Philadelphia local news, sports, jobs, cars, homes

Category: Health

  • Feeling wonder every day improves our health. Here’s how to do it.

    Feeling wonder every day improves our health. Here’s how to do it.

    I just had a most eventful week.

    I watched in horror as a terrible storm in the Mediterranean dashed a ship against a rocky coast, forcing its crew and passengers into a desperate attempt to save themselves and rescue their cargo.

    I soared with the birds among snow-covered peaks in the Rockies, marveling at the many shades of white and blue.

    And I joined picnickers on a serene hillside along the Hudson River, where I watched the sunlight and clouds play above a sheep pasture and a tiny village beyond it.

    What’s more, I did all of this in just 90 minutes at the National Gallery of Art in Washington. I took the museum’s “Finding Awe” tour and, with the help of staff, unlocked a sense of wonder I did not know I could feel while looking at art — in this case, a 1772 shipwreck scene by Claude-Joseph Vernet, a 1946 abstraction by Georgia O’Keeffe, and an 1860 landscape by Jasper Francis Cropsey.

    The West and East Buildings of the National Gallery of Art.

    The National Gallery, working with University of California at Berkeley psychologist Dacher Keltner, has so far hosted 36 awe tours for the 800 people lucky enough to get a slot. You can also take a self-guided awe tour using the museum’s tools, or apply the same techniques to experience wonder while looking at art anywhere.

    A growing body of evidence demonstrates that the experience of awe that visual arts can trigger has mental and physical health benefits for us. They are similar to the restorative effects produced by awe-inspiring natural settings, such as a mountain vista or open sea, but we can access them more easily. The best part is you don’t need to know anything about the art you are looking at.

    “In some ways I think it’s actually easier if you don’t have an understanding,” National Gallery of Art Director Kaywin Feldman told me, because “that moment of ‘oh my goodness’ is part of wonder. You have to sort of stop in your tracks, have that moment of surprise.”

    This was excellent news for me, because that one semester of art history I took in college didn’t stick. Until now, the primary feeling I’ve had when visiting a museum has been drowsiness. I call it “museum head.” I race through one of the world’s best collections — the Louvre, the Uffizi, the Prado, the Met — and glimpse as many works of art as I can take in until, overstimulated and overwhelmed, I find a seat near the gift shop and wait for the others in my party to finish.

    But now I know the cause of museum head: I was doing it all wrong. The way to experience awe in visual art — in fact, the way to experience awe in any setting — is to slow down. The point is not to see it all but to see a few things, or even one thing, deeply.

    Kaywin Feldman, director of the National Gallery of Art, talks about a self-portrait by Rembrandt.

    Feldman’s first such awe experience came in Padua, Italy, when she was 22 and, though hungry, tired, and dirty from her travels, she decided to see the Giotto de Bondone frescoes in the Scrovegni Chapel. “When I walked out of that chapel, I felt like I was walking on a cloud,” she recalled. “I thought life was so beautiful, such a gift. I fell back in love with humanity and felt such optimism for the future.”

    Since then, she has made it her life’s work to help others experience such moments of wonder. She told me she once kicked a pair of donors off a Florence art tour when they declined to visit the Uffizi because they already “did it” decades earlier. “You’re there to have an experience, not to check something off the list.”

    To illustrate, she took me to see a 1659 self-portrait by Rembrandt and instructed me to study his face, brightly lit while all else in the painting was in shadow. His dark eyes locked on mine even as I moved from side to side. I studied the wrinkles in his forehead, the folds under the eyes, the loose flesh in the pallid cheeks. I could see a blood vessel on his bulbous nose, the whiskers of his thin beard and the individual curls in his hair. I saw sadness and maybe worry in that face.

    After I took that in, Feldman explained the sadness. Rembrandt, 53 in the portrait, had just gone bankrupt and had to move from his home and sell his possessions. He had lost his wife and several children and had a financial dispute with a partner. “He’s looking at you and connecting and asking you to acknowledge him,” she said. For her, the wonder comes from this “direct connection with somebody who is no longer alive.”

    I held the great man’s gaze from across the centuries and I felt a chill. This connection to immortality made my daily vanities and worries seem small and insignificant. It reminds us, as Feldman put it, that we are “part of something bigger.”

    Physiological responses

    New research out of King’s College London gauged people’s physiological responses while they viewed works by Paul Gauguin, Vincent van Gogh, Edouard Manet, and Henri de Toulouse-Lautrec for 20 minutes. The study, now in preprint, found that participants’ levels of the stress hormone cortisol dropped by 22% on average, while markers of inflammation dropped even more sharply and heart rhythms indicated greater relaxation.

    This is consistent with other recent research connecting immersion in visual art to human flourishing, including by reducing pain and illness, raising levels of neurotransmitters associated with well-being such as serotonin and oxytocin, and increasing feelings of altruism and cooperation.

    “Simply slowing down to take in the simple beauties around us is an antidote to the moral ugliness of our attention-captured, online life, and visual art and the spaces of such contemplation a gym for such training,” Keltner writes in a forthcoming book.

    “It’s mind-blowing,” the Berkeley psychologist told me, “that experiencing awe standing in front of a painting makes you feel more compassionate … and it makes you more interested in being a good citizen.”

    In a sense, science is catching up with philosophy. The 13th-century thinker Albertus Magnus wrote that “wonder is defined as a constriction and suspension of the heart caused by amazement at the sensible appearance of something so portentous, great, and unusual, that the heart suffers a systole.”

    So how can we induce that systole, or contraction, of the heart?

    Nathalie Ryan, who runs the “Finding Awe” project, poses in front of “Autumn — On the Hudson River,” an 1860 painting by Jasper Francis Cropsey.

    For some, awe will be found in the oldest art, which allows us to meet the ancients. For others it will be in the Impressionists, because they are crowd pleasers. Some find it standing back from a piece and thinking abstractly, while others find it by studying intricate detail. In all cases, it’s better if you don’t read up on the work of art beforehand, or even read the label. Just stop at something that catches your eye — and study it for 10 minutes or longer.

    Nathalie Ryan, who runs the “Finding Awe” project at the National Gallery, has been working with the Harvard Graduate School of Education to bring the concept of “slow looking” to the art world.

    “The research that we’ve done for years with Harvard has shown that the longer you look at something and give it your attention and really work to make sense of it yourself and connect, the more curious you become,” Ryan said. Curiosity, in turn, leads you to states of wonder and awe.

    So Ryan and colleague Cassandra Anderson start the awe workshops with breathing exercises and a 15-minute icebreaker in which participants describe to each other moments of awe they have experienced. She then turns to the session’s piece of artwork, starting with 35 minutes of quiet meditation (“linger in the pleasure of just looking … taking in all the details of this work”) followed by a group discussion about emotions and impressions and possible symbolism and metaphors. Only when that is done does Ryan take 15 minutes to provide information about the work’s history and common interpretations, which participants then reflect on for the final 15 minutes.

    In terms of brain science, Keltner explained, the slow looking activates the amygdala, which processes emotions, and the periaqueductal gray matter, which regulates autonomic functions such as heart rate and breathing.

    “You let those images and forms move into your feelings, and you remember things, and it calls to mind images of your childhood or a place you’ve been, and you start to transport,” he said. But once you start learning about the work’s history, the action moves to the prefrontal cortex and its organizing function — and the awe process quiets down.

    The National Gallery produced a set of two dozen flash cards that allow people to take a self-guided awe tour. The selections range from the 17th to the 21st century and each contains a series of prompts to help you find awe.

    Johannes Vermeer’s A Lady Writing comes with a prompt to “write a letter to your future self.” John Constable’s Cloud Study encourages us to go outside and watch the clouds and “contemplate their transient beauty.” Archibald John Motley Jr.’s Portrait of My Grandmother invites us to “remember a mentor’s advice” and contemplate “how might you pass this wisdom along.”

    Some of the works inspire awe by conveying the power of nature, or the moral beauty of its subject, or by making us contemplate spirituality or themes of life and death. But in all cases, Ryan said, “it’s a way of looking more deeply at ourselves and coming to understand ourselves in relationship to this world.”

    If you can’t visit the National Gallery, you can use these prompts when looking at art wherever you live. Just find something that resonates with you — and skip the audio tour.

    Hits and misses

    After the Rembrandt, my awe guides took me to see a work by sculptor Dario Robleto, Small Crafts on Sisyphean Seas. It is an intricate collection of seashells, urchin spines and teeth, coral, tusks, claws, butterfly wings, and more, all arranged with precision and symmetry. The artist intended it as his “gift for the aliens, when we meet them,” as Feldman explained it. For some, it might provoke awe-inspiring thoughts about space and extraterrestrial life and induce them, as the flash card put it, to “meditate on the interconnectedness of all things.” But I found it a bit too abstract to transport me. We moved on, sampling other works featured in the finding-awe tours.

    I felt more of a connection when we visited O’Keeffe’s A Black Bird With Snow-covered Red Hills. Here, I was soaring with an oddly shaped bird in a blue sky, looking down at the blue fading to white where two snow-covered hillsides formed a “V.” It was exhilarating. And puzzling. After a few minutes, Ryan gave me some context: The bird was a nod to the artist’s late husband, Alfred Stieglitz, called by the nickname “Old Crow,” who had died just before O’Keeffe painted the work. Some see loneliness and loss. O’Keeffe herself described “the snow-covered hills holding up the sky,” and the black bird “always there, always going away.”

    I came still closer to finding awe in Vernet’s The Shipwreck, which the artist paired with a tranquil harbor scene as pendants, Moonlight. The latter filled me with calm: A full moon illuminated the sea, which made barely a ripple as it touched the shore, where people slept, smoked, washed, or stood around a campfire.

