For decades, a pancreatic cancer diagnosis was among the most devastating words a patient could hear from their physician. The five-year survival rate for metastatic pancreatic cancer — cancer that has spread to other organs by the time it is caught — has historically hovered around 3%. Standard second-line chemotherapy for patients whose cancer had stopped responding to first-line treatment offered a median overall survival of just 6.7 months. These were not numbers that inspired hope. They were numbers that ended conversations about the future and began conversations about end-of-life planning.
That calculus may be changing. In one of the most significant oncology results of the decade, Revolution Medicines presented Phase 3 trial data for daraxonrasib on May 31, 2026 at the American Society of Clinical Oncology annual meeting in Chicago — the most important cancer research gathering in the world. The results were extraordinary: compared to standard chemotherapy, daraxonrasib nearly doubled overall survival for metastatic pancreatic cancer patients who had already received prior treatment, extending median overall survival from 6.7 months to 13.2 months. It reduced the risk of death by 60%. One-third of patients on the drug achieved at least a 20% reduction in tumor size. For a cancer that has been called “undruggable,” this is a scientific watershed.
The Molecular Breakthrough: Targeting KRAS for the First Time
Understanding why daraxonrasib is historically significant requires a brief excursion into cancer genetics. The KRAS gene — Kirsten rat sarcoma viral proto-oncogene — is mutated in approximately 92% of pancreatic cancer cases, making it the most consistently mutated driver gene in this disease. For over four decades, KRAS was classified as literally undruggable: the protein it produces lacks the obvious binding pockets that most targeted therapies need to attach to and inhibit. Multiple generations of pharmaceutical researchers attempted to develop KRAS inhibitors and failed.
Daraxonrasib belongs to a new class of drugs called pan-RAS inhibitors — molecules engineered to target the RAS protein family in an entirely new way, blocking its activity regardless of which specific RAS mutation is present. The RASolute 302 Phase 3 trial enrolled 500 participants with solid tumors harboring activating RAS mutations, with 300 mg selected as the Phase 3 dose after dose-escalation established the therapeutic window. The drug is administered orally once daily — an important practical advantage over intravenous chemotherapy that requires hospital infusion visits.
Why This Matters Especially for Dallas and Texas
The Dallas–Fort Worth metroplex is home to one of the most formidable oncology ecosystems in the United States. UT Southwestern Medical Center’s Harold C. Simmons Comprehensive Cancer Center, Baylor Scott & White Health, Texas Health Resources, and the UT Health San Antonio MD Anderson Cancer Center Network collectively serve the cancer care needs of tens of millions of Texans. Texas Cancer Registry data show pancreatic cancer among the leading causes of cancer death in the state for both men and women. In Tarrant and Dallas counties combined, hundreds of new pancreatic cancer diagnoses are made each year — the majority of them late-stage, given that pancreatic cancer is notoriously asymptomatic until it has already advanced.
“This achievement exemplifies the strength of UT Southwestern as a premier institution for interdisciplinary patient care, discovery-driven research, and the development of breakthrough therapies,”said Dr. J. William Harbour, Chair of Ophthalmology at UT Southwestern, reflecting the institution’s broader commitment to breakthrough oncology. UT Southwestern’s Simmons Cancer Center is already offering novel whole-liver chemotherapy delivery for rare eye cancers — the first program in Texas and the surrounding region to do so — illustrating how Dallas’s premier academic medical center is positioned to rapidly adopt next-generation treatments as they receive regulatory approval.
The ACS Cancer Statistics 2026: The Bigger Picture of Progress
Daraxonrasib arrives at a moment of genuine, documented progress in cancer outcomes across the board. The American Cancer Society’s Cancer Statistics 2026 report records that the five-year relative survival rate for all cancers combined has reached a historic milestone of 70% during the 2015–2021 period — up from 49% in the mid-1970s. Since the cancer death rate’s peak in 1991, it has declined by 34%, with approximately 4.8 million cancer deaths prevented as of 2023. Prostate cancer death rates have decreased 53% since 1993. Colorectal cancer mortality is down 55% from its 1980 peak. Breast cancer death rates dropped 44% between 1989 and 2023. Metastatic melanoma five-year survival has more than doubled.
For distant-stage cancers — the most advanced, metastatic presentations — the relative survival rate has doubled from 17% in the mid-1970s to 34% in the most recent data period. Dr. Marc Siegel, Fox News senior medical analyst, attributed the improvement to “more awareness of cancer risks and symptoms, much better screening, earlier diagnosis leading to earlier treatments,” and specifically to advances in targeted therapy and immunotherapy. Daraxonrasib, if it receives FDA approval following the Phase 3 data, would represent precisely this kind of targeted advance — a drug designed for a specific molecular driver that is present in a specific tumor type, delivering outcomes that chemotherapy’s blunt-force approach never could.
The One Critical Warning: Funding Threats to Future Progress
The ACS 2026 report is explicit about a threat that must be named alongside the good news: “continued progress is threatened by proposed federal cuts to cancer research and health insurance.” The breakthroughs driving today’s improved survival rates — daraxonrasib, immune checkpoint inhibitors, CAR-T therapies, cancer vaccines — are the downstream product of decades of federal investment in basic science through the National Institutes of Health and the National Cancer Institute. Cutting that foundational research funding now, as multiple federal budget proposals have contemplated, would not produce savings — it would produce future deaths, from cancers that a funded scientific community would have learned to cure.
