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“That’s a society-ending pandemic.” — James Lawler, MD, MPH, of the University of Nebraska Medical Center’s Global Center for Health Security, on viruses with high case fatality rates and the unknown risks of the H5N1 avian flu.
“They’re looking for needles in haystacks.” — William Schaffner, MD, of Vanderbilt University in Nashville, discussing possible seizure risk following COVID-19 vaccination in kids.
“We believe that kind of less is more.” — Robert Montgomery, MD, DPhil, of the NYU Langone Transplant Institute, differentiating his team’s recent living pig kidney transplant from the world’s first performed last month.
“It is a band-aid solution to the wicked problem of misinformation.” — Becky Smullin Dawson, MPH, PhD, of Allegheny College in Meadville, Pennsylvania, commenting on X’s (formerly Twitter) new misinformation countermeasure.
“There are a lot of opportunities to try to protect infants against RSV.” — Jennifer Saper, MD, of the Ann & Robert H. Lurie Children’s Hospital in Chicago, on high vaccine interest among pregnant individuals.
“These drugs can cause a number of harms for these patients.” — Adam Sacarny, PhD, of the Mailman School of Public Health at Columbia University in New York City, on antipsychotic use in older dementia patients.
“So often I hear patients say, ‘I feel normal or myself again,’ and are in disbelief.” — Smita Das, MD, PhD, MPH, chair of the Council on Addiction Psychiatry at the American Psychiatric Association, on benefits of buprenorphine for opioid use disorder.
“Canceled surgeries are sometimes never rescheduled.” — Anjali Dixit, MD, MPH, of Stanford University School of Medicine in California, questioning the clinical utility of pausing GLP-1 agonists before surgery.
“There are many ways that it could potentially go wrong.” — Douglas Johnson, MD, MSCI, of Vanderbilt University Medical Center, after the use of AI tools in healthcare sparked a protest.

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Stacy is a preventive medicine and addiction medicine specialist.

Since finishing residency, I have not practiced in a hospital or traditional outpatient office. My clinical work has been in less conventional healthcare delivery settings, such as correctional facilities, methadone clinics, and virtual practices. I’ve also held non-clinical jobs as a medical writer, utilization management reviewer, and support specialist for electronic health record implementations and clinical documentation improvement programs. In addition, I’ve used my medical skills on the side for consulting engagements with law firms, investment firms, and business strategy firms.
The multifaceted nature of my career is not unique. There’s a clear interest among medical professionals in exploring alternative career paths. Burnout and wanting better work-life balance are common drivers.
Yet, a lot of physicians hesitate to make a change. This is often due to misconceptions about transferability of their skills, moral obligations of being a doctor, and financial viability of non-traditional roles. Many doctors mistakenly believe their only option for a meaningful career pivot is leaving medicine entirely.
The truth is, there’s a broad spectrum of fulfilling, lucrative career options for physicians that are off the beaten path, yet attainable.
I’d like to share three (of many) lessons that I have learned throughout my unconventional career, in hopes that you may be inspired to let your medical career meander.
Career Progression Doesn’t Always Mean Climbing a Corporate Ladder
I began my medical career by working for a correctional healthcare services provider as their corporate medical director. I hoped to one day move “up” to chief medical officer or to a similar role at a larger healthcare corporation.
But that is not the career path I ended up taking. I’ve moved further sideways than upward.
Despite this, I have experienced significant career progression. My progression hasn’t been in titles or traditional corporate achievements, but rather in the expansion of my skill set, accumulation of experiences, broadening of professional options, and increase in income. Without an emphasis on moving “up,” I’ve been able to focus on career choices that match my personality and interests, as well.
Career progression is deeply personal. Professional fulfillment for you may not match that of your peers, your bosses, or the doctors you follow on social media. And that’s OK.
Your Expertise Spans Beyond Your Medical Specialization
Medicine has become more specialized over time. Due to the structure of the healthcare system and U.S. medical training, we often become confined to our chosen specialty, repeatedly performing a specific set of procedures, prescribing a narrow range of medications, and seeing patients within a certain demographic.
Physicians working outside of conventional practice environments, however, are often seen as general experts in medicine — the definition of expertise broadens significantly.
What exactly you’re considered an expert in varies depending on where you work and the type of work you do. For clinical work, completion of a residency, board certification, and state licensure are routinely required to demonstrate competency and qualification. But in roles that don’t involve patient care decisions, the criteria to demonstrate your expertise can often be expanded. Practical experience and self-study, for instance, might carry more weight.
