How Politics Has Reshaped Medicine in 2025
The landscape of modern medicine has always evolved with science, technology, and social change. But in 2025, the most aggressive force reshaping healthcare delivery has been political. This year, physicians worldwide have felt a tightening grip of political authority around their clinical autonomy. From reproductive care to mental health access, from Vaccine distribution to gender-related treatment policies, medicine is increasingly at the mercy of lawmakers. These aren't peripheral issues-they're core matters of patient care, ethics, and scientific integrity. The medical community is now reckoning with a difficult truth: politics is no longer outside the clinic; it's in the room with the patient.
In the United States, legislative battles around abortion have reached new levels of complexity. Since the fall of Roe v. Wade, over a dozen states have passed or expanded laws that criminalize doctors for performing or even recommending certain reproductive procedures, even in medically urgent situations. In 2025, several high-profile cases have shown physicians facing prosecution for providing standard miscarriage management or ectopic pregnancy care. The legal environment is now so precarious that hospitals in restrictive states often delay critical care while waiting for legal teams to weigh in. This creates moral distress for physicians, many of whom now practice in constant fear of lawsuits or even arrest-just for doing what they were trained to do.
Outside the U.S., similar trends are unfolding. In parts of Latin America and Eastern Europe, governments have tightened control over what is considered "acceptable" reproductive care, often under the guise of protecting national values or traditional family structures. Physicians in countries like Hungary and El Salvador report mounting pressure to withhold information or restrict access to contraception and abortion, even when it goes against clinical guidelines. Meanwhile, international NGOs trying to provide comprehensive reproductive health services are being blocked or defunded. These constraints have created a two-tiered healthcare system-one for those with means to travel and another for those left behind.
One of the most heated and politically charged areas in 2025 has been gender-affirming care. Several countries have enacted legislation banning or severely limiting this type of care for minors, while others are placing restrictions on adult services as well. As doctors, we're taught to respect patients and evidence-but this issue has become increasingly fraught. Some physicians, myself included, have genuine concerns about the long-term impacts of hormone therapy and surgical interventions in adolescents. We've seen cases where patients later regret transitioning or feel they were rushed into decisions without adequate psychological assessment. These concerns are not rooted in hatred, but in caution, ethics, and a responsibility to "do no harm." Yet raising such concerns today often leads to accusations of bias or professional misconduct. Political and institutional forces seem determined to silence even respectful debate within the medical field, leaving many physicians to navigate these dilemmas quietly, without guidance or support.
The politicization of public health has also disrupted our ability to respond effectively to infectious disease outbreaks. In several countries, Vaccine programs have stalled due to partisan interference. In India, for instance, regional governments have delayed the rollout of a new dengue Vaccine due to internal power struggles, despite surging infection rates. In the U.S., routine childhood vaccination rates continue to decline, fueled by political figures who cast doubt on their safety or necessity. Physicians are once again in the position of defending settled science in the face of misinformation, while battling mistrust from patients who view every public health recommendation as a political statement.
Another major impact of politics this year has been on mental health funding and policy. In the wake of post-COVID burnout, economic strain, and social polarization, demand for mental health services has skyrocketed. Yet several governments-particularly in the UK, Italy, and Australia-have cut funding for public mental health programs as part of broader austerity agendas. In practice, this has left general practitioners, emergency room physicians, and pediatricians scrambling to manage complex psychiatric cases without adequate support. Waiting lists have ballooned. Suicide rates have risen in several countries. And physicians are increasingly asked to take on roles they are not fully trained for, simply because the systems meant to support them are collapsing under political pressure.
Even international medical collaboration has suffered. Geopolitical tensions, especially among NATO, BRICS, and non-aligned states, have made global health data harder to access. Projects on infectious disease surveillance, antibiotic resistance, and climate-related health threats have stalled due to nationalism and protectionism. Several governments are now blocking cross-border data sharing unless certain political conditions are met. This slows response time during outbreaks, stifles innovation, and undermines trust among health professionals who once relied on international cooperation to advance their work.
Ultimately, what 2025 has taught us is that medicine cannot remain insulated from politics. Whether we like it or not, our clinical decisions, patient relationships, and professional obligations are now being shaped by external forces-sometimes subtly, sometimes overtly. Physicians must adapt to this new reality. We must stay informed, protect our ethical ground, and advocate where needed. And we must find ways to voice dissent, even within a system that increasingly prefers compliance. The health of our patients-and the integrity of our profession-depends on it.
Mental, Substance Use Disorder Health Care Use Increased With Food Insecurity
MONDAY, July 24, 2023 (HealthDay News) -- Children and adolescents living in food-insecure households have greater use of health services for mental and substance use disorders, according to a study published online July 24 in CMAJ, the journal of the Canadian Medical Association.
Kelly K. Anderson, Ph.D., from the Schulich School of Medicine and Dentistry at Western University in London, Ontario, Canada, and colleagues examined the association between household food insecurity and contact with health services for mental or substance use disorders among children and adolescents in Ontario, using health administrative data linked to five waves of the Canadian Community Health Survey. Data were included for 32,321 children and adolescents, of whom 16.1 percent were living in food-insecure households.
