A Texas hospital is experimenting with hologram technology for doctors to see patients. Some health care experts wonder if it’s beneficial.A patient walks into a hospital room, sits down and starts talking to a doctor. Only in this case, the doctor is a hologram.It might sound like science fiction, but it is the reality for some patients at Crescent Regional Hospital in Lancaster, Texas.In May, the hospital group began offering patients the ability to see their doctor remotely as a hologram through a partnership with Holoconnects, a digital technology firm based in the Netherlands.Each Holobox — the company’s name for its 440-pound, 7-foot-tall device that displays on a screen a highly realistic, 3-D live video of a person — costs $42,000, with an additional annual service fee of $1,900.The high-quality image gives the patient the feeling that a doctor is sitting inside the box, when in reality the doctor is miles away looking into cameras and displays showing the patient.The system allows the patient and doctor to have a telehealth visit in real time that feels more like an in-person conversation. For now, the service is used mostly for pre- and postoperative visits.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.

Scientists say that findings from a small experiment lend hope the outbreak among dairy cattle can potentially be contained.Ever since scientists discovered influenza infecting American cows earlier this year, they have been puzzling over how it spreads from one animal to another. An experiment carried out in Kansas and Germany has shed some light on the mystery.Scientists failed to find evidence that the virus can spread as a respiratory infection. Juergen Richt, a virologist at Kansas State University who helped lead the research, said that the results suggested that the virus is mainly infectious via contaminated milking machines.In an interview, Dr. Richt said that the results offered hope that the outbreak could be halted before the virus evolved into a form that could spread readily between humans.“I think this is good news that we can most likely control it easier than people thought,” Dr. Richt said. “Hopefully we can now kick this thing in the behind and knock it out.”The findings have yet to be posted online or published in a peer-reviewed science journal.Seema Lakdawala, a virologist at Emory University who is researching the virus on dairy farms and was not involved in the new study, cautioned that breaking the transmission chain would require serious changes to how farmers milk their cows.“It’s really great that these results are coming out,” she said. “But this is a real logistical problem.”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.

Spring Fertility, a clinic in Midtown Manhattan, looks like the place where the main characters on “Broad City” would have wound up if the millennial sitcom had done an episode about egg freezing. The waiting room has books by America’s youth poet laureate Amanda Gorman and its Instagram poet laureate Rupi Kaur. The kitchen is stocked with Spindrift. A conference room also serves as a venue for “shots nights,” less raucous than they sound, where patients inject themselves with fertility drugs communally, with encouragement from staff.Spring’s medical director in New York, Catha Fischer, dressed in a loose blouse and a low ponytail, beamed as she showed me the phlebotomy stations and operating room, where patients are anesthetized so that a doctor can puncture their ovaries with a needle and suck out eggs for freezing. The room, Dr. Fischer noted, “looks like a Grey’s Anatomy O.R.”There is always a market for products, from skin care to weight loss, promising to ease the angst of womanhood. Efforts to slow down the reproductive clock are no different. The business of egg extraction is thriving, among the privileged group of people who can access it.Across Spring’s clinics nationwide, the number of egg freezing cycles undertaken last year jumped 37 percent from the year before. That surge is visible at fertility clinics around the country, according to data from the Society for Assisted Reproductive Technology. The prototypical patient also seems to be getting younger, doctors say, a change coinciding with a steady uptick in corporate benefit packages that cover fertility preservation. In 2015 just 5 percent of large employers covered egg freezing; in 2023, nearly one in five did.At Spring Fertility in Midtown Manhattan, the fridge is stocked with Spindrift and some patients attend “shots nights,” where they inject themselves with hormones in a group.Sara Messinger for The New York TimesSome medical technologies spread slowly, but the embrace of fertility preservation has grown at a remarkable rate. In 2015 there were about 7,600 egg freezing cycles recorded nationwide, and by 2022, that number hit 29,803, a nearly 300 percent increase.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.

