A critical shift in U.S. vaccination policy is brewing as a group of advisers to the Centers for Disease Control and Prevention (CDC) prepares to vote on whether to scrap or delay the long-standing recommendation that every baby receive a hepatitis B vaccination within 24 hours of birth. This move, pushed by skeptics who question the universal benefit of the shot, could be the most consequential policy change since Health Secretary Robert F. Kennedy Jr. began remaking vaccine policy. The hepatitis B vaccine, universally recommended for newborns since the early 1990s, is credited with dramatically reducing acute hepatitis B infections in children by 99%. The virus, which can be transmitted from mother to baby during childbirth, is incurable and can lead to liver disease and early death. According to one review, the birth dose policy has prevented more than 6 million infections and nearly 1 million hospitalizations. Liver cancer in children has disappeared in some previously high-risk communities since 1995 due to widespread vaccination efforts. The Advisory Committee on Immunization Practices (ACIP), which is scheduled to meet on Thursday and Friday, recently underwent significant leadership changes, with members skeptical of vaccines being appointed, including new ACIP chair, pediatric cardiologist Dr. Kirk Milhoan. Milhoan argued that the decision to give newborns the vaccine should be based on a clinician’s assessment of the baby’s individual risk, such as whether the pregnant mother tested positive for the infection. He also cited the risk of neonatal fever associated with the "day one" shot, which can trigger additional medical interventions. However, mainstream medical experts and data strongly counter these concerns. Dr. Sean O’Leary, a spokesman for the American Academy of Pediatrics, stated that he has never seen a serious reaction or a fever associated with the hepatitis B vaccine after thousands of administered doses. Furthermore, a review of over 400 studies found no evidence  that the birth dose causes any short- or long-term health problems. Doctors warn that delaying the shot could revive deadly cases. Hepatitis B is highly infectious, capable of spreading through sexual contact, sharing drug paraphernalia, and even through microscopic amounts of blood or bodily fluids left on shared items like toothbrushes, razors, or toys. While the CDC recommends screening all pregnant people for the virus, up to 16% are not tested and may fall through the cracks. Experts emphasize that if the mother happens to be positive, waiting a month to vaccinate establishes the infection in the baby’s liver, making prevention too late. Without vaccination, 90% of babies exposed to the virus during birth develop chronic hepatitis. The ACIP’s recommendations hold significant weight, as they influence insurance coverage for vaccines. Furthermore, vaccine makers have expressed concerns that even small changes to the schedule could disrupt the U.S. supply of the hepatitis B vaccine, or combination vaccines, for a year or longer. Vaccine proponent Dr. William Schaffner advises expectant parents to talk to their doctors about the strong safety profile of the three-dose vaccine series, noting that the only common adverse events reported are minor fussiness and crying. Experts like Schaffner and O'Leary stress that the universal birth dose is the best way to prevent the establishment of this incurable infection. 🔖 Sources CDC advisers could reverse newborn hepatitis B vaccine recommendations Doctors warn delaying hepatitis B shot for newborns could revive a deadly threat US vaccine committee's hepatitis B changes would be most consequential yet Keywords: Hepatitis B Birth Dose Recommendation Hepatitis B Birth Dose Recommendation

A German man, often referred to as Berlin 2 (B2) and reported to be 60 years old, has become the seventh known patient worldwide to achieve long-term remission from HIV. This extraordinary development occurred six years after he received a stem cell transplant to treat an aggressive form of acute myeloid leukemia (cancer). The patient was first diagnosed with HIV in 2009 and developed leukemia in 2015. Following chemotherapy to wipe out most of his immune system, he received a full stem cell transplant later that year. In 2018, against medical advice, he stopped taking antiretroviral therapy (ART). Since that time, virus levels in his body have remained undetectable and may be nonexistent. While ART is the cornerstone of treatment for HIV, making life manageable and suppressing the virus’s progression, it does not eliminate the virus. HIV is a tenacious virus that attacks immune cells and can remain dormant within long-lived immune cells, forming latent reservoirs that are essentially invisible to the immune system and untouched by ART. If ART is stopped, the virus can re-emerge. Full stem cell transplants, however, have a proven record in depleting these reservoirs. In five of the seven documented cases of long-term HIV remission (including the original Berlin patient, London, Duesseldorf, New York, and City of Hope patients), the stem cell donors possessed two copies  (homozygous) of a rare mutation called CCR5 Δ32. This mutation breaks the CCR5 "keyhole" that HIV exploits to attach to and enter host cells, essentially preventing the virus from unlocking the door and depriving it of new places to hide. What makes B2's case a significant breakthrough is the characteristic of his donor. Unlike the majority of successful previous cases, B2 received donor stem cells containing only one copy  (heterozygous) of the CCR5 Δ32 mutation. B2 himself already had one inherited copy of the mutation. Previously, experts had assumed that homozygous donor cells (two copies) were essential for curing HIV. The success achieved with B2—who remains HIV-free three years after stopping ART—suggests that double copies of CCR5 Δ32 are not a requirement  for durable HIV remission after stem cell treatment. This shifts the focus away from relying on rare "unicorn donors" who carry two copies of the mutation. Researchers led by immunologist Christian Gaebler believe this result offers a tantalizing new path toward understanding other potential ways of curing HIV. The key may be mechanisms like the graft-versus-reservoir response —where the new donor cells recognize and wipe out remaining HIV hideouts—and sustained reduction of persistent reservoirs. This case, along with the sixth patient from Geneva whose donor completely lacked the CCR5 Δ32 allele, supports the idea that significant reductions of persistent reservoirs can lead to HIV cure independent of homozygous CCR5 Δ32-mediated viral resistance. These mechanisms may be achievable through pharmaceutical treatments and gene editing, and research is already underway to that effect. The success of the stem cell procedure underscores the critical importance of modulating and potentially eliminating the HIV reservoir in strategies aimed at long-term remission and cure. The findings for the Berlin patient (B2) were published in the journal Nature . 🔖 Sources 7th HIV Remission Raises Hope of Long-Lasting Treatment For More People Another HIV Patient Goes Into Remission After Cancer Treatment Keywords: Long-Term HIV Remission Breakthrough   Long-Term HIV Remission Breakthrough

