How scientists are getting closer to linking the microbiome and chronic diseases

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Remember when the microbiome was a revolutionary concept? The recognition that microbes in us and on us not only outnumber our cells but act on our health was something like discovering a new planet. Over the last decade, characterizing these bugs — different and continually changing for each of us — has dominated research. Treatments that followed have a short but checkered past.

Now, STAT’s Isabella Cueto reports, links are being formed between microbes and chronic diseases with the hope of easing their burden. Three recent research papers focus on colorectal cancer, rheumatoid arthritis, and lupus. “I do not doubt that someday we will get there for certain disease management, prevention, or even cure — but I anticipate a long bumpy ride ahead,” said Juliana Durack, a clinical microbiologist who was not involved in the research. Read more about the studies and what they hint about the field.

New guidance for opioid prescribing favors flexibility for treating pain

How opioids should be used to relieve pain is an evolving practice, one that federal health officials recognized in new guidelines issued yesterday that remove specific dose and duration targets — rules that pain experts said caused unintended harm. Guidelines from 2016 helped further drive down opioid prescribing levels that had already been declining since 2012, as the country confronted years of overprescribing that contributed to the overdose epidemic. Critics then said while prescriptions dropped, other harms rose for people already on opioids, cutting off some patients from medication they depended on.

The new guidelines emphasize individualized, flexible care while trying to lower the risk of harm that comes with opioid use. “They’re really saying to payers and health systems and states, you need to course correct,” Kate Nicholson of the National Pain Advocacy Center told STAT’s Andrew Joseph about CDC’s revision. Read more.

Pfizer data show bivalent boosters offer more protection against Covid variants

A slew of small studies have tried to ascertain just how well new bivalent Covid boosters — designed to protect against the original virus and its later variants — work. Data released today from Pfizer and BioNTech suggests their updated Covid-19 vaccine may be more protective against more recent Omicron subvariants than the original version of the vaccine, the companies said this morning.

They report that neutralizing antibodies targeting the BA.4 and BA.5 subvariants of the SARS-CoV-2 virus were four times higher in people aged 55 and older who received the bivalent booster than in similarly aged people who received a monovalent booster. The trial looked only at antibody levels, not how likely people were to contract Covid. Still, Eric Topol of Scripps found the results promising. “I think this is encouraging,” he told STAT’s Helen Branswell. “We just need more people to get the darn booster.” Read more.

Closer look: How doulas can help prevent childbirth harms

(MOLLY FERGUSON FOR STAT)

It’s an issue patients have long known, and leading health organizations are recognizing it, too: Widespread harm can happen during childbirth — from unnecessary episiotomies and exams performed without consent to dehumanizing or dismissive language. Patients may not be aware that doulas, midwives, and other birth workers — whose chief job is to ensure parent and infant are safe and healthy during delivery — can help mitigate those harms by serving as a trusted liaison between doctors and patients.

With maternity care "deserts" in the U.S. leaving some 7 million people with limited access to maternity care during pregnancy, the need for birth workers has never been more urgent, STAT contributor Candace Y.A. Montague writes. In April 2022, the federal health department announced $4.5 million in new grants to invest in doulas as part of its effort to reduce maternal mortality and other severe complications, which take a particularly high toll on Black people. Read more.

Uganda's Ebola outbreak not yet under control, WHO warns

The growth of new cases in Uganda’s Ebola outbreak may have slowed a little but it is too soon to suggest the outbreak is coming under control, WHO officials warn. The outbreak is already the eighth-largest on record, with 152 confirmed and probable cases, and 67 confirmed and probable deaths.

A problem the WHO sees is the fact that infected people are not being found and isolated fast enough, remaining in the community where they may transmit the virus to family and friends. The average time from symptom onset to isolation is five days, Ibrahima Socé Fall, WHO’s assistant director-general for emergency response said this week. “We need to make sure that this is reduced,” Fall said. In one case in this outbreak, a single individual infected 31 other people. Eighteen of the cases have been health workers; six of them have died.

Long Covid diagnosis and care are fraught with uncertainty, VA study says

Long Covid can be a long list of lingering symptoms reflecting a condition that still resists definition, not to mention prevention, treatment, or estimates of prevalence. A new qualitative study in JAMA Network Open sums up the challenge of diagnosing and treating long Covid, based on a national sample of health records for 200 veterans (mostly white men). Two themes emerged: clinical uncertainty (was it long Covid or something else?) and care fragmentation (silos of treatments). Some excerpts:

“[Patient] has several different cognitive issues that affect his memory and ability to process frustrations. He has [traumatic brain injury] from a self-inflicted gunshot wound to his head, the aftermath of long-term Covid-19, and the effects of long-term alcoholism.”
“[Patient] says he had a CT done which was ordered by the Covid team. … CT shows upper lobe [pulmonary] nodule which no one told [patient] about, my telling him is new information to him.”

What we're reading

What does the booming sperm-donor industry owe to people it helps conceive? Quartz
'Death at your toes': A look inside a Mississippi maternity care desert, Mississippi Today
‘Our community is supported at the highest levels’: Adm. Rachel Levine on gender-affirming care, STAT
Opinion: Respiratory infection surge sounds a wake-up call for pediatric emergency care, STAT
Haven’t seen your doctor in a few years? You may need to find a new one, Kaiser Health News
A leaked version of a U.K.-India free trade deal sparks alarm over access to medicines, STAT