By MIKE STOBBE, Associated Press

NEW YORK (AP) — U.S. health officials have told more than a half-dozen of the nation’s top medical organizations that they will no longer help establish vaccination recommendations.

The government told the organizations on Thursday via email that their experts are being disinvited from the workgroups that have been the backbone of the Advisory Committee on Immunization Practices.

The organizations include the American Medical Association, the American Academy of Pediatrics and the Infectious Diseases Society of America.

“I’m concerned and distressed,” said Dr. William Schaffner, a Vanderbilt University vaccine expert who for decades has been involved with ACIP and its workgroups.

He said the move will likely propel a confusing fragmentation of vaccine guidance, as patients may hear the government say one thing and hear their doctors say another.

One email said the organizations are “special interest groups and therefore are expected to have a ‘bias’ based on their constituency and/or population that they represent.”

A federal health official on Friday confirmed the action, which was first reported by Bloomberg.

The decision was the latest development in what has become a saga involving the ACIP. The committee, created in 1964, makes recommendations to the Centers for Disease Control and Prevention on how vaccines that have been approved by the Food and Drug Administration should be used.

CDC directors have traditionally almost always approved those recommendations, which are widely heeded by doctors and greenlight insurance coverage for shots.

U.S. Health Secretary Robert F. Kennedy Jr. was a leading voice in the anti-vaccine movement before becoming the U.S. government’s top health official, and in June abruptly fired the entire ACIP after accusing them of being too closely aligned with manufacturers. He handpicked replacements that include several vaccine skeptics.

The workgroups typically include not only committee members but also a number of experts from medical and scientific organizations. At workgroup meetings, members evaluate data from vaccine manufacturers and the CDC, and formulate vaccination recommendation proposals to be presented to the full committee.

The structure was created for several reasons, Schaffner said. The professional groups provide input about what might and might not be possible for doctors to implement. And it helped build respect and trust in ACIP recommendations, having the buy-in of respected medical organizations, he said.

Workgroup members are vetted for conflicts of interest, to make sure than no one who had, say, made money from working on a hepatitis vaccine was placed on the hepatitis committee, Schaffner noted.

Also disinvited from the groups were the American Academy of Family Physicians, the American College of Physicians, the American Geriatrics Society, the American Osteopathic Association, the National Medical Association and the National Foundation for Infectious Diseases.

In a joint statement Friday, the AMA and several of the other organizations said: “To remove our deep medical expertise from this vital and once transparent process is irresponsible, dangerous to our nation’s health, and will further undermine public and clinician trust in vaccines.”

They urged the administration to reconsider the move “so we can continue to feel confident in its vaccine recommendations for our patients.”

Some of the professional organizations have criticized Kennedy’s changes to the ACIP, and three of the disinvited groups last month joined a lawsuit against the government over Kennedy’s decision to stop recommending COVID-19 vaccines for most children and pregnant women.

In a social media post Friday, one of the Kennedy-appointed ACIP members — Retsef Levi — wrote that the working groups “will engage experts from even broader set of disciplines!”

Levi, a business management professor, also wrote that working group membership “will be based on merit & expertise — not membership in organizations proven to have (conflicts of interest) and radical & narrow view of public health!”

HHS officials have not said which people are going to be added to the ACIP workgroups.

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.

By Kate Ruder, KFF Health News

More states are passing laws to protect information generated by a person’s brain and nervous system as technology improves the ability to unlock the sensitive details of a person’s health, mental states, emotions and cognitive functioning.

Colorado, California, and Montana are among the states that have recently required safeguarding brain data collected by devices outside of medical settings. That includes headphones, earbuds and other wearable consumer products that aim to improve sleep, focus and aging by measuring electrical activity and sending the data to an app on users’ phones.

A report by the Neurorights Foundation, an advocacy group that aims to protect people from the misuse of neurotechnology, found that 29 of 30 companies with neurotechnology products that can be purchased online have access to brain data and “provide no meaningful limitations to this access.” Almost all of them can share data with third parties.

In June, the American Medical Association called for greater regulation of neural data. In April, several Democratic members of the U.S. Senate Committee on Commerce, Science, and Transportation asked the Federal Trade Commission to investigate whether companies are exploiting consumers’ brain data. Juliana Gruenwald Henderson, a deputy director of the FTC’s Office of Public Affairs, said the agency had received the letter but had no additional comment.

Although current devices gather relatively basic information like sleep states, advocates for brain data protection caution that future technologies, including artificial intelligence, could extract more personal and sensitive information about people’s medical conditions or innermost thoughts.

“If you collect the data today, what can you read from it five years from now because the technology is advancing so quickly?” said Democratic state Sen. Cathy Kipp, who sponsored Colorado’s 2024 neural data protection bill when she was in the state House of Representatives.

As both excitement and trepidation about AI build, at least 28 states and the U.S. Virgin Islands have enacted some type of AI regulation separate from the privacy bills protecting neural data. President Donald Trump’s “One Big Beautiful Bill” included a 10-year halt on states passing laws to regulate AI, but the Senate stripped that provision out of the budget reconciliation bill before voting to approve it on July 1.

The spirit of laws in Colorado, California, and Montana is to protect the neural data itself, not to regulate any algorithm or AI that might use it, said Sean Pauzauskie, medical director for the Neurorights Foundation.

But neurotechnology and AI go hand in hand, Pauzauskie said. “A lot of what these devices promise is based on pattern recognition. AI is really driving the usability and significance of the patterns in the brain data.”

Cristin Welle, a professor of neurosurgery at the University of Colorado School of Medicine, said that AI’s ability to identify patterns is a game changer in her field. “But contribution of a person’s neural data on an AI training set should be voluntary. It should be an opt-in, not a given.”

Chile in 2021 became the first country to adopt a constitutional amendment for neurorights, which prioritize human rights in the development of neurotechnology and collection of neural data, and UNESCO has said that neurotechnology and artificial intelligence could together pose a threat to human identity and autonomy.

Neurotechnology can sound like science fiction. Researchers used a cap with 128 electrodes and an AI model to decode the brain’s electric signals from thoughts into speech. And two years ago, a study described how neuroscientists reconstructed the Pink Floyd song “Another Brick in the Wall” by analyzing the brain signals of 29 epilepsy patients who listened to the song with electrodes implanted in their brains.

The aim is to use neurotechnology to help those with paralysis or speech disabilities, as well as treat or diagnose traumatic brain injuries and brain disorders such as Alzheimer’s or Parkinson’s. Elon Musk’s Neuralink and Synchron, funded by Bill Gates and Jeff Bezos, are among the companies with clinical trials underway for devices implanted in the brain.

Pauzauskie, a hospital neurologist, started worrying four years ago about the blurring of the line between clinical and consumer use of neural data. He noted that the devices used by his epilepsy patients were also available for purchase online, but without protections afforded by the Health Insurance Portability and Accountability Act in medical settings.

Pauzauskie approached Kipp two years ago at a constituent meetup in his hometown of Fort Collins to propose a law to protect brain data in Colorado. “The first words out of her mouth that I’ll never forget were, ‘Who would be against people owning their own brain data?’” he said.

Brain data protection is one of the rare issues that unite lawmakers across the political aisle. The bills in California, Montana, and Colorado passed unanimously or nearly unanimously. Montana’s law will go into effect in October.

Neural data protection laws in Colorado and California amend each state’s general consumer privacy act, while Montana’s law adds to its existing genetic information privacy act. Colorado and Montana require initial express consent to collect or use neural data and separate consent or the ability to opt out before disclosing that data to a third party. A business must provide a way for consumers to delete their data when operating in all three states.

“I want a very hard line in the sand that says, you own this completely,” said Montana state Republican Sen. Daniel Zolnikov, who sponsored his state’s neural data bill and other privacy laws. “You have to give consent. You have the right to have it deleted. You have complete rights over this information.”

For Zolnikov, Montana’s bill is a blueprint for a national neural data protection law, and Pauzauskie said support of regulatory efforts by groups like the AMA pave the way for further federal and state efforts.

Welle agreed that federal regulations are needed in addition to these new state laws. “I absolutely hope that we can come up with something on a national level that can enshrine people’s neural rights into law, because I think this is going to be more important than we can even imagine at this time.”

©2025 KFF Health News. Distributed by Tribune Content Agency, LLC.

By LORNE COOK and JOHN LEICESTER

BRUSSELS (AP) — President Donald Trump’s administration says it is weighing what to do with family planning supplies stockpiled in Europe that campaigners and two U.S. senators are fighting to save from destruction.

Concerns that the Trump administration plans to incinerate the stockpile have angered family planning advocates on both sides of the Atlantic. Campaigners say the supplies stored in a U.S.-funded warehouse in Geel, Belgium, include contraceptive pills, contraceptive implants and IUDs that could spare women in war zones and elsewhere the hardship of unwanted pregnancies.

U.S. State Department deputy spokesman Tommy Pigott said Thursday in response to a question about the contraceptives that “we’re still in the process here in terms of determining the way forward.”

“When we have an update, we’ll provide it,” he said.

Belgium says it has been talking with U.S. diplomats about trying to spare the supplies from destruction, including possibly moving them out of the warehouse. Foreign Ministry spokesperson Florinda Baleci told The Associated Press that she couldn’t comment further “to avoid influencing the outcome of the discussions.”