We often underestimate our qualifications for roles outside of direct patient care, such as jobs in the pharmaceutical industry, at insurance companies, or in media. Our training and experience give us a broad base of medical knowledge that can be applied in diverse ways.
Recognize that your value as a physician extends beyond your medical specialty. We’re capable of making great contributions in various types of organizations, sectors, and industries by using our medical skills as a foundation.
People Won’t Judge You for Doing Something Atypical
Most doctors have some degree of apprehension when they start down an unconventional career path. They feel uneasy about how others will perceive their career choices. I certainly did.
The traditional image of a doctor — dressed in a white coat, tirelessly caring for patients — is ingrained in our minds and we feel a sense of duty to fulfill it. Moreover, many medical trainees pick up on the concept of “paying your dues” through a grueling clinic schedule or a high-stress patient care environment. These mindsets can come at the expense of personal well-being.
Perceived judgment from peers, mentors, family, and even patients are also to blame for our personal doubts. We ask ourselves questions like, “Am I wasting my medical training if I transition my career?” or “Why can’t I just stick it out with the job I already have?”
However, my experience suggests these fears are unfounded. Starting my post-residency career with minimal direct patient care or on-call responsibilities, I braced myself for criticism that never came. I thought my decision to work in correctional medicine would be met with skepticism. It wasn’t! Instead, my choice seems to spark interest when I share it with others. Many even express gratitude that I work with an underserved population in a setting that is often overlooked.
I have witnessed similar scenarios among my peers. In general, physicians overestimate the judgment they’ll face when considering an unconventional job.
The depth and breadth of what you can do with a medical degree has grown. And our work as physicians is valued regardless of where and how we do it. Follow the path that feels right for you, rather than getting caught up in worrying about others’ perceptions.
Admittedly, if your career path is atypical, you may need to put in extra effort to articulate your experiences and qualifications to recruiters, hiring managers, and your professional network. But you can be confident that they will respect the diverse ways you have contributed to healthcare and patient outcomes.
Don’t let the fear of judgment hold you back from exploring job opportunities that align with your personal interests and life goals.
Sylvie Stacy, MD, MPH, is a preventive medicine and addiction medicine specialist. She is author of “50 Nonclinical Careers for Physicians” and “50 Unconventional Clinical Careers for Physicians.”

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Greater feelings of loneliness and social isolation were associated with a higher risk of mortality among cancer survivors, according to a retrospective longitudinal study.
Over the study period of 10 years, cancer survivors with higher loneliness scores on the UCLA Loneliness Scale had higher mortality risk compared with those who had low/no loneliness scores, following a dose-response association:Mild loneliness: adjusted HR 1.19 (95% CI 0.86-1.63)Moderate loneliness: aHR 1.41 (95% CI 1.01-1.96)Severe loneliness: aHR 1.67 (95% CI 1.25-2.23, P=0.004)The adjusted HR was 1.03 (95% CI 1.01-1.06) when loneliness score was included in multivariable models as a continuous variable, noted Jingxuan Zhao, MPH, of the American Cancer Society, and colleagues in the Journal of the National Comprehensive Cancer Network.
“Our findings underscore the importance of incorporating loneliness screening as a routine part of cancer survivorship care,” they wrote. “Healthcare providers should consider adding loneliness assessment tools to their standard practice, and these tools should be employed at multiple time points, from initial diagnosis throughout survivorship care.”
Zha0 and colleagues said these findings are particularly relevant in light of last year’s advisory from the U.S. Surgeon General warning of an “epidemic of loneliness and isolation” in the U.S., even before the start of the COVID-19 pandemic, and highlighting the importance of relevant training for healthcare providers, as well as the need for research on loneliness to help increase public awareness.
“Early detection of loneliness is crucial because it may prevent the escalation and complications of loneliness among cancer survivors,” Zhao and team wrote. “In addition, identification of survivors experiencing loneliness can inform needs for intervention, such as mental health counseling, community support, social network involvement, and integrating loneliness intervention into cancer treatment and cancer survivorship care. Future studies should focus on the optimal screening tools for loneliness and examine the effectiveness of loneliness screening and interventions.”
The authors suggested that oncologists in particular should provide loneliness screening while treating their patients, furnish education about the emotional challenges that can accompany a diagnosis and treatment, and be ready to give referrals to psychologists who can provide more specialized assessment and tailored counseling.
For this study, Zhao and colleagues used data from the 2008-2018 Health and Retirement Study (HRS), a nationally representative longitudinal panel survey conducted biennially with questions about health, employment, and psychosocial well-being among individuals ages 50 and older.