    But the tranquility only accentuated the terror in the shipwreck scene, where people clung to the crow’s nest of the submerged ship and tried to slide down a rope to safety. Huge waves crashed on the nearby rocky shore, winds splintered the bough of a tree, and a lightning bolt made a fiery patch in an otherwise dark sky.

    After I took in the scenes, Ryan explained that Vernet, influenced by Edmund Burke’s Philosophical Inquiry Into the Origins of Our Ideas of the Sublime and the Beautiful, was contrasting calm beauty with the frightful sublime. A quarter-millennium later, the terror still chilled me.

    Claude-Joseph Vernet’s “Moonlight,” also a 1772 painting, is paired with his work “The Shipwreck” at the National Gallery.

    It was in Cropsey’s Autumn — On the Hudson River, however, that I found my true awe moment. The massive panorama, five feet high and nine feet across, invited me in and held me there.

    I was on a shaded hillside on a warm autumn afternoon, looking down toward the village and river beyond. I heard a gurgling waterfall in the foreground and smelled the earthy decay of fallen trees and leaves. A trio of hunters enjoyed a picnic on a blanket, a bottle of wine in their basket, while their dogs rested. I moved on into the scene, past the red-winged blackbird and the paper birch, past the cattle in the stream and the sheep dotting the pasture, to the kids and dogs on a wooden bridge. Ahead of me, a man on horseback passed a log cabin and headed down the road toward the village, where wood smoke rose from chimneys. Sailing ships and steamboats plied the river, framed by low clouds on the far shore and a rocky mountainside. Streaks of sunlight streamed from behind a cloud, igniting the gold and scarlet leaves.

    It brought me thoughts of my grandparents’ house in the woods, then thoughts of my grandfather, and of how his love of the land became part of my life. I wanted to linger in the now-lost woodlands and wetlands in the painted landscape. In my chest, I felt a deep yearning, almost an ache.

    The National Gallery staff, in its follow-up surveys of awe tour participants, found that 95% of respondents sought more awe in their daily lives, and half reported that they experienced more awe. I can confirm these findings.

    In the days after my visit, I found myself pausing to marvel at things I often take for granted: A Christmas fern poking through the snow, the intricate forms of lichens on a tree, a sweet birch clinging to a rocky hillside, the pink and orange in a winter sunset, the power of a house-rattling windstorm. The more you seek awe, the more you find it.

  • 7 home remedies to try for a sore throat

    7 home remedies to try for a sore throat

    Woke up to a sore, scratchy throat? You may want to blame it on dry air, but it’s usually a sign your body is fighting a viral infection.

    “The top five causes of a sore throat are a virus, a virus, a virus, a virus, and a virus,” said Elisabeth Fowlie Mock, a family physician and director at the American Academy of Family Physicians. The culprits that can trigger a sore throat include rhinoviruses (the most common cause of colds), influenza, coronavirus, and respiratory syncytial virus.

    Throat pain is often your first symptom because viruses first latch on in this area of your body, said Benjamin C. Tweel, an assistant professor of otolaryngology at the Icahn School of Medicine at Mount Sinai.

    “The virus is getting into the cells lining the throat, and it’s probably causing an inflammatory response in your body’s immune system,” said Tweel, also the medical director for the department of otolaryngology at Mount Sinai Health System. When the body recognizes a viral intruder, lymphatic tissue in the back of the nose and throat swells and becomes inflamed, causing pain, the experts said.

    “Every so often, your body fights it off, and you don’t get the full-blown thing,” Mock said. Other times, the classic symptoms of an upper respiratory infection follow, including a runny nose, congestion, and cough.

    Throat pain from an upper respiratory infection usually gets better within one week, according to the Centers for Disease Control and Prevention. Over-the-counter pain relievers such as ibuprofen or naproxen can help, and they may have an advantage over medications such as acetaminophen, Tweel noted, because they reduce pain and inflammation. And of course, there are some home remedies that may soothe your pain. Here are a few to consider:

    Saltwater gargle

    Salt water has long been considered a tried-and-true approach for sore throats, and there is some scientific research to support it. A small 2019 randomized controlled trial, published in the Journal of Complementary and Alternative Medical Research, found that people with nonbacterial sore throats who gargled with salt water had less severe pain and difficulty swallowing one week later compared with those who used thymol solution, a type of antiseptic gargle or mouthwash.

    It’s possible salt helps reduce tissue swelling in the throat, said Cameron Wick, an otologist and neurotologist at University Hospitals. “When you do a saltwater rinse, it’s basic high school chemistry and the whole process of osmosis,” he said. “Some of the water in the cells in your throat actually come out of your tissue and go into the salt solution, so that decreases some of the inflammation.” Saltwater gargling “probably also helps wash out debris and virus particles,” Tweel added.

    The research is limited, but saline gargling “is highly unlikely to be harmful,” Mock said. “It might help a little bit, and it’s probably not going to hurt.” A safe ratio is 1 teaspoon of salt for every 8 ounces of warm water, Wick said.

    Saltwater rinses may have other benefits. If you’re experiencing thick mucus, congestion, or symptoms of allergies, an over-the-counter saline spray or nasal irrigation device can clear out your nasal passages for easier breathing, Wick said. These products also help hydrate the nasal passages and reduce swelling.

    Only use water that is distilled, sterile, or boiled and cooled in nasal irrigation devices, since tap water may contain germs that are dangerous if they enter your sinuses.

    Honey

    Honey is known for its antibacterial properties, Wick said, and its thickness may shield your sore throat from further irritation. It should feel good on the throat or a mucosal membrane, he explained. Honey acts as a barrier, so the throat isn’t “exposed to the elements in general and passing liquids and air.”

    There’s some research to support honey’s use for the relief of upper respiratory infection symptoms such as a sore throat and cough. One small 2023 study also found that gargling with honey — 15 milliliters of honey mixed in 5 ml of water — helped ease pain from a tonsillectomy, or surgery to remove the tonsils.

    Honey can also be an option for children with sore throats and coughing who are at least 1 year old. The American Academy of Pediatrics recommends it instead of over-the-counter medications for children, since there’s little evidence cold medicine offers much benefit to kids younger than 6.

    “As long as they’re over 1 year old, a little bit [of honey] in warm liquid or a teaspoon of honey” may help ease kids’ sore throats and help them sleep better, Mock said. You should never give honey to babies under 12 months because of the risk of infant botulism, a rare but dangerous condition.

    Tea

    Sipping a cup of tea feels good on a sore throat, but not all types are recommended when you have an upper respiratory infection.

    “Make sure it’s a non-caffeinated tea,” Wick said. “Black teas, those really tannic teas, often have a relatively high caffeine level, and caffeine does things to your kidneys that makes you urinate more and can actually dehydrate you.”

    There have been limited studies linking herbal teas to reduced throat pain; chamomile, ginger, and turmeric tea are particularly good options, Wick said.

    To give your tea a sore throat-soothing boost, squeeze in honey and lemon. The citrus fruit “adds vitamin C, which has immune support, and increases saliva production,” Wick said. The latter is beneficial because it may help saliva glands in your mouth and throat (there are “hundreds of minor ones underneath the mucosal surface,” he said) flush themselves, so “rather than thick, congested mucus, it’s thinner, and the body can handle it more.”

    Warm beverages

    If you’re not a tea drinker, other warm beverages such as warm water, bone broth, vegetable broth or soup may be similarly soothing. “There’s a kind of calming effect that occurs with warm water,” Wick said.

    Warm beverages may also be easier to drink and thus can increase your overall hydration. “[This] is probably one of the better things you can do for a sore throat,” Tweel said. “The drier you are, the worse your throat is going to be.”

    Plus, as long as it doesn’t contain ingredients that irritate the throat, soup can be comforting, Mock added.

    Cool foods

    Some people prefer cool foods such as ice chips or ice pops for a sore throat, especially if they’re experiencing more significant throat pain, Wick said. After a tonsillectomy, “kids get to binge on ice cream and Popsicles. Usually that is because the coolness calms down those pain fibers and nerve endings,” he said.

    There’s little research on cold foods for sore throats caused by upper respiratory infections, but some studies suggest cooling therapies might help ease throat discomfort after medical procedures such as intubation and surgery.

    Using a humidifier

    Dry air can make your nose, mouth, and throat feel scratchy and uncomfortable. “This is part of the reason why people feel worse sometimes immediately after flying on a plane,” Tweel said. Running a cool-mist humidifier or vaporizer may ease some of that scratchiness when you have a sore throat.

    The big caveat is you have to keep these devices clean. “I personally don’t use one because I find it hard to keep it sanitized,” Tweel said. Mold and bacteria can proliferate in portable humidifiers, and breathing in that germ-containing mist could make you sick.

    The CDC recommends cleaning your humidifier regularly according to the manufacturer’s instructions, emptying the water tank daily, and using distilled or boiled and cooled water, which are less likely to cause germ growth.

    If cleaning a humidifier feels too burdensome, you can get similar benefits from a steamy shower or inhaling the steam that comes off boiling water or a cup of tea, Tweel said.

    Lozenges

    For adults, lozenges or cough drops “help your throat produce more saliva,” Tweel said, which can in turn reduce dryness. “So much of the soreness [of a sore throat] is being dry or dehydrated,” he said, “so if you can do anything to combat that dryness, it will be helpful.”

    There are many varieties available, and “essentially whatever feels good is worthwhile,” Tweel said, but some people are partial to the cooling sensation from menthol or eucalyptus lozenges.

    Lozenges or cough drops shouldn’t be given to children under 4 years old, since they are choking hazards.

    When to see your doctor for a sore throat

    A sore throat typically lasts a few days, then starts to get better, Mock said. After that, you’re likely to have a runny nose and congestion, followed by a chest cough. “That’s a normal upper respiratory infection,” she said. “As long as it’s progressing and not getting worse, [the virus] can take a week or two to run its course.”

