What a week!! Last week…
- Charlie Kirk’s assassination in Utah drew national attention (again) to political violence and hyper-partisan politics.
- Global tensions heightened as Israel fired on Doha (Qatar), Russia struck Poland, wars continued in Ukraine and Gaza, possible conflicts in Venezuela and civil wars in Myanmar, Yemen, Sudan continued.
- HHS Secretary Robert Kennedy Jr. amped-up his suspicions about vaccines, the MRNA methodology and root causes of autism and the FDA announced tighter restrictions on drug advertising.
- The Trump administration announced its intent to send troops to Memphis to address its crime at the invitation of TN Governor Bill Lee.
- The U.S. Bureau of Labor Statistics revised its jobs reports for the 2024-2025 downward by 911,000 acknowledging its over-count prompting speculation in the business and political communities about a methodology change.
- 9/11 observances in DC, NYC and PA refreshed memories of the world-changing attack on U.S. soil 24 years ago.
- And the University of Michigan released its latest Consumer Sentiment Index– 55.4, down from 58.2 in August and a 21% decline year-over-year.
And, this week promises more…
- The Federal Reserve will meet Tuesday and Wednesday where markets are 95% confident it will approve a quarter-point rate cut, bringing the federal funds rate down to 4.00%–4.25%.
- The newly constituted and controversial CDC Advisory Committee on Immunization meets to discuss its vaccine policies Thursday and Friday (September 18-19)
- Congress will debate federal spending and debt as threats of a government shutdown loom (again).
- In states, redistricting (gerrymandering) will pre-occupy partisans in TX, MO, PA and other hotspots as Campaign 2026 nears and legislators will debate Medicaid funding vs. other priorities.
while the engine of health industry commerce soldiers on….
- Layoffs, re-organization, take-private and compliance risks highlight increasingly loaded Board agendas across the industry.
- Industry pow-wows will inventory domestic and global issues and challenges impacting their followers i.e. the International Conference on Public Health and Healthcare Research in Phoenix, the International Conference on Nursing Science and Healthcare in DC, the International Conference on Healthcare and Clinical Gerontology in Kansas City, the International Conference on Pulmonary, Respiratory Medicine and Healthcare in Oklahoma City, the International Conference on Nursing Science and Healthcare in El Paso.
- Corporate gatherings like Workday’s “Healthcare Rising” (San Francisco) and Hospitalogy’s “Value-Based Care Summit” (Austin) will convene customers to exchange ideas about strategies and solutions to problems in the system (I am honored to be speaking at both).
Perspective
“Lost but making record time”—that’s an apt description of where U.S. healthcare is. Attributed to Yankee’s legend Yogi Berra, it captures the absurdity of misguided efficiency and unbridled innovation without direction. The growing level of anxiety, frustration, uncertainty and even fear that grips the nation is also at play in across every organization in healthcare. The destination for the industry is unknown, but the pace is quickening.
Cost reductions and layoffs, capital deployment, interoperability, vertical and horizontal consolidation, price transparency, R&D priorities, integration of social services with delivery systems, et al. are means to an end that’s regrettably unclear to the majority of Americans just as perplexed about its destiny as they are our political system. That includes the 23 million who serve as its workforce.
There is no consensus among insiders about the health system’s future; only agreement the status quo is unsustainable. Accountability for the system’s lack of direction is widely shared: everyone in healthcare says “they serve the greater good” and everyone knows it’s a complicated business where money matters are priorities for non-profits and for-profits alike. Responsibility for setting its direction rests with the Boards of Directors who guide the industry’s trade associations and its organizations (public and private). Regrettably, most aren’t focused on the future state outside the narrow context of their constituents’ self-interests. Executive compensation for their leaders is weighted heavily toward short-term financial results well-above transformational leadership to be safe. Organizational strategies are premised on incomplete assumptions and organizational sacred cows. And CEOs are scrambling to keep organizational ships afloat as bigger waves crash on their shores.
The systemic re-setting of policies, players and economies in higher education, financial services, retail trade, organized religion and others and pending disruptions in housing, hospitality and municipal services are the result of 3 convergent trends–they’re instructive:
- Changing consumer expectations: more value, fewer hassles, discontent with the status quo and receptivity to alternatives..
