Like many rural states, Alabama struggles with a dwindling workforce of primary care physicians, which means growing gaps in access to care for its residents, but osteopathic medicine is on the rise, and it may be one way to address the challenge.
Osteopathic doctors are trained to focus on a patient's lifestyle factors and prevention of disease and injuries.
Dr. Robert Cain, president and CEO of the American Association of Colleges of Osteopathic Medicine, said their schools and residencies are targeting the needs of rural areas.
"Our (osteopathic) schools have shown themselves to be high producers of primary care physicians who stay in the state where they are trained," Cain explained. "Our philosophy is sort of draw from the local area, train in the local area, and then try to keep them in the local area."
Alabama currently lacks around 3,000 physicians. Cain pointed out osteopathic medical students make up 25% of future physicians in the country, with a projection the number will grow to one-third by 2030.
The Alabama Legislature passed the Physician Workforce Act this year to help address doctor shortages in the state. Among other things, it makes it easier for doctors from other states to come to work in Alabama. Cain added recruitment in osteopathic medicine around the country must also continue to be a focus.
"We do have two schools also located in Alabama, that have been there for about that same period of time," Cain noted. "I know we have a very high percentage of counties also without care, so we're hoping to see the change in that location."
According to the Association of American Medical Colleges, a 2021 study predicted the U.S. will face a shortage of between 38,000 and 124,000 physicians by 2032.
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The organization Practical Farmers of Iowa is helping urban crop growers use beneficial insects to control pests, boost soil health and increase pollination.
It is part of the group's efforts to use natural resources to create healthier farms. Farmers do not like most bugs but in some cases, they can help.
Tricia Engelbrecht, a flower farmer at Engelbrecht Farm near Waverly, introduced ground beetles, lacewings and parasitic wasps into the habitat, to stay ahead of the pests that like to feed on her flowers.
"I can never get rid of pests," Engelbrecht acknowledged. "They are just part of the ecosystem. But if I could manage them, that would be very helpful to me. Like aphids, they suck the plant. They're like eating the plants. Some bugs go after the blooms."
Engelbrecht uses native "insect strips" and "beetle banks," which allow the good bugs to integrate into the habitat and keep the pests under control.
The bugs also reduce the need for chemicals, which in the end, creates healthier flowers. She admitted things do not always go as planned when she introduces good bugs, likening it to an eighth grade science project.
"It's not always foolproof," Engelbrecht pointed out. "Last year, I put all those egg sacs out. It comes on like a strip of paper to keep them off the ground. I hung it up and something ate all of the eggs. I don't know if a rodent or something came and ate all the eggs. I came the next day and everything was gone."
It was not a complete loss. Engelbrecht gets new shipments of healthy bugs every few weeks and Practical Farmers of Iowa pays for the habitats so she is getting financial help from the program, while striking a balance with Mother Nature.
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By Nina B. Elkadi for Sentient.
Broadcast version by Mark Moran for Iowa News Service reporting for the Sentient-Public News Service Collaboration
The “Got Milk?” campaign is one of the most infamous advertisements campaigns funded by the food industry. Though the images of people sporting milk mustaches were once practically ubiquitous, consumers may have difficulty pinpointing who exactly funded the project. The source was a unique agricultural marketing partnership of both industry and government commonly referred to as “checkoffs.” Today, checkoffs promote a wide range of foods — eggs and pork, and also watermelon and Hass avocados — but a growing number of critics, including farmers, are raising objections to the mandatory payment scheme. Some critics have even called for Elon Musk’s DOGE to curb checkoff programs, yet that kind of cut may not be popular, or legal.
Historically, checkoffs were a way for farmers to “self-tax” — paying a fee into a consolidated pool to market their product — University of Iowa agricultural resource economist Silvia Secchi tells Sentient. Once a voluntary practice, farmers could elect to pay into the checkoff to support their own commodity — agricultural products sold at a large scale, like corn, beef and hogs. The funds would go toward one big marketing pool, and the checkoff was to promote and provide information about the commodity rather than a particular brand — selling milk rather than DairyPure, for instance.