    But a sore throat sometimes warrants a doctor visit. You should make an appointment with your primary care practitioner if you have a fever along with throat pain, severe pain, or difficulty breathing or swallowing, or if you notice white patches on the back of your throat or “any major asymmetry, meaning a size difference between your tonsils,” Wick said. These might signal a bacterial infection such as strep throat, which may require antibiotics.

    Long-lasting throat pain is also worth getting checked out. “Should you have a severe sore throat for more than seven days? No, it should be getting better by then,” Mock said.

  • Recruiters flew people from Kensington to California for what they described as free luxury rehab. Critics say it’s a scam.

    Recruiters flew people from Kensington to California for what they described as free luxury rehab. Critics say it’s a scam.

    Christina Gallo and Daniel Zehnder came to McPherson Square in the Kensington neighborhood looking for a fix, as they did almost every day.

    But on this day in late April, an SUV pulled up. A woman bounded out with an offer that sounded like a miracle: an all-expenses-paid trip for free treatment at a luxury rehab center in California.

    Gallo and Zehnder, both then 37, hoped their lives were finally about to turn around after two decades struggling with addiction.

    “We wanted to get clean,” Gallo said.

    Christina Gallo and Daniel Zehnder, pictured here in Kensington’s McPherson Square in June, were recruited to what they thought would be a luxury rehab in California.

    Within days, they were in a Lyft from their Bucks County trailer to the Philadelphia airport. Everything — the Lyft, the flight, the rehab — had been paid for, by whom they did not know.

    They landed at a treatment facility in Los Angeles with a gleaming swimming pool, but said they did not see doctors or nurses and were offered little medical treatment to ease their agonizing withdrawal symptoms. Within a few days, the couple had left the clinic, relapsed, and the life-changing trip they envisioned ended in an ambulance rushing to a nearby hospital, where Gallo was admitted to intensive care.

    Their California dreams were dashed. But the trip notched another recruitment for The Rehab Specialist, a year-old operation that makes money by scouting the streets for people in addiction to send to independently run rehab centers across the country.

    Rehab Specialist recruiters working in Philadelphia offered free plane tickets, housing, and medical care — and at times cash, cell phones, cigarettes, and clothes — to entice people into recovery homes, Inquirer reporters found in interviews with seven people who had firsthand knowledge of the recruiting tactics.

    With a single conversation in Kensington, recruiters also got willing patients enrolled in private health insurance that could pay higher rates, often without the patients understanding what they had signed up for — until bills started to arrive.

    Businesses like The Rehab Specialist operate as middlemen in an industry where one person’s recovery can be cashed in for hundreds of thousands of dollars in insurance payments.

    Some referral and marketing services in the addiction treatment industry are legal. But the business is also notoriously rife with insurance fraud and patient brokering — a term that describes referrals to specific clinics in exchange for illegal kickbacks or bribes.

    Rehab Specialist brochure, advertising a Spanish-Colonial style mansion with a pool in the backyard.

    Pennsylvania is seeing a resurgence of patient brokering, according to tracking in 2023 by Highmark Health, a Pittsburgh-based Blue Cross Blue Shield affiliate. Such schemes are especially a concern in Kensington, home to one of the nation’s largest open-air drug markets.

    Federal laws and a patchwork of state laws are supposed to protect vulnerable people. Prosecutors have limited resources, however, and rarely investigate low-level players.

    Pennsylvania considered stronger laws after a major scandal. In 2019, federal and state prosecutors uncovered a multimillion-dollar insurance fraud scheme at Liberation Way, a Bucks County recovery home. The abuses spurred Pennsylvania lawmakers to introduce legislation that would have made it a felony to use money or services to lure patients into addiction rehabs and other healthcare facilities. The measure died without advancing to a vote.

    “People get pretty brazen when nobody’s looking,” said Alan Johnson, chief assistant state attorney in Palm Beach County and a national expert on fraud in the industry.

    Johnson called a description of The Rehab Specialist’s practices “classic patient brokering.”

    For months, Philadelphia advocates for people in addiction circulated warnings about the business and posted photos of its recruiters on Facebook. They tried to alert police, but never heard back.

    Screenshot of text messages between Christina Gallo and a Rehab Specialist recruiter, saying that Gallo and Zehnder got approved for private insurance that would pay for their treatment in California.

    The Philadelphia Police Department did not respond to requests for comment, and the Philadelphia District Attorney’s Office said it has not opened an investigation and declined to comment on The Rehab Specialist’s practices. The Pennsylvania Attorney General’s Office also declined comment.

    On social media, The Rehab Specialist’s director and founder, Gus Tarrant, strongly disputed critics who accused his business of patient brokering.

    “I have never and would never give a client money to go to rehab or encourage them to cycle in and out of programs,” Tarrant wrote in a March post to a Facebook group that monitors addiction treatment.

    Tarrant, in a June interview with The Inquirer, reiterated that he and his business have done nothing wrong.

    Tarrant said that his operation has a national focus and came to Philadelphia this spring because the city has “the worst drug epidemic in the country.”

    Tarrant said his recruiters send patients out of their home state to avoid triggers for relapse, a practice he strongly believes in, having gone through his own recovery from addiction about five years ago. (Though popular in some recovery circles, some research suggests that it can be less effective than getting treatment closer to home, where people have established support networks.)

    “Our goal is to help as many people as we can,” Tarrant said. Now based in Myrtle Beach, S.C., Tarrant has channeled his experience into starting at least two businesses in the past five years focused on people in addiction.

    He said rehab centers pay his business a flat fee to arrange for people from Kensington to receive treatment in California, but declined to share details. Two Los Angeles treatment centers told The Inquirer they had paid Tarrant and his operation a flat fee for “marketing,” but both also declined to give specific details of the arrangement.

    On business cards, Tarrant’s title is listed as The Rehab Specialist’s founding partner; his LinkedIn profile says he started working there in 2024.

    The Inquirer was unable to find any documentation indicating the business was formally incorporated in a search of state corporate registries where its recruiters and Tarrant have operated. The Inquirer also did not identify any lawsuits filed against The Rehab Specialist.

    The Inquirer interviewed Tarrant by phone this summer. He did not return multiple calls, texts, and emails this month requesting additional comment.

    Reporters interviewed five people who were approached by The Rehab Specialist’s recruiters on the street, and another two whose relatives were recruited.

    All shared similar stories about how the process worked. Two said they enjoyed eating chef-made meals and benefited from group therapy and daily outings in Los Angeles.

    One mother said her son ultimately decided not to board the plane to California, though he continued to receive frequent calls from Rehab Specialist recruiters urging him to travel for treatment. In another case, a woman said her brother did not get the care he needed in California and ended up in the ICU.

    Gallo and Zehnder were among the three people interviewed who said the medical care they received in California did not meet their expectations for a luxury rehab facility. The couple blames The Rehab Specialist for launching them on a journey that ended with them worse off than before.

    “I don’t know if they have the intention of trying to help people,” Gallo said, “but they’re going about it totally the wrong way.”

    Christina Gallo and Daniel Zehnder in June, sitting in the spot where they were first approached by The Rehab Specialist recruiters in McPherson Square Park.

    Lofty promises and dire warnings

    The fliers that The Rehab Specialist recruiters passed out in Kensington featured photos of a Spanish Colonial-style mansion surrounded by palm trees, with a pool in the backyard. They advertised “holistic treatment” including equine therapy, medical detox, and an intensive outpatient program.

    All that, in sunny California.

    The pitch has particular appeal in Philadelphia, where people have struggled through long waits to access medical detox programs that allow patients to withdraw under the supervision of a doctor or nurse. These programs typically offer medications to help ease intense withdrawal symptoms like nausea, vomiting, and agitation, all of which have become more dangerous as potent animal tranquilizers and industrial chemicals contaminate the local drug supply.

    Despite often lofty promises, the addiction treatment industry has long seen high-profile prosecutions over exploitative practices.

    In the Philadelphia area, the Liberation Way prosecution sent the company’s CEO and medical director to federal prison. Prosecutors said the center had signed patients up for private insurance plans and paid their premiums. It then charged insurers for shoddy or unnecessary treatment that resulted in excessive insurance payouts.

    A few years later in 2022, New Jersey officials found numerous cases of addiction providers illegally paying workers to direct patients with private insurance to their facilities. A second investigation in 2024 prompted two new state laws cracking down on patient brokering.

    California and Florida in particular have emerged as hot spots for addiction treatment fraud. In South Florida, a 2022 federal prosecution of a $112-million scheme led to prison sentences for eight people accused of using cash bribes and free rides, flights, drugs, and alcohol to attract patients to a rehab center. The payments were distributed via a network of lower-level street recruiters, purportedly hired for “marketing,” according to an affidavit from the case.

    California, with its large number of rehab centers and overburdened regulators, has become such a magnet for fraud that industry insiders refer to the greater Los Angeles area as “Rehab Riviera.”

    But addiction treatment scams are often ignored because they involve sprawling national investigations that require significant resources. State prosecutors can’t justify the expense and federal prosecutors won’t take on low-level fraudsters, according to Johnson. Palm Beach County prosecutors stepped up enforcement after the state passed stricter laws in 2017.

    “You have to prioritize cases. This is not high on their hit list, unless it’s going to make a big splash,” said Deb Herzog, a former federal prosecutor turned fraud investigator at Anthem Blue Cross.

    Melissa Ruby, an activist who runs a national Facebook group to monitor patient brokering, in Philadelphia in October.

    Warnings about The Rehab Specialist instead came from Melissa Ruby, 46, and other local advocates. Ruby runs a Facebook group dedicated to monitoring patient brokering nationwide, and started sharing photos on social media as soon as the recruiters showed up in Kensington. She did the same when they were reportedly spotted in Pittsburgh.