Dr. Alex Arroyo, a director of pediatric medicine in Brooklyn, gets to live out his “Star Wars” dreams, practice jujitsu and make a big mess while cooking for his family.“Hey, buddy, how are you doing?” a man wearing a Boba Fett costume said as he leaned over the bed of a young boy in a hospital gown.It was a Sunday afternoon in the emergency room at Maimonides Medical Center in Brooklyn, where Dr. Alex Arroyo, the hospital’s director of pediatric emergency medicine, often dons one of more than 20 costumes when he visits patients. His favorite is Boba Fett, the famed bounty hunter from the “Star Wars” films.“I love what I do, but it’s sure hot in there!” said Dr. Arroyo, 48, who has worked at the hospital since 2006. He started wearing costumes in 2021.A die-hard “Star Wars” fan who grew up watching the original trilogy with his parents, Dr. Arroyo has passed that love on to his two youngest children, Grayson, 8, and Karra, 6. For New York Comic Con each year, the whole family dresses up, including his wife, Dr. Sharon Yellin, 44, a fellow pediatric emergency medicine physician who works at NewYork-Presbyterian Brooklyn Methodist Hospital. One year they went as the family from “Encanto.”“I was the big, strong sister with the donkey,” Dr. Arroyo said, referring to the character Luisa.Dr. Arroyo, who also has a 21-year-old son, Colin, from a previous marriage, was born in the Borough Park neighborhood of South Brooklyn — at Maimonides, in fact. Now he lives less than a mile from the house where he grew up, in a four-bedroom, three-story 1920s brownstone. He uses one of the spare bedrooms as his office and rents out the third floor.“It’s a frightening place to be inside of because I’m also an active-duty comic collector,” he said of his office. “It’s filled wall to wall with toys. It’s my sanctuary away from the world.”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.

The statement followed a report in The Times that a federal health official had urged the removal of age minimums from treatment guidelines for transgender minors.The Biden administration said this week that it opposed gender-affirming surgery for minors, the most explicit statement to date on the subject from a president who has been a staunch supporter of transgender rights.The White House announcement was sent to The New York Times on Wednesday in response to an article reporting that staff in the office of Adm. Rachel Levine, an assistant secretary at the Department of Health and Human Services, had urged an influential international transgender health organization to remove age minimums for surgery from its treatment guidelines for minors.The draft guidelines would have lowered the age minimums to 14 for hormonal treatments, 15 for mastectomies, 16 for breast augmentation or facial surgeries, and 17 for genital surgeries or hysterectomies. The final guidelines, released in 2022, removed the age-based recommendations altogether.“Adm. Levine shared her view with her staff that publishing the proposed lower ages for gender transition surgeries was not supported by science or research, and could lead to an onslaught of attacks on the transgender community,” an H.H.S. spokesman said in a statement on Friday evening.Federal officials did not elaborate further on the administration’s position regarding the scientific research or on Adm. Levine’s role in having the age minimums removed.The administration, which has been supportive of gender-affirming care for transgender youth, expressed opposition only to surgeries for minors, not other treatments. The procedures are usually irreversible, critics have said.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.

A loss of salt and body fluid can stimulate kidney regeneration and repair in mice, according to a USC Stem Cell study. This innate regenerative response relies on a small population of kidney cells in a region known as the macula densa (MD), which senses salt and exerts control over filtration, hormone secretion, and other key functions of this vital organ.
The scientists focused on how healthy kidneys originally evolved from the primitive kidney structure of the fish into more complicated and more efficiently working kidneys to absorb more salt and water. The research team fed lab mice a very low salt diet, along with a commonly prescribed drug called an ACE inhibitor that furthered lowered salt and fluid levels. In the region of the MD, the scientists observed regenerative activity, which they could block by administering drugs that interfered with signals sent by the MD. This underscored the MD’s key role in orchestrating regeneration. In the mouse MD cells, the scientists also identified specific signals from certain genes, including Wnt, NGFR, and CCN1, which could be enhanced by a low-salt diet to regenerate kidney structure and function. In keeping with these findings in mice, the activity of CCN1 was found to be greatly reduced in patients with chronic kidney disease (CKD). To test the therapeutic potential of these discoveries, the scientists administered CCN1 to mice with a type of CKD known as focal segmental glomerulosclerosis. They also treated these mice with MD cells grown in low-salt conditions. Both approaches were successful, with the MD cell treatment producing the biggest improvements in kidney structure and function.
