Medicaid for people with disabilities.”

“There are many reasons why someone may no longer be eligible for a benefit they once received or believe they deserve,” Walsh said. “All of the eligibility systems we support are owned by the states and built to their unique specifications. We will continue to work at the direction of our state clients.”

Lynn Sutfin, spokesperson for Michigan’s Department of Health and Human Services, said it “is not aware of any widespread or systemic issues” within Bridges, Michigan’s eligibility system for Medicaid, SNAP, and other benefits, “related to disability‑based eligibility pathways.”

Since 2006, Deloitte’s contracts with the state have said the company is responsible for development, implementation, maintenance, operations, and enhancements to the Michigan system.

Computer system problems foreshadow trouble as states prepare to roll out the most significant and complicated changes to their Medicaid programs in years. Those changes, dictated by President Donald Trump’s landmark One Big Beautiful Bill Act, have states rushing to update their Medicaid computer systems to verify details such as employment.

Nationwide, roughly 15.5 million people on Medicaid have a disability, according to KFF.

“When these administrative systems get overloaded, everyone gets impacted,” said Pamela Herd, a University of Michigan professor who researches bureaucratic obstacles to accessing government benefits. “The systems are going to be really, really strained.”

In Michigan, Noon was eligible for Medicaid through a program that provides coverage to disabled adults who work. But the state’s computer system didn’t register that she is disabled and said she earned too much to qualify, according to documents reviewed by KFF Health News and interviews with Noon and Anastassia Kolosova, a disability rights attorney who helped her.

Anastassia Kolosova, a supervising attorney with Disability Rights Michigan, helped Marie Noon navigate the complicated process to obtain safety net health insurance through Medicaid. Kolosova says she has seen multiple wrongful coverage denials and fears problems will soon get worse because of changes required by federal law. “I’m really worried about more people falling through the cracks,” she says, because the state’s benefits system “is going to be even more overburdened than it is right now.”

Kate Wells for KFF Health News

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Kate Wells for KFF Health News

Without Medicaid coverage, Noon paid hundreds of dollars out-of-pocket for prescriptions, after scrounging for discount coupons. She takes some of the drugs twice a day.

Without them, “I’m toast,” she said. It was stressful “not knowing if my medicine’s going to be $50 or $500 this month, because it changes constantly.”

Noon said her doctor agreed to fewer visits to avoid medical bills.

“It was kind of a nightmare,” Noon said.

“I just wanted to give up”

Medicaid, a safety net health program jointly run by the federal government and states, covers roughly 67 million people with low incomes or disabilities. State governments rely on companies such as Deloitte to design and operate computer systems that assess whether people qualify for Medicaid or food aid through the Supplemental Nutrition Assistance Program, commonly known as food stamps.

Deloitte-run technology has a history of errors that deprive eligible people of benefits, earlier KFF Health News investigations have shown. As reported previously, Kenneth Smith, a Deloitte executive who leads its national human services division, said Medicaid eligibility technology is state-owned and agencies “direct their operation” and “make decisions about the policies and processes that they implement.”

“They’re not Deloitte systems,” he said, noting Deloitte is one player among many who together administer Medicaid benefits.

States are under immense pressure to update their eligibility systems on a tight schedule to adhere to requirements in the Republicans’ sweeping 2025 tax and spending law. Companies including Deloitte, Accenture, and Optum are being paid millions in taxpayer funds to make the changes, which are projected to strip Medicaid from roughly 7.5 million people and SNAP from 2.4 million people by 2034.

Many coverage restrictions in the new federal law don’t apply to seniors, children, or people who are disabled, such as Noon. Nonetheless, the law’s demands on state agencies and the computer systems they oversee will disrupt benefits, advocates for Medicaid enrollees and other healthcare experts said in interviews.

The same systems also need to correctly classify why someone is eligible for Medicaid — and therefore which rules and restrictions apply.

The law’s SNAP restrictions began to take effect in 2025, and major Medicaid provisions begin later this year, generally after the midterm elections.

Kolosova is a supervising attorney with Disability Rights Michigan, a legal advocacy organization for people with disabilities. She said she has been unable to get a meeting with Michigan officials to understand the underlying problem that deprived Noon of health coverage.

State records show Deloitte has held contracts for at least 14 years for Bridges. In its attempts to secure more business, the company often cites its nationwide footprint in Medicaid operations.

“Deloitte understands Bridges,” and its history in Michigan makes the company “the ideal vendor,” the firm said in its bid documents. Given Deloitte’s work on similar systems in 31 other states, the firm said, “Michigan benefits from our technical expertise drawn from across the nation.”

But advocates who work with people with disabilities say Michigan’s computer system has failed to recognize when certain adults should receive Medicaid benefits.

Problems aren’t unique to the Great Lakes State. Medicaid beneficiaries who brought a class-action lawsuit against Tennessee in 2020 said the state’s Deloitte-built system “does not reliably test for eligibility” for several categories of people with disabilities. The firm’s contract in Tennessee is worth $1.12 billion over a decade.

A federal judge in 2024 sided with the Medicaid beneficiaries, ruling that Tennessee violated federal law and the U.S. Constitution. The lawsuit does not name Deloitte as a defendant.

In Michigan, a 2010 report from the state’s Office of the Auditor General said government agencies “did not provide effective project administration” and failed to ensure that the state could “independently maintain and operate Bridges” because “the contractor did not transfer knowledge and skills” to state officials, according to the audit.

The auditor’s report said that, as a result, Deloitte’s original contract — valued at roughly $70 million — ballooned by $50 million over the initial cost, a 71% increase. State records show Michigan would go on to add millions more, bumping the cost of Deloitte’s initial contract to $124.1 million.

The audit said maintaining the contract would result “in significant additional costs.”

Sutfin said “the state is now fully capable of operating and maintaining Bridges independently.”

Deloitte’s latest contract in Michigan — worth $197.4 million — is set to expire in 2030.

Noon applied for Medicaid in August, she and Kolosova said. In September, the Michigan Department of Health and Human Services sent a notice denying her coverage, citing incorrect income information and stating she wasn’t disabled, according to Kolosova and state documents reviewed by KFF Health News.

Noon said that when she called the state for help, state workers “didn’t know anything about” the Medicaid program she had applied to, Freedom to Work.

“I can’t tell you how many times I just wanted to give up,” she said.

After Marie Noon was wrongly denied Medicaid coverage by Michigan’s benefits system, she paid hundreds out-of-pocket for medications she takes each day to manage her rare disease. “It was kind of a nightmare,” she says.

Kate Wells for KFF Health News

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Kate Wells for KFF Health News

For some people with disabilities, Medicaid is supposed to count only half their earnings when assessing whether they should receive benefits. That didn’t happen. Kolosova said she thinks Michigan’s eligibility system didn’t identify Noon as disabled, even though the state “already had all the information they needed” to show she was.

By failing to recognize her disability, the state used the wrong income formula and said Noon earned too much to qualify for Medicaid, she added. Deloitte and Michigan declined to respond to a detailed list of questions about Noon’s experience.

Kolosova said Disability Rights Michigan has seen a growing number of calls from people about Freedom to Work benefit denials. “Maybe two or three a month,” she said.

“There’s something wrong with the system if they’re relying on individual caseworkers to catch this,” Kolosova said. “The system needs to work.”

Enrolled in the wrong coverage

Noon’s experience isn’t the first time in recent years that people with disabilities have been denied benefits by Deloitte-run eligibility systems.

In Texas in 2023, Lilly Livingston, who has Down syndrome and is now 22, was abruptly cut off from Medicaid benefits, according to Livingston’s mother, Marie. She has undergone numerous surgeries to reconstruct her severely misaligned jaw, which caused sleep apnea, and impaired her speech and chewing ability. She relied on an array of Medicaid services, including speech and occupational therapy.

When Livingston lost benefits, she was wrongly enrolled in Healthy Texas Women, a limited program that provides breast and cervical cancer screenings and family planning services.

“Trying to fix that was a nightmare,” Marie Livingston said.

Terry Anstee, an attorney with Disability Rights Texas, intervened.

In a September 2023 email with the subject line “URGENT,” Anstee begged a Texas Medicaid eligibility worker for help.

Some unknown “error” had occurred and stripped Livingston of her benefits, Anstee said in an email he sent to a state Medicaid staffer. “Lilly has had 2 major surgeries, and her recovery is contingent on Medicaid.”

It was clear that Livingston qualified for Medicaid through multiple paths, Anstee said: “It never made any sense.”

Deloitte declined to respond to a detailed list of questions about Livingston’s case. Jennifer Ruffcorn, spokesperson for Texas Health and Human Services, confirmed that Livingston was erroneously enrolled in Healthy Texas Women. However, Ruffcorn said, she did not experience a lapse in Medicaid coverage in 2023.

Anstee disputed the state’s characterization: “A glance in the system by a Texas HHS press officer or other staff 3 years after the fact may not tell the full story or show the issues that Ms. Livingston endured in August and September 2023. Ms. Livingston experienced lapses in coverage.”

The problem Livingston encountered in Texas was also reported in Michigan.

In 2024, mental health services advocates in Michigan raised red flags about a similar error: People with disabilities were being enrolled in a limited Medicaid program covering sexual health and family planning services, instead of in a comprehensive health care plan. Plan First covers only services such as birth control and treatment for sexually transmitted infections. It doesn’t cover other health needs.

But some enrollees were “being automatically enrolled in Plan First,” Malcolm Kletke, a lobbyist representing the Community Mental Health Association of Michigan and other mental health providers, wrote to a Michigan health official, according to emails obtained by KFF Health News through a public records request.

These enrollees had “long received Medicaid due to their disability,” and getting enrolled in the wrong plan meant losing access to “services essential to their recovery and quality of life,” Kletke wrote in September 2024 to Amy Epkey, a senior deputy director of the Michigan Department of Health and Human Services.

In fact, the state’s own records show that Medicaid enrollment for those with disabilities did decline.

Over roughly four years, enrollment in the Medicaid category that includes people with disabilities fell by 10% in the state, according to the Michigan House Fiscal Agency, which provides nonpartisan analysis to lawmakers. The drop was unusual given people generally leave the program because of death or having recovered from a temporary disability, and it’s unlikely those numbers would balloon, said Robert Sheehan, who was the mental health association’s CEO at the time.

Sutfin said the state examined the decline in enrollment and found “several contributing factors, including post‑COVID renewal patterns, changes in beneficiary circumstances and movement to other coverage categories.”

After inquiries from KFF Health News, the Michigan health department acknowledged in April that it had made changes to “address concerns raised by advocates.”

Michigan’s computer system now prevents approval of Plan First benefits until all other coverage options are evaluated, Sutfin told KFF Health News. Sutfin said the changes were implemented but “not to correct system errors.”

Sutfin said the state submitted a change request to Deloitte to address this problem. The fix was implemented in January 2025.

Until presented with Kletke’s email, the state had denied there were problems related to Plan First.

Even after the state addressed that issue, other problems persisted.

Noon’s coverage denial notice arrived in September. She fought with the state for months to reverse its decision, “paying cash for all of the medicines through these appeals over and over and over again.”

It was only in January that she was approved.

“I literally cried,” Noon said. “It was a really big deal.”

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.

Attilio Cecchetto (right), pictured here with his son Gino. Attilio was born on a farm in Italy and lived in California since the 1960s, working as a tile journeyman and contractor for decades.

Marco Cecchetto

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Marco Cecchetto

Sam Ato Timaloa, a paroled sex offender who also served time for attempted murder, had dementia and an acute intolerance of noise — especially from roommates at Sunrise Post Acute, a nursing home in Banning, California. Over four months in 2025, a state investigative report found, Sunrise switched Timaloa’s room eight times, the last into one occupied by Attilio Cecchetto, 92, a retired tile installer whose dementia led him to frequently moan, mumble, and yell.

Overnight, a nurse aide walked into their room and saw blood splattered on the floor, walls, and ceiling, according to a grand jury transcript. Cecchetto’s face “looked twisted and smashed,” the aide testified. A Banning city police officer testified that Timaloa, 77, told him that he had punched Cecchetto twice.

“He just kept saying that Attilio was being too loud: ‘He talks too much,'” the officer said.

Cecchetto died two days later from blunt force facial trauma.

“You get placed in a facility like this to be taken care of, not to be murdered,” one of his sons, Gino Cecchetto, said in an interview. “This was completely preventable at many different points.”

Timaloa pleaded not guilty to assault. The charges were later upgraded to murder, and a judge ordered a mental health evaluation. The judge will rule as early as August on whether Timaloa is competent to stand trial.

PACS Group, the nursing home chain that owns Sunrise, denied negligence. “We strive to provide quality care to everyone we serve, and our hearts continue to go out to the Cecchetto family for their loss,” PACS spokesman Brooks Stevenson said in an email.

In nursing homes primarily occupied by impoverished people as well as posh assisted living facilities that cost upward of $10,000 a month, agitated residents have shoved, punched, bit, and kicked others. They have wielded canes, walkers, pens, a plate, a mop stick, a shoe, a belt buckle, and even the footrests of wheelchairs as weapons, federal inspection reports show.

How often these altercations take place nationwide is unknown, but an in-depth study of 14 assisted living facilities in New York state led by Cornell University researchers estimated 1 in 7 residents experienced aggression within a month, including verbal, physical, or sexual acts. Their separate study of 10 New York state nursing homes estimated 1 in 5 residents experienced an altercation in a month. Researchers have found that these assailants are disproportionately likely to have dementia.

The diseases that cause dementia can impair brain circuits involved in impulse control and threat perception, raising the risk of aggressive behavior. Residents with Alzheimer’s disease and other dementias constitute more than 900,000 of the 2.2 million people living in these settings, many of which include specialized memory care units.

Often, altercations involving a resident with dementia erupt after danger signals are missed or ineffectively addressed, according to a KFF Health News examination of court records, police reports, and state and federal inspection reports.

Since the start of 2024, the federal Centers for Medicare & Medicaid Services has faulted nursing homes at least 700 times for failing to protect residents from physical, sexual, or verbal abuse by other residents, CMS inspection reports show. The federal records do not include assisted living facilities, which are regulated by states.

In the first three months of this year, CMS cited nursing homes more often for resident-to-resident abuse than for any other type of abuse, neglect, or exploitation, including abuse by employees, the reports show.

The long-term care industry says not every clash can be averted. Presbyterian Homes & Services, a nonprofit Christian chain of senior living facilities, said in a statement: “Caring for individuals living with advanced dementia is complex, and behaviors can change in ways that are difficult to fully predict or prevent, even with clinical interventions in place.”

Eilon Caspi, a dementia consultant and researcher who studies resident-on-resident altercations, said that usually there is a specific unmet need that precedes an altercation. “In the vast majority of incidents,” he said, “there are warning signs in the months, weeks, days, hours, and sometimes minutes and seconds prior.”

Breeding grounds

One psychological theory about Alzheimer’s, the most common dementia disease, holds that as the brain’s networks deteriorate, the balance shifts between the prefrontal cortex, which helps govern judgment and self-control, and limbic regions including the amygdala, which helps process fear and threat responses.

As cognition clouds, people lose the ability to understand what is happening around them and to put distress into words, researchers say. Pain, infection, medication side effects, and other physical and emotional distresses may be expressed through shouting, intimidating gestures, kicking, pushing, or punching. Long-term care facilities can be triggering environments, with intimate care often delivered by a changing stream of aides whom residents can’t recognize. Amid noise, close quarters, and rigid routines, interactions become flash points.

“You don’t feel safe, because you don’t know these strangers who are coming in and taking off your clothes,” said Al Power, a geriatrician and an advocate for alternative models of care for people with cognitive issues. “These things will be distressing to anybody.”

The Cornell researchers found verbal altercations were the most common type of aggressive interaction but estimated 4% of assisted living residents and 5% of nursing home residents in their studies experienced physical assaults in a month.

Another Cornell study found that Connecticut police were called to nursing homes for resident-to-resident clashes more often than allegations of staff abuse, theft, and residents wandering away without supervision combined. A national analysis of survey data from the Centers for Disease Control and Prevention calculated nearly 8% of residents in assisted living facilities engaged in physical aggression or abuse toward other residents or staff members.

Many of the physical aggressions KFF Health News identified in CMS inspection reports were perpetrated by residents with diagnoses of dementia, schizophrenia, or other cognitive disorders. In some physical altercations, both residents were aggressors, while other fights were one-sided. Sometimes the residents were roommates.

Laura Mosqueda, a geriatrician at the University of Southern California’s Keck Medicine in Los Angeles and a senior adviser to the National Center on Elder Abuse, said: “What worries me is that we just end up blaming two people who have either cognitive impairment or severe, uncontrolled mental health issues, when they’re supposed to be in an environment where people are safe.”

“Only a matter of time”

Rebecca Norton warned officials at her mother’s memory care facility that another resident was harassing her mother, Gladys Lynch. Lynch was later shoved down by the resident and died five days later, a Minnesota report said.

Liam James Doyle for KFF Health News

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Liam James Doyle for KFF Health News

Gladys Lynch, a retired department store accountant, transferred into the memory care unit at Harbor Crossing in White Bear Lake, Minnesota, in September 2025. Her monthly cost was more than $10,000, according to an invoice provided by the family.

One of Lynch’s daughters, Rebecca Norton, installed web cameras in her room and often saw another resident inside. “Every day I looked at it, this woman would be walking into my mom’s room, harassing her, digging through her things, using her bathroom, yelling at her,” Norton said in an interview. She informed Harbor Crossing’s administration, and the facility said it would start locking her mother’s door.

Norton emailed a Harbor Crossing administrator a list of issues with her mother’s care. “My biggest concern,” she wrote, was that her mother’s door was not consistently locked and the webcam showed the woman had again entered, rummaged through the bathroom, and taken a couple of adult diapers.

Unknown to Norton, Harbor aides had raised concerns about the other resident, who like Lynch was new to Harbor Crossing’s memory unit, according to a Minnesota Department of Health report. Diagnosed with Alzheimer’s, severe dementia with agitation, depression, and anxiety, the woman was confused, had difficulty communicating her needs, and hit aides.

Aides repeatedly reported that the woman had “ongoing aggression, entered other residents’ apartments, invaded others’ personal space, and was difficult to redirect,” the health report said. They said medications had been ineffective and pressed for new ones. The report said one nurse told the woman’s doctor it was “only a matter of time before” she “hurts another resident.”

Captured on camera

On the last day of September, she entered Lynch’s room and resisted leaving, the state report said. The next morning, she reappeared. Video of the incident was described in the police and state reports and reviewed by KFF Health News. It shows Lynch guided the woman out and appeared to attempt to lock the door, but the woman opened it and returned once more.

The woman declared it was her house, went into Lynch’s bathroom, used the toilet, and then returned to the room Lynch was in. Lynch can be seen repeatedly pressing the alert pendant around her neck to signal nurses for help.

The video shows the woman was almost out of her apartment door when she attempted to touch an object near the door. Lynch put her hands up to block her. The woman slapped at her hands and said, “I’m going to kill you if you don’t quit it.” She pushed Lynch, who fell, her head hitting the floor and blood seeping out.

Aides arrived 13 minutes after she had initially pressed her pendant, the state report said. Lynch suffered a brain hemorrhage and fractures to her eye socket and ribs, according to the state report. She died in the hospital five days later at age 96; the medical examiner’s office declared it a homicide.

Gladys Lynch was a department store accountant and raised three daughters before developing dementia. Here is a collection of Lynch’s personal letters and photographs at her daughter Rebecca Norton’s home in Hugo, Minnesota.

Liam James Doyle for KFF Health News

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Liam James Doyle for KFF Health News

Norton said her mother was kind and pleasant and never combative. “My mom deserved better than what they gave her,” she said.

Prosecutors declined to bring charges, according to the police report. The state investigation concluded Harbor Crossing was responsible for neglect because it was aware the woman “exhibited violent and aggressive behaviors” and, yet, had failed to put in place effective interventions. Harbor Crossing has requested the state reconsider its findings.

Before Gladys Lynch’s death, employees at the memory care unit at Harbor Crossing in White Bear Lake, Minnesota, struggled to keep the resident who fatally assaulted her from behaving aggressively and wandering into other residents’ rooms, a state report found. Harbor Crossing has asked the state to reconsider its findings of negligence.

Liam James Doyle for KFF Health News

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Liam James Doyle for KFF Health News

In June, Suzanne Scheller, the attorney for Lynch’s family, filed a wrongful death lawsuit against Presbyterian Homes, which owns Harbor Crossing.

Presbyterian said in a statement: “We are deeply saddened by the loss of Ms. Lynch, and our thoughts remain with her family and all those impacted.” It declined to comment further on the incident or the lawsuit.

Preventive tactics

Geriatricians, researchers, and resident advocates say long-term care homes should employ strategies to reduce the risk of altercations, including closer supervision of residents at high risk, relocating them closer to nursing stations, separating residents with repeated conflicts, and adjusting roommate assignments or seating in shared spaces.

Each resident should have a care plan, and homes should train staff to be alert to a resident’s triggers and intervene quickly, dementia specialists say. Organized activities are essential to keep residents occupied and engaged. Antipsychotics and other psychotropic medications are often prescribed, but they can increase the risk of falls, strokes, and even death.

An aide can be assigned to watch a particularly challenging resident one-on-one, but many places lack enough staff for protracted, dedicated supervision. Some assisted living facilities will tell a resident’s family they must hire a personal aide, who can cost thousands of dollars extra each month. In extreme situations, facilities might send a resident to an emergency room for evaluation or to a psychiatric hospital, or evict or discharge them.

Camille Russell, who served as Kansas’ long-term care ombudsman until 2024, said she observed nurses and aides were often “woefully undertrained” in basic elements of dementia care.

“We’ve gotten too far away from making decisions that are caring decisions,” Russell said. “There has to be a balance, and the balance has gotten too far to the profit side.”

A debilitating kick

Many physical altercations between residents result in a scratch or a bruise, but nonfatal scraps can leave permanent damage on deeply frail residents.

Linda Twiddy’s first weeks in a Chesapeake, Virginia, memory care unit in August 2024 were happy, her daughter, Barbara Howerin, said in a May interview. Twiddy, a former church secretary with vascular dementia, sang along with a visiting church choir, decorated pumpkins, and visited a cat cafe. The facility, The Vero at Chesapeake, charged Twiddy a one-time $6,825 move-in fee and monthly charges of $7,475, according to the lease.

Seven weeks after Twiddy started living there, a nurse called Howerin. She told her that her mother had been kicked in an altercation with another resident and was being sent to the hospital.

When Howerin arrived at the hospital, she was shocked by the extent of the injury. “It was like 10 inches long by 6 inches wide, the whole front of her shin,” she said. “The calf was just like dangling down.”

According to an internal facility incident report the family obtained, an aide heard Twiddy scream for help and raced over to see a male resident with dementia trying to hit Twiddy as she sat on the floor in “a pool of blood.” The report said, “Linda was screaming get him away from me, he pushed and kicked me.”

The man had prior episodes of aggression, according to documents Twiddy’s family obtained in a lawsuit they brought against The Vero in Chesapeake Circuit Court. At his previous facility, a progress note from 2023 stated, he was “becoming very aggressive in tone and actions to residents and staff.” He “grabbed another resident by the wrists and pushed her,” according to the note. He was sent to an emergency room for evaluation of agitation, according to a hospital report. It did not make clear whether he was discharged back to the facility or elsewhere.

Agitation tied to pain

The male resident’s medical records at The Vero said he was diagnosed with late-onset Alzheimer’s disease, agitation, and anxiety, according to his doctor’s deposition. He had chronic pain in his back and trouble sleeping. He could answer simple yes-or-no questions but had trouble providing more extensive answers and couldn’t communicate that he was in pain, she testified. His behavioral changes usually occurred when he had a urinary tract infection, the doctor said.

When he was agitated, aides could sometimes calm him by turning on the television so he could watch his beloved New England Patriots, one aide testified in a deposition. A former aide said she tried to avoid dealing with him altogether. “If you go up to him and he was agitated, he’d reach out to try to grab you,” she testified. “If he had that cane, he would swing that cane or he would punch at you.”

In a court filing, The Vero denied allegations by Twiddy’s family that it should have protected residents from him. The filing said The Vero complied with all standards of care and that any injuries Twiddy sustained “were caused by her own negligence” or acts of others.

In their investigation of the incident, Virginia regulators alleged The Vero had failed to assume responsibility for the health, safety, and well-being of its residents. The inspection report said The Vero pledged to appropriately staff the memory care unit based on the number of residents and to ensure someone completed rounds at least every two hours during sleeping hours.

Twiddy underwent three surgeries at the hospital for her leg, including a skin graft, then spent a month in rehabilitation. “She was never able to walk again,” her son, Doug Twiddy, said in a May interview.

The family moved Linda Twiddy to a different memory care facility where the nursing station had a clear view of all the rooms. She lived there until her death earlier this year.

The lawsuit was settled on confidential terms in early June. Carlton Bennett, the family’s attorney, declined to comment. In an email, Lauren Rogers, a spokesperson for Sinceri Senior Living, which operates The Vero, said the company was pleased the legal case had been resolved but could not comment further, citing confidentiality and patient privacy.

“The Vero at Chesapeake is committed to providing a caring, supportive environment where resident health, safety, and well-being remain our highest priorities,” she said.

A history of violence

After Attilio Cecchetto was fatally bludgeoned at Sunrise Post Acute, his adult children and their attorney, Jody Moore, discovered disturbing details about Sam Ato Timaloa. He had been imprisoned in 1999 after being convicted of raping an underage girl and sentenced in 2008 to 24 years in prison for attempted murder involving domestic violence, according to Riverside County court records. His public defender declined to comment.

Cecchetto’s sons, Moore, and her colleagues at Moore Hutchins Moore also learned more about the home’s owner, PACS Group, a publicly-traded company with more than 300 long-term care facilities. Last year, PACS earned $191 million on revenue of $5.3 billion, according to its annual securities filing.

In the lawsuit the Cecchettos and their father’s widow filed against PACS, they accused the company’s founders, Jason Murray and Mark Hancock, of draining resources from their nursing homes to pay for the chain’s expansion and swell their personal wealth.

The two had earned more than $650 million through stock sales since taking the company public and bought two private luxury jets, according to the lawsuit and securities filings. PACS has also purchased corporate sponsorships for Utah sports teams even though it owns no nursing homes in the state, the lawsuit said.

California regulators fined Sunrise $120,000 for failing to protect Cecchetto and for not taking Timaloa’s articulated dislike of noise into account when assigning rooms. Medicare issued its own $62,810 fine.

In legal papers responding to the Cecchettos’ lawsuit, PACS denied negligence for his death and alleged he “failed to exercise ordinary care on his own behalf for his own safety.” It has sued to overturn the $120,000 state fine, saying it was issued too late and that Sunrise “did what might reasonably be expected of a long-term health care facility licensee acting under similar circumstances” to comply with state rules.

Police photographed Attilio Cecchetto’s bed after he was taken to a hospital. He died two days later.

Banning Police Department

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Banning Police Department

The Cecchettos’ lawsuit asks for a judge to impose robust procedures PACS homes must follow for admissions, staff training, room changes, and the reporting of altercations between residents. The suit asks for a court-appointed monitor to oversee compliance. In its written statement to KFF Health News, PACS said “important context” would come out during the process and declined further comment.

In an interview, Cecchetto’s three sons, Dino, Gino, and Marco, described their father’s life. He spent his childhood on a farm in Italy, growing up under Benito Mussolini. After World War II he moved to Canada, where he learned to tile and lay marble and terrazzo, a decorative flooring material made of chips of stone, glass, or other materials embedded in cement or resin. He relocated to California in the early 1960s, became naturalized, and worked as a tile journeyman and a contractor for decades.

“We don’t want this to happen to somebody again,” Gino Cecchetto said. “With the life he led, he deserved a quiet, dignified death. Instead, he ended his life in pain and fear.”

DATA METHODOLOGY

KFF Health News’ analysis of federal nursing home inspection reports focused on citations for violations of Medicare and Medicaid regulations stating that each resident has the right to be free of abuse, neglect, and exploitation.

The analysis looked at the most serious levels of citations, those in which inspectors determined that one or more residents had been harmed, or that the facility’s actions caused — or were likely to place residents in immediate jeopardy of — serious injury, harm, impairment, or death. We reviewed the reports since January 2024 and tallied those that explicitly described resident-to-resident altercations.

We conducted a more granular analysis of a subset of the inspection reports from January through March 2026 involving harm or immediate jeopardy. Each report was reviewed and categorized by the type of abuse, neglect, or exploitation.

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 — the independent source for health policy research, polling, and journalism.

Smoke from massive wildfires in Canada and Minnesota engulf the Washington, D.C. skyline on July 17, 2026, reducing visibility and casting a colored haze over the Lincoln Memorial.

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WASHINGTON — Poor air quality persisted in the Northeast, Mid-Atlantic and Midwestern states on Saturday, as smoke from hundreds of wildfires burning in Minnesota and Canada continued to spread and envelop skylines. The National Weather Service (NWS) said heavy rain and storms could help clear the air in the northeast and mid-Atlantic this weekend, while dangerous levels of air pollution will still hang over the Midwest.

“As we start clearing out here in the east, they’re going to get the next batch of smoke later this afternoon into tonight across areas from upper Michigan, eastern Wisconsin, into Illinois and Indiana, including Chicago,” NWS Forecaster Brian Hurley told NPR. “That will continue through [Sunday], unfortunately.”

Major League Baseball postponed Friday’s game between the Pittsburgh Pirates and the Cleveland Guardians due to poor air quality in Cleveland until Saturday.

Hurley said conditions in the National Capital Region are improving, following the eerie appearance of Washington, D.C. landmarks in a thick, smoky haze. Air pollution will still be elevated.

“But not nearly to the level that we’ve been seeing. We’re only talking about maybe a fourth or a third of the concentration of particulates,” he explained, adding the haze will have mostly faded away by Sunday.

Clearer air conditions are also expected in areas north of D.C. along the east coast, including New York City and northern New Jersey, where Sunday’s World Cup final between Argentina and Spain will be played at MetLife Stadium, an open-air venue.

More than 900 active wildfires are burning in Canada, including in the Manitoba and Ontario provinces bordering the northern U.S.

President Trump threatened to impose new tariffs on Ottawa in a post on Truth Social on Friday. He accused Canada of failing to maintain its forests and said the U.S. is being “invaded by filthy, polluted, and unhealthy air.” Trump said he planned to call Prime Minister Mark Carney:

“This is Willful Negligence, and becoming a yearly occurrence, costing the United States Billions of Dollars, which cost of this pollution must of necessity be added to the TARIFFS Canada is currently paying,” Trump’s post read in part.

Canadian officials have said in recent days both countries share responsibility in fighting climate change. Human-caused climate change has increased the risk of wildfires and intensified them.

Concerns about toxic smoke particles

Health experts are concerned about the effects on public health.

Peter DeCarlo, a professor in the Department of Environmental Health and Engineering at Johns Hopkins University, recommended using an air clearing device such as an air purifier to eliminate toxic air particles spread by the smoke.