    She said she also alerted a Philadelphia police officer who runs an independent nonprofit to help people in addiction, but never heard back.

    For Ruby, the issue is personal: She has a relative who was a victim of patient brokering.

    “BEWARE!!” she wrote in a March post about The Rehab Specialist, punctuated with red stop sign emojis. “No good will come from any of this!!”

    Tarrant, the Rehab Specialist director, was a member of Ruby’s Facebook group at the time and wrote that the vast majority of the negative information Ruby had posted about him was “completely wrong.”

    “I am not paid by the client or any ‘referral fees’ based on clients sent,” Tarrant wrote.

    When asked in the Facebook group why The Rehab Specialist was sending patients out of state on free flights, he declined to answer, writing that he believed the questions were in bad faith. He encouraged people to reach out to him directly so he could explain.

    After a few weeks, Ruby kicked him out of the group. “Adios, Gus!” she wrote.

    A sunny pitch in Kensington

    One day in April, two female Rehab Specialist recruiters introduced themselves to Samuel Rosato, 47 at the time, as he got off the El near Kensington. He was immediately intrigued.

    “They were just real pretty and tan,” Rosato said.

    They later said all they needed were a few identifying details, and they would be able to set him up with private insurance that would pay for everything at a luxury rehab out west.

    Rosato scribbled down his Social Security number and handed over his ID card. Within 10 minutes, he said, the recruiters told him they had secured him Blue Cross Blue Shield insurance. Rosato, like others interviewed by The Inquirer, did not know who was paying for his insurance or lodging.

    The Rehab Specialist recruiters, whose names he shared with The Inquirer, are not licensed insurance brokers or healthcare navigators in Pennsylvania.

    Allison Hoffman, a health law professor at the University of Pennsylvania, said that without more information on how patients were signed up for insurance plans, it is difficult to say definitively whether insurance laws were violated. But, she added, “it sounds potentially illegal.”

    Tarrant said his employees “don’t deal with any of the insurance.” He said they do not directly enroll clients in insurance, but rather direct recruits to independent, licensed insurance brokers.

    Patients “sign up for the insurance themselves,” he said. He declined to say more, citing patient confidentiality.

    A week later, Rosato said an Uber picked him up at his mother’s home in Northeast Philadelphia for his flight to California. He said he was joined by three other people from Kensington who told him they had also been recruited by The Rehab Specialist.

    “I love it out here,” Rosato said in June, several months into his recovery in California. “I’m trying to rebuild my life now, starting at the bottom.” (Rosato stopped responding to calls and texts from The Inquirer in the fall; his mother said this month that he’s back in Philadelphia, but she is not sure where.)

    Jerome Hayward, 48 at the time, and his girlfriend, Megan McDonald, 39 at the time, also didn’t ask too many questions when they were recruited in front of a Kensington soup kitchen and traveled separately to California in the spring.

    Told only that she had been “approved” for treatment, McDonald said she didn’t realize she had been signed up for a Blue Cross Blue Shield plan until she received paperwork at a hospital.

    “How would we pay for it?” McDonald asked. “Because we’re broke. We got no money.”

    Megan McDonald and Jerome Hayward at a drop-in center in Philadelphia’s Kensington neighborhood.

    A rising entrepreneur

    Tarrant rose in the rehab industry after getting his start vacuuming floors at a rehab company run by LaMitchell Person, a mentor who Tarrant credited for giving him “the opportunity to get sober and clean,” in an interview with a local news station in California. The two later became business partners.

    They were working together at a California rehab company in 2021 when a 22-year-old named Dean Rea died of a fentanyl overdose after leaving an associated sober home.

    Rea’s mother later accused Tarrant, Person, and other employees of contributing to the death in a lawsuit filed against the facility, Ken Seeley Communities. Neither Tarrant nor Person, then the facility’s executive director, was named as a defendant in the case.

    In court records, Rea’s mother claimed Tarrant falsely told Rea that his insurance wouldn’t cover more intensive treatment elsewhere.

    “Gus is, essentially, a salesman whose goal is to admit as many patients to KSC as possible,” their legal complaint said. The rehab company denied the allegations, and Rea’s suit was settled in a confidential agreement in 2023 for an undisclosed amount.

    In an interview this month, Person called the lawsuit’s claims inaccurate. “Fentanyl killed her son. Not Gus, not me, and not the organization,” Person said.

    By the time the suit was settled, Tarrant and Person had both left the business.

    In 2022, they filed paperwork to incorporate a company called Origin Addiction Services, based in Idaho, according to state corporate records. An official address on the website is a P.O. box in a Boise strip mall.

    The company’s website said it offered addiction recovery services such as interventions, sober companionship, counseling, and transportation.

    The company’s website featured an ‘about’ page with professional headshots of a nine-member executive team. All but three of those headshots appeared to be drawn from stock photo services, and The Inquirer was unable to trace the individuals to authentic social media or LinkedIn accounts.

    After The Inquirer contacted Person about the photos in September, all of them – except his own — were removed overnight. Person later said in a phone interview that the stock photos and some of the employee names were “placeholders,” but insisted that the staffers were real.

    The company filed paperwork to dissolve a year later; Person said it had never done business, and he and Tarrant went on to pursue separate endeavors.

    Person was in Philadelphia recruiting people at the intersection of Kensington and Allegheny Avenues in March, according to a city employee there to help people in addiction. Person handed him a business card identifying himself as a “regional director” of The Rehab Specialist, said the employee, whom The Inquirer is not naming because he was not authorized to speak to the media and feared losing his job.

    Person answered the phone this summer when The Inquirer called the Rehab Specialist’s general number, but he said he did not work there.

    In a follow-up interview this month, he said that Tarrant had hired him to build a call center for a California rehab, saying that was his only involvement with The Rehab Specialist.

    He said he had not come to Kensington and was not responsible for business cards that listed him as the regional director.

    “Gus wanted me to work for him, because we are friends,” Person said.

    Christina Gallo and Daniel Zehnder in McPherson Square Park in June.

    A dream dashed in California

    Desperate to get clean, Christina Gallo and Daniel Zehnder accepted the offer to fly to California after being recruited in Kensington earlier this year. A luxury van picked the couple up when they arrived at Los Angeles International Airport on May 3, they said.

    The driver took the couple to Gevs Recovery, a large gated house in a residential neighborhood in Northridge. Gevs has been licensed as a drug abuse recovery home since 2024. State records show that as of early August, no complaints about its care have been filed with the California Department of Public Health.

    Gallo and Zehnder said the Gevs house was dark and empty when they arrived, aside from a handful of employees. Gallo began to panic as drug withdrawal left her shaking and sweating, with a bloody nose and headache pangs that felt like she had stuck her finger in an electrical outlet.

    “I said, ‘What’s going on here? Where’s any of the nurses or the doctors?’” she recalled. “‘Who’s going to be taking care of us, medically?’”

    “We don’t do that here,” she remembers them saying. The Gevs employees told Gallo they could send her to a hospital, or give her some Tylenol, she said.

    Alarmed, Gallo and Zehnder decided to leave. On their way out, they said a woman descending the stairs told them she had just left the hospital after a month there.

    “Are you guys from Philadelphia, too?” Gallo recalled the woman asking.

    She and Zehnder headed to a cheap motel, but they didn’t feel they could stand the withdrawal effects and decided to buy drugs nearby. By the morning, their symptoms had grown worse, and they returned to Gevs to demand plane tickets home.

    Gevs agreed to buy the tickets, a requirement under California law for rehab centers that provide free one-way airfare.

    Kristine Kesh, an operations manager at Gevs, told The Inquirer the center does have medical staff on site and does offer medication treatment for withdrawal.

    “These clients have been addicts for most of their lives, and they come in expecting this glorious detox,” Kesh said. “Whatever they’re expecting is not realistic. I mean, you can’t help everybody.”

    At the airport, Gallo vomited on herself before collapsing to the ground in pain. Zehnder defecated and vomited on himself. An ambulance took them to the emergency room, where Gallo was placed in intensive care.

    After two days in the emergency room and the intensive care unit, Gallo and Zehnder were released. Zehnder’s mother paid for their flights home.

    While Zehnder was away, bills from Highmark started arriving at his mother’s house — even though he had been promised free treatment.

    The bill, which misspelled his last name, said he owed a $267 premium for the month of May. He said he also received a $700 bill for the ambulance ride from the LA airport to the emergency room, which he threw away.

    Six months after their disastrous trip, recovery feels as far away as when their return flight from California landed. At the Philadelphia airport, they hailed a cab and went straight to Kensington. They wanted to inject heroin, right away.

    Kensington Avenue near McPherson Square.
  • Twenty years into fracking, Pennsylvania has yet to reckon with its radioactive waste

    Twenty years into fracking, Pennsylvania has yet to reckon with its radioactive waste

    This article originally appeared on Inside Climate News, a nonprofit, nonpartisan news organization that covers climate, energy and the environment. Sign up for their newsletter here.

    When John Quigley became the secretary of the Pennsylvania Department of Environmental Protection (DEP) in 2015, he knew that he would be busy trying to keep up with the consequences of the state’s rapid increase in natural gas production. But when reports landed on his desk that trucks carrying oil and gas waste were tripping radioactivity alarms at landfills, he was especially concerned.

    “There was obviously a problem that the state was not dealing with,” Quigley said. “Which was the threat to not only public health, but to the folks driving the trucks and people handling the waste in the oil and gas industry. They were unnecessarily put at risk.”