“Our personal and professional mission is to find a cure for kidney disease, a growing global epidemic affecting one out of seven adults, which translates to 850 million people worldwide or about 2 million in the Los Angeles area,” said Peti-Peterdi, a professor of physiology, neuroscience and medicine at the Keck School of Medicine of USC. “Currently, there is no cure for this silent disease. By the time kidney disease is diagnosed, the kidneys are irreversibly damaged and ultimately need replacement therapies, such as dialysis or transplantation.”
To address this growing epidemic, Peti-Peterdi, first author Georgina Gyarmati, and their colleagues took a highly non-traditional approach. As opposed to studying how diseased kidneys fail to regenerate, the scientists focused on how healthy kidneys originally evolved.
“From an evolutionary biology perspective, the primitive kidney structure of the fish turned into more complicated and more efficiently working kidneys to absorb more salt and water,” said Peti-Peterdi, who also directs the Multi-Photon Microscopy Core at the Zilkha Neurogenetic Institute (ZNI). “This was necessary for adaptation to the dry land environment when the animal species moved from the salt-rich seawater. And that’s why birds and mammals have developed MD cells and this beautiful, bigger, and more efficient kidney structure to maintain themselves and functionally adapt to survive. These are the mechanisms that we are targeting and trying to mimic in our research approach.”
With this evolutionary history in mind, the research team fed lab mice a very low salt diet, along with a commonly prescribed drug called an ACE inhibitor that furthered lowered salt and fluid levels. The mice followed this regimen for up to two weeks, since extremely low salt diets can trigger serious health problems if continued long term.
In the region of the MD, the scientists observed regenerative activity, which they could block by administering drugs that interfered with signals sent by the MD. This underscored the MD’s key role in orchestrating regeneration.

When the scientists furthered analyzed mouse MD cells, they identified both genetic and structural characteristics that were surprisingly similar to nerve cells. This is an interesting finding, because nerve cells play a key role in regulating the regeneration of other organs such as the skin.
In the mouse MD cells, the scientists also identified specific signals from certain genes, including Wnt, NGFR, and CCN1, which could be enhanced by a low-salt diet to regenerate kidney structure and function. In keeping with these findings in mice, the activity of CCN1 was found to be greatly reduced in patients with chronic kidney disease (CKD).
To test the therapeutic potential of these discoveries, the scientists administered CCN1 to mice with a type of CKD known as focal segmental glomerulosclerosis. They also treated these mice with MD cells grown in low-salt conditions. Both approaches were successful, with the MD cell treatment producing the biggest improvements in kidney structure and function. This might be due to the MD cells secreting not only CCN1, but also additional unknown factors that promote kidney regeneration.
“We feel very strongly about the importance of this new way of thinking about kidney repair and regeneration,” said Peti-Peterdi. “And we are fully convinced that this will hopefully end up soon in a very powerful and new therapeutic approach.”
Additional co-authors are Urvi Nikhil Shroff, Anne Riquier-Brison, Dorinne Desposito, Audrey Izuhara, Sachin Deepak, Alejandra Becerra Calderon, James L. Burford, Hiroyuki Kadoya, Ju-Young Moon, Yibu Chen, Nariman Ahmadi, Berislav V. Zlokovic, and Inderbir S. Gill from USC; Wenjun Ju and Matthias Kretzler from the University of Michigan; Sean D. Stocker from the University of Pittsburgh School of Medicine; Markus M. Rinschen from the University of Cologne; Lester Lau from the University of Illinois at Chicago; Daniel Biemesderfer from Yale University School of Medicine; Aaron W. James from Johns Hopkins University; and Liliana Minichiello from the University of Oxford.
