Author: bkellaway

Shannon Sharpe was having one of those 15-minutes-of-internet-infamy moments. Social media blew up in September after the retired Denver Broncos tight end — accidentally, he later said — broadcast some of his intimate activities online.

One of his sponsors took advantage of the moment: the telehealth company Ro, which sells a variety of prescription medicines for erectile dysfunction and hair and weight loss. The company revved up a social media campaign on the social platform X for an ad in which Sharpe boasted about his experience with the company’s erectile dysfunction medications, a company spokesperson confirmed.

The ads were more than just a passing attempt to hitch a corporate caboose to a runaway social media locomotive. A group of direct-to-consumer telehealth companies have become omnipresent across just about all media formats, seeking patients interested in their low-stigma, low-fuss, low-touch, high-convenience health products.

They’re on your favorite podcasts and in the background on the cable TV in your gym. Thirteen telehealth entities spent a combined $111 million in 2023 on television ads, more than double the sum in 2019, according to an analysis from iSpot.tv, a television ad-tracking company, provided to KFF Health News.

The ads feature high-wattage celebrities such as Jennifer Lopez as well as lesser-known influencers who are paid four figures to post a snapshot or short video to Instagram, according to interviews with marketers. Three publicly traded telehealth companies spent a total of more than $1.4 billion on advertising, sales, and marketing in 2023, according to financial reports filed with the Securities and Exchange Commission, categories that reflect the extent of their online efforts.

The companies’ advertising typically emphasizes convenience in a health care system that’s often just the opposite. They promise judgment-free birth control or care for conditions like erectile dysfunction and hair loss that have traditionally been stigmatized. As the companies expand, they’re venturing into more complex kinds of medicine, such as care for mental health conditions and obesity.

Services that telehealth companies offer, critics warn, may shortchange patients in need of close, sensitive attention. Researchers differ on telehealth services’ quality, with some saying telehealth companies offer little follow-up and inconsistent care from a revolving cast of doctors.

Still, they agree the care is fundamentally different from the traditional style. A company’s model can “kind of flip what you’re taught at medical school on its head,” said Ateev Mehrotra, a Brown University professor of public health who studies telehealth.

Typically, he said, a patient goes to the doctor with a complaint; there, the parties figure out a diagnosis and, if appropriate, a medication. By contrast, he said, telehealth companies’ advertising invites patients to make their own diagnoses, while pairing them with clinicians who, if they confirm their conditions, prescribe medicines the patients already think they want.

Under this style of medicine, the clinician is “now a screener, and you just want to make sure that that medication is safe for that patient,” Mehrotra said.

The model may work for certain kinds of care, Mehrotra said, such as birth control. He and some colleagues conducted a study in which they recruited patients with standardized backstories to patronize startups offering contraceptive medicines over the internet. Generally, the study found, the services performed well.

Harley Diamond, a patient at Nurx, a startup offering birth control prescriptions and other services, offers an example of how these companies can work well in some circumstances. After she saw an Instagram ad, she signed up to get birth control. She lives in Tennessee, a red state where it can be difficult to access contraception: Local clinics have closed and an arsonist burned down a Planned Parenthood. (The facility recently reopened.)

But when she turned to Nurx for her mental health, she found the service confounding and its convenience lacking.

The company’s app sends her frequent questionnaires about symptoms and reactions to drugs, she said. “There is no comforting face to validate you,” she wrote in an email to KFF Health News. The questions were the same each time, and she said she spoke with a new doctor in every interaction.

“It can feel like you’re having to start from scratch explaining yourself to someone new every month,” she said.

When she expressed concerns — for example, about side effects of an antidepressant she was taking — it would take “days, generally,” to hear back, with no change in her protocol, she said. Often, she said, her messages would get no response at all.

Rajani Rao, senior vice president at Nurx, said the company is “constantly working” to improve response times, “especially as we experience a high volume of patient care requests.” In mental health, the majority of Nurx’s patients experience elimination of symptoms after six months of treatment, she said.

Rao also referred to Nurx as providing an “integrated care team,” using language echoed across the industry. Ro, for example, says its care is available in the time and format of its patient’s preference and that it audits the quality of its services.

Continuous care is crucial to make sure mental health patients are on the right doses of medications and that they’re not experiencing side effects, said Reshma Ramachandran, an assistant professor of medicine at Yale who has conducted her own secret-shopper study of telehealth sites.

