ACA Enrollment Collapse, India's Chemo Crisis, & Amy Adams' Canceled CBS Show

Unknown Speaker (0:07): Welcome to Medline, your weekly resource for quick, credible, on the go medical news for those of us too busy practicing to clean the backyard grill. Brought to you by the New England Journal of Medicine.

Alok Patel (0:17): I just wish I had a backyard. Today is 07/03/2026. Happy almost July 4. Happy almost 200 birthday, United States Of America. We've got a lot to celebrate at the desk today.

Alok Patel (0:28): We're also celebrating the very first episode of Medlines, the latest headline news in health care. I'm doctor Alok Patel. First episode, Alok. We did it.

Unknown Speaker (0:38): If people like it, it won't be the last episode either. How about that?

Unknown Speaker (0:42): It'll be the first of thousands.

Will Flannery (0:44): And joining doctor Alok Patel, I am doctor Will Flannery. Over the last week, enrollment in affordable care act marketplace plans fell sharply after tax credits expired. India is rationing two cornerstone chemotherapy drugs after supply disruptions, and light those sparklers with safety glasses, please. A possible connection between shingles vaccine and dementia risk, the return of 980 LGBTQ plus hotline, an actress using medical TV training in real life, and more coming up.

Alok Patel (1:14): What a spectrum of medical news. Thank God that you're listening to this. But before we begin, today's trivia question. What cancer drug was discovered by accident after researchers noticed bacteria stopped dividing near platinum electrodes? So the bacteria were were not turned on anymore.

Unknown Speaker (1:35): No pun intended. Where did they go? Where did they direct their

Unknown Speaker (1:38): where did they direct their attention to afterwards? Stick around.

Unknown Speaker (1:41): Bacteria friend zoned. We'll find out the answer at the end. And now, this week's Medlines.

Will Flannery (1:50): Our first story is about a major drop in ACA Marketplace enrollment after the expiration of enhanced premium tax credits. ACA marketplace sign ups reached 24,200,000 in 2025, the highest level since the exchanges opened. NPR reports enrollment is now about 19,200,000, which is a drop of roughly 5,000,000 enrollees in one year. About 1,000,000 fewer people enrolled up front, while roughly 4,000,000 dropped exchanges mid year after failing to pay premiums. Enhanced tax credits had made ACA plans cheaper for millions of people, and in some cases brought monthly premiums close to zero.

Will Flannery (2:26): Once those credits expired, many enrollees faced much higher monthly bills. According to NPR, average premiums roughly doubled from 2025 to 2026. Not great.

Alok Patel (2:36): Oh, from a public health standpoint, this all gives me hypertension. But for clinicians, the practical concern is straightforward. When patients lose coverage, routine visits become easier to postpone, medications become harder to afford, and preventative care can turn into crisis care all because of costs. And for hospitals and clinics, fewer insured patients can mean more uncompensated care and more pressure on safety net systems, which already feel a lot of pressure. Politically, the fight now moves to whether Congress restores some version of the enhanced credits.

Alok Patel (3:09): Without action, the Marketplace enrollment may keep shrinking as premiums rise. I definitely don't need healthcare to be harder for people to afford with this. We already spend more per capita than any other wealth donation on healthcare. How do things keep somehow getting

Unknown Speaker (3:26): Especially those rural hospital systems, hospitals that are already struggling with Medicaid cuts, then you just make it harder for the people in those communities. We got some things to figure out.

Unknown Speaker (3:38): And I wish it wasn't political at all, and it just was the way it is anyway.

Unknown Speaker (3:42): Well, from the cost of coverage, we turn to the cost of treatment itself. In India, oncologists are rationing two of the most important drugs in cancer care.

Unknown Speaker (3:54): Our second story takes us to Gujarat. By the way, birthplace of the last name, Patel, you're welcome. Will impress all of your Doctor. Patel's in your life by telling them, What up Gujarati? I love that.

