WASHINGTON (AP) — The Food and Drug Administration’s top drug regulator, Dr. Tracy Beth Hoeg, is working to hire a researcher and friend who wants the agency to add new warnings to antidepressants about unproven pregnancy risks, The Associated Press has learned.

Dr. Adam Urato, a maternal-fetal medicine specialist and critic of antidepressant safety, is pressing the FDA to add a boxed warning to SSRIs, the drugs most commonly prescribed for depression. Urato’s petition says the medications can cause pregnancy complications, including miscarriages and fetal brain abnormalities that may lead to autism and other disorders in children.

That proposed labeling change has become a top priority for Hoeg, who regularly consults with Urato and is working to bring him on as a full-time FDA employee, according to people familiar with the situation. They spoke to the AP on condition of anonymity to discuss confidential FDA matters.

Within the agency, Hoeg’s close relationship with Urato is viewed as a clear conflict of interest that, under normal FDA standards, would result in her recusing herself from any work on the petition. But Hoeg is actively working to speed up the agency’s review of her friend’s proposal, according to the people familiar with the situation.

Outside experts say the petition relies on flimsy data, including animal studies and small trials in people. They fear a new FDA warning could cause pregnant women to stop medication unnecessarily, leading to serious health risks from untreated depression.

“A black box warning is a big red flag with both practitioners and patients,” said Dr. Jennifer Payne, a University of Virginia reproductive psychiatrist. “What’s missing in this petition is an understanding of the risks of maternal mental illness during pregnancy, not just to the woman, but to the pregnancy and ultimately the infant.”

The FDA is legally required to respond in writing to each citizen petition and explain its reasons for granting or denying the request.

SSRIs include most of the bestselling depression medications, including Prozac, Paxil, Zoloft and their generic equivalents.

More than 15% of U.S. women, or about 26 million people, take medication for depression, according to the latest federal figures. Professional guidelines state that antidepressants are generally safe during pregnancy and should be discontinued only after careful consultation with a doctor.

Last fall, Hoeg gave a talk on the SSRI petition to top FDA drug officials, presenting the work as her own. Staffers who reviewed her slides found they were created by Urato, according to the people who spoke to the AP. The incident was first reported by Stat News.

Urato said in an email Wednesday that Hoeg is “an excellent scientist,” and that they have known each other for several years.

“I am friendly with her, as I am with many colleagues, but we do not have a longstanding personal friendship that would in any way prevent her from reviewing the citizen petition,” Urato said.

A spokesman for the Department of Health and Human Services, which oversees the FDA, said that the agency would respond directly to Urato about his petition.

In January, Urato was named to the Centers for Disease Control and Prevention’s panel on vaccine recommendations, which has been completely reshaped by Health Secretary Robert F. Kennedy Jr. to include a number of anti-vaccine voices.

The latest COVID-19 contrarian elevated into FDA’s leadership

The antidepressant review is the latest in a series of controversial topics taken up by Hoeg, a sports medicine physician with no previous government or management experience.

During the COVID-19 pandemic, Hoeg attracted attention as a critic of masking, vaccine mandates and other public health measures. She co-wrote papers with medical contrarians who would go on to join the Trump administration, including FDA Commissioner Marty Makary and FDA’s vaccine chief, Dr. Vinay Prasad. All three have become top surrogates for Kennedy.

Before the pandemic, Hoeg had published only a handful of medical papers, including one on health issues affecting ultramarathon runners.

A Danish American citizen and marathon runner, Hoeg was instrumental in the Republican administration’s recent decision to drop a number of vaccine recommendations for children. That is a change she has long proposed, to bring the United States more in line with Denmark.

Like many critics of vaccines, including Kennedy, Hoeg has also been skeptical of antidepressants, questioning their safety and benefits. Last July, she hosted a panel of outside experts at the FDA on SSRIs that included Urato and nine other critics of the drugs.

“Never before in human history have we chemically altered developing babies like this, especially the developing fetal brain, and this is happening without any real public warning,” Urato said at the meeting.

On a podcast shortly afterward, Hoeg echoed many of Urato’s points.

“I think women should be informed about the potential risks so that they have time to come off SSRIs if they want to when they’re trying to get pregnant,” Hoeg told the hosts of the Mom Wars podcast.

FDA officials typically avoid making public comments about matters under review because it could suggest the agency is basing its decision on individual opinions, rather than science.

But Hoeg has taken a hands-on approach to the SSRI petition, telling FDA staffers that their proposed review timeline of nine months needed to be shortened, according to the people familiar with the situation.

Reviewing a citizen petition involves detailed analysis of scientific references, legal issues and a number of other steps to ensure that the agency’s final decision can be defended in court.

“Apart from it serving FDA’s public health mission, there’s always going to be some concern about legal risk if the agency doesn’t take sufficient time to consider all the relevant data and arguments,” said Patti Zettler, a former FDA attorney now at Ohio State University’s law school.

Hoeg was tapped to the lead FDA’s drug center in December, inheriting the job during a period of unprecedented upheaval, including layoffs, buyouts and leadership changes. She is the sixth person to lead the 5,000-person center in the past year.

Staffers did not hear from Hoeg directly until a town hall last month, where she voiced her concerns about the safety of SSRIs and injectable RSV shots for children, a class of drugs that FDA is reviewing at her request. RSV is a respiratory virus that sends thousands of children in the United States to the hospital each year.

Antidepressant questions clouded by other health factors

The safety of antidepressants has been scrutinized for decades, leading to several updates to their FDA label, including the addition of a black box warning about the risk of suicidal behavior in children.

For pregnant women, the current label lists a number of documented safety issues, including risks of excess bleeding after giving birth.

Doctors who treat women with depression say they discuss those risks with their patients, balancing the possible safety issues against the potential harms of relapsing into depression: self-harm, substance abuse and other behaviors that negatively impact women and fetuses.

Researchers who have reviewed Urato’s SSRI petition say many of the studies claiming to show connections to disorders such as autism don’t take into account other important health factors. For example, women with depression have higher rates of smoking, diabetes and family histories of mental illness that can all increase the likelihood of developmental disorders.

“So how do we say that these outcomes are a result of the SSRI when all of these other factors are at play?” said Dr. Amritha Bhat, a University of Washington perinatal psychiatrist.

Bhat and other researchers say they support more research into the effects of SSRIs, and they acknowledge possible downsides to their use.