- Changing market conditions: demographic shifts, regulatory policies (elections, laws, courts), disruptive technologies (quantum computing, AI), global alliances and economies.
- Changing capital sourcing: more private (households/investors), less public (taxes/appropriations) within more tightly regulated rules of deployment.
They apply to healthcare today and we’ve been slow to respond. That’s recognized by outsiders who grimace when insiders declare ‘healthcare is different’.
I am optimistic about U.S. healthcare’s future because each of the changes above is resident and ‘newer and better’ is necessary to our collective success. The big unknown is who will step forward to lead healthcare’s response. Being ‘lost but making record time’ is not a plan, it’s an excuse.
Paul
Sections in this week’s report
- Quotables
- Economy
- Employers
- Hospitals
- Insurers
- Physicians
- Prescription Drugs
- Polling
- Public Health
Quotables: on Charlie Kirk Assassination in Orem UT Wednesday, September 10:
Keckley Report (September 11, 2025) on Kirk assassination: “In our society, emotional and economic anxiety is at its peak. Opinions are sharply divided on major issues and self-serving flame throwers exploit these tensions to fuel fires.
Healthcare is no exception. The murder of UnitedHealth Group executive Brian Thompson was a reminder. People feel strongly about issues and institutions these days. Our industry’s business practices and institutions evoke strong emotion. Misinformation is high and the public’s understanding of the system is low. How it’s structured, funded, regulated and operated is unknown to the majority who depend on personal experiences and media coverage as their surrogate sources….
The public’s somewhat aware but increasingly held hostage by echo chambers that reinforce their views and discount others.
The status quo in healthcare is Darwinian: survival means defending turf against all others i.e. hospitals vs. insurers, primary care vs. specialty, public health vs. local delivery systems, drug companies vs. pharmacy benefits managers, alternative (non-western) medicine vs. allopathic medicine, et al. In many cases, these fights feature corporate heavyweights fending for shareholder expectations and not-for-profit operators who extract eye-popping profits and compensate executives handsomely. And these fights have devolved in each sector to winning and losing based on size, locations and alliances. And these fights provoke violence.
It’s time to re-think the industry’s future with the public’s wellbeing its only purpose. Sectarian war games have served their purpose but at a cost that’s unsustainable. A national debate akin to the collegiate debate should consider the following proposition:
Resolved: the U.S. health system should be fundamentally transformed to prioritize sustainability, accessibility, affordability and the health and wellbeing of the entire population.”
The Keckley Report September 11, 2025 www.paulkeckley.com
Utah Governor Cox on Kirk murder: “We can return violence with violence. We can return hate with hate, and that’s the problem with political violence — is it metastasizes. Because we can always point the finger at the other side. And at some point, we have to find an off-ramp, or it’s going to get much, much worse.
This is certainly about the tragic death, political assassination of Charlie Kirk. But it is also much bigger than an attack on an individual. It is an attack on all of us. It is an attack on the American experiment. It is an attack on our ideals. This cuts to the very foundation of who we are, of who we have been, and who we could be in better times…”
On Politics: A Republican governor tries to stop the blame game
MD Governor Moore on Cox statements: “Spencer Cox is Spencer Cox. And he doesn’t change depending on who the audience is, and he doesn’t change depending on who he’s standing in front of. And that’s one of the things I love about him most.
He’s just a deeply good human being and I’m thankful that in this moment of real tension in our country, that Spencer is helping to lead us through.”
Utah Gov. Spencer Cox’s message to ‘disagree better’ faces its biggest test
Sullivan on Charlie Kirk murder: “… we should all grieve Charlie Kirk — because free speech vs violence is much more crucial a divide than left vs right. And the proper response to this horror is serious introspection about how violence has burrowed its way into our widening, post-liberal gyre…. Which makes the next three years so perilous and so vital. It really is up to us. We can tip this broken democracy into an abyss or we can walk back slowly, calmly, with perspective. Cool the rhetoric. Find someone in your life you disagree with and have a conversation. Get off social media. Remember how much we still have in common, how blessed we are in this country in so many ways we forget. Tell the truth fearlessly but always be open to correction. Decency, civility, nonviolence, humor, humility, grace: these are the virtues a free society needs to endure. Lose them and it won’t.”
