Breaking News

How primary care doctors are learning about trans health

August 1, 2023
Reporter, Morning Rounds Writer
Good morning. First off, the long story of NIH-sponsored research into long Covid treatments has just begun a new chapter. Then we hear about gaps in gender-affirming care and deserts for maternity care. And we introduce you to a gatekeeper at a famed Silicon Valley accelerator.

Long Covid

After delay, NIH begins trials of long Covid treatments

Patients are now being enrolled in clinical trials to test long Covid treatments, a long-anticipated development. Back in December 2020, Congress gave the NIH $1.15 billion to research and test treatments for long Covid, but trials set to start last fall were delayed three times, according to documents obtained by STAT. Yesterday the NIH said the one trial in progress will see if a Paxlovid regimen longer than a Stanford trial testing the antiviral eases symptoms of viral persistence. 

Other trials on tap:

  • Brain fog: Brain training software from Posit Science Corp. and Mount Sinai Health System, and a device for home-based transcranial direct current stimulation from Soterix Medical.
  • Sleep: Wakefulness-promoting modafinil and solriamfetol; melatonin; light therapy; and educational coaching.
  • Heart rate, breathing, and digestive activity: IV immunoglobulin therapy and the heart-failure drug ivabradine. 
  • Exercise intolerance on hold: A controversial trial has been delayed.

STAT's Rachel Cohrs has more.


health inequity

There's a gap in gender-affirming care. PCPs can fill it

Anna Casell, a newborn medicine doctor, holds up the backside of her name tag which reads "doctor" and has a pride flag sticker
Vanessa Leroy for STAT

If you are a trans person, finding a physician is not easy. Trying in rural North Carolina is especially tough, where doctors can ghost you after first contact. "It's literally like dating," said Harrison, a paramedic-firefighter, ski patrolman, and high school swim coach (STAT is only using his first name for privacy). Obtaining gender-affirming care is particularly difficult in states where it's banned for minors and facing restrictions even for adults: Testosterone must be prescribed in person now that the pandemic public health emergency is over.

Making gender-affirming care a form of specialty care doesn't help. So while a  first-year medicine-pediatrics resident at Brigham and Women's Hospital, Raquel Selcer helped create a pilot program to educate physicians. "I'm trying to really reinforce for primary-care doctors that you can do this. We manage a lot of other medications that are more high-risk or more complicated," Selcer told STAT's Theresa Gaffney. Read more.


reproductive health

Maternity care 'deserts' persist in the U.S.

The U.S. remains plagued by maternity care deserts, according to the latest report from the March of Dimes, released today. More than 5.6 million women live in counties with no or limited access to maternity care, according to March of Dimes CEO Elizabeth Cherot. Access is worst in states like North Dakota, Oklahoma, and Mississippi, where over half of all counties have no hospital or birthing facility offering obstetric care, or any obstetric providers. 

"The U.S. is one of the most dangerous places to deliver in," Cherot told STAT's Theresa Gaffney, especially for Black, brown, and Indigenous birthing people. Living in a maternity care desert compounds a mother's risk for preterm birth and other complications.

Solutions like telemedicine, extending Medicaid's postpartum coverage period, and improving access to midwife and doula services can all help to improve care. "There isn't going to be, 'Here's one thing you need to do,'" Cherot said. Revisit Theresa's story on last year's data, and read this year's full report.



Closer Look

The gatekeeper: How Y Combinator's only health care partner decides which startups have a shot

Surbhi Sarna poses for a portrait at the Y Combinator offices in San Francisco, California.
Constanza Hevia for STAT

Surbhi Sarna (above) knows what it takes to make it in health care. She sold her women's health company to Boston Scientific for $275 million at age 32. She's also tasted failure, so she understands success requires both a compelling idea and the entrepreneur's commitment to it. As the only health care partner at Y Combinator, she brings that knowledge to vet projects and people vying for a place in the famed Silicon Valley accelerator.

"Sometimes you'll talk to a team and they have all these side projects or they want to keep many doors open at the same time," she said. "If you have your full-time job and you're also consulting and you have two different [ideas] you're not taking on the risk for what it means to be a founder." STAT's Mohana Ravindranath spent time with Sarna for the first report in "The Gatekeepers," a series profiling influential figures in health tech. Read more.


medical education

Black M.D.-Ph.D. students leave training at higher rates than their white peers

A new study of nearly 5,000 students enrolled in M.D.-Ph.D. programs between 2004 and 2012 found attrition rates were 50% higher for Black students than white students, with 17% of white students not completing training and 29% of Black students not doing so, STAT's Usha Lee McFarling reports. While the study, published in JAMA Internal Medicine, did not probe the reasons for the difference in attrition rates, the authors noted that Black medical students report higher rates of mistreatment and discrimination that can lead to depression, burnout, and leaving training. 

Higher attrition rates, they noted, are harming efforts to diversity the biomedical workforce. A STAT investigation published last year found that Black residents were far more likely to be dismissed from or leave residency training than white physicians — especially in the most lucrative and elite specialties — providing one explanation for why the number of Black physicians in many of these fields has not risen appreciably in decades.


in the lab

Mythbusters come for microbiome hype

More than two decades after research into the microbiome began blooming, we're familiar with the population of microbes that live in or on us, outnumbering us by 10 to 1. But that last bit is just one of many myths, scientists writing a perspective piece in Nature Microbiology assert (it's more like 1:1). So is the source of the word "microbiome": No, Nobel laureate Joshua Lederberg did not name it in 2001. Here are my favorites among the dozen misconceptions Alan Walker and Lesley Hoyles puncture so they don't undermine the real importance of this research:

  • Awareness of the microbiome is new: Not really. That 10:1 back-of-the-envelope estimate dates to the 1970s; you can go back centuries.
  • We inherit our microbiota from our mothers at birth: Actually, most gut microbiota diversity occurs after birth, most dramatically after weaning.
  • Most diseases come from a microbiome gone bad: "Microorganisms and their metabolites are neither 'good' nor 'bad', they merely exist," the authors say, so more like correlation than causation.

More around STAT
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What we're reading

  • Doctors emerge as political force in battle over abortion laws in Ohio and elsewhere, ProPublica
  • Marijuana addiction is real. Those struggling often face skepticism, Washington Post
  • Vivek Ramaswamy wants to 'gut' the FDA. His claims don't hold up to scrutiny, STAT
  • Phoenix's month in hell: 31 days of extreme heat tests the city, New York Times
  • Medicare wants to improve Alzheimer's care, but sidesteps drug prices, STAT

Thanks for reading! More tomorrow,


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