As Nuns Disappear, Many Catholic Hospitals Look More Like Megacorporations
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ST. LOUIS — Inside the more than 600 Catholic hospitals across the country, not a single nun can be found occupying a chief executive suite, according to the Catholic Health Association.
Nuns founded and led those hospitals in a mission to treat sick and poor people, but some were also shrewd business leaders. Sister Irene Kraus, a former chief executive of Daughters of Charity National Health System, was famous for coining the phrase “no margin, no mission.” It means hospitals must succeed — generating enough revenue to exceed expenses — to fulfill their original mission.
The Catholic Church still governs the care that can be delivered to millions in those hospitals each year, using religious directives to ban abortions and limit contraceptives, in vitro fertilization, and medical aid in dying.
But over time, that focus on margins led the hospitals to transform into behemoths that operate for-profit subsidiaries and pay their executives millions, according to hospital tax filings. These institutions, some of which are for-profit companies, now look more like other megacorporations than like the charities for the destitute of yesteryear.
The absence of nuns in the top roles raises the question, said M. Therese Lysaught, a Catholic moral theologist and professor at Loyola University Chicago: “What does it mean to be a Catholic hospital when the enterprise has been so deeply commodified?”
The St. Louis area serves as the de facto capital of Catholic hospital systems. Three of the largest are headquartered here, along with the Catholic hospital lobbying arm. Catholicism is deeply rooted in the region’s culture. During Pope John Paul II’s only U.S. stop in 1999, he led Mass downtown in a packed stadium of more than 100,000 people.
For a quarter century, Sister Mary Jean Ryan led SSM Health, one of those giant systems centered on St. Louis. Now retired, the 86-year-old said she was one of the last nuns in the nation to lead a Catholic hospital system.
Ryan grew up Catholic in Wisconsin and joined a convent while in nursing school in the 1960s, surprising her family. She admired the nuns she worked alongside and felt they were living out a higher purpose.
“They were very impressive,” she said. “Not that I necessarily liked all of them.”
Indeed, the nuns running hospitals defied the simplistic image often ascribed to them, wrote John Fialka in his book “Sisters: Catholic Nuns and the Making of America.”
“Their contributions to American culture are not small,” he wrote. “Ambitious women who had the skills and the stamina to build and run large institutions found the convent to be the first and, for a long time, the only outlet for their talents.”
This was certainly true for Ryan, who climbed the ranks, working her way from nurse to chief executive of SSM Health, which today has hospitals in Illinois, Missouri, Oklahoma, and Wisconsin.
The system was founded more than a century ago when five German nuns arrived in St. Louis with $5. Smallpox swept through the city and the Sisters of St. Mary walked the streets offering free care to the sick.
Their early foray grew into one of the largest Catholic health systems in the country, with annual revenue exceeding $10 billion, according to its 2023 audited financial report. SSM Health treats patients in 23 hospitals and co-owns a for-profit pharmacy benefit manager, Navitus, that coordinates prescriptions for 14 million people.
But Ryan, like many nuns in leadership roles in recent decades, found herself confronted with an existential crisis. As fewer women became nuns, she had to ensure the system’s future without them.
When Ron Levy, who is Jewish, started at SSM as an administrator, he declined to lead a prayer in a meeting, Ryan recounted in her book, “On Becoming Exceptional.”
“Ron, I’m not asking you to be Catholic,” she recalled telling him. “And I know you’ve only been here two weeks. So, if you’d like to make it three, I suggest you be prepared to pray the next time you’re asked.”
Levy went on to serve SSM for more than 30 years — praying from then on, Ryan wrote.
In Catholic hospitals, meetings are still likely to start with a prayer. Crucifixes often adorn buildings and patient rooms. Mission statements on the walls of SSM facilities remind patients: “We reveal the healing presence of God.”
Above all else, the Catholic faith calls on its hospitals to treat everyone regardless of race, religion, or ability to pay, said Diarmuid Rooney, a vice president of the Catholic Health Association. No nuns run the trade group’s member hospitals, according to the lobbying group. But the mission that compelled the nuns is “what compels us now,” Rooney said. “It’s not just words on a wall.”
