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When Josef Woodman's shoulder gave out in 2012 — strained from chopping firewood on his farm outside Chapel Hill, North Carolina — he said he was quoted between $2,400 and $3,200 for an MRI at Duke University Hospital.He didn't want to shell out the cost of a nice vacation just to find out he didn't need surgery, so he decided to wait, even as his mobility decreased to the point where he had to severely limit his farm work and could hold only one-third of the weight he normally could. Two years later, his patience was rewarded: While on a work trip to Bangkok, he got an MRI for just $460, landing an appointment two days after his consultation at a hospital."The results came back and they said, 'You don't need surgery. You've got a separated rotator cuff,'" Woodman said. The surgeon prescribed physical therapy, which he completed in the US. "The shoulder got way better," he told me. He was glad he waited.Like Woodman, millions of Americans travel abroad for medical procedures each year, saving anywhere from 40% to 90% on the services they receive. Many <a target="_blank" href="https://www.amjmed.com/article/S0002-9343(18)30620-X/fulltext">don't have health insurance</a> or don't get coverage for the procedures they seek out — dental work and cosmetic procedures like breast implants and liposuction are by far the most popular. There's also a small but growing market for people seeking thorough checkups and testing abroad. An ascendant medical-tourism industry is offering these types of screenings, including MRIs and electrocardiograms, in beautiful locations around the world and packaging them with transportation, accommodations, food, shopping, and sightseeing. And with an increasing obsession with "wellness" and celebrities like Kim Kardashian promoting full-body imaging, it's easy to see why more and more Americans are looking to pair cabanas with CAT scans."If you've got some kind of joint pain, or if you have some kind of condition that isn't progressing, incorporate that into your normal travel plans," Woodman, now 72, said. In 2007, he founded Patients Beyond Borders, a healthcare-consulting company that helps Americans plan medical vacations, after growing up taking trips to Mexico for dental work with his dad. "In any kind of industrialized nation, you'd be able to get access to good-quality screening and people who can interpret the results," he said.Medical tourism comes with risks; the American Medical Association recommends going only to medical facilities recognized by international accrediting bodies and following up testing with care at home. But a growing number of Americans are willing to take those risks, as suites of tests abroad are often cheaper and faster than just a single test in the US."We just don't have a preventative-oriented society here in the United States," Woodman said. "Our approach is reactive."In a July <a target="_blank" href="https://www.tiktok.com/@bryn.elise/video/7386406512593325355?lang=en">TikTok</a> that's amassed over 17 million views, Bryn Elise documented her experience at a Turkish hospital where she received over 30 scans and tests, including an EKG, chest X-ray, and abdominal and thyroid ultrasounds, in a single day. The bill? $830. Without insurance, the cost of an EKG alone in the US <a target="_blank" href="https://enhancehealth.com/blog/how-much-does-an-ekg-cost-at-urgent-care-without-insurance/#:~:text=The%20total%20cost%20of%20an,where%20you%20get%20the%20service.">can vary from $100 to $5,000</a>."Personally, I'd rather spend $700 on a flight to Turkey, get dozens of tests there, and take a whole vacation than spend the thousands that this would have cost in the United States," Elise said in the video, which also featured clips of her on a beach, poolside, and eating a spread of delicious-looking Turkish veggie bowls. The 29-year-old health- and beauty-tourism influencer said she booked the trip because she wanted to investigate some "mysterious ailments," including brain fog, vision problems, and heart palpitations, without paying America's sky-high healthcare costs. She told her followers she had struggled with an eating disorder for 10 years and that "since our US checkups are only a tap on the knee and a blood-pressure check, I've been low-key terrified that I've caused permanent damage to my body but would never find out until it's too late."Her tests unearthed an astigmatism, early signs of osteoporosis, and "critically low" levels of vitamin B12. "The feeling of impending doom I've had due to health concerns is gone," Elise said.She chose a hospital that had been accredited by the Joint Commission International, an Illinois-based organization that has accredited over 1,000 health facilities in more than 70 countries. Dr. Paulo Neno, an international-accreditation surveyor at the commission, told Business Insider the accreditation process takes up to two years to complete and is renewed every three years. It includes a 12-part evaluation, during which a team of doctors and nurses visit the medical facility and assess everything from its operating theaters and intensive-care units to its power and water systems."We are focused on understanding how they are providing safe care for high-risk patients," Neno said.It's unclear, though, how many medical tourists visit accredited facilities, and there's still the question of whether all these tests are useful for someone who is seemingly in good health. Woodman knew he had an issue that needed to be examined, but Elise was more interested in a holistic screening regimen. One person commented on Elise's TikTok, "The hypochondriac in me thinks this is the perfect vacation. I'd go every year."Since COVID-19 came into the picture, health screenings and extensive physicals have received some buzz. Last year, Kardashian got a full-body MRI done by Prenuvo, a US chain of diagnostic clinics that offers the service for $2,500. In an Instagram post promoting it, Kardashian described it as a "life saving machine" that could detect cancer or conditions like aneurysms in their earliest stages. Especially given the <a target="_blank" href="https://www.businessinsider.com/colon-cancer-cases-doubled-young-people-2024-5">rise in colon cancer</a> among young people — a disease that can spread with no or minimal symptoms — <a target="_blank" href="https://www.businessinsider.com/get-colonoscopy-colon-cancer-symptoms-colorectal-oncologist-2024-4">early screenings</a> are on more people's minds.But Arturo Vargas Bustamante, an associate professor of health policy and management at the University of California, Los Angeles, said these kinds of rigorous tests can often do more harm than good."You may get a lot of things that you may not need based on your age profile, or you may get screenings that ultimately would find something that could lead to treatment that may harm you," he said. US guidelines on which demographics should get tested are based on scientific evidence, he added, while clinics abroad may be more motivated by profit.If a test finds cancer at a very early stage when it's very slow-moving, Vargas Bustamante said, the patient may feel compelled to treat it immediately, subjecting themself to chemotherapy and radiation. But in reality, it's possible they could have gone years without needing to start treatment. "Sometimes knowing too much may not be that good for you," he said.Others, however, think that America's lack of access to robust preventive screening is a critical failure.Dr. Misael Uribe Ramos is the director of international medicine at Médica Sur in Mexico City, a Joint Commission International-accredited hospital that offers checkups with eight different specialists for $1,600. Uribe Ramos has seen interest in rigorous physicals boom since the outbreak of the COVID-19 pandemic — and he thinks it's a good thing.Often when you go to the doctor, it's to treat a specific issue or disease, he said. "But why is that? Because you don't have prevention," he said. "Prevention is the best way to be healthy."In America, chronic illnesses such as heart disease, diabetes, and cancer are leading causes of death and disability, driving the majority of the US's $4.5 trillion in yearly healthcare expenses, <a target="_blank" href="https://www.cdc.gov/chronic-disease/about/index.html">according to</a> the Centers for Disease Control and Prevention. These illnesses are largely preventable. The CDC also says that between 30% and 50% of cancers diagnosed today could be prevented by reducing risk factors (like not smoking and maintaining a healthy body weight) and getting recommended screenings and vaccinations. However, according to the <a target="_blank" href="https://health.gov/news/202401/prevention-still-best-medicine">US Office of Disease Prevention and Health Promotion</a>, only 5.3% of Americans 35 and older received all recommended clinical prevention services in 2020 — a number that dropped from 8.5% in 2015. Why? Simply put, many Americans aren't regular healthcare users. They often don't have a family doctor, they live too far from one, they don't have a way to get there, or they simply can't afford it, the Office of Disease Prevention and Health Promotion says. Meanwhile, preventive-care services aren't prioritized because healthcare providers are paid to treat diseases — not to prevent them by keeping people healthy. A 2020 study said the National Academy of Medicine <a target="_blank" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7309216/">estimated</a> that missed prevention opportunities cost the US $55 billion annually.Other countries take a different approach. In Japan, for instance, the most basic annual checkups include EKGs, chest X-rays, blood tests, eye and hearing tests, and stool and urine tests. And some residents require a more comprehensive version that includes cancer screening. Japanese employers are required to provide them for all of their employees. In 2019, about 74% of men and 66% of women in Japan completed some type of medical checkup, according to the country's Ministry of Health, Labour and Welfare.South Korea's regimen is similar to Japan's. On a work trip there in 2010, Woodman had extensive testing done, including an MRI and CT scan, as part of a "wellness preventative program" he tried out for work, he said. He was offered an endoscopy and colonoscopy as part of the package but declined."Testing in the United States is really kind of pathetic," Woodman said. "They weigh you. They take your blood test. 'How tall are you?' And that's pretty much it."Americans seeking better preventive screening tend to visit South Korea, Thailand, and the United Arab Emirates, while Mexico, Barbados, and Thailand are popular for genetic and fertility testing, as well as testing related to gender-affirming care, medical-tourism advocates told BI.Many of these countries have hospitals that cater to foreigners. In Mexico, Médica Sur's checkups take about five hours, with screenings across disciplines such as internal medicine, cardiology, gynecology, and ophthalmology. (In the US, a typical physical takes less than an hour.) Packages include breakfast, transportation, accommodation, menus catering to dietary restrictions, discounted sightseeing for an extra cost, and concierge staff who help patients coordinate their stay and remain by their side for the duration. The hospital is also connected to a Holiday Inn if visitors want to stay on-site.Results are available within two weeks, at which point the patient can discuss the findings with a doctor in person or remotely; a checkup three months later is also included in the price. If, for example, the screenings indicate a malignant tumor, Uribe Ramos said, doctors will explain to a patient which follow-up tests they need, either in their home country or at Médica Sur. He recommends getting a thorough exam once a year.Since opening its international-medicine wing in 2019, the hospital has seen 5,000 foreign patients, most of them American and Canadian, Uribe Ramos said.Imani Bashir was living in Cancún three years ago when she felt what she thought was a lump in her breast. At the time she was 34 — <a target="_blank" href="https://www.cancer.org/cancer/screening/screening-recommendations-by-age.html#:~:text=Women%20ages%2040%20to%2044,should%20get%20mammograms%20every%20year.">young</a> to be receiving a mammogram — but her family had a history of the disease, so she booked an appointment anyway. In the US, the median <a target="_blank" href="https://ascopubs.org/doi/10.1200/JCO.2023.41.16_suppl.e18917">cost</a> of a mammogram ranges from $140 to $360 for women who aren't insured. In Mexico, it was under $50. As a Black woman who grew up in the US without health insurance, the 37-year-old communications director found the experience especially validating."When we go to the doctor and say that we're in pain, it's kind of just shooed away, like it's not a big deal," Bashir said. In Mexico, the medical center didn't question her. Now that she's living in Washington, DC, she continues to travel to Mexico for both her and her son's dental appointments and other medical issues because it's cheaper and easier to get appointments. "It always feels good when you feel like you can take care of yourself, and financially, it's not going to be a detriment to your life and your health," she says.Given how many people experience difficulty navigating the American healthcare system, it's no surprise that the medical-tourism market is growing rapidly. Patients Beyond Borders estimates the industry is growing between 15% and 25% each year. And 2022 <a target="_blank" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9104082/#:~:text=The%20increase%20in%20medical%20tourism,other%20time%20in%20the%20past.">research</a> found that the increase in international tourism had helped fuel the trend. As <a target="_blank" href="https://www.businessinsider.com/travel-agents-back-gen-z-millennials-vacation-planning-overseas-resorts-2024-6">more people spend time abroad</a>, it becomes easier to tack a few small medical tests onto your trip.Vargas Bustamante thinks traveling internationally for rigorous testing probably most benefits healthy people who just want "peace of mind." Despite the risk factors, the industry's growing appeal illustrates the limitations of American healthcare."Why would someone have to buy a plane ticket to go all the way on the other side of the world just for an adequate amount of healthcare? It's nuts," Bashir said. "But if people have the privilege, if people have the money to be able to do so, then I say, yeah."<a target="_blank" class="" href="https://www.businessinsider.com/author/manisha-krishnan">Manisha Krishnan</a> is an Emmy award-winning journalist who covers healthcare. She is based in Brooklyn.

