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Tuesday, April 11, 2017

Morning Rounds by Megan Thielking

Good morning, folks! Here's what you need to know about health and medicine today. For more STAT stories, head to our homepage

Your rundown of the new cancer screening guidelines

A panel of preventive medicine experts has rolled out the newest draft guidelines this morning on prostate cancer screening. Back in 2012, the US Preventive Services Task Force told doctors unequivocally to discourage prostate cancer screenings that use blood tests for prostate-specific antigen, or PSA. In large part, that's because the risks of false positives and overtreatment far outweighed any benefits of PSA screening. But that advice has changed — here's what you need to know. 

  • PSA tests for men age 70 and older and men under age 55 are discouraged, according to the new recommendations. 
  • For men between 55 and 69, the panel is punting the decision to doctors
  • The task force backed down on its earlier advice in light of new evidence. Back in 2012, the best evidence suggested that for every 1,000 men screened, 0.8 prostate cancer deaths would be prevented in the next 10 to 15 years. But a longer look at the participants in prostate cancer studies has raised that to 1.3 deaths prevented in the same time frame.
  • The panel also took into consideration that how men seek treatment has shifted. More men now who receive cancer diagnoses are opting for active surveillance — watching their cancer closely — rather than treatment. That lessens the potential harms, such as impotence and incontinence after surgical treatment, compared to the last time the task force evaluated the screenings.
STAT's Sharon Begley has more here

Scotland agrees to cover HIV prevention drug

Scotland has become one of only a handful of countries worldwide that have approved government payment for a protective medication against HIV called PrEP. The decision by the Scottish Medicines Consortium, part of the UK’s National Health Service, follows a lengthy legal battle in England over who should be responsible for paying for the treatment. 

Research has shown that a daily dose of pre-exposure prophylaxis, or PrEP, is highly effective in preventing HIV infection. But experts have suggested that it hasn't been adopted in more countries in part due to stigma around the disease and in part because of the drug's cost. One month of the medication runs more than $550 in Scotland. Meanwhile in England, after a grassroots push to make the drug more widely available, the NHS announced late last year it would conduct a clinical trial of PrEP involving at least 10,000 participants.

Kentucky's last abortion clinic can stay open — for now

A district judge has handed down an order to keep the doors of Kentucky’s last abortion clinic open for the time being. EMW Women’s Surgical Center in Louisville is at the center of a fierce legal battle. The state notified the clinic in March that it would be revoking the center’s license after determining its agreements with a nearby hospital and ambulance service, mandated in case of emergency, were deficient. The clinic and the ACLU are suing to fight that decision, and the new order permits the clinic to keep operating while the legal case plays out.

The ACLU and the clinic have also filed a separate lawsuit against new abortion restrictions signed by Governor Matt Bevin earlier this year. Those restrictions require doctors providing an abortion to perform an ultrasound and to show and describe the ultrasound images to the woman seeking an abortion. The restrictions also require providers to give a pregnant woman an audio recording of the fetal heartbeat before she’s allowed to have an abortion.

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Inside STAT: The design importance of birthing centers 

Expectant parents checking out prospective places to give birth might focus on whether they are comfortable for family or how nice the amenities are in the delivery rooms. The design of those facilities is often overlooked — but factors such as how far the birthing room is from the nursing station might play a much bigger role in the birth experience. Those nursing stations — which can be anywhere from 23 to 114 feet from a birthing room — are home to monitoring equipment that keeps track of fetal heart rates and a mother’s vital signs. Stretching the distance between that station and a patient’s room could burden the medical staff and, in turn, potentially increase C-section rates. STAT’s Bob Tedeschi has a great look at the issue here

Lab Chat: Tumor size predicts response to cancer drugs

researchers are trying to capture how drugs impact the body's immune response to melanoma cells, shown here. (NIH)

Cancer drugs known as immune checkpoint inhibitors unleash the body’s immune cells to attack tumors. And for some patients in whom the drugs seemingly fail, there actually is an immune response — it’s just not powerful enough to kill off cancer cells. Researchers have found a new way to predict which patients will have a response, however small, and hope it'll give clinicians a way to strike while the iron is hot with combination therapies that might improve outcomes. Here’s what microbiologist John Wherry of the University of Pennsylvania told me about the work, published in Nature.

How did you study the gap between activating those immune cells and seeing an actual clinical effect?

We wanted to use peripheral blood, just blood circulating through the body, as a way to understand what’s happening in the immune system. We were looking for a specific type of T cell that we suspect is activated by the drugs. And by looking for them, we could identify which patients were and weren’t responding clinically. We determined that in patients that have small tumors, the body doesn’t need a very large amount of immune change to have effect. In patients with larger tumors or more metastases, what the drug is asking the immune system to do is substantially greater. That tells us the immune system is calibrated to the amount of disease.

How can you use that information?

So we took that information and determined a ratio that is able to predict who is going to respond and who is not. It gives us an early measure to look at the effect of drugs that patients have just started taking. And for patients with a less powerful response, it gives us an opportunity to come in with additional therapies when their response to the [checkpoint inhibitor] drugs is at its highest.

A new report on stopping scientific fraud

Keep an eye out this morning for a new report coming out from the National Academy of Sciences about what it’ll take to better protect scientific integrity in research. Scientific fraud is a significant problem. There are countless cases of faked patient data, scans, and lab tests — and there’s also evidence that federal officials have swept some of that fraud under the rug. The scientific community is also trying to grapple with illegitimate or predatory research journals that publish papers without reviewing or editing them. The new report coming out today will lay out steps that individual scientists, research centers, and journals should take to put a stop to scientific fraud. You can watch a briefing on the report live here at 2 p.m. ET.

Health officials push to prevent polio's spread in Yemen

Health officials are striving to combat the risk of polio as health care resources remain strained amid the conflict in Yemen. A nationwide polio vaccination campaign has wrapped up with nearly 5 million kids under age 5 immunized against the virus. The country carried out a measles vaccination campaign as well. Health officials had only recently gotten control of measles in the country — before 2006, measles was one of the leading causes of child death in Yemen. The civil war in the country has threatened to reverse that progress, as the infrastructure needed to run an immunization program has been devastated by the conflict.

What to read around the web today

  • Why are so many people taking vitamin D? New York Times
  • Colleges can get free doses of naloxone for students overdosing on heroin and other opioids. Washington Post
  • Why send a firetruck to do an ambulance's job? WBEZ

More reads from STAT

Thanks for reading! More tomorrow,

Megan

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