This work was federally funded by the National Institutes of Health (grants DK064324, DK123564, DK135290, S10OD021833, and 2P30-DK-081943) and further supported by an American Heart Association predoctoral research fellowship (grant 19PRE34380886).
Disclosure: Peti-Peterdi and Gyarmati are cofounders of Macula Densa Cell LLC, a biotechnology company that develops therapeutics to target MD cells for a regenerative treatment for CKD. Macula Densa Cell LLC has a patent entitled “Targeting macula densa cells as a new therapeutic approach for kidney disease” (US patents 10,828,374 and 11,318,209). Gill declares equity interest in OneLine Health and Karkinos.

Hoau-Yan Wang, a professor at City College, published studies supporting simufilam, now in advanced clinical trials.A scientist whose research has been at the center of controversy over an Alzheimer’s drug candidate has been charged with fraud.A federal grand jury on Thursday indicted Hoau-Yan Wang, a professor at the City College of New York, on charges of falsifying data to obtain grants totaling roughly $16 million from the National Institutes of Health.Dr. Wang’s studies underpinned research into a diagnostic test for Alzheimer’s disease and simufilam, a drug in advanced clinical trials. Simufilam’s manufacturer, Cassava Sciences, a pharmaceutical company based in Texas, has said the drug improves cognition in Alzheimer’s patients.Alzheimer’s disease affects roughly six million Americans — a number that is expected to double by 2050 — and promising treatments generate tremendous excitement. Cassava’s stock soared after each round of reported results from its trials.But some scientists had publicly disparaged the drug, saying its mechanism of action and purported results were implausible. Some went further and accused the company and Dr. Wang, its scientific consultant, of manipulating results. Several journals retracted or attached statements of concern to publications by Dr. Wang and a co-author at Cassava.Hoau-Yan WangAfter the indictment was announced on Friday, Cassava’s stock plummeted to its lowest price since October 2020.Remi Barbier, the founder and chief executive of Cassava, did not immediately respond to a request for comment. But in a statement posted on its website, the company said Dr. Wang’s work “was related to the early development phases of the company’s drug candidate and diagnostic test.”“Dr. Wang and his former public university medical school have had no involvement in the company’s Phase 3 clinical trials of simufilam,” the statement said.A publicist for the company pointed to a September 2023 publication that he said provides “independent verification of the science.”An investigation by the City University of New York, of which the college is a part, struggled for months to obtain access to Dr. Wang’s files. Eventually, members of the investigating committee concluded that Dr. Wang had been “reckless” in his failure to keep or provide original data, an offense that “amounts to significant research misconduct.”Neither the college nor Dr. Wang immediately responded to requests for comment on the indictment.Dr. Wang is now accused of falsifying data in grant applications over nearly eight years ending in April 2023, according to the Justice Department. Some of the grants funded Dr. Wang’s salary and laboratory research at the university.Federal prosecutors charged Dr. Wang with multiple counts of fraud and false statements. If convicted, he faces a maximum prison sentence of 55 years.The Federal Bureau of Investigation’s Washington field office is investigating the case. The indictment was handed down in Maryland, where the N.I.H. is based.In an emailed statement, Renate Myles, a spokeswoman for the N.I.H., said the agency “does not discuss grants compliance reviews on specific funded awards, recipient institutions or supported investigators.”“However, N.I.H. takes research misconduct very seriously,” she said. “N.I.H. promptly and carefully reviews all allegations of research misconduct received.”

Most people, when they think about pythons, visualize the huge snake constricting and swallowing victims whole. But did you know that pythons initially hold onto their prey with their sharp, backward-curving teeth? Medical researchers have long been aware that these teeth are perfect for grasping soft tissue rather than cutting through it, but no one has yet been able to put this concept into surgical practice. Over the years, mimicking these teeth for use in surgery has been a frequent topic of discussion in the lab of Dr. Stavros Thomopoulos, a professor of orthopedics and biomedical engineering at Columbia University.
