Surgery paid more and offered a more comfortable lifestyle, DeLeon said.

On the other hand, family medicine meant juggling an inbox full of questions, requests, referrals and test results for hundreds of patients, not to mention cramming in as many office visits as possible each day.

In the end, DeLeon chose family medicine based partly on the family doctor who served his small rural hometown of Kingsville, Texas.

“The primary care doc in my hometown is kind of the jack of all trades and community leader,” DeLeon said. “I would see him on the school board, he was a good family friend, and I think I was drawn to how everybody kind of gravitated towards him and looked for advice beyond even medical and healthcare concerns.”

Unfortunately, not enough medical students are following DeLeon to a career in family medicine.

The United States will need about 40,400 more primary care physicians by 2036 to meet the needs of a growing population, according to the Association of American Medical Colleges.

The federal Health Resources and Services Administration paints an even more dire picture, projecting a shortage of more than 70,600 primary care physicians by 2038. This includes around 39,000 family doctors, 20,600 internal medicine docs, 9,300 pediatricians and 1,500 geriatricians.

That means there needs to be a steady influx of medical students choosing family medicine, both to expand the workforce and replace many doctors of the baby-boom generation who are now reaching retirement age.

“A lot of medical students are choosing family medicine and general internal medicine, just not enough,” said Michael Dill, director of workforce studies for the Association of American Medical Colleges (AAMC).

Many potential family doctors hear of the specialty’s downsides — lower pay, longer hours, loads of red tape — and decide they’d rather pursue some other field, researchers said.

Even worse, some are told by instructors that family medicine is beneath them.

“There’s a stigma that’s getting passed around in med schools, and I heard it too as a medical student — ‘You’re too smart for family medicine,’ ” DeLeon said. “I think that line gets used a lot.”

Others simply can’t find the path to family medicine, because it’s not emphasized as an option by medical schools or there aren’t enough training positions available to them.

Many schools don’t offer a specific family medicine clerkship, and it can also be a struggle for a budding family doc to find a place to complete their residency.

Clerkships are structured rotations that occur during the final two years of medical school, to give students a taste of different fields and a chance to apply their classroom knowledge to real patients. Residencies are the postgraduate training programs that follow medical school.

So even if enough students want to enter family medicine to meet the nation’s needs, not all will be able to find the training opportunities they need to become full-fledged professionals, Dill said.

“The real bottleneck here is not the number of people interested in becoming physicians, it’s our capacity to train new ones,” he said.

Pay And Headaches

Low pay is certainly a part of the equation in a student’s consideration of family medicine.

Family doctors, internal medicine docs and pediatricians are among the lowest-paid specialties in the U.S. Unfortunately, these doctors are as apt to graduate with as much school debt as those who choose more lucrative specialties, making monthly loan payments a lot harder to manage.

The AAMC estimates that 7 of 10 medical students graduated with some medical debt in 2023. The average amount of debt was more than $202,000, and half graduated with loan debt of more than $150,000.

And that number doesn’t count whatever debt they accrued in college prior to medical school.

“It depends on the institution, but some people are leaving medical school with half a million dollars in debt,” said Dr. Catherine Coe, chair of family medicine at the University of California, San Diego.

But experts said pay usually isn’t foremost on the minds of medical students choosing their specialty.

Instead, they’re more driven by how the specialty will fit their personality and their lifestyle, Dill said.

In an AAMC graduate questionnaire from 2024, 98% of medical school graduates said fit with personality, interests and skills was most important in a specialty. After that, just under 98% said the content of the specialty mattered a lot, followed by 81% citing work/life balance and 78% who said they followed the lead of an influential role model, as DeLeon did.

About 55% said income expectations influenced their specialty choice, and 25% cited their anticipated level of college debt, the questionnaire found.

“It’s not as if income isn’t on the list, but it’s seventh or eighth,” Dill said. “First is fit with personality, interests and skills. Then you have work-life balance, where it’s geographically located, how it fits with your family plans, and so on. And then you get the income expectations, but it’s fairly far down the list.”

Sadly, family medicine often doesn’t appeal to some budding doctors on those metrics, either.

There is a load of paperwork, as well as pressure to see as many patients as possible in a day, often eating into a doctor’s personal time.

“There is in primary care a very high administrative burden,” said Dr. Tracy Kedian, associate dean of admissions at UMass Chan Medical School in Worcester, Massachusetts. “There’s a lot of paperwork, authorizations, communications, things that we need to do that are not direct care of our patients. It takes a lot of time and it adds a lot of hours to your day.”

On top of that, patients these days often come to their doctor in worse condition and needing more comprehensive care for multiple conditions, Kedian said.

“Our patients are much sicker than they were before the pandemic, because no one went to the doctor for two years,” she said. “The amount of heart disease and cancer and dementia that happened and wasn’t treated during the pandemic is all falling back on the primary care physician.”

Worse, it doesn’t seem that the burden is going to ease anytime soon, Dill said.

“It seems like every time a new thing comes along that we want done to improve the delivery of healthcare, more often than not it’s something we ask primary care physicians to do,” he said.

Dill pointed to a new concept called social determinants of health, “which are things that drive people’s health status that happen outside of healthcare.” Examples include access to good food, the ability to get around your town by walking, or the income necessary to make healthier choices.

“In order to provide healthcare, you need to be aware of those things, and so we ask primary care physicians to know more about them,” he said. “And that’s one more thing to do. It’s a thing they want to do, and they understand the importance of, but if you keep piling on enough of those things it becomes more of a pressure cooker to be a primary care physician, right?”

Medical School Obstacles

In 2026, family medicine represented about 1 out of 10 (11%) of all residencies matched to medical school students, according to the American Academy of Family Physicians (AAFP).

Family medicine had about 12,000 applicants for approximately 5,000 residency positions open in 2026, the AAFP said. There were about 900 unfilled positions left following the first round of matching, but all but 76 were filled by the end.

But in some ways, medical school is structured to steer many good students away from family medicine, experts say.

For example, students who choose to take on a primary care residency often wind up floating away to some other field, such as cardiology, neurology, nephrology or gastroenterology, said Dr. Caroline Richardson, chair of family medicine at Brown University Warren Alpert Medical School in Providence, Rhode Island.

“People say things like, why don’t people who go into primary care residencies end up doing primary care, and the answer is because they’re not primary care residencies,” Richardson said. “They’re hospital training grounds and subspecialty preparation. That’s what they’re designed to do. That’s how they’re sold, that’s how their curriculum is developed, and that’s what residents are exposed to during their training, because they’re not exposed to primary care, really.”

Likewise, said UC San Diego’s Coe, many medical students looking for a clerkship prior to graduation might be hard-pressed to find one devoted to family medicine.

These clerkships are a key driver of students choosing family medicine as their specialty, according to a November 2025 study in the Journal of The American Board of Family Medicine.

About 37% of MD (Doctor of Medicine) residents and 43% of DO (Doctor of Osteopathic Medicine) residents said that they chose to pursue family medicine during their clerkship rotation in that field, the study found.

By comparison, only 16% of MDs and 19% of DOs decided to pursue family medicine before entering medical school, and only 10% of MDs and 11% of DOs chose the track during the first two years of medical school — before exposure to a family medicine clerkship.

“Some medical schools don’t have a family medicine clerkship,” she said. “They have a surgery clerkship. They have a pediatrics clerkship. They have an internal medicine clerkship. It’s like, what’s in a name? Sometimes calling out that there’s a family medicine rotation is really important.”

To test this theory, UC San Diego recently renamed its primary care clerkship. It’s now called a family medicine clerkship, Coe said.

“We’ve actually seen interest increasing in family medicine, just based on the name and people knowing that exists as a specialty,” she said.

Perhaps most pernicious is what Coe refers to as the “hidden curriculum.” That’s the quiet advice that teachers and administrators pass along to students, “where people don’t know about or are actively dissuaded from family medicine,” she said.

“Things like, you’re too smart to be a family doctor,” said Coe, echoing what DeLeon himself heard as a student.

Myths Of Family Medicine

Another part of the hidden curriculum that might dissaude others is the thought that by becoming a family doctor, you may be limiting yourself in one way or another, Coe said.

In fact, she argued, the field offers a wide field of opportunities.

“What I typically say to students is: The nice part about family medicine is it’s a continuous choose-your-own-adventure,” Coe said. “You are well-trained in everything, so you can reinvent yourself throughout the course of your career based on where your interests lie and what your community needs.

“Some people want to deliver babies. They don’t think they can do that in family medicine. They absolutely can do that,” Coe said. “In fact, there are fellowships that allow you to do obstetrical care.”

The same goes for dermatology, or infectious disease care, or women’s health, or reproductive medicine, or any of the other areas of medicine that a family doctor must be aware of to serve as a point person for patients’ healthcare, she said.

“You can become anything based on where your interests lie and what your community needs,” Coe said. “It’s cool to be able to flex like that.”

DeLeon agrees.

“I’ll be honest, some of the sharpest individuals that I’ve met are family medicine docs or primary care providers, because you have to learn all the specialties,” DeLeon said. “You have to learn all the diagnoses and when to send them to those specialists in the first place.”

In fact, DeLeon said his experience as a quarterback for his Texas high school team guided his decision to pursue family medicine.

“That relationship that you get with the patients, that responsibility, we call it being the quarterback: You’re overseeing everything,” DeLeon said.

“Everything a family medicine doc is responsible for, literally from the beginning of life to the end, the happy times, the difficult conversations, and the responsibility that you have in the relationship you can form with patients that you don’t get in surgery,” he said. “I really like that relationship, talking through patient concerns on a daily basis, and that definitely set me down the path.”

Mentorship like that offered by Coe can be essential when a student is weighing their career options, said Dr. Mary Bailey, a second-year resident at the Center for Family Medicine at Akron General Hospital in Ohio.

Bailey recalled another student who came to Akron General fired up to pursue ER medicine.

“I’m not going to say we coerced or convinced him, but he got to see some of the really incredible things about family medicine and is now considering it as a future career,” Bailey said. “I think allowing students to have high-quality experiences with family medicine and providers who are passionate about it as a specialty could draw more people in.”