They included 3,447 cancer survivors with 5,808 person-years of observation. Most had been diagnosed >2 years prior to the survey. Their analysis was adjusted for sex, marital status, education, number of health conditions, and years since cancer diagnosis.
Loneliness was measured using an abbreviated 11-item version of the UCLA Loneliness Scale. Respondents were asked to answer questions about feeling a lack of companionship or feelings of isolation.
Loneliness scores were assigned according to answers (1 for the least, 2 for moderate, and 3 for the loneliest response option), with a total score of 11-12 classified as low/no loneliness, 13-15 as mild loneliness, 16-19 as moderate loneliness, and 20-33 as severe loneliness.
Of the included survivors, 24.3%, 24.5%, 23.6%, and 27.6% reported low/no, mild, moderate, and severe loneliness, respectively.
Male sex, non-white race/ethnicity, unmarried status, less education, more health conditions (other than cancer), and feeling depressed in the past year were linked with a higher probability of being lonelier.
There were 686 deaths among the entire cohort during the study period. Cause of death was not available in this dataset.
Zhao and colleagues acknowledged several limitations to their study, including the use of an abbreviated measure to assess loneliness and the use of self-reported data.
Furthermore, cancer-related information — cancer type and number of diagnoses, stage at diagnosis, and whether respondents were receiving cancer treatment at the time of the survey — was not systematically collected in the HRS.

Mike Bassett is a staff writer focusing on oncology and hematology. He is based in Massachusetts.

Disclosures
The study authors had no disclosures.

Primary Source
Journal of the National Comprehensive Cancer Network
Source Reference: Zhao J, et al “Loneliness and mortality risk among cancer survivors in the United States: a retrospective, longitudinal study” J Natl Compr Canc Netw 2024; DOI: 10.6004/jnccn.2023.7114.

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Despite an arsenal of drugs, many Americans are still unaware of their infections until it’s too late. A Biden initiative languishes without Congressional approval.In the 10 years since the drugmaker Gilead debuted a revolutionary treatment for hepatitis C, a wave of new therapies have been used to cure millions of people around the world of the blood-borne virus.Today, 15 countries, including Egypt, Canada and Australia, are on track to eliminate hepatitis C during this decade, according to the Center for Disease Analysis Foundation, a nonprofit. Each has pursued a dogged national screening and treatment campaign.But the arsenal of drugs, which have generated tens of billions of dollars for pharmaceutical companies, has not brought the United States any closer to eradicating the disease.Spread through the blood including IV drug use, hepatitis C causes liver inflammation, though people may not display symptoms for years. Only a fraction of Americans with the virus are aware of the infection, even as many develop the fatal disease.A course of medications lasting eight to 12 weeks is straightforward. But the most at-risk, including those who are incarcerated, uninsured or homeless, have difficulty navigating the American health system to get treatment.Of those diagnosed in the United States since 2013, just 34 percent have been cured, according to a recent analysis by the Centers for Disease Control and Prevention.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 24-hour news cycle is just as important to medicine as it is to politics, finance, or sports. At MedPage Today, new information is posted daily, but keeping up can be a challenge. As an aid for our readers, and for a little amusement, here is a 10-question quiz based on the news of the week. Topics include protesting nurses, a new therapy for bladder cancer, and COVID olfactory dysfunction. After taking the quiz, scroll down in your browser window to find the correct answers and explanations, as well as links to the original articles.

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TTHealthWatch is a weekly podcast from Texas Tech. In it, Elizabeth Tracey, director of electronic media for Johns Hopkins Medicine in Baltimore, and Rick Lange, MD, president of the Texas Tech University Health Sciences Center in El Paso, look at the top medical stories of the week.
This week’s topics include autism rates among males and females, consequences of atrial fibrillation, antipsychotics among those with dementia, and antibiotic use utilizing artificial intelligence.
Program notes:
0:41 Atrial fibrillation and its complications
1:41 Increased risk factors
2:41 Treat with medication or ablation
3:30 Autism heritability in males and females
4:30 No support for environmental shared factors
5:33 Tried to account for with modeling
6:23 Antibiotics, artificial intelligence, and common infections
7:23 50 different variables
8:23 Patient-specific factors
9:10 Antipsychotics and dementia
10:10 New antipsychotic use increased risk of pneumonia
11:10 Care providers
12:42 End
Transcript:
Elizabeth: Can we explain the different rates of autism between males and females?
Rick: The lifetime risk of atrial fibrillation and its complications.
Elizabeth: What are the adverse outcomes associated with any psychotic use in people with dementia?
