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What's next for the abortion pill, a European 'tug of war' over drug development, chronicling the U.S. Covid response 

April 24, 2023
Reporter, Morning Rounds Writer
Good morning. We're looking at what's next for an abortion pill, what we can learn from the U.S. Covid response, and what tighter regulations on telehealth could mean for people who seek medically assisted suicide.

reproductive Health

Mail-order access to abortion pill may be key issue for appeals court

Now we wait some more. After Friday night's U.S. Supreme Court ruling that an abortion pill could remain on the market pending further legal review, it's up to an appeals court to say whether the pill stays that way. Friday's decision preserved the FDA's authority to approve and regulate drugs, putting on hold a Texas district court decision that would have forced mifepristone off the market, as STAT's Sarah Owermohle reported.

Now the central question may become whether mail-order access to mifepristone will be preserved, after Justice Samuel Alito highlighted that issue in his dissent. As of December 2021, doctors no longer had to dispense the drug in person and earlier this year, pharmacists were allowed to provide mifepristone. The appeals court has oral arguments on the case on May 17.


infectious disease

'You call it out': Health experts chronicle failures in U.S. Covid response in hopes of fixing them

A history of how the U.S. handled the Covid-19 pandemic doubles as a warning for the future. A book coming out tomorrow describes an underprepared country, polarizing politics, and a vacuum of leadership facing a deadly foe. Two authors from the Covid Crisis Group talked with STAT's Helen Branswell.

What were the worst mistakes the U.S. made?

Carter Mecher: We spent January and February, when it was clear that this was moving pretty quickly and this was a significant event, to really get on a war footing and to get moving. The problems with our testing just meant … we really were flying blind.

The report says "the Covid war revealed a collective national incompetence in governance." How does that get fixed?

Philip Zelikow: First of all, you call it out. And actually it's fixable. Once people know that in big cities before blizzards, big city mayors buy snow plows, then you get in trouble if you don't buy snow plows. And you hold people to a certain standard that you didn't hold them to before we had snow plows. And that's the thing that a book like this can do.

Read the full interview.


health

Crackdown on telehealth would hit dying patients, too

As the DEA moves to tighten prescribing regulations that were loosened during the pandemic's first three years, we've heard from patients worried about losing access to virtual prescriptions for controlled substances such as Adderall and medications used to treat opioid use disorder. There's another group of patients who fear they'll lose out, too: people who seek medically assisted suicide and hospice care.

"They completely forgot that there was a population of people who are dying," said Lonny Shavelson, a California physician who chairs the American Clinicians Academy on Medical Aid in Dying, which helps patients access care under right-to-die laws. DEA's new rule, under consideration through May 11, would allow some drugs to be prescribed with telemedicine for an initial 30-day dose, but patients would need to be seen in person to get a refill. That's a high bar for people who live far from a qualified provider. The Associated Press has more.



Closer Look

In a 'tug of war,' Europe tries to revamp drug development and access

https://www.statnews.com/2023/04/24/europe-pharmaceuticals-shortages-access-orphan-drugs/Sean Gallup/Getty Images

How do you make the European pharmaceutical industry more competitive while making sure people in all 27 member countries can get the medicines they need? Those two challenges inspire draft legislation the European Commission will unveil Wednesday, an ambitious effort whose last legislative foray came 20 years ago. The proposals reflect what has changed since then: the dawn of rare disease therapies and other specialized treatments, persistent shortages, and inequitable access to medicines, among other weaknesses exposed by the Covid-19 pandemic. The goals include:

  • Reworking incentives for drug development
  • Preparing for drug shortages
  • Altering the availability of medicines throughout the E.U.
  • Streamlining the European Medicines Agency to speed drug approvals.

Resolving these issues will take time, Victor Maertans of the pharmaceutical trade group EUCOPE warned. "The European Commission is trying to address too many problems with one piece of legislation, so there is this tug of war." STAT's Andrew Joseph and Ed Silverman explain.


cancer

Vitamin D levels linked to how melanoma patients respond to checkpoint inhibitors

Vitamin D has many beneficial effects, among them helping our bodies absorb bone-building calcium and phosphorus. There's also evidence it can help the immune system. A new study published today in Cancer also links vitamin D levels to how well patients with advanced skin cancer fared when receiving immunotherapies known as checkpoint inhibitors. Researchers measured vitamin D levels in the blood of 200 patients with melanoma every three months while they got the drugs nivolumab (Opdivo) or pembolizumab (Keytruda). 

Just over 36% of patients with low vitamin D levels responded to the immunotherapy, but 56% of the patients with normal vitamin D did. After finishing treatment, cancers progressed after almost six months in the low-vitamin D group but it took a little over 11 months in the normal vitamin D group. Overall survival, however, was not significantly different. The researchers say vitamin D could be boosting the immune system during immunotherapy, but they call for more research.


vaccines

Opinion: How small vaccine stockpiles can keep disease outbreaks small

Equatorial Guinea and Tanzania are experiencing their first Marburg outbreaks. A safe and effective vaccine couldn't come soon enough for a disease with a mortality rate over 50%, Seth Berkley, CEO of Gavi, the Vaccine Alliance, writes in a STAT First Opinion. But Marburg could soon follow the Sudan strain of Ebola and have experimental vaccine candidates ready for testing under an emergency use listing. 

While fast-tracking candidate vaccines represents a positive step forward in the race to stop these outbreaks and improve global health security, he writes it would have been better if stockpiles of vaccine were ready to go when the first cases were detected. There's no perceived market for selling these kinds of vaccines, but "this is a solvable problem," Berkeley argues. "The strategic use of relatively small vaccine stockpiles to stamp out outbreaks quickly is likely to become increasingly important." Read how that might be done.


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What we're reading

  • Scientists identify thousands of unknown viruses in babies' diapers, Washington Post
  • How a small hospital in Nebraska has thrived through the pandemic, STAT
  • Health care access for trans youth is crumbling — and not just in red states, Politico

  • HCA bags big first quarter as patient volumes soar, STAT

Thanks for reading! More tomorrow,


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