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    ‘The Pitt’ Captures the Real Overcrowding Crisis in Emergency Rooms

    From the “chairs” to the hallway medicine, the show’s depiction of an emergency medicine system that is beyond capacity rings true for medical experts.The emergency department waiting room was jammed, as it always is, with patients sitting for hours, closely packed on hard metal chairs. Only those with conditions so dire they needed immediate care — like a heart attack — got seen immediately.One man had had enough. He pounded on the glass window in front of the receptionist before storming out. As he left, he assaulted a nurse taking a smoking break. “Hard at work?” he called, as he strode off.No, the event was not real, but it was art resembling life on “The Pitt,” the Max series that will stream its season finale on Thursday. The show takes place in a fictional Pittsburgh hospital’s emergency room. But the underlying theme — appalling overcrowding — is universal in this country. And it is not easy to fix.“EDs are gridlocked and overwhelmed,” the American College of Emergency Medicine reported in 2023, referring to emergency departments.“The system is at the breaking point,” said Dr. Benjamin S. Abella, chair of the department of emergency medicine at Mount Sinai’s Icahn School of Medicine in New York.“The Pitt” follows emergency room doctors, nurses, medical students, janitors and staff hour by hour over a single day as they deal with all manner of medical issues, ranging from a child who drowned helping her little sister get out of a swimming pool to a patient with a spider in her ear. There were heart attacks and strokes, overdoses, a patient with severe burns, an influencer poisoned by heavy metals in a skin cream.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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    ‘The goal is to disassemble public health’: experts warn against US turn to vaccine skepticism

