Tuesday, December 22, 2015

Morning Rounds by Megan Thielking

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Good morning, folks. This is Melissa Bailey, the STAT Longwood reporter, back with you for another dose of health and medicine news.

Looking for the next Martin Shkreli? Check this database.

Amid public outcry over the rising cost of medication, the Centers for Medicare and Medicaid Services has released a new online tool that lets you see how much Medicare is spending on prescription drugs. The largest price increase from 2013 to 2014 was the painkiller Vimovo, which shot up over 500 percent, from $1.94 to $12.46. Play around with the tool here.

Inside STAT: Delivery vans targeted by pill-seeking thieves

As a nationwide opioid epidemic worsens, thieves, addicts, and drug dealers have found a new target: the vans that deliver prescription painkillers from warehouses to pharmacies and hospitals. Thefts of those delivery vans are on the rise, STAT investigative reporter David Armstrong found. In one harrowing episode, a 67-year-old Alabama courier was hijacked at gunpoint while delivering pain pills. “You really can’t stop this,” the driver told Armstrong. “People who are addicted to these painkillers, they will pay for it.” Read more here.

Lab chat: Genetic clues to Lou Gehrig’s disease

Hunting for genetic clues to neurodegenerative diseases such as amyotrophic lateral sclerosis (better known as ALS, or Lou Gehrig’s disease) and spinal muscular atrophy (SMA), scientists at the Salk Institute in California have zeroed in on a tiny molecule, microRNA 218. The team used the CRISPR gene editing tool to produce mice without that molecule — and what they found could improve understanding of the diseases. I chatted with lead investigator Samuel Pfaff about his work, published in the journal Science.

What happens to mice that don’t have microRNA 218?

Right after they’re born, they die. They die because they can’t breathe. They can’t move. They can’t eat. It’s basically the most extreme form of paralysis you can envision.

What was going on?

[Their motor neurons] were unable to form good synaptic connections with muscles. It’s sort of like having the cord to your lamp on the floor, close to the electrical outlet, but not plugged in: The lamp isn’t going to turn on…. Also, the the motor neurons began to die. These are all the hallmarks, the signature features, of ALS and SMA.

What’s the next step for your research?

We have shown that the loss of the microRNA looks a lot like a motor disease. [Now we need to] show that the motor diseases have an effect on the microRNA. We have begun looking at gene activity levels in patients with ALS and SMA, to see if there’s a link.

What kind of drug therapies could come out of your work?

The idea would be to infuse a patient with something that is structurally similar to microRNA 218. Think of it as a supplement …That’s only a speculative idea. But it’s not implausible, if the microRNA turns out to be directly relevant to motor diseases.

A miniature human lung — on a chip

Wyss Institute at Harvard University

Next in its lineup of tiny organs-on-chips, Harvard’s Wyss Institute has replicated the small passageways of the human lung that move air to and from the alveoli. On one side of a porous membrane, air flows past human lung cells lined up on the chip; on the other side, fluid carrying white blood cells and nutrients flows past blood vessel cells, creating a system that can stay alive for weeks. It’s not just a curiosity: The researchers lined the chips with diseased lung cells from patients with chronic obstructive pulmonary disease to test how their tissue responded to drugs. Above is an electron microscope image of the airway’s hairlike cilia, which help move mucus along. Read more in Nature Methods.

Survey: End-of-life discussions happen too late

Doctors are waiting too long before having end-of-life discussions with blood cancer patients, a new survey of 349 oncologists found. Nearly a quarter said they waited until the patient was about to die before talking about hospice care. And 40 percent waited until death was clearly imminent before discussing where the patient wanted to die. The study was published in JAMA Internal Medicine. For more on efforts to improve end-of-life conversations, here’s a flashback to a piece last month by STAT columnist Bob Tedeschi.

Night-shift workers risk dangerous commutes

This might make you want to stay off the roads near hospitals: People who drive home after working a night shift are at high risk of crashing, a study published yesterday by Proceedings of the National Academy of Sciences found. Researchers from Brigham and Women's Hospital took workers on daytime test drives after they had worked a night shift and found that 37.5 percent of drivers nearly crashed. The same workers’ near-crashes after a good night’s sleep? Zero.


Dom smith/Stat
Why did cows graze outside Boston Children’s Hospital a hundred years ago? Find the answer and other fun facts about the Longwood Medical Area, Boston's hospital hotspot, in my latest Pulse of Longwood column.

What to read around the web

  • Nursing home workers share explicit photos of residents on Snapchat. ProPublica
  • Why living in a poor neighborhood can make you fat. Nautilus
  • The aging brain's internal clock may have a backup. NPR
  • Can yoga help prevent osteoporosis? New York Times

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