After surprising news on an experimental Alzheimer’s therapy, what’s next?

Tuesday night’s news that an investigational Alzheimer’s treatment called lecanemab showed a slower decline compared to placebo in people with mild Alzheimer’s has sparked debate in academic labs, biotech circles, and in doctors’ offices. Here's what STAT reporters are following:

We just don’t know such crucial things as how well it really works, what the trial participants were like, how much it might cost, and what it means for other Alzheimer's drugs in development, Adam Feuerstein, Damian Garde, and Rachel Cohrs write.
Geriatricians aren’t sure the 27% difference in the rate of cognitive decline attributed to the drug will be meaningful for patients, Andrew Joseph reports, or how that might balance with side effects.
All the fuss around Aduhelm’s clinical trial failure wasn’t a waste, Matthew Herper opines. Lecanemab’s success matters because such randomized controlled trials are “medicine’s mic drop.”

Monkeypox vaccine may be cutting infection risk in U.S., early data say

A preliminary analysis of data from 32 states — which one expert called premature — appears to suggest that the monkeypox vaccine used in the U.S. is reducing the risk of infection among vaccinated people, CDC Director Rochelle Walensky said yesterday. People eligible because of their personal risk but didn't get vaccianted were 14 times more likely to contract monkeypox than those who were vaccinated, the analysis showed, two weeks after receipt of a single dose. “It might be true. But we can’t tell from this,” Michael Osterholm of the University of Minnesota told STAT’s Helen Branswell.

A big reason for the caution: It’s unknown if there were important differences between the vaccinated and unvaccinated people, such as whether people motivated to get vaccinated also cut back on the number of sexual partners they had to reduce their risk of contracting the virus. Read more.

‘I’m still the hope guy’: Barack Obama reflects on the future of health care

Former President Barack Obama stopped by Illumina’s genomics forum in San Diego yesterday to talk about the legacy of the Affordable Care Act and its role in nearly halving the number of uninsured Americans. STAT’s Jonathan Wosen was in the room and brings us his takeaways:

In a sit-down with Sonia Vallabh of the Broad Institute, Obama spoke about how his mother died of an aggressive cancer at 53. “It’s clear that she was diagnosed late,” he said. It’s a story he shared countless times, though one that took on extra significance given Illumina’s contentious acquisition of Grail, a company focused on early cancer detection.
In a room full of biotech bigwigs optimistic about the future of genetic medicine, Obama didn’t shy away from offering criticism. “What I’ve been frustrated by is that we’re still not maximizing even the data we currently have,” he said, noting data silos and few incentives for cooperation.
Reflecting on his eight years in the White House, Obama said that if a problem was easy to solve, it didn’t make it to his desk. “Poop rolls uphill, not downhill” when it comes to the presidency, he said. He drew parallels between the need for persistence in the rough-and-tumble world of politics and in the error-prone, slow-going world of scientific research. After all these years, he said, “I’m still the hope guy.”

Closer look: A family shaped by China's one-child rule confronts post-Roe abortion ban

(ANDREA MORALES FOR STAT)

Jen (above) was 38, expecting her second child and planning with her husband to again choose the name of a planet — this time, Mars — as a middle name. But her blood work showed signs of a serious genetic problem called trisomy 18. It was confirmed at week 18 of her pregnancy, when Roe v. Wade had been overturned. “I can’t keep carrying a child I’m going to lose,” she thought. Her own mother had an abortion in China because of its one-child policy, but Jen lives in Tennessee, where her maternal-fetal specialist was afraid he could go to jail for talking with her about abortion.

She felt lost. “You’re the person who’s supposed to take care of me,” she thought. “You’re the person who’s supposed to take care of my health.” STAT’s Eric Boodman has more of her story here, part of a series of snapshots from post-Roe America.

Virtual drug screen turns up LSD-like antidepressant without the trip

In the search for new and better antidepressant drugs, psychedelics like psilocybin have drawn the most attention — not all of it good. One of the biggest challenges has been how to separate the hallucinations from the hallucinogen. A new study in Nature gets at that question through virtual drug screening that turned up LSD-like molecules that seemed to have distinct antidepressant activity — minus the trademark hallucinations.

The computational biologists started with 3D iterations of more than 75 million LSD-related molecules, winnowing them down to two they tested in mice. They worked as well in mice as fluoxetine, or Prozac, but at a dose that was 40 times lower, and the antidepressant effects lasted for week. STAT’s Meghana Keshavan has more, including how you can tell when a mouse is happy, sad — or hallucinating.

A new bionic pancreas shows promise in managing type 1 diabetes

Counting carbs is serious, life-sustaining business for people who have type 1 diabetes. Even with automated insulin delivery systems, they still have to calculate the amount of carbs they eat in a meal and the amount of insulin they need to balance them out. New clinical trial results reported in NEJM conclude a system that lets users say whether an upcoming meal has more, less, or the same number of carbs than normal led to improvements in glucose control.

Those results are similar to what existing automated systems offer, but Beta Bionics, which created the device it calls iLet, says ease of use could complement what’s available now. “I think about my diabetes 24/7, and I think these systems just allow us to offset some of that,” Jen Sherr, a pediatric endocrinologist at the Yale School of Medicine, told STAT’s Katie Palmer. Read more.

What we're reading

Ebola experimental vaccine trial may begin soon in Uganda, STAT
Lasker Award honors development of noninvasive prenatal DNA test, New York Times
A ‘disaster,’ or a ‘clear path’ forward?: New FDA guidance on AI in medicine sparks strong reactions, STAT
When Indigenous people move to cities, health care funding doesn’t follow, Kaiser Health News
When will the pandemic truly be 'over'? Wired
FDA proposes new rules for which foods can be called ‘healthy,’ STAT