The Catholic Health Association urges its hospitals to evaluate themselves every three years on whether they’re living up to Catholic teachings. It created a tool that weighs seven criteria, including how a hospital acts as an extension of the church and cares for poor and marginalized patients.
“We’re not relying on hearsay that the Catholic identity is alive and well in our facilities and hospitals,” Rooney said. “We can actually see on a scale where they are at.”
The association does not share the results with the public.
At SSM Health, “our Catholic identity is deeply and structurally ingrained” even with no nun at the helm, spokesperson Patrick Kampert said. The system reports to two boards. One functions as a typical business board of directors while the other ensures the system abides by the rules of the Catholic Church. The church requires the majority of that nine-member board to be Catholic. Three nuns currently serve on it; one is the chair.
Separately, SSM also is required to file an annual report with the Vatican detailing the ways, Kampert said, “we deepen our Catholic identity and further the healing ministry of Jesus.” SSM declined to provide copies of those reports.
From a business perspective, though, it’s hard to distinguish a Catholic hospital system like SSM from a secular one, said Ruth Hollenbeck, a former Anthem insurance executive who retired in 2018 after negotiating Missouri hospital contracts. In the contracts, she said, the difference amounted to a single paragraph stating that Catholic hospitals wouldn’t do anything contrary to the church’s directives.
To retain tax-exempt status under Internal Revenue Service rules, all nonprofit hospitals must provide a “benefit” to their communities such as free or reduced-price care for patients with low incomes. But the IRS provides a broad definition of what constitutes a community benefit, which gives hospitals wide latitude to justify not needing to pay taxes.
On average, the nation’s nonprofit hospitals reported that 15.5% of their total annual expenses were for community benefits in 2020, the latest figure available from the American Hospital Association.
SSM Health, including all of its subsidiaries, spent proportionately far less than the association’s average for individual hospitals, allocating roughly the same share of its annual expenses to community efforts over three years: 5.1% in 2020, 4.5% in 2021, and 4.9% in 2022, according to a KFF Health News analysis of its most recent publicly available IRS filings and audited financial statements.
A separate analysis from the Lown Institute think tank placed five Catholic systems — including the St. Louis region’s Ascension — on its list of the 10 health systems with the largest “fair share” deficits, which means receiving more in tax breaks than what they spent on the community. And Lown said three St. Louis-area Catholic health systems — Ascension, SSM Health, and Mercy — had fair share deficits of $614 million, $235 million, and $92 million, respectively, in the 2021 fiscal year.
Ascension, Mercy, and SSM disputed Lown’s methodology, arguing it doesn’t take into account the gap between the payments they receive for Medicaid patients and the cost of delivering their care. The IRS filings do.
But, Kampert said, many of the benefits SSM provides aren’t reflected in its IRS filings either. The forms reflect “very simplistic calculations” and do not accurately represent the health system’s true impact on the community, he said.
Today, SSM Health is led by longtime business executive Laura Kaiser. Her compensation in 2022 totaled $8.4 million, including deferred payments, according to its IRS filing. Kampert defended the amount as necessary “to retain and attract the most qualified” candidate.
By contrast, SSM never paid Ryan a salary, giving instead an annual contribution to her convent of less than $2 million a year, according to some tax filings from her long tenure. “I didn’t join the convent to earn money,” Ryan said.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
Subscribe to KFF Health News’ free Morning Briefing.
This article first appeared on KFF Health News and is republished here under a Creative Commons license.
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The first pig kidney has been transplanted into a living person. But we’re still a long way from solving organ shortages
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In a world first, we heard last week that US surgeons had transplanted a kidney from a gene-edited pig into a living human. News reports said the procedure was a breakthrough in xenotransplantation – when an organ, cells or tissues are transplanted from one species to another. https://www.youtube.com/embed/cisOFfBPZk0?wmode=transparent&start=0 The world’s first transplant of a gene-edited pig kidney into a live human was announced last week.
Champions of xenotransplantation regard it as the solution to organ shortages across the world. In December 2023, 1,445 people in Australia were on the waiting list for donor kidneys. In the United States, more than 89,000 are waiting for kidneys.
One biotech CEO says gene-edited pigs promise “an unlimited supply of transplantable organs”.
Not, everyone, though, is convinced transplanting animal organs into humans is really the answer to organ shortages, or even if it’s right to use organs from other animals this way.