Mojitos and an MRI: Meet the Americans who are getting health screenings on vacation 

<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

All Indian <keyword id="19926225" type="General" weightage="20" keywordseo="salt" source="keywords">salt</keyword> and <keyword id="20109149" type="General" weightage="20" keywordseo="sugar" source="keywords">sugar</keyword> brands, whether big or small, packaged or unpackaged, contain <keyword id="19970180" type="General" weightage="100" keywordseo="microplastics" source="keywords">microplastics</keyword>, according to a study published on Tuesday. The study, titled "Microplastics in Salt and Sugar" and conducted by the <keyword id="22774411" type="General" weightage="20" keywordseo="environmental-research-organisation" source="keywords">environmental research organisation</keyword> <keyword id="21593811" type="General" weightage="20" keywordseo="Toxics-Link" source="keywords" meta.keywordsubtype="org" meta.entityname="Toxics Link" meta.hostid="281" meta.entityid="Toxics Link">Toxics Link</keyword>, tested 10 types of salt -- including table salt, rock salt, <keyword id="158885" type="General" weightage="20" keywordseo="sea-salt" source="Orion">sea salt</keyword> and local raw salt -- and five types of sugar purchased from both online and local markets. The study revealed the presence of microplastics in all salt and sugar samples, in various forms, including fibre, pellets, films and fragments. The size of these microplastics ranged from 0.1 mm to 5 mm. The highest levels of microplastics were found in <keyword id="630077" type="General" weightage="20" keywordseo="iodised-salt" source="Orion">iodised salt</keyword>, in the form of multi-coloured thin fibre and films. Toxics Link founder-director Ravi Agarwal said, "The objective of our study was to contribute to the existing scientific database on microplastics, so that the global plastic treaty can address this issue in a concrete and focused manner." "We also aim to trigger policy action and attract researchers' attention to potential technological interventions that could reduce exposure risks to microplastics." Toxics Link associate director Satish Sinha added, "Our study's finding of substantial amounts of microplastics in all salt and sugar samples is concerning and calls for urgent, comprehensive research into the long-term health impacts of microplastics on human health." The concentration of microplastics in the salt samples ranged from 6.71 to 89.15 pieces per kilogramme of dry weight, the report said. Iodised salt had the highest concentration of microplastics (89.15 pieces per kilogramme) while organic rock salt had the lowest (6.70 pieces per kilogramme), according to the study. In sugar samples, the concentration of microplastics ranged from 11.85 to 68.25 pieces per kilogramme, with the highest concentration found in non-organic sugar. Microplastics are a growing global concern because they can harm both health and the environment. These tiny plastic particles can enter the human body through food, water and air. Recent research has found microplastics in human organs such as the lungs, heart, and even in breast milk and unborn babies. Previous studies found that the average Indian consumes 10.98 grams of salt and around 10 spoons of sugar every day -- much higher than the <keyword id="19896311" type="General" weightage="20" keywordseo="world-health-organization" source="keywords">World Health Organization</keyword>'s recommended limits.