The Weekly Dish <andrewsullivan@substack.com September 12, 2025
Quotables across the Industry from week of September 8, 2025
NYT on inconsistencies in RFKJ’ HHS initiatives: “Far from cracking down on food and farming practices, Mr. Kennedy’s MAHA commission report on Tuesday defended existing pesticide review procedures and, in some cases, called for loosening food regulations, even as the report promised future steps to clean up what children eat.
To many scientists — and some of Mr. Kennedy’s own followers — the gap between the health secretary’s use of his authority over food quality and his pummeling of vaccines has created a jarring split screen….
Mr. Kennedy’s restraint in using the levers of government on those parts of the MAHA agenda has dismayed some supporters, threatening to fracture the uneasy alliance between the movement’s anti-chemical activists and Republican lawmakers who see themselves as champions of the agriculture industry.
At the same time, scientists sympathetic to the health secretary’s ideas about cleaning up the food supply worry that he has diluted measures long backed by studies, even as he works aggressively toward a separate goal — undercutting vaccines — that defies decades of research.”
The Jarring Contradiction at the Heart of RFK Jr.’s Agenda – The New York Times
Washington Post on health insurance costs: “Health insurance costs in the United States are on track for their biggest jump in at least five years, according to multiple surveys, adding turbulence to an uncertain economy and boosting expenses for millions of Americans already beset by inflation.
In 2026, businesses will be hit with an increase of 9% or more, and they are expected to push some of the burden onto employees, according to the research.
For the 24 million enrollees of Affordable Care Act insurance plans, however, the news is far worse. The end of enhanced federal subsidies for that program means their costs are expected to rise by more than 75% next year, according to KFF, the nonpartisan health policy organization.
Insurers and employers point to two recent factors to explain the rising prices: the tariffs on pharmaceutical imports being considered by the Trump administration and the high cost of new obesity treatments, called GLP-1 drugs.
With inflation top of mind for many Americans, and broad discontent with health care, the spike in prices in both government-sponsored and private health insurance could make the cost of coverage an issue in the 2026 midterm elections. A Gallup poll in December reported that “Americans’ rating of the quality of U.S. healthcare has fallen to the lowest reading in 24 years, and views of healthcare coverage nationally remain broadly negative.”
Health insurers set to hike prices, increasing costs for consumers – The Washington Post September 12, 2025
Wall Street Journal on importance of healthcare job growth: “America’s labor market has slowed markedly in recent months. If it weren’t for job gains in the health-services sector, it would barely be growing at all.
Health services, which include healthcare and social assistance, have long been an engine of U.S. job growth, bolstering the labor market through thick and thin…
Friday’s jobs report reinforced the trend, painting a picture of a sharply slowing labor market, with health services one of the few relatively bright spots. Indeed, absent gains in health-services employment in August, the private sector would have shed jobs last month.
So far in 2025, the economy has added an average of about 74,000 private-sector jobs a month, according to the Labor Department, a step down from last year’s average gain of about 130,000 jobs. Take away the roughly 64,000 jobs that health services have been adding each month, though, and the remainder of the private sector has been contributing only about 9,400 jobs a month.
Both healthcare and social assistance tend to add jobs steadily, even in economic downturns. Healthcare is something people spend money on even when they are cutting back elsewhere, and the healthcare needs of an aging population have contributed to the sector’s underlying growth. The same goes for the closely related social-assistance sector: A bit more than half of its 5.2 million jobs are in services such as home care for the elderly and disabled.
All told, there are now 23.5 million health-services jobs in the U.S., or about one in six private-sector jobs. That compares with 12.7 million manufacturing jobs, and 15.6 million jobs at retailers. Only the professional and business-services sector, a catchall category that includes everything from lawyers to security guards to telemarketers, comes close, with 22.5 million employees.”
Healthcare’s Steady Job Growth Is Keeping a Weakening Labor Market Afloat—but for How Long? – WSJ September 8, 2025
Derek Thompson on over-diagnosis in health system: “America is sicker than ever. That’s what the data say, anyway.
