Florida wildflowers and pollinators get a boost with two grants

Researchers will evaluate the feasibility of maintaining milkweed populations along roadsides and a variety of wildflowers within a new solar farm in Florida

Grant and Award Announcement

FLORIDA MUSEUM OF NATURAL HISTORY

 

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THE DANIELS LAB AT THE FLORIDA MUSEUM OF NATURAL HISTORY HAS RECEIVED TWO GRANTS TO HELP BOOST WILDFLOWER AND POLLINATOR POPULATIONS IN FLORIDA.

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CREDIT: FLORIDA MUSEUM PHOTO BY KRISTEN GRACE

The Daniels Lab at the Florida Museum of Natural History was recently awarded two grants to help support pollinators in Florida. The Florida Department of Transportation has set aside $155,002 for the team to plant and monitor thousands of milkweeds along roads in North Florida, and Duke Energy Florida will distribute $144,421 over three years to evaluate the establishment of pollinator habitat at its new solar site Alachua County.

Pollinators are declining on a global scale, the collateral damage of continued habitat destruction and urbanization, among other stressors. But according to Jaret Daniels, a curator at the museum’s McGuire Center for Lepidoptera and Biodiversity, humans already have many of the resources required to stave off further declines — we just need to make better use of them.

“We have a lot of conservation land, but not enough to maintain pollinator populations and offset the losses from human impacts,” he said. “We need to look to environments that we, as humans, manage every day. That includes yards and neighborhoods, as well as the most visible landscapes that each of us encounter every day, such as roadsides, easements and other non-traditional spaces.”

Wildflowers are the new roadside attraction

There are an estimated 4 million miles of roadways that crisscross the U.S., fragmenting natural spaces and creating barriers that restrict the free movement of pollinators. This maze of asphalt is surrounded by 17 million acres of roadside, an amount of land equal to the size of Ireland. More and more states are sowing wildflower seeds along these embankments, transforming them from barriers into corridors for pollinators.

Current roadside management practices, such as periodic mowing, can even be beneficial to plants that rely on pollinators with little to no fine-tuning. Such is the case for milkweeds that are adapted to dry areas prone to fire.

“There’s anecdotal evidence that milkweed populations are decreasing broadly, but they’re often found outside of conservation land, primarily on roadsides and in pastures,” Daniels said. “Many of the upland species are surviving in these heavily managed areas because mowing and grazing are proxies for fire.”

FDOT is in the process of expanding its support of pollinators through enrollment in the Nationwide Candidate Conservation Agreement with Assurances for the Monarch Butterfly on Energy and Transportation Lands. The agreement targets practices that benefit the imperiled migratory monarch butterfly (Danaus plexippus). Through the grant, Daniels and his team will annually plant 3,000 juvenile milkweed plants along roadsides in North Florida for three years in an effort to enhance monarch breeding habitat. In a separate study, they’re testing out the use of remote sensing and AI to identify milkweed plants in the field.

“It's a lot of energy to do boots-on-the-ground surveys. We may be able to use images taken by drones to identify these plants and monitor the populations long term.”

Duke Energy Florida recently opened a solar site in High Springs, Florida, which it hopes will double as a source of clean energy and a haven for native wildflowers and pollinators.

CREDIT

Duke Energy

Solar farms are a model for mixed-use land management

The expansion of solar farms across the U.S. is similarly creating an abundance of bright, open spaces that require regular upkeep. Unused areas near the solar arrays are increasingly being viewed as prime real estate for growing native flowering plants that support pollinators. Duke Energy Florida recently completed construction of a new solar site in High Springs, Florida, and approached Daniels to see if he’d be willing to conduct a feasibility study that would assess plant selection, establishment, survival, time to bloom, bloom abundance and overall cost.

For this project, Daniels will be planting a variety of native wildflower species. In determining which plants to test, he’ll use a combination of previous experience, cost-benefit analyses and a long list of potentially suitable species included in an upcoming solar toolkit published by the Florida Fish and Wildlife Conservation Commission. From there, Daniels and his team will find themselves in a somewhat unexplored frontier. There's no end to available resources that aid homeowners in growing an effective pollinator garden. However, very few studies, especially in the Southeast, have tested how best to establish larger-scale pollinator habitat in this type of landscape.

According to Daniels, most of the information that does exist is anecdotal and not broadly applicable to a wide region. Even the most basic questions, like how many seeds to sow and in what proportions, are still open-ended.