The researchers found that 9.0 and 0.6 percent of the total sample had an outpatient contact and an acute care contact, respectively, for a mental or substance use disorder. The prevalence rates of outpatient contacts and acute care contacts for a mental or substance use disorder were 55 and 74 percent higher, respectively, for children and adolescents in food-insecure households; however, contacts for substance use disorders were uncommon.
"The coexistence of household food insecurity and service use for mental and substance use disorders here is problematic, given that both of these conditions have each been found to have negative consequences for social, educational, and developmental outcomes among children and adolescents," Anderson said in a statement.
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IDSA: MVA-BN Vaccine Against Mpox Tolerated, Effective for Teens
The Modified Vaccinia Ankara-Bavarian Nordic (MVA-BN) vaccine, licensed in the United States to prevent smallpox and mpox, is well tolerated and seems effective in adolescents, according to a study presented at the annual meeting of the Infectious Diseases Society of America (IDWeek), held from Oct. 16 to 19 in Los Angeles.
Catherine Mary Healy, M.D., from Baylor College of Medicine in Houston, and colleagues examined the safety and immunogenicity of two doses of MVA-BN vaccine administered subcutaneously 28 days apart in adolescents aged 12 to 17 years compared to adults (aged 18 to 50 years) in a phase 2, open-label, multisite clinical trial. A total of 315 adolescents were compared to 211 adults.
The researchers found that both groups had similar solicited systemic and local events and unsolicited adverse events. Adolescents had dizziness more often (nine events in eight patients versus none in adults), which was similar to rates reported after other adolescent vaccines. MVA-BN was well tolerated overall. The day 43 antibody responses elicited by MVA-BN in adolescents were noninferior to the response in adults (geometric mean titer ratio for adolescents to adults, 1.60).
"These findings mark an important milestone for people living in areas with mpox," Healy said in a statement. "This mpox vaccine is an increasingly important solution to protect vulnerable adolescents and manage current and future outbreaks."
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USPSTF: Evidence Lacking for Screening Asymptomatic Patients for Skin Cancer
TUESDAY, April 18, 2023 (HealthDay News) -- The U.S. Preventive Services Task Force (USPSTF) concludes that the current evidence is insufficient for assessing the balance of benefits and harms of screening asymptomatic adults and adolescents for skin cancer. These findings form the basis of a final recommendation statement published in the April 18 issue of the Journal of the American Medical Association.
Nora B. Henrikson, Ph.D., M.P.H., from the Kaiser Permanente Washington Health Statement Research Institute in Seattle, and colleagues conducted a systematic review of the benefits and harms of screening for skin cancer. Data were included from 20 studies in 29 articles, with 6,053,411 asymptomatic individuals aged 15 years or older. The researchers found that based on direct evidence on screening effectiveness from three nonrandomized analyses, no melanoma mortality benefit was seen at the population level over four to 10 years of follow-up. Inconsistent evidence on the association between clinician skin examination and lesion thickness or stage at diagnosis was seen in six studies. Routine clinician skin examination was not associated with increased detection of skin cancer or precursor lesions or with stage at melanoma detection compared with usual care.
Based on these findings, the USPSTF concludes that the evidence is inadequate for assessing the balance of benefits and harms of visual skin examination to screen for skin cancer in asymptomatic adolescents and adults (I statement).
"We need more research on whether or not screening for skin cancer in people without symptoms is beneficial," a task force member said in a statement. "To help prevent skin cancer, people should minimize sun exposure, protect their skin when in the sun, and avoid tanning beds."
Final Recommendation Statement
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Clinical Report Addresses Management of Sickle Cell Disease in Children, Teens
Management of children and adolescents with sickle cell disease (SCD) requires comprehensive care from a pediatric primary care provider and a multidisciplinary team, according to a clinical report published online July 22 in Pediatrics.
Amber M. Yates, M.D., from the Baylor College of Medicine and Texas Children's Hospital in Houston, and colleagues present an overview focusing on the practical management of children and adolescents with SCD.
The authors note that SCD is a complex disorder with multisystem manifestations requiring comprehensive care from a pediatric primary care provider and a multidisciplinary SCD team. All aspects of general pediatric care should be managed by the pediatric primary care provider, and they should co-manage SCD-specific manifestations with the SCD team. The patient and family should be involved in all decisions. At least annual consultation with a multidisciplinary SCD team is strongly advised, although the extent to which the comprehensive care is delivered by a pediatric primary care provider versus the multidisciplinary specialist team will vary by community as well as family preference and the frequency and severity of SCD manifestations. Age-specific screening for disease complications is important at all SCD comprehensive visits. Education about and planning for urgent medical evaluation should be developed early and reviewed at each visit. The patient and family should be made aware that SCD is treatable but requires attention and active management to achieve optimum life outcomes.
"Improvements in care have resulted in almost all children with SCD surviving into adulthood and transitioning into adult care, which has allowed shifting the goal of care to improved quality of life," the authors write.
Several authors disclosed ties to the pharmaceutical industry.
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Oseltamivir Not Linked to Reduced Risk for Flu Hospitalization
WEDNESDAY, June 14, 2023 (HealthDay News) -- For outpatients with influenza infection, oseltamivir is not associated with a reduced risk for hospitalization, according to a review published online June 12 in JAMA Internal Medicine.