“That’s going to minimize the amount of particles that you would be breathing in that space,” DeCarlo said.

He added: “The age of the home and how tight the building is adjusts how much of that particulate matter from outside smoke comes in. A rough estimate is on the order of 50% for a lot of the houses in the continental U.S.”

DeCarlo also warned that children, pregnant women, older adults and people with pre-existing conditions face a particular risk of experiencing harmful impacts from poor air quality.

“N-95 masks are protective, not only from COVID particles, but also for pollution,” said DeCarlo. “You can put on an N-95 and actually protect yourself pretty significantly with that if you want to go walk around the block and get some time outdoors.”

The National Weather Service issued air quality alerts across New England on Saturday.

“A lot of these advisories or alerts are going to be through midnight. I think most areas are going to start to see improvement before that,” said Hurley.

However, state and federal officials in Minnesota are warning fire conditions there remain volatile. MPR News reports more than 600 fire fighters are battling wildfires in northeast Minnesota in extremely hot and dry conditions. The flames have burned through more than 70,000 acres, and are approaching residential and resort areas that were under evacuation orders on Saturday. Air quality levels in Minnesota have broken records in recent days, according to officials.

Thunderstorms, flooding and a possible risk of tornadoes are forecasted in the mid-Atlantic, most of Pennsylvania and other areas of the northeast this weekend.

ICE agents stand guard outside a immigrant detention center in Newark, New Jersey in May 2026. Medicaid officials improperly shared data about millions of people with ICE, who then shared that data with the data analytics firm Palantir, according to new court filings.

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Adam Gray/Getty Images

After Medicaid officials improperly shared data about millions of people in January with immigration officials, ICE then shared that data with the data analytics firm Palantir, according to new court filings. Palantir operates an app called ELITE that is used by ICE agents to show the addresses of noncitizens who may be subject to deportation.

That revelation was made public in a motion filed Thursday by more than 20 Democratic attorneys general who sued the Trump administration last year over its data-sharing agreement between the Centers for Medicare and Medicaid Services and ICE.

U.S. District Judge Vince Chhabria in California ruled in December that health officials could share with ICE certain details from Medicaid data about immigrants without lawful status from the states that had sued, such as home addresses, dates of birth and immigration status.

Chhabria, who was appointed by former President Obama, then temporarily paused data sharing between CMS and ICE for immigration enforcement purposes in late May after federal officials admitted CMS had shared data with ICE in January that went beyond what the court order allowed. One dataset of refugees in Minnesota included U.S. citizens, and another that was transferred on Jan. 7 contained data of millions of people, including those in the country legally.

ICE was supposed to delete the improperly shared data. Chhabria set a hearing for August to further clarify his order and clear up ambiguity regarding which categories of noncitizens’ data could be lawfully shared with ICE.

But in recent days, federal officials have admitted to additional instances of improper data sharing.

In a court filing last week, the Justice Department said that CMS again inadvertently reshared with ICE the dataset with millions of names that CMS had first improperly shared with ICE in January. The government said the error occurred during an effort to share data from states not involved in the lawsuit.

Alberto Briseno, a section chief for ICE’s Homeland Security Investigations, wrote in a declaration that ICE personnel deleted the file after it was discovered and it was not used for law enforcement purposes.

Then Briseno revealed that a day later, the agency had done a broader search and discovered that half a dozen users still had a copy of the Jan. 7 dataset.

In that most recent declaration, Briseno said he was not aware of any additional copies of the dataset, but said the recent searches have “highlighted technological difficulties of making a representation that every possible variation of the file has been searched for and located.” He added, “ICE will continue to make good faith efforts to delete any copies that may be found in the future.”

Meanwhile, the Department of Justice is asking the judge to expand his order to allow ICE to receive data on a broader category of noncitizens – to potentially include all immigrants who are not legal permanent residents, citizens or have another form of permanent status.

“ICE’s inability to identify Medicaid records in its possession undercuts any claim that the agency should be entitled to more access to that data,” the Democratic attorneys generals wrote in their motion filed late Thursday.

Their motion continued, “Each successive revelation of a violation of the Order makes it more difficult for Plaintiff States to have confidence in Defendants’ ability to maintain and secure this data in compliance with the Order, and more difficult for Plaintiff States to communicate assurances to Medicaid providers, enrollees (and their counsel), and the public at large about the privacy and confidentiality of their healthcare data.”

Palantir did not immediately return a request for comment about whether the company had deleted the Jan. 7 dataset that ICE had shared after improperly receiving it from CMS. DHS also didn’t immediately return a request for comment about its transfer of data to Palantir.

According to a declaration filed by California deputy attorney general Anna Rich, when plaintiffs asked what federal officials did to ensure Palantir and other contractors had purged the data, defendants responded that the data had been shared over a Microsoft Teams chat and the shared data was deleted from the chat. Rich shared in her declaration a document turned over in discovery from federal officials that shows a redacted transcript of what appears to be ICE personnel asking Palantir to delete the file.

In an April 30 hearing, Chhabria had warned the federal government would not be able to continue using Medicaid data for deportation efforts if it continued improperly sharing the data of citizens and legal immigrants.

“If the federal government cannot be sufficiently careful then it can’t use the information, ok?” Chhabria had said.

Taco Bell announced it is removing all iceberg lettuce from its supply chain and replacing it after federal health officials linked an outbreak of cyclosporiasis to a single supplier.

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The Centers for Disease Control and Prevention and the Food and Drug Administration advise consumers to avoid eating shredded iceberg lettuce at Taco Bell locations in Indiana, Kentucky, Michigan, Ohio and West Virginia.

Health officials analyzed 190 cases of cyclospora in Michigan where a person who fell ill reported eating at Taco Bell. Officials found that 90% of those people said they ate iceberg lettuce.

More than 1,644 sick people in this multi-state cyclospora outbreak reported eating at Taco Bell in those states starting May 13, according to the agencies. There have been 94 hospitalizations and no deaths reported.

The FDA traced this subset of cases identified nationwide to a single supplier of contaminated iceberg lettuce from Mexico, but did not name the supplier.

FDA says it’s working with the supplier to identify other locations where the contaminated lettuce has been distributed. The agency notes this is one large cluster that is epidemiologically related. There are other clusters across the country that may or may not be associated. Cases have been identified in 34 states.

Want the latest stories on the science of healthy living? Subscribe to NPR’s Health newsletter.

Taco Bell issued a statement July 16 that it took “immediate action to voluntarily remove potentially impacted lettuce from a supplier in select states.” The statement also said the lettuce would be removed from the supply chain nationwide and replaced within 24 hours.

A wide reach for salad suppliers

The Associated Press, citing an unnamed federal official, has reported that Taylor Farms was the supplier of the lettuce. NPR has not independently confirmed that, and Taylor Farms has not responded to a request for comment.

A handful of big players with integrated supply chains and advanced processing infrastructure, including Taylor Farms, dominate the bagged lettuce and salad industry in the U.S.

With such a big reach, a single supplier can provide lettuce products to a number of retailers, so it’s possible that additional clusters of cyclospora around the country could be linked to lettuce from the same supplier. It’s also possible that there are multiple sources and suppliers linked to other cases around the country.

The FDA and CDC say the investigation is continuing.

How to protect yourself

The symptoms of the illness include watery diarrhea, loss of appetite and fatigue, and people contract it by eating or drinking contaminated food or water.

To protect yourself from the parasite, the CDC advises people to follow standard food safety handling protocols. “Wash your hands and any fresh produce thoroughly under running water before eating, cutting or cooking. This will reduce the risk of infection. Cooking kills the parasite, so heating food to 158 F or 70 C or higher is effective,” said Dr. Gwen Biggerstaff with the CDC’s Division of Foodborne, Waterborne, and Environmental Diseases.

If people do develop symptoms, health officials advise people to contact their healthcare providers to be tested specifically for cyclospora. Routine stool tests often don’t include that test.

“People with symptoms should stay well-hydrated and avoid preparing food for others while acutely ill, out of general caution, even though person-to-person spread is very unlikely,” Biggerstaff said.

Smoke from massive wildfires in Canada and Minnesota engulf the Washington, D.C. skyline on Friday morning, reducing visibility and casting a haze over the Washington Monument and Lincoln Memorial.

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A version of this story was originally published on Jan. 10, 2025. It has been updated to reflect the wildfires currently bringing smoke to the U.S.

Interest in air filters and purifiers is spiking as wildfire smoke spreads, including questions about how to build a homemade air purifier.

On Friday, the air in a large section of the U.S. — from Minnesota to Virginia — was listed as “very unhealthy” due to particulate matter from large wildfires, according to the federal AirNow air quality monitor.

The smoke is coming from wildfires in Ontario, Canada, and northern Minnesota — where Duluth and other cities are enduring hazardous air at record levels, as Minnesota Public Radio reports.

On AirNow’s map, a purple zone signals “very unhealthy” air quality index values from 201 to 300. That level triggers public health alerts, because “everyone may experience more serious health effects,” the Environmental Protection Agency says. Of particular concern are children, older adults, and people with heart of lung disease.

Within the warning area, many communities are currently in an even more dire “hazardous” category, reflecting an AQI of at least 301 — a level the EPA considers “extremely rare.”

A big worry, experts say, is fine inhalable particulate matter known as PM 2.5 (for 2.5 microns) that can lodge deep into our lungs.

And as researchers at the University of Washington note, “Smaller ultrafine particles (PM 0.1) can pass into the bloodstream and organs, including the brain.”

Here’s a quick guide to getting cleaner air:

Search filters by their MERV rating

Filters are key, whether you’re using them to upgrade your home’s HVAC system or put them in an air purifier or a DIY air cleaner. A filter’s ability to pull particulates and other matter out of the air are rated by Minimum Efficiency Reporting Values, or MERV. Filters with higher values can catch smaller contaminants like smoke, bacteria and viruses.

A MERV rating of 13 means the filter is efficient at catching items from 0.3 to 1 micron in size: “Bacteria, droplet nuclei (sneeze), most tobacco smoke, insecticide dust,” according to the California Air Resources Board, or CARB.

“Upgrading to a filter rated MERV 13 or higher can be especially important during smoky periods to effectively remove fine particle pollution from smoke in the indoor air,” the EPA says. It adds that most HVAC systems work fine using MERV 13 filters, as long as the filter is replaced frequently — but if you’re in doubt, ask an HVAC technician to be sure.

One thing to remember: If you’re using your HVAC system to clean your home’s air, it only does so when the unit is running. You can learn more about filter rating systems at member station LAist.

An air quality map shows a large part of the U.S. with “very unhealthy” air on Friday morning, due to large wildfires in Minnesota and Canada.

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Air Now/EPA

Build an air cleaner at home

All you need is a box fan, good air filters and some duct tape, and you’re in business.

NPR has previously posted a design and guide to building an air purifying cube known as a Corsi-Rosenthal Box, using four 20-inch MERV 13 filters, a 20-inch box fan and two 20-inch panels of cardboard.

A smaller and more affordable approach is to attach one MERV filter to the back of a box fan, an idea laid out in a website from the Montana group Climate Smart Missoula. The group notes that people using that option should use newer box fans, and be sure the motor is clean to reduce the risk of overheating.

The Centers for Disease Control and Prevention says these DIY purifiers can be effective for a temporary solution, especially if you don’t have any other alternatives.

A satellite image from 8 a.m. ET shows a plume of dark smoke extending from Minnesota to Virginia and out into the Atlantic Ocean.

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NOAA/NESDIS/STAR GOES-19

Use HEPA air purifiers and other methods

HEPA (for high-efficiency particulate air) filters are used in many air purifier machines. HEPA is roughly equivalent to a MERV 17 filter, the California Air Resources Board says.

“A well-sealed HEPA filter is more than 99.9% efficient for all sizes of particles,” according to the American Society of Heating, Refrigerating, and Air-Conditioning Engineers, or ASHRAE.

If you plan to buy a portable air cleaner or purifier, the EPA says you should make sure it has a HEPA filter. To help your search, the EPA has a guide on matching your room size with the appropriate unit. And California has a table of state-certified air cleaners that lists more than 1,000 products by brand, model number, and type.

Whichever strategy you choose, experts say you should also make sure doors, windows and air ducts are well sealed, to keep out smoke and pollution. You should also drink plenty of water to help ease irritation — and wear a mask if you go outside, as NPR has reported.

These three children died in the wake of the cutoff of funding from the U.S. Agency for International Development. Their parents say that the loss of medical services supported by these funds played a role. From left: Abdullahi Ibrahim of Nigeria, age 10, suffered a fatal asthma attack. Purity Wamboi of Kenya, 16, contracted tuberculosis. Ibrahim Garba of Nigeria, 8, succumbed to typhoid.

From left: David Augustine, Lameck Nyagudi and Kazeem Olawale Nasiru for NPR

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From left: David Augustine, Lameck Nyagudi and Kazeem Olawale Nasiru for NPR

Abdullahi Ibrahim developed asthma when he was 5. Over time, it became increasingly serious.

“Sometimes he would wake up suddenly, gasping for air,” recounts his father, Ibrahim Musa, through an interpreter. “I feel very, very scared. We usually rush him to the hospital.”

They would take the motorcycle Musa uses as a taxi driver, Abdullahi sandwiched between his parents.

Those visits, plus the drugs and inhalers, were usually free, says Esther Agbo, a nurse at Mucciya Primary Health Care who often interacted with the family living in the north of Nigeria, in Sabon Gari. She says that the costs had been offset by USAID — the United States Agency for International Development.

“Because of that support,” says Musa, “people like us who don’t have much could still get treatment.”

Last year, when he was 10, Abdullahi had an especially severe asthma attack. “He told me, ‘Daddy, I can’t breathe well,'” says Musa. “He was just lying there, helpless. We rushed to the clinic.”

He says the clinic told them the drugs were no longer free of charge. “USAID stopped supplying the treatment [for] free,” says Agbo, who was not on duty there at the time. “The cost of the medication was too much for the parents,” she says.

Fatima Ibrahim sits alongside a portrait of her son, Abdullahi, in the family’s one-room home in Sabon Gari, Nigeria.

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David Augustine for NPR

Abdullahi died from that final asthma attack, says his father. “If there was still help coming from USAID,” says Musa, “I’m very sure my child would still be alive today.”

Naming names

In May of last year, Secretary of State Marco Rubio testified before Congress about the termination of USAID. He said, “No children are dying on my watch.”

As recently as June 28 and 29 of this year, Elon Musk wrote on X that deaths in Africa went down after funding to USAID was cut and that those who indicate otherwise “cannot cite a single name of someone who died out of the ‘millions’ they falsely claim have died. Not a single name!” Last year, as head of President Trump’s Department of Government Efficiency, Musk presided over the shutdown of the agency, noting that he was “feeding USAID into the wood chipper.”

Abdullahi Ibrahim is one name. And there are others. NPR worked with photojournalists who are part of a global consortium called The Everyday Projects to identify the names of children whose deaths over the past year and a half had a strong connection to the cutback in services provided by USAID funding.

In this story, we are looking at the deaths of Abdullahi and two other children.

In each instance, we interviewed a parent of the child and a health worker familiar with the case.

NPR reached out to the U.S. State Department to ask for comments on the cases of these three children in Nigeria and Kenya. The department didn’t address the specifics of their deaths.

In its response, the department pointed to the Trump administration’s signing of 32 bilateral global health memorandums of understanding, including with the Kenyan and Nigerian governments, as proof of a different type of foreign assistance commitment.

It is difficult to say for sure what would have happened had USAID remained, says Brooke Nichols, an infectious disease modeler and health economist at Boston University, but the agency had been in Africa enabling a range of treatments.

Nichols created the Impact Counter to tally the number of projected deaths likely associated with reductions in U.S. foreign aid starting in March 2025. “Over the course of one year,” she says, “we estimate more than 700,000 people have died from the abrupt stopping of USAID, including more than half a million children.”

These deaths occurred largely in low- and middle-income countries, with the vast majority in sub-Saharan Africa — including the three deaths described here.

Purity’s mother: “I could see her shivering”

Last August, in central Nairobi, Kenya, 16-year-old Purity Wamboi was home on a school holiday. She loved to read and was happy to help wash clothes and do other chores around the house.

Her mother, Rachael Wanjiru, noticed something was off in her girl.

Rachael Wanjiru, 43, holds a photo of her 16-year-old daughter, Purity Wamboi, who died from tuberculosis-related complications after missing her medication.

Lameck Nyagudi for NPR

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Lameck Nyagudi for NPR

“She wasn’t feeling too well,” Wanjiru says through an interpreter. “She used to cough severely. She had chest pains. Sometimes I could see her shivering. And therefore I asked her to take a break.”

Purity tried to keep the discomfort to herself. “I would ask her what was it that she was hiding,” recalls Wanjiru. “She understood that I didn’t have money, and she didn’t want to stress me.” (Wanjiru had developed a goiter, so she wasn’t working at the time.)

She got Purity some painkillers, which helped.

Her younger brother, 14-year-old James Gitau Mwai, remembers thinking, “I thought Purity was going to get well and be able to be like she was before.”

Pages from Purity’s journal.

Lameck Nyagudi for NPR

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Lameck Nyagudi for NPR

But after she returned to school, the chest pain came back even stronger.

Over the next three weeks, things deteriorated quickly. Purity’s family raced to figure out what was wrong — amid a lapse in USAID funding that they say undermined their urgent search.

When Wanjiru brought Purity in for a checkup at the Tumutumu Community Medical Centre in Nairobi, the medical staff explained that she had pneumonia. But she didn’t respond to the treatment.

A couple of weeks passed before Tabitha Mugweru bumped into Wanjiru and Purity on the road. She’s a close family friend and a community health promoter — a role that involves visiting households, making medical referrals and supporting the health needs of underserved communities.

“They were coming from a private hospital,” says Mugweru. “I saw Purity was very weak. Purity was not doing well at all.”

So Mugweru referred the family to Mwiki Health Centre, a governmental facility, which sent Purity to a different hospital for a chest X-ray. The scans revealed that Purity didn’t have pneumonia at all. She was suffering from tuberculosis.

Purity received new medications, but “the TB was diagnosed very, very late,” says Mugweru. This meant that the bacterial infection had already consumed a portion of her lungs.

Mugweru says there had been a more extensive team of community health promoters who once fanned out across Kenya, visiting families in their homes, where they may have caught something like Purity’s tuberculosis sooner. These workers were paid with funds that came from USAID, according to Mugweru.

So when the Trump administration shuttered the agency last year, Mugweru says, that money dried up.

“Most of them stopped working when USAID withdrew their support,” she explains. “They could have reached Purity earlier during [a] home visit.”

The TB treatment wound up coming too late for Purity — who at that point didn’t even want to take all the pills because she felt they were causing unpleasant side effects. Then came the day when she asked to sit in the sunshine and have a cup of porridge.

Purity’s mother, Rachael Wanjiru, and her 14-year-old brother, James Gitau Mwai, sit outside their home in Nairobi, Kenya.

Lameck Nyagudi for NPR

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Lameck Nyagudi for NPR

It was later, after Purity went back inside, that things got bad. “She started shaking,” says Mugweru, who was there. “And then her eyes were wide open. And they turned white.”

The family called an Uber to take her to the hospital. But she didn’t survive the trip.

“Purity died when I was holding her,” says Mugweru. “We didn’t think that Purity was going to die, no. We thought everything was going to be good. Then all of a sudden, boom, Purity was no more.”

Her younger brother says he has felt lonely without having Purity as a playmate.

Ibrahim’s father: “He would just look at me and tell me, ‘Baba, I am tired'”

In early 2025, in central Nigeria, a cheerful 8-year-old named Ibrahim Garba contracted typhoid fever. It’s a dangerous bacterial infection that his father, Yakubu Garba, says he likely picked up from the drinking water.

“It started like a normal sickness,” says Garba. “He had fever, weakness and was not eating well.”

Ibrahim Garba’s portrait hangs inside his family’s home. The boy had written, “God is with us” on the wall.

Kazeem Olawale Nasiru for NPR

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Kazeem Olawale Nasiru for NPR

Ibrahim’s condition worsened. The family visited the local clinic and received an antibiotic and rehydration regimen for free. They say the staff told them that USAID was picking up the tab, a fact that Grace Samuel, a nurse at the nearby Zokotu Primary Health Centre, confirmed to NPR.

Soon, Ibrahim was feeling better, so much so that he didn’t complete his course of antibiotics. “Once the fever goes down, we may forget some of the dose,” explains Garba. “Sometimes, too much stress at home will make us not to remember to give the child the medicines to take.” If Ibrahim had finished the antibiotics, perhaps the drugs would have cured him of the illness.

Instead, his typhoid rebounded and knocked him flat. “He would just look at me and tell me, ‘Baba, I am tired,'” says Garba. “That broke me.”

When he and his family returned to the clinic, the meds were no longer free — another apparent casualty of the dismantling of USAID. “It’s something that happened everywhere,” says Samuel, who observed the same situation unfold at her own health facility. Ibrahim’s family couldn’t afford the new round of drugs. They took him home, tried an herbal remedy … and prayed.

“We delayed, hoping we could find money or that he would get better,” says Garba. “But he did not. That delay we keep thinking about till now.”

Swapping USAID for MOUs

In the comments that the State Department sent to NPR for this story, it championed the use of memorandums of understanding — MOUs — as a new way of providing assistance.

The State Department stated: “This co-investment model ensures greater country ownership and accountability, while building a strong long-term foundation for surveillance and outbreak response, laboratory systems, health commodities, frontline healthcare workers, and data systems, and reducing dependency on U.S. taxpayers.”

In Kenya, the five-year MOU amounts to a total of $2.5 billion from both countries combined to support tuberculosis programs in part. And in Nigeria, across the same time horizon, the MOU consists of nearly $2.1 billion in health assistance from the U.S. alongside another roughly $3 billion from the Nigerian government. These amounts represent a 23% and 22% decrease in U.S. government contributions to health funding for Kenya and Nigeria, respectively, compared with earlier USAID levels, says Dr. K.J. Seung of the Health Security Policy Academy at Brigham and Women’s Hospital.

“In theory, setting up these systems is great,” observes Boston University’s Nichols. “This amount of investment by the U.S. government and by the countries themselves will actually generate a lot of good health.”

“But,” she continues, “that doesn’t answer the question as to whether or not deaths occurred because of how this all happened in the first place — the cutting overnight of aid.” Nichols argues that this abrupt termination led to a breakdown of trust and supply chains, which are challenging to reinstate.

“It’s one thing to turn something off,” she says. “It is something entirely different to turn something back on again. This funding could have done much more good if there was a transition from the before-times into the current MOU because we wouldn’t have had that disruption of services.”

A set of final chapters

These bilateral agreements came too late to help the family from Kenya and the two Nigerian families.

Musa and his wife, who have four kids including their oldest, Abdullahi, who died of the asthma attack, are left with their memories.

“His heart is just kind,” says Musa. “If someone was sad, he would go and sit with them.”

Four days after Ibrahim’s family was told they’d have to pay for the typhoid antibiotics, he passed away. “The day we lost him,” says his father, Yakubu Garba, “it felt like everything stopped working.” Samuel, the nurse who knows the family, remembers seeing Garba afterward. “He just looked broken,” she says.

Asibi Garba and her husband, Yakubu Garba, sit outside their home holding a portrait of their son, Ibrahim, who died from typhoid.

Kazeem Olawale Nasiru for NPR

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Kazeem Olawale Nasiru for NPR

For Rachael Wanjiru, Purity’s mother, she says that since her daughter’s death, “I have felt like a part of me has been taken away.”

“Sometimes I feel like I could just take my two sons and just go with them far, far away,” she says. “A place that I do not have to come back.”

Purity’s death, she says, “has really put a dent of pain in my heart.”

Relatives and friends place flowers on Purity Wamboi’s gravesite in Kenya.

Family photo

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Family photo

Mugweru, who held Purity during her final moments in the Uber, is left wondering what might have happened had her fellow health promoters continued to receive their pay. Maybe they could have kept on doing their work in the community.

And that leads her to the hardest hypothetical of all: “If [USAID] did not withdraw their support,” she says, “maybe Purity could be alive today.”

David Augustine, Kazeem Olawale Nasiru and Lameck Nyagudi are part of The Everyday Projects, a global community of photographers using images to challenge harmful stereotypes.

A centerpiece of President Trump’s push to make prescription medicines more affordable is a government website for drug discounts that carries his own name. TrumpRx, launched in February, now boasts 92 deals on brand-name prescription drugs made by pharmaceutical companies that announced highly publicized agreements with the Trump administration.

But nearly six months since the website’s launch, those deals on TrumpRx represent fewer than 12% of the more than 800 brand-name drugs made by the participating pharmaceutical companies.

A wide range of medicines — including treatments for inflammatory conditions, HIV and cancer — aren’t offered by TrumpRx, according to an NPR analysis of a database of drugs on the market maintained by the Food and Drug Administration.

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“The key takeaway is that most of these companies are doing this for a small number of products and in a limited setting,” says Dr. Ben Rome, a health policy researcher and physician at Brigham and Women’s Hospital in Boston. “They’re not engaging to do this on a large scale.”

TrumpRx touted as a marketplace for better drug prices

TrumpRx’s origins go back to the Trump Administration’s May 2025 executive order aimed at bringing American drug prices in line with or below what other wealthy countries pay. Last summer, the administration sent letters to 17 drug companies with a list of demands.

The demands included selling drugs directly to consumers at lower prices, which is something some drug companies, such as Eli Lilly and Novo Nordisk, had already started doing.

Drugmakers had 60 days to meet the administration’s demands voluntarily, or, the letters stated, “if you refuse to step up, we will deploy every tool in our arsenal to protect American families from continued abusive drug pricing practices.”

Then came the closed-door negotiations, which included the threat of tariffs stemming from an investigation into whether pharmaceutical imports posed a threat to national security.

Although the text of the agreements hasn’t been made public, the administration began announcing the pacts in the fall, starting with Pfizer. That’s also when the administration announced it would create TrumpRx, a government website for direct-to-consumer discounts.

TrumpRx launched on February 5, with 43 drugs made by five of those companies.

“It’s the biggest thing to happen in healthcare, I think, in many, many decades,” President Trump said during the launch event at the Eisenhower Executive Office Building next to the White House. All 17 companies that received letters have announced agreements with the Trump administration, concluding with Regeneron in April.

A sparse menu of brand-name drugs 

As of mid-July, there are 92 brand-name drugs on TrumpRx from 15 of the 17 companies that announced deals with the Trump administration. But those companies make more than 800 brand-name drugs that are on the market today, according to NPR’s analysis of a Food and Drug Administration database of marketed drugs.

Pfizer has 30 drugs listed on TrumpRx, by far the most drugs on the site. But those drugs represent a fraction of the company’s portfolio of at least 178 brand-name drugs on the market.

In addition, some of the drugs that generate the most revenue for Pfizer are not offered at a TrumpRx discount, according to financial filings. Those include Eliquis, Pfizer’s blood thinner marketed with Bristol Myers Squibb, and Ibrance, a drug for advanced and metastatic breast cancer. Pfizer’s COVID treatment drug Paxlovid is also nowhere to be found on TrumpRx.

Pfizer does offer its blockbuster pill Xeljanz for inflammatory diseases like rheumatoid arthritis for $1,518 on TrumpRx, as much as a 53% discount off the brand-name price. But Xeljanz is now also available as a generic, called tofacitinib, which can be purchased for about $30 for a bottle of 60 tablets for patients paying out-of-pocket on Mark Cuban’s Costplusdrugs.com website.

Pfizer said in a statement that it was offering savings as high as 85% off its sticker prices on more than 30 medicines, spanning various treatment areas. “We will continue to make regular assessments and adjustments as the program evolves,” Pfizer spokesperson Kat Romaniuk wrote in an email to NPR.

Gilead and Regeneron both announced deals with the Trump Administration that included TrumpRx discounts and still have no drugs on the site. The companies tell NPR they will add one drug each: Gilead’s Epclusa for hepatitis C and Regeneron’s Praluent for bad cholesterol. But when those drugs will appear at a discount on TrumpRx has not been determined, the companies said.

Generic alternatives beat some of the presidential deals

In May, TrumpRx added hundreds of generic drugs available at partners like Cost Plus Drugs and Amazon Pharmacy. The site then was effectively divided in two. There is a tab for “presidential deals” on brand-name drugs that have the lowest prices available on the site. A second tab is for drugs with “standard prices,” which include generics and some brand-name drugs that cost more than generic options.

NPR found that at least some of the 79 presidential deal drugs on TrumpRx also have generic competition. For example Januvia and Janumet, two of the three Merck drugs listed as TrumpRx presidential deals, are available as generics.

At $84.57, Janumet on TrumpRx is a better deal than the generic version sold on CostPlusDrugs, where it costs $142.31 for the same strength and number of tablets. Pristiq, a Pfizer drug for major depressive disorder, is a presidential deal listed on TrumpRx for $200.10, but its generic costs less elsewhere: $20 to $30 with a GoodRx coupon, depending on which pharmacy the patient wants to use.

But Merck’s biggest drug, Keytruda, a treatment for various cancers, is not available for a discount on TrumpRx and isn’t available yet as a generic. The oral cancer medications Lynparza and Lenvima aren’t available either. Merck didn’t respond to requests for comment in time for publication.

Boston University health economist Rena Conti says it’s telling that companies haven’t added some of their most popular and crucial medicines.

“The companies are offering deals on the products that they choose, not the universe of products that they offer,” she says. “And that consequently sounds good and may help a small share of people who are purchasing these products at a cash price but are not helping all the consumers of their products.”

TrumpRx could boost sales a little, she says, and offering discounts to consumers paying cash won’t hurt the drugmakers much. The insured market is where they make the majority of their money. 

She adds that many consumers with health insurance would be better off simply using their coverage to pay for drugs whether those drugs appear on TrumpRx or not. Insurance copays will be cheaper than the discounts, she says.

TrumpRx can fill insurance gaps 

Still, TrumpRx can be useful, particularly for patients whose drugs are not covered by their insurance plans, such as people undergoing fertility treatments and people seeking obesity medications, says Rome of Brigham and Women’s Hospital.

“But that is not the majority of prescription drugs,” he says. “It’s not the majority of patients who need prescription drugs.”

The top of the TrumpRx website says it has saved more than $400 million dollars for Americans. But that statistic hasn’t been updated in more than a month and it’s difficult to verify.

NPR didn’t receive a response from the White House about how many patients have used the site and the specific drugs people were purchasing most frequently on TrumpRx.

Some pharmacists have had patients come in seeking TrumpRx prices, says Ronna Hauser, the senior vice president of policy and pharmacy affairs for the National Community Pharmacists Association. “I wouldn’t say that it’s extremely common.”

Most patients who mention TrumpRx are seeking discounts on GLP-1s, she says.

