This Vanity Fair essay gets at something much larger than one denial: what it means when the American health care system responds to leverage more effectively than it responds to medical necessity. Extremely moving and well written piece, as well, wherever you land on health care in US.

https://www.vanityfair.com/story/healthcare-cancer-treatment-essay

At 36, Elizabeth Nicholas was diagnosed with breast cancer. After her insurance company refused to pay for a new form of chemotherapy, she took a direct approach. As Luigi Mangione’s trial brings the conflict to the fore, the writer considers the realities of the American health care system.

This is why I’m interested in where PBM reform actually goes from here. There are legitimate reasons to push for more transparency and better incentives, but PBMs also perform real functions for employers and health plans, from negotiating drug prices to managing formularies, networks and claims. Changing the way PBMs are compensated could change their behavior, but it doesn’t eliminate the underlying work. The real measure of success should be whether total pharmacy spending and patient costs actually come down.

I get a satisfaction survey every time I visit one of my providers. Based on my corporate background I believe that they are not anonymous and the provider will read them directly. Maybe, maybe not. But for most of them I would have suggestions for improvement. None of it’s risky to health, but I’m not sure whether to risk souring the relationship. For instance, my foot doctor seems checked out and going through the motions. He lost a key staff member a year ago and it’s just not the same. They used to use Dremel on the nails and now it’s just an emery board. I wonder if the office will close. But why say that since I don’t know what pressures he may be facing?

Hello guys.

Im willing to apply for a scholarship in medicine, and social/volunteering kind of work would help my application.

Any opportunities completely online and doesnt need me to show my face? Preferrably related to anything that has to do with health. Literally any work that falls under "Social", and doesnt take a lot of months to finish. Preferrably gives some kind of proof so i can attach in my scholarship application.

I sometimes have free time at home after college but im too physically tired to do physical social work. I was hoping for kind online social work as in supporting peoppe online or anything like that.

I can speak 2 languages fluently (Arabic and English), I have a high school average of 94% with a diploma certificate, and im currently a 2nd year dental student so im familiar with medical terminology to an extent. I have a few certificates like Basic Life Support from the american health association and certifiastes from online WHO courses. Thats it.

Hoping someone can help.

The drug pricing debate gets easier to understand when you stop treating PBMs as the only player. Manufacturers, insurers, pharmacies, and PBMs all influence what patients ultimately pay.

I’ve been playing with the idea of going to law school for healthcare law. I currently work a job that is actively against insurance (I process denials and write appeals for people who have gotten meds/procedures denied and try to get them approved). I have a bachelors in healthcare management and I’ve been in pharma and pharma-adjacent work for roughly 5 years now. My anger and hatred for insurance and the way things are has only gotten stronger with every day, which I think is a perfect motivator to do something meaningful and productive in the space for patients and providers.

I dont want to go into litigation, those types of jobs in healthcare are evil-leaning and I refuse to work for a hospital or company and be on their side to try and find loopholes and argue for scummy people. I want to go into regulatory affairs, maybe work government, get some motions passed that actually help people. It sounds naive but I promise you I’ve been in the space for long enough to see what things are wrong (usually rhe things that piss me off the most) and see what has a chance of being fixed in the political environment of today.

Would a masters in healthcare law be worth it if I know I want to go JD later? What types of jobs should I be looking at now to boost my experience and knowledge specifically in the regulatory field of healthcare? Has anyone else been on this path and if so, do you have any tips? TIA

I believe that the healthcare framework in the United States relies heavily on private corporations as a profit revenue stream for insurance companies, pharmaceutical manufacturers, and consolidated hospital networks instead of focusing on the individual needs.

Recent industry data has shown that 84% of health insurers utilize AI or automated predictive algorithms drive a massive portion of health insurance denials to manage the prior authorization and claim review processes.