“But in the meantime we need to provide options to people that are struggling with these symptoms during pregnancy,” she said. “We cannot just ask them to white knuckle their way through it.”

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.

BATON ROUGE, La. (AP) — As people awoke to headlines over the weekend about deadly U.S.-Israeli strikes on Iran and potential of widening conflict, alerts, social media and conversations at the dining room table were consumed by the news.

While medical experts say it is normal for people to experience stress and anxiety — or feeling that the world descended into chaos overnight — it is important to find coping mechanisms and ways to responsibly take in the news in order to protect one’s mental health.

“Fear, sadness, confusion… these are very normal reactions to very extreme circumstances,” Michael S. Ziffra, a Northwestern Feinberg School of Medicine professor and psychiatrist, told The Associated Press. “People shouldn’t feel guilty, or they shouldn’t feel like it’s wrong to feel anxiety. It’s a very normal human response. The key is to know how to manage it.”

Normal feelings

Since 2020 — a year marked by the deadly COVID-19 pandemic, social and political unrest and weather-related disasters — Ziffra said he has “absolutely, without question” seen an uptick in patients bringing up increased anxiety provoked by current news.

Some patients vent, some talk about obsessively scrolling on social media and others discuss feeling helpless and frustrated.

But, psychiatrists say those feelings are absolutely normal and to be expected. In fact, sometimes they can result in something positive — from getting involved in advocacy, joining a social or political organization or just contacting lawmakers.

Other’s may seek to learn more about what is going on. But like with most things in life, moderation is important.

“The problem is, for a lot of people, they just kind of wallow in it. They ruminate and obsess and just sort of stew in it,” Ziffra said.

Consuming distressing news

In today’s world, people are just a click away from learning about practically anything they want — sometimes even less, with a predetermined algorithm on social media pushing posts or alerts on their phone interrupting their day. People have access to 24/7 news cycles and phone cameras can capture, and disseminate, videos and images of disasters within seconds.

For years, Dana Rose Garfin, a psychologist and professor at University of California, Los Angeles, has been studying “cascading collective traumas” and researched how the media’s continuous coverage of COVID increased anxiety. Garfin said the reality is that people don’t consume the news how they used to. Instead of reading a newspaper or flipping on the evening news once a day, people are “much more exposed” to current events.

And as people learn about disasters or breaking news, they become distressed.

“In terms of any kind of crisis, people turn to the media for information. And that’s a very logical, rational and helpful reaction,” Garfin said.

“But, what we’ve seen in our research is there’s this sort of reciprocal effect. An event happens, people learn about it, they turn to the media to learn more about it, and they’re really distressed,” Garfin said, adding that what occurs next is a cycle that people have a hard time removing themselves from. “It sort of activates these processes where then they’re both more distressed and want to know more about this event because they’re distressed.”

Responsibly consuming media

While experts said they understand people’s need to continue to seek out news, there is a way to do it responsibly without becoming overwhelmed and emotionally exhausted. Their top suggestion was to eliminate or cut down on social media and obsessive “doomscrolling.”

“I don’t immerse myself in social media, and that’s a very conscious decision on my part to protect my own mental, and physical, health,” said Roxane Cohen Silver, a psychologist at the University of California, Irvine, and who co-authored the study with Garfin. She specifically raised concerns about graphic images and video that quickly circulate on social media that can cause distress and long-term anxiety when seen repeatedly.

“I think that one can stay informed without immersing oneself in graphic images,” she said.

Garfin suggested finding more “enjoyable” ways to consume news, such as an informative news article, listening to a podcast or watching a news segment. “That’s different than this kind of letting the algorithm suck you in for eternity in a mindless fashion.”

Experts also urged people to set timers, when scrolling on their phone. Both iPhones and Android devices have controls to help regulate screen time.

Ziffra suggested choosing neutral news sources. “Try to avoid things where it’s very partisan and where there’s going to be a lot of inflammatory content, because that’s going to likely exacerbate your anxiety and make you feel anxious, angry, scared.”

Identifying coping mechanisms

Even if a worrisome news event is happening thousands of miles away, and even if it doesn’t directly impact a person reading about it, it can still cause intense stress and anxiety. For that reason, medical experts urge people to identify other ways to cope.

“People have a lot of inherent knowledge of what helps them… and things that they find comfort in, which is different for everybody,” Garfin said.

From breathing exercises, going for a walk, leaning into hobbies, getting together with friends, talking to a therapist, creative pursuits and self care, psychiatrists say it is important to redirect your attention in other ways.

“Things that are going to get your mind off of all of the obsessing and worrying and really putting your thoughts on something more positive,” Ziffra said.

Lawmakers in at least eight states this year are aiming to reel in wage garnishment for unpaid medical bills.

The legislation introduced in Colorado, Florida, Hawaii, Indiana, Maine, Michigan, Ohio, and Washington builds on efforts made in other states in past years. This latest push for patient protections comes as the Trump administration has backed away from federal debt protections, health care has become more costly, and more people are expected to go without medical coverage or choose cheaper but riskier high-deductible insurance plans that could lead them into debt.

“In the wealthiest country on Earth, people are going bankrupt, suffering wage garnishment, just because they get sick,” said Colorado state Rep. Javier Mabrey, a Democrat who introduced legislation on Feb. 19 that would, among other measures, ban wage garnishment for medical debt.

That legislation is under consideration after a KFF Health News investigation found that courts approved wage garnishment requests in an estimated 14,000 medical debt cases a year in Colorado. The investigation also showed that it isn’t just urban hospitals or big health care chains allowing their patients’ wages to be garnished. It’s also small rural hospitals, physician groups, and public ambulance services, among other medical care providers. And the reporting showed that wage garnishment can erroneously target patients. For example, one family lost wages — and subsequently power to their home, because they couldn’t pay their electric bill — after an ambulance company incorrectly billed the family instead of Medicaid.

Wage garnishment is one tool creditors can use in most states to recoup money from people with unpaid bills. In many states, they can garnish someone’s bank account or put a lien on their home, too. To garnish a person’s wages, a creditor must typically get permission from a court to make the person’s employer hand over a piece of the debtor’s earnings.

“The creditor is taking the money directly out of somebody’s paycheck, and so it doesn’t leave people with any choice to say, ‘I need to prioritize food for my children,’” said Lauren Jones, legal and policy director for the National Center for Access to Justice. The center, based at Fordham Law School, scores states and the District of Columbia on how fair their laws are to consumers who get sued over debt.