Rick: And harnessing our electronic health records to improve our antibiotic prescribing.
Elizabeth: That’s what we’re talking about this week on TTHealthWatch, your weekly look at the medical headlines from Texas Tech University Health Sciences Center in El Paso. I’m Elizabeth Tracey, a Baltimore-based medical journalist.
Rick: I’m Rick Lange, president of Texas Tech University Health Sciences Center in El Paso, where I’m also dean of the Paul L. Foster School of Medicine.
Elizabeth: Rick, if you’re okay with it, I would like to start with The BMJ and this issue of atrial fibrillation and its complications, which this study was kind of a surprise to me.
Rick: I tee this up as the lifetime risk of atrial fibrillation, and they used the Danish nationwide population information to look at how common is atrial fibrillation over a lifetime and specifically what complications are associated with it.
They looked at two different decades, 2000 to 2010 and then 2011 to 2020, to compare those two different decades. Atrial fibrillation is an irregular heart rhythm, where the upper chamber of the heart kind of quivers. In the U.S. alone in the next 20 to 25 years, there will be about 16 million people that have it.
What’s the danger? They said, okay, let’s say you make it to age 45 and you haven’t had atrial fibrillation. What’s the risk that you’ll get it before you turn 100? Once you have it, what are the associated complications? In the first decade between 2000 and 2010, it was about 1 in 4 individuals over the age of 45 developed atrial fibrillation. In the most recent decade, it’s now 1 in 3. That may be because we have had increased risk factors like high blood pressure, obesity, and diabetes, and it is more common in men as well.
Here was a surprising thing to me. All healthcare providers and most of our listeners will be aware that it’s associated with an increased risk of stroke. About 20% of the individuals experienced a stroke after atrial fibrillation, despite the fact they were supposed to be on blood thinners. But the amazing thing is they were twice as likely, there were 40% of those, that actually developed heart failure. Then about 15% developed a heart attack.
Unfortunately, even though we have gotten better at diagnosing and trying to treat atrial fibrillation, the incidence of those was a relatively minor decrease. Atrial fibrillation is on the rise and the complications happen pretty frequently.
Elizabeth: I thought it was just surprising, this rate of heart failure, and I think they were a little bit surprised by that also.
Rick: Yeah, 40%. If you’ve got a 1-in-3 risk of developing atrial fibrillation and 40% of those develop heart failure, that says something. About a third of patients really don’t have symptoms. When they do have atrial fibrillation, it is to treat either with medications or we now have ablation to hopefully help lower that risk. But more importantly is to prevent it from occurring.
The risk factors for heart failure are the same for atrial fibrillation. We can reduce the risk of atrial fibrillation and its complications if we control those things.
Elizabeth: Allow me to also interject a question about exercise and its ability to prophylax against development of atrial fibrillation.
Rick: It’s a really interesting thing, Elizabeth. If you’re an elite athlete, it actually increases your risk of atrial fibrillation. But for those of us that do a modest amount of exercise, 150 minutes a week, it actually lowers all the other risk factors and also reduces the risk of atrial fibrillation as well. If you’re serious about preventing heart failure and you’re serious about preventing atrial fibrillation, a lot of that is within our control.
Elizabeth: That’s the good news. Let’s turn, since we’re over in this area of the world, to Sweden. This is JAMA Psychiatry, the study that was examining sex differences in autism heritability. Autism spectrum disorder [ASD] is extremely common and it feels like it’s getting diagnosed more and more often. Nobody has ever really tried to nail this down in this particular way before.
The authors put forward the fact that the cause of ASD is largely genetic and they wanted to look at the sex-specific heritability of this disorder. Using the health registers of non-twin siblings and cousins from Sweden between 1985 and 1998, they followed them up to 19 years of age. They had a sample of over a million individuals, with each family having about two children; 1.17% of that sample received a diagnosis of ASD — almost twice as many males as females.
They estimate the heritability among the males at 87%, and at 76% for females. It said there was no support for shared environmental contributions. They posit a number of potential reasons that might be true, but they don’t really come to a conclusion.
Rick: Part of that, Elizabeth, is that even though 2% to 3% of American kids will be diagnosed with an autism spectrum disorder and we know there is some heritability, there are probably some environmental or other things that we just don’t understand.
Let me take a step back for a second, because some kids with ASD have intellectual disability and some don’t. It appears that those with intellectual disability and autism that the heritability between males and females is the same. But it’s those that have the less severe form where it looks like the males have an increased heritability than the females.
