Breaking News

Capitalizing on fear of fentanyl, concerns about AI in medical note-taking, & what rolling back SNAP benefits means

March 28, 2023
Reporter, Morning Rounds Writer
Good morning. Our new STAT Report on depression treatment details the challenges, possibilities, and frontrunners in the race to remake treatment of the world's most common mental health problem.

 addiction

There's a gold rush for expensive overdose-reversal drugs. It's distorting the naloxone market

An illustration of two naloxone nasal sprays, the one on the right is decked out with bells and whistles to represent expensive and unnecessary versions of the same drug –– addiction coverage from STATMike Reddy for STAT

The more naloxone, the better, right? And at escalating doses, too? That's not necessarily the case for the overdose-reversal drug, which will mark a milestone as Narcan is set to move over the counter tomorrow. But now, as fears of fentanyl soar, companies are selling naloxone in new patent-protected incarnations, from an ultra-high-dose nasal spray to a mechanized injector that gives robotic voice commands. And the price is escalating for these more complex versions, all higher than for generic ones of a medication that has been off-patent for 40 years.

"The average person would assume that a higher dose is stronger and perhaps can work better," said Robert Ashford, a substance use researcher and advocate who runs Unity Recovery in Philadelphia. "The unfortunate truth is that's just not supported by science. The industry is grasping at straws — I think for a profit motivation, not a scientific or medical one." STAT's Lev Facher has more.


health

Many teens in Colorado say they can easily find guns

There was another mass shooting yesterday, where a former student killed six at a Nashville school. On the same day, researchers reported in JAMA Pediatrics that among the almost one-third of teenagers in Colorado who had access to a loaded gun, 1 in 4 said they could get their hands on one within 24 hours — and almost half said it would take them under 10 minutes. The results came from the Healthy Kids Colorado Survey, administered online at middle and high schools across the state.

While Colorado has seen several school shootings, dating to Columbine in 1999 and again last week, the researchers also worry about the risk of suicide. Nearly half of the people who tried to die by suicide acted within 10 minutes of considering it, the research letter says, citing a previous study. "Given the impulsive nature of suicide, reducing adolescent access to firearms during times of crisis or suicidal ideation is critical," the authors write.


If you or someone you know may be considering suicide, contact the 988 Suicide & Crisis Lifeline: call or text 988 or chat 988lifeline.org. For TTY users: Use your preferred relay service or dial 711 then 988.


Health policy

Opinion: Rolling back SNAP benefits risks long-term suffering for children

Easing hunger and improving health would seem to be enough success to guarantee a program's survival. Still, the rollback of pandemic-driven SNAP benefits that began on March 1 has STAT First Opinion authors Megan Sandel and Charlotte Bruce pulling all the levers they can. On top of overwhelming proof that SNAP meets nutritional needs, the authors, both of Children's HealthWatch, point to SNAP's power to reduce emergency room visits and even slow the growth of Medicaid costs. And yet, millions of kids are at risk of hunger from slashed benefits.

"While I have powerful medicines and nutritional supplements at my disposal," Sandel, a pediatrician at Boston Medical Center, writes, "there is no more potent tool than extra money to afford the foods I recommend to help their children grow, like eggs, whole milk, and cheese, whose prices are up more than 50% since 2022." There's a chance to improve SNAP benefits in the upcoming federal Farm Bill. Read how that might work.



Closer Look

'You actually want the truth': Where AI for medical notes falls short

AI_Clinical_IntelligenceMolly Ferguson for STAT

When you're ceding control of medical notes to AI, how good is good enough?The technology is hailed by doctors as a godsend to end the drudgery of off-hours note writing, but once it no longer relies on humans to check its work, worries soar over fewer guardrails with little independent oversight. Inspired by Nuance's announcement that it would integrate GPT-4 into its new medical scribe product and remove human reviewers, STAT's Brittany Trang spoke to AI researchers, executives, and clinicians using the platforms; she also took part in demonstrations.

More often than not, experts told her, the technology struggles to get the note just right without human help. Companies can be close-mouthed and these tools don't fall under FDA review. "I like to say that they are storytellers, not truth tellers," said Enrico Coiera of Macquarie University. "With a medical record, you don't want a plausible story, you actually want the truth." Read the special report.


health

Data are scant, but study suggests students with a disability are more likely to experience homelessness

You can find data on how many children and young people are homeless and other data on how many have disabilities, but understanding how many of them fall into both categories, from age 3 through 21, is challenging. Even though laws protect them, students experiencing homelessness are less likely to be evaluated for learning disabilities and placed in special education programs than their housed peers.

A new paper in Pediatrics today exploring that intersection found that students with disabilities were more likely to experience homelessness in the 2019-2020 school year compared with students without disabilities, across eight Middle Atlantic and Northeastern states. Earlier, in the 2018-2019 school year in Massachusetts, students with disabilities had 1.5 times the risk of experiencing homelessness as students without disabilities. Across the seven other states and districts, the highest percentage of students with disabilities experiencing homelessness was in Washington, D.C., at 9.4%, and the lowest in Connecticut, at 1.2%.


health

Analysis questions the virtues of exercise for improving cognition

Regular physical exercise is good for both mind and body, right? A new umbrella review of 24 meta-analyses says not so fast, challenging what's been gospel for decades. The research in Nature Human Behaviour takes pains to say that while it may be true, there isn't enough high-quality evidence in the randomized controlled trials they studied to draw such a conclusion about healthy people, activity, and cognition. The statistical sins they cited include low statistical power and publication bias (when positive results are more likely to win journal acceptance). 

Biological explanations have been proposed but not proven for why active people might have better brain health: blood vessel growth, synaptic plasticity, reduced inflammation. But maybe it's the cognitive and social enrichment exercise can bring, and maybe we should be happy with that: "Let us not forget the pleasure of doing something for its own sake," the authors conclude.


More around STAT
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What we're reading

  • Sick all the time, The Atlantic
  • These women survived combat. Then they had to fight for health care, Washington Post

  • Matt's Take: Bernie Sanders' accidentally great drug pricing idea, STAT
  • Volunteer pilots fly patients seeking abortions to states where it's legal, KMUW

  • Ohio attorney general accuses pharmacy benefit managers of drug price fixing, STAT

Thanks for reading! More tomorrow,


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