Image Credit: People.com . Fair Use. S eason 21 of Grey’s Anatomy  pushed the boundaries of surgical innovation while revisiting classic, high-stakes trauma. From awake kidney transplants to groundbreaking osseointegration for amputees, the medicine was as cutting-edge as ever. The season also tackled deeply personal medical crises for the staff, including a pregnancy complication for Jo Wilson and Catherine Fox's battle with cancer complications. Below is a comprehensive, episode-by-episode review of the medical cases, diagnoses, and treatments presented in Season 21. Content ⁉️ 1️⃣ Episode 1 2️⃣ Episode 2 3️⃣ Episode 3 4️⃣ Episode 4 5️⃣ Episode 5 6️⃣ Episode 6 7️⃣ Episode 7 8️⃣ Episode 8 9️⃣ Episode 9 🔟 Episode 10 1️⃣1️⃣ Episode 11 1️⃣2️⃣ Episode 12 1️⃣3️⃣ Episode 13 1️⃣4️⃣ Episode 14 1️⃣5️⃣ Episode 15 1️⃣6️⃣ Episode 16 1️⃣7️⃣ Episode 17 1️⃣8️⃣ Episode 18 🔖 Key Takeaways Episode 1 Severe Chest Trauma from Vehicular Crash C harlie Scott. A driver struck by falling bungee jumpers suffered catastrophic blunt trauma, including a displaced clavicle fracture and bilateral hemophoresis. Progression:  Hypotension and tachycardia indicated massive internal bleeding. Emergency surgery revealed venous bleeding from the subclavian vein , injured by the clavicle fracture. Treatment:  A subclavian incision allowed for vascular repair. However, his severed index finger could not be reattached due to ischemia time. Expanding Neck Hematoma and Airway Compromise Wanda Gallagher. A protestor on Warfarin for DVT suffered blunt neck trauma. She disappeared into the hospital ceiling, where she developed acute respiratory distress. Diagnosis:  An expanding neck hematoma compromised her airway. Treatment:  An emergency decompression was performed in the ceiling to secure the airway, followed by formal neck exploration and ligation in the OR. Subacute Budd-Chiari Syndrome Catherine Fox. Catherine Fox, battling cancer, collapsed due to Subacute Budd-Chiari Syndrome —a clot in the hepatic vein and IVC caused by her hypercoagulable state. Treatment:  She refused invasive procedures like TIPS, opting for heparin anticoagulation to preserve her quality of life. Other Medical Conditions Discussed Bilateral Hemophoresis:  Blood in both sides of the chest. Alzheimer's Research:  Ongoing studies mentioned. Episode 2 Diffuse Intrinsic Pontine Glioma (DIPG) and Li-Fraumeni Syndrome C al Huang. A teen with Li-Fraumeni Syndrome  (genetic cancer predisposition) presented with back pain. Imaging found a thoracic schwannoma compressing the spinal cord. Progression:  After successful tumor removal, he suffered a medical event. Scans revealed a new, fatal diagnosis: DIPG , an aggressive brainstem tumor with a terminal prognosis. Aorto-Esophageal Fistula Nora Young. A patient with a prior esophageal perforation from a Nissen fundoplication suffered massive hematemesis (vomiting blood). Diagnosis:  An aorto-esophageal fistula , a life-threatening connection between the aorta and esophagus. Treatment:  A Minnesota tube halted bleeding temporarily. Definitive repair involved a TEVAR  (thoracic endovascular aortic repair) stent graft. Hepatic Lesions (Benign vs. Malignant) Catherine Fox. Follow-up scans showed liver lesions. While metastasis was feared, Dr. Bailey pushed for a biopsy to rule out benign causes like hemangiomas or fatty changes from Budd-Chiari syndrome. Other Medical Conditions Discussed Adrenocortical Carcinoma:  A previous cancer in the Li-Fraumeni patient. Thoracic Schwannoma:  A benign tumor compressing the cord. Episode 3 Hemangioblastoma in Pregnancy R hiannon Fletcher. A pregnant surrogate developed a thoracic hemangioblastoma . Pregnancy hormones accelerated its growth, threatening paralysis. Treatment:  Despite high risks, neurosurgery removed the tumor to save the patient's mobility and the pregnancy. Emergency TIPS Procedure Catherine Fox. During a liver biopsy, Catherine suffered esophageal hemorrhage. Treatment:  An emergency TIPS procedure  (shunt) was performed to stop the bleeding and prevent liver failure. Awake Kidney Transplant Tom Costello. A scrub nurse underwent a kidney transplant  under spinal anesthesia without general anesthesia. This "awake" surgery aimed to speed recovery. Other Medical Conditions Discussed Hepatitis C:  Research mentioned regarding viral "masking." Congestive Heart Failure:  A patient with low ejection fraction. Episode 4 Rectal Cancer and Ovarian Transposition C hloe Yasuda. Intern Mika Yasuda’s sister was diagnosed with Stage 3B rectal cancer . To preserve fertility before radiation, she underwent Ovarian Transposition , moving the ovaries out of the radiation field. Necrotizing Fasciitis (Post-BBL) Judith Dunn. A patient with diabetes and a recent Brazilian Butt Lift (BBL)  suffered a thigh laceration that rapidly progressed to Necrotizing Fasciitis . Treatment:  Emergency debridement of the glute and thigh was required to stop the spread of infection. Multi-Drug Resistant Pneumonia (ECMO) Darren Riley. A patient with pulmonary fibrosis developed severe pneumonia. He failed conventional ventilation and was placed on VV ECMO  to oxygenate his blood. Other Medical Conditions Discussed Hip Joint Effusion:  A differential for hip pain. Sepsis:  A complication of the necrotizing infection. Episode 5 Necrotizing Pneumonia (Pneumonectomy) D arren Riley. The pneumonia patient (Ep 4) developed lung necrosis ("liquified lung"). Treatment:  A total pneumonectomy  (removal of the lung) was performed. He remained on ECMO as a bridge to transplant. Avascular Necrosis (Sickle Cell Disease) Zayne Johnson. A patient with Sickle Cell Disease presented with hip pain due to Avascular Necrosis  (bone death). He underwent a total hip replacement. Organophosphate Poisoning Ofelia Lopez. A pediatric trauma patient exposed to farm pesticides developed organophosphate poisoning  (bradycardia, pinpoint pupils). She was treated with atropine. Surgical Innovation:  A temporary vascular shunt using IV tubing was placed in-flight to save her leg from ischemia. Cardiac Tamponade (Post-Op) Aurelio Wheeler. A post-cardiac surgery patient developed cardiac tamponade  (fluid compressing the heart). An emergency bedside procedure relieved the pressure. Other Medical Conditions Discussed Triplets:  High-risk pregnancy mentioned. Nonfunctional Spleen:  A consequence of Sickle Cell Disease. Episode 6 Metastatic Adenocarcinoma M r. Jiménez. An incarcerated patient evaluated for TB was found to have widespread metastatic adenocarcinoma . The cancer was inoperable, and he transitioned to palliative care. Osseointegration for Amputation Misty Valentine. A teen amputee suffered socket pain. Dr. Lincoln