Monday, December 11, 2017

Morning Rounds by Megan Thielking

Good morning, folks, and weclome to Morning Rounds. 

Lyme experts are meeting this morning amid a growing fight over the disease

A federal working group tasked with scrutinizing the science and policy around Lyme disease meets this morning — just a month after a federal lawsuit was filed accusing insurers of conspiring to deny coverage for the condition. The CDC says that Lyme disease, which is spread by tick bites, is curable. Prominent medical groups say that even if symptoms stick around, the bacterial infection goes away. But there’s a growing contingent of patients who say they have chronic Lyme disease that requires long-term antibiotics that insurers won’t cover. The lawsuit, filed on behalf of 28 patients, alleges that health insurers conspired to keep costs down by paying doctors affiliated with the Infectious Diseases Society of America to establish guidelines which say Lyme can be treated with 28 days of antibiotics. 

One author of the ISDA’s 2006 guidelines, Dr. Gary Wormser, was originally named to the task force, but his name has since been removed from the roster, though it’s not clear why. Nearly 12,000 people signed a petition demanding that he leave the working group.

Smoke from California fires causes health problems

The massive fires that’ve burned across Southern California in the past week are causing health problems for people exposed to heavily polluted air. The Los Angeles Times reports that dozens of patients have turned up in area hospitals with smoke-related health problems. Smoke can be particularly dangerous for people with heart or lung problems like asthma and emphysema. Health officials have been handing out special masks to filter the air and reminding people to spend at least a few hours every day somewhere with clean air.

Window blind cords injure thousands of kids

Despite safety warnings, window blind cords still pose a serious risk to young kids. A new study finds that nearly 17,000 kids under age six were treated in the ER for injures blamed on window blind cords between 1990 and 2015. Even cords tied up to keep them out of a child’s reach were found to be risks. Toddlers are the most likely to be injured. The authors of the new study argue that there should be a new safety standard that gets rid of any kid-accessible window blind cords.

Sponsor content by Dana-Farber Cancer Institute

Keeping the promise of immunotherapy for cancer 

Driven by discoveries over the last 25 years, immunotherapy is proving to be a potent treatment for a variety of cancers. Today, scientists whose work first generated skepticism are celebrated as visionaries, as researchers race to expand the anti-cancer arsenal. 
“This is really a different strategy,” says Dana-Farber’s Gordon Freeman, PhD, who led the discovery of the critical protein, PD-L1. “Instead of poisoning the cancer cell, we are letting the immune system directly kill it.”

Inside STAT: Over-the-counter drug regulation is a mess

The FDA has limited the amount of acetaminophen in any prescription painkiller to 325 milligrams a dose for years. But walk into your local pharmacy and you’ll find a wide range of non-prescription pain medications containing 500 or even 650 milligrams of the ingredient. Or you might find over-the-counter codeine cough syrups with dosing information for kids, even though the FDA requires prescription codeine products to carry a warning that they’re unsafe for kids under 12. By nearly all accounts, the way in which over-the-counter medicines are regulated is a mess, which frustrates drug makers, the FDA, and many public health groups. Now, Congress is poised to act. STAT’s Erin Mershon has more here.

How cells gain traction to go where they're needed


carry on, my wayward son. (Nordenfelt et. al, Nature Communications 2017)

Scientists using a special kind of fluorescent microscope have captured how cells move to where they’re needed in the body, like immune cells that barrel toward an invading virus. Specifically, they were looking at integrins, proteins that sit halfway inside the cell and halfway on the cell surface. They allow cells to respond to signals from other cells. The researchers saw that when those integrins spread out from the cell’s surface and bind to other surfaces, they do so in the same direction the cell is heading, giving the cell traction to move in that direction. It’s a basic science finding that could be used to flesh out what we know about how human cells, like the white blood cell shown here, move around the body.

Breast milk in the NICU varies by zip code

Babies in the NICU are given breast milk much less often if the hospital is located in a predominantly black neighborhood, according to a new report from the CDC. Black women are at a higher risk of preterm birth than Hispanic and white women, and experts say breast milk is particularly beneficial for preterm infants. But just 49 percent of hospitals in predominantly black zip codes met the threshold of at least 75 percent of NICU babies receiving breast milk. By comparison, 64 percent of hospitals in minority-black areas met that threshold. Researchers say that might be due to a slew of factors, including differences in health care, mothers' access to information on breastfeeding, and proximity to milk banks.

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