All Indian salt and sugar brands have microplastics, notes a recent study

<ul class="summary-list"><li>Gavin Wren, a food policy expert and TikToker, is trying a new diet each month in 2024.</li><li>So far, his favorites have been the Mediterranean diet and veganism.</li></ul>A food policy expert who is trying a different diet each month in 2024 told Business Insider that the vegan and <a target="_blank" class="" href="https://www.businessinsider.com/guides/health/diet-nutrition/mediterranean-diet">Mediterranean diets</a> are his favorite so far. They were easy to follow, good value for money, and made him feel great.<a target="_blank" class="" href="https://www.businessinsider.com/tiktoker-eats-expired-food-got-ill-in-date-spinach-ecoli-2023-5">Gavin Wren</a>, who is based in the UK and shares his food policy insights on TikTok, is trying to find the <a target="_blank" href="https://www.businessinsider.com/popular-heart-healthy-diets-ranked-doctors-aha-2023-4">way of eating that works best</a> for him and sharing the results on social media. He judges this based on his mood and mental health on each diet, how easy it is to maintain a social life and function normally, and its value for money.So far this year, Wren has tried veganism, UK-based weight loss company Slimming World, only eating <a target="_blank" class="" href="https://www.businessinsider.com/huel-meal-replacement-drink-week-no-solid-food-slideshow-2016-12">Huel products</a>, intermittent fasting, paleo, and the Mediterranean diet.His overarching message to his followers is that <a target="_blank" href="https://www.businessinsider.com/guides/health/diet-nutrition/best-diet-for-weight-loss">diets aren't one size fits all</a>, and people should experiment to find what works for them."We all react quite differently to these diets, and it's so subjective to how much time you've got, what you do at the weekends, if you do any sport or not, or if you love pizza or not," he said."The <a target="_blank" href="https://www.businessinsider.com/mediterrean-diet-healthiest-best-overall-2024-1">healthiest diet</a> is a balanced one that you can maintain long term," he said in one <a target="_blank" href="https://www.tiktok.com/@gavinwren/video/7333569043154177312">TikTok</a> video. This chimes with what dietitians have previously told BI, including Elena Paravantes who said it's best to make gradual changes when trying to <a target="_blank" href="https://www.businessinsider.com/mediterranean-diet-nutritionists-tips-to-make-it-easy-to-follow-2023-7">eat more healthily</a>.<h2 id="eb6b034d-0a5c-42ca-a011-6b23af70d06c">Wren felt the best on the vegan diet</h2>Wren said most months of the challenge have followed a similar pattern. The first week is often quite exciting as he adjusts to a new diet, but by week two, he starts to encounter challenges in how he's feeling and how easy it is to socialize. Week three is typically where things go wrong, such as on the paleo diet when he had no energy and feelt terrible.But this wasn't the case for veganism, as he "started feeling fantastic" in week three."My energy levels on the <a target="_blank" href="https://www.businessinsider.com/plant-based-diet-dinner-recipes-delicious-2023-8">plant-based diet</a> were fantastic, and I felt like I was recovering really well from training" for triathlons, he said.The vegan diet was also the most cost-effective diet he's followed so far. He focused on making as many of his meals from scratch as possible, using pulses, lentils, legumes, and vegetables, rather than opting for expensive plant-based processed foods such as fake meats and cheeses.He encountered some issues in social settings, though, because the options for pre-prepared food and takeout were limited, and friends served him animal products, which did "remove some of the fun of eating," he said in a <a target="_blank" class="" href="https://www.tiktok.com/@gavin.wren/video/7330671703816670470">TikTok video</a>.But, overall, he told BI, "I felt really good on that diet. I really enjoyed it and it was the most personally rewarding out of all of them."Wren might enjoy some health benefits if he continues with the diet. BI previously reported on a 2017 study that found that vegans tended to have a lower body mass index, lower cholesterol levels, and <a target="_blank" href="https://www.businessinsider.com/guides/health/diet-nutrition/vegan-vs-vegetarian">lower risks of developing cancer</a> than meat eaters.<h2 id="57a1b05f-ed1c-4a48-a3c9-accd031e29ac">The Mediterranean diet was also great, but easier to follow in Italy</h2>Wren found the Mediterranean diet to be really cheap and easy to follow, since "it's largely vegetarian with lots of fresh fruit and veg," he said.One of the most misunderstood parts of the Mediterranean diet is that it's more of a lifestyle than a diet, he said, including plenty of socializing and physical activity as well as certain foods.The Mediterranean diet has been voted <a target="_blank" href="https://www.businessinsider.com/mediterrean-diet-healthiest-best-overall-2024-1">the healthiest diet</a> for seven years in a row by the US World News &amp; Report. And, according to a 2023 study, the <a target="_blank" href="https://www.businessinsider.com/mediterranean-diet-lifestyle-food-sleep-health-benefits-lower-death-cancer-2023-8">Mediterranean lifestyle</a> people who follow it are less likely to die of any cause, including from cancer and cardiovascular disease, BI previously reported.The Mediterranean diet also appeared to be best for his mental health, he said in a TikTok <a target="_blank" href="https://www.tiktok.com/@gavinwren/video/7389660503737486625">video</a>.Importantly, though, Wren was on holiday in Italy in June when he followed the Mediterranean diet.This meant that fresh food was easier and cheaper to source than in the UK, he worked less and exercised more, enjoyed wonderful weather by the sea, and socialized more than he would have at home. So the positive effects may have been down to other lifestyle changes he made that month, he said in the video.

A food policy expert is trying a different diet every month this year. Here's why the vegan and Mediterranean diets are his favorites so far.