The first commodity checkoff was the formation of the Cotton Board in 1966, eventually institutionalized by Congress in 1996, when lawmakers officially sanctioned the use of “industry-funded, Government-supervised” commodity checkoff programs. More than a quarter-century later, checkoffs have ballooned into a combined pot of almost $1 billion supervised by the United States Department of Agriculture but operated by commodity boards. It is mandatory for producers selling cattle to pay $1 per head to the checkoff. Beef imported to the U.S. is “self-taxed” too. Ready to capitalize on the sweeping governmental changes, some farmers and farm groups are calling for a change.
Signs the Trump Administration Might Slash Checkoffs
Elon Musk’s Department of Government Efficiency (DOGE), which is moving through federal agencies slashing positions and programs, put out a call on X (formerly known as Twitter) asking for the public’s help with what to cut from the United States Department of Agriculture (USDA).
Some advocacy groups, like Farm Action, asked DOGE to investigate illegal checkoff spending on lobbying. They also penned a letter to USDA Secretary Brooke Rollins asking her to halt checkoff expenditures, which she has neither confirmed nor denied she will do.
Checkoffs were a target of Project 2025, where author Daren Bakst wrote that “Marketing orders and checkoff programs are some of the most egregious programs run by the USDA. They are, in effect, a tax — a means to compel speech — and government-blessed cartels. Instead of getting private cooperation, they are tools for industry actors to work with government to force cooperation.” Bakst called for the elimination or reduction of checkoff programs.
“That could’ve come out of the mouth of Senator Sanders or Senator Warren,” Austin Frerick, antitrust expert and author of “Barons: Money, Power, and the Corruption of America’s Food Industry,” tells Sentient. Frerick sees checkoff reform as essential. “We can’t make meaningful reforms in the American food system until we bring in the checkoffs, because they’re just too much money. They’re too much of a slush fund. They control the conversation too much.”
What Checkoff Programs Do
The goal of checkoff programs is to increase the reputation of and desire for a commodity, like beef, among consumers. Checkoffs tend to promote food made by large-scale, industrial agriculture, Secchi says; there are overwhelmingly the kinds of farms that produce most of the feed crops and meat consumed in the U.S. “If you’re the kind of farmer who is doing a lot to promote soil health on their farm, or who is really concerned about animal welfare and things like that, the checkoff doesn’t really benefit you,” she says. “The checkoff benefits the commodity, right? And the commodity, by definition, is homogeneous.”
Checkoffs also fund a hefty amount of university research. This industry-funded research is not a behind-the-scenes aspect of checkoffs, either. In fact, the USDA labels these programs under a “research & promotion” umbrella.
It’s also not an insignificant sum. According to reporting by Investigate Midwest, “between 2012 and 2022, the pork checkoff gave $17,184,763 in funding to land-grant colleges across the country. More than half went to research at Iowa State University…” In the same time period, the National Cattleman’s Beef Association gave $6.4 million and the dairy checkoff, Dairy Management Inc., gave almost $5.8 million to land-grant colleges.
How Checkoffs Can Skew Academic Research
Industry-funded research is ubiquitous in the field of agriculture. While defenders of the practice say working with conventional agriculture is a way to improve it, critics say industry-funded research ends up favoring questions of interest to industry over other research areas. And a growing body of industry-funded research is going toward messaging to defend the meat industry — like building trust in the pork industry, for instance.
“I actually think checkoffs are the main reason why our efforts in climate change and agriculture have been largely a farce,” says Frerick. Agriculture is one of the largest contributors to climate change, responsible for around a third of all greenhouse gas emissions, most of which is driven by beef. Frerick says industry-funded research is often focused on the false solutions. “We’re getting a lot of dumb scholarship, like ethanol and airplanes and other digesters for industrial animal facilities. And as all that, to me, is being driven and led by checkoffs.”
One recent paper claims that the beef industry (via the checkoff funded National Cattlemen’s Association) “planned to obstruct efforts to shift U.S. diets to reduce emissions,” funding university research that downplayed the effects of the industry on climate change. Frerick says research is what drives hiring in academia, and some researchers may feel pressured to write favorably about the big-funders.
