Health insurers have made an enticing pitch to local governments across the country: When your workers see doctors outside your health plan’s network, costs can balloon, but we offer a program to protect against outrageous bills.Cities, counties and school districts have signed up, hoping to control the costs of their medical benefits.Then come the fees.In Shelby County, Tenn., the insurer’s charges for administering the program climbed last year to $1.3 million — more than the county budgeted this year for long-term disability insurance for all of its roughly 6,000 employees.In Hoboken, N.J., the charges sometimes exceeded the amount paid to doctors for providing treatment. And in a stretch of California’s Central Valley where two counties share a health plan, the fees unexpectedly quintupled in one year to more than a quarter-million dollars, contributing to a plan deficit.MultiPlan, a data analytics firm, helps insurers reduce payments to doctors, then keeps a portion of the savings for itself.José A. Alvarado Jr. for The New York TimesFrom southern Florida to the Pacific Northwest, local governments have paid similar fees, often with little awareness that their taxpayer dollars have become a lucrative revenue stream for some of the nation’s largest insurers, according to a review of documents obtained in two dozen public records requests and interviews with city and county officials and benefits consultants.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Getty ImagesA doctor found to have urinated in a consultation room’s sink and failed to adhere to restrictions on his registration has been struck off.

The company said it would put Quarter Pounders back on the menu, without the raw onions that were considered the likely source of the bacteria.McDonald’s announced on Sunday that tests in Colorado had ruled out its Quarter Pounder beef patties as the source of a deadly E. coli outbreak, and said that the popular burger would be back on the menu at hundreds of locations in a dozen states.But the company said Quarter Pounders would not be topped with raw slivered onions — which federal regulators have identified as the likely culprit in the outbreak that health officials said had sickened 75 people and caused the death of one Colorado resident.In a statement, McDonald’s cited tests conducted in Colorado, the state that had the most cases reported in the outbreak. On its website, the state’s Agriculture Department said that tests were done on “dozens of subsamples from all the lots and all samples were found to be negative for E. coli.”Colorado health officials tested beef samples from the two beef suppliers that provided patties to the 900 affected locations in a dozen states, McDonald’s spokesmen said.The company said it was not aware of any other state health agency that was still testing the beef patties for E. coli.As for the slivered onions, McDonald’s said on Friday it would stop buying onions from the Colorado Springs site of its major regional supplier Taylor Farms, a multistate producer of vegetables and fruits. Last week, Taylor Farms recalled several yellow onion products — among them diced and slivered — because of “potential E. coli contamination.”Several other fast-food chains, including Taco Bell, KFC, Pizza Hut and Burger King, have stopped offering onions in their menu items as a precautionary measure in the region.U.S. health officials said they believed that the recall of onions from the region’s food supply chain would lower the risk to consumers.Among the 75 people who became ill, at least a quarter were hospitalized, according to the most recent data from the Centers for Disease Control and Prevention. Two developed a serious kidney condition associated with E. coli, the agency said. The illnesses were reported between Sept. 27 and Oct. 10.A McDonald’s spokesman said that the number may rise, as federal regulators process case information, but said that they were “very confident” that they had removed the source of contamination from the supply chain.Since the C.D.C. first announced the outbreak on Tuesday, McDonald’s shares have fallen roughly 7 percent.

BBCFive times Prof Kevin Fong broke down in tears in a nondescript hearing room in West London, while giving evidence to the Covid inquiry.