There are two critical barriers to the procedure’s success: organ rejection and the transmission of animal viruses to recipients.
But in the past decade, a new platform and technique known as CRISPR/Cas9 – often shortened to CRISPR – has promised to mitigate these issues.
What is CRISPR?
CRISPR gene editing takes advantage of a system already found in nature. CRISPR’s “genetic scissors” evolved in bacteria and other microbes to help them fend off viruses. Their cellular machinery allows them to integrate and ultimately destroy viral DNA by cutting it.
In 2012, two teams of scientists discovered how to harness this bacterial immune system. This is made up of repeating arrays of DNA and associated proteins, known as “Cas” (CRISPR-associated) proteins.
When they used a particular Cas protein (Cas9) with a “guide RNA” made up of a singular molecule, they found they could program the CRISPR/Cas9 complex to break and repair DNA at precise locations as they desired. The system could even “knock in” new genes at the repair site.
In 2020, the two scientists leading these teams were awarded a Nobel prize for their work.
In the case of the latest xenotransplantation, CRISPR technology was used to edit 69 genes in the donor pig to inactivate viral genes, “humanise” the pig with human genes, and knock out harmful pig genes. https://www.youtube.com/embed/UKbrwPL3wXE?wmode=transparent&start=0 How does CRISPR work?
A busy time for gene-edited xenotransplantation
While CRISPR editing has brought new hope to the possibility of xenotransplantation, even recent trials show great caution is still warranted.
In 2022 and 2023, two patients with terminal heart diseases, who were ineligible for traditional heart transplants, were granted regulatory permission to receive a gene-edited pig heart. These pig hearts had ten genome edits to make them more suitable for transplanting into humans. However, both patients died within several weeks of the procedures.
Earlier this month, we heard a team of surgeons in China transplanted a gene-edited pig liver into a clinically dead man (with family consent). The liver functioned well up until the ten-day limit of the trial.
How is this latest example different?
The gene-edited pig kidney was transplanted into a relatively young, living, legally competent and consenting adult.
The total number of gene edits edits made to the donor pig is very high. The researchers report making 69 edits to inactivate viral genes, “humanise” the pig with human genes, and to knockout harmful pig genes.
Clearly, the race to transform these organs into viable products for transplantation is ramping up.
From biotech dream to clinical reality
Only a few months ago, CRISPR gene editing made its debut in mainstream medicine.
In November, drug regulators in the United Kingdom and US approved the world’s first CRISPR-based genome-editing therapy for human use – a treatment for life-threatening forms of sickle-cell disease.
The treatment, known as Casgevy, uses CRISPR/Cas-9 to edit the patient’s own blood (bone-marrow) stem cells. By disrupting the unhealthy gene that gives red blood cells their “sickle” shape, the aim is to produce red blood cells with a healthy spherical shape.
Although the treatment uses the patient’s own cells, the same underlying principle applies to recent clinical xenotransplants: unsuitable cellular materials may be edited to make them therapeutically beneficial in the patient.
CRISPR technology is aiming to restore diseased red blood cells to their healthy round shape. Sebastian Kaulitzki/Shutterstock We’ll be talking more about gene-editing
Medicine and gene technology regulators are increasingly asked to approve new experimental trials using gene editing and CRISPR.
However, neither xenotransplantation nor the therapeutic applications of this technology lead to changes to the genome that can be inherited.
For this to occur, CRISPR edits would need to be applied to the cells at the earliest stages of their life, such as to early-stage embryonic cells in vitro (in the lab).
In Australia, intentionally creating heritable alterations to the human genome is a criminal offence carrying 15 years’ imprisonment.
No jurisdiction in the world has laws that expressly permits heritable human genome editing. However, some countries lack specific regulations about the procedure.
Is this the future?
Even without creating inheritable gene changes, however, xenotransplantation using CRISPR is in its infancy.
For all the promise of the headlines, there is not yet one example of a stable xenotransplantation in a living human lasting beyond seven months.
While authorisation for this recent US transplant has been granted under the so-called “compassionate use” exemption, conventional clinical trials of pig-human xenotransplantation have yet to commence.
But the prospect of such trials would likely require significant improvements in current outcomes to gain regulatory approval in the US or elsewhere.
