Corporate ED Clash; Trimester Zero; Who Americans Trust on Public Health

The following is a transcript of the podcast episode:

Rachael Robertson: Hey everybody, welcome to MedPod Today, the podcast series where MedPage Today reporters share deeper insights into the week’s biggest healthcare stories. I’m your host, Rachael Robertson.

Today, we are talking with Joedy McCreary about a battle in Oregon over local versus corporate emergency room ownership. Then, I will share what ob/gyns have to say about the so-called “trimester zero.” To close out, Shannon Firth will tell us which public health figures the public actually trusts.

For more than three decades, the emergency departments at a hospital system in Oregon have been staffed by local physicians. But that’s about to change, and the local physicians are not happy about it. MedPage Today reporter Joedy McCreary is here to fill us in on the situation and how the outcry is reaching far beyond the Northwest.

So Joedy, what is happening here?

Joedy McCreary: Well, the focus is on the emergency room at the medical center that the PeaceHealth health system runs at what’s called RiverBend in Springfield, Oregon — that’s just outside of Eugene. Now, for years, the ER there has been run by a local group of doctors called Eugene Emergency Physicians or EEP. But last month, PeaceHealth announced the change: starting July 1, the ER will be managed by a firm out of Atlanta called ApolloMD, and they could bring in physicians from across the country. Now, that firm has said it’s open to hiring those local doctors, but the doctors say they won’t do it because they don’t want to work for a corporate group.

After the decision was announced, workers at the hospital held a few votes; 98% said they would rather keep the local doctors, and 93% voted no confidence in the two leaders who made the decision. In a separate vote of nurses in the union, that no confidence number was up to 98%.

Robertson: Jeez, so why did they make that change in the first place?

McCreary: Well, the local doctors said they haven’t gotten a clear answer yet. I’ve reached out to PeaceHealth to ask that very question, but they’ve not gotten back to me. In a local radio interview, one of the leaders at PeaceHealth said it has to do with patient volume. In about a year and a half, RiverBend went from 210 ER patients a day to 240. Why? Well, one of the local doctors told me the jump came after PeaceHealth closed a separate ER in Eugene a couple of years ago. She said they warned PeaceHealth that those numbers were going to go up, but that was ignored.

Now both sides do agree on one point: one factor will not be cost. The executive told the radio station that they don’t expect to be spending less money, and the doctor says paying for those levels of management is expensive.

Robertson: So what has the reaction been to all of this?

McCreary: It’s been loud. The member of Congress who represents that part of Oregon wrote a letter urging PeaceHealth to reconsider. The American Academy of Emergency Medicine agrees. It says local ownership is best for everyone involved, especially the patients. And it says this is a sign of corporate involvement in local practice, a growing trend and a defining issue in emergency medicine.

Now, the reason it is such a big deal has to do with community. ApolloMD has had ties to private equity in the past, and the local doctor told me they’re offering big money to locums to work there temporarily. The doctors and nurses both told me the local physicians are deeply invested in the area they know, the people and the issues that affect. They warn that getting rid of that institutional knowledge could wind up being a big problem. Now it’s not happening yet. There are still a few months before the move goes into effect, and it’s something MedPage Today will keep watching.

Robertson: Thank you so much, Joedy.

McCreary: Thanks, Rachael. My turn!

Now, according to some influencers, the secret to a successful pregnancy lies in a woman’s lifestyle choices in the months leading up to conception. They’re calling it “trimester zero.” But is there any merit to the advice? Rachael Robertson talked to ob/gyns to find out, and she’s here with us now.

Rachael, what kind of things are influencers recommending for so-called trimester zero?

Robertson: So the specific advice varies, but the through-line is that by self optimizing, women can and should take control of their own fertility to ensure a healthy pregnancy. So for instance, there’s an emphasis on eliminating stress. Some go so far as to stop high intensity exercise. There’s also a focus on whole foods, good sleep, and supplementation. Some influencers are selling courses on how to optimize trimester zero and many link to specific products that they swear by.

Ob/gyns told me that not all of the advice being peddled is bad, but often a patient’s own responsibility to act on their own behalf is emphasized over a nuanced and ongoing conversation with their medical team.

McCreary: What else did the ob/gyns tell you?

Robertson: So what influencers are calling trimester zero here is kind of a rebranding of the care and medical advice that patients can get during preconception counseling. Preconception care looks at all aspects of a woman’s health to help her carry the pregnancy with as little risk as possible. Basically, the goal is to optimize a woman’s health going into pregnancy and if she’s already had another kid, to optimize birth spacing.

Some risk factors are modifiable, like smoking and drinking and even weight, but factors like age are not modifiable. About two thirds of reproductive-age women have at least one modifiable risk factor for birth defects, and supplementing with folic acid, for instance, during the preconception period, is actually proven to reduce the risk of neural tube defects. However, a lot of patients don’t even know that preconception counseling is available, or they miss the opportunity to do it by not knowing they’re pregnant in the first place, which can complicate things.

