"There are many tentacles to an influence operation in Washington."

February 15, 2024 Check out STAT+

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By Elizabeth Cooney Reporter, Morning Rounds Writer

Good morning. Do take a look at what Nicholas Florko discovered in internal emails and other documents showing how the e-cigarette maker Juul sought influence in Washington. You'll learn about Juul, but also about the way things work in D.C.

politics Juul's internal playbook opens a rare window into influence in Washington Alex Hogan/STAT It's one thing to acknowledge that lobbying is a high-stakes pursuit in Washington. It's another to look behind the curtain to see which levers e-cigarette maker Juul pulled to promote its interests. STAT's Nicholas Florko dove deep into a new trove of internal emails and other documents to see how the company tried to advance its cause, from orchestrating untraceable political donations to paying think tanks for favorable research.  And then there's the former head of lobbying for the international firefighters labor union, put on retainer for $20,000 a month — just one part of Juul's effort to revamp its image and prevent both Congress and the FDA from taking action that could cost the company financially. "There are many tentacles to an influence operation in Washington," Michael Beckel, research director at the advocacy organization Issue One, told Nick. Read more, including Juul's response. health tech Remote blood-pressure monitoring might help narrow disparities  About half of American adults have high blood pressure, a condition they can monitor themselves with a blood pressure cuff or an educational app to help bring those numbers down. But as useful as those tools can be, they may not be reaching the people who need them most: marginalized patients without good access to health care. A new analysis in JAMA Network Open tells us what happens when they do reach these people. In 28 studies of digital health interventions targeting minorities and low-income patients, these novel hypertension programs for people experiencing health disparities worked. Overall, participants saw an average reduction of 4 mmHg more than those in control groups, the researchers found, a drop that was clinically meaningful. Another significant takeaway: The studies were testing digital tools, but their power can't be separated from the community health workers or skilled nurses who delivered them. STAT's Mario Aguilar has more. health Smoking damages immune response even after quitting, study says By now we all know that smoking is bad for us, raising our risk of myriad diseases. A new study in Nature paints an even starker picture of how bad cigarettes are for us, tracing smoking's effect beyond the lungs or heart to the immune system. Based on questionnaires and blood samples from people in the long-running Milieu Intérieur project, researchers from the Institut Pasteur found three factors affected immune response: smoking, BMI, and infection with cytomegalovirus (a member of the herpes family). After people quit smoking, their innate immune system — the arm that ​​mounts fast and general responses to invaders — improved. But the slower, more targeted adaptive T cell defenses did not. That was significant, the study's lead author Violaine Saint-André said on a call with reporters. "It's about the same level of the effect of age or sex or genetics on some of the disease risks. So it's considerable." I have more here.

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closer look Independent physicians are an endangered species, one says  Independent physicians are disappearing — a far cry from 40 years ago, when more than three in four doctors cared for patients in their own medical practices. Buffeted by rising costs and by lower reimbursements from Medicare, doctors are leaving private practice to become employees of hospitals or other entities, gastroenterologist Paul Berggreen writes in a STAT First Opinion. He's also a founding member of the American Independent Medical Practice Association, which advocates on behalf of independent physicians like himself. Doctors caring for patients in their own practices used to be the bedrock of our health care system, offering better care at lower cost, in his view. "Disappearing independent docs ought to alarm patients and policymakers," he writes. "Patients and doctors deserve a system that puts their interests above hospitals' and insurers' bottom lines. Lawmakers can help create that system." Read more. pandemic Long Covid research gets a big bump The NIH research initiative to study long Covid, called RECOVER, just got another $515 million to study the persistent condition. Amounting to a nearly 50% increase in the the project's budget, the additional funding will go toward testing treatments in clinical trials, studying how long Covid affects each part of the body, examining who fully recovers in the long term, and maintaining research infrastructure. "NIH expects this investment of time and resources in building a research program of this scale, scope and rigor will increase the odds in finding treatments that work," the agency said in its announcement. But as STAT's Rachel Cohrs reminds us, STAT and MuckRock investigations previously found the project started off sluggishly and its timelines slipped repeatedly. Patients also expressed strong concerns that too few resources were being devoted to testing potential treatments. Critics of the project still have questions. Read more. mental health Living alone and feeling depression Percentage of adults age 18 and older who experienced feelings of depression, 2021. NCHS More Americans are living alone, and more of us are feeling lonely, a condition with risks U.S. Surgeon General Vivek Murthy calls as deadly as smoking. Today's new report from the CDC, based on survey responses, gives us some numbers to see the scope of the problem. As the number of people living alone grew by 4.8 million to 37.9 million from 2012 to 2022, that meant single-person households have more than doubled since 1962. Feelings of depression were higher among adults living alone (6.4%) compared with adults living with others (4.1%), for both men and women, across most race and Hispanic-origin groups, and by family income. Living alone can be a preference as well as a reflection of physical independence, the researchers note. Still, nearly 1 in 5 adults living alone who never or rarely got the social and emotional support they needed also reported more feelings of depression, compared to 11.6% of adults living with others.

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What we're reading Some pregnant women and infants received the wrong RSV shots, New York Times Largest post-pandemic survey finds trust in scientists is high, Nature Inside the plan to diagnose Alzheimer's in people with no memory problems — and who stands to benefit, Los Angeles Times How Maple Leafs staff helped save a rec-leaguer from a skate cut to the throat: 'I thought I was going to die,' The Athletic A Jewish American and a Palestinian American are tackling science's toughest challenges, Boston Globe FTC to probe the role of middlemen in worsening drug shortage crisis, STAT

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Thanks for reading! More tomorrow,

elizabeth.cooney@statnews.com

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