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<ul class="summary-list"><li>Microplastics have been found in the human body in recent studies.</li><li>Scientists are trying to understand their potential negative effects on our health.</li></ul>An expert on how <a target="_blank" class="" href="https://www.businessinsider.com/guides/health/human-blood-microplastics">microplastics</a> affect our health shared how she reduces her exposure at home.Professor Fay Couceiro leads a team at Portsmouth University, UK, that researches the potential health impacts of these fragments of plastic measuring less than five millimeters long. She told Business Insider that the study of microplastics initially started in marine biology. Not only do microplastics harm marine ecosystems, they damage associated economies. An estimated $500 to $2,500 billion is lost annually because of how marine microplastics impact industries including fishing and recreation, according to a 2019 study by researchers at the Plymouth Marine Laboratory.Once scientists found microplastics in all parts of the marine ecosystem, they discovered them everywhere else they thought to look, too, Couceiro said.<div type="image" title="A glass beaker with water and microplastics, held by someone in a white coat and plastic gloves." height="1414" width="2121" msid="114325882" hostid="261" sizebytes="53160"></div>Research suggests that microplastics could contribute to the development or worsening of health issues such as asthma, Couceiro said. A study released earlier this year, meanwhile, suggested <a target="_blank" class="" href="https://www.businessinsider.com/microplastics-risks-heart-attack-stroke-study-2024-3">microplastics increase the risks of stroke</a> and heart attacks. That's concerning, considering that microplastics have been found in <a target="_blank" class="" href="https://www.businessinsider.com/microplastics-found-in-human-testicles-what-to-do-2024-5">human blood, brains, and testicles</a>.Although experts don't yet fully understand how <a target="_blank" href="https://www.businessinsider.com/you-are-consuming-microplastics-how-much-what-to-know-risks-2022-4">microplastics</a> affect our health, Couceiro said that "it would be sensible to try to limit the number we expose ourselves to while we determine what the problems are."Couceiro added that while legislation and wider systemic changes are needed to meaningfully reduce the number of microplastics we come into contact with, there are things we can do to <a target="_blank" class="" href="https://www.businessinsider.com/expert-how-i-keep-baby-family-safe-toxic-plastic-microplastics-2023-1">reduce exposure</a> at home.<h2 id="af91ad2d-fdb9-4cc9-a1d1-4c2028bb7c07">Don't microwave food in a plastic container</h2>Couceiro tries to remove food from plastic packaging before microwaving it whenever she can. But she doesn't stress if this isn't possible when she eats out.<div type="image" title="A steaming Thai green curry in a microwaveable plastic pot." height="1414" width="2121" msid="114325879" hostid="261" sizebytes="121222"></div>Heating plastic means it breaks down more easily and can release microplastics into food, a 2023 study published in Environmental Science &amp; Technology found.<h2 id="d8db174e-3632-4810-87d9-0365d40b9dd6">Don't buy plastic clothes and carpets</h2>Couceiro recommends people buy clothes and carpets that aren't made from plastic."You don't have to go and replace all your clothes and carpets — especially not at the moment when things are so tight," she said. "But if something is starting to wear out, and you're thinking about buying a new one, look at what non-plastic alternatives are out there that you can afford."She still has a few pieces of polyester clothing, which she plans to replace non-plastic items when the time comes.<h2 id="151047ca-b498-4803-8816-c2a5992dea67">Vacuum regularly</h2>"The more you vacuum, the less plastic will be in the air from your carpet," Couceiro said.If you don't have much carpet in your home, don't worry about this one too much, she said.<h2 id="418e7f7a-deb6-41af-9b4b-24a2c93e90f1">Avoid plastic cookware</h2><div type="image" title="Wooden and ceramic kitchen utensils and bowls with a metal grater." height="1412" width="2124" msid="114325880" hostid="261" sizebytes="103910"></div>"When you see things like plastic spatulas melting and bubbling, there's little pieces of plastic coming off them," she said.Where possible, Couceiro cooks with metal or wood cookware instead of plastic, and avoids buying plastic utensils.<h2 id="4cc175a5-ccca-4fe1-9305-a291d8397f47">Avoid really fluffy materials</h2>This can be tough with kids, so Couceiro just limits fluffy materials in her home rather than banning them.But she's wary of them because they are more likely to be made of plastic fibers that shed easily.<h2 id="d6503b62-a0ec-48e9-8d00-de373ad69f39">Ventilate your home</h2>Couceiro likes to have fresh air in the house, and recommends ventilating your living space by opening windows to reduce the number of microplastics in the air.But, she said, you have to make sure that you won't be undoing the benefits by allowing pollution into your home, which is more likely if you live near busy roads or in a city center.Alternatively, <a target="_blank" href="https://www.businessinsider.com/guides/home/best-air-purifier">air purifiers</a> can help improve air quality if left running for long periods, she said.

An expert in how microplastics affect our health does 6 things to avoid them at home

People with pre-existing allergic conditions are more vulnerable to experience long-term symptoms associated with Covid-19, or <keyword id="9814327" type="General" weightage="20" keywordseo="long-covid" source="Orion">long Covid</keyword>, according to a study. Although the data as a whole from the studies suggested that individuals with <keyword id="6465125" type="General" weightage="20" keywordseo="asthma" source="Orion">asthma</keyword> or rhinitis might be at increased risk of long Covid after <keyword id="8858345" type="General" weightage="20" keywordseo="sars-cov-2" source="Orion">SARS-CoV-2</keyword> infection, the evidence for these associations was very uncertain. Therefore, more robust epidemiological research is needed to clarify the role of allergy in the development of long Covid, said researchers. The new findings, published in Clinical &amp; Experimental Allergy, were based an analysis of 13 studies, published between January 1, 2020 and January 19, 2023. The analysis included a total of 9,967 participants of all ages with confirmed SARS-CoV-2 infection who were followed for at least 12 months. Four of the 13 studies provided estimates on the association between pre-existing allergic conditions such as asthma or hay fever and long Covid. Pre-existing asthma was associated with an increased risk of long Covid, but the evidence was very uncertain, the authors said. The odds ratio (OR) for preexisting asthma and long Covid was 1.94. In an analysis of three studies that included data on preexisting allergic rhinitis, the condition was significantly associated with an increased risk of long Covid. Only 3 of the 13 studies measured long Covid with physical examinations and comprehensive questionnaires, the authors cautioned. Moreover, among the 13 studies, the researchers found a high risk of bias due to patient selection (mostly hospitalised patients) and loss to follow-up. "We need a better, harmonised definition of what is considered long Covid for epidemiological studies of this sort. Regardless we will be updating our analysis once further studies have been published in the next few months," said corresponding author Christian Apfelbacher, from the Institute of Social Medicine and Health Systems Research, in Germany. <div type="image" title="Allergies and long Covid" agency="IANS" height="900" width="1200" msid="105090105" hostid="261" sizebytes="15652"></div>