The ‘Click’

In his role with the AAMC, Dill regularly talks to medical students about why they chose to pursue any given specialty.

“It comes down to at some point along the line, they found something that clicked with them,” he said. “And it’s really remarkable. Every single medical student I’ve talked to who’s had to make that choice has a specific story about, I was doing my clinical rotation in this and, my God, it hit me — that’s what I want to do.”

For Bailey, that “click” came with one of the patients she saw on the first day of her residency at Akron General.

“Our visit was so long because it was my first day as a resident and I didn’t know how to do anything,” she recalled. “She ended up having like all of these very concerning signs and symptoms and we ended up getting this whole workup.

“She came back to follow up with me and just was so grateful. She said ‘I had no clue that what I was doing was causing all of these symptoms and I feel better now and I am just so grateful for you and for how you took the time and followed up with my family,’ ” Bailey said.

She has since followed this patient through a diagnosis of dementia.

“This dementia and memory loss and the loss of who she is has been just so meaningful and heartbreaking at the same time, and to be able to carry just a little bit of that burden on behalf of the family is just such an honor, and I’m just so honored that they’ve entrusted me with her care,” Bailey said.

DeLeon said his “click” came while doing his family medicine rotation at a free clinic for patients in downtown Indianapolis.

“You go from a prenatal visit, checking on Mom to see if you need to send her to the hospital, is she in labor, we’re getting fetal heart tones,” DeLeon recalled, ”And then ride over to the next visit and you’re checking in on a cyst that you removed in a patient last week.”

One patient that stayed in DeLeon’s mind was a child who’d just immigrated from Burma.

“Come to find out they had some genetic syndrome that needed a little bit of tying into the healthcare system with some specialists,” DeLeon said. “So we got that situated for them, got follow-ups scheduled with specialty clinics — and then cleaned out their ears just because their ears had been full of earwax.

“There’s the serious side of things where we need to get you in with the specialist and get you in with the long-term management of very complex things,” DeLeon said. “But we’ll also make you comfortable by cleaning out your ears. You get very humbled and you remember why you entered medicine in the first place.”

Both DeLeon and Bailey now carry a roster of 250 to 300 patients. Neither is sure where they’ll end up in family medicine, but both are enthusiastic about their prospects.

“I’m really, really hoping that I get to do full-spectrum family medicine, from itty-bitty babies to my sweet little 90-year-olds,” Bailey said. “Time will tell. I’ve got a little time to figure it out.”

SOURCES: Dr. Genaro DeLeon, resident physician, Cleveland Clinic; Michael Dill, director of workforce studies, Association of American Medical Colleges; Dr. Catherine Coe, chair of family medicine, University of California-San Diego; Dr. Tracy Kedian, associate dean of admissions, UMass Chan Medical School; Dr. Caroline Richardson, chair of family medicine, Brown University Warren Alpert Medical School; Dr. Mary Bailey, second-year resident, Center for Family Medicine at Akron General Hospital; Association of American Medical Colleges; Health Resources and Services Administration; American Academy of Family Physicians; Journal of The American Board of Family Medicine

A recent multi-state parasitic outbreak linked to shredded iceberg lettuce has thrust Taylor Farms, one of North America’s largest fresh produce suppliers, back into the public health spotlight.

As federal health officials continue investigating a Cyclospora outbreak that feels a lot larger than the verified numbers report, industry observers note that this is far from the first time the agricultural giant has faced regulatory turbulence.

A History of Recalls

The Cyclospora investigation is among a recurring series of food safety notices and voluntary recalls involving Taylor Farms products over recent years.

• October 2024: Taylor Farms voluntarily recalled yellow onions supplied to food service clients following a multistate E. coli outbreak linked to quarter-pound hamburgers.

• March 2024: Taylor Farms Pacific launched a USDA Class II recall for nearly 20,000 pounds of Kroger-brand ready-to-eat chicken salad bowls due to an undeclared wheat allergen.

• August 2020: An onion recall initiated by Thomson International, Inc., which resulted in a recall by Taylor Farms’ onion supplier. These recalls were due to concerns for potential contamination by Salmonella.

Furthermore, KeyPedia a regulatory database that aggregates regulatory filings — reveals that U.S. Food and Drug Administration (FDA) inspectors have repeatedly documented sanitation problems at the company’s processing plants.

Following the October 2024 onion pull, an FDA inspection report (called Form 483) at Taylor Farms Colorado documented sanitation violations and positive tests for Listeria throughout 2024.

According to a 2022 inspection report of Taylor Farms Tennessee, an estimated 20 positive Listeria results were recorded within 30 days, highlighting chronic and lingering food safety issues.

Testing Drama: FDA Walks Back Positive Finding

The current investigation, however, took an unusual turn when federal regulators issued conflicting statements regarding laboratory testing.

The U.S. Food and Drug Administration (FDA) initially announced that a sample of Taylor Farms lettuce had tested positive for Cyclospora during routine import surveillance. Less than 24 hours later, however, the agency issued a correction, revealing that the initial result was a false positive.

Despite the testing error, the FDA stressed that its broader public health warning remained active.

“To clarify, this false-positive lab sample DOES NOT change the basis for FDA’s ongoing outbreak investigation or the overwhelming epidemiological data supporting the current voluntary recall by Taylor Farms,” the FDA stated in a social media post.

Public health analysts note that Cyclospora is notoriously difficult to culture in a laboratory, making accurate diagnostics an ongoing challenge for food safety inspectors.

High-Stakes Political Financing

While navigating federal oversight, Taylor Farms’ parent entity, Taylor Fresh Foods, Inc., has established a significant political presence in Washington, D.C.

Federal Election Commission (FEC) records show that the corporation donated $1 million to MAGA Inc., the primary Super PAC supporting President Donald Trump.

While Cyclospora may not be the next global pandemic, Katrine Wallace, epidemiologist and adjunct assistant professor at the University of Illinois, Chicago, told HealthDay, the illness is not short-lived.

“This isn’t a 24-hour illness,” she said. “Untreated, it can last weeks, and it tends to relapse, so each case can mean weeks of illness and lost work that a simple case count doesn’t capture.

“But the uncounted cases are probably also the milder ones who don’t seek medical attention, and deaths are rare, so this is about the outbreak being wider and longer-lasting than the tally suggests, not about hidden fatalities or anything like that,” Wallace said.

More information

Visit the U.S. Food and Drug Administration for more on food safety and active product recalls.

SOURCES: U.S. Food and Drug Administration, recall alert, July 19, 2026; PBS News, July 20, 2026; U.S. Centers for Disease Control and Prevention, July 18, 2026; Keypedia, FDA Enforcement Reports; Federal Election Commission, Taylor Fresh Food disclosures

“I was one of those rare three-sport athletes” in high school and college, said Block, 67, who lives in Columbus, Ohio. “I played football in the fall, I played basketball in the winter, and I either played baseball or ran track in the springtime.”

Sports helped Block get through college but left him with a lifetime of back and neck issues. A hospitalization for a herniated disk in January 2019 was the final straw, leading him to quit practice and round out his career as an administrator for Ohio’s Medicaid program.

“By that time it had been kind of something in the planning, and Mrs. Block was adamant that I should have retired a few years prior,” he said.

“But family doctors are really dedicated to their patients and their craft,” Block noted. “Seeing patients back to back to back, never wanting to turn anyone away who needed to be seen, it takes its toll physically, mentally and emotionally.”

America is now facing a shortage of family doctors, driven in part by physicians like Block who’ve served their communities for decades and are now ready to kick back, relax and follow other pursuits.

“We have a very large generation, the baby boomers, who are now retiring at the natural point in their careers,” said Dr. Jennifer Brull, board chair of the Kansas-based American Academy of Family Physicians (AAFP). “We want to celebrate their retiring. It’s just that there are a lot of them that are family doctors and primary care physicians, and we will miss them.”

But the family medicine crisis also is being driven by younger doctors who are leaving primary care.

Physicians are leaving clinical practice at younger ages than ever before, according to a study published in May in The Permanente Journal.

The average age of physicians leaving practice in 2024 was 48, nine years younger than found when doctors were surveyed in 2008.

Burnout — driven largely by red tape and paperwork — is causing some doctors to throw up their hands, studies say. Lower-than-average pay also can tempt family doctors to consider other specialties or even a career outside clinical medicine.

This double-whammy — older doctors retiring and younger doctors quitting — is creating a bind for America when it comes to family medicine.

Average folks either can’t find a primary care doctor, or can’t get in to see their doctor because the practice is juggling too many patients.

“Doctors went into medicine because they want to help, but so much administrative burden is crowding out the joy that comes from serving patients,” said Dr. Kisha Davis, Maryland-based president-elect of the AAFP.

“There are some docs who maybe would have worked another five to 10 years, maybe they were 65 and would have kept going until they were 70 or 75, who are now saying, ‘I’m out,’ ” Davis said. “And you’re also seeing that in younger physicians, docs who are in their 50s who aren’t working as long as previous generations did.”

Low Prestige Job?

Last year, the United States had only about 77% of the family doctors the nation needs to provide adequate care to Americans — 111,900 docs versus a demand for 146,300, according to a November 2025 study in the Journal of General Internal Medicine.

By 2037, that gap is expected to increase to 73%, with only 116,330 available docs and a projected demand for 159,550, the study said.

Family doctors must be jacks-of-all-trades, which can be immensely satisfying to people with a bent toward puzzle solving, said Dr. Rebecca Andrews, a primary care doctor in Connecticut and immediate past chair of the American College of Physicians.

These docs must have a broad knowledge of all aspects of medicine, so they can identify any health problem a patient might present and refer them to the proper specialist if necessary.

Family medicine is considered the gateway to medicine — the first stop people take in their journey to figure out what is ailing them.

“We have to be able to do 80% of medicine, while some specialists have the luxury of developing expertise into 20% of medicine,” Andrews said. “But that’s what makes us great at patient care. We get to look at how things interact and intercede.”

Despite the complexity of the job, “primary care is often treated as just low prestige,” she noted.

This is partly reflected by what family doctors are paid.