Psychological and psychiatric diagnoses have soared in the last few decades, including depression, anxiety, bipolar, PTSD, Tourette’s, migraines, and eating disorders. Since the 1990s, the number of children diagnosed with ADHD has increased by a factor of seven, and autism has grown by a factor of sixty…
What accounts for this across-the-board upsurge? Maybe we are being poisoned by modern life—its food, its chemicals, its screen time. Maybe doctors are getting better at seeing what was always in front of their noses….
There is a third possibility. Perhaps the rise in diagnoses isn’t just about more illness or more symptoms. It’s about more diagnosis. It’s about a modern culture that has expanded its definition of illness and now pathologizes behavior that we used to consider normal. For many Americans, perhaps, what we used to call forgetfulness is now labeled ADHD. What we used to call a lack of motivation is now labeled depression. What we used to call nervousness is now clinical social anxiety. What we used to call awkwardness is now labeled autism. In this telling, it’s not our biology or our psychology that has changed. It’s our words.
(12) Derek Thompson | Substack
AMA President Bobby Mukkamala on HHS new 21st Century Cures Act information blocking enforcement: Background, under the new policy announced last week, the HHS Office of Inspector General is authorized to impose civil monetary penalties of up to $1 million per violation against developers of electronic health records (EHRs), health information networks, and other actors that engage in information blocking:
“With decisive enforcement and AMA’s continued advocacy, information blocking can finally give way to the data liquidity patients deserve and physicians need. Once a tolerated industry practice, information blocking is now a target for real accountability. And that means better, faster, safer care for patients. Information blocking is not just a technical nuisance. It’s a direct threat to safe, coordinated, high-quality care. This enforcement framework is the clarity physicians and patients have been waiting for. We welcome this step and will work with HHS to ensure swift, even-handed enforcement that ends portal runarounds, reduces phone-and-fax scavenger hunts, and gets complete records into the EHR in time to support real-time decision making.”
AMA applauds HHS crackdown on information blocking; Violators beware | American Medical Association September 10, 2025
Rochelle Walensky on CDC Trustworthiness: “What I can say is the vaccine information on the CDC is not necessarily that of the subject matter experts or the CDC, but there’s a lot of other great information on this CDC website that I don’t believe has been tainted with as of yet…
What I will also say is that our medical societies — AAP, ACOG, the Infectious Disease Society of America, AMA — are putting out information…All of that used to be consistent with the CDC’s websites…Now it’s no longer. And the thing that has changed is not the societies. It’s what’s being posted on the CDC by our vaccine skeptics.”
Former CDC Director says be wary of vaccine info on CDC website | STAT
Economy
Projected Results of Medicaid Bill Provisions by 2034: Per UCSF research (Sanjay Basu, MD, PhD, Department of Medicine, University of California, San Francisco, 2021 Fillmore St, San Francisco, CA), the projected impact of the Big Beautiful Bill and other trends include:
- Medicaid coverage changes: -10.3 million
- Number of uninsured: 7.6 million
- Number of excess deaths: 1,484
- Number of preventable hospitalizations: 94,802
- Number of people delaying care due to cost: 1.6 million
- Number of rural hospitals at high risk of closure: 101
JAMA Health Forum, Projected Health System and Economic Impacts of 2025 Medicaid Policy Proposals, July 2025
BLS Jobs report revision: The U.S. economy probably added close to a million fewer jobs in 2024 and early 2025 than previously reported, the latest sign that the labor market, until recently a bright spot in the economy, may be weaker than it initially appeared.
The data released on Tuesday showed that employers added 911,000 fewer jobs in the 12 months through March than had been indicated in the monthly payroll figures. That implies the economy added only about 850,000 jobs during that time — half as many as previously reported.
Current Employment Statistics Preliminary Benchmark (National) Summary – 2025 A01 Results
Pitchbook on middle market strength: “The first half of 2025 underscored the resilience of the US middle market, which continues to distinguish itself from the broader PE landscape. Middle-market deal activity managed to defy the broader market deceleration, posting sequential growth in value and volume at $97.2 billion in Q2—a 4.9% gain QoQ and an 18.1% rise YoY. The tally of 978 closed or announced deals marks expansions of 6.1% QoQ and 39.1% YoY. Extrapolating these figures, the year is on track for $383 billion in total deal value and 3,829 transactions, an 11.8% YoY increase that potentially positions 2025 as the second-best year on record, trailing only 2021…Despite the challenges, there are bright spots. In the technology enabled services sector, demand for automation, data analytics, and cybersecurity solutions is driving growth. In healthcare, particularly behavioral health and outpatient services, demographic trends and reimbursement stability are fueling expansion. Clients are exploring roll-up strategies and platform investments with confidence. Construction and real estate services are also seeing renewed momentum, especially in regions benefiting from infrastructure spending and reshoring initiatives. Firms aligned with public private partnerships or green building trends are well positioned.”