By the same token, regulatory approval of any “off-the-shelf” xenotransplantation organs, including gene-edited kidneys, would seem some way off.
Christopher Rudge, Law lecturer, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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12 Questions For Better Brain Health
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We usually preface our “Expert Insights” pieces with a nice banner that has a stylish tall cutout that allows us to put a photo of the expert in. Today we’re not doing that, because for today’s camera-shy expert, we could only find one photo, and it’s a small, grainy, square headshot that looks like it was taken some decades ago, and would not fit our template at all. You can see it here, though!
In any case, Dr. Linda Selwa is a neurologist and neurophysiologist with nearly 40 years of professional experience.
The right questions to ask
As a neurologist, she found that one of the problems that results in delayed interventions (and thus, lower efficacy of those interventions) is that people don’t know there’s anything to worry about until a degenerative brain condition has degenerated past a certain point. With that in mind, she bids us ask ourselves the following questions, and discuss them with our primary healthcare providers as appropriate:
- Sleep: Are you able to get sufficient sleep to feel rested?
- Affect, mood and mental health: Do you have concerns about your mood, anxiety, or stress?
- Food, diet and supplements: Do you have concerns about getting enough or healthy enough food, or have any questions about supplements or vitamins?
- Exercise: Do you find ways to fit physical exercise into your life?
- Supportive social interactions: Do you have regular contact with close friends or family, and do you have enough support from people?
- Trauma avoidance: Do you wear seatbelts and helmets, and use car seats for children?
- Blood pressure: Have you had problems with high blood pressure at home or at doctor visits, or do you have any concerns about blood pressure treatment or getting a blood pressure cuff at home?
- Risks, genetic and metabolic factors: Do you have trouble controlling blood sugar or cholesterol? Is there a neurological disease that runs in your family?
- Affordability and adherence: Do you have any trouble with the cost of your medicines?
- Infection: Are you up to date on vaccines, and do you have enough information about those vaccines?
- Negative exposures: Do you smoke, drink more than one to two drinks per day, or use non-prescription drugs? Do you drink well water, or live in an area with known air or water pollution?
- Social and structural determinants of health: Do you have concerns about keeping housing, having transportation, having access to care and medical insurance, or being physically or emotionally safe from harm?
You will note that some of these are well-known (to 10almonds readers, at least!) risk factors for cognitive decline, but others are more about systemic and/or environmental considerations, things that don’t directly pertain to brain health, but can have a big impact on it anyway.
About “concerns”: in the case of those questions that ask “do you have concerns about…?”, and you’re not sure, then yes, you do indeed have concerns.
About “trouble”: as for these kinds of health-related questionnaires in general, if a question asks you “do you have trouble with…?” and your answer is something like “no, because I have a special way of dealing with that problem” then the answer for the purposes of the questionnaire is yes, you do indeed have trouble.
Note that you can “have trouble with” something that you simultaneously “have under control”—just as a person can have no trouble at all with something that they leave very much out of control.
Further explanation on each of the questions
If you’re wondering what is meant by any of these, or what counts, or why the question is even being asked, then we recommend you check out Dr. Selwa et al’s recently-published paper, then all is explained in there, in surprisingly easy-to-read fashion:
Emerging Issues In Neurology: The Neurologist’s Role in Promoting Brain Health
If you scroll past the abstract, introduction, and disclaimers, then you’ll be straight into the tables of information about the above 12 factors.
Want to be even more proactive?
Check out:
How To Reduce Your Alzheimer’s Risk
Take care!
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Ultra-Processed People – by Dr. Chris van Tulleken
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It probably won’t come as a great surprise to any of our readers that ultra-processed food is—to make a sweeping generalization—not fabulous for the health. So, what does this book offer beyond that?
Perhaps this book’s greatest strength is in showing not just what ultra-processed foods are, but why they are. In principle, food being highly processed should be neither good nor bad by default. Much like GMOs, if a food is modified to be more nutritious, that should be good, right?
Only, that’s mostly not what happens. What happens instead is that food is modified (be it genetically or by ultra-processing) to be cheaper to produce, and thus maximise the profit margin.