Biomimicry key to new study
A leading researcher focused on the development and regeneration of the tendon-to-bone attachment, Thomopoulos is particularly interested in advancing tendon-to-bone repair, necessary for rotator cuff repair and anterior cruciate ligament reconstruction. In a paper published today by Science Advances, his team reports that they have developed a python-tooth-inspired device as a supplement to current rotator cuff suture repair, and found that it nearly doubled repair strength.
“As we grow older, more than half of us will experience a rotator cuff tear leading to shoulder pain and decreased mobility,” said Thomopoulos, who has joint appointments at Columbia Engineering and Columbia’s Vagelos College of Physicians and Surgeons as the Robert E. Carroll and Jane Chace Carroll Professor of Biomechanics (in Orthopedic Surgery and Biomedical Engineering). “The best medical intervention is rotator cuff surgery, but a remarkably high percentage of these repairs will fail within just a couple of months. Our biomimetic approach following the design of python teeth helps to reattach tendons to bone more securely. The device not only augments the strength of the repair but can also be customized to the patient. We’re really excited about the potential of our device to improve the care of rotator cuff injuries.”
Rotator cuff injuries
Among the most prevalent tendon injuries, rotator cuff tears affect more than 17 million people in the United States each year. The incidence of injury increases with age: more than 40% of the population over 65 years old experience a rotator cuff tear.
Because rotator cuff tears typically occur at the tendon-to-bone insertion site, rotator cuff repair is aimed at anatomically restoring the tendon attachment. Surgical repair is the primary treatment for restoring shoulder function, with more than 600,000 procedures performed annually in the United States at a cost of $3 billion.

However, successfully reattaching tendon to bone remains a significant clinical challenge. High failure rates occur following surgery, with rates increasing with patient age and tear severity. These rates range from 20% in younger patients with minor tears to a staggering 94% in elderly patients with massive tears. The most common failure of rotator cuff repairs is sutures tearing through the tendon at the two or four grasping points where forces concentrate.
While there have been advancements in rotator cuff repair techniques over the past 20 years, the fundamental approach of sewing two tissues together has remained largely unchanged, still relying on sutures transferring tension at high-stress grasping points. Following tendon-to-bone reattachment surgery, sutures can tear through tendons at these points of high stress, a phenomenon known as “suture pull-through” or “cheesewiring,” leading to repair-site gapping or rupturing.
“We decided to see if we could develop a device that mimics the shape of python teeth, that would effectively grasp soft tissues without tearing, and help reduce the risk of tendon re-tearing after rotator cuff repair,” said Iden Kurtaliaj, the study’s lead author and a former biomedical engineering PhD student in the Thomopoulos’ lab.
The device
The team’s original idea was to copy the shape of python teeth, but they went much further, using simulations, 3D printing, and ex vivo experiments on cadavers to explore the relationship between tooth shape and grasping vs. cutting mechanics. Kurtaliaj manufactured a range of tooth designs, optimized individual teeth, arrays of teeth, and finally a rotator cuff-specific array of teeth. The end result was a biomimetic device, made of a biocompatible resin — an array of teeth atop a curved base — capable of grasping, not cutting, tendon. The teeth are relatively small — 3mm high for a human rotator cuff, about half the length of a standard staple — so that they won’t poke through the tendon. The base can be customized via 3D printing to match the patient-specific curvature of the humeral head at the supraspinatus tendon attachment site (the most commonly torn rotator cuff tendon).
“We designed it specifically so that surgeons won’t need to abandon their current approach — they can simply add the device and increase the strength of their repair,” Kurtaliaj noted.

The team
Kurtaliaj led the research as a PhD student under the mentorship of Drs. Stavros Thomopoulos and Guy Genin, the Harold and Kathleen Faught Professor of Mechanical Engineering at Washington University in St. Louis, with input for clinical implementation from Dr. William Levine, Chair of the Department of Orthopedic Surgery at Columbia University’s College of Physicians and Surgeons.
“Due to our laboratory’s close collaboration with orthopedic surgeons, we were especially fortunate to get input from Dr. Levine, along with other surgeons at Columbia, throughout the device’s design development process,” said Thomopoulos.
