Breaking News

Inside a clinic trying to reimagine how miscarriages are treated

August 31, 2023
Reporter, Morning Rounds Writer
Morning. Don't miss today's special report on how miscarriage is — and isn't — treated.

special report

A new approach to miscarriages treats them like the medical problem they are

A portrait of Dr. Barbara C. Toppin at the clinic in Woodbury, Minnesota.Jenn Ackerman for STAT

All too often, miscarriages are called bad luck and grieving parents are urged to just try again. And again. Barbara Toppin (above) is among a few physicians across the country pushing for a proactive approach. That means treating miscarriages like a medical problem, not just a fact of life. So she asks patients for details about their pregnancies and any family history of heart disease or stroke. She looks for uterine abnormalities and tests for blood-clotting problems, chronic inflammation, and autoimmune conditions. 

"Do physicians treat heart attacks like this? Strokes? Why do we make women wait for so many losses?" she said. STAT contributor Sadia Rafiqqudin spoke to a dozen women who have had miscarriages, who told her their treatment varied wildly across the country. But they all felt one thing in common: Their losses were brushed off. Read more on conflicting standards of care and pushback Toppin has received.


infectious disease

U.K. moves up vaccine plan in light of new variant

U.K. health authorities are pushing forward the start of their fall vaccination campaigns for Covid-19 and influenza in response to the emergence of a new, highly mutated version of SARS-CoV-2, STAT's Helen Branswell reports. The twin campaigns, which were to begin in early October, will start on Sept. 11, the U.K. Health Security Agency said in a statement yesterday. The move is motivated by BA.2.86, a SARS-2 subvariant that has recently been detected in the U.K., the U.S., and a number of other countries.

"This precautionary measure to bring forward the autumn program will ensure … people have protection against any potential wave this winter," said Dame Jenny Harries, chief executive of the U.K. Health Security Agency. The statement acknowledged, however, that it's not yet clear how much of a threat BA.2.86 poses. Nor is it known how well the updated boosters will protect against the new subvariant; they target a version of SARS-2 that was circulating in the spring. The U.K. plan is to vaccinate older adults, people who are immunocompromised, and workers who care for them.


public health

Striking ProMED moderators agree to return to work

Striking moderators of the infectious disease surveillance program ProMED signaled yesterday that they will resume work for the embattled service. But the moderators, who went on strike in early August to protest the way the International Society of Infectious Diseases is running ProMED, said they would return to work 10 days after a deadline imposed by the ISID, STAT's Helen Branswell tells us. The society insisted moderators who want to remain part of ProMED resume work on Sept. 1. In a letter to the ISID's administrative staff, the moderators said they would return Sept. 11.

The moderators and the society have been in talks with a number of academic and nonprofit organizations that have come forward looking for a way to save ProMED, since the moderators' strike drew attention to the fact that its future is in peril. Moderators — subject matter experts who curate and contextualize news and intelligence from around the globe on disease outbreaks — earn a modest stipend of $7,000 a year. Still, their pay is months overdue. Several strike organizers indicated they felt the work stoppage had had the desired effect — initiating the start of talks about finding a new home for ProMED. "We are persuaded that our highest duty is to our readership and those beyond who depend on our timely, accurate, and perceptive posts and commentaries for the good of public health worldwide," they wrote.



Closer Look

Over-the-counter naloxone is here, but will it make a difference in overdose deaths?

GettyImages-1258771351Angela Weiss/AFP via Getty Images

Now that naloxone is available over the counter, two questions loom: Will people be able to afford the overdose-reversal treatment? And will it end up saving lives? So far, only one major plan, Blue Cross Blue Shield of Massachusetts, has said it would cover this critical component of the U.S. response to the opioid crisis. Narcan, a popular nasal spray version of the medication, typically sells for $50 or more for a two-pack. Manufacturers have made higher-dose versions that sell for far more, despite uncertainty about whether they're any more effective. 

Asked whether this will make a dent in overdose deaths, Maya Doe-Simkins of the nonprofit Remedy Alliance reminds us "the way that naloxone is distributed in our country is completely outside of the normal medication acquisition process." That means not at the pharmacy but from the hands of laypeople and emergency responders. STAT's Lev Facher explains.


drug prices

Pharma's unhappy about Medicare's drug negotiation. Doctors and hospitals? Crickets. Here's why

For all the Sturm und Drang surrounding Medicare's thunderclap announcement of which 10 drugs' prices it will negotiate with their makers, there's been silence from another sector of health care: doctors and hospitals  administering or prescribing the medicines. STAT's Bob Herman wondered why. The American Hospital Association told him it's "not commenting on this issue right now." The AMA? Same. The Federation of American Hospitals? Same again.

Here's an explanation, Bob submits. Medicare already sets their prices. And they're doing fine. "If we advocated for the price-fixing of pharmaceuticals, we have no leg to stand on if we say we don't like price-fixing for physicians," former AMA president and oncologist Barbara McAneny said at an AMA meeting in 2017. And also this: "[Providers] are making money on expensive drugs and don't want that to end," Gerard Anderson, a health economist at Johns Hopkins University, told Bob. Read more.


health outcomes

Female vs. male surgeons, the longer-term story

If your surgeon is female, your chances of a poor post-operative outcome — including death — 90 days to a year later are lower than if your surgeon is male, a new JAMA Surgery study finds. If that sounds familiar, that's because previous research reached a similar conclusion when looking 30 days after common procedures. Of the more than 1 million people in the Canadian study, patients treated by the 2,306 male surgeons were 25% more likely to die within 90 days and 24% more likely to die within a year compared to patients treated by the 700 female surgeons. 

The difference may originate outside the OR. "It's not because females are technically better surgeons," said pediatric surgeon Cassandra Kelleher, who was not involved in the research. "It's because somehow women are either preparing patients for surgery better, as suggested by their elective patients having better outcomes than emergent patients." STAT's Deborah Balthazar has more.


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What we're reading

  • Medicaid rebukes states for mistakenly disenrolling children, STAT
  • Mitch McConnell appears to freeze during news conference a second time, Axios
  • Women may face higher risk of stroke following infertility treatment, New York Times
  • Workforce, capacity constraints slow ramp-up of new Alzheimer's drug Leqembi, Boston Globe
  • J&J cuts the price of its lifesaving TB pill by more than half for many low- and middle-income countries, STAT

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