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The 'gut punch' of cancer drug shortages, the bias GPT can add to diagnoses, & the way to cut noise from heart wearables

July 19, 2023
Reporter, Morning Rounds Writer
Good morning. If you wondered what it's like for cancer patients to live through the current drug shortage, read what they told STAT contributor Charlotte Huff and what their doctors say, too.

cancer

'A gut punch again': Living with cancer drug shortages

Mairéad McInerney sits for a portrait at her home in Pennsylvania. Hannah Yoon for STAT

This is what it's like to live with cancer now. Patients coping with the physical and psychological distress of cancer and its treatment also face the nightmare of not being sure they can get the drugs they need. Mairéad McInerney (above) will never know if changes in her treatment plan have undercut her odds of surviving stage 3 triple-negative breast cancer. Critical shortages in cancer drugs have forced her to change course not once, but twice. Supplies are being rationed and difficult decisions are being made.

"You navigate so much and do all these mental gymnastics to wrap your head around enduring and getting through your infusions and your treatments," said McInerney, a 38-year-old health care executive who lives in suburban Philadelphia. "And then to hear that something is not available, it really is such a gut punch again, because you're still out of control." STAT contributor Charlotte Huff tells us more.


health tech

Researchers enlist AI to work with noisy heart signals from wearables

That medical device on your wrist, also known as your Apple Watch, may be able to detect your heart's electrical signals and rhythm, but it's a far cry from what hospital-grade electrodes can deliver. Wearables' readings are messier, often because skin contact is less than ideal, among other limitations. Now researchers are testing a solution: training an AI algorithm on noisy electrocardiograms to see if they can eventually pick up less than pristine signals from our watches.  

Their paper in Nature reports some success: Trained to detect measurements indicating heart failure and then tested on EKG readings ranging from no noise to excessive noise, the noise-adapted model's performance never dropped below 88%. Further studies will test this approach in the real world, and with multiple devices. It will also be critical to see how it works across demographics like age, race, ethnicity, and gender. STAT's Lizzy Lawrence has more on the challenges.


health inequity

Medicaid coverage policies shape maternal care

Medicaid is an essential source of maternal and postpartum care for low-income Americans, covering 42% of births in the U.S. People who give birth receive maternity care until at least two months after delivery, depending on state or local policies. But Medicaid coverage is out of reach for many immigrants, a new JAMA study shows. Looking at nearly 73,000 postpartum patients across 19 states and New York City between 2012 and 2019, the researchers found that in states with no coverage for recently documented and undocumented immigrants, 20% of low-income postpartum immigrants didn't receive any care, compared to 12% of low-income non-immigrants. 

In states where access was granted to all immigrants, more low-income immigrants accessed postpartum care (89.5%) than non-immigrants (87.7%). "If we are really serious about wanting to improve pregnancy outcomes," study co-author Laura Wherry said, "then we need to revisit this model." STAT's Annalisa Merelli has more.



Closer Look

In test cases, GPT-4 displays bias in diagnoses

OpenAI logo reflected to another surface from a phone screenOlivier Douliery/AFP via Getty Images

Sometimes large language models can crack tough diagnostic cases surprisingly well, but sometimes they magnify problems in the data they draw from, a new study posted on medRxiv says. "GPT-4, being trained off of our own textual communication, shows the same — or maybe even more exaggerated — racial and sex biases as humans," Adam Rodman of Beth Israel Deaconess Medical Center told STAT's Katie Palmer. He was not involved in the research, which has not been peer-reviewed.

In the study, the GPT tool ranked possible diagnoses differently after the gender or race of the case study patient was changed. For shortness of breath in a woman, it ranked panic and anxiety disorder higher on its list than for a man. For a sore throat, mono was correctly identified for 100% of white men but only 86%, 73%, and 74% of the time for Black, Hispanic, and Asian men, respectively — placing gonorrhea first instead. Read more.


addiction

Opioids are not alone in overdose deaths

Screen Shot 2023-07-18 at 12.57.41 PMNational Center for Health Statistics

The opioid overdose crisis, aggravated by fentanyl infiltrating the illicit drug supply, sometimes commands all our attention. A new CDC report reminds us that people are dying of overdoses involving other drugs, from cocaine and from psychostimulants like methamphetamine, amphetamine, and methylphenidate. In combination with opioids, the results are deadly and growing. In 2021, more than three-quarters of overdose deaths involving cocaine also included an opioid.

That rising slope is similar for psychostimulants plus opioids. In 2021, just under two-thirds of overdose deaths involving psychostimulants included an opioid. Other numbers:

  • In 2021, the rate of drug overdose deaths involving both cocaine and opioids was 7.4 times the rate in 2011.
  • In 2021, the rate of overdose deaths involving psychostimulants was 14.3 times the rate in 2011; the rate increased 33.3% from 2020 through 2021.

Mental health

People with bipolar disorder face a premature mortality gap

It's well-known that people with mental illness have an overall shorter life expectancy than others, but when it comes to bipolar disorder, why premature death rates are double the general population's aren't known. A new study in BMJ Mental Health separates some causes of the mortality gap, breaking down years of life lost to alcohol-related causes, cardiovascular disease, and suicide, among others. 

Analyzing health records in Finland of more than 47,000 people 15 to 64 years old with bipolar disorder, the researchers found they were six times more likely to die prematurely from accidents, violence, and suicide than those without the condition. They were also twice as likely to die from physical illnesses, with alcohol a major contributing factor, followed by heart disease and stroke, and cancer. Nearly half of the deaths by suicide involved overdoses with prescribed mental health medications. "Suicide prevention remains a priority," the authors write.
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.

On this week's episode of the "First Opinion Podcast," STAT's Torie Bosch chats with registered nurse Tara Rynders about the ways the arts can help address health care worker burnout, and policies that can support nurses. Listen here.


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  • Medicine is plagued by untrustworthy clinical trials. How many studies are faked or flawed? Nature
  • Johnson & Johnson sues to stop Medicare negotiation, STAT

Thanks for reading! More tomorrow,


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