Fighting hep C with a miracle cure and the 'Netflix model' hasn't been enough

The good news is there’s a cure for hepatitis C. The bad news is how hard it is to bring that miracle cure to the people who need it. For years experts assumed the drug’s astronomical price was the biggest barrier. So in 2019, Louisiana and Washington state adopted the “Netflix model,” as in paying a lower price for abundant access to the drug. Just last week the White House jumped on board for a national version.

But STAT’s Nicholas Florko has found that neither state is near its goal. In Washington, the treatment rate for Medicaid patients is now lower than before the initiative began, even with a lower price. “The further you get out in the population … the more you start to hit this population that is harder — harder to identify, more costly to convert to treatment,” Rena Conti of Boston University told Nick. Read his investigation here.

Biden: Time to ‘supercharge’ Cancer Moonshot

President Biden sought yesterday to re-energize a yearslong personal mission to defeat cancer, wrapping the longtime Cancer Moonshot goal in a message of national unity and bipartisanship, my colleague Sarah Owermohle tells us. The effort got a reboot earlier this year, setting a more modest goal of curbing cases and slashing deaths over the next decade. But there’s a big “but”: That renewed mission has no new funding. “I'll use my authorities as president to increase funding, break logjams, and speed breakthroughs,” he pledged yesterday at the JFK Library in Boston, 60 years after President Kennedy vowed the original moonshot would land a man on the moon.

Biden also highlighted new ARPA-H director Renee Wegrzyn, saying she’ll “bring the legendary DARPA attitude and culture bolus and risk-taking to ARPA-H to fill a critical need.” Besides cancer, advocates want to see ARPA-H tackle Alzheimer’s disease and other health challenges, including outcomes disparities.

A version of this item also ran in D.C. Diagnosis, STAT's twice-weekly newsletter about the politics and policy of medicine. You can sign up for it here.

Cannabis use in pregnancy tied to higher risk of kids' mental health disorders

As legal marijuana has become more common, its use during pregnancy has also grown, despite mounting evidence that it can harm children. A new JAMA Pediatrics study builds on previous research linking prenatal cannabis exposure to behavior problems when children were 9 to 10 years old. The new analysis connected prenatal cannabis exposure to mental disorders into adolescence, including attention, social, and behavioral difficulties, which could raise the risk of mental health disorders and substance use in later adolescence.

The researchers reached their conclusion after analyzing data from a study tracking nearly 12,000 children as they grew into young adults — the same group as in the earlier trial. Animal studies have shown that THC, the main psychoactive substance in cannabis, can cross the placenta and potentially affect brain development. The authors warn against cannabis use in pregnancy, which can be a difficult topic for doctors to address.

Closer look: It’s time for Medicare to upgrade wheelchair coverage, two users say

(DAVID NAPRAVNIK)

With the push of a button, wheelchairs can elevate people to eye level with a nondisabled person or position them into a “standing” posture (shown above, as Scott Liesch washes the windshield of his truck). That makes it possible to go to the bathroom or stock kitchen cabinets — everyday tasks nearly impossible when seated in wheelchairs without these capabilities. It seems Medicare doesn’t know how these devices allow healthier lives with dignity and independence, Paul Amadeus Lane of the United Spinal Association’s Tech Access Initiative and Jim Meade, a disability advocate, write in a STAT First Opinion.

Medicare doesn’t cover wheelchairs equipped with these technologies, which can cost $10,000 or more, because they are “not primarily medical in nature.” The writers call that a dubious claim because research shows these technologies improve health and avert serious and expensive injuries. “Our lives are a testament to that research,” they say. Read more.

Clues to how blood cancer patients respond to CAR-T could help match treatments

CAR-T therapy works in many but not all blood cancer patients. Among people who have their T cells engineered in a lab so they’ll kill cancer cells when re-infused, just 40% are cured. A new study in Nature Medicine used single-cell sequencing to study samples from 32 lymphoma patients treated with different CAR-T therapies: axi-cel (Yescarta) and tisa-cel (Kymriah). The analysis turned up molecular markers of treatment response and specific immune cells that likely lead to relapse.

Patients who relapsed after axi-cel therapy got more regulatory T cells, the brakes of the immune system. And patients who responded better to tisa-cell therapy had more CD8+ T cells (descended from memory cells) in their blood compared to patients who had a weaker response. “Understanding predictive molecular features of response specific to each product … may help identify which product is most likely to succeed in a given patient,” the authors write.

Opinion: ‘Disability does not exist in a silo,’ so med school curricula should add it

Nearly one-quarter of Americans say they have a disability, but you wouldn’t suspect that from medical school curricula, authors of a new commentary write in Trends in Molecular Medicine. Only 3.1% of practicing physicians report they have a disability, and that under-representation matters, they say. “Disability does not exist in a silo. Existing curricula on diverse conditions should consider opportunities to include disability health training, since disabilities coexist frequently with many chronic health conditions (e.g., diabetes).”

Among their recommendations:

Require and integrate disability health into objective structured clinical exams, board examination questions, and licensure requirements.
Increase representation of faculty, students, and staff members with disabilities.
Involve people with disabilities in developing education and training for medical students.
Prioritize and support the inclusion of 187 disability health curricula.

What to read around the web today

One of long Covid’s worst symptoms is also its most misunderstood, The Atlantic
Paying attention: Boston hospital helps breastfeeding Black moms, babies thrive, The Emancipator
Data likely support approval of Amgen’s KRAS-targeted drug, but still come with disappointments, STAT
Monkeypox shots, treatments, and tests are unavailable in much of the world, New York Times
Opinion: Health care needs a Black Friday sale: the case for legalizing discounts on medical services, STAT