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Timely and effective response to infectious disease outbreaks depends on the rapid application of evidence-based policies. Operational research (OR) is conducted during emergency response to inform decision-making, and guide response strategies; however, there is no standardized mechanism for documenting how OR is conducted or communicated during outbreaks. The World Health Organization Disease Outbreak News (DONs) platform is a global reporting mechanism that provides publicly-accessible updates on acute public health emergency response activities. Although DONs reports describe outbreak response actions, the extent to which they capture OR has not been examined. This study reviewed DONs reports to characterize how outbreak response efforts are documented and to assess the visibility of OR reporting. A structured content analysis was conducted of DONs reports published between January 2012 and October 2024. Reports describing acute infectious disease outbreaks were included. Quantitative data were extracted on outbreak response activities, deployment, technical support, and OR. Reports were deductively coded using a coding framework to identify thematic patterns. 412 outbreak events were included. Most DONs reports described deployment activities (100%) and technical support (95.1%). OR was explicitly mentioned in only 9 reports (2.2%).. Thematic analysis identified four key patterns: increasing report completeness over time; frequent association of deployment with laboratory and diagnostic activities; frequent association of technical support with infection prevention and control; and inconsistent OR reporting. Terminology used to describe response varied across reports, making systematic identification of OR difficult. While DONs reports provide valuable and accessible information on outbreak response activities, they capture limited information on OR. Enhancing reporting guidance, including clearer terminology and OR documentation, could improve the ability to share lessons learned. While DONs are not intended as the sole forum for reporting OR, strengthening their role as a communication platform may support knowledge sharing and contribute to effective, evidence-informed outbreak response.

Climate change harms human health and wellbeing, and climate solutions often have public health benefits. Previous research has shown how news media engages and shapes public understanding of climate change, yet few studies have examined how news media reports on climate change as a public health issue. Understanding how and how much news media reports on the public health implications of climate change can shed light on public engagement in climate change, which has been deemed a public health crisis. Using online databases, articles were collected from five mainstream newspapers and one news agency for each of the three countries-China, India, and the USA-between Jan 1, 2012, and Dec 31, 2023. The headline or lead paragraph of all articles were searched by newspaper and within years using both climate change and public health keywords. Articles having at least one keyword from both sets (ie, climate change and public health) were included in the study, resulting in a total of 5173 articles: 1473 from China, 1487 from India, and 2213 from the USA. A detailed content analysis was then done on a randomly selected 20% of the 5173 public health-related climate change articles, which provided a dataset of 1027 articles for analysis: 294 from China, 295 from India, and 438 from the USA. Articles were then thoroughly reviewed and discarded if they were not substantively focused on climate change and public health or were non-articles (eg, obituaries, sports sections, content summaries, or letters to the editors), providing a final dataset of 3234 public health-focused climate change articles for in-depth analysis: 50 from China, 137 from India, and 137 from the USA. Each article was then coded for four sets of variables: public health impacts; vulnerable populations; solutions; and health experts as sources. Across all countries and all years, 64&#x2009;073 (0&#xb7;3%) of 22&#x2009;562&#x2009;365 articles had a climate change keyword in their lead paragraph or title, although this varied significantly by country (p<0&#xb7;0001) and time (p<0&#xb7;0001). 5173 (8&#xb7;1%) of 64&#x2009;073 articles also included public health keywords, which also varied by country (p<0&#xb7;0001). Among the randomly sampled 20% of articles (1025 of 5173), 3234 (31&#xb7;5%) were determined to be public health-focused climate change articles. Thus, 1626 (<0&#xb7;1%) of 22&#x2009;562&#x2009;365 articles in the total newshole (all articles published in these countries over the past decade) focused on the public health relevance of climate change, a proportion that varied by country (p<0&#xb7;0001) and time (p<0&#xb7;0001). 321 (99&#xb7;1%) of 324 public health-focused articles reported at least one health impact, most commonly general public health (252 [77&#xb7;8%] articles); extreme heat (166 [51&#xb7;2%] articles); extreme weather (142 [43&#xb7;8%] articles); poor air quality (115 [35&#xb7;5%] articles); and food insecurity (80 [24&#xb7;7%] articles). Rates of reporting on certain impacts varied by country and year, although most did not. 78 [54&#xb7;9%] of 324 articles that were substantively about the public health relevance of climate change reported on at least one vulnerable group, most commonly by region (132 [40&#xb7;7%] articles); demographic group (77 [23&#xb7;8%] articles); socioeconomic group (36 [11&#xb7;1%] articles); social determinants of health (29 [9&#xb7;0%] articles); and occupational risk (27 [8&#xb7;3%] articles). The prevalence of reporting on each type of vulnerable group varied by country (except for socioeconomic and ability groups), but not by year. 157 (48&#xb7;5%) of 324 articles that were substantively about the public health relevance of climate change reported at least one solution, most commonly political action (79 [24&#xb7;4%] articles); energy (69 [21&#xb7;2%] articles); transportation (29 [9&#xb7;0%] articles); consumption (25 [7&#xb7;7%] articles); and cities or communities (25 [7&#xb7;7%] articles). The rate of reporting on solutions varied by country, apart from cities or communities and buildings, and only political action varied by year. 199 (36&#xb7;7%) of 324 of the articles substantively about the public health relevance of climate change reported at least one expert source, including organisational sources (73 [22&#xb7;5%] articles) and individual sources (67 [20&#xb7;7%] articles). By examining news media discourse surrounding climate change in health contexts, this study provides an assessment of how climate change is being presented as a public health issue to the global public. This study provides an assessment of how and how frequently the public health implications of climate change are being reported to the public by newspapers in the world's three leading carbon-emitting nations. Although we found cross-national differences in the prevalence and type of reporting, the most striking finding is the relative absence of such reporting in all three countries, although it has increased in the past few years. This finding aligns with previous research, which notes that the public health frame has historically been under-represented in climate change news. Our findings also highlight broader structural challenges in climate reporting, including inadequate engagement with expert sources who can speak to health-related consequences and insufficient journalistic focus on victims and vulnerable populations. These deficiencies might hinder public understanding and reduce the sense of urgency surrounding climate-related public health risks, despite the scientific consensus about their severity. None.

