Tuesday, August 2, 2016

Morning Rounds by Megan Thielking

Good morning, everyone, and welcome to the Morning Rounds. Let's get you ahead of the day's big news in science and medicine. 

What to make of the new hospital rankings out this morning

New US hospital rankings are out this morning, and Mayo Clinic has booted Massachusetts General Hospital from the top spot on the list. The switch-up might be in part due to new methods implemented by US News and World Report this year. The hospital rankings are a composite of how a hospital scores in 25 specialties, like oncology and gynecology. Previously, a hospital would garner the same number of points for falling anywhere in the top 10 hospitals for a speciality. Now, the No. 1 spot in a speciality receives more points toward the total score than the No. 2 spot does. But STAT hospitals reporter Casey Ross says you should take the rankings with a big grain of salt, no matter how they’re added up — they're inherently subjective and hospitals can game the system. 

Inside STAT: A story of best friends, addiction, and a stealth killer

Justin Laycock on his understanding of fentanyl. 

Justin Laycock and DJ Shanks met on their first day of kindergarten in a small town outside Toledo, Ohio. They were still best friends in their early 20s, when DJ called Justin up during his shift at a Tim Hortons doughnut shop, feeling dope sick and seeking heroin. The drugs Justin dropped off weren’t heroin, though — it was fentanyl, an opioid developed in secret labs and designed to be up to 100 times more powerful than heroin. DJ died of an overdose.

STAT’s David Armstrong and Matthew Orr have pieced together a stunning report on the case, and what it says about the broader opioid crisis happening in the US. Read here.

Comments on controversial generic drug rule come to a close  

Today’s the last day to weigh in on a controversial draft guidance regarding biosimilars, which are generic versions of brand-name biologics — drugs that are manufactured inside living plant or animal cells. The first such drug was approved in the US just last year, pushing the FDA to issue labeling guidelines. The agency determined that biosimilar drugs just needed the same info on the label as the brand-name drugs, with a small note that it’s a biosimilar. Brand-name companies aren’t happy about that, though, because it could lead to stiffer competition from generics. A study published yesterday backed up biosimilars with evidence that a group of the drugs are just as good as their pricey counterparts.

Here's what patients with serious illness say is worse than death

What’s worse than death? Bowel and bladder incontinence, according to a new survey of 180 hospitalized patients with serious illnesses. Nearly 69 percent of patients said bowel and bladder incontinence was worse than or equal to death, while 67 percent said they felt the same way about relying on a machine to breathe. Those findings are key, given that in most research studies, death is considered the worst possible outcome — but that may not reflect real people's experiences. Read the full findings in JAMA Internal Medicine.

Lab Chat: Watch how a brain injury wreaks havoc on neurons

A neuron dies after undergoing a traumatic injury. (Courtesy Christian Franck)

A traumatic brain injury can cause neurons to shrivel up and die, but scientists are hopeful there’s a small window of time where treatment might be able to save some of those cells. Researchers examined neurons in petri dishes to see what exactly happens after a blow to the head. Here’s what lead researcher Christian Franck of Brown University told me about the work, published this morning in Scientific Reports.

What were you studying?

We wanted to understand, from a trauma perspective, how much is too much for these cells to take. When is their breaking point? And once they reach it, how long does it take for them to degenerate and die? The timeline from that initial trauma to cellular shut down is important to understand how much time one has to intervene therapeutically [after a brain injury].

How long did it take?

After six hours, you have biological events that’ve taken place that are irreversible. Cells shut down and cell death can’t be avoided. You know that you’ll have less time than that to do anything about it. There’s nothing you can do but hope the brain helps resolve itself.

Does that differ from one patient to the next?

The model we built is very simple. We only looked at neurons, but the brain has thousands of millions of cells involved. We didn’t look at that interplay. It’s important to note that what we built in the dish is not the brain.

High BMI doesn't impact risk of heart attack, study finds

A high BMI doesn’t translate to a higher risk of heart attack or death, finds new research. The finding comes from a study of around 4,000 pairs of genetically identical twins. Researchers followed the twins — each set of whom had different levels of body fat — for an average of 12 years. The twins with the higher BMIs didn’t have an increased risk of heart attack or mortality compared to their thinner siblings. The study did, however, note an association between obesity and risk of developing type 2 diabetes.

Crowdsourced science turns up genetic variations tied to depression

Researchers have discovered 15 areas of the genome tied to depression, all without having to lift a finger to sequence a genome themselves. They culled genetic data from people who’d paid to have their genomes tested by 23andMe, and who opted in to let their information be used for research. That gave researchers a huge sample size: more than 75,000 people who reported being diagnosed or treated for depression, compared to nearly 232,000 health controls. One major caveat: The analysis only included individuals of European ancestry, so the researchers may have missed genetic variations tied to depression among other races and ethnicities.

What to read around the web today

More reads from STAT

Thanks for reading! More tomorrow,


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