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Wednesday, May 3, 2017

Morning Rounds by Megan Thielking

Happy Wednesday! STAT reporter Andrew Joseph here. This is what's happening today in science and medicine. 

Dems want more info on surgeon general firing

Democrats on the Senate health committee this morning fired off a letter to President Trump and HHS Secretary Tom Price asking for more information about why Surgeon General Vivek Murthy was fired last month before the end of his term. The seven senators wrote that they are "troubled by the abrupt nature of his dismissal and whether it allowed for adequate transition planning" and said it raised concerns "in light of your administration's pattern of politically motivated and ethically questionable personnel decisions." Murthy was known for focusing on emotional well-being and opioids as surgeon general, but had a heated confirmation battle in 2014 because of his views on gun control and violence as public health issues. 

'Critical disparities' in life expectancies in US

Despite seeing larger declines in their death rates since 1999, black Americans still have life expectancies that are shorter than those of white Americans, new data out of the Centers for Disease Control and Prevention show. Overall, the death rate among blacks declined 25 percent from 1999 to 2015, with drops in all three leading causes of death: heart disease, cancer, and stroke. “Death rates have declined substantially in the past 17 years,” said the CDC’s Leandris Liburd. And while the disparity in deaths between blacks and whites declined by more than half, she said, “critical disparities still remain.” Another concern: Blacks in their 20s, 30s, and 40s are more likely to die from chronic conditions that are associated with older age in whites, such as stroke and diabetes.  

More hints that ketamine could help depression

A new study adds to the evidence that ketamine, which is used legitimately as an anesthetic and illicitly as a hallucinogenic drug, has promise as a possible treatment for depression. For the study, published in Scientific Reports, researchers dug through the records of more than 40,000 people who had taken ketamine for pain and who had reported some adverse effects to the FDA. Those adverse effects were much less likely to include depression in people who were taking ketamine compared to those on other pain drugs. The study is limited in that it is a retrospective one, not a clinical trial. So far, the apparent benefits of ketamine for depression are only based on anecdotes and small studies.

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Inside STAT: How states are revamping addiction care

(erica yoon for STAT)

In just a few weeks, the number of substance abuse residential programs in Virginia that take Medicaid patients has gone from four to 71. How? Spurred by the opioid epidemic, Virginia is the latest state to revamp how its Medicaid system treats addiction, expanding access to care and providing new services. But doing so requires states to get around Medicaid rules — some of which date back to the program’s creation in 1965 — that some advocates and providers say limit what they can do for low-income people struggling with addiction. I have the story from Lynchburg, Va., here.

Lab Chat: Understanding 'hitting the wall'

With the help of some treadmill-running mice, researchers have gained new insights into what goes on when endurance athletes “hit the wall” — which occurs when the brain lacks sufficient glucose — and how training can push that wall farther away. The answer, according to a study in Cell Metabolism, lies with a transcription factor called PPAR-delta that balances how much fat and glucose are burned by the body. Here's what one of the authors of the study, Ronald Evans of the Salk Institute, told me about the discovery.
 
How does training allow you to extend the time you can exercise?
 
If you’re going for a long time, then you’re going to be naturally burning down both sugar and fat, in a concurrent fashion. That doesn’t work so well for the brain [which can only burn sugar]. What happens with training is that you progressively begin to increase your ability to burn fat, and at the same time decrease your ability to burn sugar. And that is a process that is controlled by PPAR-delta. Sugar is no longer be able to be metabolized, or it gets harder to do that, so it just leaves more sugar in the blood for the brain. It turns out that endurance limit is determined by the brain, not the muscle. If you want to keep running, you have to keep sugar going to the brain.
 
What happened to mice when you either knocked out PPAR-delta or boosted its activity?
 
When you knock out PPAR-delta, the mice show very poor running performance. They run less than half the time of control animals, which run about 180 minutes continuously. If we give a drug to mice [to promote PPAR-delta], they can run an additional 100 minutes. It delays the fall of the sugar without any training. That means your ability to control that sugar usage, and the availability of sugar for the the brain, is preserved for that much longer.

A campaign to reach HIV goals in Africa

One year into a campaign to expand HIV testing and treatment in sub-Saharan Africa, more people who have HIV know their infection status and are on antiretroviral therapies, but it may not be enough to reach global goals, according to research published in PLOS Medicine. The campaign, called PopART, is active in 21 communities in Zambia and South Africa and includes sending care providers to homes to test people and connect them with treatment services. The one-year update only looked at four communities in Zambia, where the proportion of people who know their status has gone from 52 to 78 percent for men and 56 to 87 percent for women. Now, 61 percent of people are getting ART, up from 44 percent. While the study showed improvements, other experts writing in a perspective say the results show that the world may not reach global health officials’ goals of getting 90 percent of people with HIV on ART by 2020 and having 90 percent of them see suppressed viral loads. 

Will the US get a safe-injection site?

When and where will the country’s first safe-injection site open? More public health advocates are calling for authorities to open places where people can inject drugs under medical supervision, but those sites remain a politically touchy issue. Officials in the Seattle area in January announced plans to open two facilities, but they still needed to lock down locations and funding. California lawmakers are considering a bill that would end the state’s ban on safe-injection sites. The latest battleground: Massachusetts, where the state medical society just endorsed opening sites. But it looks like it won’t happen overnight; state officials said this week they have yet to be convinced. Canada, Switzerland, and Australia are among the countries with safe-injection sites. 

What to read around the web today

  • Late Tuesday night, Republicans were still changing their health bill. Politico
  • Scientists have a new test for measuring urine in pools. New York Times
  • NIH to limit the amount of funding a scientist can have at one time. Nature

More reads from STAT

The latest from STAT Plus

Thanks for reading! More tomorrow,

Megan

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