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SEPTEMBER 2026

Official Publication of SDCMS

The Revolution in Blood-Based Early Detection Is Coming

HE ADER HERE

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Contents SEPTEMBER

Editor: William T–C Tseng, MD, MPH Editorial Board: James Santiago Grisolia, MD; William T-C Tseng, MD; Holly B. Yang, MD, MSHPEd, HMDC, FACP, FAAHPM Marketing & Production Manager: Jennifer Rohr Art Director: Lisa Williams Copy Editor: Adam Elder

VOLUME 113, NUMBER 8

OFFICERS President: Maria T. Carriedo–Ceniceros, MD President–Elect: Karrar H. Ali, DO, MPH Immediate Past President: Preeti Mehta, MD Secretary: Rakesh R. Patel, MD, MBA, FAAFP, CPE Treasurer: Arlene J. Morales, MD GEOGRAPHIC DIRECTORS East County #1: Randall J. Young, MD, FAAEM, FACEP, MMM East County #2: Rachel Buehler Van Hollebeke, MD Hillcrest #1: Vikant Gulati, MD Hillcrest #2: Stephen R. Hayden, MD [DELEGATION CHAIR] Kearny Mesa #1: Anthony E. Magit, MD, MPH Kearny Mesa #2: Dustin H. Wailes, MD La Jolla #1: Toluwalaşé [Laşé] A. Ajayi, MD La Jolla #2: Audra Robertson Meadows, MD, MPH, FACOG La Jolla #3: Emily A. Nagler, MD North County #1: Quinn Kerr Lippmann, MD, FACOG, MPH (Board Representative to the Executive Committee)

North County #2: Theophilos [Phil] E. Yphantides, MD North County #3: Nina Chaya, MD South Bay #1: Paul J. Manos, DO South Bay #2: Latisa S. Carson, MD, FACOG AT–LARGE DIRECTORS #1: Steven L.W. Chen, MD, FACS, MBA (Board Representative to the

Executive Committee)

#2: Kelly C. Motadel, MD, MPH #3: Kyle P. Edmonds, MD #5: Daniel D. Klaristenfeld, MD, FACS #6: Alexander K. Quick, MD #7: Karl E. Steinberg, MD, FAAFP #8: Steve Sang–Hyun Koh, MD, MPH, MBA ADDITIONAL VOTING DIRECTORS Young Physician: Quinne C. Sember, MD Retired Physician: Mitsuo Tomita, MD Medical Student: Adarsh Jagadish CMA OFFICERS AND TRUSTEES Trustee: Sergio R. Flores, MD Trustee: Timothy A. Murphy, MD Trustee: William T–C Tseng, MD, MPH Trustee: Holly B. Yang, MD, MSHPEd, HMDC, FACP, FAAHPM AMA DELEGATES AND ALTERNATE DELEGATES District I: Mihir Y. Parikh, MD District I Alternate: William T–C Tseng, MD, MPH At–Large: Kyle P. Edmonds, MD At–Large: Sergio R. Flores, MD At–Large: Robert E. Hertzka, MD At–Large: Theodore M. Mazer, MD At–Large: Albert Ray, MD At–Large: Holly B. Yang, MD, MSHPEd, HMDC, FACP, FAAHPM CMA DELEGATES District I: Christopher M. Bergeron, MD, FACS District I: Corrie D. Broudy, MD District I: Puja Chitkara, MD District I: Mojgan Hosseini, MD District I: Yolanda Marzan, MD District I: Bijal V. Patel, MD, MBA District I: Eric L. Rafla–Yuan, MD District I: Ran Regev, MD District I: Kristen N. Rice, MD District I: Kosala Samarasinghe, MD District I: Mark W. Sornson, MD District I: Wynnshang [Wayne] C. Sun, MD District I: Patrick A. Tellez, MD, MHSA, MPH District I: Nicholas [dr. Nick] J. Yphantides, MD, MPH

Opinions expressed by authors are their own and not necessarily those of San Diego Physician or SDCMS. San Diego Physician reserves the right to edit all contributions for clarity and length as well as to reject any material submitted. Not responsible for unsolicited manuscripts. Advertising rates and information sent upon request. Acceptance of advertising in San Diego Physician in no way constitutes approval or endorsement by SDCMS of products or services advertised. San Diego Physician and SDCMS reserve the right to reject any advertising. Address all editorial communications to Editor@SDCMS.org. All advertising inquiries can be sent to DPebdani@SDCMS.org. San Diego Physician is published monthly on the first of the month. Subscription rates are $35.00 per year. For subscriptions, email Editor@SDCMS.org. [San Diego County Medical Society (SDCMS) Printed in the U.S.A.]

FEATURES

The Revolution in Blood-Based Early Detection Is Coming By Julio Guiterrez, MD and Robert Gish, MD

Newsom Vowed to Transform Kids’ Mental Health. Many California Schools are Still Waiting By Christine Mai-Duc

DEPARTMENTS

Briefly Noted: Advocacy • Medicare

CDC Warns of Severe Arboviral Disease With B-Cell Drugs By Ian Ingram

16 15

Three Factors Tied to 13 Additional Dementia-Free Years By Judy George

Newsom Promotes Affordable Insulin, but California’s Generic Label Off to a Slow Start By Angela Hart

A Ray of Hope in Challenging Times By Adama Dyoniziak

Classifieds

SANDIEGOPHYSICIAN.ORG

ADVOCACY

SDCMS Steps Up for Dr. Pan for Congress

SAN DIEGO COUNTY MEDICAL SOCIETY leadership recently attended an event supporting fellow physician and former Democratic State Senator Richard Pan, MD, in his race for California’s 6th Congressional District. Dr. Pan is one of the few physicians running

for Congress and is strongly supported by the California Medical Association and SDCMS. In attendance were (from left to right) Dr. Mihir Parikh, Dr. Rakesh Patel, Dr. Mark Sornson, Dr. Pan, Dr. Quinn Lippmann, Dr. Sergio Flores, and Dr. Will T. Tseng.

MEDICARE

Congressional Doctors Caucuses Introduce Bipartisan Medicare Physician Payment Reform Bill A BIPARTISAN GROUP OF PHYSICIAN lawmakers has introduced comprehensive legislation to modernize Medicare physician payment, addressing longstanding flaws in the current system that have contributed to years of declining physician reimbursement and growing challenges for physician practices. The legislation comes as physicians face yet another proposed cut to Medicare physician payment, underscoring the urgent need for comprehensive reform of a system that has failed to keep pace with the cost of providing care. The Patients First Act was introduced by Reps. Kim Schrier, MD (D-Wash.), John Joyce, MD (R-Pa.), and Greg Murphy, MD (R-N.C.), the Democratic and Republican leaders of

SEPTEMBER 2026

the Congressional Doctors Caucuses. The legislation would strengthen Medicare physician payment, expand opportunities for physicians to participate in value-based care, and help preserve independent physician practices. The California Medical Association (CMA) supports the legislation, which reflects many of the reforms physicians have long urged Congress to adopt. Over the past two decades, physician payment has failed to keep pace with inflation while Medicare payment updates have remained inadequate to cover rising practice costs. Adjusted for inflation, Medicare physician payment has declined by approximately 33% since 2001. These financial pressures have contributed to physician shortages, practice consolidation, and reduced access to care for Medicare patients — particularly in rural and underserved communities. Physicians are also the only Medicare provider type that does not currently receive an annual payment update tied to inflation.

ADVOCACY

CMA Board of Trustees Votes to Support Proposition 3 to Protect Healthcare Funding THE CALIFORNIA MEDICAL Association (CMA) Board of Trustees has voted to support Proposition 3, a November ballot measure that would permanently extend California’s existing tax on the state’s highestincome earners to help protect funding for Medi-Cal and other essential healthcare programs. The measure would permanently extend the income tax rates on California’s highest-income earners that voters most recently approved under Proposition 55 in 2016. By preserving those tax rates before they expire, Proposition 3 would maintain an estimated $10 billion in annual General Fund revenue that supports public education, Medi-Cal, and other critical public services. The board’s action comes as California’s healthcare safety net faces growing financial pressure, including uncertainty surrounding future federal Medicaid funding. Maintaining a stable, reliable source of state funding is essential to protecting access to care for MediCal beneficiaries and supporting the physicians and hospitals that serve them. “Proposition 3 is a critical safeguard for our state’s healthcare

safety net,” said CMA President René Bravo, MD. “At a time of growing financial uncertainty, making this funding permanent helps ensure that millions of Californians who rely on Medi-Cal can continue to see their doctors. It provides long-term stability and preserves a proven and effective funding source.” Last month, the CMA Board of Trustees voted to oppose the proposed Billionaire Tax Act (Prop. 40), warning that the ballot measure would increase budget volatility and fail to provide a sustainable, accountable solution to California’s healthcare funding challenges. Proposition 3, by contrast, preserves a stable revenue source that is necessary for the state to continue supporting California’s healthcare system at current levels. CMA’s support is rooted in its longstanding commitment to protecting stable, sustainable funding for California’s healthcare system. By making that revenue source permanent, Proposition 3 would help protect patient access to care while providing greater financial certainty for California’s healthcare safety net. For more information on Prop. 3, see yesprop3ca.com.