Family doctors made about $288,000 on average in 2025, according to Medscape’s 2026 Physician Compensation Report. Pediatricians made even less, around $266,000 a year.

That lags the $386,000 average annual pay for doctors across all fields of medicine, the report said. Practitioners in eight specialties earned more than $500,000 on average, including orthopedists, cardiologists, radiologists, plastic surgeons, anesthesiologists, urologists, gastroenterologists and otolaryngologists.

“It’s not like you’re poor, but family medicine along with pediatrics, we’re the lowest-paid specialties,” said Dr. Teresa Zyrd, a family doctor in Xenia, Ohio, who retired this year.

Overall, primary care accounts for about 5% of all the money spent on healthcare in the United States, despite the central role that family doctors play, said Dr. Caroline Richardson, a practicing family medicine physician and chair of family medicine at Brown University’s Warren Alpert Medical School in Providence, Rhode Island.

“In other countries it’s 30% to 40%, and most Americans think it should be about 50% because that’s their perception of the burden,” Richardson said. “We’re down to around 4% to 5% in most states in this country, and that’s not going to work. We’re never going to get enough primary care doctors that way.”

Block agreed.

“Primary care manages close to 40% of all patient care, yet they’re at 5%, maybe 10% in some good states of total health expenditure,” Block said.

Burnout And Paperwork

Experts said hassles associated with the role of a family doctor are contributing to burnout.

Nearly 1 in 10 family physicians (8%) changed practices or quit the profession between 2016 and 2020, researchers reported in March in JAMA Internal Medicine.

That study found that family docs reporting burnout were nearly 50% more likely to quit or move to another field, compared with doctors who aren’t burned out.

Primary care doctors in the U.S. are more likely to experience burnout compared to docs in nearly all other wealthy nations, according to a November 2025 report from The Commonwealth Fund.

More than 2 out of 5 (43%) U.S. primary care physicians reported feeling burned out, compared to 38% in Canada and New Zealand; 34% in the U.K. and Sweden; 32% in Australia; 25% in France and Germany; 19% in Switzerland; and 11% in The Netherlands, the report said.

About 45% of U.S. primary care doctors experiencing burnout say they are dissatisfied with practicing medicine, a clear sign they might quit, according to The Commonwealth Fund report.

By comparison, only 9% of doctors who aren’t burned out say they’re fed up with medicine, the report said.

Interference from insurance companies is a prime cause of stress and burnout, Zyrd said.

“Having a family doctor who knows what they’re doing is one of the biggest positives in healthcare,” she said. “But insurance companies have tended to take over, and they tell you what you can and can’t do, even though they’re not necessarily physicians.

“They require lots of documentation, pre-authorizations, and all of that gets frustrating because you don’t want to do paperwork,” Zyrd continued. “If you say, ‘I need this person to have a chest X-ray,’ you don’t need somebody saying, ‘well, prove it.’ It’s always like pushing the boulder up the hill.”

More than 2 out of 5 American primary care doctors reporting burnout said that their administrative burden was the primary cause, according to The Commonwealth Fund report. These tasks included filing insurance, chasing down payments and documenting patient visits.

By comparison, even though U.S. doctors are under pressure to see more patients due to supply and demand, this doesn’t appear to contribute to burnout.

Only 14% of American primary care doctors experiencing burnout cited the size of their patient pool as the reason, The Commonwealth Fund report said.

Electronic health records also have added to a family doctor’s paperwork woes, resulting in what physicians call “pajama time” — time off the clock that they spend tapping away at a keyboard, updating patients’ charts and passing along messages.

On top of that, patient portal messaging has taken off in the U.S., providing people with more access to their doctors through the clinic’s website.

Portal messages from patients more than doubled between 2020 and 2025, increasing from an average of one message per patient per year to two and a half messages per patient, according to a study published in June in the Journal of the American Medical Association.

Despite the increase in messages, phone calls to doctors’ offices dropped only 6%, the study found. At the same time, office visits increased by 17%.

“You end the day and then walk into portal messages,” Davis said. “There’s an expectation of availability and accessibility all the time, and so these patient portal messages, they really kind of add up.”

The Value Of Family Medicine

Now retired, Zyrd, 72, stuck with medicine longer than she wanted, delaying her retirement for a few years as a favor to a new boss. Eventually, “I just got tired of dealing with all of the new changes that were coming,” she said.

In addition, “I wanted to spend more time with my family,” Zyrd said. “Two and a half years ago, I became a grandma. I have a granddaughter and my son in San Diego, so I wanted to have more time to go back and forth. I wanted to have more time to spend with my husband and travel.”

Recent retiree Block thinks things went wrong for family medicine when doctors started working for health systems rather than running their own practices.

“Docs didn’t want to be in independent practice anymore,” he said. “They didn’t want to be businessmen. They simply wanted to see patients. And the result of that movement essentially took autonomy away from physicians. And that hit primary care docs, I think, much harder than specialty medicine.”

Block suspects government intervention will be needed to turn things around, with new laws requiring more pay and better support for primary care.

Doctors also might need to become businesspeople again, entering into new models of care that will let them regain their autonomy, he said.

Davis, meanwhile, said it also might help if the healthcare industry at large gets a handle on just how much primary care contributes to the health of Americans.

“You think about hospitals opening up a new stroke center or cancer center,” she said. “Those are really expensive. They bring money into the hospital. But you don’t see them opening institutes of primary care that could actually save money in the long term, right?

“Instead of putting in a big fancy facility to treat the stroke that has already happened, if we invested even a quarter of those finances in preventing that stroke from happening in the first place through primary care, the patient would be better off and the system would save money, too,” Davis said.

More information

The AAMC, a group representing medical education programs, has more on the primary care shortage in the U.S.

SOURCES: Dr. Dale Block, Columbus, Ohio; Dr. Teresa Zyrd, Xenia, Ohio; Dr. Jennifer Brull, board chair, American Academy of Family Physicians; Dr. Kisha Davis, president-elect, American Academy of Family Physicians; Dr. Rebecca Andrews, primary care doctor and immediate past chair, American College of Physicians; Dr. Caroline Richardson, chair of family medicine, Brown University Warren Alpert Medical School; The Permanente Journal, May 7, 2026; Journal of General Internal Medicine, Nov. 18, 2025; Medscape, 2026 Physician Compensation Report, May 15, 2026; JAMA Internal Medicine, March 30, 2026; The Commonwealth Fund, The Causes and Impacts of Burnout Among Primary Care Physicians in 10 Countries, Nov. 20, 2025; Journal of the American Medical Association, June 22, 2026

The Patient Safety Movement Foundation (PSMF), a nonprofit founded in 2012, has set an ambitious goal: zero preventable patient deaths by 2030.

“What we’re asking is not rocket science,” Dr. Michael Ramsey, the foundation’s CEO, said in an exclusive interview with HealthDay TV. “What we are asking is basic human safety factors being put in place.”

Some estimates put the U.S. death toll from medical error as high as 200,000 people a year, which would make it the third-leading cause of death, according to the foundation. Worldwide, the toll may reach 3 million, more than malaria, tuberculosis and HIV combined, according to PSMF.

Many of those deaths are preventable, Ramsey said. Common causes include medication mistakes, misdiagnosis, hospital-acquired infections and sepsis, a life-threatening response to infection that can turn deadly within hours.

The trouble, Ramsey said, is that overworked clinicians often juggle too many tasks and aren’t able to listen closely to the people in front of them.

“There’s so many things going on with patients that they make some errors that they should not make,” he said. “We can help them prevent making those errors, because there are systems out there to help do that.”

Two families know that cost firsthand.

Rory Staunton, a 12-year-old boy, cut his elbow during a school basketball game, developed sepsis and died five days later after the infection was missed. His family successfully pushed for “Rory’s Regulations,” which require New York hospitals to follow sepsis protocols.

Anders Pederson died after donating a kidney to his sister. While recovering from the surgery, he received too much pain medication and stopped breathing with no monitor in place to catch it, his mother said. She now urges hospitals to use pulse oximeters, which track blood-oxygen levels, for patients on such drugs.

The single most important fix, Ramsey said, is simple: Listen to the patient’s voice.

The foundation has published 20 evidence-based safety practices for hospitals on its website and promotes a safety culture modeled on the airline industry, complete with surgical checklists and timeouts.

Hospitals that adopt these steps have cut complication rates by 30% to 50%, he said.

Patients can protect themselves, too. Ramsey recommends bringing a trusted friend or relative to appointments to act as an advocate, writing down concerns in advance and never hesitating to ask questions — including exactly what medication is being given, and why.

“No question is stupid,” he said.

Even Ramsey, a physician, said he once had to refuse a middle-of-the-night dose when a student nurse admitted she didn’t know what the medication was.

More information

The Agency for Healthcare Research and Quality has more about preventing medical errors.

SOURCES: HealthDay TV, interview with Dr. Michael Ramsey, chief executive officer, Patient Safety Movement Foundation, July 9, 2026; PSMF interviews with Ciaran and Orlaith Staunton, parents of Rory Staunton, and with Melissa Pederson, mother of Anders Pederson

This year’s annual meeting hit an all-time attendance record. We had over 45,000 people registered, representing 129 countries. Amazing. It really felt very global.

All five of the abstracts in the plenary session really will change standard of care, at least when the drugs become available in the US.

I think, you know, the overwhelming most impressive big game changer was the RASolute 302 Trial of daraxonrasib, you know, the RAS inhibitor. And it got a standing ovation when the survival curves went up of multiple minutes. You know, probably the biggest advancement in the treatment of cancer in the past decade.

So, it was a study in metastatic pancreatic adenocarcinoma patients who had already received one line of therapy in the metastatic setting. The five-year survival rate would be 3% in that setting. There are not good treatments.

It was a randomization between daraxonrasib versus an investigator’s choice of standard-of-care chemo.

The daraxonrasib is a RAS inhibitor, but it’s a very cool approach because the problem and the reason we called RAS undruggable was because the way the protein folds, it doesn’t have any kind of a deep pocket for a drug to kind of stick in to, very, very shallow pocket.