By project’s end, Daniels’ team will help generate more rigorous recommendations that can be broadly applicable to the southeast U.S.

“Duke Energy wants something they can apply not just to this particular solar site, but to other sites throughout their Florida service territory," Daniels said. “We can give them something backed by data on how they can do this better and more effectively, to benefit the pollinators and also maximize their impact.”

“Duke Energy is excited to work with the Daniels lab at the Florida Museum of Natural History to discover best practices for successful pollinators at our solar facilities,” said Melissa Seixas, Duke Energy Florida state president. “Duke Energy is committed to environmental stewardship and ensuring we do everything we can to preserve and enhance pollinator habitats that are vitally important to our ecosystems and the health of our planet.”

“This work will help us understand how to prepare our facilities to have a healthier and more thriving environment for the monarch butterfly and other declining species,” Seixas said.

  

Glyphosphate: a silver-bullet weed killer no more

Peer-Reviewed Publication

PNAS NEXUS

For decades, corn and soy farmers have heavily relied on one herbicide: glyphosate. Crops bred to resist glyphosate have been extremely successful, with over 90% of corn and soy hectares planted with glyphosate-resistant varieties by 2014. But as Christopher Landau and colleagues document, the chemical was not quite the “silver bullet” it was promised to be. With an entire industry using the same chemical—the US and Canada alone apply more than 130 million kg annually—evolutionary selection pressures on weed plants have been intense. Since 1996, there have been 354 confirmed cases of glyphosate resistance in 57 weed species around the world. The authors compiled herbicide evaluation trials from 24 institutions across the US and Canada from 1996 to 2021. The analysis was restricted to the seven species that had more than 50 observations from three or more locations: Abutilon theophrasti Medik. (Velvetleaf), Amaranthus palmeri (Palmer amaranth), Amaranthus tuberculatus (waterhemp), Ambrosia artemisiifolia L. (common ragweed), Ambrosia trifida L. (giant ragweed), Chenopodium album (common lambsquarters), and Erigeron canadensis (horseweed). Over time, weed control declined and variability of control increased for glyphosate used after crops emerged from the soil. However, fields treated with both post emergence glyphosate and an effective pre-emergence herbicide applied before crops sprouted did not show control declines or variability increases. According to the authors, the result highlights the need for diversity in weed management programs to provide high and consistent weed control.

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JOURNAL

PNAS Nexus

ARTICLE TITLE

The silver bullet that wasn’t: Rapid agronomic weed adaptations to glyphosate in North America

ARTICLE PUBLICATION DATE

5-Dec-2023

The silver bullet that wasn't: Glyphosate's declining weed control over 25 years

Peer-Reviewed Publication

UNIVERSITY OF ILLINOIS COLLEGE OF AGRICULTURAL, CONSUMER AND ENVIRONMENTAL SCIENCES

 

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A NEW PNAS NEXUS STUDY FROM USDA ARS AND CROP SCIENCES RESEARCHERS FROM THE UNIVERSITY OF ILLINOIS FOUND GLYPHOSATE, WHEN USED ALONE, BECAME UP TO 32% LESS EFFECTIVE WITHIN A DECADE OF ITS INTRODUCTION. THE COMBINATION OF GLYPHOSATE WITH A PRE-EMERGENCE HERBICIDE, HOWEVER, WAS STILL EFFECTIVE.  

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CREDIT: UNIVERSITY OF ILLINOIS

URBANA, Ill. -- It has been a quarter century since corn and soybeans were engineered to withstand the withering mists of the herbicide glyphosate. Initially heralded as a “silver bullet” for weed control, the modified crops and their herbicide companion were quickly and widely adopted across corn and soybean-growing regions of North America. In the years that followed, though, weeds targeted for eradication quietly fomented a rebellion. 

A new PNAS Nexus study led by scientists from the USDA Agricultural Research Service (USDA-ARS) and the University of Illinois Urbana-Champaign takes a retrospective look at glyphosate efficacy after the engineered crops were commercialized. Amassing data from annual herbicide evaluation trials at land-grant universities across the U.S. and Canada, the researchers show a significant and rapid decline in glyphosate control for all seven major weed species they examined. 

“Our analysis represents one of the largest cumulative measures of how weed communities have adapted to the simplified weed management tactics adopted at an unprecedented scale throughout North America,” said Chris Landau, postdoctoral researcher for USDA-ARS and first author on the paper.

