Doctors want more data on Paxlovid prescribing

The pool of people who can prescribe Paxlovid got even broader yesterday, but the picture is no clearer on when to prescribe it and to whom. The FDA now allows pharmacists to prescribe the antiviral, shown to reduce the risk of hospitalization and death by 89% in an early study. The three pills taken twice a day for five days should be prescribed within five days of symptom onset to people 12 and older who have tested positive and are “at high risk for progression to severe Covid-19.”

Exactly what that means is up to clinicians. “There is a real dearth of evidence right now out there, and obviously there’s a lot of confusion,” physician Jonathan Li told STAT’s Edward Chen. Doctors are also clamoring for more data on rebound — when symptoms return — which is complicating and sometimes changing their calculus about when to give it. Read more on where opinions diverge.

Four candidates to lead ARPA-H share one thing

The names almost rhyme. Francis Collins, currently White House science adviser, is focusing on former DARPA officials as he vets candidates to lead ARPA-H, the Biden administration’s new high-stakes science agency. Collins has spoken with at least four people who served at the renowned Pentagon research office — neuroscientist Justin Sanchez, biologist Renee Wegrzyn, genomics researcher Brad Ringeisen, and materials scientist Alicia Jackson — sources familiar with the process told STAT’s Lev Facher. A spokesperson for the White House Office of Science and Technology Policy declined to comment.

Such a hiring strategy makes sense because the new Advanced Research Projects Agency for Health is explicitly modeled after DARPA, famous for helping create the internet and GPS technology. While each of the candidates Collins has spoken with has extensive DARPA experience, none has run a federal agency as a whole. Lev has more about the four in an exclusive story.

Common injections no better than placebo for knee osteoarthritis, another study concludes

Osteoarthritis is a painful, chronic condition that follows the breakdown of cartilage that should cushion knees, hips, or other joints. Because there is no cure, people often manage their knee osteoarthritis with exercise, physical therapy, medications, and injected therapies. Since the 1970s, hyaluronic acid has been one of those injectables. But a new review of 50 years' worth of data on this commonly used treatment found that it was barely more effective than the placebo effect in reducing pain and improving function.

The BMJ study caps decades of mounting evidence showing hyaluronic acid injections don’t help most osteoarthritis patients, but the shots are widespread and costly, adding up to $300 million each year in Medicare claims alone. STAT’s Isabella Cueto has more on how this came to be.

Closer look: It’s suddenly ‘hot’ to discuss gut diseases

(BELLIWELLI)

In Los Angeles, near the corner of busy Santa Monica Boulevard and Corinth Avenue, underneath lines of skinny palm trees and against an almost perpetually bright-blue sky, a hot pink billboard declared: Hot girls have IBS. If you didn’t already know, STAT’s Isabella Cueto explains that irritable bowel syndrome has become, half-jokingly, "a membership card for a club of online it-girls, generating a wider conversation about health, seeking out care, and advocating for oneself in the doctor’s office."

Joking and all, it's helping people talk about not just mildly uncomfortable conditions, but also more severe, chronic ones. Young women are making jokes about bloating — and recommending foods to avoid it. And blogger and TikTok creator Renée Welch is among those giving visibility to incurable, more disabling chronic diseases affecting their guts — in her case, the much more serious Crohn’s disease. Read more.

Pulse-oximeter bias confirmed outside the ICU, too

It’s a long-documented disparity that’s been getting renewed attention during the pandemic: Inaccurate oxygen readings from devices that can work poorly in darker-skinned individuals are delaying organ-protecting, lifesaving therapies in Black people. There has also been pushback against research showing the poor performance of pulse oximeters from critics who say other factors than the fingertip sensors could have been at play as Covid crashed ICUs. Researchers writing in BMJ took another tack, looking at more than 30,000 patients on other hospital wards in more than 100 VA hospitals from 2013 through 2019.

They confirmed greater discrepancies in Black than white patients when the devices were compared to more accurate arterial blood gas readings within 10 minutes. The probability of hidden but dangerously low oxygen was 19.6% in Black veterans, 16.2% in Hispanic or Latino veterans, and 15.6% in white veterans.

Hypertension control wanes in middle-income countries, study says

It’s easy to take blood pressure control for granted in countries where people with hypertension commonly take medications to treat the world's leading preventable cause of heart disease. But a new study in Science Translational Medicine points out that’s not always the case in middle-income countries. After following more than 8,500 patients in China, Indonesia, Mexico, and South Africa for five to nine years, the researchers found that most people diagnosed with high blood pressure discontinued treatment, leaving their blood pressure uncontrolled. Only 30% of people were diagnosed in the first place, and only 25% got treatment.

They also note that up to two-thirds of people with hypertension live in low-income countries, which may have wider gaps in care. “Policies solely aimed at improving diagnosis or initiating treatment may not lead to large improvements in control,” the authors write.

What to read around the web today

In a high-profile misstep, the FDA backtracks on its ban on Juul. STAT
Cancer drug greatly reduces deaths in hospitalized Covid patients, New York Times
Did Covid vaccine mandates work? What the data say, Nature
FDA will help overseas formula makers to keep selling in U.S. past shortages, Wall Street Journal
Here’s what Democrats changed in their latest drug pricing bill, STAT
Under new ownership, IBM Watson Health’s core assets get a rebranding, STAT