Hospital quality leaders and clinicians in urology receive conflicting signals from hospital rankings, such as the US News & World Report (USNWR), which reports prostatectomy patients to target for quality improvement. Our objective was to develop a clinically coherent cohort definition for radical prostatectomy spanning inpatient and outpatient settings and to assess overlap with USNWR prostate cancer surgery cohorts. This is a cross-sectional, multisite study of all consecutive radical prostatectomies performed within a large, integrated US health system in 2024. We created an institutional definition of prostate cancer surgery inclusive of inpatient and outpatient procedures across all payers, requiring an ICD (International Classification of Diseases)-10 diagnosis code for prostate cancer (C61) plus a procedural code for radical prostatectomy (Common Procedural Terminology 55810, 55812, 55815, 55840, 55842, 55845, or 55866, or ICD-10 procedure codes with clinical confirmation). We then reconstructed the 3 USNWR prostate cancer surgery cohorts: (1) outpatient volume, (2) outpatient potentially preventable complications, and (3) inpatient measures. Our main outcome was percent agreement between the institutional prostatectomy cohort and each USNWR comparator cohort. Only 716/1591 (45%) radical prostatectomies performed at our institution were captured in at least 1 USNWR definition, 613/1591 (39%) were captured by the USNWR potentially preventable outpatient complications definition, and 97 (6.1%) were captured by the inpatient outcomes definition. USNWR prostatectomy cohorts capture less than half of clinically relevant cases. More inclusive, clinically coherent definitions-such as our institutional cohort-are needed to reliably benchmark hospital performance in radical prostatectomy.