So, with really elegant protein design, this is an oral tricomplex. So, what they took was a chaperone protein, Cyclophilin A; they bound it to RAS and so this, the Cyclophilin A, could attach to RAS kind of right next to where the anti-RAS, the agent, would fit into the pocket and keep it there, right.

The primary endpoint was focused on the KRAS G12 population, but that was 90% of the patients. And in that KRAS G12-mutant population, overall survival was 13.2 versus 6.6 months.

Progression-free survival 7.3 versus 3.5 months, both strongly statistically significant. And the grade 3, 4 toxicities were less with the daraxonrasib, 43.6% versus 57.5%.

There was more rash and more stomatitis. We’re going to have to learn how to take care of those. We did hear a little bit in talking to the authors about using topical creams and stuff.

Discontinuation related to a treatment-related adverse event was only 1.2% in the daraxonrasib versus 11.2% in the chemo. So, game changer for sure.

We know the FDA is already allowing expanded access. We’ve already got trials going on, moving it from second line to first line. Then I’m sure we’ll move it into the adjuvant setting.

But you know, other cancers have RAS mutations as well. Huge numbers of colorectal and lung cancer have RAS mutations. And when you look at the numbers, up to a third of cancers might actually have RAS mutations that could be treated with this. So, you know, real game changer here.

ASCENT-04: Analysis of efficacy by biomarker subgroups with sacituzumab govitecan (SG) + pembrolizumab (pembro) vs chemotherapy (chemo) + pembro in participants (pts) with previously untreated PD-L1+ metastatic triple-negative breast cancer (mTNBC)

My name is Sara Tolaney. I’m a breast medical oncologist and chief of the breast oncology program at Dana-Farber Cancer Institute.

So, at ASCO this year, we presented results from the ASCENT-04 study. This is a trial that looked at sacituzumab govitecan, a Trop 2-directed antibody drug conjugate, in combination with pembrolizumab compared to chemotherapy plus pembrolizumab in patients who have previously untreated metastatic triple negative breast cancer that is PD-L1+.

We’ve actually previously seen the results from this trial looking at the progression-free survival where we saw that sacituzumab plus pembrolizumab was associated with a significant improvement in progression-free survival compared to chemotherapy plus pembrolizumab.

This year, we are presenting biomarker data from the trial, looking at various biomarkers in association with efficacy.

In this particular analysis, we looked at a variety of different biomarkers, including Trop 2 expression, which is the target for sacituzumab govitecan. We also looked at BRCA mutation status and looked at HER2 expression and looked for associations with efficacy.

What we saw was that patients really benefited from sacituzumab plus pembrolizumab compared to chemotherapy plus pembrolizumab, irrespective of biomarker status.

So, for example, for patients when we looked at a Trop 2 expression, we found that sacituzumab plus pembrolizumab did better than chemotherapy plus pembrolizumab, even in the patients with low Trop 2 expression, as well as those patients with high Trop-2 expression.

We saw similar benefits amongst patients who have BRCA mutations compared to those patients who are BRCA wild-type, and also saw benefit irrespective of degree of HER2 expression.

I think these data really suggest that benefits for sacituzumab plus pembrolizumab can be seen irrespective of Trop-2, BRCA status and HER2 expression.

And so, I think the sacituzumab plus pembrolizumab combination really should be a standard-of-care option for our patients who have metastatic triple negative breast cancers that are previously untreated and are PD-L1+.

For patients who are PD-L1 negative, we actually also saw data from ASCO this year from the ASCENT-03 study. This trial had compared sacituzumab to chemotherapy in those patients who are not eligible for a checkpoint inhibitor.

And we’ve previously seen the efficacy data from this trial demonstrating that sacituzumab resulted in significant improvement in progression-free survival compared to chemotherapy.

So, I think it should also be a first line standard of care option for those patients who have PDL-1 negative tumors.

Welcome to the first installment in HealthDay’s exclusive investigative series, "Is There A Doctor In The House? The U.S. Family Medicine Crisis.” Through original reporting, expert interviews and patient stories, we examine the growing breakdown in access to family medicine in America — and what it means for you and the future of healthcare nationwide.

TUESDAY, May 26, 2026 (HealthDay News) — Retired physician Ken Licker is old enough to remember a time when you could call your family doctor and see them within a matter of days, if not hours.

“You call for an appointment now, and you’re a regular patient but you need to see him for a new problem,” Licker, 82, of Frisco, Texas, said. “Well, today is May 15. He can see you on June 30. At that point, it isn’t worth it.”

Licker isn’t alone in his frustration – and experts say it’s very likely to get much worse before it gets better.

More than 8 in 10 U.S. adults (84%) have a family physician or primary care doctor, according to a new HealthDay/Harris Poll survey.*

But many of these folks have a family doctor only on paper, it seems.

The survey found that nearly 3 out of 5 people who have a family doctor (58%) say they are unable to receive care when they need it – due to a lack of available appointments, an inability to reach a receptionist, a too-long wait for the next open date or other similar problems.

“These findings underscore a paradox at the heart of American healthcare: People clearly understand the value of family medicine, yet our systems have failed to make it accessible or reliable,” said Kathy Steinberg, vice president of health care research at The Harris Poll.

“There are barriers to getting a family doctor for those who want one, and even for those who have a primary family doctor, they still sometimes experience barriers in accessing the care that they need,” Steinberg told HealthDay.

Finding a family doctor or getting in to see them when you’re sick is likely to become even more challenging in the coming years, as the United States faces a growing shortage of primary care physicians, said Dr. Jennifer Brull, board chair of the American Academy of Family Physicians.

“We know that we’re going to need about 40,000 more primary care physicians by the year 2036, which is a really scary number,” Brull said.

“The beautiful thing is that the shortage is solvable if we make the right investments, but the reality on the ground right now? There is a shortage,” she added.

Watch our video here

Why Family Medicine Matters

Having a family doctor is vital, given that more than 2 out of 3 U.S. adults (68%) surveyed in the HealthDay/Harris Poll are living with a chronic health condition like high blood pressure, anxiety, depression, heart disease, diabetes, obesity or asthma.

In the United States, primary care physicians serve on the front lines of health care. They provide regular care to their patients, track their health over the years and refer them to specialists for more treatment as necessary.

“I had a patient today who has not seen a doctor in 20 years,” said Dr. Jason Goldman, immediate past president of the American College of Physicians. “He came to me because last month he had a stroke, a heart attack, multiple procedures and now realizes he needs to be seeing a primary care doctor.

“If a patient like that had seen me 20 years ago, we would have prevented possibly these issues, by treating their cholesterol, their heart disease and everything else,” Goldman said.

The 15% of Americans who don’t have a family doctor – more than 40 million people – further highlight the benefits of having a physician focused on your care, the poll found.

Of those, 45% have had a health issue related to their lack of a family doc. Among them:

• 15% were unable to get a diagnosis for their symptoms.

• 14% wound up in an emergency room due to an untreated illness or injury.

• 14% went without any treatment for an illness or injury.

• 12% were unable to get a prescription filled.

• 10% had worsening illness because they couldn’t get a diagnosis or treatment.

• 10% had to visit multiple providers or clinics to finally get the care they needed.

“We asked adults who don’t have a family doctor, who or what do you turn to when you need medical or health care?” Steinberg said of the poll.

“I don’t think it’ll come as a surprise to anyone that the No. 1 answer was urgent care (40%),” she said. “The No. 2 answer was the ER (26%).

“What I found shocking and concerning is that 29% of those who don’t have a doctor said none,” Steinberg said. “They just don’t receive care from another source when they need it. That’s a lot of unmet need.”

A future segment of HealthDay’s series will dive deeper into how the family doctor shortage affects everyday Americans’ health.

Finding A Family Doctor

But it’s not necessarily easy to find a primary care physician who’s taking on new patients, even if you have insurance.

About 27% of those who have a primary care doctor or family physician said they found them through their health insurance plan, and another 27% said they were referred by a friend or family member.

Around 15% said they were referred by another health care provider, and 22% said they searched online to find their doc.

Unfortunately, many of these folks reported barriers to finding and maintaining a relationship with a family doctor:

• 38% said it’s hard to find a doctor they like.

• 36% came up against docs not taking new patients.

• 36% said their insurance wouldn’t cover the doc they wanted to see.

• 25% said there aren’t enough primary care providers.

• 23% said they didn’t have health insurance.

• 22% said they didn’t know where to look in the first place.

The United States is facing a family doctor shortage because of several factors, Brull said.

“We have a very large generation of family doctors who were part of the baby boomers who are reaching the age of retirement, and it’s time for them to celebrate and take a break and not work anymore,” she explained.

“And that’s wonderful for them,” she continued. “Unfortunately, they are leaving the workforce in addition to a significant number of family physicians who are experiencing burnout and leaving clinical care because of that burnout.”

Brull said the stress and strains of the COVID-19 pandemic added to this burnout, prompting some doctors to leave family medicine for other medical careers or to give up medicine altogether.

“The rate at which people are leaving family medicine and primary care in general is exceeding the rate of those entering family medicine,” she said. “So we have a historic problem in which the value of primary care physicians is underrecognized, and this is driving a shortage of clinicians.

Panel Predicaments

To counter the family doctor shortage, physicians are under pressure to increase the number of patients under their care, which doctors refer to as their panel.

“Family physicians today are caring for a growing number of patients on their panel,” Brull said. “These people are identified as their patients perhaps through an insurance or an employer program, and yet there just isn’t space on the physician’s calendar to see all of the patients that are attributed to them or who claim them as their own.”

It’s natural that average folks – and even some doctors – are dumbfounded by the concept of taking on more people than you can reasonably treat, said Dr. Caroline Richardson, a practicing family medicine physician and chair of family medicine at Brown University’s Warren Alpert Medical School in Providence, Rhode Island.

“How do you get your entire practice booked up and you have no access for urgent appointments? What happened there?” she told HealthDay.

“We’re being pushed to have larger and larger panels of patients,” Richardson said. “Where before you may have been 1 patient out of 1,500, now you’re 1 patient out of 3,000, and there’s just not enough slots.”

In fact, family doctors who work for a large health system are rewarded for taking on more patients, even if they won’t be able to actually see them, Richardson said.