<ul class="summary-list"><li>This post originally appeared in the Insider Today newsletter.</li></ul>Welcome back to our Saturday edition! Headed to Atlanta? Well, skip the hotel you had in mind and <a target="_blank" href="https://www.businessinsider.com/hotel-clermont-review-most-beautiful-hotel-atlanta-2024-11">stay at this unassuming, historic o</a><a target="_blank" class="" href="https://www.businessinsider.com/hotel-clermont-review-most-beautiful-hotel-atlanta-2024-11">ption instead</a>. One of our editors called it the "most beautiful" hotel in the peachy city.On the agenda:<ul><li>Longevity doctors are scrambling to <a target="_blank" href="https://businessinsider.com/longevity-doctors-dangers-of-taking-multiple-supplements-less-is-more-2024-11">deprescribe flashy, expensive supplements.</a></li><li>Step aboard a luxury <a target="_blank" href="https://www.businessinsider.com/river-cruise-deluxe-suite-photo-tour-scenic-spirit-mekong-river-2024-11">river cruise through Vietnam and Cambodia</a>.</li><li>A chef shares six things to order at a steak house <a target="_blank" href="https://www.businessinsider.com/steak-house-best-things-to-order-from-chef-dishes-avoid">and four dishes to skip</a>.</li><li>Millennials are raising pets instead of kids. <a target="_blank" href="https://www.businessinsider.com/millennials-raising-pets-instead-kids-spoiled-dogs-cats-anxiety-health-2024-11">It's not going well for the pets</a>.</li></ul>But first: Inside the vacation-home tax drama in South Lake Tahoe.If this was forwarded to you, <a target="_blank" href="https://www.businessinsider.com/subscription/newsletter/insider-today-sunday-edition">sign up here</a>. Download Insider's app <a target="_blank" rel="" href="https://www.insider.com/app">here.</a><h3 id="2d2d81c1-e984-4ab1-b11e-26ada0d3da0b">This week's dispatch</h3><h2 id="ef84679e-5101-4303-beb5-fc75bc92b8c0">To tax or not tax?</h2><div type="image" title="A cabin surrounded by a large forest and mountain range." height="3266" width="4898" msid="115116343" hostid="261" sizebytes="1895900"></div>For Amanda Yen, a Business Insider fellow, her grandparent's <a target="_blank" href="https://www.businessinsider.com/south-lake-tahoe-vacation-homes-tax-vacancy-2024-11">vacation home in South Lake Tahoe</a> is "the stuff of legend."It's where her parents fell in love, where she'd spend winters learning how to ski, and the place where she'd always imagined getting married.However, a proposed annual tax measure on last Tuesday's ballot that was voted down by local residents made her family question whether they'd keep their house. Measure N would've made their cabin, which her grandparents bought in 1984 for $113,000, much more costly to keep. It suggested vacation homeowners pay $3,000 in 2026 and $6,000 every year after to benefit the local economy.I spoke to Amanda after the measure failed to pass on Tuesday to see where things stand.What's been the initial reaction from second homeowners now that Lake Tahoe locals voted against Measure N?The overwhelming feeling among second homeowners in Lake Tahoe is relief. Still, the problems that supporters of the tax raised — like declining funding for education and out-of-control home prices — are urgent. Year-round and seasonal residents need to put their heads together to fix it.What are you hearing from locals — who supported the tax and opposed it — now that the measure has been voted down?I spoke to Amelia Richmond, one of the architects of the tax, shortly after it failed on the ballot. The message she gave was pretty similar to the vibe of <a target="_blank" href="https://www.businessinsider.com/kamala-harris-addresses-nation-following-donald-trump-big-win-election-2024-11">Kamala Harris' concession speech</a> — facing defeat, but not defeated — and looks forward to working with the opposition on future affordable-housing policy solutions.Local opponents were jubilant, but they're also ready to come to the table and work with supporters of the tax on a new solution. As Steve Teshara, one of the opposition leaders, put it: "Tonight, we celebrate, and tomorrow it's back to work."<h2 id="cc30e20d-acf4-4a4e-ad8f-02c3a04a9dbb">Put down the supplements</h2>Over the past several years, a plethora of new supplements have emerged, promising to boost human longevity and keep people feeling young. Now, longevity doctors are scrambling to get people to slow down.BI spoke with several longevity medicine doctors who are recommending patients stop taking many of the flashy new supplements they learned about online. They can cause subtle build-up in the kidneys and liver, impacting your longevity.<a target="_blank" href="https://businessinsider.com/longevity-doctors-dangers-of-taking-multiple-supplements-less-is-more-2024-11">When it comes to supplements, less is more.</a><h2 id="f3efdf5d-fcfc-4813-9e6c-8e3b9040c25d">Set sail on the Mekong River</h2><div type="image" title="Cruise Collage" height="1374" width="1832" msid="115116345" hostid="261" sizebytes="177184"></div>Cruises are all the rage this year, but flashy megaships aren't for everyone. Enter: the luxury river cruise. One writer spent nine days traveling through Vietnam and Cambodia aboard the Scenic Spirit.Her nine-day trip was sweetened by a larger-than-expected room, complete with a butler, walk-in closet, and a convertible balcony.<a target="_blank" href="https://www.businessinsider.com/river-cruise-deluxe-suite-photo-tour-scenic-spirit-mekong-river-2024-11">See inside the deluxe cabin</a>.<h2 id="4e812ecf-a060-401e-9848-be206a63cddb">What to order at a steak house</h2><div type="image" title="Sliced pink-center steak on a plate in a circle" height="4160" width="6240" msid="115116347" hostid="261" sizebytes="975398"></div>Despite the name, there's far more to eat at a steak house than just, well, steak. For one trained chef and food writer, crab cakes, fresh oysters, and fries are typically must-order dishes.Still, some meals aren't worth the splurge. She suggests skipping the chicken breast and wedge salads. And unless you're in New England, don't even bother with the clam chowder.<a target="_blank" href="https://www.businessinsider.com/steak-house-best-things-to-order-from-chef-dishes-avoid">This, not that — steak house edition</a>.Also read:<ul><li><a target="_blank" href="https://www.businessinsider.com/red-flags-how-to-spot-good-steak-house-from-owners">The 5 red flags steak-house owners look for when dining at a high-end steak house</a>.</li></ul><h2 id="483172dd-9e06-415f-8357-1bdb6f813f7b">Generation Fido</h2><div type="image" title="A dog in a stroller" height="2250" width="3000" msid="115116352" hostid="261" sizebytes="175894"></div>Almost a third of millennials have pets — and they're obsessed with them. In an online survey, more than a third of millennial pet owners said they'd turn down a higher-paying job to spend more time with their animal companions.Millennials are spending more time and money on their pets, but pet trainers and veterinarians say that could have a downside. Excessive pampering could lead to health and behavioral problems for Spot and Mittens.<a target="_blank" href="https://www.businessinsider.com/millennials-raising-pets-instead-kids-spoiled-dogs-cats-anxiety-health-2024-11">Why you might want to ease up on the coddling</a>.<h2 id="5fef756b-4b6b-4037-8f33-9635854b9d8b">What we're watching this weekend</h2><div type="image" title="Screenshot of Cristin Milioti in The Penguin in TV" height="1500" width="2000" msid="115116348" hostid="261" sizebytes="384250"></div><ul><li>"The Penguin": HBO's crime drama, a spinoff of 2022's "The Batman," airs its finale this weekend.</li><li>"Yellowstone": After a two-year hiatus, the Paramount Network hit returns with the second half of its fifth season.</li><li>"Arcane": The "League of Legends" show, one of Netflix's most successful animated series ever, also kicks off its second and final season.</li></ul><a target="_blank" href="https://www.businessinsider.com/best-shows-movies-streaming-netflix-max-apple-november-8-24">See the full list</a>.<div type="image" title="A red shopping bag surrounded by $100 bills." height="1500" width="2000" msid="115116349" hostid="261" sizebytes="244828"></div><h2 id="a09a70ef-5e7e-4bf4-80b2-3731f70bdc6e">Deals we love</h2><ul><li>Smart Ray-Bans: These Wayfarers can do more than protect your eyes; they can take photos, videos, and calls, too. The Ray-Ban Meta Glasses come in three different styles — <a target="_blank" href="https://www.businessinsider.com/guides/deals/where-to-buy-ray-ban-meta-glasses">here's how to buy them</a>.</li><li>Tried-and-true work bags: Don't trust just any old tote with your work essentials. We've spent years testing to find the <a target="_blank" href="https://www.businessinsider.com/guides/style/best-work-bag-women">best work bags for women</a> that balance style, organization, and comfort.</li><li>Dry skin begone: Cold weather can be tough on skin and cause dryness to worsen — but our guide to the <a target="_blank" href="https://www.businessinsider.com/guides/beauty/best-face-moisturizers-for-dry-skin">best dry skin moisturizers</a> is here to keep you hydrated and protected.</li></ul><h2 id="3a2e4b99-8063-4f80-8653-d1ec4a2af89a">More of this week's top reads:</h2><ul><li>Beyoncé, Chappell Roan, and other rising female pop stars <a target="_blank" href="https://www.businessinsider.com/grammy-awards-2025-nominees-winners-list-details-2024-11">lead 2025 Grammy nominations</a>.</li><li>Seven men share how <a target="_blank" href="https://www.businessinsider.com/married-men-when-they-knew-spouse-was-the-one-2024-10">they knew their spouse was The One.</a></li><li>Big Sky, a Montana ski town, is <a target="_blank" href="https://www.businessinsider.com/big-sky-most-luxurious-ski-resort-us-better-than-aspen-2024-11">giving Aspen a run for its money</a>.</li><li>How to prepare for common mishaps on <a target="_blank" href="https://www.businessinsider.com/amtrak-prepare-for-long-train-rides-problems-frequent-traveler-2024-11">long-haul Amtrak journeys</a>.</li><li>A plague of endless options has <a target="_blank" href="https://www.businessinsider.com/online-shopping-ecommerce-comparison-burnout-too-many-choices-overwhelming-decision-2024-11">ruined online shopping</a>.</li><li>This small Connecticut town is <a target="_blank" href="https://www.businessinsider.com/visited-madison-connecticut-things-to-do-great-beach-town-2024-11">a calmer alternative to the Hamptons</a>.</li><li>Review: A night on the Fingal, <a target="_blank" href="https://www.businessinsider.com/stayed-at-luxury-floating-hotel-fingal-review-edinburgh-2024-11">Edinburgh's ship-turned-floating-hotel</a>.</li><li>Washington, DC's obsolete government buildings are <a target="_blank" href="https://www.businessinsider.com/office-conversion-washington-dc-cotton-annex-turned-into-luxury-apartments-2024-11">being turned into luxury apartments</a>.</li><li>Review: A $120 meal at <a target="_blank" href="https://www.businessinsider.com/is-trump-grill-worth-it-for-two-review-2024-11">the Trump Grill</a>.</li></ul>The Insider Today team: <a target="_blank" href="https://www.businessinsider.com/author/dan-defrancesco">Dan DeFrancesco</a>, deputy editor and anchor, in New York City. <a target="_blank" class="" href="https://www.businessinsider.com/author/grace-lett">Grace Lett</a>, editor, in New York. <a target="_blank" href="https://www.businessinsider.com/author/lisa-ryan">Lisa Ryan</a>, executive editor, in New York. <a target="_blank" class="" href="https://www.businessinsider.com/author/amanda-yen">Amanda Yen</a>, fellow, in New York.