    Ten years after the alarms first unsettled Quigley, fracking in Pennsylvania has continued to grow, generating huge volumes of oil and gas waste and wastewater in the process. Seventy-two percent of the solid waste ends up in landfills within state borders, and a truck carrying it sets off a radioactivity alarm every day on average, an Inside Climate News analysis found.

    Radioactive elements such as radium, uranium, and thorium in rocks deep underground come to the surface as a byproduct of oil and gas drilling. Experts have long worried about the potential health and environmental impacts of this waste. Radium exposure is linked to an increased risk for cancer, anemia, and cataracts.

    New research from the University of Pittsburgh suggests that the wastewater created by fracking the Marcellus formation, the ancient gas deposit beneath Pennsylvania, is far more radioactive than previously understood. And there is also evidence that some of it is getting into the environment: Researchers have found radioactive sediment downstream from some landfills’ and wastewater treatment plants’ outfalls.

    But the state has barely shifted its approach to regulating the waste. “Nothing material has been done,” said Quigley, who left in 2016. “Nothing has really changed.”

    In 2023, radioactivity alarms were triggered more than 550 times at Pennsylvania landfills because of oil and gas waste, according to an analysis of landfills’ annual operations reports conducted by Inside Climate News. The vast majority of this waste was disposed of on-site; landfills rejected the waste only 11 times. Radium-226 was the most common isotope cited as the reason for the alarm.

    DEP issued a new guidance document for solid waste facilities and well operators that handle radioactive materials in 2022, with some of the changes specifically aimed at the fracking industry. Landfills have been required to submit a Radiation Protection Action Plan to the state since 2001, covering protocols for worker safety, monitoring and detection, and records and reporting, and DEP may require sites to test regularly for the long-lasting radium-226 and radium-228 if they have received large volumes of radioactive oil and gas waste.

    But DEP has fallen behind on many other aspects of regulating this waste.

    In 2021, then-Gov. Tom Wolf said the state would require regular radium testing of landfills’ leachate, a liquid byproduct created when rainwater passes through waste, accumulating contamination. Wolf’s announcement came more than five years after DEP had recommended adding radium to leachate testing requirements. But leachate testing results from 2021 through 2024 acquired by Inside Climate News via a right-to-know request do not contain results for radium.

    In an email, DEP spokesperson Neil Shader said the agency does not currently require landfills to test for it. He did not explain why the policy has not yet been implemented.

    “DEP is still finalizing a policy around radiological material in leachate,” he said.

    Understanding the scope of the problem is difficult because Pennsylvania’s tracking of oil and gas waste and leachate remains disorganized and piecemeal, an Inside Climate News investigation found. Landfills are supposed to turn away waste that is too radioactive based on the total volume of waste they have already accepted that quarter. If the volume estimates are inaccurate or misreported, it could mean that some sites are exceeding the allowable amounts.

    Meanwhile, DEP’s last comprehensive study of radioactivity in oil and gas waste is more than nine years old, even though the agency said at the time that follow-up investigations were needed. DEP confirmed to Inside Climate News that it is studying the radioactivity of landfill leachate but offered no timeline for publication.

    The Marcellus Shale Coalition, an industry trade group, maintains that the solid waste and wastewater generated by fracking in Pennsylvania are well managed and pose no health risks to the public or workers. Landfill employees face less danger from oil and gas waste than someone getting a routine CT scan, the group argues, and landfill permits contain restrictions on how much oil and gas waste they can accept in any given year.

    In a statement to Inside Climate News, the coalition’s Patrick Henderson said there is “no greater priority” for the industry “than worker and community safety, which is delivered through recurrent trainings, development and sharing of best practices, and strict adherence to modern regulatory standards.”

    “Operators follow stringent protocols for handling, managing, and transporting waste — including radioactive screening, characterization, and reporting,” he said.

    The industry also frequently notes that DEP’s 2016 investigation into radioactivity in oil and gas waste concluded that there is “little or limited potential for radiation exposure to workers and the public” from natural gas development.

    Quigley called this study, the initial version of which was published just before he took office as DEP secretary, “the big mistake,” because in his view it falsely suggested that there was “nothing to worry about.”

    He thought that another study was warranted to investigate the true scope of the issue, but he said he was not able to push forward a new one before he left office.

    The study was limited in some ways by its size and distribution: Between 2013 and 2014, DEP sampled 38 well sites, only one in the northeast, which researchers now say is a radioactivity hot spot. Sixteen of the sampled sites were in the southwest.

    David Allard was the lead health physicist overseeing the study’s design and execution. He retired from DEP in 2022 after 23 years as the director of the Bureau of Radiation Protection, where he oversaw the management of radioactivity in the oil and gas industry. In 2001, he fought for the radiation protection plans and radioactivity monitoring at landfills that are required today.

    These rules and Pennsylvania’s rules for landfills in general are stricter than most other states’, he said. Ohio, for instance, stopped requiring landfills to report on the oil and gas waste they accept.

    Scientists learned about the radioactivity of oil and gas fields more than a century ago, not long after the discovery of radium in 1898. Waste predating the fracking era had been triggering radiation alarms in Pennsylvania landfills for years.

    But the waste created by fracking is different from conventional drilling wastes. In the 2010s, as fracking increased oil and gas waste volumes, Allard wanted to investigate how radioactive it was and what possible dangers it might pose to the public and the environment.

    The 2016 study concluded that the radioactivity levels found in the waste at the time posed little danger to truck drivers and workers. But it warned of potential radiological risks to the environment from spills, waste treatment facilities, and long-term disposal in landfills, a point that is often overlooked in summaries of the study’s contents. All of these things remain a problem today, Allard said.

    “I fought very hard to get this thing going,” he said of the study. “I will stand behind all of the science.” But he said that one of the reviewers, a political appointee, had argued for language in the synopsis that he felt obscured the nuances of the study’s conclusions: “little or limited potential for radiation exposure.”

    “It’s a true statement. But I think it did downplay the need for additional work,” he said. Variations of this phrase appear at the beginning of each bullet point in the summary. Each one is followed by caveats.

    DEP used computer modeling from Argonne National Laboratory to determine whether a closed landfill that had accepted this waste and other toxic material would still be dangerous to a farmer living on the site far into the future. Even 1,000 years from now, DEP found, a farmer digging a drinking well on top of such a site would not want to drink the water.

    “It’s not going to be pretty,” Allard said. “It’s not going to be very palatable.”

    Pennsylvania’s guidance for how much radioactive oil and gas waste a landfill can accept each year, updated a few years into the fracking boom in the 2010s, is supposed to prevent the hypothetical future farmer from being exposed to harmful levels of radiation. But this guidance is not codified into law, Allard said. It also relies on regular radioactivity monitoring and accurate tracking of waste quantities at landfills.

    Recent research from Pennsylvania State University and the University of Pittsburgh showing that radium is getting into the environment also concerned him. These radioactive discharges into waterways are unregulated, he said.

    “I think the EPA really needs to stand up,” he added. In 2020, Allard was part of a committee formed by the National Council on Radiation Protection and Measurements that highlighted the need for national, standardized regulations for oil and gas waste because the rules are so inconsistent among states.

    Road-spreading, the practice of using salty oil and gas wastewater as a dust suppressant, is another area where he says the study could have done more to figure out how much radioactivity was ending up in the environment as a result. Although the state has largely banned the practice, there is evidence that companies continue it.

    Landfills’ leachate also deserves more study, he said, and he sees testing it for radium and releasing the results to the public as an important step.

    “We tried to make it as comprehensive as possible,” Allard said of the study. “But I think it is timely to go back and visit some of these things.”

    Environmentalists have long clamored for an updated government study of radioactivity in oil and gas waste using more recent data. Pennsylvania’s fracking industry is much larger and more geographically dispersed now than it was when the information for the first study was collected.

    Forthcoming University of Pittsburgh research suggesting that oil and gas wastewater produced by fracking in Pennsylvania is more radioactive than previously thought involved samples from 561 well pads between 2012 and 2023. The wastewater contained much more radium than was found by studies early in the fracking boom.

    The median radium values were four times the level of those published by the U.S. Geological Survey in 2011 and twice that of DEP’s findings in 2016, said Daniel Bain, an associate professor of geology and environmental science at the University of Pittsburgh who was involved in the research.

    The maximum value that Bain found was above 41,000 picocuries per liter — a measure of radioactivity in a substance. For comparison, the EPA’s limit on total radium in drinking water is 5 picocuries per liter.

    Radium is a naturally occurring material, and surface and groundwater can contain between 0.01 and 25 picocuries per liter. Natural levels above 50 picocuries per liter are rare.

    “I think it necessitates a reevaluation of the kind of personal protection that specific jobs require. If you’re in contact with this waste every day, you need to be monitored,” Bain said. “They probably also have to rethink how they’re going to manage their waste streams.”

    Bain’s research also found that radioactivity was far higher in the Marcellus formation’s wastewater than in wastewater from drilling in other parts of the country, including Texas and North Dakota.

    He said that the finding echoes earlier industry realizations that the Marcellus is different from other natural gas formations. “One of the first hard lessons of the Marcellus was that it’s not like some of the Texas shales. They came up here and tried to use the methods they used in Texas, and they had issues,” he said. “They’re basically learning as they’re doing. It’s a big experiment, and sometimes you wish you could redo the experiment.”

    Marcellus wastewater has higher than expected levels of barium, strontium, and lithium, a discovery that spurred industry interest in 2024 because of lithium’s status as a critical mineral.

    Wells in the northeastern part of Pennsylvania contained much higher concentrations of radium than others, suggesting that earlier conclusions based on drilling in the state’s southwestern region might be misleading.

    Bain’s research did not focus on the radioactivity of solid oil and gas waste, the lion’s share of what Pennsylvania landfills take from the industry. But he did look at what kind of waste would be created if companies were to start treating Marcellus water with the goal of removing valuable components like lithium.