It is legal to garnish patients’ wages for medical debt in all but a few states, according to the Commonwealth Fund, a nonprofit foundation based in New York focused on health care.

Now, lawmakers in additional states seek to ban the practice entirely. Others want to limit it by exempting debtors whose household income falls under a certain threshold or by upping the amount of earnings immune from garnishment.

Such policies on wage garnishment fit into a larger push around the country to address the effect of medical debt on people’s lives and finances. Those efforts include barring medical debt from credit reports, prohibiting liens on people’s homes, capping interest rates, and limiting the ability to file lawsuits against people with low incomes over unpaid medical bills.

Debt collectors have fought against such measures, arguing they don’t solve the problem of health care affordability and hurt the ability of medical providers to continue to provide care.

“The wage garnishment process is already highly regulated at the federal and state level and includes many consumer protection measures,” said Scott Purcell, chief executive of ACA International , an association of credit and collection professionals.

Even before the Colorado legislation was introduced, BC Services sent a letter warning its clients that the legislation “poses an existential threat,” especially to rural health providers. And Bridget Frazier, a spokesperson for the Colorado Hospital Association, said Feb. 20 that the bill “could drive up costs and financial risk for health care providers, making it harder to keep hospitals sustainable and ensuring Coloradans have access to care when they need it most.”

The pending Colorado measure would ban wage garnishment for all patients. It also would limit bank garnishments, in which a patient’s financial institution must hand over a chunk of the money in the person’s account. Additionally, among other things, it would prevent payment plans from exceeding 4% of weekly net income, require creditors to check whether uninsured patients are eligible for public health insurance before collecting, bar creditors from collecting on bills that are more than three years old, and leave medical care providers liable to the patient for at least $3,000 if collectors don’t comply.

“No one is saying, ‘Don’t get paid for your services.’ We’re saying getting health care should not lead to financial ruin for people,” said Dana Kennedy, co-executive director at the Denver-based Center for Health Progress, a health advocacy group that has been working with lawmakers on the Colorado measure.

Kennedy said that KFF Health News’ investigation drove home how many kinds of Colorado health care facilities are willing to let this collection practice happen to their patients, and that the people whose wages are being garnished are often working at Family Dollar, Walmart, Amazon, or gas stations and restaurants.

“Medical debt is typically different from other forms of indebtedness,” said Colorado state Sen. Mike Weissman, a Democrat co-sponsoring the legislation. “You could choose to keep driving your old car or buy a new one and take on debt for that. You could upgrade your home. You could buy consumer appliances. There’s not usually that voluntary element in a health care context.”

Carolyn Carter, a senior attorney with the National Consumer Law Center, said broad laws that don’t require patients to jump through hoops to access protections are the most likely to be effective. Because of that, she and other consumer advocates prefer state policies that get rid of wage garnishment for all debtors and all types of debt.

“It can be hard to identify medical debt as medical debt,” Carter said. “For example, if you have a medical debt and you put it on your credit card, it’s not going to be easy for a court system to identify that debt as medical debt.”

She said another reason is that complexity is the enemy of effectiveness. Carter pointed to a report about Hamilton County, Tennessee, showing that even though people in the state can keep $10,000 in their bank accounts safe from garnishment, few consumers take advantage of the protection. They must know the protection exists, know where to find the relevant form, get the form notarized, file it, and mail copies to creditors. The same report found that garnishments can also be burdensome for employers, who must process garnishments and can find themselves in court if they make an error.

Jones, at the National Center for Access to Justice, said outlawing wage garnishment fully, rather than limiting it, has other benefits. “It’s also to protect people’s jobs, because in most states, if somebody has two or more orders of garnishment, they can lose their job for it,” she said.

Still, some lawmakers are pushing for the intermediate route. In Washington state, Democratic state Sen. Marko Liias is spearheading legislation to rope off a larger portion of low-wage earnings from garnishment. So, for example, a person making $1,000 a week would be able to keep their whole paycheck, as opposed to the $800 that the law would currently protect.

Mindy Chumbley, owner of a Washington-based collections company and an ACA International board member, testified against the bill on Feb. 2. “Washington has made sweeping changes to medical debt policy year after year without pausing to study the cumulative impact,” she told lawmakers. “Our clients are reporting clinic closures, urgent care centers shutting down, staffing shortages, and rural facilities struggling to stay open.”

The Washington State Hospital Association said it is neutral on the legislation. The American Hospital Association said it does not take positions on state policies.

Liias told KFF Health News that lawmakers need to ensure health care providers can recoup their costs while also protecting patients. “We don’t want families either to be driven into bankruptcy or to be driven into under-the-table work to avoid these garnishment thresholds,” he said.

Liias said his measure follows the lead of Arizona, which passed similar consumer protections in 2022. “Obviously, the health care system is still functioning in Arizona, and folks are able to make it work.”

©2026 KFF Health News. Distributed by Tribune Content Agency, LLC.

The California program that provides the world’s only medical treatment for potentially deadly infant botulism also offers traumatized families hope of a different sort – silly cards on their babies’ first birthdays.

Every year, staff at the state’s Infant Botulism Treatment and Prevention Program decorate and mail roughly 200 cards to celebrate the recovery of children affected by the rare and dangerous condition.

In recent months, that group has included dozens of U.S. babies affected by an outbreak of botulism tied to contaminated ByHeart infant formula.

Amy Mazziotti, of Burbank, California, received a birthday card for her son, Hank, in September, months after he was hospitalized for 12 days with botulism after drinking ByHeart formula.

“The fact that they take the time to send hand-drawn cards to each baby is incredibly special,” Mazziotti said. “When you’re worried about your baby, it’s the small acts like this that somehow feel really big.”

The cards are coordinated by Robin Hinks, a program assistant whose duties include decorating, tracking and mailing them.

“I am a big fan of drawing animals with party hats,” said Hinks, who favors crayons and colored pencils. “Like, here’s a frog with some balloons and a little penguin.”

The program’s primary purpose is to help diagnose and treat the disease that occurs when babies ingest botulism spores that germinate in the intestine and produce a dangerous toxin that attacks the nervous system, causing paralysis. Death rates were once as high as 90%, but now are less than 1% with treatment.