Allergies may increase risk of developing long Covid: Study

<ul class="summary-list"><li>Cuddling a pet can give you a sense of comfort and security. </li><li>Sleeping with pets can have its benefits, but it also has drawbacks. </li></ul>If you've been scrolling through social media lately, you've probably seen videos of people letting pets sleep in their beds. I admit it: my dogs sleep with me, too.In one video, creator <a target="_blank" href="https://www.instagram.com/aguyandagoldenn/reel/C9kJt1ZuhUX/?igsh=MTUxaDhveGpmYXdweA==">Johnathan Lower</a> demonstrates how he has to twist his body into uncomfortable positions so as not to disturb his Golden Retriever, who is <a target="_blank" href="https://www.businessinsider.com/guides/pets/how-long-do-dogs-sleep">soundly asleep</a> next to him. The video shows his dog hogging the blanket, breathing in his ear, and blocking his partner from touching him.The most relatable moment for me is Lower waking up alone and wondering where his dog went. Sharing your bed with a pet is kind of like being an amateur contortionist, but it can also be a <a target="_blank" href="https://journals.sagepub.com/doi/10.1177/00380385221081365">good bonding experience</a>.Given the importance of sleep for overall health and well-being, you might be wondering if having pets in the bedroom is a good idea. We asked a sleep expert and a veterinarian about the benefits and drawbacks of co-sleeping with pets and how to decide if you need a "sleep divorce" from your beloved companion.<h2 id="0e54b8b3-b372-4c8c-b581-f2abc45b8a68">Co-sleeping with a pet has advantages</h2>Cuddling with a pet can provide a sense of comfort and security. So, it's only natural that you'd want to extend these intimate moments by allowing your pet to sleep in your bed.Research shows that co-sleeping with pets can have a positive or neutral effect on <a target="_blank" href="https://pubmed.ncbi.nlm.nih.gov/33406702/">sleep quality</a>. And because pets thrive on having a routine, they might even encourage you to develop a consistent sleep schedule."Co-sleeping with a pet can help with anxiety and stress levels, which could <a target="_blank" href="https://www.businessinsider.com/tips-for-getting-better-sleep-2023-8">help you sleep better</a>," <a target="_blank" href="https://sleepopolis.com/experts/shelby-harris/">Shelby Harris</a>, director of sleep health at Sleepopolis, told Business Insider. If you live alone or struggle with nightmares, having a pet nearby can be a source of emotional support and companionship.Since animals tend to give off heat while sleeping and their body temperature is higher than ours, dogs, in particular, can make your <a target="_blank" href="https://www.businessinsider.com/make-your-bed-more-comfortable-and-luxurious-interior-designers-2024-3">bed feel warm and cozy</a>, Amy Attas, a veterinarian and founder of New York-based practice <a target="_blank" href="https://www.citypetsvets.com/">City Pets,</a> told BI. In addition, people with cats may find it soothing to listen to the sound of purring.<h2 id="3fc7ef47-b38e-46bf-bfab-605d3716346e">Pets can also interrupt your sleep</h2>While co-sleeping may enhance the human-pet bond, pets can disturb your sleep by moving around, snoring, or vocalizing in their sleep, Harris said. A recent study found that co-sleeping with pets can contribute to poorer sleep quality and more <a target="_blank" href="https://pubmed.ncbi.nlm.nih.gov/38448628/">severe insomnia</a>.Given their exceptional hearing, pets may be awakened by sounds that people can't hear, causing sleep disruptions. "Pets who are startled in their sleep may have an aggressive response toward the individual in the bed," Attas said.Pets can get sick in the middle of the night and vomit or have diarrhea in bed. "Indoor cats can track soiled kitty litter onto sheets and pillowcases in close contact with a person's face," Attas said. Older pets or those with kidney disease may be prone to urinary incontinence.If your pet goes outdoors, they can <a target="_blank" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9606909/">introduce dirt and bacteria</a> into your bedroom, affecting the cleanliness of your bed and your health, Harris said. <a target="_blank" class="" href="https://www.businessinsider.com/flying-with-pet-allergies-2017-9">Breathing in pet dander</a> can worsen allergy and asthma symptoms.<h2 id="7ec0dd8b-2d3a-496e-b065-6cfb6f960846">The type of pet matters, and where they sleep</h2>Once you've fallen asleep, staying asleep can be challenging with larger pets or multiple pets taking up space. On the other hand, a large breed dog might have a calmer temperament than a smaller or younger dog who gets the zoomies or a cat who enjoys playing at night.As nocturnal animals, <a target="_blank" class="" href="https://www.businessinsider.com/things-every-cat-owner-should-do-for-their-pet-according-to-vets">cats tend to be more active at night</a> and in the early morning, which can cause more frequent sleep disturbances, Harris said. In contrast, dogs tend to be more adaptable, eventually mirroring their owner's sleep schedule.During the night, <a target="_blank" class="" href="https://www.businessinsider.com/guides/pets/cat-zoomies">cats may change locations</a>, even sleeping on top of their owners' heads or pillows. Likewise, "dogs tend to reposition themselves more as they relax, which can be disruptive," Attas said.Some pets, <a target="_blank" class="" href="https://www.businessinsider.com/dad-built-an-elevator-for-his-old-dog-tiktok-video-2023-6">because of age or mobility issues</a>, may require help with getting on or off the bed overnight. They may also need to stretch or change positions to relieve pressure on their joints.<h2 id="e152d9a6-af68-4831-9193-c6cce0bcac2b">How to improve sleep when co-sleeping with a pet</h2>Having a consistent bedtime and wake-up time can be helpful and keep your pet from getting too excited at night. "Make sure your pet is well-exercised and has gone to the bathroom to minimize any night-time activity," Harris said.If you're sharing a bed with your pet, "ensure your bed is large enough to fit you and your pets comfortably," Attas said. You may wish to purchase a waterproof pad to protect your mattress from urine or vomit.Both experts recommended r<a target="_blank" class="" href="https://www.businessinsider.com/funny-animal-photos-groomed-pets-2019-7">egular grooming</a> and cleaning to keep your bedroom hygienic and reduce exposure to allergens and parasites. For extra protection against pet dander, consider buying an air purifier with a HEPA filter.Attas said that in addition to training your pet to discontinue disruptive behaviors, you can also use an eye mask and a <a target="_blank" class="" href="https://www.businessinsider.com/guides/health/white-noise-for-sleep">white noise machine</a> to reduce noise from pets. She also suggested putting your pet's favorite bed on top of your bed to encourage them to stay in one place.If all else fails, a good compromise would be letting your pet sleep in the same room but not in your bed. This setup can help you enjoy your pet's companionship while allowing you to have a restful sleep environment, Harris said.<h2 id="6b4a9018-9cd1-4b1e-a24e-37d7bd2e5e25">What to do if it's time for a sleep divorce</h2>Helping your pet transition out of your bed and into his or her own space requires patience and consistency. If your pet is accustomed to sleeping on a spacious and <a target="_blank" href="https://www.businessinsider.com/guides/home/best-mattress">comfortable mattress</a>, be sure to invest in a <a target="_blank" href="https://www.businessinsider.com/guides/pets/best-dog-bed">high-quality pet bed</a> and introduce it to your pet on your bed, initially, Attas said.Place the bed close to where your pet had been sleeping, along with your pet's favorite toys and blankets. Then, sit with your pet on or near the new bed and lie down close to it.Pair commands like sit or down with "positive reinforcement such as a delicious treat to encourage your pet to spend time on the new bed," Attas said. "Provide additional reinforcement if the pet goes to the new bed on their own."If they jump on your bed, you can gently nudge them off or redirect them to their new bed using a treat. You can also <a target="_blank" href="https://www.businessinsider.com/how-veterinarians-care-for-their-own-pets-advice-2022-6">consult with your veterinarian</a> about ways to ease your dog's anxiety during the transition.Nandini Maharaj is a freelance writer covering health, wellness, identity, and relationships. She holds a master's degree in counseling and a doctorate in public health.

Co-sleeping with your pet can be good for your bond but not for you. Here's when you might need a sleep divorce. 

<keyword id="22976106" type="General" weightage="20" keywordseo="indoor" source="keywords">Indoor</keyword> <keyword id="19900550" type="General" weightage="100" keywordseo="air-pollution" source="keywords">air pollution</keyword> is a bigger <keyword id="21117961" type="General" weightage="20" keywordseo="health-risk" source="keywords">health risk</keyword> than <keyword id="20543591" type="General" weightage="20" keywordseo="outdoor" source="keywords">outdoor</keyword> air pollution in India, and sometimes cities are cleaner than nearby villages where <keyword id="22976772" type="General" weightage="20" keywordseo="household-pollution" source="keywords">household pollution</keyword> is higher, according to the country's two top policy experts. Addressing the India <keyword id="20445293" type="General" weightage="20" keywordseo="clean-air" source="keywords">Clean Air</keyword> Summit (ICAS) 2024, Principal Advisor, <keyword id="19904190" type="General" weightage="20" keywordseo="Ministry-of-Health-and-Family-Welfare" source="keywords" meta.keywordsubtype="org" meta.entityname="Ministry of Health and Family Welfare" meta.hostid="83" meta.entityid="Ministry of Health and Family Welfare">Ministry of Health and Family Welfare</keyword>, Soumya Swaminathan said, "Studies done in Delhi have shown that women's average exposure to high levels of <keyword id="20827287" type="General" weightage="20" keywordseo="black-carbon" source="keywords">black carbon</keyword> (women <keyword id="19895006" type="General" weightage="20" keywordseo="WHO" source="keywords">who</keyword> are mostly at home) is as much as auto-rickshaw passengers going around outdoor exposed to the ambient air pollution in Delhi, resulting in high systolic blood pressure." "Cities contribute less than 20 per cent to the overall state emissions, wherever they have been assessed, but household emissions predominate, ranging between 20 per cent and 40 per cent. Across the country, we are seeing is that sometimes cities are cleaner than the surrounding villages where household air pollution predominates," she said at the summit organised by think-tank Center for Study of Science, Technology and Policy. This builds a strong case for expanding the scope of India's National Clean Air Programme (<keyword id="20133150" type="General" weightage="20" keywordseo="NCAP" source="keywords">NCAP</keyword>), which currently focuses on non-attainment cities. Air pollution is a major threat to public health and contributes to a significant amount of morbidity as well as mortality. Apart from PM2.5 and PM10, short-lived climate pollutants such as black carbon, methane, ozone, and hydrocarbons have the potential to harm the environment and warm the atmosphere even more than CO2. Black carbon can cause chronic respiratory illnesses, lung cancer, emphysema, pneumonia, asthma, heart disease, and low birthweight. "In terms of reducing our life expectancy, globally, PM2.5 is contributing to about 2.3 years of life lost. Just below that is tobacco. In fact, there's so much attention on tobacco and global frameworks for control, but not the same level of attention has been paid to PM2.5 and certainly not the same level of commitments," Swaminathan said. The impact of air pollution is not limited to public health but has a significant economic cost as well. Recently, the World Bank published a study highlighting that air pollution has resulted in a loss of around USD 8.1 trillion in 2019, which is 6.1 per cent of the global gross domestic product (GDP). "We are always talking about air pollution as a problem but studies also show a strong economic case for action on clean air. There are significant positive consequences to investing in cleaning up the air in terms of the return on investments. We know air pollution is not just bad for our health, but it's also bad for agriculture, because it reduces the sunlight that's reaching the crops and it's bad for our economy or any country's economy as it deters people from coming and living or visiting those places," Swaminathan added. Kalpana Balakrishnan, Director, WHO Collaborating Center for Occupational and Environmental Health, said that the main barrier to shifting to clean cooking fuels that can help reduce household air pollution levels is finance. "If we give free LPG to women for two years, they are unlikely to shift back to biomass cooking even if you remove the subsidies," she said. Through Pradhan Mantri Ujjwala Yojana (PMUY) launched in May 2016, more than 100 million households in India received LPG cylinders by the end of March 2023. Studies shows over 50 per cent of the households that received new LPG cylinders under PMUY did not choose to refill it even once. Around a third of the world's population - 2.4 billion people globally (including 500 million people in India) - still lack access to clean cooking solutions. Although the Ministry of Petroleum and Natural Gas (MOPNG) claims that the country's household LPG "coverage" stands at 99.8 per cent, the National Family Health Survey conducted in 2019-21 (NFHS-5) shows that 41 per cent of the population still cooks on biomass.