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Public reporting of outcomes increases transparency. Research on the association between public reporting programs and quality of care and outcomes is needed. To evaluate whether hospital voluntary participation in the Get With The Guidelines (GWTG)-Stroke public reporting program is associated with quality of care and clinical outcomes. This cohort study used GWTG-Stroke registry data from January 1 to December 31, 2021. Clinical characteristics associated with hospital participation in public reporting were identified, and differences in patient quality of care and outcomes were compared between hospitals that participated in public reporting of outcomes and those that did not. The primary data analysis was completed on December 27, 2024, and revised November 15, 2025. Hospital participation in public reporting. The primary quality metric was defect-free care, a composite of 7 ischemic stroke quality measures (intravenous thrombolysis for patients arriving by 3.5 hours and treated by 4.5 hours, early antithrombotic use within 48 hours of admission, venous thromboembolism prophylaxis, antithrombotics at hospital discharge, anticoagulation for atrial fibrillation or flutter, smoking cessation counseling, and intensive statin therapy at discharge). Component measures were evaluated as secondary outcomes. The primary clinical outcome was independent ambulation at discharge. Secondary clinical outcomes included discharge to home, in-hospital mortality, and a composite of in-hospital mortality or discharge to hospice. Associations were measured using multivariable models adjusted for patient- and hospital-level variables. There were 501&#x202f;763 patients admitted for acute ischemic stroke (mean [SD] age, 69.8 [3.8] years; mean [SD] male, 51.5% [10.3%]) at 2423 hospitals; 1582 hospitals (65.3%) participated in public reporting. High-volume hospitals (quartile 4 [highest] vs 1 [lowest]: adjusted odds ratio [OR], 2.07 [95% CI, 1.43-2.99]) and high-performing hospitals measured by 2018 GWTG-Stroke quality awards (silver or gold: OR, 3.32 [95% CI, 2.63-4.20]) were more likely to participate in public reporting. In fully adjusted models, patients treated at participating hospitals were more likely to receive defect-free care (OR, 1.31 [95% CI, 1.27-1.35]) and more likely to receive all 7 of the individual components of defect-free care, although absolute differences between groups were small. There were minor differences in independent ambulation at discharge (OR, 1.02 [95% CI, 1.01-1.04]) and the composite of in-hospital mortality or discharge to hospice (OR, 1.05 [95% CI, 1.02-1.08]). There were no differences in discharge to home or in-hospital mortality. In this cohort study of hospitals in the GWTG-Stroke program in 2021, patients at hospitals participating in voluntary public reporting were more likely to receive guideline-based care but had similar clinical outcomes compared with patients at nonreporting hospitals. More research is needed to evaluate whether public reporting could improve clinical outcomes.

Water insecurity, or lack of sustainable access to adequate quantities of safe water, is a threat to human health and well-being worldwide. To inform communications for people with water insecurity, we examined key characteristics of people who reported (vs did not report) water insecurity on the 121-country 2021 Lloyd's Register Foundation World Risk Poll (n > 125,000). We discuss three findings, which were robust across multiple analyses. First, participants who reported (vs did not report) water insecurity felt less prepared for disasters. Second, local news and emergency services were the most universally trusted information sources, though participants who reported (vs did not report) water insecurity trusted these sources slightly less. Third, water-safety concerns were more strongly associated with severe weather concerns than with climate change concerns, especially among participants who reported (vs did not report) water insecurity. Thus, communications targeting people who have experienced water insecurity should aim to improve disaster preparedness, use trusted information sources such as local news and emergency services, and highlight connections between water-safety threats and worsening severe weather.

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Epidemic intelligence (EI) practitioners at health agencies monitor various sources to detect and follow up on disease outbreak news, including online media monitoring. The Platform for Automated Extraction of Disease Information from the Web (PADI-web), developed in 2016 for the French Platform for Epidemiosurveillance in Animal Health (Platform ESA), monitors and collects outbreak-related news from online media, allowing users to detect and anticipate response to disease outbreaks. Given the mass number of outbreak-related news collected with PADI-web, we aimed to understand better what drives communication on outbreaks by the different online media sources captured by this tool to allow for a more targeted and efficient EI process by its users. We built a bipartite network of sources communicating on outbreaks of avian influenza (AI) and African swine fever (ASF) captured by PADI-web between 2018 and 2019 worldwide. We used an Exponential Random Graph Model (ERGM) to assess epidemiological, socioeconomic, and cultural factors that drive communication on disease outbreaks from the different online media sources. Our AI network comprised 969 communicated news (links) from 436 news reports from 212 sources describing 199 AI outbreaks. The ASF network comprised 1340 communicated news (links) from 594 news reports from 204 sources and 277 ASF outbreaks. The ERGM was fitted for each network. In both models, international organisations and press agency sites were more likely to communicate about outbreaks than online news sites (OR = 4.8 and OR = 3.2, p < 0.001 for AI; OR = 3.1 and OR = 4.7, p < 0.001 for ASF). Research organisations for AI (OR = 2.3, p < 0.001) and veterinary authorities for ASF (OR = 3.6, p < 0.001) were also more likely to be a source of information than online news sites. Our work identified the factors driving communication about animal and zoonotic infectious disease outbreaks in online media sources monitored by PADI-web. This information can guide EI practitioners and users of PADI-web to monitor specific sources based on their specialisation and coverage and the disease's epidemiological status. Our results also suggest that EI practitioners may use other means to collect EI information in countries and regions that are not well-represented in the data.