“There’s a contract between the health system and the physician who’s practicing as an employee of the health systems,” she said. “Often in the contract there’s some stipulation of you have to carry this many people on your panel, that’s the expectation, and often there’s a payment attached to meeting that expectation.”

As a result of taking on all these patients, doctors find themselves run ragged, Brull said.

“Most physicians spend almost as much time charting, doing prior authorizations, reaching out and trying to find consultant notes and closing loops as they do in actually seeing patients face to face,” she said. “A lot of that explains why patients have doctors but can’t see those doctors.”

Are There Alternatives?

Folks who can’t see their doctor are forced to go to an urgent care center, a retail medicine clinic or an ER. About 74% of Americans say they’ve gone to an urgent care or retail medicine clinic, and 72% have been treated at an ER, the survey found.

Of those who went to these centers in lieu of a family doc, the vast majority felt they got the care they needed. Nearly 9 in 10 (89%) said they were satisfied with their treatment, with more than 2 in 5 (43%) strongly agreeing that they were satisfied.

While people got the care they needed in the moment, having to go to urgent care or the ER might mean patients aren’t getting the nuanced level of treatment they might receive from the doc who knows them best, experts said.

“The benefit to having a partner in your life and your health is that that partner knows you a whole lot better than someone that you are meeting for the first time in an urgent care center,” Brull said. “They’re going to be aware of your chronic conditions, your past medical history, the medications you’re taking. Even if you can’t remember all of them, they’re going to.”

For Goldman, this also somewhat applies to another tactic that family medicine clinics are using to meet patients’ needs – relying on nurse practitioners and physician assistants to consult with patients who can’t score a doctor’s appointment.

“Nurse practitioners have their appropriate role, but they are not the head of the medical team,” Goldman said. “If there are not enough pilots, do you let the flight attendants fly the plane just because they’re there?”

Not to mention, people who must resort to urgent care or the ER also face bigger medical bills, Brull noted.

“Certainly, there is a financial cost to that patient because almost always the cost of going to the emergency room, whether you have insurance or you don’t have insurance, is greater than the cost of seeing your primary care physician,” she said.

In addition, “you’re probably going to wait a really long time to be seen in that emergency room,” Brull continued. “That might cost you hours away from your job. It certainly costs you hours away from your family. And it’s no fun to sit in an emergency room waiting room.”

In a future installment, HealthDay will look into how other care models fit in with U.S. family medicine – and whether any might pose a challenge to the current status quo.

Americans Still Appreciate Family Medicine

Despite these frustrations, the HealthDay/Harris Poll found a lot of evidence that Americans continue to support and appreciate family medicine.

“Nearly 9 in 10 Americans, regardless of whether they have a provider or not, agreed that it is important to have an ongoing relationship with one primary care doctor who oversees your medical care,” Steinberg said. “And more than half strongly agreed with that statement.”

Family doctors also are the top source people turn to when they have a medical question, with 28% saying that’s where they go first. By comparison, internet search engines were the first stop for 21% of those polled, and friends and family, 14%.

“This is a reaffirmation of what we are seeing in our offices every day,” Brull said. “[We know there are] patients that we don’t know about who live in our communities who are trying to reach care that aren’t able to do so.”

That includes Licker, a retired urologist who now is fighting kidney cancer with chemotherapy.

“I have some pretty terrible side effects from it, sometimes it takes two days to get a response,” he said.

“In one case, I got put on terminal hold,” he explained. “I called at around 4 p.m. and I’m holding, and at 4:45 I get a message, our office is now closed, please call tomorrow.

Licker laughed ruefully, and added, “Thank you for being so responsive.”

*HealthDay/Harris Poll surveyed people across the United States regarding their experiences and views of family medicine. The survey was performed in two waves in March and April of 2026, involving a total 4,180 people.

More information

The Association of American Medical Colleges has more on the U.S. physician shortage.

SOURCES: Health Day/Harris Poll; Kathy Steinberg, vice president of health care research, The Harris Poll; Dr. Jennifer Brull, board chair, American Academy of Family Physicians; Dr. Jason Goldman, president, American College of Physicians; Dr. Caroline Richardson, practicing family medicine physician and chair of family medicine, Brown University Warren Alpert Medical School

The Make America Healthy Again (MAHA) movement, spearheaded by Health and Human Services Secretary Robert F. Kennedy Jr., is built on a foundation of deep distrust toward the wellness “establishment,” Big Agriculture and Big Pharma. To advocate for a “back to basics” approach, prioritize food safety, remove chemical additives and reduce the nation’s reliance on chronic-disease medications are all commendable objectives for our government department tasked with managing the health and welfare of Americans. Marty Makary went to Washington with the qualifications and knowledge to drive this change. His sudden departure and the reasons behind it, however, underscore the sad reality that, while MAHA talks about promoting the greater well-being of the country, the actions of RFK Jr. and his HHS, have proven to support only those interests that have the ear of RFK and the president.

The three issues most frequently cited as the basis for Makary’s ouster — approval of Replimune for melanoma, the delay on the ban for Mifepristone and the reluctance to approve fruit-flavored vapes — tell the story of how the MAHA movement crushed one of its greatest supporters.

Makary arrived at the FDA with a vision to modernize an outdated bureaucracy, championing a more efficient system intended to shave months, or even years, off the approval process for life-saving innovations. His support for drugs like Replimune’s RP1 for melanoma was rooted in this very philosophy: a belief that the agency should prioritize scientific flexibility over rigid, outdated trial designs when the “plausible” benefits for terminally ill patients are clear. However, this nuanced attempt to balance speed with safety was quickly quashed by the heavy hand of political optics. Rather than being seen as a rigorous reformer, Makary found his scientific standards reframed by interests with the administration’s ear as “slow-walking” the deregulation agenda, transforming a legitimate debate over evidence into a narrative of bureaucratic insubordination.

This same commitment to the scientific process defined his cautious approach to the administration’s push for a national ban on Mifepristone. While political allies within the MAHA movement clamored for an immediate revocation of the drug’s approval, Makary advocated for a more nuanced, comprehensive review of the safety data. To Makary, the “right decision” required a data foundation that could withstand judicial and public scrutiny. Yet, in the eyes of the HHS leadership and anti-abortion activists, this methodical delay was not seen as scientific diligence, but as a betrayal of core promises, leading to increasingly vocal calls for his dismissal.

The final fracture occurred over the approval of fruit-flavored vapes, a line Makary, as a physician, evidently did not want to cross. He remained convinced that these products — despite the technological “locks” proposed by industry — were fundamentally designed to hook a new generation of youth on nicotine. However, the political reality of May 2026 revealed a president and an HHS Department far more responsive to the “screws” being turned by Big Tobacco than to the warnings of their own commissioner, as reported by The New York Times. Forced to choose between signing off on a policy he viewed as a public health failure or maintaining his seat at the table, Makary chose his conscience, resigning rather than becoming a figurehead for an administration that had traded its “back to basics” health mandate for the interests of its most deep-pocketed donors.

This contrast highlights the fundamental irony of the MAHA movement: While it rose to power by accusing the previous administration of prioritizing politics over public safety, it has ultimately sacrificed public health at the altar of corporate and political interests. Makary’s downfall exposes the ultimate “MAHA Paradox” — The movement claims to be cleaning up the “corrupt” health establishment, yet it has replaced a mandate of public safety with a system of political patronage, where the health of the American citizen is often traded for the financial and political interests of those who have Trumps ear.

The ultimate irony of Marty Makary’s downfall, however, is that he was consumed by the very same “simple messaging” machine he once criticized Dr. Anthony Fauci for wielding. During the pandemic, Makary argued that public health leaders treated the American public as “too stupid to understand” nuance, specifically regarding natural immunity and age-stratified risk. He positioned himself as the champion of “common sense” and “gold-standard science,” promising to restore integrity by embracing complexity rather than hiding behind a political badge.

However, his brief and turbulent tenure as FDA commissioner proved that the “simple message” is a siren song that neither side of the political aisle can resist. While the COVID-era establishment may have taken to oversimplifying the truth in the name of publicsafety, the MAHA movement has shown a willingness to flatten the truth for the sake of political patronage and personal gain. Makary’s failed attempts at nuance — trying to weigh the data on vapes or find the middle ground on drug approvals — ultimately underscore just how Herculean the task of nuanced communication truly is at the federal level. Ultimately, our greatest responsibility as health journalists is to explain the nuances of these different perspectives, because those with vested interests will push their own agenda through easier-to-communicate generalizations.

I’m Aasma Shaukat. I’m a professor of medicine at NYU Grossman School of Medicine and a gastroenterologist as well as a clinical researcher in colon cancer screening.

For the DDW, I am the outgoing chair of the Clinical Practice Session for the AGA Council. And we did all the programming for clinical practice.

There’s been some very exciting science being presented at DDW this year.

We had a few sessions with colon cancer screening, updates at colonoscopy, and I’d like to mention perhaps the most notable abstract in this space, which was presented as a late-breaking abstract this morning by Michael Bretthauer. He is the PI of the NordICC trial.

This is a randomized, controlled trial of colonoscopy versus no screening done in the Nordic countries. And he presented the 13-year follow-up results of the study.

The results were quite remarkable. Colonoscopy conferred a 19% reduction in the risk of colorectal cancer incidence. It did not reduce colorectal cancer mortality.

And what was new, they also presented subgroups and it appeared that men benefit more than women from colorectal cancer screening. And their explanation was that it’s because men have a higher risk of colorectal cancer than women, so colonoscopies just seem to provide more benefit there.

There were several studies covering GLP-1, its effect on the GI tract. Some were geared towards using GLP ones for treatment of MASH or MASLD, which is metabolic-associated steatohepatitis, or as we call it fatty liver disease. And we know that it affects a very large size of the U.S. population.

And these studies were largely positive, showing that even in individuals that have liver disease, including advanced cirrhosis, they all were able to benefit from GLP-1s in reducing that risk, not just by weight loss, but also through its anti-proliferation effects.

So, there might be more to come on this and GLP-1s might be used more frequently in patients with fatty liver disease and even advanced cirrhosis.

