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Thursday, March 22, 2018

Morning Rounds by Megan Thielking

Good morning, everyone! Here's what you need to know about science and medicine this morning. 

House passes 'right to try' measure

The House voted 267-149 last night to approve a 'right to try' bill that aims to help some dying patients get access to experimental therapies. It's the same bill that the House rejected last week under a process that required a more significant majority. Supporters say it’ll give dying patients a new way to access experimental treatments. Critics, including Democrats and a number of major patient groups, say it'll limit the FDA's oversight of the drug approval process and that it's unnecessary, given the agency's existing expanded access program. STAT's Erin Mershon has the details here

Your rundown of the big spending bill that just dropped

Congressional leaders unveiled a massive spending plan late last night to fund the government. Here's a quick look at some of the details in the roughly 2,232 pages of text:
  • ACA stabilization left out: Lawmakers didn't include any plans to stabilize health insurance markets through payments to insurers known as cost-sharing reductions. 
  • No donut hole: Congress didn't agree to drug maker's requests to roll back a policy that requires them to pay 70 percent of the prescription costs for seniors stuck in Medicare's “donut hole” coverage gap. The bill did, however, include a big win for a tiny eye drug company — more here
  • Clarity on gun research: The omnibus bill makes it clear that the CDC can fund research to study gun violence, which the agency has long steered clear of due to an amendment passed in 1996. 
  • A tight deadline: Congress has to approve the deal by midnight Friday, pass a stopgap measure to keep the government open, or face another shutdown. 

The CDC is getting a new director

Dr. Robert Redfield — a physician, longtime AIDS researcher, and professor at the University of Maryland’s medical school — has been selected as the next CDC director. "Dr. Redfield has dedicated his entire life to promoting public health and providing compassionate care to his patients," HHS Secretary Alex Azar said in a statement. He isn’t a completely controversy-free choice — he was criticized more than two decades ago for overstating the efficacy of an experimental AIDS vaccine and for some of his policy stances. Dr. Brenda Fitzgerald resigned as director in late January and since then, Dr. Anne Schuchat has served as the agency’s acting director.

Lab Chat: What cave fish can tell us about diabetes

just keep swimming! (harvard medical school)

Scientists have found fish swimming in dark caves in Mexico with high blood sugar and insulin resistance — but unlike humans with those conditions, they don't have any negative health effects. Here's what researcher Misty Riddle told me about the work, published in Nature.

What did you set out to study?

We wanted to see how these fish regulate their blood sugar levels, so we used a blood glucose monitor. After eating, the cave fish’s blood sugar levels were much higher than that of their fish cousins, which evolved in rivers. The cave fish have a mutation that affects how their cells bind to insulin, which we think helps them gain weight when food isn’t reliable in the cave. It's the same mutation that leads to a rare insulin resistance in humans.

What does that tell you about type 2 diabetes in humans?

In humans, when we have high sugar in our blood all the time, the proteins in our blood get sugar-coated and this prevents them from functioning normally and leads to tissue damage. The cave fish don’t have that happen, but we don’t know why yet. That could be interesting to look at for potential clinical treatments.

Good news about Guinea worm transmission

South Sudan has interrupted transmission of Guinea worm, officials say. Given that the Guinea worm has a one-year life cycle, no new cases in 15 months suggests the country's water may be Guinea worm free."Having known the suffering that it inflicts on the people, one is very, very happy today that the future generation will just read it in the books as part of history," health minister Dr. Riek Gai Kok said. South Sudan has to go three years to be certified as having eliminated Guinea worm. Only Chad and Ethiopia, which each reported 15 cases in 2017, are known to have had Guinea cases in the past year. When the eradication effort started in 1986, Guinea worms affected 3.5 million people a year. 

Inside STAT: What mega-mergers mean for the future of PBMs

As their role in prescription drug pricing comes under increasing scrutiny, the nation’s biggest pharmacy benefit managers —  the middlemen who stand between manufacturers and consumers in the nation’s drug market — are changing shape. Three PBMs control about 70 percent of the U.S. market. And if two looming deals get the green light from federal authorities, all three of those PBMs will soon be joined with insurance companies. That would spell the end of the nation’s largest standalone PBMs. STAT’s Casey Ross breaks down what that would mean here.

Antibiotic resistant infections are costing billions 

Antibiotic resistance added $2.2 billion to the total bill for treating patients with bacterial infections in the U.S. in 2014, according to a new report in Health Affairs. Researchers analyzed health spending data from 2002 to 2014 and found that while the number of bacterial infections remained relatively steady each year, the slice of those infections that were resistant to antibiotics has continued to grow. In 2014, 11 percent of bacterial infections were antibiotic resistant, compared to 5.2 percent in 2002. One note: The study was sponsored by Merck, which has a research program on treatments for bacterial infections. 

What to read around the web today

  • Getting sick can be really expensive, even for the insured. New York Times
  • HHS strips lesbian, bisexual health content from women’s health website. Politico
  • Survey finds female surgical residents grapple with balancing training, motherhood. Boston Globe

More reads from STAT

The latest from STAT Plus

Thanks for reading! More tomorrow,

Megan

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