Indoor air pollution poses greater health risk than outdoor: Experts

Even as climate models have indicated an increasing heatwave this summer for <keyword id="3658" type="General" weightage="80" keywordseo="india" source="Orion">India</keyword>, people suffering from asthma, a respiratory disease, may be at significant risk, said experts here on World Asthma Day. World Asthma Day is an annual event observed on the first Tuesday of May, aimed at raising awareness about asthma, a chronic respiratory disease affecting millions worldwide. According to the <keyword id="43588" type="General" weightage="80" keywordseo="world-health-organization" source="Orion">World Health Organization</keyword>, approximately 339 million people suffer from asthma globally, and the number is expected to rise to 400 million by 2025. "Heatwaves can be a challenging time for individuals with asthma, as extreme heat can worsen symptoms and trigger an asthma attack," Dr Nikhil Modi, Senior Consultant, Respiratory and Critical Care Medicine, Indraprastha Apollo Hospitals, told IANS. "The high temperatures and increased humidity can cause airways to become inflamed and constricted, making it difficult to breathe. This can lead to shortness of breath, wheezing, coughing, and chest tightness," he added. Moreover, hot weather also increases the levels of air pollutants, such as ozone, which can further aggravate asthma symptoms. The global climate crisis is fuelling heat waves to become more frequent, intense and lethal in India. In 2022, India experienced its hottest April in 122 years and its hottest March on record. And it experienced extreme weather on 242 out of 273 days between January and October 2022, revealed a recent study by Cambridge University. The study also showed that about 90 per cent of India is in the "extremely cautious" or "danger" zone from heat wave impact and almost all of Delhi is particularly vulnerable to severe heat wave impacts. Meanwhile, the India Meteorological Department (IMD), last week, predicted above-average temperatures and heat waves until the end of May in the country. It said for states like Bihar, Jharkhand, Odisha, Gangetic West Bengal, East Uttar Pradesh, coastal <keyword id="37102" type="General" weightage="80" keywordseo="andhra-pradesh" source="Orion">Andhra Pradesh</keyword>, Chhattisgarh, Madhya Pradesh, Telangana, and coastal Gujarat, heatwave days "will be more than usual". To combat the effects of heatwaves on asthma, it is essential to take precautionary measures to minimise exposure to triggers. Health experts suggested people with asthma to stay indoors during the hottest parts of the day, typically from 11 a.m. to 3 p.m., and avoid strenuous outdoor activities. "To stay protected, people with asthma should avoid exposure to extreme heat and humidity, stay hydrated, and keep your rescue inhaler with you at all times. Additionally, be sure to stay on top of your asthma management plan and regularly check in with your healthcare provider," <keyword id="16927023" type="General" weightage="80" keywordseo="ambarish-joshi" source="Orion">Ambarish Joshi</keyword>, Senior Consultant, <keyword id="4368953" type="General" weightage="80" keywordseo="pulmonary" source="Orion">Pulmonary</keyword> and Sleep Medicine, Primus Super Speciality Hospital, told IANS. When outside, individuals with asthma should wear a mask or scarf over their mouth and nose to reduce exposure to pollutants and warm, moist air. Avoid caffeinated and alcoholic beverages, the expert suggested. SEE ALSO: <a target="_blank" class="c-link c-message_attachment__title_link" href="https://www.businessinsider.in/careers/news/26-million-jobs-to-be-wiped-out-globally-by-2027-clerical-and-administrative-roles-on-more-risk/articleshow/99930222.cms">26 million jobs to be wiped out globally by 2027 – Clerical and administrative roles to see the biggest decline, says WEF’s Future of Work Report</a> <a target="_blank" class="c-link c-message_attachment__title_link" href="https://www.businessinsider.in/finance/banks/news/after-us-bank-failures-agencies-directed-to-analyse-deposit-insurance-mechanism/articleshow/99928860.cms">After US bank failures, agencies directed to analyse deposit insurance mechanism</a>

Severe heatwave may trigger and worsen asthma, say experts

<ul class="summary-list"><li>I was shocked when my daughter's monthly asthma prescription costs doubled.</li><li>I learned that Americans spent $35.5 billion (and rising) on asthma conditions alone.</li></ul>I stood in shock at the pharmacy counter. "Your copayment is $75," the pharmacist said. The pulmonologist changed my daughter's asthma-inhaler prescription from Flovent to Advair that morning, but I was not expecting this. I swallowed and handed over my credit card, mentally preparing for the fact that our monthly prescription costs had suddenly doubled. It turns out I wasn't alone in experiencing this sort of sticker shock; the latest studies show that <a href="https://www.atsjournals.org/doi/full/10.1164/rccm.202202-0294OC" target="_blank" rel="noopener">Americans spent $35.5 billion on asthma conditions</a> in 2016 alone (with prices increasing every day), the <a href="https://www.atsjournals.org/doi/10.1513/AnnalsATS.201703-259OC" target="_blank" rel="noopener">bulk of which is spent</a> on prescription medications. The $150 monthly copayments for my children's asthma medications place our family <a href="https://www.cdc.gov/asthma/most_recent_national_asthma_data.htm" target="_blank" rel="noopener">among the 25 million Americans</a> paying a premium just to breathe. Although most asthma conditions can be controlled with proper treatment and medication, the Centers for Disease Control reported that "above-average copays" <a href="https://www.cdc.gov/sixeighteen/asthma/index.htm#:~:text=References-,Fast%20Facts,and%201%20in%2013%20adults).&amp;text=Each%20year%2C%20asthma%20accounts%20for,each%20year%20in%20healthcare%20costs." target="_blank" rel="noopener">deter patients from filling their prescriptions</a>. Uncontrolled asthma leads to more hospital visits, more missed school and workdays — and it <a href="https://www.cdc.gov/sixeighteen/asthma/index.htm#:~:text=References-,Fast%20Facts,and%201%20in%2013%20adults).&amp;text=Each%20year%2C%20asthma%20accounts%20for,each%20year%20in%20healthcare%20costs." target="_blank" rel="noopener">kills</a> an average of 10 Americans a day, the CDC says. Asthma disproportionately affects racial and ethnic minorities and lower-income people. The high cost of medications to treat and control this disease <a href="https://aafa.org/wp-content/uploads/2022/08/asthma-disparities-in-america-burden-on-racial-ethnic-minorities.pdf" target="_blank" rel="noopener">widens these disparities even further</a>. <h2>New medications and the high cost of generic drugs have dire consequences</h2>Many experts attribute the high cost of asthma medication and the increase in <a href="https://www.insider.com/guides/health/conditions-symptoms/types-of-asthma">asthma diagnoses</a> and complications to <a href="https://www.hsph.harvard.edu/c-change/subtopics/climate-change-and-asthma/" target="_blank" rel="noopener">climate change</a>. The <a href="https://pubmed.ncbi.nlm.nih.gov/25962128/" target="_blank" rel="noopener">US Clean Air Act of 2005</a> banned the use of chlorofluorocarbons, which contribute to depleting the ozone layer. This <a href="https://www.fda.gov/drugs/frequently-asked-questions-popular-topics/transition-cfc-propelled-albuterol-inhalers-hfa-propelled-albuterol-inhalers-questions-and-answers" target="_blank" rel="noopener">required</a> the replacement of<a href="https://www.fda.gov/drugs/frequently-asked-questions-popular-topics/transition-cfc-propelled-albuterol-inhalers-hfa-propelled-albuterol-inhalers-questions-and-answers" target="_blank" rel="noopener"> CFC asthma inhalers</a> with a new type of inhaler — and the opportunity for pharmaceutical companies to <a href="https://www.healthaffairs.org/doi/10.1377/hlthaff.2021.01874" target="_blank" rel="noopener">renew their patents</a> by inventing new medicine-delivery mechanisms. Renewed patents are detrimental to asthma patients because they cause a delay in the availability of these drugs at a lower price on the generic market. Even when the patents expire and the generic versions of these medicines become available, the <a href="https://www.businessinsider.com/generic-drug-quality-called-into-question-by-us-military-bloomberg-2023-6">generic versions</a> themselves are often costly. Fluticasone propionate HFA, the generic for the daily-controller medication Flovent HFA, <a href="https://www.goodrx.com/flovent?utm_campaign=14054846107&amp;utm_content=124097909406&amp;utm_source=google&amp;utm_medium=cpc&amp;utm_term=kwd-607386969&amp;gclid=CjwKCAjwrJ-hBhB7EiwAuyBVXeOLt-qLrvbD87VWDRGRmB19eDhFjTX2D2TGIfGfnbcqo7l8H1txvRoCwAsQAvD_BwE&amp;gclsrc=aw.ds&amp;sort_type=price" target="_blank" rel="noopener">retails between $88 to $277</a>. For those underinsured or without insurance, these monthly prescriptions can add up quickly. Between pharmacy deductibles and copayments, Le-Ann Clark Griese, an information-technology project manager in New Jersey, pays about $340 a year for her husband's asthma inhalers. Monica Iskander, a calligrapher in California, requested a specific type of inhaler and spacer (a plastic holding chamber that gives space for the medicine to break down into smaller drops before inhalation) to help her son <a href="https://www.insider.com/polypharmacy-what-to-know-about-taking-multiple-medications-at-once-2022-11">use his medication</a> more effectively. Her insurance denied the request, and her family could not afford the monthly $300 retail cost. "I was pretty upset and frustrated that a 4-year-old was being denied coverage," she said. Thankfully for Iskander, their doctor was able to find a more effective medication that was covered by her insurance and so <a href="https://www.businessinsider.com/us-gov-could-save-taxpayers-billions-mark-cuban-pharmacy-study-2022-6">more affordable</a>.<h2>Learning to be savvy can help you save</h2>Eva, a nurse practitioner from Arizona, said that she has had to be "savvy" about her asthma-medicine costs. While uninsured, she paid $36 for a yearly prescription plan at <a href="https://www.krogersc.com/" target="_blank" rel="noopener">Kroger's</a> that covered her daily medications, and she used the manufacturer's patient-assistance program for her $400-a-month Dulera inhaler prescription."It's a very convoluted web behind the pharmacy counter," Mary Andrawis, a pharmacist and the founder of the Washington, DC-based Serafina Health Strategy, told Insider. Pharmacy-benefit managers, insurance companies, and pharmaceutical companies are all involved in pricing medications, contributing to a system void of transparency. National legislation like the bipartisan <a href="https://www.congress.gov/bill/118th-congress/senate-bill/113" target="_blank" rel="noopener">Prescription Pricing for the People Act</a>, the <a href="https://www.congress.gov/bill/118th-congress/senate-bill/127" target="_blank" rel="noopener">Pharmacy Benefit Manager Transparency Act</a>, and the <a href="https://www.congress.gov/bill/118th-congress/senate-bill/150" target="_blank" rel="noopener">Affordable Prescriptions for Patients Act</a> all seek to address this.The <a href="https://www.hhs.gov/about/news/2023/03/15/inflation-reduction-act-tamps-down-prescription-drug-price-increases-above-inflation.html" target="_blank" rel="noopener">Inflation Reduction Act</a> passed in August last year requires pharmaceutical companies to offer rebates to patients if they raise drug prices on their prescriptions faster than the inflation rate. It also mandates that by 2026, Medicare will <a href="https://www.cms.gov/files/document/fact-sheet-medicare-drug-price-negotiation-program-initial-guidance.pdf" target="_blank" rel="noopener">negotiate directly with pharmaceutical companies</a> over the most expensive medications. As the country's largest insurer, Medicare "sets the tone and the cadence for others to follow," Andrawis said.<h2>Copay-assistance programs are helpful but not without complications</h2>Lindsay Meyer, the director of US corporate communications for GlaxoSmithKline, <a href="https://www.marketwatch.com/press-release/asthma-drugs-market-top-manufacturers-by-2030-2023-04-25" target="_blank" rel="noopener">one of the world's largest manufacturers of asthma medication</a>, said in an email that "difficulties with manufacturing what are called 'complex drug-device combinations' such as inhalers" might be one of the factors behind the high costs of asthma medications. She also said that GSK is committed to "responsibly pricing our products" and pointed to its participation in patient- and copay-assistance programs to mitigate the out-of-pocket costs for eligible participants.Christine Malati, a pharmacist who has worked in government, community, and nonprofit capacities, facilitated assistance programs for many eligible patients not covered by Medicaid when she volunteered at a nonprofit clinic in Northern Virginia. Malati said these programs are funded by the "pharmaceutical companies' corporate social-responsibility programs in exchange for tax benefits." Individuals ineligible for Medicaid can also apply for patient-assistance programs, copay-assistance programs, rebate programs, and other options — if they know how to. Griese's copay-assistance program, arranged by her health-insurance company, saved her an additional $3,200 every three weeks to pay for her daughter's Dupixent injections, which help control her severe asthma. Patients whose insurance companies don't facilitate these programs can apply directly to the drug manufacturer for help.The Asthma and Allergy Foundation of America <a href="https://allergyasthmanetwork.org/what-is-asthma/what-if-i-cant-afford-my-asthma-medication/" target="_blank" rel="noopener">provides a list of asthma medications</a> and links to manufacturers' patient-assistance programs for ease of reference. <a href="https://www.rxassist.org/" target="_blank" rel="noopener">RXAssist</a> provides a database of these programs for patients and healthcare providers. Not all medicines are covered, though, even under these programs. My daughter's inhaler, the popular asthma drug Advair, was dropped off the GlaxoSmithKline copay-assistance program on June 1. Until the "convoluted web" of pharmaceutical pricing is untangled, Americans living with asthma need to navigate the system themselves to breathe more easily.

