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The following is a transcript of the podcast episode:

Rachael Robertson: Hey everybody. Welcome to MedPod Today, the podcast series where MedPage Today reporters share deeper insight into the week's biggest healthcare stories. I'm your host, Rachael Robertson.

Today, we are talking with Michael DePeau-Wilson about how the murder of United Healthcare's CEO raised questions about the risks healthcare leadership faces. After that, Shannon Firth will tell us about health-related conspiracy theories that Robert F. Kennedy Jr. has spewed -- and what the evidence actually says. Lastly, Joyce Frieden will share her reporting on "gold card" laws.

On to the show.

In the aftermath of the shooting of United Healthcare CEO Brian Thompson and the subsequent hunt for his alleged killer, the healthcare community started to reflect on the state of violence in the industry. There have been numerous studies and reports about violence against frontline healthcare workers, but these recent events expose something that is discussed far less: the dangers of serving in leadership positions in healthcare organizations. Michael DePeau-Wilson is here to talk about the very real threats of violence facing leaders in the health industry.

So Michael, what can you tell us about the concerns that leaders in the healthcare industry have about violence?

Michael DePeau-Wilson: Yeah, first, I should say that we didn't get a chance to talk to very many leaders about this topic on the record. Most of the organizations we contacted referred us to existing reports about violence against all healthcare workers, especially those who are on the frontlines of healthcare, like emergency medicine physicians and nurses.

But we were able to speak to a few people about the challenges facing leaders in the industry.

Chris Van Gorder, who is the president and CEO of Scripps Health in San Diego, told us that this affects everyone in his organization. He said that they receive threats frequently and that they have even received manifestos written by individuals who were patients or unhappy family members of patients as well. And if you've been online or especially social media over the past couple of weeks, you would probably have seen that a lot of people share those feelings of frustration about the healthcare industry, and especially health insurance companies, and so some of that definitely gets directed towards the leaders of those companies.

So you know, and of course, obviously, we saw in the direct coverage of the shooting that Thompson had received threats prior and that the alleged shooter was holding a manifesto when arrested, so it sort of tracks along those lines with a lot of healthcare leaders.

Robertson: Got it. So this isn't necessarily a new concern for people in healthcare leadership, then.

DePeau-Wilson: Right. You know, there's not a lot of data or even general reporting about this issue as a trend, though. We were able to find some information about this being a very real threat of violence against healthcare leaders. For example, there was one high-profile case in New Jersey in 2014 where John Sheridan, the CEO of Cooper Health, and his wife were found dead in their home. And initially the medical examiner declared their deaths a murder-suicide, but that decision was eventually reversed, and now officials believe the couple was murdered. That case is actually still being investigated, so they haven't really found any answers as to what happened and what the motivation of those murders might have been.

And not all of the dangers are external, either. There have been several examples that we found where healthcare leaders have died by suicide as well. So without a complete report, it's impossible to know just how prevalent these dangers are, but it seems clear that people in these positions are receiving threats, and they are being targeted with violence in certain situations, and generally, there just seems to be a lot of risk around the job. And with Thompson's death, that just seemed to really highlight these concerns in a very big and noticeable way.

Robertson: Has Thompson's shooting changed anything for healthcare organizations and their leadership?

DePeau-Wilson: It's hard to say definitively, but we did find some evidence of that. You know, for example, some of your reporting for this story actually revealed that there were several healthcare-related organizations -- including United Healthcare, Blue Cross Blue Shield, CVS -- that had actually removed personal information about the leaders of their organizations [from their websites].

They didn't say for sure that that was out of precaution for their safety, but it was done in the immediate aftermath of this shooting. We also heard from Van Gorder that his team has met to kind of re-discuss their security plans moving forward. And then there was some reporting that we found in other sources, like the New York Times, that head security officials at a lot of organizations have actually come together to talk about best practices for security measures and sort of re-discuss whether or not things are being done in the best way possible.

Robertson: Well, thank you for these updates, Michael.

DePeau-Wilson: Thank you, Rachael.

Robertson: Robert F. Kennedy Jr. has been chosen by President-elect Trump to run the Department of Health and Human Services. When most people think of Kennedy, one of the first things that springs to mind are his anti-vaccine views. RFK Jr. is the former chair of the Children's Health Defense, an anti-vaccine nonprofit known for spreading misinformation, including the entirely false claim that vaccines cause autism. Shannon Firth is here to tell us more about some of RFK Jr.'s views.

So as your story highlights, vaccine misinformation is not the only misinformation that RFK Jr. has been spreading. He's also been a proponent of AIDS denialism.

Shannon Firth: That's right, Rachael. RFK Jr. has tried to sow doubt around the idea that HIV left untreated causes AIDS -- but the causal connection between the virus and AIDS was borne out decades ago in the 1980s. And in 2008, two French researchers won a Nobel Prize for this discovery.

Yet RFK Jr. has repeatedly, including in a video posted to social media just last year, claimed a link between AIDS and recreational drugs. He said that the first thousand people who died of AIDS were "addicted to poppers." Poppers, or amyl nitrates, are a type of recreational drug, and they do not cause AIDS. As Carl Schmid, executive director for the HIV+Hepatitis Policy Institute here in Washington, told me, this type of misinformation can be "dangerous and clearly wrong."

