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Doctors are navigating political landmines as conservative views collide with science

October 3, 2023
Reporter, Morning Rounds Writer
Hello again. Glad to be back and grateful to my colleagues for their lively voices over the last 10 days. Let's hear about what makes the two winners of the Nobel in medicine so distinctive, about calculating risk from medical devices, and about the vitriol and violence doctors face in a divisive political environment.

science

Nobel in physics goes to electron breakthroughs

 

Three scientists whose work on electrons widened the world's understanding of the particles' behavior inside atoms and molecules won the 2023 Nobel Prize in physics on Tuesday. 

The award went to Pierre Agostini of the Ohio State University, Ferenc Krausz of the Max Planck Institute of Quantum Optics in Germany, and Anne L'Huillier of Sweden's Lund University. They will split 11 million Swedish kronor, about $1 million, and have their names added to a list of physics Nobel winners that prior to this year included 221 laureates, only four of whom are women.

The scientists were recognized for their experimental methods that create flashes of light that are measured in attoseconds — one quintillionth of a second. Their work has enabled scientists to study how electrons move and swap energy, which happens so quickly that it would be impossible to study without the laureates' breakthroughs. 

In the world of medicine, attosecond pulses could be used in medical diagnostics. 


vaccines 

Honoring mRNA discoveries — and a true partnership

Weissman-and-Kariko-5_Peggy-Peterson-Photography-courtesy-Penn-Medicine

Peggy Peterson/Penn Medicine

Katalin Karikó and Drew Weissman were widely expected to win the Nobel Prize in Medicine for discoveries that set in motion the record-breaking development of mRNA vaccines against Covid-19. Here's what's rare about their recognition: Their work together exemplifies complementary expertise, in RNA-based therapies for Karikó and in immune responses to vaccines for Weissman. Their true scientific partnership, working side by side at the lab bench over two decades, sets them apart from laureates who independently reached pinnacles in their fields.

They labored in a scientific backwater, STAT's Megan Molteni reminds us, having first met at a photocopier. While waiting for his turn, Weissman struck up a conversation with Kariko — already using the machine. He learned that her specialty was mRNA. She learned he needed a way to deliver foreign proteins to cells to make an HIV vaccine. They decided to collaborate. Read more, about early rejection and later success.


infectious disease

CDC offers new policy to cut STIs in high-risk people

To fight soaring rates of sexually transmitted infections, the CDC is proposing that gay and bisexual men who have sex with men, as well as transgendered women, be offered access to the antibiotic doxycycline for use after having unprotected sex. The idea is to lower their risk of acquiring chlamydia, gonorrhea, or syphilis. The guidance, published yesterday, relies on research showing "doxy PEP" — post-exposure prophylaxis in a single, 200-milligram dose taken no later than 72 hours after unprotected sex — can cut acquisition of chlamydia and syphilis by nearly 80%, and gonorrhea by about 50%. 

"One of the things that I think sometimes gets lost in the discussion is, this is not an intervention for everyone, but one for people who are particularly high risk," Connie Celum, who is director of the International Clinical Research Center at the University of Washington, told STAT's Helen Branswell  in an interview. Read more.



Closer Look

Political vitriol — and violence — put doctors in harm's way

msb-1120282modcolorM. Scott Brauer for STAT

Remember when people stood on their balconies to applaud health care providers for their sacrifices early in the pandemic? That's hard to imagine now, when doctors are being been doxxed or threatened or otherwise attacked for their views not just on Covid or vaccines, but also on abortion, gender-affirming care, gun control, or diversity initiatives. This divisive political environment exacts a toll not just on individuals but the medical profession as a whole, physicians and advocates told STAT's Sarah Owermohle, lessening the appeal of careers in health care with record retirements on the horizon. 

"There's this broad trend of disdain for medicine, science, evidence, expertise," said Kellan Baker, executive director of the Whitman-Walker Institute, a network of LGBTQ-focused providers. "It's no accident that the same governors that are going after trans kids have also gone after mask mandates, have also gone after vaccines, are also peddling lies about what good medicine and good science look like." Read more.


health tech

Analyzing risk and marshaling data to move past 'one device at a time'

Madris Kinard has long thought about calculating risks and eliminating threats, from her FDA job as a public health analyst to building a device recall database for Avalere to launching her own business, Device Events, to consolidate adverse event reports. She talked recently with STAT's Lizzy Lawrence:

There was public outcry about regulating medical devices after the 2018 documentary "The Bleeding Edge." Has anything changed?

There's been no overnight "Wow, we need to do everything like this now." It's one device at a time or one process at a time. 

What are your hopes for the Medical Device Recall Improvement Act, if it passes?

The FDA is going to work through how to improve the communications. This device was recalled, what do I do now? It's supposed to shorten the time it takes to find out so that you don't have doctors still implanting devices that are recalled. That does happen a lot.

Read the full interview. 


health

Loneliness tied to higher risk of Parkinson's

The case is getting stronger for loneliness being a powerful psychosocial determinant of health. A large new study in JAMA Neurology found a link between loneliness and the risk of Parkinson's disease, even after accounting for such confounders as physical and mental health (including depression), genetic risk, and sociodemographic differences. It was the loneliness people felt, not social isolation, that mattered the most in the analysis of U.K. Biobank participants over age 50 who were followed for 15 years.

Loneliness has been implicated before in Alzheimer's and other dementias, but the mechanism driving the association isn't known. The authors suggest metabolic, inflammatory, and neuroendocrine pathways might be involved, based on diabetes and visits to a psychiatrist weakening (but not eliminating) the association with Parkinson's the most. "This study adds evidence on the detrimental health impact of loneliness and supports recent calls for the protective and healing effects of personally meaningful social connection," they write.


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  • Verily lands $38 million deal with CDC for wastewater surveillance, STAT
  • Court strikes down Trump-era rule that allowed health insurers to broadly use copay accumulators, STAT

Thanks for reading! More tomorrow,


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