Have researchers hit a wall searching for drugs to treat severe Covid?

Make no mistake: People are still dying of Covid-19, at a rate of 2,000 patients a day around the globe, including 300 to 500 in the U.S. But as the death toll dips to levels not seen since March 2020, it becomes harder to test treatments. Severely ill patients are filling ICU beds in numbers that are sometimes too small to draw conclusions from therapies tried on them. That’s in contrast to the four effective therapies discovered from January 2020 to February 2021.

Patients are different now, too: more likely to have severe preexisting conditions and compromised immune systems, or to be unvaccinated. Their needs are different, and as of now, unmet. “If I get Covid when I’m 90, I’d like whoever’s taking care of me to know what to do,” Davey Smith, infectious disease physician at the University of California, San Diego, told STAT’s Jason Mast. Read more.

'I never saw that coming': Francis Collins on low Covid vaccination rates

Former NIH director and current White House science adviser Francis Collins told a group of health journalists last week about his passion for both the Cancer Moonshot and ARPA-H, the new biomedical research agency. But he also revealed his pain at seeing people spurn mRNA Covid vaccines developed with breathtaking speed. Some remarks that struck me:

On low vaccine uptake:
I never dreamed that six months later, when anybody who wanted the vaccine could get it, that 50 million people weren't and still aren’t [vaccinated]. I never saw that coming. And the consequences of that are all around us now. And it continues.

On what went wrong:
We failed to convey scientific information in a fashion that was compelling. We were basically outgunned dramatically by lies and conspiracies in social media. We should have had our own version of flooding the system with truth instead of having the system completely flooded with lies.

Read more of what he said, before we headed to the venue’s bar to hear him sing and strum his guitar.

CRISPR treatment safely corrects DNA of six patients with rare disease, Intellia reports

The results are so early that it’s too soon to say if they’ll hold up in larger studies. Still, data from Intellia Therapeutics show — for just the second time — the promise of CRISPR-based gene editing delivered and performed in the body. At a symposium in Berlin on Friday, the company said the first six patients to receive its CRISPR-based treatment, NTLA-2002, for a genetic swelling disorder called hereditary angioedema have safely had small, corrective changes made to dysfunctional DNA inside their liver cells. Other companies developing treatments based on CRISPR either perform the work on cells in a lab and then re-administer them to patients, or inject them directly into the target tissue.

NTLA-2002, like Intellia’s lead candidate, NTLA-2001, for treating transthyretin amyloidosis, is starting to show how a platform technology like lipid nanoparticle-delivered CRISPR might address any genetic disease where there is a liver-expressed protein. STAT’s Megan Molteni explains.

Closer look: Medicare wields its payment hammers to fix the dialysis system

(OSCAR DEL POZO/AFP via Getty Images)

Dialysis is a fact of life for the millions of Americans living with chronic kidney disease. A transplant may be the ideal solution, but that gold standard is out of reach for many who go to dialysis centers three times a week or for the minority who can do dialysis at home. Those treatments use machines to do the work of kidneys in cleansing blood, something largely controlled by two businesses, DaVita and Fresenius. Medicare — which covers most of the health care related to end-stage renal disease — is challenging them to make sure patients are told about their options for care, whether it’s home dialysis or pursuing a kidney transplant.

The large trial, called the End-Stage Renal Disease Treatment Choices (ETC) model, mandates about 30% of dialysis providers in the country to participate, and the other 70% are used as a control group. STAT’s Isabella Cueto explains the stakes involved.

Medical debt spirals into other problem, study says

Medical debt is common in the U.S., even among people who have insurance. A new study in JAMA Network Open connects unpaid medical bills to a cascade of worsening social determinants of health. The researchers’ analysis of national data on income, insurance coverage, and ability to pay for food, housing, and utilities found that 1 in 11 American men, 1 in 8 women, and nearly 1 in 5 households carry medical debt. As might be expected, people with middle-class or low incomes bear the brunt of the medical debt burden.

“Our findings suggest that incurring medical debt leaves many unable to pay for utilities, and worsens housing and food security, key [social determinants of health] associated with adverse health outcomes,” the authors write. “Unaffordable medical bills may constitute a [social determinant of health] in their own right and contribute to a downward spiral of ill-health and financial precarity.”

Opinion: Surgery needs a pay model free from incentives to do more procedures

Oh, the perversities of the U.S. medical reimbursement system. You’re probably familiar with the fee-for-service model, which rewards doctors financially for the more things they do, not for the better health of their patients. Writing in a STAT First Opinion, neurosurgeon Simone Betchen explains how surgeons are paid, based on the relative value unit (RVU) scale. Intended to pay busier and harder-working surgeons more, it has coincided with surgeons performing more procedures and surgeries, incentivizing the longer and bigger surgery when there are choices, for example, between discectomy and lumbar spine fusion.

“Given how health care works in the U.S., solutions will be evasive, imperfect, and hard to craft,” she writes. “Changing to risk sharing models and getting all of the stakeholders to agree on a new model is a lot easier said than done, but it is possible — and necessary.”

What to read around the web today

WHO raises alarm on disease in flood-hit areas of Pakistan, Associated Press
Coivd is still killing hundreds a day, even as society begins to move on, Los Angeles Times
Patients for Affordable Drugs taps new leader, STAT
Biden’s monkeypox adviser is trying manage a virus while dodging talk of Satanism, Politico
Opinion: FDA and USDA need to get on board with the CDC about reducing antibiotic use in raising animals for food, STAT