Q2_2025_US_PE_Middle_Market_Report September 12, 2025
BLS: Healthcare job growth forecast: Projected employment growth by 2034:
- Nurse practitioners – 40%
- Medical and health services managers – 23%
- Physical therapist assistants – 22%
- Physician assistants – 20%
- Psychiatric technicians – 20%
- Ophthalmic medical technicians – 20%
- Occupational therapy assistants – 19%
- Hearing aid specialists – 18%
- Health specialties teachers, postsecondary – 17%
- Home health and personal care aides – 17%
- Nursing instructors and teachers, postsecondary – 17%
- Substance abuse, behavioral disorder and mental health counselors – 17%
Employers
Beckers on employer health costs for 2026: “Multiple surveys said employers are pointing to chronic and high-cost conditions, greater utilization and drug spending — particularly on GLP-1s — as factors in rising costs. “
- Mercer: The 2025 National Survey of Employer-Sponsored Health Plans found total health benefit costs per employee could increase 6.5% in 2026, marking the highest jump in 15 years. Employers estimated a 9% increase in plan cost before cost-reduction measures.
- Aon: The professional services firm projected employer healthcare costs would increase 9.5%, reaching over $17,000 per employee.
- Willis Towers Watson: The Wall Street Journal published WTW employer survey results predicting a 9.2% surge, indicating the fastest rate of increase since at least 2011.
- International Foundation of Employee Benefit Plans: The highest prediction is a 10% increase. Surveyed employers attributed this spike to catastrophic claims, costly drugs, utilization due to chronic conditions and medical provider costs.
The forces driving 2026 health insurance price hike forecasts – Becker’s Payer Issues | Payer News
KFF Analysis: small business benefit from marketplaces: Using data from the Current Population Survey (CPS) Annual Social and Economic Supplement, we estimate that 48% of adults under age 65 enrolled in individual market (direct purchase) coverage are either employed by a small business with fewer than 25 workers, self-employed entrepreneurs, or small business owners. In other words, about half of adult enrollees in the individual health insurance market – the vast majority of which is purchased through the ACA Marketplaces – is affiliated with a small business. For context, 16% of all adults under age 65 nationwide are employed by a small business or are self-employed…
The enhanced premium tax credits have lowered premium costs for enrollees across the Marketplaces. If those subsidies expire as scheduled at the end of 2025, individual market enrollees—including many people tied to small businesses—would face higher out-of-pocket premiums.”
Report: corporate healthcare tax strategy: “Seven large U.S. health care corporations have avoided paying over $34 billion in collective taxes because of Trump 1.0’s 2017 tax law that was recently extended under Republicans’ One Big Beautiful Bill, a new report from Community Catalyst and Americans for Tax Fairness finds. The analysis included CVS Health, Centene, Cigna, Elevance, Humana, HCA Healthcare, and Universal Health Services.
Those companies raised the average annual pay for their six highest-paid employees by 42% — almost $100 million — in the seven years since the law was enacted, the report said. Meanwhile, median worker pay increased by $14,000, or about 25%.
Hospitals
Kaufman Hall: Hospital performance: Latest report
- “Patient volumes and revenues are trending upward. However, bad debt and charity care continue to be elevated.
- Expense growth is outpacing revenue growth. Non-labor expenses continue to put pressure on hospitals.
- Margins have improved over prior years, though there has been some softening in recent months. Given an uncertain future outlook, many hospitals are taking steps to build long term resiliency.”
