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Parsing abortion pill's day in court, balancing tax breaks vs. community benefit, & FDA falling behind on research site inspections

March 27, 2024
Reporter, Morning Rounds Writer
Good morning. This study caught my eye: Ancient DNA and a diverse genetic resource came together to answer a question about cancer disparities.

reproductive health

On abortion pill, Supreme Court justices zero in on physicians' right to sue, not FDA approval

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Drew Angerer / AFP via Getty Images

In yesterday's closely watched first day of oral arguments on restricting the abortion pill mifepristone, questions from Supreme Court justices focused more on physicians' standing to sue the FDA than on the agency's decisions on mifepristone. Approved in 2000, it's now used in nearly two-thirds of all abortions in the U.S. A Christian-based medical organization is arguing that the agency acted hastily and politically when approving it and when reducing prescribing limits later.

Justices Elena Kagan and Ketanji Brown Jackson repeatedly asked the plaintiffs for examples of when objecting physicians were forced to assist with abortion or its complications as a direct result of the FDA's decisions. Conservative Justice Samuel Alito asked if that scenario was "too speculative." The plaintiff's lawyer replied that it's difficult to name specific instances because they happened in emergencies. STAT's Sarah Owermohle has more on this first glimpse into the justices' thinking. A decision is not expected until this summer.


hospitals

Tax breaks are supposed to balance hospitals' charity care, but they don't add up, report says

Nonprofit hospitals get exemptions on their property, income, and sales taxes. The idea is to even out their spending on charity care or other community benefits, but a new study from the Lown Institute says 80% of 2,425 non-profit hospitals spent less on charity care and community investment than they received  in estimated tax breaks. The think tank came to this conclusion after comparing nonprofit hospitals' estimated tax breaks to their reported spending on financial assistance programs and community benefits in 2021.

"It's not obvious that in all the ways that we might care about, that nonprofit hospitals are behaving in more prosocial ways than for-profit hospitals to 'deserve' this tax exemption," said Genevieve Kanter of the University of Southern California. She was not involved in the study. STAT's Brittany Trang has more, including hospitals' argument that the Lown Institute report is "biased" and "narrow and incomplete."


in the lab

From ancient DNA, a clue to cancer disparities in kids

They had to look back 13,000 years, but scientists have found a genetic clue to ethnic disparities among children who develop acute lymphoblastic leukemia, the most common cancer in children. Today, 40% more Hispanic/Latino children are diagnosed with ALL than their white non-Hispanic/Latino peers, a difference researchers say in a Cell Genomics study stems from a genetic variant that stalls the maturation of an important immune cell, a delay that favors a cancerous mutation's appearance.

Working with a diverse genetic database, the researchers found this harmful variant in the oldest previously sequenced ancient DNA from an Indigenous American individual. Because the variant is almost absent in people with European ancestry, the researchers conclude it was present among the first migrants entering the Americas roughly 13,000 years ago. And it may explain why ALL incidence is higher in Mexico, where indigenous ancestry is greater, than Argentina, where it is lower. The variant may have persisted through natural selection if it protected people from infection, the authors speculate.



closer look

Opinion: We need primary care providers involved early in Alzheimer's care

Even President Biden's widely covered annual physical last month didn't include a cognitive assessment. But the political debate about which presidential candidate might be mentally fitter for office overlooks questions about the role of primary care providers in cognitive testing, a policy researcher writes in a STAT First Opinion.

The first drugs approved for Alzheimer's, despite a litany of limitations, are designed to work in the early stages of the disease, Katherine O'Malley of the Boston University School of Public Health notes. And while primary care providers are critical to prompt diagnosis and treatment, "this workforce isn't currently up to the challenge," she writes. The clinicians may lack training, and their patients, especially if they live in rural areas, may not be able to find them. Read more.


research

FDA is still behind on inspections of clinical research sites, watchdog says

The FDA has inspected far fewer clinical research operations in hospitals and clinics in recent years, the Government Accountability Office reports, a shortfall blamed on pandemic disruption and difficulty retaining investigators needed to keep up this kind of oversight. In 2022, the FDA inspected 537 hospitals and clinics engaged in studies of experimental drugs their manufacturers hoped would win approval. That compares to 976 clinical study sites inspected in 2017. 

Also, from fiscal year 2018 through July 2023, the FDA couldn't complete 30% of one type of common inspection within the requested time frames. GAO's new report follows last year's discovery that the FDA inspects relatively few institutional review boards, the bodies that vet ethical and safety issues in trials. The GAO does say the FDA has taken steps to increase recruitment and retain investigators, but attrition remains a "persistent" problem. STAT's Ed Silverman has more.


health

Update: FDA approves Merck's drug for a rare cardiovascular disorder

In a development we told you to expect yesterday, the agency approved Merck's drug to treat a rare cardiovascular disorder called pulmonary arterial hypertension Tuesday, making available a new approach to treat a deadly condition whose causes have been challenging to address. Merck will sell the drug, called sotatercept, under the brand name Winrevair. It will be priced at $14,000 per vial, which is injected every three weeks.

"[Winrevair] is the first medicine to act on the basis of the disease, on what is happening in the blood vessel wall that causes the problem," Eliav Barr, Merck's chief medical officer, told STAT's Elaine Chen. "It's a really huge step forward in the treatment of pulmonary arterial hypertension." Read more.


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What we're reading

  • Teens who talk about their mental health on this app may be taking a big risk, Mashable
  • Viking Therapeutics to move its oral obesity drug into Phase 2 study after early success, STAT
  • Do birds dream? New York Times
  • Amgen sues Colorado over its prescription drug affordability board, STAT

Thanks for reading! More tomorrow,


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