For Dallas-area patients with pancreatic cancer, the immediate clinical question is access. Daraxonrasib is not yet FDA-approved — Revolution Medicines is expected to file for approval based on the Phase 3 data in the second half of 2026. Patients with pancreatic cancer harboring RAS mutations who have already received first-line chemotherapy should discuss clinical trial eligibility with their oncologist at UT Southwestern, Baylor Scott & White, or Texas Health Resources. Revolution Medicines’ clinical trial locator identifies open enrollment sites for ongoing RAS-inhibitor trials. This is the most important oncology news in pancreatic cancer in decades. Dallas’s world-class cancer infrastructure puts its patients in the best possible position to access it.
A rectal exam is not something most people would associate with heart rhythm problems, yet in one unusual case, it played a surprising role in restoring a patient’s atrial fibrillation. The patient arrived at the hospital with an irregular heartbeat reaching 140 beats per minute, a clear sign of a serious rhythm disturbance that typically requires immediate medical intervention.
Doctors initially prepared standard irregular heartbeat treatment, including cardioversion and anticoagulants, but something unexpected happened before those steps were taken. During a routine rectal exam, the patient’s heart rate dropped significantly, and his rhythm returned to normal without medication or procedures, highlighting a rare connection between the digestive system and heart rhythm regulation.
Atrial Fibrillation Pathophysiology and Vagal Triggers
Atrial fibrillation is a condition where the heart’s electrical signals become disorganized, causing the upper chambers to quiver instead of contracting properly. This leads to an irregular heartbeat and reduced blood flow, which can increase the risk of stroke, heart failure, and other complications. According to Mayo Clinic, atrial fibrillation disrupts the coordination between the heart’s chambers, making circulation less efficient and placing stress on the cardiovascular system.
The parasympathetic nervous system plays a key role in regulating heart rate, particularly through the vagus nerve. When this system is activated, it slows electrical conduction in the heart, helping stabilize rhythm disturbances. In some cases, digestive or physical triggers can stimulate this pathway, influencing how the heart behaves during episodes of atrial fibrillation.
This interaction explains why certain physical actions, such as straining or pressure in the abdominal area, can affect heart rhythm. These triggers may not always be intentional treatments, but they demonstrate how closely linked the body’s systems are when it comes to managing an irregular heartbeat.
Rectal Exam Vagus Nerve Stimulation Mechanism
In this case, the rectal exam was originally performed to check for gastrointestinal bleeding before starting anticoagulant therapy. During the procedure, the patient was asked to bear down, a technique similar to the Valsalva maneuver, which increases pressure in the chest and abdomen. According to the American Heart Association, vagal maneuvers like this can stimulate the vagus nerve and slow heart rate by affecting electrical signals in the heart.
As the patient performed this action during the rectal exam, his heart rate dropped from 140 beats per minute to around 80 beats per minute. Further monitoring showed that the irregular rhythm had resolved, effectively restoring normal sinus rhythm without the need for immediate medical intervention.
This suggests that the rectal exam triggered a chain reaction involving the vagus nerve and the parasympathetic nervous system. The stimulation likely counteracted the abnormal electrical signals causing the atrial fibrillation, demonstrating a rare but powerful example of how physical reflexes can influence cardiac function.
Irregular Heartbeat Treatment Alternatives and Vagal Maneuvers
Irregular heartbeat treatment for atrial fibrillation typically focuses on restoring normal rhythm and preventing complications like stroke. According to the National Heart, Lung, and Blood Institute, treatment plans vary based on symptom severity and risk factors, often involving medications or procedures. However, some cases highlight how alternative methods like vagal maneuvers can influence heart rhythm in unexpected ways.
Standard Irregular Heartbeat Treatment – Common treatments include medications such as beta-blockers or antiarrhythmics to control heart rate and rhythm, along with electrical cardioversion to reset the heartbeat. These approaches remain the primary and most reliable methods for managing atrial fibrillation.
Vagal Maneuvers and Parasympathetic Activation – Techniques like the Valsalva maneuver, coughing, or applying cold stimuli to the face can stimulate the parasympathetic nervous system. This slows electrical conduction in the heart and may help regulate certain types of irregular heartbeat without medication.
Rectal Exam as an Unintentional Trigger – In this case, the rectal exam acted as a form of vagal stimulation, likely due to the patient performing a straining action similar to the Valsalva maneuver. This unexpected response shows how physical reflexes can sometimes influence heart rhythm.
Future Potential of Non-Drug Methods – While not a replacement for standard care, these findings suggest that non-pharmacological approaches could play a supportive role in managing specific arrhythmias. Further research is needed to determine how these techniques can be safely integrated into medical practice.
Vagus Nerve Stimulation and Irregular Heartbeat: What This Case Reveals
This case highlights the complex relationship between the nervous system and the heart, particularly how vagus nerve stimulation can influence rhythm control. It also shows that the body has built-in mechanisms capable of correcting certain irregularities under specific conditions.
At the same time, it’s important to recognize that this outcome is rare and should not change how atrial fibrillation is typically treated. Instead, it offers insight into how alternative pathways might support traditional irregular heartbeat treatment in the future, especially as research into non-invasive therapies continues to grow.
A Surprising Link Between Body Reflexes and Heart Rhythm
The idea that a rectal exam could restore a normal heart rhythm may sound unusual, but it reflects how interconnected the human body truly is. Through vagus nerve stimulation and activation of the parasympathetic nervous system, even routine procedures can sometimes produce unexpected physiological effects.