What’s more, research shows many mental health medications are best paired with therapy, Ramachandran said.

Ramachandran thinks frustrations like Diamond’s might be widespread, based on her team’s research. She said she’s frustrated at the “very groovy, glossy” picture painted by telehealth ads.

Ramachandran said her study is still under consideration for publication in medical journals. But she provided preliminary results to congressional offices examining the telehealth sector.

Last year, Sen. Dick Durbin, an Illinois Democrat, and former Sen. Mike Braun, an Indiana Republican, introduced legislation to regulate some telehealth advertising practices. A spokesperson for Durbin said he intends to reintroduce the bill this year.

This article was produced by KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism. 

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In summertime, cows wait under a canopy to be milked at Mark McAfee’s farm in Fresno, California. From his Cessna 210 Centurion propeller plane, the 63-year-old can view grazing lands of the dairy company he runs that produces products such as unpasteurized milk and cheese for almost 2,000 stores.

Federal regulators say it’s risky business. Samples of raw milk can contain bird flu virus and other pathogens linked to kidney disease, miscarriages, and death.

McAfee, founder and CEO of the Raw Farm, who also leads the Raw Milk Institute, says he plans to soon be in a position to change that message.

Robert F. Kennedy Jr., the anti-vaccine activist President Donald Trump has tapped to run the Department of Health and Human Services, recruited McAfee to apply for a job as the FDA’s raw milk standards and policy adviser, McAfee said. McAfee has already written draft proposals for possible federal certification of raw dairy farms, he said.

Virologists are alarmed. The Centers for Disease Control and Prevention recommends against unpasteurized dairy that hasn’t been heated to kill pathogens such as bird flu. Interstate raw milk sales for human consumption are banned by the FDA. A Trump administration that weakens the ban or extols raw milk, the scientists say, could lead to more foodborne illness. It could also, they say, raise the risk of the highly pathogenic H5N1 bird flu virus evolving to spread more efficiently, including between people, possibly fueling a pandemic.

“If the FDA says raw milk is now legal and the CDC comes through and says it advises drinking raw milk, that’s a recipe for mass infection,” said Angela Rasmussen, a virologist and co-editor-in-chief of the medical journal Vaccine and an adjunct professor at Stony Brook University in New York.

The raw milk controversy reflects the broader tensions President Donald Trump will confront when pursuing his second-administration agenda of rolling back regulations and injecting more consumer choice into health care.

Many policies Kennedy has said he wants to revisit — from the fluoridation of tap water to nutrition guidance to childhood vaccine requirements — are backed by scientific research and were established to protect public health. Some physician groups and Democrats are gearing up to fight initiatives they say would put people at risk.

Raw milk has gained a following among anti-regulatory conservatives who are part of a burgeoning health freedom movement.

“The health freedom movement was adopted by the tea party, and conspiracy websites gave it momentum,” said Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia, who has studied the history of the anti-vaccine movement.

Once-fringe ideas are edging into the mainstream. Vaccine hesitancy is growing.

Arkansas, Utah, and Kentucky are weighing legislation that would relax or end requirements for fluoride in public water. And 30 states now allow for the sale of raw milk in some form within their borders.

While only an estimated 3% of the U.S. population consumes raw milk or cheese, efforts to try to restrict its sales have riled Republicans and provided grist for conservative podcasts.

Many conservatives denounced last year’s execution of a search warrant when Pennsylvania agriculture officials and state troopers arrived at an organic farm tucked off a two-lane road on Jan. 4, 2024. State inspectors were investigating cases of two children sickened by E. coli bacteria and sales of raw dairy from the operation owned by Amish farmer Amos Miller, according to a complaint filed by the state’s agricultural department.

Bundled in flannel shirts and winter jackets, the inspectors put orange stickers on products detaining them from sale, and they left toting product samples in large blue-and-white coolers, online videos show. The 2024 complaint against Miller alleged that he and his wife sold dairy products in violation of state law.

The farm was well known to regulators. They say in the complaint that a Florida consumer died after being sickened in 2014 with listeria bacteria found in raw dairy from Miller’s farm. The FDA said a raw milk sample from the farm indicates it was the “likely source” of the infection, based on the complaint.

Neither Miller’s farm nor his lawyer returned calls seeking comment.

The Millers’ attorney filed a preliminary objection that said “shutting down Defendants would cause inequitable harm, exceed the authority of the agency, constitute an excessive fine as well as disparate, discriminatory punishment, and contravene every essential Constitutional protection and powers reserved to the people of Pennsylvania.”