The only treatment, known as BabyBIG, is an IV medication made from the pooled blood plasma of adults who have been immunized against botulism. California’s program is the sole source worldwide.

Because the disease is so rare, with about 200 cases treated each year, the botulism center has become a source of information and connection for families facing the ordeal.

“Support of the babies and their families remains paramount to our program and our mission,” said Dr. Jessica Khouri, the program’s senior medical officer.

Heather Goody, of Gallipolis, Ohio, said she felt alone when her daughter, MaryEllen, contracted infant botulism in 2016. Nearly a decade later, Goody still runs a Facebook group, Infant Botulism Awareness, to connect the parents of sick babies. It now has more than 500 members.

She still recalls how touching it was to receive a card on MaryEllen’s first birthday.

“It brought all the feels, but most importantly the feeling of gratitude that she was thriving in all areas of life,” Goody said.

Maintaining that connection was a priority for the late Dr. Stephen Arnon, who with colleagues in 1976 identified the rare form of botulism that affects babies younger than 1 — and then spent the next 45 years figuring out how to treat it.

Arnon, who died in 2022, stayed in close touch with families of kids sickened by infant botulism, updating them as his scientific work progressed.

Today, nearly 1,500 families are part of the botulism program’s parent network, which includes children treated two decades ago. The group shares everything from preschool graduations to college acceptances and other milestones.

“Former patients have gone on to have families of their own and keep in touch with us,” Khouri said. “It really is an incredible part of the work we do.”

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.

Minnesota on Monday sued President Donald Trump’s administration in an attempt to stop it from withholding $243 million in Medicaid spending, warning it may have to cut health care for low-income families if the funding is held back.

The lawsuit asked a U.S. court in Minneapolis to issue a temporary restraining order to block the withholding for Medicaid, which is the health care safety net for low-income Americans.

The move came after Vice President JD Vance said last week the administration would “temporarily halt” some Medicaid funding to Minnesota over fraud concerns, as part of what he described as an aggressive crackdown on misuse of public funds.

Minnesota Attorney General Keith Ellison said his office has a strong track record of fighting Medicaid fraud and has won more than 300 convictions and $80 million in judgments and restitutions during his time in office.

“Trump’s attempts to look like he’s fighting fraud only punish the people and families who most need the high-quality, affordable healthcare that all Minnesotans deserve,” Ellison said in a statement. “As long as I am attorney general, I will do everything in my power to defend our tax dollars, both from fraudsters and from the Trump administration’s cruelty.”

The lawsuit names the Department of Health and Human Services and the Centers for Medicare and Medicaid Services as well as Dr. Mehmet Oz, in his official capacity as CMS administrator, and Robert F. Kennedy Jr. in his official capacity as HHS secretary.

The Department of Health and Human Services, which includes CMS, didn’t immediately return messages seeking comment late Monday.

The threatened cuts amount to roughly 7% of Minnesota’s quarterly Medicaid funding, Ellison’s office said in a news release. Minnesota could be required to significantly cut health care services for low-income families or other government services if the cuts take effect, it said.

Medicaid, which is known as Medical Assistance in Minnesota, provides health insurance to 1.2 million Minnesotans who would otherwise be unable to afford it. A family of four may qualify for Medical Assistance with an income at or under $42,759, the attorney general’s office said.

The lawsuit said the administration violated due process procedures because it was taking hundreds of millions of dollars without proving Minnesota’s noncompliance with Medicaid regulations through discovery and an evidentiary hearing.

It alleged the administration failed to provide Minnesota with details about its decision, in violation of federal law. It cited legal precedents, including one that said Congress may impose conditions on states’ acceptance of federal funds, but “’the conditions must be set out unambiguously.’”

Minnesota’s complaint further charged the administration violated the Constitution because the withholding imposed retroactive conditions on Minnesota’s Medicaid funding.

It said withholding the funds was arbitrary, capricious and part of a pattern of political punishment of Minnesota.

The administration said it would hold off on paying $259.5 million to Minnesota for Medicaid spending in the fourth quarter of 2025. Minnesota’s lawsuit challenges the withholding of $243 million of this money.

Question: Although active, my father at age 83 has a number of chronic conditions. Among them are painful knees and urinary incontinence. He believes both can be fixed or cured and continues to respond to ads that claim to be the answer.  How can I convince him that most of these are hoaxes? He just cannot accept the fact he is getting older. — B.K.

Answer: The quest for the fountain of youth is not new, yet it continues to endure. In a society that tends to value youth over old age, fighting to retain what we perceive as youth is understandable. Of course, quick fixes are always appealing.

Perhaps the first step is to determine whether your father’s physician has addressed the two issues you raised.

If so, what were the recommendations, and are they being followed by your father?

If you have some doubts about the conversation, consider accompanying your father to his next doctor’s appointment.

Next is the question of determining what conditions are related to normal aging and what are possibly caused by disease, medications or lifestyle.

Consider reviewing lifestyle habits that involve sleep, nutrition, exercise, social connections and having a purpose in life.

One approach to potential hoaxes is to have a plan that analyzes health information. Sandra Alters and Wendy Schiff, authors of “Essential Concepts for Healthy Living,” developed a
six-point approach that might be helpful. (This is an early edition, which has since been updated. I believe the points are still valid.)

Verify statements in the advertisement: Determine which are verified by fact, are unverified or are claims about the product’s value. Verifiable facts are conclusions from scientific research or statements from credible resources. Unverified claims are conclusions with no support. Value claims simply suggest something is useful or effective.

Evaluate the credentials of the person who wrote the advertisement: Articles that may be part of the advertisement usually state the name and credentials of the author. In some cases the credentials may be fraudulent. Anyone can claim to be a doctor, nutritionist or health expert. Credentials can be checked by contacting any institutions named; accreditation can be checked by contacting the U.S. Department of Education (ed.gov).

Determine the motive or possible biases of the author: Ads are designed to persuade the consumer to buy the product. If the author developed the product, that person may have a financial interest that could affect objective reporting of the product’s effectiveness and value.

Assess relevant and irrelevant information: In particular, be aware of red flags that may suggest misinformation such as the following: “all natural,” “chemical free,” “scientifically proven,” “guaranteed to work” and “everyone is using it.” Note that testimonials often are given by celebrities and sports figures who get paid to promote the product.