The Trump administration’s dismantling of the U.S. Agency for International Development, which managed foreign aid programs, left the supplies’ fate uncertain.

Pigott didn’t detail the types of contraceptives that make up the stockpile. He said some of the supplies, bought by the previous administration, could “potentially be” drugs designed to induce abortions. Pigott didn’t detail how that might impact Trump administration thinking about how to deal with the drugs or the entire stockpile.

Costing more than $9 million and funded by U.S taxpayers, the family planning supplies were intended for women in war zones, refugee camps and elsewhere, according to a bipartisan letter of protest to U.S. Secretary of State Marco Rubio from U.S. senators Jeanne Shaheen, a New Hampshire Democrat, and Alaska Republican Lisa Murkowski.

They said destroying the stockpile “would be a waste of U.S. taxpayer dollars as well as an abdication of U.S. global leadership in preventing unintended pregnancies, unsafe abortions and maternal deaths — key goals of U.S. foreign assistance.”

They urged Rubio to allow another country or partner to distribute the contraceptives.

Concerns voiced by European campaigners and lawmakers that the supplies could be transported to France for incineration have led to mounting pressure on government officials to intervene and save them.

The executive branch of the European Union, through spokesman Guillaume Mercier, said Friday that “we continue to monitor the situation closely to explore the most effective solutions.”

The U.S. branch of family planning aid group MSI Reproductive Choices said it offered to purchase, repackage and distribute the stock at its own expense but “these efforts were repeatedly rejected.” The group said the supplies included long-acting IUDs, contraceptive implants and pills, and that they have long shelf-lives, extending as far as 2031.

Aid group Doctors Without Borders said incineration would be “an intentionally reckless and harmful act against women and girls everywhere.”

Charles Dallara, the grandson of a French former lawmaker who was a contraception pioneer in France, urged President Emmanuel Macron to not let France “become an accomplice to this scandal.”

“Do not allow France to take part in the destruction of essential health tools for millions of women,” Dallara wrote in an appeal to the French leader. “We have a moral and historical responsibility.”

Leicester reported from Paris. Matthew Lee contributed from Washington, D.C.

By MATTHEW PERRONE, AP Health Writer

WASHINGTON (AP) — The Food and Drug Administration’s polarizing vaccine chief is leaving the agency after a brief tenure that drew the ire of biotech executives, patient groups and conservative allies of President Donald Trump.

Dr. Vinay Prasad “did not want to be a distraction” and was stepping down from his role as the FDA’s top vaccine regulator “to spend more time with his family,” a spokesperson for the Department of Health and Human Services said in a statement late Tuesday.

Two people familiar with the situation told The Associated Press that Prasad was ousted following several recent controversies. The people spoke on condition of anonymity to discuss internal personnel matters. Prasad did not immediately respond to requests for comment Wednesday morning.

Prasad joined the FDA in May after years as an academic researcher at the University of California San Francisco, where he frequently criticized the FDA’s approach to drug approvals and COVID-19 vaccines.

His contrarian approach appeared to match FDA Commissioner Marty Makary, who repeatedly praised Prasad’s work and intellect.

But in recent weeks Prasad became a target of right-wing activists, including Laura Loomer, who flagged Prasad’s past statements criticizing Trump and praising liberal independent Senator Bernie Sanders.

“How did this Trump-hating Bernie Bro get into the Trump admin???” Loomer posted on X last week.

Trump previously fired several national security officials a day after Loomer raised concerns about their loyalty.

Prasad also attracted scrutiny for his handling of a recent safety issue surrounding the only approved gene therapy for Duchenne’s muscular dystrophy.

Under his direction, shipments of the therapy were briefly halted after a series of patient deaths, then resumed late Monday following vocal pushback from families of boys with the fatal muscle-wasting disorder.

Prasad has long been skeptical of the therapy and other muscular dystrophy drugs sold by the drugmaker, Sarepta Therapeutics. As an academic, Prasad gained prominence by attacking the FDA for being too lenient in its standards for approving cancer drugs and other new therapies.

That approach is at odds with Trump’s Republican supporters, who generally favor speedier approvals and unfettered access to experimental treatments. During Trump’s first term he signed the “ Right to Try ” law, a largely symbolic piece of legislation that won popular support from conservatives seeking to give dying patients expanded access to unproven drugs.

Prasad’s decision to pause Sarepta’s therapy was criticized last week by a columnist and the editorial board of The Wall Street Journal.

Separately, Prasad’s division issued rejection letters this month to three small biotech firms seeking approval for new gene therapies.

Those therapies have been vigorously embraced many of the anti-abortion groups in Trump’s base for their potential to address intractable diseases that sometimes lead parents to terminate pregnancies.

Prasad’s predecessor in the role, Dr. Peter Marks, oversaw a dramatic rise in approvals for new gene therapies, which aim to treat or prevent disease by replacing or modifying a portion of patients’ genetic code.

Prasad has been an outspoken critic of Marks’ leadership at FDA, which included overseeing the approval of the first COVID vaccines and therapies.

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.

By JOCELYN GECKER, Associated Press

As artificial intelligence technology becomes part of daily life, adolescents are turning to chatbots for advice, guidance and conversation. The appeal is clear: Chatbots are patient, never judgmental, supportive and always available.

That worries experts who say the booming AI industry is largely unregulated and that many parents have no idea about how their kids are using AI tools or the extent of personal information they are sharing with chatbots.

New research shows more than 70% of American teenagers have used AI companions and more than half converse with them regularly. The study by Common Sense Media focused on “AI companions,” like Character. AI, Nomi and Replika, which it defines as “digital friends or characters you can text or talk with whenever you want,” versus AI assistants or tools like ChatGPT, though it notes they can be used the same way.

It’s important that parents understand the technology. Experts suggest some things parents can do to help protect their kids:

— Start a conversation, without judgment, says Michael Robb, head researcher at Common Sense Media. Approach your teen with curiosity and basic questions: “Have you heard of AI companions?” “Do you use apps that talk to you like a friend?” Listen and understand what appeals to your teen before being dismissive or saying you’re worried about it.

— Help teens recognize that AI companions are programmed to be agreeable and validating. Explain that’s not how real relationships work and that real friends with their own points of view can help navigate difficult situations in ways that AI companions cannot.

“One of the things that’s really concerning is not only what’s happening on screen but how much time it’s taking kids away from relationships in real life,” says Mitch Prinstein, chief of psychology at the American Psychological Association. “We need to teach kids that this is a form of entertainment. It’s not real, and it’s really important they distinguish it from reality and should not have it replace relationships in your actual life.”

The APA recently put out a health advisory on AI and adolescent well-being, and tips for parents.

— Parents should watch for signs of unhealthy attachments.

“If your teen is preferring AI interactions over real relationships or spending hours talking to AI companions, or showing that they are becoming emotionally distressed when separated from them — those are patterns that suggest AI companions might be replacing rather than complementing human connection,” Robb says.

— Parents can set rules about AI use, just like they do for screen time and social media. Have discussions about when and how AI tools can and cannot be used. Many AI companions are designed for adult use and can mimic romantic, intimate and role-playing scenarios.

While AI companions may feel supportive, children should understand the tools are not equipped to handle a real crisis or provide genuine mental health support. If kids are struggling with depression, anxiety, loneliness, an eating disorder or other mental health challenges, they need human support — whether it is family, friends or a mental health professional.

— Get informed. The more parents know about AI, the better. “I don’t think people quite get what AI can do, how many teens are using it and why it’s starting to get a little scary,” says Prinstein, one of many experts calling for regulations to ensure safety guardrails for children. “A lot of us throw our hands up and say, ‘I don’t know what this is!’ This sounds crazy!’ Unfortunately, that tells kids if you have a problem with this, don’t come to me because I am going to diminish it and belittle it.”

Older teenagers have advice, too, for parents and kids. Banning AI tools is not a solution because the technology is becoming ubiquitous, says Ganesh Nair, 18.

“Trying not to use AI is like trying to not use social media today. It is too ingrained in everything we do,” says Nair, who is trying to step back from using AI companions after seeing them affect real-life friendships in his high school. “The best way you can try to regulate it is to embrace being challenged.”

“Anything that is difficult, AI can make easy. But that is a problem,” says Nair. “Actively seek out challenges, whether academic or personal. If you fall for the idea that easier is better, then you are the most vulnerable to being absorbed into this newly artificial world.”

The Associated Press’ education coverage receives financial support from multiple private foundations. AP is solely responsible for all content. Find AP’s standards for working with philanthropies, a list of supporters and funded coverage areas at AP.org.

By JOCELYN GECKER, Associated Press

No question is too small when Kayla Chege, a high school student in Kansas, is using artificial intelligence.

The 15-year-old asks ChatGPT for guidance on back-to-school shopping, makeup colors, low-calorie choices at Smoothie King, plus ideas for her Sweet 16 and her younger sister’s birthday party.

The sophomore honors student makes a point not to have chatbots do her homework and tries to limit her interactions to mundane questions. But in interviews with The Associated Press and a new study, teenagers say they are increasingly interacting with AI as if it were a companion, capable of providing advice and friendship.

“Everyone uses AI for everything now. It’s really taking over,” said Chege, who wonders how AI tools will affect her generation. “I think kids use AI to get out of thinking.”