GoodRx, which is a website that helps patients find discounts on prescription drugs, has been a key partner for TrumpRx, providing the coupon infrastructure that works in the existing healthcare system. When someone uses a TrumpRx coupon for a brand-name drug at the pharmacy counter, GoodRx processes the claim on the back end.

The company told investors in May that it was “seeing encouraging traction” from the site, adding that “early data shows strong demand concentrated in GLP-1 therapies. … expanding access to new patients rather than shifting existing demand.”

Cancer disparities cost lives and researchers push to understand what is behind these gaps. Federal funding for such work has slowed since last year.

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Andrew Brookes/Image Source/Getty Images

Why are some people more likely to get cancer, and to die from it than others? Rural Americans, for instance, are 18% more likely to die from cancer overall, and Black women are 35% more likely to die from breast cancer than white women. That’s according to a recent report from the American Association for Cancer Research, or AACR.

Cancer disparity researchers study these gaps and how to close them. Their work has contributed to reductions in many disparities.

But the AACR report found that federal policy changes have affected about 93% of surveyed researchers in this field.

“Many medical trials were stopped in the middle — meaning those patients suddenly didn’t receive the treatments they were getting, because the funding stopped,” says Mariana Stern, professor of preventive medicine and urology at the Keck School of Medicine of USC and chair of the report committee.

The report draws on a survey of 122 researchers including professors, scientists and students. Seventy-eight percent said they’ve been unable to apply for funding, and 59% said ongoing research projects were disrupted. And 59% of respondents said the funding that was lost came from the National Institutes of Health, or the NIH.

The report also points to data published in JAMA Oncology in November showing that in roughly the first half of 2025, the Trump administration canceled 181 grants from the National Cancer Institute, or NCI, a division of the NIH. The grants totaled more than $317 million and many studied disparities.

All told, thousands of grants across NIH were terminated in 2025, according to a non-profit called Grant Witness which tracks terminations and other changes to grant funding for scientific agencies. These funding cuts followed an executive order in January 2025 calling to end “radical” and “wasteful” DEI research.

Heather Pierce, senior director for science policy at the Association of American Medical Colleges, AAMC, described the funding disruption as a mass termination “for simply not moving forward priorities of a new administration.” She says that under prior administrations “termination was reserved as a very extreme remedy,” and that the scale was unprecedented.

While many cancelled NIH grants were restored after several court cases fighting the change, there have been other terminations since, reported by the Department of Health and Human Services, the agency overseeing the NIH. And, fewer new grants from the Cancer Institute and the National Institute of Minority Health and Health Disparities have been awarded this year than they have at this time in previous years.

There have been other disruptions with grant funding. Pierce says that there has been a “continued slowdown this year” in grant making and renewals.

Some researchers in the field are alarmed about the funding slowdown — and are worried that as it hinders their ability to do their work, it will translate to poorer patient outcomes.

“If we take our foot off the pedal of disparities research, there will be more Americans — in rural communities and others not near [centers of excellence] — who will not do well,” says Dr. Robert Winn, the cancer center director at the Fox Chase Cancer Center in Pennsylvania who was not an author of the 2026 report but whose work was discussed in it.

In response to questions about cuts to cancer disparities funding, the NIH said in a statement: “NCI identifies cancer disparity research as a priority and recognizes that advancements in the field generate knowledge benefiting all patients across the cancer continuum, from prevention and early detection to treatment and survivorship.”

“Completely unprecedented”

Scarlett Lin Gomez, a professor of epidemiology and biostatistics at University of California, San Francisco, says the Greater Bay Area Cancer Registry, which she leads, has gotten NCI funding for the last 53 years.

“We received a cut that was completely unprecedented in the years my registry has been funded through the NCI. We’ve not had a cut of this magnitude at all — by far,” Gomez says.

Gomez runs a lab of approximately 50 people. Gomez says she had to let go of about seven full-time employees last year and expects she’ll have to let go five or six more this year.

“It literally keeps me up at night — the impacts on individuals in my lab,” Gomez says. “I’m hearing from colleagues over the past several months [that] everybody’s looking at doing the same thing … It’s scary to even think about what that’s going to look like and what the impact is going to be.”

Winn concurs: “It’s been disruptive. It’s forced folks to be creative to keep things going.”

Stern, who researches cancer epidemiology, personally had to reframe some of her work to stay compliant and keep funding. In some cases, she simply reworded funding requests. In other cases, she had to change the focus of the project.

Stern had previously gotten federal grant funding for training and career development for students from racial and ethnic minorities to help them get into medical school or go into research. This is important, she says, to “overcome structural reasons minorities are underrepresented” in medicine.

“The data show that patients do better when they’re treated by people who look like them, speak their language, and understand their culture — and research moves faster when teams are diverse and include members of the communities they’re trying to understand,” Stern says.

But, she says, the researchers had to change focus under Trump’s executive orders: “We are no longer allowed to have programs that target exclusively racial and ethnic minorities.”

“When you look at what percent of Ph.D. or medical graduates belong to racial and ethnic minority communities, you see underrepresentation,” she says. “We still have a way to go — but with the current political climate, right now, it’s impossible to do that.”

Tackling gaps

The AACR report stresses that progress has been made on cancer disparities and that today’s gaps are narrower than they were a generation ago.

For example, Stern says “the Black community historically has had much higher cancer death rates and incidence compared to the white population.” That gap has narrowed from about 34% higher in the 1990s to 9% higher today.

Cancer disparities research contributed to this progress, according to the report.

“If we don’t continue to support the research and the clinical care, all the progress we’ve made over the last 30-plus years — and all the progress to come — is literally at risk,” Winn says. “That keeps me up at night.”

Many disparities remain. The report finds veterans face 72% higher odds of skin cancer and rural Americans are 18% more likely to die from cancer overall — including a 36% greater likelihood for lung cancer.

The report calls such disparities “among the most profound forms of inequity and injustice.”

“It’s an injustice,” Gomez says, “and we understand that a lot of these disparities can be avoidable.”

And medical disparities cost American society about $451 billion a year, says Stern, citing a 2023 study published in JAMA, which estimated the medical costs and the value of productive life-years lost, calculated at $100,000 a year.

Cancer disparities research, Gomez says, informs not only the gaps in outcomes and care among everyone in the U.S. but also the effect of individual and biological differences — providing a clue for scientists to better diagnose and treat cancer.

“Without both of those lines of evidence … we simply have no way of intervening,” Gomez says.

Winn led a program studying cancer disparities when he was director of the Virginia Commonwealth University Massey Comprehensive Cancer Center. The program partnered with the Chickahominy Tribe, assessing the cancer burden in rural Virginia, identifying possible environmental factors, and deploying culturally tailored cancer care.

“We did water testing, we had interesting findings,” Winn says. But more importantly, he says, “we were building trust, because we were creating access to care.”

Winn says that everyone should care about cancer disparities research because it could mean life or death for a disease that can happen to anyone.

“Cancer doesn’t care whether you’re rich or poor, whether you’re from the south side of Chicago or the east end of Richmond,” he says. “It doesn’t care.”

Researchers also worry about the impact funding cuts will have on the next generation of physicians and scientists.

“The studies we do don’t only contribute data — they contribute to training and workforce development, so all that stops when the funding stops,” Stern says.

Stern says more and more of her students are now hesitant to go into academia.

Gomez agrees. “We’re definitely seeing an academic brain drain, and this current environment is certainly going to further hasten that,” she says.

“Please do not stop the research,” Chickahominy Tribe citizen and cancer survivor Melanie Stewart says. “Everyone deserves health care.”

It’s a summer of extreme heat around much of the world.

I know what that feels like. In Uttar Pradesh, India, where I grew up, temperatures easily soar upward of 120 degrees in May and June. But few people have access to an air conditioner. With a per capita income of around $1,000 a year, many people in this part of the country can’t afford to buy an AC unit or pay the power bills that come with using one.

So how do people keep cool?

People in India and other countries across the Global South have long figured out ways to deal with horrible heat. I’d like to share a few tips I’ve learned from my elders back home in India. Some of the advice is just what you’d think — drinking lots of liquids and staying out of the sun. Other strategies might surprise you.

I know that each of these tips on its own may seem trivial. But as a heat wave researcher, I can tell you that done together, they can really help the body cool down. The key is to be mindful of the power of heat — and be prepared to prevent its adverse effects.

And remember, upon seeing any signs of heatstroke — like fever, headache, nausea, confusion or weakness — call an ambulance ASAP and get medical help. Use ice packs while waiting to be treated at the hospital. Seriously, folks, don’t delay. Heatstroke can be fatal.

(Also: We want to hear from you! Scroll to the end of this story to find out how to share tips from your culture on how to cope with heat.)

Drink lots of liquids — it doesn’t have to be water!

One of the childhood lessons seared into my head was to always be aware of your hydration status. And drink water, even in small sips, as soon as you do any physical activity. Carrying a water bottle when going out is not just common sense but is lifesaving.

Some of the drinks that are popular in India can help replenish the electrolytes lost in sweat, as well as keep your body hydrated.

We quench our thirst with fruity drinks like sugarcane juice, coconut water and a tangy and raw mango juice called aam ka pana. Made from boiled and blended tart raw mangoes, aam ka pana replenishes electrolytes lost in sweat. Premade mix is available from online vendors and in ethnic grocery stores. Just add chilled water and enjoy!

In India, we also like cooling, milk-based drinks like lassi, a yogurt beverage popular in the summertime, and buttermilk.

And eat something!

Another lesson was to never go out on an empty stomach — always eat something. A cucumber (which contains dissolved electrolytes) or a pineapple snack will do the trick. In India, we’ll sprinkle black salt on a cuke, adding to its restorative powers.

Shower power

If you feel hot, take a cold shower or at least periodically splash water on your face and hands and douse your head in water — that’ll bring down body temperature.

You can also play with water. When I was a kid in India, I’d have water balloon fights with neighborhood kids. Or we’d fill a tub with water and splash it on each other in the backyard.

Find a cool spot to chill out

Seek out the coolest parts of the building where you live and make that the place where you sleep or hang out. Because heat rises, lower floors in a multistory house are cooler. Verandas are shady and airy. During the day, block out the sunlight with heavy curtains. Turn on any fans you have. And don’t be afraid to move furniture around in your quest for coolness. Back in Uttar Pradesh, we used to scoot our beds closer to the windows so we could catch a breeze while we slept.

If it becomes impossibly stuffy indoors, move outdoors and lie in a hammock. Air created from swinging helps cool the body down. As a kid, I remember that mango orchards were the best for hanging out. The dense foliage provided maximum shade coverage. The shade is your friend!

Take inspiration from architecture

Among many architectural innovations is a building design called jaali (meaning simply a net in Hindi and Urdu). Think of the Taj Mahal. It’s basically a way of turning a stone wall into a latticed screen by carving geometric patterns with a series of small openings rather than a solid wall. This stone screen blocks direct sunlight and also causes air to speed up as it passes through the holes.

Now, it’s true there’s no way you can rebuild your house in the style of the Taj Mahal.

But you can take inspiration from another architectural ploy. Some buildings have a small body of water outside — like the Hawa Mahal (the Wind Palace) in Jaipur. Wind enters the palace through the jaali holes in the thousand windows and picks up moisture from the courtyard water body. The humid wind then moves toward the palace’s thousand windows and cools down the inside air.

A nifty trick to bring in cool, humid air is to hang a curtain woven from grass on the door. Sprayed with water, it converts the hot air into a cool breeze. A special fragrant grass called khus is used for this purpose in India. I’ve also seen curtains made of fine bamboo — offering protection from direct sunlight — with a fine wet cloth added on the inside for cooling. Or a heavy, dampened cloth curtain will do the job.

The swamp cooler effect

The ubiquitous swamp cooler works best in low-humidity settings. Also known as an evaporative cooler, this electrical device passes a room’s air over water-saturated pads, which cools down the air, then blows that air back into the room. These devices are cheaper than air conditioners and use less energy. You can even make one yourself.

Wear airy and light-colored clothing

Rabari people (a nomadic tribe in western India) and many other tribal communities use small mirrors on their clothes to reflect sunlight.

Besides the use of cotton and linen fabrics for their clothing — both materials are cooling because they have big pores in their woven threads that allow for air circulation — their choice of color in their clothes is ingenious. They cleverly make use of the fact that black not only takes in heat faster than white but that it also gives off heat much faster than white. Due to the nature of their work, women frequently go in and out of their tents while men grazing livestock stay out for longer durations. Therefore, to stay cool, it makes sense for women to wear darker colors (these hues cool down fast as soon as women go indoors) and men to wear lighter colors (which heat up more slowly than darker colors during prolonged outdoor stays).

Cover your head or neck

In the summers, covering one’s head is an age-old practice. Whether it was the nobles wearing a pagdee (a turban) or the commonfolk using a wet rectangular piece of traditional cotton cloth called gamcha for men and dupatta for women. A variation of a white wet towel, it is almost universal in the countryside and even seen in cities.

Or take a light towel, called a gamchha in Hindi, dampen it and wear it around your neck or on your head like a scarf. This wet garb is omnipresent among men in the hinterlands and small towns.

Even our erstwhile British colonial masters fended off the sun with pith helmets — made of an extremely lightweight, dried, milky-white, spongy plant material that could be pressed into various shapes.

Avoid the noonday sun

During the hottest parts of the day, try not to burn energy or exhaust yourself by going out, exercising or standing outside, because the scorching sunlight and hot air will make you hotter. Instead, do what I did in Uttar Pradesh: chill at home or take an afternoon siesta. If you have to work and have a flexible schedule, try to perform your duties in the cooler hours of the day. Farmers in my state, for example, toil in the early mornings and late evenings. And markets close in the hot afternoons but remain open until late in the night.

Embrace the shade

Whether you are working outdoors or walking down the street, stay in the shade provided by trees. The actual air temperature is the same as in the sun, but your skin won’t absorb the sun’s rays and cause your body to heat up. Thanks to our forefathers for planting trees for us! And we return the favor by planting trees now, even when we know we aren’t going to enjoy that shade in our lifetime. Our kids will. And that’s what makes us a civilization.

Your turn: Share tips on how to cope with the heat

Did you grow up without an air conditioner in a hot place? How did you deal with the heat? Email us at globalhealth@npr.org with the subject line “Heat hacks,” and we may feature your story on NPR.org. Please include your name and location. Submissions close on Monday, July 20. 

Dr. Gulrez Shah Azhar is a Seattle-based Aspen New Voices fellow who researches the health impacts of heat. Previously, he was a postdoctoral fellow at the University of Washington, a policy researcher at the RAND Corp. and an assistant professor at the Indian Institute of Public Health.

Dr. Erica Schwartz faces a Senate confirmation hearing for the role of CDC director.

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U.S. Department of Health and Human Services

Dr. Erica Schwartz, Trump’s latest nominee to lead the Centers for Disease Control and Prevention, is scheduled to appear before a Senate committee Wednesday morning, to answer questions about her vision and qualifications for the role.

The confirmation hearing, with the Senate Health, Education, Labor and Pensions committee, will be Schwartz’s first public appearance since Trump nominated her for the role in mid-April. Schwartz is Trump’s third nominee to lead the nation’s beleaguered public health agency, which has not had a permanent director for most of Trump’s second term in office.

If confirmed, Schwartz will work under Robert F. Kennedy, Jr., secretary of the Department of Health and Human Services, which oversees the CDC.

Schwartz is a retired Rear Admiral in the U.S. Public Health Service Commissioned Corps, with degrees in medicine, law and public health. She previously served as chief medical officer of the U.S. Coast Guard, and as deputy surgeon general in the first Trump administration.

Earlier this year, on Instagram, Schwartz voiced her support for vaccines as tools to prevent illness and prevent readiness in the military. (Her Instagram page was removed soon after she was nominated for the CDC director role).

Public health veterans say she has the credentials and experience for the job. “People are very optimistic about her candidacy and are supportive of her potentially being in the role,” says Dr. Marcus Plescia, district health director for Fulton County, which includes Atlanta where the CDC is headquartered.

“What we really need right now is a CDC director who can step in and be a spokesperson on some of the emerging issues we’re facing,” says Plescia, “We need somebody in that position who can get in and establish themselves and be there to stay.”

Schwartz is generally expected to clear the Senate confirmation process. However, the role comes with major challenges and pitfalls.

Health Secretary Kennedy came into office with an agenda to change vaccine policy. In recent months, his changes have largely been blocked by a federal judge, but the intention remains, Dr. Georges Benjamin, head of the American Public Health Association, told NPR. “The political agenda is still there,” he says.

Still, the political winds have shifted a bit. “The president said he was going to let the secretary go wild, and he did. He’s now had to pull him back because it is creating political damage.” Benjamin says it may give the next CDC leader some space to follow the evidence with less political interference.

Roadblocks for an early director

Trump’s first pick for CDC head was Dr. Dave Weldon; his nomination was withdrawn shortly before his confirmation hearing because he did not have the votes to pass.

Trump’s second pick, Susan Monarez, received Senate confirmation but served in the role for less than a month last summer, before she was fired by Kennedy.

The next director would be tasked with turning around a CDC that’s been through an exceptionally tough period, including facing pressure to bend to political directives and cuts to staffing and capacity while needing to respond to pressing outbreaks on several fronts.

A recent trove of internal CDC emails, released by Senator Bernie Sanders of Vermont, shed insights into Monarez’s brief, rocky tenure and the chaotic months preceding it.

They show select, high-level exchanges between top CDC officials during a tumultuous period from January through August 2025, as the CDC lost thousands of staffers to cuts and attrition, faced public criticism from Secretary Kennedy, upended typical procedures and adjusted to new levels of political oversight.

The last director lacked autonomy in making policy and hiring decisions. For instance, on August 19, 2025, Matt Buckham, then chief-of-staff to Secretary Kennedy, sent an email to Susan Monarez, the recently confirmed CDC director. “I wanted to elevate the absolute need for political review of major policy decisions at CDC,” by the immediate office of the Secretary and political leadership at CDC, he wrote. “Please err on the side of caution,” he wrote, before signing off with “Make America Great!”

Other exchanges chronicled confusion from HHS over who was leading the CDC, the pervasive disorganization around reductions in force, and how Secretary Kennedy’s delegates worked to direct vaccine policy outcomes against the legal and scientific advice of CDC scientists and general counsel.

In an internal CDC all-hands meeting last month, new leadership at the agency addressed the impacts of all that’s happened on remaining employees.

“I’ve heard a lot … from people about what the morale is like here, how we’ve gotten to a point where it’s not as happy as it used to be, the stress level’s extremely high,” said Sean Slovenski, a former Walmart executive and now the CDC’s deputy director and chief operating officer, in a recording of the meeting reviewed by NPR.

NPR obtained this recording from a current CDC employee who asked to remain anonymous for fear of professional repercussions.

“If any organization went through one of the things you’ve had to endure in the last year and a half, it would be traumatic to that organization, institution, for years to come. You’ve had multiple ones,” he said.

Slovenski pledged to proceed with an upcoming reorganization with care. “I’m not promising that everyone will be happy. What I’m promising is that everyone will be clear,” he said. “Everyone will know what’s coming and they’ll know it was done in the most thoughtful manner.”

Also up for confirmation: head of preparedness and response

Wednesday’s session also includes a confirmation hearing for Sean Kaufman, nominated by the White House to serve as the Assistant Secretary for Strategic Preparedness and Response at HHS.

Kaufman is a senior adviser for global affairs at CDC, and has previously responded to infectious disease outbreaks including anthrax and West Nile Virus. He has also served as an expert witness in multiple cases defending people who faced professional consequences for refusing COVID vaccines, according to his Linkedin profile. Kaufman has questioned the safety and need for universal COVID and hepatitis B vaccines. The head of ASPR oversees the development of vaccines and countermeasures against pandemics and emerging threats.

The Centers for Disease Control and Prevention offices in Atlanta are seen in 2022. The agency is investigating a rise in cyclosporiasis cases.

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Ron Harris/AP

A large number of cases of intestinal illness that causes diarrhea, nausea and fatigue have been detected in 34 states, according to federal health authorities, but the source is still under investigation.

As of Tuesday, the Centers for Disease Control and Prevention said it had received reports of 1,645 confirmed cases of cyclosporiasis, the gastrointestinal affliction caused by the parasite Cyclospora.

But the true number of infections is likely much higher, because that figure only represents cases reported by states directly to the CDC. There is also a lag between symptom onset and reporting, and many people recover from the illness without medical treatment. Michigan alone reported 3,309 cyclosporiasis cases as of Tuesday.

According to the CDC, as of Thursday, there have been 141 hospitalizations nationwide and no deaths.

Health officials are also investigating several clusters of cases that may be epidemiologically linked, including a multistate outbreak that includes at least four states: Michigan, Ohio, West Virginia, and Kentucky

People can contract the illness by eating food or drinking water contaminated with the parasite. Previous outbreaks have been linked to fresh produce. In 2018, McDonald’s removed salads from restaurants in 14 states after federal health officials linked them to dozens of cases of cyclosporiasis, and tainted lettuce imported from Mexico was suspected to have sickened 400 people in the U.S. in 2013.

The illness does not spread from person to person, noted Gwen Biggerstaff, deputy director of CDC’s Division of Foodborne, Waterborne, and Environmental Diseases at a press conference Tuesday: “The source of this outbreak is what we eat or drink — not casual contact with someone who’s sick. “

It’s typical for cyclosporiasis infections to rise in the spring and summer, but the CDC said Friday that multiple states had reported a larger jump in cases over the previous two weeks than they had during the same period last year. Only 249 cases had been reported nationally at this time last year.

For the latest stories on the science of healthy living, subscribe to NPR’s Health newsletter.

Where are cyclosporiasis infections occurring?

Health officials from California to Texas to Florida have reported cases of cyclosporiasis since the start of May.

Some of the hardest-hit areas appear to be in the Midwest and Northeast, including Michigan and New York.

The Ohio Department of Health reported 177 cyclosporiasis cases as of July 2, most of which occurred in June. Dr. Bruce Vanderhoff, director of the Ohio Department of Health, said cyclosporiasis is a “serious illness that can cause dehydration and require people to seek emergency medical care, and it should be taken seriously.”

According to the CDC, those sickened with the disease have ranged in age from 5 to 88 years old.

The total number of nationwide cases is expected to grow, due to the estimated six-week gap between when illnesses begin and when they are reported to federal health authorities.

What’s causing the outbreak?

That is still unclear. The CDC says it is continuing to try to identify the source or sources of the recent surge of cyclosporiasis infections.

Investigators do that in part by interviewing those who’ve become sick to find out what they’ve eaten. But since symptoms can appear anywhere between two days and two weeks or more after a person was infected, they may not remember everything they ate during that period.

Previous U.S. outbreaks of cyclosporiasis have been associated with raspberries, basil, cilantro, snow peas and lettuce, according to the Food and Drug Administration.

Federal health officials are urging doctors to test for the condition and to specifically request laboratory testing on stool samples.

How to prevent cyclosporiasis

Cooking produce is an effective way to avoid an infection, as heating food to 158 degrees Fahrenheit or higher kills Cyclospora.

Public health officials advise thoroughly rinsing all fresh produce under running water, even items that say they are prewashed. Do this before eating (if eaten raw) or cooking.

It is also important for home cooks to observe standard food safety rules, and that includes washing your hands with soap and water before and after handling fresh produce.

Public health officials don’t yet know what foods may be the sources of the recent cases and stress the importance of washing any fresh produce you intend to eat.

What to do if you have symptoms

The CDC encourages people to seek medical attention if they have symptoms of cyclosporiasis, especially if you develop prolonged watery diarrhea along with fatigue or loss of appetite.

Dr. Kawsar Talaat, a physician at Johns Hopkins Hospital board certified in pediatrics, internal medicine and infectious diseases, says that cyclosporiasis can present in different ways. “If your diarrhea persists for more than a couple days, go see your doctor,” Talaat says.

Some patients might experience a waxing and waning pattern. “If the diarrhea goes away and comes back, that’s another sign of a potential cyclospora infection,” she says. “And again, go see your doctor.”

Talaat says there is also an epidemiological importance to reporting. She says getting tested could help officials understand where the outbreak is coming from and how it’s being transmitted.

Talaat also explains that standard tests for diarrhea can’t diagnose cyclosporiasis. She echoes the CDC recommendation that clinicians need to request a test specifically for cyclosporiasis if suspected. It’s a stool test, Talaat explains, but it can miss cyclospora if the sample is small or taken at the wrong moment in the life cycle of the organism. You may have to send in more than one stool sample to confirm you have the parasite she says.

For those with cyclosporiasis, Talaat says there is an effective treatment: The antibiotic trimethoprim/sulfamethoxazole, brand name Bactrim or Septra, taken for seven to ten days. While cyclospora is a parasite, not a bacteria, the antibiotic is effective against it.

Talaat says many won’t even realize they had cyclosporiasis. “For most healthy adults, it’s often a self-limited infection, it will go away by itself,” she says.

But for those who are older, younger or immunocompromised, Talaat says to be proactive in getting tested and treated earlier to avoid risk of hospitalization.

Carmel Wroth contributed to this report.

A health worker stands at the Evangelical Medical Center, in Bunia, eastern Congo, Friday, July 3, 2026, where Ebola clinical trials are scheduled to take place.

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Eighty percent of new Ebola cases in eastern Congo are emerging from unknown chains of transmission, the World Health Organization said Tuesday, a sign the outbreak is spreading faster than health officials can track despite an expanding response.

Congo has been battling an outbreak of a rare type of Ebola since May, with no approved treatment or vaccine. The Africa Centres for Disease Control says it is the fastest-growing Ebola outbreak on the continent.

“Perhaps the most alarming finding is that many of the newly reported deaths are people who died in their communities without ever reaching a health facility and without receiving care,” Chikwe Ihekweazu said after returning from Bunia, in Ituri province, one of the worst-hit cities. “And as of today, 80% of new cases are outside our contact lists and so are coming to us from unknown chains of transmission.”

People who die outside the health system cannot be isolated, treated or have their contacts traced promptly, increasing the risk of further transmission.

The outbreak, Ihekweazu said, “continues to outpace the response efforts.”

As of Monday, at least 1,926 people have been infected, of whom 702 have died, in three provinces in Congo from the rare Bundibugyo virus, Congolese authorities said. Cases have also been confirmed in neighboring Uganda.

Ihekweazu told reporters in Geneva that his visit to Bunia had been “quite encouraging on many fronts, but also deeply concerning.”

Treatment capacity in Bunia is now close to 800 beds, with capacity increasing every week, and lab capacity has grown from 1 to 14 labs, an effort the emergency chief lauded.

However, Ihekweazu said that despite “our best efforts … we have not caught up in the race.”

A funding gap, attacks on health centers, an ongoing conflict in eastern Congo, and mistrust among local communities have hampered the response.

Dozens of healthcare workers at an Ebola virus treatment center in northeast Congo went on strike over unpaid salaries and bonuses on Monday. On Tuesday, they agreed to resume work under the condition that the government pays them within 72 hours.

“Just one day of strike action has already caused damage. Patients were unable to access the center,” the striking health workers said in a statement. “We hold the government solely responsible for any loss of life if the site closes after this ultimatum.”

The Congolese authorities declared a fresh Ebola outbreak on May 15 after the disease had been transmitting for weeks without official detection, according to the WHO. Clinical trials for treatment began last week after researchers launched a highly anticipated study in the hope of fighting the virus.

The U.S. Centers for Disease Control and Prevention said on July 11 that a U.S. citizen working for a humanitarian organization in Congo has tested positive for the Ebola virus, without providing further details.

Protestors rally for healthcare for transgender people at a march in June 2025 in Manhattan. NPR has learned the Trump administration shelved a plan to cut off all Medicare and Medicaid funding to any hospital that provided gender-affirming care to minors.

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The Trump administration is abandoning its most aggressive attempt to end gender-affirming care for youth nationally, according to an official document obtained by NPR.

The document shows that the Department of Health and Human Services will not be finalizing a proposed rule that would have blocked all Medicaid and Medicare funding for hospitals that provide pediatric gender-affirming care. The Centers for Medicare and Medicaid Services and the Department of Health and Human Services did not immediately respond to a request for comment.

Not a “retreat” from anti-trans efforts

The fact that the Trump administration is backing off from this action is “a victory for people who are defending the rights and interests of trans people,” says Sam Bagenstos, a professor at Michigan Law who served as general counsel at HHS under the Biden administration. “But I don’t think it indicates a more general retreat from the aggressive posture of the Trump administration.”

Bagenstos notes that this type of leverage — a “conditions of participation” rule for the Medicare and Medicaid program — has historically been used by HHS to compel states and hospitals to meet basic health and safety standards. Things like “making sure that you have stockpiles of certain kinds of equipment, making sure that you have certain kinds of emergency protocols, making sure that you have certain staffing ratios,” he explains.

The proposed rule was unprecedented, Bagenstos says, because it instead would have prohibited certain kinds of treatments for a certain population. He says it seemed unlawful in a variety of ways. For one, “it violates the Medicare Act, which says that Medicare and Medicaid can’t be used to control the practice of medicine within the state — states get to regulate the practice of medicine,” Bagenstos says.

Medical groups opposed the change

Normally, HHS would propose a rule, accept public comment for 60 days, and then finalize the rule so that it could take effect. In this case, after proposing the rule in December and receiving more than 30,000 comments, the administration is abandoning the rule. At least in the next year, it will not be finalized and will not take effect.

The American Medical Association and the Children’s Hospital Association both submitted comments urging the agency to rescind or withdraw the proposed rule. Major U.S. medical groups say that puberty blockers and sex hormones are safe and can be effective for transgender young people.

Even so, gender-affirming care for youth is banned in 27 states after a flurry of laws passed over the last several years. In the remaining 23 states, many hospital clinics that offer gender-affirming care have continued to operate, while others have shuttered in the past year citing pressure from the Trump administration.

That pressure has come in the form of this proposed rule, another rule that would bar federal Medicaid reimbursement for transgender pediatric patients, and a declaration from Health Secretary Robert F. Kennedy Jr. that aimed to redefine the standard of care. (Interestingly, the press release issued when those actions were unveiled in December is now missing from the HHS website, as is the Kennedy declaration document.)

The Medicaid rule is currently in the final stage of review and appears to be on track to take effect in the coming weeks. A coalition of Democratic-led states sued over the so-called Kennedy declaration and succeeded in blocking it in federal court in Oregon. The Trump administration has not appealed that decision so far.

Protesters who are against gender-affirming care for young people gathered outside Boston Children’s Hospital in Sept. 2022.

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At the same time, the Department of Justice has issued administrative and criminal subpoenas to hospitals seeking full personal medical files for transgender youth and employment files for their medical providers, although many of those attempts have been blocked in court so far. The Trump administration has also reached settlements with hospitals in Texas and Ohio that involved establishing “detransition” clinics.

And last month, when the Supreme Court allowed states to bar young transgender girls from sports, the White House issued a press release saying that the decision “Bolsters President Trump’s Push to Eliminate Transgender Insanity.” The release listed actions targeting transgender people across the federal government, from passport markers to military service to research funding.

Will hospitals that ended care for trans youth restart it?

