Good morning and happy Friday. We’ll be on hiatus until Tuesday, Jan. 4, 2023, when we'll wish you a Happy New Year. (Scroll down for some year-end favorites.)

The latest Alzheimer’s drug should be cheaper than the last one, analysis says

One of the many questions swirling around two new Alzheimer’s drugs — Aduhelm, which was approved last year amid controversy, and lecanemab, whose FDA nod could be nigh — is their cost. Aduhelm was first priced at $56,000 per year, but that was later slashed in half. Medicare balked because of doubts about whether the drug works, putting in place a policy that all but prohibits reimbursing for Aduhelm and any Alzheimer’s medicines that work by targeting toxic plaques in the brain. That category that includes lecanemab, the latest Alzheimer’s disease treatment from Eisai and Biogen.

Enter a draft analysis from ICER. The influential nonprofit said yesterday lecanemab must be cheaper than $20,000 a year to be cost-effective for modestly delaying the advance of Alzheimer’s. Eisai hasn’t said how much it will charge for the drug, expected to win FDA approval by Jan. 6. STAT’s Damian Garde has more.

Merck Covid antiviral didn’t keep high-risk, vaccinated people out of the hospital but did help

A randomized trial of over 25,000 higher-risk but vaccinated Covid patients in the U.K. showed that molnupiravir, the Merck antiviral, didn’t reduce the risk of hospitalization and death but did hasten patients' recovery. The study, published yesterday in the Lancet, comes amid questions around how effective molnupiravir — while proven to reduce hospitalizations in unvaccinated patients — is at preventing severe Covid in vaccinated people, STAT’s Jason Mast reports.

In the U.S., molnupiravir is used far less often than Pfizer’s more effective drug, Paxlovid. But doctors may deploy it for very high-risk patients, including immunocompromised people, who can’t take Paxlovid because it interferes with another drug they take. In a commentary, an Australian researcher cautioned against generalizing these data to those patients. “Butler and colleagues acknowledge that their findings might be ‘less applicable’ in people with COVID-19 who are extremely clinically vulnerable. We would go a step further and urge caution in seeking to apply the findings of this study to those at highest risk from COVID-19 complications,” wrote Michael Kidd, a professor at the Australian Government Department of Health and Aged Care.

Health care providers should be on the lookout for group A strep in children

The CDC issued a health alert yesterday notifying clinicians of a recent rise in invasive group A streptococcal (iGAS) infections in kids. While the overall number of cases has remained relatively low and these infections remain rare in children, the agency is investigating reports coming from Colorado and other states. The uptick in cases has coincided with more respiratory syncytial virus, influenza viruses, SARS-CoV-2, and other respiratory viruses. There has been a sharper increase of illnesses due to group A strep in Europe and in the U.K., where it’s been showing up as scarlet fever.

In the U.S., cases have been lower than usual throughout the Covid-19 pandemic before ticking up this past fall. “However, it is too early to determine whether this rise is beyond what would be expected for pre-Covid-19 GAS seasonal patterns,” CDC notes, while also reminding providers there’s a shortage of amoxicillin to treat infections.

Closer look: Unlocking digital health records could make 'apples to apples' comparisons possible

A big change is coming to the world of health data. At the stroke of midnight on Dec. 31, electronic health care record vendors will have to provide the tools to easily pull big batches of patient data from their systems. The impact won’t be felt overnight, but one could imagine an app that taps into records to recruit matches for clinical trials, “so we can democratize, expand to underserved populations, reach into new parts of the country that don’t normally enroll in clinical trials,” Aneesh Chopra, president of CareJourney and former chief technology officer under the Obama administration, told STAT’s Katie Palmer.

Developers say standardized bulk data access holds the promise of “push button population health.” But informatics experts agree the biggest impact could be the ability to hold providers accountable for the quality and cost of their care. Read more about the complexities and challenges of the new rule.

Long Covid coda: ‘I refuse to let it define me or defeat me’

(Lissa Gotwals for STAT)

As the year draws to a close, I'm thinking of people who told me their stories of living with long Covid. I checked back in with Joni White (above), who, back in February, was excited to get back into her art studio, more than a year after she tested positive for Covid-19 and months after headaches, brain fog, fatigue, frustration, and depression had left her unable to carry out what had been ordinary tasks, much less fuse glass into art.