While this case does not replace established treatments for atrial fibrillation, it adds an interesting perspective on how irregular heartbeat treatment could evolve. As more is learned about these reflex pathways, future approaches may combine traditional medicine with targeted stimulation techniques to improve outcomes and reduce the need for invasive procedures.
Frequently Asked Questions
1. Can a rectal exam really fix an irregular heartbeat?
In rare cases, it may trigger vagus nerve stimulation that helps restore normal rhythm. However, this is not a standard or reliable treatment method. Most irregular heartbeat conditions still require medical intervention. This case is considered unusual and not widely applicable.
2. What is atrial fibrillation?
Atrial fibrillation is a type of irregular heartbeat where the heart’s upper chambers beat out of sync with the lower chambers. This can reduce blood flow and increase the risk of stroke. Symptoms may include palpitations, fatigue, and shortness of breath. It often requires medical treatment to manage.
3. What is the Valsalva maneuver?
The Valsalva maneuver involves holding your breath and straining, which increases pressure in the chest. This action can stimulate the vagus nerve and slow heart rate. It is sometimes used to manage certain types of arrhythmias. However, it should only be done under medical guidance.
4. Are vagal maneuvers safe for treating heart rhythm issues?
They can be safe when performed correctly and under supervision. Doctors may recommend them for specific types of arrhythmias. However, they are not suitable for all patients or conditions. Professional medical advice is always necessary before trying them.
A French doctor accused of intentionally poisoning 30 child and adult patients, 12 of whom died, went on trial Monday, saying before the hearing he was not responsible for the “distress” of his alleged victims and their families.
Frederic Pechier, 53, worked as an anaesthetist at two clinics in the eastern city of Besancon when patients went into cardiac arrest in suspicious circumstances between 2008 to 2017. Twelve could not be resuscitated.
He is accused of triggering heart attacks in patients so he could show off his resuscitation skills and discredit co-workers.
Pechier’s youngest alleged victim, a four-year-old identified as Teddy, survived two cardiac arrests during a routine tonsil operation in 2016. The doctor’s oldest alleged victim was 89.
The trial caps an eight-year investigation that stunned the medical community. Pechier has denied the charges.
Pechier was greeted on his arrival at the court by several relatives, including one who shouted: “Come on, Fredo.”
“It’s necessary to lay all the cards on the table,” Pechier told broadcaster RTL earlier Monday, adding that he had “strong arguments” in his defence.
Asked about the suffering of the families who will attend the trial, set to last until December, Pechier replied: “I understand it completely, but on the other hand, I am not responsible for their distress.”
Pechier, a father of three, faces life imprisonment if convicted. He is not currently in custody but under judicial supervision, an alternative to pre-trial detention.
Pechier has not practised medicine since 2017, even though in 2023, he was authorised to work provided he does not come into contact with patients.
“I’ve been waiting for this for 17 years,” said Amandine Iehlen, whose 53-year-old father died of cardiac arrest during kidney surgery in 2008.
An autopsy revealed an overdose of lidocaine, a local anaesthetic.
Prosecutor Etienne Manteaux has said the case is “unprecedented in French legal history”.
An investigation was opened in 2017 after suspicious cardiac arrests during operations on patients considered low-risk.
Pechier is suspected of tampering with his colleagues’ paracetamol bags or anaesthesia pouches to create operating room emergencies where he could intervene to show off his resuscitating talents.
“What he is accused of is poisoning healthy patients in order to harm colleagues with whom he was in conflict,” Manteaux said.
“Frederic Pechier was the first responder when cardiac arrest occurred,” he added. “He always had a solution.”
Pechier has blamed “medical errors” by his colleagues for most of the poisonings.
Some colleagues described Pechier as a “star anaesthetist”, while others said he came across as arrogant and manipulative.
One co-worker claimed Pechier was “certain he was the best” and liked to “think of himself as Zorro”.
Over the course of the inquiry, investigators examined more than 70 reports of “serious adverse events”, medical jargon for unexpected complications or deaths among patients.
The cases of 30 patients who suffered cardiac arrest during surgery at the Saint-Vincent Clinic and the Franche-Comte Polyclinic made it to trial.
He has criticised the investigation. “What happened to the other cases? They were not retained because Pechier was not involved in them,” he said.
His defence team will argue for acquittal.
“It’s very easy to accuse people, it’s harder to prove things,” one of his lawyers, Randall Schwerdorffer, told reporters.
More than 150 civil parties will be represented at the trial.
For the first two weeks, the court will examine Pechier’s most recent cases, those that aroused the investigators’ suspicions and led to the anaesthetist being placed under investigation in 2017.
Afterwards each of the poisonings attributed to the doctor will be examined.
“It’s going to be a legal marathon, but we’re ready,” Stephane Giuranna, a lawyer for several civil parties, told AFP.
“All roads lead to Pechier.”
‘I just want people to listen for once,’ Frederic Pechier said in an interview
In a world shaped by filters, high-definition selfies, and social media perfection, cosmetic surgery has become increasingly mainstream and increasingly expensive. What was once reserved for celebrities and the ultra-wealthy is now a standard line item on the budgets of millennials, Gen Z, and working professionals alike. According to the American Society of Plastic Surgeons, Americans spent over $14.6 billion on aesthetic procedures in 2021, a figure that continues to rise.
Yet as the demand rises, so do the prices. With most cosmetic procedures not covered by insurance, patients are left to foot the whole bill, often thousands of dollars out of pocket. The result? A growing number of people are seeking creative ways to afford their aesthetic goals.
