Breaking News

Biden seeks $20B for public health, scientists discuss mice with two fathers and base-edited baby monkeys, & doctors raise concern about gatekeeping at 'The Match'

March 10, 2023
Reporter, Morning Rounds Writer
Good morning. Lots of budget news from our D.C. team as well as a hint of genome editing's future from Megan Molteni at the London summit.

politics

Biden administration asks for $20 billion to boost public health

While the White House wants a big boost in public health funding across federal health agencies, its budget request yesterday for $20 billion over five years did not include specific funding for Covid-19 activities. Instead, the request submitted to Congress, which aligns with the Biden administration's National Biodefense Plan, seeks support for pandemic preparedness efforts at the Administration for Strategic Preparedness and Response, CDC, NIH, and FDA. 

Of that $20 billion ask, $6.1 billion would go to the CDC to modernize and build lab capacity, strengthen public health data systems, and enhance disease surveillance. The CDC has come under fire from both sides of the aisle, but Republicans and Democrats disagree on how to fix it. STAT's Rachel Cohrs reminds us that budget proposals are wish lists, but they do reveal an administration's priorities and values for the budget battle to be waged in the year ahead. Read more.


politics

To end hepatitis C, White House seeks $11 billion

In a budget request larger than the amount sought for the FDA, the Biden administration is calling on Congress to fund a more than $11 billion program to eliminate hepatitis C in the U.S. As Francis Collins, current White House science adviser and former NIH director, hinted at a STAT event Tuesday, the ambitious plan would save the government money by curing a disease that, if left untreated, can lead to liver cancer and death. After accounting for reduced care costs, the program would cost only $5.2 billion over five years, the budget proposal says.

The plan would involve speeding up testing from requiring two visits to something like point-of-care Covid tests. The program would also seek to put in place a national "subscription model" to lower the price of drugs. STAT's Nicholas Florko has more.


science

Mice with two fathers and base-edited baby monkeys: a glimpse of heritable editing's complex future

After the 2018 CRISPR baby scandal, there's been an understandable chill on research into germline editing, which alters the DNA of sperm, eggs, and embryos. But on the last day of the Third International Summit on Human Genome Editing, scientists discussed emerging alternatives to altering embryos. Editing upstream of fertilization avoids some ethical concerns and legal restrictions because it means growing and editing stem cells in a dish. While it's easier to test genetic changes that way, the technical challenges are still significant. Two highlights:
  • Katsuhiko Hayashi, a pioneer who has produced functional mouse sperm and eggs from stem cells, revealed his latest creation (not yet published) on stage in London: mice with two biological fathers.
  • Yuyu Niu showed summit attendees a rare look at base editing in monkey embryos.
STAT's Megan Molteni has more, including a look at a new paper pointing out flaws in sequencing methods from envelope-pushing embryologist Shoukhrat Mitalipov.


Closer Look

Opinion: To see if The Match limits diversity, data is needed on who doesn't win a residency spot 

Dom Smith/STAT

In many ways, The Match is a black box. The algorithm-driven system places graduating medical students in residency programs, each year announcing decisions on the third Friday in March that follow medical school, application preparation, interviews, and recruitment. Like no other job search, it matches applicants who rate their residency program picks with institutions that rank candidates, using categories like "guaranteed match," "highly desired," "matchable range," "unlikely to match," and "do not rank."

Writing in a STAT First Opinion, three emergency medicine physicians from Harvard and Stanford — Onyekachi T. Otugo, Al'ai Alvarez, and Adaira I. Landry — spotlight those last two designations, noting that thousands of applicants go unmatched, despite the need for more doctors, especially from underrepresented groups. But while data on who has successfully matched are made public, who doesn't is confidential. "This process can create a smokescreen that allows potential factors, such as structural discrimination, to go unchecked," they write. Read more.


public health

CDC advises universal screening for hepatitis B

The same day that the Biden administration sought $11 billion from Congress to eliminate hepatitis C (see item above), the CDC updated its recommendations on screening for a related disease: hepatitis B. While a cure exists for hepatitis C in the form of a daily pill, there is no cure for hepatitis B, but proper treatment and monitoring can prevent related liver damage and liver cancer. 

The guidelines now says all adults should be tested for hepatitis B at least once in their lifetimes; they also expand the list of people at risk who should be tested more frequently. That includes anyone who is or was incarcerated in a jail, prison, or other detention setting; anyone with a history of sexually transmitted infections or multiple sex partners; and anyone with a history of hepatitis C virus infection. In this first update to hepatitis B recommendations since 2008, the CDC notes that more than half of people with hepatitis B don't know they're infected.


health

FDA requires breast density notice for mammograms

The FDA issued new requirements yesterday that patients receive information about breast density along with their results, adopting a national policy that mirrors what some states already mandate. Breast density raises the odds of cancer in two ways: More fibrous or glandular tissue — the definition of density — compared with fatty tissue in the breast has been linked to a higher risk of invasive breast cancer. And because dense tissue looks white on a mammogram, as do growths in the breast, cancers in those images are harder to detect.  

Patients whose scans reveal dense breasts will receive a written notice alerting them that their status "makes it harder to find breast cancer." They'll be advised to talk with their doctors about it, although the Associated Press notes professional guidelines don't say what to do next, which could include further tests using MRI or ultrasound. Read more.


by the numbers

A note to our readers

When President Biden said last fall the pandemic was "over," he was roundly accused of over-rosy optimism. As STAT's Helen Branswell reminded us then, there's no on-off switch for the pandemic. But here we are at a transition that's more black and white: The major providers of data on daily Covid-19 cases and deaths — which we rely on for our own charts — either aren't going to do it anymore or are switching to less frequent reporting. At their best, they've alway been snapshots, but Johns Hopkins is shutting down its tracker today, CDC will update its stats only weekly (which may be bumpier due to delays at its sources), and Our World in Data has switched over to WHO's weekly updates.

All this comes as few home testing results are reported to public health entities, adding a big asterisk to those case totals and making that snapshot blurrier. So we're suspending our daily Covid charts, too, not because the pandemic has disappeared but because the most reliable data have.


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What we're reading

  • My mom died while I was covering Covid. It changed my views on grief, Washington Post
  • Inside the mind of criminals: How to brazenly steal $100 billion from Medicare and Medicaid, CNBC
  • Biden makes big demands for cancer research and new ARPA-H agency, STAT
  • Girls in Texas could get birth control at federal clinics — until a dad sued, Kaiser Health News
  • Medicare will take R&D costs, effectiveness into account when it negotiates drug prices. But studies show that doesn't affect prices, STAT

Thanks for reading! More tomorrow,


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