Consider if the source provides reliable information: Does the advertisement give the pros and cons of the product along with the risks and benefits? Look for the inclusion of referenced articles from peer-reviewed journals. These are publications with articles that have been reviewed by experts in the field prior to publication.

Determine if the advertisement discredits the credibility of scientists and medical authorities: “Unknown to western medicine” or “used for centuries in China” suggest the U.S. is lagging in scientific knowledge and application. Statements that attack usual medical practices might be unreliable.

The next task is to influence your father’s thinking about the value and relevance of the analysis.

If he is reluctant to change his mind, it might be necessary to go through this process for each product and advertisement that your father encounters to protect him from possible harm and wasting his dollars.
You also might have a conversation about gratitude for what is working well in his life. It might provide a level of new awareness.

B.K., you have a challenge. Keep at it and hopefully your father will acknowledge that factfinding is for his benefit. Clearly you are a caring daughter. And thank you for your good question. Stay well and know all acts of kindness count.

Send emails to Helen Dennis at helendenn@aol.com, or go to facebook.com’s Successful Aging Community

CELO COMMUNITY, N.C. — On a 15-degree morning in January, a clinic in the Appalachian Mountains of North Carolina began to fill up with patients.

An older couple in flannel pajamas sat together in the waiting room. A toddler waved as Patricia Hall walked past him, a stethoscope draped over her neck. The family physician waved and smiled back.

But in the privacy of a conference room, her mood shifted. She is often bogged down with paperwork and can’t get patients timely appointments with specialists. She also fears that a health care worker shortage affecting her clinic — and many others across the nation — will only get worse.

Hall’s clinic, the Celo Health Center, is one of seven locations that make up the Mountain Community Health Partnership, which was supposed to receive up to $10 million over the next decade through Making Care Primary, a federal program to improve primary care, especially in rural areas, by providing payments for physicians to address patient needs. Her organization planned to use the money to hire staff, build better connections with local specialists, and buy more vehicles to shuttle patients to appointments, according to its CEO, Tim Evans.

Then, in March, clinic administrators received an email during the Department of Government Efficiency’s whirlwind of federal cuts: The Centers for Medicare & Medicaid Services would soon shutter Making Care Primary, a year into what was supposed to be a 10-year program. Nearly 700 practices in eight states enrolled in Making Care Primary. North Carolina had 23 clinics and centers in the program, the most of any state, followed by Washington, New Mexico, and New York. Doctors who had signed up for it said they were stunned.

“I’m angry, but more than that, I am so very sad,” Hall said. “It’s heartbreaking — to have an already inadequate health care system be made even more inadequate, to throw away opportunities to improve, even a little.”

Now, CMS’ Innovation Center, which created Making Care Primary, is set to launch a new 10-year program to boost primary care called the Long-term Enhanced ACO Design, known by its acronym LEAD. In that program, funding will be sent to health care organizations, often managed by companies, instead of directly to primary care doctors and clinics.

CMS wouldn’t say how much the programs cost. But it maintained that eliminating Making Care Primary reduced spending without sacrificing its mission to improve quality of care. Nixing Making Care Primary and three other programs at the agency — including another focused on primary care — would save taxpayers $750 million, CMS said at the time.

Making Care Primary “was not on track to meet its intended savings goal,” CMS spokesperson Alexx Pons said. Innovation Center models are meant to save money over time, in part by improving patients’ access to health care and helping them avoid costly hospital visits. Practices that signed up for Making Care Primary and want to join LEAD will have to apply for the program beginning in March.

Yet Making Care Primary’s elimination has created skepticism among doctors. The change exacerbated their fears about uncertain funding overseen by the Trump administration as covid-era Medicaid provisions expired, enhanced Affordable Care Act subsidies ended, and Congress passed more funding cuts in President Donald Trump’s One Big Beautiful Bill Act.

William Hathaway, a physician and the CEO of the Mountain Area Health Education Center in western North Carolina, which serves 16 mostly rural counties, questions how his organization is supposed to plan for the future “when the future can just go away so quickly.”

A Chance To Change Primary Care

The U.S. is facing a primary care crisis. In 2023, more than 100 million people in the U.S. had no access to a primary care doctor in their area, the National Association of Community Health Centers reported. Some states, such as Colorado, have passed legislation to ensure more primary care funding at the state level.

The health care shortage where Hall works in western North Carolina is so severe, she said she often makes personal calls to doctors to schedule appointments.

Hall said one of her patients is an uninsured woman who has been waiting six months for a colonoscopy. The patient has severe anemia and possibly gastrointestinal bleeding. Hall has been trying to get the patient somewhere that offers free or discounted care.

The additional funding through Making Care Primary would have allowed the network of clinics to improve its communication systems with specialists. Coordination of this kind of care is one of the challenges Making Care Primary was supposed to address.

“I’m still not sure what we’re going to do for her,” Hall said.

Making Care Primary sought to create an efficient payment system for primary care clinics and help them better track patients, allowing doctors to be less burdened by administrative duties and focus more on care.

It provided bonuses to primary care doctors for maintaining their patients’ health, as well as flexible funding that could be used to improve patients’ quality of life in numerous ways. That included patients’ transportation to health care facilities, food vouchers, moving expenses, or help with utility bills.

Spokespeople for health departments in the states that signed up for Making Care Primary said some doctors have since lost trust in federal support.

“It can be difficult for providers, especially smaller community base practitioners, to pool resources to invest in non-clinical development,” said Cadence Acquaviva, a spokesperson for New York’s health agency. “An abrupt change can damage the confidence in future programs’ sustainability.”

An Uncertain Future

The CMS Innovation Center tests health care models to find those that improve care and lower costs for the health system and patients. The center created Making Care Primary after testing it as one of those models. It’s unclear whether the models have ultimately saved money; a 2023 Congressional Budget Office report criticized the Innovation Center for increasing spending by nearly double the amount the CBO projected the center would save in taxpayer money over 10 years.

Elizabeth Fowler, who directed the center under President Joe Biden, said Making Care Primary ended so early that it could not have produced any meaningful data on whether the patients it served became healthier.

She acknowledged that the program didn’t draw in as many clinics as she hoped and lagged in enrollment. But if it were her decision to make, “I would have said, ‘It’s not enough time,’” Fowler said. “It takes more than a year to get the numbers.”