The New Normal for Cosmetic Procedures
The stigma around plastic surgery is fading fast. Social media has helped normalize cosmetic procedures as part of routine self-care. At the same time, celebrity transparency has made it easier for everyday people to talk openly about Botox, fillers, and “tweakments.” Procedures such as lip lifts, body contouring, and nonsurgical facial rejuvenation have surged in popularity over the past five years, particularly among patients under 35.
In a 2023 survey by the American Society of Plastic Surgeons, over 70% of surgeons reported a dramatic increase in interest from younger patients, many citing social media, video conferencing, and pandemic-era self-reflection as key motivators.
And the rise isn’t just in major surgeries like breast augmentation or rhinoplasty. Noninvasive treatments, such as lip fillers, laser resurfacing, and injectables, have become as routine for some as a trip to the hair salon.
But normalization doesn’t mean affordability. While procedures have become more widely accepted and accessible in terms of availability, the cost remains a significant barrier. Unlike medically necessary treatments, most cosmetic procedures aren’t covered by insurance, meaning patients have to navigate a complex financial landscape just to access the services they want.
Sticker Shock: What Popular Surgeries Cost
If you’re considering cosmetic work, it’s easy to underestimate the cost until the consultation.
According to the American Society of Plastic Surgeons, the average cost of popular elective surgeries in the U.S. is:
Rhinoplasty (nose reshaping): $5,400
Breast augmentation: $4,500–$6,000
Liposuction: $3,600 per area
Facelift: $9,000
Brazilian Butt Lift (BBL): $8,000–$12,000
Eyelid surgery: $4,100
Botox/fillers (non-surgical): $300–$1,200 per session
These numbers only reflect surgeon fees. So, add the costs of anesthesia, facility fees, post-op medications, or follow-up visits, and you’re looking at procedures that cost tens of thousands of dollars.
For many, these price tags are intimidating, especially when paired with inflation, stagnant wages, and limited insurance assistance. And while some patients can save up in advance or use credit cards, others are turning to new methods of managing these rising costs.
How People Are Paying: Credit, Savings, and Financing
With cosmetic procedures costing thousands and insurance rarely covering them, many patients are finding creative ways to pay. Some save for months or even years. Others turn to credit cards, medical credit lines, or installment plans offered by clinics themselves.
But increasingly, people are relying on cosmetic surgery financing options that help break up the cost over time.
These financing programs are often similar to “Buy Now, Pay Later” services used in retail, offering promotional interest rates or short-term payment plans. Popular providers, such as CareCredit, Alphaeon Credit, and PatientFi, have partnered with plastic surgeons across the U.S., enabling patients to apply for loans or revolving credit during the consultation.
The result? Access to procedures that once seemed out of reach, and a growing normalization of medical financing in the beauty industry.
The Risks of Medical Debt and Deferred Interest
While financing can make plastic surgery more accessible, it doesn’t come without risks. Medical financing through private lenders can carry high-interest rates, hidden fees, and deferred interest clauses that catch borrowers off guard. If a patient misses a payment or fails to repay within a promotional window, they could end up owing far more than they anticipated.
For example, a $6,000 procedure might be divided into 12 payments of $500 each. And while some plans are interest-free if paid on time, others can carry steep interest rates if the balance goes unpaid. That’s why patients must understand the terms before signing on the dotted line.
The Consumer Financial Protection Bureau (CFPB) has warned consumers about the rise of medical credit cards and third-party financing arrangements that lack adequate transparency. Some patients end up with long-term debt, especially if complications arise or additional procedures are needed down the line.
Experts recommend treating plastic surgery financing like any other significant loan: review the terms carefully, ask about interest rates, and avoid borrowing more than you can reasonably afford to repay. Patients should also compare financing options, consider savings, and avoid making impulsive decisions based on pressure or emotion.
Empowerment or Pressure? Navigating the Trend Ethically
For many people, getting cosmetic work done isn’t just about changing their appearance. Instead, it is a way for individuals to feel more confident and more at ease in their own bodies. These procedures can offer a sense of control or relief, especially for individuals who have struggled with a particular issue for years.
But as surgery becomes more accessible, with clinics offering payment plans and financing options right alongside before-and-after photos, you need to take a step back and consider the full picture before going under the knife.
When cosmetic enhancements are presented as quick, affordable fixes, it can be hard to tell where personal choice ends and social pressure begins. What feels empowering for one person might feel like an expectation for someone else. And with financing more common than ever, the decision to have surgery can start to feel like just another financial commitment rather than a meaningful, personal choice.
Are patients choosing these procedures freely, or feeling pushed by societal expectations and beauty standards amplified by social media?
Platforms like Instagram and TikTok are filled with influencers and creators showcasing their “glow-ups“ or recovery journeys, often without disclosing how they paid or what risks were involved. The pressure to conform to a certain appearance can be intense, particularly for young people. When the option to finance is just a click away, that pressure can translate into quick decisions with long-term consequences.
That’s why many experts stress the importance of thoughtful, informed choices. Cosmetic surgery is a personal decision, but it should never feel like an obligation.
Conclusion
Cosmetic surgery has come a long way. It’s more accepted and more available than ever before. But just because the barriers to entry are lower doesn’t mean the decision should be taken lightly.
Before booking a procedure, patients should take a step back and consider the full picture. Not just what the final result might look like, but also what it will cost, how it will be paid for, and whether the decision is being made for the right reasons. That means asking questions, reviewing payment options like plastic surgery financing, and understanding the long-term financial commitment involved.