Now, maybe they are more likely to develop it. It could be something about the females that’s protective. Some of it is the age at which they are diagnosed — because females are typically diagnosed later than males — and the presentations are different. They tried to account for all of this by doing different modeling. I would agree with you that there is an increased incidence among males. Exactly why that is, is still unknown.
Elizabeth: They talk about this female protective effect, which we have seen in other circumstances that female sex just seems to confer protection. We even know this if we examine lifespans, for example. They tried to correct for so many of these factors, though — the usual suspects like parental age, the existence of the condition already in the family. Again, I feel like they are saying, “Yep, okay, there are a number of possibilities, and the answer is we don’t know.”
Rick: Yeah, I mean, for almost 20 years we have been reporting, we very seldom reported on ASD initially and now it seems like we’re reporting on two or three things per year. We’re trying to get to the root cause.
Elizabeth: Indeed. Okay, so let’s turn to JAMA. What are we going to do about these antibiotics? How can we use them best in common infections?
Rick: Another surprising fact is that approximately half the hospitalized adults in the U.S. receive antibiotics. The two most common infections, by the way, are pneumonia and urinary tract infection [UTI]. Again, over the last two decades, we have talked a lot about antibiotic stewardship, making sure the person has a bacterial infection, they’re on the right antibiotic for their particular organism, and we keep them on it for the minimal amount of time. We’re doing this to try to prevent resistant bacteria, what are called multidrug-resistant organisms or MDROs.
The way we typically do that is we admit somebody and we put them on a broad spectrum. We do that because we don’t know what the organism is and we’re concerned it could be a really deadly one. Get cultures to find out what bacteria is infecting them and then 3 or 4 days later we change the antibiotics.
But what these investigators said is, hey, wait a minute. Less than 10% of individuals have a multidrug-resistant organism infection. Can we target those individuals for the broad spectrum and for the rest of them use something that’s less selective?
To do that, they actually used the electronic health record [EHR] and they looked at 50 different variables. Some of them are related to the organism. Some of it related to the patient, their comorbidities, and where they have been hospitalized. It predicted whether or not they were going to have an infection with a multidrug-resistant organism and needed broad-spectrum antibiotics or they didn’t.
They reduced the broad-spectrum antibiotic use in those with pneumonia by about 30%. For those with urinary tract infection, it reduced it by about 20%.
Did it harm the patients that were in the hospital longer? Do they have to go to the intensive care unit? Did they have to switch antibiotics? The answer is none of those things. These were patients that were hospitalized with pneumonia or a UTI, but weren’t going to the intensive care unit, so it looks like the electronic health record can improve our antibiotic stewardship. This is really a good news story.
Elizabeth: It’s a great news story, and I guess I’m interested in what some of those factors are that predict what specific organism someone might be infected with.
Rick: They look at what I call a local antibiogram. What are the most common organisms causing pneumonia or urinary tract infection in that particular hospital region and do they respond to antibiotics? Then there are patient-specific things like demographics and comorbidities. Do they have a prior healthcare exposure, which would increase our risk overall?
Elizabeth: Well, I’m really interested in this notion that there are local flora, that there are certain organisms that are found in certain regions and that are most commonly going to cause infections. What I would love to see would be a study over time, or seasonally, that looks at variations among that population and I’m sure we can get that data.
Rick: Yep. In fact, what you mentioned is one of the limitations of this study. First of all, it requires a large EHR, and some small hospitals don’t have that or local doctors don’t. The second is people have moved from region to region. If we’re going to really, broadly apply this, we’re going to have to look at how to overcome those things.
Elizabeth: Finally, let’s turn back to The BMJ and this is a situation that we also have reported on previously: adverse outcomes associated with antipsychotic use in people with dementia.
This is, however, a really big study from the Clinical Practice Research Datalink, CPRD, in England. They had adults 50 years of age or older with a diagnosis of dementia between 1998 and 2018 — just shy of 200,000. Each new antipsychotic user, which was 35,000+, was matched with up to 15 non-users using this incidence density sampling.
What they wanted to find out was if you are on an antipsychotic, did you experience stroke, VTE [venous thromboembolism], an MI [myocardial infarction], heart failure, ventricular arrhythmia, fracture, pneumonia or acute kidney injury. Then they had as negative controls the outcomes of appendicitis and cholecystitis.
Sure enough, if you were on a new antipsychotic, you did have an increased rate of primarily pneumonia. That was the biggest increased risk. But all these other risks were also increased with that. They did not observe any increased risk in appendicitis or cholecystitis. It was pretty concerning and confirmatory of what we have reported on previously.