performed osseointegration , implanting a titanium rod directly into the femur for prosthetic attachment. Targeted Muscle Reinnervation (TMR)  was also performed to reduce phantom pain. Upper GI Bleed (Stress Ulcer) Dorian. A long-term ICU patient developed a stress ulcer causing a massive GI bleed. It was treated endoscopically with epinephrine and clips. Other Medical Conditions Discussed Phantom Pain:  Neurological pain in a missing limb. Necrotizing Enterocolitis:  Mentioned as a cause of death in a NICU patient. Episode 7 HELLP Syndrome and Eclampsia L auren Ferguson. A pregnant patient progressed to eclampsia and HELLP Syndrome . During a crash C-section, she developed a ruptured liver hematoma and DIC , requiring a hysterectomy and massive transfusion. Arnold-Chiari Malformation Gillian Mendelson. A trauma patient’s headache was relieved by yelling. This led to the diagnosis of Arnold-Chiari Malformation  (brain tissue extending into the spinal canal). Enterocutaneous Fistula Dorian Cardenas. Dorian developed an enterocutaneous fistula  (leakage from bowel to skin), requiring NPO status and eventual surgical repair. Other Medical Conditions Discussed Uterine Atony:  A cause of postpartum hemorrhage. Episode 8 Frozen Abdomen and STEP Procedure D orian Cardenas. During fistula repair, Dorian was found to have a "frozen abdomen" (massive scar tissue). Resection would cause Short Bowel Syndrome . Treatment:  Surgeons performed a Serial Transverse Enteroplasty (STEP)  to lengthen the bowel and improve absorption. Neurofibroma Caroline Early. A teen's knee lump was identified as a neurofibroma  on the nerve sheath, requiring careful neurosurgical excision. Other Medical Conditions Discussed Cystic Fibrosis:  Mentioned in a teen patient. Tension Pneumothorax:  A trauma complication. Episode 9 Domino Heart Transplant M ason Peterson & Brady Hauser. A rare "domino transplant" was performed. Patient 1 (Mason):  Had pulmonary hypertension. He received a heart-lung block. Patient 2 (Brady):  Received Mason's native heart, which was healthy but maladapted to Mason's lung pressures. Treatment:  Brady required complex SVC reconstruction to accept the new heart. Other Medical Conditions Discussed Chronic Rejection:  The cause of Brady's heart failure. Episode 10 Ruptured Abdominal Aortic Aneurysm (AAA) G arrett. A patient’s elective AAA repair was cancelled due to a wildfire influx. The aneurysm ruptured, and despite emergency surgery, the repair failed, leading to fatal hemorrhage. SMA Avulsion (Crush Injury) Theo Ruiz. A firefighter suffered a crush injury that avulsed the Superior Mesenteric Artery (SMA) . Dr. Altman performed a vascular reconstruction with a saphenous vein graft to save the bowel and life. Other Medical Conditions Discussed Biliary Atresia:  A pediatric surgery case. Smoke Inhalation:  Treated in wildfire victims. Episode 11 Split Liver Transplant T asha Lawson & Lisa Saito. Two patients needed a liver: Tasha (PSC/Alzheimer's) and Lisa (Acetaminophen toxicity). Solution:  A split liver transplant  gave Tasha the larger portion and Lisa the smaller portion as a bridge to recovery. Temporal Lobe Epilepsy Molly. A patient with Temporal Lobe Epilepsy  underwent Deep Brain Stimulation (DBS). Experimental memory retrieval surgery was performed simultaneously. Other Medical Conditions Discussed Acetaminophen Hepatotoxicity:  Liver failure from overdose. Episode 12 Carcinoid Syndrome M elissa Walker. A patient with flushing and diarrhea post-cholecystectomy was diagnosed with Carcinoid Syndrome  from a neuroendocrine tumor on the appendix. She underwent an appendectomy. Pectus Excavatum (Nuss Procedure) Carlos Navarro. A teen underwent a modified Nuss procedure  to correct a sunken chest. Complication:  A needle puncture to the heart required a pericardial window. Other Medical Conditions Discussed Alzheimer's Research:  Research into the gut microbiome connection continued. Episode 13 Achalasia with Megaesophagus in Pregnancy L iz. A pregnant patient with severe indigestion was found to have Achalasia  (esophagus fails to relax) causing food impaction. Treatment:  Esophageal disimpaction and Botox injection into the sphincter. Other Medical Conditions Discussed PTLD:  Post-transplant lymphoproliferative disorder. Episode 14 Pancreatic Adenocarcinoma (Vascular Reconstruction) G abby Mims. A patient with a pancreatic tumor encasing the SMA underwent resection. Innovation:  The SMA was reconstructed using a saphenous vein graft to allow tumor removal. Penetrating Aortic Injury Brendon Browning. A patient impaled by an ice pick suffered a fatal aortic injury when the object moved. Tibia Malunion Jack Moss. A patient with a malunited fracture and vascular kink underwent osteotomy and bypass to save the leg. Other Medical Conditions Discussed Mesothelioma:  Treated with HIPEC. Episode 15 Transverse Vaginal Septum N avy Sutherland. A teen with abdominal pain and amenorrhea was diagnosed with a Transverse Vaginal Septum  trapping menstrual blood (hematometra). Treatment:  A laparoscopic incision drained the blood, avoiding external drains. Carotid Artery Laceration Beau Caraway. A window washer suffered a carotid artery laceration . During repair, a clot formed, requiring a thrombectomy. Other Medical Conditions Discussed Mesenteric Tear:  Repaired via laparoscopy. Episode 16 Deep Infiltrative Endometriosis (DIE) M ariana. A patient with severe pain had Deep Infiltrative Endometriosis  invading the pubic bone. Treatment:  Multidisciplinary excision involving shaving the bone and removing pelvic lesions. Brain Stem Cavernous Angioma Dylan Gatlin. A child had a cavernous angioma  in the brain stem. Innovation:  Using DTI mapping ("trail map"), Dr. Shepherd resected the lesion. However, the patient woke up with Locked-In Syndrome. Other Medical Conditions Discussed Lung Herniation:  A rare chest wall injury. Episode 17 Locked-In Syndrome D ylan Gatlin. Post-op from the angioma resection, Dylan developed Locked-In Syndrome  due to a hematoma. Conservative management failed, necessitating re-operation. Infected Aortic Graft Nora Young. Nora (Ep 2) returned with an infected graft and aortoenteric fistula . An ax-fem bypass failed due to hypercoagulability, leaving no surgical options. Toxic Megacolon (C. diff) Deb. Antibiotic use led to C. diff  colitis and Toxic Megacolon . The colon perforated, requiring an emergency colectomy. Other Medical Conditions Discussed Hypercoagulopathy:  Complicating vascular repairs. Episode 18 Experimental Aortic Reconstruction N ora Young. With no other options, surgeons performed a "Hail Mary" procedure to build a new aorta from a synthetic graft, diverting blood flow away from the infection. Post-Op Coagulopathy Dylan Gatlin. During re-operation for the brain stem hematoma, Dylan developed coagulopathy . FFP was used to control bleeding and successfully close. Shattered Liver Carter Samuels. A trauma patient re-bled in the ICU. Surgeons performed a bedside exploratory laparotomy to control mesenteric bleeding. Other Medical Conditions Discussed Acidosis:  A sign of physiological decompensation. 🔖 Key Takeaways 🗝️ Surgical Firsts:  Season 21 showcased advanced procedures like the Awake Kidney Transplant  and Osseointegration  for amputees, highlighting trends toward faster recovery and better quality of life. 🗝️ Complex Oncology:  The show explored the surgical management of complex cancers, from Ovarian Transposition  to preserve fertility to vascular reconstruction  for pancreatic tumors. 🗝️ Trauma Innovation:  The use of REBOA  and bedside laparotomies  in the ICU demonstrated the evolving nature of critical care trauma management. 🗝️ Rare Diagnoses:  Conditions like Achalasia , Moebius Syndrome , and Situs Inversus  provided unique diagnostic challenges. 🗝️ Neuro-Navigation:  The use of DTI mapping  in brain stem surgery illustrated the intersection of technology and neurosurgery. Keywords: Medical Diagnoses Grey's Anatomy Season 21 Medical Diagnoses Grey's Anatomy Season 21