For the past couple of years, concerns about cheating at school have dominated the conversation around kids and AI. But artificial intelligence is playing a much larger role in many of their lives. AI, teens say, has become a go-to source for personal advice, emotional support, everyday decision-making and problem-solving.

‘AI is always available. It never gets bored with you’

More than 70% of teens have used AI companions and half use them regularly, according to a new study from Common Sense Media, a group that studies and advocates for using screens and digital media sensibly.

The study defines AI companions as platforms designed to serve as “digital friends,” like Character. AI or Replika, which can be customized with specific traits or personalities and can offer emotional support, companionship and conversations that can feel human-like. But popular sites like ChatGPT and Claude, which mainly answer questions, are being used in the same way, the researchers say.

As the technology rapidly gets more sophisticated, teenagers and experts worry about AI’s potential to redefine human relationships and exacerbate crises of loneliness and youth mental health.

“AI is always available. It never gets bored with you. It’s never judgmental,” says Ganesh Nair, an 18-year-old in Arkansas. “When you’re talking to AI, you are always right. You’re always interesting. You are always emotionally justified.”

All that used to be appealing, but as Nair heads to college this fall, he wants to step back from using AI. Nair got spooked after a high school friend who relied on an “AI companion” for heart-to-heart conversations with his girlfriend later had the chatbot write the breakup text ending his two-year relationship.

“That felt a little bit dystopian, that a computer generated the end to a real relationship,” said Nair. “It’s almost like we are allowing computers to replace our relationships with people.”

How many teens are using AI? New study stuns researchers

In the Common Sense Media survey, 31% of teens said their conversations with AI companions were “as satisfying or more satisfying” than talking with real friends. Even though half of teens said they distrust AI’s advice, 33% had discussed serious or important issues with AI instead of real people.

Those findings are worrisome, says Michael Robb, the study’s lead author and head researcher at Common Sense, and should send a warning to parents, teachers and policymakers. The now-booming and largely unregulated AI industry is becoming as integrated with adolescence as smartphones and social media are.

“It’s eye-opening,” said Robb. “When we set out to do this survey, we had no understanding of how many kids are actually using AI companions.” The study polled more than 1,000 teens nationwide in April and May.

Adolescence is a critical time for developing identity, social skills and independence, Robb said, and AI companions should complement — not replace — real-world interactions.

“If teens are developing social skills on AI platforms where they are constantly being validated, not being challenged, not learning to read social cues or understand somebody else’s perspective, they are not going to be adequately prepared in the real world,” he said.

The nonprofit analyzed several popular AI companions in a “ risk assessment,” finding ineffective age restrictions and that the platforms can produce sexual material, give dangerous advice and offer harmful content. The group recommends that minors not use AI companions.

A concerning trend to teens and adults alike

Researchers and educators worry about the cognitive costs for youth who rely heavily on AI, especially in their creativity, critical thinking and social skills. The potential dangers of children forming relationships with chatbots gained national attention last year when a 14-year-old Florida boy died by suicide after developing an emotional attachment to a Character. AI chatbot.

“Parents really have no idea this is happening,” said Eva Telzer, a psychology and neuroscience professor at the University of North Carolina at Chapel Hill. “All of us are struck by how quickly this blew up.” Telzer is leading multiple studies on youth and AI, a new research area with limited data.

Telzer’s research has found that children as young as 8 are using generative AI and also found that teens are using AI to explore their sexuality and for companionship. In focus groups, Telzer found that one of the top apps teens frequent is SpicyChat AI, a free role-playing app intended for adults.

Many teens also say they use chatbots to write emails or messages to strike the right tone in sensitive situations.

“One of the concerns that comes up is that they no longer have trust in themselves to make a decision,” said Telzer. “They need feedback from AI before feeling like they can check off the box that an idea is OK or not.”

Arkansas teen Bruce Perry, 17, says he relates to that and relies on AI tools to craft outlines and proofread essays for his English class.

“If you tell me to plan out an essay, I would think of going to ChatGPT before getting out a pencil,” Perry said. He uses AI daily and has asked chatbots for advice in social situations, to help him decide what to wear and to write emails to teachers, saying AI articulates his thoughts faster.

Perry says he feels fortunate that AI companions were not around when he was younger.

“I’m worried that kids could get lost in this,” Perry said. “I could see a kid that grows up with AI not seeing a reason to go to the park or try to make a friend.”

Other teens agree, saying the issues with AI and its effect on children’s mental health are different from those of social media.

“Social media complemented the need people have to be seen, to be known, to meet new people,” Nair said. “I think AI complements another need that runs a lot deeper — our need for attachment and our need to feel emotions. It feeds off of that.”

“It’s the new addiction,” Nair added. “That’s how I see it.”

The Associated Press’ education coverage receives financial support from multiple private foundations. AP is solely responsible for all content. Find AP’s standards for working with philanthropies, a list of supporters and funded coverage areas at AP.org.

By Owen McCarthy, The Detroit News

The National Weather Service has issued an extreme heat advisory throughout Metro Detroit for Thursday as persistent high temperatures and humidity in the southeastern United States are expected to briefly creep into Michigan.

The advisory is in effect from 11 a.m. until 8 p.m. for the entire southeast Michigan region, the weather service said.

It covers the following counties in Metro Detroit: Midland, Bay, Huron, Saginaw, Tuscola, Sanilac, Shiawassee, Genesee, Lapeer, St. Clair, Livingston, Oakland, Macomb, Washtenaw, Wayne, Lenawee and Monroe.

Temperatures are expected to climb into the 90s, said NWS Detroit meteorologist Bryan Tilley, and high humidity is expected to push the heat index to 101 — crossing the threshold for a heat advisory.

The mercury is expected to drop in the evening, he added, with “pretty good chances of thunderstorms” additionally cooling things off.

Then, late tonight and into early Friday, “there’s a front coming through that pushes all that humidity down south of the Michigan border,” Tilley said. “Generally speaking, the heat will be more persistent in the south central and southeast U.S., but it only is pushing into lower Michigan for about 24 hours.”

The temperatures in the 90s are especially high for July in southeast Michigan. They outpace the average 83.7 degrees for the middle summer month in southeast Michigan, according to the National Weather Service.

The weather service advises people to limit time outdoors and keep the air conditioning on. If you must be outside, NWS recommends wearing light clothes and staying hydrated.

Pontiac is offering the Robert Bowens Senior Center at 52 Bagley Street as a cooling center from 8 a.m. until 8 p.m. Farmington Hills

The extreme heat could strain the state’s utilities, with many likely to crank up the A.C.

DTE Energy says it’s prepared, though.

“When we experience extreme, sustained temperatures in the 90s or more like what we’re seeing this week, our electric system feels the pressure, too,” said DTE Senior Communications Strategist Cindy Hecht. “Periods of extreme heat can also be followed by stormy weather including high winds, which can lead to power outages.

“DTE works hard year-round to prepare the system to withstand severe weather events and has teams ready to respond quickly and safely should customers be affected by this week’s weather.”

The post Detroit Evening Report: Detroit grassroots coalition working to reduce truck traffic on residential streets appeared first on WDET 101.9 FM.

By Jordan Rau and Irena Hwang, KFF Health News

Rehab hospitals that help people recover from major surgeries and injuries have become a highly lucrative slice of the health care business. But federal data and inspection reports show that some run by the dominant company, Encompass Health Corp., and other for-profit corporations have had rare but serious incidents of patient harm and perform below average on two key safety measures tracked by Medicare.

Yet even when inspections reveal grave cases of injury, federal health officials do not inform consumers or impose fines the way they do for nursing homes. And Medicare doesn’t provide easy-to-understand five-star ratings as it does for general hospitals.

In the most serious problems documented by regulators, rehab hospital errors involved patient deaths.

In Encompass Health’s hospital in Huntington, West Virginia, Elizabeth VanBibber, 73, was fatally poisoned by a carbon monoxide leak during construction at the facility.

At its hospital in Jackson, Tennessee, a patient, 68, was found dead overnight, lying on the floor in a “pool of blood” after an alarm that was supposed to alert nurses that he had gotten out of bed had been turned off.

In its hospital in Sioux Falls, South Dakota, a nurse gave Frederick Roufs, 73, the wrong drug, one of 26 medication errors the hospital made over six months. He died two days later at another hospital.

“I can still see Fred laying in the bed as they shut each little machine off,” said his widow, Susan Roufs. “They clicked four of them, and then the love of my life was gone.”

Encompass, which owns 168 hospitals and admitted 248,000 patients last year, has led the transformation of this niche industry. In 2023, stand-alone for-profit medical rehabilitation hospitals overtook nonprofits as the places where the majority of annual patient admissions occur, a KFF Health News and New York Times analysis found. A third of all admissions were to Encompass hospitals. Such facilities are required to provide three hours of therapy a day, five days a week.

Across the nation, there are now nearly 400 stand-alone rehab hospitals, the bulk of which are for-profit. These hospitals collectively generate profits of 10%, more than general hospitals, which earn about 6%, and far more than skilled nursing homes, which make less than 0.5%, according to the most recent data from the Medicare Payment Advisory Commission, an independent congressional agency.

At the same time, the number of small, specialized units within acute care hospitals — where most rehab used to be provided — has dwindled. There are now around 800 of those, and most are nonprofits.

