A long road for childhood obesity guidelines, ketamine patients scramble, & what is a p value, exactly?

Pediatric guidelines mark a sea change that troubles experts in obesity medicine, nutrition, and sociology, as well as fat activists.

March 20, 2023 Check out STAT+

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By Elizabeth Cooney Reporter, Morning Rounds Writer

Good morning. Our obesity coverage continues with a look at guidance for children, we hear from patients left adrift when their ketamine clinics abruptly closed, and a Medicare report tells us that the hospitals are all right.

the obesity revolution New childhood obesity guidelines still face a long road to consensus Molly Ferguson for STAT Obesity among children is hardly new. Rates among children and adolescents have been rising steadily since the 1960s, with little other than "watchful waiting" as general guidance for pediatricians and families. But in January, the American Academy of Pediatrics released its first formal clinical practice guidelines for the screening and treatment of young patients with obesity. By coincidence, that was two weeks after the FDA approved the weight loss drug Wegovy for children 12 and older who have a BMI at or above the 95th percentile for their age and sex.  While the advent of such drugs marks an obesity revolution in full swing, the pediatric guidelines also mark a sea change that troubles some experts in obesity medicine, nutrition, and sociology, as well as fat activists. STAT's Isabella Cueto and Theresa Gaffney explore some fraught questions, from who gets access to treatment to what might it mean for disordered eating. Read more. health Their ketamine clinics shuttered, patients scramble for treatment Photo illustration: STAT, Google Maps Struggling with PTSD, depression, anxiety, and an onslaught of suicidal thoughts, Army veteran Adam Blazak had tried treatment after treatment from the VA, combining psychotherapy with medication — "I tried every pill imaginable" — with no luck. Then he found something that worked. Ketamine nasal spray at an Arizona clinic, Ketamine Wellness Centers, finally provided relief from his suicidal thoughts so he could benefit from other therapy, adding up to a dramatic improvement. Last week, he and other patients got an email saying his clinic and the 12 other Ketamine Wellness Centers across the country had closed. It was an abrupt end to a once-expanding business administering ketamine. A short-lived anesthetic turned party drug, it's being studied for its therapeutic potential in psychiatric disorders that don't respond to other treatments. Now, people are left to find new providers, some of them rushing to get appointments before their symptoms come back, they told STAT's Isabella Cueto. Read more. business Hospitals are doing fine, Medicare review says So the sky is not falling after all, at least not on hospitals, Medicare policy experts are telling Congress. In its newest report, the Medicare Payment Advisory Commission said profit margins hit all-time highs in 2021, with almost $200 billion of taxpayer subsidies helping hospitals get through the worst of the pandemic. "Federal relief funds and increased Medicare payments more than offset pandemic-induced costs," MedPAC officials wrote. Not all hospitals are the same, of course. If they care for low-income and uninsured people, they've have fared worse than the dominant systems treating commercially insured patients. And last year was worse than 2020 and 2021, the years in the report, but MedPAC's staff believe hospital operations are still in line with pre-pandemic levels even after higher labor and supply costs in 2022. "Hospitals are doing fine," Yevgeniy Feyman of Boston University, who reviewed the report, told STAT's Bob Herman. Read more.

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Closer Look You've heard of the p-value. What does that really mean?  Alex Hogan/STAT In another installment of "The Facts, STAT!", national biotech reporter Damian Garde and senior multimedia producer Alex Hogan wade into the waters of statistical significance in the form of p-values. The "p" is short for probability, and careful readers like to see it fall below 0.05. When it's that low, it means, for example, that for data saying a given drug is better than a placebo, there's less than a 5% chance that the result was due to random chance. P doesn't stand for perfect (and watch out for p hackers), but without something like it, Damian says, "it would be very difficult to know whether a given trial was a slam dunk or a roll of the dice." Watch here. reproductive health Wyoming prohibits abortion pills While the nation waits for a Texas judge to rule on a lawsuit whose goal is to overturn FDA approval of an abortion drug, Wyoming became the first state to specifically prohibit medication abortion, a method now used in more than half of pregnancy terminations. Other states have included restrictions on abortion medication in legislation designed to end abortion, but Wyoming's move, effective July 1, is separate from a law banning abortion and making it a felony to provide one that took effect yesterday. After lawsuits said that ban defied the Wyoming state Constitution's guarantee of freedom in health care decisions, the new law was changed to say abortion is not health care. Separately, a bill has been introduced in Texas that would not only prohibit medication abortion, but would also require internet service providers to take steps to block medication abortion websites so people in Texas could not see them, the New York Times reports.  medicine Opinion: Will there be any emergency doctors when you need one? It's no secret that hospital emergency rooms are under almost unbelievable strain. Hammered by the pandemic, they are still struggling to care for patients with shrinking staff amid increased pressure to meet productivity metrics. Their situation is compounded by a sense that they have been abandoned by hospital leadership, leading to increasing levels of physician burnout and attrition, Christian Rose of Stanford, Adaira I. Landry of Brigham and Women's Hospital, and Kaitlin M. Bowers of UNC Health Nash write in a STAT First Opinion.  After this year's National Resident Matching Program, better known as the Match, which left 555 positions unfilled, that picture does not look brighter. "Medical students have picked up on the chaos within the emergency medicine physician community — and it's making them less interested in entering our specialty," they write. The solution isn't simply adding more trainees. Read more.

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Thanks for reading! More tomorrow,

elizabeth.cooney@statnews.com

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