Alok Patel (4:05): But our story takes us to Gujarat, where shortages of cisplatin and carboplatin are forcing oncologists to make difficult choices about treatment. According to reporting in The Lancet, the two chemotherapy drugs have been in short supply across India since mid May. Cisplatin and Carboplatin are used to treat a wide range of solid tumors, including ovarian, testicular, bladder, lung, and head and neck cancers. A shortage forces oncologists to choose between delaying care, conserving supply for the highest priority patients, or moving to regimens with less certainty. None of those are great options.

Will Flannery (4:37): Mm-mm. Because both drugs depend on platinum, the shortage is partly an economics problem. Rising global platinum costs and capped essential medicine prices have strained production. Doctors are reportedly rationing doses and switching chemotherapy regimens mid course. Oncologists warn that the clinical consequences may not be visible immediately.

Will Flannery (4:57): Earlier recurrences and poor treatment responses could take six to twelve months to appear. The government has moved to blunt the shortage by temporarily raising price caps on cisplatin and carboplatin by 50%, hoping that manufacturers can restart or maintain supply. But stabilizing availability may mean higher costs in a system where many patients already struggle to pay.

Unknown Speaker (5:21): Oh, I feel like we see a supply chain disaster in healthcare every six months, and to have one happen in India that already has a complicated, strained healthcare system, Very sad story.

Unknown Speaker (5:31): We've seen it time and time again from IV fluids. I don't know if you remember the IV fluids shortage from a while back. To also, I know that there was an erythromycin ointment shortage that left ophthalmologists wailing in the streets. They were they were just beside themselves with agony.

Unknown Speaker (5:47): Yeah. I I feel you. Was an amoxicillin shortage, and pediatricians were hitting their faces on the wall.

Unknown Speaker (5:53): That's a tough one.

Alok Patel (5:56): With that, to wrap things up, we're hitting you with the TLDRs that you, we, everyone should have on our radar going into the weekend. This is off the clock.

Will Flannery (6:05): First up, shingles vaccination and dementia risk. A new annals of internal medicine study found that older adults who receive a shingles vaccine had a lower risk of dementia diagnosis over a follow-up. The study focused on older adults after a stay in a skilled nursing facility. The vaccinated group had a twenty four percent lower relative risk of dementia diagnosis. Because this was an observational study, it can show an association, but it cannot prove the vaccine caused the lower dementia risk.

Will Flannery (6:35): But still, I mean, get your vaccines, folks.

Alok Patel (6:38): I know. And this is the longevity story, by the way, that wellness bros should be talking about. Just saying. That's right. This next headline is a cause for an alarm.

Alok Patel (6:45): A study in the American Journal of Psychiatry links hotter summer days with higher suicide among people ages 15 to 24, a group already at elevated risk for impulsive self harm. For every one degree Celsius increase above a region summer average, suicide mortality among people in that age range rose two point six eight percent, about twelve additional deaths per month nationally. The clinical concern is that heat can worsen sleep, irritability, substance use, agitation, and emotional regulation. Those short term stressors may matter most when someone is already in crisis.

Will Flannery (7:21): The specialized LGBTQ plus option for the 988 and Crisis Lifeline is expected to relaunch this year. The service had provided crisis support for LGBTQ plus youth and young adults, but its future became uncertain after earlier funding cuts and operational changes. Its welcome return would restore a valuable resource for a population at elevated risk of suicide and crisis related distress. It's it's great to have that resource back.

Alok Patel (7:49): And I wish the resource didn't need to come back, and the funding was there, but this is good news, Will. I'll take it. It is, for sure. In the New England Journal of Medicine, a phase three trial found in once daily oral infantgretinib increased annualized height velocity in children with achondroplasia compared with placebo after one year. Achondroplasia is one of the most common forms of disproportionate short stature, and the study adds to a fast moving therapeutic area focused on growth and skeletal development.

Unknown Speaker (8:16): Oh, you nailed in fegratinib. Nicely done. I I was I was dialed in. Was focused.

Unknown Speaker (8:21): You're you're probably a spelling

Unknown Speaker (8:22): bee champion, weren't you? Are you just saying that because I'm Indian?