Although glyphosate provided superior weed control in the early years, most of the weeds in the dataset showed signs of adaptation to the chemical in just two to three years. Within a decade, weeds were up to 31.6% less responsive to glyphosate, with further linear declines as time went on. 

“Nature did exactly what we were trying to help people avoid: it adapted,” said co-author Aaron Hager, professor and faculty Extension specialist in the Department of Crop Sciences and Illinois Extension, part of the College of Agricultural, Consumer and Environmental Sciences (ACES) at U. of I. 

In addition to loss of control, glyphosate efficacy became more variable over time.

“When glyphosate-tolerant crops were first adopted, weed control was high in every environment; however, year after year glyphosate performance became less consistent,” said co-author Marty Williams, an ecologist with the USDA-ARS and affiliate professor of crop sciences. “For example, glyphosate provided nearly 100% control of a given species in most plots in the mid-1990s. But over time, acceptable weed control became rarer, often deteriorating below 50%, 30%, and worse.”  

These patterns were derived from annual herbicide evaluation trials conducted at land-grant universities, usually in conjunction with their respective Extension services. These carefully managed trials test new and existing herbicides against numerous common and troublesome weed species. Most land-grant universities have multiple herbicide evaluation trials running statewide each year, with some continuously operating since the 1970s.

A couple of years ago, Landau, Hager, and Williams mined historical data from U. of I. herbicide evaluation trials to look at the effect of climate change on weed control in Illinois corn and soybean fields. When they decided to look at the history of the country’s most widely used herbicide, the team knew it would be more powerful to access data beyond Illinois. In cooperation with 24 institutions throughout North America, Landau compiled a massive database representing nearly 8 million observations from 1996 to 2021.

For the current study, Landau winnowed the data down to fields that tested glyphosate annually, alone or in combination with a pre-emergence herbicide. He also narrowed the target weeds to seven major players: annual and giant ragweed, horseweed, lambsquarter, Palmer amaranth, velvetleaf, and waterhemp. In the end, the dataset represented trial data from 11 institutions.

After documenting patterns of glyphosate control and variability over time, Landau re-ran the analysis for plots in which a pre-emergence herbicide had been applied before glyphosate. The results were strikingly different.

“Adding a pre-emergence herbicide effective against the target weed species significantly improved control and reduced variability of glyphosate over time,” Landau said. “The most we saw for any weed species was a 4.4% loss of control per decade, compared to 31.6% loss for glyphosate alone.”

Hager isn’t surprised. Along with several U. of I. colleagues, he has been cautioning against reliance on any single chemistry for 15 years. His 2008 recommendation aimed at avoiding glyphosate resistance included guidance to use a pre-emergence herbicide at the full rate. Far from common practice at the time, the recommendation was largely ignored. 

“Having already seen loss of control with ALS- and PPO-inhibitors [other classes of herbicides], we eventually reached the point where we felt it necessary to come out with some very specific recommendations for glyphosate. Because if we didn't, we had a pretty good idea of where this was going to end up,” Hager said. “And, unfortunately, we were right.”

The dataset for glyphosate can only show patterns, not explanations. While herbicide resistance might be to blame — the issue has become a major problem in agricultural weeds in recent decades — it’s not the only reason glyphosate may have loosened its grip.      

Landau noted that two species he tracked in the analysis — velvetleaf and lambsquarter — have not yet had a confirmed case of glyphosate resistance anywhere in the world. Yet both followed the same trends as glyphosate-resistant species in the dataset. He said herbicide pressure — or concurrent climate changes — over the past 25 years may have selected for larger leaf area or earlier emergence, both of which could help weeds survive glyphosate.

Regardless of the mechanism, the pattern is clear: silver bullets for weed control don’t exist. The researchers urge diversification in chemistries, including soil- and foliar-applied products; crop rotation patterns; and mechanical controls. 

And if another silver bullet is marketed in the future? Hager says the glyphosate story should serve as a cautionary tale. 

“Let's imagine a company says they have the next silver bullet. It's going to enjoy a huge market share almost instantaneously. But it needs to come with a stewardship plan to better preserve that chemistry over time,” he said. “Why would we think nature would behave any differently? It won’t."

The study, “The silver bullet that wasn’t: Rapid agronomic weed adaptations to glyphosate in North America,” is published in PNAS Nexus [DOI:10.1093/pnasnexus/pgad338]. Landau and Williams are with the Global Change and Photosynthesis Research Unit of USDA ARS, which supported the study. 