In its latest annual report, Encompass, which is publicly traded, reported an 11% net profit in 2024, earning $597 million last year on revenues of $5.4 billion.

Federal data on the performance of about 1,100 of the rehab facilities show Encompass tends to be better at helping most patients return home and remain there. In a two-year period ending in September 2023, Medicare rated 233 rehab facilities as performing better than the national rate for this major metric, called “discharge to community.” Most rehabs with better community discharge rates are for-profit, and Encompass owns 79 of them.

But data from Medicare also reveals Encompass owns many of the rehabs with worse rates of potentially preventable, unplanned readmissions to general hospitals. Medicare evaluates how often patients are rehospitalized for conditions that might have been averted with proper care, including infections, bedsores, dehydration, and kidney failures.

Encompass accounts for about 1 in 7 rehab facilities nationally, but owned 34 of the 41 inpatient rehab facilities that Medicare rated as having statistically significantly worse rates of potentially preventable readmissions for discharged patients. (Overall, rates of readmission after discharge ranged from 7% to 12%, with a median of 9%.)

And it owned 28 of the 87 rehab facilities — 65 of which were for-profit — that had worse rates of potentially preventable readmissions to general hospitals during patient stays. (The median for these kinds of readmissions was 5%, and rates for individual rehabs ranged from 3% to 9%.)

Patrick Darby, the executive vice president and general counsel of Encompass, strongly defended the company’s record in written responses to questions. He dismissed Medicare’s readmissions ratings of “better,” “worse,” and “no different than the national rate” as “a crude scoring measure” and said “performance is so similar across the board.” He called the violations found during health inspections “rare occurrences” that “do not support an inference of widespread quality concerns.”

“The simplest and most accurate reason for EHC’s success is that our hospitals provide superior care to patients,” he said, referring to Encompass by its corporate initials.

Chih-Ying Li, an associate professor of occupational therapy at the University of Texas Medical Branch at Galveston School of Health Professions, said in an interview that a research study she conducted found the profit status of a rehab facility was the only characteristic associated with higher unplanned readmissions.

“The finding is pretty robust,” she said. “It’s not like huge, huge differences, but there are differences.”

Alarming Mistakes

VanBibber was admitted to Encompass’ Huntington hospital in 2021 for therapy to strengthen her lungs. At the time, the hospital was undergoing a $3 million expansion, and state regulators had warned the company that areas of the hospital occupied by patients had to be isolated from the construction “using airtight barriers,” according to a health inspection report.

In her room, which was about 66 feet from the construction zone, she began having trouble breathing, the report said. When she told the staff, they ignored her and shut her door, according to a lawsuit brought by her estate. Staff members eventually noticed that she was “lethargic and gasping for air,” and called 911.

When the emergency medical squad arrived, the carbon monoxide detectors they wore sounded. By that time, VanBibber’s blood oxygen levels were dangerously low, the inspection report said. She died three days later from respiratory failure and carbon monoxide poisoning, according to the inspection report and the lawsuit. A plumber had been using a gas-powered saw in the construction area, but there were no carbon monoxide detectors in the hallways, the report said.

In court papers, Encompass and its construction contractors denied negligence for VanBibber’s death. The case is pending.

Inspectors determined Encompass failed to maintain a safe environment for all patients during construction and didn’t properly evaluate other patients for signs of poisoning, the report said.

Since 2021, the federal Centers for Medicare and Medicaid Services, or CMS, which oversees health inspections, has found that 10 Encompass hospitals, including the one that cared for VanBibber, had immediate jeopardy violations, federal records show. Such violations — like the ones that Medicare also found in connection with the deaths of Roufs and the patient who fell after leaving his bed — mean a hospital’s failure to comply with federal rules has put patients at risk for serious injury, serious harm, serious impairment, or death.

Darby, the general counsel for Encompass, said the company regretted any clinical problems and had promptly addressed all such findings to the satisfaction of inspectors. He said Encompass that has an “excellent compliance record,” including superior results from its accreditation agency, and that its overall number of health citations was tiny given how many hospitals Encompass owns and how many patients it treats.

Six other corporate-operated for-profit hospitals were also cited, while none of the 31 stand-alone nonprofit rehab hospitals received such violations from 2021 to 2024. (Inspection reports for general hospitals do not systematically specify in which part of the building a violation occurred, so rehab unit violations cannot be identified.)

An alert called a bed alarm was at the root of immediate jeopardies at Encompass hospitals in Morgantown, West Virginia, and Jackson, Tennessee. The devices are pressure- and motion-sensitive and emit a sound and display a light to alert staff members that someone at a high risk of falls has left his or her bed.

In its Morgantown hospital, a nurse technician discovered a patient face down on the floor with a large gash on her head after a defective alarm did not go off, an inspection report said. After she died, the nurse told inspectors: “We are having a lot of problems with the bed alarms.”

Medicare is not authorized by law to fine rehab hospitals for safety rule violations, even ones involving deaths uncovered during inspections, as it has done with nearly 8,000 nursing homes during the last three years, imposing average fines of about $28,000.

The only option is to entirely cut off a rehab hospital’s reimbursement for all services by Medicare and Medicaid, which cover most patients. That step would most likely put it out of business and is almost never used because of its draconian consequences.

“Termination is typically a last resort after working with the provider to come back into compliance,” Catherine Howden, a CMS spokesperson, said in an email.

As a result, because there’s no graduated penalty, even the most serious — and rare — immediate jeopardy violations effectively carry no punishments so long as the hospital puts steps in place to avert future problems.

“Only having a nuclear weapon has really hurt patient safety,” said Michael Millenson, a medical quality advocate.

One immediate jeopardy incident did result in a punishment, but only because the hospital was in California, which allows its health department to issue penalties. Encompass’ Bakersfield hospital paid a $75,000 fine last year for failing to control the blood sugar of a patient who died after her heart stopped.

Rapid Growth and a Troubled History

Encompass has accelerated its expansion in recent years and now operates in 38 states and Puerto Rico. It plans to open 17 more hospitals in Arizona, Connecticut, Florida, Georgia, Maine, Pennsylvania, South Carolina, Texas, and Utah by the end of 2027, according to its latest report.

It frequently moves into new markets by persuading local nonprofit hospitals to shutter their rehab units in exchange for an equity stake in a newly built Encompass hospital, company executives have told investors.

The president of Encompass, Mark Tarr, calls it a “win-win proposition”: The local hospitals can use their emptied space for a more lucrative line of service and Encompass gets a “jump start” into a new market, with partner hospitals often referring patients.

Tarr, who was paid $9.3 million in compensation last year, told investors that Encompass requires that the existing hospitals sign a noncompete deal. Sixty-seven Encompass hospitals are joint ventures, mostly with nonprofit hospitals as investors, according to the company’s June financial filing, the most recent available.

Darby said the company’s profits allow it to build hospitals in areas that lack intensive inpatient rehabilitation and improve existing hospitals. “High-quality patient care is not only consistent with shareholder return, but quality and shareholder return are in fact critical to one another,” he said.

The success of Encompass is particularly notable given that it barely survived what experts said was one of the largest modern accounting scandals in 2003.

The Securities and Exchange Commission charged that the company, then known as HealthSouth, overstated earnings by $2.7 billion to meet Wall Street analyst quarterly expectations, leading to the ouster of its founder and directors. In 2004, the company agreed to pay the government $325 million to settle Medicare fraud allegations without admitting wrongdoing. Darby credited the company’s new leaders for obtaining a $2.9 billion judgment on behalf of shareholders against the company’s founder.

The company changed its name to Encompass in 2018 after acquiring Encompass Home Health and Hospice. In 2019, the Justice Department announced the company had agreed to pay$48 million to settle whistleblower lawsuit claims that it misdiagnosed patients to get higher Medicare reimbursements, and admitted patients who were too sick to benefit from therapy. The company denied any wrongdoing, blaming independent physicians who worked at its hospitals. Darby said Encompass settled the case only to “avoid more years of expense and disruption.” He said the Justice Department never filed a lawsuit despite years of investigation.

Medication Harms

Rehab hospital inspection reports are not posted on Care Compare, Medicare’s online search tool for consumers. KFF Health News had to sue CMS under the Freedom of Information Act to obtain all its inspection reports for rehab hospitals. In contrast, Care Compare publishes all nursing home inspection reports and assigns each facility a star rating for its adherence to health and safety rules.

So people now choosing a rehab hospital would not know that at the Encompass hospital in Sioux Falls, South Dakota, in 2021, a nurse accidentally gave Roufs a blood pressure drug called hydralazine instead of hydroxyzine, his prescribed anti-anxiety medication, according to an inspection report. Roufs went into cardiac arrest. This type of error, called a“look-alike/sound-alike,” is one hospitals and staff members are supposed to be especially alert to.

Months before, an internal safety committee had identified a trend of medication errors, including when a nurse accidentally gave a patient 10 times the prescribed amount of insulin, sending him to the hospital, the inspection report said. The nurse had misread four units as 40. Since Roufs’s death, inspectors have faulted the hospital six times for various lapses, most recently in April 2024 for improper wound care.

