Good morning. Gun deaths. Opioid overdoses. Inequities. It's not just Covid that calls for our attention.

Gun deaths and disparities surged in pandemic’s first year

(CDC)

Guns were the weapons wielded in more than three-quarters of homicides in the U.S. during the first year of the Covid-19 pandemic, jumping 35% from 2019 to 2020 and marking the highest level since 1994, a new CDC analysis says. The suicide rate involving guns was stable at just over half of suicides, but there were increases among Native Americans and Alaska Native people. The most striking disparity came among young people. Guns killed Black children and young adults from 10 to 24 years old at a rate 21 times as high as among their white peers. “We're losing too many of our nation's children and young people, specifically Black boys and young Black men,” Debra Houry, an ER doctor and CDC's acting principal deputy director, told me. Read our full interview.

Medications to prevent overdoses are underused

Medications that lower overdose risk among people with opioid use disorder work only if those people get them. A new study in JAMA Network Open reports that fewer than half of people with opioid use disorder were prescribed one of the two most common drugs — buprenorphine or naltrexone — and fewer than 3 in 10 people got them for polysubstance use disorder, a mix of opioids, alcohol, stimulants, or other drugs. While both buprenorphine and naltrexone reduce the risk of future overdoses, buprenorphine worked better, the analysis of nearly 180,000 insurance claims showed. Each medication has its downside: naltrexone requires complete detox before people can start taking it and buprenorphine users must maintain abstinence for it to work. As overdose deaths grow, the researchers urge targeted efforts to needed to expand access to medications for opioid use disorder.

'When you lead with equity, everybody benefits'

Physicians, health equity champions, and twin sisters Uché Blackstock and Oni Blackstock sat down with STAT’s Nicholas St. Fleur for a conversation yesterday. Some highlights:

On their mother, Dale Blackstock:

“Our mom was part of the first wave of medical students that were recruited as a result of affirmative action, so she started [Harvard Medical School] in the late ’70s. … She was at the vanguard and at the forefront of all the changes that happened in medicine over those decades.” — Oni
“Both of us can continue her legacy.” — Uché

On 1 million U.S. Covid deaths and health inequity:

“This milestone is incredibly grim. We need our leadership to continually center health equity in every policy decision … Who's going to be disproportionately impacted by this change?” — Uché
“When you lead with equity, everybody benefits. … If you center the most vulnerable, everyone benefits.” — Oni

Closer look: Rooting out bias in machine learning models

(adobe)

After an explosion of excitement in the potential for machine learning in medicine, cracks in the foundation are emerging. More and more research is focusing on the ways that medical models can introduce algorithmic bias into health care. But in a new paper, machine learning researchers caution that such self-reflection is often ad hoc and after a model is released. They argue that to get “an unbiased judgment of AI bias,” there needs to be a more routine and robust way of analyzing how well algorithms perform. Without that process, they argue, researchers will only find the bias they think to look for. So they created a new framework designed to help regularly and holistically assess for drops in performance — whether a model is being developed or spot-checked for real-world use. STAT’s Katie Palmer explains, including how it’s like buying a car.

Model projects the costs of moving away from a zero-Covid strategy in China

Anyone watching China strictly enforce its zero-Covid strategy to stifle coronavirus variants — particularly in Shanghai, where most of the country’s 500,000 Omicron infections have been reported — might want to see a new modeling study in Nature Medicine. Its authors project what could happen if China pivoted away from cutting transmission toward mitigating the disease. Their answer is chilling: The researchers project that the country could see an Omicron wave causing about 1.55 million deaths and ICU demand up to 15.6 times hospitals’ existing capacity. And that takes into account primary vaccination levels above 91% and boosters over 53% of people over age 3. The study authors did say strategies including further vaccination of elderly and vulnerable people, providing access to antiviral medication, and mass testing along with restricted movements could save lives and the health care system.

Opinion: There's a danger in letting primary care be a rescue path for burned-out specialists

Sara Pastoor, a family medicine physician in Austin, Texas, has noticed an emerging phenomenon: Emergency medicine physicians are leaving the frontlines of Covid crisis care and opening independent primary care practices in direct primary care. That sector of health care operates at the fringes of the health care industry, funded by subscription-based payments that patients usually pay out of pocket, she writes in a STAT First Opinion. “The U.S. desperately needs more primary care clinicians. Yet as a residency-trained, board-certified family medicine physician, I have concerns about this phenomenon,” she says, countering an antiquated mindset that primary care physicians are general practitioners who know just enough to diagnose and treat the basic stuff. “The U.S. desperately needs more primary care clinicians. Yet as a residency-trained, board-certified family medicine physician, I have concerns about this phenomenon.” Read why.

If you or someone you know is considering suicide, contact the National Suicide Prevention Lifeline at 1-800-273-8255 (Español: 1-888-628-9454; deaf and hard of hearing: 1-800-799-4889) or the Crisis Text Line by texting HOME to 741741.

On this week's episode of the "First Opinion Podcast," First Opinion editor Patrick Skerrett talks with Michelle Proser about medical debt and potential stopgaps that could help patients get into necessary, supportive health care environments. Listen here.

What to read around the web today

Inside the sales machine of the ‘kingpin’ of opioid makers. Washington Post
How do people with disabilities feel about abortion? New poll sheds light for the first time. The 19th
Pfizer to buy Biohaven for $11.6 billion, raising hopes for the broader biotech market. STAT+
Parents hunting for baby formula as shortage spans US. Associated Press
A company with an early contract to produce coronavirus vaccine hid evidence of problems. New York Times
A new biotech investment firm, headed by a pair of noteworthy VCs, seeks to ‘free the founders.’ STAT+