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JOURNAL

PNAS Nexus

DOI

10.1093/pnasnexus/pgad338 

 

Z-scheme heterojunction g-C3N5/Bi5O7I high-efficiency mercury removal photocatalyst

Peer-Reviewed Publication

BEIJING INSTITUTE OF TECHNOLOGY PRESS CO., LTD

 

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SCIENTISTS FROM [SHANGHAI UNIVERSITY OF ELECTRIC POWER OF COLLEGE OF ENERGY AND MECHANICAL ENGINEERING] DEVELOPED NEW HIGH-EFFICIENCY MERCURY REMOVAL PHOTOCATALYST

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CREDIT: [HEAVY METAL POLLUTION CONTROL LABORATORY, SHANGHAI UNIVERSITY OF ELECTRIC POWER]

They published their work on October. 23 in Energy Material Advances.

 

 "It is imperative to develop energy-saving, safe and sustainable photocatalytic mercury removal technology," said paper author Wu Jiang, professor with College of Energy and Mechanical Engineering of Shanghai University of Electric Power. "Currently, thermocatalytic technologies account for most of the market, but they are constrained in terms of manufacturing costs and sustainability."

 

Wu explained that as an alternative to thermocatalytic technology, photocatalysis technology has several significant advantages, especially as a photocatalytic mercury removal technology for flue gas, which can effectively control flue gas mercury emissions.

 

"Photocatalytic technology uses the principle of converting solar energy into chemical energy, which has great potential in solving the problem of air pollution, and has the characteristics of environmental friendliness, energy saving, safety and sustainable development." Wu said. "Photocatalytic oxidative mercury removal technology, using the generation of active free radicals under visible light, oxidizing Hg0 to Hg2+, and using existing air pollution equipment to remove mercury, the technology has no secondary pollution, good stability, and is gradually applied in pollutant control."

 

However, photocatalytic technology cannot be simply exchanged with thermal catalytic technology to remove flue gas mercury. Efficient mercury removal photocatalysts need to have the following conditions: (1) Small band gap, which can improve the response spectral range and improve the utilization rate of light energy. (2) It should be ensured that the valence band potential of the material is corrected compared to the potential that can produce a strong oxidizing substance, and the conduction potential of the material should be more negative than the potential that can produce a strong oxidizing substance. (3) More active sites, the current view of the catalytic community is that the active site has the highest photocatalytic activity, so a larger specific surface area is required to load more active sites and improve the activity of the photocatalyst. (4) Higher carrier lifetime, photon excitation electron transition, produce electron-hole pairs, once the electron and hole in vivo recombination, will not be able to occur catalytic reduction reaction, so increasing carrier life is to improve the probability of the reaction between electron holes and mercury. According to Wu, the development and improvement of photocatalytic mercury removal technology has a long way to go.

 

Wu Jiang and his team reviewed previous work and developed a series of bismuth-based photocatalytic mercury removal materials. “The strategy of constructing heterojunctions can effectively adjust the energy level structure of composite photocatalysts, optimize the photoresponse performance, and accelerate the efficient transport and separation of carriers” “In this work, we introduce defect engineering and couple g-C3N5, which further improves the photocatalytic mercury removal performance of bismuth-based materials. "Our results provide theoretical support for the application of g-C3N5 and its composites in the field of flue gas mercury removal.”

 

"In order to develop reliable and stable photocatalytic mercury removal materials, we constructed a g-C3N5/Bi5O7I composite photocatalyst by calcination. The composite's unique Z-scheme heterojunction structure has nitrogen and oxygen vacancies, which facilitate efficient separation and migration of electrons and holes. Wu said. In this work, the photocatalytic mercury removal reaction mechanism of built-in electric field and defect structure co-treatment is proposed. This work opens up a new route for the synthesis and development of g-C3N5 photocatalytic heterojunction materials."

 

Wu is also affiliated with Shanghai Institute of Pollution Control and Ecological Security, Shanghai, China. Other contributors include Zhanwei Qiao, Haojie Huang, Ping He, Tianhui Cui, Sheng Chen, and Mao Lin, College of Energy and Mechanical Engineering, Shanghai University of Electric Power, Shanghai 200090, China; Chen Gong, School of Environmental Science and Engineering, Sun Yat-Sen University, Guangzhou 510006, China; and Zhengrong Zhu, Solid Waste Division, Shanghai Environment Group, Shanghai 200336, China.

