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Welcome to the latest edition of Investigative Roundup, highlighting some of the best investigative reporting on healthcare each week.

What Contributes to Doctors' High Salaries?

A 2020 paper analyzing 10 million tax records revealed doctors earn a mean of $350,000 a year, causing a small uproar on social media among physicians. The took a closer look in an analysis of tax data to find out why, exactly, doctors make so much.

For one, the top 1% of earners in medicine made as much as $4.1 million a year in 2017, though most of it came from capital gains or business income. For another, certain specialties earn substantially more than others: neurosurgeons, orthopedic surgeons, and radiation oncologists, all earned more than $700,000 a year.

Part of the reason so many were surprised at the high figures, Stanford economist Maria Polyakova, PhD, told the Washington Post, was that if physicians make so much, "you're somehow implying that they're instead going into medicine because they want to make money. And that narrative is uncomfortable to people."

But, the data show that this is true, to some extent. Graduates from top medical programs tend to choose specialties that pay the most. As economist Joshua Gottlieb, PhD, of the University of Chicago put it, "They may be very good people, but that doesn't mean that they don't care about economics."

U.S. physicians make more than double what U.K. physicians do, according to Atul Grover, MD, PhD, of the Association of American Medical Colleges' Research and Action Institute. This may be due to a doctor shortage made possible, according to the Washington Post, by government caps on residency slots. However, physician pay is not a large contributor to overall healthcare costs, the article stated.

Did the NIH Kill a Project Over Politics?

The NIH's acting director appears to have killed a $150 million dollar project aimed at studying health communications over its fraught political implications, reported.

The project, known as Advancing Health Communication Science and Practice, would have studied how mass communication affects Americans' health in the aftermath of the pandemic, and how doctors and patients communicate with each other.

Previous NIH Director Francis Collins, MD, PhD, publicly proposed the project idea in 2021, saying, "We basically have seen the accurate medical information overtaken, all too often, by the inaccurate conspiracies and false information on social media," and "I do think we need to understand better how -- in the current climate -- people make decisions."

The agency held a workshop on the project in May 2022 and presented it to the NIH Council of Councils, made up of outside researchers, with a favorable reception. It had even been included in the budget as a potential project, and designated important enough to be funded by their Common Fund, which is reserved for high priority projects, the article stated.

But once new acting director Larry Tabak, DDS, PhD, took over, three sources told KFF he reversed course on the project. Dean Schillinger, MD, a researcher at the University of California San Francisco, got a call from NIH telling him the project was "killed." An official statement said the project had been put on "pause" "to reconsider its scope and aims in the context of the current regulatory and legal landscape around communication platforms."

A spokesperson for Tabak and the agency gave KFF varying reasons for the reversal, including "budget concerns" and "lawsuits," a possible reference to a push in Louisiana by Republican attorneys general and anti-vaccine groups to limit government communication with social media agencies. Sources familiar with the project told KFF that "the agency is acting in response to political pressures over misinformation and is effectively censoring itself."

FDA and EPA at Odds Over Sanitizing Chemical

A chemical used to sterilize half of medical devices in the U.S. has been classified by the EPA with "high" confidence to be carcinogenic to humans -- and it may be sickening Americans who live near commercial sterilization facilities. But the EPA and FDA are at odds over the regulation of ethylene oxide, according to .

Although the FDA has announced a program that will help find safer alternatives to the odorless chemical, the EPA has proposed new rules, not yet finalized, that would cut ethylene oxide emissions by 80%. Medical device companies say the rules assume maximum emissions, and are too aggressive "in the absence of an EtO [ethylene oxide] alternative," according to Axios.

"Other methods of sterilization cannot currently replace the use of EtO for many devices," an FDA spokesperson told Axios, while the EPA said their "goal is to lower cancer causing EtO exposure to workers and community members, while maintaining the integrity of the supply chain" of sterile medical devices.

FDA commissioner Robert Califf told Congress in May, "We do have concerns" about the EPA's proposed rules. "A sudden restriction would create substantial difficulty with critical medical devices. EPA is in the lead in this. We're working on it. There's an interagency process."

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