Letter to House and Senate Leaders Opposing the Tax Cuts and Jobs Act

Letter to CMS Regarding Proposed Rule on Short-Term, Limited-Duration Insurance Plans

ACP Letter to ONC Providing Feedback on Health IT Playbook

Letter to Medicare Payment Advisory Committee (MedPAC) on Studying the Effects of Eliminating or Lowering Co-Payments on Medications Used for Chronic Illness

Joint Letter to Congress Recommending Improvements to Medicaid, CHIP, and Private Insurance Coverage

Joint Letter regarding Funding for Health Resources & Services Administration in FY 2021

Joint Comment Letter to CMS re PACE Program Request for Information

Improving Access to Health Care for Uninsured Americans: The Economic Recovery and Assistance for American Workers Act of 2001. Letter to members of the Senate Finance Committee.

Letter to the Office of the National Coordinator: Concerns with Stage 2 Meaningful Use Requirements

Inclusion of Health Insurance for Unemployed Workers in the Economic Recovery and Assistance for American Workers Act of 2001. Letter to Congress.

How Would You Manage This Patient With Frequent Migraine Headaches? Grand Rounds Discussion From Beth Israel Deaconess Medical Center

Migraine headaches are highly prevalent and, for women below the age of 50, the leading cause of years lived with disability. Migraines disproportionately affect persons of lower socioeconomic status and those who are uninsured, and they result in millions of office and emergency department visits annually. Migraines are also responsible for billions of dollars in lost productivity and health care expenses each year. Medication classes traditionally used for migraine headache treatment have included nonsteroidal anti-inflammatory drugs, acetaminophen, antihypertensive drugs, antiseizure drugs, antidepressant drugs, and botulinum toxin. In recent years, triptans have come into widespread use for acute treatment, and calcitonin gene-related peptide antagonists, including gepants and monoclonal antibodies, have been used for both acute treatment and prevention. In 2025, the International Headache Society and the American College of Physicians published guidelines on pharmacotherapy for migraine headaches covering both acute and preventive treatments. Here, 2 experts in this field, a primary care physician and a neurologist and headache specialist, debate how to manage the case of a patient with frequent migraine headaches. They discuss the diagnostic considerations and the acute and preventive treatment challenges in the care of this population.

Cardiologists weigh in on medications for obesity

Q&A: Engaging patients in violence prevention

Initiation of Medications for Alcohol Use Disorder Among Hospitalized Veterans: A Retrospective Cohort Study: Annals of Internal Medicine: Vol 179, No 6

Background: Hospitalization for alcohol use disorder (AUD) offers an opportunity to initiate evidence-based medications for alcohol use disorder (MAUDs). Objective: To describe patterns and factors associated with hospital initiation of MAUD. Design: Retrospective cohort study. Setting: Veterans Health Administration (VHA). Participants: Veterans hospitalized with a primary diagnosis of AUD in 2022 or 2023. Measurements: Patients had MAUD initiated as an inpatient or within 7 days of discharge. Logistic regression models estimated the predicted probabilities of MAUD initiation based on hospital fixed effects and demographic and clinical characteristics. Results: Among 29 041 hospitalizations for AUD of veterans without MAUD at baseline in 142 hospitals (median age, 55 years; 94% male), in 8932 hospitalizations (30.8%), MAUD was initiated as an inpatient or within 7 days; MAUDs were naltrexone (57.9%), acamprosate (16.5%), and injectable naltrexone (13.9%). Of MAUD initiations, 6221 (69.6%) were during an inpatient stay and the rest were within 7 days. Of the 6221 inpatient initiations, 97.7% had a prescription for MAUD within 30 days after discharge. In adjusted analyses, MAUD initiation was more likely for hospitalizations with a specialty addiction consultation and those receiving psychiatry versus medicine service. Initiation of MAUD was less likely for persons aged 65 years or older, men, American Indian or Alaska Native versus White veterans, frail veterans, veterans diagnosed with opioid use disorder, and those in the intensive care unit. The median hospital-level rate of MAUD initiation was 29.9% (IQR, 22.6% to 36.3%). Limitation: Generalizability to other health care systems. Conclusion: Within the VHA, 30% of hospitalizations for AUD resulted in MAUD initiation as an inpatient or within 7 days of discharge, with substantial variation across hospitals and patient demographic and clinical factors. These data indicate a need to identify and disseminate successful hospital-based strategies to increase prescribing of MAUD. Primary Funding Source: U.S. Department of Veterans Affairs and National Institute on Aging.