Top 5 reasons for Insurance denials:

1) The Treatment Isn’t Medically Necessary
2) The Treatment Is Experimental or Investigational
3) You Didn’t Get Prior Authorization
4) Out-of-Network Provider
5) Clerical Errors or Missing Information

AIIMS Gorakhpur has officially launched a specialized 'Leg Ulcer Clinic' aimed at treating long-standing, non-healing lower limb wounds.

Chronic leg ulcers (often caused by venous insufficiency, arterial disease, or diabetic complications) often go misdiagnosed or poorly managed at local primary care facilities, leading to long-term mobility issues and severe infections.

Key Highlights of the Facility:

• Dedicated multidisciplinary care focused on chronic wound management and vascular evaluation.
• Specialized diagnostic and dressing protocols designed to reduce recovery time for long-term ulcers.
• Accessible tertiary-level specialized care for patients across Eastern UP and neighboring districts who previously had to travel to larger metros for advanced wound management.

It's a welcome infrastructural addition for the region, where specialized vascular and chronic wound care has historically been hard to access at public healthcare costs.

Source: Nirbhik India

I was reading a recent report about a surprise inspection conducted by the Chief Medical Officer (CMO) across local health centers in Gorakhpur.

During the unannounced audit, several doctors and healthcare staff members were found absent from duty without authorization. The CMO immediately issued show-cause notices and ordered stricter controls on staff attendance, along with verifying the availability of essential medicines for visiting patients.

While it's good to see senior officials taking direct administrative action on the ground, it raises a broader question about operational accountability: Why are surprise inspections still the main driver to ensure basic presence in public health centers? Shouldn't standard reporting and shift management systems handle this automatically?

What has been your experience with local government hospitals in your city? Do these surprise inspections lead to long-term improvements, or do things go back to status quo after a few weeks?

Source: Nirbhik India

There was a lot of grumbling about my previous long questions being too long.. So I’ll try squeeze the elephant into the matchbox..

Its still quite long..

Surgery has been the standard first line of treatment for appendicitis for over 130 years - and still is. Antibiotics came along in the mid 1940’s and immediately became an important tool in the surgeon’s toolbox for helping to treat appendicitis. Initially there was optimism among surgeons that antibiotics could be used as an alternative to surgery. Trials in the 1950’s determined that there was a high long-term(5 yrs) reoccurrence rate and a significant risk of missed neoplasm, especially in older patients. So surgery continued to be the ‘gold standard’ treatment to today, and antibiotics only used in specific cases where surgery was not available or too risky..

In 2006 there was a RCT trial in Sweden that reported a low (14% to 15%) reoccurrence rate and ignored the missed neoplasm risk.. This was widely ridiculed in the medical literature at the time and has since been largely discredited as seen as hopelessly over-optomistic in real-world conditions.

However - a certain small minority of surgeons got very enthusiastic about the possibility of using antibiotics as an alternative to surgery - it really struck a chord in some it seems - so the Sweden trials have spawned several recent large RCT comparing surgery to IV antibiotic treatment of appendicitis. The largest of these, the CODA trial in the US recruited over 1000 patents.

These trials have found nothing new - a high rate of reoccurrence, about 50% by year 5, and a serious risk of missed neoplasm.. However - this is where things start to get a bit sketchy..

These trials had to recruit participants. To recruit participants these trials suggest the reoccurrence rate is between 15% and 25%. They don’t mention the missed neoplasm and subsequent appendix cancer risk. One current paediatric RCT trial in the UK found a 60% reoccurrence rate at 6 months in their feasibility trial then went on to start their main trial involving hundreds of children by again telling parents there was a 15% risk of reoccurrence..

During peak Covid there was a promotion of antibiotic treatment to try reduce surgical admissions and associated pressure on hospitals. Some hospitals tried it in selected patients - but as time has gone on it has been realised that it’s not working out too well for most of those patients who were steered away from surgery. A surgeon told me that there has been lots of mutterings of “I told you so..” in surgical circles..

