Birth control vending machines, seasonal shots, and the “Snoo”

Plus: Embedded Bias Part 2!

September 4, 2024 Check out STAT+

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By Theresa Gaffney Morning Rounds Writer and Podcast Producer

Good morning! Is your blue my blue? The STAT newsroom was lit up over this existential question yesterday. This test attempts to determine at which hue you perceive the boundary between green and blue to be. The more design-oriented staffers especially didn't like the binary nature of the task. Multimedia director Alissa Ambrose said: "Teal is neither blue nor green and I really resent being asked to choose!"

STAT Investigation How did we get here? The history of race in medical algorithms You've heard about those roads, the ones that are paved with the best intentions. "No one was meeting in back rooms or alleys saying, 'How can I hurt Black patients?'" pathologist La'Tonzia Adams told STAT's Usha Lee McFarling and Katie Palmer about the way race has become embedded in important medical algorithms. "This started with good intent." It started — some say — in the '90s, when the NIH started requiring researchers to collect racial data. The idea was to understand how race influences health outcomes. But back then, people considered race to be a biological explanation for health differences, rather than the socially created category with a weak relationship to genetic differences that scientists know it to be today. At the same time, clinicians were often haphazard when recording a person's race, sometimes dividing the whole world into two racial categories: "Black" and "white." In the second story in their Embedded Bias series, Usha Lee McFarling and Katie Palmer dive into the history of how race became ubiquitous in medical decision-making tools. "For me one of the challenging issues was talking to people about race," Usha told me about the reporting process. "There's always a level of discomfort in grappling with race and I appreciate the folks (of all races) who were willing to talk about this, let me know what they've learned and how they've had their eyes opened, and even admit to me that they would do things differently now." Read more in today's story — and don't miss yesterday's. reproductive health How abortion bans are affecting miscarriage care The best medications to manage a miscarriage — mifepristone and misoprostol — are the same ones used in medical abortions. As some U.S. states enact bans on abortions using these medications, people experiencing miscarriages can be left without necessary medical care. A study published yesterday in Health Affairs aimed to estimate the number of people experiencing miscarriage across the country who could be affected by these policies. The researchers found that more than 1 million miscarriages occur each year in the U.S. In states that had either total or six-week abortion bans as of this past May, about 317,000 miscarriages occur annually. And since the data analysis was done, Florida and Iowa have also enacted six-week bans. These numbers show the large number of people each year who could potentially be denied medication for a miscarriage, the study authors write.  Miscarriage isn't the only health condition affected by legislation limiting access to these drugs. Louisiana was the first state to recategorize mifepristone and misoprostol as controlled substances, similar to cocaine or heroin. The law goes into effect on Oct. 1, and physicians are already worried about how it will affect care for postpartum hemorrhage, according to a story published yesterday in the Louisiana Illuminator.  more reproductive health Plan B vending machines and the push to broaden birth control access  In the U.S., about 19 million women live in a contraceptive desert (a county that doesn't have at least one health center for every 1,000 women in need of publicly funded birth control). More than 1 million of those women live in New York, where gaps in access remain despite progressive reproductive health policies.  A big, systemic problem like this might bring to mind big, systemic solutions. But what about vending machines? At SUNY Upstate Medical University in Syracuse, that's exactly what they're trying. Students can go to the machine 24/7 to get affordable Plan B, pregnancy tests, and other products like Tylenol. It's one example of the wide range of interventions that experts say are needed to help increase access to birth control. Read more.

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infectious disease Happy September, it's time to think about your seasonal shots While brat summer is officially over, the wave of Covid-19 that spread across the U.S. this season doesn't show any signs of slowing down. Wastewater testing shows that levels of the virus haven't been this high during summertime since 2022. This complicates the question of when to get your Covid shot for the season. If you're only eligible for one shot per year, should you get it now? Or do you wait until later in the fall to hopefully get more winter protection? As usual, STAT's Helen Branswell is on the case. Also as usual, the answer is complicated. A number of experts that Helen spoke with suggested getting a Covid shot now makes a lot of sense. And of course, the standard advice is to get your Covid and flu (and RSV, if you're eligible) shots at the same time. These are simple marching orders designed to maximize compliance. But if you're willing to book separate Covid and flu vaccination appointments, it might also make sense to wait a while for your flu shot. Read more from Helen on how to consider all the most important factors in making this decision. cancer Refusing cancer surgery is associated with higher suicide rates Cancer patients who don't get surgery as their first course of treatment — whether it's recommended or not — are more likely to die by suicide than those who do get surgery. Those who are recommended surgery but refuse it are at the highest risk. That's according to a study published yesterday in JAMA Network Open that analyzed 20 years of patient data from a national cancer surveillance program. Among those who didn't get surgery, patients with pancreatic, esophageal, lung, and stomach cancers had the highest risk of suicide.  It's unclear exactly what causes the correlation between surgical status and suicide risk. The authors note that it could be due to those patients having more advanced, inoperable tumors. But when they looked just at people with advanced stages of cancer, the correlation persisted. Other factors like social or psychological comorbidities, or unrelated medical reasons why a surgery may be more harmful than helpful, could also play a role.  The stress of a cancer diagnosis can affect an entire family or household. Last month, STAT's Angus Chen wrote about the heightened suicide risk that spouses of cancer patients face in comparison to those whose spouses do not have cancer.   first opinion Is this smart bassinet a money grab? Parents swear by the Snoo, a smart bassinet that will gently rock a baby all night long while white noise plays. While it costs a whopping $1,700, there's a healthy re-sale market, journalist Ellery Roberts Biddle writes in a First Opinion essay. Now that cost is going up: Parents will need to pay $20 per month for "premium" features including a mode that weans babies off the rocker, a sleep log, and a locking mechanism so that the bassinet doesn't rock too hard.  "The Snoo touches two of the most precious things in your life — your baby, and your ability to get sleep — but in the end, it is a tech product, and a high-end one at that," Biddle writes. The pediatrician who created the Snoo says he was motivated by the desire to improve infant safety for all, but at this price point, Biddle asks, who is this product really serving? Read more.

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What we're reading UCSF favors pricey doctoral program for nurse-midwives amid maternal care crisis, KFF Health News How machines learned to discover drugs, The New Yorker Dana-Farber CEO Laurie Glimcher to step down, saying 'we must look to the next generation,' STAT Worked to the bone, India's doctors fear for their safety, too, New York Times Recursion presents mixed data on lead AI-derived drug candidate for potentially fatal brain condition, STAT

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Thanks for reading! More tomorrow,

theresa.gaffney@statnews.com

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