An Encompass hospital in Texarkana, Texas, misused antipsychotic medications to pacify patients, resulting in an immediate jeopardy finding from CMS, the report said. And the company’s hospital in Erie, Pennsylvania, was issued an immediate jeopardy violation for not keeping track of medication orders in 2023, when a patient had a cardiac arrest after not receiving all of his drugs, according to the inspection report.

The federal government’s overall quality oversight efforts are limited. Medicare docks payment to rehab facilities for patients readmitted to a general hospital during shorter-than-average rehab stays, but unlike at general hospitals, there are no financial penalties when recently discharged rehab patients are hospitalized for critical health issues.

The Biden administration announced last year it intended to develop a rating scale of 1 to 5 stars for rehab facilities. The industry’s trade association, the American Medical Rehabilitation Providers Association, requested a delay in the creation of star ratings until the current quality measures were refined. The Trump administration has not determined whether it will continue the effort to rate rehab facilities, according to a CMS spokesperson.

Deadly Bedsores

The family of Paul Webb Jr., 74, claimed in a lawsuit that the Encompass hospital in Erie left Webb unattended in a wheelchair for hours at a time, putting pressure on his tailbone, in 2021. His medical records, provided to reporters by the family, list a sitting tolerance of one hour.

Webb — who had been originally hospitalized after a brain bleed, a type of stroke — developed skin damage known as a pressure sore, or bedsore, on his bottom, the lawsuit said. The suit said the sore worsened after he was sent to a nursing home, which the family is also suing, then home, and he died later that year. In his final weeks, Webb was unable to stand, sit, or move much because of the injury, the lawsuit said.

In court papers, Encompass and the nursing home denied negligence, as Encompass has in some other pending and closed lawsuits that accused it of failing to prevent pressure sores because nurses and aides failed to regularly reposition patients, or notice and treat emerging sores. Darby said Webb’s death occurred three months after his Encompass stay and was not related to his care at Encompass. He said no hospital with long-term patients could prevent every new or worsening pressure sore, but that Encompass’ rates were similar to the 1% national average.

One of Webb’s sons, Darel Webb, recalled a warning given to the family as they left an appointment their father had with wound specialists: A doctor brought up Christopher Reeve, the actor who played Superman in movies in the 1970s and 1980s.

“He goes, ‘Remember, Superman was paralyzed from falling off the horse, but he died from a bedsore,’” he said.

____

Jordan Rau has been writing about hospital safety since 2008. Irena Hwang is a New York Times data reporter who uses computational tools to uncover hidden stories and illuminate the news.

____

METHODOLOGY

To examine the medical rehabilitation hospital industry, we obtained and analyzed a database of inspection reports of freestanding rehabilitation hospitals from the federal Centers for Medicare & Medicaid Services, or CMS. We also obtained inspection reports from several states through public records requests.

We analyzed inpatient rehabilitation facility characteristics and patient volume data contained in hospital data files from the Rand Corp., a nonprofit research organization. This dataset compiles cost reports all hospitals submit each year to CMS. For each facility for the years 2012 to 2023, we categorized annual discharges by facility type (freestanding rehabilitation hospital or unit within an acute care hospital); facility ownership status (for-profit, nonprofit, or government); and which hospitals were owned by Encompass Health under its current or prior name, HealthSouth.

Financial information about Encompass Health was obtained from the company’s Securities and Exchange Commission disclosure filings.

We examined the readmission rates for all inpatient rehabilitation facilities that CMS publishes in its quality data. CMS evaluates the frequency with which Medicare patients were readmitted for potentially preventable reasons to an acute care hospital during their rehab stay. Separately, CMS also evaluates the frequency of potentially preventable readmissions to an acute care hospital within 30 days of discharge from rehab. We also examined the rate of successful return to home or community. Figures for all three metrics were available for about 1,100 of the roughly 1,200 rehab facilities in the CMS data. The most recent readmission data covered Medicare discharges from October 2021 through September 2023.

We examined nursing home penalties from the last three years from CMS’ data on nursing homes.

©2025 KFF Health News. Distributed by Tribune Content Agency, LLC.

By Shalina Chatlani, Stateline.org

States must begin verifying millions of Medicaid enrollees’ monthly work status by the end of next year — a task some critics say states will have a hard time carrying out.

A provision in the tax and spending bill President Donald Trump signed into law July 4 will require the 40 states plus Washington, D.C., that have expanded Medicaid to check paperwork at least twice a year to ensure those enrollees are volunteering or working at least 80 hours a month or attending school at least half time.

The new law provides states $200 million for fiscal year 2026 to get their systems up and running. But some experts say states will have difficulty meeting the deadline with that funding and worry enrollees might lose their health benefits as a result.

A year and a half to comply is likely not going to be enough time for most states, especially since the federal government must craft guidance on how they should implement their programs, said Dr. Benjamin Sommers, a health economist at Harvard T.H. Chan School of Public Health. He predicted it will be difficult to create technology simple enough — such as a phone app — to streamline the process for all enrollees.

“Two hundred million [dollars] is not going to cover the 40 expansion states that we have,” he told Stateline. “There is not a silver bullet here, and there isn’t a single app out there that’s going to keep people who should be in Medicaid from losing coverage. That’s just not realistic.”

A spokesperson for the North Carolina Department of Health and Human Services, Hannah Jones, told Stateline that “it will take a significant amount of time and investment in order to implement work requirements.”

Jones said an estimated 255,000 people in North Carolina could lose coverage because of these requirements and their “administrative burden.”

“More automation reduces manual work on beneficiaries and eligibility case workers, but it requires more time, funding, and staff resources to implement,” Jones wrote in an email.

Emma Herrock, a spokesperson for the Louisiana Department of Health, wrote in an email that the vast majority of the state’s Medicaid enrollees already work, and the agency expects few people to be disenrolled. Herrock said the department will establish work verification systems by the end of 2026.

“The department is taking a thoughtful approach to implementation,” Herrock wrote. “We are already working with several Louisiana agencies … in order to receive data on recipients who are working.”

She added that the department views work requirements “as a means to grow our economy, while reinforcing the value of work and self-sufficiency.”

In New York, it could cost the state $500 million to administer the new requirements, New York Department of Health spokesperson Danielle De Souza wrote in an email.

Between 600,000 and 1.1 million individuals who are eligible for and enrolled in Medicaid could potentially lose coverage because of work reporting requirements, she wrote, based on what happened when states were required to resume checking eligibility after the COVID-19 health emergency ended.

“The department will remain steadfast in its commitment to protecting the health of all New Yorkers and will work to mitigate the impacts of this law,” De Souza wrote.

The new rules apply to states that expanded Medicaid to adults between the ages of 19 and 64 with incomes below 138% of the federal poverty line (about $22,000 for an individual), an option that was made available under the 2010 Affordable Care Act. More than 20 million people were enrolled through Medicaid expansion as of June 2024 — those are the patients who will face work requirements.

Reapplying for Medicaid, which typically has been required once a year, already is burdensome for some patients, said Dr. Bobby Mukkamala, president of the American Medical Association.

“On top of that, now we’re going to be challenging so many people who were at least able to deal with it financially with things like … proving that they got a job,” Mukkamala said in an interview.

Previous attempts at implementing work requirements have ended up costing states millions in administrative and consulting fees. And in some cases, people who were eligible for Medicaid lost their coverage due to paperwork issues.

Arkansas’ example

Several states wanted to implement work requirements during the first Trump administration. But only Arkansas fully did so, in 2018, before a federal judge halted the requirements. More than 18,000 Arkansas residents lost Medicaid coverage during the 10 months the requirements were in effect.

Sommers, of Harvard, noted that most people were disenrolled because they didn’t know about the policy or made paperwork errors, not because they weren’t working.

“Red tape led to people losing their coverage,” he said. “They had more trouble affording their medications. They were putting off needed care.”

Brian Blase, president of the Paragon Health Institute, a conservative policy group that advises congressional Republicans, said he thinks concerns about the new requirements are overblown because there’s more advanced technology now.

“Lots of government programs have initial implementation challenges,” Blase told Stateline. “Arkansas was seven years ago, and if you just think about the change in the technological advancements over the past seven years … we didn’t have artificial intelligence and just the ability of modern tech.”

As it stands, each state has varying technological capabilities, and will have a different timeline and budget, said Michael Heifetz, a managing director at consulting firm Alvarez & Marsal and a former Medicaid director in Wisconsin. His team contracts with states to implement Medicaid, including work requirements, and other programs.

He also noted that the Trump administration can give states a deadline extension on implementing work requirements to Dec. 31, 2028, if they show they are making a “good faith effort.” States will need to share data across agencies in new ways, he said.

“It will require some form of data sharing and communications with educational agencies, workforce training agencies and some other agencies that typically aren’t in the Medicaid ecosystem,” Heifetz said.

State governments may resist hiring full-time positions for those tasks, he said, but “artificial intelligence and other tools can help work through these processes in a smoother fashion.”

Other state efforts

Efforts in other states to implement work requirements have had mixed results.

In Georgia, for example, an experimental work requirement program cost taxpayers more than $86 million in its first 18 months but enrolled just 6,500 people during that time, according to an investigation by ProPublica and The Current published in February. That’s 75% fewer participants than the state had estimated for the program’s first year.

The nonpartisan U.S. Government Accountability Office in 2019 looked at five states that tested systems to track Medicaid work requirements under the first Trump administration. Those demonstration projects were rescinded during the Biden administration.