Kinnon MacKinnon, a Canadian researcher, was only faintly surprised this spring when the website for an upcoming conference did not list his talk alongside the dozens of others. He was slated to discuss one of the most fraught topics in medicine: patients who transition to a different gender but later change their minds, known as detransition.The Pediatric Endocrine Society, which organized the conference, said that his presentation was kept under wraps because of safety concerns; there were protests against gender medicine at the previous year’s gathering. When he gave the talk in a Chicago hotel ballroom, the audience was asked to submit questions anonymously, on notecards. No recording was allowed. The room, though full, was eerily quiet.Dr. MacKinnon, a 39-year-old assistant professor of social work at York University in Toronto, is transgender, and he presented alongside another trans researcher. As he took the microphone, he joked: “They really get the trans people in to talk about the easy topics, eh?”He’s gotten used to trying to defuse tension — at scientific meetings and gender clinics, and in TikTok posts — as detransition, a once-obscure topic, has vaulted into the U.S. presidential campaign and an upcoming Supreme Court case.A small group of detransitioners — mostly young women who underwent medical treatment to live as trans men, but later regretted it — have become the public faces of Republican-led bans on gender medicine for minors. In frequent testimonies in statehouses and appearances in right-wing media, they have described sometimes irreversible procedures they received while adolescents, arguing that they were misled or neglected by their doctors.Activists defending youth gender medicine have argued that such experiences are exceedingly rare, and that patients are much less likely to regret their transitions than to regret common medical procedures, like knee surgeries.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Health officials say that recalls of onions — the suspected source of the contamination — would help lessen the risk to consumers. Other major fast-food chains have also stopped offering onions.The number of people hospitalized from the E. coli outbreak linked to raw onions on McDonald’s Quarter Pounder hamburgers has more than doubled, and those reporting they have been sickened rose to 75, the Centers for Disease Control and Prevention reported on Friday.Illnesses of people ranging in age from 13 to 88 were reported in 13 states. Additionally, the C.D.C. said a second person had developed the life-threatening condition associated with E. coli called hemolytic uremic syndrome.While cases had been originally clustered in the Mountain West, updated data from the C.D.C. now shows cases in Michigan, Washington and Oregon. It is still unclear whether those people ate at McDonald’s in their home states or stopped at one of the restaurants while traveling.One older person in Colorado has died in the outbreak. The C.D.C. said the most recent illness occurred on Oct. 10, although the agency said more cases could be reported because it can take three to four weeks to determine whether an illness is part of the outbreak.Federal health officials said they hoped the risk to consumers would now be lower because onions have been recalled in many of those states, and many other fast-food chains including Taco Bell, KFC, Pizza Hut and Burger King also decided to stop offering onions in their menu items as a precautionary measure.News of the outbreak broke this week when the C.D.C. issued a food safety alert, as McDonald’s pulled its Quarter Pounders from locations in 10 states.The fast-food chain and the Food and Drug Administration have said preliminary investigations indicated that the raw, slivered onions served mainly atop the popular quarter-pound beef patties were a “likely source of contamination.” McDonald’s has also stopped providing fresh onions on its other burger items in the region.McDonald’s identified Taylor Farms as its onion supplier in the Mountain West and that company has since recalled several yellow onion products — slivered, diced and whole — because of “potential E. coli contamination.”Taylor Farms, a major fruit and vegetable supplier, did not respond to repeated requests for comment.Other restaurants that were customers and received the recalled onions have been notified and asked to remove the vegetables, the C.D.C. said.McDonald’s has halted sales of Quarter Pounders at restaurants in Colorado, Kansas, Utah, Wyoming, Idaho, Iowa, Missouri, Montana, Nebraska, Nevada, New Mexico and Oklahoma. Other hamburger items are not affected by the outbreak, the company emphasized.Regulators are still investigating whether the ground beef in the Quarter Pounder patties could have been a source of the bacteria.One lawsuit has already been filed by a resident who became sick after eating at a McDonald’s in Colorado, according to the law firm Ron Simon and Associates. That state has the higher number of cases, 26, the C.D.C. said, with Montana at 13 and Nebraska 11.

