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OpenAI shakeup, Anna Eshoo's exit, & housing and health for veterans on dialysis

November 22, 2023
Reporter, Morning Rounds Writer
Good morning. Before we pause the newsletter for a Thanksgiving holiday hiatus, I'd like to thank you for spending part of your day with us. I'm grateful for your interest in the topics we care about at STAT and appreciate your letting us know what matters to you. My Morning Rounds teammate Theresa Gaffney will be back to bring you Monday morning's updates.

health tech

OpenAI's shakeup highlights the need for AI standards in health care

Amid the turmoil surrounding leadership changes at OpenAI, the creator of ChatGPT, what will happen to the movement to establish standards for generative AI's use in health care? Microsoft, which swooped in to hire executives Sam Altman and Greg Brockman, is far along in its efforts to deploy the technology in health care. Now it may have even more power over the technology's development, testing, and use in the patient care.

The consolidation echoes a similar process in the sale of electronic health records, where Epic and Oracle own most of the market. Microsoft has already aligned itself with Epic to begin to embed generative AI tools and capabilities in health systems. "All of a sudden, … it feels like things have completely changed," said Suresh Balu of the Duke Institute for Health Innovation. "It's even more important to have guardrails where we have an independent entity through which we can ensure safety, quality, and equity." STAT's Casey Ross explains.


politics

Anna Eshoo, an ally of pharma, says she'll retire

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Greg Nash/Pool via AP

A stalwart ally of Democrats on health care issues and a supporter of medical innovation in the pharmaceutical industry is retiring from the U.S. House of Representatives after 32 years. Rep. Anna Eshoo, whose district includes Silicon Valley, is the top Democrat on the House Energy & Commerce panel's health subcommittee, where she has jurisdiction over the NIH and the FDA. One of her signature achievements was adding a provision to the Affordable Care Act ensuring biologics have 12 years of market exclusivity.

Eshoo also voted to pass the Inflation Reduction Act, which allows Medicare to negotiate drug prices. A major advocate of insurance reforms, she spearheaded an Obamacare component that caps catastrophic out-of-pocket spending. She has pressed NIH for answers about its $1 billion long Covid study, following STAT reporting that the agency's efforts were slow and focused more on observational research than actually testing treatments. STAT's Rachel Cohrs and John Wilkerson have more.


mental health

Rosalynn Carter, first lady of mental health reform

Tributes to Rosalynn Carter, who died Sunday at age 96, often mention her commitment to mental health. Decades ago, she pushed for what we now take for granted: Mental health is health, stigma is deadly, and people with mental illness deserve to be part of society instead of hidden away in overcrowded, dangerous facilities. "While she called her autobiography 'The First Lady of Plains,' to many she was also the first lady of mental health reform," historian and journalist Phyllis Vine writes in a STAT First Opinion.

Carter believed society should not give up on anyone, and paid an early visit to a distant cousin of Jimmy Carter's at the Georgia Central State Hospital in Milledgeville, Vine says. Rosalynn Carter later went to all 12 of Georgia's psychiatric hospitals and volunteered one day a week at the Georgia Regional Hospital, where, she said, she "listened and learned." Read more about her work before and after arriving at the White House.



Housing and health coincide for veterans receiving dialysiscloser look

AI startups turn up the heat on White House AI order GettyImages-1754149957

Brendan Smialowski/AFP Via Getty Images 

AI entrepreneurs across the U.S. are racing to deploy tech in health care while regulators in Washington are simultaneously working to protect patients from harmful, biased algorithms. Their imperatives are competing as HHS builds a task force mandated by the White House's recent executive order and charged to issue a strategic plan in one year. The 111-page order outlines several steps federal agencies and companies must take to guard against such pitfalls as privacy and safety violations. 

AI experts applaud attempts to protect patients, but they still have some concerns:

  • Regulations might focus too narrowly on evaluating models' training datasets as a way to root out algorithmic bias.
  • It's not clear how HHS guidance will interact with general laws about the practice of medicine, and with state medical boards.
  • The order doesn't discuss AI's potential impact on a clinical workforce facing burnout. 

STAT's Mohana Ravindranath has more.


chronic conditions

Housing and health coincide for veterans receiving dialysis

A new study of U.S. veterans finds an often-overlooked factor may be influencing the outcomes of dialysis patients: housing. In a retrospective cohort study of nearly 26,000 veterans who received dialysis between 2012 and 2018, researchers found that patients who reported unstable housing before starting dialysis had an increased risk of all-cause mortality. The researchers defined unstable housing as including "homelessness and housing that one might lose because it is unaffordable, overcrowded, or dangerous."

The findings, published in JAMA Network Open on Tuesday, also suggest risks increased as the veterans got older. Hispanic ethnicity, a lack of kidney care before starting dialysis, and insurance other than Medicare were also associated with unstable housing. And these patients were also more likely to receive dialysis through a graft (instead of a fistula, which is considered the preferred method).

Homelessness among veterans in the U.S. was halved between 2010 and 2022, but socioeconomic disparities might still be creating a gap in outcomes among dialysis patients, including by making day-to-day care more difficult, the researchers write. "Interventions addressing housing as part of clinical care have the potential to lower risk of mortality."


COVID-19

People with long Covid more likely to be reinfected, study says

A new study from China looking back at three-year outcomes for more than 1,350 people who recovered from the first known cases of Covid-19 concludes that people with long Covid were more likely to be reinfected during the Omicron wave than people who recovered from Covid without lingering symptoms. Three-quarters of the people with long Covid were reinfected, compared to two-thirds of people who recovered from Covid but had no persistent problems. People with long Covid were also more likely to develop pneumonia and other new or worsening symptoms. 

The researchers say impaired immune function in long Covid patients could explain the higher proportion of reinfections, so they urge vaccination with three or more doses. "Although the organ function of survivors of Covid-19 recovered over time, those with severe long Covid symptoms, abnormal organ function, or limited mobility require urgent attention in future clinical practice and research," they write in Lancet Respiratory Medicine.


On this week's First Opinion podcast, First Opinion Editor Torie Bosch talks with Mara Buchbinder and Jesse Summers about living in cancer limbo. Listen here


More around STAT
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What we're reading

  • Border Patrol sending migrants to unofficial camps in California's desert, locals say, NPR
  • House Republicans call CDC director to testify, STAT
  • Microbiologist who was harassed during Covid pandemic sues university, Nature

  • Sen. Bernie Sanders publicly pressures Merck, J&J, and Bristol Myers Squibb to testify on drug pricing, STAT

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