When my daughter's asthma medication doubled in cost, I learned we weren't the only ones paying a premium to breathe

<ul class="summary-list"><li>Kricket Bushnell legally changed her name from Ashley Krick when she wed. Kricket was her nickname.</li><li>She wanted the cute version of her family name to be included in her new name after marriage. </li></ul>This as-told-to essay is based on a conversation with Kricket Bushnell. It has been edited for length and clarity.I was born a month early on my mother, Nancy Krick's birthday in 1989. Her parents were in town to celebrate what was supposed to be her last birthday before she <a target="_blank" href="https://www.businessinsider.com/woman-shares-how-becoming-a-mom-changed-all-her-relationships-2023-5">became a mother</a>.My grandfather got to hold me when I was just a few hours old. It was partly because <a target="_blank" href="https://www.businessinsider.com/preemie-baby-weight-guilt-parents-miracle-pressure-2024-3">I was premature</a> that I was <a target="_blank" href="https://www.businessinsider.com/guides/health/conditions-symptoms/is-asthma-genetic">born with asthma</a>. I had a real chirp in my lungs.It was down to my chirping and a play on my last name, Krick, that my grandfather said, "She's my little cricket."My parents named me Ashley because they liked it, and it was easy to spell. It wasn't until I went to elementary school that we realized that Ashley had been a popular name in 1989.Over the years, at least one other Ashley was always in my class. I was outgoing but didn't feel like I stood out when I wanted to.<h2 id="a5129d8d-3329-4f8f-8c43-7b1f2c6a439a">I wanted a new beginning</h2>When I <a target="_blank" href="https://www.businessinsider.com/guides/gifts/high-school-graduation-gifts-for-her">graduated from high school,</a> the valedictorian's name was Ashley Michelle. We even shared a middle name.Meanwhile, as I went through grade school, I <a target="_blank" href="https://www.businessinsider.com/daughter-goes-by-nickname-ella-shouldve-named-her-that-2024-5">earned the nickname</a> Kricket. I thought it was far cooler than Ashley and developed an attachment. My parents and teachers never used it, but I was delighted when my close friends did.Then, on my <a target="_blank" href="https://www.businessinsider.com/harvard-freshman-what-my-first-day-of-classes-was-like-2023-9">first day at college</a> in another state, the girls in charge of the dorm hall had put plaques with our names on everybody's door.But I wanted a new beginning where nobody knew me. I put a line through Ashley and wrote Kricket instead.<div type="image" title="Two middle-aged parents with their daughter" height="338" width="450" msid="110420269" hostid="261" sizebytes="11802"></div>After that, the name stuck. Nobody called me Ashley, apart from some of the professors. People sometimes asked why I had the name of an insect, or a <a target="_blank" href="https://www.businessinsider.com/top-10-cricket-scandals-2011-2">popular sport overseas</a>, but they understood when they realized my last name was Krick.<a target="_blank" href="https://www.businessinsider.com/one-third-fewer-people-are-training-to-become-teachers">During my student teacher training</a>, I referred to myself as Kricket, and it made me happy. In 2019, a few months before I turned 30 and was also getting married, Mom had an idea.She told my dad she would gift me by officially calling me Kricket. Dad wasn't so keen and said he couldn't do the same. But he changed his mind when she told him how emotional and thankful I'd been for her blessing.<h2 id="ae04b199-ba70-4c28-8512-6545013fb375">My parents' blessing meant they respected me as a woman</h2>I'm an only child, and was sad that I wouldn't carry the name forward. But I didn't want to be Kricket Krick. So, I applied to legally change my name Kricket Bushnell — Bushnell was my future husband's last name — a few weeks before our wedding. The court fee was only $40.I cried when I received the <a target="_blank" href="https://www.businessinsider.com/changed-kids-names-to-include-my-last-name-2024-4">name change certificate</a> in the mail. The tears were because my parents could have called me whatever they wanted and stuck to Ashley. But now it felt like they respected me as a woman, not just their daughter.Sadly, my father passed away in 2021. It gave me some comfort that, as Kricket, I was honoring him by taking part of his name.Do you have an interesting story about your name that you'd like to share with Business Insider? Please send details to <a target="_blank" href="mailto:jridley@insider.com">jridley@businessinsider.com</a>.

I changed my name to Kricket. I didn't feel like Ashley represented me, and it's a nod to my maiden name.

