Another reform plan for NIH

The NIH restructuring floated by two House Republicans Friday is the latest in an onslaught of GOP demands for agency reform and scrutiny. But they're not alone in mulling change at the Bethesda campus. Even if a plan to whittle institutes down from 27 to 15 never takes flight, researchers and advocates say there's room to work on director term limits, some institute mergers, and bringing back that elusive review board.

That sweeping changes could find traction — some even in the upcoming appropriations process — shows how once-bipartisan goals for NIH have splintered in the wake of the coronavirus pandemic and leadership shakeups.

"I don't think anybody would question, or should question, that the NIH can be made better, but I don't think this is the right approach," said one researcher. Well, it's not the only one: Sen. Bill Cassidy (R-La) has also gathered reform proposals, while Trump surrogates have put forward sweeping changes that — in part — would make firing institute directors easier. More from me on what this moment means.

summer reads

Key takeaways from Fauci's new memoir

STAT's Jason Mast did quick work this weekend to digest Anthony Fauci's new memoir, "On Call: A Doctor's Journey in Public Service." The book navigates through Fauci's childhood in Brooklyn, his early work in HIV research, when the conversation around science started getting political, and the one time the White House asked him to withdraw an op-ed.

"At times, I am deeply disturbed about the state of our society," Fauci writes. "But it is not so much about an impending public health disaster. It is about the crisis of truth in my country and to some extent throughout the world, which has the potential to make these disasters so much worse."

The book hits shelves today, just a few weeks after the retired doctor testified before a House panel on the coronavirus pandemic. I'll be starting it myself soon, so send thoughts!

Read all nine of Jason's takeaways.

tobacco policy

Study: Vaping just as good as Chantix for quitting smoking

E-cigarettes were about as effective at helping people quit smoking as the gold-standard pharmaceutical drug, varenicline, according to a clinical trial published Monday in JAMA Internal Medicine.

The trial included 458 people who smoked daily and wanted to quit. After 26 weeks, roughly equal percentages of participants using varenicline, or Chantix, and e-cigarettes — 43.8 percent and 40.4 percent, respectively — had stopped smoking.

This is the first published randomized controlled trial to compare Chantix directly to e-cigarettes, Nick Florko reports. It's also likely to cause a stir within the tobacco-control community, which has been bitterly divided over whether e-cigarettes are a help or hindrance for adults who want to quit smoking. More from Nick.

hospital payments

Senate Democrats propose Medicaid bumps for rural OBGYNs

A group of Senate Democrats led by Finance Chairman Ron Wyden (D-Ore.) on Monday launched a bill aimed at keeping rural labor and delivery units from closing, in part by increasing Medicaid payment rates and creating "standby" payments for low-volume periods.

Their proposal, the Keeping Obstetrics Local Act, would also require all states to provide Medicaid postpartum coverage for a year after birth. The legislation comes after a Finance hearing in May on rural hospital closures. Wyden said that from 2011 to 2021, 267 rural hospitals stopped providing obstetrics services, or roughly a quarter of the country's rural providers.

research corner

Sweeping NIH study failed to curb opioid deaths

The NIH in 2019 launched a research study with an ambitious goal: to lower opioid overdoses in participating communities by 40%, in part by distributing naloxone and providing addiction medications.

But communities that implemented the public health strategies did not see a statistically significant reduction in opioid overdose deaths, according to data published Sunday in the New England Journal of Medicine.

Given the study's simple premise — that helping communities use proven strategies could help prevent deaths — the results came as a surprise, STAT's Lev Facher writes. But its leaders warn against making too much of the disappointing data, citing the fast-changing drug supply and, critically, the backdrop of the Covid-19 pandemic. More from Lev on what they're saying.

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