    His analysis found that this process could create a solid, highly radioactive byproduct that would exceed U.S. Department of Transportation transport limits for radium in sludge. Although questions remain about the financial viability of extracting lithium from fracking wastewater, at least one company in Pennsylvania has already tried to do so.

    In 2021, environmentalists were heartened when Wolf announced that landfills would be required to test their leachate for radium and report the results to the state quarterly. The new requirement would “improve public confidence that public drinking water and our precious natural resources are being appropriately protected,” Wolf said at the time.

    Josh Shapiro, now governor and then attorney general, commended Wolf’s announcement, which came after Shapiro’s office had “urged Gov. Wolf to direct DEP to prevent harmful radioactive materials from entering Pennsylvania waterways.”

    “The improved monitoring and promised analysis by DEP is a step in the right direction,” Shapiro said at the time. Other states with active fracking, including North Dakota, West Virginia, and Colorado, require this kind of leachate testing.

    John Stolz, a professor at Duquesne University who has studied oil and gas waste and fracking contamination for years, said he was “very disappointed” that DEP was still not requiring this testing or releasing it to the public.

    “We were told they were going to start monitoring for these additional parameters, and it just hasn’t happened,” he said.

    Stolz would like DEP to go beyond radium and require testing at landfills for other oil- and gas-related substances that could help scientists better trace fracking’s impact, such as lithium, strontium, and bromide. “They’re still only monitoring parameters that you would monitor if you were looking at a discharge from, say, a wastewater treatment facility,” he said.

    Bain, who has collaborated with Stolz on research, said he has tried without success to get DEP to rethink the issue of its testing requirements missing many key indicators for fracking.

    “If you don’t look, you don’t see,” he said. “This is really something that DEP should be doing.”

    The radium levels Stolz has discovered in testing landfill leachate are relatively low, but not when considering the millions of gallons of leachate produced every year. “That’s a lot of radium,” Stolz said. “It doesn’t seem like a lot [at first], but then you realize the volumes involved, right? It’s a huge amount of water going on for years and decades.”

    Radium’s tendency to be “sticky” and to accumulate — in stream sediment, for example — could create problems over the long term for the environment and for public health, Stolz said.

    Those most at risk from this radioactivity are the workers at landfills, wells, and treatment facilities that handle and transport large quantities of oil and gas waste. “The levels can be high,” said Sheldon Landsberger, a professor in nuclear and radiation engineering at the University of Texas at Austin who has studied the radioactivity of oil and gas waste. “I would not say that they are dangerous levels, to the tune of Chernobyl or Fukushima or anything like that. However, if you are a worker and you do work in the field, you need to be monitored.”

    Landsberger reviewed records from Pennsylvania landfills that showed radioactivity measurements for truckloads of oil and gas waste coming in and for workers exposed to those shipments. “They are definitely above background,” he said, though none of the measurements are above the legal limits for radiation exposure.

    Landsberger said it was hard to deduce much from the records about long-term impacts because there are too many unknowns about how the measurements were taken and what happened to the waste after it was disposed of in the landfill. This is why he advocates for workers wearing radiation dosimeters, which measure the radiation dose that a person receives.

    Jack Kruell lives a quarter-mile south of the Westmoreland Sanitary Landfill in Belle Vernon, a site in the southwestern part of the state that has taken hundreds of thousands of tons of oil and gas waste over the years. Stolz’s testing of the landfill’s leachate in 2019 showed that it was consistent with contamination from oil and gas operations and that it had elevated levels of radium-226, radium-228, and bromide, all likely linked to the landfill’s acceptance of that waste. (Westmoreland did not respond to requests for comment.)

    In 2012, when the fracking boom was well underway, Kruell noticed strange smells in the air. “The odors were so horrific, and it was constant. I did some work for one of the oil and gas exploration companies, and I was familiar with smells, and this was not a normal landfill smell,” he said.

    Over the next few years, he experienced medical symptoms he hadn’t before: fatigue, bone pain, respiratory reactions, mental fog. As the odors worsened, he avoided going outside. Later, when he got involved with advocating for changes at the landfill, Kruell learned about something that alarmed him even more: the radioactivity in the landfill’s liquid waste.

    “When you look at the half-life of radium-226, it’s 1,600 years,” Kruell said. “This is never going to go away.”

  • Temple University Hospital is being investigated by CMS over its care of a homeless patient who died

    Temple University Hospital is being investigated by CMS over its care of a homeless patient who died

    A patient with no home to return to was pushed in a wheelchair to the curb outside Temple University Hospital. Staffers left him sitting on a bench, even though he was considered at a high risk of falling.

    An hour later, a security officer found the man had fallen and was lying on the ground.

    He was shaking when the guard brought him back into the hospital, but didn’t respond to a nurse’s questions. So hospital staff again sent him away — this time leaving him alone in a wheelchair outside the emergency department.

    He was found there five hours later, slumped over, unresponsive, and without a pulse. He died the following week.

    Temple’s treatment of the patient during the Oct. 3 incident prompted state and federal investigations. In a report released earlier this month, the Pennsylvania Department of Health cited Temple for violating state rules that require hospitals to provide emergency care.

    Experts say the hospital’s actions amounted to “patient dumping,” a practice prohibited under a federal law that requires hospital emergency departments to medically screen and stabilize all patients.

    The Centers for Medicare and Medicaid Services (CMS), which oversees hospital safety nationally, confirmed it is also investigating, but has not released details.

    Hospitals that violate the Emergency Medical Treatment and Labor Act, known as EMTALA, risk hefty fines or losing their Medicare license, though such penalties are rare.

    Temple acknowledged that its own protocols were not followed. Health system officials told state investigators the patient should not have been removed from the hospital without being evaluated and cleared by medical staff.

    “The safety of our patients, visitors and staff is Temple’s highest priority,” the hospital said in a statement to The Inquirer. “We believe that everyone deserves high quality care.”

    The hospital declined to say whether any of the staff members involved were disciplined or fired.

    But such incidents are rarely the fault of one individual, legal experts and homelessness advocates said. Rather, they are a sign of systemic problems, such as understaffing that can leave staff overwhelmed, and bias among medical providers that can put vulnerable patients at risk of being dismissed.

    “If you work in an environment where safety is prized and honored and enforced from the top down, everyone feels that’s their mission,” said Eric Weitz, a medical negligence lawyer in Philadelphia. “If that’s not a priority being set by leadership, then it’s no surprise the culture doesn’t reinforce it.”

    Jefferson Abington Hospital was cited for a security guard’s excessive use of force. A patient was told she was to blame.

    Hospital administrators said the triage nurse who turned away the patient should have sought help, if the patient wasn’t responding to questions. The nurse said she was overwhelmed and working without sufficient support in one of the region’s busiest trauma hospitals.

    “I was busy and alone,” she told state inspectors.

    The incident violated Temple’s emergency department protocol, staff told Pennsylvania Department of Health inspectors.

    Pa. Department of Health investigates Temple

    To piece together what went wrong, Pennsylvania Department of Health inspectors watched security camera footage, interviewed staff members, and reviewed internal hospital reports. Their timeline shows a series of mistakes.

    At about 3:15 p.m., an employee brought the patient in a wheelchair to a bench near the curb outside the hospital, and left him there on the mild October day with highs near 70 degrees.

    He was being discharged to “the community” because he was experiencing homelessness, according to the inspection report. (The state report does not say whether staff attempted to place him at a skilled nursing facility, rehabilitation center or homeless shelter.)

    The man sat alone on the bench for an hour before standing unsteadily, taking a few steps, and ultimately falling to the ground.

    He managed to get back up, leaning against a tree for support, only to fall again. He was on the ground for 10 minutes before a security guard found him.

    The guard brought the man back into the emergency department in a wheelchair about two hours after he had been released.

    Back inside the hospital, the man followed orders to raise his arms for a security check at the door. Then he waited in line to be seen by the triage nurse responsible for checking in patients at the emergency department.

    When he reached the front of the line, he did not respond to the nurse’s questions. “He was not answering any questions, just shaking,” according to a Temple incident report reviewed by inspectors. Staff said the patient was “not cooperating” and should be sent to the back of the line.

    After two minutes with the nurse, a security guard moved his wheelchair to a corner of the emergency department near the entrance.

    The man was once again wheeled outside the hospital a few minutes later and left alone.

    He was found by medical staff around 9:30 p.m., slumped over in his wheelchair.

    Staff began CPR, rushing him back inside for trauma care.

    Pennsylvania Department of Health’s inspection report details how a patient in Temple’s emergency department was rolled away in a wheelchair without being evaluated.

    The inspection report does not identify the patient’s name, age, or provide details on the medical condition for which he had been hospitalized. It also does not say what happened after he was found unresponsive. He died five days later, on Oct. 8.

    Temple responds

    Medical screening of every patient who comes to the emergency department is “explicitly required” under Temple’s EMTALA policies, according to the hospital’s response to the state findings.

    “It doesn’t matter if they were just there an hour ago, every time they present, it is a new encounter and should be documented as such,” a Temple staffer said in an interview with inspectors.

    The hospital told the state it would retrain staff on EMTALA rules, making clear that security officers cannot remove patients from the emergency department unless they have been evaluated and cleared for release by a medical professional.

    A week after the incident, hospital staff were instructed to keep a log of patients who are removed from the emergency department and the name of the provider who approved their release. (Temple police may still remove patients from the emergency department if they are threatening the safety of other patients or staff.)

    The hospital also said that it would order mobility evaluations for patients who are being discharged “to the community” if they had a high risk of falling, with a doctor’s sign-off required.