 

National Natural Science Foundation of China (52076126), Science and Technology Committee of Shanghai Municipality (22dz1208800), Shanghai Science and Technology Committee (22010501500), and Key Laboratory of Clean Power Generation and Environmental Protection Technology in Mechanical Industry.

 

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Reference

Authors: WEIQUN CHU, ZHANWEI QIAO, JIANG WU , ZHENGRONG ZHU, CHEN GONG, HAOJIE HUANG, PING HE, TIANHUI CUI, SHENG CHEN, AND MAO LIN

Title of original paper: Z-Scheme Heterojunction g-C3N5/Bi5O7I High-Efficiency Mercury Removal Photocatalyst

Journal: Energy Material Advances

DOI: 10.34133/energymatadv.0064

Affiliations: 

1College of Energy and Mechanical Engineering, Shanghai University of Electric Power, Shanghai 200090, China.

2Shanghai  Institute  of  Pollution  Control  and  Ecological  Security,  Shanghai,  China.

3Solid  Waste  Division, ShanghaiEnvironment Group, Shanghai 200336, China.

4School of Environmental Science and Engineering, Sun Yat-Sen University, Guangzhou 510006, China.

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JOURNAL

Energy Material Advances

DOI

10.34133/energymatadv.0064 

METHOD OF RESEARCH

Experimental study

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

Z-Scheme Heterojunction g-C3N5/Bi5O7I High-Efficiency Mercury Removal Photocatalyst

 

Tonsil, adenoid removal improved sleep quality, some behavioral problems in children with mild sleep apnea

Peer-Reviewed Publication

BRIGHAM AND WOMEN'S HOSPITAL

The surgery did not improve the children’s neurodevelopmental functioning but was associated with improved quality of life, sleep symptoms, and blood pressure 12-months post-surgery according to a randomized control trial led by researchers at Brigham and Women’s Hospital and the Harvard Pilgrim Health Care Institute

Between 6% and 17% of children suffer from sleep-disordered breathing, characterized by habitual snoring, increased respiratory effort, and sleep apnea. If left untreated, the disorder may put children at higher risk of neurodevelopmental impairment, reduced quality of life, and cardiovascular and metabolic diseases. Enlarged tonsils are one of the main risk factors for sleep-disordered breathing, and adenotonsillectomy—surgical removal of the tonsils and adenoid glands—is a first-line treatment for children with the disorder. However, there is limited data to either support or refute the benefits of this surgery for children with mild forms of the disease.

In a randomized clinical trial, a team led by researchers at Brigham and Women’s Hospital, a founding member of the Mass General Brigham healthcare system, in collaboration with the Harvard Pilgrim Health Care Institute, evaluated the effects of early adenotonsillectomy. The surgery did not result in a significant difference in the study’s two primary endpoints of executive function and attention, but it did lead to improved sleep quality, reduced snoring, and was associated with improved behavior and reduced daytime sleepiness for children with mild sleep-disordered breathing. Children who received the surgery also had reduced blood pressure and were less likely to show signs of disease progression compared to children in the control group. The findings are reported in The Journal of the American Medical Association.

“Our data suggests that for children with no symptoms other than snoring, it's reasonable to monitor them over time without proceeding to surgery,” said first author Susan Redline, MD, MPH, director of Programs in Sleep Medicine Epidemiology and Sleep and Cardiovascular Medicine. “On the other hand, for children who are having issues with disturbed sleep, daytime sleepiness and behavioral problems, our data suggest that surgery may be a very reasonable option, even if a sleep study shows that they don't have frequent apneas.”

To examine the impact of early adenotonsillectomy on neurodevelopment, sleep quality, behavior, and overall health, the researchers performed a randomized clinical trial of 459 children with mild sleep-disordered breathing (defined as habitual snoring without frequent apnea events [“breathing pauses’]) and enlarged tonsils. The children—half of whom received adenotonsillectomies—ranged in age from 3-12.9 years and were enrolled at seven academic sleep centers across the United States. The team collected measurements of sleep quality, cognition, behavior, and overall health before treatment and during 6- and 12- month follow-up appointments. Caregivers also completed questionnaires regarding their child’s social behavior and executive function.