The states estimated their projected administrative costs for implementing work requirements for one to three years, and the total far surpassed the $200 million Congress has provided in the new law. Kentucky alone estimated $270 million, Wisconsin $70 million, Indiana $35 million, Arkansas $26 million and New Hampshire $6 million.

Susan Barnidge, an assistant director on the GAO health care team and an author of the report, said the agency found that across states there wasn’t much federal oversight of administrative costs on test programs. Oversight will be key as states roll out their work requirement systems, she said.

“We found some weaknesses in [federal] Centers for Medicare & Medicaid oversight of certain federal funding for certain administrative activities. So we found examples of things that states sought federal funding for that didn’t appear to be allowable,” Barnidge said in an interview. “I think that will remain relevant.”

Mukkamala, of the American Medical Association, said the burden will in some ways fall to doctors’ offices to help keep patients enrolled, as they work with patients to check eligibility and possibly help get them on Medicaid. He works in Flint, Michigan, as an otolaryngologist, or ear, nose and throat doctor, and said a third of his patients are on Medicaid.

“As if it’s easy to take care of their health care issue, given things like prior authorization,” Mukkamala told Stateline. “Now to add to the challenge, we have to figure out how to get them covered.”

Stateline reporter Shalina Chatlani can be reached at schatlani@stateline.org.

©2025 States Newsroom. Visit at stateline.org. Distributed by Tribune Content Agency, LLC.

Health care in Michigan is about to get more expensive.

According to a recent report from the health policy research group KFF, insurers offering plans through the Affordable Care Act will increase premiums by 15% next year, with some even proposing 20% hikes. Medicaid is set for $1.2 trillion in national cuts, including work mandates and higher fees.

Michigan Attorney General Dana Nessel also announced last week that she joined a multi-state coalition lawsuit challenging a Trump administration rule that would “create significant barriers to obtaining health care coverage under the Affordable Care Act.”

So, what does all this mean for you and your family’s health care costs?

Thomas Buchmueller, a health economist at the University of Michigan, joined The Metro on Tuesday to break down what’s changing, who will feel it first, and what Michigan can do to soften the blow.

Use the media player above to hear the full conversation.

Listen to The Metro weekdays from 10 a.m. to noon ET on 101.9 FM and streaming on-demand.

Trusted, accurate, up-to-date.

WDET strives to make our journalism accessible to everyone. As a public media institution, we maintain our journalistic integrity through independent support from readers like you. If you value WDET as your source of news, music and conversation, please make a gift today.

Donate today »

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A recent survey of Wyandotte’s water system by state regulators has identified “significant deficiencies” that they say “pose a significant health risk” to water consumers in the city.

The Michigan Department of Environment, Great Lakes, and Energy (EGLE) survey, released in April, reported deficiencies in four specific areas, including water treatment plant maintenance, distribution maintenance, finished water storage, and management and operations.

Additionally, the survey suggests that 40% of Wyandotte’s water system has “significant deterioration.”

“As a result,” the report said, “the city is not demonstrating the technical, managerial and financial capacity necessary to own and operate a water system.”

Paul LaManes, general manager for Wyandotte Municipal Services, says the city is currently working to address the issues highlighted in EGLE’s survey, but insisted that the water is safe to drink and poses no health risk to the public.

He joined The Metro to share more details about the survey and how the city is responding.

Use the media player above to hear the full conversation.

Listen to The Metro weekdays from 10 a.m. to noon ET on 101.9 FM and streaming on-demand.

Trusted, accurate, up-to-date.

WDET strives to make our journalism accessible to everyone. As a public media institution, we maintain our journalistic integrity through independent support from readers like you. If you value WDET as your source of news, music and conversation, please make a gift today.

Donate today »

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By Roberta Burkhart, Pittsburgh Post-Gazette

Many people don’t know it, but men under age 40 are the most likely age group to develop testicular cancer.

Just ask Jay Riepenhoff of Upper Arlington, Ohio, who was 29 and still adjusting to life as a new father when he discovered a suspicious lump.

He wasn’t thinking cancer. In fact, Riepenhoff got up for work the next morning and forgot all about it.

He felt the lump again that night, and thought he’d maybe set an alarm to remind himself to call the doctor the next day.

Riepenhoff didn’t feel the first twinge of worry until his doctor told him to come in immediately. And then sent him the same day for an ultrasound.

“Still, I even thought in my head, ‘I’ll go check it out. It’s not like it’s cancer,’” he said.

Soon, Riepenhoff discovered what many don’t realize: Of the approximately 10,000 cases of testicular cancer diagnosed annually, 51% are diagnosed in young men between the ages of 20 to 34, according to the National Cancer Institute, part of the NIH.

Yet a recent survey from The Ohio State University Comprehensive Cancer Center shows that few Americans — just 13% — associate the disease with young men.

“When you’re young, in your 20s or your 30s, you certainly do think your health is just something you might take for granted,” said Shawn Dason, a urologic oncologist at OSU’s cancer center and an associate clinical professor of urology at The Ohio State College of Medicine. “You’re more focused on other parts of life: your career, your family, your education.”

While 6% of testicular cancer cases are diagnosed in children and teens and another 8% affect those older than age 55, the vast majority of cases affect men aged 20 to 50. The average age of diagnosis is 33, according to the American Cancer Society.

It is the most common form of cancer among men 20 to 40 and the second most common cancer (trailing leukemia) in ages 15 to 19, but it can happen at any time, according to John Hopkins Medicine.

The Ohio State survey questioned 1,008 respondents about their knowledge of testicular cancer and found general awareness lacking in many areas.

While most — 63% — knew that testicular cancer is often curable if caught early, just over half correctly said that self-checks should be conducted every month. Additionally, two-thirds of respondents thought that medical evaluations should be conducted during annual exams after age 40.

But waiting until 40 would miss the men most at risk — young men like Riepenhoff.

Self-exams are most relevant between the ages of 20 and 40 and are especially important for anyone with a family history of testicular cancer or who has had an undescended testicle at any time during their life, Dason said.

A painless lump is the most common first sign that testicular cancer may be present, Dason said. Often, that lump will continue to grow and possibly harden.

Few men report that pain is associated with lumps, he said, adding that many incorrectly assume that the absence of pain means the lumps are harmless.

If the cancer has spread — becoming metastatic — other symptoms could develop, like abdominal and back pain, or a cough and shortness of breath if it has spread to the lungs.

Still, testicular cancer is among the rarer cancers compared to, for instance, prostate cancer, the second most common cancer in men after skin cancer. There are approximately 313,000 new cases of prostate cancer diagnosed annually and nearly 36,000 deaths from it every year, according to the American Cancer Society.

While not as prevalent as other cancers, testicular cancer is a fast-growing one, Dason said, and one that will spread to other parts of the body if left untreated.

The majority of testicular cancer cases are curable, however, especially when they’re caught early.

“Now that might beg the question, ‘Well, if it’s mostly curable, what would be the harm in just finding it later?’ And the harm is really that he might need more treatment to ultimately cure it. And these treatments, they can be pretty serious.”

When testicular cancer metastasizes, it often requires a far more invasive surgery — one with a longer, more challenging recovery, Dason said.

Chemotherapy, too, is generally necessary when the cancer spreads. It is a life-saving measure and “a critical instrument in achieving a cure in many patients,” but it can have a variety of both short- and long-term side effects, many of them unpleasant.

“We really do have evidence that some men will pass away from testicular cancer. And so could those men, if they had presented earlier, have been saved? Very, very possibly,” Dason said.

In Riepenhoff’s case, testing following his radical orchiectomy — the surgery to remove his cancerous testicle — revealed that the cancer had begun to spread, and he underwent three weeks of chemotherapy. All of his treatment took place at the OSU cancer center, although he was not treated by Dason.

Fertility especially becomes a concern when chemotherapy is necessary, Dason said.

Riepenhoff and his wife, Rana, had welcomed their first child, John Patrick Riepenhoff V, just five months before he discovered the cancerous lump. They had long hoped for three children, so before surgery, Riepenhoff chose to freeze sperm in case treatment affected his ability to have more children.

His fertility was not affected, and they expect to welcome their second son in August.

While testicular cancer is highly curable — the 5-year survival rate is 95%, per the National Cancer Institute — dismissing the early symptoms such as a newly discovered lump can make it much more challenging to treat.

Dason pointed out that younger men — and, often, men in general — have acquired a reputation for putting off medical care until absolutely necessary.

In his experience as a physician, Dason said, younger men tend to eschew annual physicals. “When you’re in your 20s and your 30s, there aren’t a lot of chronic health conditions that these young men have, and a lot of them are not regularly visiting their primary care provider.”

Plenty of patients put off seeking care “because they were embarrassed about it, or they were busy or they were hoping it would go away.” Often, a partner is the one who insists they finally see a doctor, he said.

“It’s normal to have a male sexual health complaint. It’s normal to feel something abnormal and go get it checked out. And that’s what our medical practitioners are there for: to help out with all of these concerns, not just a flu or an ankle injury.”

And like Riepenhoff once did, many young men see cancer as a far-off threat. And it’s just not discussed much, Riepenhoff said.