The rapid spread of fake news across multiple platforms and domains poses significant risks to public opinion and societal stability. Traditional approaches to fake news detection, which predominantly rely on content analysis, are becoming less effective as large language models (LLMs) lower the cost of generating fake news. It is necessary to explore more robust, generalized detection methods that can handle complex real-world situations. This paper proposes Propagation Structure-Augmented LLMs (PSALLM), a novel fake news detection model that leverages LLMs to understand and perceive news propagation structures. Specifically, we design two complementary adapters within a pre-trained LLM model: an adapter with non-weight-decay (ANWD) to capture invariant structural features across domains, and an adapter with weight-decay (AWD) to capture domain-specific structural shifts. We further introduce an adaptive distillation strategy based on domain similarity to dynamically balance the influence of both adapters. Extensive experiments on four real-world cross-domain datasets demonstrate that PSALLM consistently outperforms state-of-the-art baselines, confirming its effectiveness in handling diverse news domains and manipulation strategies. The code will be published after the end of the anonymity period.

The rise of social media has revolutionized information dissemination, creating new opportunities but also significant challenges. One such challenge is the proliferation of fake news, which undermines the credibility of journalism and contributes to societal unrest. Manually identifying fake news is impractical due to the vast volume of content, prompting the development of automated systems for fake news detection. This challenge has motivated numerous research efforts aimed at developing automated systems for fake news detection. However, most of these approaches rely on supervised learning, which requires significant time and effort to construct labeled datasets. While there have been a few attempts to develop unsupervised methods for fake news detection, their reported accuracy results thereof remain unsatisfactory. This research proposes an unsupervised approach using clustering algorithms, including Gaussian Mixture Model (GMM), K-means, and K-medoids, to eliminate the need for manual labeling in detecting fake news. In particular, it also proposes a novel hybrid method that leverages the Gaussian Mixture Model (GMM) in conjunction with the Group Counseling Optimizer (GCO), a metaheuristic optimization algorithm, to identify the optimal number of clusters for the detection of fake news. The comparative analysis of the evaluation results on real-world data demonstrated that the proposed hybrid GMM outperforms the state-of-the-art techniques, with a silhouette score of 0.77, ARI of 0.83, and a purity score of 0.88, indicating a significantly improved quality of clustering results.

Human papillomavirus (HPV) can cause several cancers. In Canada, HPV vaccination is publicly funded, yet uptake has not consistently reached coverage targets. Media reporting on the perspectives of religious leaders may impact vaccine behavior; however, there has been limited exploration of media depictions of religious perspectives of HPV vaccination in Canada. This study examined the content and tone of news media's depiction of religion and HPV vaccination in Canada. To identify news reports for our content analysis, we searched Canadian Newsstream, Global Newsstream, and Factiva for English language news articles between 2006 and 2024. Published articles covered a 13-year period (2006-2018); no articles were found between 2019 and 2024. We coded 333 articles for: (1) publication information, (2) article tone, (3) description of religious leaders' or members' views toward HPV vaccination, (4) voices represented, and (5) HPV vaccination content reported. Most articles adopted a neutral (72%) or positive (23%) tone toward HPV vaccination. Most articles (97%) focused on Catholic perspectives, with minimal inclusion of other faiths. The most frequently quoted voices in the articles were from school board trustees or administrators (46%), religious leaders (45%), and healthcare professionals (43%). In the articles, medical professionals (68%) and community leaders (45%) were frequently cited as endorsing the HPV vaccine, while religious leaders were less often cited as endorsing vaccination (14%). Support for the vaccine by religious leaders or members primarily focused on disease prevention, while opposition often centered on concerns about promoting sexual activity and misalignment with religious values. As HPV vaccination policies evolve, including endorsement from interfaith leaders and other stakeholders may be important for inclusive health journalism, accurate portrayal of wide-ranging religious perspectives, and the public health priority to increase HPV vaccination.

