Closer Look
Studies say top surgery is safe for fat people, but some surgeons still balk
Logan Cyrus for STAT
Transmasculine people who decide to have top surgery face hurdles. They need to secure insurance approval, find thousands of dollars to cover fees, take time off work, and in some cases, supply a letter from a therapist. But their body size could still keep them from the gender-affirming procedure. "The doctor had a look at the pictures and your weight is very concerning," Vince Wescott (above) recalled a nurse saying. "He is not going to be able to do this unless you lose about 100 pounds."
That common experience flies in the face of research showing that top surgery is safe. The complication rates for patients with higher BMIs aren't much higher than for those with lower BMIs, in contrast to facial feminization, breast augmentation, and genital (bottom) surgeries. STAT contributor H Conley explains how anti-fat bias is often compounded by transphobia and racism, leading to worse health outcomes. Read more.
medicare
Medicare holds steady on coverage for new Alzheimer's drugs
It's not just Aduhelm. After the FDA granted accelerated approval to that polarizing Alzheimer's drug in 2021, Medicare restricted coverage for all Alzheimer's drugs in that class, requiring patients to be enrolled in clinical trials. Now, despite pressure from Congress and advocates, Medicare is sticking with that plan. Its Thursday statement repeated the agency's mandate to monitor patients to see how well the treatments work, even beyond full FDA approval.
That could prove significant for Eisai's Leqembi, which might gain full approval within the next month. If it does, those restrictions will relax slightly, but providers would still need to collect data about all patients who receive the drugs in a patient registry. Leqembi's effectiveness data are promising, but brain swelling and potential connections to the deaths of three patients in clinical trials have caused alarm. STAT's Rachel Cohrs explains.
Public health
Cherokee Nation reports progress and gaps in eliminating hepatitis C infections
CDC
Because American Indian and Alaska Native people are disproportionately affected by hepatitis C virus infections, Cherokee Nation Health Services — which provides care for more than 100,000 people in 11 health care facilities across the reservation — launched a program in 2015 to eliminate the curable disease. After five years, 1,423 people were diagnosed with hepatitis C infections. While 86% of them were connected to care, only 56% completed treatment and 49% were declared free of the virus at 12 weeks after concluding treatment.
Reasons for the gap between diagnosis and treatment may have to do with payment, the CDC report suggests. Medicaid didn't cover treatment for people with little or no liver scarring until 2018 and payers required prior authorization and sometimes a specialist visit before approving medications. "Barriers to [hepatitis C] treatment initiation need to be addressed to achieve [hepatitis C] elimination," the researchers write.
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