In 2015, Jonathan Buckelew was a healthy, 34-year-old man when a chiropractic neck adjustment triggered symptoms that would quickly spiral. He fell unconscious, then was rushed to a hospital. Over the next hours, several physicians failed to recognize that he was having a stroke. That misdiagnosis cost him his ability to move or speak — he developed locked-in syndrome, a condition where a person is aware and awake but cannot move or communicate except by eye movements or blinks. Earlier recognition and prompt treatment might have avoided that outcome. In 2025, a court ruled in his favor, awarding damages totaling $75 million for what was deemed an entirely avoidable tragedy.
Jonathan’s story is painful. It shows how even when we know what to do — for stroke, timing is critical — system failures, delays, or misapplication of evidence can turn treatable situations into life-altering disasters. The U.S. invests heavily in medical research, new therapies and care infrastructure, yet in outcomes that depend heavily on swift, evidence-based action — like strokes, cardiac arrests, maternal emergencies and preventive screenings — we often fall short. Reporting on the shortfalls, as well as programs and initiatives that are enhancing health delivery, can help build awareness, transparency and accountability.
Evidence vs. reality gap
By nearly every measure of population health, the U.S. continues to trail its peers despite spending more on health care than any other country in the world. Life expectancy remains lower than in other wealthy nations, deaths from preventable causes are higher and access to basic care is uneven. The disconnect between knowledge and practice offers an important story for journalists to tell: It’s not the quantity of research or dollars that matters, but how well evidence is applied to prevention, access and delivery of care.
A 2024 Commonwealth Fund report put it bluntly: the U.S. ranks last among 10 high-income countries in overall health system performance, despite spending nearly 20% of its gross domestic product on health care. The report found that Americans die younger than their peers abroad, often from conditions that could have been prevented or treated. In fact, U.S. life expectancy is more than four years below the average of comparable nations.
Take stroke care, for example. Decades of research show that early intervention — using clot-busting drugs (thrombolytics), mechanical thrombectomy, and fast transport to appropriate care centers — can reduce disability and death. But numerous cases, including Jonathan’s and others, show that even when people show unmistakable symptoms, delays in diagnosis, misinterpretation of imaging, or failure to transfer to a high-capability center lead to far worse outcomes.
More research alone isn’t solving these problems
It’s not that we lack knowledge. There is strong evidence in many areas: how to prevent disease, how to organize care, how to deliver it in ways that reduce disparities. What is missing is the consistent, large-scale, systematic application of that evidence.
Some concrete examples:
- Preventable deaths are still high. Despite evidence around smoking cessation, vaccination, hypertension control and obesity prevention, substantial numbers of deaths remain preventable, especially in disadvantaged populations. The U.S. has not translated enough of that into policy or sustained community interventions. The Commonwealth Fund shows “avoidable mortality” rising in U.S. states even as it falls elsewhere.
- Health insurance is still inaccessible and unaffordable for many. Evidence has long shown that expanding Medicaid or making insurance affordable leads to better outcomes (lower mortality, better chronic disease control, earlier detection). States that expanded Medicaid have done better on many metrics; those that didn’t, lag. Still, many remain uninsured or underinsured, and proposals under consideration threaten to roll back protections.
- Data and predictive tools are skewed by access gaps. A recent study shows that when people delay care due to cost, or otherwise have limited access, their medical records are less reliable; that in turn makes risk‐prediction models less accurate, especially for people with worse access. So a model validated in academic medical centers might underperform in disadvantaged communities.
- Social determinants and disparities persist. The fundamental causes of health inequities (income, environment, housing, racism) are well documented. But research and resources often focus on downstream medical treatment rather than upstream prevention (i.e. clean air, safe housing, food access). In places where upstream interventions have been tried consistently (i.e. tobacco control, clean water), improvements are seen; elsewhere, inertia continues.
What journalists can do
There are places where stroke care and outcomes are improving — where networks of primary stroke centers work in tandem with comprehensive centers, where protocols are followed, where EMS education ensures stroke signs are recognized in the field, and where public health campaigns raise awareness of stroke symptoms (for example, FAST: Face-Arm-Speech-Time). Where these systems work well, lives are saved and disability is reduced.
If the U.S. could reduce delays and misdiagnosis even partially — to mirror best-practice systems — it could reduce the burden of disability and death. And that’s true not just for stroke, but for many other conditions: heart attacks, infections, cancers and chronic disease progression.
- Dig into local data. State or county care systems often reveal much more about what works or doesn’t.
- Ask not just “how many” but “for whom and where.” Numbers are meaningful only when disaggregated by race, income and geography.
- Hold leaders accountable for implementation. Research yields evidence, but only policy plus execution lead to change. Show gaps, for example,, when states don’t adopt known effective programs, or when health systems fail to follow evidence-based guidelines.
- Cover upstream causes. Air quality, housing, food, economic inequality. These are harder to report on than clinics, but they are powerful indicators of the state of health.
- Spotlight lived experiences. Patients, caregivers and community groups know where “evidence” fails in practice. Their stories make the disconnect visible and can humanize the numbers.
