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An unusual arrangement at UnitedHealth, genetics and obesity drugs, & Wall Street's panic

October 18, 2023
Reporter, Morning Rounds Writer
Good morning. It's a big day for us: We're kicking off the STAT Summit today. Look here tomorrow for highlights of conversations on everything from the new class of GLP-1 drugs to the fight against opaque hospital pricing practices.

business

UnitedHealth's board chair also owns a personal investment firm

HEMSLEY_nomoney-1Photo illustration: Alex Hogan; Source: AP

Stephen Hemsley (above), the former CEO of UnitedHealth Group and its current board chair, also owns an investment firm that manages his own portfolio of UnitedHealth stock and oversees other wealthy individuals' accounts that have held shares of companies that have direct business with or indirect ties to United. It's an unusual arrangement for someone in such a prominent role at one of the largest health care corporations in the world, according to several experts in securities and corporate law interviewed by STAT's Bob Herman, and one that they said highlights shortcomings in government disclosure requirements and raises concerns about potential conflicts of interest.

The arrangement is perfectly legal. But while other board chairs at large publicly traded health care companies, like Thomas Frist III at HCA Healthcare, hold high-ranking titles in the investment world, none were longtime chief executives of the same company they chair, like Hemsley. Read more, including a response via UnitedHealth.


chronic illness

When Medicare changed how it paid doctors, rates of  stroke and heart disease changed, too

It worked. In a pilot program, Medicare paid doctors to assess patients for their risk of cardiovascular problems, focus on the sicker ones, and then paid them more if metrics like blood pressure and cholesterol improved. After five years, patients of doctors in the pilot had a 3.3% lower rate of heart disease and stroke than those in the control group, according to the study, published yesterday in JAMA. Medium-risk patients also did better, but the high-risk patients had the biggest change: their death rate was 14.4% lower from coronary heart disease compared to high-risk patients in the control group. 

The program didn't examine whether this approach changed outcomes for Black patients, who are more likely than white patients to die from heart disease. The pilot does stand out from other initiatives launched after passage of the Affordable Care Act that failed to deliver savings, STAT's John Wilkerson reminds us. Read more.


the obesity revolution

Genes might clarify responses to obesity drugs

Did you know not everyone loses 15% to 20% of their body weight on treatments like Ozempic, Wegovy, and Mounjaro? Those percentages are averages that obscure big variations in how much weight people actually lose, so researchers are looking into genes to explain the differences. After all, genetics plays a significant role in why people develop obesity, and genetics may also contribute to how people respond to bariatric surgery, early research shows. 

"The variability is so wide that we want to understand what predicts response," Lee Kaplan, director of The Obesity and Metabolism Institute in Boston, said about his work on Mounjaro and one particular mutation, which was among the studies presented at Obesity Week, a conference hosted by The Obesity Society. "What we're seeing is the beginning of the expectation that we're going to have variability and then we're going to try to understand that variability," he said. STAT's Elaine Chen has more.



closer look

Logic can't explain Wall Street panic on obesity drugs

Oz-plainChristine Kao/STAT 

Meanwhile, Wall Street is freaking out about the runaway success of weight loss drugs. And they're worrying not just about the market implications for other drugs but other products, too. "The baseline thesis is a future in which everyone is skinny and has no appetite," Jared Holz of Mizuho Securities said. "And if that's the case, then you don't want to be owning some of these stocks." 

Buy Bumble, sell McDonald's. Short Pepsi, go long Louis Vuitton, that thinking goes. The only problem, Holz and other analysts said, is the thesis makes little sense. "Some idealized GLP-1 user might indeed forgo fast food, sign up for Tinder, and finally pull the trigger on that Moncler coat, as so much analyst research suggests," as STAT'S Damian Garde puts it. But millions of people would need to do the same to justify the market's reaction, said Gary Taylor of TD Cowen. Read more.


insurance

Insurance rates are going up and abortion coverage isn't a sure thing, employer survey says

If you get your health insurance through your employer, your costs went up over the past year, a new KFF survey of health benefits says. Average annual premiums for families and individuals rose by 7% in 2023, a big jump over last year's slight increase over 2021. It looks like inflation and labor costs might be affecting premiums, but those two factors are expected to settle down over the next two years. Family premiums have grown 22% over the last five years, close to the rate of inflation (21%) and a 27% increase in wages over that period. 

Also, nearly a third of large firms (those with at least 200 employees) cover legal abortions in most or all circumstances — but 1 in 10 of these employers said the largest plan they offered does not cover legal abortion under any circumstances. An additional nearly 1 in 5 large companies cover legal abortions under only limited circumstances such as rape, incest, or endangerment of health or life.


mental health

Adult ADHD linked to later dementia risk

It's not a new idea that adult ADHD and dementia might be connected, but research has been inconclusive, sometimes confounded by the stimulant drugs people take to manage their ADHD. Some of the symptoms overlap, such as memory problems, as do such risk factors as depression, midlife hypertension, smoking, type 2 diabetes, and low levels of education and physical activity. A new study in JAMA Network Open set out to answer this question by following more than 109,000 people born between 1933 and 1952 into old age. 

The researchers conclude that adult ADHD was associated with a 2.77-fold higher risk of dementia. They offer this explanation: "It may be plausible that adult ADHD reflects a brain pathobiological process that reduces the ability to compensate for the effects of later-life neurodegenerative and cerebrovascular processes," they write. "Less cognitive and brain reserve may result in pathobiological processes of ADHD that, in turn, reduce compensatory abilities."


On this week's episode of the First Opinion Podcast, First Opinion Editor Torie Bosch speaks with Steven Phillips and Michelle Williams about "long Covid" being a new name for an old syndrome. Listen here.


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What we're reading

  • Breast cancer is deadlier for Black women. A study of mammograms could help close the gap, Associated Press
  • How gas utilities used tobacco tactics to avoid gas stove regulations, NPR
  • Opinion: Preventive drugs may be the best solution to the antibiotic resistance crisis, STAT
  • How Lunchables ended up on school lunch trays, Washington Post
  • 'Like the brakes of a train never coming to a stop': author Michel Faber on the torture of tinnitus, The Guardian
  • Adam's Take: It's time for the FDA to halt Cassava Sciences' Alzheimer's clinical trials, STAT

Thanks for reading! More tomorrow,


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