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Exclusive: Who's not invited to a naloxone summit; what's next for BMI in medicine; & what happens after race is removed from clinical algorithms for colorectal cancer

June 16, 2023
Reporter, Morning Rounds Writer
Good morning. Lev Facher has an exclusive on who isn't invited to a White House meeting on naloxone, Elaine Chen asks what's next after the AMA's new stance on BMI, and Katie Palmer looks at what happens to colorectal cancer outcomes when you try to omit race from clinical algorithms.

exclusive

White House summit on naloxone leaves out advocates for lower costs

On Tuesday the White House will host a summit to address pricing and accessibility of naloxone, part of the Biden administration's strategy to ease the opioid crisis. But while the meeting is notable for its focus on overdose-reversal medications, its guest list is drawing attention for the players not on it. Two prominent organizations working to provide much cheaper overdose-reversal medications aren't invited, STAT's Lev Facher reports in an exclusive story: Harm Reduction Therapeutics, a nonprofit drug manufacturer seeking approval for a naloxone nasal spray, and Remedy Alliance, which distributes cheap naloxone to harm-reduction groups.

Michael Hufford of Harm Reduction Therapeutics told Lev it was excluded because its drug is under review. Maya Doe-Simkins of the Remedy Alliance confirmed it was told the meeting is for manufacturers only. Read more.


health 

BMI is embedded in medicine. How will the AMA's new policy change that?

Now that the AMA has gone on record with its waning confidence in BMI as a valid measure of health, what does that mean? The metric is so widely used throughout medicine, from surgical procedures and fertility treatments to drug approvals and insurance reimbursement, it won't be easy to unwind. While the statement by the doctors' group was unequivocal, Mayo Clinic cardiologist Francisco Lopez-Jimenez told STAT's Elaine Chen, "Paradigm changes take more than a single statement."

BMI is used extensively in obesity medicine, determining who's eligible for new weight loss drugs or for more traditional bariatric surgery, based on research gathered using the metric. AMA's new stance says BMI should be used in conjunction with other inputs to help assess fat mass, such as waist circumference and body composition. And it's not just obesity: Eating disorder treatment is also reimbursed based on the measure. Read more.


chronic disease

After leaving the NFL, pain is worse for Black players than white players, survey finds

Former Miami Dolphins player Julius Thomas holds a football as he runs on fieldAdrian Kraus/AP

Professional athletes may have access to the best health care and other resources during their careers, but that doesn't erase disparities. Black former NFL players report worse and more disruptive chronic pain than white players, a new study in Pain reports, based on survey data from nearly 4,000 former pro American-style football players. 

"It's important for people to understand that there's not a status, income level, or amount of money in your savings that removes the racial disparities in chronic pain," study co-author and two-time Pro Bowler Julius Thomas (above), who is pursuing a doctorate in psychology at Nova Southeastern University in Florida, told STAT's Isabella Cueto. Seeing the data can be discouraging, he said, but "disseminating this information to players, we can help them understand, 'Hey, this is the case, what it looks like today, but this doesn't determine what it's going to be like in the future.'"

Read the full interview.



Closer Look

Omitting race from a clinical algorithm for cancer isn't an easy fix, study says

Clinicians and health policy makers alike have been calling for the elimination of race and ethnicity from formulas used to calculate risk scores and clarify care decisions. In two recent examples, race has been removed from calculators used to estimate kidney function and predict the success of a vaginal birth after a cesarean section. A new study in JAMA Network Open suggests a fair algorithm doesn't necessarily ensure fair health outcomes.

In the study, researchers used data from thousands of colorectal cancer patients to evaluate how well four algorithms predicted the likelihood that cancer would return after a tumor was removed. The model that included race and ethnicity as a predictive variable, they found, performed more equally across groups than a model with race redacted. Their conclusion: Simply removing race (or keeping it) isn't a guarantee of equally accurate results for patients — or more equitable health outcomes. STAT's Katie Palmer explains.


pandemic

FDA advisers endorse Omicron-only Covid vaccine for the fall

No matter how many Covid vaccine doses you've had, they've all contained at least some of the original coronavirus strain that sent us into our current pandemic. Now FDA advisers have voted for the next round of shots to include protection only against the Omicron strains now dominating transmission worldwide, the Associated Press reports. Yesterday's meeting did not conclude with an exact recipe for vaccines aimed at fall delivery, but they will come from a branch of the Omicron family tree named XBB. 

The final decision is FDA's. Vaccine makers said during the meeting that they could have updated vaccines available within months, depending on the strain. "We're concerned that we may have another wave of Covid-19 during a time when the virus has further evolved, immunity of the population has waned further, and we move indoors for wintertime," FDA's Peter Marks said as the daylong meeting opened.


mental health

Deaths by homicide and suicide spiked early in the pandemic for young Americans

During the first two years of the pandemic, the homicide rate for older teens in the U.S. hit a 25-year peak and the suicide rate for adults in their early 20s was the highest in 50 years, a new CDC report says. The analysis, which covered 2001 through 2021, placed suicide and homicide as the second and third leading causes of death for 10- to 24-year-olds, after accidental deaths such as motor vehicle crashes, falls, drownings, and overdoses. Guns were used in 54% of suicides and 93% of homicides among the age group in 2021.

"Picture a teenager sitting in their bedroom feeling desperate and making a decision, impulsively, to take their own life," researcher Steven Woolf of the Virginia Commonwealth University, who was not involved in the study, told the Associated Press. If they have access to a gun, "it's game over." Read more.


If you or someone you know may be considering suicide, contact the 988 Suicide & Crisis Lifeline: call or text 988 or chat 988lifeline.org. For TTY users: Use your preferred relay service or dial 711 then 988.


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