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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  • Trout vs Haddock – Which is Healthier?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Our Verdict

    When comparing trout to haddock, we picked the trout.

    Why?

    It wasn’t close.

    In terms of macros, trout has more protein and more fat, although the fat is mostly healthy (some saturated though, and trout does have more cholesterol). This category could be a win for either, depending on your priorities. But…

    When it comes to vitamins, trout has a lot more of vitamins A, B1, B2, B3, B5, B6, B12, C, D, and E, while haddock is not higher in any vitamins.

    In the category of minerals, trout has more calcium, copper, iron, magnesium, potassium, and zinc, while haddock has slightly more selenium. Given that a 10oz portion of trout already contains 153% of the RDA of selenium, however, the same size portion of haddock having 173% of the RDA isn’t really a plus for haddock (especially as selenium can cause problems if we get too much). Oh, and haddock is also higher in sodium, but in industrialized countries, most people most of the time need less of that, not more.

    On balance, the overwhelming nutritional density of trout wins the day.

    Want to learn more?

    You might like to read:

    Farmed Fish vs Wild Caught: It Makes Quite A Difference!

    Take care!

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  • No, you don’t need the ‘Barbie drug’ to tan, whatever TikTok says. Here’s why melanotan-II is so risky

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    TikTok and Instagram influencers have been peddling the “Barbie drug” to help you tan.

    But melanotan-II, as it’s called officially, is a solution that’s too good to be true. Just like tanning, this unapproved drug has a dark side.

    Doctors, researchers and Australia’s drug regulator have been warning about its side effects – from nausea and vomiting to brain swelling and erection problems.

    There are also safer ways of getting the tanned look, if that’s what you’re after.

    AtlasStudio/Shutterstock

    What is melanotan-II?

    No, it’s not a typo. Melanotan-II is very different from melatonin, which is a hormonal supplement used for insomnia and jet lag.

    Melanotan-II is a synthetic version of the naturally ocurring hormone α-melanocyte stimulating hormone. This means the drug mimics the body’s hormone that stimulates production of the pigment melanin. This is what promotes skin darkening or tanning, even in people with little melanin.

    Although the drug is promoted as a way of getting a “sunless tan”, it is usually promoted for use with UV exposure, to enhance the effect of UV and kickstart the tanning process.

    Melanotan-II is related to, but different from, melanotan-I (afamelanotide), an approved drug used to treat the skin condition erythropoietic protoporphyria.

    Melanotan-II is not registered for use with Australia’s Therapeutic Goods Administration (TGA). It is illegal to advertise it to the public or to provide it without a prescription.

    However, social media has been driving unlicensed melanotan-II sales, a study published last year confirms.

    There are many black market suppliers of melanotan-II injections, tablets and creams. More recently, nasal sprays have become more popular.

    What are the risks?

    Just like any drug, melanotan-II comes with the risk of side effects, many of which we’ve known about for more than a decade. These include changes in the size and pigmentation of moles, rapid appearance of new moles, flushing to the face, abdominal cramps, nausea, vomiting, chest pain and brain swelling.

    It can also cause rhabdomyolysis, a dangerous syndrome where muscle breaks down and releases proteins into the bloodstream that damage the kidneys.

    For men, the drug can cause priapism – a painful erection that does not go away and can damage the penis, requiring emergency treatment.

    Its use has been linked with melanoma developing from existing moles either during or shortly after using the drug. This is thought to be due to stimulating pigment cells and causing the proliferation of abnormal cells.

    Despite reports of melanoma, according to a study of social media posts the drug is often marketed as protecting against skin cancer. In fact, there’s no evidence to show it does this.

    Social media posts about melanotan-II rarely mention health risks.

    There are no studies on long-term safety of melanotan-II use.

    Then there’s the issue of the drug not held to the high safety standards as TGA-approved products. This could result in variability in dose, undeclared ingredients and potential microbial contamination.

    Young, pale man walking along street, looking down at phone in hand
    Thinking about melanotan-II? The drug can cause a long-lasting painful erection needing urgent medical care. Eugenio Marongiu/Shutterstock

    The TGA has previously warned consumers to steer clear of the drug due to its “serious side effects that can be very damaging to your health”.

    According to an ABC article published earlier this week, the TGA is cracking down on the illegal promotion of the drug on various websites. However, we know banned sellers can pop back up under a different name.

    TikTok has banned the hashtags #tanningnasalspray, #melanotan and #melanotan2, but these products continue to be promoted with more generic hashtags, such as #tanning.

    Part of a wider trend

    Australia has some of the highest rates of skin cancer in the world. The “slip, slop, slap” campaign is a public health success story, with increased awareness of sun safety, a cultural shift and a decline in melanoma in young people.