Hathaway said his Mountain Area Health Education Center signed on to Making Care Primary believing it could change the profession: It promised to ensure practices received immediate, consistent federal money to enhance primary care. Other models made that funding more difficult to obtain.

It’s unclear whether LEAD will draw more enrollment than Making Care Primary, but Hathaway, who has years of experience with elements included in LEAD, is skeptical of the program.

“Anytime you put multiple layers of bureaucracy between us and the patients and the dollars, it just costs more,” he said.

Hall said doctors “see the suffering firsthand” but often feel helpless in a system that cuts people off from primary care. She has been frustrated with the nation’s health care system, she said, which she feels focuses on profits over patients.

“We should be rolling out the red carpet for everybody to come see their family doctor and keep them out of the emergency room,” Hall said. “That would keep costs lower for the whole system. I’m wearing rose-colored glasses now, but I really believe that.”

©2026 KFF Health News. Distributed by Tribune Content Agency, LLC.

It’s the rare policy question that unites Republican Gov. Ron DeSantis of Florida and the Democratic-led Maryland government against President Donald Trump and Gov. Gavin Newsom of California: How should health insurers use AI?

Regulating artificial intelligence, especially its use by health insurers, is becoming a politically divisive topic, and it’s scrambling traditional partisan lines.

Boosters, led by Trump, are not only pushing its integration into government, as in Medicare’s experiment using AI in prior authorization, but also trying to stop others from building curbs and guardrails. A December executive order seeks to preempt most state efforts to govern AI, describing “a race with adversaries for supremacy” in a new “technological revolution.”

“To win, United States AI companies must be free to innovate without cumbersome regulation,” Trump’s order said. “But excessive State regulation thwarts this imperative.”

Across the nation, states are in revolt. At least four — Arizona, Maryland, Nebraska, and Texas — enacted legislation last year reining in the use of AI in health insurance. Two others, Illinois and California, enacted bills the year before.

Legislators in Rhode Island plan to try again this year after a bill requiring regulators to collect data on technology use failed to clear both chambers last year. A bill in North Carolina requiring insurers not to use AI as the sole basis of a coverage decision attracted significant interest from Republican legislators last year.

DeSantis, a former GOP presidential candidate, has rolled out an “AI Bill of Rights,” whose provisions include restrictions on its use in processing insurance claims and a requirement allowing a state regulatory body to inspect algorithms.

“We have a responsibility to ensure that new technologies develop in ways that are moral and ethical, in ways that reinforce our American values, not in ways that erode them,” DeSantis said during his State of the State address in January.

Ripe for Regulation

Polling shows Americans are skeptical of AI. A December poll from Fox News found 63% of voters describe themselves as “very” or “extremely” concerned about artificial intelligence, including majorities across the political spectrum. Nearly two-thirds of Democrats and just over 3 in 5 Republicans said they had qualms about AI.

Health insurers’ tactics to hold down costs also trouble the public; a January poll from KFF found widespread discontent over issues like prior authorization. (KFF is a health information nonprofit that includes KFF Health News.) Reporting from ProPublica and other news outlets in recent years has highlighted the use of algorithms to rapidly deny insurance claims or prior authorization requests, apparently with little review by a doctor.

Last month, the House Ways and Means Committee hauled in executives from Cigna, UnitedHealth Group, and other major health insurers to address concerns about affordability. When pressed, the executives either denied or avoided talking about using the most advanced technology to reject authorization requests or toss out claims.

AI is “never used for a denial,” Cigna CEO David Cordani told lawmakers. Like others in the health insurance industry, the company is being sued for its methods of denying claims, as spotlighted by ProPublica. Cigna spokesperson Justine Sessions said the company’s claims-denial process “is not powered by AI.”

Indeed, companies are at pains to frame AI as a loyal servant. Optum, part of health giant UnitedHealth Group, announced Feb. 4 that it was rolling out tech-powered prior authorization, with plenty of mentions of speedier approvals.

“We’re transforming the prior authorization process to address the friction it causes,” John Kontor, a senior vice president at Optum, said in a press release.

Still, Alex Bores, a computer scientist and New York Assembly member prominent in the state’s legislative debate over AI, which culminated in a comprehensive bill governing the technology, said AI is a natural field to regulate.

“So many people already find the answers that they’re getting from their insurance companies to be inscrutable,” said Bores, a Democrat who is running for Congress. “Adding in a layer that cannot by its nature explain itself doesn’t seem like it’ll be helpful there.”

At least some people in medicine — doctors, for example — are cheering legislators and regulators on. The American Medical Association “supports state regulations seeking greater accountability and transparency from commercial health insurers that use AI and machine learning tools to review prior authorization requests,” said John Whyte, the organization’s CEO.

Whyte said insurers already use AI and “doctors still face delayed patient care, opaque insurer decisions, inconsistent authorization rules, and crushing administrative work.”

Insurers Push Back

With legislation approved or pending in at least nine states, it’s unclear how much of an effect the state laws will have, said University of Minnesota law professor Daniel Schwarcz. States can’t regulate “self-insured” plans, which are used by many employers; only the federal government has that power.

But there are deeper issues, Schwarcz said: Most of the state legislation he’s seen would require a human to sign off on any decision proposed by AI but doesn’t specify what that means.

The laws don’t offer a clear framework for understanding how much review is enough, and over time humans tend to become a little lazy and simply sign off on any suggestions by a computer, he said.

Still, insurers view the spate of bills as a problem. “Broadly speaking, regulatory burden is real,” said Dan Jones, senior vice president for federal affairs at the Alliance of Community Health Plans, a trade group for some nonprofit health insurers. If insurers spend more time working through a patchwork of state and federal laws, he continued, that means “less time that can be spent and invested into what we’re intended to be doing, which is focusing on making sure that patients are getting the right access to care.”

Linda Ujifusa, a Democratic state senator in Rhode Island, said insurers came out last year against the bill she sponsored to restrict AI use in coverage denials. It passed in one chamber, though not the other.

“There’s tremendous opposition” to anything that regulates tactics such as prior authorization, she said, and “tremendous opposition” to identifying intermediaries such as private insurers or pharmacy benefit managers “as a problem.”

In a letter criticizing the bill, AHIP, an insurer trade group, advocated for “balanced policies that promote innovation while protecting patients.”