Will Flannery (8:26): Moving on. And finally, actress Amy Adams says she was leaving a Santa Monica restaurant with her family when she helped a man who had been stabbed in the neck. According to Variety, Adams said her role in the short lived CBS medical drama, Doctor Vegas, helped her stay calm, use beach towels to apply pressure, and talk the victim through slowing his breathing until help arrived. Who knew that a canceled CBS medical drama could provide first aid training? Never seen Doctor.

Will Flannery (8:52): Vegas, I don't know about you.

Unknown Speaker (8:53): I haven't, but if someone's gonna get stabbed in the neck and be resuscitated with a beach towel, it's happening in Vegas. I'm just saying, Amy Adams is probably at some pool party. Absolutely. But, I love it. And, this might be the only off the clock segment that requires both a neurologist and Amy Adams' IMDB page.

Will Flannery (9:10): And, honestly, maybe an oncologist, a psychiatrist, and a climate scientist while we're at it.

Unknown Speaker (9:15): So basically, need to dial up the booking department. This segment now needs a I referral think we do, yeah. That wraps up another great week in medicine. Stick around, we'll be right back with the answer to this week's trivia question. Before we go, here is today's trivia question again.

Alok Patel (9:36): I know you all have been drumming up all your guesses. Here we go. What cancer drug was discovered by accident after researchers noticed bacteria stopped dividing near platinum electrodes? It's platinum electrodes that stopped the hanky panky. What was it?

Unknown Speaker (9:51): Could it be one of the medications we've already talked about during this episode, Alok?

Unknown Speaker (9:57): I'm just going on a very short limb here.

Unknown Speaker (10:00): I mean, according to you, I a spelling bee champion, and plat Yes. Just start with plat.

Unknown Speaker (10:04): How cisplatin or carboplatin?

Unknown Speaker (10:08): Or carboplatin. Which team are you on? Are you on team cis or carbo? I'll go carbo. I'm gonna go cis then.

Unknown Speaker (10:13): Here we go. Cisplatin for the win.

Unknown Speaker (10:15): Alright. What do we got? Oh, the answer is cisplatin. You got it. Flips In the nineteen sixties, researcher Barnett Rosenberg, who was studying how electric fields have affected bacterial growth, which one does occasionally, when he noticed when he noticed that bacteria stopped dividing near platinum electrodes.

Will Flannery (10:36): That accidental observation helped lead to cisplatin, one of the most important chemotherapy drugs in modern oncology. There you go.

Alok Patel (10:43): I want this as a Netflix docuseries right now. I wanna know about what Barnett was going through in the sixties.

Unknown Speaker (10:49): I think it's, why not? There's documentaries for every single thing on earth. Why not this?

Alok Patel (10:55): Why not this? But more importantly, this is a reminder that sometimes the experiment is wrong in exactly the right way. And with that, thanks for listening to this week's Medlines. I'm Doctor. Alok Patel.

Unknown Speaker (11:06): And I'm Doctor. Will Flannery. A big thank you to the New England Journal of Medicine for sponsoring today's episode.

Alok Patel (11:12): To learn more about their research and discoveries, visit nijem.org. If you want to learn more about any of today's stories, which I know you do, sources and media attributions can be found for this and all episodes on medlinespod.com.

Will Flannery (11:26): Love what we're doing and want to support medical journalism like Medlines? Please share today's episode or the show with your colleagues and friends. This is the place for healthcare professionals to stay up to date on the go and shows like this live or die by word-of-mouth.

Alok Patel (11:39): Yeah. So share it with everyone. And now the part where we remind you that listening to a podcast does not establish a doctor patient relationship with either of us. We will support you spiritually and emotionally, but not as actual patients and a health care professional.

Unknown Speaker (11:53): Yeah, good point. MedLions is a news and commentary podcast and is not intended as individualized medical advice. Let's see if I can do this in one breath. The views, news, and media shared on this platform do not reflect the views of our team, sponsors, or affiliated parties. To review our program complete program disclaiming ethics policies and verification and licensing terms and HIPAA release terms, please visit medlionspod.com/legal.

Unknown Speaker (12:18): Wow. Will Flannery JD. That was, like, spot on. Good at talking.

Unknown Speaker (12:22): And with that, MedLions is a human content production.