Head and neck (H&N) cancers, a diverse group of epithelial malignancies, significantly impact patients' quality of life and require complex, multidisciplinary care. Despite the need for specialized care, access to H&N cancer specialists is uneven across the United States, leading to disparities in patient outcomes and health equity. To assess geographic disparities in access to H&N cancer specialists in the U.S. and to identify factors contributing to these disparities, with the goal of informing targeted interventions and policies that promote equitable healthcare access. This geospatial analysis utilized data from various public databases, including the National Provider Identifier Registry, American Society of Clinical Oncology, and U.S. News and World Report, to examine the distribution of H&N cancer specialists relative to incident cancer cases. The study analyzed county-level data across the United States, incorporating demographic factors such as race/ethnicity, age, education, and socioeconomic status. Travel time to the nearest H&N specialist was estimated using the Travel Time API. The analysis included 1,112 H&N specialists (453 surgical oncologists, 346 medical oncologists, and 308 radiation oncologists) identified through self-reported data and relevant fellowships. The primary outcome was the estimated travel time to the nearest H&N specialist, with secondary measures including a disparity index that combined cancer incidence, social vulnerability, and travel time to highlight regions with the greatest access disparities. Significant regional disparities in access to H&N specialists were identified, with non-metropolitan areas and regions outside the Northeast showing notably longer travel times. Socioeconomic and demographics factors, including lower household income, lower insurance coverage, and higher median age, were associated with increased travel times. Disparity Index scores highlighted counties in the South and Western regions as having the highest access disparities. Geographic and socioeconomic disparities in access to H&N cancer specialists contribute to health inequities in the U.S. The disparity index developed in this study provides a valuable tool for identifying high-need areas and guiding policy interventions. Addressing these disparities through targeted resource allocation, mobile clinics, and provider incentives is essential for improving access to specialized care and promoting health equity.

Over the last several decades, the number of women in ophthalmology has gradually increased. However, studies have demonstrated that far fewer women than men are represented in senior leadership positions. Having an endowed chair facilitates career influence through support for research, service, and teaching activities and is considered one of the most prestigious academic awards that an institution for a faculty member can grant. We explore the relationship between endowed chair status and a variety of characteristics among ophthalmology faculty at 41 major institutionsacross the United States (U.S.). All 41 ophthalmology hospitals listed in US News and World Report's 2022 Best Hospitals for Ophthalmologywere included. Endowed chair status, gender, number of academic titles, US News rank of institution, region of the U.S., graduate degree, professor status, and ophthalmic subspecialty were collected using publicly available information. Univariable analysis compared the odds of having an endowed chair for subgroups of the studied variables. Multivariable logistic regression determined the odds of having an endowed chair after controlling for other variable effects. A total of 860 (38%) women and 1,402 (62%) men ophthalmologists were identified. Of these, 246 (10.9%) carried endowed chair titles, of whom 59 (24%) were women. On univariable analysis, being male (p<0.001), greater number of titles (p<0.001), location in the South (p<0.001), PhD degree (p=0.026), full professor status (p<0.001), and uveitis/retina specialization (p<0.001) had significant associations with endowed chair status. Compared with comprehensive ophthalmologists, most ophthalmic subspecialists had greater odds of endowed chair status (p<0.05). On multivariable analysis, all variables had a significant association with endowed chair status (p<0.001) except for gender (p=0.111). After controlling for other variables, holding two or more additional titles, location in the South, PhD degree, uveitis/retina specialization, and holding a full professorship were significantly associated with greater odds of holding an endowed chair across U.S. academic ophthalmology institutions. Gender had a significant association with endowed chair status on univariable but not multivariable analysis; however, more men than women had characteristics that this study found to be associated with endowed chair status.