Insider Today: Rethinking supplements

<ul class="summary-list"><li>A human performance scientist shared the 9 supplements he takes daily to optimize his health.</li><li>Professor Andy Galpin said a healthy lifestyle is the goal but supplements can play a role in great health.</li></ul>A human performance scientist who's coached elite athletes and celebrities, from the LA Clippers to <a target="_blank" href="https://www.businessinsider.com/cringe-couple-pics-social-media-relationship-health-happiness-therapist-2024-2">Travis Barker</a>, shared the nine supplements he takes daily for gut, brain, and muscle health with Business Insider.Andy Galpin, a professor of kinesiology at California State University, Fullerton, encourages a well-rounded approach to health that encompasses movement, a diet packed with whole foods and high-quality protein, positive relationships, plenty of sunshine, and quality sleep. He also believes <a target="_blank" href="https://www.businessinsider.com/should-i-take-supplements-scientist-benefits-2024-4">supplements</a> can play a role in enhancing performance and optimizing health.Most experts agree we should take a <a target="_blank" href="https://www.businessinsider.com/i-tracked-my-diet-get-nutrients-food-supplements-2022-11">food-first approach</a> to nutrients, and Galpin is a paid scientific advisor at the supplement brand Momentous. But he told BI that while he doesn't want to "oversell supplements at all," he's seen them improve people's nutrient levels hundreds of times. They're not a panacea by any stretch, he said, but there's compelling evidence of the benefits of some ingredients.Galpin is part of a growing number of people who personalize their approach to health in the hope of preventing disease and living longer, in a trend dubbed <a target="_blank" href="https://www.businessinsider.com/what-is-a-longevity-clinic-executive-physical-2024-5">"Medicine 3.0."</a> It can involve taking supplements or undergoing medical treatments that might not be backed by robust scientific evidence as an insurance policy.He himself just launched RAPID Health Optimization, an online company that offers a "custom, state-of-the-art solution" to health problems with extensive testing and <a target="_blank" href="https://www.businessinsider.com/personalized-nutrition-dietary-advice-dna-test-microbiome-2017-6">personalized nutrition</a>, supplementation, and lifestyle advice.Each quarter, Galpin does blood tests and adjusts his supplements based on the results, plus his <a target="_blank" href="https://www.businessinsider.com/personal-trainer-supplements-never-take-energy-drinks-protein-bars-2024-4">workout goals</a>. (Galpin previously shared his <a target="_blank" href="https://www.businessinsider.com/longevity-workout-human-performance-scientist-2024-5">longevity-focused exercise regime</a> with BI).This means his regime is personalized to his specific needs and may not be right for another person, he said. Consult a medical professional before taking new supplements.Here's Galpin's current supplement protocol.<h2 id="67d850b6-d0e7-40cd-bd52-33408d3e7ae7">Multivitamin</h2>While many studies suggest <a target="_blank" href="https://www.businessinsider.com/most-vitamin-supplements-are-useless-according-to-new-study-2018-5">taking a multivitamin is mostly useless</a>, some people take them as a cheap insurance policy."It's a few cents a day and people that are very active and exposed to high amounts of stress, there is some literature suggesting they could benefit," Richard Bloomer, a researcher at Memphis University, who tests <a target="_blank" href="https://www.businessinsider.com/supplement-scientist-heart-health-inflammation-daily-2024-3">how effective supplements </a>are, previously told BI.Galpin falls into this camp. He eats a healthy diet but also takes a multivitamin daily to ensure he's covering his basic nutritional needs. He takes two capsules of Momentous's multivitamin in the morning and evening.There's also some evidence to suggest that older adults may derive <a target="_blank" href="https://www.businessinsider.com/multivitamins-for-memory-older-adults-benefit-2023-10">subtle memory benefits </a>from taking a multivitamin.<h2 id="41c95869-7ee3-4391-9222-f2ba24dffe66">Fish oil</h2>Every day, Galpin takes 4 grams of fish oil to support <a target="_blank" href="https://www.businessinsider.com/best-memory-supplement-plant-protein-berries-scientist-2024-2">brain health</a> and reduce inflammation, he said.Fish oil contains omega-3 fatty acids, which our bodies need but can't produce. They play important roles in brain function, normal growth and development, and reducing inflammation, according to Harvard Medical School. Deficiencies have been linked to cardiovascular disease, some cancers, mood disorders, and more.Some evidence suggests fish oil has anti-inflammatory effects that can be protective against muscle soreness and damage from hitting the gym. One small study found that men who took 3 grams of fish oil capsules a day for four weeks experienced less muscle soreness after working out than those who didn't.Foods high in omega-3 include fatty fish such as salmon, some vegetable oils, walnuts, flax seeds, and leafy vegetables. It's unclear if capsules provide the same benefits as whole foods containing omega-3 fats, according to Harvard Medical School.<div type="image" title="Fish oil supplements" height="2217" width="3332" msid="110709383" hostid="261" sizebytes="160892"></div><h2 id="d63b0c5a-7653-480e-9400-96597ae2ce6f">Creatine</h2>Galpin takes 7.5 grams of <a target="_blank" href="https://www.businessinsider.com/creatine-supplements-build-muscle-how-to-use-expert-advice-2022-3">creatine daily</a> because he believes it provides numerous short and long-term health benefits, including helping build muscle mass.The body can make creatine from three amino acids, the building blocks of protein. It mainly stores creatine in the muscles, where it's used for energy, but also in the brain, according to The Mayo Clinic.Studies consistently suggest that taking creatine supplements can enhance physical performance and strength and reduce recovery time after workouts, according to a 2021 review of research.The results of studies looking into the potential benefits of taking creatine supplements on brain function are mixed. A 2019 meta-analysis of studies on the subject found that creatine may improve short-term memory and reasoning in healthy adults but its effect on other cognitive skills such as planning, attention and response time were unclear.<h2 id="4a44d974-183b-432b-9876-6e77a295c99d">Collagen</h2><a target="_blank" href="https://www.businessinsider.com/guides/health/diet-nutrition/collagen-benefits">Collagen</a> is the most abundant form of protein in the body. It's the primary building block of skin, muscles, bones, tendons and ligaments, and other connective tissues, and is also found in organs, blood vessels, and intestinal lining, according to Cleveland Clinic.Galpin said he takes two collagen shots before a workout for joint health.Collagen supplements are made of components of collagen broken down into a form absorbable by the body, according to MD Anderson Cancer Center.There's not robust evidence to suggest collagen improves physical performance but some studies have reported positive results. One small study based on 24 active men found that those who took 20 grams of collagen a day for seven days before and two days after performing 150 drop jumps had a moderately better recovery time and less muscle soreness than those who took a placebo. But it had no impact on inflammation and bone collagen synthesis.Whether taking collagen supplements supports joint health or improves joint-related conditions such as osteoathritis is a tricky question to answer based on the information currently available.A 2018 meta-analysis published in the journal International Orthopaedics found that overall, collagen was effective in reducing pain and stiffness in patients with osteoarthritis.However, in a <a target="_blank" href="https://www.statnews.com/2022/01/20/painfully-weak-evidence-supporting-collagen-supplements-for-arthritis/">2022 STAT article</a>, Paul T. von Hippel, a professor of data science and statistics at the University of Texas, Austin, noted that only five articles were used and their results appeared contradictory at times.<h2 id="9ad3211b-7e20-4fdb-812d-f3060b3aef4e">Magnesium</h2><a target="_blank" href="https://www.businessinsider.com/risks-popular-supplements-vitamin-d-magnesium-2024-4">Magnesium</a> is a mineral that helps more than 300 enzymes carry out various chemical reactions in the body, such as building proteins and bones, regulating blood sugar and blood pressure, and relaxing muscles, according to Harvard T.H. Chan School of Public Health.Galpin takes 200 mg a day of magnesium for muscle health, recovery, and sleep. "Most high-exercising people are going to benefit from magnesium supplementation," he said.According to the American Sports and Fitness Association, without enough magnesium, muscles are less efficient and more prone to fatigue and injury. It also acts as a relaxant, helping to ease muscle stress and tension from intense workouts, which aids recovery.The mineral has also become<a target="_blank" href="https://www.businessinsider.com/peter-attia-nighttime-supplements-ashwagandha-lysine-magnesium-sauna-2023-10"> popular as a sleep aid</a>, and there is some evidence to suggest that it can help people who are struggling to sleep.For example, a small 2012 study found that participants ages 65 and up who took 500 mg of magnesium daily for eight weeks slept longer and woke up less in the middle of the night compared to the placebo group.However, if you don't have a <a target="_blank" href="https://www.businessinsider.com/guides/health/diet-nutrition/magnesium-for-sleep">magnesium deficiency</a>, increasing your intake is unlikely to improve your sleep, Dr. Rami N. Khayat, a professor with the University of California Irvine School of Medicine and director of the UCI Sleep Disorders Center, previously told BI.<h2 id="e1f92976-fcd1-4277-949c-120ef9078628">Rhodiola Rosea</h2>Rhodiola rosea is a herb that's been used in parts of Europe and Asia for centuries to increase physical endurance, and treat fatigue and depression, among other things.Galpin takes 200 mg daily for stress management and muscular endurance, he said. It's considered an <a target="_blank" href="https://www.businessinsider.com/adaptogens-compound-mushroom-plants-help-reduce-stress-2023-10">adaptogen</a>, which are plants and mushrooms that are said to help the body respond to stress, anxiety, and fatigue.More research is needed, but some studies suggest Rhodiola rosea could help with stress. In one small single-arm study, participants experiencing stress-related burnout took 400 mg Rhodiola rosea daily for 12 weeks. Participants reported that their symptoms lessened, and in particular, they felt less tired and tense, and felt more joy.One study highlighted in a 2023 literature review found that participants could cycle for longer than normal after taking and felt they were exerting less effort after taking Rhodiola rosea. But the improvements were statistically small, the authors said.<h2 id="42830511-b07a-49a8-8c6d-7134ca8762fd">Green tea extract</h2>Galpin said he takes 225 mg of green tea extract once a day to support his immune system.<a target="_blank" href="https://www.businessinsider.com/guides/health/diet-nutrition/what-are-antioxidants">Antioxidants</a>, such as polyphenols in green tea, can neutralize free radicals, which damage cells and DNA and contribute to the aging process. Free radicals are also thought to cause health problems such as cancer and heart disease, according to Mount Sinai.Research suggests green tea could aid the immune system, but more research in humans is needed.<div type="image" title="Cup of green tea." height="1405" width="2135" msid="110709384" hostid="261" sizebytes="48724"></div><h2 id="e052021d-ab0f-4b27-88a8-cacf87d3812a">Vitamin D</h2><a target="_blank" href="https://www.businessinsider.com/guides/health/diet-nutrition/vitamin-d-benefits">Vitamin D</a> helps the body absorb calcium and phosphorous and is needed for healthy teeth, bones, and muscles. Although some foods, including egg yolks and red meat, contain vitamin D, sunlight is thought to be the best source.Galpin takes 5,000 International Units daily for muscle, brain, and gut health.Studies consistently show that vitamin D plays a role in the healthy functioning of the digestive system, however, there's less evidence that vitamin D supplements mimic this. One study based on 80 women who were deficient in vitamin D but otherwise healthy found that vitamin D supplementation increased gut microbial diversity, which is a sign of a healthy gut.Research suggests that vitamin D may play a role in preserving cognitive function.<h2 id="96464901-d913-4c4c-93a3-19384b076d55">L-Glutamine</h2>Galpin takes 5 mg of L-Glutamine twice daily for gut health and immune support.L-Glutamine is an amino acid that plays a key role in digestive and immune health. It's a vital source of energy for immune cells such as white blood cells and intestinal cells, according to Healthline. It also helps maintain the barrier between the inside of the intestines and the rest of the body.L-Glutamine is sometimes used in clinical settings to treat people with low levels of the amino acid as a result of injury or illness.

