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The science of desire, the long wait for a Parkinson's diagnosis, & living with Fabry disease

July 10, 2023
Reporter, Morning Rounds Writer

Good morning and welcome back, loyal readers. We have a full slate of news for you, but let's not forget these gems from last week while the newsletter was on hiatus:

The obesity revolution

How new weight loss drugs intersect with the circuitry of desire — and not just for food

FINAL-ART-PIZZA-Katy Lemay for STAT

Maybe it's not too surprising that the new weight loss drugs have skyrocketed in popularity, from about 230,000 Americans taking the GLP-1 agonists in 2019 to 5 million prescribed in 2022. But even for scientists who've made gut hormones their life's work, the potency of these drugs to suppress appetite and calm craving has been astonishing. Now it's becoming increasingly clear that these drugs also work in the brain, altering neural pathways that drive desire. 

Now, STAT's Megan Molteni reports, researchers are asking if hormone hacking can erase food cravings, what other destructive desires might it liberate us from one day? Substances like alcohol, nicotine, and opioids are all addictive because they also ignite the brain's reward system, creating a burning hunger for another drink, another smoke, another hit. (And don't miss lessons from the vervet monkeys on Saint Kitts and Nevis that got a taste for alcohol).


politics

Biden's NIH nominee is still waiting for her hearing

The NIH has been without a permanent head since December 2021. President Biden has nominated Monica Bertagnolli to lead the agency, but standing in the way of this otherwise uncontroversial pick are demands from two senators.

Sen. Bernie Sanders, chair of the committee charged with scheduling her  confirmation hearing, has said he will not schedule it until the Biden administration promises more drug pricing reform. And before giving her support, Sen. Elizabeth Warren wants Bertagnolli to pledge she won't join pharmaceutical company boards after her tenure as director ends, according to three people familiar with internal deliberations.

"People in the biomedical community are very anxious because there's a lot going on at the NIH," said former director Harold Varmus, a Clinton appointee. "An agency as big as ours needs a Senate-confirmed director and we haven't had one for over a year and a half." STAT's Sarah Owermohle has more.


Health

The long road to Parkinson's care has gaps

When Richard Huckabee was finally diagnosed with Parkinson's by a neurologist, it felt like a cruel joke. "I was happy to find out what I finally had," he said. "I was devastated at nine years of in-and-out doctors, and here is this one doctor that says in 10 minutes, 'You have Parkinson's disease.'" Huckabee's not alone: In 2019, 40% of Medicare beneficiaries living with Parkinson's, or nearly 250,000 Americans, didn't see a neurologist for their disease, according to a new study out today in npj Parkinson's Disease. 

These gaps in care were worse for Asian, Black, Hispanic, and Native Americans, as well as women and rural Americans. There is no diagnostic test for Parkinson's or even a standard presentation of disease. A referral from primary care is often not enough for patients because there simply aren't enough neurologists. STAT's Simar Bajaj has more.



Closer Look

His rare disease runs through generations. So he built a community around it

LIVING_WITH_JackJohnsonPhoto illustration: Casey Shenery for STAT

By the time Jack Johnson was 7, he'd already seen many family members struggle with Fabry disease, a rare condition that was beginning to affect him, too. It causes the fatty lipid Gb3 to build up in the body, causing gastrointestinal issues, kidney failure, stroke, chronic pain, and dangerous heart abnormalities. Growing up in Bakersfield, Calif., where his job on the family farm was to cool down the pigs in scorching weather, he could sympathize because he couldn't sweat, either.  

Now a husband, small farmer, and father to two sons, he leads the online the Fabry Support & Information Group. "The disease affects everybody differently in many regards and people have to be able to make their own decisions," he told STAT's Isabella Cueto. "We just try to give them the information that they need to be able to do that." Read more.


insurance

New White House guidelines take aim at sticker shock in health care

New guidelines issued by the Biden administration seek to take the "surprise" out of surprise billing in health care, going beyond 2020 restrictions and their loopholes while also taking aim at short-term insurance policies that often fail to cover essential treatment. Also on the hit list are high-interest credit cards and payment plans specifically marketed to help patients cover medical debt. Another target: facility fees, surprise bills tacked on on by hospitals when they provide services in an outpatient location.

The White House intends to force health plans and providers to share information about these fees, with the goal of making them more transparent and less of a shock to patients who might not be informed about the fees ahead of time or even be familiar with the concept. Whether that will translate into savings for patients is another question, STAT's Annalisa Merelli reports, reminding us that hospital price transparency has had limited impact. Read more.


emergency medicine

Pre-hospital dosing of emergency medications for kids falls short of guidelines, study says

In emergencies, children may need medication on their way to the hospital. A new study published today in Pediatrics found dosing of 10 common medications varied widely, often deviating from national guidelines that are determined by weight. Based on its review of more than 990,000 electronic medical records from roughly 2,000 U.S. emergency medical services, the researchers conclude that these drugs were given correctly only 42.6 out of 100 times. 

In most cases, the differences were underdoses, particularly for sedating medications such as benzodiazepines and morphine, likely from concern about overdoses. But underdosing can be dangerous for children having seizures or asthma attacks. The authors also note that estimating weight when it isn't known can be an obstacle to getting the dose right. Citing other work in addition to their own, they say "there may be even greater opportunities for improving dosing of pediatric medications in prehospital compared with in-hospital acute care settings."


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What we're reading

  • America is wrapped in miles of toxic lead cables, Wall Street Journal
  • Blue Cross Blue Shield insurers keep winning from Affordable Care Act's risk program, STAT
  • Studying the link between the gut and mental health is personal for this scientist, NPR

  • Medicare wants to send $9 billion to 340B hospitals — coupled with cuts, STAT
  • Opinion: Why the aspartame in Diet Coke and Coke Zero probably isn't worth worrying about, STAT

Thanks for reading! More tomorrow,


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