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PREVENTIVE MEDICINE

The Revolution in Blood-Based Early Detection Is Coming By Julio Guiterrez, MD and Robert Gish, MD

A SIMPLE BLOOD DRAW MAY SOON BECOME ONE of the most powerful tools in preventive medicine. Advances in blood-based testing could soon provide earlier detection for cancer, neurodegenerative disease, and chronic conditions, delivered through a test as familiar as a complete blood count (CBC). These diagnostics may in the future expand the role of primary care or even direct access to patients, enabling earlier risk stratification, timelier specialist referral, and reductions in the type of diagnostic delays that contribute to worse outcomes in San Diego’s diverse population. Primary Care Physician Implications • PCPs are first point of contact for most patients; patient’s best chance for early detection • Tools expand — not replace — the PCP’s role in prevention and risk stratification • Earlier identification allows PCPs to coordinate timely specialist referral and reduce diagnostic delays MULTI-CANCER EARLY DETECTION TESTS Late-stage diagnosis of cancer represents a failure in preventive medicine and often results in tragic loss of life, especially in younger people. Multi-cancer early detection (MCED) or multicancer screening tests (MCSTs) use simple blood tests to detect cancer before other costly or complicated tests. Advantages include the ability to detect cancers without established screening pathways, such as pancreatic, ovarian, and other cancers where late-stage presentation is common, and the ability to find cancer early before it has metastasized. Studies show that early cancer diagnosis is associated with longer survival, improved quality of life, and lower healthcare costs and resource utilization1. MCED tests use a single blood test to screen for multiple types of cancer at the same time. Current MCED tests ana-

SEPTEMBER 2026

PCP Considerations: MCD Limitations • Not a replacement: These tests do not replace standard single-cancer screenings like mammograms or colonoscopies. • Out-of-pocket costs: Most health insurance plans and Medicare do not cover MCED tests, meaning patients usually pay hundreds of dollars independently. • Diagnostic limits: A positive result indicates a signal that needs further invasive diagnostic workups to confirm.

lyze cell-free DNA (cfDNA) circulating in the bloodstream, evaluating methylation and fragmentation patterns (fragmentomics). By using next-generation nucleic acid sequencing (NGS) and machine learning (ML) algorithms to analyze biomarkers, these tests are estimating a likelihood that a cancer is present, not a diagnosis. If validated in clinical trials, these tests may offer a relatively painless entry, when compared to mammograms or colonoscopies, and they may provide signals for cancers without existing screening tests or for individuals not meeting current screening criteria for some cancers2,3. As MCDs become more common, they could provide PCPs with a low-effort method for addressing low participation rates and disparities among underserved populations4. The CCGA and PATHFINDER studies are providing evidence that MCED tests can detect cancers early and predict cancer origin, even in asymptomatic individuals5–8. Liver cancer represents an opportunity for earlier detection. Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related death9. While metabolic dysfunctionassociated steatohepatitis (MASH) prevalence is rising, ultrasound surveillance of at-risk populations remains inconsistent, with substantial disparities in adherence. Current guidelines recommend HCC surveillance for cirrhosis9, yet identifying patients with advanced fibrosis in primary care remains challenging, resulting in many patients never entering the surveillance pathway. In addition, an increasing proportion of HCC occurs in patients with non-cirrhotic MASH, who are not currently recommended for routine surveillance10. Existing surveillance strategies also have limitations: AFP-based blood testing alone may miss half of HCCs and ultrasound performance varies by operator and patient characteristics11. MCED tests could provide primary care physicians a powerful tool to identify hepatocellular carcinoma earlier in all patients12,13. While no MCED tests are currently FDA-approved, some tests like the Galleri Test by GRAIL and Abbott’s Cancerguard are available commercially as laboratory-developed tests (LDTs) ordered by a doctor through high-complexity labs certified under Clinical Laboratory Improvement Amendments (CLIA) regulations. Though not formal FDA pre-market approval, developers are actively submitting clinical data for future federal authorization through ongoing trials.

SINGLE-DISEASE CANCER BLOOD TESTS Leading the way into blood-based cancer tests are diseasespecific blood tests. Colorectal cancer is the second leading cause of cancer death, yet adherence to recommended screening, including colonoscopy, remains suboptimal, with only 59% of eligible adults up to date with screening14. Unlike MCED tests, several blood-based tests have received FDA approval for specific single-disease clinical indications. For colorectal cancer screening, the FDA has approved Shield™ (Guardant Health), evaluated in the ECLIPSE trial, for average-risk adults aged 45 years and older and SimpleScreen™ CRC (Freenome), commercialized by Abbott, as blood-based screening options for average-risk individuals. While colonoscopy is still needed for diagnosis, the value of these new tests lies in reaching more patients in order to reduce missed or delayed diagnoses14–17. FDA-Approved Single-Cancer Screening and Profiling Tests • Shield™ (Guardant Health): Approved in July 2024 as a primary blood-based screening test for colorectal cancer in average-risk adults aged 45 and older. • SimpleScreen™ CRC (Freenome): Approved in July 2026 as an average-risk blood screening test for colorectal cancer, commercialized by Abbott. • Guardant360® CDx & FoundationOne® Liquid CDx: Broadly approved liquid biopsy tests that sequence cellfree DNA to identify mutations across various solid cancer types (acting as companion diagnostics). ALZHEIMER’S DISEASE BLOOD TESTS Memory concerns often surface first in primary care, either with patients or their caregivers, so PCPs need to be ready to diagnose Alzheimer’s and other neurodegenerative diseases. As more drugs become available to treat Alzheimer’s disease, PCPs will need diagnostic pathways for their patients to access new treatments. Traditional diagnostic tools, such as positron emission tomography (PET) imaging and cerebrospinal fluid (CSF) biomarker analysis, are expensive and invasive. Blood biomarker assays, like the Lumipulse G pTau217/ß-Amyloid 1-42 Plasma Ratio and PrecivityAD, allow PCPs a practical way to triage earlier, counsel families sooner, and determine when neurology referral is warranted versus when monitoring is appropriate18–21.

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PREVENTIVE MEDICINE Primary Care Physician Implications • Memory concerns often surface first in primary care • Blood biomarker tests are less invasive and expensive • Treatment requires a diagnosis to begin CHRONIC DISEASE BLOOD TESTS PCPs can make a difference in their communities when they screen their patients for chronic diseases such as liver disease including hepatitis C and hepatitis B. For those with heavy alcohol use, phosphatidylethanol (PEth) testing provides an objective measure of alcohol use over the previous month and can help identify patients with alcohol-associated liver disease. For patients at risk for MASH, PCPs should further risk-stratify those with elevated Fib-4 score (>1.3) or high-risk patients with type 2 diabetes or cardiometabolic risk factors using the Enhanced Liver Fibrosis (ELF) test, an FDA-approved blood biomarker test for fibrosis risk assessment22–24. Earlier identification of chronic liver disease improves outcomes and will remain essential for identifying populations at highest risk for HCC as blood-based cancer detection and surveillance strategies continue to evolve. Primary Care Physician Implications • Screen patients with high alcohol use • Screen other high-risk patients • Identify liver disease earlier to improve outcomes for patients CLINICAL INTEGRATION: WHAT SAN DIEGO PHYSICIANS NEED TO KNOW As blood-based diagnostics enter routine practice, PCPs will need clear guidance on ordering, interpreting, and communicating results to patients. Key considerations to still be worked out in many organizations include:

• Criteria for accepting tests (FDA-approved tests vs LDTs covered under CLIAs) • When new blood-based tests are appropriate for a given patient • If insurance coverage is available (CMS frameworks for emerging diagnostics)25 • How to bring these tests to more patients, providing more equitable care27 • Ethical dilemmas around testing that uses LLMs to interpret findings and how to protect patient privacy and data security and avoid harm from false positive tests26 • How to incorporate these tools into annual wellness visits and chronic disease management • When and how to efficiently refer patients to specialists Primary Care Physician Implications • What’s available? • What will it cost patients? • How can we incorporate into visits? • When do we refer patients to specialists? PREPARING FOR THE NEXT DECADE OF EARLY DETECTION Blood-based early detection tools hold enormous promise, but adoption must remain evidence-driven and clinically grounded. San Diego’s physicians are well positioned to lead thoughtful implementation in their communities; it’s time to start conversations in our organizations to prepare for a potentially new way of working. As these tools become part of routine care, primary care will remain the central driver of screening, risk identification, and coordinated follow-up — offering a meaningful opportunity to reduce late-stage diagnoses across multiple diseases.

SEPTEMBER 2026

REFERENCES 1. Aguiar-Ibáñez R, Mbous YPV, Sharma S, Chawla E. Assessing the clinical, humanistic, and economic impact of early cancer diagnosis: a systematic literature review. Front Oncol. 2025;15:1546447. doi: 10.3389/fonc.2025.154644 2. National Cancer Institute. Questions and answers about multi-cancer detection tests. Accessed July 28, 2026. https://prevention.cancer.gov/research-areas/networksconsortia-programs/csrn/q-a-about-mcd-tests 3. Kahwati LC, Avenarius M, Brouwer L, et al. Blood-based tests for multiple cancer screening: A systematic review. Rockville (MD): Agency for Healthcare Research and Quality. Published May 2025. Accessed July 28 2026. https:// www.ncbi.nlm.nih.gov/books/NBK618308/MCED 4. Carbonell C, Hutchinson JM, Hilsden RJ, Yang H, Brenner DR. Blood-based multi-cancer early detection tests (MCEDs) as a potential approach to address current gaps in cancer screening. Cancer Control. 2024;31:10732748241307360. doi: 10.1177/10732748241307360 5. Liu MC, Oxnard GR, Klein EA, et al; CCGA Consortium. Sensitive and specific multi-cancer detection and localization using methylation signatures in cell-free DNA. Ann Oncol. 2020;31(6):745-759. doi: 10.1016/j.annonc.2020.02.011 6. Klein EA, Richards D, Cohn A, et al. Clinical validation of a targeted methylation-based multi-cancer early detection test using an independent validation set. Ann Oncol. 2021;32:1167–1177. doi: 10.1016/j.annonc.2021.05.806 7. GRAIL PATHFINDER 2 results show Galleri® multicancer early detection blood test increased cancer detection more than seven-fold when added to USPSTF A and B Recommended Screenings. News release. GRAIL.com. October 17, 2025. Accessed July 21, 2026. https://grail. com/press-releases/grail-pathfinder-2-results-show-galleri-multi-cancer-early-detection-blood-test-increasedcancer-detection-more-than-seven-fold-when-added-touspstf-a-and-b-recommended-screenings/ 8. GRAIL Presents PATHFINDER 2 results of more than 35,000 participants showing the Galleri® test substantially increased cancer detection with robust performance and favorable safety at 2026 ASCO Annual Meeting. GRAIL.com. News release. May 31, 2026. Accessed July 21, 2026.https:// grail.com/press-releases/grail-presents-pathfinder-2-results-of-more-than-35000-participants-showing-the-galleri-t est-substantially-increased-cancer-detection-with-robust-performance-and-favorable-safety-at-2026-a/ 9. Singal AG, Llovet JM, Yarchoan M, et al. AASLD Practice Guidance on prevention, diagnosis, and treatment of hepatocellular carcinoma. Hepatology. 2023;78(6):1922-1965. doi: 10.1097/HEP.0000000000000466 10. Liu Y. The emerging challenge of non-cirrhotic MASLDrelated hepatocellular carcinoma: Etiology, immunopathology, and precision oncology. Liver Cancer. 2025. doi: 10.1159/000550163 11. Lee CW, Tsai HI, Lee WC, et al. Normal alpha-fetoprotein

