Special report: The obesity revolution; dogs of Chernobyl; & how Lilly's insulin price cuts avoid Medicaid penalty

You can find some semi-feral but nevertheless totally good boys hanging outside the Chernobyl cafeteria.

March 6, 2023 Check out STAT+

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By Elizabeth Cooney Reporter, Morning Rounds Writer

Good morning. Today brings the first part of a new STAT series: The Obesity Revolution. The article looks back to similar inflection points and forward to experts' concerns about how powerful new weight loss drugs are changing the narrative and affecting patients.

special report The obesity revolution: New drugs are changing the way we view weight  Maria Fabrizio for STAT The obesity revolution is just getting started. Long framed as a failure of willpower and the price of poor lifestyle decisions, obesity is now more often viewed as a biological disease — one that new drugs can treat. But as people clamor for Ozempic and Mounjaro, conceived to treat diabetes, concern is rising that in the rush to prescribe them, the root causes of obesity may be overlooked, including environmental factors. And eating-disorder experts worry people's body images could be further stigmatized. This is a moment reminiscent of other pharma turning points, such as when Valium and Prozac changed how people perceived anxiety and depression. But both the social media buzz and pharma's marketing — including attempts to shape medical school curricula, STAT has learned — raise fears that treating obesity could be taken too far, draining health care dollars along the way. Read more from STAT's Elaine Chen and Matthew Herper in the first of a series.  hospitals Small-hospital mergers pose antitrust questions, too Smaller hospital mergers may not get the same attention as big blockbuster cross-market deals, but they still hold the same potential for higher costs to patients, in their insurance premiums or on their medical bills. Case in point: Last week Novant Health, a not-for-profit conglomerate in North Carolina, said it's buying two hospitals in Iredell County — Lake Norman Regional Medical Center and Davis Regional Medical Center — and their affiliated clinics. It's an area north of Charlotte where Novant owns several other nearby hospitals, so it's sparking concern.  The FTC and North Carolina Attorney General Josh Stein have the final say, but "if the same thing happens with [this deal] as it did with the last Novant acquisition, the quality of care is going to go down, and the cost of care is going to go up," Dale Folwell, North Carolina's treasurer, told STAT's Bob Herman. Read more. pharma How Lilly's price cuts for insulin mean avoiding big Medicaid rebates By now we've all heard about Eli Lilly's price cut for two of its insulins. The company said last week it lowered the price of Humalog and its biosimilar Lispro to help people afford the life-saving drugs for diabetes. President Biden tweeted about it, crediting last fall's drug-pricing legislation. But STAT's John Wilkerson points to another driver, one whose details are "wonky and counterintuitive." Here's the bottom line: Lilly would've had to pay Medicaid about $150 for each vial of insulin used by patients in the program if it hadn't made those dramatic price cuts. Why? Medicaid hits drug companies with a penalty if they hike their prices faster than the rate of inflation. Lowering Humalog's list price by 70% means it won't trigger that penalty for Lilly. Lispro's price will fall to $25 a vial. John has more on how a different law, the American Rescue Plan and its inflation rebate cap ending in January, come into play.

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Closer Look Life on the edge: Lessons to be learned from the dogs of Chernobyl  Clean Futures Fund They're not supposed to even exist. After the Chernobyl nuclear accident 37 years ago, soldiers were charged with putting down residents' dogs after the meltdown to prevent spreading radiation. But in addition to moose, birds, and even the truly wild horses that roam the 1,000-square-mile irradiated and largely human-free zone, you can find some "semi-feral but nevertheless totally good boys" hanging outside the Chernobyl cafeteria, STAT's Jason Mast writes, waiting for scraps from the workers who still keep the plant in order.  The dogs have much to teach us, researchers propose in their new Science Advances paper. Their analysis suggests the animals are in fact descended from pets left behind by townsfolk who fled the disaster in 1986. Now scientists can query the dogs' genomes to learn how they survived for generations under extreme radiation. "It's a nuclear armageddon, it's kind of Orwellian," said study co-author Tim Mousseau. "But it's actually extremely useful to us." Read more. public health CDC warns of measles exposure at Asbury University religious revival Some people called it a "Woodstock" for Christians, when more than 20,000 people flocked to a spiritual revival held over two weeks at a small college in Kentucky. Now the CDC has alerted doctors and public health officials to be on the lookout for measles after a case was confirmed on Feb. 24 in an unvaccinated person who attended the gathering after recent international travel. While infectious, the person was at the religious event at Asbury University in Wilmore, Ky., on Feb. 17 and 18. The CDC said anyone who was there on those two days and who is unvaccinated or not fully vaccinated against measles should quarantine for 21 days and watch for symptoms so they don't spread the highly contagious illness to others. Anyone with symptoms should isolate and call a health care facility before testing. Measles can cause severe health complications, including pneumonia, encephalitis, and death, the agency warns. coronavirus Long Covid tied to higher risk of cardiovascular problems People experiencing long Covid symptoms for one year had a higher risk of cardiovascular complications such as stroke than people who were never infected with the virus, a new case-control study in JAMA Health Forum finds. Using insurance records, researchers compared more than 13,000 long Covid patients to more than 26,000 people without Covid-19 whose health histories were otherwise similar. The study focused on cardiovascular problems because so many patients diagnosed with Covid were receiving care for abnormal heart rhythms, blood clots, and stroke as well as respiratory disorders like asthma. People with long Covid had a significantly increased risk for cardiovascular conditions, the researchers concluded. While other research has tied such outcomes to the severity of the initial Covid infection, they note that nearly three-quarters of the patients in the current study were not hospitalized. "Assessing ongoing needs of this population will be crucial," they write.  by the numbers

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Thanks for reading! More tomorrow,

elizabeth.cooney@statnews.com

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