While the Trump administration does not appear to be backing down from anti-transgender actions broadly, its decision not to finalize its most aggressive healthcare rule is significant, says Katie Keith, director of the Health Policy and the Law Initiative at Georgetown University who also worked in the Biden administration. Those other efforts are not nearly as durable as a finalized rule that takes effect, she notes.

The decision of the Trump administration not to finalize this rule “should give hospitals more confidence to either resume or continue offering the care,” she says. Because the rule was never in effect, “I would argue that they should have been doing this all along anyway.”

Kellan Baker agrees. He’s a senior adviser for health policy at the Movement Advancement Project think tank, which focuses on LGBTQ issues. “This administration may have checked itself in one of the most extreme expressions of its agenda and I think people should take solace in that,” he says. “But at the same time, this administration is continuing to show that its ultimate goal is eliminating health care for trans people and that it is apparently prepared to use almost any means necessary to do so.”

The Medicare and Medicaid rule could theoretically be revived at some point, since it has not been formally withdrawn. An entry in the Trump administration’s recent unified agenda sets a final action date for the proposed rule as December 2028, just before President Trump leaves office.

Oncologist and bioethicist Zeke Emanuel takes a back-to-basics approach to maintain good health in his new book, including tips like allowing yourself to enjoy ice cream.

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If you’re hankering for a cool treat on a hot day, nothing screams summer like ice cream.

And a physician renowned for shaping U.S. healthcare policy has a message: Go ahead and enjoy it.

Zeke Emanuel is an oncologist and bioethicist who served as an advisor to the Obama administration, helping shape the Affordable Care Act. He believes in a system that invests in prevention, one that aims to keep people healthy. So when he released his book, literally titled Eat Your Ice Cream: Six Simple Rules For A Long And Healthy Life, I asked him what motivated him.

“Mostly anger at the wellness industrial complex,” Emanuel told me. He says the wellness industry is selling people all kinds of things that are expensive and clinically unproven, pointing to the latest peptide trend, whole body scans and “all sorts of supplements” marketed as anti-aging elixirs.

Emanuel takes a back-to-basics approach, based on evidence, to maintain good health in his book.

And though the title is a bit tongue-in-cheek, he points to evidence that people who are in the habit of eating ice cream have a lower risk of metabolic disease, despite the fact that it has lots of sugar and fat. Researchers have dubbed this the “ice cream paradox.” There’s data from 2015 that suggests “that ice cream is actually pretty good at preventing development of type two diabetes, and dairy in general is good at preventing type two diabetes,” Emanuel says.

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Dairy contains whey protein that may benefit glucose regulation which may partially explain the association, though the research doesn’t nail down cause and effect. Emanuel is also big on consuming more fiber and fermented foods, pointing to the need to feed the bacteria in our guts.

“Evolution would have gotten rid of them if they weren’t there for a reason,” Emanuel says. “And so treating them well, through eating more fermented foods, whether it’s yogurt or cottage cheese or hard cheeses like gruyere or kimchi or sauerkraut, good things for us.”

Prioritize sleep and stay active

Emanuel’s other recommendations for increasing your chances of a long, healthy life track with a huge body of evidence on the importance of daily habits, including exercise, social connections and sufficient sleep. A new study published this month in the Annals of Internal Medicine finds people who skimp on sleep for just six weeks start to gain weight, in part because lack of sleep throws off hunger hormones.

“We know that biologically sleep is important. We know that it’s important to clear out the brain’s, to basically empty the garbage, as it were. We know it’s important to consolidate long-term memories. We know it’s important for DNA to repair. So there’s a lot of very important elements,” Emanuel says.

Bottom line: Sleep, he says, should not be shortchanged.

Emanuel’s most controversial advice: Do not retire. He points out that work provides a structure and a schedule, “so you get up and you go. It also provides a mental challenge and a social environment,” Emanuel says. So, you’ve got to think through how you’ll find structure, purpose and a social circle if you plan to leave a job that provides these elements.

He says that unless you consciously recreate this sense of purpose, you could increase your risk of cognitive decline. There are endless hobbies and volunteer opportunities to take up instead. Research from UC Davis shows people who report a higher sense of purpose in life are 28% less likely to develop cognitive impairment.

“There are lots of organizations that need help, and you have skills, and you can get to know people,” Emanuel says, pointing to everything from volunteering at a school or food bank to signing up for a class or joining a club — all good ways to meet people.

People who may want to meet up, he suggests, could also get ice cream.

“I enjoy it, that’s for sure,” Emanuel says. Chocolate hazelnut is his flavor of the summer. But of course, everything should be taken in moderation.

Here’s a take on his six simple rules:

1. Don’t be a schmuck! Avoid self-destructive risks. “Smoking is obviously not good for you. Vaping is also not good for you,” he says. Emanuel recommends limiting alcohol to 3 or 4 drinks a week, avoiding distracted driving, and he says it’s probably a “schmuck move” to climb Mt. Everest, pointing to high risk of harm or death.

2. Talk to people. Strike up conversations. “My standard when I get into an Uber is to ask the person, where are you from?” Emanuel says. If you initiate a conversation, people will likely respond. “People actually like to interact. We’re social beings. We’re programmed to interact. And so you just need to take the initiative.” Casual interactions are meaningful and can promote positive feelings.

3. Expand your mind. Emanuel says he realizes most people eventually retire, but take steps to maintain lifelong learning and stay curious. Finding ways to stay engaged and having a strong sense of purpose can reduce the risk of cognitive decline.

4. Eat your ice cream. A balanced diet matters, and people should eat to nourish and enjoy. Making simple shifts such as limiting soda and sugary drinks and snacks while focusing on healthy meals and having a treat at the end of the day. Everything in moderation.

5. Move it! Regular movement is important, including aerobic exercise that gets your heart rate up, as well as strength training. Walking after a meal is a great way to stabilize blood sugar and can help offset the harms of sitting.

6. Sleep like a baby. Sleep is fundamental to good health, and people who give short-shrifts to sleep are more likely to gain weight and be more sedentary. Sleep aides don’t work well, so practice good sleep hygiene, including setting a regular bedtime and optimizing your bedroom for sleep.

Pythons have several unusual traits that scientists are studying for potential clues for treating human disease.

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When Skip Maas first adopted Agrapina, a mottled ball python, she hadn’t eaten in 14 months.

But as he soon observed, she was still a taut coil of spring-loaded muscle. Presented with a rat, she struck quickly, constricted it and then gorged on her meal.

And then her body performed another feat pythons are known for: It accelerated its metabolism dramatically to deal with the sudden influx of protein and fats, says Maas, “to help break down that meal and extract all of its nutrients.”

Most people prefer to keep their distance from pythons — and for good reason. A quick strike followed by relentless constriction can be lethal. But Maas, a molecular biologist at the University of Colorado Boulder, and his colleagues argue that these snakes may hold secrets that could help people live longer and better.

In addition to being able to fast for weeks or months and still maintain muscle tone, they’re able to grow and shrink their heart and other organs during feast and famine with seemingly no issue.

Molecular biologist Skip Maas holds his pet ball python Agrapina alongside fellow python researchers Jack Gugel (left), Tommy Martin (right) and Yuxiao Tan (far right), in Boulder, Colo.

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Ari Daniel for NPR

“It makes a lot of sense that pythons, because they live in such extreme environments, would have secrets that would apply to humans,” says Leslie Leinwand, a geneticist who, two decades ago, first came up with this idea of translating the unique biology of pythons into medical treatments.

She’s currently the executive science officer of CU Boulder’s BioFrontiers Institute. And her lab runs an ongoing research project studying the reptiles, regularly publishing findings they hope could lead to medical breakthroughs.

Pythons “are so adapted to their lifestyle,” says Maas, who recently completed his Ph.D. in Leinwand’s lab. “I think it’s a really great avenue to look at something that evolution has already figured out to take inspiration.”

A python’s dramatic internal renovation

One particularly extreme feature of the python is its metabolism — the rate at which it can transform food into usable energy.

“Pythons ramp up their metabolism from 10 to 40 times following a feeding, depending on the size of the meal,” says Tommy Martin, an assistant professor at the University of Nebraska Medical Center and a former researcher in Leinwand’s lab.

Leslie Leinwand is a a geneticist who, two decades ago, first came up with the idea of translating the unique biology of pythons into medical treatments.

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Ari Daniel for NPR

That’s “the equivalent of a Kentucky Derby racehorse at rest, compared to when they’re sprinting around the track,” says Jack Gugel, a molecular biologist at CU Boulder and former student of Leinwand. But pythons, he notes, can maintain “that high metabolic state for days as they digest the meal.”

To handle such super-high metabolism, the python’s body undergoes a dramatic renovation. “Their organs will actually grow,” says Gugel. That includes the snake’s heart — to be able to pump more blood and oxygen to digest the meal.

Human hearts can increase in size too, over years. When that growth is due to high blood pressure or a heart attack, the heart stays enlarged and it stiffens — with potentially fatal consequences.

“Some people, no matter what they do, even if they have the perfect diet and they’re exercising every day, they’re still going to have heart disease,” adds Gugel.

In pythons, however, a month or so after consuming a meal, their heart returns to its previous size.

“And we were really interested in figuring out — OK, what are the signals that tell this heart to get bigger?,” says Gugel. “And then also, what are the signals that tell the heart to go back down to a normal size?”

Answering such questions might offer insights into how to stop or even reverse problematic heart growth in people.

Yuxiao Tan, a molecular biologist at CU Boulder is researching python cardiac cellls. Here he poses with a toy python in the lab.

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Ari Daniel for NPR

Yuxiao Tan, a molecular biologist at CU Boulder who was supervised by Leinwand, has revealed another important insight in a soon-to-be published study. “Their heart can not only become bigger,” he says, “but their cardiac muscle cells also increase in numbers after they eat.”

It’s different in humans. “When people suffer a heart attack,” explains Tan, “they end up getting a scar over their heart because our heart muscle cells aren’t able to proliferate and repair the scar.”

The research in Leinwand’s lab is still underway, but it’s possible that pythons may carry the clues for how we might remodel human hearts to improve our own cardiac health at different stages of life.

Of muscles and molecules

Another line of investigation that these researchers are pursuing is related to the python’s apparent ability to resist muscle atrophy.

Take Agrapina, Maas’ pet python. Even after months of not eating and barely moving, when she caught site of the rat he offered her, “she was strong enough to then constrict it completely. She was fully capable,” he says. “She had lost very little muscle tone despite all that time fasting.”

“I know of no other creature that can do this kind of fasting without losing muscle function,” says Leinwand. She believes this ability could one day lead to treatments for people dealing with muscle atrophy as they age.

And Leinwand says the snake’s digestive processes have something to teach us as well, pointing to the countless small molecules produced as the animal breaks down a meal. “I think that this could be what we call a gold mine.”

Indeed, Leinwand coauthored a paper, published this spring in the journal Nature Metabolism, with collaborators from a variety of institutions, describing a molecule coursing through the blood of both Burmese and ball pythons that surged a thousand times after feeding.

“If I were a betting person,” says Leinwand, “I’d bet that something that changes a thousand-fold is probably doing something important.”

The study confirmed her suspicion. Gugel says the molecule, which is called pTOS, appears to act as an appetite suppressant by targeting the hypothalamus in the brain.

Jack Gugel stands with a pet python around his neck in front of the Flatirons, the iconic slabs of sandstone that help make Boulder a climber’s paradise. Gugel has been researching how pythons are able to rapidly increase the size of their hearts.

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Ari Daniel for NPR

“When we give this molecule to obese mice, they eat less and they lose weight,” he says.

Jasmin Camacho, an evolutionary biologist at the Stowers Institute for Medical Research, applauds the python work as another way of looking in unexpected places for potential drugs and cures. “By going to this extreme animal, that molecule was expressed at a higher level in a way that it just stood out,” she says.

Camacho, who wasn’t involved in the python research, studies bats that she thinks might hold secrets for fighting diabetes since they can consume large amounts of nectar without any apparent health problems.

“Evolution’s been running natural experiments for hundreds of millions of years,” she says. “So by studying these adaptations, we start to think of other ways that our bodies can work.”

Animal-inspired renaissance

GLP-1 weight loss drugs, like Ozempic, came out of research on the venomous gila monster lizard. Gugel hopes for a similar trajectory for the new molecule that the python studies uncovered.

“I think that there’s big potential in the market for a drug that specifically can inhibit appetite in the brain to help people with weight loss,” he says.

To that end, Gugel, Leinwand, Martin, and Jonathan Long of Stanford University have formed a company called Arkana Therapeutics to develop this and other discoveries into new drugs and treatments. They hope to look beyond pythons to other overlooked species, Martin says.

Ashley Zehnder is the CEO of Fauna Bio, a company that searches for disease resistance therapies among mammals equipped with unique adaptations. She says the approach that Leinwand’s team at CU Boulder is taking could expand the drug discovery palette.

“You can find these really potent bioactive molecules in these extreme species,” she says, “because they were evolutionarily perfected, and we can use that for medicines.”

There are challenges to this approach, naturally, says Zehnder, including learning how to care for the animals in the lab and having to figure out their complex inner workings from scratch.

But the payoff, Zehnder argues, could be potential cures for our afflictions drawn from the great tree of life. “I think there’s a lot that we can learn by putting ourselves back in that evolutionary tree and saying, ‘what can we learn from these other animals?,'” she says.

“And I think what it will do at the end of the day is make us really greatly appreciate the value of that diversity.”

The Centers for Disease Control and Prevention offices in Atlanta are seen in 2022. The agency is investigating a rise in cyclosporiasis cases.

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Ron Harris/AP

An outbreak of an intestinal illness that causes diarrhea, nausea and fatigue has been detected in 31 states, according to federal health authorities, but the source is still under investigation.

As of Thursday, the Centers for Disease Control and Prevention said it had received reports of 843 cases of cyclosporiasis, the gastrointestinal affliction caused by the parasite Cyclospora.

But the true number of infections is likely much higher, because that figure only represents cases reported by states directly to the CDC. There is also a lag between symptom onset and reporting, and many people recover from the illness without medical treatment. Michigan alone reported 1,562 cyclosporiasis cases as of Friday.

According to the CDC, as of Thursday, there had been been 86 hospitalizations nationwide and no deaths.

People can contract the illness by eating food or drinking water contaminated with the parasite. Previous outbreaks have been linked to fresh produce. In 2018, McDonald’s removed salads from restaurants in 14 states after federal health officials linked them to dozens of cases of cyclosporiasis, and tainted lettuce imported from Mexico was suspected to have sickened 400 people in the U.S. in 2013.

It’s typical for cyclosporiasis infections to rise in the spring and summer, but the CDC said Friday that multiple states had reported a larger jump in cases over the previous two weeks than they had during the same period last year.

Where are cyclosporiasis infections occurring?

Health officials from California to Texas to Florida have reported cases of cyclosporiasis since the start of May.

Some of the hardest-hit areas appear to be in the Midwest and Northeast, including Michigan and New York.

The Ohio Department of Health reported 177 cyclosporiasis cases as of July 2, most of which occurred in June. Dr. Bruce Vanderhoff, director of the Ohio Department of Health, said cyclosporiasis is a “serious illness that can cause dehydration and require people to seek emergency medical care, and it should be taken seriously.”

According to the CDC, those sickened with the disease have ranged in age from 5 to 88 years old.

The total number of nationwide cases is expected to grow, due to the estimated six-week gap between when illnesses begin and when they are reported to federal health authorities.

What’s causing the outbreak?

That is still unclear. The CDC says it is continuing to try to identify the source or sources of the recent surge of cyclosporiasis infections.

Investigators do that in part by interviewing those who’ve become sick to find out what they’ve eaten. But since symptoms can appear anywhere between two days and two weeks or more after a person was infected, they may not remember everything they ate during that period.

Previous U.S. outbreaks of cyclosporiasis have been associated with raspberries, basil, cilantro, snow peas and lettuce, according to the Food and Drug Administration.

How to prevent cyclosporiasis

Cooking produce is an effective way to avoid an infection, as heating food to 158 degrees Fahrenheit or higher kills Cyclospora.

Public health officials also suggest that people thoroughly wash all of their fresh produce, including herbs, though the parasites are not easy to rinse off.

It is also important for home cooks to observe standard food safety rules, such as washing their hands with soap and water before and after handling fresh produce.

Anyone who suspects they’ve been sickened with cyclosporiasis and is experiencing dehydration or severe diarrhea is encouraged to see a doctor. Cyclosporiasis infections are typically treated with antibiotics.

NPR’s Allison Aubrey contributed reporting.

Researchers net tilapia, which they’ll transport to the paddies of a rice farm in the Senegal River Valley.

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Momy Seck Ndao has been planning for this day for months.

The environmental engineer is standing beside two swimming-pool sized ponds, each lined with a black tarp and full of hundreds of tilapia. Two of her colleagues trudge through the pond in waders, trying to corral the fish with a net.

“For this project, we need a lot of tilapia, about 1,900,” says Ndao, as she eyes the horizon. They’re in a race against the rising sun.

It’s still relatively low but will soon heat this part of the Senegal River valley to about 100 F, hot enough to bake the fish on the way to their final destination — a rice field.

There, these tilapia — and a handful of other fish — are the key ingredients in an ambitious experiment. Ndao and her colleagues are trying to see if adding fish to rice farms can help solve three problems plaguing rice farmers, and Senegal more broadly — food insecurity, poverty and a debilitating disease.

To Ndao, it’s a particularly Senegalese solution.

The national dish, thieboudienne, is a delectable combo of rice and fish. “We eat it every day. So if you grow rice and fish in the same area, you just need to add vegetables,” Ndao says with an easy laugh, “and you will have your daily dish.”

Fishing expedition

But first, Ndao and her team have to catch those tilapia and schlep them to the farm.

Once enough fish are concentrated by the net into a writhing mass, other colleagues swoop in with smaller buckets to scoop them up. Quickly, but careful not to spill, they shuttle the buckets to a big green tank on the bed of a pickup.

The team is on a mission to scoop up nearly 2,000 tilapia at a fish farm in Dagana, Senegal.

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It takes about an hour to load up the fish. Kayla Kauffmann, a Stanford disease ecologist on the project, rushed over to the truck just after the tank was sealed. “I wanted to look in before they closed it,” she says. “It’s quite the operation.”

Today’s operation began before dawn and is far from over.

On the outskirts of the coastal town of Saint Louis, the team — over a dozen scientists, aquaculture technicians and interns — set off in the dark. Before reaching the tilapia farm in Dagana, about 80 miles northeast across the vast expanse of the Sahel, some of the caravan peeled off to catch a few larger fish of a different species, which will be the main disease-fighters.

Momy Seck Ndao, an environmental engineer who is part of the fish-rice project, wrangles an African bonytongue fish, also called heterotis, that escaped its bucket. The fish will soon be introduced to a rice farm, where researchers hope it’ll eat snails that spread a debilitating disease called schistosomiasis.

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The next and final stop, about 20 minutes away, is Keur Mbaye, where the fish will be introduced to a rice field. There, all those fish will live and poop, fertilizing the crop.

It’s one of 60 fields across the region where the team, in conjunction with local farmers, will be trying out this potential win-win-win solution. To Ndao, the stakes are high.

“The potential is here,” she says. “Everything will depend on what they will see in this experiment, what they will learn.”

Dangerous worms, protective fish

Rice production is booming along the winding Senegal river, which forms the border with Mauritania to the north. The immense Sahara is just a hundred-some miles away. Historically, the semi-arid climate meant that farming could only happen during the rainy season. But dam construction starting in the 1980s helped supply a steadier stream of water for crops.

Knee-deep in a Keur Mbaye rice field, Kauffman holds out in her gloved hand a tiny example of what else the dams allowed to flourish — freshwater snails that can carry the disabling disease known as schistosomiasis.

Small snails like this one can carry the worms that spread schistosomiasis.

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Ricci Shyrock for NPR

“The link between dam construction and schistosomiasis is really strong,” she says. “After a dam is built, way more people end up with schisto.”

The disease, which afflicts more than 200 million people a year, is caused by a parasitic worm that spends part of its life cycle in freshwater snails. There, the worm replicates itself, producing thousands of parasites that slink back into the water.

“They then try to find a person that’s wading in the water, like a rice farmer, and burrow into that person’s skin,” says Kauffmann. Ultimately, they lay eggs in the intestines or urinary tract, causing a slew of problems from stomach pain to bladder cancer.

Before dam construction, freshwater snail numbers were kept in check by migratory prawns that eat snails. But the dam “cut off their migration route,” says Kauffman. Fewer prawns meant more snails, and more schistosomiasis. Now, this part of Senegal has among the highest burdens of schistosomiasis anywhere, affecting about a third of children.

For rice farmers, the disease has become an occupational hazard. Dgibi Dia has farmed these fields in Keur Mbaye for decades. Standing near the pickup truck holding nearly 2,000 fish, he says he’s had multiple painful bouts with schistosomiasis.

Dgibi Dia is a rice farmer who has had multiple painful bouts with schistosomiasis.

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“This always happens to us since we are in the water most of the time,” he says. Each time, he and his fellow farmers get the same sort of symptoms.

“We cannot sleep at night because of the itching,” he says. Stomach pain is accompanied by “gurgling sounds,” he says, “as if we had something running inside the stomach.” He also experiences bloody diarrhea and fever, and symptoms can persist for months.

“It’s difficult,” he says. “When you are sick, you cannot work properly.”

There are drugs to treat schistosomiasis, but Dia says they’re hard to come by. Abdoulaye Ndiaye, another farmer, agrees, adding that they’re often too expensive. And while the drugs can cure a single bout, they don’t prevent re-infection.

“We live in the fields,” Ndiaye says. “Prevention is for our benefit.”

Rice farmer Abdoulaye Ndiaye hopes that adding fish to farms can help him avoid getting schistosomiasis.

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Ricci Shyrock for NPR

That’s where the fish come in — as snail superpredators.

Tilapia may eat the occasional snail, but that’s not their main job. The team is adding a few heavyweights — African bonytongue — to each field to be superpredators. The three-foot-long fish are also known as heterotis.

“It’s a species which can eat a lot of snails per day,” says Ndao.

African bonytongue fish, also called heterotis, can eat a lot of snails in a day.

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Ricci Shyrock for NPR

Thrashing fish

Adding them to rice fields, she hopes, will lead to fewer snails, and thus less schistosomiasis. Getting them into the fields proves tricky. One of the heterotis leapt out of its container onto the dusty ground. Ndao had to rush over to grab hold of the thrashing fish with both hands.

“Heterotis is very, very crazy,” she says, “very hard to catch.”

Eventually, she succeeds. After checking to make sure the water in the rice fields is suitable for the fish, the team starts shuttling both the few heterotis, and the hundreds of tilapia, to the water in buckets.

Ndeye Mbaye, part of the research team, releases tilapia into a rice field. The roughly 600 tilapia added to this field will fertilize the rice with their feces, and help feed the farmers.

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Ricci Shyrock for NPR

Gently, the buckets are lowered into the water, so the fish can acclimate to the temperature. “We do it slowly and let the fish go by themselves.”

Several minutes later, their scales flash in the sun as the fish disappear into the shoots of growing rice. There, the heterotis will eat snails. And all those tilapia, about 600 per field, have a different job — pooping.

“The feces of the fish is a very important natural fertilizer for the rice,” says Ndao, and should boost yield.

Many benefits

Rice production may be booming in the Senegal River Valley, but it’s not enough to meet the county’s appetite. As a result, Senegal imports about half the rice it consumes.

Rice fields in the Senegal River Valley.

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“We need to increase the yield, to obtain food security,” says Ndao. Fertilizer can boost yields, but is often expensive for farmers and the chemicals can runoff into rivers and lakes. Adding fish to farms could be a more sustainable way to boost yields, says Ndao. As a final bonus, the farmers can harvest some of the fish to eat for themselves or sell.

These benefits have helped sustain fish and rice aquaculture across Asia for centuries, but it’s pretty rare in Africa. Not many of the farmers Ndao talks with have heard of it. She highlights these possible benefits when trying to recruit farmers.

Dgibi Dia was drawn to the project for many reasons, but especially the fish. “There are no fish in this area,” he says, gesturing around his fields. “We have a shortage. We pray that it will be a success.”

There’s reason to think it will be. Over the past several years, Ndao and her colleagues tried growing fish and rice together on a smaller number of farms. One of them, near Saint Louis, belongs to Ousmane Diallo.

One day, “madam Ndao came to see us while we were working in the rice fields and explained the project,” he says. He’d never heard of growing rice and fish together, but was game to try. Once fish were introduced to the farm, Ndao checked in often to see how things were going. It’s a major part of her job.

“I call them every two days, until harvest,” says Ndao. With dozens of farmers to track, that means a lot of time on the phone. “My colleagues, they call me Sonatel, the national telecom agency,” she says laughing, because “I’m always on the phone.”

Diallo says whenever his phone rang, “it’s usually her. She is very determined.”

A blueprint for success

That kind of determination is essential for Ndao and her team’s ultimate goal — scaling up. This year, that means more than doubling the number of fields they’re studying to get a fuller understanding of what growing rice and fish together can do.

Researchers Momy Seck Ndao and Kayla Kauffman search for snails in the rice fields. The research team is measuring snail density before and after adding fish to farms, to see whether the fish can reduce the snail-borne parasite that causes schistosomiasis.

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A smaller pilot study, published earlier this year, hints at the benefits. Ndao and her colleagues found that adding fish to farms increased rice yields by about 25%, significantly boosted income and slightly reduced snail numbers. But the sample size was relatively small, so big questions remain, says Ndao. “There are so many things to do.”

Over the coming months, the team will be using drones to more closely track rice growth, taking more detailed measurements of changes in snail numbers to understand the impact on schistosomiasis, and gathering more information on what farmers are actually doing with the fish.

Answering all these questions is crucial for understanding just how big a difference fish-rice aquaculture could make. In turn, Ndao says the results will help make the case to more farmers to try putting fish on their farms, and hopefully, sustain the practice. For the project to make a meaningful dent in reducing disease, improving food security and farmer livelihoods, the practice has to be expanded.

The farmers who’ve participated in the project so far offer a compelling personal case.

Abou Diallo was able to paint and renovate his house from the extra money he earned after adding fish to his rice farm boosted crop yields.

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“I make more income, and sell much more rice than before,” says Abou Diallo, standing outside his freshly painted turquoise-and-white cement house, not far from Saint Louis.

Before adding fish to his farm, Abou Diallo could sell about 60 bags of rice a season. After adding fish, he sells between 90 and 95 bags, he says. “It has changed my life.” The extra funds allowed him to buy a flock of sheep and renovate his home, he says, including giving it a new coat of paint. He was able to eat and sell his own fish, which he says taste better than those he gets from the ocean. “There is a big difference.”

Mirjahan Choudhury receives a free eye screening at the Rangia Post office in India.

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Subhamoy Bhattacharjee for NPR

In recent years, Sangita Kalita has watched as her mother and mother-in-law go to the local temple — called a naamghar — in Assam State, India and leave disappointed.

Each visit, their hope was to read the sacred Hindu texts, “but due to vision issues, they faced a lot of problems recognizing the small letters in the book,” explains Kalita.

According to the World Health Organization, they are among more than 800 million people worldwide who suffer from presbyopia — age-related loss of close-up vision — for which basic reading glasses would help. Yet, according to WHO, in many lower-income countries, fewer than one in four people who need eyeglasses have them.

Kalita says for her family, getting reading glasses was simply too complicated and expensive. While in many high-income countries, readers are available in all kinds of stores, in lower-resourced settings, getting a pair often requires a trip to the hospital or a specialized optical shop, usually in a big city.

Kalita is trying to change that.

In northeastern India, she’s part of a team testing a new effort to address the challenge of getting vision care in remote areas. The idea involves the country’s massive network of post offices.

A quick eye test in an unusual place

Kalita used to be a school teacher. Now, she spends her days at a red and white kiosk that’s against the bright white walls of the post office in the town of Rangiya.

From that vantage point, she watches as customers come in. Some are there to mail packages while others use a wide variety of services offered in Indian post offices, such as opening and accessing small savings accounts. Kalita notices how they go about their task.

“A lot of old people come in who are not even able to fill out the deposit form,” she says.

When she sees them struggling, that’s when she steps in. She approaches, asking if they’d like a quick eye test. If so, she invites them to the kiosk where the words “get a free eye-screening and high-quality eye glasses here” are written at the top. After they work through a few simple tests in a spiral bound book, Kalita can tell if they need reading glasses. And if they do, they walk out with a free pair.

Sangita Kalita, an eye screening volunteer, helps clients at the Rangia Post office.

Subhamoy Bhattacharjee for NPR

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Subhamoy Bhattacharjee for NPR

The idea for this model came from a partnership between WHO and the Universal Postal Union or UPU. “With an estimated 680,000 post offices operating globally, postal services offer a unique opportunity to reach remote and underserved areas,” the report explains.

The plan was to tap into the world’s largest postal network — India Post has over 150,000 offices.

“The whole thinking was that we look at an established channel, which has a reach, which has infrastructure, which has people,” says Shweta Verma, deputy director for programs and operations at VisionSpring India.

Under a pilot program run by VisionSpring, Verma says, between December 2025 and May 2026, more than 5,000 people were screened in five post offices in Assam State.

Verma says 80% of those who received glasses were first time wearers. That “tells us that there was no screening or program for eye health” in the area prior to the pilot, she says.

Convincing skeptics

Getting reading glasses can make a big difference for a person’s income, in addition to making every day tasks easier. That’s especially true in Assam State, a region known for tea production.

A study published in The Lancet Global Health found that reading glasses increased tea pickers’ productivity by almost 22% since they need to see which leaves to pick and are paid based on the quality of their harvest.

Over the course of the post office pilot, Verma says, they’ve had to earn the support of postal workers and postmasters.

Initially, she says, “we got a lot of buy-in from the higher-ups,” but postal workers were skeptical, worrying how this new undertaking would impact workload. So Verma’s team hired and trained outside individuals — like Kalita — to implement the program. “Once the program started,” Verma says, “there was a lot of traction also from postmasters.”

Babul Boro is the postmaster where Kalita works. Since the pilot started in December 2025, he says over 1,000 people have come into his post office for eye tests and many have gone on to use postal services. He says this boost to his business is enough to make him hope that the pilot becomes permanent.

The current pilot is slated to wrap up in September. Then, Ella Gudwin, CEO of VisionSpring, says they’ll look through all the data and consider the funding before deciding whether to continue — or even expand. WHO and UPU have expressed interest in taking the model worldwide.

Beyond vision care

While VisionSpring says this model is a first for eyeglasses, the hope is that this undertaking demonstrates that post offices can be used “for a wide range of health-related services worldwide,” says the WHO and UPU report.

Dr. Elisabeth Rosenthal, a physician and a senior contributing editor at KFF Health News, has written about repurposing post offices to address medical needs. She says France and Japan are strong examples of where this is already happening.