Rick: Unfortunately, the use of antipsychotics in people with dementia was starting to decline, and then during the COVID years it actually increased. We have known for, gosh, about 15 years that the antipsychotics are associated with the complications that you mentioned, and they really have very marginal benefit at all.
We need to be really restrictive in who we give these medications to — for those that prescribe medications, to be aware of this, but also for caregivers as well. Because we think the easiest thing to do is if mom or dad has dementia and we can try to control the antipsychotics, we can actually increase the risk of these severe complications and shorten their life.
Elizabeth: I guess my heart really goes out to care providers for people with dementia and the huge struggle it can be to deal with a lot of these behavioral issues. The temptation to turn to … and I should mention in this study that they note that risks are associated both with what are called atypical antipsychotics as well as typical antipsychotic drugs. It just seems like, gosh, this is a fix for something that can be quite intractable.
Rick: It is. One of the things that the investigators mentioned is that we actually need to do more research into what are some safer drug treatments. If there are behavioral or environmental changes that we can make short of using medications, that would be the actually preferred treatment.
Elizabeth: They note that the attempt to use other things hasn’t been very fruitful either with what we have currently in the armamentarium. Let’s just then end with the authors’ perception. They state that when an antipsychotic prescription is the least bad option clinicians should try to do it for the shortest period of time as possible.
Rick: Both the smallest dose, it gets the desired effect, and for as short as possible. Great.
Elizabeth: On that note, that’s a look at this week’s medical headlines from Texas Tech. I’m Elizabeth Tracey.
Rick: I’m Rick Lange. Y’all listen up and make healthy choices.

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Despite the fact men have lower life expectancy than women and are at a higher risk of developing serious health conditions like heart disease and lung cancer, women spend 25% more of their lives in poor health compared to men. This is in part because women disproportionately experience stroke-related disability, ovarian and breast cancers, dementia, and autoimmune diseases including multiple sclerosis (MS), which have long gone without a cure.
At the same time, research and anecdotal accounts show that women often feel underserved and underrepresented in terms of the healthcare they receive. For instance, a study last year from the Kaiser Family Foundation showed that 29% of women versus 21% of men have felt dismissed by a healthcare provider, and nearly twice as many women as men reported feeling discriminated against by their doctors.
These experiences can have severe consequences beyond just a few bad visits at the doctor’s office: data show that women, particularly women of color, are misdiagnosed or receive delayed diagnoses across several diseases compared to men. Pervasive biases in healthcare play a major role.
The gender gap in chronic disease diagnosis and management is a nuanced issue interwoven with socioeconomic structures. There’s no one-size-fits-all solution, especially considering the unique needs of trans or nonbinary individuals. However, one important step — especially for conditions that disproportionately affect those assigned female gender at birth — is to recruit and uplift not only more female clinicians, but also female scientists who can prioritize studying the challenges facing female patients.
Not only are they more likely to empathize with female patients’ experiences, but research also shows that diverse teams can help ensure that the benefits of research and care innovations are spread equitably. Without more female scientists and leaders, we can’t fully tackle health problems that most severely impact women.
Women’s Participation and Leadership in MS Research
Take MS — the field in which we predominantly conduct our research — as an example. Women are three times more likely than men to be diagnosed with MS, and women who have MS outnumber men by a ratio of nearly 4:1 — a gap that has only widened in recent decades. These disparities aren’t just limited to gender: a January 2024 study found that Black and Hispanic women with MS have more advanced disease progression and face greater challenges in pregnancy than white women.
And yet, we see a gender gap among those who study this disease and others like it. For instance, a 2022 study found that neurology is one of the most underrepresented specialty areas with female physicians as first authors on research papers. This is especially true in MS research.
Why does this matter? In our own work, we frequently see how impactful our research can be when we investigate the challenges most pressing for our center’s female patients. For example, cerebellar dysfunction in MS patients can progress independently of other symptoms, and many of our female patients report that gait and balance challenges make them feel less empowered to exercise or engage socially. With that in mind, one of our research focuses is mitigating cerebellar damage to increase quality of life and health-promoting behaviors. In turn, our female patients feel confident that they have a team of researchers who take their challenges seriously.
Female-driven research requires a strong female voice in patient care and inside the lab. Unfortunately, although the healthcare industry is dominated by women overall (74%), only 33% occupy a leadership position. Ensuring that women have a seat at the table in deciding what type of research to pursue is the most basic step we can take to ensure the quality of female healthcare. In doing so, the industry will see the ripple effect that female healthcare leaders have on tackling some of the world’s most challenging medical questions.