Regulators in Pennsylvania said in a press release they must protect the public, and especially children, from harm. “We cannot ignore the illnesses and further potential harm posed by distribution of these unregulated products,” the Pennsylvania agricultural department and attorney general said in a joint statement.

Unpasteurized dairy products are responsible for almost all the estimated 761 illnesses and 22 hospitalizations in the U.S. that occur annually because of dairy-related illness, according to a study published in the June 2017 issue of Emerging Infectious Diseases.

But conservatives say raiding an Amish farm is government overreach. They’re “harassing him and trying to make an example of him. Our government is really out of control,” Pennsylvania Republican Sen. Doug Mastriano said in a video he posted to Facebook.

Videos show protesters at a February 2024 hearing on Miller’s case included Amish men dressed in black with straw hats and locals waving homemade signs with slogans such as “FDA Go Away.” A court in March issued a preliminary injunction that barred Miller from marketing and selling raw dairy products within the commonwealth pending appeal, but the order did not preclude sales of raw milk to customers out of state. The case is ongoing.

With Kennedy, the raw milk debate is poised to go national. Kennedy wrote on X in October that the “FDA’s war on public health is about to end.” In the post, he pointed to the agency’s “aggressive suppression” of raw milk, as one example.

McAfee is ready. He wants to see a national raw milk ordinance, similar to one that exists for pasteurized milk, that would set minimal national standards. Farmers could attain certification through training, continuing education, and on-site pathogen testing, with one standard for farms that sell to consumers and another for retail sales.

The Trump administration didn’t return emails seeking comment.

McAfee has detailed the system he developed to ensure his raw dairy products are safe. He confirmed the process for KFF Health News: cows with yellow-tagged ears graze on grass pastures and are cleansed in washing pens before milking. The raw dairy is held back from consumer sale until it’s been tested and found clear of pathogens.

His raw dairy products, such as cheese and milk, are sold by a variety of stores, including health, organic, and natural grocery chains, according to the company website, as well as raw dairy pet products, which are not for human consumption.

He said he doesn’t believe the raw milk he sells could contain or transmit viable bird flu virus. He also said he doesn’t believe regulators’ warnings about raw milk and the virus.

“The pharmaceutical industry is trying to create a new pandemic from bird flu to get their stock back up,” said McAfee, who says he counts Kennedy as a customer. His view is not shared by leading virologists.

In December, the state of California secured a voluntary recall of all his company’s raw milk and cream products due to possible bird flu contamination.

Five indoor cats in the same household died or were euthanized in December after drinking raw milk from McAfee’s farm, and tests on four of the animals found they were infected with bird flu, according to the Los Angeles County Department of Health.

In an unrelated case, Joseph Journell, 56, said three of his four indoor cats drank McAfee’s raw milk. Two fell sick and died, he said. His third cat, a large tabby rescue named Big Boy, temporarily lost the use of his hind legs and had to use a specialized wheelchair device, he said. Urine samples from Big Boy were positive for bird flu, according to a copy of the results from Cornell University and the U.S. Department of Agriculture.

McAfee dismissed connections between the cats’ illnesses and his products, saying any potential bird flu virus would no longer be viable by the time his raw milk gets to stores. He also said he believes that any sick cats got bird flu from recalled pet food.

Journell said he has hired a lawyer to try to recover his veterinary costs but remains a staunch proponent of raw milk.

“Raw milk is good for you, just not if it has bird flu in it,” he said. “I do believe in its healing powers.”

This article was produced by KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism. 

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States and the nation’s health industry were thrown into disarray after the Trump administration ordered Monday that the government freeze nearly all federal grants at 5 p.m. ET Tuesday, a sweeping directive that at least initially appeared to include funding for Medicaid, the state-federal health insurance program that covers more than 70 million Americans.

By midmorning Tuesday, state officials around the country reported they had been shut out of a critical online portal that allows states to access federal Medicaid funding.

Sen. Ron Wyden of Oregon, the top Democrat on the Senate Finance Committee, said on the social media site Bluesky that the portals were down in all 50 states following the Trump administration’s order.

“This is a blatant attempt to rip away health care from millions of Americans overnight and will get people killed,” he wrote.

Around midday Tuesday, as state health officials pressed the federal government for clarity, the White House Office of Management and Budget — which issued the Monday memo — put out new guidance clarifying that “mandatory programs like Medicaid” were not included in the freeze.