A human performance scientist shares the 9 supplements he takes daily for gut, brain, and muscle health

<ul class="summary-list"><li>A doctor shortage is projected to hit 86,000 by 2036. Rural communities already feel the impact.</li><li>Educational initiatives and congressional bills aim to combat issues like limited appointment slots.</li></ul>Every three to four months, Mellisa Case drives three and a half hours from her small town of Prineville, Oregon, to Portland to see her orthopedist for help with arthritis, a condition she believes she could have avoided at this stage in her life.In 2021, Case had surgery for a meniscus tear at an orthopedic center in Bend, an hour away from her home. However, she couldn't schedule appointments for follow-up care, which doctors consider necessary for proper recovery. For several months after her meniscus surgery, Case kept calling the center for an appointment with no success while her knee deteriorated.Now Case takes time off from work and spends up to $125 round trip on gas while traveling to Portland for arthritis care. Case said that symptoms like stiffness, swelling, and discomfort — which resulted from a lack of postsurgical medical support — could interfere with her sleep, gait, and ability to enjoy her hobbies like hiking and gardening."Until you've experienced not being able to see a doctor, you don't really realize how frustrating it is," Case, who is 53, told Business Insider. Eventually, she will need surgery for a <a target="_blank" class="" href="https://www.businessinsider.com/nc-woman-plans-finally-getting-knee-surgery-after-winning-lottery-2023-1">full knee replacement</a>.Case said that she remains concerned that the overall lack of medical care in her community, as she's observed doctors retiring or leaving her area.Some of her family members and friends also struggle to find physicians close to home, Case said, so they have to drive long distances or wait for appointments.A March report from the Association of American Medical Colleges projected that the US would face a <a target="_blank" class="" href="https://www.businessinsider.com/why-hospital-wait-times-are-bad-physician-shortage-low-pay-2024-4">physician shortage</a> of up to 86,000 specialists and primary-care doctors by 2036.Michael Dill, the organization's director of workforce studies, said this estimate was conservative."The country needs hundreds of thousands of doctors to provide an equal amount of care to everyone, including minorities, those without medical insurance, and people living in rural areas," he told BI.An aging population, physician retirement, and the administrative challenges of running a practice contribute to the shortage and disproportionally affect vulnerable populations such as older people, those lacking transportation options, and people with disabilities, public-health advocates told BI.Two solutions could be increasing medical-training programs in rural communities and passing legislation to retain and <a target="_blank" class="" href="https://www.businessinsider.com/best-high-paying-jobs-hiring-doctors-construction-accounting-2024-4">bolster the physician workforce</a>.<h2 id="0a289233-786f-4ff1-969a-24da2c3ab5eb">An aging population and provider burnout are contributing to a worsening doctor shortage</h2>The effects of a doctor shortage are already here, Dr. Bruce Scott, the president of the American Medical Association, said.Scott practices in Louisville, Kentucky, and said that in addition to patients in rural areas driving hours to appointments, they're waiting months to see a doctor.Various factors, including an aging population, play a part in the situation, Dill said.In 2020, 55.8 million Americans, or 16.8% of the population, were 65 or older, and by 2030, all baby boomers will have reached age 65, according to a <a target="_blank" class="" href="https://www.census.gov/library/stories/2023/05/2020-census-united-states-older-population-grew.html ">US Census report.</a> As people age, they require more physician services, such as cardiologic or neurological care, and at the same time, doctors are aging and retiring, adding to the shortage, Dill said.<a target="_blank" class="" href="https://www.businessinsider.com/labor-shortage-hospital-beds-empty-nurses-doctors-staff-covid-vaccine-2021-10">Physician burnout</a> further exacerbates the problem, Scott said. In one survey that was part of AMA Organizational Biopsy report, of over 12,400 doctors, 48% of respondents said they were burned out. In another survey from the same report, one in three respondents said they planned to retire or reduce hours within two years.One AMA survey found some doctors were leaving their practices because they were being paid less to handle more <a target="_blank" class="" href="https://www.businessinsider.com/electric-health-records-causing-doctor-burnout-2018-12">administrative burdens</a>, such as spending 12 hours a week filling out prior-authorization requests. "Medicare is paying us nearly 30% less in 2024 than it did in 2001, when adjusted for inflation," Scott said, citing further data compiled by the AMA.<h2 id="1d068686-c4d6-4ee0-81d9-f17918ad516a">Strategies to alleviate the shortage</h2>To help alleviate the physician shortage in rural areas, medical students need to receive training there, said Molly Fox, the vice president of institutional advancement at Kansas Health Science University."We engage students with the rural community because we know that people tend to practice where they feel connected," Fox said.At KHSU's Kansas College of Osteopathic Medicine, for example, third- and fourth-year students can complete clinical rotations at St. Catherine Hospital in Garden City, four hours from Wichita, where the university is.Chase Hearn, a third-year student, said he'd seen doctors at the hospital who have worked 26-hour shifts to meet patient needs."I've also heard patients say they can't take a day off work to travel 200 miles to see their OB-GYN," Hearn said. He added that his training had strengthened his resolve to practice in a rural community but that he anticipated challenges, like burnout and working with patients who lack consistent access to care.<a target="_blank" class="" href="https://www.businessinsider.com/how-el-paso-trying-solve-us-physician-shortage-2023-7">Rural residency programs</a> are also needed to address the shortage, Dill said. Only 2% of residency training occurs in rural areas, the US Government Accountability Office says.A residency program through Oregon Health &amp; Sciences University aims to alleviate the doctor shortage in three central-Oregon counties, including Crook County, where Case lives. The program is training physicians in primary care, family birthing, emergency medicine, behavioral health, and hospital medicine.According to the Rural Medical Training Collaborative, 133 rural residencies in family medicine and 69 rural-track programs are recruiting for 2025 enrollment, along with 30 internal-medicine residencies and 16 psychiatry residencies.Several pieces of legislation have also been introduced to Congress to address the doctor shortage. Scott said bills to adjust Medicare payments for doctors — no matter where they practice — to the annual rate of inflation and rules to reduce the need for prior authorization could help ease administrative burdens.Some legislation, if passed, would specifically influence rural areas.For example, HR 7855, the Association of American Medical Colleges-endorsed Rural Residency Planning and Development Act of 2024, would codify the Rural Residency Planning and Development Program, which funds the startup costs of residency training in rural areas, Dill said. From 2019 to 2024, the program has enabled the launch of 46 accredited rural residency programs across 38 states and Puerto Rico.Hollie Davis Frick, an immigration lawyer for Wintersteen Patel Law Group, said congressional action could easily incentivize doctors born abroad and who receive advanced medical training in the US to remain here and practice in rural areas."Many doctors who come here for residencies and fellowships return abroad because of our ineffective immigration policies," Davis Frick said.If passed, S 665, the Conrad State 30 and Physician Access Reauthorization Act, would allow state health departments to sponsor additional visa waivers for foreign-born doctors who agree to practice in underserved areas within those states.While Case remains skeptical that doctor-training initiatives and legislation will directly affect her community anytime soon, she considers herself fortunate, she said."I have the ability to drive, afford travel expenses, and pay for out-of-network doctors," Case said. "Not everybody does."