National Hospital Flash Report: July 2025 Data | Kaufman Hall
Insurers
Congressional action on prior authorizations: “Early Wednesday morning, House appropriators tacked on an amendment to the HHS funding bill that would block funding for CMS’s new pilot program requiring prior authorization for procedures under traditional Medicare plans…
The Trump administration has also sought to reform the process, with HHS in June securing commitments from major health insurers, including Aetna and UnitedHealthcare, to take a series of steps to speed up and streamline the prior authorization for patients enrolled in commercial coverage, Medicare Advantage and Medicaid managed care.”
Prior auth catches congressional heat – POLITICO
Physicians
Study: Physician Employment setting and costs: “Physician Practice Affiliation Drives Site of Care Cost Differentials: An Opportunity to Reduce Healthcare Expenditures,” Journal of Market Access & Health Policy. Researchers sought to examine the relationships among practice models, sites of care and cost of care for high-volume procedures in procedure-intensive specialties, across Medicare and private insurance payment.
“The result: site of care “contributes meaningfully” to health care costs, and costs are consistently higher in hospital-based settings. Prices were lower when services were provided by physicians remaining in independent practice with financial support from private equity (PE) investors, according to the study… facility fee payments from 2001 to 2021 have outpaced physicians’ practice expense, growing 60% over that time, compared with 11% for doctors’ professional fees…”
The study results showed hospital outpatient departments receive reimbursement from Medicare that is up to 861% of the reimbursement that ambulatory surgery centers or physician’s offices receive. Commercial insurance pays HOPDs as much as 1,346% of the reimbursement that ASCs or doctor’s offices receive.
Polling
LexisNexis study about provider directory use: Per the Ipsos survey of 3,014 U.S. adults conducted June 12 – June 18, 2025:
- 82% have used a healthcare directory.
- 33% of provider directory users have encountered outdated or incorrect information.
- 21% of provider directory users found it difficult to use a healthcare provider directory to find a provider.
- 49% said they use a healthcare provider directory to find a specialist.
- 58% of users report network coverage/participation as among the most important factors when selecting a provider, with 30% reporting it as the single most important factor.
- 56% of users report that ensuring the provider can deliver the specific type of care needed is among the most important factors when selecting a provider.
New Survey Reveals Healthcare Provider Directory Accuracy and Usability Hurdles
Prescription drugs
Bloomberg: Administration adds side-effects disclosure in drug ads: “The Trump administration announced a crackdown on pharmaceutical advertising on television and social media platforms, potentially disrupting billions of dollars in annual ad spending.
President Donald Trump signed a presidential memorandum on Tuesday that calls on federal health agencies to require pharmaceutical companies to disclose more side effects in their ads and enforce existing rules about misleading ads. The administration is pitching the moves as a way to increase transparency for patients.”
Trump Announces Crackdown on Drug Ads on TV, social media – Bloomberg
Stat: House spending bill includes MRNA research: “At their Tuesday markup, House GOP appropriators included an amendment to their HHS spending bill that would mandate research on messenger RNA vaccines, despite health secretary Robert F. Kennedy Jr.’s effort to roll back mRNA research funding…
In August, Kennedy announced that HHS’ Center for Biomedical Advanced Research and Development Authority would no longer support research related to mRNA vaccines, the technology used to develop Covid-19 shots. At the time, he said HHS would terminate $500 million in grants supporting development of mRNA vaccines.
On Tuesday, Republican appropriators included $1.1 billion for “advanced research and development” at BARDA — “including of mRNA vaccines.”