Karoline Leavitt, the White House press secretary, declined to confirm that Medicaid was exempt when pressed by reporters during an early afternoon briefing.

But she later said in a post on the social platform X that “no payments have been affected” by what she described as a “portal outage.”

The possibility that federal Medicaid funding would be shut off overnight spooked advocates already on edge about the program’s future. President Donald Trump vowed on the campaign trail not to seek cuts for Medicare or Social Security, the nation’s major entitlement programs serving mostly retired people. But he did not make the same promise about Medicaid, which pays for health care for primarily low-income and disabled people — approximately 1 in 5 Americans.

Separate from the freeze, congressional Republicans are discussing cutting the nearly $900 billion program, arguing costs have ballooned with enrollment, notably including the program’s expansion to cover more low-income adults. Lawmakers are also eyeing ways to save money for Trump’s other legislative priorities — in particular, extending the tax cuts from his first term that expire at the end of this year.

The federal government pays most costs for Medicaid, which is operated by states. Medicaid pays for most long-term care for Americans and for about 40% of all U.S. births, and together with the related Children’s Health Insurance Program covers about 38 million children.

Federal funding for Medicaid does not go directly to individual enrollees but to the states, which then distribute it to providers, health plans, and other entities that serve Medicaid enrollees.

State officials can access that funding through internet portals.

Joan Alker, who is executive director of the Center for Children and Families at the Georgetown McCourt School of Public Policy, said on X Tuesday that the portal lockout is “a major crisis.”

She pointed out that many states access their federal funding at the end of the month — “i.e. this week,” she wrote.

The original freeze order came in the form of a vaguely worded two-page memo from the Office of Management and Budget to all federal agencies directing them to “temporarily pause all activities related to obligation or disbursement of all Federal financial assistance.”

“This temporary pause will provide the Administration time to review agency programs and determine the best uses of the funding for those programs consistent with the law and the President’s priorities,” the memo said. The only programs explicitly noted as exceptions were Medicare and Social Security, which left it unclear how states would continue to pay doctors, hospitals, nursing homes, and private health plans to manage Medicaid.

Around the nation, health officials scrambled to make sense of the order, which was scheduled to take effect at 5 p.m. ET Tuesday. A federal judge halted the freeze shortly before its implementation, blocking the change until next week.

Even as OMB clarified that Medicaid was not included, the immediate impacts to other critical health programs were becoming clear, especially for community health centers and medical research centers.

Democrats in Congress expressed outrage at the Trump administration for pausing federal funding not only to Medicaid but also to numerous other programs, including the Supplemental Nutrition Assistance Program, also known as food stamps, the WIC nutrition program for pregnant and postpartum women and infants, and school meal programs for low-income students.

“The Trump Administration’s action last night to suspend all federal grants and loans will have a devastating impact on the health and well-being of millions of children, seniors on fixed incomes, and the most vulnerable people in our country,” Sen. Bernie Sanders (I-Vt.) said in a statement Tuesday. “It is a dangerous move towards authoritarianism and it is blatantly unconstitutional.”

The National Association of Medicaid Directors and the major nursing home associations were among those seeking clarification from the White House on Tuesday about the order’s impact on Medicaid funding.

Numerous state officials and groups said they were considering or had already filed litigation challenging the order. One lawsuit was filed Tuesday against OMB in federal court in Washington, D.C., by the National Council of Nonprofits and the American Public Health Association, seeking a temporary restraining order to “maintain the status quo until the Court has an opportunity to more fully consider the illegality of OMB’s actions.”

Attorneys general in California, New York, and four other states announced Tuesday afternoon a joint lawsuit against the Trump administration over the order, which they said had already frozen systems for Medicaid, Head Start, and even child support enforcement across multiple states.

“There is no question this policy is reckless, dangerous, illegal, and unconstitutional,” said New York Attorney General Letitia James. She added that she and other Democratic attorneys general would seek a temporary restraining order to halt the OMB policy from going into effect.

Leavitt defended the freeze during her White House briefing — the first of the new administration — saying it was critical to ensuring that federal funding was being used appropriately.

“This is a very responsible measure,” she said.

Reporting contributed by Bram Sable-Smith, Jordan Rau, Renuka Rayasam, Brett Kelman, and Christine Mai-Duc.

This article was produced by KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism. 

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