Though adenotonsillectomy had no significant impact on measures of neurodevelopmental function, the treatment was associated with improvements in sleep quality and reduced snoring, and reduced behavioral problems, daytime sleepiness, and blood pressure. Children who received surgery were also less likely to show disease progression — at the 12-month follow-up, only 1.3% of children in the adenotonsillectomy group progressed to having more than three apnea events per hour compared to 13.2% of children in the control group.

“We’re hoping that our data will provide evidence to inform future clinical guidelines to help surgeons, pediatricians, and sleep physicians practice evidence-based care,” said Redline. “And for parents, we hope that this information can be communicated by physicians in a way that will help parents decide — alongside their physician — whether their children should in fact go forward and have surgery.”

Next, the researchers plan to investigate the impact of adenotonsillectomy on health care utilization, and hope to also investigate the longer-term impacts of surgery. “Our team is very interested in a longer term follow up of children,” said Redline. “There are open questions about the impact of having tonsils removed over a child's lifetime, as well as its impact on trajectories of growth and development beyond a year.”

Authorship: Additional authors include Kaitlyn Cook, Ronald D Chervin, Stacey Ishman, Cristina M Baldassari, Ron B Mitchell, Ignacio E. Tapia, Raouf Amin, Fauziya Hassan, Sally Ibrahim, Kristie Ross, Lisa M. Elden, Erin M Kirkham, David Zopf, Jay Shah, Todd Otteson, Kamal Naqvi, Judith Owens, Lisa Young, Susan Furth, Heidi Connolly, Caron A.C. Clark, Jessie P Bakker (BWH), Susan Garetz, Jerilynn Radcliffe, H. Gerry Taylor, Carol L Rosen, and co-lead author Rui Wang (BWH and the Harvard Pilgrim Health Care Institute) for the PATS study team

Disclosures: Redline reports consulting fees from Jazz Pharmaceuticals, Eli Lilly, and ApniMed Inc. unrelated to this manuscript. Additional disclosures for co-authors can be found in the paper.

Funding: This work was supported by the National Heart, Lung and Blood Institute (cooperative agreements: 1U01HL125307 and 1U01HL125295).

Paper cited: Redline, S et al. “ADENOTONSILLECTOMY FOR SNORING AND MILD SLEEP APNEA IN CHILDREN: A Randomized Clinical Trial” The Journal of the American Medical Association DOI: 10.1001/jama.2023.22114

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JOURNAL

JAMA

DOI

10.1001/jama.2023.22114 

METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

People

ARTICLE TITLE

ADENOTONSILLECTOMY FOR SNORING AND MILD SLEEP APNEA IN CHILDREN: A Randomized Clinical Trial

ARTICLE PUBLICATION DATE

5-Dec-2023

COI STATEMENT

Redline reports consulting fees from Jazz Pharmaceuticals, Eli Lilly, and ApniMed Inc. unrelated to this manuscript. Additional disclosures for co-authors can be found in the paper.

Objective sleep duration and all-cause mortality among people with obstructive sleep apnea

JAMA Network Open

Peer-Reviewed Publication

JAMA NETWORK

About The Study: In this study of 2,574 participants with obstructive sleep apnea, compared with participants with objective sleep duration of at least seven hours, those sleeping less than seven hours had higher risks of all-cause mortality independent of apnea-hypopnea index. Further studies would be needed to investigate health benefits of extending sleep length among people with obstructive sleep apnea with short sleep duration. 

Authors: Shichao Wei, M.D., of Fujian Medical University in Fuzhou, China, is the corresponding author. 

To access the embargoed study: Visit our For The Media website at this link https://media.jamanetwork.com/ 

(doi:10.1001/jamanetworkopen.2023.46085)

Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.

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Embed this link to provide your readers free access to the full-text article 

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About JAMA Network Open: JAMA Network Open is an online-only open access general medical journal from the JAMA Network. On weekdays, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication. 

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JOURNAL

JAMA Network Open

FOR PROFIT HEALTHCARE

Medicare is overpaying for generic drugs

Disturbing financial practice by Medicare Part D sponsors revealed in UC San Diego study of data from the Centers for Medicaid and Medicare Services

Peer-Reviewed Publication

UNIVERSITY OF CALIFORNIA - SAN DIEGO

Medicare is the single largest provider of health insurance in the United States, serving 63.8 million senior citizens as of 2022. Three-quarters of these recipients are enrolled in optional Medicare Part D plans, which provide outpatient prescription drug coverage to seniors through private insurance companies. In 2022, Medicare paid more than $160 Billion for prescription drugs, making it the single largest payer of pharmaceuticals in the US.