In France, for a small fee, letter carriers can check on elderly individuals, she says, “just stopping in and having a chat, and kind of checking to see: Is there food in the house? Are they able to get around okay?”

Mantu Das takes a vision test at the Rangia Post office.

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Subhamoy Bhattacharjee for NPR

In Japan there’s something similar. And in some parts of the U.S., carriers can look for mail piling up and alert a local agency to initiate a welfare check.

In Kalita’s post office in India, she says, one thing motivates her: The smile she sees on people’s faces after she gives them eye glasses. She says it makes her “feel very accomplished and happy too.”

She says she’s thinking of the teacher who no longer gets headaches each day. Her mother and mother-in-law who can now read the sacred texts. And the tailor who never knew that reading glasses could be so life changing — and that getting them could be as easy as swinging by the post office.

In this 2022 photo, three university students check their smartphones. In June, the Taliban announced a ban on the devices in certain sectors of society. The ripple effect is making students afraid to bring their smartphones to school.

Wakil Kohsar/AFP/via Getty Images

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Wakil Kohsar/AFP/via Getty Images

Farzana, 40, is a midwife who covers 10 villages in Moqor district of Afghanistan’s Ghazni province. Until recently, worried mothers often sent her photos of newborns with rashes, swelling or skin infections so she could decide who needed help most urgently.

But since the Taliban began enforcing a ban on smartphones that took effect in June, Farzana says she has stopped using her smartphone out of fear. She can now only be reached through a regular phone line — a more costly option in a country where people rely heavily on WhatsApp for calls, messages, photos and urgent coordination.

“I cannot be everywhere at once,” said Farzana, who like many Afghans goes by one name. “Sometimes a photo or a message helps me understand whether a mother or newborn needs urgent help.”

Across Afghanistan, smartphones have become part of a fragile support system. Families use them to consult doctors remotely, arrange transport to distant clinics, send photos of wounds and symptoms, ask relatives for money, document abuse and reach schooling that is no longer available in person to many girls and women. That fragile network is now under threat.

Smashed and confiscated

Taliban authorities in Afghanistan have ordered government employees, judges, police and members of the military to stop using smartphones under a directive that took effect June 16. The order threatens violators with confiscation, destruction of their devices and punishment (which are not specified).

The use of what are known as feature phones — with calling and texting options but no touch screen and no photo or recording capabilities — is permitted.

The ban does not yet apply to private phone ownership by ordinary Afghan civilians. But in some provinces, restrictions have already moved beyond government offices and into hospitals, schools and universities, raising fears that the policy could become an early test for broader limits on public smartphone use.

The restrictions began as a verbal order from Taliban supreme leader Hibatullah Akhundzada and were later formalized in a military court directive circulated to court heads, police commanders and intelligence chiefs across the country’s eight administrative zones. The directive says anyone caught using a smartphone will have the device smashed and face “legal and sharia punishment.” Exemptions require a written decree from Akhundzada himself. A separate court order covers “all officials of the military and civilian institutions, including judges.”

The Taliban have also created monitoring lists recording employees’ names, positions, workplaces, mobile carriers and phone numbers. Security officials have instructed members to destroy their own smartphones and submit proof on a designated form.

One government employee in Herat, who requested that NPR not use his name for fear of retaliation by the Taliban, says phone restrictions had quietly been in place in his office for months before the June order took effect nationally. When he and his colleagues resisted, he said, officials confiscated and smashed their phones.

A possible trigger for the ban

The timing of the order followed protests in Herat in early June, after Taliban forces arrested women and girls accused of “improper hijab” — not meeting the dress code of covering the face and body in the prescribed manner and not wearing makeup. Witnesses said Taliban forces opened fire on demonstrators, killing at least one person. Video of the shooting spread online before the Taliban could contain it.

The Taliban administration did not respond to a request for comment.

Taliban staff used to rely on smartphones. After a ban was announced, they’re using feature phones — also known as “dumb phones” — which do not have a screen and are designed for calls and texts. This Taliban administrator is using such a phone at the Department of Information and Culture building in Kandahar.

Sanaullah Seiam/AFP/via Getty Images

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Sanaullah Seiam/AFP/via Getty Images

The restrictions have reached deeply into education, where phones are not only tools for communication but also part of how students study, save lessons, contact teachers and stay connected to their families.

In Kandahar province, an 18-year-old madrassa student named Baryalai, who also requested anonymity because he fears retaliation from the Taliban, said the change at his school was total. “Now there’s a complete ban,” he said. “No one brings smartphones anymore.”

A teacher at the same school, 30-year-old Omar Istanikzai, said he had left his own phone at home that morning without being told to. “I think this is a good decision so that there is more focus on studies,” he said.

Others see the policy very differently.

How schools are responding

At Kabul University, the leadership council ordered a complete smartphone ban for professors, staff and students effective June 21. The decision was announced at an academic council meeting where members were not permitted to ask questions. At Herat University, notices posted at the entrance warn that no one may enter with a smartphone, and the restriction extends into student dormitories, where Wi-Fi service has also been suspended. In Baghlan province, students carrying smartphones have been turned away at the university gate.

A student at Kabul University said the restriction has also made it harder for students to remain in touch with their families during emergencies. He asked that his name not be used because he has been targeted by the Taliban before and is afraid he would face retaliation for speaking out if they could identify him. His family lives in Badakhshan province, he said, and after a security incident involving students on July 4, his mother was terrified because she could not easily reach him.

“She was so worried,” he said. “If something happens, our families need to know whether we are safe. Without our phones, we are cut off from them.”

For many students, a phone is a classroom and a library. They use it to photograph lessons written on the board, receive assignments, download books, search for academic materials, use dictionaries and contact instructors outside class. For girls and women barred from secondary school and university, it can be one of the last ways to keep studying privately.

In Kandahar, the provincial Education Department said its own ban on students and teachers was rooted in a “sharia perspective” and warned that smartphones risked “the destruction of the future generation.” The Taliban’s higher education minister has called smartphones “one of the three main enemies of Muslims” and last October restricted their use on university premises to only the most senior administrators.

What could be lost

For many Afghans, however, the phone is not destroying their future. It may be one of the few tools they still have to protect it.

That is especially true in healthcare, where distance, poverty and Taliban restrictions already make treatment difficult. Afghanistan’s health system is under severe strain, with many hospitals and clinics facing shortages of staff, medicine and funding. Patients in rural provinces often travel for hours, sometimes across several districts or provinces, to receive treatment. For women, the barriers are even greater. Taliban restrictions on movement, education and employment have limited women’s access to care and threatened the future pipeline of female doctors, nurses and midwives.

In that environment, a phone can narrow the distance between a patient and help. A pregnant woman can call relatives to arrange transport. A mother can ask a midwife whether her newborn needs urgent care. A patient can send a photo of an injury before deciding whether to make a costly trip to a hospital. A health worker can consult colleagues through messaging apps.

For Farzana, those messages are part of daily work. They help her decide when a situation cannot wait.

“The ban makes it hard to attend to every woman in every village,” she said.

Faraidon Farzad, 29, grew up in a village in Malistan district of Ghazni province, where reaching a doctor was never simple. Now pursuing a Ph.D. in artificial intelligence, he has developed a system that analyzes smartphone photos of wounds for signs of infection — redness, discoloration and changes in tissue — that could help flag when a patient needs medical attention.

The project won a special award at Moscow’s Archimedes innovation exhibition this year. It is still in the research stage and would need larger datasets and clinical validation before wider use, Farzad said.

“Mobile phones are widely available, affordable and easy to use,” he said. “In many areas, especially rural communities, people may not have quick access to specialists, but they often have access to a smartphone. A mobile-based tool could provide early guidance and encourage patients to consult healthcare professionals sooner.”

Farzad’s project is not ready for broad use. But it shows what mobile technology could make possible in a country where access to medical care is already fragile.

Esmat Khan Amiri, 26, from Daykundi province, used his phone for a different kind of health-related action. After his father was repeatedly brought to an operating room at a hospital in Kandahar and turned back without surgery, Amiri posted a video describing the ordeal.

“I did not have power, money, or connections, but I had a phone,” he said. “I wanted people to know what was happening.”

The video spread on social media, and Amiri said the resulting pressure led the hospital to finally operate on his father.

Giving voice

“A smartphone is not only a tool for entertainment or communication,” Amiri said. “For people who are ignored, silenced, or discriminated against, it can become a voice.”

Since the Taliban returned to power in 2021, phone footage has repeatedly captured images the government could not control: protests, arrests, public punishments and complaints from inside hospitals. The same device that helps families seek medical advice can also expose mistreatment.

That visibility is part of what makes smartphones threatening to the Taliban. They allow information to move beyond official control — from a village, a classroom or a hospital ward to the wider public.

For Afghans who have few other ways to demand help, that matters. A phone can connect a mother to a midwife, a student to a lesson, a patient to a doctor or a family to an audience when institutions ignore them.

Now, as the Taliban moves to restrict smartphones, one of the country’s most popular tools has become one of its most contested.

Fatima Faizi is a journalist based in New York. She previously reported for The New York Times in Afghanistan, and her work focuses on human rights, women, education and the impact of Taliban rule on daily life.

Health workers interact at the Evangelical Medical Center, in Bunia, eastern Congo, Friday, July 3, 2026, where Ebola clinical trials are scheduled to take place.

Dirole Lotsima Dieudonne/AP

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Dirole Lotsima Dieudonne/AP

KINSHASA, Congo — New suspected cases of Ebola have been reported in parts of Congo that were previously unaffected, the government said Thursday, as the death toll in the country’s latest Ebola outbreak reached 600.

According to the Congolese health ministry, suspected cases have now been recorded in the provinces of Tshopo and Haut-Uele, signaling the continued spread of the disease beyond the epicenter in Ituri.

A Congolese government report, published late Wednesday, said two new cases were suspected in Kisangani, in Tshopo province. The minister did not say how many cases were suspected in Haut-Uele. The total number of confirmed cases across the country has now reached 1,759.

The report said one of the two suspected cases in Tshopo was linked to the Nia-Nia health zone in Ituri province, where the first cases were reported, while the other case “has no apparent geographical connection to known outbreaks.” Authorities were investigating.

The Africa Centre for Disease Control said on Thursday that the latest outbreak is the fastest-growing Ebola outbreak on the continent.

The Congolese authorities declared a fresh Ebola outbreak on May 15, after the disease had been transmitting for weeks without official detection, according to the World Health Organization. The latest outbreak is caused by the rare Bundibugyo virus, which has no approved vaccine or treatment.

Last week, clinical trials for treatment began after researchers launched a highly anticipated study in the hope of fighting the virus.

Efforts to contain the virus have also been hampered by a funding gap, attacks on health centers, and an ongoing conflict in eastern Congo, the epicenter of the outbreak.

The Education Department plans to shift oversight of special education to another agency, alarming many disability rights advocates.

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In a call with disability rights advocates Thursday, officials from the U.S. Department of Education tried to ease concerns about plans to move the agency’s special education offices to the Department of Health and Human Services (HHS).

The effort seemed to fail.

“Today’s briefing left more questions than answers for parents and educators,” says Chad Rummel, who leads the Council for Exceptional Children, and was one of many disability advocates who attended the call. “Today we heard that there is no clear and transparent plan around the move to HHS.”

According to a recording of the call obtained by NPR, the acting assistant secretary overseeing special education, Kelly Rogers, said she wanted to reassure advocates that the move would not harm federal protections for students with disabilities. “The U.S. Health and Human Services is not taking over IDEA. Period.” Rogers was referring to the Individuals with Disabilities Education Act, a federal law that guarantees students with disabilities a quality public education alongside their nondisabled peers.

Yet Rogers also said in the same breath that staff at the Office for Special Education and Rehabilitative Services (OSERS) — many of the people actually responsible for supporting states and schools in implementing IDEA — would be moving to HHS. She said she would continue to oversee that staff from her perch at the Education Department “with additional support by HHS.”

While department officials have been pitching this move as a way to streamline federal bureaucracy in education, advocates think it is doing the opposite. “This proposal appears to add another layer of bureaucracy while creating additional confusion and uncertainty for families, educators, and state agencies,” says Denise Marshall, CEO of the Council of Parent Attorneys and Advocates (COPAA).

In Thursday’s call, Rogers said, “This administration is firmly committed to carrying out the federal government’s duty to enforce federal protections for individuals with disabilities.” She continued, “This partnership does not alter that obligation.” Rogers did not share a specific timeline for these changes to take effect.

NPR followed up with the Education Department by email after the call, and while the agency did not respond to questions about its timeline, press secretary Savannah Newhouse wrote, “Advocates, parents, and teachers in the special education community have nothing to fear” about the changes. “What our partnership with HHS does is place these important federal responsibilities in a better positioned agency and draw on HHS’ expertise of working with people with disabilities of all ages.”

The private briefing came three weeks after the initial announcement that the Education Department would move two of its core functions — special education and civil rights — to other agencies in an ongoing Trump administration effort to dismantle the department altogether. The department has already shared plans to move more than a dozen of its offices to other agencies as part of its “Returning Education to the States” campaign.

For decades, the Education Department has overseen IDEA and other services for people with disabilities, like helping adults transition to life after school. While the federal government has never directly managed how schools serve students, it has been responsible for keeping schools accountable for meeting the needs of those students, providing federal funding for services and offering technical assistance to local leaders.

For months, the disability community has been on edge about how moving oversight of IDEA could affect students.

“The concern is not that IDEA disappears overnight. The concern is that the administration is preserving IDEA at the Department of Education on paper, while moving much of the work that makes IDEA real for families somewhere else,” said Jacqueline Rodriguez, CEO of the National Center for Learning Disabilities. “For students, that could mean more confusion, slower guidance, weaker monitoring and less accountability when services are delayed or denied.”

Newhouse, from the Education Department, denied that the changes would affect how staff do their jobs. “A different building, a different floor, or a different desk doesn’t change their job responsibilities and commitment to serve students with disabilities every single day.”

Department officials say federal funds dedicated to special education will continue to flow to states and schools through the agency for now, but it’s unclear how those systems may change when OSERS staff move to HHS.

“The administration acknowledged today what the law has always required: The Department of Education and the secretary of education remain legally responsible for administering and enforcing IDEA. This reorganization neither advances the stated goal of closing the department nor transfers new authority to the states,” says Marshall of COPAA. She called on Congress to step in and stop this move — a federal agency can only be completely dissolved by an act of Congress.

But as Marshall and other advocates pointed out, administration officials seem keenly aware of this fact, which may be why the Education Department is keeping some staff, including Rogers, at the Education Department.

Marshall called the strategy “a sham.”

Edited by: Nirvi Shah
Visual design and development by: LA Johnson

An exhaust pipe is pictured atop a truck traveling along Interstate 35 on July 30, 2025 in Austin, Texas. The EPA is proposing changes to rule limiting hazardous pollution from heavy trucks.

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The Trump administration is proposing changes to what it calls “unnecessary and unworkable” Biden-era environmental rules designed to cut pollution from heavy-duty vehicles, including buses and large trucks.

The proposal — part of a series of deregulatory actions by the Trump administration that have rolled back emissions standards for new vehicles — includes changes that are welcomed by trucking organizations and denounced by environmental groups.

Specifically, the proposal from the Environmental Protection Agency would scale back and postpone two provisions designed to make sure emissions-reducing technology keeps working while a vehicle is in use; one related to warranties, and another related to the useful life of emissions technology.

Additionally, the current set of rules requires truck engines to automatically operate at reduced power if their emissions reduction systems aren’t working, which truckers and other heavy-duty vehicle operators have called disruptive. The EPA proposes getting rid of that requirement altogether and replacing it with an alert to drivers.

According to the EPA’s analysis, the changes would save the trucking industry between $4,130 and $6,152 per diesel engine affected. Compared to the current emissions rules, the change would increase ozone-forming nitrogen oxide pollution from heavy duty trucks by 4.2% in 2030 and by 11.6% by 2055.

The EPA did not model the resulting effect on air quality or human health, but noted that the modifications would likely reduce the benefits of prior rules changes in 2023.

The proposal is now open for a period of public comment.

“If finalized, these changes will help manufacturers keep improving their vehicles without being forced to rush products to market before they’re ready,” EPA administrator Lee Zeldin said in a statement, adding that the rules changes “will ease real burdens for operators.”

Kelly Loeffler, who heads the U.S. Small Business Administration, wrote that the rules change would alleviate “burdensome diesel regulations on behalf of farmers, truckers, and small business owners who were crushed by unworkable environmental activist demands that became costly mandates.”

The American Trucking Association had called for changes to the rules, writing in February that the Biden-era policies would require “a premature rollout of commercial motor vehicles with unproven engine technologies onto our highways.” The group specifically asked the agency to allow truck manufacturers to pay penalties instead of comply with the rules, as long as they were working on developing compliant engines, an option the EPA included in the proposal.

Environmental groups criticized the proposed changes, citing concerns about the health hazards of emissions. “Clean truck standards save lives,” Katherine García, director of the Sierra Club’s Clean Transportation for All campaign, wrote in a statement emailed to NPR. “Weakening them would mean more toxic pollution in the air and more families paying the price with their health.

The Environmental Defense Fund noted that while heavy trucks make up only 5% of vehicles on U.S. roads, they are the largest source of “pollutants that cause asthma attacks, bronchitis, heart attacks, strokes and preventable deaths,” and argued that truck manufacturers are already capable of meeting the Biden-era rules.

Carl Smigielski, 61, is single now, after being a caregiver to his husband, Moshe, who died in 2019. He expects to be a “solo ager,” someone who doesn’t have a family member to rely on as he gets older.

Ashley Milne-Tyte for NPR

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Ailene Gerhardt hears a lot of stories. It’s all part of her job. She’s a patient advocate, helping people navigate their care and the complexities of the healthcare system. During the last several years she’s heard from more and more people getting older without adult children, a spouse, or both. But the healthcare system remains stuck in the past, she says, assuming older people have family to support them, when that’s often not the case.

Gerhardt started and runs a network called Navigating Solo, which offers support and community to this group of older adults, often referred to as “solo agers.”

“Instead of looking at the concept of solo aging as something that’s a crisis to be solved — it’s not a crisis to be solved,” she says. “It’s a reality to be supported.”

That reality is growing as Baby Boomers and Gen Xers age. According to a 2023 AARP report, one in ten adults over age 50 lives alone and doesn’t have a partner or children. Different lifestyles and changing societal attitudes suggest these numbers will grow in the future. Plenty of people are single by choice.

More inclusive systems

Gerhardt says right now, solo agers are expected to take the lead in planning for their housing, finances, and transportation to appointments, often by hiring professionals to help them. But rather than feeling like the odd ones out in systems that cater to couples and families, she says, why can’t the systems themselves be more inclusive of solo agers?

To take one example: instead of assuming every patient has someone who can pick them up from a medical appointment after being under anesthesia — and drive them home — she’d like the onus to be on hospitals and medical offices to arrange transport and an escort. She says she has heard from people who have canceled a procedure because their ride backed out at the last minute.

“In both my solo aging advocacy hat and my healthcare advocate [hat], like, that is just infuriating,” she says, “that people do not have the support they need to maintain their health in a productive way.”

But Gerhardt says this isn’t an intractable problem. “Let’s look at designing the system, or re-designing the system, so that anyone and everyone can have strong support. Quite honestly that benefits everyone,” she says, citing curb cuts as a good example of this. Disability rights advocates fought for years to have towns and cities install curb cuts — a slope from the sidewalk to the street that lets a wheelchair user cross the road easily and safely. But curb cuts quickly became popular with people pushing strollers, bikers, and anyone else seeking an easier way into the street.

Building services for the future

Sara Zeff Geber has been writing and speaking about solo aging for more than 10 years, including giving talks to lawyers and financial planners, “to bring awareness to the fact that not everybody is a couple and not everybody has that proverbial adult daughter to help them.”

She believes she was the first person to use the term “solo aging,” seeing it as a lot more positive than the previous description: “elder orphans.”

Ideas about relationships and parenthood are less rigid than they used to be. Given this, she says, “Whatever foundation we build now” for solo agers, “is going to be hugely important for generations that follow.”

Jason Resendez hopes those generations will have more government support than the current crop of older adults. He is CEO of the National Alliance for Caregiving. He says there is growing recognition that many people are aging by themselves. That said, federal funding cuts are coming to home-based services for older adults, and to Medicaid, he says, “which makes it a lot harder to age in place when you don’t have a family caregiver to absorb the elimination of those social service supports.”

On the whole, Resendez says, U.S. society is still hooked on the idea of “individual ruggedness.” But as he looks to the future, “More and more people will be aging, more and more people will be aging alone,” and the social safety net will come under a lot of strain. “I think it’s when we are at that boiling point, that maybe we’ll have policymakers finally recognize, ‘Hey, this isn’t just an individual responsibility.'”

Creating the resource he will need

Carl Smigielski was a family caregiver to his husband, Moshe, a Vietnam veteran who died in 2019 after living with Alzheimer’s for several years.

But Smigielski doesn’t expect to have a caregiver of his own. He’s 61, lives alone in Richmond, R. I., and believes it’ll stay that way. “Right now it wouldn’t align with me to have another intimate relationship so I was pretty clear,” he says. “You’re going to be doing this alone.”

Carl holds a photo of himself (r) and his late husband Moshe Gara (l), towards the end of Moshe’s life. Carl was Moshe’s caregiver when he had Alzheimer’s disease.
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But he’s gotten involved with a nonprofit organization that has long recognized solo agers. It’s called the Villages (not to be confused with the large retirement communities in central Florida.) The Village Movement consists of hyperlocal groups that are mostly run by volunteers.

The Villages started 25 years ago with one village in Boston. There’s now a network of them dotted across the U.S. Their aim is to help people live independently by offering a combination of practical and social support, such as rides to appointments, help moving furniture or changing lightbulbs, friendly check-ins for those who want them, and social events.

People gather for lunch at the Richmond Community Center in Richmond, R.I., where Carl Smigielski is about to explain the concept of a local ‘village’ for older adults.

Ashley Milne-Tyte for NPR

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Ashley Milne-Tyte for NPR

Members join to tap the network’s resources. Volunteers make it happen. While not designed specifically for solo agers, Barbara Hughes-Sullivan, executive director of the Village to Village Network, says “anywhere from 30 to 60%” of village members are in that demographic, depending on the individual village.

Smigielski is both a member and a volunteer. He is helping to start a new village in his rural part of Rhode Island. “I wanted to retire to something,” says the longtime software engineer. “I didn’t want to retire to boredom … and I really have met the kindest people.”

He’s spending part of this day at a community center to explain the village concept to a group of older adults over lunch, including his mother, Jacqueline. She is 87, a widow, and eager to volunteer. Afterwards he heads back to the home he used to share with his husband. After speaking in front of the group, he needs to decompress in the quiet of the house and yard.

Smigielski says he’s not an obvious candidate for a network like this. He enjoys his own company, and doesn’t expect to need help changing lightbulbs for decades. But after years of caregiving, followed by the Covid years, he realized something.

“The social support, regardless of how able we are, that’s intrinsic to us,” he says. “I went through my battles of thinking I was an exception to that rule, I could be the human who didn’t need social connection – because I don’t need a lot of it, but I need it.”

For now, he still has his mom to drive him to medical procedures where he needs help getting home afterwards. But eventually he expects to tap the network he’s helping create to sustain him as he gets older.

Carl Smigielski and his mother, Jacqueline, outside the Richmond Community Center in Richmond, R. I. Each is part of the other’s support system.

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Ashley Milne-Tyte for NPR

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Should surgeons be allowed to perform euthanasia by removing patients’ hearts and other organs while they’re still alive?

The idea, dubbed “Death by Organ Donation,” would enable euthanasia patients to donate organs for transplantation in a way that would make their organs more likely to be usable. It would also kill them.

“It would be an ethical thing to do because this is something the patients have chosen for themselves,” says Dr. Robert Truog, a physician and bioethicist at Harvard Medical School who co-authored a paper outlining Death by Organ Donation in the New England Journal of Medicine. “They have very generously thought: ‘How might my death help other people?’ It’s a very altruistic, generous thing to do.'”

But the idea is controversial for a variety of reasons, including because it goes against fundamental principles that have guided organ donation for decades. The Dead Donor Rule requires that patients must be dead before any organs are removed. Doctors also can’t kill patients in the process of removing organs.

The rule has long generated intense debate, including disputes over how to precisely determine when a person is dead, as well as the development of new ways to extend the lives of dying patients and recover usable organs for transplants.

At the same time, many countries, including Canada, the Netherlands and Spain, have made it legal for doctors to help patients die through euthanasia.

“What if they chose to be organ donors? The problem is that under current standards doctors must not cause death in the process of procuring organs for transplant,” Truog says.

So hearts, lungs, livers and kidneys can only be removed from euthanasia patients after they have received a lethal dose of drugs, which makes their organs, especially their hearts, much less useful for transplantation.

“Why would it not be OK for patients to say, ‘I’ve chosen to die by a lethal injection. Isn’t there some way I can help others?’ They should be able to donate organs as a lasting gift to others. And denying them that option doesn’t seem to make any sense,” Truog says. “I would say a more appropriate framework is that for patients who are choosing to die from euthanasia they could also choose to have euthanasia linked with organ donation.”

A “creepy idea” that might have merit

Euthanasia involves doctors administering lethal drugs to cause the death of a patient. The practice is illegal in the U.S., but a growing number of states have legalized assisted-suicide, in which doctors give patients lethal drugs to take at home.

Instead of a doctor administering lethal medication to a patient, Death by Organ Donation patients would end the patient’s life by anesthetizing them and then removing their organs while they are still functioning.

“So the organs would still be in ideal condition,” says Truog says.

Some other bioethicists say the argument could have merit.

“The concept of death by donation is an extremely troubling notion at first glance. It’s a creepy idea,” says Ruth Faden, a bioethicist at Johns Hopkins University. “But in fact if you look at it critically in terms of the foundational ethical considerations, it’s not as disturbing as it first appears.”

That’s because, she says, of the spread and acceptance of euthanasia and the desires of some of those patients to be organ donors.

“If we’re committed to respecting the autonomy of individuals at the end of their life. And if they prefer to maximize the good their bodies can do at the end of their life, that’s the ethical justification for death by donation,” Faden says. She adds it would be important for strong safeguards to be implemented to ensure full informed consent and to protect patients from abuse.

A shift could undermine patient trust

But some other bioethicists are horrified by the mere notion.

“This is asking surgeons to take a living person into the operating room and to come out with a dead person, which I think is murder,” says Lainie Friedman Ross, a bioethicist at the University of Rochester. “There are limits to consent. And one of the things we’re not allowed to do is consent to saying that somebody else can just murder you.”

Others worry this approach would undermine trust in both organ donation and end-of-life care at a time when some potential donors are already wary because of controversies about organ procurement efforts.

“You could be doing real damage to both the physician-assisted suicide system and the organ donation system,” says Lori Andrews, a bioethicist and professor emerita at the Chicago-Kent College of Law. “It might give people the image that these are vultures that no longer wait until you die to attack. It does give up visions of body snatchers from prior centuries.”

Critics also fear that allowing Death by Donation for euthanasia patients could open the door to someday saying it would be acceptable practice for physician-assisted suicide patients and even potentially hospice patients.

But others argue that for now this approach could be considered for at least some euthanasia patients.

“If there are people who want to donate organs, this would be the way to maximize their wishes and their altruistic goal to help others,” says Dr. Carter Winberg, a Canadian critical care physician working on his master’s degree in bioethics at Harvard who co-authored the New England Journal of Medicine paper. “These are people who are already consenting to voluntary euthanasia and already consent to organ donation. That warrants a new conversation about whether this is possibly ethical.”

A LiFT workshop in the Navaho Nation in Arizona. The evidence-based course has teens bring a trusted adult with them to learn about relationships, safe sex and preventing pregnancy.

Hózhǫ́ Horizons

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Hózhǫ́ Horizons

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Last July, the Trump administration issued a notice to the dozens of organizations receiving Teen Pregnancy Prevention Program grants.

“Program materials are expected [to] reflect the immutable biological reality of sex, not radical gender ideology, and may not promote anti-American ideologies such as discriminatory equity ideology,” the document reads, listing five executive orders organizations needed to comply with to keep their grants. “Programs with such unauthorized content are not eligible for federal funding.”

Grantees scrambled to adapt to the new requirements. One of them, Healthy Futures of Texas, provides sexual health education in community centers, school districts, and juvenile justice and faith communities in San Antonio, Dallas, and the Rio Grande Valley in Texas.

“We had to essentially adapt and revise all of the already approved curricula to be in alignment with the executive orders — so that for us was 11 different programs that we adapted,” explains Ginger Mullaney, the organization’s president and CEO.

The process took months. “After all of that work, we were re-awarded and all of our programs have been deemed in compliance,” she says. “We have submitted progress reports thus far and our programs were still in alignment even up until recently — in November, we submitted another adaptation for a program and were approved.”

So two weeks ago, when the organization’s $2 million annual grant was canceled, effective immediately, Mullaney was stunned.

In fact, in late June, the federal Department of Health and Human Services canceled all but a dozen Teen Pregnancy Prevention Program grants, totaling $66 million for grantees across the country. Grantees included a wide range of organizations from public health departments and universities, to Planned Parenthood and Bethany Christian Services affiliates. The five-year grants had two years left to go.

According to a list of terminations obtained by NPR, the given reason was: “Misalignment with agency priority, specifically normalizing sexual activity for minors.”

For Mullaney, the sudden funding cut means 13 employees are losing their jobs, and they may have to reduce their services.

“I’m frustrated that these are lives that were being changed — there’s generational impact and social and economic mobility for our communities using programs that are proven and demonstrated to be effective,” she says.

A history of ‘rigorous’ evaluation

The teen pregnancy rate has declined dramatically in the U.S. since the 1990s, but rates are still higher than they are in peer countries. The cost to young parents is high — they are less likely to earn a high school diploma and more likely to have lower lifetime earnings. The costs to taxpayers were estimated in one study to be $9 billion per year.

Before the Teen Pregnancy Prevention funding stream was established in 2010, a series of programs were “evaluated using randomized controlled trials, which are really the gold standard for understanding the effectiveness of public policy,” explains Nicholas Mark, a sociologist at the University of Wisconsin Madison.

Congress then established the funding stream “to put in place the programs that had been shown to be effective in reducing teen pregnancy, increasing healthy behaviors, decreasing unhealthy sexual behaviors among teens,” he says. “So the whole basis of the program was in effective, rigorously evaluated programs.”

But the grants have long been a target of the Trump administration and some conservative groups like the Heritage Foundation. All of the grants were canceled by the Trump administration during the president’s first term, although the funding was restored after grantees sued.

Even before the administration canceled the grants, President Trump’s recent budget request called for eliminating the Teen Pregnancy Prevention program. “There is no evidence that these specific programs have contributed to this historic decline in teen pregnancy, which is now at an all-time low. Moreover, TPP issues grants to problematic organizations like abortion clinics that waste American taxpayer dollars on abortion services and promote radical leftist ideology,” the document reads.

