| | | |   By Elizabeth Cooney | Good morning. We're pausing the newsletter in observance of Martin Luther King Jr. Day on Monday, but we'll be back Tuesday. Meanwhile, nominations for STAT Madness close on Jan. 17 for the bracket-style tournament that honors the best innovations in science and medicine. Apply here. | | | Routine childhood vaccinations drop again  (LISA LEUTNER/AP) Whether family life was disrupted by Covid-19 or parents’ sentiments were swayed by anti-vaccine rhetoric, the percentage of kindergarteners who’d received their standard immunizations dipped over the 2021-2022 school year. Most kids did get their routine shots against 14 childhood diseases, but not as many as before, dropping from about 95% in the 2019-2020 school year to 94% in 2020-2021 and then 93% in 2021-2022, according to data released yesterday.
That leaves about 250,000 children vulnerable to measles, for one, a concern given recent outbreaks. The Columbus, Ohio, area has a measles cluster and last year, several New York counties detected polioviruses in wastewater. The drop in vaccinations could be related to fewer doctor’s visits and the Covid-driven closure of schools, which require vaccination or exemptions. Also: Another CDC report out yesterday found vaccination coverage for some shots was reduced in low-income and rural areas during the pandemic. STAT’s Andrew Joseph has details. | A program to boost doctors in infectious diseases needs funding It sounds like a salve for a struggling medical specialty. A pilot loan repayment program to help people who work in infectious diseases and health emergency response was part of the massive government funding bill passed late last year. Advocates are hopeful the program could bring in more medical residents choosing to train in the lagging fields. But so far, the program has no funding from Congress and it seems doubtful the newly Republican-controlled House would point resources its way.
Infectious disease specialists earn less than their peers in cardiology or oncology, for example, so even before the pandemic overwhelmed people in the specialty, its ranks were slimmer than others'. “We know we’ll have more of these emergencies going forward, and we need to do something to build this workforce,” Amanda Jezek of the Infectious Diseases Society of America told STAT’s Andrew Joseph. | Why PBMs are in FTC's crosshairs So last year STAT’s Bob Herman had a memorable story venturing you could get a Ph.D. in health policy from one slide. John Wilkerson’s story today on pharmacy benefit managers — the middlemen between drugmakers and health plans — could be at least a tutorial on antitrust doctrine. That’s pertinent because the FTC may now focus more on competition, not prices, in an industry that influences which medicines are covered by insurance and how much patients pay out of pocket.
The FTC has for years allowed mergers and business tactics that lower prices for consumers, even if they put small companies out of business. Three PBMs — CVS Caremark, Express Scripts, and Optum Rx — manage about 80% of U.S. prescriptions. Now, under Chair Lina Khan, the agency is focused more on protecting competitors, especially small and medium businesses. “FTC’s power to challenge unfair conduct will be supercharged,” David Balto, former policy director of the FTC’s Bureau of Competition, told John. Read more. | Another pandemic is inevitable. The time to prepare is now. Covid-19 was a stark reminder that a single virus can bring the world to its knees in a matter of weeks. In the midst of one of the worst flu outbreaks in more than a decade, one company is working to address what could be the next major pandemic. Learn more about Vir Biotechnology’s novel approach to addressing some of the world’s greatest infectious disease threats. | Closer look: One clinician’s way to get insurers to better cover addiction treatment Treatment for addiction is both expensive and undervalued by U.S. insurance companies and other payers, clinician and data scientist Nick Hayes says. “Access to treatments that work are available to the few who can pay for it — as I once needed to do — while millions of Americans get substandard treatment or none at all,” Hayes writes in a First Opinion. Treatment for substance use disorder faces limited covered benefits, delays, and denials of care at higher rates than medical and surgical care.
Even though decades of research point to longer treatment as the number one predictor of addiction treatment outcomes, insurers often approve the minimum number of treatment days to reduce upfront costs. Hayes has a solution: Data-driven collaborations between payers and providers. “The data are there. What’s needed are more collaborations with payers to turn information into action, improving outcomes and saving lives.” Read more. | Overall, cancer mortality is down, but progress is uneven Since 1991, overall cancer mortality has dropped by one-third, translating into about 3.8 million fewer deaths. The decrease is driven by changes in cancer prevention and screening, a new American Cancer Society report says, yet progress has been uneven, disparities remain, and effects of delayed care during the pandemic aren’t yet known. Some striking statistics: - Cervical cancer rates fell 65% from 2012 through 2019 in women age 20 to 24, among the first to benefit from the HPV vaccine.
- Prostate cancer rose by 3% per year from 2014 through 2019 after declining for 20 years. Incidence in Black men is 70% higher than in white men, and mortality rates in Black men are two to four times higher than in all other men.
“Of concern are rising incidence for breast, prostate, and uterine corpus cancers, all of which have a wide racial disparity in mortality and are amenable to early detection,” the authors write. | Nudges worked to spark end-of-life conversations Conversations between clinicians and seriously ill patients as they near the end of life are difficult but valuable in discerning patients’ wishes and preventing futile measures. A new study in JAMA Oncology looked at prompts to oncologists in electronic medical records generated by machine learning estimates of patients’ risk of death within six months. Clinicians received weekly emails comparing their rates of conversations with patients about serious illness against peers’ rates, weekly lists of high-risk patients, and opt-out text messages to suggest conversations before encounters with patients at high risk.
The nudges worked. Oncologists who got them were significantly more likely than doctors who didn’t to have conversations with patients about end of life. Medicaid patients were as likely to be part of these talks, in contrast to previous research showing them less likely to be included. And patients in these conversations were less likely to have aggressive care. | | | | | What we're reading - Worst cholera outbreak in decades kills 750 people in Malawi, Associated Press
- The doctor won’t see you now: Covid winters are making long hospital waits the new normal, Washington Post
- Opinion: A lesson from JPM: Too many digital front doors in health care lead to nowhere, STAT
- How India's caste system limits diversity in science — in six charts, Nature
- ‘We become millionaires and we retire babe’: Former Takeda worker and boyfriend accused of $2.3 million scam of drug firm, Boston Globe
| Thanks for reading! Til Tuesday,  P.S.: Not health or medicine, but from Scientific Reports, here's a flower fossilized 33 million years ago: Symplocos kowalewskii (Symplocaceae) from Baltic amber. At 28 millimeters across, it's nearly three times the size of other preserved flowers.  Carola Radke, MfN (Museum für Naturkunde Berlin) | | | | Have a news tip or comment? Email Me | | | | Kendall Square February 9 | | | | | New York City February 16 | | | | | | | |
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