Robertson: Yikes. What other kinds of fringe theories has RFK Jr. supported?

Firth: Well, RFK Jr. has also given voice to the completely false claim that pesticides make children gay. Here, Kennedy has conflated studies of frogs with potential impact on actual human children.

In studies involving male African clawed frogs that are exposed to the pesticide atrazine, which is an endocrine disruptor, the exposure leads to chemical castration and feminizes the frogs as adults. RFK Jr. claims that these chemicals could similarly affect children. Meanwhile, the author of the study, Tyrone Hayes, PhD, of the University of California at Berkeley, has said that while he'd like to see more research on atrazine, "there are NO data to really make that link." That's according to a conversation Hayes had with fact-checkers .

Robertson: Are there any other wild conspiracy theories backed by RFK Jr. that our listeners should know about?

Firth: Lots! But the other claims that I focused on in my story are his belief that antidepressants are to blame for mass shootings -- they are not -- and that Wi-fi causes cancer – it does not.

As recently as last year, RFK Jr. suggested in a conversation with Elon Musk over social media that before Prozac came on the market, there were "almost none of these events in our country." And by events, he's talking about mass shootings. For the record, according to Ragy Girgis, MD, a professor of clinical psychiatry at Columbia University in New York City who studies mass shootings, a causal link between mass shootings and antidepressants, including SSRIs or selective serotonin reuptake inhibitors, has never been established -- and other experts agree.

As for Kennedy's beliefs about Wi-fi causing cancer, , RFK Jr. recently shared claims that 5G "damages human DNA, causes cancer, and is being installed in order to carry out mass surveillance." And in a 2023 interview with the podcaster Joe Rogan, Kennedy said that "Wi-fi radiation opens up your blood-brain barrier, so all these toxins that are in your body can now go into your brain."

The American Cancer Society (ACS), on its website, is clear in stating that there is no evidence of a causal link between wireless device use and cancer or other illnesses. However, the ACS stressed that there is a need for more and longer-term research of wireless devices.

Robertson: Thank you for doing this research for us, Shannon. This is really helpful.

Firth: My pleasure, Rachael, thank you.

Robertson: As physicians and other providers continue to struggle with administrative burdens like prior authorization, some states have passed "gold card" laws that aim to exempt clinicians from prior authorization in some circumstances. Joyce Frieden is here to tell us more.

Joyce, what are you hearing about how these laws are working out?

Joyce Frieden: Hi, Rachael. Well, so far six states have passed these gold card laws, which generally require insurers and in some cases pharmacy benefit managers, too, to give providers a gold card that exempts them from having to seek prior authorization for a particular service, procedure, or drug if they meet certain criteria, such as having at least 90% of prior authorizations for that service approved in the past 6 months.

However, in at least one state, Texas, the law there, which was passed in 2021, is not working out as well as its backers had hoped. According to the Texas Department of Insurance, only 3% of healthcare providers had received a gold card as of a survey taken in January 2023.

Zeke Silva, MD, chair of the Council on Legislation for the Texas Medical Association, told me the reason for that is likely because even though the law only requires providers to have gotten approval for a minimum of five instances of a particular procedure or service in the prior 6 months, that actually turns out to be a high bar, because CPT [Current Procedural Terminology] codes are very specific. So if the doctor gets approval for a CT scan with contrast and then gets approval for one without contrast -- those are two different CPT codes and can't be grouped together toward that five procedure minimum.

The same is true for prescribing a particular drug at different dosages or in different therapeutic regimens.

Robertson: Are there any efforts being made to change the Texas law so that more providers can take advantage of it?

Frieden: Yes, Dr. Silva said he and his colleagues are seeking several changes to the law. One is to lower the minimum number of required approvals for a particular service from five to as few as one. Another request is to increase the amount of time a gold card is good for, currently set at 6 months to 1 year, "so that physicians aren't constantly having to engage or think about this process."

And finally, the association would like to see more transparency from health insurers about the exact criteria used to grant the gold cards, which are supposed to be given without any effort on the provider's part, and about their processes.

Robertson: What are experts predicting for the future of these types of laws?

Frieden: Well, here's what Emily Donaldson, a principal at the healthcare consulting firm Avalere, told me: "When we first saw gold carding legislation being discussed, it was more on the medical services side, and as the legislation has evolved, we have now seen states also apply gold carding to prior authorization for medicines, or subsets of medicines."

She also said she wasn't surprised at the results of the Texas law, because the law gives insurers a lot of latitude in designing their gold card programs. She said there has been an uptick in interest from state legislatures in gold card laws, and that she expects they will look at the lessons learned from the Texas law when writing their own gold card laws.

Robertson: Thanks, Joyce. We'll turn to you for future updates.

Frieden: Thanks, Rachael.

Robertson: And that is it for today. If you like what you heard, please leave us a review wherever you listen to podcasts, and hit subscribe if you haven't already. We'll see you again soon.

This episode was hosted and produced by me, Rachael Robertson. Sound engineering by Greg Laub. Our guests were MedPage Today reporters Michael DePeau-Wilson, Shannon Firth, and Joyce Frieden. Links to their stories are in the show notes.

MedPod Today is a production of MedPage Today. For more information about the show, check out .

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