S imulation training is actively reimagining nursing education  across North Carolina and nationwide, moving beyond traditional methods to provide critical hands-on experience for future and current healthcare professionals. At UNC-Chapel Hill , the School of Nursing, in collaboration with UNC Medical Center and UNC Health Rex, launched a program utilizing actors and realistic scenarios to better address workplace violence . While prevention and de-escalation are taught in the classroom, hands-on experience is necessary to solidify these skills. Workplace violence has historically been minimized, often viewed as simply "part of the job". However, a 2023 survey revealed that eight in ten nurses experienced at least one type of workplace violence within the past year. This problem severely impacts retention and leads to burnout. The grant-funded UNC-CH program, which utilizes a low-budget classroom setting with human actors, includes scenarios depicting verbal abuse, patient escalation due to feeling unheard, and co-worker bullying. The interactive "tag team" approach ensures engagement, as students can be tagged into the scenario or write suggestions for the director to incorporate. Although the training can be emotionally triggering, positive feedback indicates its extreme value and potential to translate directly into practice. Administrators are highly interested in continuing and expanding the program, which could help address North Carolina’s projected nursing shortage. Meanwhile, Duke University’s  School of Nursing is incorporating advanced technology to enhance empathy and specialized care training. The Center for Nursing Discovery (CND), led by Nikki Petsas Blodgett, utilizes Virtual Reality (VR)  headsets to allow students to embody the patient, such as an older adult experiencing blurred vision, decreased hearing, or hallucinations. This immersion provides a powerful experience of being "left out of the healthcare decisions". The CND also employs hologram machines , allowing students to interact with full-scale, remote patient holograms—often based on common patient types from PACE providers—to practice observing body language and asking questions related to the "Four M’s": mentation, medication, mobility, and what matters. Both the VR and hologram trainings are supported by the NU-AGE-SIM grant, focused on improving care for medically underserved older adults facing behavioral and mental health challenges. Students and alumni from both UNC-CH and ECU praise simulation training for offering a safe environment to learn and make mistakes without fearing impact on an actual patient. 🔖 Sources 'Using theater to teach nurses:' Simulation training is shaping the future of nursing education Simulation Technology is Helping Reimagine Nursing Education Keywords: Simulation Training Nursing Simulation Training Nursing

T he landscape of obesity treatment is undergoing a transformation as popular GLP-1 drugs, originally developed for diabetes, become more accessible and affordable. On the financial front, an agreement between the Trump administration and two major drugmakers, Eli Lilly and Novo Nordisk, is set to drastically reduce the cost of these medications for millions of Americans enrolled in Medicare and Medicaid, as well as for cash buyers. While current injectable versions can retail for up to 1,000permonth,oralversionsbeingdevelopedareexpectedtorangefrom∗∗149 to $350 a month** if approved by the FDA, potentially expanding access significantly. However, experts stress that increased access must be paired with clinical clarity and a comprehensive treatment strategy, as obesity is a chronic, multifactorial disease, not merely a failure of willpower. Lia Gass Rodriguez, MD, Chief Medical Officer at CVS Healthspire Payor Solutions, noted that despite the clinical benefits, these drugs remain "egregiously priced," which creates access challenges. Currently, only 29% of commercial health plan members have coverage for GLP-1s for obesity. A key concern raised by University of Virginia associate professor Siddhartha Angadi is that weight loss is not synonymous with good health . Angadi, a cardiovascular exercise physiologist, emphasizes that there is limited information regarding the long-term effects of taking medications like semaglutide and tirzepatide. Furthermore, data indicates that the weight often returns once patients discontinue the medication, underscoring the need to view these drugs as "for life". A critical finding in recent research co-written by Angadi highlights the risk to muscle mass. Approximately 40% of the weight people lose when using drugs like Wegovy or Zepbound comes from fat-free mass (everything in the body that is not fat), and up to 50% of that non-fat mass can be muscle . This raises serious questions about long-term issues related to aging, frailty, and fitness. Angadi noted the importance of physical activity and strength training, stating that an individual who is obese but fit has half the risk of death  compared to someone who is normal weight but unfit. This clinical complexity demands that pharmacotherapy be paired with structured lifestyle interventions. Dr. Rodriguez made a strong case for this integrated approach, citing CVS’ own program data. Individuals who combine medication with support, such as registered dietitian-led medical nutrition therapy, have shown remarkable results, with some achieving weight loss exceeding 18%. Critically, those who discontinued the drug but remained engaged with dieticians for at least six months retained 90% of the weight they lost . Leaders are urged to view GLP-1s not as "silver bullets," but as one vital component of a broader, evidence-based strategy that prioritizes sustained behavior change and clinical integration. 🔖 Sources GLP-1s and the future of obesity care: 4 takeaways on coverage, cost + clinical clarity As GLP-1 drugs go mainstream, this expert says health is more than a number on a scale Keywords: Obesity Drug Access  Obesity Drug Access

