Closer Look
Opinion: It's time for a 'Wiley' moment to set standards in digital mental health
Adobe
First, some history. The groundbreaking 1906 Food and Drug Act set standards for safe and effective medications and food additives in the U.S. It followed an utter lack of regulation, when formaldehyde preserved meat and morphine was an ingredient in infant "soothing syrups." Known as Wiley's Law in tribute to Harvey Washington Wiley, a chemist who advocated for regulations to protect the public, it later led the FDA to establish its gold standard for defining safety and efficacy of new drugs.
"We have arrived at a similar 'Wiley' moment today for digital mental health," psychiatrist and neuroscientist Thomas R. Insel writes in a STAT First Opinion. He's a co-founder and adviser to more than a dozen companies in that space as well as a former director of the National Institute of Mental Health. Read his ideas on how a public-private effort might set standards for digital mental health.
reproductive health
Pregnancy rates — overall and unintended — have dropped
Reproductive health has dominated the news since the U.S. Supreme Court overturned Rose. w. Wade last June, accelerating restrictions on abortion. In what may serve as a benchmark to measure the future impact of those legal changes, a new CDC report (the first since 2015) documents a 9% drop in overall and unintended pregnancy rates in the U.S. from 2010 through 2019. Pregnancies ending in abortion declined 17%, unintended pregnancy rates declined by 15%, and the percentage of pregnancies ending in live birth and of those ending in loss (miscarriage or spontaneous abortion, ectopic pregnancy, and stillbirth) each increased 3%. There were differences by age and race and ethnicity:
- Overall pregnancy and unintended pregnancy rates for teens ages 15 to 19 fell by 52%.
- Unintended pregnancy rates dropped by 23% among Hispanic women; 17% among non-Hispanic women of races other than Black or white; 12% among Black, non-Hispanic women; and 11% among white, non-Hispanic women.
The report didn't explore why rates dropped, but added, "Future updates to this analysis will be challenging given all of the changes that occurred in 2020 and later."
health
What weight loss can mean for older adults
Amid all the attention focused on new weight-loss drugs, it's worth remembering not all weight loss is desirable, especially for older adults, a recent study in JAMA Network Open tells us. In results that further complicate defining what a "healthy" weight might be, significant weight loss — more than 10% of body weight — was linked to a higher risk of dying than stable weight or weight gain during the study's average 4.4 years. The causes of death included cancer, cardiovascular disease, and other serious conditions. How much a person weighed at the study's start didn't make a difference.
Among the study's nearly 17,000 Australian adults 70 or older and more than 2,000 U.S. adults 65 or older, this association was stronger for men than women. Participants were screened for illness before the study began, but the researchers say "a likely explanation for these findings is that weight loss can be an early prodromal indicator of the presence of various life-shortening diseases." They advise clinicians to watch weight loss.
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