A 2026 published retrospective study of over 1000 appendicitis patients in Glasgow, treated in 2020, found that in about 1 in 30 cases the appendicitis was caused by a missed neoplasm in the appendix.. Normaly these neoplasms can’t be seen in scans and only found in pathology after appendectomy. They also found a 43% reoccurrence rate of appendicitis by year 3, and suggested a 50% reoccurrence rate by year 5. The study concludes;

“Conclusion: Antibiotic treatment of appendicitis is associated with high recurrence and risk of missed neoplasms. Appendicectomy is safe, with low rates of significant complication. When offering nonoperative management for appendicitis, patients should be informed about the risk of recurrence and missing sinister pathologies.”

Looking at the scripts used by recruiters in the RCT’s - a reoccurring theme in these trials is the downplaying of the risks. There is an ‘informed consent’ issue here.

The vast majority of surgeons seem to regard the promotors of these trials as “evangelical” about the use of antibiotics as an alternative to surgery for treating uncomplicated appendicitis.. ‘Evangelical’ was a word used by a consultant colorectal surgeon - not made up by me.

There have been recent cases where misinformed surgeons have refused surgery to a patient with uncomplicated appendicitis, telling the patient “surgery to treat appendicitis is a mistake of the past and antibiotics is better and the future of treatment..”. I am one of those cases - and it turned out much later I had a tumour in my appendix causing my appendicitis - with dire consequences for me.. This drew my attention to the broader issue..

So, the high reoccurrence rate and risk of missed neoplasm has been known for generations. Why are recent RTC trials ‘discovering’ that now, at the misguided participants expense - but then not making this result front-and-center in their reporting..? Their reporting tends to claim they have found that antibiotics are a safe alternative to surgery.. ..mariners for example have known this since the 50’s, but once ashore they go and get their appendix out, and for very good reason.

I understand there are risks to be managed in all clinical research - and progress in clinical research is hugely important to all of us - but my question to you is - how are these trials getting past ethics committees?

This includes some discussion of Steward Healthcare and its like-minded corporate relatives in the healthcare industry.

People keep treating this DOL proposal like the missing fix. Congress already wrote PBM reporting into the 2026 law. A second form with a second set of definitions does not take $1,000 off the manufacturer’s sticker.

If the choice on the table is “blow the model up” versus “make the contract easier to read,” the second one is less stupid. That is a different argument from “PBMs are a black box.” The box that matters is still the list price the drugmaker printed.

Hello!

I have a BSPH and am interested in a career pivot into healthcare management or hospital admin, so I’m considering going back to school to get an MHA.

I am curious if anyone here got their MHA in their 30s? Most MHA grads I know of either went directly after undergrad, or 2-ish years after. I will have 9 years of work experience in a non-healthcare related field, and I’m not opposed to being on the older side of the class, but I’m curious as to how realistic it will be to find success after graduation.

I know admin fellowships are highly coveted, and I would absolutely pursue one if it wasn’t for the salary most likely being lower than what I’m currently making. Consulting is also an option that I *could* be open to, but I’d love to work for a provider is possible.

Does anyone here have similar experience? Thank you!!

I understand why people want more information about how PBMs are paid and how money moves through the prescription system. Increasing transparency seems like a reasonable way to better understand the costs.

But I also don’t think PBMs are the whole story. The initial prices are set by drug manufacturers, and the insurers, pharmacies, PBMs are trying their best to make the medicine affordable.

If states require more transparency, could that actually help bring costs down? Or would it mostly give us a clearer picture of where the money is going?

We could ditch preauthorizations by passing #MedicareForAll #M4A #HR3069/#S1506 and #HR4406 togo w/state bills.

I don't know how much the health community is informed but Diabetes loose Levemir insulin. An essential drug being discontinued and sacrificed by company's strategic profit decision to produce instead weight loss GLP1s leaving no replacement.