However, Trump also signed $101 million in funding for the program into law earlier this year, a point raised by Senate and House Democrats in a pair of letters sent to Health Secretary Robert F. Kennedy Jr. last week, demanding that the funding be reinstated.

The Department of Health and Human Services did not respond to multiple requests for comment from NPR about why the grants were canceled.

‘Normalizing sexual activity for minors’

Paige Preston just turned 18. She lives in Tuba City, Arizona, part of the Navajo Nation. Earlier this year, she attended a LiFT workshop — one of the evidence-based programs that the federal grants support — put on by Hózhǫ́ Horizons from the Johns Hopkins Center for Indigenous Health.

Paige Preston was set to volunteer to help other teens in the LiFT workshop after she completed it herself. It’s been canceled after federal funding cuts.

Jolene Robertson

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Jolene Robertson

“It connects you with your trusted adult, so for me, I went with my sister and she is the person that I kind of go to for everything,” Preston says. “She was learning how to create a safe space for me and to make me feel heard. And then what I learned was how I show my affection for other people and how to be safe if we ever do come to that conclusion that there’s some activity that we want to participate in.” She says she also learned about birth control options beyond condoms, such as the pill and IUDs.

Preston says she knows this information is important — several of her peers got pregnant in high school. Nationally, American Indian and Alaska Natives have the highest teen pregnancy rate among racial and ethnic groups.”I know in my community it is a big problem,” she says.

Preston is now the chair of the Hózhǫ́ Horizons Youth Council, and was ready to help with another LiFT workshop later this summer. It was canceled when the funding was cut.

“In all honesty, I’m very sad and disappointed,” she says. She thinks the workshop brings information to young people that they might not learn at home or at school. “When you participate and you learn from people like you — like in Indigenous communities — that means a lot more because it’s showing you that someone like you is so knowledgeable about a subject, and they’re really passionate about that and it kind of makes you want to listen more.”

Nicholas Mark from the University of Wisconsin argues that the reason that agency gave for canceling these grants — “normalizing sexual activity for minors” — is a “bizarre” framework.

“In a world where teens have smartphones, teens are surrounded by sex and such easy access to sex and sexual imagery, sexual iconography,” he says. “It seems silly to think that having a source of verifiable, trusted information on safe sex would be worse than the information environment that people are already steeped in.”

A rescue team assists Hernan Gil, a survivor of Venezuela’s twin earthquakes, on July 2, eight days after the quake. In addition to caring for survivors, the country’s medical workers are facing a range of issues in the state of La Guaira, which was devastated by the disaster.

Federico Parra/AFP/via Getty Images

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Federico Parra/AFP/via Getty Images

When the first earthquake hit, Luz Noguera was in the shower.

Noguera, 36, grabbed her keys, forced the door open and ran out into the street in a panic. Her first thoughts were for her kids and family members, and their immediate safety. Then, it was survival.

“We gathered on the main road and stayed there,” she says. “It started to rain, the electricity went out and there was no cell service, no way to contact our families. We spent the whole night in the street.”

Luz Noguera, 36, says she is simply grateful to be alive after the quakes. “The day after the catastrophe, I took this photo with a smile,” she says.

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The last thing on Noguera’s mind was her asthma medication — still in a bag on her nightstand.

The numbers following the June 24 earthquakes trace a devastating outline: At least 3,535 dead, with thousands more missing. And some 16,700 injured.

As hopes fade of live rescues from the rubble, health workers have turned their focus to the living. With an estimated 18,000 people now homeless, doctors must face a new wave of health issues — the kind that happen when thousands of people are suddenly displaced in the heat, the rain and the dust.

People displaced by the June 24 earthquakes rest on bunk beds inside a temporary shelter set up at the Jose Maria Vargas sports complex in Catia la Mar, La Guaira state, Venezuela, on July 6.

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Miguel Medina/AFP/via Getty Images

“We’re seeing diarrhea, respiratory infections — skin diseases, because they’re exposed to the sun for many hours,” says Dr. Eduardo Celades, a senior health adviser for UNICEF.

Dehydration. Asthma attacks. Sunburn. The ailments of normally healthy people, who no longer have easy access to their medications, regular meals, or running water.

“As well, there will be risks of outbreaks — like for example measles, respiratory infections. This is going to be our priority,” Celades tells NPR.

Three hospitals suffered critical structural damage and were knocked out of service during the earthquakes, the World Health Organization said. Several others are only partially functional, with staff doctors and other frontline health workers among the victims of the disaster.

“The lady who was running the entire maternal pathways (maternity program) is missing, and unfortunately is presumed to have perished in the earthquake,” says Ian Clarke, incident manager for the WHO’s health emergency response in Venezuela.

International aid groups have flown in doctors and set up field clinics to help. A 56-bed field hospital set up by the nonprofit Samaritan’s Purse includes intensive care units and operating theaters. Project Hope has set up a mobile clinic offering primary care at a shelter in one of the hardest hit neighborhoods, including ultrasounds for pregnant women.

Doctors say they struggled to help the first victims treated after the disaster: patients who needed limb amputations or who had suffered crushing injuries or cuts from broken glass. Now, they are focused on caring for a traumatized, displaced population that no longer has a functional healthcare system. Doctors in other parts of Venezuela and abroad have stepped up to volunteer for telehealth services, while other aid groups have focused on reinforcing primary care providers and mobile clinics.

“A team of doctors and psychologists travels there daily to provide primary healthcare to all those affected and to offer psychological first aid,” said Dr. Lydia Gordon, an OB-GYN with Project Hope in La Guaira. “What I see with my own eyes as I pass by all these buildings are thousands of people walking in the street, disoriented, who need help.”

The World Health Organization has delivered six metric tons of medical supplies, with another 28 tons of aid on the way from its hub in Dubai. The donations included trauma kits, personal protective equipment for frontline workers, and supplies to prevent communicable diseases. Vaccines to prevent tetanus, diphtheria and yellow fever are being donated by the Chilean and Brazilian governments. The International Federation of Red Cross and Red Crescent Societies has dispatched 36 tons of aid, including hygiene kits, cleaning supplies and water filters.

“But even prior to the earthquake, there were massive shortages, up to 37% of essential medicines in many hospitals,” Clarke says.

Under the rule of ousted president Nicolas Maduro, Venezuela’s economy collapsed under hyperinflation and oil sanctions. Medical supplies grew scarce, vaccination rates dropped and cases of measles, diphtheria and malaria surged. Many Venezuelans emigrated, including about a third of the nation’s doctors, according to the Venezuelan Medical Federation. The remains of the country’s once-robust public health system was ill-equipped to respond to the scale of the disaster and its aftermath.

“That’s the normal situation. But in a crisis, that spike in demand — it’s exacerbated by the history,” says Alejandro Arrieta, a health economist at Florida International University.

Even in normal times, most patients are required to purchase their own medical supplies at pharmacies and shops near the hospital. It’s not an unusual practice in many Latin American countries, but the scale is more extreme in Venezuela’s underfunded system.

“You go to the doctor, and the doctor tells you okay, you need surgery, here’s the [shopping] list,” Arietta says.

This leaves patients at the mercy of price increases and supply issues, which are common in a disaster scenario.

Luz Noguera and her family were among those temporarily displaced by the earthquake and its aftershocks. They spent two weeks in an informal encampment near the wreckage of her sister’s home.

“Some people don’t even have tents, so their situation is even more difficult,” Noguera said. “They sleep on mattresses placed directly on the ground, with their children.”

Replacing her asthma medication felt like a daunting task, but she reached out to friends and family for help. Through her nephew, she was able to get in touch with an education nonprofit in another state, which has joined the earthquake response effort.

“It was a race against the clock to find the medicine she needed and the right equipment,” says Nicolle Giraud, who runs the E-VEN project, an education nonprofit that pivoted to help with the aid effort.

She and her team reached out to WhatsApp groups, to see if they could find the right medication in another city.

“Checking the obvious places like pharmacies, but then asking in [WhatsApp] groups because they were either sold out or it was very expensive, or not the kind they were looking for,” Giraud recalls.

Luz Noguera and her relatives with donations of food and tents after the earthquakes. An education nonprofit based in another state, the E-VEN Project, arranged to refill her asthma prescription in the middle of the crisis.

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Finally, a volunteer for the project found the medicine and drove it to Noguera personally, along with tents and other supplies.

This, Giraud says, is the reality on the ground. While medical workers do the best they can with the resources they have, it’s everyday people who have stepped up to fill the gaps.

“There’s a saying here,” Giraud says. “Los buenos somos más. The good people, we’re the majority.”

Noguera and her family are safe. She says she feels as if she has another chance at life. The only thing left to do, she says, is pray that the situation stabilizes.

“But I am alive, thank God,” Noguera says.

As aftershocks continued, Luz Noguera and her relatives spent two weeks sleeping in tents near her sister’s home. “Some people don’t even have tents, so their situation is even more difficult,” Noguera says. “They sleep on mattresses placed directly on the ground, with their children.”

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Federal regulators are considering allowing compounding pharmacies to manufacture several peptides that are currently popular among consumers.

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George Frey/Bloomberg/Getty Images

Every day, Dr. Alexander Weber finds himself fielding another round of questions about peptides — and whether the trendy therapies can help his patients recover from sports injuries or surgery.

He doesn’t offer them in his practice as an orthopedic surgeon, but he shares what the research shows about how well they actually work.

“My stock answer is we just don’t have enough data,” says Weber, chief of sports medicine at the University of Southern California.

“The anecdotal evidence, even from patients that I see, is that they feel like these injectables help them, but we just need to study it,” he adds. Weber authored a review of the research, published early this year, noting the lack of evidence supporting their clinical use.

However, cautionary words from the medical establishment seem to have done little to quench the public’s appetite for these therapies, which have not undergone the large-scale trials needed to gain approval from the Food and Drug Administration.

They are promoted widely in wellness and longevity circles for injury recovery, muscle growth, skin health, metabolism and more. Health Secretary Robert F. Kennedy Jr. has extolled their benefits in an interview with Joe Rogan earlier this year and promised to reverse Biden-era restrictions that have prevented compounding pharmacies in the U.S. from making them.

The restrictions have, in effect, relegated the substances to a grey market, fed by suppliers overseas — raising new safety concerns as users inject themselves with unvetted substances.

The era of peptide prohibition could soon be over, though.

Later this month, a new panel of outside experts appointed by the FDA will make recommendations on whether seven peptides — including some of the most popular injectables like TB-500, BPC-157 and MOTs-C — should be added to a list that gives compounding pharmacies the greenlight to, again, manufacture the products.

“Nobody is recommending these peptides. This is about ensuring patients have safe and effective access to these medications,” says Lee Rosebush, a pharmacist and attorney who represents peptide makers and others in the industry.

“The FDA’s actions during the Biden administration opened up the Wild Wild West,” he adds.

For new discoveries, everyday mysteries, and the science behind the headlines, follow NPR’s Short Wave podcast.

An air of credibility

Peptides are a string of amino acids — smaller than a protein — that often act as signaling molecules in our bodies and help regulate the immune system, metabolism and many other critical functions. They can be synthesized and delivered as drugs. Some of those like insulin are naturally occurring in the body. Others are modified versions, as with the blockbuster GLP-1 weight loss drugs.

One of the highly sought after synthetic peptides under consideration this month, called BPC-157, is based on a peptide found in human stomach juices. Another, TB-500, is related to a molecule found in many types of cells, called thymosin beta-4.

Weber believes the massive success of the GLP-1 drugs for diabetes and weight loss has lent an air of credibility to these injectable wellness peptides, even though those drugs underwent extensive human trials before coming to market. That’s not the case for any of the seven peptides under consideration this month.

“Whenever I see these people on social media saying they’re experts in this field and they’ve been doing it for a really long time, sure, you can say those things, but show me the data,” he says.

In a review of the evidence last month, the FDA’s own scientists recommended against changing the status of any of the seven peptides under consideration at the July meeting.

But it’s unclear how the newly-assembled FDA panel — called the Pharmacy Compounding Advisory Committee — will weigh the agency’s assessment of the data.

Many of its members have ties to the peptide industry and work for clinics that offer injectable peptides or for compounding pharmacies that stand to benefit.

“I think what’s going on here is the advisory committee may be stacked with people who are known to have certain viewpoints on a topic rather than who are coming at this in an unconflicted and unbiased way,” says Dr. Aaron Kesselheim, an expert on FDA law and professor at Harvard Medical School and Brigham and Women’s Hospital.

In a statement to NPR, a spokesperson for the Department of Health and Human Services said all the committee members have “undergone an ethics and vetting process,” and the agency is “committed to robust, transparent discussions about the products.”

While the panel is tasked with making recommendations, FDA leadership has the final say on what happens.

Risks vs. benefits

Outside groups have echoed the concerns raised by the agency’s career scientists. For example, the nonprofit Institute for Safe Medication Practices published a white paper on wellness peptides earlier this year, drawing attention to the gaps in evidence and warning that much of the data comes from preclinical studies done in animals, not humans.

“With anything that you’re taking, whether it’s an FDA-approved product or a supplement, you always have to weigh the risk versus benefit,” says the institute’s president Rita Jew.

“These peptides really do not have established effectiveness, so the only thing you have is risk,” she says.

Peptide proponents like Rosebush counter that pharmaceutical companies have no interest in running the kind of costly studies on these peptides that are needed to legitimize them because many of them can’t be patented.

“These products will likely never go through an FDA approval process,” he says. “So without allowing compounding pharmacies to do this, patients will never get access.”

The agenda for the July 23 and 24 meeting specifies that the committee will review the data behind these injectable peptides for specific indications, such as migraines, ulcerative colitis and osteoporosis.

But, if the FDA ultimately reclassifies these peptide therapies so they can be compounded, Kesselheim says patients will have no trouble finding doctors who are comfortable prescribing them for all sorts of conditions.

“That’s why this discussion is so important and why the FDA’s authority here is an important one to exercise appropriately with optimal outside advice,” he says.

Purity Wamboi was diagnosed with TB when it was pretty far advanced. It’s possible that had health funding from the U.S. not been reduced, the illness may have been caught in time to save her.

Transcript

MARY LOUISE KELLY, HOST:

Last August 16-year-old Purity Wamboi was home during her school break in Nairobi, Kenya, helping with chores, says her mom, Rachael Wanjiru.

RACHAEL WANJIRU: (Through interpreter) She wasn’t feeling too well. She used to cough severely. She had chest pains. Sometimes I could hear her shivering. And therefore, I asked her to take a break.

KELLY: But things kept getting worse. As Ari Daniel reports, for three weeks, Purity’s mother raced to figure out what was wrong amidst a lapse in USAID funding in the country.

ARI DANIEL, BYLINE: Rachael Wanjiru says that her daughter tried to keep the discomfort to herself.

WANJIRU: (Through interpreter) She understood that I didn’t have money, and she didn’t want to stress me out.

DANIEL: Wanjiru got her some painkillers, which helped. But after Purity returned to school, the pain came back stronger. Wanjiru brought her into a local clinic for a checkup. It was pneumonia, the medical staff told her, but she didn’t respond to the treatment. A couple of weeks passed. Tabitha Mugweru works as a community health promoter and is a close family friend.

TABITHA MUGWERU: I met them on the road. They were coming from a private hospital. Then I saw Purity was very weak. Purity was not doing well at all.

DANIEL: Mugweru referred Purity to a governmental health center, which sent her for a chest X-ray. This wasn’t pneumonia. It was tuberculosis.

MUGWERU: The TB was diagnosed very, very late.

DANIEL: She got new medications, but the bacterial infection had already consumed a portion of Purity’s lungs. Mugweru says there had been a more extensive team of community health promoters who used to fan out into Kenya visiting families in their homes, where they may have caught something like Purity’s TB sooner. But these workers were paid with funds that came from USAID. When the Trump administration shuttered the agency, Mugweru says that money dried up.

MUGWERU: Most of them stopped working when USAID withdrew their support. They could have reached Purity earlier during home visit.

DANIEL: The TB treatment came too late for Purity, who, at that point, didn’t even want to take all the pills. Her condition deteriorated rapidly. Then came the day when she asked to sit in the sunshine and have a cup of porridge. Mugweru recalls that after Purity went back inside, things got bad.

MUGWERU: She started shaking – shaking, shaking, shaking. And then her eyes were wide open, and they turned white.

DANIEL: They called an Uber to take her to the hospital.

MUGWERU: Purity died when I was holding her. We didn’t think that Purity was going to die, no. We thought everything was going to be good, then all of a sudden, boom, Purity is no more.

DANIEL: Mugweru says that she wished those health promoters continued getting paid so they could have kept on doing their work. Maybe, she says, Purity would still be alive. NPR reached out to state department officials. They sent a statement that didn’t address the specifics of Purity’s story but pointed to the Trump administration’s signing of the first bilateral health memorandum of understanding with Kenya, amounting to a total of $2.5 billion over five years with funding from both countries that supports, in part, tuberculosis programs. The State Department wrote, quote, “this co-investment model ensures greater country ownership and accountability.” But the new U.S. contribution is less than previous USAID funding levels for Kenya. For Rachael Wanjiru, she says her life has a different shape since her daughter’s passing.

WANJIRU: (Through interpreter) Sometimes, I feel like I could just take my two sons and go with them far, far away to a place where I don’t have to come back from. Since Purity’s death, I felt like a part of me has been taken away.

DANIEL: It’s a reality, she says, that’s put a dent of pain in her heart. For NPR News, I’m Ari Daniel.

(SOUNDBITE OF ADRIAN’S “9 AM IN CALABASAS”)

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A health worker takes a woman’s temperature as part of Ebola screening efforts in Goma, Democratic Republic of Congo. As part of the effort to quash the outbreak, the first patients have been enrolled in a clinical trial to test two drugs against the Bundibugyo strain of the virus that is spreading there. In addition, researchers plan to study whether another drug could protect people exposed to the virus.

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It’s been over 50 days since the Ebola outbreak was declared in the Democratic Republic of Congo and Uganda. Clinicians on the ground are working to save dying patients, but they lack crucial tools to fight the kind of Ebola that’s spreading.

“We urgently need treatments that can help people affected by Bundibugyo virus disease,” says Amanda Rojek, a physician scientist at the University of Oxford — that’s a rarer species of Ebola than the much-researched Zaire strain behind many previous outbreaks.

But because of that rarity, there are no specialized treatments to give patients. Nor are there drugs that might protect those exposed to the virus from getting sick.

That reality is changing. Clinical trials are underway, or soon will be, to test new tools that health officials hope could help turn the tide against an outbreak which has already killed over 500 people and sickened more than 1,560 – and which some say could become the largest Ebola outbreak ever.

Last Thursday, the World Health Organization announced that the first patients were enrolled in a clinical trial designed to test two drugs against Bundibugyo. And sometime this week, researchers will likely begin studying whether another drug could protect people exposed to the virus.

“One of the key lessons from recent outbreaks is that research needs to happen alongside the response, not after it,” says Rojek, who is helping to coordinate the treatment trials.

The three trials are a collaborative effort between WHO, Africa CDC, universities and nonprofits. Each will test existing drugs against Bundibugyo.

“To start from scratch takes years,” says Salim Abdool Karim, director of the Centre for the AIDS Programme of Research in South Africa and member of the Africa CDC emergency committee that’s been following the outbreak. “So we take existing medicines and see whether [they] can be repurposed.”

“This will take some time”

For Ebola treatment, researchers are testing two drugs, the antiviral remdesivir, manufactured by Gilead Sciences, and the monoclonal antibody MBP-134, developed by Mapp Biopharmaceutical. Both drugs are delivered intravenously.

Remdesivir rose to prominence during the COVID-19 pandemic, when it was used (to mixed effect) to treat patients in the hospital. But the drug was developed to target a broad range of viruses, including Ebola. It was tested during the 2018 Ebola outbreak in the Democratic Republic of Congo, but proved relatively ineffective against the Zaire species.

MBP-134 is a monoclonal antibody treatment, designed to mimic the immune system’s natural defenses against the virus. It’s a cocktail of two monoclonal antibodies, both isolated from a survivor of the 2014-2016 West African Ebola outbreak, also caused by the Zaire species. But there’s some lab data that suggests it could work against Bundibugyo.

The Biomedical Advanced Research and Development Authority, or BARDA, played a major role in funding research behind MBP-134 and technically owns the doses. BARDA is a U.S. government agency within the Department of Health and Human Services and the government has donated the doses necessary for the clinical trial, according to Vasee Moorthy, WHO’s research and development lead for the outbreak.

Each drug will be tested alone, and in combination, against the current standard of care — supportive therapy that aims to replace lost fluids and manage pain. So far, only one clinic in the DRC is involved in the trial, but there are plans to expand in the coming weeks, said Moorthy at a press conference last Thursday.

Researchers will monitor whether the drugs boost survival. How long that takes depends on a variety of factors, says Moorthy.

“From what we see at the moment, this will take some time,” he said. “It will take some months. It could go even into next year. It could be that we need over 1,000 patients enrolled in the trial until we get a definitive answer.” If either treatment proves super effective, that timeline could be shorter, he said.

Treatments aren’t enough

To help control the epidemic, which shows no sign of slowing anytime soon, health officials need more than treatments. They need to prevent people from becoming sick, says Yazdan Yazdanpanah, an infectious disease physician and epidemiologist at ANRS Emerging infectious diseases, a research agency in France.

A vaccine would be best, “but we don’t have a vaccine today,” he says, and it’ll be months before testing candidates begins. But giving an antiviral soon after exposure can help prevent disease and could be faster-acting than a typical vaccine.

That’s where the third trial comes in, which is slated to start sometime this week, says Yazdanpanah. He and his colleagues will be testing whether popping obeldesivir pills, an antiviral also made by Gilead Sciences, can help prevent close contacts of Ebola cases from contracting the disease, a method known as post-exposure prophylaxis.

The study relies heavily on contact tracers quickly identifying anyone who might have been exposed to an Ebola patient. For contacts who enroll, the research team will go to the participant twice a day to deliver the drug and track whether they develop symptoms.

If obeldesivir proves effective, it could become a powerful tool for reining in the epidemic, says Yazdanpanah. It could also help attract more contacts to come forward, since health officials would have something to give them besides instructions to quarantine.

Challenges ahead

Proving the effectiveness of any of these three drugs will depend on the clinical trials running smoothly. That’s a challenge in any outbreak, especially one beset by ongoing armed conflict.

There’s also been violence aimed at health centers. Several have been attacked since the outbreak, likely spurred by mistrust. Community members are often wary of outside health workers who descend on their town in full protective gear. Rumors swirl that humanitarian aid groups are murdering people or withholding care.

In fact, WHO officials declined to disclose the exact location of the clinic now enrolling patients for the treatment trials to protect its clinicians.

“There’s a lack of trust,” says Yazdanpanah. Building that community trust is crucial for running an effective and ethical clinical trial. WHO officials are hoping that will result from holding lots of community advisory meetings, with everyone from healthcare workers to faith groups participating.

“Discussions with the community are absolutely central,” said Moorthy. “There are open lines of communication to the trial team from the community, so that we can make sure that their interests come first.”

Karen McNenny is a certified divorce coach, certified co-parenting specialist and author of the book The Good Divorce: How to End Your Marriage Without Ending Your Family.

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When Karen McNenny was facing divorce about 15 years ago, she was afraid of what it would mean for her future: despair, debt and a lifetime of resentment, she says.

At the same time, she was thinking of her two children, she says. She didn’t want their father to become her enemy.

So she and her former husband chose to approach divorce differently as a couple. “We’re going to renovate and transform this family. We’re not going to destroy it,” she says. “The marriage is ending, not your relationship.”

For McNenny, a mediator, certified divorce coach and certified co-parenting specialist, divorce is a tool, not a weapon. She expands on this concept in The Good Divorce: How to End Your Marriage Without Ending Your Family, which came out this spring. The book offers guidance on how to maintain compassionate and respectful ties with a former spouse while also healing and moving forward.

According to Pew Research Center, a third of Americans who have ever been married had a first marriage that ended in divorce. For that reason, McNenny hopes her book becomes a must-read for couples before they get married. “The best time to talk about divorce is before you need to talk about it,” she says.

She shared insights from her book in a conversation with Life Kit. This interview has been edited for length and clarity.

The book is called The Good Divorce. What does that mean?

[For those with kids,] the good divorce is about protecting the future of the family while we dissolve the marriage.

After the paperwork is done and the assets have been divided, can you and your co-parent sit on the same side of the bleachers during the basketball game? Can you still see yourselves as a partnership, with the ability to have thoughtful conversations about your kids?

For those who don’t have kids, [the good divorce is] about protecting your health — your mental health and your physical health. If we are doubling down with resentment and bitterness, all of that gets stored in the body and shows up in different ways. You deserve a pathway that’s less destructive.

Let me also be clear: There are times when an amicable, collaborative process is not possible and maybe even inappropriate. For instance, where there’s active addiction, abuse, domestic violence, coercion or unmanaged mental health issues.

How do you get to a place where you don’t feel triggered by your partner, so you both can work together toward a good divorce? 

That, my dear, does not happen overnight. That is more like a dimmer switch going up and down and up and down, and the gift of time helps to get there.

It’s a complex emotional journey because we do feel relief in walking away from our spouse and the challenges. But with it, there is extraordinary grief that comes with divorce that I think is often underestimated and undersupported.

If my spouse had died, people would’ve been checking in with me regularly. I never would’ve spent a holiday alone in that first year. There probably would’ve been a meal train.

But he didn’t die. My marriage died, my family structure died, my identity as a wife and a partner died. There’s so much grief through these transformations that come with divorce that we don’t see.

So supporting friends in all those ways that you would as if there had been an actual death is doing a lot for your friends who are going through divorce.

How do you let your friends, family and community know that you’re getting a divorce and that you might need support? 

Put a communication strategy together. It’s not just for how we tell the kids. It’s also a communication strategy for the grandparents; to the circle of support around the kids, like teachers, coaches and mentors; and our shared community.

It’s extraordinary when a couple can write that message together, not unlike a marriage announcement. [You might say:] We’ve made a really difficult decision. We wanted to let you know. We’re not going to court. Don’t expect a battle. Please don’t ask us why. Just ask us how we’re doing. We’re on the same side as the kids. You don’t need to pick sides.

In doing so, we’ve given everyone the same information at once. It’s a unified message that comes from the parent team, and it allows your community to know how best to support you. And it takes out all the gossip and wonder about what is going on.

If you have kids and they’re splitting time between two homes, what are some ways to make that change easier for them?

Our kids were 5 and 7 when we divorced, so it was three or four nights at a time in each home. By the time they got to be about 8 or 10, it made sense to go a week in each residence. After COVID, the kids came to us and said, “Can we just have two weeks in a house? We wanna be able to settle in more.” [So we said] OK.

A lot of parents are so rigid about the schedule. There’s no flexibility. That doesn’t serve anyone. So I recommend liberating yourselves from the calendar and letting it grow and bend with your kids appropriately.

Knowing what you know now about divorce, what questions do you think couples should ask themselves before they get married?

So often when people arrive at the threshold of divorce, couples are like, “We don’t know what we’re doing.” Get educated about the business part of it.

There is no harm in having a prenuptial agreement. Even if you decided not to file it, have the conversation about the implications. What does it mean if we buy this house together? What does it mean if one of us works more and one of us works less?

We also underestimate what it means to be roommates. What are your value systems around cooking and cleaning? How much alone time do you need? It’s easy to fall in love and not know if you’re compatible.

Do you think you’d get married again?

I absolutely hope that I get to say yes to a lifelong commitment with a partner, as I believe we often are given the opportunity to become a better version of ourself through partnership.

The story was edited by Meghan Keane. The visual editor is CJ Riculan. We’d love to hear from you. Leave us a voicemail at 202-216-9823, or email us at LifeKit@npr.org.

Listen to Life Kit on Apple Podcasts and Spotify, and sign up for our newsletter. Follow us on Instagram: @nprlifekit.

Thousands of Medicare beneficiaries lost drug coverage after their premiums went up and they didn’t know.

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Jude Pare and his partner, Diane Tix, live in rural Minnesota until temperatures dip below freezing, when they take refuge in Arizona for the winter. While away, their mail is forwarded. But Pare, 77, said he didn’t receive any warning from his Medicare prescription drug plan that his $0 monthly premium was about to increase.

So he didn’t know he had a bill to pay. After he and Tix returned home to Minnesota in April, they got a letter from Wellcare, the insurer that provided his drug plan, saying his coverage had been terminated after three months of unpaid premiums totaling $28.80. Under Medicare’s rules, he can’t enroll in a plan again until the fall, for coverage beginning in 2027.

Pare takes Xarelto, a blood thinner that reduces his risk of strokes, blood clots, and pulmonary embolism. “He could bleed to death without it,” Tix said. A 90-day supply of the drug costs about $1,800 using a coupon from GoodRx, a discount drug website, she said.

Pare is among tens of thousands of Medicare beneficiaries who were on Wellcare’s Value Script drug plan who will likely go without prescription drug coverage for the rest of the year because they didn’t pay premiums for three months.

Next year, thousands more people in 32 states and Washington, D.C., enrolled in zero-premium drug plans from Wellcare and other insurance companies may find themselves in the same situation if their premiums go up and they don’t realize it, according to a KFF Health News analysis of drug plan data. Premiums and other changes for 2027 will be unveiled in September.

Caught off guard

Going without medication can be life-threatening, especially for Medicare beneficiaries. Nearly 90% take one or more prescription drugs, according to the Centers for Disease Control and Prevention. Almost half live with four or more chronic health conditions that can cause functional or cognitive impairments.

By the time Jude Pare and his partner, Diane Tix, found out he owed $28.80 for three months of drug plan premiums, his coverage had been canceled. He is among tens of thousands of Medicare beneficiaries who will likely go without prescription drug coverage for the rest of the year after their drug plans were canceled.

Diane Tix

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Diane Tix

Congress added prescription drug coverage to Medicare in 2003. But the coverage is administered by commercial insurance companies, which compete fiercely with one another for the business of about 56 million Medicare beneficiaries enrolled in drug plans.

Zero-dollar or very low monthly premiums have helped make Wellcare’s Value Script the bestselling stand-alone prescription drug plan in Medicare, with nearly 6 million customers across the U.S., according to government data. But in 26 states and Washington, D.C., some Value Script members who didn’t have to pay a premium last year were caught off guard by increases in 2026.

After a two-month grace period — which Wellcare extended to three — Medicare drug plans can drop customers who don’t pay their premiums, no matter how small the amount. Some members who lost their coverage in Nevada, for example, owed as little as $8.10 for three months, according to a KFF Health News analysis of Medicare drug plan data.

Wellcare terminated coverage for about 140,000 Value Script beneficiaries in April, according to a person with knowledge of the matter who was not authorized to speak publicly about it and feared reprisals at work for doing so. About 40,000 of the people who were dropped may be able to enroll in new coverage immediately because they have low incomes and receive financial assistance through a program Medicare calls “Extra Help.”

