Breaking News

Polio cases from new oral vaccine, pandemic's harm to families, & AI to predict C-sections

March 17, 2023
Reporter, Morning Rounds Writer
Good morning. Can tech fix primary care? That's the question STAT's Bob Herman, who covers the business of health care, will tackle in a March 20 virtual discussion with Owen Tripp, the founder and CEO of Included Health. They'll consider using technology to find doctors, the benefits and challenges of telemedicine — and whether it's peaked. Register for the event here.

Infectious disease

Polio cases derived from new oral vaccine reported for first time

Experts have long known that a new polio vaccine developed to try to minimize the risks associated with the oral polio vaccine made by Albert Sabin might also cause the problem it was created to sidestep. So there was disappointment but not surprise yesterday when the Global Polio Eradication Initiative announced that seven children in the Democratic Republic of the Congo and Burundi have been paralyzed by viruses from the new vaccine, which is referred to as novel oral polio vaccine, or nOPV2. (The "2" signals the vaccine targets type 2 polioviruses.)

Like the oral vaccine it was designed to replace, nOPV2 contains live but weakened polioviruses. In settings where sanitation and hygiene are poor, polioviruses from oral vaccines can regain the power to paralyze by spreading from child to child. In recent years, hundreds of children have developed paralytic polio from Sabin vaccine viruses. These cases associated with the new oral vaccine occurred at a much less frequent rate. "It's not perfect," Walter Orenstein, a polio expert at Emory University, told STAT's Helen Branswell. "[But] it's a much better tool than we used to have." Read more.


public Health

How the pandemic has harmed some families more than others

The pandemic is certainly not over, nor is the toll it has taken on children and families in marginalized communities, warns a new National Academies report focused on Black, Latino, and Native American families and low-income families. These statistics stopped me in my tracks:  

  • 65% of children who lost a parent or primary caregiver to Covid-19 are from Black, Latino, or Native American families. 
  • The steepest declines in early childhood program enrollments were among families from those groups, or families that have low-incomes or do not speak English at home.
  • Relative maternal mortality rates increased by 33%, with the largest increases for Black and Latina women.

"Across almost every outcome, low-income and racially and ethnically minoritized children and their families have borne the brunt of the pandemic's negative effects, and without urgent, thoughtful interventions for their health and well-being, they will continue to bear it," the report says.


mental health

Network of ketamine clinics abruptly closes

Clinics offering ketamine to treat depression and other conditions have proliferated in recent years, whether they offer ketamine itself, an anesthetic long used in surgery but later popularized as a club drug, or FDA-approved esketamine, which also comes in the form of a nasal spray called Spravato. But one of the largest networks of ketamine clinics in the country abruptly closed their doors this week, leaving patients adrift. Ketamine Wellness Centers in nine states were shuttered, leaving laid-off employees and patients with more questions than answers. 

The centers were run by Delic, which calls itself the "leading psychedelic wellness platform" in the U.S., and has hinged its growth on the potential legalization of MDMA and psilocybin treatments. But in a January blog post, the CEO of the parent company of the centers described growth in the ketamine clinic business as not "as expansive as we had planned" in 2022. STAT's Isabella Cueto has more.



Closer Look

Predicting an emergency C-section in advance sounds promising, but there may be pitfalls

marking on the belly of a pregnant person for caesarean section
Adobe

The name says it all: emergency C-section. Of the 30% of C-section deliveries in the U.S., 10% come urgently, after hours of labor and carrying compounded risks when exhausted doctors and patients decide at the last minute. Researchers who believe there must be a better way have developed an answer: a new machine learning model that predicts who is at risk of an emergency C-section — before it's time to give birth — so parents can consider a planned C-section instead.

But like other AI solutions, there could be pitfalls, STAT contributor Ida Emilie Steinmark reports. One is possibly encouraging unnecessary C-sections. And another: The model uses race-based risk factors, which some experts say could unfairly bias care. Black and Asian people are more likely to get an emergency C-section, and for Black patients, the reason is more likely to be the potentially subjective interpretation of the baby's heart rate. Read more.


drug development

FDA chief asks insurers to chip in on drug research

FDA Commissioner Robert Califf got feisty yesterday, as STAT's John Wilkerson puts it. He lobbed a new idea into the mix at an America's Health Insurance Plans conference, suggesting private insurers step up on post-approval clinical trials on drugs that reach the market on an accelerated pathway. "I looked at the profits, by the way, on the internet before coming over, and there's a lot of money being made in this business," he said. "And it would seem like we ought to all be working together to develop the evidence so we spend the money on the things that work and we don't spend the money on the things that don't work." 

And in an apparent reference to a STAT investigation on how Medicare Advantage plans use algorithms to deny care, Califf said, "I am very concerned that there is data sharing, information sharing, going on with companies, totally outside of sunshine." Read more.


health

Elite soccer players face higher risk for dementia, Swedish study says

If you follow sports like football, boxing, ice hockey, or rugby, you know repeated hits to the head have been linked to later brain damage and disease. A new Lancet study from Sweden finds the same connection for male soccer players, suggesting they're 1.5 times more likely than similar men to develop dementia. That held true for outfielders, who were 1.4 times more likely than goalkeepers to be diagnosed with Alzheimer's and other dementias, but among all the players, there was no link to ALS or Parkinson's. 

Because the players shared generally good health, the researchers say their work strengthens the hypothesis blaming repeated mild head impacts that the fielders but not the goalies sustained over their playing days. There are caveats: The results, gleaned from players from 1924 through 2019, might not hold up among more contemporary players and they may not be the same for elite female players.


Correction: While the FDA declined Helen Branswell's request to interview Peter Marks, director of its Center for Biologics Evaluation and Research, for her story about spring Covid bivalent boosters, it did eventually reply — so I was incorrect to say this morning the agency had not responded. It sidestepped her questions, saying only, "We continue to closely monitor the emerging data in the United States and globally, and we will base any decision on additional updated boosters upon those data."


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What we're reading

  • The strongest evidence yet that an animal started the pandemic, The Atlantic
  • Sanofi becomes the third leading insulin maker to lower list prices, cutting Lantus price by 78%, STAT
  • In Florida, showing mental health struggles could get a child detained, Washington Post

  • JAMA's new editor settles in, bringing open access and other changes, STAT
  • Opinion: The aftermath of a pandemic requires as much focus as the start, New York Times

Thanks for reading! More Monday,


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