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Morning Rounds Megan Thielking

How will the Democrats approach health care?

Now that Democrats have won the House of Representatives, they need to decide how they’re going to tackle health policy. Here's a look at some of the burning questions Democrats will have to answer: 

  • Will they support Trump's drug pricing plan or go their own way? Leaders from both parties have suggested they're willing to work together to bring down prescription drug prices. Democrats could cooperate with the Trump administration's drug pricing efforts or might pursue their own ideas.
  • Will they drag more pharma execs before Congress? Mylan CEO Heather Bresch was hauled before a House committee in 2016 to account for rising EpiPen prices. With Rep. Elijah Cummings (D-Md.) likely to lead the committee next year, other pharma CEOs might be called in as well.
  • Will someone new investigate opioid manufacturers? Sen. Claire McCaskill, who lost her re-election bid, had investigated the marketing practices of opioid manufacturers. It's not clear who — if anyone — will carry on that work. 

STAT's Nicholas Florko has more here.

WHO releases a first-of-its-kind guideline 

The WHO just released its first-ever set of guidelines on how to meet the physical health needs of people living with serious mental illnesses. People with severe mental disorders — which include moderate to severe depression, bipolar disorder, schizophrenia, and other conditions — are at a higher risk of certain other health conditions. They also often lack access to high-quality care. The WHO is trying to close some of those gaps with the new guidelines, which lay out how clinicians should approach everything from tobacco cessation to heart disease in people with serious mental illnesses.

Surgery patients prescribed far more opioids than they take

Researchers counted how many tablets of hydrocodone/acetaminophen — at a dose of 5/325 mg — patients were given and took. (JAMA Surgery)

New research adds to that evidence that opioids are often overprescribed after surgery. Researchers looked at data from nearly 2,400 patients who had surgery in Michigan in 2017. Patients were often sent home with many more painkillers than they actually took: The median prescription was 30 pills, while the median use was just nine pills. And the more opioids patients were prescribed, the more likely they were to use more opioids. Excessive opioid prescribing after surgery [is] widespread," the authors write. "Recognizing overprescribing and accurately identifying patient consumption after surgery is the first step in improving prescribing practices."

Uganda vaccinates health workers against Ebola

Uganda has started vaccinating its frontline health workers against Ebola as an outbreak continues in neighboring Democratic Republic of the Congo. Here's a rundown on the response efforts:

  • In Uganda: There haven't been any cases detected in the country, but health officials are working with the WHO to vaccinate health workers in high-risk areas as a precaution.

  • In DRC: Top U.N. and WHO officials traveled to DRC this week to evaluate the security situation. Ongoing violence and attacks by rebels have seriously hampered the response, and local health officials said this week that medical teams are attacked several times a week.

  • The case count: As of Nov. 5, there have been 305 confirmed and probable cases of Ebola in DRC, including 189 deaths, according to the WHO.

Inside STAT: The costs of heroin and naloxone offer a tragic snapshot of the opioid crisis

The cost of heroin has fallen dramatically over the past few decades, and fentanyl and other illicit opioids can be rapidly mass produced. The lifesaving, overdose-reversing drug naloxone is also cheap to make and has been around for decades — but its prices have climbed dramatically over the past 10 years. Michael Hufford, co-founder of a nonprofit to improve naloxone access, and Dr. Donald Burke, dean of the University of Pittsburgh's public health school, raise the issue in a new First Opinion for STAT. Their suggested solution: Make naloxone available over the counter, in much greater quantities, and at lower prices. Read here

Laypeople could improve care for older adults with depression

Depression among older adults is a growing challenge in low- and middle-income countries where resources for treatment are often scarce — but a small new study suggests laypeople trained to provide care might be able to lend a hand. Laypeople were trained to provide problem-solving therapy, teach patients about self-care for common health conditions, and assist people in accessing medical and social programs. In a randomized trial with 181 participants in an Indian city, patients who worked with a lay counselor were less likely to experience major depressive episodes than their peers who didn't. Now, the study needs to be run again with a bigger group in other areas. 

What to read around the web today

  • Trump administration issues rules letting some employers deny contraceptive coverage. Washington Post
  • What if the placebo effect isn't a trick? New York Times Magazine
  • Experimental treatment appears effective against gonorrhea in small study. STAT
  • Watch people beatbox in an MRI. Popular Science
  • Behind the patent thicket: tactics AbbVie allegedly used to thwart biosimilar versions of Humira. STAT Plus

Thanks for reading! More tomorrow,


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Thursday, November 8, 2018


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