While Medicare is meant to keep healthcare affordable for seniors, millions of Americans still face steep costs for prescription medications. Researchers at Skaggs School of Pharmacy and Pharmaceutical Sciences at the University of California San Diego, West Health, and the University of Washington have now explained part of the problem.

The researchers found evidence that the private insurers that sponsor Medicare Part D are artificially inflating the costs of certain generic drugs by overpaying pharmacies. The findings published December 5, 2023 in the Journal of the American Medical Association.

Generic over-reimbursement is one of the areas targeted for reform by the United States Senate, after anecdotal evidence submitted earlier this year by the non-profit manufacturer CivicaRx raised concerns about Part D sponsors potentially over-reimbursing pharmacies for abiraterone, a cancer drug. The concern: that patients are ultimately impacted by these reimbursement practices because of how out-of-pocket costs, such as copayments and deductibles) are calculated.

“For instance, if a patient pays 30% as a copayment for a drug, that 30% would be applied to the inflated price, which could mean higher out-of-pocket costs for seniors,” said corresponding author Inmaculada Hernandez, PharmD, PhD, professor at Skaggs School of Pharmacy and Pharmaceutical Sciences at UC San Diego.

However, whether Part D Plan sponsors are engaging in generic over-reimbursement has been an outstanding question until now.

“This is the first study to investigate whether these practices actually take place in the Medicare Part D program,” added Hernandez.

To fill prescriptions, pharmacies purchase drugs wholesale and are reimbursed by insurers. In order to be reimbursed, pharmacies must adhere to contractual obligations that allow insurers to take back money in certain circumstances, such as when the reimbursement to the pharmacy is higher than a certain threshold or if the pharmacy’s cost of acquisition is very low. These ‘clawbacks’ by Part D Plans can be financially devastating to a pharmacy.

“It doesn’t make sense that insurers would overpay for drugs, then use clawbacks to retroactively adjust payments after the patient has paid their co-payment,” said co-author Sean D. Sullivan, PhD, professor of pharmacy at the University of Washington. “This practice is opaque and ultimately harms patients and pharmacies.”

The researchers gathered and analyzed data from the Centers for Medicare and Medicaid Services (CMS), focusing on spending and reimbursement data for the 50 generic drugs that Medicare Part D spent the most on in 2021. They found that some Medicare Part D sponsors were reimbursing at much higher rates than what pharmacies spent to acquire the drugs.

“The results are alarming,” said Hernandez. “We are talking about markups of 6000% or 7000% in some cases.”

In one of the most dramatic examples, the researchers found that insurers were reimbursing pharmacies an average of $126 per tablet for a cancer drug that cost $4.20 per tablet to the pharmacy. This corresponds to an average markup of 3000%, or $3600 per 30-day prescription. Some insurers paid even more.

“Seniors are clearly paying more for their medications as a result of these markups,” said Hernandez. “More research is needed to confirm the scope of these practices, but the evidence is concerning.”

Co-authors include: Nico Gabriel at UC San Diego, Anna Kaltenboeck at ATI Advisory, Cristina Boccuti at West Health Policy Center and Ryan N. Hansen at the CHOICE Institute, School of Pharmacy, University of Washington.

This study was funded by West Health Policy Center.

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JOURNAL

JAMA

DOI

10.1001/jama.2023.21481 

The role of marketing in disrupted health care markets: It’s time to move beyond conventional strategies to account for new actors, roles, and exchanges

News from the Journal of Marketing

Peer-Reviewed Publication

AMERICAN MARKETING ASSOCIATION

Researchers from Duke University, University of New South Wales, University of Wisconsin, and University of Washington published an editorial for the Journal of Marketing that calls for marketing to tackle the challenges and opportunities in dynamic contemporary health care markets.

The editorial, introducing a special issue on “Marketing in the Health Care Sector” for the Journal of Marketing, is titled “Marketing in the Health Care Sector: Disrupted Exchanges and New Research Directions” and is authored by Christine Moorman, Harald J. van Heerde, C. Page Moreau, and Robert W. Palmatier. The special issue editors introduce a series of articles that offer novel contributions regarding marketing’s role in the health care sector as well as a research agenda outlining more opportunities for marketing scholars to examine whether and how these disrupted exchanges are improving health, empowering choice, and fostering competition.