Medical schools and legislation aim to address a worsening doctor shortage that's already hitting rural communities 

<ul class="summary-list"><li>Vaccine stocks have tumbled since Trump appointed vaccine skeptic Robert F. Kennedy Jr. to health secretary.</li><li>Vaccine-makers Moderna, Pfizer, and GSK saw sharp losses.</li></ul>It's been a tough day for health stocks since Donald Trump announced his appointment of <a target="_blank" href="https://www.businessinsider.com/trump-robert-f-kennedy-jr-rfk-department-health-human-services-2024-11">Robert F. Kennedy Jr.</a> — a staunch vaccine skeptic — as health secretary.The news, which came late in the day on Thursday, sent the shares of vaccine-makers sharply lower on Friday, with <a target="_blank" class="" href="https://markets.businessinsider.com/stocks/mrna-stock">Moderna</a> leading the losses, falling as much as 10%. <a target="_blank" class="" href="https://markets.businessinsider.com/stocks/pfe-stock">Pfizer</a> and <a target="_blank" class="" href="https://markets.businessinsider.com/stocks/nvax-stock">Novavax</a> both dropped 6% at intraday lows, while <a target="_blank" class="" href="https://markets.businessinsider.com/stocks/gsk-stock">GSK</a> lost 5%.But the selling wasn't contained to just vaccine names. It spread into US-exposed European healthcare stocks, such as Novo Nordisk and Roche, which were down 5% and 3% at intraday lows, respectively.The losses extend a days-long skid for the sector after the election results last week saw investors boost bets that Kennedy — a key Trump ally — would notch a cabinet role.Since Election Day, Moderna has fallen more than 30%, while Pfizer has slid 11%. Those losses have stood in contrast to the rally enjoyed by the rest of the market, which has <a target="_blank" class="" href="https://markets.businessinsider.com/news/stocks/trump-election-win-stock-market-today-record-high-sp500-dow-2024-11">rallied</a> on the hopes that Trump's lighter regulatory stance and corporate tax cuts could boost corporate earnings.<a target="_blank" href="https://www.businessinsider.com/robert-f-kennedy-jr-views-vaccines-autism-testing-debunked-2023-7">Kennedy</a> has long railed against vaccines, once calling those that protect against Covid-19 a "crime against humanity." He has treaded more carefully in recent weeks, though, and has said he wouldn't outright ban vaccines."If vaccines are working for somebody, I'm not going to take that away. People ought to have choice," he told <a target="_blank" href="https://www.nbcnews.com/politics/2024-election/trump-win-rfk-jr-says-wont-take-away-anybodys-vaccines-rcna178955">NBC</a> after Trump's election.Since Trump's election win, several analysts have downgraded their outlooks on vaccine stocks amid the rising uncertainty in the industry. Bank of America analysts lowered their price target on Moderna last week, from $110 to $90, partially citing uncertainty after Trump's election win, while Deutsche Bank analyst Emmanuel Papadakis cut his rating on GSK to a hold after Kennedy's appointment."We consider vaccines to be amongst the greatest scientific achievements to impact public health: unfortunately this view is not shared by the nominee," Papadakis wrote in a client note <a target="_blank" class="" href="https://www.bloomberg.com/news/articles/2024-11-15/health-stocks-slide-as-trump-picks-vaccine-skeptic-kennedy">seen by Bloomberg</a>.Formerly an environmental justice lawyer, Kennedy pivoted to running an anti-vaccine charity in recent years, and ran for president as an independent candidate in this election cycle. He dropped out to <a target="_blank" href="https://www.businessinsider.com/rfk-jr-drops-out-presidential-race-2024-8">endorse Trump</a> in August, which some sources reported was a bid to <a target="_blank" href="https://www.businessinsider.com/rfk-wanted-white-house-job-exchange-for-endorsing-trump-report-2024-7">secure a position</a> in the administration.In his role as <a target="_blank" href="https://www.businessinsider.com/how-rfk-jr-plans-to-make-america-healthy-again-2024-11">health secretary</a>, Kennedy will have a top role in health policy in the US, but likely won't be able to actually control which vaccines children are required to get for school. That will remain up to individual states, but he could change vaccine requirements for federal employees or the US military.That's if the Senate confirms his appointment, which some have said could be a close vote considering mixed reactions among policymakers so far.Kennedy has also promoted removing fluoride from water supplies and overhauling federal food regulations, and has supported products like raw milk, which the Food and Drug Administration warns against.He's also floated hopes to cut highly processed food from school lunches, which was a priority under the Obama administration.

Health stocks are tumbling after Trump's appointment of vaccine skeptic RFK Jr.

<ul class="summary-list"><li>The high price of weight-loss drugs is frustrating for patients who can't access them, a doctor said.</li><li>Patients struggle to afford these drugs, leading to cycling, rationing, or using risky alternatives.</li></ul>Pharmaceutical companies are facing a <a target="_blank" class="" href="https://markets.businessinsider.com/news/stocks/novo-nordisk-ceo-faces-senate-questions-over-high-prices-of-ozempic-and-wegovy-in-us-1033798280">new wave of criticism</a> for the high price of groundbreaking weight-loss drugs.<a target="_blank" class="" href="https://www.businessinsider.com/how-weight-loss-meds-injections-compare-costs-results-side-effects">GLP-1 medications</a> like semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro, Zepbound) have skyrocketed in popularity, helping people lose up to 15-20% of their body weight and even slash their <a target="_blank" class="" href="https://www.businessinsider.com/wegovy-reduces-risk-of-heart-attack-stroke-death-study-2023-8">risk of heart attack</a>.But a list price of around $1,000 per month or more means the treatments are out of reach for many patients.It puts doctors in an awkward position, too — wanting to prescribe these potentially life-changing drugs, but knowing they could be sending their patients on a complicated financial journey."Patients that I speak to have tried nearly every strategy to obtain anti-obesity medications," <a target="_blank" rel="noopener nofollow" href="https://trueyouweightloss.com/about/meet-the-team/dr-christopher-mcgowan/">Dr. Christopher McGowan</a>, a gastroenterologist and obesity medicine specialist, told Business Insider.Many insurers have dropped coverage in the past year, McGowan said."While it's clear that semaglutide and tirzepatide represent tremendous advances in obesity management, what does it matter if no one can afford them?" McGowan said.The end result is that the people who need these drugs most are taking uncharted, unresearched risks to get the medications.<h2 id="98c0484b-95b1-476a-be13-71c0822e754e">Patients are rationing doses to cut costs</h2>GLP-1 medications work by mimicking a hormone in the body that helps regulate appetite and blood sugar.The <a target="_blank" class="" href="https://www.businessinsider.com/weight-loss-glp-1-drugs-ozempic-wegovy-mounjaro-effects-future-2023-12">latest generation of these class of drugs</a>, medications like Ozempic, Wegovy, Mounjaro, and Zepbound, are once-weekly injections.The caveat is that in order to maintain the weight loss, you need to keep taking the drugs, but McGowan said that's just not possible at the current price point."This is why we so often see patients cycling on and off medications. Unfortunately, short-term use doesn't translate into long-term benefit," he said.In some cases, patients say they've tried to <a target="_blank" class="" href="https://www.businessinsider.com/what-its-really-like-find-affordable-weight-loss-drugs-patient-2024-9">space out their doses</a>, and found their weight creeping back up.<h2 id="ffe4633a-0741-4479-9135-9ecd9bb4e9ff">Copycat drugs are dominating the online market</h2>A booming industry of websites and telehealth companies have jumped at the chance to sell patients their weight loss drugs for cheap, but there's a major catch, according to McGowan.These providers are offering <a target="_blank" class="" href="https://www.businessinsider.com/buy-compounded-semaglutide-online-risks-wegovy-ozempic-2023-1">compounded semaglutide</a> and tirzepatide, which contains the same active ingredient as branded products, but isn't FDA-approved."The compounded GLP-1 market has absolutely exploded," he said. "These drugs are everywhere and can be obtained with incredible ease and at a fraction of the cost of brand-name medication. However, this entirely unregulated industry presents significant risks related to quality, safety, and efficacy."<h2 id="538abdcc-03f9-459d-8b0f-54139cf4de87">It could take years for prices to drop</h2>Political pressure on pharmaceutical companies may move the needle when it comes to drug prices, according to Ted Kyle, a health professional with decades of experience in policy, marketing, and obesity care."It's going to be really messy but five years from now, prices will more reasonable, access much better, and more people will be getting care with a whole lot less blame and shame," Kyle told Business Insider.The competitive pressure will also help drive prices lower as companies aim to attract consumers back to their brand with <a target="_blank" class="" href="https://www.businessinsider.com/eli-lilly-cut-price-zepbound-tirzepatide-weight-loss-drug-copycats-2024-8">cheaper options for weight-loss drugs</a>.But McGowan said he isn't optimistic that the situation will improve for his patients in the near future."We can beg insurers to cover medication and plead with pharmaceutical companies to lower prices, but there simply isn't any incentive for them to do so right now," McGowan said.

