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A weight management plan for a 9-year-old, telehealth for menopause, & CRISPR for Alzheimer's (in mice)

July 17, 2023
Reporter, Morning Rounds Writer

Good morning. Today we go inside an LA obesity clinic for kids, see what big businesses like Google and Epic Systems think about regulating AI in health care, and catch up with telehealth companies going after menopause care.

obesity revolution

'Not just running in the park': What a 9-year-old patient learns at an LA obesity clinic

06-07-23_LONDON_STAT_75010Brittany Bravo for STAT

Nine-year-old LR (above) arrived at the Fit Clinic late, delayed by her school's refusal to grant any more early dismissals. She joined the clinic's relay race in progress, surmounting another obstacle to better health that the Los Angeles program is designed to help her overcome. Its mission is to bring intensive health behavior and lifestyle treatment to children on the threshold of obesity, in line with recent American Academy of Pediatrics recommendations.

LR's weight and body mass are tracked in her electronic health record, but the numbers never come up in conversation. There are other things to talk about: abnormal liver function; high triglycerides, blood pressure, and blood sugar;  and the reasons why. LR is near puberty, when kids naturally gain weight. Controlling issues before then is important, but actually doing so is more complicated. "Being well is not just running in the park," social worker Bobby Verdugo said. STAT's Isabella Cueto brings us LR's story.


health tech

A federal agency proposes guardrails for AI in health care. Big businesses are pushing back

As artificial intelligence technologies become more powerful, companies are racing to deploy them in health care. Concern is rising over the safety of these largely opaque technology tools. Proposed federal rules would increase oversight and fairness of AI tools used to help make decisions about patient care, but some companies are fighting back, via comments on the plan:

  • Even though Google's own scientists have raised alarms about AI's potential dangers, the company objected to disclosing how AI models are designed, trained, and tested.
  • Electronic health record vendor Epic Systems argued against requiring disclosures related to quality standards to get health IT systems certified.
  • Insurer UnitedHealth Group called the agency's definition of predictive AI tools "vague and overly broad." 

STAT's Casey Ross has more.


in the lab

Scientists aim CRISPR at Alzheimer's in early research

Scientists are already using the genome-editing tool CRISPR to gain ground on diseases caused by particular mutations, like sickle cell. Now researchers are adding Alzheimer's disease to that list, reporting at a conference Sunday on early-stage research:

  • A team from the University of California, San Diego, homed in on the amyloid precursor protein, or APP. They used CRISPR to snip out a small amount from the end of the APP gene in mice bred to have a version of Alzheimer's, reducing production of the "bad" amyloid that is a hallmark in Alzheimer's.
  • Scientists at Duke University used CRISPR to tamp down APOE4, a gene that raises the risk of developing Alzheimer's. They aimed their CRISPR complex at the epigenome surrounding and regulating the gene. Hitting the right spot essentially closed off the APOE4 gene, limiting its expression in mice.

STAT's Andrew Joseph has more.



Closer Look

Telehealth startups target menopause care

MenopauseHRT_Illustration_MollyFerguson_071423Molly Ferguson for STAT

It's a very different world now than it was in 2002 for women dealing with the hot flashes, night sweats, and other symptoms of menopause. Back then, right after the Women's Health Initiative was halted early, millions of women who relied on hormone therapy abandoned it after the landmark trial suggested estrogen and progesterone raised risk of breast cancer and cardiovascular disease. More recent research has added nuance to the all-or-nothing approach, pointing to more benefits than risks for most healthy women under 60 using hormone therapy.

More than a dozen new telehealth startups are now catering to women in and approaching menopause, including with hormone therapy. "Women fall through the cracks," internist Lisa Larkin, president-elect of The Menopause Society and founder of concierge women's health network Ms. Medicine, told STAT's Katie Palmer. "That's why the telemedicine business is booming." Read more, including concerns about whether the pendulum has swung too far.


chronic disease

How does celiac disease do its damage?

When someone with celiac disease eats food containing gluten, part of it remains in the small intestine and ignites a full-blown inflammatory response. Consequences from the autoimmune condition can be severe: poor absorption of nutrients, chronic diarrhea and fatigue, brain fog, and osteoporosis. Scientists have said CD4+ T cells trigger inflammation, later activating T-IELs, a population of T cells in the GI tract that harm the intestinal lining. 

New research published in Science Immunology suggests these T-IELs, which have natural killer receptors, are being activated by gluten right away. Small intestine biopsies performed on 37 patients and 17 healthy controls suggest T-IEL cells shift from anti-inflammatory to pro-inflammatory, killing intestinal tissue. Understanding exactly how these immune cells are triggered by gluten and how they damage the gut could prove important for not just celiac, but other autoimmune diseases. STAT's Isabella Cueto has more.


health

Not to worry: Kids' IQ scores after concussion stable 

Concussions, which are common among school-age children, are classified as mild traumatic brain injuries if they don't involve a prolonged loss of consciousness, amnesia after 24 hours, or other serious problems. Still, the headaches and temporary confusion can seed fears of cognitive issues. Studies have been conflicting, so researchers writing in today's Pediatrics combined data from 866 children age 8 to 17 from seven EDs in the U.S. and in Canada. They compared those who'd had concussions to those who'd had a strain, sprain, or break in an arm or leg. 

IQ tests given at least three days and then three months after their injuries showed no difference in scores between kids with brain or orthopedic injuries. Ideally, prospective studies would look more deeply into this question, the researchers say. While acknowledging the limitations of IQ tests, they also say for now, IQ scores aren't a useful way to measure concussion outcomes.


In this week's episode of Color Code, STAT's Nicholas St. Fleur explores how wildfire pollution widens asthma inequities on Long Island. Listen here.


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What we're reading

  • Subtle revolution: In the treatment of MS, small steps add up to a new approach to disease, The New Yorker
  • Exclusive: Blue Cross Blue Shield plans in California evaded $170 million in taxes, whistleblower says, STAT
  • They lost their legs. Doctors and health care giants profited, New York Times

  • J&J expands global access to TB drug as popular novelist joins advocacy campaign, STAT

  •  A red state boosted public health funding by 1,500%. This is how they did it, Politico

  • Opinion: No one — M.D. or otherwise — should use the honorific 'doctor' with patients, STAT

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