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Tuesday, October 11, 2016

Morning Rounds by Megan Thielking

Happy Tuesday! Here's what you need to know about science and medicine this morning. 

Is preventive care shaped by lobbying?

Former chairs of the US Preventive Services Task Force — which comes up with guidelines for preventive care like cancer screenings — are saying it’s time to reconsider a key relationship between the USPSTF and insurance companies. It’s written into Obamacare that certain evidence-based recommendations by the task force must be covered by insurance. “The laudable intent was to remove financial barriers to access, in particular for people with limited resources who might give those services lower priority,” Dr. Virginia Moyer, a former USPSTF chair, tells me. But that’s made the relationship between the task force and drug makers quite tricky.

Moyer and other former chairs say Mylan lobbied the task force to get guidelines that would help get the EpiPen into the hands of consumers. They say such pressure from political and advocacy groups could make it difficult for USPSTF to make independent, evidence-based recommendations. It might therefore be time to consider cutting the tie between recommendations and mandated coverage. But that decision could cost patients, too. “De-linking preventive services from first-dollar coverage could have the unfortunate effect of decreasing access to preventive services, especially for people with limited resources,” Moyer said. “Suffice it to say that this is not a simple problem.” Read their commentary in Annals of Internal Medicine.

Helping SNAP recipients get healthy, well-rounded diets

The Supplemental Nutrition Assistance Program — a federal program that works to address food insecurity in low-income households — has come under fire for not providing an adequate, healthy diet for recipients. Last year, 53 percent of SNAP households experienced food insecurity. The federal government wants to take a first step in addressing those concerns. The Food and Nutrition Service wants to survey SNAP participants to find out more about their food budgets, their knowledge about healthy diets, and what barriers they experience to getting the nutrition they need. The agency is taking comments on the proposed survey here.

Platelets perform feats of strength

On the right, red platelets push green proteins. On the left, a tiny platelet gym. (myers et. al, nature materials)

Doctors could one day give your platelets a workout to screen for bleeding disorders. Scientists studying the tiny bits of cells that help your body form clots discovered healthy people have stronger platelets than people with bleeding disorders. So the team of biomedical engineers from Emory devised a new testing platform that lines platelets up in rows and puts them to work. Each platelet works to squeeze two tiny proteins together; the researchers can then measure how far the platelets were able to push those dots. That method could one day be used to detect potential clotting problems. Read about the research in Nature Materials.

Sponsor content by precisioneffect

Leveraging the science of storytelling to change health behaviors

It can take years for medical advances to be incorporated into care pathways. While the pace of scientific change continues at rapid speed, the forces that perpetuate the status quo in medical practice and human behavior are mighty foes. Circumventing those forces, to spark interest, trial and adoption begins by understanding just what underlies current choices. Boston medical marketing agency, precisioneffect, has spent nearly 40 years uncovering motivation to change the minds and behaviors of physicians, patients and caregivers. Some of those stories start here.

Inside STAT: Unhealthy towns say election won't help

Paul Hall, chairman of the county's criminal task force, doesn’t think either candidate will solve the area’s heroin epidemic. (andrew spear for stat)

Brown County, Ohio, is Donald Trump’s America. People carry Trump/Pence signs across the county fair’s promenade. But Brown County is also an unhealthy place, where residents die younger than all but a few other counties in the swing state and the suicide rate is higher than the national average. There was a 50 percent increase in drug overdose deaths over two years. The area remains a stronghold for the Trump/Pence ticket, as is Austin, Ind., a town not far from Governor Pence’s Indiana office. There, nearly 200 people have been diagnosed with HIV in the town of 4,000. But a visit to both areas shows even staunch Trump supporters don’t think he’s the answer to their deep concerns about their health. “Way I look at it, no matter who you get in there, the damage has already been done,” said Ron Snowden, 66, of Austin. “Whoever gets in there, it’s going to take 30 years to fix what’s been done.” STAT’s Dylan Scott has more here.

Racial disparities seen in genetic databases

A new study concludes that widely used genetic databases are biased toward genetic variations seen in people of European descent. Researchers created a genome data set using 642 subjects from the African diaspora to compare it to current clinical genetic databases and found there’s a deficit of genetic data on people of African ancestry. What that means: If an African-American patient gets genetic testing, the variants that turn up and the disease risks they’re tied to could be much less accurate than if someone of European descent does the same thing. The study’s authors say that warrants expanding those clinical databases to have a broader swath of ancestries included. The study comes out in Nature Communications today. 

Anger, emotional stress tied to heart attack onset

Being angry, upset, or engaged in demanding physical activity is associated with a significantly higher risk of heart attack, a new study published in Circulation finds. Researchers analyzed data from more than 12,000 patients who’d experienced their first heart attack and completed a questionnaire about potential triggers. Patients who recalled being angry, upset, or doing heavy physical exertion were twice as likely to experience symptoms of a heart attack within an hour than patients who hadn’t. That finding held true even after researchers accounted for age, smoking status, and other factors that could influence heart attack risk. The research bolsters previous studies that have pointed to stress as a trigger for cardiovascular issues. 

Tallying up breast cancer treatment costs

The cost of treatment for breast cancer can vary widely from one regimen to the next — and from one patient to the next. Researchers broke down the data on nearly 15,000 women who were diagnosed with breast cancer between 2008 and 2012 and started chemo within three months of their diagnosis. The median insurance payment for patients who received chemo along with trastuzumab — a monoclonal antibody that's used in some combination therapies — totaled $160,590. For patients who were on a similarly effective standard chemotherapy treatment, the median insurance payment was just $82,260. There were also disparities from one treatment to another when it came to the amount patients had to pay out-of-pocket. The research will be published in the journal Cancer.

What to read around the web today

More reads from STAT

Thanks for reading! More tomorrow,

Megan

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