<ul class="summary-list"><li>Ann Ramirez Dudas was a self-described "go-getter" before she was diagnosed with heart failure.</li><li>She needed a new heart when she was 50 years old, as she struggled to breathe and keep food down.</li></ul>When Ann Ramirez Duda woke up in the middle of the night struggling to breathe, she thought she must be having a <a href="https://www.insider.com/guides/health/mental-health/anxiety-heart-rate">panic attack</a>.It was the summer of 2018, and Duda, then 48, was taking care of her ailing father at home. She told Insider she assumed her shortness of breath was caused by anxiety and exacerbated by the <a href="https://www.insider.com/california-camp-fire-smoke-blotting-out-sun-in-sf-sacramento-oakland-2018-11">wildfires that were raging in California</a> at the time. "It was the fires, the menopause; it's the kids, or too much work," she said. "Never in my million years did I ever think it was my heart."After postponing two doctor's appointments, Duda finally saw her primary care doctor in October 2018. She was diagnosed with congestive heart failure, which was causing her to feel breathless and exhausted. Medication and a new diet would help her manage the condition, but eventually, she would need a new heart.Duda said she has <a href="https://www.insider.com/yoga-teacher-had-three-heart-attacks-2023-2">learned to advocate for her health</a> throughout her lengthy medical journey. Now, she's sharing her story as a volunteer for the American Heart Association's Go Red For Women "Real Women" campaign.<h2>Backed-up fluid in the lungs was making her feel short of breath</h2>Congestive heart failure occurs when the heart muscle doesn't pump as well as it should, leading to a buildup of blood in the veins. Compared to other types of heart failure, CHF must be treated quickly to prevent fluid from collecting in the lungs.At the time of her diagnosis, Dudas was already having trouble breathing. She said she could not walk from her car to the gym where she taught children's gymnastics without stopping to catch her breath."It was at that point that the doctor even dropped the word transplant, but as a far away thing," Dudas said.For two years, Dudas managed her condition with medication, a low-sodium diet, and closely monitoring her fluid intake. Too much fluid could send her into respiratory distress or cause swelling, as her heart failure also affected her kidneys' ability to clear salt and water from the body, according to the <a href="https://www.heart.org/en/health-topics/heart-failure/what-is-heart-failure/types-of-heart-failure" target="_blank" rel="noopener">American Heart Association</a>.<h2>Her health took a 'nosedive' in 2020</h2>In March 2020, Dudas said her health took a scary turn."I started losing weight. <a href="https://www.insider.com/heart-failure-signs-symptoms-breathlessness-nausea-american-heart-association-2022-8">I couldn't hold any food down</a>," she said. "I would just wake up during the night and be throwing up — and it wasn't even like I was eating anything."Doctors told Dudas that she had developed mitral valve regurgitation, which was causing blood to flow backward in the heart. Her ejection fraction — a measure of how the heart contracts and relaxes — plummeted from bad to worse.She was hospitalized in April 2020, then again in September at her local hospital. She said she advocated to get herself admitted at UCLA instead of going back and forth.Dudas said she remembers telling her doctor, "With all due respect, I know you have your team to consult with, but I have mine. My team consists of my three daughters and my grandson, and we don't have time."She was admitted to UCLA Health on October 6, 2020, and she wouldn't leave the hospital until she had a new heart.<h2>In prep for her transplant, doctors found a brain tumor that needed to be removed</h2>During one evaluation for her heart transplant, Dudas said she asked her doctor to come to the other side of her bed. She was having trouble seeing out of her right eye, and the doctor was outside of her field of vision.A CAT scan revealed <a href="https://www.insider.com/man-headache-brain-cancer-glioma-symptoms-diagnosis-optician-2022-9">a tumor the size of a golf ball</a> was pressing on her optic nerve. Dudas was pulled from the transplant list as soon as she got on it, as her doctors opted to remove the tumor before her heart surgery."The discussion became, do we take out the brain tumor first and then do a heart transplant, or do we do a heart transplant first and then do a brain surgery?" she said. "They weren't sure if I would survive the brain surgery without the heart."Doctors inserted a balloon pump in her groin to help blood move throughout the body until she got a new heart. Then, they took her to surgery and removed the tumor through her nose."In hindsight, the brain tumor surgery was harder than the heart transplant," she said.<h2>She got a new heart two weeks later</h2>Dudas said she was cleared to get back on the transplant list 10 days post-surgery, on October 31. She had a successful heart transplant on November 7, 2020.The medical team had Dudas up and walking the day after surgery, and she said it was "glorious." "My daughter looked at me and started crying and said, 'Oh my god, Mommy's got color in her face.' They were so used to seeing me look gray and ashen," she said.Dudas, now 53, said she is still legally blind in her right eye after the brain surgery. As for her heart, she's determined to make it count."I still watch what I eat. I have to exercise even when I'm tired," she said. "I have to treat it right, because otherwise the gift was wasted. And I'm here just to prove that it wasn't wasted."

A woman dismissed her exhaustion as anxiety, asthma, and menopause. She actually needed a heart transplant and brain surgery.