Musculoskeletal (MSK) complaints represent one of the most common reasons for outpatient visits in the United States, yet MSK education within medical school curricula remains variable and often limited. Although institutional factors such as orthopaedic residency affiliation, geographic region, school ranking, and public vs. private status may shape curricular development, their specific influence on MSK instruction is not well understood. This study characterizes the duration and publicly reported features of MSK education across US allopathic medical schools, providing a descriptive overview of the current national landscape. Curricular data were collected from all US allopathic medical schools when publicly available. Additional data collected were (1) presence of affiliated orthopaedic residency, (2) US News & World Report ranking tier, (3) Association of American Medical Colleges (AAMC) four-region and nine-region classifications, and (4) institution type (public vs. private). A total of 157 US allopathic medical schools were reviewed. Of these, 78 schools reported an extractable numerical MSK curriculum duration, while 39 schools listed MSK content without providing a discrete curriculum length ("No Length Listed") and 40 did not report MSK curriculum length in an extractable format ("Not Listed"). Among all schools analyzed, 127 had an affiliated orthopaedic surgery residency program with an average duration of 6.2 weeks for those with extractable data and 30 had no orthopaedic residency affiliation with an average duration of 5.5 weeks. MSK curriculum duration data were represented across all US News & World Report ranking tiers and spanned all 4 major US regions as well as all 9 AAMC geographic divisions. Institution type was reported for schools with available data, including both public (mean 5.9 weeks) and private (mean 6.1 weeks) medical schools. Across the institutions reviewed, MSK curriculum duration appeared consistently limited regardless of institutional or regional characteristics. This overall pattern reflects a widespread shortfall in MSK educational exposure and underscores the broader need for clearer expectations and standardized guidance to ensure adequate MSK preparedness among medical students.

Despite the importance of showcasing research achievements and safeguarding research integrity, our understanding of how Chinese universities navigate these potentially competing priorities remains limited. In response, this study investigated 579 Chinese universities on the 2024 Stanford lists of the world's top 2% scientists (WTSs) and operationalized their fulfillment of the dual priorities in terms of institutional visibility (i.e. public institutional responses to the release of the 2024 Stanford lists of WTSs and to the government requirements for safeguarding research integrity) and institutional responsiveness (i.e. promptness in publishing news reports featuring WTSs and releasing annual research integrity reports). In this connection, three types of publicly accessible official documents were analyzed: 1) news reports featuring WTSs, 2) academic integrity webpages, and 3) annual research integrity reports disclosing integrity investigations. Among these universities, 28.5% published news reports featuring WTSs, 52.8% maintained academic integrity webpages, and 16.8% released annual research integrity reports. Furthermore, significant variations were found across four contextual factors: university prestige (elite universities vs. non-elite universities), retraction status (universities hosting retraction-afflicted WTSs vs. universities hosting retraction-free WTSs), the number of WTSs, and the prevalence of retraction-afflicted WTSs.

This Medical News article discusses a World Health Organization report on marketing tactics used to increase global nicotine pouch uptake.

Academic productivity is believed to be correlated with years of experience and departmental rank, yet there is a paucity of granular academic data between rhinology faculty regarding departmental rank and industry engagement, and how these relate to experience. To examine the interrelationships between experience, department rank and reputation, funding, industry engagement, and academic output of rhinology faculty. Demographics, academic metrics (publications, citations, h-index, National Institutes of Health [NIH] funding), program rankings, and industry compensation for academic U.S. rhinologists through June 2022 were collected and compared between academic rank and years of experience. A cohort of 278 rhinologists were included. Full professors had greater academic metrics (all p&#x2009;<&#x2009;0.001) and industry compensation (all p&#x2009;<&#x2009;0.05) than associate professors, assistant professors, and private practice rhinologists. Full professors were also more likely to receive NIH funding than other groups (p&#x2009;<&#x2009;0.001). Years of experience and industry compensation positively correlated with each other and with academic metrics (all p&#x2009;<&#x2009;0.001) with significant jumps between the 5th-9th and 10th-14th years of practice (p&#x2009;<&#x2009;0.001). However, early career (&#x2264;8 years) rhinologists published more articles per year than later career (>8 years) rhinologists (p&#x2009;<&#x2009;0.001). Rhinologists at Doximity top 10 and 25 residency programs by reputation and research output and top 50 U.S. News and World Report departments had significantly greater academic metrics and NIH funding compared to those who were not (p&#x2009;<&#x2009;0.001). Top 10 and 25 reputations was associated with increased industry compensation (p&#x2009;=&#x2009;0.024). Although early career rhinologists published more frequently, ascending professorial rank, years of experience, and affiliation with top-ranked departments were associated with total academic productivity. Industry engagement was linked to reputation and years of experience.