Turning Words Into Action
However, simply pledging to hire more women scientists or appoint more women to leadership roles is not enough. At every level of the medical establishment, decision-makers must take tangible action to formalize this commitment through targeted programs like scholarships and mentorship opportunities. These give women an early opportunity to pursue their scientific interests with the guidance of a female mentor who knows what it’s like to grow her career in research and in healthcare’s unique environment.
For example, my (Harris) PhD supervisor left for maternity leave shortly after I started my work with her. That was the first time I had a model for what it looked like to have a family and a successful career in science, which became one of the most meaningful parts of my PhD experience. To this day, she is still the only female boss I have ever had in research — and she inspires me to take very seriously the responsibility of mentoring young women who come through my lab.
Mentors aside, the ultimate key to ensuring women’s long-term success in health research relies on proactively eliminating systemic barriers. These steps include equitable compensation compared to male colleagues, and robust benefits that include parental leave and childcare support. While female healthcare leaders may most immediately feel the positive impact of these resources, they ultimately benefit every employee long-term.
While several factors are at play in the chronic disease gender gap, the industry can take a meaningful first step to close it by investing in female scientists. Without them, the lab lacks an essential perspective that informs research that will one day find cures for complex conditions like MS.
Violaine Harris, PhD, is a senior research scientist with the Tisch MS Research Center of New York. She joined the Tisch MSRCNY laboratory in 2004, where she has been developing stem cell therapy strategies to promote repair and regeneration in multiple sclerosis. Jamie Wong, PhD, is a senior research scientist with the Tisch MSRCNY. She joined the center in 2015, and has used her surgical expertise to develop a novel animal model for primary progressive MS (PPMS).

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The practice of giving sedatives to people detained by police spread quietly across the nation over the last 15 years, built on questionable science and backed by police-aligned experts, an investigation led by the Associated Press has found.
At least 94 people died after they were given sedatives and restrained by police from 2012 through 2021, according to findings by the AP in collaboration with Frontline (PBS) and the Howard Center for Investigative Journalism at Arizona State University in Phoenix. That’s nearly 10% of the more than 1,000 deaths identified during the investigation of people subdued by police in ways that are not supposed to be fatal.
Supporters say sedatives enable rapid treatment for drug-related behavioral emergencies and psychotic episodes, protect front-line responders from violence, and are safely administered thousands of times annually to get people with life-threatening conditions to hospitals.
Critics say forced sedation should be strictly limited or banned, arguing that the medications, given without consent, are too risky to be administered during police encounters.
The injections spanned the country, from a desert in Arizona to a street in St. Louis to a home in Florida. They happened in big cities such as Dallas; suburbs like Lithonia, Georgia; and rural areas such as Dale, Indiana. They occurred in homes, in parking lots, in ambulances, and occasionally in hospitals where police encounters came to a head.
It was impossible to determine the role sedatives may have played in each of the 94 deaths, which often involved the use of other potentially dangerous force on people who had taken drugs or consumed alcohol. Medical experts told the AP their impact could be negligible in people who were already dying; the final straw that triggered heart or breathing failure in the medically distressed; or the main cause of death when given in the wrong circumstances or mishandled.
While sedatives were mentioned as a cause or contributing factor in a dozen official death rulings, authorities often didn’t even investigate whether injections were appropriate. Medical officials have traditionally viewed them as mostly benign treatments. Now some say they may be playing a bigger role than previously understood and deserve more scrutiny.
Here are takeaways from AP’s investigation:
The Deceased Are Disproportionately Black
The investigation found that about half of those who died after injections were Black.
Behind the racial disparity is a disputed medical condition called excited delirium, which fueled the rise of sedation outside hospitals. Critics say its purported symptoms, including “superhuman strength” and high pain tolerance, play into racist stereotypes about Black people and lead to biased decisions about who needs sedation.
Guidelines require paramedics to make rapid, subjective assessments of the potential dangers posed by the people they treat. Only those judged to be at high risk of harming themselves or others are supposed to be candidates for shots.
But the investigation found that some whose behavior did not meet the bar — who had already largely calmed down or in rare cases even passed out — were given injections. In some cases, paramedics cited fears that people would become violent on the way to hospitals.
The 2019 death of Elijah McClain in Aurora, Colorado, put a spotlight on the practice. A paramedic convicted of giving McClain an overdose of ketamine was sentenced last month to 5 years in prison, and a second paramedic was scheduled to be sentenced Friday.
Injections Administered After Other Forms of Restraint
Time and time again, the AP found, agitated people who were held by police facedown, often handcuffed and with officers pushing on their backs, struggled to breathe and tried to get free. Citing combativeness, paramedics administered sedatives, further slowing their breathing. Cardiac and respiratory arrest often occurred within minutes.