T he pharmaceutical landscape is experiencing a profound transformation, driven by artificial intelligence (AI) both accelerating the pace of developing novel therapies and modernizing the oversight of regulated products. News this week highlighted a significant preclinical triumph facilitated by generative AI, coupled with a major regulatory modernization effort by the US Food and Drug Administration ( FDA ). Insilico Medicine, a clinical-stage company specializing in generative AI Drug Discovery , announced promising preclinical results for its new AI-designed cancer immunotherapy candidate, ISM3830 . This compound is designed as a potential best-in-class, orally available, and highly selective CBLB Inhibitor , built on a novel scaffold identified using Insilico’s proprietary AI platform. The target, CBLB (Casitas B-lineage lymphoma-b), functions as an intracellular checkpoint and a key negative regulator of T-cell and natural killer (NK) cell activation. CBLB is highly expressed in multiple immune cell subsets and various cancers, making it a particularly promising immunotherapy target. By inhibiting CBLB, ISM3830  has demonstrated a strong potential to modulate immune tolerance, enhance T-cell and NK-cell activity, and even restore function in exhausted T cells. Dr. Feng Ren, co-CEO and CSO of Insilico Medicine, emphasized that the fundamental mechanism of CBLB inhibition supports indications with low response or resistance to current immune checkpoint inhibitors—an area of significant unmet need. The company’s generative AI Drug Discovery  platform was crucial to this success, overcoming traditional bottlenecks related to metabolism and absorption that have previously hindered CBLB inhibition therapies. The platform deployed over 40 generative AI models, utilizing Chemistry42 and its ADMET predictor module to design and optimize the candidate compound. Preclinical studies in mouse models revealed robust anti-tumour efficacy  and evidence of long-term tumor immunity in CT26 rechallenge experiments. Furthermore, the compound demonstrated favorable druggability and ADME/PK characteristics in vitro  and in vivo , alongside low risks of hypotension, gastrointestinal toxicity, and off-target toxicity. This milestone contributes to Insilico's growing pipeline, which has nominated 23 preclinical candidates since 2021, following the June report of the first clinical proof-of-concept for an AI-discovered drug, Rentosertib. This advancement is part of a broader trend, with a drug explicitly "engineered with AI" recently reaching Phase 3 testing, marking a key innovation milestone. Meanwhile, the US regulator is dramatically expanding its internal use of technology. The FDA  announced on December 1, 2025, the deployment of Agentic AI  capabilities for agency staff. Agentic AI  systems are advanced AI models designed for planning, reasoning, and executing multi-step actions autonomously, following built-in guidelines. This new deployment is intended to help staff create more complex AI workflows and harness AI models to achieve operational efficiency. While voluntary for staff, the Agentic AI  systems will assist with complex functions such as pre-market reviews, post-market surveillance, inspections, compliance, and administrative tasks. Jeremy Walsh, the FDA’s Chief AI Officer, stated that Agentic AI  will provide a powerful tool to streamline work and help ensure the safety and efficacy of regulated products. This follows the successful June 2025 launch of Elsa, a generative AI tool (LLM) already used by staff to accelerate clinical protocol reviews and scientific evaluations. Crucially, both the Elsa tool and the new Agentic AI  models are securely built within high-security GovCloud environments and are designed not  to train on input data or submitted regulatory industry data, thus safeguarding sensitive research. Commissioner Marty Makary, MD, MPH, stressed that this modernization helps the agency "radically improve our ability to accelerate more cures and meaningful treatments". This dual evolution—accelerated AI Drug Discovery  and streamlined regulation through Agentic AI —signals a mature integration of technology across the entire healthcare ecosystem.powerful tool to streamline work and help ensure the safety and efficacy of regulated products. This modernization drive is aimed at accelerating "more cures and meaningful treatments". 🔖 Sources A drug that was ‘engineered with AI’ enters Phase 3 testing AI powers discovery of new CBLB inhibitor ISM3830 FDA doubles down on its push into AI FDA Deploys Agentic AI Capabilities for Agency Staff Keywords: AI Drug Discovery AI Drug Discovery

T he third quarter of 2025 delivered a powerful signal of recovery across the healthcare sector, as five major U.S. health systems reported successfully driving their Operating Margins  back into the black for the period ending September 30. This marks a crucial continuation of a Financial Turnaround  following significant operating losses recorded during the same quarter last year. The systems reporting positive Q3 2025  operating income include: • Community Health Systems  achieved the largest operational success with an income of $243 million  (7.9% operating margin), dramatically reversing a $205 million operating loss (-6.6% margin) from Q3 2024. • Kaiser Permanente  posted an operating income of $218 million  (0.7% margin), up substantially from a $608 million operating loss (-2.1% margin) the year prior. • Providence  reported an operating income of $21 million  (0.3% margin), improving by $229 million compared to their $208 million operating loss (-2.7% margin) in Q3 2024. • UPMC  recorded an operating income of $45.6 million  (0.5% margin), rebounding from a $57.6 million operating loss (-0.7% margin). • Allegheny Health Network  also moved into profitability, reporting an operating income of $7 million  (0.5% margin), up from a $30.9 million operating loss (-2.4% margin) last year. For Providence, a 51-hospital nonprofit system, achieving this profit marks a milestone in its multiyear effort to reach a "breakeven financial sustainability goal". The improvement in Health Systems Finances  was attributed to higher patient volumes and improved pay rates. Operating revenues rose about 6% year over year (excluding divestitures) to $8 billion. Growth was robust, with inpatient admissions increasing 5% and case mix-adjusted admissions up 4%. Crucially, operating expenses were managed tightly, rising only 3% despite costs associated with serving higher patient volumes. The system noted substantial labor productivity improvements, including a 33% reduction in contract labor costs  year over year. These reductions stem from decisive actions such as paused hiring, departmental consolidations, and restructuring efforts that involved laying off approximately 600 full-time equivalent positions, primarily in administrative roles. Despite the strong