Today in bird flu: Remember PPE? Remember wastewater testing?

Credit u/lc

So far, dairy farmers have been reluctant to report outbreaks of H5N1 bird flu within cow herds, or to allow testing of workers, or to wear protective gear when close to infected animals. To encourage protection and detection, the federal government announced Friday that it will provide livestock farms with as much as $28,000 apiece. Another $98 million has been allotted to aid states in restricting the movements of affected cattle, and $101 million will go toward expanded surveillance, tests, treatments, and vaccines for the virus.

In addition, the Centers for Disease Control and Prevention is expected to unveil a public dashboard tracking influenza A viruses in sewage from 600 wastewater treatment sites around the country today. The testing isn't specific to bird flu — influenza A is a larger family that includes H5N1. But other flu viruses circulate at very low levels during the summer, so high levels could be a reliable indicator that something unusual is going on in a given area.

Read more on federal funding from STAT's Sarah Owermohle, and more on wastewater monitoring from STAT's Megan Molteni and Helen Branswell.

smoking

You either die an anti-smoking legend, or live long enough to become … ?

For decades, Cliff Douglas woke up every day with the goal of making life as difficult as possible for Big Tobacco. Now, at age 66, he's taking over a foundation that some say is inextricably linked to a major former adversary: the Foundation for a Smoke-Free World. The organization has, until recently, been funded solely by cigarette giant Philip Morris International. By taking the job, Douglas has firmly planted himself at the center of one of the most controversial debates in public health, STAT's Nick Florko reports.

Tobacco companies have a history of hiring well-respected health experts and then sullying their careers. Already, some of Douglas's colleagues see a change in him. He once publicly slammed "billionaires in fancy suits" who supported smoking "purely out of greed and an attitude of simply caring less for the welfare of the public," as he put it. Now, when asked if tobacco companies selling lower-risk products could be a force for good in the world, Douglas calls them "neutral profit-making corporate entities."

Read Nick's story on the impactful role Douglas played in shaping American smoking regulations, and what's next for him.

hospitals

Private health plans pay much more than Medicare at the hospital

In 2022, private health insurers and employers paid hospitals an average of 254% more than what Medicaid would have paid for both inpatient and outpatient services, according to a new RAND report published today. Researchers analyzed claims data from all states (except Maryland, where hospitals charge all payers the same price) with information from more than 4,000 hospitals. The price hikes varied widely by state: Five saw private plans pay less than twice Medicare's rates, but in seven states the increase was more than 300%.

Even after recent legislation aimed at creating more transparency, employers often have little insight into how insurance carriers and third-party administrators negotiate on their behalf, the authors write. "Employers and purchasers who view the prices negotiated on their behalf as higher than they are comfortable paying might seek to use this study's information to reduce spending," they conclude.

first opinion

Stop ignoring seniors when it comes to addiction treatment

YUKI IWAMURA/AFP VIA GETTY IMAGES

It's easy to focus on adolescents and young adults when thinking about the tragedies of the opioid crisis. But more than 7 million older Americans struggle with substance use disorders, and opioid use disorder in particular has skyrocketed among Medicare beneficiaries. Opioid overdose death rates have been rising among those over 65 for decades.

Despite the need for services, Medicare doesn't cover non-hospital residential treatment for substance use disorders, or outpatient treatment in community-based facilities. Nor does it provide adequate coverage for services delivered by the full range of providers who make up a significant part of the substance use disorder and mental health care workforces. This failure is discriminatory and needs to change, argues Brian Hurley, the president of the American Society of Addiction Medicine, in a new First Opinion essay. Read more on what policy changes are needed to better support older people struggling with addiction.

hiv

A trial of CRISPR gene editing to cure HIV didn't work. What's next?

An ambitious effort to cure HIV with CRISPR genome editing fell short in an early clinical trial, investigators announced on Friday. Researchers had tried to use the gene editing tool to address a chief reason the virus has been so hard to cure. HIV can worm its way into a patients' own DNA in certain cells, so if they ever stop taking medicine, those cells start pumping out HIV particles and the infection roars back.

Researchers hoped they could send CRISPR to those cells and, by cutting the HIV DNA lurking there at two spots, slice out the virus. They administered the treatment to five patients, then took three of them off their conventional antiviral medicine. Unfortunately, the virus rebounded and the patients needed to resume the antiviral therapy, STAT's Jason Mast reports. But all hope was not lost: One patient's infection didn't rebound until 16 weeks later, which is much later than the typical three- to four-week timespan. Read more from Jason on the implications of the research.

More around STAT