Rationing RSV shots, mining fossils for future antibiotics, & why maternity leave for doctors is such a mess

"It's time we develop and receive the gold standard of care we give to our patients."

October 25, 2023 Check out STAT+

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By Elizabeth Cooney Reporter, Morning Rounds Writer

Good morning. We have a lot to share today: rationing RSV shots and maybe allowing at-home flu vaccinations; mining woolly mammoth DNA for future antibiotics; and a doctor wondering why maternity leave for doctors is such a mess. Read on.

infectious disease As doctors and parents scramble, CDC recommends rationing RSV shots  STAT/AstraZeneca via AP Babies at highest risk for RSV should be the first to get doses of a scarce monoclonal antibody that can protect them against the viral disease, the CDC said yesterday in a health alert about the top cause of hospitalization of infants in the country. Supply of the new medicine, Sanofi's Beyfortus, is short, just as RSV activity in the southern U.S. appears to be reaching seasonal epidemic levels. That suggests transmission elsewhere will likely climb in the next month or two. Beyfortus was approved just this past summer, making the timeline tight to deliver it this fall, along with uncertainty about whether insurers would cover the $495 price per dose. A maternal RSV vaccine was recommended by the CDC last month for pregnant people whose babies will be born between October and March, when RSV transmission is typically highest. STAT's Helen Branswell has more on the shortage. in the lab (and in the past) Mining the fossilized past for future antibiotics Here's a mining expedition that's part "Jurassic Park" and part robotic resurrection. Its mastermind Cesar de la Fuente calls it "molecular de-extinction," a project that enlists algorithms to scour genetic databases and robots to find DNA snippets deep in the fossilized past, hunting for potential drugs lurking in the code of Neanderthals, giant sloths, and woolly mammoths, among other ancient animals. "What if we brought back molecules instead of just an entire organism?" he asks. The point of the search is to find the next breakthrough antibiotic, which de la Fuente thinks might come from animals that have been dead for thousands of years. Since 2018, his lab at the University of Pennsylvania has been trawling for protein fragments, called peptides, with microbe-squashing properties. His research, detailed in a July publication and preprint earlier this month, relies on genomes painstakingly cobbled together by paleogeneticists over decades. STAT's Jason Mast tells us more. health Traditional Chinese medicine reduced heart attacks in randomized trial, but how it works is unknown A new study in JAMA says a traditional Chinese medicine — a compound of powders and extracts from plants, centipedes, cicada, and other sources — might cut down rates of serious heart attacks, strokes, and deaths. But some experts expressed skepticism about the result. The compound, tongxinluo, has been approved in China since 1996 as a dietary supplement for angina and stroke. How and why it works remains unknown after the trial in 3,800 Chinese patients who'd had heart attacks. After a year, those on tongxinluo did better than those on a placebo. U.S. experts found that interesting, but noted that no specific active ingredient was identified. "We can't exclude the possibility that it is the real deal," Steven Nissen of the Cleveland Clinic said. But, he added: "How does the FDA review something that's made up of crushed insects and plants?" STAT's Annalisa Merelli and Matthew Herper have more.

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closer look 'So many levers you can pull': A cardiologist helps colleagues choose the best one Courtesy Ruey Hu As a kid, Ruey Hu (above, right) learned an extra instrument so he could create orchestral music and taught himself nine computer programming languages. His motivation was pure curiosity then, and now. After earning a masters of public health, a medical degree, and a cardiology fellowship, he's blending his expertises to create novel technologies for doctors. Hu, 31, was drawn to cardiology by altruism and fascination with the human heart. "There's just so many levers you can pull to help a patient really get to the place they need to be," he said. Yet picking the right lever can be challenging. Hu's tools allow a provider to type in parameters from a patient's medical history and get an algorithmically derived recommendation that aligns with the national guidelines. He's built the award-winning, independent GDMT for Everyone for guideline-directed medical therapy in heart failure, and is looking at heart attack and chest pain. STAT's Isabella Cueto has more on this 2023 STAT Wunderkind. HEalth Administering FluMist at home could be coming If you're eligible to receive the nasal flu vaccine FluMist, you might be able to protect yourself and your children at home next year. AstraZeneca requested the vaccine be considered for FDA approval yesterday, a move that would affect people 18 to 49 years old who could give FluMist to themselves and to children at least 2 years old. It wouldn't be sold over the counter; people would need to see a clinician who would order the vaccine, which must be refrigerated. And people could still get FluMist administered to them in doctors' offices or pharmacies. "It is meant to enhance the ability to access influenza vaccination," Lisa Glasser, of AstraZeneca told STAT's Helen Branswell. Administering a vaccine at home may seem more familiar now that so many people are accustomed to swabbing their noses for home Covid tests. The FDA is expected to decide on FluMist early next year, with a rollout in time for the 2024-25 flu season. Read more. off the charts  A doctor asks why maternity leave for doctors is such a complete mess Mike Reddy for STAT Preparing for a parental leave is much harder than it needs to be — and it seems particularly onerous for physicians, psychiatrist and STAT columnist Jennifer Adaeze Okwerekwu writes, describing the confusing experience she went through — twice — while pregnant as a doctor. "My profession attracts people who are great at making sense of the complexity of the human body and experience," she writes. "We painstakingly gather evidence to develop clinical protocols and guidelines that allow us to deliver high-quality care to our patients. We don't wing it. Where, then, are the protocols that would help us manage work while pregnant and preparing for leave?" Medicine is not known for practicing what it preaches, she points out. Three months' leave may be recommended by medical organizations for patients, but the reality is often different for doctors. "It's time we develop and receive the gold standard of care we give to our patients." Read more. In this week's First Opinion podcast, First Opinion Editor Torie Bosch talks with Leonard Rubinstein, author of "Perilous Medicine: The Struggle to Protect Health Care From the Violence of War," about health care in war, the Geneva Conventions, and why it's so difficult to hold those who break international law accountable. Listen here.

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Thanks for reading! More tomorrow,

elizabeth.cooney@statnews.com

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