Ryan Hanula, from the McGill University Health Centre in Montreal, and colleagues examined the efficacy and safety of oseltamivir in preventing hospitalization among influenza-infected adult and adolescent outpatients in a systematic review and meta-analysis. Data were included from 15 studies, with an intention-to-treat infected (ITTi) population of 6,295 individuals; 54.7 percent were prescribed oseltamivir.
The researchers found that within the ITTi population, oseltamivir was not associated with a reduced risk for hospitalization (risk ratio [RR], 0.77; 95 percent confidence interval [CI], 0.47 to 1.27). Oseltamivir was also not associated with a reduced risk for hospitalization among older populations (mean age, 65 years and older; RR, 0.99; 95 percent CI, 0.19 to 5.13) or among those considered at elevated risk for hospitalization (RR, 0.90; 95 percent CI, 0.37 to 2.17). Oseltamivir was associated with increased nausea and vomiting but not with serious adverse events within the safety population.
"There is a lack of convincing evidence that oseltamivir reduces serious complications in outpatients with influenza, though its use is associated with an increase in nonsevere gastrointestinal adverse events," the authors write. "This meta-analysis provides important data for clinicians, patients, and policy makers to contextualize the evidence and inform guidelines."
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Texas AG Sues Dallas Doctor Over Transgender Care for Minors
A Dallas doctor has been sued by Texas Attorney General Ken Paxton for allegedly providing transgender care to nearly two dozen minors in violation of state law.
In the lawsuit filed Thursday, Paxton claimed that Dr. May Chi Lau, who specializes in adolescent medicine, provided hormone replacement therapy to 21 minors who were transitioning from October 2023 to August 2024. Last year, Texas enacted a law banning hormone replacement therapy and other forms of gender-affirming care for minors.
“Texas passed a law to protect children from these dangerous unscientific medical interventions that have irreversible and damaging effects,” Paxton said in a statement announcing the lawsuit. “Doctors who continue to provide these harmful ‘gender-transition’ drugs and treatments will be prosecuted to the full extent of the law.”
The statement also claimed that Lau used "false diagnoses and billing codes" to mask "unlawful prescriptions."
Paxton’s suit is the first filed in the country by an attorney general against an individual doctor alleging violation of a restriction on transition-related care for minors, NBC News reported.
Neither Lau nor her employer, the University of Texas Southwestern Medical Center, responded to a request for comment from NBC News.
If Lau is found guilty, she could lose her medical license and face a financial penalty of hundreds of thousands of dollars, NBC News reported.
Texas’ law includes a provision that allows doctors to continue to prescribe puberty blockers and hormone therapy to patients who began treatment before June 1, 2023, to safely wean them off the medications, according to Paxton’s suit.
Minors are also required to have attended at least 12 counseling or psychotherapy sessions for at least six months before they start treatment. It wasn't clear whether Lau’s patients could fall under that provision, NBC News said.
Twenty-six states ban at least some forms of gender-affirming care for minors, according to the Movement Advancement Project, an LGBTQ think tank.
The U.S. Supreme Court is expected to hear oral arguments and rule this session on whether to strike down a similar law in Tennessee, NBC News reported. How the court rules on the Tennessee law will affect similar restrictions in other states.
Major medical organizations, such as the American Medical Association and the American Academy of Pediatrics, state that transition-related care is an effective and medically necessary way to treat gender dysphoria, which is distress felt by people whose gender identities differ from their genders assigned at birth.
More information
Johns Hopkins has more on transgender healthcare.
SOURCE: Texas Attorney General's office, news release, Oct. 17, 2024; NBC News
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AI Can Identify Guardian Authorship of Messages in Teen Patient Portal
Large language model (LLM)-based classifiers can accurately detect guardian authorship of messages sent from an adolescent patient portal, according to a research letter published online June 25 in JAMA Network Open.
April S. Liang, M.D., from the Stanford University School of Medicine in Palo Alto, California, and colleagues examined the ability of a LLM to detect guardian authorship of messages originating from adolescent patient portals. Messages from adolescent patient portal accounts at Stanford Children's Health were sampled and manually reviewed for authorship. Two prompts were iteratively engineered on a random subset of 20 messages until perfect performance was achieved: one focusing on authorship identification (single task) and one that generated response to the message and identified authorship (multitask). Both prompts were tested on remaining messages.
Of the 2,088 test messages, 71.8 and 28.2 percent were labeled as parent- or guardian-authored and patient-authored, respectively. The researchers found that the single-task LLM achieved sensitivity and specificity of 98.1 and 88.4 percent, respectively, while the multitask LLM achieved sensitivity and specificity of 98.3 and 88.9 percent, respectively. This corresponded to a positive predictive value and negative predictive value above 95 percent for multitask LLM. Statistically identical performance was seen for the single-task and multitask classifiers.
"Ultimately, reliable identification of nonpatient-authored messages has implications beyond adolescent medicine. Among adults, care partners commonly access patient portals using the patient's credentials, especially relevant for geriatric patients or individuals with developmental differences," the authors write. "Our results found that this study's LLM has potential in improving safeguards for patient confidentiality."
One author disclosed ties to nference.