The addition of a compound that increases shelf-life but harms the health, increases sales and is a net positive for the manufacturer, for instance. Dr. van Tulleken offers us many, many, examples and explanations of such cost-cutting strategies at our expense.
In terms of qualifications, the author has an MD from Oxford, and also a PhD, but the latter is in molecular virology; not so relevant here. Yet, we are not expected to take an “argument from authority”, and instead, Dr. van Tulleken takes great pains to go through a lot of studies with us—the good, the bad, and the misleading.
If the book has a downside, then this reviewer would say it’s in the format; it’s less a reference book, and more a 384-page polemic. But, that’s a subjective criticism, and for those who like that sort of thing, that is the sort of thing that they like.
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The Fiber Fueled Cookbook – by Dr. Will Bulsiewicz
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We’ve previously reviewed Dr. Bulsiewicz’s book “Fiber Fuelled” (which is great), but this one is more than just a cookbook with the previous book in mind. Indeed, this is even a great stand-alone book by itself, since it explains the core principles well enough already, and then adds to it.
It’s also about a lot more than just “please eat more fiber”, though. It looks at FODMAPs, purine, histamine intolerance, celiac disease, altered gallbladder function, acid reflux, and more.
He offers a five-part strategy:
Genesis (what is the etiology of your problem)
- Restrict (cut things out to address that first)
- Observe (keep a food/symptom diary)
- Work things back in (re-add potential triggers one by one, see how it goes)
- Train your gut (your microbiome does not exist in a vacuum, and communication is two-way)
- Holistic healing (beyond the gut itself, looking at other relevant factors and aiming for synergistic support)
As for the recipes themselves, there are more than a hundred of them and they are good, so no more “how can I possibly cook [favorite dish] without [removed ingredient]?”
Bottom line: if you’d like better gut health, this book is a top-tier option for fixing existing complaints, and enjoying plain-sailing henceforth.
Click here to check out The Fiber Fueled Cookbook; your gut will thank you later!
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Honeydew vs Cantaloupe – Which is Healthier?
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Our Verdict
When comparing honeydew to cantaloupe, we picked the cantaloupe.
Why?
In terms of macros, there’s not a lot between them—they’re both mostly water. Nominally, honeydew has more carbs while cantaloupe has more fiber and protein, but the differences are very small. So, a very slight win for cantaloupe.
Looking at vitamins: honeydew has slightly more of vitamins B5 and B6 (so, the vitamins that are in pretty much everything), while cantaloupe has a more of vitamins A, B1, B2, B3, C, and E (especially notably 67x more vitamin A, whence its color). A more convincing win for cantaloupe.
The minerals category is even more polarized: honeydew has more selenium (and for what it’s worth, more sodium too, though that’s not usually a plus for most of us in the industrialized world), while cantaloupe has more calcium, copper, iron, magnesium, manganese, phosphorus, potassium, and zinc. An overwhelming win for cantaloupe.
No surprises: adding up the slight win for cantaloupe, the convincing win for cantaloupe, and the overwhelming win for cantaloupe, makes cantaloupe the overall best pick here.
Enjoy!
Want to learn more?
You might like to read:
From Apples to Bees, and High-Fructose Cs: Which Sugars Are Healthier, And Which Are Just The Same?
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Rehab Science – by Dr. Tom Walters
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Many books of this kind deal with the injury but not the pain; some source talk about pain but not the injury; this one does both, and more.
Dr. Walters discusses in detail the nature of pain, various different kinds of pain, the factors that influence pain, and, of course, how to overcome pain.
He also takes us on a tour of various different categories of injury, because some require very different treatment than others, and while there are some catch-all “this is good/bad for healing” advices, sometimes what will help with one injury with hinder healing another. So, this information alone would make the book a worthwhile read already.
After this two-part theory-heavy introduction, the largest part of the book is given over to rehab itself, in a practical fashion.
We learn about how to make an appropriate rehab plan, get the material things we need for it (if indeed we need material things), and specific protocols to follow for various different body parts and injuries.
The style is very much that of a textbook, well-formatted and with plenty of illustrations throughout (color is sometimes relevant, so we recommend a print edition over Kindle for this one).
Bottom line: if you have an injury to heal, or even just believe in being prepared, this book is an excellent guide.
Click here to check out Rehab Science, to overcome pain and heal from injury!
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