mental health
Amid national crises, SAMHSA is decimated
Maria Fabrizio for STAT
For 33 years, the Substance Abuse and Mental Health Services Administration has been the main federal vehicle shepherding the country through behavioral health catastrophes like the ongoing suicide and drug overdose epidemics. But since January, layoffs and funding cuts have ground much of the agency's work to a halt. Less than half of its 900 staff remain, including just 5 of the agency's 17 most senior leaders. In some cases, the administration has used layoffs to brute-force policy and personnel changes that Congress had previously ignored.
To understand the Trump administration's full impact on the agency and its work, STAT's O. Rose Broderick and Lev Facher interviewed more than 30 current and former SAMHSA officials, Capitol Hill aides, lobbyists, and leaders in the behavioral health field. Experts told them that beyond threatening existing mental health and addiction programs, losing the expertise of hundreds of employees could derail Trump administration initiatives, too.
"You wouldn't want to get your car repaired from someone who just read a book about a car," said Anne Mathews-Younes, a retired SAMHSA employee. Read more of my colleagues' comprehensive accounting of the decimation of the agency and its murky future.
science
New study offers insights into how the immune system changes with age
It's no secret that our bodies' ability to ward off pathogens and mount strong vaccine responses weakens with age, but researchers don't fully understand how this happens. Now a study published in Nature on Wednesday offers fresh insights.
A research team led by the Allen Institute studied immune cells taken from more than 300 healthy adults, ranging from 25 to 90 years old. They found that while immune cells from participants tracked over a two-year period didn't show major changes, there were clear differences in gene activity between cells from 25-to-35-year-olds compared with 55-to-65-year-olds. Many of these differences showed up in T cells, which shape the scale and strategy of an immune response.
One change in particular caught the authors' eye. Memory T cells, which help the immune system mount faster and stronger responses to pathogens it has seen before, became less adept with age at supporting effective flu vaccine responses. The authors suggest that it might be possible to prevent or reverse these changes by pairing vaccines with immune signals that steer T cell activity in the right direction. — Jonathan Wosen
immigration
How much we rely on international clinicians
Last month, President Trump announced that new H-1B employment visa applications — intended for skilled workers in specialized fields — will now come with a $100,000 fee, a massive increase from the previous cost of a few thousand dollars. Health policy experts are worried that the change will have disastrous effects on the U.S. health care system, and professional groups are pushing for a fee exemption for doctors. A study published yesterday in JAMA gives an in-depth picture of how much the country's clinics rely on providers who arrive on these visas.
Researchers analyzed data from all 2024 employer petitions for H-1B visas. Almost 1% of all doctors in the U.S. are here on H-1B visas, according to the study. Fewer advanced practice providers, dentists, and other health care workers are brought in through the program. But importantly, there was also variance in which parts of the U.S. most heavily rely on international clinicians. Rural areas have twice as many H-1B sponsored doctors as urban areas, and counties with the most poverty relied on them four times as often as those with the lowest poverty rates.
Exempting physicians from the fee "is, therefore, in the national interest," an accompanying JAMA essay argues. "Policies should bring physicians to the bedside, not push them away."
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