    Temple treats some of Philadelphia’s most vulnerable patients in an emergency room that sees more than 150,000 visits a year, including high numbers of gunshot victims and people experiencing opioid withdrawal. It operates a Level I trauma center in a North Philadelphia community where 87% of patients are covered by publicly funded Medicare or Medicaid.

    The emergency department is so busy that about 8% of patients choose to leave before being seen, according to CMS data, compared to about 2% of patients at hospitals nationally and across Pennsylvania.

    The triage nurse on duty Oct. 3 is not identified in the inspection report.

    The Temple chapter of Pennsylvania Association of Staff Nurses and Allied Professionals, which represents 1,600 nurses and 1,000 other medical professionals on Temple campuses, declined to comment.

    A Virtua Voorhees nurse reported a baby-switch mistake. Then she was fired.

    Legal experts raise questions

    Two healthcare lawyers who reviewed the state’s inspection report said the entire episode is troubling.

    “It sounds like they violated every part of EMTALA,” said Sara Rosenbaum, professor emerita of health law policy at George Washington University.

    The law does not require specific treatment, but mandates that hospitals evaluate everyone who walks in the door seeking care, and prohibits them from sending them away or transferring them until they are medically stable.

    “They failed to screen him, threw an unstable person back on the street, and didn’t arrange a medically appropriate transfer,” she said.

    What’s more, the hospital could be sued for malpractice over how it initially discharged the patient.

    The incident appears to be “a classic EMTALA violation,” said Weitz, the Philadelphia lawyer who serves on Pennsylvania’s Patient Safety Authority, an independent state agency that monitors hospital errors.

    The health department’s description of what happened is “almost eerily the exact fact pattern the law was passed to prevent,” he said.

    Healthcare challenges for patients experiencing homelessness

    People who are experiencing homelessness often receive subpar treatment when they seek medical care, research shows.

    One study that analyzed thousands of California patient records found that those who were described in their medical records as “homeless” were more likely than patients who have a permanent legal address to be discharged from the emergency department, rather than being admitted for care.

    In the Philadelphia region, caring for this population is increasingly challenging. The number of available shelter beds has declined in recent years, while the number of people who are considered unhoused has risen, according to Philadelphia’s Office of Homeless Services.

    Stephanie Sena, CEO of Breaking Bread Community Shelter in Delaware County, said the colder months also see more people experiencing homelessness coming to hospitals to get off the street.

    “If they say they’re sick, they might get a bed and be able to survive the night,” Sena said.

    The pattern can make doctors and nurses less likely to believe patients when they report real medical needs. Especially when staff are overwhelmed in busy hospitals, patients experiencing homelessness may be at greater risk of getting denied or discharged when they need help, she said.

    Sena said she was disappointed to hear about the Temple incident.

    “It is tragic,” she said, “but also not at all surprising, unfortunately.”

  • Is nutrition the key to ADHD? | Expert Opinion

    Is nutrition the key to ADHD? | Expert Opinion

    Years ago, I took my kindergartener with attention-deficit/hyperactivity disorder (ADHD) to a pediatric specialist for advice. She suggested we try the Feingold diet, an elimination diet that requires avoiding artificial dyes, sweeteners, and salicylates, naturally occurring substances found in many fruits and vegetables. With an already picky eater, I worried about how much I would need to eliminate and found the list included foods such as apples, berries, cucumbers, and tomatoes.

    I wondered, was diet the best way to manage ADHD?

    As a pediatrician, I often get this question from parents as they look for alternatives to stimulant medications for ADHD. The Feingold diet our pediatrician mentioned has been around since 1973. If it were a miracle cure, the parents of 7 million children with ADHD would have popularized it. However, the research on this diet is mixed, with the benefits being modest and not universal for all children with ADHD.

    Whenever confronting medical myths or treatments with limited, but potential benefits, I ask myself: is there harm in trying it?

    Elimination diets can cause some harm, especially if a child already has a limited palate, and further cuts may not meet their nutritional needs. In addition, as any parent of a child with food allergies knows, a restrictive diet requires strict adherence, meaning holidays, birthday parties, and traveling become extra challenging.

    Top federal health officials have presented a plan to phase out petroleum-based synthetic dyes from the food supply by 2028. Artificial dyes, especially Red No. 40, have been highlighted as triggers of hyperactivity, yet research indicates that only 8% of children with ADHD are sensitive to artificial dyes. Given that so few children are in this group, rather than focusing on elimination, a better approach may be emphasizing a healthy diet overall.

    Lately, rather than elimination diets, social media has popularized adding foods like saffron to the diet to manage hyperactivity symptoms. The research on saffron seems promising, with a similar effect on hyperactivity to methylphenidate, a popular stimulant medication for managing ADHD. However, the studies that exist are small and short- term, and the dosing needed is much more than would typically be used in cooking. Saffron is not regulated like medications are, so purity can’t be certain. This makes it hard to recommend saffron as a standard treatment at this time.

    Social media, which we scrutinize for accuracy on the Pediatric Health Chat website, seems to prefer addressing ADHD through diet rather than medication. This sends the message that medications are bad or to be avoided. Yet we know stimulants have been used for ADHD for over 85 years and are well tolerated by most children with a success rate of 70-90%. This success is measured through improvements in academic performance and lower risk of injuries. I have seen the use of stimulant medications provide life-changing benefits for some of my patients and their families.

    So, for my family, the Feingold diet’s cons outweighed the potential benefits, but to others it may not. We try to avoid artificial dyes and sweeteners, but also emphasize exercise, sleep hygiene, and screen time limits.

    ADHD management is more than nutrition or medication management, but includes important interventions like behavior training for parents, school-based supports, organizational skills training, and helping children learn to regulate their emotions. There’s no one-size-fits-all approach. A child’s treatment may evolve over time, as they develop and their ADHD symptoms change. Children with ADHD are much more varied than social media portrays, and families deserve the facts and freedom to make decisions that fit their child.

    Katie Lockwood MD, MEd is a primary care pediatrician at Children’s Hospital of Philadelphia. She and CHOP neonatologist Joanna Parga-Belinkie, MD, are co-founders of Pediatric Health Chat, (chop.edu/pediatric-health-chat), an online initiative providing resources for families looking for good information on the latest myths and misconceptions about children’s health.

  • Drug distribution giant Cencora is boosting its reach in medical specialties

    Cencora Inc., a drug-distribution giant based in Conshohocken, is expanding its presence in oncology and retina care, two medical specialties that rely heavily on pharmaceuticals.

    The company announced on Dec. 15 that it had agreed to buy out its private-equity partner in a national cancer practice management company, OneOncology, for $5 billion in cash and debt.

    Cencora already owned 35% of OneOncology, which has a small presence in the Philadelphia area.

    In January, Cencora spent $5 billion, including contingency payments, for Retina Consultants of America, a network of specialized practices with locations in 23 states, including two in Pennsylvania outside the Philadelphia area.

    The deals are part of Cencora’s effort to extend its reach into medical specialties that rely heavily on pharmaceuticals to treat patients. By positioning itself closer to patients, Cencora can capture more of the profit margin that goes along with selling drugs.

    “We like those two spaces because they’re pharmaceutical centric,” Cencora’s CEO Robert Mauch said at the 2025 J.P. Morgan Healthcare Conference. He said the company doesn’t see other specialties with the same makeup as oncology and retina.

    “That’s where we will continue to focus,” he said. “Now as we look forward, there could be other specialties. There could be other innovations in the pharma industry that create something in another area.”

    Cencora had $321 billion in revenue in its fiscal year that ended Sept. 30. It had $1.5 billion in net income. That’s a great deal of money, but amounted to less than half a percent of its revenue.

    McKesson and Cardinal Health, Cencora’s two biggest U.S. competitors in the drug-distribution business, face similarly narrow margins from drug distribution. Both also own companies that manage cancer practices. Among the benefits of owning the management companies is securing the customer base.

    Cencora’s follow-up to 2023 deal

    Cencora, then known as AmerisourceBergen, paid $718.4 million for a 35% stake in OneOncology in June 2023. That deal, in partnership with TPG, valued OneOncology at $2.1 billion. The seller was General Atlantic, a private equity firm that had invested $200 million in the Nashville management services company in 2018, according to the Wall Street Journal.

    The deal announced last week valued OneOncology at $7.4 billion, including debt. The big increase in value came thanks to a doubling in the company’s size. OneOncology now has 31 practices with 1,800 providers who treat 1 million patients across 565 sites, according to the company.

    Rittenhouse Hematology Oncology, which has offices in Bala Cynwyd, Brinton Lake, King of Prussia, and Philadelphia, became part of OneOncology last year.

  • Have that nasty stomach bug? It hit one South Jersey school hard. Here’s how to avoid it.

    Have that nasty stomach bug? It hit one South Jersey school hard. Here’s how to avoid it.

    A South Jersey school was hit with an outbreak of gastrointestinal illness last week, as cases of norovirus, a common stomach bug, recently surged nationwide.

    Camden County officials could not definitively say the illness was norovirus, since no lab testing has been done. However, they noted it was a candidate.

    “The symptoms, infectious period, and incubation periods seem to be consistent with norovirus,” said Caryelle Vilaubi, director of the Camden County Department of Health and Human Services.

    The school in Haddonfield, which officials declined to identify further, first reported a spike in gastrointestinal symptoms among students on Dec. 10, followed by an increase the next day.

    Cases have since fallen dramatically, Vilaubi said, as outbreak control measures — including use of disinfectants, sending sick students home, and promoting proper hand hygiene — have been put into place.

    They’re hoping to end the outbreak in the school community as early as next week, if they can go without new cases for four days, she said.

    A variety of sources can cause gastrointestinal illness, including viruses, bacteria, and parasites. Norovirus is one of the common culprits this time of year.

    “We typically see a spike from November through April, not just in Camden County, but throughout the state, and often throughout much of the country,” Vilaubi said.