A doctor shares how his patients are trying to afford weight-loss drugs — and what happens if they can't

<ul class="summary-list"><li>Nestlé is launching a new line of frozen foods for weight loss.</li><li>The meals are designed for people on GLP-1 drugs like Ozempic, who don't have much of an appetite.</li></ul>The world's biggest food company is going small today.Nestlé is launching new frozen meals designed for busy Americans who just aren't that hungry anymore — or who may be interested in losing some weight via portion control.Nestlé's newest product line "Vital Pursuit" is a slate of low-calorie, <a target="_blank" href="https://www.businessinsider.com/high-protein-meal-plan-weight-fat-loss-nutritionist-2024-2">high-protein meals</a> that are designed to be relatively cheap and easy on-the-go foods for people on drugs like Ozempic, Wegovy, Mounjaro, and Zepbound.<div type="image" title="vital pursuit meals" height="1080" width="1920" msid="113461754" hostid="261" sizebytes="152196"></div>The meals cost less than $5 and are available at retailers including Target and Walmart, starting Wednesday, according to the company. They don't explicitly say it on the box, but Nestlé told Business Insider these new products were designed for the rising number of people on <a target="_blank" class="" href="https://www.businessinsider.com/weight-loss-glp-1-drugs-ozempic-wegovy-mounjaro-effects-future-2023-12">GLP-1 weight-loss drugs</a>, who typically consume around 1,200 to 1,800 calories per day.Many GLP-1 users suddenly discover they don't have as much "food noise" or constant thoughts about eating anymore. They also may feel full very quickly, and experience slower digestion than others. These small meals, branded as protein-rich, are designed to help GLP-1 users lose more fat, and less muscle.Kristen Stoehr, a registered dietician and the Vital Pursuit brand manager at Nestlé, says you don't have to be a GLP-1 user to eat these foods. After all, only about 6% of Americans are actually on a GLP-1 drug right now, according to data from the health policy research firm <a target="_blank" href="https://www.kff.org/health-costs/poll-finding/kff-health-tracking-poll-may-2024-the-publics-use-and-views-of-glp-1-drugs/">KFF</a>."We want to be a brand for those 82% of Americans who are managing their weight," Stoehr told Business Insider, referencing a Morgan Stanley report.I tried two of the new meals before their release on Wednesday, and though I was skeptical, I have to say they tasted better than I expected.And they were clearly designed to keep me full for a while.The last time Nestlé brought new processed foods to the frozen aisle was about four years ago, when <a target="_blank" href="https://www.businessinsider.com/how-to-keto-what-is-ketosis-keto-diet-explained-2018-8">keto diets</a> and plant-based meals were trending, Stoehr said. The new meals are leaning into some fresher, newer nutrition trends — they're high protein, with many <a target="_blank" href="https://www.businessinsider.com/gluten-free-diet-unhealthy-most-people-without-celiac-disease-2017-10">gluten-free</a> options, and a decent amount of fiber in each box."We're just always tweaking our lineup to make sure we're relevant for today's consumer," she said.Registered dietician Alix Turoff and nutrition coach Mike Molloy, both independent nutrition experts who don't work at Nestlé, took a look at the nutrition facts and components in the meals for Business Insider. Their reviews, like my taste test, were relatively positive, but not glowing.<h2 id="d53e8495-0b13-4acf-91a0-35a77cbeb699">A 380-calorie mini pizza with 26% of the daily protein recommendation</h2><div type="image" title="cooked pizza" height="1575" width="2100" msid="113461758" hostid="261" sizebytes="207202"></div>For a frozen pizza the flavor on this little item was decent, with a nice tangy sauce. While gluten-free, cauliflower crusts tend to be more chewy or crumbly, this had a crunchy crust. It wasn't on par with actual pizza, but it was just as good as any other microwaveable option I've had. The pepperoni was my least favorite part. It tasted rubbery, thick, and didn't have much flavor. It could never compete with the perfectly greasy, crunchy, spicy cup pepperoni on most New York pizza pies.Turoff says this meal is a bit high in saturated fat for her liking (7 grams, 35% DV) but she was more concerned about the sodium content (930mg, 40% DV) — often a concern in <a target="_blank" href="https://www.businessinsider.com/scientists-making-ultra-processed-foods-healthier-in-major-new-study-2024-6">ultra-processed convenience meals</a>. She said that the meal could use a little more fiber, so she would recommend eating it with some veggies or a side salad. The protein dose, at 22 grams, is "solid" but not high, she said."For someone trying to lose weight without GLP-1's, I'd actually recommend aiming for more like 30+ grams of protein per meal for satiety purposes," she told BI in an email. Though it isn't the most nutritious, wholesome meal in the world, Turoff said it was important to consider what it might actually be replacing in someone's diet."They're likely trying to make a healthier choice within the realm of convenience foods," she said. "At the end of the day, a meal like this can be a practical, balanced option for someone trying to manage their weight or make healthier choices compared to what they might otherwise grab on a busy day."Malloy said people should practice the 80/20 rule here: if they're getting 80% of their diet from whole, fresh foods like whole grains, veggies, and protein sources including eggs, seafood, and chicken, then he's OK with the extra 20% of their diet being things like these ultra-processed meals.I had my pizza for lunch and was satisfied until after dinnertime, without snacks.<h2 id="0b7dc2d8-2f0e-412a-889c-43349ba6e59c">A 340-calorie grilled chicken bowl with 22 grams of protein was an OK desk lunch</h2><div type="image" title="chicken in microwave" height="2800" width="2100" msid="113461760" hostid="261" sizebytes="194742"></div>The garlic herb grilled chicken bowl wasn't half bad either, though it did leave me a bit hungrier than the pizza. I liked the herby and just slightly creamy flavor, which after a quick glance at the ingredient panel I chalked up to the presence of some Parmesan cheese, basil, garlic, lemon juice, and feta.The sauce wasn't heavy, and paired well with the coin-sized pieces of chicken (small!), brown rice, carrots, and broccoli. Turoff was more impressed with the ingredient list here, and said the sodium (640mg, 28% DV) and vitamin A (70% DV) stats were better than the pizza.Both independent nutrition professionals we spoke to for this story said there are plenty of other options out there for weight loss and portion control. It's not like Nestlé suddenly reinvented the convenience food."These meals seem like a decent option... but not a great one," Malloy wrote in an email to Business Insider. He said the focus on upping protein is important for people on GLP-1 drugs."That is one thing I think is contributing to the excessive muscle mass loss that people are experiencing," he said. "If this helps them to get more protein overall, that's a win in my book."Turoff was also sensitive to the fact that people on GLP-1s may not have much of an appetite, and as a result, they may not be motivated to cook or prepare their own food at home."This is where convenient, portion-controlled frozen meals like these can be really helpful," she said. "These products can serve as a useful tool for those who may not yet feel comfortable in the kitchen or who struggle to maintain a consistent routine of preparing balanced meals. For someone on GLP-1 medications, who might be overwhelmed by appetite changes or simply trying to adjust to their new eating patterns, having a frozen meal that is quick and easy to prepare can reduce decision fatigue."<div type="image" title="cooked chicken" height="2800" width="2100" msid="113461759" hostid="261" sizebytes="499046"></div>While I'm not the target audience for these meals, I was happy to have this chicken and rice on hand during a busy day at the office, and ready in under five minutes.<h2 id="665e06c1-bdc0-4601-b2de-6d1ddcc1375e">Nestlé is bracing for a drop in appetite for fast-food</h2>This is not Nestlé's first foray into the growing business of catering to GLP-1 users across the US. For several months now, the <a target="_blank" href="https://www.nestle.com/media/news/health-science-glp-1-nutrition-support-platform">company has been selling</a> protein powders, shakes, supplements, electrolytes and other nutrition products geared towards GLP-1 weight loss on a dedicated website.On a call with BI, Nestlé's senior manager for health and wellness, Marlene Schmidt, cited Morgan Stanley's recent <a target="_blank" href="https://www.morganstanley.com/ideas/obesity-drugs-food-industry">report</a> predicting that by 2035, roughly 7% of the US population will be on a weight loss drug.In that same report, Morgan Stanley said that consumption of sodas, baked goods, and salty snacks "may fall up to 3% by 2035."Clearly, the biggest food giant in the world wants to make sure it's ready for that consumer shift.

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