    However, the image of a bronzed beach body remains a beauty standard, especially among some young people.

    Disturbingly, tan lines are trending on TikTok as a sought after summer accessory and the hashtag #sunburnttanlines has millions of views. We’ve also seen a backlash against sunscreen among some young people, again promoted on TikTok.

    The Cancer Council is so concerned about the trend towards normalising tanning it has launched the campaign End the Trend.

    You have other options

    There are options beyond spraying an illegal, unregulated product up your nose, or risking unprotected sun exposure: fake tan.

    Fake tan tends to be much safer than melanotan-II and there’s more long-term safety data. It also comes with potential side effects, albeit rare ones, including breathing issues (with spray products) and skin inflammation in some people.

    Better still, you can embrace your natural skin tone.

    Rose Cairns, Senior Lecturer in Pharmacy, NHMRC Emerging Leadership Fellow, University of Sydney

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • A Fresh Take On Hypothyroidism

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    The Three Rs To Boost Thyroid-Related Energy Levels

    This is Dr. Izabella Wentz. She’s a doctor of pharmacology, and after her own diagnosis with Hashimoto’s thyroiditis, she has taken it up as her personal goal to educate others on managing hypothyroidism.

    Dr. Wentz is also trained in functional medicine through The Institute for Functional Medicine, Kalish Functional Medicine, and the American Academy of Anti-Aging Medicine. She is a Fellow of the American Society of Consultant Pharmacists, and holds certifications in Medication Therapy Management as well as Advanced Diabetes Care through the American Pharmacists Association. In 2013, she received the Excellence in Innovation Award from the Illinois Pharmacists Association.

    Dr. Wentz’s mission

    Dr. Wentz was disenchanted by the general medical response to hypothyroidism in three main ways. She tells us:

    • Thyroid patients are not diagnosed appropriately.
      • For this, she criticises over-reliance on TSH tests that aren’t a reliable marker of thyroid function, especially if you have Hashimoto’s.
    • Patients should be better optimized on their medications.
      • For this, she criticizes many prescribed drugs that are actually pro-drugs*, that don’t get converted adequately if you have an underactive thyroid.
    • Lifestyle interventions are often ignored by mainstream medicine.
      • Medicines are great; they truly are. But medicating without adjusting lifestyle can be like painting over the cracks in a crumbling building.

    *a “pro-drug” is what it’s called when the drug we take is not the actual drug the body needs, but is a precursor that will get converted to that actual drug we need, inside our body—usually by the liver, but not always. An example in this case is T4, which by definition is a pro-drug and won’t always get correctly converted to the T3 that a thyroid patient needs.

    Well that does indeed sound worthy of criticism. But what does she advise instead?

    First, she recommends a different diagnostic tool

    Instead of (or at least, in addition to) TSH tests, she advises to ask for TPO tests (thyroid peroxidase), and a test for Tg antibodies (thyroglobulin). She says these are elevated for many years before a change in TSH is seen.

    Next, identify the root cause and triggers

    These can differ from person to person, but in countries that add iodine to salt, that’s often a big factor. And while gluten may or may not be a factor, there’s a strong correlation between celiac disease and Hashimoto’s disease, so it is worth checking too. Same goes for lactose.

    By “checking”, here we mean testing eliminating it and seeing whether it makes a difference to energy levels—this can be slow, though, so give it time! It is best to do this under the guidance of a specialist if you can, of course.

    Next, get to work on repairing your insides.

    Remember we said “this can be slow”? It’s because your insides won’t necessarily bounce back immediately from whatever they’ve been suffering from for what’s likely many years. But, better late than never, and the time will pass anyway, so might as well get going on it.

    For this, she recommends a gut-healthy diet with specific dietary interventions for hypothyroidism. Rather than repeat ourselves unduly here, we’ll link to a couple of previous articles of ours, as her recommendations match these:

    She also recommends regular blood testing to see if you need supplementary TSH, TPO antibodies, and T3 and T4 hormones—as well as vitamin B12.

    Short version

    After diagnosis, she recommends the three Rs:

    • Remove the causes and triggers of your hypothyroidism, so far as possible
    • Repair the damage caused to your body, especially your gut
    • Replace the thyroid hormones and related things in which your body has become deficient

    Learn more

    If you’d like to learn more about this, she offers a resource page, with resources ranging from on-screen information, to books you can get, to links to hook you up with blood tests if you need them, as well as recommended supplements to consider.

    She also has a blog, which has an interesting relevant article added weekly.

    Enjoy, and take care of yourself!