    As vaccine hesitancy increases in the US, isolated, tight-knit and religious communities have frequently been at the center of high-profile outbreaks.Such is the case in west Texas, where a rural community is the center of an expanding measles outbreak that has already claimed the lives of two Americans – the first deaths from the disease in nearly a decade.However, as the conspiracy theories of Maga conservatism marry the bugbears of the US health secretary and vaccine skeptic Robert F Kennedy Jr, the one-time fringe view of vaccines has become increasingly mainstream – with activists in right-leaning population centers taking lessons learned from the Covid-19 pandemic into the realm of childhood inoculations.One need look no further than Sarasota, Florida, for a full-throated political denunciation.“Generally, people are weak, lazy,” said Vic Mellor, an activist based near Sarasota, and a close ally of former Trump national security adviser Michael Flynn.Mellor owns the We the People Health and Wellness Center in nearby Venice. Mellor, in a shirt that shouts “VIOLENCE MIGHT BE THE ANSWER”, is a self-professed attendee of the January 6 insurrection at the US Capitol.“And that lazy part just makes them ignorant … Covid has proven that obviously this is true. I mean, all the facts are starting to come out on Covid now – that it was a hoax. That is just an extension of where this hoax began decades earlier with the vaccines, OK? This is all a money grab, this is all a power grab.”The pandemic was real, and it started Mellor down the road of questioning vaccines. Where he once opposed only the Covid-19 shots, he now opposes vaccines entirely – arguing they harm children despite experts on vaccines considering them one of mankind’s greatest medical achievements.“This is not an isolated, rural, religious community, which I think is what a lot of people associate with an anti-vaccine mentality,” said Kathryn Olivarius, the author of Necropolis: Disease, Power, and Capitalism in the Cotton Kingdom, and a historian of disease at Stanford University. “This is in the heart of everything.”Sarasota has become a proving ground for the Maga right. Among nail salons, mom-and-pop Cuban restaurants and roadside motels lining US 41, known locally as the Tamiami Trail, a visitor can find the gates of New College. This was once a public university prized for its progressive liberal arts education. Now it is part of the new conservative experiment in remaking higher education led by activists aligned with Donald Trump and the Republican Florida governor, Ron DeSantis.Along the same road is the Sarasota memorial hospital, an aberration in American healthcare – it is publicly owned with open board elections. The normally sleepy election became contentious when insurgent “health freedom” candidates, supported in part by Mellor, entered the race. Three won seats on the nine-member board in 2022.Even the name of this stretch of sun-bleached asphalt is up for debate. This year, a state Republican lawmaker – who has also introduced bills to limit vaccine requirements – briefly proposed changing its name to the “Gulf of America Trail” – a nod to Trump’s renaming of the Gulf of Mexico.Arguably the most salient artifact of this activism in Sarasota is the least visible: vaccination rates against measles.Measles vaccination rates for kindergarteners have plummeted over the last two decades – from 97% in 2004 to 84% in 2023, according to state health records. Sarasota is roughly on par with the vaccination rates in rural Gaines county, Texas – the center of the ongoing measles outbreak that sickened 279 people in in that state alone. Notably, both Gaines county and Sarasota have large home-schooling communities, meaning vaccination rates could in fact be lower.It is well known in research circles that right-leaning states across the US south and west have worse health metrics – from obesity to violence to diseases such as diabetes. That reality was supercharged during the pandemic; as vaccine mandates became a fixation on the right, Republican-leaning voters became more skeptical of vaccines. In turn, places with politically conservative leaders experienced more Covid-19 deaths and greater stress on hospitals.Measles is one of the most contagious diseases known to medicine. At least 95% of the population needs to be vaccinated to prevent outbreaks of the disease. But despite a supremely effective vaccine that eliminated the disease from the US in 2000, vaccine hesitancy has increasingly taken hold.skip past newsletter promotionafter newsletter promotionConservative activism alone can’t be blamed for declining measles vaccination rates. The measles vaccine in particular has been subject to a sustained firehose of misinformation stemming from a fraudulent paper linking the vaccine to autism in 1999. For years, this misinformation was largely nonpartisan. And Florida’s anti-vaccine movement was active even before the pandemic – with a vocal contingent of parents arguing against strengthening school vaccine standards in 2019.What appears new in Sarasota is how local conservative activists have brought opposition to vaccines into the heart of their philosophy. By Mellor’s telling, he and a loosely affiliated group of Maga activists began to adopt anti-vaccine beliefs as the pandemic wore on – helping organize major health protests in the area in recent years, such as mask mandate opt-outs and the “health freedom” campaign for hospital board seats.Mellor said his nearby property, the Hollow, was a gathering place during the pandemic (it is also a part-time gun range). He cites ivermectin, an anti-parasitic drug that became a fascination of the right, as the reason “we didn’t lose people at all” during the height of the pandemic. Available clinical evidence shows it is not effective against Covid-19.Kennedy has fit neatly into this realignment. He enjoys trust ratings among Republicans nearly as high as Trump, according to polling from the health-focused Kaiser Family Foundation. Kennedy has already spread dubious information about measles vaccines in public statements (notably: from a Steak ’n Shake in Florida) – a response one vaccine expert said “couldn’t be worse”.“While children are in the hospital suffering severe measles pneumonia, struggling to breathe, [Kennedy] stands up in front of the American public and says measles vaccines kill people every year and that it causes blindness and deafness,” said Dr Paul Offit, the director of the Vaccine Education Center and an attending physician in the division of infectious diseases at the Children’s Hospital of Philadelphia. Severe side effects from the vaccine are possible, but they are much rarer than disability and death from measles.“This is what happens when you have a virulent anti-vaccine activist, a science denialist, as the head of the most important public health agency in the United States,” said Offit. “He should either be quiet or stand down.”The same poll found trust in public health agencies has fallen precipitously amid Republican attacks. More than a quarter of Republican parents report delaying childhood vaccines, the poll found, a rate that has more than doubled since 2022. There is no analogous trend among Democratic parents. Despite how claims espoused by vaccine skeptics can be easily refuted, their power has not been undercut.“The anti-vaccine business is big business,” said Offit, pointing to the myriad unproven “treatments” offered by promoters of vaccine misinformation, some of which are offered at Mellor’s We the People health center. “We have been taken over by a foreign country, and the goal of that foreign country is to disassemble public health.”The misery of measles did not take long to appear in Texas – measles-induced pneumonia has already led pediatricians to intubate children, including at least one baby, according to the Associated Press. About one to three people out of 1,000 who are infected by measles die from the infection, and one in 1,000 suffer severe brain swelling called encephalitis, which can lead to blindness, deafness and developmental delays.“We actually don’t have the perspective people in the past had on these diseases,” Olivarius. “I have spent many, many, many years reading letters and missives from parents who are petrified of what’s going to happen to their children” if there are outbreaks of yellow fever, polio or measles, Olivarius said about diseases now largely confined to history – thanks to vaccines.“The lesson from history is these are not mild ailments,” she said. “These are diseases that have killed hundreds of millions of people – and quite horribly too.” More