quarterly performance, executive leaders, including Providence CFO Greg Hoffman, cautioned that significant challenges persist. Supply costs remain a pain point, rising 8% year over year, driven by increases in pharmaceutical and medical supplies. Furthermore, the anticipated passage of H.R.1 (the One Big Beautiful Bill Act), which is expected to cut federal Medicaid spending by almost $1 trillion over a decade, reinforces the urgency of transformation across the healthcare sector. Providence is adapting by planning investments in Artificial Intelligence-powered tools  to better predict and schedule demand for high-acuity procedures and length-of-stay initiatives, while also continuing efforts to reduce payer delays and denials. The collective return to profitability across these major systems suggests the sector has navigated a difficult stabilization phase. However, external financial pressures, particularly legislative changes like H.R.1, loom like dark clouds on the horizon, signaling that sustained financial turnaround relies on continued, disciplined operational adaptation. 🔖 Sources Kaiser, Providence and more: 5 systems back in the black in Q3 Providence Health Returns to Profit in Q3 Amid Ongoing Sector Challenges Providence’s financial turnaround plan delivers results in Q3 Providence reports positive Q3 2025 results Keywords: Health Systems Finances Health Systems Finances

Image credit: MSN. Fair use. R yan Murphy, the creator of the successful FX drama series Nip/Tuck , believes his show acted as a catalyst in changing how cosmetic procedures are discussed and viewed in society. During an appearance at New York Comic Con, Murphy offered a compelling reflection on what he termed an "evolution" in societal attitudes toward physical enhancement. Murphy highlighted the profound difference between the era of Nip/Tuck  (2003 to 2010) and today. When the show debuted, he was "amazed at how taboo it was to talk about" plastic surgery. At that time, people who underwent procedures would appear in public and "acted like nothing had changed," upholding a culture of mandated concealment. This pervasive need for secrecy has now largely diminished, leading Murphy to assert that physical alteration has transitioned from a source of shame to "kind of a new status symbol, in a weird way". Content ⁉️ 1️⃣ The Era of Secrecy: The Grip of the Plastic Surgery Taboo 2️⃣ The Evolution of Acceptance: Flaunting the Status Symbol 3️⃣ Expanding the Definition of Enhancement 4️⃣ The Cautionary Future: Murphy’s The Beauty 🔖 Key Takeaways Image credit: Vulture / Nip/Tuck . Fair use. The Era of Secrecy: The Grip of the Plastic Surgery Taboo T he cultural environment of the early 2000s, when Nip/Tuck  was created, was strictly defined by the need for concealment regarding aesthetic modifications. Murphy recalled that plastic surgery was "taboo". The expected social protocol for anyone who changed their body was to return to public life and pretend the enhancement had never occurred. This cultural judgment maintained a strong plastic surgery taboo , forcing those seeking physical perfection to operate in secrecy. Nip/Tuck's Catalyst: Exposing the Forbidden Nip/Tuck  was a drama series centered on the professional and personal lives of two plastic surgeons, Julian McMahon  (who died in July) and Dylan Walsh . The show, which aired for six seasons, featured "graphic depictions of plastic surgery procedures" on the fictional company’s clientele and also followed the complicated lives of the doctors. By airing these unflinching depictions and ethical dilemmas, Nip/Tuck  helped challenge the prevailing social norms. The series received significant recognition for its impact, winning a Golden Globe for Best Television Series—Drama in January 2005 and an Emmy for Outstanding Prosthetic Makeup in September 2004. Murphy believes the show helped pioneer a culture of vocal transparency around surgical enhancements. The Evolution of Acceptance: Flaunting the Status Symbol M urphy’s current assessment of the culture indicates a dramatic shift toward openness. He notes that today, people "sort of flaunt it more and are talking about it," calling this change an "evolution in some strange way". Crucially, Murphy links this increasing transparency to a significant decrease in social condemnation. He told the Comic Con audience that "with every passing month, there seems to be less and less and less and less judgment about Semaglutides and plastic surgery". Semaglutides are noted as medications used to treat type 2 diabetes and for chronic weight management. This profound reduction in stigma has fundamentally redefined the meaning of cosmetic procedures. Murphy states that physical alteration is now "kind of a new status symbol, in a weird way". Image credit: Vulture / Nip/Tuck . Fair use. Expanding the Definition of Enhancement T he sources support the idea that the breakdown of the plastic surgery taboo  has broadened cultural acceptance to include pharmaceutical interventions. The diminishing judgment around medications like Semaglutides suggests that highly effective, non-surgical options are also becoming normalized. This acceptance is echoed by prominent figures within the cosmetic industry. Dr. Terry Dubrow, known for the series Botched , has argued that Ozempic-type drugs are not just "the new Botox" but are actually "better," equating their positive effects to major surgical procedures such as breast augmentation, liposuction, and facelifts. Furthermore, public figures are actively contributing to the new culture of openness. Jenny McCarthy spoke candidly about her decision to undergo AirSculpt procedures, clarifying that the choice was "100 percent not about the weight" and stating that she does not "even own a scale". This willingness to openly discuss specific procedures and motivations moves away from the secretive euphemisms that characterized the pre- Nip/Tuck  era. The Cautionary Future: Murphy’s The Beauty R yan Murphy is set to continue his thematic exploration of physical appearance and perfection with his upcoming TV series, The Beauty . The show, which will premiere in January or 2026, is based on a comic about a sexually transmitted disease (STD). The premise of The Beauty  offers a darker perspective on the pursuit of aesthetic ideals. The comic, created by Image Comics, details a world where physical perfection is widespread because the "vast majority of the population has taken advantage of it," but Detectives Foster and Vaughn discover that this perfection "comes at a terrible price". The show is described as following a sexually transmitted virus that "makes those affected more beautiful, but with deadly consequences". The series, which stars Ashton Kutcher , Evan Peters , Anthony Ramos , and Jeremy Pope  (along with Rebecca Hall), will blend "really heightened genres," including "amazing action sequences," significant "body horror," a "great love story," and a "great buddy-comedy thing going on," all rooted in the source material. This upcoming project suggests Murphy is examining the potential ultimate cost of relentlessly chasing aesthetic supremacy in a world where the plastic surgery taboo  has crumbled. 