Riepenhoff pointed out that breast cancer awareness is everywhere. “You hear it from parents, schools and physicians,” he said. “But with testicular cancer, I don’t really recall. I’m sure in school we talked about it one time or something, but I don’t ever recall that being hammered into your brain the way that breast cancer is.”

He understands well the reasons men might wait to reach out to a physician.

“I’m sure there are a lot of men out there that got testicular cancer that waited to go to the doctor because they just thought it was an abscess or something. Nothing to be worried about. Had they known that this could be testicular cancer, they may have gone to the doctor earlier, and that can change your diagnosis pretty dramatically.”

Riepenhoff said he asked his doctor what would have happened if he had waited to come in or if he skipped the chemotherapy.

“He said within a year or two, I would have been dead.”

© 2025 the Pittsburgh Post-Gazette. Visit www.post-gazette.com. Distributed by Tribune Content Agency, LLC.

By AMANDA SEITZ and JONEL ALECCIA, Associated Press

WASHINGTON (AP) — Health secretary Robert F. Kennedy Jr. on Monday praised a company that makes $7-a-pop meals that are delivered directly to the homes of Medicaid and Medicare enrollees.

He even thanked Mom’s Meals for sending taxpayer-funded meals “without additives” to the homes of sick or elderly Americans. The spreads include chicken bacon ranch pasta for dinner and French toast sticks with fruit or ham patties.

“This is really one of the solutions for making our country healthy again,” Kennedy said in the video, posted to his official health secretary account, after he toured the company’s Oklahoma facility last week.

But an Associated Press review of Mom’s Meals menu, including the ingredients and nutrition labels, shows that the company’s offerings are the type of heat-and-eat, ultraprocessed foods that Kennedy routinely criticizes for making people sick.

The meals contain chemical additives that would render them impossible to recreate at home in your kitchen, said Marion Nestle, a nutritionist at New York University and food policy expert, who reviewed the menu for The AP. Many menu items are high in sodium, and some are high in sugar or saturated fats, she said.

“It is perfectly possible to make meals like this with real foods and no ultra-processing additives but every one of the meals I looked at is loaded with such additives,” Nestle said. “What’s so sad is that they don’t have to be this way. Other companies are able to produce much better products, but of course they cost more.”

Mom’s Meals do not have the artificial, petroleum dyes that Kennedy has pressured companies to remove from products, she noted.

Mom’s Meals said in an emailed response that its food products “do not include ingredients that are commonly found in ultra-processed foods.” The company does not use synthetic food dyes, high fructose corn syrup, certain sweeteners or synthetic preservatives that are banned in Europe, said Teresa Roof, a company spokeswoman.

The meals are a “healthy alternative” to what many people would find in their grocery stores, said Andrew Nixon, U.S. Health and Human Services spokesman, in response to questions about Mom’s Meals.

Mom’s Meals is one of several companies across the U.S. that deliver “medically tailored” at-home meals. The meal programs are covered by Medicaid for some enrollees, including people who are sick with cancer or diabetes, as well as some older Americans who are enrolled in certain Medicare health insurance plans.

Patients recently discharged from the hospital can also have the meals delivered, according to the company’s website.

It’s unclear how much federal taxpayers spend on providing meals through Medicaid and Medicare every year. An investigation by STAT news last year found that some states were spending millions of dollars to provide medically tailored meals to Medicaid enrollees that were marketed as healthy and “dietician approved.” But many companies served up meals loaded with salt, fat or sugar — all staples of an unhealthy American’s diet, the report concluded.

Defining ultraprocessed foods can be tricky. Most U.S. foods are processed, whether it’s by freezing, grinding, fermentation, pasteurization or other means. Foods created through industrial processes and with ingredients such as additives, colors and preservatives that you couldn’t duplicate in a home kitchen are considered the most processed.

Kennedy has said healthier U.S. diets are key to his vision to “Make America Healthy Again.” His call for Americans to increase whole foods in their diets has helped Kennedy build his unique coalition of Trump loyalists and suburban moms who have branded themselves as “MAHA.”

In a recent social media post where he criticized the vast amount of ultraprocessed foods in American diets, Kennedy urged Americans to make healthier choices.

“This country has lost the most basic of all freedoms — the freedom that comes from being healthy,” Kennedy said.

Aleccia reported from Temecula, Calif.

Phillip Reese, KFF Health News

As summer ushers in peak mosquito season, health and vector control officials are bracing for the possibility of another year of historic rates of dengue. And with climate change, the lack of an effective vaccine, and federal research cuts, they worry the disease will become endemic to a larger swath of North America.

About 3,700 new dengue infections were reported last year in the contiguous United States, up from about 2,050 in 2023, according to the Centers for Disease Control and Prevention. All of last year’s cases were acquired abroad, except for 105 cases contracted in California, Florida, or Texas. The CDC issued a health alert in March warning of the ongoing risk of dengue infection.

“I think dengue is here with us to stay,” said infectious disease specialist Michael Ben-Aderet, associate medical director of hospital epidemiology at Cedars-Sinai in Los Angeles, about dengue becoming a new normal in the U.S. “These mosquitoes aren’t going anywhere.”

Dengue is endemic — a label health officials assign when diseases appear consistently in a region — in many warmer parts of the world, including Latin America, India, and Southeast Asia. Dengue cases increased markedly last year in many of those places, especially in Central and South America.

The disease, which can spread when people are bitten by infected Aedes mosquitoes, was not common in the contiguous United States for much of the last century. Today, most locally acquired (meaning unrelated to travel) dengue cases in the U.S. happen in Puerto Rico, which saw a sharp increase in 2024, triggering a local public health emergency.

Most people who contract dengue don’t get sick. But in some people symptoms are severe: bleeding from the nose or mouth, intense stomach pain, vomiting, and swelling. Occasionally, dengue causes death.

California offers a case study in how dengue is spreading in the U.S. The Aedes aegypti and Aedes albopictus mosquitoes that transmit dengue weren’t known to be in the state 25 years ago. They are now found in 25 counties and more than 400 cities and unincorporated communities, mostly in Southern California and the Central Valley.

The spread of the mosquitoes is concerning because their presence increases the likelihood of disease transmission, said Steve Abshier, president of the Mosquito and Vector Control Association of California.

From 2016 through 2022, there were an average of 136 new dengue cases a year in California, each case most likely brought to the state by someone who had traveled and been infected elsewhere. In 2023, there were about 250 new cases, including two acquired locally.

In 2024, California saw 725 new dengue cases, including 18 acquired locally, state data shows.

Climate change could contribute to growth in the Aedes mosquitoes’ population, Ben-Aderet said. These mosquitoes survive best in warm urban areas, often biting during the daytime. Locally acquired infections often occur when someone catches dengue during travel, then comes home and is bitten by an Aedes mosquito that bites and infects another person.

“They’ve just been spreading like wildfire throughout California,” Ben-Aderet said.

Dengue presents a challenge to the many primary care doctors who have never seen it. Ben-Aderet said doctors who suspect dengue should obtain a detailed travel history from their patients, but confirming the diagnosis is not always quick.

“There’s no easy test for it,” he said. “The only test that we have for dengue is antibody tests.” He added that “most labs probably aren’t doing it commercially, so it’s usually like a send-out test from most labs. So you really have to suspect someone has dengue.”

Best practices for avoiding dengue include eliminating any standing pools of water on a property — even small pools — and using mosquito repellent, Abshier said. Limiting activity at dusk and dawn, when mosquitoes bite most often, can also help.

Efforts to combat dengue in California became even more complicated this year after wildfires ripped through Los Angeles. The fires occurred in a hot spot for mosquito-borne illnesses. San Gabriel Valley Mosquito and Vector Control District officials have worked for months to treat more than 1,400 unmaintained swimming pools left in the wake of fire, removing potential breeding grounds for mosquitoes.

San Gabriel vector control officials have used local and state resources to treat the pools, said district spokesperson Anais Medina Diaz. They have applied for reimbursement from the Federal Emergency Management Agency, which has not historically paid for vector control efforts following wildfires.

In California, vector control agencies are often primarily funded by local taxes and fees on property owners.

Some officials are pursuing the novel method of releasing sterilized Aedes mosquitoes to reduce the problem. That may prove effective, but deploying the method in a large number of areas would be costly and would require a massive effort at the state level, Abshier said. Meanwhile, the federal government is pulling back on interventions: Several outlets have reported that the National Institutes of Health will stop funding new climate change-related research, which could include work on dengue.

This year, reported rates of dengue in much of the Americas have declined significantly from 2024. But the trend in the United States likely won’t be clear until later in the year, after the summer mosquito season ends.

Health and vector control researchers aren’t sure how bad it will get in California. Some say there may be limited outbreaks, while others predict dengue could get much worse. Sujan Shresta, a professor and infectious disease researcher at the La Jolla Institute for Immunology, said other places, like Nepal, experienced relatively few cases of dengue in the recent past but now regularly see large outbreaks.

There is a vaccine for children, but it faces discontinuation from a lack of global demand. Two other dengue vaccines are unavailable in the United States. Shresta’s lab is hard at work on an effective, safe vaccine for dengue. She hopes to release results from animal testing in a year or so; if the results are positive, human trials could be possible in about two years.

“If there’s no good vaccine, no good antivirals, this will be a dengue-endemic country,” she said.

Phillip Reese is a data reporting specialist and an associate professor of journalism at California State University-Sacramento.