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Universal, School-Based Screening Increases Identification of Teens at Risk for Suicide
FRIDAY, Feb. 10, 2023 (HealthDay News) -- Universal, school-based, adolescent suicide risk screening effectively identifies at-risk adolescents and increases initiation of mental health services versus relying on concerning behavior, according to a study published in the December issue of The Journal of Pediatrics.
Deepa L. Sekhar, M.D., from the Penn State College of Medicine in Hershey, and colleagues evaluated the effectiveness of adolescent suicide risk screening to increase initiation of mental health services. The analysis included 12,909 students in 14 Pennsylvania high schools who were randomly assigned by grade to either targeted referral for behavior raising a concern for suicide risk or universal screening using the Patient Health Questionnaire-9.
The researchers found that adolescents in the universal screening arm had 7.1-fold greater odds of being identified as at risk for suicide, 7.8-fold greater odds of follow-up needs, and 4.0-fold greater odds of initiating mental health treatment.
"Although the Patient Health Questionnaire-9 is a major depressive disorder screening tool, its use in universal screening increased identification and treatment initiation for adolescents at risk for suicide," the authors write. "This confirms the value of universal screening and suggests that a suicide-specific risk assessment would have even greater impact on treatment initiation for identified youth."
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Housing Insecurity Linked to Poorer Teen Health Outcomes
There is an association for housing insecurity starting in infancy and poorer adolescent outcomes, according to a study published online July 1 in Pediatrics.
Kristyn A. Pierce, M.P.H., from the NYU Grossman School of Medicine in New York City, and colleagues created a composite measure of housing insecurity using five indicators for participants at ages 1, 3, 5, 9, and 15 years based on data from the Future of Families and Child Wellbeing Study. Group-based trajectory modeling was used to identify distinct patterns of housing insecurity, sociodemographic predictors of these patterns, and how these patterns relate to health outcomes among adolescents.
The researchers identified three trajectories of housing insecurity from infancy to adolescence: secure, moderately insecure, and highly insecure. Reduced odds of excellent health were seen for adolescents who experienced moderately and highly insecure housing (adjusted odds ratios, 0.81 and 0.67, respectively); they also experienced more depressive symptoms compared to adolescents with secure housing (adjusted incidence rate ratio, 1.05). Significantly higher anxiety symptoms were reported by adolescents who experienced highly insecure housing (adjusted incidence rate ratio, 1.06).
"Housing insecurity is preventable and addressable through policy and public health intervention," the authors write. "Future work is needed to validate a universal measure for housing insecurity and implement screening and referral procedures for families with young children to appropriate services."
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American Society of Hematology, Dec. 9 to 12
The annual meeting of the American Society of Hematology was held from Dec. 9 to 12 in San Diego and attracted participants from around the world, including hematology specialists as well as clinical practitioners and other health care professionals. The conference featured presentations focusing on the diagnosis, treatment, and prevention of disorders affecting blood, bone marrow, and the immunologic, hemostatic, and vascular systems.
In one study, Julie Kanter, M.D., of the University of Alabama in Birmingham, and colleagues found that treatment of patients with sickle cell disease (SCD) with lovotibeglogene autotemcel (lovo-cel) results in sustained antisickling hemoglobin production and nearly complete resolution of vaso-occlusive events and severe vaso-occlusive events up to 18 months following treatment.
The authors reported on efficacy and safety from the phase 1/2 HGB-206 and phase 3 HGB-210 studies of lovo-cel. Data were included from adult and pediatric (age 12 to <18 years) patients in the HGB-210 study and health-related quality-of-life data from the HGB-206 study. The researchers found that one-time treatment with lovo-cel resulted in near-complete resolution of acute pain events (vaso-occlusive crises) for all patients, with complete resolution of moderate and severe crises in 88 and 94 percent of patients, respectively. In addition, 100 percent of adolescent patients demonstrated complete resolution of all vaso-occlusive crises. A majority of patients were free of acute pain events through last follow-up (median, 35.5 months). The safety profile of the lovo-cel treatment regimen was consistent with underlying SCD and known effects of myeloablative conditioning.
"Lovo-cel uses a gene that makes hemoglobin A (similar to the adult HbA that is naturally occurring) and is highly effective and durable at improving hemoglobin, almost completely resolving hemolysis and reducing patient reported pain intensity and interference," Kanter said. "We will certainly be discussing this therapy with people with frequent acute pain events who are interested in pursuing a transformative treatment and also pursuing payment options."
Several authors disclosed financial ties to pharmaceutical and biotechnology companies, including Bluebird Bio, which manufactures lovo-cel.
In another study, Jatinder Lamba, Ph.D., of the University of Florida in Gainesville, and colleagues found that low ACS10 (10-SNP Ara-C_SNP) scores are more prevalent in Black patients with acute myeloid leukemia (AML) and are associated with inferior outcomes among patients treated with standard (low-dose cytarabine) induction therapy.
The authors compared results from an investigation of ACS10 differences between Black and White patients with AML across three treatment arms. The researchers observed a greater abundance of low ACS10 scores in Black patients (70 percent) compared with White patients (30 percent). They also found a low ACS10 score was associated with poor outcomes in patients treated on a standard dose of cytarabine, with the use of an intensified regimen improving outcomes in the groups with low ACS10 scores.