<ul class="summary-list"><li>Big businesses such as hospital systems, insurers, and PE firms are gobbling up medical clinics.</li><li>Some doctors and industry experts fear corporate owners could prioritize profits ahead of patients.</li></ul>Independent doctors are almost a thing of the past.UnitedHealth Group struck a deal in March to buy the nine-state doctor group of the struggling hospital system Steward Health Care. The same month, the powerful healthcare conglomerate, which owns the nation's largest <a target="_blank" href="https://www.businessinsider.com/one-medical-patients-affected-unitedhealthcare-mount-sinai-dispute-2024-3">health insurer</a>, got the green light to take over a decades-old independent Oregon <a target="_blank" href="https://www.oregonlive.com/business/2024/03/oregon-health-officials-give-emergency-ok-to-corvallis-clinics-acquisition-by-insurance-giant-unitedhealth-group.html">medical practice</a>, adding another 100 healthcare providers to its roster. It picked up a 400-doctor <a target="_blank" href="https://www.fiercehealthcare.com/payers/unitedhealth-quietly-scoops-new-york-physician-group-crystal-run">group</a> in New York about a year before.These are just the purchases we know about; there could be many more. Physician practice deals often go unannounced and get little attention from regulators, but they add up. Near the end of 2023, <a target="_blank" href="https://www.businessinsider.com/optumhealth-ceo-plans-to-make-clinics-a-100-billion-business-2021-4">UnitedHealth's Optum</a>, the business unit housing its clinics and surgery centers, said it employed or was affiliated with 90,000 doctors. That's a whopping 10% of all doctors in the US.Though it's the hungriest, <a target="_blank" href="https://www.businessinsider.com/optumhealth-ceo-plans-to-make-clinics-a-100-billion-business-2021-4">UnitedHealth</a> is just one buyer in the market for physicians. Little by little, big businesses have taken over healthcare in the US. Hospitals have been scooping up medical practices for decades to create giant health systems. Insurance companies fought back with their own clinic purchases. Private equity firms increasingly staked claims to nursing homes and groups of specialists such as emergency physicians and dermatologists.And in the last few years, tech companies and retailers like Amazon, CVS Health, and Walgreens added thousands of doctors to their payrolls when they bought <a target="_blank" href="https://www.businessinsider.com/cvs-walgreens-amazon-primary-care-acquisition-strategy-2024-3">primary-care chains</a>.Nearly 78% of US doctors are employed by hospitals or other corporate entities, such as insurers and PE firms, according to <a target="_blank" href="https://www.physiciansadvocacyinstitute.org/PAI-Research/PAI-Avalere-Study-on-Physician-Employment-Practice-Ownership-Trends-2019-2023">research</a> from consultancy Avalere and the Physicians Advocacy Institute. For the first time, more medical practices were owned by corporate entities (30%) than hospitals (28%) as of January 2024, the research found.There's mounting evidence that this trend toward corporatization could harm patients. Research has found that prices go up when hospitals and private-equity firms buy medical groups. Sometimes, care gets <a target="_blank" href="https://www.nber.org/papers/w30928">worse</a>, but there's still much unknown about how corporate ownership affects medical care, especially when it's a giant like UnitedHealth or CVS doing the buying.Some doctors and experts in the industry fear corporate owners could prioritize their investors and profits ahead of patients, and doctors could lose the ability to make their own decisions about what's best for a patient."The big guys aren't cheaper. They don't deliver better customer service, they aren't more timely, none of that. They're just able to negotiate higher prices," said Farzad Mostashari, the CEO of Aledade, a company that aims to help primary care practices stay independent.The federal government is starting to pay attention. In March, it <a target="_blank" href="https://www.ftc.gov/news-events/news/press-releases/2024/03/federal-trade-commission-department-justice-department-health-human-services-launch-cross-government">launched</a> an inquiry into PE firms and other corporate owners' "increasing control over healthcare" and how this might threaten patients' access to affordable and quality care.The feds also zeroed in on UnitedHealth, <a target="_blank" href="https://www.wsj.com/health/healthcare/u-s-launches-antitrust-investigation-of-healthcare-giant-unitedhealth-ff5a00d2">reportedly</a> facing an antitrust investigation by the US Justice Department into how its medical group acquisitions affect consumers and competitors. News of the probe surfaced before a <a target="_blank" href="https://www.businessinsider.com/change-healthcare-cyberattack-small-mental-health-practices-payments-money-2024-3">cyberattack on UnitedHealth's</a> technology business, Change Healthcare, caused hospitals and clinics nationwide to forgo billions in payments — raising more questions about UnitedHealth's chokehold on the healthcare industry.<h2>Doctors are hot commodities</h2>It's tough to lump the many buyers of medical practices together, as they're pursuing different strategies. But, in essence, they're all hiring doctors for their relationships with patients, who bring opportunities for more profits. <a target="_blank" href="https://www.businessinsider.com/gen-z-millennials-giving-up-medical-care-cant-afford-costs-2024-2">US healthcare spending</a> reached $4.5 trillion in 2022, representing almost a fifth of the national GDP.Hospitals rely on doctors — especially those who provide primary care — to refer patients for lucrative procedures or surgeries. <a target="_blank" href="https://www.businessinsider.com/unitedhealth-stock-exec-medical-costs-rising-2023-6">Insurers like UnitedHealthcare</a> and CVS' Aetna are required by federal law to spend most of the money they collect in premiums on medical care. Still, they can pocket more of those premiums by sending patients to clinics they own.Pharmacies hope that buying medical practices will give more prescriptions to fill and get more customers to buy over-the-counter products at the front of the store."They all realize that patients will follow what their doctors tell them to do or where their doctors tell them to go," said Chas Roades, a longtime healthcare consultant. "So it allows them to both drive traffic to a downstream profit model that they're interested in growing, and I think it also is a way to get consumers to trust them."Meanwhile, independent doctors have a tough time going it alone. Reimbursement is shrinking, and small practices don't have the ability to <a target="_blank" href="https://www.ama-assn.org/system/files/2022-prp-practice-arrangement.pdf">negotiate higher rates</a> as big hospital systems do. Plus, running a modern medical practice is expensive, requiring investments in staffing, technology, and electronic health records. <a target="_blank" href="https://www.businessinsider.com/ai-chatbots-tech-doctors-medicine-healthcare-system-empathy-quality-email-2023-6">The pandemic</a> made things even more challenging, spurring many doctors to sell their private practices.<h2>The quiet takeover of physician practices</h2>Much of the takeover of physician practices has slid under the radar. That's because acquisitions valued below <a target="_blank" href="https://www.ftc.gov/enforcement/competition-matters/2024/02/new-hsr-thresholds-filing-fees-2024">$119.5 million</a> don't have to be reported to federal regulators, and many practice purchases don't meet that threshold. Publicly traded UnitedHealth, for instance, rarely announces its purchases of medical groups and surgery centers."We're really flying blind here with respect to understanding how many acquisitions by which entities and what geographies and what specialties," said Yashaswini Singh, an assistant professor at Brown University who studies healthcare consolidation.This lack of disclosure has made consolidating doctor practices difficult to study. Research into private equity's effects on healthcare is just emerging, and there's little to no academic, peer-reviewed research on how other corporate owners' acquisitions affect healthcare prices and quality, Singh said.Studies, including Singh's <a target="_blank" href="https://jamanetwork.com/journals/jama-health-forum/fullarticle/2795946">research</a>, have shown, however, that PE ownership leads to steeper prices and more utilization, meaning patients may have more frequent doctor's appointments. Together, that drives healthcare costs higher. Research also suggests that PE ownership of nursing homes and hospitals <a target="_blank" href="https://jamanetwork.com/journals/jama/article-abstract/2813379?guestAccessKey=e0cef9be-d55c-4bcf-8892-412af8f24355&amp;utm_source=For_The_Media&amp;utm_medium=referral&amp;utm_campaign=ftm_links&amp;utm_content=tfl&amp;utm_term=122623">worsens the quality</a> of care. One <a target="_blank" href="https://www.nber.org/system/files/working_papers/w28474/w28474.pdf">paper</a> found that patients who went to nursing homes owned by private equity firms had a 10% greater chance of dying.And yet, private equity companies are rapidly expanding their presence in healthcare. A 2023 <a target="_blank" href="https://www.antitrustinstitute.org/wp-content/uploads/2023/07/AAI-UCB-EG_Private-Equity-I-Physician-Practice-Report_FINAL.pdf">study</a> found that one private equity firm owned 30% of the market share for physician practices in over a quarter of metropolitan areas across the US. A single PE firm owned over half the market share in some areas.<h2>'An unsatisfying way of practicing medicine'</h2>Acquisitions by other corporate giants might not produce the same outcomes as PE firms, said Zirui Song, an associate professor of healthcare policy and medicine at Harvard Medical School who studies private equity in healthcare. PE firms are unique in holding on to their acquisitions for only a few years and saddling their acquired companies with debt and fees. Owners who hang on to their medical groups might be more motivated to improve services, he said.Anecdotally, though, many doctors don't like working for corporate overlords, Roades said. Older physicians who own equity in their medical practice get a nice payday when they sell, but the younger ones left behind are closely managed and measured in terms of cost and productivity, he added.It's "an unsatisfying way of practicing medicine. We're seeing a growing number of disgruntled early and mid-career physicians in these groups who find themselves suddenly working for large corporations, and this is not what they wanted to do with their lives," he said.After a few years working at Optum-owned Oregon Medical Group, Dr. Nick Jones opened a <a target="_blank" href="https://www.businessinsider.com/direct-primary-care-a-no-insurance-healthcare-model-2017-3">direct primary care practice</a>, a type of clinic that charges a monthly fee instead of billing insurance. He said there's a sense of powerlessness for primary-care doctors in the traditional healthcare system — whether they're employed by Optum, a large hospital system, a private-equity firm, or a nonprofit clinic.With thousands of patients to treat, they face a mountain of administrative paperwork and have no control over their schedules. These problems stem from the fact that primary-care doctors are <a target="_blank" href="https://kffhealthnews.org/news/article/compensation-pay-primary-care-shortage-solution/">underpaid</a> in the traditional "<a target="_blank" href="https://www.commonwealthfund.org/publications/newsletter-article/moving-health-care-system-away-fee-service">fee-for-service</a>" healthcare system, in which doctors are paid for every visit, he said.While he felt supported at his previous Optum-owned clinic because of his office manager, "the financial underpinnings and the economics of medicine" made it unsustainable and stressful, Jones said. "There was a three or four month wait for patients to see me. There was still too much on our plate to do, and [during the pandemic] there weren't enough medical assistants or case managers or nutritionists or other support to make 20 patients a day feel like the right thing to do."<h2>Doctors worry corporate giants put profits over patients</h2>The insurers and retailers say care is better and cheaper when integrated under one roof, connected to the health plan, pharmacy, or other provider organizations.For its part, Optum says it wants to improve the health and well-being of people and lower the cost of care with integrated care teams and better technology. It says it's helping clinics transition to providing <a target="_blank" href="https://www.businessinsider.com/optumhealth-ceo-plans-to-make-clinics-a-100-billion-business-2021-4">"value-based"</a> or "accountable" care, which means that its doctors get paid fixed fees upfront that, in theory, encourages them to keep patients healthy and order fewer unnecessary tests.Optum said in a statement it continues "to focus on supporting physicians, advance practice clinicians, and nurses in closing gaps in care and helping the health system perform better for everyone."A spokesperson pointed to a <a target="_blank" href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2799376">study</a> by Optum published in JAMA Network Open in December 2022 that found seniors in value-based care arrangements were less likely than seniors in traditional payment models to visit the emergency room, or be admitted at the hospital for COPD, asthma, stroke, or heart attack.But there are potential dangers. Patients may end up with fewer choices as bigger companies edge out competitors.California health system Emanate Health sued Optum in 2023 for anticompetitive behavior. It alleged that Optum canceled its contracts with Emanate hospitals and steered patients away after Emanate refused to agree to certain terms. Among the terms: Emanate primary-care doctors would serve only Optum patients, and Optum would get first dibs if Emanate decided to sell its primary-care practices.Care might also feel less personal. Some <a target="_blank" href="https://www.businessinsider.com/one-medical-patients-affected-unitedhealthcare-mount-sinai-dispute-2024-3">One Medical patients</a> complained that since the chain folded into Amazon, their appointments were shortened, and certain features for seniors, like having health coaches available during patient visits, went away, according to a report from <a target="_blank" href="https://www.washingtonpost.com/technology/2024/02/28/amazon-health-one-medical/">The Washington Post</a>.<h2>Patients could end up spending less time with doctors and face higher costs</h2>Dr. Mitch Li, an emergency physician who started Take Medicine Back, a group that opposes corporate owners pushing into healthcare, said patients will spend less time with their doctors and potentially face higher costs from predatory billing practices."The corporate practice of medicine is the reason why <a target="_blank" href="https://www.businessinsider.com/gen-z-millennials-giving-up-medical-care-cant-afford-costs-2024-2">healthcare costs</a> are out of control," Li said.Above all, some doctors fear having to make decisions that benefit the owner's bottom line, even though they may not be the best option for a patient.Dr. Michelle Cooke, a primary-care physician, previously practiced at an Atlanta clinic owned by a hospital system. Though the system was not-for-profit, it didn't operate like that, and over time, the job became unbearable, she said.She had more than 3,000 patients assigned to her care — <a target="_blank" href="https://www.jabfm.org/content/jabfp/29/4/496.full.pdf">far more</a> than typical — and appointments were too short, especially for the chronically ill, she said. The hospital system would prioritize lucrative physicals for <a target="_blank" href="https://www.businessinsider.com/cigna-selling-medicare-advantage-business-insurers-higher-costs-slower-growth-2024-2">Medicare patients</a> rather than seeing patients with an urgent need."It really got to the point where I feel like I was working to feed the corporation," Cooke said. "It really wasn't incentivizing what the patients needed."Cooke has since opened a direct primary care practice, where she sees just a few hundred patients and can spend more time with them. She said she's found that she prescribes less medication now because she has time to educate patients on lifestyle habits and nutrition.<h2>The federal government and states are dialing up the scrutiny</h2>The Federal Trade Commission, the US Department of Justice, and the Department of Health and Human Services are <a target="_blank" href="https://www.wsj.com/articles/federal-agencies-probe-private-equity-profiteering-in-healthcare-2ba4c23a">stepping up scrutiny</a> of healthcare deals, particularly those backed by private-equity firms. The agencies also signaled that they want to look at smaller deals that typically wouldn't trigger an antitrust review.Several states have also increased their oversight of local healthcare consolidation. Some state lawmakers are also trying to strengthen <a target="_blank" href="https://www.nejm.org/doi/full/10.1056/NEJMp2306904#f1">laws prohibiting</a> corporations from practicing medicine. Most states have these bans on the books, but companies have found various ways around them.It's unclear if any of these efforts will meaningfully slow the corporatization of healthcare. And, to be sure, some physician practices may not have survived without an infusion of capital from a corporate buyer.A bill introduced by Oregon State Rep. Ben Bowman would have closed certain <a target="_blank" href="https://www.opb.org/article/2024/02/22/oregon-lawmakers-could-limit-corporate-ownership-of-medical-practices/">loopholes</a> and put more distance between corporate entities and their medical practices. Bowman told Business Insider he wanted to prevent big businesses from eroding doctors' autonomy."A physician who went to medical school who took an oath — their highest ethical duty is to care for their patients. Whether it's a private equity firm or a large corporation, their highest ethical duty is to generate a return on investment for their shareholders. Those two incentives are fundamentally at odds," Bowman said.The bill, opposed by Amazon and CVS, died in March, but Bowman said he plans to reintroduce it in 2025.Around the same time the bill died, UnitedHealth's Optum and The Corvallis Clinic — the small Oregon medical practice that Optum struck a deal to buy — requested that their tie-up receive an emergency exemption from state review because of the Oregon clinic's deteriorating finances.The proposed acquisition, first announced in December, had received plenty of pushback from state residents. The request also came as hospitals and clinics nationwide faced cash shortfalls because of the cyberattack on UnitedHealth's Change Healthcare.A week later, Oregon's health authority approved the request.

