No fix yet for surprise ambulance bills, biosimilar pricing explained, & the bioethics of stem cell research

Ground ambulances were excluded from the law that banned most types of surprise medical bills starting in 2022.

February 13, 2023 Check out STAT+

Sponsored By

By Elizabeth Cooney Reporter, Morning Rounds Writer

Good morning. Be sure to watch Ed Silverman explain the byzantine saga of pricing the first Humira biosimilar to hit the market.

HospitalS No fix for surprise ambulance bills in sight Alex Hiogan/STAT Surprise billing — when patients are asked to pay for out-of-network services not covered by their insurance and not on their radar — has earned outrage and gained traction in not just the public consciousness but also in federal legislation. There's one glaring exception: Ground ambulances were excluded from the law that banned most types of surprise medical bills starting in 2022 — even though roughly 85% of all emergency ambulance rides are out-of-network. And prospects don't look good for Congress to craft a solution anytime soon.  Instead, the federal law known as the No Surprises Act created an ambulance advisory committee, which will study patient billing more and make formal recommendations. That doesn't look so promising, either: Its inaugural meeting in January was postponed; now it won't meet for the first time until March. STAT's Bob Herman has more . in the lab Grappling with the ethics of stem cell research Growing human stem cells into brain organoids, tiny 3D structures whose electrical activity resembled what's seen in a full-size human brain. Nudging mouse stem cells into synthetic embryos, with a beating heart and the beginnings of a brain and intestines. These breakthroughs advance our understanding of early development, but they spur ethical questions about consciousness and the creation of human life.   Those possibilities animated debate at a recent meeting at the Sanford Consortium for Regenerative Medicine. "Some people think this might be too early to discuss and we shouldn't because the funding agencies might get scared, the public might get scared, and that might create an unnecessary roadblock for research," Alysson Muotri said about brain organoids. "It is a balance. And how to navigate that? I don't have the right answer." STAT's Jonathan Wosen has more.  health Air pollution is linked to depression later in life Around the world, researchers have found an association between air pollution and the risk of mental illness. A new analysis in JAMA Network Open pinpoints a link between long-term exposure to pollutants and depression in older people. To reach their conclusion, researchers looked at health records of nearly 9 million Americans on Medicare. Their exposure to air pollution was tracked by their ZIP code from 2000 through 2016. As pollution exposure rose, so did rates of depression. Having a condition like heart failure or COPD was tied to increased risk, as was socioeconomic disadvantage. "This adds to a growing picture that we should be concerned about the effects of pollution on mental health on top of the more obvious links to respiratory health," said Oliver Robinson of University College London. He was not involved in the study.

---

---

Closer Look Breaking down the convoluted world of biosimilars It's a byzantine saga that sounds simple at first but on closer inspection is nowhere near easy to understand. Humira, the world's best-selling medicine since its debut in 2002, has new competition now that the last of its patent protection has faded. Amgen's Amjevita, a biosimilar version of the biologic drug, is the first to hit the market, so prices should fall and patients and payers should benefit, right? Not so fast, STAT's Ed Silverman tells us in this video from Alex Hogan. "This gets complicated and weedy," Ed tells us in classic understatement before mentioning opaque pharma pricing, a mysterious process that takes place in a gray area where decisions are made. Here's the bottom line question about setting any new biosimilar: "Will it really benefit the patients or just the companies that do the behind-the-scenes dealing that help determine what the pricing looks like?" Watch here. health tech Opinion: ChatGPT poised to help in diagnosis If you've been tempted to dismiss ChatGPT, here's another look at the artificial intelligence chatbot. A team from Harvard tested the AI model to see how it compared to online symptom checkers and to doctors when responding to 45 vignettes about problems people could handle at home, issues that should prompt a call to a doctor's office, and emergencies requiring immediate care. The symptom checkers got it right only half the time, but doctors, as one would hope, listed the top three options 87% of the time. ChatGPT's accuracy hit 82%. "We are seeing a computer come close to the performance of physicians in terms of diagnosis, a critical milestone in the development of AI tools," the Harvard team of Ruth Hailu, Andrew Beam, and Ateev Mehrotra write in a STAT First Opinion, while noting the small sample size and AI models' history of bias. "ChatGPT is only the start." Read more. science Food for thought: Cockatoos can carry, choose, and wield tools  Thomas Suchanek Move over, humans. Here's more evidence that we have no lock on all the mental skills. Or, in a similar vein to what this all-time favorite from STAT's Sharon Begley said about crows, they're more brainiacs than birdbrains. The latest chapter comes from a recent study in Current Biology that documents cockatoos like Figaro (above) choosing and using two tools to fetch some tasty cashews.   In their experiments, the researchers showed the cockatoos a box containing a cashew behind a transparent paper membrane. To reach the cashew, the cockatoos had to get through the membrane and then fish out the cashew. Given a short stick to punch holes in the membrane and a plastic straw cut in half the long way for fishing, they mastered the process to capture the cashew, and adapted when the membrane was removed. Like chimps using sticks to catch termites, the authors say, these birds knew what they were doing. by the numbers

---

More around STAT

Check out more exclusive coverage with a STAT+ subscription Read premium in-depth biotech, pharma, policy, and life science coverage and analysis with all of our STAT+ articles.

---

What we're reading Childbirth is deadlier for Black families even when they're rich, expansive study finds, New York Times ERs staffed by private equity firms aim to cut costs by hiring fewer doctors, Kaiser Health News I tried ketamine to treat my depression. It was terrifying, Washington Post Hugh Auchincloss was Anthony Fauci's longtime deputy. Now he's taking his job as House Republicans probe the pandemic, Boston Globe Opinion: How you can inspire your clinicians to reduce health-care-generated climate change, STAT

---

Thanks for reading! More tomorrow,

elizabeth.cooney@statnews.com

---

Enjoying Morning Rounds? Tell us about your experience Continue reading the latest health & science news with the STAT app Download on the App Store or get it on Google Play

STAT, 1 Exchange Place, Boston, MA ©2023, All Rights Reserved. I no longer wish to receive STAT emails

Update Newsletter Preferences     •    Contact Us     •    Advertise with Us     •    View in Browser