The body’s cooling defenses fail at lower “wet bulb” temperatures than scientists had estimated.Last month was the second-hottest September ever recorded; it came after the world’s warmest summer ever, in a year that is on track to be the most searing in recorded history.There’s only so much the human body can take. Heat killed 60,000 people in Europe alone in 2022, and at least 55,000 people in Russia in 2010. Now, growing research suggests that humans may be more vulnerable to rising temperatures than scientists had previously believed.“It’s scary as hell,” said Matthew Huber, director of the Institute for a Sustainable Future at Purdue University.In 2010, Dr. Huber and Steven Sherwood, a climate scientist at the University of New South Wales in Australia, first proposed a limit to how much heat the body could handle.They knew that humidity impedes evaporation and reduces the body’s ability to cool itself by sweating. And sweat is critical: It’s responsible for up to 80 percent of heat loss from the body. So the researchers turned to a measurement that accounts for this effect, called wet bulb temperature, or Tw.A wet bulb thermometer is essentially a thermometer wrapped in a damp wad of cotton. As water evaporates it cools the bulb, which makes it a convenient proxy for the way that sweating cools the body.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Federal officials have celebrated a striking drop in drug overdoses across the country. But state-level data shows that Black people are suffering significantly worse outcomes than white people.Overdose deaths across the country decreased by more than 12 percent between May 2023 and May 2024, according to new federal data, a major development in the nation’s efforts to combat the effects of fentanyl. The decrease continued a trend observed in recent months, and was the largest on record, the White House said last week.But a new analysis from Georgetown University researchers tells a more complicated story about a health crisis still claiming about 100,000 lives every year. In 22 states that track drug overdoses by race and ethnicity, the number of fatal overdoses among Black Americans typically increased between 2022 and 2023, while deadly overdoses among white Americans often decreased, the researchers found.The findings reveal a continuation of what federal and state health officials have described as a two-track epidemic, with white Americans experiencing better outcomes and Black Americans struggling to keep up. As overdose deaths rose to record levels in recent years, rates among Black and Native Americans were higher. But the more recent data goes further in showing how sharply the experiences of drug users have diverged by race.In Arizona, for instance, fatal drug overdoses among white people decreased by more than 2 percent, while overdoses among Black people increased by roughly a third. In Michigan, deadly drug overdoses among white people decreased by 12 percent, and increased among Black people by 6 percent. In Maine, fatal overdoses dropped by about 20 percent among white people but rose by over 40 percent among Black people.In states where decreases were found in both groups, they were typically smaller for Black Americans. In states where increases were found in both groups, they were often greater for Black people. And in places that tracked overdoses among Native and Hispanic Americans, similar disparities arose.Drug policy experts said that the new data underscored how public health strategies for drug addiction were still being applied unevenly, with deadly consequences. Naloxone, the overdose-reversing medication, has been harder to find for some Black Americans, as have addiction treatments.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Climate change, civil conflict and growing resistance to insecticides and treatments are all contributing to an alarming spread of cases.Malaria infection rates are soaring in Ethiopia, where a combination of armed conflict, climate change and mosquitoes’ growing resistance to drugs and insecticides has accelerated the spread of a disease the country once thought it was bringing under control.More than 6.1 million malaria cases, and 1,038 deaths, have been recorded in the country this year through the end of September, compared with 4.5 million cases, and 469 deaths, for all of 2023. Worse, cases are likely to soar far higher in the next couple of months because peak malaria season, driven by seasonal rains, begins in September and runs through the end of the year.“We’re backsliding so fast — we’ve gone back a decade,” said Fitsum Tadesse, the lead scientist overseeing the malaria program at the Armauer Hansen Research Institute in Addis Ababa, the capital of the country.The malaria surge in Ethiopia could prove to be a harbinger for other countries in the region, where the same underlying biological factors exist, and war and climate change are making more people vulnerable.Dr. Tadesse believes some of the rise in cases in Ethiopia is due to growing drug resistance: The parasites that cause malaria in East Africa are increasingly resistant to treatments that have long been the bedrock of the response.At the same time, mosquitoes are becoming more resistant to the insecticides that are used on protective bed nets and in indoor spraying programs. And they have evolved to evade diagnosis by some of the most common malaria tests.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

BBCPioneering surgery to remove large brain tumours through the eyebrows of patients has been successfully carried out in Scotland.