Multiple state officials said they had heard the same disenrollment figures, including Nevada’s insurance commissioner, Ned Gaines, who chairs the National Association of Insurance Commissioners’ senior issues task force; Rebecca Gouty, director of the State Health Insurance Assistance Program in West Virginia; and Tim Smolen, director of Washington state’s Statewide Health Insurance Benefits Advisors.

The West Virginia and Washington initiatives are part of the federally funded State Health Insurance Assistance Program (SHIP), which provides free, unbiased help navigating Medicare.

Surprise bills

The Centers for Medicare & Medicaid Services, which oversees Medicare drug plans, declined to provide the number of Value Script members who lost coverage due to unpaid premiums. “The agency does not publicly provide plan-specific disenrollment figures or state-level breakdowns related to the non-payment of premiums,” Christopher Krepich, a spokesperson, said in a written statement to KFF Health News.

Centene Corp., Wellcare’s parent company, also declined to provide disenrollment numbers.

“We recognize how disruptive a loss of coverage can be and are committed to helping members understand their options,” said Sarah Baiocchi, senior vice president for specialty and prescription drug plans at Centene. She acknowledged that “some members in our Value Script plan experienced a premium for the first time, or for the first time in several years.”

Baiocchi said all Value Script members received a CMS-required annual notice of changes in September, before the premium increases took effect.

A version of the booklet sent to members in two states and Washington, D.C., is 21 pages long. The new premium is mentioned on pages 3 and 8, along with changes to out-of-pocket costs and how to find updates on covered drugs and network pharmacies.

Wayne Bennett lost his Medicare drug coverage because he didn’t pay the premium, which was free last year but — without his knowing — went up this year. “Medicare should be doing something about this so that we can go ahead and get coverage now,” he says.

Wayne Bennett

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Wayne Bennett

The company also informed members about 2026 premium changes through phone calls, text messages, regular mail, or email, Baiocchi said.

People who are dropped are not able to reenroll or join another drug plan until the start of the open enrollment period this fall for coverage beginning Jan. 1, unless they qualify for an exception, Krepich said.

And because they will have gone without coverage for at least 63 days, they could be hit with a permanent late-enrollment penalty that increases every year for the rest of their lives.

“Medicare should be doing something about this so that we can go ahead and get coverage now,” said Wayne Bennett, 74, who lives in Durham, North Carolina.

In May, he found out that Wellcare had canceled his Value Script plan because he hadn’t paid his $3.60 monthly premiums. He takes nine prescription drugs to treat his blood pressure, glaucoma, chronic obstructive pulmonary disease, and other health problems. He filled most of his prescriptions — including several at no cost — before he lost coverage. He doesn’t know what he’ll have to pay when his supply runs out.

Gouty, the West Virginia program head, said many Medicare beneficiaries arrange for their monthly drug plan premium to be automatically deducted from their Social Security benefits, and that many likely thought that choice remained in place until they changed it.

“They didn’t realize that when the plan was a zero premium in 2025, that stopped the Social Security premium deduction and they would have had to reelect it for 2026,” Gouty said.

In other words, even if they mistakenly thought the premium was still zero, Medicare beneficiaries would have needed to somehow allow Social Security to make deductions — something the agency doesn’t do — or else set up a payment plan through their bank or credit card in case payment was necessary.

“That sounds goofy,” Tix said.

Centene’s Baiocchi blamed the Social Security Administration for the problem: “We believe this was a key driver of non-payment disenrollments and subsequent complaints.”

Spokespeople for the agency referred questions about the matter to CMS.

Krepich said legal requirements for drug plan enrollment and disenrollment limit what CMS can do to help beneficiaries who lose coverage for not paying their premiums.

“Pretty upset”

Now that Pare has no prescription drug coverage, his doctor replaced his blood thinner medication with a much less expensive drug that should be just as effective. Pare paid $111 for four other medications that used to be free under his Value Script plan. He hasn’t had to refill four more prescriptions yet and doesn’t know what they will cost, Tix said.

If Wellcare members knew about the premium increases, they could have set up direct billing or an automatic payment plan early this year before the payment grace period ended April 1. But they would have been able to fill prescriptions during the grace period, so if they didn’t see Wellcare’s notices, they likely assumed there was no problem with their coverage.

Bennett, the North Carolina man, said Wellcare used to send him text messages with health tips and reminders when it was time to pick up a prescription. He didn’t know his premium had increased from $0 to $3.60 until it was too late.

“I was pretty upset,” he said, when he called the company. “The premium wasn’t that much, and I was ready to pay it right off the bat. I had my credit card out ready to make the payment.”

The customer service representative wouldn’t let him pay because his coverage had been canceled, Bennett said.

Hoping to restore it, Bennett called Senior PharmAssist, a Durham nonprofit that advises Medicare beneficiaries and is one of more than 2,200 SHIP sites across the country. He was told he must wait until January to restart his drug coverage, said the group’s executive director, Gina Upchurch.

He doesn’t qualify for the “Extra Help” low-income subsidy or meet other CMS criteria for a special enrollment period, which would allow him to change drug plans during the year. CMS typically allows midyear switches for beneficiaries who, for example, move out of their plan’s service area, experience a natural disaster, or get help paying for drugs from a state program.

Senior PharmAssist was able to help one of its participants join another drug plan after she lost Value Script coverage because she is in North Carolina’s pharmacy assistance program for people with HIV/AIDS and has limited income, Upchurch said.

A further exception allows any Medicare beneficiary to enroll at any time in a drug plan that has earned five stars, the top grade in Medicare’s performance ratings. However, there are no five-star Medicare drug plans available to the general public. Only two insurers offer five-star plans, and only for retirees from certain employers. Their combined enrollment is about 8,700 as of June 1, according to the insurers.

But Upchurch, with more than two decades of Medicare expertise, doesn’t blame beneficiaries for not paying attention or for assuming Wellcare’s messages were bogus. Older adults are particularly vulnerable to identity theft and other scams and are often advised to ignore junk mail and calls from telemarketers.

Since Value Script members such as Bennett continued to get their prescriptions filled during the payment grace period, “why wouldn’t they think this was a scam?” Upchurch asked. “They are constantly bombarded by people selling them something that’s illegitimate or trying to scam them.”

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.

In a study, researchers found that people in their 80s and older who walked faster than their peers were less likely to develop cognitive decline.

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Crossword puzzles and brain teasers have long been touted as ways to keep the mind sharp. But a new study points to another strategy that may matter just as much: staying fast on your feet.

Researchers have found that people in their 80s who maintain an exceptionally quick walking pace, dubbed “super movers,” are also far more likely to stay mentally sharp compared to their slower-moving peers of the same age.

“A super mover is someone who is older than age 80 and performing much better than their peers,” says Dr. Sofiya Milman of the Albert Einstein College of Medicine, one of the study’s authors.

Milman and her collaborators analyzed data from nearly 4,000 older adults enrolled in a long-term aging study. Participants had taken a timed walking test and the fastest 9% – who had a gait speed at least 1.5 standard deviations above the average of their same aged peers – qualified as super movers. Those individuals were also markedly less likely to experience cognitive decline.

“The biggest takeaway was that super movers are about 50% less likely to develop cognitive decline than their peers who are not super movers, which is very impressive,” Milman says. The results are published in the medical journal Neurology.

The muscle health connection

Walking well requires balance, coordination and strength, all of which depend on healthy muscle, says Bonnie Tsui, a science writer and author of On Muscle: The Stuff That Moves Us and Why It Matters.

“I think that the finding isn’t surprising because we know that muscle health is very much correlated with cognitive health, especially as we age,” Tsui says. “Exercise makes your muscles grow, but it also makes your brain grow.”

Prior research has linked regular exercise to greater volume in the hippocampus, the brain’s hub for memory and navigation. The new study found that super movers tended to preserve hippocampal volume as they aged.

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Tsui says the benefits trace back to what happens inside contracting muscles during exercise.

“Muscle is an endocrine tissue, which means when we move, our muscles release signaling molecules that affect other body systems, including boosting brain cell growth and regulating metabolism,” she says. “So muscle health is cognitive health.”

Among those signaling molecules is a protein known as brain-derived neurotrophic factor, or BDNF, which helps regulate glucose and plays an important role in the survival and maintenance of neurons, helping support memory and cognitive function.

A body’s network at work

Dr. Amit Saini, a geriatrician with Kaiser Permanente in Northern California, says walking, and maintaining the ability to walk well, is a marker of good health because it draws on so many of the body’s systems at once. He says walking supports cardiovascular health and lung health.

“As you walk, your heart is beating faster, and when the heart is beating faster, not only is it pumping the blood into the muscle, blood is being pumped to the brain, also into the nerve, and to your other systems,” Saini says. “Your lungs are also breathing at a little faster rate, which again is keeping them lighter and healthier.”

One of the study’s more surprising findings: Some super movers showed brain plaques and tangles, which are abnormal proteins associated with Alzheimer’s disease and dementia, despite having no symptoms. Researchers say that suggests movement and all the benefits of staying active may help the brain stay resilient even as it undergoes age-related changes.

Genetics and lifestyle are also important

Genetics likely play a role in who becomes a super mover. A recent study found that genetics accounts for about 50% of a human lifespan, and Milman says among super agers, people who are thriving in their eighties and beyond, the role of genetics may be even greater.

Yet the authors emphasize that lifestyle habits, including decisions people make every day about what to eat, prioritizing sleep, taking time to de-stress and gather with friends and family, all matter. In fact, research shows that nearly half of all dementia cases could be prevented or delayed by addressing 14 modifiable risk factors.

People have agency over improving their odds of healthy aging, and one way to gauge your personal risks, and take steps to decrease your risk, is to assess your Brain Care Score. This is a free, online tool developed by doctors at Massachusetts General Hospital to calculate your risks and take steps, through changes to daily habits, that can help decrease the risk of stroke, dementia, heart disease and cancer.

“Fast walking is a marker that the brain and body are aging well,” says Joe Verghese, a researcher and one of the study authors. “But also it’s possible that people who walk faster might, by engaging in these activities, also protect their brain health through a variety of mechanisms by reducing inflammation, improving cardiovascular health, and promoting brain growth in areas that are essential to maintain cognitive function as you get older.”

Verghese says the findings carry a message for people of all ages and fitness levels.

“One of the main messages is, you know, keep mobile,” he says. “Exercise regularly, and you know, that might put you on the pathway to being a super mover as you age.”

Whether it’s walking, swimming or cycling, researchers say the form of movement matters less than the consistency. It’s a habit that could pay off for both muscle and memory over the long run.

Students take part in a tiling class at the Buildher training facility in Nairobi, Kenya.

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On the busy workshop floor at Furniture International on the outskirts of Nairobi, workers often have to shout to be heard over the din of circular saws, hammers and machinery. “At first, I was very shy,” says 24-year-old machine operator Diana Ojiambo — slight, with a blue bandana tied over long braids — as she feeds cabinet panels through a PVC edger. “I didn’t know how to stand in front of people and speak up. But now I can.”

Nearby, amid a sea of male coworkers, three other women sand and assemble cabinetry, while 23-year-old supervisor Jane Mwangi moves between stations, checking measurements and overseeing progress. Barely a year ago, none of these women had ever worked in the industry. Ojiambo had never worked alongside men before.

Women remain a rarity across Kenya’s building trades, even as a frenetic construction boom, particularly in Nairobi, has helped turn the sector into a multi-billion-dollar industry. According to figures from Kenya’s National Construction Authority, women accounted for just 3% of the country’s accredited construction artisans.

Those who do enter the sector are mostly confined to lower-paid informal jobs — carrying water, hauling sand or cleaning sites — rather than trained for more specialized roles. Women are also typically saddled with the vast majority of unpaid caregiving and household work in a country that continues to battle long-held assumptions about gender roles.

Women take part in a year-long training and internship programs in tiling (above), carpentry, painting and other finishing trades.

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Buildher, a Nairobi-based nonprofit, is trying to change that. The organization runs year-long training and internship programs in carpentry, tiling, painting and other finishing trades, helping women access steadier, better-paid work in the sector. Since its inception in 2019, Buildher says it has trained more than 1,000 women, with graduates increasing their average daily earnings roughly five- to six-fold within a year of training — from about $1.50 to between $11 and $12.

A 2024 study by Dalberg, a global development advisory firm, found that around 65% of Buildher graduates were still working in construction 12 months after completing the program.

“I had seen women get stuck in low-paying jobs, and it was like a mental barrier where they couldn’t see the potential right in front of them,” says architect and Buildher cofounder Tatu Gatere. “So I wanted to help women see that.”

Buildher’s founder, Tatu Gatere, wants to give women the skills and confidence they need to enter and advance in the construction field.

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For many women, Gatere says, simply hearing about others succeeding in the trades can make the idea feel possible. As a result, much of Buildher’s growth has spread through word of mouth, as graduates encourage friends and neighbors to apply.

Ojiambo, a single mother of two young children, was unemployed and struggling to make ends meet when she first heard about Buildher from a friend in the informal settlement of Kibera, where she lives. “My life was so challenging,” she says. “But now I can support myself, I can support my kids.”

Ojiambo is already looking to the future. Within the next year, she hopes to start her own carpentry business in Kibera. “Inside this company, some of the men still think we ladies are not fit for this kind of work,” she says, gesturing toward some of her coworkers.

“But if you know what you want, and you believe in yourself, you show them that whatever they can do, you can do better.”

Diana Ojiambi, 24, at her workplace in the Furniture International factory in Nairobi, Kenya. She is one of several former Buildher students who have found work with the company.

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Sticking to it

Early on a clear weekday morning, clusters of young women gather outside the cobalt-blue doors of Buildher’s training center inside Spectrum Business Park, a network of warehouse buildings with green corrugated roofs in Nairobi’s bustling Baba Dogo industrial area.

Orientation for a new intake of students has just wrapped up. In a conference hall near the entrance, 16 trainees settle into plastic chairs for an introductory presentation on solar installation, a course launched this year as Buildher expands into additional technical trades.

In a neighboring warehouse unit, trainees crouch over a concrete floor, spreading tile adhesive into thin grey patches before dragging notched trowels through it to create neat ridges. Trainer Robert Ndungu moves between them, occasionally kneeling to demonstrate the correct technique. The women scrape the adhesive back into buckets, and the exercise begins again.

Students at a Buildher Academy class.

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“These women come here knowing nothing about tiling. By the end of this training, they are able to work, earn money and improve the life of their family,” Ndungu says. “That really inspires me.”

But Buildher cofounder Gatere says learning a trade is often only one part of the challenge facing women. Many arrive here carrying pressures that extend far beyond the workshop floor — from childcare and deep financial instability to resistance at home from husbands or parents uneasy about women doing construction work.

Others find it hard to imagine themselves feeling safe in male-dominated workplaces where harassment is often rife. Reflecting on her own experiences as an architect, Gatere notes that even as women increasingly entered leadership positions within their firms, construction sites remained hostile environments. “You’re supposed to be a decision maker, but you’d still be getting catcalled and harassed by men,” she says.

Those experiences, combined with feedback from trainees and employers, have helped shape Buildher’s broader approach to preparing women not only technically but also emotionally and physically for work in the industry.

Yoga classes (shown above) and calisthenics are part of the training to prepare women for construction jobs.

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Elsewhere on campus, bass-heavy dance music pulses from a crowded gym class, where an energetic instructor leads around 30 trainees through squats, stretches and lifting drills. Across the courtyard, a similarly sized group gathers in a large warehouse for a yoga and mindfulness session, sitting cross-legged on their mats as another instructor shares tips on staying focused and remaining calm under pressure.

Buildher also employs a mental health coach and on-site nutritionist, while trainees attend group wellness sessions every two weeks — support systems shaped directly by feedback about the difficulties many women faced both at home and in the workplace.

Dalberg’s research, based on a survey of 354 women working in the construction industry, suggests such investments are paying off. Buildher graduates reported not only higher incomes after completing the program but also greater participation in household decision-making and stronger community support.

Students hone their carpentry skills.

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“They also take more pride in what they do,” says Naoko Koyama, a Dalberg partner who worked on the report, adding that the combination of technical and soft-skills training offers a model for other male-dominated industries.

One of the women taking part in today’s yoga class is 27-year-old Ruth Kiarie, a single mother who joined Buildher’s painting and decorating cohort just two weeks earlier. Kiarie first became interested in painting while helping to renovate classrooms in Kibera, where she also lives, as part of a community leadership project.

At the same time, caring for her autistic daughter has made her think differently about color and space. One day, she hopes to work in color psychology, advising families and businesses on how different colors affect mood and behavior. “You don’t have to just do blue or pink,” she says. “We can create more colors.”

“All about the mindset”

Sprawling across 5,000 acres of former coffee plantations about 12 miles north of Nairobi, Tatu City, a private mixed-use development of housing estates, factories, schools and office parks, is the most ambitious symbol of Kenya’s rapidly changing urban landscape.

A construction site at Tatu City, where trainees worked and several graduates are now employed.

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For Buildher, developments like Tatu City have become an important testing ground for its broader ambitions. Around 50 trainees worked on finishing and interior jobs inside Eneo at Tatu Central, a sleek glass-fronted office complex near the development’s entrance that now houses a growing cluster of Kenyan and international companies.

“The tiling contractor was so impressed with the quality of the women’s work that he then employed seven of them full-time,” says Pumi Lukhele, head of stakeholder engagement at Gateway Real Estate Africa, or GREA, which developed the building. She says contractors were equally impressed by the women’s professionalism and ability to take feedback, which she attributes to Buildher’s broader approach to training. Tatu City is one of roughly 150 employers that Buildher currently works with in and around Nairobi, as the organization pushes to expand women’s participation in a far larger share of the construction industry. The hope is to increase women’s participation in skilled construction jobs from the current roughly 3% to 10% by 2030.

For Gatere, achieving those goals will require broader structural changes to an industry that, until last year, was not even required by law to provide separate toilets for women. Alongside its training programs, Buildher now works with dozens of firms on issues ranging from harassment and equal pay to basic conditions for women on construction sites.

Looking ahead, Gatere sees a future where ensuring women’s safety, dignity and inclusion in the industry is no longer a constant battle, allowing more of them to focus on bigger ambitions. “I see more and more women starting their own businesses. I see women’s collectives bidding for contracts independently,” she says. “We shouldn’t still be advocating for breadcrumbs.”

Further inside the development, a few residents lean over the metal balconies of newly completed apartment blocks, topped with solar water heaters, watching workers move through the exposed concrete interiors of a neighboring building still wrapped in scaffolding and green mesh sheeting.

In a first-floor unit that overlooks a gravel footpath and a small wetland area, 22-year-old Margaret Klamaitha kneels on the floor, cutting and fitting bathroom tiles.

Tiler Margaret Klamiatha works at a construction site at the Tatu City development on the edge of Nairobi.

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Klamaitha completed Buildher’s six-month tiling program last year and now works on a rolling three-month contract at Tatu City, her first full-time construction job. Though she says she enjoys the work, she sees it as a stepping stone. One day, she hopes to move into quality control, then eventually start her own construction-related business.

“It’s all about the mindset,” she says. “Once you start to do something as a woman, don’t let anyone put you down.”

Christopher Clark is a freelance journalist based in France. He reports on power, inequality and social change across Africa and Europe.

Tommy Trenchard is an independent photojournalist based in Cape Town, South Africa. He has previously contributed photos and stories to NPR on the Mozambique cyclone of 2019, Indonesian death rituals and illegal miners in abandoned South African diamond mines and won a World Press Photo prize for the images in his story for NPR on clashes between elephants and people in Zambia.

The game “Schisto & Ladders” is introduced to students in an elementary school in a part of Nigeria where the neglected tropical disease schistosomiasis, spread by parasitic worms, affects many residents. This version of the classic “Chutes & Ladders” games aims to teach children how to avoid getting infected — and details of the treatment for those who catch it.

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Daniel Amao

Chutes & Ladders has been a beloved board game in the U.S. since the 1940s — adapted from an ancient Indian game that aimed to teach moral lessons.

Kids in Nigeria are now playing a version called “Schisto & Ladders.” It too aims to teach — about how to prevent a disease called schistosomiasis. It’s a parasitic

infection caused by a worm that infects humans via skin contact with infested waters.

An unlucky player might land on a square that says “playing in a river” That puts you at risk for this tropical disease — and sends your game token down a worm instead of a chute.

Nigerian researcher and educator Cynthia Umunnakwe is one of the developers of the game — it’s part of an arsenal of creative approaches to warding off the illness. Known locally at “Atosi Aja” or Bloody Urine, the disease not only causes blood in the urine but has other short-term symptoms such as fever and rash. If untreated, it can cause major organ and neurological damage, infertility and even bladder cancer. In Nigeria, it is associated with higher rates of bladder cancer in young people.

Known as a Neglected Tropical Disease because of the lack of funding to fight it, schistosomiasis is a serious challenge for impoverished communities. There are over 200 million cases across sub-Saharan Africa. School age children are at the greatest risk of infection because they like to play in the water and their immune systems aren’t fully developed.

Nigerian researcher and educator Cynthia Umunnakwe is one of the developers of the game Schisto & Ladders. It’s part of an arsenal of creative approaches to warding off the illness.

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Daniel Amao

Though effective medication exists, the issue is persistent in areas with a lack of easy access to testing, treatment and clean water so people don’t rely on local bodies of water for drinking and bathing. Awareness of its transmission is also an issue. Touching infested water, even just a splash, can risk infection, as microscopic larvae swimming along the surface are able to wriggle through skin.

Uh oh, a worm!

The game, created in 2014 by a team led by Professor of Parasitology Uwem Ekpo of Akwa Ibom State University, follows the classic pattern: Roll a dice to advance up a winding path to the top of the colorful board. A player could land on a square that sends them up a ladder or sliding down a Schisto worm (which takes the place of the traditional chute). An example of a positive square is “eat before taking medicine” – the right thing to do for someone who’s infected and sends the player up a ladder to move ahead in the game.

They trademarked their name.

Another square with negative consequences says  “Blood in Urine” but the neighboring square offers the player a path to redemption: “visit the health center” with a drawing of a smiling health worker.

“Children go up the ladder when they encounter a good behavior [in the game] that would prevent schistosomiasis,” Cynthia Umunnakwe says. These include “Take praziquantel at school” and “Cutting vegetation around a river” – removing invasive plants that offer ideal conditions for proliferation of the intermediate snail hosts, which carry the parasite.

The game also highlights key steps of transmission.

The “Fetching water from a stream” square showed a child stooped at the river’s edge. A schistosome worm stretched from this square down the board to the complication of the illness, depicted in another square reading “Swollen belly”; while “Defecating near a river,” brings the player’s piece far down the board, landing on a square reading “Spreading infection.” These represent two chances to interrupt the parasite’s life cycle: Avoiding infection of humans at the larval stage via water contact and discouraging propagation of the parasite into river water via human waste, where eggs in waste can then reinfect snails.

Playing the game

On a visit to a schoolhouse in Apojola village in July 2025, Cynthia Umunnakwe taught young children to play “Schisto & Ladders” — part of a Ministry of Health program that also provided urine testing and treatment for those affected.

And it’s not just a game. In this part of Ogun State, a third of residents screened at a urine testing clinic were found to have active schistosomiasis infection. The disease is common in these rural fishing villages where residents rely on freshwater for daily living. Tthe Oyan River is used for the essential daily tasks of washing clothes, fishing and cleaning and preparing cassava root, the main crop. The shallow river’s edge is also a playground for schoolchildren, who splash around for fun — and also are told by their parents to check fish traps.

“Hi everyone, I am Dr. Cynthia from Nigeria.” she says with a smile – she holds a Ph.D in parasitology – and offers a wave. She supervises the pushing of tables and benches into clusters in the classroom, and then the game begins.

Umunnakwe also brought in live snails — familiar to the youngsters who play in the river — so they could recognize the host for the parasite that infects humans, leading to this illness. They were collected by her colleague, Dr. Olubukola Adelakun. a veterinary public health researcher and post-doctoral scholar at Federal University of Agriculture in Abeokuta who researches the habitat of these snails. She had waded waist-deep in the river water the day before, clad in waterproof waders to protect from infection. She had scrubbed their shells clean for easy identification, as there are many similar freshwater snails in the area, though none of them had the characteristic shell shapes of the parasite-carrying snails.

The day’s activities included medical help as well. In a neighboring schoolhouse, Ministry of Health staff offered all children the oral drug praziquantel, which can both prevent and treat the disease. They got free snacks for participating, since eating before treatment can help ease stomach pain that often occurs if the drug is taken on an empty stomach.

The team’s doctor administered treatment doses according to height, with a standardized measuring tape against the wall to help determine the dose.

In previous years, Cynthia Umunnakwe had conducted research demonstrating the game’s impact, published in International Health. In a six-month study involving 275 students across six schools in rural Ogun State — schools where praziquantel had previously been rejected because of false rumors that it caused fainting and even death — not a single child in the study group had heard of the drug before playing the game. The game was played in each school for the duration of the trial, and the team surveyed children before and after the trial, conducted focus group discussions with students, parents, and caregivers. By the end of the trial, more than two-thirds of the students knew what the drug was and understood it was safe, and 65% put their names down, with parental permission, to receive treatment.

“So we are hoping that by playing this game that the schoolchildren will actually translate the knowledge acquired into changing their behaviors,” Umunnakwe said,

And not only that, the kids have fun.

“Hey, wò ó, mo wà lókè!” said a boy who won the game by reaching the final “Schisto-free child” square: “Hey look, I’m on top!”

William McCarthy is a medical student at McGovern Medical School and a researcher and writer committed to global child health problem-solving. His research includes environmental health and global health diagnostics innovation. Currently, he studies schistosomiasis with the Prakash Lab at Stanford Bioengineering, where he works on community-led approaches to infectious disease control. He’s CEO and co-founder of the student-led nonprofit group Health In Your Hands Diagnostics.

Ambassador Samantha Power (C), former head of the United States Agency for International Development (USAID), embraces fired employees and their supporters outside the agency’s headquarters on February 27, 2025 in Washington, D.C.

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When Samantha Power walked out of the United States Agency for International Development’s headquarters in Washington, D.C., for the last time on January 20, 2025, she had no idea what was to become of the agency she had led for the Biden administration for the past four years.

Within days, the new Trump administration had put a stop work order on all U.S. foreign assistance, halting thousands of programs around the world — including emergency lifesaving ones — and began dismantling USAID.

“I was as shocked as I was horrified,” Power said in an interview with NPR. “I could not believe in the first instance that any human would suspend assistance, particularly life-saving assistance, without taking into account the human consequences or trying to do so in a manner that would allow people to make adjustments.”

Power was the last confirmed administrator of the 64-year-old agency — USAID was officially shut down in July 2025. It had employed around 15,000 people globally, and managed thousands of programs aimed at fighting disease and poverty. Only a handful of former agency staff now work at the State Department, and most of the programs were terminated.

A year later, Power is still grappling with the loss and legacy of USAID and is filled with indignation over the administration’s treatment of its staff.

“It was so cruel, and it was as if cruelty was the point,” Power says of the way the administration went about the dismantling.

Still, Power is holding onto hope that there’s enough bipartisan support for foreign aid in Washington that the agency could be reconstituted in some form in the future.

This interview has been edited for length and clarity.

When you realized what the Trump administration intended to do with USAID what did you do?

I did what so many did, which is I went and appealed to the Republicans [in Congress], who I knew were both close to the President and huge champions of USAID. Initially they worked with me and others behind the scenes to try to restart this program and get a waiver for that, but at a certain point they clearly decided that it was in their self-interest to go along [with President Trump].”

Many former USAID staff who spoke to NPR described feeling like they were in a prolonged grieving process in those six months since the Trump administration began dismantling USAID until its official shutdown in July, 2025. How did you feel during that time?

For a long time, I think I not only grieved the agency, but the sense of powerlessness that I felt toward the people who had faithfully worked in the Biden administration under my leadership, in partnership with me.

This was a mini cataclysm for 15,000 USAID workers all around the world. Every single one of them had served our country faithfully. They certainly weren’t doing it for the money; they were doing it out of a sense of purpose and mission. And to be unable to support them, to know that they weren’t going to be able to make rent, to know that some of them had to pull their kids out of daycare — the personal heartbreak they felt, compounded with the livelihood questions and the existential questions in terms of their careers that they were going through, I just wanted to be able to do something, and just felt massively ineffective in that period.

How do you think the loss of USAID is being felt around the world?

I think about that village that doesn’t get electrified because Power Africa no longer exists, which had brought electric, broader, improved electricity to 150 million people in the short time it had been operating. What does it mean to not have U.S. funded election monitors in parts of the world when we know that many of the democratic trends are going in the wrong direction with mass job displacement coming with AI? What does it mean that there is far less independent media out there scrutinizing whether governments are stealing from their people and serving as a check and balance?

When you shut down anti-corruption civil society organizations, as has happened all around the world, because the USAID and State Department funding was pulled out from them, you lose things that won’t be measured in the here and now, but that will cause really negative ripple effects over generations.

A year after the agency shutdown NGOs and aid groups appear to be moving on with the work. Why do you think we should still talk about what happened with USAID?

USAID was created by John F. Kennedy, and over the decades, the amount of goodwill that this agency has earned the United States and the American people is impossible to quantify, because it is just boundless.

Walking away from USAID is, on top of being cruel, just incredibly dumb. It’s literally like having the best brand name and saying, let’s invent a new brand name, even though this is the most popular, most beloved, most respected arm certainly of US foreign policy in the world. Though not without its flaws, Americans want to help, and that is what USAID really understood.

Trump administration officials say they are nimbler and more efficient at disaster response now than when USAID existed. When you look at the responses to the ongoing Ebola outbreak and the earthquake in Venezuela what do you see?

I see an improved response, not an adequate response, but an improved response from the U.S. State Department’s response to the Myanmar natural disaster, and clearly getting quicker and dedicating more resources to the Venezuela response, in part, because of the major foreign policy and military investment made in Venezuela, in part because Marco Rubio definitely cares a great deal personally about Venezuela, but for whatever reason, doing more is better.

But I think the bigger gaps are not the ones that are causing or earning headlines like the earthquakes and the hurricanes and Ebola — it’s the fact that so much is no longer even measured in terms of the health metrics. Around HIV, for example, or in some communities, the toll of losing U.S. assistance for girls’ education around the world, that’s not a metric that people, social scientists or economists, have yet quite figured out how to nail down.

Critics of USAID say the agency created dependency among low-income countries, and I know this is an issue that you were trying to solve during your tenure. The Trump administration is arguing that it is making countries more self-reliant by cutting off aid and by being transactional with governments. Do you think there’s merit to the administration’s argument there?

Government-to-government assistance, which is actually something that the Trump administration is doing more of, was something that I was very enthusiastic about, and we had launched a big new government-to-government strategy [during my term]. But it was really Congress’s concerns from decades ago about whether governments were stealing USAID resources that caused USAID and other foreign assistance arms of the U.S. government to move through non-governmental actors.