Big corporations are quietly taking over your medical practice. Some doctors and experts say it's ruining healthcare.

<ul class="summary-list"><li>Nvidia is working with Hippocratic AI to provide patients with cheap AI nurses.</li><li>The AI nurses offer a wide range of services, including screenings and medication onboarding.</li></ul>This week, California tech giant <a target="_blank" href="https://www.businessinsider.com/what-is-nvidia-investment-strategy-venture-capital-startups-ai-chips-2024-3">Nvidia</a> announced a <a target="_blank" href="https://static1.squarespace.com/static/644f377bcdcff95fb90fd4a5/t/65f89c4397bc677dfc91227f/1710791747565/Press+Release_NVIDIA+Partnership.pdf">new collaboration</a> with <a target="_blank" href="https://www.businessinsider.com/hippocratic-generative-artificial-intelligence-raises-seed-funding-general-catalyst-a16z-2023-5">Hippocratic AI</a>: AI-generated nurses, for only $9 an hour.In a <a target="_blank" href="https://www.youtube.com/watch?v=yg0m8eR7k24">demo video</a>, a woman named Sarah meets Rachel, her "AI care manager" who checks in with her after her appendectomy.Rachel asks Sarah if she was able to get her prescribed medications, reassures her that the medications are safe to take considering her penicillin allergy, and to avoid carbs during recovery, as Sarah is diabetic.AI nurses are one of the latest AI innovations to <a target="_blank" href="https://www.businessinsider.com/ai-genetic-analysis-personalizing-medicine-in-the-clinic-2023-10">offer personalized and cheaper healthcare services</a>. According to <a target="_blank" href="https://gizmodo.com/nvidia-wants-replace-nurses-with-ai-1851347917">Gizmodo</a>, over 40 healthcare companies are already testing the technology.The move to using low-cost virtual nurses brings into question the safety of trusting a non-human medical professional, as well as what it means for US nurses, who've already been <a target="_blank" href="https://www.businessinsider.com/nurse-regrets-quitting-job-joined-great-resignation-doesnt-have-power-2022-8">quitting their jobs en masse</a> partly due to <a target="_blank" href="https://www.businessinsider.com/thedacare-asks-judge-block-workers-leaving-higher-pay-competitor-2022-1">being underpaid</a>.<h2>AI nurses will answer "low-risk" calls</h2><div type="image" title="A roster of AI nurses from Hippocratic AI" height="1000" width="2566" msid="108716247" hostid="261" sizebytes="93088"></div>Currently available for testing, <a target="_blank" href="https://www.hippocraticai.com/home">Hippocratic AI's website</a> features a roster of glowing, <a target="_blank" href="https://www.businessinsider.com/tiktok-skincare-trends-glass-skin-cloud-skin-donut-skin-2023-7">glass-skinned</a> nurses who cover a fairly wide swath of treatment areas, including:<ul><li>Pre-op services for procedures like cataract surgeries and hysterectomies</li><li>Discharge</li><li>Chronic care for conditions like diabetes, Alzheimer's, breast cancer, and asthma</li><li>Nutrition</li><li>Health risk assessment</li><li>Explanation of benefits</li><li>Ancillary program enrollment</li><li>Screenings for PAP smear, mammograms, and colonoscopies</li><li>Remote patient monitoring</li><li>Clinical trial recruiting</li><li>New medication onboarding</li><li>Insulin supply check-in</li><li>Dialysis continuity</li><li>Assisted living services, including a loneliness companion</li></ul>In some cases, you can even select nurses based on your bedside manner preferences, such as "engaging" or "direct," according to the website.<h2>Trusting AI with medical issues is dicey</h2>Nvidia isn't the first AI company scrambling to enter the healthcare space. Ventures range from tackling <a target="_blank" href="https://www.businessinsider.com/corti-health-tech-ai-patient-outcomes-60m-pitch-deck-2023-9">AI patient consultation</a> and <a target="_blank" href="https://www.businessinsider.com/thymia-ai-mental-health-startup-27-million-pitch-deck-2023-7">mental health services</a> to <a target="_blank" href="https://www.businessinsider.com/pitch-deck-alfie-health-seed-funding-treat-obesity-ai-ozempic-2023-6">obesity treatment</a> and protecting <a target="_blank" href="https://www.businessinsider.com/detecting-and-preventing-cognitive-decline-with-ai-2023-11">brain health</a>.While AI has had some success in <a target="_blank" href="https://www.businessinsider.com/chatgpt-diagnose-child-disease-tethered-cord-syndrome-doctors-2023-9">diagnosing diseases even human doctors missed</a>, other AI tools used for <a target="_blank" href="https://www.businessinsider.com/tech-site-issued-corrections-after-ai-writing-got-facts-wrong-2023-1">tech websites</a> and <a target="_blank" href="https://www.businessinsider.com/magazine-employees-ai-tools-almost-doubled-workload-clarkesworld-2023-7">sci-fi writing</a> led to confounding errors.It's too soon to say how effective glossy AI nurses will be compared to <a target="_blank" href="https://www.wsj.com/articles/ai-medical-diagnosis-nurses-f881b0fe">real-life ones</a> in potentially spotting more subtle symptoms or offering adequate compassion to a distressed patient.<h2>It doesn't fix bigger US healthcare problems</h2><a target="_blank" href="https://www.hippocraticai.com/about">Hippocratic AI offers</a> its cheap, readily accessible AI nurses as a solution to the <a target="_blank" href="https://www.businessinsider.com/icu-nurse-encourages-others-to-quit-after-pandemic-burnout-2022-1">growing healthcare worker shortage</a>.It still doesn't address the issues in the US healthcare system that make AI nurses appealing in the first place, including <a target="_blank" href="https://www.businessinsider.com/former-surgeon-general-medical-bill-shows-broken-healthcare-system-2024-2">astronomic bills</a> and <a target="_blank" href="https://www.businessinsider.com/how-wealthy-investors-got-rich-looting-needy-hospitals-healthcare-system-2024-3">the continual shuttering of hospitals</a>. As <a target="_blank" href="https://futurism.com/neoscope/nvidia-ai-nurses">Futurism pointed out</a>, the nursing shortage isn't caused by nurses demanding sky-high salaries, but "by hospital cost-cutting leading to abysmal working conditions, unfair contracts, and low wages."Time will tell how consistently accurate AI nurses can be.But even if they are, outsourcing medical care to polite, uninvested avatars may be more like placing a pixelated band-aid on top of a spreading infection.