Efficacy and Safety of the First Co-Antibody Therapy, JNJ-78934804, in Patients with Moderately to Severely Active Crohn’s Disease Refractory to Systemic Therapies

Bruce Sands, MD, Chief of the Division of Gastroenterology, Mount Sinai and Professor of Medicine, Icahn School of Medicine at Mount Sinai

This week at DDW 2026 in Chicago, I presented the DUET-CD study. This is a very interesting study looking at combination therapy in patients with Crohn’s disease.

The idea is that by combining two different biologic therapies, one an anti-TNF called golimumab and another an anti-IL-23 antibody called guselkumab, that you might be able to achieve better efficacy than with either one alone.

So, these patients were all patients with moderately to severely active Crohn’s disease and they had failed at least one class of systemic therapy. That means they could have failed multiple drugs within the same class, but at least one class. And in many cases, there were many classes that they had failed.

The study was designed as a phase 2B study to explore various levels of doses of a combination of therapies. The guselkumab and golimumab were co-formulated together at a low, medium, and high dose formulation. They were injected with an auto injector at the same time.

And this was compared to monotherapy with golimumab injection or monotherapy with guselkumab injection. And finally, there was also a placebo arm.

The results of the overall study, looking at all the patients, showed that the high dose combination, which was the intended comparison, that comparison to golimumab was clearly numerically and statistically superior.

However, when the overall group of patients was compared to guselkumab, while numerically superior, it did not reach statistical significance with the high dose formulation.

This then led to an exploration of the patients who had failed two or more classes of systemic therapies. And that accounted for about 50 percent of the overall population.

And when you did the same sort of analysis in this subset of patients who were more refractory and failed more systemic therapy classes, what you found was the high dose combination was superior to golimumab monotherapy. It was superior as well now to the guselkumab monotherapy for the endpoints of clinical remission by Crohn’s disease activity index at week 48, and also the co-primary endpoint of endoscopic response by the SES-CD at week 48.

So, we concluded that the efficacy of the combination was most beneficial for patients who had failed two or more classes of systemic therapies.

The good part is despite combining two different drugs with two different mechanisms of action, we did not see any increased safety signals.

So, beyond what we would expect for either one alone, we didn’t see any excess infection, or certainly there was not excess of cancer or major adverse cardiovascular events. It really seemed to be safe to combine these two drugs.

A parallel study was conducted in patients with ulcerative colitis and similar results were found showing that the high dose co-formulation of golimumab and guselkumab was superior to golimumab alone or to guselkumab alone.

I think it’s exciting news to see that combining two different therapies of different sorts can achieve more benefit than either one alone. And this is important for the field, not only for this particular co-formulated agent, but also because of the principle it demonstrates -- the idea that we want to explore in the future of combining other agents of different sorts to see what we can get out of them.

Hello, I am Dr. Nanette Rollene and I am the General Program Chair for the 2026 ACOG Annual Scientific Meeting this year held in Washington, DC.

We’re celebrating our 75th anniversary this year with the theme, ‘Build on Legacy, Shape the Future,’ and are proud of the record-breaking engagement this year.

The theme, ‘Build on Legacy, Shape the Future,’ represents us as a specialty community with a long-standing commitment to patient-centered care, demonstrating our equally strong commitment to meet future patient needs.

Another overall trend was the remarkable engagement of attendees in the meeting sessions, particularly those addressing menopause, emergency obstetrics, and perinatal mental health.

One particular educational session was on opioid use disorders. It emphasized the importance of supporting the patient with multidisciplinary care and emphasized long-term support as vital to care.

Perinatal mood disorders was an important topic, which discussed screening, assessment, and offering non-pharmacological options when applicable for the best care of the patient.

The third overall trend was the robust presence of well-being programming, including ACOG’s National Wellbeing Program featuring the peer support program.

A small percentage of our overall meeting does include original research presentation.

This year’s first place award winner was by McClain et al. from Henry Ford Health. It was on clinical judgment versus clinical guidelines, diagnostic challenges, and intraamniotic infection using ACOG criteria.

Key takeaway points were: Most patients were diagnosed per ACOG criteria… 76.8 % adherence suggests guidelines are broadly applied.

But there was noted poor concordance with placental pathology. Clinical criteria and histologic evidence frequently disagreed, highlighting diagnostic imprecision.

Clinical implications are important as you want to avoid overtreatment with unnecessary antibiotics or on the other side of the spectrum, untreated infections.

And antibiotic practices are widely variable, reflecting the need for standardized protocols.

Cannabis Use During Pregnancy and Effect on Maternal and Fetal Health Outcomes: A Retrospective Chart Review

Arisha Tariq, Fourth-Year Medical Student, Penn State College of Medicine

Hi, I’m Arisha Tariq. I’m a fourth year medical student at Penn State College of Medicine in Hershey, Pennsylvania.

Our research was cannabis use and the impacts on maternal and fetal health. We analyzed pregnancies. We did a retrospective cohort study looking at the effects of cannabis exposure and given its increasing legalization and also perceived safety, we wanted to look at the impacts and see what we can do about in terms of public health and safety and also in terms of on the clinician side.

At Penn State, we do have an addiction medicine pregnancy clinic, as well. So, we mainly looked at patients at Penn State.

And from using the Electronical Health Record data, we were able to analyze pregnancies specifically that tested positive for THC. And we also did ask patients to complete screenings, self-reported screenings, as well.

And then we also compared them to control pregnancies that were negative for THC.

So, we looked at both maternal and fetal outcomes. We looked at things like postpartum infection rates, placental abruptions, and the delivery types.

And on the fetal side, we looked at things like fetal growth restriction, the NICU outcomes, the birth weights of these babies. And we found more significant effects in the fetal side.

Our results are most significant in the fetal effects. We found most commonly in our patients that reported using THC, 45 % of those babies ended up in the NICU due to things like prematurity, about 30 % reported for respiratory distress, hypoglycemia was at 20 %, and also due to some co-substance use, we found neonatal abstinence syndrome at 20 % as well.

We weren’t able to look at dose response, but that would be an interesting addition to this study in order to determine more effects.

Right now, we do know that ACOG does not recommend using cannabis during pregnancy as there is no safe limit established. However, that would be an interesting study to take that forward and see what that could mean.

According to recent reports, there have been shortages of supply of hormone replacement therapies. The shortage appears to be particularly acute for estrogen patches.

Today, we are happy to be joined by Dr. Stephanie Fabian, the director of the Mayo Clinic Center for Women’s Health and the medical director for The Menopause Society.

Thanks so much for joining us today.

Stephanie Faubion, MD, MBA, Director of the Mayo Clinic Center for Women’s Health; Medical Director for The Menopause Society

Delighted to be here. Thanks for having me.

Andy Meyers, CEO, HealthDay

So, we’re hearing about some shortages for common HRT. Tell me, you’re definitely on the front lines of this. Are you hearing some instances and some talk about this?

Stephanie Faubion, MD, MBA, Director of the Mayo Clinic Center for Women’s Health; Medical Director for The Menopause Society

We are hearing some, although I have to say it’s sporadic and it’s some doses and not other doses.

So, it’s patchy. It can be a little hit or miss. And usually if we rewrite the prescription, if they couldn’t get the once a week patch, we do the twice a week patch or we get to the dose a little bit in a different way by either doing two lower dose patches together.

So, usually we can cobble it together. But I think this is sort of occurring because we have more women asking about hormone therapy than have in the past.

We don’t have data yet that more women are actually using it yet. And I’ll tell you a preview for an abstract that we published over a year ago now, but the paper is about to come out, that says that hormone therapy usage rates in this country are still at an all-time low at 1.7%.

That was as of the end of 2023. So, we don’t have data over the last year, two years to say that there’s been an uptick, but it appears to be the case.

But we know that that hormone therapy usage rates were really, really very low.

Andy Meyers, CEO, HealthDay

Interesting. So, some people have said that this recent uptick in use or shortage, however you want to look at it, is a result of the FDA requiring makers to change the labeling on the hormone replacement therapy packaging. Do you think that there’s any truth to that? Or do you think there are some other important factors that are really driving this?

Stephanie Faubion, MD, MBA, Director of the Mayo Clinic Center for Women’s Health; Medical Director for The Menopause Society

I’m not sure that I could pin it to that specifically. Although that may have contributed to more women using hormone therapy, most of the women who are in my office really have no idea that any boxed warning has been removed. So, I think it’s more than that.

I think it’s that women and clinicians and people in general are talking about menopause much more so now than in the past, which is a good thing.

And so, I think women are starting to ask questions about, well, are all these symptoms related and are there any treatments and what about hormone therapy and can I be using it? Is it safe for me?

So, I think there’s a lot more discussion around menopause in general.

This is a different generation than the baby boomers who really didn’t talk about things like menopause in public.

So, we have a different generation, the Gen Xers and the first of the millennials are now in the age range where they would start to experience symptoms. And hearing that there’s nothing that can be done for their symptoms is not acceptable to this generation and you got to love it.

So, they’re not only asking for answers, they’re crowdsourcing answers and using social media to do so.

They’re educated. A lot of them have money and their own jobs and they have a need that has not been fulfilled. And so that sucking sound, that vacuum has created an industry around menopause now, which did not exist before.

Andy Meyers, CEO, HealthDay

So, I’d like to step back for just a second and kind of talk about what your feeling is on people’s perception about the safety of hormone replacement.

Stephanie Faubion, MD, MBA, Director of the Mayo Clinic Center for Women’s Health; Medical Director for The Menopause Society

So, backing up, we don’t call it hormone replacement therapy anymore. We call it hormone therapy.

And the reason for that, we don’t use the replacement part because we’re not actually trying to replace what the ovaries used to make premenopausally.

We are trying to manage symptoms and the dose required to manage symptoms is way lower than the dose that would be required to fully replace the ovary if the ovary wasn’t there or wasn’t working.

So, the Women’s Health Initiative, very important key study. The initial results were published July 9th, 2002, which anyone in the menopause world remembers the date that it actually came out because it was such an impactful thing. And it was also reported in a way that was very scary.