Paramedics drugged people who were not a threat to themselves or others, violating treatment guidelines. Medics often didn’t know whether other drugs or alcohol were in people’s systems, although some combinations cause serious side effects.
Police officers sometimes suggested paramedics give shots to suspects they were detaining — a potential abuse of power.
The majority of those who died had been restrained facedown in handcuffs, which can restrict breathing.
Experts say giving sedatives to someone who is already struggling to breathe can create a risk for death, because the drugs slow the respiratory drive. If someone is unable to get enough oxygen and blow off enough carbon dioxide, their hearts can stop or they can stop breathing.
Strategy Rapidly Spread Based on a Now-Discredited Concept
The use of sedatives by emergency medical responders outside hospitals spread rapidly over the last two decades based on a now-discredited theory. Law enforcement leaders in the 2000s were concerned by the number of people who were dying after they were shocked with police Tasers and forcibly restrained.
They began promoting a new strategy calling for officers to view encounters with severely agitated people, including those experiencing psychotic episodes or who were high on drugs, as medical emergencies. Rather than use force to try to gain compliance, officers were encouraged to call emergency medical services (EMS) to sedate people and transport them to hospitals.
Supporters of this approach promoted a term to describe behavior they said put combative people at risk of sudden death: excited delirium.
The strategy received a boost in 2009 when the American College of Emergency Physicians recognized excited delirium and urged the rapid use of ketamine, midazolam, and other drugs to treat it.
EMS agencies quickly adopted excited delirium protocols, though drugs like ketamine had not been thoroughly studied in the field. The paramedics who injected McClain with ketamine said they were following one such policy.
Critics have argued that the concept of excited delirium shifts blame from police in the deaths. The National Association of Medical Examiners and the American College of Emergency Physicians distanced themselves from the concept in 2023.
Sedatives Are Rarely the Focus of Death Investigations
Deaths involving police often result in news headlines and criminal investigations that focus on the use of force by officers. But the AP investigation found that medical personnel who gave sedatives were often largely ignored.
The use of sedatives in nearly half the deaths has not been previously reported by news outlets. Many reasons explain this lack of attention.
Police narratives omit the use of sedatives due to medical privacy concerns. EMS treatment records are not subject to public records laws. Medical examiners view sedatives as treatments and rarely cite them as contributing factors in deaths. Investigators are unknowledgeable about the role sedatives play and are uninterested in diving into the complicated details.

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The early results suggest that pasteurization is killing the H5N1 virus in milk, something that regulators were not certain of.Federal regulators on Friday said that they had not yet discovered live bird flu virus in the first batch of retail milk samples they tested, a reassuring indication that the milk on store shelves remains safe despite an outbreak of the virus among diary cows.In an online update, the Food and Drug Administration said an initial set of tests looking for live virus, not just genetic fragments, suggested that the pasteurization process was effectively neutralizing the pathogen.“These results reaffirm our assessment that the commercial milk supply is safe,” the F.D.A. wrote in the update, adding that the testing efforts were ongoing.Officials also tested infant and toddler formula, which incorporate powdered dairy, and did not find the virus, the agency wrote.The F.D.A. embarked on a national survey of milk samples shortly after an outbreak of the bird flu virus, called H5N1, was discovered among dairy cows. Government scientists have been testing 297 samples of retail dairy products from 38 states, a swath of the country that covers regions far beyond the nine states known to have infected herds.The first type of testing regulators conducted, a form of polymerase chain reaction, or PCR, is relatively speedy, but it picks up only genetic traces of the virus and does not tell researchers whether the live pathogen is present.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.

Mandating clinicians to report drivers with dementia may be associated with missed or delayed dementia diagnoses.Four states have clinician reporting mandates; 14 have mandates requiring drivers to self-report dementia diagnoses, and the rest do not have explicit requirements.The probability of underdiagnosing dementia was higher in states that required clinicians to report dementia diagnoses than in other states.

Mandating clinicians to report drivers with dementia may be associated with missed or delayed dementia diagnoses, a cross-sectional study of primary care providers suggested.
Clinicians in states that required them to report drivers had an adjusted 12.4% probability of underdiagnosing dementia, according to Soeren Mattke, MD, DSc, of the University of Southern California in Los Angeles, and co-authors.
This was higher than the probability of underdiagnosis in states that required drivers to self-report dementia (7.8%) or states with no reporting mandates (7.7%) by about 4 percentage points (P