hepatocellular carcinoma: Are they really normal? J Clin Med. 2019;8(10):1736. doi: 10.3390/jcm8101736 12. Kanwal F, Singal AG. Surveillance for hepatocellular carcinoma: current best practice and future direction. Gastroenterology. 2019;157(1):54-64. doi: 10.1053/j.gastro.2019.02.049 13. McGowan CE, Edwards TP, Luong MU, Hayashi PH. Suboptimal surveillance for and knowledge of hepatocellular carcinoma among primary care providers. Clin Gastroenterol Hepatol. 2015;13(4):799-804. doi: 10.1016/j. cgh.2014.07.056 14. Chung DC, Gray DM, Singh H, et al. A cell-free DNA blood-based test for colorectal cancer screening. N Engl J Med. 2024;390(11):973-983. doi: 10.1056/NEJMoa2304714 15. Shield – P230009. Food and Drug Administration. Content current as of: 10/08/2024. Accessed August 6, 2026. https://www.fda.gov/medical-devices/recently-approveddevices/shield-p230009 16. Premarket Approval (PMA): SimpleScreen™ CRC. Food and Drug Administration. Page last updated: 08/03/2026. Accessed August 6, 2026. https://www.accessdata.fda. gov/scripts/cdrh/cfdocs/cfpma/pma.cfm?id=P250029 17. FDA approves blood tests that can help guide cancer treatment. National Cancer Institute. Published October 15, 2020. Accessed August 6, 2026. https://www. cancer.gov/news-events/cancer-currents-blog/2020/fdaguardant-360-foundation-one-cancer-liquid-biopsy 18. FDA approves treatment for adults with Alzheimer’s disease. Content current as of 07/02/2024. Accessed August 3, 2026. https://www.fda.gov/drugs/news-events-humandrugs/fda-approves-treatment-adults-alzheimers-disease 19. FDA clears first blood test used in diagnosing Alzheimer’s disease. Content current as of 05/16/2025. Accessed August 3, 2026. https://www.fda.gov/news-events/ press-announcements/fda-clears-first-blood-test-useddiagnosing-alzheimers-disease 20. Anderson J, Pierce C. PrecivityAD for diagnosis of Alzheimer disease. American Family Physician. 2022;105(1):79-81. 21. Burns JM, Alford S, Coppinger J, et al. Early Alzheimer’s diagnosis: U.S. primary care physicians and use of blood biomarkers. Alzheimer’s Dement. 2026;22:e70986. doi: 10.1002/alz.70986 22. Nadella P, Schaefer E, Landefeld C. Preventing cirrhosis: Why primary care clinicians should screen for liver disease in patients who drink heavily. Cleve Clin J Med. 2026;93(2):88-93. doi: 10.3949/ccjm.93a.25045 23. Pandyarajan V, Gish RG, Alkhouri N, Noureddin M. Screening for nonalcoholic fatty liver disease in the primary care clinic. Gastroenterol Hepatol (N Y). 2019;15(7):357-365. 24. Ouzan D, Penaranda G, Jlaiel M, Joly H, Corneille J. Using the FIB-4, automatically calculated, followed by the ELF test in second line to screen primary care patients

SANDIEGOPHYSICIAN.ORG

PREVENTIVE MEDICINE for liver disease. Sci Rep. 2024;14(1):12198. doi: 10.1038/ s41598-024-62549-3 25. Centers for Medicare & Medicaid Services. Coverage framework for emerging diagnostics. Published August 07, 2024. https://www.cms.gov/newsroom/fact-sheets/ final-notice-transitional-coverage-emerging-technologies-cms-3421-fn 26. American Medical Association. Augmented intelligence development, deployment, and use in health care. Published November 2024. Accessed July 27, 2026. https:// www.ama-assn.org/system/files/ama-ai-principles.pdf 27. Febbo PG, Allo M, Alme EB, et al. Recommendations for the equitable and widespread implementation of liquid biopsy for cancer care. JCO Precis Oncol. 2024;8:e2300382. doi: 10.1200/PO.23.00382 PATIENT RESOURCES Based on this article, here is a list of organizations focused on specific chronic diseases: American Pacific Health Foundation provides health education and free community health screenings for hepatitis B and C, diabetes, hypertension, cholesterol disorders, osteoporosis, and vision health at community centers. www. aphfsd.org Alzheimer’s San Diego provides care, support, information, and resources for individuals and caregivers impacted by memory loss. www.alzsd.org California Colorectal Cancer Coalition works to lower colorectal cancer incidence and mortality, increase screening rates, strengthen public awareness, and improve timely access to high-quality care. www.cacoloncancer.org Cancer Health Collaborative works to improve access to information on cancer prevention, early detection, treatment, survivorship support, and services through collaborative partnerships. www.moorescancercenter.ucsd.edu/ outreach/cancer-health-equity-collaborative.html Cheeky Charity aims to normalize conversations about colorectal and anal health through education, humor, and community engagement, particularly among LGBTQ+ and younger populations. www.cheekycharity.org Liver Coalition of San Diego works to save lives by improving liver health and preventing liver disease through community-based education, linkages to care, advocacy, and research programs. www.livercoalition.org Ovarian Cancer Alliance of San Diego advances cancer research and educates the medical community about early diagnosis and treatment of ovarian cancer while improving the quality of care for patients. www.ocaofsd.org Patient Advocates United in San Diego County supports patients living with chronic health conditions to advocate and engage with policymakers and healthcare leaders to ensure access to quality healthcare. www.paunitedsd.org

SEPTEMBER 2026

National Health Council engages in a wide range of direct-service programs — including support, advocacy, education, and research — and, as a coalition of more than 180 national health-related organizations, includes many of the nation’s leading patient groups. www.nationalhealthcouncil.org

Julio Gutierrez, MD (left) is a hepatologist and gastroenterologist with the Scripps Division for Organ Transplantation. He is widely recognized as an authority in hepatitis B and C (HBV and HCV), fatty liver disease, and alcohol-associated liver disease. His clinical expertise also includes liver cancer, cirrhosis, and the care of patients who need or have undergone liver transplantation. Dr. Gutierrez has authored more than 90 peer-reviewed publications in the field of liver disease and currently serves as chair of the Liver Coalition of San Diego’s Medical Advisory Council (www.scrippsclinicmedicalgroup.com). Robert Gish, MD (right) is a hepatologist who teaches at UC San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences and the University of Nevada, and serves as medical director for the Hepatitis B Foundation and American Pacific Health Foundation. His recent multicenter study evaluated a multi-analyte cell-free DNA blood test for earlier detection of hepatocellular carcinoma, addressing limitations of traditional surveillance. He continues to advance research, screening, and clinician education in hepatitis B and delta, with a focus on earlier diagnosis and reduced liver cancer mortality (www.robertgish.com). Coordination for this article was provided by the Liver Coalition of San Diego, an organization dedicated to promoting liver health and addressing the needs of those affected by liver disease (www.livercoalition.org).

A DV E R T I S E M E N T

Sharp Mesa Vista Supports Children and Teen Mental Health In the U.S., 15% of youth ages 12 to 17 had a major depressive episode in the past year, according to a 2025 Mental Health America report. Yet more than half did not receive treatment. It is crucial for parents and medical professionals to help young people access mental health care so they can build coping skills and lead healthier lives. For more than 60 years, Sharp Mesa Vista Hospital has been a leading provider of behavioral health services in

Intensive outpatient programs meet three evenings

San Diego County — delivering compassionate care to

a week and help youth manage mood and behavior.

children, adolescents and their families through inpa-

“Through cognitive behavioral therapy in a group set-

tient treatment, partial hospitalization and intensive

ting, we help young people improve self-esteem and

outpatient programs.

develop effective communication and social skills,” says Dr. Bradshaw. “We also provide family therapy and

“As with adults, many factors influence the mental

medication management as part of treatment.”

health of young people, such as genetics, relationships and community,” says Dr. Kelsey Bradshaw, a clinical

Sharp Mesa Vista also offers the Changes Substance

child psychologist at Sharp Mesa Vista. “But children

Use Intensive Outpatient Program for adolescents

and teens are especially affected by family dynamics,

facing both chemical dependency and mental health

and their brains are still developing, so they need help

challenges. Experts in this after-school, dual-diagnosis

with understanding emotions and developing healthy

program use recovery-based treatment to help young

coping habits.”

people maintain sobriety and develop healthier alterna-

Specialized care for children and teens

Sharp Mesa Vista’s multidisciplinary team includes board-certified child psychiatrists, child psychologists,

tives to substance use.

Supporting long-term recovery

Sharp Mesa Vista offers San Diego’s most comprehen-

psychiatric nurses, recreation therapists and social

sive mental health care services for young people. “Our

workers. Together, they care for youth ages 5 to 17

programs are designed to meet children and teens

experiencing challenges such as self-harm, depression,

where they are and provide the level of support they

anxiety, and drug and alcohol use that may affect

need,” says Dr. Bradshaw. “Caring for young people in

school, home life or relationships.

the most appropriate treatment setting significantly

Personalized treatment

enhances healing and supports a lasting recovery.”

Inpatient services support youth at immediate risk of

Addressing mental health concerns early can help pre-

harming themselves or others, and patients remain in

vent more serious challenges later in life. “By collaborat-

the hospital for treatment. Participants in the partial

ing across specialties and partnering with community

hospitalization program receive therapy five days a

providers, Sharp Mesa Vista is proud to support the

week and return home each evening.

well-being of San Diego’s youth,” says Dr. Bradshaw.

To connect a patient with Sharp Mesa Vista’s child, teen, or other behavioral health programs, call 858-836-8555 or visit sharp.com/mesavista.

