What Marty Mackary will do at the FDA & what taxi drivers can teach scientists

Plus: Should people on lithium keep taking it during pregnancy?

December 17, 2024 Check out STAT+

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By Theresa Gaffney Morning Rounds Writer and Podcast Producer

Good morning! I just learned in Lizzy Lawrence's great profile of Marty Makary that the TV show "The Resident" is based on his book about the medical system. I've never seen the show, due to my dislike for a character the lead actor plays in a completely different series, but perhaps now is the time to check it out.

politics Which version of Marty Makary will run the FDA? Photo illustration: Christine Kao/STAT; Photo courtesy : Johns Hopkins University Some people see Trump's pick to lead the FDA as a truth-teller and independent thinker with a deep respect for science. Others consider him a contrarian for contrarian's sake who too often opines on matters outside of his expertise. Marty Makary got his start as a surgeon trying to raise awareness about the impact of hospital workplace culture on patient care. "He would leave people with a feeling of, 'Oh my gosh, I should be doing that,'" said one psychologist who worked closely with him on the issue. But as STAT's Lizzy Lawrence reports, Makary can fall victim to hyperbole. In 2016, he led a paper asserting that medical error was the third-leading cause of death in the U.S. that got widespread coverage — even STAT reported on it. But experts quickly saw that the conclusion was the misleading product of some methodological errors.  Still, Makary is more trusted by traditional health care leaders than some of Trump's other nominees. Read more in Lizzy's illuminating profile on Makary and what kind of commissioner he might be.  equity Hispanic adults face underinsurance at higher rates The number of uninsured Hispanic adults dropped from 33 to 18% after the Affordable Care Act became law. But more than 55% of Hispanic adults are underinsured, meaning they don't have health insurance or can't afford the health care services they need, according to a report released today by the Commonwealth Fund. This compares to 42% of the nation's non-Hispanic population. More than half of those surveyed said they either did not pick up prescriptions, get follow-up tests that had been ordered, or see a physician when they were sick due to cost, while 30% said they were paying off medical or dental debt over time.  "The United States spends more on health care than any other high-income nation, yet we have the least to show for it," said report author Joseph R. Betancort, the fund's president. "Undoubtedly uninsurance, underinsurance, and affordability challenges are major root causes of this painful difference." — Usha Lee McFarling reproductive health Should people on lithium keep taking it during pregnancy? For people with bipolar disorder or other psychiatric conditions, lithium can serve as critical treatment. But upon getting pregnant, they must weigh the benefits of the drug against its potential risks. Across the world, the proportion of people who do continue their prescriptions during pregnancy varies wildly depending on where they live, according to a study published yesterday in JAMA Network Open. Over more than two decades, about 2% of people in South Korea who took lithium before getting pregnant were still taking it in the second trimester. In Denmark, that proportion was 80%.  The study used data from more than 21 million pregnancies in 14 countries, including the U.S., between 2000 and 2023. In 10 populations, use of the drug during pregnancy increased over that time period. Overall rates of lithium use ranged from 0.07 per 1,000 pregnancies (in Hong Kong) to 1.56 per 1,000 (among those publicly insured in the U.S.). The authors recommend the development of "internationally harmonized guidelines" to help people better navigate medical decisions during pregnancy.

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science What taxi drivers can teach neuroscientists Jeff Spicer/Getty Images  Here's an interesting factoid for you: Taxi drivers die from Alzheimer's disease at lower rates than people in other professions. In a study published yesterday in The BMJ, researchers posit that the reason may be how the job requires drivers to constantly exercise the parts of the brain responsible for navigation.  But it's not just a factoid. Understanding the reasons behind the association could have implications for the rest of us as well. Read more from STAT's Anil Oza on the study. You'll come for the science and stay for the history of how taxi drivers have been teaching neuroscientists about the brain for over 20 years.  cardiovascular health A new model to estimate heart failure About a year ago, the American Heart Association released the PREVENT calculator to predict cardiovascular risk. A report published yesterday used the tool to model risk of heart failure versus other types of cardiovascular disease and found that there's a substantial group of people who are at risk for heart failure, but not for the common clogged arteries that can lead to angina, heart attacks, and strokes. More than half of participants at elevated risk of heart failure had high blood pressure, and half were overweight or had obesity.  As you might remember, the calculator drew attention earlier this year for its potential to reduce the number of Americans who are eligible to receive widely-prescribed cholesterol-lowering statins. But fewer people discussed the addition of heart failure to the list of conditions that it estimated. Read more from STAT's Liz Cooney on the new data and how it could shape new guidelines on statin use.   data EDs test more for flu now than a decade ago The percentage of people in emergency departments who get tested for the flu increased from just 2.5% in 2013 to almost 11% in 2022, according to CDC data released today. This doesn't mean that more people are actually sick, but rather that emergency rooms have been using the tests more than in the past. Fever, cough, nausea, and shortness of breath were all reasons that people visited the ED before receiving a test. Coming in with psychological symptoms didn't lead to any flu tests in 2013, but that was the first reason for a visit in almost 17% of all flu tests done in the ER in 2022.  The CDC report doesn't present any potential reasons for the increase in testing, but it's hard to imagine that the Covid-19 pandemic didn't play any part.

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What we're reading How are states spending opioid settlement cash? We built a database of answers, KFF Health News Doctors seethe over insurance companies' 'out of control' tactics, Vanity Fair Who stood out as Best Biopharma CEO of 2024? STAT The skin's 'surprise' power: it has its very own immune system, Nature A strange alliance: Oxygen companies and their Medicare patients want Congress to pay the companies more, Propublica

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Thanks for reading! More tomorrow,

theresa.gaffney@statnews.com

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