"The negative impact of low ACS10 score was mitigated by intensification of cytarabine during induction therapy, suggesting that Black and White patients with low ACS10 scores may benefit from this intervention," Lamba said. "Using genotype-guided intensification regimens can help overcome the negative impact of low ACS10 score by intensification of cytarabine during induction therapy. This can further mitigate racial differences in outcomes given that Black patients have high abundance of low ACS10 scores."
Several authors disclosed financial ties to the pharmaceutical and biotechnology industries.
ASH: Female Researchers Receive Only One-Third of NIH R01 Grants
MONDAY, Dec. 18, 2023 (HealthDay News) -- From 2012 to 2022, female researchers were awarded only one-third of National Institutes of Health Research Project Grants, according to a study presented at the annual meeting of the American Society of Hematology, held from Dec. 9 to 12 in San Diego.
ASH: Ibrutinib-Venetoclax Beneficial for Relapsed/Refractory Lymphoma
THURSDAY, Dec. 14, 2023 (HealthDay News) -- For patients with relapsed/refractory mantle cell lymphoma, ibrutinib combined with venetoclax provides a progression-free survival benefit, according to a study presented at the annual meeting of the American Society of Hematology, held from Dec. 9 to 12 in San Diego.
ASH: MRD-Directed Ibrutinib-Venetoclax Treatment Beneficial in Leukemia
WEDNESDAY, Dec. 13, 2023 (HealthDay News) -- For patients with chronic lymphocytic leukemia, measurable residual disease-directed ibrutinib-venetoclax treatment improves progression-free and overall survival, according to a study published online Dec. 10 in the New England Journal of Medicine to coincide with the annual meeting of the American Society of Hematology, held from Dec. 9 to 12 in San Diego.
ASH: Daratumumab Beneficial for Patients With Multiple Myeloma
WEDNESDAY, Dec. 13, 2023 (HealthDay News) -- For transplantation-eligible patients with newly diagnosed multiple myeloma, the addition of subcutaneous daratumumab combined with bortezomib, lenalidomide, and dexamethasone induction and consolidation therapy and with lenalidomide maintenance therapy improves progression-free survival. These findings were published online Dec. 12 in the New England Journal of Medicine to coincide with the annual meeting of the American Society of Hematology, held from Dec. 9 to 12 in San Diego.
ASH: Axi-Cel CAR T-Cell Treatment Effective in High-Risk Lymphoma Patients
TUESDAY, Dec. 12, 2023 (HealthDay News) -- For patients with relapsed or refractory large B-cell lymphoma, including those with comorbidities, the autologous anti-CD19 chimeric antigen receptor T-cell therapy axicabtagene ciloleucel yields five-year progression-free survival of 28.5 percent and overall survival of 40.3 percent, according to a study presented at the annual meeting of the American Society of Hematology, held from Dec. 9 to 12 in San Diego.
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Specialty choice and race, is there a connection?
New data show the choices of America’s doctors by gender, race, and age. Here are some notable trends revealed by the 2021 data, which covers about 950,000 active physicians.
- Wide varieties in race/ethnicity
- Native Hawaiian or Other Pacific Islander — 0.1%
- American Indian or Alaska Native — 0.3%
- Multiple races, non-Hispanic — 1.3%
- Black or African American — 5.7%
- Hispanic — 6.9%
- Asian — 20.6%
- White — 63.9%
Among the most popular specialties, by race/ethnicity:
- Native Hawaiian or Other Pacific Islander — Sports medicine, pediatric anesthesiology, pain medicine and pain management
- American Indian or Alaska Native — Family medicine/general practice, preventive medicine, pain medicine and pain management
- Multiple races, non-Hispanic — Pediatric anesthesiology, sports medicine, vascular and interventional radiology
- Black or African American — Obstetrics and gynecology, preventive medicine, child and adolescent psychiatry
- Hispanic — Geriatric medicine, infectious disease, child and adolescent psychiatry
- Asian — Nephrology, interventional cardiology, geriatric medicine
- White — Orthopedic surgery, sports medicine (orthopedic surgery), otolaryngology
“One clear takeaway is that physicians from groups underrepresented in medicine are more concentrated in primary care and a few other specialties, like pain medicine and pain management,” says Michael Dill, the AAMC’s director of workforce studies...Read More
Are you surprised that different races have different specialty preferences?
Radiological Society of North America, Dec. 1 to 5
The annual meeting of the Radiological Society of North America was held from Dec. 1 to 5 in Chicago, drawing participants from around the world, including radiologists, radiation oncologists, physicists in medicine, radiologic technologists, and other health care professionals. The conference featured scientific papers from a number of subspecialties covering the newest trends in radiological research, as well as education and informatics exhibits.
In an observational study, Elena Ghotbi, M.D., of the Johns Hopkins University School of Medicine in Baltimore, and colleagues identified an association between bone loss and levothyroxine, the second most commonly prescribed medication among older adults in the United States. The association did not include an increased prevalence of clinically significant low bone density, such as rates of osteoporosis.
The authors aimed to determine if levothyroxine use and higher thyroid hormone levels within the reference range were associated with higher bone loss with normal thyroid function. Data from the prospective, observational, Baltimore Longitudinal Study of Aging were evaluated.