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MENTAL HE ALTH

Newsom Vowed to Transform Kids’ Mental Health. Many California Schools Are Still Waiting By Christine Mai-Duc Plumas Charter School students have experienced trauma from the COVID-19 pandemic and recent wildfires. (Christine Mai-Duc/KFF Health News)

WHEN TALETHA WASHBURN AND THE STAFF AT Plumas Charter School in Quincy, Calif., first heard that the state wanted to help schools treat more kids struggling with mental health, it felt like a well-timed remedy for a rural community where families struggle to find care. Getting the program funding up and running, however, has proved difficult. Employees spent two years “spinning our wheels,” attending state-led webinars, filling out countless forms, and researching electronic health record systems to prepare, said Washburn, the school’s executive director. When they reached out for assistance, she said, they waited months for a state response. The school received its first reimbursement check in April. Washburn said the school has been reimbursed $8,000 and

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has at least $12,000 in outstanding claims. For a program Washburn had thought could be a game changer in her small rural town, it’s been a disappointing bust. Plumas Charter is among roughly 1,000 public schools, community colleges, and universities that participate in Gov. Gavin Newsom’s first-in-the-nation initiative requiring that health insurance companies reimburse them for on-campus behavioral healthcare. California schools have been adding counselors, therapists, and psychiatrists to provide services where young people spend most of their time, making mental health treatment more accessible to kids whose families might have spent months waiting to see private therapists. Five years after the program’s launch, Washburn and other California school officials say they have encountered a rollout fraught with inadequate guidance from the state, an incom-

Left: Plumas Charter School Executive Director Taletha Washburn says the school’s experiences navigating the state’s new behavioral health billing program soured her and her staff on the initiative. (Christine Mai-Duc/KFF Health News) Below: Plumas Charter School staffers collected paperwork, webinar printouts, and other documents over the two years it took them to enroll and start billing for services in the Children and Youth Behavioral Health Initiative. (Christine Mai-Duc/KFF Health News)

plete billing infrastructure, a lack of standardized forms, and persistent delays signing up and getting paid. More than half of California’s school systems and colleges don’t participate in the billing program. Of those that do, fewer than one-fifth had filed claims as of June 1, according to the latest state data. The program hasn’t come close to bringing in the half-billion dollars in promised revenue to cover the salaries of thousands of counselors, therapists, and wellness coaches, many of whom school districts hired with a deluge of federal COVID pandemic funding. As a result, schools across California have issued thousands of pink slips amid local budget cuts. “One of the things that makes people hate government is when we make a promise and then we struggle to keep that promise because we can’t get the administrative part of it up and running,” said Assemblymember Dawn Addis, a former special education teacher and Democrat who has criticized the program’s slow implementation. Newsom’s office declined to make the governor available for an interview for this article. At a May press conference to release his final state budget proposal, the Democratic governor pointed to the “unprecedented” initiative, saying “no other state in the nation has done more.” “We have a lot more work to do to deal with the crisis of our time,” Newsom said. “Making investments in wellness, not just physical health, but mental health for our kids, is a good investment.” He did not answer when asked whether he considered the program a success. Tom Insel, the former head of the National Institute of Mental Health, who has advised Newsom, said the rocky rollout, in many ways, reflects the groundbreaking nature of what California is trying to do. Still, given the level of investment so far, he too had expected clearer evidence of dramatic improvement. “What we struggle with in California is: We spend the money, but we don’t always see the outcomes. It’s sobering to realize, especially as an advocate, that you could actually get the programs, get the money, get everything that you want from the policy side, but the execution just isn’t there.”

A First-in-the-Nation Plan? In 2021, 1 in 10 high school students nationwide said they’d attempted suicide, by then the second-leading cause of death for young people ages 10 to 24. In response, Newsom announced a $4.4 billion “Master Plan for Kids’ Mental Health,” promising an overhaul of California’s behavioral health system that he said would be transformative. National mental health experts said Newsom’s initiative was the most ambitious attempt of any state to tackle a youth mental health crisis that had metastasized during the pandemic. The state funneled $730 million in one-time funding into workforce efforts, such as campaigns to recruit mental health workers and programs to repay student loans. An additional $220 million has gone to facilitate partnerships between local governments and school officials, and $381 million was distributed in grants to schools and community groups for facilities or services, according to an analysis of program funding by KFF Health News. The state has spent roughly $532 million to date on digital apps designed to connect families with counseling and provide a consultation service for primary care physicians handling behavioral health issues outside their expertise, while an additional $232 million has gone toward state operations and program evaluations. And the state has added 1,855 school counselors since 2021, according to statistics from the American School Counselor Association, which in recent years has integrated mental health into professional standards. That’s well below the 10,000 Newsom had pledged by the end of this year as part of his initiative.

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MENTAL HE ALTH The “flagship” component of Newsom’s Children and Youth Behavioral Health Initiative focused on schools and was designed to increase behavioral health services on campus — at no cost to families. Schools would be able to bill health insurers, who would be required to reimburse them. Some $1.3 billion — nearly a third of the total investment — has gone toward setting up campus wellness centers, new billing infrastructure, and beefing up school-based mental health support in other ways. Filing claims became an administrative nightmare for schools unfamiliar with the complex world of medical billing. In February 2025, when the Fresno County Office of Education launched its medical billing, it felt “like building the plane while flying it,” Trina Frazier, assistant superintendent of student services, told lawmakers in a public hearing a couple of months later. The delays were so acute that lawmakers last year authorized $20 million in grants to Fresno and 170 other school systems so they wouldn’t have to lay off newly hired mental health staffers while waiting for reimbursements. Anaheim Elementary School District in Orange County, which state officials called a “champion” of the program, has recouped more than $1.1 million since its 23 campuses began billing student insurance in February 2025, said program specialist Shirley Diaz. Still, that accounts for less than 30% of the behavioral health services the district has provided to students over that time. It’s not just the complexity of medical billing that has hampered the claims process. Parents have also been reluctant to provide health insurance information in the largely Latino district, where residents have been fearful of immigration raids carried out by the Trump administration. To help administer claims across California, the state signed a $65 million contract with Carelon Behavioral Health, a service operated by Elevance Health, one of the nation’s largest health insurers. But schools have struggled to get claims cleared, and many have spent hundreds of thousands of dollars hiring outside vendors to troubleshoot and bill claims. As of June 1, the Boston-based administrator has approved about 232,100 claims totaling more than $11.3 million to 186 school districts and educational agencies, according to the Department of Health Care Services. That’s a small fraction of the thousands of entities the state had hoped would participate and far from the $500 million a year state officials told schools the program could eventually provide for school-based mental health services. “We probably were given the impression that this was going to happen more quickly and now there’s this reality of a kind of slow growth,” said Amy Blackshaw, behavioral health project director for the California School-Based Health Alliance. Carelon contract manager Christina Kim declined to

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Binders full of documentation for the Children and Youth Behavioral Health Initiative sit in the office of Maggie Hennessy, business manager for Plumas Charter School. (Christine Mai-Duc/KFF Health News)

comment to KFF Health News and referred questions to the state. Autumn Boylan, deputy director of the Office of Strategic Partnerships at DHCS, said staff members incorporated early feedback from school districts and extended claim deadlines, loosened onboarding requirements, and hosted webinars and office hours. But changes of this magnitude, she said, take time. “We’re trying to help the school districts increase their scale,” Boylan told lawmakers at a May 4 hearing. “It’s not a problem of claims being submitted and not paid. It’s a problem of claims not yet being submitted for payment.” Boylan noted the volume of reimbursements has increased exponentially since the first claims were filed in November 2024. Meanwhile, children and youths continue to struggle and have trouble accessing care. In 2024, nearly 14% of those ages 12–17, for example, reported delaying or skipping mental healthcare because they couldn’t get an appointment, while 1 in 4 teens said they did so because of cost, up from roughly 6.5% the previous year, according to data from the California Health Interview Survey. The share of young adults 18–24 who reported ever seriously considering suicide has stabilized but remains higher than pre-pandemic, according to the annual survey, conducted by the UCLA Center for Health Policy Research. And while the suicide rate among Californians ages 12–25 has dropped from its high in 2021, this mirrors national trends, and state rates for female and Black youths increased from 2023 to 2024. “We have to have high expectations that when we invest in the magnitude of billions as this program did, we would have results to show,” said Assemblymember David Alvarez, a Democrat from San Diego.

Other states have taken note of California’s implementation difficulties, some adopting a few strategies rather than the dozens California chose to roll out at once, said Sharon Hoover, formerly the co-director of the National Center for School Mental Health at the University of Maryland. Illinois, for instance, has focused on universal mental health screenings for schoolchildren, while Colorado has expanded coverage of some behavioral health services for youths who lack a formal diagnosis. “It’s always hard to be first, and someone has to be brave enough and hopeful enough to take that leap,” Hoover said. Launching its reimbursement program before billing infrastructure was in place, Hoover said, created momentum but also posed challenges to school districts and providers. Still, she added, Newsom’s focus on prevention and early intervention became one of the biggest national policy shifts in years. “We’re going to look back on this thinking it was one of the most progressive actions in the history of public systems,” said Alex Briscoe, a principal at the nonprofit Public Works Alliance, who has pushed for system reform in kids’ mental health. “We spent a significant amount of money preparing for it. I just don’t think we did that very well or strategically.”

Quincy, California, at the heart of what’s known as the “Lost Sierra,” is a remote Northern California town where kids’ behavioral health needs are high and wait times to get help are long. (Christine Mai-Duc/KFF Health News)

Rural Schools Struggle Most Students at Plumas Charter School had endured a relentless wave of trauma by fall 2021: wildfires, COVID shutdowns, and, weeks into the school year, a car accident that killed a classmate and left two others severely injured. Teachers saw signs of depression, anxiety, and frequent outbursts among their K–12 students. Nine kids that year reported considering suicide, an all-time high. So, the school hired a full-time therapist and wellness coach with temporary federal funds.

