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Tuesday, May 23, 2017

Morning Rounds by Megan Thielking

Good morning, everyone. I'm here to get you ahead of the day's science and medicine news. 

Trump's budget calls for massive cuts to Medicaid

President Trump’s full budget proposal comes with massive cuts to Medicaid and the agencies and programs that run the nation’s public health and biomedical research efforts. The administration released a more bare-bones budget in March, but the new budget paints a clearer picture of what the president is proposing. 

  • Medicaid’s budget would be slashed $610 billion over the next decade — in addition to the $839 billion that would be cut if the AHCA passes. It isn't clear yet where in the program those cuts would take place. 

  • The NIH budget would be cut by 18 percent from 2017 spending levels, down to $26 billion. The National Cancer Institute, which falls under the NIH umbrella, would see a budget cut of 19 percent.

  • The CDC budget would take a 17 percent cut, which shakes out to a $6.3 billion decrease in funding. Spending on HIV/AIDS, hepatitis, sexually transmitted infections, and tuberculosis prevention would be reduced by 17 percent. The CDC’s global health program — which is responsible for helping fight disease outbreaks abroad — would take an 18 percent cut.

  • The FDA would see a 31 percent decrease in direct government funding, leaving the agency with a $1.9 billion budget. The administration is hoping to offset that loss with a $1.3 billion increase in revenue from the user fees that drug and medical device makers pay when applying for FDA approval.

The WHO is set to elect its next leader today

Representatives of nations around the world are gathering today to elect the next leader of the World Health Organization. It’s the first time every member of the organization will be involved in picking the director-general. Here’s who is in the running:

  • Tedros Adhanom Ghebreyesus, a former foreign affairs minister and health minister in Ethiopia. He has a doctoral degree in community health.

  • David Nabarro of Britain, who currently serves as special adviser to the UN secretary general on sustainable development and climate change. He has also spent part of his career at the WHO.

  • Sania Nishtar, a cardiologist from Pakistan who previously worked as minister of health in a caretaker government.

Lab Chat: How bacteria sense it's time to build a biofilm

bacteria, questioning their whereabouts and forming a biofilm. (Vernita gordon / university of texas at austin)

Bacterial biofilms pose a big threat — the sticky, microbial slime can coat medical equipment and cause dangerous infections in patients. But scientists have long been puzzled by how bacteria know when they’re on a surface and can start to form a film. Now, scientists have shed some light. Here’s what study author and physicist Vernita Gordon of University of Texas at Austin told me about the work, published in PNAS.

What can happen when bacteria are on the surface of a medical device?

It’s been known for a long time that when bacteria are attached to a surface they start changing their behavior a lot. But for them to change their behavior, they must know they’re on a surface. As humans, we have a really obvious way of knowing we’re on a surface. We can see we’re suspended in air, we can feel air rushing past us, we’ll be dizzy. But a bacterium doesn’t have all those things. They don’t have an inner ear to say they’ve lost their balance or eyes to see they’re five feet off the ground.

What did you find about how they figure that out?

Imagine we had no senses except when are bodies are being stretched and our muscles are trying to do stuff. They feel they’re on a surface when they’re trying to pull themselves along and realize it’s harder. They’re having to use a different force. If we can make a surface that doesn’t pull back on their bodies, we can have something that doesn’t give them that mechanical signal. This might be a way you could trick the bacteria so they don’t start forming a biofilm.

Inside STAT: What Trump's syntax could say

President Trump’s broken syntax, mid-thought subject changes, and difficulty speaking in complete sentences in an unscripted speech have been fodder for critics and a headache for professional transcribers. But there’s solid science that connects declining brain function, whether from normal aging or neurodegenerative disease, to a deterioration in the fluency and complexity of spontaneous speech. STAT reviewed decades of Trump’s on-air interviews and measured them against Q&As since his inauguration. The differences are noteworthy, experts said. STAT’s Sharon Begley has the story here.

FDA weighs in on contrast agent that stays in the brain

The FDA is weighing in on safety concerns about a commonly used contrast agent in MRIs. The agency reviewed the scientific evidence and adverse event reports involving gadolinium. Gadolinium can stick around in the brain and other tissues in the body after being given as a contrast agent. That sparked concern that it might be toxic to the body's tissues and cause adverse health effects. But the FDA hasn't found any evidence so far that gadolinium is harmful, and says radiologists can keep using the contrast agent as they always have. Health officials say they'll continue to keep a close watch on contrast agents and will hold a public meeting going forward to address any concerns. 

Doctors can play a role in curbing firearm injuries

A new paper out this morning is calling on doctors to play a critical role in curbing accidental firearm injuries among kids. The review, run by Children’s National Health System, found that roughly 20,000 kids are taken to ERs every year for firearm-related injuries in the US. Adolescents between ages 12 and 19 account for 90 percent of those visits. The study also found that parents aren’t always aware of the risk those weapons might pose; 40 percent of parents with firearms in their home thought that their kids didn’t know where the weapons were stored when their children in fact did. The study’s authors say doctors have a unique opportunity to ask patients and their families about firearms in the home while providing care to kids. 

An experimental asthma therapy advances 

There’s positive new data out from a phase 3 clinical trial for an experimental treatment being tested for asthma. Researchers tested the drug, dubbed Zonda, on 220 adults with severe asthma who needed regular prednisone to keep their symptoms in check. Long-term use of prednisone can lead to severe side effects, including osteoporosis, diabetes, and adrenal suppression. Researchers are hoping to help some patients with severe asthma avoid those side effects.

Trial participants were given either one of two dosages of the treatment or a placebo. One-third of the patients on either dose of Zonda were able to reduce their prednisone use by 90 percent. The medication didn’t, however, significantly improve how much air an asthma patient can forcefully exhale, a common measure of respiratory function. Read the full results in the New England Journal of Medicine.

What to read around the web today

  • This town wants to be the Silicon Valley of medical marijuana. Los Angeles Times
  • In some rural counties, hunger is rising, but food donations aren't. NPR
  • Some social scientists don't want to ask permission for their experiments anymore. New York Times

More reads from STAT

The latest from STAT Plus

Thanks, as always, for reading! More tomorrow,

Megan

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