“If you write a bunch of articles about how you squeeze more hogs into a metal shed, you’re probably more likely to get tenure than if you are talking about the fact that Iowa has the second-highest cancer rate in America,” he says. “The structures are really, really broken right now.”
Secchi is critical of the kinds of research land grant institutions are investing in. “The research that this kind of money finances is what I call small science research that perpetuates the practices of conventional agriculture,” she says. “It basically is just increasing demand for these products without any thinking about their environmental impact [or] their human health impact in a real way.”
Some Farmers Say Checkoffs Offer Them Little
On February 25, 2025, the USDA released a radio broadcast talking up the benefits of checkoffs, telling listeners that they do not know the extent to which the checkoff touches their lives, citing campaigns like “Beef, it’s what’s for dinner,” and educational programs such as “Pork Loin Roast vs Tenderloin.” The checkoff can also support events, the host said, such as the American Lamb Board’s Lamb Jam, “a tour of cities where local restaurants feature their best bites of lamb, along with games, music and giveaways to attract audiences and potential new customers of lamb.”
But not all farmers are convinced. Iowa farmer John Gilbert wrote to Sentient that, “Check off taxes are built on a faulty premise that prices can be increased by working only on the demand side.”
He wrote that the checkoff system “went to crap” when it became mandatory, causing the revenue to “invariably [shift] to the organization’s preservation, self promotion and influence peddling.”
“The checkoffs invariably led to the commodity cartel that has a stranglehold on Iowa politics and agriculture,” he wrote.
Aaron Lehman, President of the Iowa Farmers Union, wrote to Sentient that “Commodity checkoff programs must be accountable to the needs of family farmers,” noting that the term “checkoff” implies that they should also all be voluntary, “or at the very least should have built in regular farmer elections regarding the collection of funds from farmers.”
In conversations with farmers, Frerick has heard similar complaints. For decades, he says, many farmers have vocally opposed the checkoff, feeling like “their own money is being used against them.”
DOGE As Enforcer?
When the advocacy group Farm Action took to X to blast checkoffs, they highlighted the “lack of transparency and oversight.” Yet even though Project 2025 called for the elimination, or complete reform of the program, DOGE cannot (legally) single-handedly eliminate checkoffs, Secchi says.
“I have never been a fan of the checkoffs. But I think what’s really dangerous here is to concede that the process doesn’t matter,” she says. “If they get rid of the checkoffs, that’s not good, because that’s illegal. That’s not their job to get rid of the checkoffs.”
Moreover, checkoffs are not funded by the average taxpayer, they are funded by the farmer, making the DOGE goal of saving the average taxpayer money moot.
“It is not conducive to good policy to think that eliminating the subsidies in the system we have now is going to result in good outcomes,” Secchi says. “The people who are going to survive are the people who are already big.”
Project 2025 likely targeted checkoffs because, at its core, the plan calls for less government and more free market ideology, Secchi explains. But the entire agricultural market in the U.S., as Secchi explains in a recent paper, is based on government-driven extraction of the land; things like railroads to ship pigs across the country and corn yield advancements because of land grant university research.
“This tech bro idea that the market exists in a vacuum, and it’s this ideal that we have to aspire to is really not based in any reality,” she says. “The market is created by institutions like the state.”
DOGE aside, Frerick does not believe that much is likely to change at USDA with Brooke Rollins at the helm. “Her whole career is being a hack for [corporations] and the oligarch class, so I just don’t expect her to find the light all of a sudden,” he says. “But who knows?”
Based on an initial review of the DOGE website, one contract within the Agricultural Marketing Service has been terminated. It is unclear how this might affect checkoffs.
When asked if checkoffs were on the chopping block, Rollins told Farm Journal, “That is to be determined … I have not even begun to look at those. I know we’ve got a team looking at them. We’re going to get through the next few weeks and then we’ll start evaluating.”
Nina B. Elkadi wrote this article for Sentient.
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