Face transplants, Frances Collins on God, and insurance denials

Plus: When diagnostic errors lead to unnecessary deaths

September 19, 2024 Check out STAT+

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By Theresa Gaffney Morning Rounds Writer and Podcast Producer

Good morning! Last night was the premiere of Survivor 47, but don't tell me what happened because I haven't watched it yet! I'm so curious to see how politico and podcast host Jon Lovett fares on the island and in the edit.

politics Francis Collins on God, his cancer diagnosis, and Trump Graeme Jennings/Pool via AP Former NIH director Francis Collins is a scientist's scientist. But he's also an outspoken Christian who believes that his faith could help him extend a hand to others, spreading the message that science is not the enemy. Here are a couple of the comments Collins made while speaking to a group of journalists earlier this month: How he came into his religious beliefs: "In medical school, encountering some of those deeper questions like 'Why am I here? And what happens after you die? And is there a God' and watching people struggling with the advances of their illnesses and their likely inability to survive, I realized I hadn't given this a whole lot of thought." What he learned from his own experience with cancer: "We've come a long way in how to detect and respond to this cancer in the last ten years. But our health care system hasn't necessarily figured that out." Read more from STAT's Brittany Trang on what Collins had to say. surgery 50 face transplants have been performed worldwide. Here's how they went Since 2005, 50 face transplants have been performed worldwide on patients with severe disfigurements from trauma, burns, or tumors. A study published yesterday in JAMA Surgery assessed the success of these grafts and found the data promising. More than half of the transplants were of the full face, and 33 contained bone in addition to soft tissue.  Researchers looked at the five- and 10-year survival of the transplants — meaning not only whether the patient survived, but whether the transplant stuck. At five years post-procedure, the survival rate for the patient and the transplant combined was 85%, and at 10, it was 74%. When only considering if the transplant was lost or not, survival rates were 96% and 83%, respectively. These numbers "compare favorably" with survival in solid organ transplants like kidney and liver, the authors write.  Graft losses and patient deaths were common between eight and 12 years post-transplant, which the authors say could be attributed to complications from chronic immunosuppressant use. But odds of survival increased as time went on, suggesting that surgeons were improving as they performed more procedures. first opinion Will Medicaid cover the new HIV wonder drug? Yesterday, former CDC director Rochelle Walensky and physician Mark Siedner wrote in First Opinion about how drug companies test HIV drugs among women in Africa, but rarely make those treatments accessible in African countries afterward.  Today, two health care leaders argue that even here in the U.S.,the new, less-frequent injection will only fulfill its potential if Medicaid ensures that the medication is accessible to the populations that need them most. Medicaid is the largest source of HIV care financing in the U.S. and must be prepared to cover the drug.  "Widespread availability of longer-acting HIV products in the United States may still be years away," the authors write. But "if we wait until then to address Medicaid accessibility it will be too late." Read more.

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first opinion The care team was kind, but they couldn't save his life Courtesy Lisa Venticinque  Last year, almost 800,000 Americans died or became permanently disabled because of diagnostic error. This week, the CDC and CMS took a step to combat this by launching the Diagnostic Excellence Core Elements project.  It's more than a decade too late for Vonda Vaden Bates, a patient safety advocate whose husband died after going to the hospital with a brain bleed. It wasn't the bleed that killed him, but a common post-surgical complication. In a First Opinion essay, Vaden Bates shares her experience confusing kindness with competence when it came to her husband's care team. She also writes on what needs to happen to ensure that other families don't suffer similar loss. Read more. social determinants of health How race, income, & education affect insurance denials Technically, the Affordable Care Act eliminated most out-of-pocket costs for patients when it comes to preventative care like screenings and wellness visits. In practice, lots of people face challenges to getting care covered. A study published yesterday in JAMA Network Open shows certain populations are more often denied insurance coverage for preventative health care. Researchers analyzed claims data for more than 1.5 million patients with private insurance between 2017 and 2020. They found that while white patients had preventative care denied 1.13% of the time, Asian, Hispanic, and Black patients had significantly higher denial rates of at least 2%. The lowest-income patients had 43% higher odds of a denial than those with the highest incomes. And those without college degrees were more likely to get preventative care denied than those with a degree. More than two-thirds of these denied claims were never resubmitted by a doctor, the researchers found. This means the costs of preventative care are being inequitably put on marginalized patients. Uniform billing standards as well as improved communication and language assistance could help combat these coverage disparities, the authors write. biotech Biotech CEO gossip, anyone? Competition is normal for biotech companies. But for two rivals racing to develop new ways to screen for colon cancer, that drama has been playing out on social media this week. On Monday, Exact Sciences reported positive initial results in their blood test for colon cancer. But in the days before the announcement, the co-CEO of another biotech, Guardant Health, took to Linkedin to challenge the results. Tagging the Exact CEO, the Guardant CEO wrote: "I'll publicly bet you $1M that your … data at ESMO (whatever the readout) won't hold up in your pivotal trial." Despite Monday's positive data, Exact Sciences (whose CEO hasn't responded to the post) is still waiting for the pivotal trial results, meaning no true winner in this battle can be declared just yet. In the meantime, cancer survivors and industry veterans have decried the post as clumsy and counterproductive. Read more in STAT+ from Jonathan Wosen.

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What we're reading U.S. overdose deaths plummet, saving thousands of lives, NPR Why Big Tobacco is betting on Trump, Washington Post House panel advances bill to extend Medicare's telehealth flexibilities, setting up December talks, STAT Bulletproofing America's classrooms, New York Times Hospital giant Ascension recorded about $1.3 billion in losses from its cyberattack, STAT

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Thanks for reading! More tomorrow,

theresa.gaffney@statnews.com

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