Next steps
The researchers are now working to develop a bioabsorbable version of the device that would degrade as the rotator cuff heals back to bone, further enhancing its clinical applicability. They are also preparing for a pre-submission meeting with the FDA to facilitate the transition of their device into the market.

The Supreme Court’s decision on Friday to limit the broad regulatory authority of federal agencies could lead to the elimination or weakening of thousands of rules on the environment, health care, worker protection, food and drug safety, telecommunications, the financial sector and more.The decision is a major victory in a decades-long campaign by conservative activists to shrink the power of the federal government, limiting the reach and authority of what those activists call “the administrative state.”The court’s opinion could make it easier for opponents of federal regulations to challenge them in court, prompting a rush of new litigation, while also injecting uncertainty into businesses and industries.“If Americans are worried about their drinking water, their health, their retirement account, discrimination on the job, if they fly on a plane, drive a car, if they go outside and breathe the air — all of these day-to-day activities are run through a massive universe of federal agency regulations,” said Lisa Heinzerling, an expert in administrative law at Georgetown University. “And this decision now means that more of those regulations could be struck down by the courts.”The decision effectively ends a legal precedent known as “Chevron deference,” after a 1984 Supreme Court ruling. That decision held that when Congress passes a law that lacks specificity, courts must give wide leeway to decisions made by the federal agencies charged with implementing that law. The theory was that scientists, economists and other specialists at the agencies have more expertise than judges in determining regulations and that the executive branch is also more accountable to voters.Since then, thousands of legal decisions have relied on the Chevron doctrine when challenges have been made to regulations stemming from laws like the 1938 Fair Labor Standards Act, the 1970 Clean Air Act, the 2010 Affordable Care Act and others.In writing laws, Congress has frequently used open-ended directives, such as “ensuring the rule is in the public interest,” leaving it to agency experts to write rules to limit toxic smog, ensure that health plans cover basic medical services, ensure the safety of drugs and cosmetics and protect consumers from risky corporate financial behavior.But that gave too much power to unelected government officials, according to conservatives, who ran a coordinated, multiyear campaign to end the Chevron doctrine. They believe the courts, not administrative agencies, should have the power to interpret statutes. The effort was led by Republican attorneys general, conservative legal activists and their funders, several with ties to large corporations, and supporters of former President Donald J. Trump.“Overturning Chevron was a shared goal of the conservative movement and the Trump administration. It was expressed constantly,” said Mandy Gunasekara, who served as chief of staff at the E.P.A. under President Trump and has helped write Project 2025, a policy blueprint for a next Republican administration. “It creates a massive opportunity for these regulations to be challenged. And it could galvanize additional momentum toward reining in the administrative state writ large if the administration changes in November.”Still, Jonathan Berry, who served as a senior Labor Department official under Mr. Trump, noted that overturning the Chevron doctrine itself “doesn’t immediately blow anything up.”Rather, Mr. Berry said, the fate of the regulations will be determined by what happens when they start moving through the courts without the protection of Chevron. “The mystery is exactly how much of this stuff goes down,” Mr. Berry said.Here is a look at how the decision might affect various government agencies.The Environmental Protection AgencyEnvironmentalists fear that the end of the Chevron doctrine will mean the elimination of hundreds of E.P.A. rules aimed at limiting air and water pollution, protecting people from toxic chemicals and, especially, tackling climate change.Over the past six months, the Biden administration has issued the most ambitious rules in the country’s history aimed at cutting climate-warming pollution from cars, trucks, power plants and oil and gas wells. Without those rules, it would very likely be impossible for President Biden to achieve his goal of cutting greenhouse gas emissions in half by the end of the decade, which analysts say all major economies must do to avoid the most deadly and catastrophic impacts of global warming.All of the Biden climate rules have already been the target of lawsuits that are winding their way through the courts.Legal experts say that the reversal of Chevron will not remove E.P.A.’s foundational legal obligation to regulate climate-warming pollution: that was explicitly detailed in a 2007 Supreme Court decision