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Pathologizing race, recriminalizing drugs, & treating neuropathic pain

September 9, 2024
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Morning Rounds Writer and Podcast Producer
Good morning, there's a lot of news about pain today. One-time and chronic, emotional and physical. I hope you experience none of that today. Read on & I'll talk to you tomorrow.

stat investigation

How medicine pathologizes Black patients' normal test results

In their Embedded Bias series, STAT's Usha Lee McFarling and Katie Palmer have reported extensively on how the use of race in medical algorithms can delay or forgo necessary care for Black patients. In Part 5, Usha brings a story on the other side of the coin: How Black patients can receive too much medical care when they're found to have low levels of white blood cells — which is normal for some people with African or Middle Eastern ancestry.

That's exactly what happened to Vanessa Apea, pictured above, when she was just 21 years old. Apea wasn't feeling as energetic as usual, so she got her blood drawn. Physicians told her she had neutropenia, which could be a sign of leukemia. But at a follow-up appointment, a Black doctor told her she probably just had "racial neutropenia." In other words, she was completely healthy.

There's a simple, cheap test to see if somebody has the genetic variant that causes these lower white blood cell counts, but most doctors don't order them. "You've placed norms and let people feel they are abnormal for no reason at all," said Apea, who is now a doctor in London. "I don't want to be left feeling there is something wrong with me because I'm a Black woman." Read more.


substance use

Did Oregon's controversial drug law really lead to more overdose deaths?

Almost four years ago in November 2020, Oregon became the first state in the U.S. to decriminalize all nonprescription drugs for personal use. (The legislation also aimed to expand treatments for substance use in the state.) But the next year, fatal overdoses increased in the state by about 50%, leading policy-makers to reverse the legislation. As of this month, drug possession is illegal again in Oregon.

But did decriminalization actually cause the sharp increase in deaths? A study published last week in JAMA Network Open calls that assumption into question. Researchers analyzed the association between overdose deaths and the legislation by comparing the situation in Oregon to the rest of the country. They found that when accounting for the rapid spread of fentanyl through the illegal market in Oregon, there was no association between decriminalization and overdose mortality. 

While fentanyl entered the scene as early as 2014 in northeastern states, it wasn't until late 2020 and early 2021 that it spread to California and Oregon — right when drugs were decriminalized. On top of that, state funds to expand treatment weren't distributed by health authorities until mid-2022. "Recriminalization in Oregon may not reduce the rate of overdoses observed in a state saturated with fentanyl," the authors wrote.


infectious disease

This outbreak's first case of bird flu in someone without animal contact

A Missouri resident who had no contact with animals has tested positive for bird flu, the state's health agency and CDC announced Friday. However, it's not clear if the person was infected with the same strain that's causing the ongoing outbreak among dairy cattle.

A CDC spokesperson told STAT's Helen Branswell that analysis of the virus is still ongoing, but to date the agency's scientists have seen no evidence of changes that would suggest the virus has evolved to become more transmissible to and among people. Read Helen's story from Friday on the case, then read her latest on the five pressing public health questions it raises.



chronic disease

The mystery of persistent Lyme disease meets the enigma of long Covid

Lexey Swall for STAT 

Over 10 million people in the U.S. have chronic symptoms of Covid or Lyme disease. But how do you know which you have? Long Covid and chronic lyme disease can cause a litany of similar symptoms, including body pain, intense fatigue, and brain fog. And they're both slippery diagnoses, leaving patients uncertain if an infection truly was the source of their problems.

"We have to come up with a plan to care for these patients, a plan to do the research that's needed. It ain't going to go away," said John Aucott, director of the Johns Hopkins Lyme Disease Clinical Research Center. Even to an expert like him, long Covid, post-treatment Lyme, and other post-infectious conditions "all look remarkably similar," he said.

Read more from STAT's Isabella Cueto and contributor Alia Sajani.


reproductive health

People have been writing about IUD pain for years. Is anything changing?

The first story I remember reading about the pain involved in the insertion of an intrauterine contraceptive device was a 2021 article in the Washington Post that described how many women find the process "excruciating." Readers submitted descriptions of pain "that left them bedridden for days or sprinting to the bathroom to vomit," wrote reporter Caroline Kitchener. More publications cataloged this phenomenon over the next few years, with HuffPost, Mother Jones, Teen Vogue, Undark, the New York Times, and others publishing stories that all essentially said: Hey! This has always been pretty painful. Why hasn't anyone done anything about it? 

The issue gained even more momentum on TikTok, where people posted videos documenting the pain they experienced during insertion. Some providers began offering sedation to patients as pain management for the procedure. And last month, federal health officials finally seemed to get the message. The CDC updated its guidance to advise physicians to counsel all patients on the pain that could occur during the procedure and on pain management, recommending lidocaine either as an injection or a topical gel, cream, or spray.

It's a step toward taking the pain reported by women and other marginalized groups more seriously. But challenges remain — this month, Manhattan's Planned Parenthood clinic stopped offering sedation for IUD insertion this year, citing budget problems. And as columnist Lisa Jarvis pointed out last week in Bloomberg, IUD insertion isn't the only procedure that regularly causes people discomfort or pain at the gynecologist's office. Ever had a pap smear?


disability

Paralympic athlete study offers clues to manage neuropathic pain

If your nervous system is damaged or doesn't work as usual, there isn't a simple fix for the neuropathic pain you may feel. It's not as well understood as the type of pain from breaking an arm or stubbing a toe, but it's no less painful. Neuropathic pain can feel at best like pins and needles, or it could feel like one is "burning alive" or "being eaten alive by acid," as Paralympian triathlete Lauren Parker of Australia identified it.

Up to 70% of the 15 million people across the globe who have spinal cord injuries experience neuropathic pain. A study published last month in BMJ Open Sport and Exercise is the first to describe it as this population experiences it. The research, which included Paralympians and recreational athletes, found that both groups struggle to describe their chronic pain. 

"We need to get closer to understanding exactly what types of movement may best influence neuropathic pain symptoms," study author Kendra Todd said to STAT's Timmy Broderick. Read more.


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What we're reading

  • How Pfizer ended up passing on my GLP-1 work back in the early '90s, STAT

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  • Breakthrough therapies have given Duchenne muscular dystrophy families like mine hope — and new fears, STAT
  • Thanks to Reddit, a new diagnosis is bubbling up across the nation, KFF Health News
  • Detailed data show Summit therapy beat Merck blockbuster Keytruda in late-stage lung cancer trial, STAT

Thanks for reading! More tomorrow,


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