McCreary: What kinds of things come up in preconception counseling?

Robertson: Physicians would make sure that the woman’s chronic conditions are being managed and that none of her medications are potentially harmful in pregnancy. And this doesn’t mean going off, say, a psychiatric medication cold turkey, but they would make sure that the woman is receiving adequate care for herself without adding additional risk to the pregnancy that could be avoided.

It’s also an opportunity to work on setting healthy habits going into pregnancy. Working with a physician on this is important, though, because, as one ob/gyn told me, “There are just some things that, either because of genetics or because of your own medical history, you can’t fix with supplements or diet.”

In general, ob/gyns are said to be skeptical of anyone pushing one way to be healthy, especially if they’re profiting off it. As long as chronic conditions are treated, a woman is nourishing herself, exercising in whatever way works for her, and is having an ongoing conversation with her medical team — those things are all more helpful and evidence backed than putting pressure on oneself to self-optimize without professional guidance.

McCreary: Thanks, Rachael.

Robertson: Thank you, Joedy. I’ll take it from here.

Public trust in federal agencies has fallen pretty sharply, according to a new survey from the University of Pennsylvania. But what about federal health agencies, the people who lead them, and the scientists who work there? Reporter Shannon Firth is here to break down the survey’s findings on who Americans actually trust.

Shannon, what were the big takeaways?

Shannon Firth: So Rachael, the survey asked who the public trusts for “information about matters concerning public health.” And in my view, one pretty stark finding is that only about 5% of the 1,600 people surveyed said they felt “very confident” in federal health agency leaders. About four in 10 surveyed said they had some level of confidence in these leaders, but about six in 10 did not.

The policy center also asked about trust in career scientists at these same health agencies, nearly seven in 10 of those surveyed had confidence in those career scientists, while a smaller share, about three and 10, did not.

Robertson: So basically, people trust people farther down the food chain more than the big bosses.

Firth: Pretty much. And I think that’s kind of troubling. These are people in charge of Medicare, Medicaid. They’re the leaders who oversee public health emergencies like a measles outbreak. And so it definitely signals that there’s a problem when the majority of Americans feel they can’t be trusted.

Robertson: The survey also looked specifically at trust in specific leaders, including HHS Secretary Robert F. Kennedy Jr., CMS administrator Mehmet Oz, MD, and former NIAID director Anthony Fauci, MD. How many people trusted these leaders?

Firth: So Rachael, the survey found that fewer Americans trust Secretary Kennedy on public health issues than trust Dr. Fauci. Overall, 38% said they trust Kennedy and 54% said they trust Fauci. Again, this meant they either said they felt somewhat confident or very confident in these leaders in terms of sharing information on issues of public health. 42% of respondents said they trusted Dr. Oz, which was not much more than Kennedy.

Robertson: The researchers also asked questions about vaccines and trust, specifically about the hepatitis B vaccine. What did they find there?

Firth: That’s right, Rachael. For years, public health experts have recommended that babies receive a hepatitis B vaccine at birth. But in December, the CDC, which is under the purview of Kennedy, ended that universal birth dose recommendation. Now, CDC recommends vaccination for “infants born to women who tested positive for the hepatitis B virus or whose status is unknown.” And for infants born to mothers who test negative, the agency advised parents to follow shared clinical decision making, meaning, basically, talk to your doctor.

Meanwhile, the American Academy of Pediatrics pushed back on the CDC’s latest recommendation urging parents to instead follow previous CDC guidance and stick with universal hepatitis B vaccination for all. When asked what recommendations they would follow, Americans were four times more likely to trust the advice of the AAP over the CDC. That’s 42% versus 11%. That said, 32% of respondents said they were not sure, and 16% said they would not take advice from either group.

Robertson: Thanks so much for your reporting here, Shannon.

Firth: Thanks, Rachael.

Robertson: Now for our weekly measles update. There were 144 new cases of measles in the past week. Texas saw a huge jump last week, 61 new cases, 896 overall, and 93 this year alone. The other big state to watch out for is Utah, which had 35 new cases and 372 overall. A week before that, we had 117 measles cases across the country. As always, check out our measles map to get a detailed look at where the disease is spreading.

And that is it for today. If you like what you heard, leave us a review wherever you listen to podcasts, and hit subscribe. If you haven’t already, we’ll see you again soon. This episode was hosted and produced by me, Rachael Robertson. Sound engineering by Greg Laub. Theme music by Palomar. Our guests were MedPage Today reporters Joedy McCreary, Rachael Robertson, and Shannon Firth. Links to their stories are in the show notes.

MedPod Today is a production of MedPage Today. For more information about the show, check out medpagetoday.com/podcasts.