Life was good for a while, but it didn’t last. Her symptoms rise and fall, with the brain fog making every other part of her life harder. She turned to cognitive exercises prescribed by the long Covid clinic she’d been attending, and found them helpful. But like other chronic conditions, “it’s never gone, but always an underlying issue.” Even as she feels the world has forgotten about people like her, she says, “I refuse to let it define me or defeat me.”

Here's to 2022

It’s time to sign off again from Morning Rounds until the new year. I'll repeat last year's fond wish that we won’t always need our charts of Covid cases and deaths. (Some context: Back then, U.S. daily cases averaged 118,700 and deaths 1,428.) Let’s reflect on just some of the stories and videos we were honored to spotlight this year:

In a doctor’s suspicion after a miscarriage, a glimpse of expanding medical mistrust, one of Eric Boodman’s first stories charting a post-Roe world.

Why Covid-19 vaccines are a freaking miracle is Helen Branswell’s ode to their development, testing, manufacturing, and global distribution.

‘The tipping point is coming’: Unprecedented exodus of young life scientists is shaking up academia. Jonathan Wosen explains why now.

From social media to pink billboards, it’s suddenly ‘hot’ to discuss gut diseases. Who knew “hot girls have IBS”? Isabella Cueto, who saw it on a billboard in LA.

Inside the culture of fear in Eric Lander’s White House science office. Lev Facher told us “not making the bomb go off” was part of the job description.

‘I fear the long-term effects’: Before his death, a nurse warned of the pandemic’s toll on health care workers. Andrew Joseph tells us Michael Odell’s story and the isolation in hospital units.

Watch: The sneaky ways Covid dodges our immune systems. Hyacinth Empinado and Andrew Joseph team up to explain a crucial concept.

Watch: In medicine, fax machines are still vital technology. Just the fax, from Alex Hogan.

Brain implants that translate paralyzed patients’ thoughts into speech creep closer to reality. Megan Molteni, a master at parsing dense science, tackles a different kind of translation.

On the Texas-Mexico border, a bold plan to diversify Alzheimer’s research takes shape. Usha Lee McFarling brings us way beyond the ivory tower.

Parents and clinicians say private equity’s profit fixation is short-changing kids with autism. Tara Bannow’s eye-opening investigation into the crisis in applied behavioral analysis.

Why formally ending the pandemic is going to be a huge headache for the entire health care system. Rachel Cohrs wrote this in March, so she looks prescient today.

Death Sentence, a tour de force by Nicholas Florko on people dying in prison of hepatitis C for want of access to a proven cure.

Get a Ph.D. in health policy — from a single Powerpoint slide. Bob Herman has surely done deeper dives, but this captures our crazy health system.

Free sunscreen, ear plugs — and Covid shots? At the NASCAR race, vaccinations are still a tough sell. Sarah Owernohle gets points for asking about vaccination in a crowd not known for supporting it.

Here’s why we’re not prepared for the next wave of biotech innovation. This is Matthew Herper’s take on “biology’s century.”

‘This is pharma’s dream’: How drugmakers are turning telehealth into a marketing gold mine. One of the more shocking stories reported by Katie Palmer.

At pioneering center for gene therapy, Jim Wilson presided over toxic, abusive workplace, staffers say. Allison DeAngelis, Adam Feuerstein, and Jason Mast team up to reveal internal strife.

Epic’s overhaul of a flawed algorithm shows why AI oversight is a life-or-death issue. Casey Ross has uncovered algorithms that deliver inaccurate information. Epic remade them.

For the ‘godfather’ of biotech, saving Biogen is the final act of a singular career. How do you profile a subject who declines to be interviewed (more politely than Frank Sinatra to Gay Talese)? Damian Garde shows us how.

Cheers!

What we're reading

'Major trustee, please prioritize’: How NYU’s ER favors the rich, New York Times
Avoiding holiday weight gain is hard, but should it be your company’s business? Wall Street Journal
Parker Institute extends ‘crazy idea’ funding to two more cancer centers, STAT
The bittersweet defeat of mpox, Wired
STAT Plus:Apple Watch hit with import ban, but ruling remains suspended as AliveCor patent battle plays out, STAT