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    Trump Returns to a Favorite Issue: Health Care Price Transparency

    In a new executive order, President Trump will reaffirm his commitment to one of his favorite health care policies of his first term: His push to make the prices paid for medical services more public and transparent.Mr. Trump will sign the order on Tuesday afternoon, according to a White House official. After years of halfhearted compliance from hospitals and insurance companies with the previous policies, Mr. Trump is signaling a more aggressive approach to enforcing the rules and making pricing data accessible to patients, the official said.Health care prices have historically been shrouded in secrecy, negotiated in private between doctors, hospitals, drug companies and the insurance companies that pay their bills. The parties in those negotiations have fought hard to keep those numbers out of public view, saying that confidentiality is key to their bargaining process. Economics literature — which relied heavily on a study of Danish concrete prices in the 1990s — has suggested that making them public could actually backfire, by increasing health care prices.But with two major rules issued jointly by the departments of Health and Human Services, Treasury and Labor during his first term, Mr. Trump tried to force the industry to become more transparent. One rule required hospitals to publish the prices they charged to various insurers for a set of common services. Another required insurance companies to publish a more comprehensive listing of the prices they had negotiated with various health care providers.Industry compliance has been grudging, slow and marked by extensive litigation. After the rules became final in 2021, many hospitals simply declined to publish the required lists. Others tried to make their price information hard to find. The Wall Street Journal reported that several had inserted code into their web pages listing prices that made the pages impossible to find using an internet search engine.Nevertheless, the requirement did provide new information to researchers, employers and some patients about the nature of health care prices — and their wide and often inexplicable variation. The policy has so far not delivered on one of Mr. Trump’s key promises from his last term, that price transparency would significantly drive down health care costs. Health care prices have continued to rise.The new executive order will task H.H.S., Treasury and Labor with considering new ways to expand the reach of current initiatives, but it does not call for much in the way of specific new policy. Any meaningful new transparency initiative would require regulatory action or legislation, or both. But the signing of the new order does suggest that Mr. Trump has not forgotten about this priority, which he often referred to in his first term as “bigger than health care itself.” More

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    An Invisible Medical Shortage: Oxygen

    Oxygen is vital to many medical procedures. But a safe, affordable supply is severely lacking around the world, according to a new report.At the height of the Covid-19 pandemic, millions of people in poor nations died literally gasping for breath, even in hospitals. What they lacked was medical oxygen, which is in short supply in much of the world.On Monday, a panel of experts published a comprehensive report on the shortage. Each year, the report noted, more than 370 million people worldwide need oxygen as part of their medical care, but fewer than 1 in 3 receive it, jeopardizing the health and lives of those who do not. Access to safe and affordable medical oxygen is especially limited in low- and middle-income nations.“The need is very urgent,” said Dr. Hamish Graham, a pediatrician and a lead author of the report. “We know that there’s more epidemics coming, and there’ll be another pandemic, probably like Covid, within the next 15 to 20 years.”The report, published in The Lancet Global Health, comes just weeks after the Trump administration froze foreign aid programs, including some that could improve access to oxygen.Boosting the availability of medical oxygen would require an investment of about $6.8 billion, the report noted. “Within the current climate, that’s obviously going to become a bit more of a challenge,” said Carina King, an infectious disease epidemiologist at the Karolinska Institute and a lead author of the report.Still, she said, governments and funding organizations should prioritize medical oxygen because of its importance across health care. People of all ages may need oxygen for pneumonia and other respiratory conditions, for severe infections including malaria and sepsis, for surgeries and for chronic lung conditions.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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    How Trump’s Medical Research Cuts Would Hit Colleges and Hospitals in Every State

    A proposal by the Trump administration to reduce the size of grants for institutions conducting medical research would have far-reaching effects, and not just for elite universities and the coastal states where many are located. Also at risk could be grants from the National Institutes of Health to numerous hospitals that conduct clinical research on […] More