and in 2022 legislation passed by Democrats in anticipation of challenges to that authority.But the specific regulations — such those designed to cut car and truck pollution by accelerating the transition to electric vehicles, or to slash power plant pollution with the use of costly carbon capture and sequestration technology — could now be more legally vulnerable.The result would quite likely be that stringent climate rules designed to sharply reduce emissions could be replaced by much looser rules that cut far less pollution. Experts say that could also be the fate of existing rules on smog, clean water and hazardous chemicals.Labor AgenciesThe elimination of the Chevron deference could affect workers in a variety of ways, making it harder for the government to enact workplace safety regulations and enforce minimum wage and overtime rules.One recent example was in April, when the Biden administration raised the salary level below which salaried workers automatically become eligible for time-and-a-half overtime pay, to nearly $59,000 per year from about $35,000, beginning on Jan. 1. Business groups have challenged the Labor Department’s authority to set a so-called salary threshold and such challenges will have far better odds of success without the Chevron precedent, experts said.The shift could also rein in protections for workers who publicly challenge the policies of their employers, according to Charlotte Garden, a professor of labor law at the University of Minnesota. The National Labor Relations Board often concludes that a single worker has the right to protest low pay or harassment or attendance policies without being disciplined or fired. But the relevant law refers to “concerted activities,” meaning the protection may now apply only to groups of employees who stage such protests, not individuals, Professor Garden said.Food and Drug AdministrationThe Food and Drug Administration flexes significant power when it sets the standards for how new drugs must be studied and whether they are safe and effective before they are approved for use. Attorneys who worked at the agency said that companies chafing at that high bar for approvals might now challenge those regulations. Others said legal challenges could ultimately affect drug prices.Challenges are also expected in the agency’s tobacco division, which authorizes the sale of new cigarettes and e-cigarettes with the intent to protect public health. “I would expect the industry to attack the F.D.A.’s authority to do premarket review at all,” said Desmond Jenson, deputy director of the commercial tobacco control program at the Public Health Law Center.Others noted the Chevron decision could have a chilling effect, compelling the F.D.A. to proceed quite carefully, given the potential for litigation, if it moves forward with proposals to ban menthol cigarettes or make them less addictive by slashing nicotine levels.Abortion opponents say the ruling could work in their favor as they seek to bring another case against the Food and Drug Administration’s approval of an abortion medication to the Supreme Court, which rejected their effort to undo the agency’s approval of the drug this month.Kristi Hamrick, a strategist for Students for Life of America, an anti-abortion organization, said in a statement that such a case was likely to get a better reception “when the F.D.A. is no longer given the benefit of the doubt.”Health CareThe court’s ruling could affect how Medicare, Medicaid and Affordable Care Act insurance plans are administered, health law experts said, as opponents gain an opportunity to challenge how these huge programs operate.The health care system is governed by elaborate regulations covering how hospitals operate, what providers are paid for medical services and how insurance companies are monitored by the government. Much of that regulation is grounded in interpretation of laws that date back decades. Major industries could be affected if rules are changed.“There’s an awful lot of regulation that flies under the radar that’s just about making sure the trains run on time,” said Nicholas Bagley, a law professor at the University of Michigan.Rachel Sachs, a health law expert at the Washington University School of Law in St. Louis, said that the complex set of rules devised and governed by the Department of Health and Human Services and the Centers for Medicare and Medicaid Services could be challenged in new ways.“There’s a lot of work to do in that process,” she said. “And therefore there are a lot of opportunities for challengers to pick at specific choices that C.M.S. and H.H.S. are making in the interpretation of these rules.”The Supreme Court decision will require Congress to specify exactly what agencies like the C.D.C. can and cannot do, several analysts said. “Nobody has any confidence that Congress can get its act together to do that,” said Dr. Georges C. Benjamin, executive director of the American Public Health Association.