“Health plans recognize that AI has the potential to drive better health care outcomes — enhancing patient experience, closing gaps in care, accelerating innovation, and reducing administrative burden and costs to improve the focus on patient care,” Chris Bond, an AHIP spokesperson, told KFF Health News. And, he continued, they need a “consistent, national approach anchored in a comprehensive federal AI policy framework.”

Seeking Balance

In California, Newsom has signed some laws regulating AI, including one requiring health insurers to ensure their algorithms are fairly and equitably applied. But the Democratic governor has vetoed others with a broader approach, such as a bill including more mandates about how the technology must work and requirements to disclose its use to regulators, clinicians, and patients upon request.

Chris Micheli, a Sacramento-based lobbyist, said the governor likely wants to ensure the state budget — consistently powered by outsize stock market gains, especially from tech companies — stays flush. That necessitates balance.

Newsom is trying to “ensure that financial spigot continues, and at the same time ensure that there are some protections for California consumers,” he said. He added insurers believe they’re subject to a welter of regulations already.

The Trump administration seems persuaded. The president’s recent executive order proposed to sue and restrict certain federal funding for any state that enacts what it characterized as “excessive” state regulation — with some exceptions, including for policies that protect children.

That order is possibly unconstitutional, said Carmel Shachar, a health policy scholar at Harvard Law School. The source of preemption authority is generally Congress, she said, and federal lawmakers twice took up, but ultimately declined to pass, a provision barring states from regulating AI.

“Based on our previous understanding of federalism and the balance of powers between Congress and the executive, a challenge here would be very likely to succeed,” Shachar said.

Some lawmakers view Trump’s order skeptically at best, noting the administration has been removing guardrails, and preventing others from erecting them, to an extreme degree.

“There isn’t really a question of, should it be federal or should it be state right now?” Bores said. “The question is, should it be state or not at all?”

©2026 KFF Health News. Distributed by Tribune Content Agency, LLC.

Republicans think patients should be shopping for better health care prices. The party has long pushed to give patients money and let consumers do the work of reducing costs. After some GOP lawmakers closed out 2025 advocating to fund health savings accounts, President Donald Trump introduced his Great Healthcare Plan, which calls for, among other policies, requiring providers and insurers to post their prices “in their place of business.”

The idea echoes a policy implemented during his first term, when Trump suggested that requiring hospitals to post their charges online could ease one of the most common gripes about the health care system — the lack of upfront prices. To anyone who’s gotten a bill three months after treatment only to find mysterious charges, the idea seemed intuitive.

“You’re able to go online and compare all of the hospitals and the doctors and the prices,” Trump said in 2019 at an event unveiling the price transparency policy.

But amid low compliance and other struggles in implementing the policy since it took effect in 2021, the available price data is sparse and often confusing. And instead of patients shopping for medical services, it’s mostly health systems and insurers using the little data there is, turning it into fodder for negotiations that determine what medical professionals and facilities get paid for what services.

“We use the transparency data,” said Eric Hoag, an executive at Blue Cross Blue Shield of Minnesota, noting that the insurer wants to make sure providers aren’t being paid substantially different rates. It’s “to make sure that we are competitive, or, you know, more than competitive against other health plans.”

Not all hospitals have fallen in line with the price transparency rules, and many were slow to do so. A study conducted in the policy’s first 10 months found only about a third of facilities had complied with the regulations. The federal Centers for Medicare & Medicaid Services notified 27 hospitals from June 2022 to May 2025 that they would be fined for lack of compliance with the rules.

The struggles to make health care prices available have prompted more federal action since Trump’s first effort. President Joe Biden took his own thwack at the dilemma, by requiring increased data standardization and toughening compliance criteria. And in early 2025, working to fulfill his promises to lower health costs, Trump tried again, signing a new executive order urging his administration to fine hospitals and doctors for failing to post their prices. CMS followed up with a regulation intended to up the fines and increase the level of detail required within the pricing data.

So far, “there’s no evidence that patients use this information,” said Zack Cooper, a health economist at Yale University.

In 2021, Cooper co-authored a paper based on data from a large commercial insurer. The researchers found that, on average, patients who need an MRI pass six lower-priced imaging providers on the way from their homes to an appointment for a scan. That’s because they follow their physician’s advice about where to receive care, the study showed.

Executives and researchers interviewed by KFF Health News also didn’t think opening the data would change prices in a big way. Research shows that transparency policies can have mixed effects on prices, with one 2024 study of a New York initiative finding a marginal increase in billed charges.

The policy results thus far seem to put a damper on long-held hopes, particularly from the GOP, that providing more price transparency would incentivize patients to find the best deal on their imaging or knee replacements.

These aspirations have been unfulfilled for a few reasons, researchers and industry insiders say. Some patients simply don’t compare services. But unlike with apples — a Honeycrisp and a Red Delicious are easy to line up side by side — medical services are hard to compare.

For one thing, it’s not as simple as one price for one medical stay. Two babies might be delivered by the same obstetrician, for example, but the mothers could be charged very different amounts. One patient might be given medications to speed up contractions; another might not. Or one might need an emergency cesarean section — one of many cases in medicine in which obtaining the service simply isn’t a choice.

And the data often is presented in a way that’s not useful for patients, sometimes buried in spreadsheets and requiring a deep knowledge of billing codes. In computing these costs, hospitals make “detailed assumptions about how to apply complex contracting terms and assess historic data to create a reasonable value for an expected allowed amount,” the American Hospital Association told the Trump administration in July 2025 amid efforts to boost transparency.

Costs vary because hospitals’ contracts with insurers vary, said Jamie Cleverley, president of Cleverley and Associates, which works with health care providers to help them understand the financial impacts of changing contract terms. The cost for a patient with one health plan may be very different than the cost for the next patient with another plan.

The fact that hospital prices might be confusing for patients is a consequence of the lack of standardization in contracts and presentation, Cleverley said. “They’re not being nefarious.”

“Until we kind of align as an industry, there’s going to continue to be this variation in terms of how people look at the data and the utility of it,” he said.

Instead of aiding shoppers, the federally mandated data has become the foundation for negotiations — or sometimes lawsuits — over the proper level of compensation.

The top use for the pricing data for health care providers and payers, such as insurers, is “to use that in their contract negotiations,” said Marcus Dorstel, an executive at price transparency startup Turquoise Health.

