The increasing demand for cosmetic procedures like Botox injections, dermal fillers and fat-dissolving treatments at popular medical spas has raised growing alarm about risky care from unlicensed providers.

Why it matters: A patchwork of state rules governing these facilities are often poorly enforced, leaving consumers more vulnerable to infection and potentially disfiguring and even life-threatening consequences, experts say.

The big picture: The global medical aesthetics industry is projected to grow from $15.4 billion in 2023 to $25.9 billion by 2028, according to a Markets and Markets analysis.

• Social media platforms like Instagram and TikTok have driven increased awareness and acceptance of medical aesthetics, helping juice demand for smoother skin, plumper lips and contoured bodies, experts say.

Yes, but: There are varying estimates of how many med spa providers aren't properly licensed, and the National Med Spa Association says it may be as high as 90%.

• "The vast majority are people doing it illegally and they have no idea what they are doing," said Kate Dee, physician-owner of Glow Medispa in Washington state and author of an upcoming book on the dangers of the industry.

Driving the news: Federal officials last month warned consumers about counterfeit Botox tied to hospitalizations across several states, and they for the first time linked cosmetic injections to HIV cases after three women receiving "vampire facials" contracted the virus at an unlicensed med spa.

Between the lines: It's often hard to tell the legitimate, well-run med spas from unscrupulous providers, because their setups are so similar, experts said.

• Consumers are often drawn to bad actors by lower prices, not realizing they may be getting fake or adulterated products, said Jamie Ravitz, who leads McDermott Will and Emery's FDA practice.
• Trade groups representing these facilities said they're pushing for state laws that could help weed out bad actors.

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Clinical trials funded by the National Institutes of Health often "fell short" in enrolling underrepresented groups, the federal health department's watchdog found in a new review.

Why it matters: There's increased focus on improving representation of women and racial and ethnic groups in medical research to ensure that they benefit from clinical advances and to prevent health disparities.

• As the world's largest funder of biomedical research, the NIH can play an important role in advancing these efforts.

What they found: Of the 30 NIH-funded trials the HHS inspector general reviewed, 10 did not plan to include at least one underrepresented racial group.

• Researchers in just over half of trials analyzed didn't adequately explain how they determined their enrollment targets for inclusive research, and most trials that completed enrollment missed their targets for at least one underrepresented group.

What they're saying: Before making funding decisions, NIH should make sure that there's a clearly described rationale for who the trial plans to study, OIG said.

• It "may be reasonable" that both sexes or that some racial and ethnic groups aren't included in a study, but explaining why could improve confidence in the research.
• NIH, which agreed with OIG's recommendations, should also look at ways to help researchers meet inclusive enrollment targets.

The rates of premature and early-term births slightly increase after heat waves, and the risk grows as extreme temperatures last longer, according to a new study of 25 years of birth data.

Why it matters: It's one way that extended heat waves, which have grown more common with climate change, may be harmful to infant health, the study in JAMA Network Open suggests.

• Premature birth is the most common cause of death for infants and can lead to many long-lasting health challenges.

What they found: After four straight days of abnormally high temperatures, there's a 2% higher chance of babies being born prematurely (before 37 weeks). The chance is 1% higher for early-term births (37-38 weeks).

• The risk was slightly higher among Black and Hispanic mothers and those with less education.
• Researchers analyzed 53 million births during the spring and summer between 1993 and 2017 in the 50 most populous U.S. metropolitan areas.
• Researchers said their study is the largest yet of the association between extreme heat and perinatal health.

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San Francisco is connecting unhoused people with addiction medicine through nightly telehealth visits under a new pilot program, Axios' Shawna Chen writes from the Bay Area.

Why it matters: A city hit especially hard by the fentanyl crisis is making use of new telehealth flexibilities to bring highly effective opioid use disorder treatments to a high-risk population.

How it works: A city street care team from 7pm to 3am provides telehealth sessions with a doctor who can prescribe buprenorphine or methadone.

• To encourage that prescriptions are filled, the program provides a place to sleep overnight, as well as caseworker support for medical and service needs.

By the numbers: In the program's first four weeks, 173 people had telehealth visits — including about 3 in 4 who received buprenorphine prescriptions. Of those, a third had their prescriptions filled.

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🕵️ Two Senate chairmen are looking into MultiPlan's business practices. (New York Times)

💊 Doctors say the first pill for postpartum depression is working, though some patients still face barriers accessing it. (NBC News)

🩺 Long COVID patients of color are being overlooked. (Washington Post)

🏥 A Mississippi hospital sends some patients awaiting mental health treatment to jail. (ProPublica)