During a median follow-up of 6.3 years, the researchers found that levothyroxine use was associated with greater loss of total body bone mass and bone density, even in participants with thyroid-stimulating hormone (TSH) levels within the normal range and when accounting for baseline TSH and other risk factors.
Data also indicated that levothyroxine may be prescribed in some older adults when it is not truly indicated. However, to establish causality and clarify the potential long-term musculoskeletal risks of levothyroxine use in this population, further research, including randomized trials, is necessary, according to the authors.
"While it is too early to draw clinical conclusions based on these preliminary observational findings, the study raises important questions. For instance, thyroid hormone is sometimes initiated in patients who do not have hypothyroidism, such as for managing symptoms despite normal hormone levels," Ghotbi said. "Patients with concerns should consider discussing their diagnosis and treatment goals with their health care provider to ensure the appropriateness of their therapy."
In another study, Kevin C. Yu, of the Wake Forest University School of Medicine in Winston-Salem, North Carolina, and colleagues found that concussions are related to reduced cortical excitability in the frontal cortex, which is associated with worse cognitive function.
The authors collected preseason and postseason resting-state magnetoencephalography data to identify the impacts of concussions on aperiodic activity. The Post-Concussive Symptom Inventory, a clinical evaluation tool for concussions, was used to correlate preseason and postseason physical, cognitive, and behavioral symptoms.
The researchers found that concussion reduces cortical excitability in parts of the brain important for cognitive function, like attention. These concussion-related changes in cortical excitability were also associated with worse cognitive symptoms.
"We believe these findings are important, both because they provide insight into the mechanisms and clinical implications of concussion in the adolescent brain, and because they may inform recommendations for clinical monitoring and intervention strategies for individuals with head trauma," Yu said. "This study highlights the importance of monitoring the brain signaling of adolescents carefully after any head injury and taking concussion seriously. It also underscores the importance of protective measures in sports and ensuring that young adults take the necessary time to fully recover before returning to play."
Mahsa Dolatshahi, M.D., of the Mallinckrodt Institute of Radiology at the Washington University School of Medicine in St. Louis, and colleagues found that visceral adipose tissue, or deep belly fat -- but not other types of fat -- plays a role in the hallmark pathologies of Alzheimer disease.
The authors evaluated 80 cognitively normal middle-aged individuals who underwent brain positron emission tomography, body magnetic resonance imaging (MRI), metabolic assessment, and blood lipid level evaluation.
The researchers found that visceral adiposity mediated the link between high body mass index (BMI) and amyloid deposition in the brain, and is likely linked to early tau pathology, independent of BMI.
While high BMI, as the classic definition of obesity, is important, it is not the whole story, as other types of fat or muscle mass are not particularly linked to these pathologies, the authors note. They stress that modification of visceral adiposity, coupled with dyslipidemia, should be the focus of interventions for brain health-related outcomes. The effect of visceral fat on amyloid accumulation is partly mediated by lower high-density lipoprotein.
"The impacts on clinical practice for now are mostly limited to suggestions at preventive levels for modifying excess body fat," Dolatshahi said. "We need more longitudinal and interventional studies to understand the effects of different lifestyle and social determinants in visceral adiposity and brain health."
Marianne Nabbout, M.D., of the University of Arkansas for Medical Sciences in Little Rock, and colleagues found that one episode of electronic cigarette inhalation can have an acute and measurable effect on vascular beds.
The researchers aimed to demonstrate the acute effects of tobacco smoking and nicotinized and nonnicotinized e-cigarette vaping on vascular function among healthy smokers and vapers using quantitative MRI. Study participants underwent two MRI exams, one before and one after each of the following smoking/vaping episodes: tobacco cigarette, e-cigarette aerosol with nicotine, and e-cigarette aerosol without nicotine.
Following nicotinized and nonnicotinized e-cigarette vaping challenges, baseline venous oxygen saturation significantly decreased in the superficial femoral vein, which suggests an immediate decrease in the uptake of oxygen by the lungs following e-cigarette smoking. In the superficial femoral artery, the time of forward flow (the duration of monophasic waveform during reactive hyperemia that occurs due to decreased microvascular resistance) was significantly decreased following both nicotinized and nonnicotinized e-cigarette vaping challenges. Following inhalation of each type of vaping or smoking, there was a significant decrease seen in the resting blood flow velocity in the superficial femoral artery. The hyperemic index (at the superficial femoral artery) was significantly decreased following nicotinized e-cigarette vaping.
"These observations may suggest depressed hyperemia in the femoral artery following induced ischemia via cuff occlusion at the level of the upper thigh," Nabbout said. "The reason we saw significant effects following nonnicotinized electronic cigarette vaping may be due to the presence of harmful constituents other than nicotine. The study is ongoing to acquire more data. The larger the sample size, the more likely we are to detect statistically significant effects."
Keegan Staab, of the University of Iowa in Iowa City, and colleagues identified a link between lung function and brain function in patients with long COVID that could lead to a better understanding of the mechanisms responsible for the persistent dyspnea and cognitive symptoms observed after COVID-19 infection.
The researchers aimed to gain insight into the link between pulmonary MRI gas exchange, structural and functional brain MRI, and cognition among patients with long COVID. They found that pulmonary gas exchange measured using hyperpolarized xenon MRI was related to cognitive function assessed using the National Institutes of Health Toolbox and brain perfusion measured via MRI.