🔖 Key Takeaways 🗝️ The Taboo Ended:  Ryan Murphy credits his series Nip/Tuck  (2003–2010) with helping to dismantle the cultural plastic surgery taboo  that required individuals to conceal their procedures. 🗝️ From Secrecy to Visibility:  The culture has shifted from people acting "like nothing had changed" to now "flaunt[ing] it more and are talking about it". 🗝️ New Status Symbol:  The diminishing social judgment concerning both cosmetic surgery and Semaglutides has led Murphy to describe physical enhancement as "kind of a new status symbol, in a weird way". 🗝️ Broader Acceptance:  Expert commentary supports this trend, with Dr. Terry Dubrow calling Ozempic-type drugs "better" than Botox and comparing them to major surgical enhancements. 🗝️ The Price of Perfection:  Murphy's new series, The Beauty , continues to explore these themes by presenting a fictional beauty-enhancing STD that has "deadly consequences," raising questions about the final cost of aesthetic perfection. 🌐 External sources Ryan Murphy Says Plastic Surgery Was 'Taboo' When He Made Nip/Tuck, but Now 'People Flaunt It More' Ryan Murphy Credits ‘Nip/Tuck’ for Making Plastic Surgery Less ‘Taboo’: ‘People Flaunt It More’ Ryan Murphy recalls era when talking plastic surgery was forbidden Keywords: Plastic Surgery Taboo Plastic Surgery Taboo

Image credit: Entertainment Daily / Call the Midwife . Fair use. T he beloved period drama Call the Midwife  is gearing up to deliver its most anticipated festive offering yet: the 2025 Christmas Special. Scheduled to premiere on December 25th on PBS and BBC One, this long-awaited holiday event promises spectacle, humor, and high drama. For fans eagerly awaiting the return of the Nonnatus House team, this special is not just a single episode but a two-episode holiday extravaganza that precedes the show’s 15th season. The consensus among the cast is that this installment is the most “Christmassy Christmas Special” they have ever created. A new teaser has hyped a particular sequence of massive proportions: the Poplar Christmas parade, an action piece so intricate and demanding that one cast member jokingly compared the experience to filming a Tom Cruise action movie, Mission: Impossible . This blend of heartwarming community celebration and unexpected on-set difficulty sets the stage for a truly memorable viewing experience. Content ⁉️ 1️⃣ The Most "Christmassy" Special Yet: Setting the Scene 2️⃣ The Poplar Christmas Parade: A Massive Production 3️⃣ Invisible Ropes and Angel Acting: The Unexpected Stunt 4️⃣ New Territory and High Stakes: Teasing the Drama 🔖 Key Takeaways Image credit: Radio Times / Call the Midwife . Fair use. The Most "Christmassy" Special Yet: Setting the Scene T he heart of the holiday special revolves around the highly ambitious Poplar Christmas parade. This event, which features the whole community along with the show's intrepid team, was clearly designed to envelop viewers in a powerful festive atmosphere. Cast members have specifically highlighted the festive costumes and the effort put into creating an authentic "winter wonderland" feel. The official Call the Midwife  social media channels teased that the Christmas parade sequence was one of the most ambitious sequences the team has ever attempted. Filming the parade was a massive undertaking, necessitating numerous elaborate floats, detailed costumes, and, notably, a lot of artificial snow. Such large-scale events require significant time to organize and shoot, yet despite the logistic hurdles, the cast reportedly found the process great fun. Achieving the Winter Wonderland Vibe Part of achieving the ultimate festive atmosphere involved meticulous management of the fake snow required for the winter wonderland setting. Zephryn Taitte, who portrays Cyril, commented on the tricky business of getting the winter wonderland atmosphere for the parade "just right". He recalled the director providing frantic and contradictory instructions during filming, shouting both "More snow! More snow!" and immediately following up with "Too much snow! Too much snow!". This anecdote highlights the complex behind-the-scenes work required to translate the director's vision of a perfect, snowy Poplar onto the screen. The Poplar Christmas Parade: A Massive Production T he scope of the Poplar Christmas parade extended far beyond festive visuals; it required professional coordination to ensure safety during the large-scale production. The necessity of incorporating a stunt coordinator for certain scenes underscored the complexity and scale of the sequence. Molly Vevers, who plays Sister Catherine, detailed her experience on the parade float, revealing that the production team had to bring in a stunt coordinator because parts of the filming were considered technically stunts. Vevers, along with Renee and Natalie, played angels on the float. This role required them to be secured to the moving platform. Image credit: Radio Times / Call the Midwife . Fair use. Invisible Ropes and Angel Acting: The Unexpected Stunt T he true measure of the complexity involved in the Poplar Parade comes from the specific details of the ‘Angel acting’ required on the float. Sister Catherine star Molly Vevers described how she and the other actresses were tied to the float using “invisible ropes”. This method allowed them to perform their roles while ensuring they remained secure. It was this specific act of being secured for performance on a moving float that led Vevers to draw her amusing comparison to blockbuster action movies. She explained that having the stunt coordinator involved and being tied down made the process feel thrilling, remarking, "It felt like Mission: Impossible !”. The notion that Call the Midwife , a beloved period drama, could share technical filming challenges with a high-stakes Tom Cruise film like Mission: Impossible  highlights the ambition and scale of the 2025 Christmas Special. Trixie’s Favorite Festive Fashion The costumes designed for the parade contributed significantly to the festive atmosphere, especially for the key cast members. Helen George, who plays Trixie Franklin, was particularly enthusiastic about the wardrobe, noting that the costumes were "incredible," thanks to the show's Head of Costume, Justine Luxton. Trixie gets to take part in the parade, traveling along on a "very Christmassy-looking van" while wearing her angel costume. George stated that this angel outfit is "probably the favourite costume I've ever worn" throughout the entire run of the show. She elaborated that the costume boasts a “1970s twist,” featuring a beautiful white coat with a fur trim, angel wings extending from the back, and unique, cool glittery stars. For George, the opportunity to dress up in such a unique and festive outfit was a source