And they said, you know what, hormone therapy is not as safe as we thought. And it not only does not prevent chronic disease, it can actually increase the risk of cardiovascular disease. So heart attacks, stroke, blood clot, et cetera. There was a secondary outcome of breast cancer that also was increased in that group. Now, all of these risks were relatively very, quite rare in younger women.

Eventually they broke down the data by age... and what we ended up finding out is for those women in their 50s... hormone therapy was actually pretty safe. And for those women, the risk of heart attack and stroke is quite rare anyway, because these are younger women.

Now, does this mean that all women should be on hormone therapy? Absolutely not. It does not. And I just want to make that clear.

Andy Meyers, CEO, HealthDay

Because one of the things that we’re always most concerned about is delivering news you can use, what are the factors that. for women, should either trigger using it or not using it?

Stephanie Faubion, MD, MBA, Director of the Mayo Clinic Center for Women’s Health; Medical Director for The Menopause Society

Yeah, so let’s break that into who should take it and who should not take it.

If you’re younger than 60 or within 10 years of menopause onset and having bothersome symptoms like hot flashes, nights, sweat, sleep disturbances, mood disturbances, all the things that are really impacting your life. Not just a little bit, but having an impact to where you say, yes, I would do something about these if I could. That would be the woman that we would want to talk about.

The other thing that we look at when you’re in the office is what is your risk for heart disease? We look at cardiovascular risk factors. If you have, for example, diabetes or high blood pressure, it doesn’t mean that you’re not a candidate for hormone therapy, but it might affect the type of hormone therapy and the route of delivery that we give to you.

Contraindication, so who should not take it? Women with a history of breast cancer, women with a history of heart attack, a history of stroke, a history of blood clot, severe liver disease.

This combined discussion features advances in once-daily oral treatments for psoriasis and atopic dermatitis, alongside emerging therapies for vitiligo and cutaneous lupus, reflecting a broader shift toward more convenient, targeted treatment options.

Also highlighted is a novel once-daily oral therapy for a rare skin and muscle disease that has received rapid review by the U.S. Food and Drug Administration, underscoring both the unmet need in this space and the potential for accelerated access to new treatments.

Together, these updates illustrate the expanding pipeline of dermatologic therapies, with a focus on improving efficacy, simplifying treatment regimens, and addressing conditions with limited existing options.

Luke Laffin, MD, a preventive cardiologist and cardiovascular clinical trialist at the Cleveland Clinic, presented results from the Kardinal Trial, which evaluated the safety and efficacy of tonlamarsen for patients with uncontrolled hypertension. Tonlamarsen is an investigational antisense oligonucleotide administered every 30 days that works by suppressing plasma angiotensinogen.

The phase 2 study enrolled patients with persistent hypertension despite treatment with two to five antihypertensive medications. Following a placebo lead-in period, all participants received an initial dose of tonlamarsen and were then randomized to continue treatment or switch to placebo.

The trial assessed two co-primary endpoints: reduction in angiotensinogen levels and change in systolic blood pressure at 20 weeks. Patients receiving ongoing tonlamarsen achieved a 67% reduction in angiotensinogen, while those receiving a single dose maintained a 23% reduction at 20 weeks. Despite this difference, both groups experienced similar reductions in systolic blood pressure, with decreases of just under 7 mmHg.

These findings suggest that blood pressure response may lag behind biochemical changes, raising important questions about the relationship between angiotensinogen suppression and clinical outcomes. Further studies are underway, including a planned trial in patients with acute severe hypertension, a population that may derive greater benefit from this targeted approach.

Hadley Wilson, MD, interventional cardiologist and past president of the American College of Cardiology, highlighted several of the most impactful studies presented at the meeting.

Among them was the HI-PEITHO trial, which evaluated ultrasound-assisted thrombolytic therapy in patients with intermediate-high-risk pulmonary embolism. The study demonstrated improved outcomes compared to standard anticoagulation, marking the first major advance in this area in over a decade.

Another closely watched study examined the use of the Impella CP device with delayed reperfusion in patients with ST-elevation myocardial infarction without cardiogenic shock. While delaying intervention by 30 minutes did not reduce infarct size, the findings suggest potential avenues for further research into myocardial unloading strategies.

Wilson also emphasized the growing importance of aggressive lipid lowering. Data from the VESALIUS trial showed that treatment with the PCSK9 inhibitor evolocumab reduced cardiovascular events in high-risk patients without established atherosclerosis. Additional research demonstrated improved outcomes when lowering LDL cholesterol targets below 55 mg/dL compared to the current standard of 70 mg/dL, suggesting that more intensive lipid management may play a larger role in future care.

Other studies highlighted the impact of lifestyle interventions, including programs that provided access to heart-healthy foods, which were associated with improved blood pressure control and outcomes in patients with hypertension.

Together, these findings underscore the breadth of innovation presented at ACC 2026, from novel molecular therapies to evolving treatment strategies that may influence future clinical practice and guideline development.

Dr. Pandolfino’s work is for patients with symptoms such as persistent heartburn, regurgitation of food, chest pain that mimics heart problems, or the sensation that food is stuck while swallowing.

Many of these symptoms are associated with common gastrointestinal conditions such as gastroesophageal reflux disease (GERD), allergic inflammatory disorders like eosinophilic esophagitis, or motility disorders in which the muscles of the esophagus fail to contract normally. While occasional heartburn after a heavy meal is common and usually harmless, symptoms that occur frequently—such as several times per week or when lying down at night—may signal something more serious.

Pandolfino’s innovation builds on common diagnostic technologies by feeding the collected physiological data into advanced mathematical models. Working with engineering colleagues at Northwestern’s McCormick School of Engineering, his team has created what they call a “virtual esophagus”—a computational simulation that replicates how fluid and food move through the organ. The model uses principles from physics and fluid dynamics to simulate esophageal motion, allowing researchers to test different disease scenarios and treatment approaches in a digital environment.

One of the first conditions studied with this technology is achalasia, a disorder in which the lower esophageal sphincter fails to relax properly, preventing food from entering the stomach. In standard treatment, surgeons cut the tight muscle to relieve the obstruction. By running simulations with different surgical approaches—varying the length and depth of the cut—researchers can predict which techniques may work best for different patients.

Ultimately, the goal is precision medicine for esophageal disorders. By combining endoscopic imaging, physiological measurements, and computational modeling, physicians may be able to tailor treatments to each individual patient’s anatomy and function. A large multi-center NIH clinical trial is now being prepared to test whether these models can accurately predict surgical outcomes and improve care. If successful, this approach could transform how doctors evaluate and treat a wide range of common gastrointestinal conditions.

That’s the idea behind culinary medicine — a growing field that combines cooking, nutrition science, and medical education.

Instead of just telling people what not to eat, culinary medicine shows them how to cook food that supports their health.

The goal: to prevent, manage and treat chronic conditions.

“Something we frequently get asked is, you know, what is the best diet for diabetes? What is the best diet for weight loss? What is the best diet for heart disease?” (Nate Wood, MD, MHS, Chef, DipABLM, DABOM, Director of Culinary Medicine, Yale School of Medicine)

Culinary medicine is a vital part of patient care at Yale New Haven Health. And Dr. Nate Wood’s passion project.

“So, there are lots of barriers to people eating healthily. I think one is knowing how to get the healthy food and knowing is what even is healthy food. But then another big one is how to prepare this healthy food in a way that makes it still taste good, right? (Nate Wood, MD, MHS, Chef, DipABLM, DABOM, Director of Culinary Medicine, Yale School of Medicine)

Inside the Irving and Alice Brown Teaching Kitchen, patients and chef-dietitians work together. All it takes to get in is a referral from a Yale clinician. And the experience is free.

“Our primary goal is to get people just more comfortable in the kitchen, build a little bit of that confidence so that they can go home and they can take these steps that we’re not only showing them, but also, again, the referring clinician has probably talked to them about healthy diet and cooking more at home.” (Max Goldstein MS, RDN, CDN, CCMS, Teaching Kitchen Chef /Dietitian, Yale New Haven Health)

Each session starts with a short nutrition lesson from a chef and registered dietitian like Max Goldstein.

Then comes the fun part — hands-on cooking. Participants chop, stir, taste, and learn alongside a team of professionals, including Chef Dani Sanders.

“In the teaching kitchen we teach a plant-forward style of eating, not necessarily plant-based, but plant-forward, meaning that you can have animal products but they’re not going to be the center of the plate.” (Dani Sanders, RDN, MPH, Teaching Kitchen Chef /Dietitian)

Yale New Haven Health

It’s really making a real difference for this couple after his recent stint in cardiac rehab.

“ Cleaner diet, less salt. Less sugar. But things taste better.” (Teaching Kitchen Participant)

“ I definitely feel more energy. Everything’s working better. Sleeping better. And it will just keep improving. Plus, I’m much more mindful of what I’m doing now as far as making choices.” (Teaching Kitchen Participant)

While the lesson is important, so is making it fun.

At the end, everyone shares the meal they made together.

The takeaway isn’t just a notebook full of recipes. It’s knowing what food to buy and how to prepare it to improve your life.

“I think bringing nutrition into the medicine conversation is extremely important because it starts to adjust the real causes of a lot of these conditions.” (Dani Sanders, RDN, MPH, Teaching Kitchen Chef /Dietitian)

And research backs the benefits.

“We know that culinary medicine interventions help people lower their blood pressure, their BMI, their sugars, their cholesterol.” (Nate Wood, MD, MHS, Chef, DipABLM, DABOM, Director of Culinary Medicine, Yale School of Medicine)

Dr. Wood and his team will be launching a long-term study to follow up on their patients within the next few months.

This is the 48th year that we have the San Antonio Breast Cancer S…

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So, this was a phase two single arm study for relapsed refractory multiple myeloma, specifically for patients that have had one to three prior lines of therapy, so early relapse.

And we targeted patients that were lenalidomide refractory. And the reason we did this is because in the second or so line setting, most patients become lenalidomide refractory in this disease.

And the treatments that we have offer comparatively poor outcomes compared to some of the emerging therapies that are often operated in more late line settings.