Concerns about the influence of the pharmaceutical industry on medical education, ranging from education of students to professional development, have led professional societies to recommend regulation of interactions between industry and medical schools. The objective of this study was to evaluate conflict of interest (COI) policies at medical schools in 2023 compared to 2014. This study used a cross-sectional design to evaluate the COI policies at the top 30 medical schools identified by US News and World Report rankings. The authors collected policies by survey and review of public websites, and assessed their quality across 15 domains informed by guidelines published by leading national organizations and previous PharmFree Scorecards. Each domain was graded on a 3-level scale derived from professional organization guidelines, which when totaled corresponded to the following letter grades: an "A" (score 38-45), "B" (32-37), "C" (25-31), and "I/F" (< 25). This study assessed industry payments to school leadership using the 2023 Open Payments database. Eleven of thirty medical schools submitted COI policies, and the remainder were analyzed based on publicly available information. No school received an "A," 22 (73.3%) schools received a "B", 6 (20.0%) schools received a "C", and 2 (6.7%) schools received an "I/F". Most schools had model policies around COI enforcement (29/30, 96.7%), gift acceptance (25/30, 83.3%), and ghostwriting (24/30, 80.0%). No schools had model policies in limiting direct faculty payments. When comparing 2014 and 2023 Scorecards over the shared 14 domains, 14 (46.7%) schools had a decrease in score, 11 (36.7%) schools had an increase, and 5 (16.7%) schools had no change. Faculty at every school accepted industry payments, including 20 (16.7%) deans and 52 (19.3%) of clerkship directors. Medical school COI policies remain less stringent than consensus recommendations; thus, renewed attention to policies and implementation is needed to ensure bias-free medical education.

Cell and gene therapies (CGTs) offer the potential for durable or curative outcomes but come with high upfront costs and uncertainty about long-term safety and effectiveness. To address these challenges, manufacturers and payers have expressed sustained interest in value-based contracts (VBCs), which tie reimbursement to real-world outcomes. While publicly disclosed VBCs have been most visible around earlier CGT launches, details on their structure, assessed outcomes, and operational execution remain limited. For treatment centers, understanding this landscape is important because they are well positioned to support data collection, outcome measurement, and validated reporting in the future. These areas represent some of the most commonly cited challenges by manufacturers and payers, suggesting a potential opportunity for treatment centers as uptake of VBCs is anticipated to increase. This study was conducted to review publicly reported VBCs between payers and CGT manufacturers in the United States and characterize outcomes assessed, implementation features, reporting gaps, and implications for treatment center involvement. A scoping review of peer-reviewed publications and press releases (January 2017 to January 23, 2026) describing VBCs involving CGTs was conducted across 7 databases: PubMed, Embase, International Pharmaceutical Abstracts, ABI/INFORM, Factiva, Newspaper Source Plus, and Regional Business News. Included articles described real-world VBCs between manufacturers and payers in the United States and are written in English were excluded. VBCs between stakeholders other than manufacturers and payers and VBCs implemented in countries other than the United States. Extracted elements included therapy type, payer/manufacturer involvement, outcome measures, contract structure, and any disclosed of outcomes adjudication. Of 1324 screened records, 16 studies/press releases met the inclusion criteria, describing 23 VBCs across such conditions such as spinal muscular atrophy, sickle cell disease, beta-thalassemia, inherited retinal disorders, hemophilia, acute lymphoblastic leukemia, and rare metabolic and dermatologic diseases. Most VBCs involved Medicaid and commercial payers (e.g. Cigna, Harvard Pilgrim Health Care). Reported outcomes focused on patient-level milestones tied to clinical benefit; for example, early remission status, improvement in functional visual testing, sustained transfusion independence, or the need to resume prophylaxis over prespecified time windows (ranging from 1 month to 5 years). Considerable variability was observed across contracts in terms of outcome definitions, assessment time horizons, and contractual structures. Additionally, no contracts disclosed how these outcomes were assessed, adjudication processes, third-party roles, or contract performance results, leaving practical implementation details largely unknown. Current VBCs for CGTs show substantial variability and minimal reporting, offering limited insight into outcome definitions, assessment timing, or how models are implemented in practice. As broader interest in VBCs increases, treatment centers may have an opportunity to help address implementation and outcome measurement challenges frequently cited by payers and manufacturers. Their experience with clinical assessment, longitudinal follow-up, and existing CGT program operations could help inform feasible, clinically meaningful approaches to scaling the adoption of VBCs.