Breaking News

Confusion over access to abortion medication, who benefits from the first Humira biosimilar, & childhood adversity's impact on the brain

February 1, 2023
Reporter, Morning Rounds Writer
Good morning. We have confusion over where medication abortion is illegal, research tracing childhood adversity's effects on brain development, and another chapter in the annals of drug pricing that seems to defy logic. 

reproductive Health

Confusion widespread over where medication abortion is legal

A bar chart showing results from a survey that nearly half of adults aren't sure if medication abortion is legal in their state.

KFF Tracking Poll (January 17-24, 2023)

More than six months after the Supreme Court's decision to overturn Roe and with it the right to an abortion, there's widespread confusion over access to medication abortion and emergency contraception, and whether the pills are legal where people live, a KFF poll published today tells us. Just under half of adults are "unsure" whether medication abortion is legal in their state, including 41% of women ages 18 to 49. One in eight adults, including one in 10 women, living in states that now ban abortion incorrectly believe medication abortion is legal in their state.

Three-quarters of adults, including 77% of women under 50, aren't aware that the FDA recently allowed certified pharmacies to fill prescriptions for mifepristone, approved to terminate pregnancies of up to 10 weeks. A third of adults aren't sure if "Plan B" emergency contraception is banned, and 73% incorrectly think emergency contraceptive pills can end a pregnancy in its early stages.


health inequity

Childhood adversity affects brain development, with more impact among Black children

Images showing differences in gray matter volume between Black and white children
Dumornay et. al., American Journal of Psychiatry

Childhood adversity leaves its traces in the brain, changing regions that process stress and trauma, a new study in the American Journal of Psychiatry says. When the researchers analyzed MRI scans, they found small differences in certain brain structures that they believe could accumulate over time and lead to mental health problems later. Black children were more affected than white children, largely because of the higher amounts of poverty and adversity they face. 

The research joins other studies examining how racism and other social factors may affect the physical architecture of the brain, potentially shedding light on racial disparities in PTSD, anxiety, depression, and drug and alcohol overuse. The finding is "a tremendous contribution to our understanding of how structural inequities evident in early development can create a pathway to increased risk for brain health disparities in Black Americans," Negar Fani, a neuroscience researcher at Emory University who was not involved in the study, told STAT's Usha Lee McFarling. Read more.


policy

Medicare official floats possibly paying less for accelerated approval drugs

If you've been following the accelerated-approval saga, you know FDA's intent is to speed novel drugs to patients in need while ensuring gold-standard clinical trials supporting their use, rather than relying on test results that only predict patient outcomes (see the Aduhelm files for more). On Monday an FDA official said the agency might allow drugmakers to start confirmatory trials after accelerated approval, rather than before they get the provisional green light. 

Yesterday, STAT's John Wilkerson reports, a Medicare official hinted that it might test a policy of paying less for drugs that receive accelerated approvals than for drugs granted traditional approvals. CMS Chief Medical Officer Lee Fleisher said his agency is working with the FDA on options. "There's no simple answer, but certainly these are things that the agency continues to think about with respect to the executive order," he said. Read more.



closer look

There's a new biosimilar for Humira, but its pricing may not help patients

It's a big deal that years of patent protection have finally run out for Humira, AbbVie's treatment for rheumatoid arthritis and other autoimmune diseases. Now that Amgen is marketing a biosimilar to nearly duplicate the biologic drug, hopes were high that the price would go down enough that patients would have to shell out less money out of pocket. But given the perversities of drug pricing in the U.S. health care system, that's unlikely, STAT's Ed Silverman explains.

Yesterday Amgen announced its biosimilar, Amjevita, would be available at two different discounts — 5% and 55% — off the roughly $80,000 list price. Sounds good, but pharmacy benefit managers and insurers see it differently, thanks to rebates that can swallow up the money they make. While a 55% discount sounds impressive, the 5% discount is likely to be more popular with payers. So much for biosimilars saving patients money. Read more.


health

Substance use fell among young people early in the pandemic

It's been difficult to collect data on substance use trends during the pandemic, but the information available still conveys some telling trends. A new study in JAMA Network Open says despite the pervasive stress of living with Covid-19, substance use of all kinds fell among young people ages 13 through 20 from 2019 to 2020. Results were mixed for older age groups, except for tobacco use, which went down over the same period. Cannabis consumption rose in adults 25 and older. 

The researchers worked with data from two different surveys, so they caution against putting too much weight in the comparison. Still, they single out two factors that might have contributed to the drop in occasions for substance use for younger people. First, the pandemic cut down on social interaction with peers when in-person learning and sports or other group activities were curtailed. And second, there may have been more parental oversight when families were at home together.


health

Planting more trees in urban heat islands could cut deaths from extreme temps, model predicts

It's winter in the Northern Hemisphere, but we can easily recall the heat waves and wildfires of last summer when those extremely high temperatures endangered people's health, especially if they had chronic illnesses. A new study in The Lancet looks at how to prevent premature deaths attributed to higher temperatures in 93 European cities. The answer could be above heads: Their model predicts planting more trees in cities could cut deaths from extreme heat by one-third. 

Going green could counteract urban heat islands, where asphalt on the ground and certain materials in buildings absorb heat. From their analysis of 2015 data, the researchers say doubling the current average tree coverage in cities to 30% could have prevented 2,644 of 6,700 deaths by lowering temperatures. "Planting urban trees offers an important opportunity to mitigate high temperatures and, compared with other strategies, is relatively simple and cost-effective to implement," they write.


by the numbers

jan. 31 cases covid-chart-export - 2023-01-31T170219.789
jan. 31 deaths covid-chart-export - 2023-01-31T170245.334

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What we're reading

  • Scant obesity training in medical school leaves docs ill-prepared to help patients, NPR
  • FDA proposes overhaul in wake of baby formula shortage, Wall Street Journal
  • 6 things to know about Apellis' eye drug ahead of FDA decision, STAT
  • Nursing home owners drained cash while residents deteriorated, state filings suggest, Kaiser Health News
  • Opinion: Unlocking the promise of learning from everyone with cancer, STAT

Thanks for reading! More tomorrow,


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