Talking With Patients About Health-Related Mis- and Disinformation

Much ado over acetaminophen

Multimodal Prehabilitation for Older Adults Undergoing Spinal Fusion: A Randomized Clinical Trial: Annals of Internal Medicine: Vol 0, No 0

Background: Older adults often have impaired physiologic reserve and are at higher risk for postoperative complications after spinal fusion surgery. Objective: To evaluate the efficacy of multimodal prehabilitation plus Enhanced Recovery After Surgery (PREERAS) versus ERAS alone on 90-day postoperative complications in older adults undergoing elective spinal fusion. Design: Multicenter, open-label, assessor-blinded, 1:1 parallel-group randomized controlled trial. (ClinicalTrials.gov: NCT06140797) Setting: 3 tertiary hospitals in China. Participants: Adults aged 75 years or older undergoing elective spinal fusion surgery between May 2024 and May 2025. Intervention: Participants were randomly assigned to receive either preoperative Vivifrail-based, multimodal PREERAS (PREERAS group) or ERAS alone (ERAS group). The 4-week prehabilitation program integrated supervised group sessions, Vivifrail multicomponent exercise, nutritional optimization, and psychological interventions. Measurements: The primary outcome was the occurrence of any postoperative complication within 90 days of surgery, recorded and graded per the Clavien–Dindo classification system. Results: A total of 312 patients were assessed for eligibility, with 164 randomly assigned. Of the 159 patients included in the final analysis (mean age, 78.7 years; 59% women), 59 patients (74.7%) in the PREERAS group and 73 patients (91.2%) in the ERAS group experienced at least 1 complication (risk ratio, 0.80 [95% CI, 0.67 to 0.95]; risk difference, −18.0% [CI, −27.0% to −9.0%]). Limitations: Unblinded participants and clinicians. Generalizability may be limited with longer hospital stays in the Chinese health care system. Conclusion: The implementation of multimodal prehabilitation in 3 tertiary hospitals in China reduced 90-day postoperative complications in older adults undergoing enhanced recovery after spinal fusion surgery. However, individual sites will need to consider applicability of findings and resource requirements of prehabilitation before implementation. Primary Funding Source: Capital’s Funds for Health Improvement and Research.

How Would You Manage This Patient With Idiopathic Acute Pancreatitis? Grand Rounds Discussion From Beth Israel Deaconess Medical Center

Acute pancreatitis is among the most frequent gastroenterologic reasons for hospitalization in the United States. This condition is associated with significant morbidity, including recurrent acute pancreatitis and chronic pancreatitis. Although most patient cases are due to biliary disease and ethanol, approximately 18% are idiopathic. Diagnostic and management options for idiopathic acute pancreatitis include genetic testing for a number of associated mutations and cholecystectomy to treat subclinical or undetected biliary disease. Endoscopic retrograde cholangiopancreatography, often with concomitant endoscopic sphincterotomy, is also sometimes considered in the management of idiopathic recurrent acute pancreatitis, although the role of this invasive procedure is generally limited. Here, 2 pancreatologists and coauthors of a recent American College of Gastroenterology guideline on the management of acute pancreatitis discuss issues related to genetic testing, cholecystectomy, and endoscopic retrograde cholangiopancreatography with endoscopic sphincterotomy for patients with acute idiopathic pancreatitis in general, and for a young woman recently diagnosed with this condition.

Neither Metformin nor Ursodeoxycholic Acid Effectively Treats Postacute Sequelae of COVID-19: A Randomized Clinical Trial: Annals of Internal Medicine: Vol 179, No 4

Background: There is no proven treatment to alleviate symptoms of postacute sequelae of SARS-CoV-2 infection (PASC), despite its substantial public health burden. Objective: To evaluate the efficacy of metformin and ursodeoxycholic acid (UDCA) in improving PASC symptoms in adults. Design: Double-blind, placebo-controlled, randomized clinical trial. (Clinical Research Information Service: KCT0009342) Setting: Two tertiary hospitals in South Korea, July 2024 to April 2025. Participants: Of 666 adults screened, 396 with a PASC index score of 12 or greater were randomly assigned. Intervention: Oral metformin (uptitrated to 1500 mg/d), UDCA (900 mg once daily), or double placebo for 14 days (1:1:1). Measurements: Proportion of participants achieving PASC recovery (index score <12) at 8 weeks. Results: Among 396 randomized participants (median age, 36 years [IQR, 28 to 49 years]; 72% women), 132 received metformin, 132 received UDCA, and 132 received placebo. The mean interval from SARS-CoV-2 infection was 9.8 months (SD, 7.5). The mean baseline PASC score was 19.3 (SD, 5.7). Recovery occurred in 63.6% (84 of 132) with metformin, 68.2% (90 of 132) with UDCA, and 68.2% (90 of 132) with placebo. Mean changes in PASC scores from baseline to week 8 were −10.05 (95% CI, −11.35 to −8.76) with metformin and −10.62 (CI, −11.79 to −9.45) with UDCA, compared with −10.43 (CI, −11.69 to −9.18) with placebo. Limitation: Findings may not be generalizable to patients with more severe or persistent long COVID. Conclusion: A 2-week course of metformin or UDCA did not significantly improve recovery from PASC. Primary Funding Source: National Institute of Infectious Diseases, National Institute of Health, South Korea

Iron Deficiency Anemia

Iron deficiency anemia (IDA) is caused by iron deficiency, a common yet underrecognized clinical entity. Populations at greatest risk include children, menstruating and pregnant persons, and people of low socioeconomic status. Timely diagnosis and management of iron deficiency are key to preventing IDA and require thorough assessment of the underlying cause and appropriate iron repletion through either oral or parenteral therapy. Blood transfusion does not provide adequate elemental iron but is sometimes indicated along with iron therapy in patients with cardiovascular compromise, active bleeding, or severe anemia where more rapid correction is warranted. Alternative causes of anemia can be differentiated by red blood cell morphology and reticulocyte count and should be considered if anemia persists despite adequate repletion of iron stores.