Health care is vital to our interconnected world and, as demonstrated during the COVID-19 pandemic, societies are deeply affected by its successes and failings. Over the last decade, health care has been disrupted on both the demand and supply sides and these changes have impacted the creation, provision, and consumption of health care in fundamental ways.

However, the role of marketing in this dynamic health care industry remains only partially understood and is often focused on conventional strategies such as business-to-business transactions (e.g., detailing or advertising to doctors) and business-to-consumer transactions (e.g., direct-to-consumer advertising). “While important,” Moorman explains, “this limited view ignores the new actors, roles, and exchanges that characterize disrupted health care markets. As a result, the health care sector is not acting on the full range of opportunities associated with these changes, including understanding their effects on consumer welfare.”

At the heart of the editorial lies a set of disrupted exchanges involving conventional and new health care producers, health care providers, and health care consumers. Health care producers refer to those who develop health-related products, services, and information, even though they do not administer health care directly to patients. Health care producers come in two categories: i) conventional health care producers (i.e., pharmaceutical and medical device companies); and ii) new health care producers (i.e., technology and diagnostic companies).

Health care providers deliver information, products, and services to consumers. These providers also come in two categories—traditional providers that include doctors, nurses, hospitals, and health centers as well as new providers that include retail health care providers, complementary and alternative health care providers, and physician influencers who preach their health gospel to the marketplace.

Health care consumers receive and use information, products, and services created by producers and providers. Traditionally, they are exclusively on the receiving end of value. In today’s health care systems, however, consumers may also be peer creators of value when they participate in health care communities, provide reviews, and/or become influencers.

The editorial focuses on two types of disrupted exchanges: i) the influence of new actors on their conventional counterparts and ii) the influence of these new actors on one another. It observes a merging of roles across producers, providers, and consumers manifesting in a “race to the provider role” that is disrupting many exchanges and changing consumer and firm behavior and the operation of these markets.

The editorial identifies initial potential impacts of these disrupted exchanges on three outcomes. The health-enhancing impact refers to the degree to which mental and physical health outcomes might be improved. The choice-empowering impact refers to the degree to which consumers have an actual or perceived improvement in their ability and motivation to understand and make health-related choices. One concern is that more information does not always equate to better choices. The competition-inducing impact refers to the degree to which the change fosters competition that improves quality, increases access, and lowers prices. These competitive effects are determined by whether consumers use new health care exchanges as substitutes or complements. If used as substitutes, disrupted exchanges may spur competition. If used as complements, the effects may be minimal or they may produce beneficial partnerships in the industry.

More research is needed to assess how the marketplace will be transformed and how marketing might contribute in positive or negative ways. Will health be improved, choice enabled, and competition fostered on quality care, access, and lower prices? Or will health be managed differently, but with no effects on morbidity and mortality, with more confusion than empowerment, and with more competition but no welfare gains?

“We see an enormous opportunity for the marketing discipline to help understand and address the complexities arising from the unprecedented pace and level of change in health care exchanges. Asking questions about how the new actors and new roles are participating in these exchanges and to what end in terms of health, choice, and competition outcomes is a valuable role we can play,” says van Heerde. The editors invite contributions for creating a stronger role for marketing in the study and management of health care.

Full article and author contact information available at: https://doi.org/10.1177/00222429231213154

About the Journal of Marketing 

The Journal of Marketing develops and disseminates knowledge about real-world marketing questions useful to scholars, educators, managers, policy makers, consumers, and other societal stakeholders around the world. Published by the American Marketing Association since its founding in 1936, JM has played a significant role in shaping the content and boundaries of the marketing discipline. Shrihari (Hari) Sridhar (Joe Foster ’56 Chair in Business Leadership, Professor of Marketing at Mays Business School, Texas A&M University) serves as the current Editor in Chief.
https://www.ama.org/jm

About the American Marketing Association (AMA) 

As the largest chapter-based marketing association in the world, the AMA is trusted by marketing and sales professionals to help them discover what is coming next in the industry. The AMA has a community of local chapters in more than 70 cities and 350 college campuses throughout North America. The AMA is home to award-winning content, PCM® professional certification, premiere academic journals, and industry-leading training events and conferences.
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JOURNAL

Journal of Marketing

DOI

10.1177/00222429231213154 

ARTICLE TITLE

Marketing in the Health Care Sector: Disrupted Exchanges and New Research Directions