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    Amid Concern Over Trump Order, New Yorkers Rally to Support Trans Youth

    Thousands of protesters in Union Square called for action against an executive order that threatens to withhold federal funding from hospitals that provide gender-affirming care.Bells, drums and chants rang out Saturday afternoon in Union Square in Manhattan as thousands of New Yorkers gathered to protest an executive order from the Trump administration targeting transgender children and teens.The order, which threatens to withhold federal funding from hospitals that provide gender-affirming treatments to trans youth, has left many local families worried and reeling.At the rally, parents and children came together with activists and lawmakers to share their stories and call for action against President Trump’s policies.Juno Krebs, 10, a nonbinary student from Brooklyn, said the executive order was “scary” and that it felt like the administration was “trying to take away our rights.”“I don’t identify as a girl or a boy, and I should be respected for that,” Juno said. “It doesn’t feel any different. It just feels like me, honestly.”For Michelle Byron, the mother of a transgender and nonbinary teenager, the order has raised painful and frightening questions about her child’s ability to continue receiving gender-affirming care, which can include hormone therapy, puberty blockers and surgery, though such procedures are rare for minors.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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    The Unnecessary Suffering of Women With Obstetric Fistulas

    One of the most dangerous things a woman can do in much of the world is become pregnant, and the risks caught up with a Kenyan named Alice Wanjiru a decade ago.Then 20 years old and pregnant for the first time, she suffered a childbirth injury called an obstetric fistula, caused by prolonged labor without access to a C-section to end it. This left her with a hole in the tissue between her rectum and her vagina, and for 10 years she endured the humiliation of continually leaking stool through her genital tract.“I could never get fully clean, for there was always some stool left,” she told me. “The other women would say, ‘She is the woman who stinks.’ I would ask God, ‘Why me? Why can’t I be like other women?’”Wanjiru bathed herself several times a day, fasted from morning until evening so there wouldn’t be much in her digestive tract during the day, and always wore a sanitary pad. Doctors misdiagnosed her, sex was a nightmare and her husband abandoned her after harshly accusing her of having poor hygiene.Shamed by the continuous odor, she withdrew from friends and stayed home from church and other gatherings. She endured her shame in solitude, year after year.Perhaps one million or two million women worldwide are enduring fistulas and leak stool or, more commonly, urine through their vaginas. These are typically impoverished women in poor countries where home births are the norm, who couldn’t get to a doctor in time for a needed C-section.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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    Syria Fighting Worsens Already Dire Conditions in Idlib and Aleppo

    Years of war and a powerful earthquake had led to crushing poverty, displacement and breakdowns in services. But over the last several days, the region’s misery deepened.Hospitals have been ripped apart by airstrikes. Nearly 50,000 people have fled their homes, and tens of thousands lack running water. Civilians are being laid out in body bags on hospital floors after shells struck their neighborhoods.Scenes from the bloodiest days of Syria’s civil war, which had lain largely dormant for several years, are now repeating themselves in the country’s northwest as pro-government forces try to beat back a surprise rebel offensive, according to aid workers, a war monitor and the United Nations, who warned of a rapidly worsening humanitarian situation.Conditions were already dire for civilians in the area: Years of war and a powerful February 2023 earthquake had led to crushing poverty, displacement and breakdowns in services. But over the last several days, the region’s misery deepened as Russian and Syrian fighter jets have repeatedly struck Idlib and Aleppo in northwestern Syria and rebels fought to capture more territory.The United Nations said more than 50 airstrikes had hit Idlib Province in northwestern Syria on Sunday and Monday. Four health facilities, four schools and two camps housing people displaced from earlier phases of the conflict suffered damage, it said.Stéphane Dujarric, a U.N. spokesman, said in a briefing Monday night that a strike on a water station had also cut off access for at least 40,000 people. And the Norwegian Refugee Council, which provides aid in the region, said its humanitarian workers were reporting that bakeries and shops had shut down in Aleppo, leading to food shortages.Damage at a camp for displaced people north of Idlib on Monday. The United Nations said two such camps suffered damage in recent days.Ghaith Alsayed/Associated PressWe are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More