Senior Will Coelho wasn’t there for any of it, but by the time he arrived in the remote California logging town of Quincy a year later, he’d been through plenty of losses of his own. Days before the pandemic lockdowns, a friend had died in a horrific murder-suicide. Isolated at home, Coelho struggled to process his grief, he said. That year, his stepfather became increasingly violent and, after a bitter, years-long custody fight, Coelho left the Central Valley to move in with his dad in the remote town in Northern California, just weeks before starting high school. One day, he found himself chatting with a faculty adviser, the new kid half-joking about therapy. At her suggestion, Coelho started seeing the school therapist weekly, on campus and free of charge. “It has had a large impact on the way I process emotions and my outlook on life,” he said. Behind the scenes, school officials struggled with how they would continue to cover the therapist’s salary. Twice, the state rejected the school’s application to the state’s landmark billing program, telling school officials they hadn’t met all the requirements, such as having sufficient systems to bill private insurers and collect student insurance information. When school staffers flagged difficulties filing claims online, Washburn added, state officials suggested they submit paper claims instead. The experience has soured Washburn and her staff on the program, which she said doesn’t work for small, rural districts like hers where the human resources director is also the office business manager, and the faculty member who manages discipline also teaches PE. DHCS spokesperson Tony Cava said that many charter schools are small and wouldn’t be expected to participate. While charter schools make up about half of eligible entities, Cava said, they serve only 12% of California’s students. Lawmakers who represent small, rural districts have argued the program should be able to serve all kids. Early this year, Addis proposed legislation that would give intensive technical help to school officials who need it. Even if it passes, it may be too late to help Plumas Charter. Washburn is unsure her school will reap enough revenue to pay for their therapist. “In theory, this should be a good program,” Washburn said. “We’re too small, and our funds are too limited to just keep waiting.”

Christine Mai-Duc is a veteran journalist who now reports for KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — an independent source of health policy research, polling, and journalism.

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INFEC TIOUS DISE ASE

CDC Warns of Severe Arboviral Disease With B-Cell Drugs Cases Have Included Chronic, Neurodegenerative Encephalitis That Played Out Over Months to Years By Ian Ingram IN AUGUST, THE CDC WARNED DOCTORS ABOUT the risk for severe arboviral neuroinvasive disease in patients on B cell-depleting or modulating agents, calling out anti-CD20 monoclonal antibodies in particular. Published case reports indicate an overall mortality of about 40% for patients on anti-CD20 antibodies with arboviral neuroinvasive disease, and neurologic sequelae were common in survivors. The most common virus involved in the reports was West Nile, but severe cases also involved eastern equine encephalitis, Powassan, La Crosse, and others. “In recent years, a novel clinical presentation of chronic, neurodegenerative encephalitis developing over months to years has been described in at least five patients receiving rituximab who were infected with an orthobunyavirus, including Jamestown Canyon virus, Cache Valley virus, or Potosi virus,” the CDC said in a Health Alert Network advisory. Arboviral viruses are transmitted by arthropods, most commonly mosquitoes and ticks, and are subclinical in most individuals. When symptoms do present they can include acute febrile or neurologic illness such as encephalitis or acute flaccid myelitis. Beyond rituximab, the class of anti-CD20 monoclonal antibodies includes ocrelizumab (Ocrevus), obinutuzumab (Gazyva), ofatumumab (Kesimpta), ublituximab (Briumvi), and ibritumomab tiuxetan (Zevalin). They carry indications

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for leukemia, lymphoma, multiple sclerosis, and rheumatoid arthritis, among others. During the early days of the pandemic, anti-CD20 agents were also linked to worse outcomes with COVID-19. “Be aware that patients with an arboviral disease who are immunocompromised can have a prolonged incubation period or an atypical course, and might not present with illness during the usual months when mosquitoes and ticks are active,” the CDC said. No approved vaccines or treatments are approved for the types of arboviral virus endemic in the U.S., such as West Nile virus. Other common arboviral viruses transmitted by mosquitoes include chikungunya, dengue, and Zika, while Oropouche virus is spread mostly by biting midges and Powassan virus by ticks. The CDC recommended that physicians educate on severe arboviral disease if a patient is starting on immunosuppressive agents such as B cell-depleting drugs and on preventive measures for mosquito and tick bites. If arboviral disease is suspected in a patient presenting with a febrile or neurologic illness, the CDC recommended molecular testing with RT-PCR or metagenomic next-generation sequencing to detect the viral RNA, with the type of preferred specimen depending “on the clinical presentation and laboratory conducting the testing.”

Ian Ingram is managing editor at MedPage Today, where this article first appeared. He helps cover oncology.

NEUROLOGY

Three Factors Tied to 13 Additional Dementia-Free Years New Study Reflects Competing Risks That Shape Aging Trajectories By Judy George

MAINTAINING THREE KEY HEALTH FACTORS DURING midlife — normal blood pressure, no diabetes, and not smoking — was associated with nearly 13 additional dementia-free years, a study of 12,000 people in the U.S. showed. Individuals who met these criteria at age 55 lived an average of 30.1 more years dementia-free, reported Josef Coresh, MD, PhD, of NYU Langone Health in New York City, and co-authors. Conversely, those who smoked, had hypertension, and had diabetes at age 55 had dementia-free survival of only 17.5 years, Coresh and colleagues wrote in Neurology Open Access. People with all three risk factors had a higher incidence of dementia (HR 2.69, 95% CI 1.94–3.73) and a higher incidence of dying before a dementia diagnosis (HR 5.61, 95% CI 4.67–6.74) compared with those who had no risk factors. Overall, women lived longer without dementia than men at all risk levels. White participants had more years free of dementia than Black participants, and APOE4 carriers had shorter dementia-free survival than noncarriers. “Our findings argue that people need to actively avert these factors in midlife as a strategy for preserving brain health for more than a decade,” Dr. Coresh said in a statement. “Discovering new ways to delay dementia is crucial with 42% of Americans at risk for developing the condition at any time after age 55.” The findings were based on 12,409 participants in the prospective Atherosclerosis Risk in Communities (ARIC) study, which started in 1986 to evaluate midlife vascular risk factors and late-life dementia. Previous research from the ARIC cohort suggested that 22% to 44% of dementia risk by age 80 could be attributed to three vascular risk factors measured in midlife and early late life, after accounting for risk factor concurrence and interactions. Hypertension was defined as systolic blood pressure ≥130mm Hg, diastolic blood pressure ≥80mm Hg, or the use of blood pressure medication; diabetes as fasting glucose ≥126mg/dL, non-fasting glucose ≥200mg/dL, a physician’s diagnosis, or the use of any diabetes medication; and current smoking was self-reported.

“Our study complements this important work by shifting focus from probability-based and attributable risk metrics to a time-based estimand — dementia-free survival years, which quantifies the expected duration of life lived cognitively intact,” Dr. Coresh and colleagues wrote. “This outcome integrates two clinically relevant processes: incident dementia and death before dementia, therefore reflecting the competing risks that shape real-world aging trajectories,” they pointed out. “In contrast to previous ARIC studies, this framework emphasizes how vascular health influences the balance between longevity and cognitive health over the life course.” In the current analysis, ARIC participants had a mean baseline age of 56, and 56% were women. Dementia was tracked through cognitive assessments, informant interviews, and continuous surveillance. Deaths without dementia were captured from multiple sources, including the National Death Index. Over a median follow-up of 26.3 years, 3,008 cases of dementia and 5,238 deaths without dementia were documented. Better vascular health was linked with longer dementiafree survival in a dose-response pattern. “Several biologic pathways likely underlie our observed associations between vascular health and dementia-free survival, including chronic cerebrovascular injury, neuroinflammation triggered by vascular damages through hypertension and diabetes, and cumulative oxidative stress resulting from smoking,” Dr. Coresh and colleagues wrote. “Together, these factors likely accelerate atherosclerosis, increase stroke risk, and may facilitate Alzheimer’s disease pathology through promoting amyloid plaques and tau tangles.” The findings relied on one midlife assessment of risk factors, the researchers acknowledged. Dementia ascertainment may have differed between participants who attended recent visits and those who didn’t. In addition, the study was observational, and residual confounding may have influenced outcomes.

Judy George covers neurology and neuroscience news for MedPage Today, where she serves as deputy managing editor and where this article first appeared. She writes about brain aging, Alzheimer’s, dementia, MS, rare diseases, epilepsy, autism, headache, stroke, Parkinson’s, ALS, concussion, CTE, sleep, pain, and more.

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HE ALTHCARE AFFORDABILIT Y

Newsom Promotes Affordable Insulin, but California’s Generic Label Off to a Slow Start By Angela Hart

AT A WALGREENS IN SAN FRANCISCO’S BUSTLING Japantown neighborhood, pharmacist Margaret On stocks two boxes of long-acting insulin pens from California’s new prescription drug label, CalRx, emblazoned with the state’s iconic grizzly bear. Although she hasn’t dispensed any, On plans to keep them on hand. “It’s good to have if a patient comes in and doesn’t have health insurance,” she said. “Or just in case of emergencies.”

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Seven months after the launch of its own low-cost insulin brand, state health officials said California has distributed more than 120,000 five-pen packs of insulin glargine priced at $55 each, significantly less than the $89 to $411 that the state says most popular brand names charge before any retail markups or consumer discounts. While it represents a tiny amount of the state’s insulin pipeline, it marks the first time a state is competing against the three biggest insulin drugmakers — Eli Lilly, Sanofi,

and Novo Nordisk — under its own prescription drug label. CalRx, Gov. Gavin Newsom’s experimental initiative, has dual aims: to act as an emergency supplier for people who are uninsured or can’t afford their prescriptions, and to disrupt the nation’s deep-pocketed pharmaceutical industry, which cost the U.S. $467 billion in 2024, the federal government reported in June. Newsom, a Democrat considering a presidential run in 2028, is expected to make healthcare a central pillar of his national platform as he concludes his second and final term as governor. To create the state brand of generic drugs, California inked a $50 million contract with Civica, a Utah-based nonprofit drugmaker, to develop the CalRx insulin, known as a biosimilar. Though major distributors make the drug available in pharmacies around the state, uptake has been limited. Newsom’s goal is to saturate the insulin market and offer generic versions of drugs either high in cost or low in supply, or that can improve public health. The state is also distributing free naloxone, used in a nasal spray to reverse opioid overdoses, and trying to bring albuterol inhalers to public schools for students with asthma emergencies. In the next two years, the state plans to launch epinephrine injectables, commonly known by the brand name EpiPen, which are used to treat severe allergic reactions, as well as a statebranded medication to treat tuberculosis. Before he leaves office in January, Newsom said, he wants to add generic GLP-1 medications to compete with brandname drugs such as Ozempic and Wegovy. The drugs have exploded in popularity, but employers have raised concerns about their cost. Taking on drug costs is a winning political issue for both Democrats and Republicans, who have for years tried to rein in soaring healthcare spending as Americans feel the pinch of high prices at pharmacy counters, in doctors’ offices, and from health insurance premiums. The U.S. spends roughly twice as much per capita on prescription drugs as other industrialized countries. Six in 10 adults in the U.S. say they’re worried about being able to afford their prescription drug costs, according to a poll last winter by KFF, and 4 in 10 say they’ve tried to save money in ways such as skipping doses and not filling prescriptions. In February, President Donald Trump launched TrumpRx to potentially lower out-of-pocket costs for consumers. But TrumpRx doesn’t produce drugs; rather, it directs consumers to find more affordable medications with coupons or on drugmakers’ websites. Newsom, in contrast, is trying to drive down the underlying price of medicines by increasing the manufacturing and availability of generic drugs. While some people with diabetes may benefit from CalRx insulin, California’s generic drug effort is largely symbolic at this time, said Geoffrey Joyce, director of health policy at the Schaeffer Center at the University of Southern California. “There is some value, but it’s for a very limited number of