of great fun, solidifying her belief that this will be one of the most Christmassy specials ever. Image credit: ACE / Call the Midwife . Fair use. New Territory and High Stakes: Teasing the Drama W hile much of the focus is on the festive community spirit of the Poplar parade, the 2025 special will not shy away from the hallmark dramatic elements that keep viewers engaged. The two-part special is set to venture into "absolutely new ground" and "completely new territory," according to Laura Main, who portrays Shelagh Turner. Stephen McGann (Patrick Turner) has teased that, as always, the special will contain real drama, but fans can also look forward to "especially humorous moments" and a "wonderful thing that happens". On the dramatic front, the stakes appear to be significantly raised. Jenny Agutter, who plays Sister Julienne, confirmed that the special will feature an element of travel, including a trip to Hong Kong for some of the Nonnatus House team. Even more dramatically, Agutter teased that the special will feature "many fatalities," suggesting that the Christmas cheer will be balanced by profound and potentially disturbing events. Meanwhile, for Trixie and Matthew, things are reportedly feeling "more stable than they possibly ever have" between the couple, suggesting their personal lives may offer a respite amid the broader drama. 🔖 Key Takeaways The 2025 Call the Midwife Christmas Special , airing on December 25th, is set to be the show's most festive and ambitious holiday offering to date. 🗝️ Massive Production Scale:  The central sequence involves the Poplar Christmas parade, a major undertaking that included numerous floats, extensive costumes, and detailed coordination to achieve a winter wonderland setting. 🗝️ Unexpected Action:  The filming of the parade required a stunt coordinator because of the technical challenges of securing actresses like Molly Vevers (Sister Catherine) to the moving float. This complex maneuvering, achieved using invisible ropes for "Angel acting," led Vevers to compare the experience to filming a Mission: Impossible Stunt . 🗝️ Festive Fashion:  Helen George (Trixie Franklin) adored her 1970s-inspired angel costume—a white coat with a fur trim, wings, and glittery stars—calling it her favorite costume ever worn on the show. 🗝️ High Stakes Drama:  Beyond the celebration, the special promises to break "new ground". It includes a plot thread involving travel to Hong Kong and severe dramatic consequences, with one star teasing that the special will feature "many fatalities". The special masterfully merges community cheer and challenging drama, promising fans a richly satisfying holiday experience that moves into entirely new territory while providing classic festive joy. 🌐 External sources Call the Midwife stars tease epic Christmas special with unexpected 'stunt': "It felt like Mission: Impossible" Call the Midwife’s Helen George and Molly Vevers tease stunt that “felt like Mission: Impossible” ‘Call the Midwife’ Star Teases The Most ‘Christmassy Christmas Special’ Ever Keywords: Call the Midwife Christmas Special Call the Midwife Christmas Special

A large-scale MRI study , presented at the annual meeting of the Radiological Society of North America (RSNA 2025), has revealed surprising Differences in Knee Injuries  between men and women based on gender and age. The analysis, which included 13,549 consecutive routine knee MRI exams performed between 2019 and 2024 at four outpatient facilities affiliated with Johns Hopkins Hospital, suggests that men suffer more knee injuries from trauma , while older women are more prone to injury from joint degeneration over time . All patients included in the study reported knee pain as their chief complaint. Co-author Jenifer Pitman, M.D., noted that in recent years, interest in the Differences in Knee Injuries  between men and women has grown. She explained that because the majority of past research has historically focused on men, researchers are now realizing that women have different risk profiles and are prone to different injuries . The study focused on extracting data concerning the presence or absence of tears in key structures like the menisci (C-shaped cartilage that acts as a shock absorber) and the anterior cruciate ligament ( ACL ), a major ligament providing stability. The most unexpected findings focused on ACL tears . The analysis showed that specific injuries—including ACL tears  alone, ACL tears combined with medial meniscal (MM) tears, or ACL tears combined with lateral meniscal (LM) tears— were observed more often in men than in women , except for individuals over 60 years old. First author Ali Ghasemi, M.D., noted that they saw more ACL tears in men, especially in the 20- to 40-year-old age group , a finding that is contrary to what has been reported in the literature . Dr. Ghasemi explained that prior studies focused on sports-related injuries often showed that young women athletes had increased rates and a greater risk for ACL tears, but the Johns Hopkins results show a significantly higher prevalence of ACL injuries in male patients across all age groups . Men had a greater number of injuries overall. Dr. Pitman theorized that this discrepancy might be due to the study’s decision to broaden its focus beyond sports-related knee injuries to include all patients with knee pain, regardless of age or cause. This means that the pre-established notion that ACL tears are more common in younger women may not be accurate 100% of the time. The researchers also found a critical age-related reversal in injury patterns regarding meniscal and medial collateral ligament (MCL) tears. Men under 41 had more meniscal and MCL tears than women, but this pattern changed in older patients. Dr. Ghasemi called it "unexpected" that women over 41 had more of these types of tears than men . These specific Differences in Knee Injuries  strongly suggest that older women are more prone to injuries that lead to joint degeneration over time . Consequently, Dr. Pitman suggests that radiologists can expect to see more frequent meniscal pathology and arthritis in older women . The findings are designed to help radiologists and clinicians tailor imaging protocols, risk assessments, and early intervention strategies to optimize patient outcomes. Dr. Pitman advised that women, especially those over 40, should pay attention to joint health and consider incorporating dedicated strength training to help protect their knees as they age. She stressed that individuals with knee pain, especially older patients, should see their physician and not just brush it off or attribute it to old age , as higher rates of meniscal tears were seen in women 40 years and older. 🔖 Sources Study finds surprising differences in knee injuries between men and women Study Finds Gender Gap in Knee Injuries MRI study finds sex differences in knee injuries Study finds gender gap in knee injuries Keywords: Differences in Knee Injuries Differences in Knee Injuries