"Previous work has attributed perceived cognitive deficits to psychological distress rather than an underlying disease process," Staab said. "Our data provide evidence that this may not be the case and could be caused by underlying physiological and persistent lung abnormalities."
RSNA: Opportunistic Assessment of Aortic Calcium Predicts MACE
MONDAY, Dec. 9, 2024 (HealthDay News) -- A fully automated algorithm to quantify aortic artery calcification on computed tomography scans performed for other clinical purposes can predict the risk for subsequent major adverse cardiovascular events, according to a study presented at the annual meeting of the Radiological Society of North America, held from Dec. 1 to 5 in Chicago.
RSNA: Genicular Artery Embolization Effective, Safe for Knee Osteoarthritis
FRIDAY, Dec. 6, 2024 (HealthDay News) -- Genicular artery embolization is effective and safe for reducing osteoarthritis symptoms among patients with knee osteoarthritis that is refractory to conservative therapy, according to a study presented at the annual meeting of the Radiological Society of North America, held from Dec. 1 to 5 in Chicago.
RSNA: Obesity, VAT Linked to Measures of Amyloid Burden in Midlife
WEDNESDAY, Dec. 4, 2024 (HealthDay News) -- Obesity and visceral fat are associated with measures of amyloid burden in the brain among cognitively normal midlife individuals, according to a study presented at the annual meeting of the Radiological Society of North America, held from Dec. 1 to 5 in Chicago.
RSNA: Silicosis Often Missed in Engineered Stone Countertop Workers
TUESDAY, Dec. 3, 2024 (HealthDay News) -- Few primary clinicians or radiologists recognize silicosis among engineered stone countertop workers, according to a study presented at the annual meeting of the Radiological Society of North America, held from Dec. 1 to 5 in Chicago.
RSNA: Levothyroxine Tied to Bone Loss Over Time in Older Adults
MONDAY, Nov. 25, 2024 (HealthDay News) -- Levothyroxine use is associated with longitudinal loss of bone mass and density in older adults, according to a study scheduled to be presented at the annual meeting of the Radiological Society of North America, held from Dec. 1 to 5 in Chicago.
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Twice-Yearly Lenacapavir Prevents HIV Infection in Young Women
For adolescent girls and young women, lenacapavir every 26 weeks is beneficial for preventing acquired HIV infection, according to a study published online July 24 in the New England Journal of Medicine to coincide with the 25th International AIDS Conference, held from July 22 to 26 in Munich.
Linda-Gail Bekker, M.B., Ch.B., Ph.D., from the Desmond Tutu HIV Centre at the University of Cape Town in South Africa, and colleagues conducted a phase 3 trial involving adolescent girls and young women who were randomly assigned to receive subcutaneous lenacapavir every 26 weeks, daily oral emtricitabine-tenofovir alafenamide (F/TAF), or daily oral emtricitabine-tenofovir disoproxil fumarate (F/TDF; active control) in a 2:2:1 ratio (2,134; 2,136; and 1,068 participants, respectively). The relative efficacy of lenacapavir and F/TAF was assessed by comparing the incidence of HIV infection versus the estimated background incidence in the screened population (8,094 participants); relative efficacy was compared with F/TDF.
The researchers observed 55 incident HIV infections among 5,338 participants who were initially HIV-negative (0.0, 2.02, and 1.69 infections per 100 person-years in the lenacapavir, F/TAF, and F/TDF groups, respectively). In the screened population, background HIV incidence was 2.41 per 100 person-years. HIV incidence with lenacapavir was significantly lower than background HIV incidence and than HIV incidence with F/TDF (incidence rate ratio for both, 0.00). No significant difference was observed for HIV incidence with F/TAF and background HIV incidence, and no meaningful difference was seen for HIV incidence between F/TAF and F/TDF.
"Twice-yearly lenacapavir offers a highly efficacious and discreet choice to potentially improve preexposure prophylaxis use among women," the authors write.
Several authors disclosed ties to pharmaceutical companies, including Gilead Sciences, which manufactures lenacapavir and funded the study.
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Guideline Developed for Opioid Prescribing in Children With Acute Pain
In a clinical practice guideline issued by the American Academy of Pediatrics and published online Sept. 30 in Pediatrics, recommendations are presented for opioid prescribing for acute pain management in children and adolescents in outpatient settings.
Scott E. Hadland, M.D., M.P.H., from Harvard Medical School in Boston, and colleagues recommend that acute pain should be treated using a multimodal approach, including appropriate use of nonpharmacologic therapies, nonopioid medication, and opioid medication, when needed. For children and adolescents with acute pain, opioids should not be prescribed as monotherapy. Clinicians should prescribe immediate-release opioid formulations, start with the lowest age- and weight-appropriate doses, and provide an initial supply of five or fewer days when using opioids for acute pain management, unless the pain is related to trauma or surgery with an expected duration of more than five days. Codeine or tramadol should not be prescribed for children younger than 12 years; for adolescents age 12 to 18 years with obesity, obstructive sleep apnea, or severe lung disease; for treating postsurgical pain after tonsillectomy or adenoidectomy in patients younger than 18 years; or for any breastfeeding patient. Caution should be exercised when prescribing opioids for acute pain in children or adolescents who are taking sedating medications. Naloxone should be provided when opioids are prescribed, and patients and families should be counseled on the signs of opioid overdose and how to respond.