The truth is, there’s no one-size-fits-all answer when it comes to cosmetic procedures. For some, it’s a profoundly empowering experience. For others, it may not be the right move at this time. What matters most is making a choice that’s informed, intentional, and genuinely your own.
A pharmaceutical company that allegedly paid doctors kickbacks to push their HIV/AIDS drugs has agreed to pay a fine of more than $200 million to settle a civil lawsuit filed by federal prosecutors.
The government alleged that Gilead had induced doctors to prescribe a slew of HIV/AIDS drugs in exchange for honoraria payments, meals, and travel expenses to healthcare practitioners. Prosecutors said the company created a scheme where healthcare practitioners who spoke at or attended Gilead speaker events, and used the events as a a way to deliver kickbacks.
“For years, Gilead unlawfully sought to increase sales of its HIV drugs, by using its speaker programs to funnel kickbacks to doctors. As alleged, Gilead spent tens of millions of dollars on these programs, including over $20 million in speaking fees and millions more in exorbitant meals, alcohol and travel, all in an effort to induce doctors to prescribe Gilead’s HIV drugs and drive up sales,” U.S. Attorney Jay Clayton said.
“With this settlement, Gilead has taken responsibility for its conduct and agreed to pay a significant financial penalty. The message is clear, companies that illegally drain taxpayer dollars from federal healthcare programs will be held accountable,” he said.
The government also alleged that the scheme led to false claims for the Gilead HIV Drugs being submitted to and paid for by federal healthcare programs. Because of this, more than $176 million of the fine will go as compensation to the government, with the remainder being distributed to several states.
One HIV speaker, who received over $300,000 in total honorarium payments, wrote prescriptions for Gilead HIV Drugs that resulted in over $6 million in Medicare, Medicaid, and TRICARE payments.
The Gilead HIV antiretroviral drugs are expensive, with Medicare paying more than $1,000 for a one-month supply of Complera®, for example. From 2011 to November 2017, the company conducted HIV speaker programs, ostensibly for educational purposes.
However, prosecutors say many of the events had little educational value and that Gilead would invite the same physicians over and over to the same program. The events were often held at fancy restaurants in New York including at James Beard House, Del Posto, Asiate, Palma, Vaucluse, Ilili, and Limani.
Other desirable locations for the events included Hawaii, Miami, and New Orleans. Prosecutors noted that sometimes the location was selected in response to an HIV speaker’s request to be booked for a program in that city.
Home / News / Private equity’s appetite for hospitals may put patients at risk
Illustration: Traci Daberko
In the wake of the Steward Health Care crisis, corporate and private equity ownership of health care has come under new scrutiny. Here, Harvard health policy experts weigh in on the growing corporatization of the U.S. health care system and what it means for patients, practitioners, and public health.
Throughout 2024, eye-opening news headlines from around the country trained a spotlight on the collapse of Steward Health Care:
As Steward hospitals teeter, CEO’s $40 million yacht is docked in the Galapagos Islands
Sick patients collapsed waiting for care in overwhelmed Steward hospital’s emergency department
Steward Health Care files for Chapter 11 bankruptcy
Steward owned more than 30 hospitals across Arizona, Arkansas, Florida, Louisiana, Massachusetts, Ohio, Pennsylvania, and Texas. Its volatility and eventual crash jeopardized access to health care for millions of patients.
How did Steward, at one point the largest private for-profit health system in the U.S., go belly up?
The long and short: In 2010, private equity firm Cerberus Capital Management purchased Caritas Christi Health Care, a struggling eastern Massachusetts hospital system, from the Archdiocese of Boston, converting it from non-profit to for-profit and rebranding it as Steward Health Care. In 2016, after years of continued financial instability, Steward signed a sale-leaseback agreement with Medical Properties Trust (MPT), selling the land and buildings occupied by its hospitals to the real estate investment trust then leasing them back. Steward made $1.25 billion from the agreement—enough to steady its financial footing, pay off Cerberus, and fund a growth spree. The next year, the company purchased 26 more hospitals across the country. But with the agreement came what many viewed as inflated rents.
By 2020, Cerberus, having made $800 million in profit on its initial investment, decided to sell Steward hospitals to a group of its physicians, essentially transferring ownership back to Steward’s management team, led by CEO Ralph de la Torre. Over the next several years, concerns about patient care and safety at Steward hospitals mounted as the company opted to cut costs and neglect bills in order to keep up with its rent payments to MPT. In January 2024, MPT announced that Steward was $50 million behind on those payments. By May, the company filed for bankruptcy. Financial documents made clear that the company had paid hundreds of millions to investors and leadership, including de la Torre, who enjoyed a lavish lifestyle while patients at Steward hospitals faced increasingly unsafe conditions. De la Torre was subpoenaed by Congress in July; he failed to appear.
After months of tense negotiations between state governments, Steward, MPT, and potential buyers, by November, most Steward hospitals had found new owners, a mix of non- and for-profit hospital systems and private equity firms. But two hospitals didn’t survive: Carney Hospital, which served Boston’s low-income, majority Black and Hispanic southern neighborhoods, and Nashoba Valley Medical Center, which served 17 suburban and rural communities across central Massachusetts. Thousands of patients and hundreds of staff have been left to find health care and jobs with new providers farther away.
The Steward meltdown has captured the attention of the public and policymakers not as an outlier, but as an object lesson. Its story shines a light on the growing role of private equity in the U.S. health system, helps explain rising discontent among patients and clinicians, and lays bare the dangers of prioritizing profits over people in health care.
A ‘core contradiction’
John McDonough, professor of the practice of public health at Harvard Chan School, calls private equity “the sharp end of capitalism.”
