Fears of bird flu, a fee to message your doctor, & calling out racism in medicine — again

Three international agencies said yesterday that the world should do more to control the dangerous bird flu virus H5N1.

July 13, 2023 Check out STAT+

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By Elizabeth Cooney Reporter, Morning Rounds Writer

Good morning. We bring you fears about bird flu spreading, an update on a landmark report on racism in medicine, and the story behind a parent's push for a rare disease therapy — and the scientist who made it happen again.

infectious disease Global health agencies warn action is needed to prevent bird flu's spread to humans Three international agencies that oversee issues of human and animal health said yesterday that the world should do more to control the dangerous bird flu virus H5N1, STAT's Helen Branswell tells us. The U.N.'s Food and Agriculture Organization, WHO, and the World Organization for Animal Health warned the unprecedented spread of H5N1 is a risk to animal species and to people. "There is a recent paradigm change in the ecology and epidemiology of avian influenza which has heightened global concern as the disease spread to new geographical regions and caused unusual wild bird die-offs, and alarming rise in mammalian cases," Gregorio Torres, science department head at WOAH said in a statement. The agencies encouraged countries to adopt or maintain robust biosecurity measures at poultry production operations. They also suggested countries could consider vaccinating poultry and asked them to increase their capacity to do surveillance for the presence of the virus, so that they can detect any human cases that occur. in the lab A parent inspires a bespoke gene therapy — again As the saying goes, so many people have rare diseases they're not rare at all. For those estimated 400 million people, hope may lie in medicines called "n of 1" therapies, scientific argot for clinical trial participants whose debilitating genetic conditions are too rare to interest pharmaceutical companies. Timothy Yu developed one such therapy and named it after the little girl who needed it: milasen for Mila and her Batten disease. Now in a new Nature study, the Boston Children's Hospital physician reports success with another personalized medicine, called atipeksen, for a young child with the genetic disorder ataxia-telangiectasia, or A-T. Like milasen, atipeksen was sparked by a parent. Brad Margus' two sons had missed the window to receive A-T treatments, but he was determined to help other families. STAT's Bree Iskandar explains how Margus inspired Yu and his team to create an individualized antisense oligonucleotide therapy for a little girl who started the bespoke treatment at age 2. Health inequity Calling out racism in medicine made waves 20 years ago. Little progress followed, a new report says Twenty years ago, "Unequal Treatment" pointed directly at racism — not poverty, lack of insurance, or refusal to seek care — as a prime mover causing health disparities. Now the National Academies of Sciences, Engineering, and Medicine has revisited that landmark work, asserting that the nation's widespread racial health disparities won't end unless we change how health care systems are funded and accredited, demand more public and financial accountability for poor patient outcomes, and do more work to overturn the income inequality and residential segregation behind poorer health and lower life expectancy for many people who are Black and brown. This week experts expressed frustration that, as STAT's Usha Lee McFarling has reported, so little progress has been made. "It's 20 years. I sat on the committee," David R. Williams of the Harvard T.H. Chan School of Public Health said. "We have not made that much progress. We need to do things differently." Read more.

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Closer Look Messaging your health care provider? There may be a fee for that Adobe Patient portals may look like an easy way to getting health questions answered, but for clinicians on the other side of the MyChart gateway, the flood of requests can be overwhelming. In response, health systems are starting to charge for especially time-consuming responses. Cleveland Clinic and the University of Washington recently followed early adopters Northwestern and University of California, San Francisco, which have recouped costs and, in some cases, slightly reduced the volume of patient portal messages. The health systems told STAT's Mohana Ravindranath they're charging for just a small segment of responses — between 1% to 5%. "This is part of a broader conversation about expectations patients and providers have of each other," Oregon Health and Science University's Anthony Cheng said. "There's a breaking point that care teams are reaching, and this is not the whole solution, but it's kind of the beginning of a conversation." Read more. health inequity How veterans feel redlining's effects today The legacy of redlining — a 1930s mortgage lending policy based on race and ethnicity — continues to harm marginalized people today, a new JAMA Network Open study says. Among veterans who had cardiovascular disease, living in a historically redlined neighborhood was linked to a 13% higher risk of death and a 14% higher risk of a major cardiovascular event compared to those living in historically white, wealthy areas. The researchers adjusted for age, sex, and race as well as diabetes, high blood pressure, and high cholesterol.  It's the first major national survey to look at redlining and comprehensive cardiovascular risk. "If you think about it, generation after generation, we know that wealth accumulates," said Hayden Bosworth, who co-authored a companion commentary. "The equivalent is that if generation after generation keeps lacking resources, it keeps on building and building, and makes it that much harder to get out of the hole." STAT's Ambar Castillo has more. mental health 988 crisis line faces lack of familiarity and fears of police involvement, survey finds Yesterday we told you what the people taking calls to the 988 crisis line think, one year after its nationwide debut. A new National Alliance on Mental Illness survey out today says only one-third of Americans are familiar with the service and more than 90% haven't contacted it for themselves or others in need. More people said they trust 911 "a great deal" than feel that way about 988. For some survey respondents, that reluctance stems from a fear of police involvement. Overall, 6 in 10 people worried police would harm a loved one having a mental health crisis, but that grew to three-quarters or more of LGBTQ+ people, Black people, and Hispanic people. The 988 mental health crisis line deploys a mobile crisis unit in only about 2% of cases, but "there's a significant concern among Black adults around what a police response would look like," NAMI's Hannah Wesolowski told STAT's Annalisa Merelli. Read more.

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Thanks for reading! More tomorrow,

elizabeth.cooney@statnews.com

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