drugs for just a fraction of the population,” Joyce said. And TrumpRx isn’t helping at a large scale either, Joyce added, because many medications it advertises have cheaper generic versions available elsewhere. It would be better, he said, to develop large-scale initiatives that tackle key drivers of the high cost of drugs, for rare cancers for instance, and produce safer and higher-quality medicines. “What you really need is a national effort that focuses on vulnerabilities like supply shortages and increasing the supply of generic products for higher-priced drugs,” Joyce said. Market Disruptor CalRx aims to make insulin more affordable and accessible for the nearly 3.7 million California adults diagnosed with diabetes. Newsom last year singled out the three major drugmakers that control more than 90% of the global insulin market, while also targeting intermediaries known as pharmacy benefit managers for promoting higher-priced drugs over cheaper generic alternatives. Patients with health insurance often receive discounts at the pharmacy counter and do not pay sticker prices. Yet those discount programs can be hard to navigate and patients can face restrictions. While drugmakers and pharmacy benefit managers said they’ve already initiated $35-a-month caps on out-of-pocket costs and pass price discounts on to consumers, Newsom argues that consumers still struggle to afford their medications. He has criticized pharmaceutical companies for gouging Californians and contended that the industry’s discounting schemes don’t adequately address inflated prescription drug spending, which in the U.S. rose 7.9% in the most recent reporting year.

Pharmacist Margaret On keeps two boxes of California’s new generic insulin product under the CalRx brand on hand in case of emergencies. (Angela Hart/KFF Health News)

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HE ALTHCARE AFFORDABILIT Y In his announcement last year that CalRx insulin would go on sale in January 2026, Newsom said the industry had been using discounts to distract consumers from solutions that could bring overall prices down. “One of the things that all of us should be increasingly concerned about is announcements around caps, announcements around discounts,” he said. In January, California joined dozens of other states in setting insulin price caps. It also passed a law attempting to ban price inflation practices by pharmacy benefit managers. Representatives for drug companies and pharmacy benefit managers said insulin is largely an affordable medicine in the U.S., arguing that consumers have benefited from discounts. “While insulin prices, set solely by pharma companies, may be high in some instances, the amount patients are paying out of pocket has declined significantly,” said Christine Rex, senior director of state public affairs for the Pharmaceutical Care Management Association, which represents pharmacy benefit managers. Reid Porter, a spokesperson for Pharmaceutical Research and Manufacturers of America, which represents brandname drugmakers, said PBMs have driven up costs for consumers by excluding lower-cost medicines from their lists of covered drugs. “Too often, patients face a system in which insurers and PBMs exclude coverage of those medicines on formularies because of supply-chain incentives,” he said. Where to Find CalRx Insulin CalRx insulin has been slow to reach pharmacies around the state, and in interviews, patient advocates said many people with diabetes aren’t aware it’s an option. In Sacramento, pharmacist Sharon Ngo, who works at a Safeway pharmacy, was surprised to learn that California had a long-acting insulin product on the market. She didn’t know that CalRx insulin was interchangeable with Lantus, which was on back order for roughly two weeks. “I had no idea this was available,” she said as she took notes on a pad of paper. “We’re going to give this a try.” CalRx insulin has a suggested retail price of $55 a pack and is available with or without insurance. California has inked deals with four health insurers to cover CalRx insulin on their health plan formularies, potentially making it cheaper, depending on copays. They include Anthem Blue Cross, Blue Shield of California, the Valley Health Plan for Santa Clara County employees, and the Federal Employees Health Benefits Program, according to the state Department of Health Care Access and Information. Elizabeth Landsberg, the department’s director, said the state is working to get more insurers to cover CalRx insulin and to provide it at more pharmacies. The state doesn’t know how many boxes have been dispensed. However, Landsberg said it was more meaningful that the state had

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reached agreements with three major pharmaceutical wholesalers to distribute its product in California. Currently, CalRx insulin is available on Amazon and at Costco, as well as at some retail and grocery store pharmacies including CVS, Walgreens, and Walmart. “What we’re really trying to do is change market behavior and offer both affordable and transparent pricing,” Landsberg said. “The rebates and discounts are hard for consumers to understand and can change at any time, so we are trying to be straightforward and say, ‘Let’s not play this shell game anymore.’” Allan Coukell, chief government affairs and public policy officer at Civica, said the company first partnered with the state on long-acting insulin that helps patients keep blood sugar steady for 24 hours or more. Next, it plans to help California develop rapid-acting insulin, which is used to pull elevated glucose down within minutes, to compete with brand names such as Humalog and NovoLog. Health insurance companies welcomed the state’s efforts, in part because they could help save money they pay out on prescriptions. “Making this drug available is really about helping people improve their health,” said Paul Markovich, CEO of Blue Shield of California’s parent company. “And the more supply we can get on the market, the more we can get rid of the profit motives in the pharmaceutical industry.” One July afternoon in the Southern California city of Corona, Chris Noble went to a CVS pharmacy to get a box of CalRx insulin. The pharmacist didn’t have any on hand, but Noble, a healthcare organizer with Type 1 diabetes, was told he could get a prescription filled in 24 hours. “I have insurance, but I see myself using this if I’m traveling and something happens like my insulin pump malfunctions,” he said. “Now I know I can go to a CVS and get insulin within a day.”

Angela Hart is a reporter for KFF Health News, where this article first appeared.

CHAMPIONS FOR HE ALTH

A Ray of Hope in Challenging Times By Adama Dyoniziak “THANK GOD WE found Project Access and a doctor who could help my husband, Bruno,” Perla said with tears of gratitude in her eyes. In 2021, Bruno’s left hand was exhibiting troubling symptoms that were affecting his ability to perform daily functions. During an emergency room visit, he was diagnosed with Parkinson’s disease. His symptoms worsened, making it difficult to work. Bruno did not have health insurance, so receiving costly treatment was not possible. Perla heard about Project Access San Diego (PASD) in 2023 and Bruno applied. “It was very difficult for me at the time,” Bruno said. “I was excited because they said they could help me see a neurologist and get medicine.” Desseray Reyes, Bruno’s PASD care manager, adds, “Bruno was struggling to get the care he needed. A 30-minute consultation with a volunteer physician can make a huge difference in a patient’s life.” Desseray connected Bruno with Dr.

James Grisolia, a neurologist and Project Access volunteer. Dr. Grisolia adds, “Bruno and his family have had to walk a difficult road. His condition is progressive and it has been a battle. On the other hand, the medications have made a big difference. They can also reach out through Project Access and get more resources. It’s been a ray of hope in a challenging situation.” Bruno speaks emotionally: “When I was accepted into Project Access and received the treatment for my Parkinson’s, my life changed in every area: in my work, in my family, they were all greatly affected,” he said. “When I received the medicine, I

could finally do these activities like go to church or family gatherings. I could perform my job and provide for my family.” He pauses, trembling, and has tears in his eyes as he looks at Perla. “This was my greatest concern. I couldn’t do it alone. With the help of Dr. Grisolia and Project Access, I feel I have hope to move forward.” “Knowing that there’s hope, that there’s a physician who understands you, trying to understand you, and trying many ways of helping you, that gives people a lot of encouragement and a lot of hope,” Dr. Grisolia says. Maria Carriedo-Ceniceros, MD, former Champions for Health Board president and current San Diego County Medical Society president, stated: “Healthcare is such an important aspect of our life. It can’t work in silos. Working together, we can do so much more for our community.” As Dr Carriedo said at her presidential installation at this year’s gala: “The SDCMS is a special entity. The beauty is the diversity: the diversity of the membership; of the board; of the communities of San Diego. We may all be from different specialties, different modes of practice, different regions of the county, but yet it seems that as physicians and human beings, we are much more alike than we are different. Because when you blend all our differences together, you’re left with the beautiful community of physicians serving San Diego, of which I’m very proud.” Project Access patients are waiting for you to volunteer with Champions for Health to provide pro bono specialty care, especially general surgery, gynecology, gastroenterology, and urology. Call (858) 300-2780 or email adama. dyoniziak@championsfh.org.

Adama Dyoniziak is executive director of Champions for Health.