Turquoise Health assembles price data by grouping codes for services together using machine learning, a type of artificial intelligence. It is just one example in a cottage industry of startups offering insights into prices. And, online, the startups’ advertisements hawking their wares often focus on hospitals and their periodic jousts with insurers. Turquoise has payers and providers as clients, Dorstel said.

“I think nine times out of 10 you will hear them say that the price transparency data is a vital piece of the contract negotiation now,” he said.

Of course, prices aren’t the only variable that negotiations hinge on. Hoag said Blue Cross Blue Shield of Minnesota also considers quality of care, rates of unnecessary treatments, and other factors. And sometimes negotiators feel as if they have to keep up with their peers — claiming a need for more revenue to match competitors’ salaries, for example.

Hoag said doctors and other providers often look at the data from comparable health systems and say, “‘I need to be paid more.’”

©2026 KFF Health News. Distributed by Tribune Content Agency, LLC.

Social media addiction has been compared to casinos, opioids and cigarettes.

While there’s some debate among experts about the line between overuse and addiction, and whether social media can cause the latter, there is no doubt that many people feel like they can’t escape the pull of Instagram, TikTok, Snapchat and other platforms.

The companies that designed your favorite apps have an incentive to keep you glued to them so they can serve up ads that make them billions of dollars in revenue. Resisting the pull of the endless scroll, the dopamine hits from short-form videos and the ego boost and validation that come from likes and positive interactions, can seem like an unfair fight. For some people, “rage-bait,” gloomy news and arguing with internet strangers also have an irresistible draw.

Much of the concern around social media addiction has focused on children. But adults are also susceptible to using social media so much that it starts affecting their day-to-day lives.

Recognizing signs of compulsive use

Dr. Anna Lembke, a psychiatrist and the medical director of addiction medicine at Stanford University’s School of Medicine, defines addiction as “the continued compulsive use of a substance or behavior despite harm to self or others.”

During her testimony at a landmark social media harms trial in Los Angeles, Lembke said that what makes social media platforms so addictive is the “24/7, really limitless, frictionless access” people have to them.

Some researchers question whether addiction is the appropriate term to describe heavy use of social media, arguing that a person must be experiencing identifiable symptoms. These include strong, sometimes uncontrollable urges and withdrawal to qualify as addiction.

Social media addiction is not recognized as an official disorder in the Diagnostic and Statistical Manual of Mental Disorders, which is the standard reference psychiatrists and other mental health practitioners use to assess and treat patients. That’s partly because there is no widespread consensus on what constitutes social media addiction and whether underlying mental health issues contribute to problematic use.

But just because there is no official agreement on the issue doesn’t mean excessive social media use can’t be harmful, some experts say.

“For me, the biggest signpost is how does the person feel about the ‘amount,’ and how viewing it makes them feel,” said Dr. Laurel Williams, professor of psychiatry and behavioral sciences at Baylor College of Medicine. “If what they discover is they view it so much that they are missing out on other things they may enjoy or things that they need to attend to, this is problematic use. Additionally, if you leave feeling overwhelmed, drained, sad, anxious, angry regularly, this use is not good for you.”

In other words, is your use of social media affecting other parts of your life? Are you putting off chores, work, hobbies or time with friends and family? Have you tried to cut back your time but realized you were unable to? Do you feel bad about your social media use?

Ofir Turel, a professor of information systems management at the University of Melbourne who has studied social media use for years, said there was “no agreement” over the term social media addiction, and he doesn’t “expect agreement soon.”

“It’s obvious that we have an issue,” Turel said. “You don’t have to call it an addiction, but there is an issue and we need, as a society, to start thinking about it.”

Noninvasive tips to reduce social media use

Before setting limits on scrolling, it’s helpful to understand how social media feeds and advertising work to draw in users, Williams said.

“Think of social media as a company trying to get you to stay with them and buy something — have the mindset that this is information that I don’t need to act on and may not be true,” she added. “Get alternate sources of information. Always understand the more you see something, anyone can start to believe it is true.”

Ian A. Anderson, a postdoctoral scholar at California Institute of Technology, suggests making small, meaningful changes to stop you from opening your social media app of choice. Moving the app’s place on your phone or turning off notifications are “light touch interventions,” but more involved options, like not bringing your phone into the bedroom or other places where you tend to use it, could also help, Anderson said.

Tech tools can also help to cut back on tech overuse. Both iPhones and Android devices have onboard controls to help regulate screen time.

Apple’s Screen Time controls are found in the iPhone’s settings menu. Users can set overall Downtime, which shuts off all phone activity during a set period of their choice.

The controls also let users put a blanket restriction on certain categories of apps, such as social, games or entertainment or zero in on a specific app, by limiting the time that can be spent on it.

The downside is that the limits aren’t hard to get around. It’s more of a nudge than a red line that you can’t cross. If you try to open an app with a limit, you’ll get a screen menu offering one more minute, a reminder after 15 minutes, or to completely ignore it.

If a light touch doesn’t work

If a light touch isn’t working, more drastic steps might be necessary. Some users swear by turning their phones to gray-scale to make it less appealing to dopamine-seeking brains. On iPhones, adjust the color filter in your settings. For Android, turn on Bedtime Mode or tweak the color correction setting. Downgrading to a simpler phone, such as an old-school flip phone, could also help curb social media compulsions.

Some startups, figuring that people might prefer a tangible barrier, offer hardware solutions that introduce physical friction between you and an app. Unpluq, for instance, is a yellow tag that you have to hold up to your phone in order to access blocked apps. Brick and Blok are two different products that work along the same lines — they’re squarish pieces of plastic that you have to tap or scan with your phone to unlock an app.

If that’s not enough of an obstacle, you could stash away your phone entirely. There are various phone lockboxes and cases available, some of them designed so parents can lock up their teenagers’ phones when they’re supposed to be sleeping, but there’s no rule that says only teenagers can use them.

Yondr, which makes portable phone locking pouches used at concerts or in schools, also sells a home phone box.

Seeking outside help

If all else fails, it may be a good idea to look for deeper reasons for feeling addicted to social media. Maybe it’s a symptom of underlying problems like anxiety, stress, loneliness, depression or low self-esteem. If you think that’s the case, it could be worth exploring therapy that is becoming more widely available.

“For people struggling to stay away — see if you can get a friend group to collaborate with you on it. Make it a group effort. Just don’t post about it! The more spaces become phone free, the more we may see a lessened desire to be ‘on,’” Williams said.