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What will save rural psychiatry?

May 29, 2024
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Morning Rounds Writer and Podcast Producer
Good morning, I'm back! I spent last week snorkeling with sharks, clambering through a cave to see ancient remains, reapplying sunblock, and laughing laughing laughing with my best friends. I forgot all about "work" — except when I harnessed all the power of my eco-lodge's paltry WiFi to read the first story in Eric Boodman's Coercive Care series last Tuesday. But now I'm back at the desk, and work calls. Let me know what I missed: theresa.gaffney@statnews.com

obesity

Special Report: Black Americans feel left behind in the age of Ozempic

Stephanie Mei-Ling for STAT

STAT has reported for over a year on how GLP-1 drugs are transforming the treatment of obesity in the U.S. But amid all the hubbub — as the drugs are touted for treating obesity, heart health, and down the line, maybe even conditions like addiction — many Black Americans worry that their community is being left behind. They say, too, that the public's obsession with the drugs serves as a reminder of how Black bodies are policed and judged by society. 

Black Americans have long experienced higher than average rates of chronic disease, for reasons that include disparities in income and education; reduced access to health insurance, housing, and healthy food; and racism-related stress. Despite this burden, experts say that Black patients don't have equal access to GLP-1s. Read more from STAT contributor Annisa Durham.

In another story, Durham, a health data reporter for Word In Black, interviewed 14 Black people about how they view their bodies. Eleven of those people are women, as it became clear to Durham during reporting that Black women's bodies are policed, surveilled, and judged more often than anyone else. They spoke with brutal honesty as they shared their journeys with weight loss, and their encounters with family and a medical system rooted in anti-Blackness. Read their stories in their own words.


chronic disease

Even common levels of lead could be dangerous for kidney patients

A first-of-its-kind study published yesterday in JAMA Internal Medicine analyzed how common household levels of lead contamination in the U.S. water supply may affect people with chronic kidney disease. Lead poisoning is common in the U.S., and people with chronic kidney disease are particularly vulnerable. So when patients receive dialysis, which helps filter the blood, their home water supply is typically tested for toxins to ensure safe treatment. The researchers found that, among more than 6,400 chronic kidney disease patients, 12% had measurable lead in their home drinking water. 

To quantify the impact of contamination, researchers measured exposure against the patients' dosage level of an anemia treatment, a proxy for the toxic effect lead has on the blood. Of patients with measurable lead in their water, a higher category of lead contamination was linked with 15% higher risk of using the maximum dose of that treatment. The results indicate, the authors write, that that even common levels of lead could have negative health effects for vulnerable individuals.



First opinion

What will save rural psychiatry services?

Adobe

This is an easy one, according to First Opinion contributor Nadir Al-Saidi: higher Medicaid payments. Al-Saidi's father runs the only private psychiatric practice in their rural Michigan town, and is the sole psychiatrist contracted at the local hospital. "If there were ever to be an empty bed in the stress unit my psychiatrist dad manages, I'm certain he would admit himself," he writes. 

Having a highly Medicaid-dependent patient panel makes it almost impossible for a psychiatrist to financially support a practice, he argues. Instead, most choose to practice in urban settings where more people are covered by private insurance enrollment, making the business more lucrative. Read more from Al-Saidi on the burden facing rural clinicians and what can be done to ease it.


climate

Heat waves are linked to early deliveries, per study

Heat waves are becoming more frequent and more intense across the world, and as temperatures rise, so do health risks. It can be especially dangerous for those with cardiovascular or chronic diseases — and several studies have identified an increased risk of preterm delivery and stillbirth after heat exposure. STAT's Nalis Merelli reported yesterday on a new study that confirms the link to early deliveries at a massive scale.

The research, published last week in JAMA Network Open, looked at more than 53 million singleton births that occurred in the 50 most populous U.S. cities during the hottest months of the year between 1993 and 2017. After a heat wave, preterm births increased by 2% and early births by 1%. But the effects were uneven: Mothers who were 29 or younger, had a lower level of education, and belonged to a minority ethnic or racial group saw a 4% increase in preterm births, and a 3% increase in early deliveries. Read more.


artificial intelligence

Health insurers boast to investors about using AI, but kept quiet when STAT reached out

Health insurers are telling shareholders that they are ramping up the use of artificial intelligence and hiring talent to implement the technology across their organizations, STAT's Brittany Trang reports. A review of regulatory filings from publicly-traded insurers showed several — including Elevance, Molina, and Cigna — investing in AI with the goal of saving money. (Elevance has hired nearly 500 people to work exclusively on AI.) 

The expansion comes at the same time the health insurance industry is lobbying Congress to minimize regulation of AI in health care. And all five of the insurers that Brittany contacted declined to elaborate on how they are using AI — a lack of transparency that poses problems for an industry that has already been slammed by lawmakers for using AI to guide patient care. Read more on what we know about insurers' AI ambitions.


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Thanks for reading! More tomorrow,


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