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The battle over race in kidney function equations

September 5, 2024
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Morning Rounds Writer and Podcast Producer

Happy Thursday! Tomorrow, you'll hear from a new character in the Morning Rounds Universe: disability reporting fellow Timmy Broderick!

(Timmy landed on the polar opposite end of the "Is my blue your blue?" spectrum than me. They were more green than 96% of the population, while I was more blue than 98%! Look at us, building bridges across the hue barrier. Brave!)

STAT investigation

How advocates won one battle in the war on race in clinical algorithms

One of the most well-known medical algorithms to incorporate race is the estimated glomerular filtration rate, or eGFR. This measurement is used to determine how well a person's kidneys filter waste. If the number is low enough, patients will be added to the waitlist for a kidney transplant. But despite the fact that Black Americans are nearly four times more likely to have end stage kidney disease than white Americans, they're less likely to receive a kidney transplant. One of many reasons for this disparity is the racial adjustment to the eGFR, according to the nation's organ transplant network.

After years of advocacy from physicians and trainees, nearly all of the nation's clinical labs have stopped using race in kidney function equations. But how did that actually happen? In Part 3 of Embedded Bias, STAT's Usha Lee McFarling and Katie Palmer tell the story of the generational fight that led to these major changes. It was a messy and painful process, featuring big contentious meetings between physicians, accusations of bullying, and the surprising opposition from an eminent Black medical leader.

"I was very quickly labeled as a problem student — by faculty and fellow students," said Naomi Nkinsi, who began advocating for change while in medical school. "It was one of the hardest times of my life."

The battle can offer a lesson on what challenges other specialties may face as they begin to grapple with their own use of race adjustments. Read more.


costs

Some older adults don't get or take prescription meds due to cost

Between 2021 and 2022, 3.6% of adults 65 and older in the U.S. didn't get their prescribed medications due to the cost. Another 3.4% got their meds, but don't take them exactly as prescribed because of costs, according to new data from the CDC's National Center for Health Statistics.

These two measures of "cost-related nonadherence" were six times higher among those who experienced food insecurity than those who didn't. People who live with a disability were twice as likely not to get or take their meds compared to those without a disability. 


first opinion

8 former CDC directors on why scaling back the agency is a bad idea

This summer, Republican lawmakers said that the CDC needed to narrow its scope to only deal with infectious diseases. It wasn't the first time that people argued the agency needs to be made smaller. In a First Opinion essay, eight former CDC directors refute these arguments, writing that they are deeply concerned by recommendations to pare back the agency.  

The CDC's "core mission" isn't infectious disease — it's the nation's health, they argue. And they believe that making the agency smaller would cost lives and damage the economy. Read more.



immunity

Immune system sex differences revealed in study of trans men

Adobe 

Men are more likely than women to die from Covid-19, but women develop long Covid more often. Researchers understand the basics behind these gendered odds. Men are more vulnerable to infectious disease, while women are more susceptible to autoimmune disorders. What we don't fully understand is: Why? 

A study on trans men published yesterday in Nature is the first, per the authors, to comprehensively examine the impact that gender-affirming hormones have on the immune system. But the study also sheds light on the potential factors behind immune differences between the sexes.

The researchers followed almost two dozen trans men who took testosterone. They found that, after a year of treatment, the participants had less of a certain class of immune cell that's linked to autoimmune diseases. But the testosterone also boosted the responses of other cells that regulate responses to infection, including the amount of inflammation behind an immune response. Basically, some aspects of their immune systems were beginning to mirror those of cisgender men. Read more on the fascinating science from STAT's Jonathan Wosen. 


infectious disease

A 'marked' increase in global cholera cases and deaths last year

The number of cholera cases around the globe increased 13% in 2023, while deaths increased by 71%, according to new data released yesterday by the WHO. Many of the cases (38%) were among children under the age of 5.

Much of the influx occurred on the African continent, which saw a 125% increase in cases, signifying gaps in access to treatment, a WHO press release noted. Cholera is easy to treat, but an increased demand for supplies such as vaccines, diagnostic tests, and treatments including oral rehydration salts and intravenous fluids poses a challenge to global efforts, the agency noted. 

"What we don't know is this large surge in outbreaks, which began maybe in late 2021, 2022 — whether this is a new normal and this incredible demand right now will be sustained, or whether this is a phenomenon that will reset over the in the next few years," Julia Lynch, the director of the cholera program at the International Vaccine Institute, told STAT's Nalis Merelli earlier this year. 

(Meanwhile, in other global infectious disease news, Moderna reported encouraging results on its mpox vaccine as that outbreak continues to spread in Africa. Read more from STAT's Helen Branswell.)


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What we're reading

  • Your body ages rapidly in two 'bursts,' at 44 and 60. Here's how to prepare, National Geographic

  • Depression: How brain scans helped predict long-term treatment outcomes, STAT
  • Dozens of Republicans file amicus brief against Tennessee's transgender care ban, NBC News
  • Can amylin drugs best Wegovy and Zepbound? Companies bet on next big obesity target, STAT

Thanks for reading! More tomorrow,


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