Special report: Despite little progress in health equity, these leaders forged ahead anyway

Risa J. Lavizzo-Mourey, a physician and co-author of “Unequal Treatment.” (hannah yoon for stat)

Yesterday STAT’s Usha Lee McFarling told us how little progress has been made in the 20 years since the landmark National Academies report “Unequal Treatment” examined how systemic racism leads to poorer medical care for people of color in the U.S. Today, she tells us in part 2 of her special report, there are signs of hope — and that the struggle to advance health equity may be at an important inflection point. They include an effort to make a medical center fully antiracist; a program to collect and use high-quality racial, ethnic, and language data to measure and counter disparities on a statewide level; another to harness the power of electronic records to reduce pneumonia deaths in young Black patients; and work to boost the number of Black and brown students at a top medical school.

Two studies unravel the genetic roots of ALS

Peering into the neurons of a person with ALS, you’d see a key protein knotted into clumps and missing from its usual post in the cell’s nucleus. It’s a telltale sign of the devastating neurological disease and a mystery that two studies published yesterday in Nature are helping to unravel. Researchers found that defects in a molecule that processes and preps RNA causes cells to churn out faulty versions of UNC13A, a protein that influences how neurons signal one another. “This discovery tells us a lot about how the disease works. And it puts a path towards designing a therapy and testing it,” Aaron Gitler, a Stanford geneticist and senior author of one of the studies, told STAT’s Jonathan Wosen. “But there’s still a long way to go.” Read more.

Better screening can narrow disparities in colorectal cancer, study says

Colorectal cancer is one of the most preventable types of cancer with early detection. Black men face a higher risk, but better screening can address this health inequity, researchers write in the New England Journal of Medicine. They describe how a large California health plan using mailed fecal tests and colonoscopy improved rates of colorectal cancer screening and detection while narrowing racial gaps. Among nearly 800,000 patients over age 50, the incidence of early-stage colorectal cancer initially increased in both groups, followed by decreases in both early- and late-stage cancers. The initial rise and fall in cases were greater among Black people, but the differences in mortality rates between Black and white people eventually shrank from 22 deaths per 100,000 people to 2 deaths per 100,000 people. The researchers credit equitable delivery of care.

Closer look: Insurance tech startups have yet to prove their business models

Tech companies looking to overhaul the health insurance industry have made much-hyped entries onto the public market. But they have yet to prove they can make money in the long run. The stocks of two star companies — Oscar Health and Clover Health — have plummeted since their initial trades. They’re still racking up losses and the proportion of premiums they spend on medical claims outpace lower-tech health insurance competitors. “There’s still a lot of investor skepticism, whether just the technology piece alone is sufficient,” Cowen analyst Gary Taylor told STAT’s Mohana Ravindranath. It’s not yet clear whether sophisticated software that identifies preventive care opportunities and lower-cost medication can eventually deliver profit for Clover, Oscar, and other competitors like Bright Health. But there are a few takeaways from the first slate of insurance tech companies’ end-of-year earnings reports. Read more in STAT+.

Mental health emergencies rise with extreme heat, study says

When we worry about climate change worsening health, we shouldn’t forget mental health. A new study in JAMA Psychiatry makes that point after tracking surges in mental health visits to hospital emergency departments when temperatures spike. Combing through insurance claims data for nearly 3.5 million ED visits, the researchers found an association between extreme heat waves and worsening symptoms from mood or anxiety disorders, substance use disorders, schizophrenia, and suicide risk. The researchers note that stress of any kind can exacerbate mental health problems, but they mention disrupted sleep when it’s hot or a more general worry about climate change as potential contributors to distress. And they acknowledge people may be suffering but not going to an ED. “As bad as certain climatic stressors already are, this truly is just the beginning,” a companion editorial warns.

Opinion: I learned from Paul Farmer we need to treat both the system and the disease

As a young physician trying to understand how he could help improve health care delivery for marginalized patients, Junaid Nabi was dismayed by the economic, social, and political barriers that impede the path toward good health. Later Nabi, who grew up in the politically fragile and economically disadvantaged Kashmir region of India, was inspired by Paul Farmer, the physician and global health champion who died earlier this week. “Farmer taught an entire generation of physicians to reimagine the practice of medicine and work toward treating the systems that surround patients, and not just the diseases they had,” Nabi, now a physician and senior researcher in health care strategy at Harvard Business School, writes in a STAT First Opinion. That means not just treating tuberculosis with antibiotics but also addressing the inadequate nutrition and poorly ventilated housing where it thrives. Read more about lessons for the pandemic.

What to read around the web today

U.S. vaccination drive is bottoming out as Omicron subsides. Associated Press
Maternal deaths rose during the first year of the pandemic. New York Times
Hedged in by rivals, Omada looks to corner the market for virtual chronic disease care. STAT+
U.S. Justice Department to end Trump-era program targeting threats posed by China. Reuters
Regulatory warnings about drugs are tied to modest drops in prescribing. STAT+