Breaking News

What the likely nominee to lead CDC brings, how a doctor views instant test results, & a clue to endometriosis

June 15, 2023
Reporter, Morning Rounds Writer
Good morning. First up, what colleagues are saying about Biden's anticipated nominee to lead the CDC, then a bacterial clue to endometriosis, and what a doctor thinks about test results his patients see before he does.

public Health

Mandy Cohen  would bring political clout to CDC 'on Day 1,' colleagues say

Black and white cutout of Mandy Cohen on reddish purple background

Cliff Owen/AP; Photo illustration Christine Kao/STAT

By now we're all familiar with all the knocks on the CDC and its leadership. It fumbled when Covid-19 first arrived, critics say, confusing the public with shifting guidance on how to avoid infection. Then it was faulted for caving to political pressure from the Trump administration when it loosened some rules. Now, with the anticipated nomination of Mandy Cohen (above), the Biden administration may have selected someone with the political clout, public health knowledge, and government experience to chart a course that makes the public health agency less an island of science in Atlanta and more of a force in Washington.

Cohen, North Carolina's former health secretary, earned high marks for communication there, and her federal connections have won praise, too. "She brings on Day 1 things that it took a long time for prior CDC directors to build," Ed Hunter, who led CDC's Washington office, told STAT's Helen Branswell. Read more.


health tech

Proposal to make tracking medical devices easier gets tabled by federal advisers

Here's a head-scratcher: Every medical device has its own unique code, allowing products to be tracked for recalls or updates. But these codes rarely make their way into health records. For years, experts have suggested adding device identifiers to insurance claims forms, making it easier to reach patients at risk of flawed devices and allowing long-term study of device efficacy, safety, and cost. 

Updating Medicare claims forms is already a slow-moving process, but the idea suffered another setback yesterday when the National Committee on Vital and Health Statistics voted not to recommend a slew of updates to claims forms — including the device identifier addition. Of note: The medical device industry supports identifiers in electronic health records but has pushed back on adding the codes to claims forms, arguing it would make the process unnecessarily burdensome. STAT's Lizzy Lawrence has more.


in the lab

Bacterial infection could be a factor in endometriosis

Endometriosis is a common, perplexing gynecological condition, one that leads many sufferers on years-long diagnostic odysseys. Despite painful symptoms, scans and exams may not detect it. The flow of menstrual blood backward through the fallopian tubes plays a role in some cases, scientists agree, but now they're looking at another player. In a study published in Science Translational Medicine yesterday, researchers say Fusobacterium might spur the development of endometriosis.

Tissue samples from 79 women with endometriosis and 76 without it showed that 64% of patients with endometriosis had Fusobacterium in their uterine lining, versus fewer than 10% of women in the control group. These bacteria are common, but while they rarely cause serious infections, recent studies have linked them to certain inflammatory conditions. Researchers don't know exactly how Fusobacterium enters the endometrial tissue, or what makes some people more susceptible to infection than others. STAT's Isabella Cueto has more on what's next.



Closer Look

Opinion: What's lost when patients see their test results before their doctors do

As a primary care doctor, Christopher Medrano frequently orders tests and imaging for chronic and acute conditions. It used to be common for labs to allow physicians to review results before alerting patients. Now, we all have immediate access through our electronic portals. "My patients often see the results before I do," Medrano writes in a STAT First Opinion. "Over time, this has led to more than a few snags."

While convenient for a Covid or strep test, immediate notification also eliminates the personal element between doctor and patient, something a waiting period might leave room for, he suggests. "I value this exchange with my patients, and I think they deserve to have it in a sensitive encounter with a professional rather than alone on a computer," he says. "Too often, we risk the chance of patients being left in the dark, which can quickly lead to confusion and fear." Read more.


Insurance

Half of insured people face hurdles to health care, survey says 

High costs aren't the only barriers blocking even insured people from health care. Red tape, denied claims, and complexity also delay people from getting care or prevent it altogether, a new KFF survey says. At least half of respondents said they had trouble once or more last year, whether covered by their employers, Medicaid, the Affordable Care Act's marketplace, or Medicare, and nearly half said their problems were not resolved to their satisfaction. Denials were less common from Medicare and Medicaid, but finding in-network providers was harder with Medicaid and marketplace coverage. Among those who had problems:

  • Two-thirds rated their own health as "fair" or "poor."
  • About three-quarters received mental health treatment in the past year.
  • More than three-quarters had more than 10 provider visits in the past year.

Even so, overall most people (81%) gave their insurers "excellent" or "good" marks.


health

Light exercise encouraged after concussion, new consensus statement says

"Don't cocoon," advised John Leddy, director of the Concussion Management Clinic at the University of Buffalo. His two words in a briefing with reporters summed up a striking change in advice for managing concussions, part of a new consensus statement from the Conference on Concussion in Sport published today in the British Journal of Sports Medicine. Past practice sent people with mild concussions home to darkened rooms and days of inactivity. 

New randomized clinical trials led the group to encourage student athletes, pros, and adult amateurs alike to engage in low-key physical and cognitive activity (but limited screen time) in the 48 hours after injury. Even if some symptoms, such as headache or dizziness, get a bit worse, that's OK because exercise helps avoid delayed recovery, the studies showed, but problems lasting more than four weeks need more attention. Other updates call for more research in kids under 12 and on long-term neurological effects.


Correction: I linked to the wrong JAMA study yesterday in an item about equine therapy being offered more often than medication to adolescents at residential addiction treatment centers. You can find the study here.


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What we're reading

  • Six years sober, she was still reported for child abuse for taking addiction medication. Is it time to change the rules? Boston Globe

  • Harvard Medical School morgue manager accused of stealing, selling human body parts as part of 'nationwide network,' WBUR

  • Health insurance stocks tumble after UnitedHealth says Medicare enrollees are getting more careSTAT
  • She was told she had to take steroids to rise in bodybuilding. He ignored warnings and nearly lost his life, Washington Post
  • Fentanyl-tainted pills now found in Mexican pharmacies from coast to coast, Los Angeles Times
  • Opinion: How I'm helping companies think through whether they should cover GLP-1s like Ozempic for employees, STAT

Thanks for reading! More tomorrow,


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