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Asian Americans with ADHD 'falling through the cracks,' testosterone safety, & an oncologist on why cancer patients should be 'rioting in the streets'

June 19, 2023
Reporter, Morning Rounds Writer
Good morning. We wish you a festive Juneteenth.  

mental health

Why Asian Americans with ADHD are 'falling through the cracks'

Portrait of Emily Chen

Vanessa Leroy for STAT

Emily Chen (above) struggled to navigate school and college, powering herself to good grades in a state of nearly constant panic. At age 23, told she had ADHD, she was the only Asian American she knew with the diagnosis. It's little wonder why. 

While knowledge of ADHD is accelerating, people of color have all too often been left behind in diagnoses. In 2021, research showed that for every 100 white children diagnosed with the condition, there are 83 Black and 77 Hispanic children, and just 48 Asian children. And ADHD diagnosis rates in Asian American children are lower than for their counterparts in Asian countries. The "model minority" stereotype — that Asian American children are strong students and well-behaved — may be to blame for deterring both diagnosis and analysis of the inequity. STAT's Olivia Goldhill has more.


health

New study finds no link between testosterone supplementation and heart attacks

More than a decade ago, a small trial of testosterone supplementation in men with low levels of the hormone was stopped early because of concerns about cardiovascular events. Now a larger and more rigorous study has found testosterone did not increase the risk of heart attacks among 5,246 participants. Shalender Bhasin, an investigator of the new NEJM study and also of the 209-participant study from 2010 flagging the risk, called the results "very reassuring." 

Researchers warn the new study does not address products that men with normal testosterone levels may use in hopes of increasing virility. "This was a specific group of men with a disease," Steven Nissen of the Cleveland Clinic, who chaired the trial's steering committee, told STAT's Matthew Herper. "We do not want our study to be used as a justification for the widespread prescription of testosterone as a tonic for aging men. … I can see the ads now." Read more.


pandemic

In 2021, Covid left clinicians isolated as they struggled to allocate care

In the pandemic's second year, the shock may have worn off, but for frontline clinicians the crisis had turned chronic. They had to allocate scarce resources and adapt longtime practices to meet daily needs, a new qualitative study in JAMA Network Open says, calling into question institutional plans intended to insulate clinicians from decisions about rationing care. Interviews with doctors and nurses revealed three themes in 2021:

  • Isolation from anything outside their own practices ("Nobody is coming to our rescue.")
  • In-the-moment decision-making ("Tough to figure out … the formula for what was right.")
  • Waning motivation ("It wasn't physically possible to do, and then there's rationing of me going on.")

In the end, "many theoretical plans intended to protect frontline clinicians from decisions about resource allocation were ultimately unworkable, leaving clinicians in the difficult position of having to allocate scarce resources and adapt care as best they could," the authors conclude. 



Closer Look

Opinion: Why U.S. cancer patients should be rioting in the streets

AdobeStock_321764882Adobe

If you have cancer right now, the treatment you need might not be obtainable in the U.S. due to ongoing shortages, medical oncologist Kristen Rice writes in a STAT First Opinion. That means she and her colleagues at Medical Oncology Associates of San Diego have to go through this decision tree for short supplies of platinum-based generic drugs called cisplatin and carboplatin used to treat lung, breast, bladder, ovarian, endometrial, and head and neck cancers:

  1. Are there any other drugs we can reasonably substitute? (In most cases, the answer is no.) 
  2. Can we delay or reduce the dose without negatively impacting their outcome?

"These are not questions any oncologist in the most highly resourced country in the world should be forced to ask," she says, calling on the private sector and policymakers to pursue ideas to fix permanently what is not a new problem. "I honestly don't understand why patients are not rioting in the streets about this." Read more.


insurance

Perspective: Medicaid should pay for obesity treatments

How we understand obesity is shifting from a calories in-calories out formula that often places blame on patients without considering factors like the food environment, other social determinants of health, or access to effective obesity treatments. Writing in NEJM, Hannah Stoops and Mohammad Dar of the University of Massachusetts Chan Medical School call for insurance coverage of these treatments to shift too, particularly in Medicaid, whose members have higher rates of obesity. 

Only six state Medicaid agencies provide coverage for all components of obesity treatment, including behavioral and nutritional counseling and medications, they point out, and some Medicaid programs pay only for bariatric surgery. Coverage of anti-obesity medications remains optional and sporadic. "We believe expansion of coverage for such approaches could help reduce disparities in obesity rates and contribute to efforts to address health inequities," they write, noting Medicaid would need to negotiate costs of newer medications, such as GLP-1 drugs.


health

What parents do when they hear 'I have a tummy ache'

Every parent knows every child at some point will tell them their stomach hurts. A new poll reports 1 in 6 parents say it happens at least once a month, but that doesn't mean they call a doctor about it. About 1 in 3 parents of kids 3 to 10 years old said they felt confident they could tell when it might be serious, according to the University of Michigan Health C.S. Mott Children's Hospital National Poll on Children's Health. But 2 in 5 didn't discuss it with a doctor.

Parents weren't indifferent to severe pain: They'd contact their child's doctor or seek emergency care if their child's belly pain includes blood in the stool (84%), if the child felt a "sharp" pain like a knife (65%), if the pain lasts for more the six hours (64%), or if the belly is swollen (63%) or hard (49%).


This week's episode of the Color Code podcast examines how "food apartheid" starves minority neighborhoods on Long Island. Listen here.


More around STAT
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Read premium in-depth biotech, pharma, policy, and life science coverage and analysis with all of our STAT+ articles.

What we're reading

  •  
  • Bitter pill: Dying patients vs. the FDA, The New Yorker 
  • These pandemic-era habits just won't die, Wall Street Journal

  • Trade group scolds drugmaker for 'unethical' attempt to gain info about rival product, STAT
  • Boris Johnson: The wonder weight-loss drug didn't work for me, Daily Mail
  • Opinion: How to separate sound wellness solutions from seductive snake oil, STAT


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