So, this is a quadruplet regimen that we prepared with a backbone of iberdomide, which is a novel CELMoD, a cereblon E3 ligase modulator, with the intent to try to rescue patients from that lenalidomide or image refractoriness.

And with a quadruplet backbone, the idea was to drive MRD [molecular residual disease] negative responses, to recapture a nice deep response, and afford the patient the opportunity to de-escalate their therapy back down to monotherapy and restore the good quality of life.

This was a 32 patient single arm study. And patients who are eligible enrolled to receive eight 28-day cycles of iberdomide, carfilzomib, daratumumab, and dexamethasone.

Iberdomide was the starting dose of 1 milligram. And then at the end of those eight cycles of reinduction therapy, so to speak, patients underwent a bone marrow biopsy.

We did MRD testing via either adaptive clonoSEQ, which is a nice generation sequencing test versus multiparametric flow cytometry. And that was the primary end point, to achieve MRD negativity at 10 to the negative fifth at the end of those need cycles of therapy.

Now, regardless of the response though, all patients would then deescalate to iberdomide monotherapy for up to 36 cycles or three years.

And to give you a little bit of a background, in this setting for patients with lenalidomide refractoriness using triplet regimens, which is sort of the standard of care, the rates of MRD negativity are around 10 to 20%.

So, for our primary end points, we had 24 evaluated patients at the time of the data cutoff. The rate was 71%, which is substantially higher than what we’ve seen in the past.

Some of the other things that you might be interested in are safety. And so, this is the first time these drugs are all used together in a combination therapy. And sort of as expected, we saw a decent amount of hematologic toxicity.

Now, this is stuff patients obviously aren’t feeling, but we worry about infection with neutropenia rates. So, what we did see was that in the first two cycles, the neutropenia rates were pretty high. We supported patients with growth factor, and we didn’t see any increase in infections related to that neutropenia in the first couple of cycles.

And despite the neutropenia, we were able to maintain a 90% relative dose intensity of iberdomide.

There were some also some non- hematologic adverse events. We had one patient that did have to come off study for previously undiagnosed coronary artery disease, had a heart attack on the study, unfortunately. But aside from that, no new safety signals and patients tolerated therapy quite well.

So, the conclusion is that you know, iberdomide does seem to be a very potent agent for lenalidomide refractory patients. And the drug is hopefully soon to be approved in some other combinations based on the results of EXCALIBER-RRMM and a couple of other studies that are ongoing.

So, I think that you should very much look out for CELMoDs, specifically iberdomide, in combination with proteasome inhibitors and also with CD38 antibodies as a really viable option for patients in the early relapse setting.

We had a terrific team who got together to write the 2025 American Society of Hematology guidelines for treating newly diagnosed older adults with acute myeloid leukemia. This included obviously people …

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My name is Dr. Joanna Chikwe. I’m Chief of Cardiac Surgery at Cedars-Sinai in Los Angeles. And I’m Chair of the American Heart Association Scientific Sessions, which means I and my good colleague Brahmajee Nallamothu MD have been responsible for leading a group of about 180 people that have been working on putting together the biggest and most important meeting in the cardiovascular and brain health space. And it’s a very special meeting because it crosses clinical and real cutting-edge translational and basic science.

I think the topics that popped this year, judging by the excitement, the applause, where the rooms were packed, would be for people that are thinking about what might transform care.

It’s probably the hyperlipidemia studies, and drugs such as evolocumab that showed really significant reductions in challenging patient populations; really may transform practice.

The gene editing therapy in much smaller studies looks to be a really promising therapy and we are going to scrutinize the larger studies to see if there are any safety signals that raise concerns. I think that’s going to be real focus.

Then I think leaping around, there was some very interesting trials in the atrial fibrillation space that were simple, indicating that patients can probably come off dual antiplatelet therapy or anticoagulation a little bit more quickly depending on whether they’ve had successful closure of their left atrial appendage or treatment of their atrial fibrillation.

I think there was one, it’s a slightly smaller study, but it may get the most interest because it touches on something that most people enjoy, which was a trial that looked at whether stopping people drinking coffee could keep them free of atrial fibrillation or not.

And I think the results surprised everyone. It seems like coffee is... Not really a problem if you’re trying to treat atrial fibrillation, so coffee’s okay.

The TARGET-D Trial: A Randomized Clinical Trial Evaluating Vitamin D Normalization on Major Adverse Cardiovascular-Related Events Among Acute Coronary Syndrome Patients

Heidi May, PhD, Epidemiologist, Intermountain Heart Institute

I’m Heidi May and I’m an epidemiologist at Intermountain Health.

The study that I presented at the American Heart Association scientific sessions in New Orleans was called Target D and it was a randomized clinical trial that evaluated patients that had just had a heart attack to see if personalized targeting dose of vitamin D supplementation to raise their blood levels of vitamin D to above 40 help reduce their risk of future cardiovascular events.

So, patients were randomized to two different groups. One group received vitamin D supplementation that was personalized to raise their vitamin D level to above 40.

And then the other patient group was randomized to what we call usual care, where the study didn’t contact them anymore and they just had their usual follow-up visits however they wanted to do it and their clinician wanted to do it.

Both groups though did receive vitamin D testing to determine what their level was in their blood. Those in the vitamin D arm received dosing based on those levels and if they were below 40, they would come back in three months to see if they were above 40.

Both groups had really low vitamin D when we started. They were around 20, 26, 27 nanograms per milliliter, which is pretty low and based on our algorithm over half of our vitamin D arm population started on 5,000 international units.

So, we compared these two groups our average follow-up was about four years and to see if, if there was a reduction in follow-up death, heart attack, stroke, heart failure, hospitalization.

We didn’t find a significant reduction when you put all those outcomes together. But the thing that we found was that in that vitamin D arm, they had a 50 % reduction in the risk of having another heart attack.

I think what this study really showed is you can’t just give patients fixed doses and think it’s going to be okay. So, it’s important to test and then have a discussion between the physician and the patient on how they want to dose, whether they want to dose.

The great thing about vitamin D, it’s easily attainable and it’s pretty reasonably priced. There (is) some blood testing but I think what the important message about this study is that it’s personalized and it is important to test and then dose accordingly that just giving a fixed dose might not be the answer.

We just wrapped up the CHEST 2025 meeting in Chicago, and I’m the chair of the scientific program committee.

Lung health was the focus and there are a lot of new and pipeline therapeutics…

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Hi, I’m Julie Carbray. I am a clinical professor of psychiatry and nursing at the University of Illinois, Chicago, Department of Psychiatry and College of Nursing. And I’m also a psychiatric nurse practitioner.

I am co-director of this year’s Psych Congress, along with doctors Jan and Mattingly. And this was a large meeting, maybe over 4000 in attendance. A big conversation at this meeting was going beyond symptom control across disease states, things like, upping the game in our treatments for persons with depression. reviewing data that really shows our antidepressants have a limit to just how much they can accomplish in overall treatment and care for persons with depression, similarly with ADHD.

Well, there’s some new agents in the pipeline that might be addressing some of those continued deficits that we see for a good functional life, and people who have these disease states.

This meeting was really focusing on looking at the whole person, although you have symptom control how do we up our game and looking at functional outcomes for people going to work, having meaningful relationships. How do we keep encouraging each other to use evidence based approaches that might go beyond, you know, they look better on this scale

This year we had a new partner at psych Congress, which is an international society looking at sleep. And so, we had several offerings this year, and this was something new, to really address sleep and sleep regulation across normal populations and across, disease states that we care about.

We had several speakers who could speak on anything from cognitive behavioral approaches to digital. They’re calling them digital therapeutics, or basically apps that help persons to be able to address and learn, new techniques that are adjunctive to what we do in clinic settings, and then new mechanisms of action that are showing some promise beyond restoring sleep to actually also improve things like anxiety and depression.

Christoph Corell, MD, International Principal Investigator of the SOLARIS Study, Professor of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra /Northwell, Chair of the Department of Child and Adolescent Psychiatry, Charité University in Berlin

Hello, my name is Christoph Correll. I’m professor of psychiatry and molecular medicine at the Zucker School of Medicine at Hofstra/Northwell in New York. And I’m also professor and chair of the department of Child and Adolescent Psychiatry at the Charité University in Berlin, Germany.

And I’m today also talking about a study that I’m the P.I, the international principal investigator for. That’s the SOLARIS study that deals with subcutaneous olanzapine, a long acting injectable that is sponsored by Teva.

Schizophrenia is a very severe mental disorder, unfortunately often relapsing and chronic and quite debilitating. And we know that relapses becoming sick again is one of the most preventable risk factors for poor outcomes.

The reason why this olanzapine subcutaneous LAI is so important is that we do have olanzapine as a deep intramuscular, long action injectable. So, okay. That’s fine. Why do we need something else?

Well, the problem is that olanzapine is very water and blood soluble. And when you give a deep intramuscular injection, you can lacerate or hurt a little bit of a blood vessel. And then all the medication that’s supposed to sit in the muscle and be released over a month, very slowly can get into the bloodstream and overwhelm the brain. And people can then become very sleepy and stop potentially even breathing, which is why they need to be observed for three hours after the injection.

So, with the SOLARIS program, there were two phases of the study that the Food and Drug Administration wanted. So, first of all, does the olanzapine formulated in a way that you can give it under the skin. Does that give you the same efficacy as we know olanzapine acutely.

In the phase three randomized, double blind, placebo controlled phase one of the SOLARIS study there were 675 patients who were randomized to three doses of the subcutaneous olanzapine, long acting injectable 531mg, 425mg, and 318mg once monthly or placebo. And these patients were then followed for eight weeks.

And there was a significant improvement in all three doses, with more than 20 to 22 point reduction from the baseline PANSS or positive and negative syndrome scale score, and around ten or less points with placebo.

Patients were then followed into the phase two of the study. That was an open label, long term safety phase of up to 48 weeks, with the same doses of one monthly subcutaneous olanzapine injection, or there was a re randomization of placebo to any of those three doses.

The total PANSS score, there was further improvement of about seven points over that period of time.

3476 injections later, there was no single post injection delirium, some sedation problem. And when you put the whole development program with more than 3900 injections, there was none.