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Wednesday, March 15, 2017

Morning Rounds by Megan Thielking

Welcome to Morning Rounds! Here's what you need to know about science and medicine today. 

Doctors take on climate change and health 

Eleven medical societies across America — which together represent more than half the nation’s physicians — are teaming up today to launch a new consortium to inform the public and policymakers about the adverse health effects of climate change. The group, which includes the American Academy of Pediatrics and the American College of Physicians, will release a new report at 10:30 ET this morning on climate change and health, a topic which received renewed attention earlier this year after the CDC cancelled a long-planned summit on the issue.

The report will include an analysis of the relationship between pollution and heart and respiratory problems and a look at how climate change can spur the spread of insect-borne disease. You can find it here once the report goes live.

Biden, Alexander applauded for supporting research

Former Vice President Joe Biden and Senator Lamar Alexander are being applauded for their efforts to support medical research. The two will receive awards at a ceremony tonight put on by nonprofit Research!America — Alexander an award for medical research advocacy, and Biden an award for leadership. The group cited Alexander’s work on the PREEMIE Act — a law to support research into preterm births passed in 2006 — as well as his efforts to increase NIH’s funding for 2016. But Alexander was less inclined to support bills to guarantee additional funding for the BRAIN Initiative, the Precision Medicine Initiative, and Biden’s cancer moonshot — a position that rankled some Democrats. Let's hope when the two men meet tonight that's water under the bridge.

Cutting cancer costs by following advice more closely

The US health care system could safely cut the costs of breast cancer treatment up to 39 percent by better implementing guidelines for radiation treatment, researchers report in the Journal of Oncology Practice. Recommendations from 2011 are designed to help doctors and patients decide if a shorter course of radiation with higher doses is feasible. The shorter therapy is cheaper and can be associated with a higher quality of life. But after looking at 40,000 cases in the National Cancer Database, this study found many women are still getting the longer course — even if their cancer’s characteristics mean they could use the shorter protocol. Study author Dr. Rachel Greenup emphasizes that the savings are “rough estimates.” 

Inside STAT: Psychoanalysts fight to keep the field fresh

(Mike reddy for stat)

Psychoanalysts have spent more than a century mining the unconscious. Now, the profession is starting to show its age. Only 15 percent of members in the American Psychoanalytic Association are under 50. Freudian analysis is no longer seen as a modern approach. It's too pricey and too time-consuming to fit into an average person's life. But the industry isn't ready to give up just yet. Psychoanalysts are reinvigorating the profession by training a new and more diverse generation of therapists, introducing the ideas behind their work in schools, and holding public conversations. They're also opening their work up for more rigorous research, teaming up with neuroscientists to collaborate on new projects. STAT contributor Carter Maness has more on their efforts here

Early hopes for AHCA don't line up with estimates

Some Republicans might've been surprised by the Congressional Budget Office's big report this week — one-third of Republicans expected health insurance coverage to increase under the GOP replacement plan, according to a new poll from the Kaiser Family Foundation. The poll was conducted after the plan was rolled out but before the CBO's report on in its impact. That report projected there would be 52 million people in the US without health insurance by 2026, compared to a projected 28 million under Obamacare. The poll also found that nearly half of people expect the American Health Care Act to increase costs for people purchasing their own insurance on the individual market.  It might for some— young, healthy people could see lower costs, while older and sicker people might see dramatically higher premiums.

Lab Chat: Harnessing CRISPR to stave off blindness

the green marks normal expression of nrl in the left image, and reduced expression of nrl after the crispr intervention on the right. (NEI)

Genetic mutations and other problems in the retina can cause the eye's cells to degenerate over time, causing vision troubles and even blindness. Scientists are trying to save one type of damaged photoreceptor by using CRISPR to turn it into another. Here's what researcher Anand Swaroop of the National Eye Institute told me about the work, published in Nature Communications.

How do rods and cones in the eye differ?

We have two kinds of photoreceptors, rods and cones. Rods allow you to see and it allows you to see in dim light. Cones aren’t as sensitive, but they allow you to see color. Cones in humans are very a small percentage of photoreceptors — 95 percent of the photoreceptors in the human retina are rods. Genetic mutations mainly impact rods. In macular degeneration, one of the first things that die are the rods. Even though rods are much higher in number and don’t seem to be that important for our vision, they are very critical in keeping cones alive. If rods die, eventually cones also die. If you have a loss of photoreceptors, that can be devastating.

How are you trying to stop that process?

One of the theories for a very long time has been if you can you keep the rods alive — even if they’re not functional — will that take care of cones? We already knew that you can change rods into to be more cone-like by inhibiting a gene called Nrl. If there was a defect in a rod gene, those rod genes are now not expressed. But that had required a germline change, which does not make sense for humans. So we did a different strategy. We used a viral vector to deliver CRISPR-Cas9 in order to target specific genes, like Nrl. We tested this in different mouse models and saw that yes, indeed, the cells suppressed rod genes and became more like cones [and restored vision]. 

Reining in symptoms of white-coat syndrome

It’s not uncommon for some patients to see their blood pressure spike while getting their vital signs checked at the doctor’s office. It’s a phenomenon known as white-coat syndrome, which seems to happen to some patients in medical settings but not in other environments. New research out of the Netherlands suggests that monitoring a patient’s blood pressure over 30 minutes might be a way to get an accurate measure in those patients.

The team took blood pressure readings for 201 patients using both the 30-minute approach or the standard, quick measurement. Average readings were lower using the longer measurement, with the largest difference seen in patients over age 70. And that could help reduce overtreatment: Doctors said they would have begun or tweaked treatment for hypertension in 79 percent of patients based on the standard measurement; with the results of a longer blood pressure reading, though, doctors said they would have done so in just 25 percent of patients.

What to read around the web today

More reads from STAT

Thanks for reading! More tomorrow,

Megan

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