Nvidia's new AI nurses treat patients for $9 an hour. Here's what they can do, from colonoscopy screenings to loneliness companionship

<ul class="summary-list"><li>Sex may trigger asthma attacks, experts told Insider.</li><li>People's sex lives can be harmed, as fear of an attack can lead to anxiety about intimacy.</li></ul>Sex is probably a trigger for asthma attacks, experts told Insider, but hardly any patients know it. This problem is likely widespread, experts who recently did a study on the topic told Insider, but so little research has been done that it's impossible to know for sure.That's because patients are often too embarrassed to bring up their sex lives in appointments and doctors don't necessarily think to ask, the experts said.That can have a knock-on effect on patients' sex lives as they can start feeling anxious about intimacy, one expert said. <h2>The elephant in the bedroom </h2>Ariel Leung and AM Aminian carried out the study — both are allergy physicians working at the Saint Agnes Medical Center in Fresno, California."I have seen many patients, throughout my 36 years of practice, who have experienced these symptoms but are either not aware of this association or too embarrassed to volunteer to talk about it," Aminian said. They were inspired to investigate what research has been done but found very little.After<a href="https://www.eurekalert.org/news-releases/969449"> scouring the academic literature, t</a><a href="https://www.healio.com/news/allergy-asthma/20221110/sexual-intercourse-may-trigger-asthma-exacerbations">hey only found only 7 studies talking about sex triggering asthma</a>, compared to about 1,806 published on asthma induced by exercise. Their findings, which have not been peer-reviewed, <a href="https://www.eurekalert.org/news-releases/969449">were presented at the annual meeting of the American College of Allergy, Asthma, and Immunology on November 10. </a><h2>Common triggers for asthma likely lurk in the sheets</h2>"The topic of sex gets buried and it really is a vital part of a person's overall health," said Barbara Kaplan, national director of asthma programs for the American Lung Association, in an interview with Insider."I love that this study is shining the light on the overall health and quality of life for people with asthma," she said.It's difficult to know for sure, but it is likely that sex exposes patients to triggers that doctors wouldn't necessarily think about, Kaplan said.Exercise is one. <a href="https://www.mayoclinic.org/diseases-conditions/exercise-induced-asthma/symptoms-causes/syc-20372300">Between 5% and 20% of the general population will have exercise-induced asthma at some point or another</a>, regardless of whether they have been diagnosed with asthma. "Many people don't realize that the energy expenditure of sexual activity is about equivalent to walking up two flights of stairs," Leung said in a press release. There are also many allergens in the bedroom that could trigger an asthma attack, like fragrances in candles and scented lotions <a href="https://www.insider.com/guides/health/conditions-symptoms/types-of-asthma">or dust mites in the bedsheets</a>, Kaplan said.<div type="image" title="Couple's feet in bed" height="3637" width="4849" msid="95588241" hostid="261" sizebytes="315952"></div><h2>Asthma may also be a turn-off</h2>Finding sex uncomfortable or awkward can have a serious effect on patients, Kaplan said.Feeling breathless can be stressful and exhausting, so it's not uncommon for patients to feel nervous facing situations where their asthma has been triggered, like sex, <a href="https://www.asthma.org.uk/advice/severe-asthma/making-life-easier-with-severe-asthma/sex-relationships-severe-asthma/">according to asthma+lung UK.</a>"Even if it's happened once when you're having sex and being intimate with your partner, you potentially can have that anxiety again going into another situation," she said. It can also cause problems with self-esteem, for instance if the asthma means you have to stop halfway.<div type="image" title="An asthma inhaler." height="4911" width="6549" msid="95588243" hostid="261" sizebytes="153172"></div><h2>Talking with a doctor will definitely help </h2>The good news is doctors can likely offer solutions if they know the patient's triggers.For instance, if the trigger is exercise, using an inhaler about 30 minutes before sex could help, Kaplan and Leung said."Some patients might think it takes away from the romance, but nothing is more romantic than taking care of yourself and not having your partner observe an asthma attack," <a href="https://www.upi.com/Health_News/2022/11/10/sex-trigger-asthma-attack/4911668097482/">Leung said to the news outlet United Press International</a>."If you stop, sit up, take your quick-relief inhaler, potentially you can continue the activity," Kaplan said. Another strategy may be to "consider the time of day when you're being intimate," Kaplan said. "So maybe it's early in the morning after you're well rested, not at the end of the work day when you're tired," she said. Putting pressure on the chest can trigger uncomfortable spasms in the lungs, so avoiding some sexual positions might also be best, Kaplan said.Spooning, cowboy, cowgirl, and standing doggy are good positions for people who have trouble breathing, for instance, <a href="https://www.insider.com/guides/health/sex-relationships/sex-positions-for-breathing-problems">Insider previously reported.</a>"Obviously making sure that your partner understands your worries and fears and knowing that sex makes you anxious is really important," Kaplan said. Above all, what you should do is to talk about these problems with a qualified expert, Kaplan said. "If you have symptoms every time you try to get intimate with your partner, then this could really be a sign that your asthma's not well managed," she said."I think is gonna be important on the healthcare provider's side to think about intimate intimacy and sex as a potential trigger. And I think that's what this study is highlighting," she said.

Sex may be a trigger for asthma attacks and patients often don't know it, scientists say

<ul class="summary-list"><li>A study found links between 32 health problems and eating ultra-processed foods.</li><li>The link was stronger for some problems than others, such as depression and type 2 diabetes.</li></ul><a target="_blank" href="https://www.businessinsider.com/ultra-processed-foods-marketed-as-healthy-2023-9">Ultra-processed foods</a> have been linked with a higher risk of developing 32 health problems in a study. But experts say that they don't need to be cut out of our diets entirely.The <a target="_blank" href="https://www.bmj.com/content/384/bmj-2023-077310">research</a>, published in The BMJ on Wednesday, was based on 45 existing studies that assessed the potential health effects of ultra-processed foods, involving over 9.8 million participants in total. The studies looked at the amount of <a target="_blank" href="https://www.businessinsider.com/reduce-ultra-processed-foods-nutritionist-tips-2024-1">UPFs</a> participants ate and if they developed any health problems.This is the latest study to look at the <a target="_blank" href="https://www.businessinsider.com/ultra-processed-foods-american-diets-2016-3">potential health risks of UPFs</a>, which have become a concern as they make up more and more of our diets. So far, research suggests that UPFs are not as healthy as whole foods such as vegetables, whole grains, and beans, but the US government's dietary guidelines don't recommend cutting them out.The review <a target="_blank" href="https://www.businessinsider.com/stop-counting-calories-avoid-processed-foods-weight-loss-tim-spector-2022-5">defined UPFs</a> as industrially produced foods made from chemically modified ingredients and additives rather than whole foods, such as packaged snacks, carbonated soft drinks, instant noodles, and readymade meals.None of the studies were funded by or associated with ultra-processed food manufacturers.<h2>UPFs were linked to health problems such as cardiovascular disease and depression</h2>The review found links between consuming UPFs and 32 health issues, including a higher risk of dying in general, as well as <a target="_blank" href="https://www.businessinsider.com/eating-ultra-processed-foods-ovarian-brain-cancer-risk-2022-2">cancer</a>, and mental, respiratory, cardiovascular, gastrointestinal, and metabolic problems.According to a press release, a 10% increase in UPF consumption was tied to a 12% higher risk of developing type 2 diabetes.Seven studies found a direct link between eating more UPFs and the risk of <a target="_blank" href="https://www.businessinsider.com/colorectal-cancer-high-mortality-young-people-signs-symptoms-disease-2024-1">colorectal cancer</a>, and a further six studies found that the risk of developing cardiovascular diseases, which include heart attacks and coronary heart disease, increased the more UPF participants consumed.Other health problems linked to eating a lot of UPFs included:<ul><li><a target="_blank" href="https://www.businessinsider.com/how-to-lower-blood-pressure-heart-attack-risk-stroke-cardiologist-2023-3">Hypertension</a> (high blood pressure)</li><li>Obesity, especially abdominal</li><li>Death from any cause</li><li>Anxiety</li><li>Depression</li><li>Sleep problems</li></ul>It also found limited evidence for associations between higher UPF consumption and asthma, non-alcoholic fatty liver disease, and other cancers, including breast, prostate, and pancreatic cancers, chronic lymphocytic leukemia, and central nervous system tumors.<h2>Some UPFs may be beneficial for our health, so more research is needed</h2>Evangeline Mantzioris, program director of nutrition and food sciences at the University of South Australia, who was not involved in the study, said in a statement: "this research highlights the importance of people limiting their intake of UPF and replacing it with whole foods."However, the researchers categorized the associations for most health problems as "low" or "very low" in credibility.Plus, the team acknowledged that not all UPFs appear to affect health in the same way. In one study, UPFs were generally associated with a higher risk of type 2 diabetes, but certain sub-categories of UPF were actually associated with a lower risk of type 2 diabetes, such as ultra-processed cereals, dark/wholegrain bread, packaged sweet and savory snacks, fruit-based products and yogurt, and dairy-based desserts.The authors of the study recommended that the public should be encouraged to eat fewer UPFs, but dietitians have previously told Business Insider it's unwise to completely cut out UPFs, as they can be an easy and cheap way to get calories and nutrients.Instead, dietitian Taylor Grasso previously told BI it's best to aim for an <a target="_blank" href="https://www.businessinsider.com/processed-ultra-processed-foods-ok-to-eat-2023-8">80:20 ratio</a> of whole to processed foods to help people eat healthily but not obsess over food.Gunter Kuhnle, professor of nutrition and food science at the University of Reading, UK, who was also not involved in the study, said in a statement that as the results discussed in the review are based on very weak data and don't touch on the causes of the health problems mentioned, they don't justify any changes in dietary recommendations.<h2>It's unclear why UPFs are linked to so many health problems</h2>The review suggested several reasons why UPFs might be linked to health problems.Firstly, a person who eats a lot of UPFs may have a poor diet in general, which can lead to health problems. Or, it could be that UPFs replace nutritious foods in people's diets.The additives in UPFs, such as non-sugar sweeteners, emulsifiers, and colorants, could also cause health issues. The authors pointed out that sweeteners, for instance, have been classified as "<a target="_blank" href="https://www.businessinsider.com/aspartame-is-a-possible-carcinogen-but-still-safe-to-ingest-2023-7">possibly carcinogenic</a>" by the International Agency for Research on Cancer, although at levels higher than most people would consume.It could also be that the industrial processing involved in producing UPFs or the packaging they tend to come in could contaminate the foods with harmful substances.But, the authors acknowledged that they don't know for sure why UPFs cause these issues, and that further research is needed.

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