“I think the decision as written solidifies employment for lawyers and judges, and undermines the authority of experts,” he added.Other scientists also expressed doubt that Congress or the judiciary could remain abreast of constantly evolving scientific evidence. “To keep up with that pace of change, even for a medical or scientific professional, is very challenging,” said Karen Knudsen, chief executive of the American Cancer Society.The Biden administration has written health regulations anticipating a world without the Chevron deference, said Abbe R. Gluck, a health law expert at Yale Law School who served in the White House at the beginning of Mr. Biden’s term. For that reason, she thinks litigation over the most recent rules may be less influenced by this change than challenges concerning some older regulations.“The Supreme Court has not relied on Chevron in quite a few years,” she said. “So the federal government, including H.H.S., has become accustomed to drafting regulations and making its interpretation arguments as if Chevron did not exist.”“They’ve already adjusted,” Ms. Gluck said.Treasury and the Internal Revenue ServiceThe Treasury Department and the Internal Revenue Service both have broad mandates to interpret legislation when they write rules and regulations and enforce the tax code.Since the Inflation Reduction Act passed in 2022, the Treasury Department has been racing to roll out regulations related to billions of dollars of clean energy tax credits that provide huge incentives for things such as the manufacturing of batteries or the purchase of electric vehicles. The Treasury Department has received pushback from some lawmakers who contend that it has not followed the intent of the law.Although Congress creates the tax code through legislation, the I.R.S. has wide latitude in how the tax laws are administered. Accounting experts have suggested that the court’s ruling could complicate the agency’s ability to administer the tax code without specific direction from Congress.A recent example is how the agency last year delayed enforcement of a contentious tax policy that would require users of digital wallets and e-commerce platforms to report small transactions. The new provision was introduced in the tax code in 2021 but was strongly opposed by lobbyists and small businesses.The I.R.S. received criticism from some lawmakers for delaying the policy, but the agency defended its decision by arguing that taxpayers needed a longer transition period before the measure should be enforced to avoid a chaotic tax season.Elizabeth Dias

A handful of common surgical procedures account for large shares of all opioids dispensed after surgery in children and adults, according to two studies recently published by researchers at the University of Michigan.
The studies, published in Pediatrics and JAMA Network Open, report that the top three procedures for children ages 0-11 account for 59% of opioids dispensed after surgery (tonsillectomies and adenoidectomies 50%, upper extremity fractures 5% and removal of deep implants 4%). Among those ages 12-21, the top three procedures account for about a third of post-surgery opioid prescriptions (tonsillectomies and adenoidectomies 13%, knee arthroscopies 13% and cesarean deliveries 8%).
For adults ages 18-44, C-sections account for the highest share of opioids dispensed post-surgery (19%), followed by hysterectomies (7%) and knee arthroscopies (6%). Among those ages 45-64, four of the top five procedures were orthopedic procedures, collectively accounting for 27% of total opioid prescriptions dispensed after surgery.
“Our findings suggest that surgical opioid prescribing is highly concentrated among a small group of procedures. Efforts to ensure safe and appropriate surgical opioid prescribing should focus on these procedures,” said Kao-Ping Chua, lead author of the study in Pediatrics, assistant professor at the U-M Medical School and School of Public Health, and co-director of the Research and Data Domain at the U-M Opioid Research Institute.
To conduct the study, the researchers developed an algorithm to identify 1,082 major surgical procedures using procedure codes, a medical classification tool used to identify specific surgical, medical or diagnostic interventions. The algorithm was then applied to identify privately and publicly insured children and adults undergoing surgery from Dec. 1, 2020 through Nov. 30, 2021.
The information was organized through a novel system developed by the study team, which allowed them to connect different sets of data that had previously been seen as unrelated. This new method allows for improved comparability and contrast, according to lead investigators.
In addition to determining which procedures accounted for the highest shares of opioids, the researchers also examined the size of opioid prescriptions for each procedure. For many procedures, prescriptions were far larger than the amount patients typically need for a particular procedure.
“Our findings suggest that there are important opportunities to reduce surgical opioid prescribing without compromising pain control,” said Dominic Alessio-Bilowus, lead author of the paper focused on adults published in JAMA Network Open and a medical student at Wayne State University who just completed a research year at U-M.