“It’s otherwise often described as ‘capitalism on steroids,’” McDonough said. “It’s for-profit business in its most aggressive form. [Private equity firms] seek returns on their investment as high as possible as quickly as possible, then rush to sell off that investment and go on to their next conquest.”
After decades establishing a presence everywhere from manufacturing, to telecommunications, to grocery stores, in the mid 2000s private equity firms began targeting health care. It was a natural next step: The industry is worth nearly $5 trillion in the U.S., offering significant, dependable cash flow. Firms saw the potential for profits and began buying up physician practices and health facilities, from hospitals to nursing homes to fertility clinics, looking to at least double their initial investment and then sell within a short time, often three to seven years.
Private equity’s foothold in health care has continued to grow. In 2021, according to researchers at UC Berkeley, 5,779 physician practices, specializing in everything from primary care to oncology, were owned by private equity firms—up from 816 in 2012. Nonprofit watchdog the Private Equity Stakeholder Project (PESP) reported that, as of February 2024, nearly 460 U.S. hospitals were owned by private equity firms. These hospitals—which include non-specialty acute care hospitals, rehabilitation hospitals, psychiatric facilities, and long-term acute care facilities—represent 8% of all private (not owned by the government) hospitals and 22% of for-profit hospitals.
5,779
physician practices were owned by private equity in 2021—up from 816 in 2012
22%
of for-profit hospitals—460 in total—are currently owned by private equity
80%
of physicians are employed by a hospital system or corporation—up from 60% in 2019
But ownership by private equity is just the latest version of capitalism’s creep into health care. Its way was paved by corporations entering the industry in the 1980s as an era of free market fundamentalism emerged and the “maximizing shareholder value” movement began to boom. Publicly traded companies began buying up hospitals and health facilities, as well as physicians and physician practices, to establish their own health systems. Today, nearly a quarter of U.S. hospitals are run by for-profit entities that promise to bring business smarts and a flow of capital to health care delivery.
“The pitch is that corporations can raise capital and invest in improving the business—quality of care, operations, professional management—in a way non-profits can’t,” said Meredith Rosenthal, C. Boyden Gray Professor of Health Economics and Policy. “But the challenge is that because health care is so important, the public expects these corporations to prioritize public interest over profits. And that’s not what they’re built to do.”
Because health care is so important, the public expects corporations to prioritize public interest over profits. And that’s not what they’re built to do.
Meredith Rosenthal, C. Boyden Gray Professor of Health Economics and Policy
“Medical care has always had a for-profit element. Physicians were mostly small businesspeople,” McDonough said. “But there’s a difference between a sole proprietor or small business and a mega-corporation that believes its only purpose in the world is return on equity to shareholders. Hold that belief up against a medical provider’s belief that patients come first, and right away there’s conflict. It’s this core contradiction that I think American society has never sufficiently grappled with.”
Non-profits like profits, too
It’s not just corporate health care providers producing this dilemma. Non-profits, which remain the majority of U.S. hospitals and health care facilities, sometimes prioritize profits over their social missions—and community benefit requirement cementing their tax-exempt status—in order to grow, and even just survive, in a tight economy and increasingly competitive health care market.
“Economists have studied whether non-profits behave differently than for-profits. Do they provide more charity care [free or discounted medical services for poor patients]? Do they invest more in community well-being? The answer generally has been no,” Rosenthal said.
One study, conducted in 2020 by Joseph Bruch, PhD ‘21 and David Bellamy, PhD ’23, indeed found no significant difference between what non-profit and for-profit hospitals spend on charity care as a percent of their total expenses.
“It’s getting harder and harder to tell the difference between a non-profit and for-profit board of directors,” McDonough said. “It’s this for-profit ethos that has swarmed and swamped the U.S. medical space. Many people think the system can prioritize patients and profits at the same time and that it will be okay. But then we look at calamities like Steward, and we think to ourselves, maybe it can’t. And maybe it won’t be okay.”
Consequences of cost-cutting
For Steward patients, it wasn’t okay. Reports of poor-quality care and compromised patient safety ran the gamut: from understaffed emergency rooms and ill-equipped maternity wards, to stairwells infested with bats, to cancelled surgeries and suspended trash service due to unpaid invoices. These extreme examples represent what a growing body of research suggests: Health care quality declines when private equity and its extreme for-profit approach take over.
A 2023 study found that Medicare patients at private equity-owned hospitals suffered a 25% increase in hospital-acquired complications compared to Medicare patients at hospitals not owned by private equity. These complications included a 38% increase in bloodstream infections from central lines—longer-term, surgically inserted ports through which patients can intravenously receive fluids, medications, and blood—despite 16% fewer central lines placed. Similarly, the rate of surgical site infections doubled at private equity-owned hospitals while those at the control hospitals decreased. And while falls at hospitals not owned by private equity have been trending downward—a product of a nationwide, decades-long hospital safety movement—falls at private equity-owned hospitals have remained steady, amounting to a 27% relative increase.
“We believe [these findings are] largely explained by staffing cuts,” said the study’s senior author Zirui Song, PhD ’12, associate professor at Harvard Medical School and Massachusetts General Hospital. “The unique financial pressures private equity-owned hospitals face, such as new debt placed on them from the acquisition and expectations of profitability in the short run, may lead to cutting the costs of delivering care—such as through reducing staffing. But while you may be able to substitute people with machines in other industries, health care remains human-labor intensive, especially inpatient care. Cutting staff can have salient consequences for quality of care and patient outcomes.”
