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Good morning! You know that part from “Little Women” (2019) where Jo says, “I can’t believe childhood is over,” as she lies on the floor at her sister’s feet? That’s how I feel about the end of summer.
That said, we’re starting September with some great journalism. My colleagues Katie Palmer and Usha Lee McFarling today launched an impressive series on race-based algorithms. Read more below.
Why are race-based algorithms so difficult to change?
Doctors use clinical algorithms every day to make decisions about the care they provide to patients. This math determines things like our surgical risk or likelihood of disease, using factors like blood pressure, age, weight, surgical history and, often, our race. But one is not quite like the other: For years, doctors have resisted the use of race in clinical algorithms.
It was a slow, patchwork effort until the use of race in these calculators became a flashpoint in 2020, when the killing of George Floyd sparked a movement for racial justice that culminated in medicine. An NEJM article published this spring highlighted thirteen common examples that created a sense of urgency across medicine to confront embedded biases.
So, how are you doing? In a new investigative series, STAT’s Katie Palmer and Usha Lee McFarling spoke with more than a hundred physicians and researchers and found a health care system struggling to reevaluate its scientific and ethical assumptions about race. “The hardest part of reporting is understanding all their perspectives is the same reason the problem is so hard to solve,” Katie told me about working on the series. “It’s really difficult to coordinate the efforts of so many different groups and institutions.”
Today you can read the first story in Katie and Usha’s series about how all of medicine depends on these tools that, as one researcher put it, are built on a foundation of Jell-O. Keep an eye on this page for more stories this week.
And after you read the story, you can dive into the weeds of these algorithms in the database Katie built with STAT’s J. Emory Parker, which tracks 45 algorithms from clinical fields. You can filter tools by specialty, racial variables, and more.
And! Sorry, one more thing: if you’re not quite ready to dance with the data, might I interest you in an explainer video produced by STAT’s Hyacinth Empinado? The video very helpfully explains what these clinical algorithms look like and how race is used in the calculations.
Does something feel weird about that medical bill? Survey says: don’t just let it go
If you get a medical bill that worries you, you should probably try to fight it, according to new survey data released Friday in JAMA Health Forum. Researchers used nationally representative data from more than 1,100 respondents, about 1 in 5 of whom reported receiving a medical bill that they disagreed with or could not pay. About 61% of these people contacted the billing office to address the issue.
Ask and you shall often receive: Of those with unaffordable bills, 75% received financial relief through bill cancellation, assistance, payment plans or price reductions. Of those who negotiated the price, almost 62% received a price drop.
Why do some people call while others don’t? “A more extroverted and less agreeable personality” increases the likelihood that someone will reach out, the study authors wrote. On a more serious and systematic note, they found that people who did not have a college degree, had less financial knowledge, or were uninsured were less likely to call.
A cancer survivor’s journey from pharmaceutical executive to patient advocate
Kathy Giusti was told she had three years to live when she was diagnosed with multiple myeloma at the age of 37. She was “scared to death,” as she wrote in a book about the experience. But nearly three decades later, Giusti is thriving. She brought the energy of an executive to her own care, changing the way drugs for multiple myeloma are developed.
“Without Kathy’s leadership, we would not be where we are today in the treatment of multiple myeloma,” said Richard Pazdur, the FDA’s chief oncology regulator. In 1998, just two years after her diagnosis, Giusti founded the Multiple Myeloma Research Foundation. The group has raised more than $600 million for research, launched nearly 100 clinical trials and helped bring more than 15 new drugs to market. According to the MMRF, the five-year survival rate for the disease had increased from 33% to 61% in 2004.
Read more in Matt Herper’s STAT+ about how Giusti changed drug development.
A new vaccine gets the green light for Novavax fans
On Friday, the FDA gave approval emergency use authorization for an updated version of Novavax’s Covid-19 vaccine. The shot, which is authorized for those aged 12 and over, corresponds to the JN.1 strain of the virus, which was dominant earlier this year. But it is now less common and vaccines from Pfizer and Moderna will target the more recent KP.2 variant.
In a story this spring, my colleague Drew Joseph described Novavax as “the beleaguered maker of a Covid-19 vaccine.” “Besieged” is fitting for a company that struggled to produce a traditional vaccine during the height of the pandemic, while makers of mRNA shots racked up billions in sales. But the company has its fans. Epidemiologist and blogger Katelyn Jetelina writes“Novavax has fewer side effects, such as pain and muscle aches. For this reason alone, I’m getting Novavax this fall.” Read more.
It will cost more than money if this research program is not funded
More data will lead to better science. That’s the basic idea behind the All of Us federal research program, which aims to collect health, medical and genetic data from a million people in the U.S. to accelerate research and precision medicine. The project is only half complete, but on October 1, funding will decrease by as much as 71%.
“The data All of Us has collected to date represents people from across America, including those from rural and urban communities and from all walks of life,” cardiologist Pradeep Natarajan writes in a First Opinion essay. But the converse of that original idea is also true. “Less data from fewer communities means less accurate genetic testing and fewer new drugs that can keep people out of the emergency room,” he argues.
The federal government must restore funding to the program, he wrote. Read more in the essay, which begins with the heartbreaking story of why Natarajan decided to become a cardiologist in the first place.
What we read
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How a Leading Chain of Psychiatric Hospitals Traps Patients, New York Times
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California, the nation’s largest milk producer, confirms bird flu outbreaks in three herds of dairy cows, STAT
- Mass polio vaccination begins in Gaza after deadly disease reemerges Washingtonpost
- At the big cardiology conference, Wegovy spoke: STAT
- Mosquito-borne diseases are on the rise: here’s how to protect yourself NPR
- Sanofi says its new pill for multiple sclerosis has succeeded in a key trial, boosting its research ambitions, STAT