Drug pricing winners and losers, helping doctors tell their stories, & a Mozart lullaby to ease the pain

Writing isn't "a Band-Aid for the American health care system, but it does give people a chance to remember why they got into this field."

August 30, 2023 Check out STAT+

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By Elizabeth Cooney Reporter, Morning Rounds Writer

Good morning. Today I couldn't resist sharing the study testing a Mozart lullaby to ease newborns' pain during the heel prick test. It worked. As the researchers conclude, it's "an easy, reproducible, and inexpensive tool for pain relief from minor procedures." So enjoy.

drug prices How the dust might settle on drug price negotiation The long-awaited list of 10 medicines subject to price negotiation in 2026 hit yesterday morning, setting up the first time that Medicare can secure lower drug prices under the Inflation Reduction Act. How big those discounts might be and whether the program will survive legal challenges remains to be seen. And it's still unclear if the government will pass on any savings to consumers, STAT's Matthew Herper and Damian Garde remind us.  Still, there are some winners and losers at this juncture. President Biden is a winner, securing a spot in his legacy for health care. But pharma has taken another hit to its reputation, burnished by phenomenally speedy Covid vaccine development but tarnished by simmering outrage over prices. Also winners: most cancer drugmakers, with only Johnson & Johnson and AbbVie's Imbruvica, for lymphoma, on the list. J&J counts as a loser because three of its drugs are up for negotiation while Pfizer has just one. Read more. in the lab KRAS, the no longer 'undruggable' quarry Molly Ferguson for STAT For decades after KRAS, one of the most common genetic mutations in cancer, was discovered, it's been deemed undruggable. As in, no medicine can successfully target it to defeat cancer. In the 1980s, scientists did establish that a single point mutation — a genetic spelling error — meant cancer is a genetic disease. But it wasn't until 2013 that a glimmer of hope appeared for going after KRAS with small molecules that would bind to a specific subset of the mutant cancer-causing KRAS. Two drugs that reach a particular KRAS mutation have had modest success: Amgen's Lumakras and Mirati's Krazati. While there's room for improvement, "KRAS remains a promising cancer target," said Julie Rotow of the Dana-Farber Cancer Institute. "We know targeting it effectively can be clinically active. That right there tells me that it's a target we should be pursuing." STAT's Angus Chen and Bree Iskandar have more. health inequity Lead levels still track with racially segregated locales It was true in 1992 and it was true 20 years later. Researchers tracking racial segregation in census tracts in North Carolina found higher levels of lead poisoning among young Black children in racially isolated neighborhoods based on testing 320,916 children, ages 6 and younger, from 1992 to 1996 or from 2013 to 2015. Racial isolation has also been implicated in poor pregnancy outcomes, lower life expectancy, type 2 diabetes, hypertension, and worse cardiovascular health for Black people.  Exposure to even low levels of lead can raise the risk of learning deficits, with effects that persist into adulthood. The new study of higher lead levels in young children underscores the "disproportionate environmental burdens borne by segregated communities and the need for attention from the health care community," the authors of the study, out today in Pediatrics, say.

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Closer Look A memoir writer helps doctors share their own stories Dania Maxwell for STAT Soon after Covid arrived, Lauren Braitman (above), director of writing and storytelling at Stanford Medical School's program for medical humanities in the arts, felt compelled to start a virtual writing workshop, free for any health care professional with an internet connection to attend. "We will just go until you people don't want to come anymore," she said, while as many as 150 Zoom squares filled up on Saturdays.  It's still going. But it was also more. Teaching medical students how to process their feelings and communicate with vulnerability was a symbiotic relationship for Braitman. She was also getting comfortable with the hard parts of her life's story. Reflective writing isn't "a Band-Aid for the American health care system," she told STAT's Isabella Cueto. "But it does give people a chance to remember why they got into this field in the first place, and how they might keep going." Read more. In the lab A lullaby to take the sting away for the littlest ones A newborn getting a heel prick to draw blood is an iconic image of an infant's first days of life. The soundtrack of pitiful squalls is also familiar, but a study in Pediatric Research suggests another way. A blinded clinical trial studying 100 infants suggests playing a Mozart lullaby might lessen the babies' pain. (I'll wait while you listen.) Researchers assessed their pain while wearing noise-canceling headphones that blocked the Mozart but couldn't hide the grimaces, crying, breathing, limb movements, and alertness (no pacifiers or comforting allowed).  Just over half of the newborns heard Mozart for 20 minutes before and during the heel prick and for five minutes after. The other babies heard no music. All the babies felt some pain, as measured by the observers, but the Mozart babies appeared to feel less — and only during the heel prick itself. Three minutes later all the infants were fine. medicine Opinion:  Even misunderstanding chaos theory helps a child psychologist help children in distress Inpatient child psychiatrist Sharmila Bandyopadhyay Mehta had a revelation when Covid eventually sent her home to recover in bed. After months of treating children experiencing mental health crises with what she understood to be the "butterfly effect," she read enough chaos theory to see she was mistaken. The flap of a butterfly wing that could lead to a tsunami on the other side of the world, or meaningful change in the life of a child facing daunting challenges, was not what she thought it was.  She'd made it through difficult days in her safety-net hospital, especially early in the pandemic, by believing the smallest change was meaningful. But the theory holds the opposite: "It is virtually impossible to predict the magnitude or direction of a small intervention," she writes in a STAT First Opinion. Still, "without that critical flap, never mind a tsunami — there was no chance for change of any kind." Read more.

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What we're reading A deadly tick-borne epidemic is raging. Dogs are key to ending it, Washington Post The mystery of long Covid is just the beginning, New York Hypodermics on the shore, The Atlantic In a decaying Queens fortress, it's one man versus 47 kinds of mosquito, New York Times Neurosurgeon investigating patient's mystery symptoms plucks a worm from woman's brain in Australia, Associated Press

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Thanks for reading! More tomorrow,

elizabeth.cooney@statnews.com

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