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Questions after abortion rulings, more questions after Genentech's review of scientific misconduct allegations, & another risk of long Covid

April 11, 2023
Reporter, Morning Rounds Writer
Good morning. There may be more questions than answers on what's next after two rulings on an abortion pill. Read some of them below.

reproductive Health

After the abortion pill rulings, now what?

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Paul Ratje/Washington Post

The two diametrically opposed federal court decisions on the abortion pill mifepristone have muddied the waters not just for patients and doctors, but also for those who make and regulate drugs. STAT's Sarah Owermohle and Ed Silverman asked experts for their takes on what might happen next. Some of their questions:

  • Is mifepristone still available? For now, after appeals by both the FDA and Justice Department. The case moves to an appeals court and possibly the U.S. Supreme Court.
  • What's next for FDA? The agency could refuse to penalize providers who continue dispensing the drug, but it might choose instead to solidify its authority in court.
  • What about other drugs? Drugmakers fear this will chill innovation. "The overarching question is should a judicial process, biased or not, be allowed to overrule the approval process done by experts?" said Kenneth Moch of Euclidean Life Sciences Advisors. 

Read more questions and answers.


pharma

PhRMA falls quiet on abortion pill ruling

You may have read yesterday about more than 400 biopharma leaders signing a letter condemning a Texas judge's ruling suspending mifepristone's approval as "judicial interference," a decision that could create serious regulatory uncertainty for companies like theirs. But PhRMA, the top-spending lobbying group in health care, has been largely silent on the subject, STAT's Rachel Cohrs reports.

In fact, when she asked for comment, the group sent a restrained statement that repeated, word for word, what it provided to STAT for a story published in February, before the ruling came down. Josh Sharfstein, formerly at FDA and now at the Johns Hopkins Bloomberg School of Public Health, said, "If the calculation is, 'This isn't a big deal; we don't have to come right out and say how bad this is,' I think that's a mistake." In contrast, BIO, which shares many members with PhRMA, called the decision on Friday a "dangerous precedent." Read more.

coronavirus

Another long Covid symptom: greater challenges finding and paying for health care

Ever since reports of lingering problems after Covid-19 infections began bubbling up from patients in 2020, research attention has focused on defining the condition, giving it a name (long Covid, among others), estimating its prevalence, and searching for ways to predict, prevent, and treat it. A new study asks a different question: What's it like finding and paying for health care to meet sometimes debilitating problems?

An Urban Institute survey whose results appear in JAMA Network Open reports that people with long Covid — 1 in 5 of respondents who'd recovered from Covid last June and July — had more trouble gaining access to clinicians, getting a prompt in-person or telehealth appointment, and paying for care than people who'd recovered from Covid with no long Covid or people who'd never had Covid. About 1 in 4 people with long Covid had trouble paying their family medical bills, compared to 1 in 6 without it. The study authors urge more attention to access barriers.



Closer Look

Stanford president says it was his call not to correct a key paper

Amid an investigation of alleged research misconduct, Stanford University's president told STAT it was his decision not to correct or retract one of the papers at the heart of the controversy and defended his actions. "It was my call to conduct additional follow-up experiments rather than to correct or retract the 2009 study," Marc Tessier-Lavigne wrote about a major study in Nature in 2009 he co-authored while a top researcher at the biotech company Genentech.

Some researchers struggled to reproduce certain findings before and after the study was published, and follow-up research showed that aspects of the paper had been wrong. That has raised concerns among scientists at Stanford and elsewhere. But, as STAT's Jonathan Wosen points out, struggling to replicate past findings doesn't automatically mean those results were fraudulent, and Genentech's review found no evidence of fraud. But there's much more to this complicated case. Read more.

public health

How Americans live with gun violence

In another measure of just how commonplace gun violence has become in the U.S., a KFF poll out today tells us 1 in 5 adults say they've been threatened by a gun (21%) or a family member has been killed by a gun, including suicide. And 1 in 6 (17%) say they've seen someone get shot. Black adults (34%) are about twice as likely as white (17%) or Hispanic (18%) adults to say a family member was killed by a gun and about twice as likely as white adults to say they witnessed someone being shot (31% v. 14%); Hispanic adults are in between (22%). 

Meanwhile, about 4 in 10 adults (41%), and slightly more parents with children at home (44%) say that they live in a household with guns. Of those, 3 in 4 (77%) say they don't store their guns using common gun-safety practices.


hospitals

Most nonprofit hospitals spent less on charity care than they got in tax breaks

More than three-quarters of more than 1,700 nonprofit hospitals in the U.S. received more money in tax breaks than they spent on charity care or community programs, a new analysis reports, adding up to $14.2 billion in 2020. The Lown Institute report calls the difference between tax breaks and community spending a "fair share" deficit or surplus and notes that 2020 IRS filings for some large hospitals were unavailable.

The five hospitals with the highest deficit: 

  • UPMC Presbyterian Shadyside, Pittsburgh (-$246 million)
  • NYU Langone Hospitals, New York (-$173 million)
  • Vanderbilt University Medical Center, Nashville (-$158 million)
  • The Hospital of the University of Pennsylvania, Philadelphia (-$151 million)
  • Indiana University Health, Indianapolis (-$136 million)

The five hospitals with the highest surplus: 

  • NewYork-Presbyterian Hospital, New York ($117 million)
  • Nebraska Medical Center, Omaha ($116 million)
  • Stanford Health Care, Stanford ($92 million)
  • Mount Sinai Hospital, Chicago ($54 million)
  • Christus Spohn Hospital, Corpus Christi ($47 million)

Correction: In an item last week about surgery to remove brain tumors without damaging nearby tissues, I misattributed "first, do no harm" to the Hippocratic oath, which does not contain those exact words. The phrase appears in another work by Hippocrates, called "Of the Epidemics." Thank you, alert readers.


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What we're reading

  • Biden signs bill ending Covid-19 national emergency, Politico
  • Two friends were denied care after Florida banned abortion. One almost died, Washington Post
  • How Utah's secretive medical malpractice panels make it even harder to sue health care workers, Salt Lake Tribune
  • More girls are being diagnosed with autism, New York Times
  • A biotech upstart takes on cancer by crowdsourcing the immune system's natural killers, STAT
  • She became an anti-vaccine icon, and vanished. She's finally ready to talk about it, NBC News

Thanks for reading! More tomorrow,


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