Jimmy Dean sausage sandwiches, Elmo, and autoimmune supervillains

Plus: How U.S. hospitals increasingly rely on international nurses

July 11, 2024 Check out STAT+

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By Theresa Gaffney Morning Rounds Writer and Podcast Producer

Happy BFF Day! In elementary school, a friend and I invented this holiday because we both had winter birthdays and wanted a way to get presents in the summer. Also, because we loved each other. Tell your BFF you love her and maybe share some of today's excellent journalism with her. I've already showed the photos in Nick Florko's story to everyone I know.

nutrition 'Medically tailored' cheeseburgers? Medicaid is buying Anthony Tiuli for STAT When you think of the growing "Food is Medicine," movement, a Jimmy Dean frozen sausage breakfast sandwich might not be the "medicine" you imagine. Nor a cheeseburger, nor biscuits and gravy. But these are just some of the meals that for-profit companies are sending to people with diet-related conditions like cancer or diabetes to help improve their health and stay out of the hospital.  While there's no universal definition for a "medically tailored" meal like these, most nutrition experts say they should be low in certain ingredients like sodium, added sugar, and saturated fat, and high in others, like fiber. They also expect meals to be free of the additives that typically lace unhealthy processed foods. Despite these standards, companies can (and do!) bill Medicaid for meals loaded with sodium and saturated fat — some of which could be bought in the grocery store at much lower cost. Read the fascinating story from STAT's Nick Florko on what these meals look like (more photos included) and what concerns they raise about federal and state oversight of meal delivery programs. racial health disparities Incomplete investigations of infant deaths stymie prevention efforts There's no adequate way to describe the anguish of losing a child to sudden unexpected infant death. Afterward, a parent's suffering is too often multiplied by bureaucracy and "paperwork thickened with accusation," as STAT's Eric Boodman wrote in a moving story about that tortured process. A study published this week shines a light on another troubling aspect of the aftermath of these deaths: Almost a quarter of all investigations into sudden unexpected infant deaths are left incomplete, especially in rural areas and for Indigenous families. "Incomplete" doesn't refer to anything as minor as a missing signature, but means that there was either no autopsy, no scene investigation, or that there was missing information about where and how a body was found. Complete investigations are necessary to "produce equitable public health surveillance data used in prevention efforts," the authors note. Researchers analyzed almost 4,000 investigations in a national death registry from 2015 to 2018. The deaths of babies in rural areas were more than 1.5 times more likely to have an incomplete investigation compared to urban areas. Investigations led by law enforcement, rather than a medical examiner, were also more likely to be left incomplete. The problems compounded for American Indian/Alaska Native populations, who were the racial group most likely to be left with incomplete investigations — and whose infant deaths were more likely to occur in rural places and to be investigated by law enforcement. chronic disease A "molecular switch" for lupus could help treatment Think of lupus in superhero terms, as STAT's Isa Cueto explains it. Loyal heroes (immune cells) become the villains, destroying their own people (the skin, lungs, and kidneys). But what if a villain could turn back into a hero — that is, if immune cells could actually help save tissue damaged by autoimmune disease? That's the central question in a new study focused on the type of helpful T cells that lupus patients lack and the destructive cells they have in higher concentrations. "We wondered if there was a molecular switch that sort of controlled how these cells can toggle between these two," Jaehyuk Choi, the paper's senior author, told Isa. Without spoiling the ending: The team found the switch. Read more in Isa's story on the action-packed science.

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muppetry Even the Muppets are being called to fight the country's mental health crisis Courtesy of Sesame Workshop  "Elmo is just checking in!" You may remember the red Muppet tweeting earlier this year. "How is everybody doing?" You may also remember the internet's response: We are resoundingly unwell! Elmo and his fuzzy pals from Sesame Street are accustomed to asking people about their feelings and sharing their own, with the goal of fostering conversations around mental wellbeing. The Health and Human Services Department has long partnered with the Sesame Workshop to distribute mental health care resources to parents, kids, and even military families specifically. "[We] try to make sure that we use our muppets in a way that is not scary, but at the same time, provides a scenario that's comforting," Sesame Workshop's Jeanette Betancourt, senior vice president for U.S. social impact, told STAT's Sarah Owermohle. Read more from Sarah on Muppets and mental health. nursing Amid visa complications, U.S. hospitals increasingly rely on international nurses Foreign-educated registered nurses covered twice as many hospital beds in 2022 as they did in 2010, according to new analysis from KFF. In total, there are 500,000 immigrant nurses working across the country in hospitals, nursing homes, doctor's offices, and home health services.  The report, which analyzed data from the American Hospital Association survey, comes in the midst of a dire nurse staffing shortage — though there's debate about whether that's truly the best name for the crisis. Regardless of what you call it, the situation remains dire as RNs continue to demand better working conditions and often cite rampant short staffing as a reason for leaving the job. Compounding the issue: Just last month, the federal government extended a pause in its processing of new international nurse visa applications. addiction Did overprescription of opioids actually drive the addiction crisis? As the opioid crisis spread across the U.S., overprescription of legal drugs was never the problem, patient advocate and researcher Richard Lawhern writes in a First Opinion essay. This story line has been perpetuated by the federal government, he argues, but it can actually be explained in part by a sort of clerical error. For years, the CDC and the U.S. Bureau of Vital Statistics were misattributing deaths involving illegal street fentanyl to deaths caused by "prescription" drugs. When this error was corrected, Lawhern says, the number of death certificates that mentioned prescription drugs dropped by half. Read more on Lawhern's surprising take on the role physicians did and didn't play in the opioid crisis.

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What we're reading 'We've created medical refugees.' LGBTQ+ healthcare workers fight for gender-affirming care amid rise in anti-trans laws, LA Times In constant battle with insurers, doctors reach for a cudgel: AI, New York Times Preparing schools for the H5N1 bird flu they're likely to face, STAT This county has dealt with pregnancy disparities for decades. Their solution? Adopt-A-Mom, The 19th FTC plans to sue PBMs over the high cost of insulin and other medicines, STAT

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Thanks for reading! More tomorrow,

theresa.gaffney@statnews.com

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