Death Sentence: An investigation into prisons’ refusal to treat hepatitis C

(nicholas florko/stat)

There is a cure for hepatitis C, a medical marvel that defeats viral infection before it damages and sometimes destroys the liver. But the lifesaving drug is out of reach for people incarcerated in state prisons. A STAT investigation from Nicholas Florko found that more than 1,000 incarcerated people died from hepatitis-C-related complications in the six years after a curative drug hit the market. In 2019, the death rate for incarcerated people was double the rate for the broader U.S. population. Prisons say the medicine, even as its price drops, is too expensive for them to distribute widely.

“Most of those deaths due to hepatitis C — not all of them, but most of them — are preventable, and it’s inexcusable that they died,” said Jeff Keller, president-elect of the American College of Correctional Physicians and former chief medical officer of a private prison health care provider. “It’s unconscionable.” Read more here, and explore the Death Sentence project here.

Incarcerated people are fighting back: Taking on Idaho's hep C rules with a typewriter

(Alex Hogan/STAT)

Nearly all the progress the country has made in treating hepatitis C in prisons has come because incarcerated people have filed their own lawsuits against their jailers. When Phil Turney (above) took on the state department of corrections in Idaho, he didn’t have a computer, let alone internet access. He toiled on his Smith Corona Wordsmith 200 typewriter, lifting legalese from a copy of the Prisoner’s Self-Help Litigation Manual and an earlier lawsuit in Minnesota.

The former cab driver — serving a life sentence for injuries and damage after driving into two parked police cars while intoxicated — argued that Idaho’s policy of treating only the sickest people for hepatitis C constituted cruel and unusual punishment for prisoners with the virus, like him. He eventually found a lawyer to help, and got his hep C pills. He was paroled in 2020, healthy, after 15 years. STAT’s Nick Florko and Alex Hogan have more.

Trials of two Ebola Zaire vaccines show promise

STAT's Helen Branswell brings this report: Two studies — one in adults, the other in children — measuring long-term immune responses to both the Merck and Janssen Ebola Zaire vaccines showed solid antibody responses as far as 12 months after the initial dose. The NEJM paper randomized adults and children from four African countries to get the two-dose Janssen vaccine, the one-dose Merck vaccine plus a placebo, two doses of the Merck vaccine 56 days apart, or placebo. Both groups that received two active doses reached higher antibody levels after the second shot. But by six months, the value of the second shot had disappeared, with the single Merck vaccine faring as well as two doses of Merck and better than the Janssen vaccine.

The findings support the value of the one-dose vaccine regimen in outbreak settings. But there remain questions about how to best protect health care workers, emergency responders, and Ebola researchers — people at ongoing risk. One of the authors, Clifford Lane, clinical director of the National Institute of Allergy and Infectious Diseases, said work is underway to study whether giving a booster dose of the Merck vaccine at 18 months would enhance the durability of the immune response.

Closer look: Tech has been hiring chief health equity officers. What does that mean?

(adobe)

Health tech companies like Teladoc and CVSHealth have appointed health equity officers this year, responding to heightened attention to troubling health disparities. George Floyd’s murder and the pandemic’s disproportionate toll on communities of color helped push these positions into the C-suite. But people in these prominent positions — and the ones hiring them — are still defining the role, and in some cases, fighting for buy-in and resources in their organizations.

“Because they don’t understand how to set strategy and the complexity of it and what all is involved, they think they can just put together some kind of cookie cutter approach and then look to the health equity officers to come in and check a box and then sign off on it,” Mary Stutts of Real Chemistry told STAT’s Mohana Ravindranath. “And the health equity officers are like, you haven’t even built it right from the beginning.” Read more.

Waiting longer for surgery after Covid tied to fewer post-op problems

The timing of surgery after Covid infection can be critical, a new study in JAMA Network Open reports. In their analysis of nearly 4,000 patients, researchers estimated a 1% reduction in risk of postoperative problems for every 10 days after a positive Covid diagnosis. Those problems included deep vein thrombosis, pulmonary embolism, stroke, myocardial injury, acute kidney injury, and death within 30 days after surgery.

The cardiovascular outcomes make sense, the authors say: Covid-19 is a respiratory disease, but it also causes vascular inflammation and sweeping changes in clotting that lead to serious damage. The infection ramps up inflammation, raising the risk of death in surgical patients with more inflammatory activation as a result of their operations. “Understanding the potential benefits associated with delaying surgery provides a key step in clinicians’ ability to optimize surgical timing for the increasing population of patients who have been infected with Covid-19,” they write.

NCI director reveals her cancer diagnosis

Monica Bertagnolli, a surgical oncologist named in July to lead the National Cancer Institute, revealed yesterday that she has been diagnosed with early-stage breast cancer. She learned last month after a routine mammogram that she has hormone receptor-positive, HER2-negative breast cancer that does not appear to have spread. She told the Washington Post she is a realist, recalling an older doctor who used to remind colleagues that every day walking through hospital doors as a doctor and not a patient was a great day.

“I always had it in my mind, yeah, one of these days I’m going to be a patient,” Bertagnolli said in the Post interview. “We all are.” As a patient, she will participate in a clinical trial of a diagnostic test designed to pick appropriate breast-cancer treatment. “To anyone with cancer today: I am truly in this together with you,” she said in an NCI statement.

What we're reading

Some of the same members of Congress pushing to restrict cigarettes and vapes are quietly investing in tobacco giants, Business Insider
Antiabortion movement seeks to jail people for 'trafficking’ illegal pills, Washington Post
Medical staff in China's hospitals say Covid-19 ripping through their ranks, Reuters
Public access to scientific research findings and principles of biomedical research — a new policy for the JAMA Network, JAMA
Opinion: Paid sick leave is good for workers — and U.S. public health, STAT