Another study by Song and colleagues found that private equity-owned hospitals earned 27% more income after acquisition than hospitals not owned by private equity. That financial gain was fueled by increasing charges—the asking prices for hospital services—by between 7% and 16%, depending on the department, as well as by issuing more charges per day and seeing fewer patients enrolled in Medicare, which provides lower reimbursements than commercial insurers.
A “Save Our Hospital” sign is displayed outside the former Nashoba Valley Medical Center, which was part of the bankrupt Steward Health Care company and closed on Aug. 31, 2024. (Charles Krupa / AP Photo)
Exacerbating disparities
What type of hospitals does private equity tend to target?
New evidence from Song and colleagues suggests that firms typically set their sights on financially healthier—rather than struggling—hospitals, compared to similar peer hospitals that were not acquired. That’s because private equity firms tend to place new debt onto acquired hospitals, and those on stronger financial footing are better able to take on that debt.
There are examples, however, of hospitals serving mostly uninsured or publicly insured patients being taken over by private equity firms. These takeovers may exacerbate health disparities, as many of these disadvantaged patients belong to racial or ethnic minorities and already suffer worse health outcomes, said Song. When discontinuation of hospital services—or total closure—occurs, it has an outsize impact in communities where access to health care is already limited. Carney Hospital is one such example; in an op-ed, Harvard Chan School’s Alecia McGregor, assistant professor of health policy and politics, called its closure “a matter of life and death” that threatens to deepen Boston’s already extreme racial disparities in health.
“I don’t think there is enough evidence to definitively say that private equity targets hospitals that mostly serve people of color. But in some cases, these financially vulnerable facilities may fit their business model,” McGregor said. “And when private equity backed acquisitions lead to closures, this is when marginalized communities often hurt the most. Take Hahnemann University Hospital, for instance—a historic facility serving mostly low-income Black and Hispanic Philadelphians that was closed by its private equity owner after less than two years. Many viewed the closure as a maneuver for the hospital’s prime city real estate.”
PESP also reports that a quarter of private equity-owned hospitals serve rural populations, whose health care alternatives are sparse if they’re unsatisfied with quality or costs and whose outcomes are jeopardized if the only hospital in town closes. Since Nashoba Valley Medical Center was closed, first responders travel around 15 miles to transport patients to emergency care, according to a local fire chief. They used to travel three.
Policy potential
“Theoretically, there could be benefits to private equity investments in health care. They could provide facilities and clinicians with an infusion of capital, but also with managerial know-how and business acumen that might improve health care, such as through making care more ‘efficient,’” Song said. “Unfortunately, however, the current evidence base does not support that. Rather, evidence seems to suggest that by cutting the human labor and other inputs that make care delivery possible—also seen in private equity acquisitions of physician practices and nursing homes—the care might just become less safe.”
Song published a series of policyrecommendations for officials looking to reduce corporate influence, specifically that of private equity, over health care delivery and outcomes. His recommendations for state policy included reviving or enforcing corporate practice of medicine laws, which, in their aim to protect physicians as independent practitioners, can go as far as prohibiting corporations from hiring physicians or influencing medical decisions. His recommendations for federal policy included:
Strengthening fraud and abuse protections
Improving Federal Trade Commission staffing and bandwidth, in order to improve oversight over health care acquisitions and mergers
Discouraging risk-taking behavior by corporate owners (sometimes referred to as moral hazard), through measures like legally affiliating private equity firms with their rolled-up set of acquired entities, limiting the percent debt a firm can use to make an acquisition, and reforming the tax benefit that allows private equity proceeds to be taxed at 20% (rather than the regular corporate business rate, which is higher)
Regulating health care prices and prohibiting surprise billing
Increasing public transparency into private equity acquisitions
Some policymakers have already begun efforts to enact these recommendations. In June, Massachusetts senators Elizabeth Warren and Edward Markey introduced the Corporate Crimes Against Health Care Act, which would penalize private equity firms if a health facility they own closes or has poor finances resulting in injury or death to a patient. A month later, Markey proposed another bill, the Health Over Wealth Act, which would require greater transparency for private equity firms and for-profit companies that own health care entities.
Meanwhile, in the last year, several congressional committees—including the Senate Budget Committee, the Senate Committee on Homeland Security and Governmental Affairs, and the House Committee on Ways & Means—have launched investigations into and held hearings on the role of private equity in health care. On a state level, legislation to regulate private equity in health care is pending in Massachusetts, New Jersey, New York, and Pennsylvania. California, Indiana, Minnesota, New Mexico, and Oregon already have programs that do so. (In September, California Governor Gavin Newsom vetoed a bill that would further intensify regulations.)
Protesters gather in front of the Massachusetts State House to advocate for keeping Nashoba Valley Medical Center and Carney Hospital open. (Steve LeBlanc / AP Photo)
Deeper changes
These regulations—if passed—could help protect physicians as well as patients. One of the significant changes from the corporatization of health care is that, increasingly, physicians are no longer working for themselves. In the 1980s, most doctors owned their own small clinics. Today, nearly 80% are employed by a hospital system or corporation—up from just over 60% in 2019, according to Avalere Health.
“If you’re a physician working in a hospital, chances are you don’t work for the hospital. You work for a corporation,” McDonough said. “And when you sign on with the corporation, you sign a non-compete clause. You can’t criticize anybody or raise your voice even as your workload keeps growing, even when you’re the only physician in the emergency department with multiple traumas, even when you’re seeing patients being put at risk and your colleagues being exploited.”