    The highly contagious virus can spread through close contact with an infected person or with contaminated food, water, and surfaces. Symptoms usually include nausea, vomiting, diarrhea, and stomach pain, and start 12 to 48 hours after exposure.

    Most people will feel better after one to three days.

    Here’s what to know about the virus:

    How can you protect yourself against norovirus?

    Norovirus is a “hardy and resistant virus,” Vilaubi noted, making it especially hard to clean off. Hand sanitizers are not effective against it.

    People should instead wash their hands frequently with soap and water, and use bleach-based disinfectants (or any Environmental Protection Agency-registered disinfecting product against norovirus) on hard surfaces, according to the Centers for Disease Control and Prevention.

    How long does norovirus stay on surfaces?

    Norovirus can survive on surfaces for weeks.

    It is also relatively resistant to heat, able to survive temperatures up to 145°F.

    People should make sure to regularly disinfect high-touch surfaces such as doorknobs, keyboards, and light switches.

    How long does norovirus last in adults?

    Though people will usually feel better after one to three days, they are still highly contagious for a few days after.

    “If your child begins to show symptoms, please keep them home until at least 48 hours after symptoms resolve to prevent further spreading the illness,” Virginia Betteridge, liaison to the Camden County Department of Health and Human Services, said in a Dec. 12 news release.

    Those infected with norovirus should avoid contact with others as much as possible during this period.

    How to treat norovirus at home?

    There is no cure or specific treatment for norovirus. The advice generally is to let the virus run its course.

    To ward off dehydration, people should make sure to drink lots of fluids to replace what’s lost from vomiting and diarrhea. Taking small sips of water and sucking on ice chips may be easier on an upset stomach.

    People can also consider drinking clear broths, noncaffeinated sports drinks, and oral rehydration solutions, which are available over the counter.

    Drinks that contain a lot of sugar, including soft drinks and certain fruit juices, can make diarrhea worse and should be avoided.

    How does norovirus spread from person to person?

    Norovirus is considered highly contagious, as only a small amount of virus is needed to infect someone.

    People contract it by accidentally touching tiny particles of stool or vomit — where the virus is primarily shed — from an infected person and getting them in their mouths.

    These particles easily contaminate hands, surfaces, food, or water.

  • Philadelphia’s Senior Law Center has taken over two of CARIE’s advocacy programs

    Philadelphia’s nonprofit Senior Law Center has taken over two of the programs that the Center for Advocacy for the Rights and Interests of the Elderly (CARIE) operated before it abruptly shut down around Thanksgiving.

    The Senior Law Center said this week in an email to supporters that it will continue CARIE’s work to support elderly crime victims under a two-year contract with the Pennsylvania Commission on Crime and Delinquency.

    That contract is for $462,094 per year and has been reassigned to the Senior Law Center. The Senior Law Center has hired four of the five CARIE employees who were involved in that work. The fifth person had already accepted another job, a Senior Law Center spokesperson said.

    Kathy Cubit, CARIE’s former advocacy director, has moved to the Senior Law Center, where she will continue her work on health equity and long-term care. Cubit chairs a group that monitors Pennsylvania’s implementation and development of Medicaid programs.

    CARIE listed 26 employees on its website the week before it closed. Few details were available on why CARIE closed after nearly 50 years. Much of its work involved long-term care ombudsman services for the elderly in most of Philadelphia and in Montgomery County. It lost both of those contracts.

  • Drug companies line up to make deals with Trump after initial hesitation

    Drug companies line up to make deals with Trump after initial hesitation

    When President Donald Trump declared in May that he wanted drug companies to voluntarily cut their prices, few pharmaceutical executives wanted to go first. Now, no one wants to be last — and risk the wrath of the president.

    Nine drug companies announced price cuts with Trump at the White House on Friday, touting discounts on medication to treat diabetes, heart disease, HIV, hepatitis B, and other conditions. The deals will offer discounts on drugs sold to the government and to Americans through a new website, TrumpRx.gov, in exchange for tariff relief and other incentives, including faster FDA reviews for future approvals.

    The program, known as the Most Favored Nation initiative, is an effort to link U.S. drug prices to lower costs abroad.

    “Every president for a generation has promised to reduce drug prices, but … I am the only one of them to ever even think in terms of ‘favored nations,’” Trump boasted Friday, flanked by drug-company executives and health officials.

    Friday’s announcements follow similar deals with five other companies, beginning in September when Pfizer CEO Albert Bourla joined Trump to unveil price cuts. Since then, other drug-company executives have joined Trump to announce discounts on fertility and GLP-1 drugs and other offerings. In return, the administration has lifted the threat of tariffs and offered the companies other benefits, such as priority vouchers to expedite FDA reviews, which can lead to hundreds of millions of dollars in additional revenue for a company if a new drug is quickly approved.

    Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Genentech, Gilead Sciences, GSK, Merck, Novartis and Sanofi all announced new price cuts Friday. Three of the 17 pharmaceutical companies initially targeted by the Trump administration — AbbVie, Johnson & Johnson and Regeneron — have yet to appear with the president to tout price cuts, but officials said that those companies are set to make their own announcements soon.

    Trump has heralded his initiative — which he attempted to pursue in his first term — as one of his most significant achievements this year, arguing that even small savings matter amid the difficulty of curbing drug prices. The deep-pocketed pharmaceutical industry has repeatedly blocked most major efforts at reform for decades, and U.S. drug spending continues to rise, outpacing other wealthy countries.

    “This is the biggest thing ever to happen on drug pricing and on healthcare,” Trump claimed. He also criticized other countries for relying on high drug prices in the United States to subsidize the cost of pharmaceutical research and development, saying that global prices needed to be more equitable.

    “We were subsidizing the entire world. We’re not doing that anymore,” the president said.

    Democrats and outside experts have credited the deals as potentially helping some patients but said the initiative’s overall savings to the U.S. health system will be negligible and dismissed Trump’s hyperbole.

    “It’s a bit laughable to call this ‘the biggest thing ever’ in health policy. I’m not even sure this cracks the top 10 health policy changes,” said Craig Garthwaite, director of healthcare at Northwestern University’s Kellogg School of Management. “Giving Most Favored Nation prices to Medicaid, particularly for older drugs, likely won’t save that much.”

    The president has sought to make regular announcements about his drug-price deals, aiming to show progress and counter voter frustration over rising healthcare costs entering a midterm year that favors Democrats. Trump is timing Friday’s event to be one of his final White House events of the year, before he heads to North Carolina for a rally on affordability and then to his Mar-a-Lago resort.

    Pharmaceutical companies also touted their willingness to cut U.S. prices. A Bristol Myers Squibb executive said the company would provide its blood-thinning drug Eliquis, its most-prescribed medicine, to Medicaid free. Merck said it would offer discounts on its drugs Januvia, Janumet, and Janumet XR, which are used to treat Type 2 diabetes.

    “I reflect on your goal, driving affordability and access to Americans, but equally getting prices up outside the United States,” Merck CEO Robert Davis told Trump. “We’re 100 percent supportive of your actions.”

    Democrats have questioned whether Trump’s dealmaking with the companies is creating a quid pro quo, with pharmaceutical executives striking agreements to give the president a political win in exchange for potential profit.

    “Congress and the American people remain in the dark about the contours of your agreement with the Trump Administration,” Sen. Ron Wyden (D., Ore.) and Reps. Richard E. Neal (D., Mass.), Frank Pallone Jr. (D., N.J.) and Robert C. “Bobby” Scott (D., Va.) wrote in letters sent this week to pharmaceutical executives participating in the initiative. The lawmakers are the top Democrats on four congressional committees that oversee aspects of the U.S. health system.

    Several former FDA officials — including two physicians who recently oversaw the agency’s drug-regulation center — have warned that the voucher program may be illegal and risk undermining public health by streamlining reviews. While the agency’s drug reviews can traditionally take about a year, as scientists pore over safety and effectiveness data, Trump officials have said that the voucher program can guarantee a review within one or two months. The administration has defended the program, saying that safety and effectiveness remain priorities despite the accelerated timetable.

    Trump officials have used other levers, too. The administration has relied on the Centers for Medicare and Medicaid Services’s innovation center, which allows officials to pilot payment changes without seeking congressional approval, to pressure drug companies that do not voluntarily lower prices. Several drug-payment pilots have already been announced, and more are expected on Friday, the people said.

    Wall Street analysts say the companies have incentives to strike quick deals with the administration, rather than tempt Trump’s ire. Medicaid represents a relatively small portion of their business, and many companies are agreeing to price cuts similar to discount programs they have begun.

    Pfizer’s announcement with Trump also sent a signal to the rest of the industry, several pharmaceutical executives and industry analysts have told reporters.

    “When you saw the lack of impact to earnings of the initial companies’ deals, for most coming after, it’s a no-brainer,” said Chris Meekins, a managing director at Raymond James.

    Trump officials have said that the initial negotiations were tough, and securing concessions has become easier over time.

    “I think the first five companies that came through the pipeline were some of the hardest ones to get through,” CMS Administrator Mehmet Oz said in an interview on Dec. 7, pointing to the size of companies like Pfizer, AstraZeneca, and Eli Lilly, which were among the first companies to agree to deals.

    Trump officials have leaned on the healthcare companies’ civic responsibilities, in addition to applying pressure through tariffs and the CMS innovation center.

    Chris Klomp, the head of the Medicare program and a lead negotiator on the drug-price cuts, said he stressed “duty and patriotism” in a conversation with one prominent CEO.

    “And when we got done, he said, ‘I didn’t get into this business for [quarterly earnings],” Klomp said in remarks at last month’s MAHA Action summit. “I have children. I want to make them proud. I understand this is important to you and the president. We will show up.’”