This article was produced by KFF Health News , which publishes California Healthline , an editorially independent service of the California Health Care Foundation .

(KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of KFF — the independent source for health policy research, polling and journalism.)

©2025 KFF Health News. Distributed by Tribune Content Agency, LLC.

The post State lands ready for visitors after ice storm recovery, but DNR urges caution appeared first on WDET 101.9 FM.

Heat is now the leading cause of weather-related deaths in the U.S. — with 12,000 lives claimed annually — and this number is expected to increase significantly by the turn of the century.

In large cities, temperatures in the summer can reach even higher than normal due to the “urban heat island” effect. 

New data compiled by the nonprofit American Forests and the UCLA Luskin Center for Innovation identifies areas in cities across the United States that lack enough protection from the sun.  These areas are known as “shade deserts.” 

The new shade map covers more than 100 of the country’s biggest urban areas, including Detroit.

One effective way to stay cooler is by increasing shade, especially through planting trees, which can reduce the effects of high temps significantly. But according to American Forests a lack of shade in Detroit — especially at bus stops and along roadways — is harming thousands. 

Less than 60% of households in Detroit have air conditioning, said Chris David, vice president of GIS & Data Science at American Forests. Additionally, he says those using public and alternative transit are even more at risk of heat-related illness and death. 

“I think there’s about 5,000 bus stops in Detroit,” David said. “About 90% of those 5,000 bus stops have poor shade.” 

He says bus shelters provide “very little” sun protection, with only about 5% of bus stops in the city covered.  

Related: Rule changes at Detroit transit centers putting riders at risk of exposure to extreme temps, advocates say

“That means we estimated about 85,000 daily transit riders in Detroit….they’re left exposed to the sun when they’re waiting for the bus… and that can have dire effects,” David said.

David says Detroit will benefit from a strategic plan to increase the tree canopy, with groups like the Greening of Detroit working toward that goal in partnership with city government. 

You can view the American Forests/UCLA Luskin Center for Innovation shade map here. 

This story is part of WDET’s ongoing series, The Detroit Tree Canopy Project.

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The post Older adults should take extra precautions during extreme heat this summer appeared first on WDET 101.9 FM.

By Jariel Arvin, KFF Health News

On Fridays, Stephanie Johnson has a busy schedule, driving her navy-blue Jeep from one patient’s home to the next, seeing eight in all. Pregnant with her second child, she schleps a backpack instead of a traditional black bag to carry a laptop and essential medical supplies — stethoscope, blood pressure cuff, and pulse oximeter.

Forget a lunch break; she often eats a sandwich or some nuts as she heads to her next patient visit.

On a gloomy Friday in January, Johnson, a nurse practitioner who treats older adults, had a hospice consult with Ellen, a patient in her 90s in declining health. To protect Ellen’s identity, KFF Health News is not using her last name.

“Hello. How are you feeling?” Johnson asked as she entered Ellen’s bedroom and inquired about her pain. The blinds were drawn. Ellen was in a wheelchair, wearing a white sweater, gray sweatpants, and fuzzy socks. A headband was tied around her white hair. As usual, the TV was playing loudly in the background.

“It’s fine, except this cough I’ve had since junior high,” Ellen said.

Ellen had been diagnosed with vascular dementia, peripheral vascular disease, and Type 2 diabetes. Last fall, doctors made the difficult decision to operate on her foot. Before the surgery, Ellen was always colorful, wearing purple, yellow, blue, pink, and chunky necklaces. She enjoyed talking with the half dozen other residents at her adult family home in Washington state. She had a hearty appetite that brought her to the breakfast table early. But lately, her enthusiasm for meals and socializing had waned.

Johnson got down to eye level with Ellen to examine her, assessing her joints and range of motion, checking her blood pressure, and listening to her heart and lungs.

Carefully, Johnson removed the bandage to examine Ellen’s toes. Her lower legs were red but cold to the touch, which indicated her condition wasn’t improving. Ellen’s two younger sisters had power of attorney for her and made it clear that, above all, they wanted her to be comfortable. Now, Johnson thought it was time to have that difficult conversation with them about Ellen’s prognosis, recommending her for hospice.

“Our patient isn’t just the older adult,” Johnson said. “It’s also often the family member or the person helping to manage them.”

Nurse practitioners are having those conversations more and more as their patient base trends older. They are increasingly filling a gap that is expected to widen as the senior population explodes and the number of geriatricians declines. The Health Resources and Services Administration projects a 50% increase in demand for geriatricians from 2018 to 2030, when the entire baby boom generation will be older than 65. By then, hundreds of geriatricians are expected to retire or leave the specialty, reducing their number to fewer than 7,600, with relatively few young doctors joining the field.

That means many older adults will be relying on other primary care physicians, who already can’t keep up with demand, and nurse practitioners, whose ranks are booming. The number of nurse practitioners specializing in geriatrics has more than tripled since 2010, increasing the availability of care to the current population of seniors, a recent study in JAMA Network Open found.

According to a 2024 survey, of the roughly 431,000 licensed nurse practitioners, 15% are, like Johnson, certified to treat older adults.

Johnson and her husband, Dustin, operate an NP-led private practice in greater Seattle, Washington, a state where she can practice independently. She and her team, which includes five additional nurse practitioners, each try to see about 10 patients a day, visiting each one every five to six weeks. Visits typically last 30 minutes to an hour, depending on the case.

“There are so many housebound older adults, and we’re barely reaching them,” Johnson said. “For those still in their private homes, there’s such a huge need.”

Laura Wagner, a professor of nursing and community health systems at the University of California-San Francisco, stressed that nurse practitioners are not trying to replace doctors; they’re trying to meet patients’ needs, wherever they may be.

“One of the things I’m most proud of is the role of nurse practitioners,” she said. “We step into places where other providers may not, and geriatrics is a prime example of that.”

Practice limits

Nurse practitioners are registered nurses with advanced training that enables them to diagnose diseases, analyze diagnostic tests, and prescribe medicine. Their growth has bolstered primary care, and, like doctors, they can specialize in particular branches of medicine. Johnson, for example, has advanced training in gerontology.

“If we have a geriatrician shortage, then hiring more nurse practitioners trained in geriatrics is an ideal solution,” Wagner said, “but there are a lot of barriers in place.”

In 27 states and Washington, D.C., nurse practitioners can practice independently. But in the rest of the country, they need to have a collaborative agreement with or be under the supervision of another health care provider to provide care to older adults. Medicare generally reimburses for nurse practitioner services at 85% of the amount it pays physicians.

Last year, in more than 40 states, the American Medical Association and its partners lobbied against what they see as “scope creep” in the expanded roles of nurse practitioners and other health workers. The AMA points out that doctors must have more schooling and significantly more clinical experience than nurse practitioners. While the AMA says physician-led teams keep costs lower, a study published in 2020 in Health Services Research found similar patient outcomes and lower costs for nurse practitioner patients. Other studies, including one published in 2023 in the journal Medical Care Research and Review, have found health care models including nurse practitioners had better outcomes for patients with multiple chronic conditions than teams without an NP.

Five states have granted NPs full practice authority since 2021, with Utah the most recent state to remove physician supervision requirements, in 2023. In March, however, Mississippi House Bill 849, which would have increased NP independence, failed. Meanwhile, 30 Texas physicians rallied to tamp down full-scope efforts in Austin.

“I would fully disagree that we’re invading their scope of practice and shouldn’t have full scope of our own,” Johnson said.

She has worked under the supervision of physicians in Pennsylvania and Washington state but started seeing patients at her own practice in 2021. Like many nurse practitioners, she sees her patients in their homes. The first thing she does when she gets a new patient is manage their prescriptions, getting rid of unnecessary medications, especially those with harsh side effects.

She works with the patient and a family member who often has power of attorney. She keeps them informed of subtle changes, such as whether a person was verbal and eating and whether their medical conditions have changed.

While there is some overlap in expertise between geriatricians and nurse practitioners, there are areas where nurses typically excel, said Elizabeth White, an assistant professor of health services, policy, and practice at Brown University.

“We tend to be a little stronger in care coordination, family and patient education, and integrating care and social and medical needs. That’s very much in the nursing domain,” she said.

That care coordination will become even more critical as the U.S. ages. Today, about 18% of the U.S. population is 65 or over. In the next 30 years, the share of seniors is expected to reach 23%, as medical and technological advances enable people to live longer.

Patient and family

In an office next to Ellen’s bedroom, Johnson called Ellen’s younger sister Margaret Watt to recommend that Ellen enter hospice care. Johnson told her that Ellen had developed pneumonia and her body wasn’t coping.

Watt appreciated that Johnson had kept the family apprised of Ellen’s condition for several years, saying she was a good communicator.

“She was accurate,” Watt said. “What she said would happen, happened.”

A month after the consult, Ellen died peacefully in her sleep.

“I do feel sadness,” Johnson said, “but there’s also a sense of relief that I’ve been with her through her suffering to try to alleviate it, and I’ve helped her meet her and her family’s priorities in that time.”

Jariel Arvin is a reporter with the Investigative Reporting Program at the University of California-Berkeley Graduate School of Journalism. He reported this article through a grant from The SCAN Foundation .

©2025 KFF Health News. Distributed by Tribune Content Agency, LLC.