It’s at least the second time GOP appropriators have directly rebuffed Kennedy on spending prerogatives. “
Lawmakers snub Kennedy, include mRNA vaccine funding in spending bill
ICER Study: Efficacy of weight loss drugs: “All three drugs generally improved health-related quality of life, as well as metabolic risk factors such as blood pressure, blood glucose, and lipids. However, stopping semaglutide or tirzepatide appears to result in weight regain and regression of improvement in metabolic risk factors. Treatment with injectable semaglutide and tirzepatide have also been associated with improvements in obesity-related complications. Injectable semaglutide has been shown to improve outcomes in knee osteoarthritis, metabolic-associated steatohepatitis (MASH), and heart failure with preserved ejection fraction, as well as reduce the risk of diabetes and chronic kidney disease. Tirzepatide has been shown to reduce the risk of diabetes and improve symptoms of obstructive sleep apnea. The most common harms of both semaglutide and tirzepatide are gastrointestinal (GI) side effects, with around three-quarters of participants taking either injectable or oral semaglutide reporting GI side effects. For tirzepatide, 20-40% of participants reported nausea, diarrhea, or constipation in clinical trials. However, serious adverse events were uncommon, occurring in 3-7% of participants in the semaglutide trials and 4-7% in the tirzepatide trials. Finally, discontinuation due to adverse events was also less than 10% for all three drugs. Because treatment with all three drugs results in substantial weight loss and improvement in metabolic risk factors, we have high certainty that all three drugs have substantial net health benefit over lifestyle modifications alone (A) (Table ES1). There is less certainty about the relative effects of the drugs to each other, particularly for outcomes beyond weight loss (e.g., CV outcomes), and thus we have judged the comparison between tirzepatide and semaglutide as “promising but inconclusive” (P/I). Treatment with oral semaglutide results in slightly lower amounts of weight loss compared with injectable semaglutide, with uncertainty about the degree of CV benefit, and thus we judged oral semaglutide to be “comparable or worse” than injectable semaglutide (C-).
Semaglutide and Tirzepatide for Obesity: Effectiveness and Value ICER_Obesity_Draft-Report_For-Publication_090925.pdf
Public Health
CDC Mortality report for 2024: “In 2024, 3,072,039 deaths occurred in the United States. The age-adjusted death rate per 100,000 U.S. standard population was 844.8 for males and 613.5 for females. The overall rate, 722.0 per 100,000 population, was 3.8% lower than in 2023. The rate decreased for most age groups. Overall, age-adjusted death rates in 2024 were lowest for the multiracial non-Hispanic population (332.3 per 100,000 population) and highest for the Black non-Hispanic population (884.0). The leading causes of death were heart disease, cancer, and unintentional injury.” Note: Covid-19 was not among the top 10 causes of death in 2024.
Vital Statistics Rapid Release, Number 039 (September 2025)
Stat: House spending bill includes MRNA research: “At their Tuesday markup, House GOP appropriators included an amendment to their HHS spending bill that would mandate research on messenger RNA vaccines, despite health secretary Robert F. Kennedy Jr.’s effort to roll back mRNA research funding…
In August, Kennedy announced that HHS’ Center for Biomedical Advanced Research and Development Authority would no longer support research related to mRNA vaccines, the technology used to develop Covid-19 shots. At the time, he said HHS would terminate $500 million in grants supporting development of mRNA vaccines.
On Tuesday, Republican appropriators included $1.1 billion for “advanced research and development” at BARDA — “including of mRNA vaccines.”
It’s at least the second time GOP appropriators have directly rebuffed Kennedy on spending prerogatives. “
Lawmakers snub Kennedy, include mRNA vaccine funding in spending bill
Report: Falls increase among seniors: “Public health experts have warned of the perils of falls for older people for decades. In 2023, the most recent year of data from the Centers for Disease Control and Prevention, more than 41,000 Americans over 65 died from falls, an opinion article in JAMA Health Forum pointed out last month.
More startling than that figure, though, was another statistic: Fall-related mortality among older adults has been climbing sharply…Among those over 85, the cohort at highest risk, death rates from falls jumped to 339 per 100,000 in 2023, from 92 per 100,000 in 1990.
The culprit, in his view, is Americans’ reliance on prescription drugs….
The Beers Criteria, a directory of drugs often deemed inadvisable for older adults, recently published recommendations for alternative medications and nonpharmacological treatments for frequent problems. Cognitive behavioral therapy for sleeplessness. Exercise, physical therapy and psychological interventions for pain”
Why Are More Older People Dying After Falls? – The New York Times September 9, 2025
McKinsey on healthy aging: “Healthspan science, which focuses on biomedical innovations that target the biological aging process and contribute to healthy longevity, is a fast-growing field. The five-year average for investment quadrupled in the past decade, and clinical trial initiation has grown 27% over five years, leading to a pipeline of several hundred drug candidates. The field is expected to continue growing, but there is no consensus on when biomedical innovations that can meaningfully target fundamental aging processes are likely to emerge.”
Healthspan science may enable healthier lives for all | McKinsey