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  • Healing Spices – by Dr. Bharat Aggarwal & Debora Yost

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    This is exactly what the subtitle promises it to be, and more. It’s actually herbs and spices, but definitely mostly spices, and includes the kinds found in even the smallest supermarket, to some you might not have heard of, and might need to order online.

    We are treated to an explanation of the health-giving properties of each (and any potential contraindications), as well as the culinary properties, many tables of what goes with what and how and why, and even recipes to use them in. For the more adventurous, there’s even advice on how to grow, prepare, and store each of them.

    An extra benefit is that everything is cross-linked such that you can look things up by spice or by health condition or by flavor profile, and find what you need and what’ll go with it.

    The style is simple and informational, clearly laid-out in encyclopedic form.

    Bottom line: this book should be in your kitchen (or related nearby kitchen-book-place).

    Click here to check out Healing Spices, and advance your culinary repertoire!

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  • Retinoids: Retinol vs Retinal vs Retinoic Acid vs..?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    It’s Q&A Day at 10almonds!

    Have a question or a request? We love to hear from you!

    In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!

    As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!

    So, no question/request too big or small 😎

    ❝I’m confused about retinol, retinal, retinoin, retinoids, etc, and of course every product claims to be the best, what’s the actual science on it?❞

    Before we get into these skincare products, let’s first note that for most people, what’s best for the skin is good sleep and hydration, a plants-centric whole foods diet, and good stress management:

    See for example: Of Brains And Breakouts: The Brain Skin Doctor

    However, the world of potions and lotions can be an alluring one, and there is some merit there too. So, in a nutshell:

    • Retinoids are the overall class of chemicals, and not a specific type
      • Retinoic acid is the strongest form of this chemical and is prescription-controlled in most places
        • Retinoin” is probably tretinoin (all-trans retinoic acid) with the “t” having fallen off; we can only find it being used as a product name, not an actual substance
      • Retinal, when it’s not an adjective referring to the retina (the part of the eye that receives refocussed light) and is instead a noun, is a less potent retinoid than the prescription-only kinds, but still stronger than retinol
      • Retinol is a much less potent form, and is the most widely found in skincare products

    All of them work the same way; it is only how serious they are about it that differs.

    The mechanism of action is that they speed up the turnover (shedding cycle) of skin, so that cells are replaced sooner. As with any non-cancerous human tissue, this means that the tissue itself (in this case, your skin) will be biologically younger than if it had been replaced later.

    The downside, of course, of this is that—while trying to make your skin healthier and more beautiful—the first thing that will happen is skin shedding. Depending on the retinoid type, dose, and the health of your skin to start with, this may mean anything from needing to exfoliate in the morning, to having to go to hospital with what looks like the world’s worst sunburn. For this reason, it is recommended to start with weaker products and lower doses, and work up carefully.

    A note on doses: the recommended doses for these products are always truly tiny, like “use a pea-sized amount of this 0.05% serum on your face”. Take them seriously until you’re absolutely sure from experience that your skin can handle more.

    Also, a tip: wear gloves when you apply any of the above products. This is because your fingers are also covered in skin, and if you don’t use gloves, then half the product that you intended for your face will be absorbed into your fingers instead. On the bright side, you’ll have beautifully rejuvenated fingertips, though.

    You can learn more about the science of retinoids here, in our article about tretinoin, the usually prescription-only form of retinoic acid:

    Tretinoin: Undo The Sun’s Damage To Your Skin

    Want to try some?

    We don’t sell it, but here for your convenience is an example product of retinal (stronger than retinol) on Amazon 😎

    Take care!

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  • How I Cured My Silent Reflux – by Don Daniels

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Acid reflux, in its various forms (not all of which include heartburn as a symptom!), affects around 1 in 8 people. Often it takes the form of coughing or excess mucus after eating, and it can trigger ostensibly random sweats, for example.

    Don Daniels does an excellent job of demystifying the various kinds of acid reflux, explaining clearly and simply the mechanics of what is going on for each of them and why.

    Further, he talks about the medications that can make things worse (and how and why), and supplements that can make it better (and supplements that can make it worse, too!), and a multiphase plan (diet on, meds weaned off, supplements on, supplements weaned off when asymptomatic, diet adjust to a new normal) to get free from acid reflux.

    The writing style is simple, clear, and jargon-free, while referencing plenty of scientific literature, often quoting from it and providing sources, much like we often do at 10almonds. There are 50+ such references in all, for a 105-page book.

    So, do also note that yes, it’s quite a short book for the price, but the content is of value and wouldn’t have benefitted from padding of the kind that many authors do just to make the book longer.

    Bottom line: if you have, or suspect you may have, an acid reflux condition of any kind, then this book can guide you through fixing that.

    Click here to check out How I Cured My Silent Reflux, and put up with it no longer!

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