"For a patient with mild-to-moderate pain, doctors should always start nonopioid medications and treatment," coauthor Rita Agarwal, M.D., from the Stanford University School of Medicine in California, said in a statement.
Two authors disclosed ties to the pharmaceutical industry.
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2015 to 2021 Saw Increase in Electronic Vaping Product Use in Teens
THURSDAY, May 16, 2024 (HealthDay News) -- From 2015 to 2021, there were significant increases in the use of electronic vapor products (EVPs) among adolescents, according to a study published in the May issue of the Ochsner Journal.
Charles H. Hennekens, M.D., from the Charles E. Schmidt College of Medicine at Florida Atlantic University in Boca Raton, and colleagues used data from the Youth Risk Behavior Survey for grades 9 through 12 from 2015 to 2021 to examine temporal trends in EVP use. Data were included for 57,006 adolescents.
The researchers found that from 2015 to 2019, there was an increase of more than 3.5-fold in daily use of EVPs, from 2.0 to 7.2 percent. In 2021, the percentage decreased to 5.0 percent. In 2015, EVP use was significantly higher in boys than girls (2.8 versus 1.1 percent), but by 2021, use was higher among girls (5.6 versus 4.5 percent). Compared with 2015, in 2021, EVP use was higher among White youth than Black, Asian, and Hispanic/Latino youth (6.5 percent versus 3.1, 1.2, and 3.4 percent, respectively); between 2015 and 2021, the highest increases of about threefold were seen for White and Black adolescents. At all periods, the highest percentages of EVP use were seen for adolescents in grade 12.
"The sustained high levels of EVP use, despite the observed decrease during the U.S. COVID-19 epidemic, suggest an urgent need for health care providers to integrate routine screening for vaping and nicotine dependence into adolescent health assessments," the authors write.
Two authors disclosed ties to industry, including one who is a co-inventor on patents for inflammatory biomarkers and cardiovascular disease.
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U-Shaped Link Detected Between Adolescent BMI and Mental Health
FRIDAY, May 17, 2024 (HealthDay News) -- There is a U-shaped association between adolescent body mass index (BMI) and mental health, according to a study published online May 15 in JAMA Psychiatry.
Shanquan Chen, Ph.D., from the London School of Hygiene & Tropical Medicine, and colleagues estimated the association between BMI and mental health and examined changes from 2002 to 2018 in a repeated multicountry cross-sectional study. Data were obtained from the Health Behaviour in School-aged Children survey in Europe and North America, including a study population of 1,036,869 adolescents (527,585 girls) aged 11 to 15 years.
The researchers identified a U-shaped association between BMI and mental health. Compared with those with healthy weight, adolescents with low body mass, overweight, or obesity had increased psychosomatic symptoms (unstandardized β, 0.14, 0.27, and 0.62, respectively), while fewer symptoms were seen for adolescents with underweight (β, −0.18). Across different years, sex, and grade, the association was observed. Psychosomatic concerns increased significantly in 2006, 2010, 2014, and 2018 compared with 2002 (unstandardized β, 0.19, 0.14, 0.48, and 0.82, respectively). Significantly higher psychosomatic concerns were seen for girls than boys (unstandardized β, 2.27). Psychosomatic concerns increased significantly in middle and high school versus primary school (unstandardized β, 1.15 and 2.12, respectively).
"These insights can inform public health and school programs, emphasizing correcting body image misconceptions, encouraging healthy weight, and creating supportive peer environments," the authors write.
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Gestational Diabetes Risk Higher in Women With Preconception Prediabetes
Preconception prediabetes is associated with increased odds of gestational diabetes among adolescents and young adults, according to a study published online Sept. 24 in JAMA Network Open.
Katharine J. McCarthy, Ph.D., from the Icahn School of Medicine at Mount Sinai in New York City, and colleagues conducted a retrospective cohort study using linked 2009 to 2017 birth registry, hospital discharge, and New York City Department of Health A1C Registry data for pregnant individuals aged 10 to 24 years. Eligibility criteria were met by 14,302 individuals: 41.0 percent Hispanic, 29.0 percent Black, 18.1 percent White, 10.6 percent Asian, and 1.3 percent other or unknown race and ethnicity.
The researchers found that 79.7 and 20.2 percent of participants had normoglycemia and prediabetes, respectively. Compared with those with normoglycemia, those with preconception prediabetes had more than twice the risk for gestational diabetes (adjusted relative risk [aRR], 2.21) after adjusting for prepregnancy characteristics. Small increases in the likelihood of a hypertensive disorder of pregnancy (aRR, 1.18) and preterm delivery (aRR, 1.18) were seen in association with preconception prediabetes. Increases were seen in the risks for cesarean delivery and macrosomia, but they were not statistically significant. For identifying gestational diabetes among adolescents and young adults, the optimal hemoglobin A1c threshold was 5.6 percent.
"Given alarming trends in adolescent obesity and diabetes risk and the high prevalence of unplanned pregnancies in adolescence and young adulthood, our results support expanded preconception screening as a mechanism to intervene on excess cardiometabolic risk earlier in the life course," the authors write.
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