As this hypothetical proves reality for more and more physicians, many are banding together to advocate for some of the policies Song recommends. A physician advocacy group called Take Medicine Back, for instance, is working to garner support for corporate practice of medicine laws.
Burnt out, frustrated—and organizing
In November, primary care physicians employed by Massachusetts’ largest health system, non-profit Mass General Brigham, cited the “corporatization of medicine” among their reasons for pushing to unionize. Across the country, a small number of doctors—around 70,000, representing 8% of the profession—already belong to a union. But that number has been growing steadily, and will likely continue to do so with the arrival of a new generation of physicians. Currently, 20% of medical residents—more than 32,000—belong to a union, a number that has doubled since 2019.
But tighter regulations on private equity and corporations in health care can only achieve so much. Many experts believe deeper changes to health policy and investments in public health are equally needed. Examples include:
Higher reimbursements for public insurance, so that, in McGregor’s words, “small community hospitals that serve populations largely on Medicare or Medicaid can better meet their costs and remain in business without the private sector filling in”
Simplified health insurance systems, like those in the Netherlands and Switzerland, that use private insurance plans that are streamlined, with fewer choices, making them more transparent and easier to understand and regulate
Funding for non-medical social care, such as housing and food—in Rosenthal’s words, “social supports that make a big difference in people’s lives and that, when underinvested in, drive up our health care costs”
‘One of the biggest lies we’ve ever been told’
These additional policy levers could help diminish for-profit health care’s influence, but by how much is a matter for debate.
“At the end of the day, I think we’re always going to have this kind of mixed public and private system,” Rosenthal said. “Politically, it would be very challenging for us to go in a more government-focused direction. There’s just a lot of distrust. And the one big thing that’s quite different about our country is that we don’t consider health a right. It’s not in our constitution like it is for many of our peers.”
But significant change may be on the horizon, driven by public discontent around health care and growing visibility, brought by cases like Steward, into the consequences of a system where profits can come at the expense of patient care.
When health care follows the money, we get sicker and sicker.
Alecia McGregor, assistant professor of health policy and politics
“As a country, we’ve become desensitized to this notion that health care is the same as any ordinary commodity, and that the provision of health care can be run like any other business,” McGregor said. “I think this is one of the biggest lies we’ve ever been told, because we’ve seen health care costs skyrocket in a way that’s different from any of our wealthy country counterparts, yet our outcomes—life expectancy, maternal health, infant mortality—are abysmal. When health care follows the money, we get sicker and sicker.”
“Surrendering our health care system to the for-profit marketplace was a fundamental error that we’re paying the debts of right now,” McDonough added. “But I see people working on it, reassessing the role and value of for-profits and asking what a post-neoliberal health care system might look like.”
In the meantime, the story of Steward, now under new ownership and a new name, continues to unfold. Its physician network, made up of 5,000 doctors, was recently purchased by Rural Healthcare Group and rebranded as Revere Medical. Rural Healthcare Group is owned Kinderhook Industries, a private equity firm.
For concerned patients, Rosenthal offered some concrete advice. “Find a provider you trust and be skeptical. Always ask about the benefits of an intervention. Because more services, more tests, more treatments are not always beneficial—but they’re always profitable.”
A new drug for urinary tract infections, Orlynvah, gets FDA approval, opening new treatment options for those patients with limited or no alternative antibacterial treatments.
A urinary tract infection (UTI) is a common infection that affects the urinary system, and nearly half of all people assigned female at birth (AFAB) will experience one in their lifetime. Although UTIs are less common in men, they can still occur. Around 1% to 2% of children may also be affected.
Orlynvah, an oral tablet from drug manufacturer Iterum Therapeutics, combining sulopenem etzadroxil and probenecid has been approved for use specifically for treating uncomplicated urinary tract infections (UTIs) in adult women. An uncomplicated urinary tract infection is a bacterial infection of the tract without abnormalities in the structure.
The new medicine could be a game-changer for those with limited treatment choices, as it showed effectiveness in two large clinical trials with over 3,800 participants. The trial results also indicated that Orlynvah would work similar, or even better than, traditional antibiotics like ciprofloxacin and amoxicillin.
“The FDA approval of ORLYNVAH™ is tremendous news for those of us who have been hoping for a new option to treat appropriate at-risk patients suffering from UTIs. Based on the totality of clinical data generated, ORLYNVAH™ has the potential to be an important treatment alternative for use in the community,” said Dr. Marjorie Golden, Site Chief, Infectious Disease, St. Raphael Campus Yale New Haven Hospital in a news release.
However, Orlynvah did not show effectiveness in treating patients with complicated urinary tract infections and complicated intra-abdominal infections.
The drug could be prescribed to be taken twice daily for 5 days.
“ORLYNVAH™ offers new hope for patients suffering from difficult-to-treat uUTIs. The introduction of novel products, like ORLYNVAH™, is an important way to combat antimicrobial resistance to other approved oral agents and offers a potential solution to patients and physicians,” said Corey Fishman, Iterum’s Chief Executive Officer.
Safety information:
Though Orlynvah is generally deemed safe, there can be certain common side effects such as diarrhea, nausea, vaginal yeast infection, headache, and vomiting.
Orlynvah is not recommended for those who have gout as it can aggravate symptoms of gout. The drug should not be taken by those patients who have hypersensitivity reactions to sulopenem etzadroxil and probenecid or other beta-lactam antibacterial drugs. It is also not safe for patients with blood dyscrasias, uric acid kidney stones, and those on ketorolac tromethamine.