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CLASSIFIEDS PRACTICE ANNOUNCEMENTS

CRANIO/MAXILLOFACIAL AND HEAD & NECK SURGERY: Accepting new adolescent and adult patients seeking evaluation and management of head and neck masses, multidisciplinary assessment of oral/facial cancers and reconstruction, nasal airway assessment and functional rhinoplasty, corrective jaw surgery including jaw advancement for obstructive sleep apnea, cleft and craniofacial reconstruction, maxillofacial fracture management and secondary facial and jaw reconstruction. We work with Medicare, Tricare, most PPO insurance plans, and some HMO plans. Referrals may be called in to (619) 452-7332, or emailed to jaw@scrippshealth. org. [2887-0808] VIRTUAL SPEECH THERAPY AVAILABLE: Accepting new pediatrics and adult patients. We accept FSA/HSA, Private pay, Medicare, Medi-Cal, and several commercial insurance plans pending credentialing. Visit virtualspeechtherapyllc.org or call (888) 855-1309. PSYCHIATRIST AVAILABLE: Accepting new patients for medication management, crisis visits, ADHD, cognitive testing, and psychotherapy. Out of network physician servicing La Jolla & San Diego. Visit hylermed.com or call (619) 707-1554. PHYSICIAN OPPORTUNITIES WE ARE SEEKING A PART-TIME NURSE PRACTITIONER, PHYSICIAN ASSISTANT, OR FAMILY PRACTICE PHYSICIAN to provide outpatient care at a private practice in the Hillcrest area. The position is 16 hours per week, with scheduled hours on Wednesdays and Thursdays. Candidates must be bilingual in English and Spanish and have experience caring for geriatric patients. Compensation is $100 per hour for Nurse Practitioners and Physician Assistants and $150 per hour for Physicians. For more information, please email fdempsey@drlmmarquez.com or call 858-270-7633. MEDICAL CONSULTANT (MD/DO): SD County Epidemiology and Immunization Services Branch is hiring a Medical Consultant! We seek a California–licensed physician with strong clinical, public health, and medical administration expertise who communicates effectively, collaborates with multidisciplinary teams, and provides clinical consultation on sensitive issues across diverse audiences. The ideal candidate is committed to underserved communities, builds community partnerships, and is board certified or board eligible in a relevant specialty; infection–prevention experience is preferred. The Medical Consultant leads mandated public health surveillance, investigation, and response activities; oversees case investigation, contact tracing, surveillance, and public education; and coordinates with healthcare partners to implement response strategies. Responsibilities include 24/7 on–call physician coverage for emerging infectious diseases, bioterrorism, and complex cases; clinical consultation and prescription oversight for reportable diseases; and physician coverage for programs such as HAI/ MDRO, overdose surveillance, BioWatch/bioterrorism, and tribal, rural, military, and base liaison work. The role also includes representing the branch and serving as media spokesperson. CLICK HERE to file your application. [2901-0429] PER DIEM ANESTHESIOLOGIST – NORTH COUNTY (92127) Facial plastics practice seeking anesthesiologist for elective cases in AAAHC-accredited, private, single-OR setting. Healthy patients, no emergencies, tight-knit team, smooth workflow. Typical 1–3 cases/day, 6AM-5PM depending on case load. Flexible per diem role. Compensation structured per case with strong effective hourly rates. Located in 92127. Looking for a reliable, longterm fit. SKY Facial Plastic Surgery | (858) 381-4801 | hello@skyfps.com. PULMONOLOGY PHYSICIAN | PHMG NORTH COUNTY: Palomar Health Medical Group is seeking a board-certified Pulmonology/Critical Care Physi-

SEPTEMBER 2026

cian to join our multi-specialty, not-for-profit practice in North San Diego County. The ideal candidate will offer expert pulmonary care in a comprehensive outpatient and inpatient setting, supported by advanced facilities at Palomar Medical Center Escondido and Poway. Responsibilities include diagnosing and treating a wide range of pulmonary conditions, performing both inpatient and outpatient procedures, and collaborating with specialists across the Palomar Health network. Candidates must hold a valid California medical license, be board-certified in Pulmonology, and preferably have at least two years of clinical experience. Per diem roles are also available, offering competitive pay and flexible scheduling. Join us in reimagining healthcare with compassion and excellence. To apply, send your application and CV to clayton.trosclair@palomarhealth. org. [2893-1015] UCSD DEPARTMENT OF FAMILY MEDICINE | FACULTY POSITIONS AVAILABLE: UCSD Department of Family Medicine seeks motivated faculty to join our team in clinical, teaching, and scholarly roles. Faculty participate in comprehensive patient care, resident and fellow education, and research or quality improvement initiatives. We welcome candidates with diverse experiences and a passion for family medicine, community engagement, and academic medicine. Opportunities are available at various academic ranks, with salary commensurate with experience, rank, and step. Join a collaborative, supportive environment committed to excellence in primary care and education. Apply here: https:// apol-recruit.ucsd.edu/JPF04341. [2889-0822] FAMILY PRACTICE | INTERNAL MEDICINE PHYSICIAN: La Jolla Village Family Medical Group is seeking a PT/FT primary care physician to join our well-established private practice. We’ve been caring for our La Jolla/UTC area neighbors for 35+ years providing comprehensive, longitudinal care to patients of all ages. Call responsibilities are minor; hours consistent with a healthy work/life balance. Our office is new, clean, modern, and well-appointed. Our clinical team is collegial, passionate, and close-knit, with a supportive, cohesive support staff. A true private practice where physicians practice artfully and build enduring relationships with patients and colleagues. Seeking a Board-certified, California-licensed MD/DO physician, passionate about medicine and looking to establish roots in a practice dedicated to the art of good medicine. Competitive salary and excellent benefits including medical, dental, vision, and retirement. Send a cover letter and CV to jcataluna@lajollafamilymedical.com. [2880-0520] VENOUS DISEASE SPECIALIST | NORTH COUNTY: La Jolla Vein & Vascular, the premier vein care provider in San Diego, is seeking a highly skilled and experienced Venous Disease Specialist to join our team at our newest location in Vista, CA, nestled in the stunning coastal region of North County San Diego. This full–time position offers competitive salary and benefits, including profitsharing and a 401(k). Our state-of-the-art facility operates Monday through Friday, with no weekend or night shifts, promoting an excellent work-life balance. Ideal candidates may also consider a locum or locum-to-hire arrangement. Join us in making a difference in our patients’ lives while enjoying your dream location! Email cv to jobs@ljvascular.com. [2875-1030] PART–TIME PRIMARY CARE PHYSICIAN: Primary Care Clinic in San Diego searching for parttime physician for 1 to 2 days a week, no afterhours calls. Please send CV to medclinic1@yahoo.com. [2872-0909] OB/GYN POSITION AVAILABE | EL CENTRO: A successful Private OBGYN practice in El Centro, CA seeking a board eligible/ certified OB/GYN. Competitive salary and benefits package is available with a tract of partnership. J-1 Visa applicants are welcome. Send CV to feminacareo@gmail.com or call Katia M. at (760) 352-4103 for more information. [2865-0809]

FAMILY MEDICINE/INTERNAL MEDICINE PHYSICIAN: San Diego Family Care is seeking a Family Medicine/Internal Medicine Physician (MD/DO) at its Linda Vista location to provide outpatient care for acute and chronic conditions to a diverse adult population. San Diego Family Care is a federally qualified, culturally competent and affordable health center in San Diego, CA. Job duties include providing complete, high quality primary care and participating in supporting quality assurance programs. Benefits include flexible schedules, no call requirements, a robust benefits package, and competitive salary. If interested, please email CV to sdfcinfo@ sdfamilycare.org or call us at (858) 810-8700. PHYSICIAN POSITIONS WANTED PART–TIME CARDIOLOGIST AVAILABLE: Dr. Durgadas Narla, MD, FACC is a noninvasive cardiologist looking to work 1-2 days/week or cover an office during vacation coverage in the metro San Diego area. He retired from private practice in Michigan in 2016 and has worked in a San Marcos cardiologist office for the last 5 years, through March 2023. Board certified in cardiology and internal medicine. Active CA license with DEA, ACLS, and BCLS certification. If interested, please call (586) 206-0988 or email dasnarla@gmail.com. OFFICE SPACE / REAL ESTATE AVAILABLE MEDICAL OFFICE SPACE FOR SUBLEASE | ENCINITAS: Beautiful, modern medical office space available for sublease in Encinitas, conveniently located just minutes from Interstate 5 with ample on– site parking for patients and staff. At approximately 2,000 sq ft it includes six spacious exam rooms to accommodate both clinic visits and minor procedures. Every room features stunning ocean views, creating a bright and welcoming environment. Additional amenities include a dedicated lab area, small break room, modern security system, and keyless entry. The entire office was fully renovated in 2023 and offers a fresh, contemporary design throughout. Flexible leasing options are available, including the opportunity to sublease a portion of the suite or the entire space. The sublease term is flexible, with the current lease running through July 2028, offering the possibility to assume or negotiate a longer–term lease directly with the landlord thereafter. Contact (760) 783-5502 for pricing and availability. [2902-0512] MEDICAL OFFICE FOR LEASE | CHULA VISTA: Former pediatric clinic which closed due to retirement of owner. Can be used for any medical specialty, podiatry, chiropractor, optometry or medical spa office. Located at 890 Eastlake Parkway in Eastlake Chula Vista, 1163 square feet. With waiting room and exam room chairs, exam tables, some basic medical instruments, credit card and telephone units. Free to use or all can be removed to suit your needs and preferences. Contact (619) 274-9904 or fbarbadillo@ cox.net. [2899-0323] MEDICAL OFFICE SPACE TO SUBLEASE IN VISTA: Recently updated and well–appointed medical office space for partial or full sublease in Vista, CA. This approximately 6,000 square foot clinic is located at 2067 West Vista Way, within a prime medical office building. The space is equipped with 16 exam rooms, 3 restrooms, and ample dedicated office and lab space. The building itself is ADA compliant and offers several amenities, including ample parking, an outdoor atrium, elevators, and public restrooms on all floors. For more information or to discuss sublease terms, please contact Denise at dporter@tpirc.org. [2896-0309] MEDICAL OFFICE AVAILABLE TO RENT | MID– CITY: Practice for sale, medical office available for rent. Centrally located in San Diego’s Mid–City community at 3250 El Cajon Blvd, San Diego, CA 92104. Contact Miguel Losada, MD at (619) 282-2178 or by fax at (619) 282-2179. [2894-1215] AVAILABILITY OF UTC MEDICAL OFFICE: Office in UTC area. 2–3 exam rooms, ample waiting room, 2 private offices. Ground floor location. Just

