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Friday, March 24, 2017

Morning Rounds by Megan Thielking

Good morning! STAT reporter Rebecca Robbins here. Exciting Friday news: The universities facing off in STAT Madness have now been narrowed down to the final four. Cast your votes here. And now, on to the latest news in health and medicine.

Today: House vote expected on repeal & replace

The House is expected to start voting this morning on the GOP plan to repeal and replace the Affordable Care Act. The anticipated vote follows a chaotic day on Capitol Hill as GOP leaders raced to sway wary party members to vote for the American Health Care Act. Not helping matters is an updated analysis released yesterday afternoon by Congress's nonpartisan budget analysts that found that the recent tweaks to the plan would save less money than the original draft while still leaving an additional 24 million people uninsured in a decade. (Today's vote is expected to happen before those analysts can assess the impact of the final version of the bill.) Yesterday also saw Kansas Senator Pat Roberts apologize for a snarky remark: "I wouldn't want to lose my mammograms." He made that comment when asked about the prospect that the AHCA would do away with minimum coverage requirements including such screenings.

Senators seek to deploy $15m to cut off flow of fentanyl

Four senators yesterday introduced legislation that would bring new resources to the push to block illicit fentanyl from entering the country. The powerful opioid painkiller, often sourced to Mexico or China, is increasingly driving overdose deaths in the US. The new bill would appropriate $15 million to redeploy scientists and give Customs and Border Protection more chemical screening devices to better scan shipments for fentanyl. If the legislation ends up passing, the new resources certainly have potential to help. But keep in mind: It's not a lot of money. And it's not clear just how many shipments would ultimately be screened as a result.

On the subject of opioids, STAT reporter David Armstrong has a story out today on a documentary about pain treatment that's being aired by public television stations across the country. What viewers aren't told: The program's producer and several quoted experts have deep financial ties to the manufacturers of opioid medications. Read the full story here.

Tuberculosis continues to decline, but elimination far off

Nearly 9,300 new tuberculosis cases were reported in the US last year, a record low amid a long steady decline, the CDC reported yesterday. All told, 32 states saw a drop in cases. People born outside of the US accounted for two-thirds of the cases, but most foreign-born racial or ethnic groups have seen a gradual decline in cases since 2013. The news sounds encouraging, but CDC researchers warn that the progress is too slow to eliminate the disease entirely this century. They called for more targeted testing and treatment of inactive TB in high-risk populations.

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Many kids with diabetes aren't getting eye exams

Very high blood sugar levels can lead to eye damage and sight loss, so eye exams are important for people diagnosed with diabetes. That's why the American Academy of Ophthalmology recommends young people get screened for diabetic retinopathy within five years of a type 1 diabetes diagnosis and immediately after a type 2 diabetes diagnosis. But many may not be getting their recommended screenings — especially children and teens who are black or Latino or from low-income families, a new study in JAMA Ophthalmology has found. The researchers looked at medical records from over 12,000 people under 21 years old. Only 65 percent of those with type 1 diabetes got an eye exam within six years of receiving a diabetes diagnosis. The numbers were even worse for people with type 2 diabetes: just 42 percent had an exam done. Perhaps physicians aren’t giving referrals often enough, or patients aren’t following up on those referrals, the authors speculated.

Inside STAT: Can healthy food count as health care?

 DIANE WOODFORD HAS diabetes, kidney disease, and congestive heart failure. (Alissa Ambrose/STAT)

For nearly three decades, a nonprofit in Boston has been providing medically-catered meals to people with chronic diseases who struggle to shop and prepare food. The organization, Community Servings, has even persuaded some insurers to cover its food deliveries as a medical expense. So, is all that chickpea curry and quinoa salad improving patient outcomes? To find out, doctors are studying the program to see if there's a case to be made that such interventions can save the health care system money. One participating patient, Diane Woodford, whose oxygen tank makes it hard to get to the grocery store, calls the weekly food deliveries "a safety net." The program "just takes away that burden of [needing] to cook, and measure things, and all of that." Megan Thielking has the full story here

Lab Chat: How the brain is rewired with blindness

Scientists have long known that the part of the brain that controls visual processing differs between individuals born blind and those born with sight. But new research shows congenital blindness creates differences in the areas of the brain tied to memory, language processing, and the other senses, too. Here's what study author Corinne Bauer of Massachussetts Eye and Ear said about the findings, published in PLOS One.

What differences did you observe between brains?

In some areas, we observed increases in white matter connections. You can think of them as the highways and the pathways in the processing centers of the brain. We saw those increases in areas that are involved in language and in sensory processing. In areas that involve visual processing, such as the occipital lobe, we saw decreases in connections. Those changes were more profound in individuals born blind than the brain changes seen in people who lose sight later in life.

What could be driving those differences?

Currently, there are two main theories as to why individuals born without sight have brain differences. One is what’s called the compensatory hypothesis, which is the idea that with blindness, other regions takes on other functions to compensate for a lack of sight. And that would probably be associated with those increased connections. The other one is a disuse hypothesis, whereby if we don’t use something, as in the visual processing region, those connections are pruned.

Tomorrow: A push to vaccinate 116m kids against polio 

More than 190,000 health workers and volunteers are setting out tomorrow on foot or by bicycle, carrying bags packed with oral polio vaccines and ice packs. Their mission for the next four days: To immunize more than 116 million children in 13 west and central African countries. (While kids in the US get four shots against polio as they grow up, public health workers often try to give more than four oral doses to kids in overseas regions where polio is still a threat.) The push is funded by the Global Polio Eradication Initiative, a project backed by governments and a handful of health and civic organizations. "We're very close to eradicating polio," Carol Pandak, the director of Rotary's polio eradication effort, told me. The push beginning this weekend, she said, is a step in getting there.

What to read around the web today

  • The science whiz who dazzled Obama has schizophrenia. His family faces crushing expenses. Washington Post
  • Obamacare did not cause the opioid epidemic. Vox
  • 'Cure' me? No, thanks. New York Times
  • An interview with the CDC's scientific photographer. The Atlantic

More reads from STAT

  • Most cancer mutations arise from ‘bad luck,’ but many cases still preventable, researchers say
  • Juggling supplies of yellow fever vaccine to prevent an outbreak. (STAT Plus.) 
  • Opinion: The doctor will hear you now

Thanks for reading! Have a great weekend,

Megan

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