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What's next for bariatric surgery, a deadline for striking ProMED moderators, & how to handle patient emails

August 28, 2023
Reporter, Morning Rounds Writer
Good morning. Happy Monday to all and thanks to my stalwart colleagues who brought you the news last week. Today we look at bariatric surgery in the era of new weight loss drugs, an ultimatum for moderators of an infectious disease early-warning system, and psychiatrists' overflowing inboxes. 

the obesity revolution

Bariatric surgery in the age of new weight loss drugs

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Guillermo Arias/AFP via Getty Images

With all the buzz about weight loss drugs and their dramatic effects (and cost), where does that leave bariatric surgery? Long the most effective treatment for obesity, its edge over drugs has narrowed, now that a recent trial of Wegovy showed the drug cut the risk of major heart complications by 20%. Bariatric surgeons told STAT's Simar Bajaj the treatments could be complementary. They also shared lessons from history:

  • Jenny Choi: Anti-reflux surgery used to be the go-to treatment for stomach ulcers and heartburn, but proton pump inhibitor medications took over. 
  • Marina Kurian: When coronary stents were on the rise in the '90s and early 2000s, "everyone was like 'cardiac surgery is dead,'" but surgeons shifted toward more complex cases, including those in which stenting failed.
  • Eric Sheu: Obesity medicine might parallel cancer treatment: Chemotherapy is given before surgery to reduce tumor size and after surgery to kill residual cancer cells.

Read more.


infectious disease

ProMED issues an ultimatum to striking moderators

There's another twist in the ProMED saga. The financially strapped infectious diseases surveillance network has warned striking moderators that if they don't promise by Wednesday to remain in the program and return by Friday, that will signal that they've "moved on." Many of the site's moderators are protesting plans by the International Society for Infectious Diseases, ProMED's host since 1999, to put the resource behind a paywall. 

That flies in the face of its public health mission, according to the moderators, who are paid modest stipends that are currently in arrears. (Their posting announcing the strike was quickly removed from the ProMED website, but you can read it here.) The subject matter experts curate and give context to the reports ProMED posts to its website and emails daily, most famously the early signs of what became the Covid pandemic. STAT's Helen Branswell has more.


in the lab

Study finds new variant for Parkinson's in African populations

It was both a startling discovery and another reminder of what's yet to be learned when genome-wide studies expand beyond people of European ancestry. A team of Nigerian, British, and U.S. scientists have found a genetic variant that raises the risk of Parkinson's disease in people of African and mixed-African descent that hasn't been detected in people of European descent. The finding, which one day could help treat people with the movement disorder who are now underserved, came from what began as a training exercise to teach scientists in Nigeria and elsewhere how to conduct genome-wide studies.

"It could be a major mechanistic basis of Parkinson's disease in African populations," the researchers write in Lancet Neurology. The variant was found in the GBA1 gene, which is known to carry other mutations that increase the risk for Parkinson's. STAT's Usha Lee McFarling has more on the implications.



Closer Look

Opinion: Psychiatrists' inboxes are overflowing

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If you're a psychiatrist working in a clinic, you're busy. Since the pandemic began, demand for mental health care has soared. And it's not just about seeing patients — it's the messaging via electronic health records, Simone Bernstein and Jessi Gold write in a STAT First Opinion. Looking back to 2011-2014, clinicians spent as much or more time answering patient messages as they did in face-to-face care. The authors' new study in JAMA Network Open found an 861.5% increase in monthly message volume from pre-pandemic.

The route to burnout is short, and it hurts patients, too, in more medical errors. And that time spent responding to patients is not reimbursed. Billing some patients or paying psychiatrists for that time could work. "If we don't create a solution soon, we run the risk of further breaking a mental health system already in crisis, and increasing the rates of clinician burnout." Read more.


health insurance

Medicare Advantage plans fined for overcharging

They may look like slaps on the wrist followed by penalties that amount to pennies under a couch cushion, as STAT's Bob Herman puts it, but the federal government may have symbolism on its side. The Centers for Medicare and Medicaid Services fined three different Medicare Advantage plans this month for the same problem: faulty technology systems that make people pay more for care and coverage than they should. The message to the plans can be read this way: Clean up compliance and IT infrastructure before regulators come knocking on their doors again.

The three Medicare Advantage plans — AultCare, EmblemHealth, and Moda Health Plan — were dinged for different violations, but "just the knowledge that CMS will be back one day and that you better have this fixed, I think, does have a sentinel effect," said Philip Legendy, an attorney at Ballard Spahr who represents Medicare Advantage plans. Read more on the infractions and one response.


health

How much edible cannabis it takes to harm kids

It's not hard to imagine children eating cannabis edibles like candy. A new study in Pediatrics looking at one hospital's 151 cases of edible cannabis ingestion in kids under 6 found that more than half of the kids had harmful exposures. They came in with drowsiness, abnormal heartbeat, loss of muscular coordination, and vomiting. More worrisome were the low blood pressure, coma, shallow breathing, and seizures in fewer than 2.5% of kids.

Allowing for how difficult it can be to discern what "dose" the children ate from gummies or other edibles, the researchers came up with a threshold for significant toxicity: 1.7 milligrams of THC (the active ingredient) per kilogram (2.2 pounds) of weight. Eating 10mg of THC — a common serving size in packages of 10 — would be unlikely to cause severe toxicity, but the researchers warn that each additional milligram of THC per kilogram of body weight tripled the odds of severe or prolonged symptoms.


The final episode of "Color Code," season two, delves into how housing — and today's housing crisis — intersects with health care. Listen here.


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What we're reading

  • How we age—and how scientists are working to turn back the clock, Wall Street Journal
  • 5,000 pilots suspected of hiding major health issues. Most are still flying, Washington Post
  • Is it real or imagined? Here's how your brain tells the difference, Wired

  • Neuroscience startup Neumora files for IPO, STAT

Thanks for reading! More tomorrow,


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