New theory on unusual hepatitis cases in kids points to three factors

There is a new theory about what may be causing puzzling cases of pediatric hepatitis of unknown origin — and it’s complex, STAT’s Helen Branswell warns us. In two new unpublished studies from U.K., scientists suggest these children may have been co-infected with two different viruses and had a genetic predisposition to an over-exuberant immune response. The prevailing hypothesis has said adenovirus 41 was causing the liver damage, although it had never been seen to do so in children with intact immune systems.

Now another virus has been found in some affected children: adeno-associated virus 2 — a “dependoparvovirus” that cannot replicate in a host’s cells unless another virus is present. “If this is correct,” Angela Rasmussen of the University of Saskatchewan told Helen, “you need the combination of all three” — a helper virus, such as adenovirus 41, the adeno-associated virus 2, and the genetic predisposition. Read more.

Clinical trials on ultra-rare diseases pose thorny challenges

(MEGGAN HALLER FOR STAT)

This sounds like the tragedy of small numbers: So few people have rare diseases that mounting clinical trials to test treatments is an uphill battle. And this is an issue likely to intensify with the rise of precision medicine to target rare diseases. STAT’s Ed Silverman brings us the story of 33-year-old Walker Burger (above), whose ultra-rare Barth syndrome has almost disappeared while taking a Stealth BioTherapeutics drug aimed at his enlarged heart, muscle weakness, and shortened life expectancy. But the FDA has refused to review the drug after a small clinical trial including Burger.

Stealth is not giving up on its medicine, elamipretide, and will meet with FDA next month. The company, and Burger, are not alone in facing hurdles compounded when science outpaces regulatory frameworks that determine when a drug makes it to market. Ed has more, including FDA’s view.

Americans give pharma high marks on Covid

It wasn’t so long ago that pharma’s reputation with the American public was less than stellar, drawing an approval rating of just 32% in January 2020. Then the coronavirus pandemic changed everything. Now, nearly three-quarters of Americans give the pharmaceutical industry credit for helping contain Covid-19, a new survey conducted by the Harris Poll for STAT says.

Asked what industries they credit for helping contain the coronavirus, 71% said the pharmaceutical industry deserves credit — more than the percentage who gave credit to the CDC, FDA, or the White House. Only hospitals, makers of protective equipment, scientists, doctors, and nurses scored higher. “Pharma is in quite a good position — it’s not the kind of numbers you’d expect historically for them to get credit on anything,” said Rob Jekielek, the managing director of the Harris Poll. STAT's Nicholas Florko has more.

Closer look: Ivermectin is back, now for long Covid, with a push from right-wing political groups

(ALFIELD REEVES FOR STAT)

Ivermectin never really went away. Discredited by evidence-based medicine as a treatment for acute Covid, the horse dewormer and human antiparasitic has returned as a remedy for long Covid, its false promise holding undeniable allure for patients who, like Dean Fritzemeier (pictured with his wife, Karen), are struggling to recover. In a new investigation, STAT’s Olivia Goldhill reports that the drug is being pushed by physicians with ties to political groups spreading anti-vaccine and anti-science messaging.

These doctors, with the support of political heavyweights, were promoted on right-wing media, including Fox News, Breitbart, and former Trump adviser Steve Bannon’s podcast. They helped create a counter-narrative that encouraged distrust of pharmaceutical companies and health agencies. Ivermectin has become a highly lucrative sword in that fight, said several doctors working to combat misinformation, playing on the same themes of distrust in science-based medicine. “It taps into existing under-currents,” said scientific-integrity researcher James Heathers. Read more.

Maternal health care delivered by telehealth stacks up with in-person visits

Maternal health care is in crisis in the U.S., with stark disparities making the need for solutions all the more urgent. Another crisis — the coronavirus pandemic — may point the way. A new review evaluating care delivered via telehealth to add to or replace in-person care concludes options adopted during pandemic lockdown were as good or better than in-person only. Like all prenatal care, the purpose is to identify conditions so timely prevention or treatment could begin. In most of the 42 studies reviewed, telehealth interventions supplemented in-person care for mental health, hypertension, and diabetes during pregnancy.

“Maternity care is particularly ripe for innovation, given the limited evidence supporting traditional approaches to prenatal care that rely on multiple in-person visits,” the researchers write in Annals of Internal Medicine. But, “The effect on access to care, health equity, and harms is unclear.”

More long Covid signs: loss of hair and libido

By now we’re familiar with the persistent symptoms of long Covid: fatigue, shortness of breath, muscle pain, joint pain, headache, cough, chest pain, altered smell and taste, and diarrhea. A new study in Nature Medicine comparing nearly half a million non-hospitalized Covid patients to an uninfected, matched control group three times as large adds new symptoms to the list of problems lingering three months or more after acute infection.

Hair loss and sexual dysfunction joined dozens of symptoms seen more frequently in long Covid patients, based on electronic health records in primary care settings from January 2020 through April 2021. Other common symptoms were loss of sense of smell, shortness of breath, chest pain, and fever, consistent with other studies. Being female, younger, or Black, Native American, Middle Eastern, and Polynesian was linked to higher long Covid risk, as was socio-economic deprivation.

What to read around the web today

How an AP reporter broke the Tuskegee syphilis story, Associated Press
‘What can we do?’: Pharma lobbyists face their biggest test in a decade, as Democrats barrel toward a vote on drug pricing, STAT
Videos promoting dangerous herbal abortions continue to circulate on TikTok despite platform's pledge to crack down, NewsGuard
Senators demand answers about federal prisons’ scant use of Covid therapeutics, STAT
For thousands of Georgians, freely traveling across state lines for an abortion is not an option, Bolts
American Cancer Society’s VC arm partners with Third Rock on oncology companies, STAT