one block from 805 exit. Close to Genesee Ave, all major shopping and restaurants in UTC. Parking available. Ground floor office, handicapped accessible. Six month–one year lease available with possibility to renew. Call (619) 585-0476. Ask for Alisha. [2890-0825] OFFICE SPACE FOR LEASE | AESTHETIC SETTING: Take your practice to the next level with this beautifully appointed office space available in a modern, fully equipped clinical environment. Whether you’re already in aesthetics or starting an aesthetic practice, we offer flexible, high–end rental options. Rentals include use of PicoSure Pro Laser and Potenza Microneedling with Radiofrequency, two private treatment rooms and staff breakroom in a professional, clean and serene setting. Available Mondays, Tuesdays, Thursdays & Fridays at $1,000/ day between the hours of 8:30am–5:00pm. Ideal for dermatologists/plastic surgeons, cosmetic physicians, nurse injectors or other licensed professionals in the aesthetic field. Must see to appreciate the quality and atmosphere. Contact us today at Vivian@sandiegomobiledoctor.com to schedule an in– person tour of this great opportunity. [2886-0804] OFFICE SPACE FOR LEASE | MEDICAL SETTING: Take your practice to the next level with this beautifully appointed office space available in a modern, fully equipped clinical environment. Whether you’re in primary care or specialty medicine, we offer flexible, high–end rental options. Rentals include use of two medical exam rooms and waiting (lobby) area in a clean, professional setting. Available Mondays, Tuesdays, Thursdays and Fridays at $350/half day or $600/day between the hours of 8:30am–5:00pm. Ideal for primary care physicians and specialists seeking flexible space. Must see to appreciate the quality and atmosphere. Contact us today at Vivian@ sandiegomobiledoctor.com to schedule an in–person tour of this great opportunity. [2885-0804] LA JOLLA/XIMED OFFICE TO SUBLEASE: Modern upscale office on the campus of Scripps Hospital — part or full time. Can accommodate any specialty. Multiple days per week and full use of the office is available. If interested please email kochariann@ yahoo.com or call (818) 319-5139. [2866-0904] SUBLEASE AVAILABLE: Sublease available in modern, upscale Medical Office Building equidistant from Scripps and Sharp CV. Ample free parking. Class A+ office space/medical use with high-end updates. A unique opportunity for Specialist to expand reach into the South Bay area without breaking the bank. Specialists can be accommodated in this first floor high-end turnkey office consisting of 1670 sq ft. Located in South Bay near Interstate 805. Half day or full day/week available. South Bay is the fastest growing area of San Diego. Successful sublease candidates will qualify to participate in ongoing exclusive quarterly networking events in the area. Call Alicia, (619) 585-0476. MEDICAL OFFICE FOR SALE OR SUBLEASE: A newly remodeled and fully built-out primary care clinic in a highly visible Medical Mall on Mira Mesa Blvd. at corner of Camino Ruiz. The office is approximately 1000 sq ft with 2 fully equipped exam rooms, 1 office, 1 nurse station, spacious and welcoming waiting room, spacious reception area, and ADA accessible restroom. All the furniture and equipment are new and modern design. Ample parking. Perfect for primary care or any specialty clinic. Please contact Nox at (619) 776-5295 or noxwins@hotmail. com. Available immediately. RENOVATED MEDICAL OFFICE AVAILABLE | EL CAJON: Recently renovated, turn-key medical office in freestanding single-story unit available in El Cajon. Seven exam rooms, spacious waiting area with floor-to-ceiling windows, staff break room, doctor’s private office, multiple admin areas, manager’s office all in lovely, drought-resistant garden setting. Ample free patient parking with close access to freeways and Sharp Grossmont and Alvarado Hospitals. Safe and secure with round-the-clock monitored property, patrol, and cameras. Available March 1st.

Call 24/7 on-call property manager Michelle at the Avocado Professional Center (619) 916-8393 or email help@avocadoprofessionalcenter.com.

CLASSIFIEDS

OPERATING ROOM FOR RENT: State of the Art AAAASF Certified Operating Rooms for Rent at Outpatient Surgery of Sorrento. 5445 Oberlin Drive, San Diego 92121. Ideally located and newly built 5 star facility located with easy freeway access in the heart of San Diego in Sorrento Mesa. Facility includes two operating rooms and two recovery bays, waiting area, State of the Art UPC02 Laser, Endoscopic Equipment with easy parking. Ideal for cosmetic surgery. Competitive Rates. Call Cyndy for more information (858) 658-0595 or email Cyndy@ roydavidmd.com. PRIME LOCATION | MEDICAL BUILDING LEASE OR OWN OPPORTUNITY IN LA MESA: Extraordinary opportunity to lease or lease-to-own a highly visible, freeway-oriented medical building in La Mesa, on Interstate 8 at the 70th Street onramp. Immaculate 2-story, 7.5k square foot property with elevator and ample free on-site parking (45 spaces). Already built out and equipped with MRI/ CAT machine. Easy access to both Alvarado and Sharp Grossmont Hospitals, SDSU, restaurants, and walking distance to 70th St Trolley Station. Perfect for owner-user or investor. Please contact Tracy Giordano [Coldwell Banker West, DRE# 02052571] for more information at (619) 987-5498. KEARNY MESA OFFICE TO SUBLEASE/SHARE: 5643 Copley Dr., Suite 300, San Diego, CA 92111. Perfectly centrally situated within San Diego County. Equidistant to flagship hospitals of Sharp and Scripps healthcare systems. Ample free parking. Newly constructed Class A+ medical office space/ medical use building. 12 exam rooms per half day available for use at fair market value rates. Basic communal medical supplies available for use (including splint/cast materials). Injectable medications and durable medical equipment (DME) and all staff to be supplied by individual physicians’ practices. 1 large exam room doubles as a minor procedure room. Ample waiting room area. In office x-ray with additional waiting area outside of the x-ray room. Orthopedic surgery centric office space. Includes access to a kitchenette/indoor break room, exterior break room and private physician workspace. Open to other MSK physician specialties and subspecialties. Building occupancy includes specialty physicians, physical therapy/occupational therapy (2nd floor), urgent care, and 5 OR ambulatory surgery center (1st floor). For inquiries contact kdowning79@ gmail.com and scurry@ortho1.com for more information. Available for immediate occupancy. LA JOLLA/UTC OFFICE TO SUBLEASE OR SHARE: Modern upscale office near Scripps Memorial, UCSD hospital, and the UTC mall. One large exam/procedure room and one regular-sized exam room. Large physician office for consults as well. Ample waiting room area. Can accommodate any specialty or Internal Medicine. Multiple days per week and full use of the office is available. If interested please email drphilipw@gmail.com. ENCINITAS MEDICAL SPACE AVAILABLE: Newly updated office space located in a medical office building. Two large exam rooms are available M-F and suitable for all types of practice, including subspecialties needing equipment space. Building consists of primary and specialist physicians, great for networking and referrals. Includes access to the break room, bathroom and reception. Large parking lot with free parking for patients. Possibility to share receptionist or bring your own. Please contact coastdocgroup@gmail.com for more information. NORTH COUNTY MEDICAL SPACE AVAILABLE: 2023 W. Vista Way, Suite C, Vista CA 92082. Newly renovated, large office space located in an upscale medical office with ample free parking. Furnishings, decor, and atmosphere are upscale and inviting. It is a great place to build your practice, network and clientele. Just a few blocks from Tri-City Medical Center and across from the urgent care. Includes:

multiple exam rooms, access to a kitchenette/break room, two bathrooms, and spacious reception area all located on the property. Wi-Fi is not included. For inquiries contact hosalkarofficeassist@gmail.com or call/text (858) 740-1928. NON–PHYSICIAN POSITIONS AVAILABLE WE ARE SEEKING A PART-TIME NURSE PRACTITIONER, PHYSICIAN ASSISTANT, OR FAMILY PRACTICE PHYSICIAN to provide outpatient care at a private practice in the Hillcrest area. The position is 16 hours per week, with scheduled hours on Wednesdays and Thursdays. Candidates must be bilingual in English and Spanish and have experience caring for geriatric patients. Compensation is $100 per hour for Nurse Practitioners and Physician Assistants and $150 per hour for Physicians. For more information, please email fdempsey@drlmmarquez.com or call 858-270-7633. NURSE PRACTITIONER | PHYSICIAN ASSISTANT: Open position for Nurse Practitioner/ Physician Assistant for an outpatient adult medicine clinic in Chula Vista. Low volume of patients. No call or weekends. Please send resumes to medclinic1@ yahoo.com. [2876-1121] POSTDOCTORAL SCHOLARS: The Office of Research Affairs, at the University of California, San Diego, in support of the campus, multidisciplinary Organized Research Units (ORUs) https://research. ucsd.edu/ORU/index.html is conducting an open search for Postdoctoral Scholars in various academic disciplines. View this position online: https:// apol-recruit.ucsd.edu/JPF03803. The postdoctoral experience emphasizes scholarship and continued research training. UC’s postdoctoral scholars bring expertise and creativity that enrich the research environment for all members of the UC community, including graduate and undergraduate students. Postdocs are often expected to complete research objectives, publishing results, and may support and/ or contribute expertise to writing grant applications https://apol-recruit.ucsd.edu/JPF03803/apply. [2864-0808]

RESEARCH SCIENTISTS (NON–TENURED, ASSISTANT, ASSOCIATE OR FULL LEVEL): The University of California, San Diego campus multidisciplinary Organized Research Units (ORUs) https:// research.ucsd.edu/ORU/index.html is conducting an open search for Research Scientists (non–tenured, assistant, associate or full level). Research Scientists are extramurally funded, academic researchers who develop and lead independent research and creative programs similar to Ladder Rank Professors. They are expected to serve as Principal Investigators on extramural grants, generate high caliber publications and research products, engage in university and public service, continuously demonstrate independent, high quality, significant research activity and scholarly reputation. Appointments and duration vary depending on the length of the research project and availability of funding. Apply now at https:// apol-recruit.ucsd.edu/JPF04449/apply. [2867-0904] PROJECT SCIENTISTS: Project Scientists (non-tenured, Assistant, Associate or Full level): The University of California, San Diego, Office of Research and Innovation https://research.ucsd. edu/, in support of the Campus multidisciplinary Organized Research Units (ORUs) https://research. ucsd.edu/ORU/index.html is conducting an open search. Project Scientists are academic researchers who are expected to make significant and creative contributions to a research team, are not required to carry out independent research but will publish and carry out research or creative programs with supervision. Appointments and duration vary depending on the length of the research project and availability of funding: https://apol-recruit.ucsd.edu/JPF04450/ apply. [2868-0904]

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Day at the Races

Del Mar Thoroughbred Club - Bob Hope Celebrity Suite

Join us for Champions for Health’s Day

at the Races at the Del Mar Thoroughbred Club. Enjoy an exclusive afternoon of exciting horse racing, delicious food, and refreshing drinks while supporting vital healthcare programs for San Diego’s underserved communities.

Saturday, November 14, 2026 12:00 pm – 4:00 pm (1st race is at 12:30 pm)

Del Mar Fairgrounds 260 Jimmy Durante Blvd, Del Mar, CA 92014

For sponsorship information, please contact Gabriela Stichler at gabriela.stichler@championsfh.org or at 858-300-2789 • Race4Health.givesmart.com