So that shift toward government-to-government, I welcome it. It does require proper oversight to make sure that the dollars are going where they need to go, and laying off all of the USAID people who did the oversight isn’t the solution.

Do you think there’s a world in which USAID comes back?

It should come back. Will it be politically challenging for President Trump’s supporters to embrace a return to [USAID]? Of course it will. So, can that happen? Can they put the letters back on the headquarters, hire everybody back, and say, “oh, whoops,”? That’s very unlikely to happen soon. But this year the Republican-led House and Republican-led Senate sent a $50 billion foreign assistance bill to President Trump’s desk for signature.

The supporters of this work are still out there, but it is going to take very delicate negotiations about how not only to build back, but to do so in a manner where majorities in both parties can rally around the cause in a manner where some can save face, because clearly a terrible mistake was made.

Do you hope to be part of that potential reconstitution of USAID?

Certainly. I’m doing everything I can to be part of the conversations about what the core of what comes back should look like. Not everything is going to come back at once, not every sector is going to be able to generate the same bipartisan enthusiasm as every other sector, but what is key is to be open to the question of where results have been achieved. USAID spent decades amassing those results, and the individuals involved in those programs need to be central to the dialog about what comes next, not just the politicians who can figure out what politics will allow, but the experts who can demonstrate the good that was done on behalf of the American people.

NPR reached out to the State Department for comment but did not immediately receive a response.

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A national physician staffing firm tried to take over the contract held by Eugene Emergency Physicians to work in local hospitals. The local physicians used a new state law to oppose the move.

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In between shifts in the emergency room, Dr. Dan McGee was in an Oregon courtroom. He was fighting for his practice — Eugene Emergency Physicians (EEP). The group of more than 40 doctors and physician assistants work at multiple emergency departments; it was being replaced by a national company.

“This was big time, David and Goliath stuff,” McGee said. “You see 14 of their lawyers sitting there and you see three of ours.”

Those lawyers argued that ApolloMD, the national company, violated Oregon’s corporate practice of medicine law. The 2025 law bans corporations from taking control of a medical practice’s operations and finances.

The case garnered national interest because Oregon’s new law targets the loopholes large staffing firms have been employing to circumvent state corporate medicine laws.

Money for control

Most states have laws requiring that doctors own medical practices, not corporations. These rules aim to put patient interests ahead of profit motives. Over the last several years, companies have used a model where a doctor technically owns the local practice, but as Erin Fuse Brown, a professor at Brown University, explains, those physician owners are often not involved in care and cede hiring, firing and other operational functions to the corporation.

Fuse Brown said these arrangements are attractive to hospitals because these companies often promise more revenue and take over the responsibilities that come with running an ER.

“There’s worry that these investors or these corporate management companies should not be totally controlling the operations and the clinical decisions of those who are trained to deliver patient care,” Fuse Brown said.

The connection to patient care concerned Dr. Jonas Pologe, who works for Eugene Emergency Physicians, in the Eugene, Ore., area. ApolloMD offered local doctors jobs, but Pologe worried that if he pushed back on decisions ApolloMD made, he could lose work hours.

“There’s certainly a chance that if you make enough of a stink, you think that something needs to change, they can just stop giving you shifts,” said Pologe.

ApolloMD’s CEO, Dr. Yogin Patel, said the group doesn’t infringe on the way its doctors practice. He says the company is being unfairly lumped in with broader concerns over physicians’ feelings of disempowerment at the hands of corporate medical takeovers.

A closely watched experiment 

Fuse Brown, policy experts and independent physicians theorized that updating state corporate medicine laws could be a fix to limit the control management companies can exert over medical doctors.

Oregon’s the first state to try this, and the case brought by the Eugene doctors group is the first test of that law. McGee, who leads the Eugene physicians group, says colleagues at other hospitals around the state were literally tuning in to their case.

“You could hear it almost like background music on an elevator,” McGee says he was told. “At key moments, all of a sudden the nurses would break out in a cheer.”

Before any ruling, the hospital system dropped its plan to work with ApolloMD and struck a deal to stick with McGee’s local group of doctors.

“This is a big victory for independent physician groups over corporate medicine,” McGee said. “This is a game changer.”

The American Academy of Emergency Medicine (AAEM) supported the Eugene doctors as part of the organization’s strategy to protect independent practices. The AAEM president, Dr. Vicki Norton, said Oregon has the strongest law in the country.

“This signals that that law works and we need it replicated in other states to really strengthen their corporate practice laws,” said Norton.

California and Vermont have passed similar legislation to Oregon, and lawmakers in other states, including Rhode Island and New Mexico, are considering related bills.

In Virginia, an independent group of ER doctors who were replaced by a large staffing firm is meeting with state legislators to try to change their laws.

Impact on Oregon physicians 

Back in Oregon, the open question is about how the law may impact the physician practice market.

A few of the largest companies, Envision Healthcare, TeamHealth and USACS, declined to answer NPR’s questions about whether this case or the new law changed their outlook on investing in Oregon practices.

Opponents of the legislation warned lawmakers that many physician groups depend on outside investment to survive.

Healthcare workers rally at a Manhattan union headquarters to show support for the Haitian and Syrian communities after the U.S. Supreme Court ruled that the Trump administration could end temporary protected status for potentially millions of foreign nationals from countries experiencing conflict and violence. The decision means that over 330,000 Haitians and Syrians could lose their work authorizations and ability to remain in the country.

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Amid the flurry of consequential Supreme Court decisions that have come down recently, it’s the one about temporary protected status that has America’s healthcare sector the most worried.

The ruling last week cleared the way for the Trump administration to cancel TPS for Haitians and Syrians. Experts say deporting Haitian TPS recipients will have a catastrophic impact on the nationwide healthcare workforce crisis — a workforce that is hugely dependent on immigrant labor.

The pain will be felt across hospitals and emergency rooms, which already operate under persistent staffing shortfalls, but it’s the long-term care sector, including senior care facilities and home care, that will suffer the greatest disruptions, said Steffie Woolhandler, a distinguished professor of health policy at City University of New York at Hunter College and a faculty member at Harvard Medical School.

“It’s going to be a disaster in the Boston area, where a lot of our nursing home and home care aides are Haitian,” Woolhandler told NPR. But beyond that, she added, “If the United States becomes inhospitable to noncitizens, which I think Trump is doing, we’re going to have a lot of problems staffing our entire healthcare system.”

Massachusetts has the third largest population of Haitians with TPS (19,000), behind Florida (158,000) and New York (40,000), respectively.

Woolhandler is one of three authors of a 2025 report analyzing the impact of Trump’s mass deportation plans, including the potential effects of stripping TPS protections from people from the 17 countries that the federal government deemed eligible. The status is meant to protect individuals from those countries who are living in the U.S. from having to return to places where armed conflicts, natural disasters or other conditions make living there unsafe. Pulling from census data, the research team found that roughly 50,000 physicians in the U.S. are noncitizens, the category that includes people with TPS protections. That’s about 9% of all doctors in the U.S. Another 145,000 are registered nurses.

FWD.us breaks down the numbers even further, estimating that 21,000 Haitian TPS holders are in hard-to-fill jobs as nursing assistants and caregivers.

The dearth of qualified healthcare workers is already putting existing institutions under tremendous strain. Woolhandler said two-thirds of hospitals report they’ve had to close beds because they don’t have enough staff, and about half of nursing homes similarly say that they can’t take new admissions because they don’t have enough personnel.

“The thing that has to be said is that the healthcare of everybody is going to be compromised by this. If you start throwing out workers that play a key role in the whole continuum of care … it tends to create a bottleneck or a backup,” she said.

If a family can’t find a bed in a nursing home or home aid caregiver, then those people may end up stuck in a hospital or in emergency rooms, Woolhandler said.

Katie Smith Sloan, president and CEO of LeadingAge, which represents more than 5,300 aging service providers nationwide, called the ruling a direct threat to the delivery of much-needed care and services.

“It puts older adults and the providers who care for them in an untenable position,” Sloan said in a statement. “Staff and caregivers who support older adults every day — legal employees who in some of our communities represent 8% or more of the entire workforce — can now lose their jobs overnight.”

The legal limbo has communities wracked with worry, particularly in Springfield, Ohio, where 1 in 4 residents is of Haitian descent. Hours after the ruling, dozens of panicked TPS holders were calling Viles Dorsainvil asking for advice. The 40-year-old is the co-founder and executive director of Haitian Support Center, a nonprofit that provides a range of services to Haitian nationals and refugees, including legal assistance.

“They’re wondering if they can still keep their assets or money at the bank, if they can still go to work because TPS came with the work permit, and with the driver’s license privilege,” Dorsainvil told NPR. “The community is devastated.”

The Trump administration has released little information about how it will withdraw protections under the program for more than 330,000 Haitian and 4,000 Syrian TPS holders affected by the high court’s ruling last week. On Wednesday, the Department of Homeland Security announced that existing Employment Authorization Documents, which permit TPS recipients to legally work in the country, will expire on July 10.

Dorsainvil said he’s advising people that the most important step they can take is to sign a power of attorney to someone they trust. Parents with American-born children should also plan to sign over guardianship of their kids, in case DHS pursues family separations, he said.

For now, he said, he’s got little else to share with the people calling, but he shares their anxiety.

Dorsainvil is also a TPS recipient, but unlike those who fled the destruction of the 2010 earthquake, he came to the U.S. in 2020 on a visitor visa. At the time, he did not intend to stay more than six months. But during his stay, Haiti’s already fragile political system devolved into unrest and violence that led to the assassination of President Jovenel Moïse, and continues to today.

“There was no way I could go home,” Dorsainvil said, adding that it was the Biden administration’s extension of the TPS program for Haitians that allowed him and his brother to stay in the country. It wasn’t until 2024, when Trump first set his eyes on ending the TPS program for Haitians, that Dorsainvil and his sibling, a former doctor in Haiti who now works as a nurse in Chicago, both applied for asylum. Those applications have still not been resolved.

Over the next few weeks, he said, he’s forging ahead with his life, trusting that somehow things will work out. He’s trying to finish his graduate studies at Wright State University in Dayton, Ohio — he’s in a dual master’s degree program for international relations and public administration.

When he first decided to stay in the U.S., phone calls home to his mother and daughter revolved around the dangers of the armed gangs that have taken over much of the country because of the political vacuum that exists. Now they spend most of their calls discussing the political turmoil in the U.S.

“When I was outside of the U.S., the way they sell it to you, you would believe that if you came to this country everything would be okay. But it’s totally different,” he said.

People cool off at Washington Square Park during hot weather in New York City on Monday.

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As the holiday weekend approaches, large swaths of the Midwest and the Eastern U.S. are under extreme heat warnings or heat advisories, according to the National Weather Service.

Heat is a serious health threat. Hundreds of people die of heat-related illness in the U.S. each year. Heatstroke can damage your body, leading to multiple organ failure or kidney failure, and it can trigger a heart attack.

If you plan to spend time outdoors this week, here’s a roundup of advice from NPR reporting on how to protect yourself and your loved ones.

For the latest stories on the science of healthy living, subscribe to NPR’s Health newsletter.

1. Assess the heat risk before you go outside

There’s not an absolute temperature at which extreme heat turns dangerous. Rather, it depends on your individual circumstances, how acclimated to heat you are and how long you’re exposed to the heat, Lewis Halsey, a professor of environmental physiology at the University of Roehampton in the U.K., told NPR.

Humidity is also a key factor, he says. Sweating works better to cool you off in dry heat than in humidity. Wind flow can also affect the risk of overheating.

“If it’s a very humid day and there’s no wind speed, then you are more at risk, even if the air temperature is lower,” Ashley Ward, director of Duke University’s Heat Policy Innovation Hub, told NPR’s Life Kit.

Keep an eye out for heat advisories or warnings in your area issued by the National Weather Service. These typically take into account the local heat index, which includes humidity as well as the air temperature, to get a more accurate read on how hot it will feel outside.

But they are not foolproof, says Nick Staub, incident commander for extreme heat response in Maricopa County, Ariz. “We see a significant number of heat-related deaths on days that are not an extreme heat warning,” Staub said, speaking on NPR’s Short Wave.

One reason for this is that the heat index values are calibrated for shady locations with light wind. If you’re in direct sunlight, it can be 15 degrees hotter than in the shade.

Instead of relying on heat indices alone, check the National Weather Service’s HeatRisk tool, which takes several factors into account, including: how far above normal the current temperature is for your location and time of year; heat duration; and humidity forecasts.

Carrying your own shade is one way to stay cool. Experts advise avoiding the midday sun altogether.

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Alex Wroblewski/AFP via Getty Images

2. Know if you’re high risk

Some people are at higher risk for heat-related illness, as NPR has reported, and they need to take extra care to stay cool.

This includes people who aren’t acclimatized to the heat because they are from cooler regions or spend little time outdoors. Infants and small children can be particularly at risk, partly because of their small body size. Kids also might not notice how they’re feeling, or not communicate it clearly, so it’s important to watch for changes in their behavior that might suggest they’re overheating.

People in their 60s and older may have a reduced ability to sweat and thus cool off. Pregnant women’s bodies also may not cool off well, and heat can raise the risk of pregnancy-related health problems. People with certain chronic health conditions or on certain medications may have trouble too.

And finally, outdoor workers or others who do strenuous outdoor activity and those without access to air conditioning are at high risk.

3. Check prescriptions — heat and some medicines don’t mix

Certain medications can make people more vulnerable to heat. For instance, blood pressure drugs, which millions of people take, are diuretic. “Those medications are trying to get rid of fluid from your body,” Wafi Momin, a cardiologist at Memorial Hermann Health System in Katy, Texas, told NPR. And if you then add heat, “that can cause a very dangerous situation” of dehydration.

Other types of medications can impair your body’s ability to cool off, including anticholinergic medications (a category that includes Benadryl) and stimulants, like ADHD drugs. ACE inhibitors, commonly prescribed for heart issues, make it harder to notice you’re thirsty, and beta blockers — another heart medication — can decrease sweating.

“When you’re taking these medications and you’re exposed to heat, it’s like asking a car to drive up a mountain in the summer with the air conditioner broken,” David Eisenman, a physician and researcher at the University of California, Los Angeles, told NPR. “Overheating becomes much more likely.”

Psychiatric medications can also interfere with your body’s thermoregulation. Antipsychotics and some antidepressants can reduce how much you sweat.

Sedative medications like benzodiazepines may “reduce alertness and perception of heat, says Dr. Ashwini Nadkarni, a psychiatrist and medical director of Brigham General Adult Psychiatry at Mass General Brigham in Boston.

Patients should still take their prescribed medications, Eisenman stresses. But he urges them to take heat risks seriously and make a plan to keep cool.

Ask your doctor whether any of your medicines could increase your risk of heat-related illness. And you can explore a list of medicines that contribute to heat sensitivity from the Centers for Disease Control and Prevention.

4. Know the difference between heat exhaustion and heat stroke and when to seek emergency care

The warning signs of heat exhaustion include fatigue, extreme thirst, nausea, headache, shortness of breath, rapid breathing, muscle cramping and feeling dizzy or lightheaded.

Heatstroke is a much more serious emergency. The warning signs include all the above but also may include a strong, rapid heartbeat, confusion, vomiting, seizures, slurred speech, or passing out. Watch for a body temperature that exceeds 103 degrees F.

The first step to help anyone who exhibits symptoms of heat exhaustion or heatstroke is to get them to immediately stop what they are doing and rest somewhere out of the sun, Dr. Matt Leonard, attending emergency physician at Suburban Hospital, Johns Hopkins School of Medicine, told NPR.

Take steps immediately to cool the person who’s overheated: Get them into air conditioning if possible, or at least shade with a fan or breeze. Mist them with a spray bottle, for example, or pour water over their head. The most important places to cool are the head and face, the armpits and the groin, he says.

If symptoms point to heatstroke (watch especially for neurological symptoms like confusion), get them to an emergency room right away.

Staying hydrated and letting your skin aerate can help you stay cool.

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5. Keep cool: Avoid midday sun and choose protective clothing

One of the simplest ways to keep your body temperature at a reasonable level on a hot summer day is to only go outside in the morning or evening when it’s cooler. And stay in the shade, especially if you’re doing anything active.

“That midday sun can add as much as 20 degrees or more to the actual air temperature,” Carol Ewing Garber, professor of movement science at Columbia University, told NPR. “You really have to be careful about that.”

And it’s important to protect your skin, says Leonard. Your skin is an “amazing self-cooling apparatus,” he says. It’s designed “to move warm blood away from your core to keep your vital organs cool.”

Consider wearing lightweight clothing that blocks the sun, and include a hat. Leonard recommends wicking athletic fabrics that allow you to sweat.

Choose loose-fitting silhouettes, recommends Dr. Renee Salas, assistant professor of emergency medicine at Harvard Medical School. If your clothes are too tight, the sweat on your skin can’t evaporate, which is key to keeping your body cool. “I’m sure people don’t love sweating profusely, but sweating is actually our friend when it comes to heat,” Salas told Life Kit.

6. Prehydrate — and rehydrate often

If you’re outside or in a hot place, dehydration can happen fast. So prepare by hydrating in advance, says Momin, of Memorial Hermann Health System. “Grab a glass of water or a sports drink before you head out to the outdoors,” he says.

Bring plenty of water with you, and don’t wait until you’re thirsty to start drinking during an outdoor activity. “The moment you begin to feel thirsty, you’re likely anywhere between 10 to 25% dehydrated already,” says Neil Gandhi, a physician at Houston Methodist Hospital.

Water is the best way to hydrate. Adding electrolytes is not necessary under normal circumstances. But they can be helpful if you’ve gotten overheated or you’re doing something very physically active and sweating a lot. In that case, it can be a good idea to replace those electrolytes promptly, Asher Rosinger, an associate professor and director of the Water, Health, and Nutrition Lab at Penn State University, told NPR.

7. If you struggle with mental health, take extra care

Higher temperatures are known to have an impact on mental health. Studies show that higher temperatures are linked to higher rates of visits to the Emergency Department for mental health conditions and addiction.

And suicide risk goes up too, a recent study found. “We think that every summer roughly an additional hundred young adults are dying by suicide due to increasing temperatures,” says study author and psychiatrist Dr. Joshua Wortzel at the Hartford HealthCare Institute of Living, who runs the institute’s Heat Mind Lab.

If you or someone you know may be struggling with suicidal thoughts, contact the 988 National & Suicide Crisis Lifeline by calling or texting 988.

So, what can people with mental health conditions do to protect themselves from excessive heat? Avoid exposure to heat as much as you can, says Nadkarni of Mass General Brigham. She advises “staying indoors in cooler places” and making sure to hydrate.

She also recommends people talk to their doctors about what their risks are. There can be added risk for people with substance use disorders — alcohol and certain drugs are diuretics and can cause dehydration. And people with mental illness are also vulnerable to heat-related illness, says Nadkarni, so it’s important to watch out for symptoms and seek medical attention promptly if they develop.

Lean into your social networks during times of high heat, suggests Amruta Nori-Sarma, an environmental health researcher at Harvard University’s Chan School of Public Health. “If you have a loved one that you know is prone or vulnerable, make sure that you’re checking in with them when there’s a heat wave,” she says.

Rhitu Chatterjee contributed to this report.

Other reporting was drawn from earlier NPR stories. Contributing reporters include: Allison Aubrey, Alejandra Borunda, Maria Godoy, Pien Huang, Emily Kwong, Suzette Lohmeyer, Christine Ro, and Clare Marie Schneider.

For more than 50 years, the Education Department has revealed a host of realities about how students are being treated in every public school across America: which kids are being bullied, which ones are being harassed and which students can access the internet, among other things. The agency’s Civil Rights Data Collection is intended to do just that — help keep schools accountable.

The latest information, collected about the 2023-24 school year, was supposed to be published last December, according to the Education Department’s own deadline.

But it hasn’t been.

The agency hasn’t responded to multiple requests from NPR asking what’s behind the delay.

Federal bureaucracy can be slow, and delays aren’t always cause for concern, but advocates are on edge in the midst of recent plans the Trump administration announced to move the Office for Civil Rights — which houses the Civil Rights Data Collection (CRDC) team — from the Education Department to the Department of Justice.

That planned transfer follows months of federal action that upends the way students’ civil rights have been protected in the past: The Trump administration has cracked down on initiatives related to diversity, equity and inclusion, for example, and prioritized investigating schools that allow transgender athletes to compete in women’s sports.

“This administration has repeatedly applied civil rights law in ways that ignore or dismiss the very real inequities that persist in our education system,” says Denise Forte, president and CEO of EdTrust, a think tank focused on addressing education inequity. The delay in releasing the CRDC data, she says, “raises serious concerns, particularly as this administration seeks to downplay the impacts of racism and economic inequality in public education.”

A former Education Department employee who worked on the CRDC tells NPR the team is still intact. However, its future is unclear: While the Trump administration has announced the Office for Civil Rights is moving to the Justice Department, the process could take months, like other plans to outsource parts of the Education Department’s work. The former employee, who asked not to be named out of fear of professional repercussions, said part of the delay may have to do with the 2025 government shutdown that affected operations at the Education Department for over six weeks, including work on the CRDC.

The department also has been winding down its operations since the Trump administration took office, cutting about half the department’s overall staff last year.

Lindsay Kubatzky, director of policy and advocacy at the National Center for Learning Disabilities, agrees with Forte’s assessment that a delay in this data may have to do with the Trump administration’s chipping away at systems that have historically helped hold schools accountable for protecting students’ civil rights. “This administration unfortunately has proposed a lot of policies that would make it less transparent on how students with disabilities in particular are being served in public schools,” he says.

For example, Kubatzky points to how the Trump administration has proposed eliminating a requirement for states to track which students are being identified as having disabilities based on race and ethnicity. Historically, Black and brown students are more often wrongly identified as needing special education than their peers.

While that disability data is not directly tied to the CRDC, Kubatzky says it’s an example of the administration working to undo federal civil rights accountability tools. The CRDC, he says, also plays a key role in helping advocates show where “schools are not serving students and it also gives us a lever to push for policies that are more inclusive and less negative toward students.”

For example, Democratic Sen. Cory Booker of N.J. and U.S. Rep. Joaquin Castro of Texas used findings from CRDC data to craft a bill proposing the expansion of access to Advanced Placement courses for underrepresented students, including minority and disabled students, whom the data found had unequal access to these classes. A spokesperson for Booker’s team said the bill would be reintroduced in the coming days.

One of the questions the delayed dataset was set to answer is which students have access to the internet as AI plays a bigger role in education, according to the former CRDC staffer who spoke on condition of anonymity. “Like, are our schools ready to usher in this wave of AI? Will all students have equal access to devices and internet capabilities?” the person said. “How do we know if the CRDC doesn’t come out?”

The former staffer described the CRDC team as a deeply committed group of people who are focused on ensuring “access and opportunity” for the nation’s most marginalized students. “We can’t make the right decisions for students if we don’t have insight into their current realities.”

Edited by: Nirvi Shah
Visual design and development by: LA Johnson

Stay safe this summer. Make sure you know the five water safety skills, designate a water-watcher when kids are swimming, know the signs of heat exhaustion and more.

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Stay safe this summer. Make sure you know the five water safety skills, designate a water-watcher when kids are swimming, know the signs of heat exhaustion and more.

Kaz Fantone/NPR

Think about all the things we do during the summer. We go outside more. We jump into bodies of open water. We bake under the hot sun. We light fires and cook over them.

This stuff is all fun, of course, but it’s also risky.

Spare a moment to think about your safety this season, won’t you? Here’s how to protect yourself against drowning, heat exhaustion, tick bites and more.

Learn these 5 water safety skills 

Reported by Marielle Segarra 

According to the American Red Cross, at a minimum, everyone should know these five basic water safety skills.

First, make sure you are comfortable with jumping into water, submerging yourself completely and bringing yourself to the surface. Once you’ve returned to the surface, you should be able to float or tread water for one minute. When treading water, stay relaxed so you don’t overexert yourself.

From there, you’ll want to be able to turn around in a full circle and find an exit. Knowing how to get out of the water is “just as important as getting into the water,” says Cullen Jones, an Olympic gold medalist swimmer and a water safety advocate.

Next, you should be able to swim 25 yards to an exit without stopping. You can use whichever stroke you’re comfortable with. Jones adds that most pools in the U.S. are 25 yards.

Finally, make sure you can exit the pool or body of water without a ladder. Jones used the phrase “elbow, elbow, tummy, knee, knee” to teach his 3-year-old son this skill. (For more tips on how to become a strong swimmer, click here.) 

Designate a “water-watcher” to prevent drowning

Reported by Marielle Segarra 

A designated “water-watcher” is an adult who is responsible for monitoring the water and the kids in it.

To take on this role, the water-watcher should be sober and focused. They should also have their phone nearby in case they need to call 911. After a set period of time, like 15 minutes, rotate water-watchers. It’s also helpful if they know CPR and have a flotation device they can use in a rescue. (Take our quiz to test how much you know about kids and water safety.) 

Know the signs of heat exhaustion 

Reported by Clare Marie Schneider 

If you’re out with a group of friends on a hot day, keep an eye on each other, looking for signs of illness. “Somebody may notice something in you that you don’t notice,” says Dr. Renee Salas, assistant professor of emergency medicine at Harvard Medical School.

Heat exhaustion is your body’s warning sign that you’re starting to overheat, Salas says. Generally, symptoms include sweating more than usual, weakness, dizziness, fainting, pale skin, nausea, vomiting and fatigue.

Pay special attention to seniors, children, people with certain preexisting medical conditions like heart disease and diabetes, and people on commonly prescribed medications to help manage blood pressure and mental health conditions. They are at higher risk of heat-related illness, Salas says.

If you or someone you know is experiencing signs of heat exhaustion, Salas recommends going into an air-conditioned room. If you can’t find a cooler place, call 911, Salas says.

If you’re still experiencing symptoms of heat exhaustion after removing yourself from the heat, seek medical care. (More tips on how to protect yourself against extreme heat here.) 

Do a tick check after spending time outdoors 

Reported by Pien Huang 

It’s estimated that about 31 million people in the U.S. get bitten by a tick every year. Summer is peak tick season, and unfortunately, ticks can spread diseases, like Lyme. 

If you’re spending time outdoors in the summer, especially in an area where ticks are common, like the Northeast, cover your skin as much as possible.

For instance, if you’re going on a hike or working in the yard, you could wear long sleeves and long pants and tuck your pants into your socks. Then spray your clothes and your skin with an EPA-recommended repellent. The Centers for Disease Control and Prevention recommends that you use permethrin on your clothes and DEET on exposed skin.

If you’re hiking, stay on the trail and out of the tall grass.

When you get home, throw your clothes in the dryer if possible — that will kill ticks — and check your body for them right away. Generally speaking, the longer a tick is latched onto your body the more likely it is to spread disease. (Listen to our episode on ticks for more information on prevention.)

Grill in an open space, away from the house 

Reported by Ruth Tam 

Take precautions to prevent fire accidents. Before you light your grill, read your grill’s manual. It’ll give you crucial information about how and where to set it up safely. Avoid putting your grill against the side of your house or under a patio roof or someone else’s balcony, for example.

“You want to have your grill in open air so there’s a lot of space for the air to circulate and for the heat to disperse itself,” says Jess Larson, founder of the food blog Plays Well With Butter.

If the fire seems like it’s getting out of hand, don’t panic. “When in doubt, just close the lid [and the vents] and have the fire die out on its own,” says Larson. Cutting off the oxygen supply should kill the fire in a matter of minutes. And, just in case, “it’s always a good idea to have a fire extinguisher on hand.” (Read our story on grilling for beginners for more tips.)

The story was edited by Meghan Keane. The visual editor is CJ Riculan. We’d love to hear from you. Leave us a voicemail at 202-216-9823, or email us at LifeKit@npr.org.

Listen to Life Kit on Apple Podcasts and Spotify, and sign up for our newsletter. Follow us on Instagram: @nprlifekit.

Garland Jones, recreational therapist and senior program director of the YMCA of South Florida’s special needs program, teaches Mackenzie Wesley, 5, to breathe safely in water by using a ping pong ball as a visual aid.

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WESTON, Fla. — Mackenzie Wesley sports a big grin and bright blue Lilo & Stitch swim gear as she runs into her weekly swim lessons. It’s fitting, because the 5-year-old has something in common with movie character Lilo: She adores water.

“Whether it’s the pool or beach, she enjoys it fully,” says her dad Steven Wesley.

Mackenzie isn’t alone: Many kids with autism share a natural love for water because it can be sensory bliss — the feeling on their skin, the pressure and the sparkle of the water can all be soothing. Lucky for her, Mackenzie lives here, less than an hour outside of Miami in a state that’s dotted with bodies of water.

But there’s a tragic reality tied to that fact, as Mackenzie’s mom, Brittany Bucknor, is all too aware. “In Florida, there’s water everywhere, and also with kids her age, and also just being on the spectrum, it’s a very — way higher — rate of having an incident of drowning.”

Kids with autism are 160 times more likely than other children to die from drowning, according to a seminal 2017 study from Columbia University. In fact, in Florida, most children drown in backyard pools. That’s largely because about half of autistic children have a tendency to wander from safe settings. That fact, combined with an attraction to water can make for a dangerous combination. Quality swim lessons can help.

That’s one of the reasons Mackenzie’s parents enrolled her in Swim Buddies, the YMCA of South Florida’s low-cost program aimed at children with disabilities. It’s also why the state of Florida, which has one of the highest childhood drowning rates in the nation, is expanding a voucher program on July 1 that will put children ages 1-7 who have autism at the front of the line for subsidized swim lessons. “We have tragic circumstances and stories across the state of Florida of young children with autism that are wandering away, they’re eloping from their homes, from their classrooms,” says Florida state Rep. Anna Eskamani, a Democrat, and one of the lawmakers who sponsored the bipartisan bill that changed the state’s swim vouchers.

“These [tragedies] are so preventable, but if that child at an early age does not have access to drowning prevention and swimming lessons, then those statistics will only continue.”

Recreational therapist Tiera Chaney works with Amir Williams, 6, during a recent Swim Buddies session.

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Once the updated law takes effect, many healthcare providers across the state will begin providing parents of newborns with information about drowning prevention and the state swim program, Eskamani says. Generally, the voucher comes out to about $200, she says, and pays for up to eight swim lessons.

A “whole-person” approach

The YMCA of South Florida has one of the largest adaptive recreational programs for kids with special needs in the area, including those with autism, who make up the fastest-growing group of children with disabilities. “We provide this program for those with a variety of disabilities, primarily over 60 percent of our youth who do come have a diagnosis of autism,” says Alison Bregman-Rodriguez, vice president of the YMCA of South Florida, where she oversees 64 locations, 27 of which serve children with learning differences. “This program, however, does serve all who want to feel like they belong.”

When Mackenzie’s parents learned that their local YMCA already had a robust and low-cost program for one-on-one instruction with kids with disabilities in mind, they jumped on the opportunity. “I really appreciate the program and specifically Miss Garland. She’s been very patient with Mackenzie and challenged her too,” Bucknor says.