What happened to Mindstrong's 'smoke alarm' for mental health, Billy Dunn's departure, & dementia's toll on caregivers

The idea was compelling, the leadership was top-tier, the financing was solid, and the need was clear.

February 28, 2023 Check out STAT+

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By Elizabeth Cooney Reporter, Morning Rounds Writer

Good morning. Even when the stars seem to align, things can go south, the decline of Mindstrong tells us.

Health tech How a rush to roll out Mindstrong's 'smoke alarm' for mental illness led to its downfall Christine Kao/STAT The idea was compelling, the leadership was top-tier, the financing was solid, and the need was clear. But Mindstrong, created to prevent mental health crises with technology, is foundering. Its digital "smoke alarm" for serious mental illness has now become an ordinary, largely text-based therapy service. Earlier this month, the company disclosed it would lay off most of its employees and close its Menlo Park, Calif., office. It will reportedly stop treating patients next month. What happened? "There was a lot of pressure to commercialize this way too early," said co-founder Paul Dagum, who came up with the passive measurement concept underlying Mindstrong's technology in 2012. He left the company in 2020. An examination by STAT's Mohana Ravindranath shows that Mindstrong, which declined to comment, struggled with the tension between the slow, measured pace of designing and pressure-testing a new tool and the breakneck demands of the startup world. Read her special report. biopharma Billy Dunn, FDA official who presided over Aduhelm approval, is stepping down Billy Dunn is leaving the FDA. If you know that name, it's likely for his involvement with the agency's controversial approval of the Alzheimer's disease treatment Aduhelm. In his more than 15 years at the agency, the neurologist built a reputation as a skilled communicator and stickler for clear clinical evidence, STAT's Adam Feuerstein and Damian Garde write. But Dunn became the center of a damaging FDA scandal in 2021 when the agency overruled its advisers to approve Biogen's Aduhelm. Two years before, Dunn had an off-the-books meeting with Biogen's head scientist, setting in motion multiple federal investigations. Dunn, 53, will "explore other opportunities while continuing his focus on improving the lives of patients with neurological diseases," according to an internal FDA email sent yesterday. Teresa Buracchio, deputy director of the office of neuroscience, has been named acting director to replace him.  Health An artificial sweetener is tied to higher heart attack risk in early study Here's a potentially disturbing report. The sweetener erythritol, commonly found in snack bars and low-sugar ice cream substitutes, may increase the risk of heart attacks and strokes, a new paper published in Nature Medicine suggests. While waiting for more data to confirm a connection, experts recommend are hewing to age-old advice: Eat whole fruits and vegetables, not processed foods whose labels need scanning for suspect ingredients. People at risk for heart attacks might want to avoid the sweetener, but going back to added sugar isn't advised. For the Nature Medicine paper, the authors showed in lab dishes and mice that erythritol seemed to increase blood clotting, a known risk for heart attack and stroke. But one scientist not involved in the study told STAT's Matthew Herper the conditions that cause heart disease might also cause high levels of erythritol in the blood. Read more about outstanding questions.

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Closer Look Shedding light on dementia and its toll on caregivers  Steven G. Smith His father's dementia taught photojournalist Steven G. Smith just how hard it can be to care for someone with dementia. To better understand the problem, he turned to a tried and true method, picking up his camera to follow Leandra Manos and her father, George Manos (above), since the spring of 2021. "I started this project to help others understand that dementia affects not just the person with it but also their loved ones," Smith writes in a STAT First Opinion. "Through it, I hope to give a personal and intimate look into the world of dementia and the daily struggles and triumphs that come with it." His goal is to help educate, raise awareness, and offer support to those who may be going through similar experiences. "I also want to shed light on the emotional toll dementia takes on caregivers and family members." More words and photos are here. health For-profit hospice offers poorer care than not-for-profits, caregivers say Hospice began as a community affair, dedicated to meeting the needs and honoring the wishes of people at the end of life. With Medicare Hospice Benefit reimbursement, the proportion of for-profit providers offering this service — when palliative care, not cure, is chosen — has grown from 30% to 73% since 2000. A new study published in JAMA Network Open tells us families and caregivers rated care from the for-profits worse than what their counterparts said about not-for-profit providers.  Although quality was uneven across the just over 3,100 providers, for-profit entities were more likely than not-for-profit ones to score lower on all survey questions, including pain and other symptom relief as well as timely care. Respondents ranked not-for-profit hospices the best, followed by independent for-profit providers, and then for-profit national chains as the worst. The researchers say those results held up after accounting for different geography and how many patients were in nursing homes. health care Workforce supporting people with disabilities near collapse, report says Health care is in the grips of a workforce shortage, driven by pandemic burnout among other causes. A new report sounds the alarm for a segment that may be less visible to most Americans: workers who provide services for people with intellectual and developmental disabilities. In their annual review, the American Network of Community Options and Resources Foundation and United Cerebral Palsy say this workforce is nearing collapse.  The report points to providers being unable to raise wages set by Medicaid reimbursement rates, meaning they can't compete with industries like fast food and retail. These direct support professionals, who are 85% women and 60% people of color (including a fast-growing segment of immigrants), earn a median hourly wage of $13.36. And while the need for their services is projected to grow, insufficient staffing has led 63% of service providers to discontinue programs or services in the last year. by the numbers

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What we're reading One MRI for 4.7 million people: the battle to treat Syria's earthquake survivors, Nature Why accurate data on abortions matters — and why it's so hard to collect, The 19th For Cytokinetics, an FDA rejection of its heart drug would help, not hinder, STAT On the edge: The next deadly pandemic is just a forest clearing away. But we're not even trying to prevent it, ProPublica Ascension, Tufts fall short of financial targets in borrowing agreements, STAT

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Thanks for reading! More tomorrow,

elizabeth.cooney@statnews.com

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