GGood morning, it’s the last Morning Rounds of the year! When I closed the document in which I drafted all the items on Friday, I saw that it was 324 pages long. That’s a lot of news. Thanks for reading along, and see you next year.
The Democrats want to break up the health care behemoth
Democratic lawmakers are calling for aggressive action to curb UnitedHealth Group’s growing market power, including a possible breakup of a business empire they say is undermining competition, corrupting Medicare and harming vulnerable patients. They condemned the targeted killing of Brian Thompson, the CEO of UnitedHealth’s insurance company. But they said the outpouring of resentment and anger that followed was not new or surprising at a time when people feel powerless to defend themselves against a company that controls their doctors, their data and their insurance policies.
“In the interests of patients, taxpayers and independent practices, policymakers must act to ban joint ownership of health insurers and their subsidiaries, including physicians and pharmacies,” Senator Elizabeth Warren told STAT.
My colleagues’ investigation into UnitedHealthy this year revealed deep-seated conflicts within its vast network of companies. The latest episode shows that UnitedHealth pays some of the physician practices it owns significantly more than other physician groups in the same market for similar services.
Learn more about the changes lawmakers want to see.
California is trying to understand the extent of the bird flu’s spread
California animal health authorities are now testing milk from all of the state’s 984 dairies every week, stepping up efforts to find new H5N1 infections in livestock. In a call with reporters Friday, California state veterinarian Annette Jones said the new strategy was implemented two weeks ago after the virus was found on a farm in Southern California. The majority of the state’s 659 infected herds are concentrated in the Central Valley.
The rapid spread of H5N1 in California has infectious disease experts questioning how well authorities understand how the virus moves between farms. Jones said California has dozens of research projects underway to study this question. But she also noted that cows can be asymptomatic for several weeks — which could have contributed to infected animals being unknowingly moved to new farms during the early stages of the outbreak in California.
The uncontrolled spread is also leading to new human cases. The California Department of Public Health reported two more H5N1 infections on Friday, both in dairy workers, bringing the state’s total to 36. State epidemiologist Erica Pan told reporters that health officials have monitored about 5,000 people and tested 130 people who had potential symptoms.
She also added that officials have investigated numerous detections of H5N1 at wastewater sites across the state, and there is still no evidence of human-to-human transmission at this time. “Almost all of our wastewater testing sites are now detecting H5,” she said.
However, officials suspect that much of what they are picking up is not live virus, but inactivated bits of viral RNA in pasteurized milk. “We think a lot of our wastewater detections are actually just from residential or other commercial milk dumps,” Pan said. — Megan Molteni
The renaissance of gender-affirming surgery is once again in jeopardy
For patients undergoing gender confirmation surgery, the experience can feel like a rebirth. “I decided that the old me would die on the table and the new me would emerge from it,” said Wendy Grogan, a trans woman who recently underwent voice and facial treatments, top surgery and a vaginoplasty.
Grogan is one of thousands of patients in the U.S. who undergo gender confirmation surgery each year. The field has changed remarkably over the past decade since insurance coverage began to open up. But transgender people and their medical care have also become a major flashpoint in American politics in recent years. This isn’t the first time trans healthcare has been reclaimed. Gender confirmation surgeries nearly disappeared in the U.S. after the country’s first specialty clinic closed in 1966. Now patients and doctors alike are concerned about what the future holds for a surgical specialty that is finally coming into its own.
Read more in my story about some of the most impressive and rewarding procedures in medicine. I still think about a 19-year-old patient I met, pictured above, during his first phalloplasty consultation. (And to give an indication of how long it actually takes to have these surgeries: that meeting was a year ago this month and that person still hasn’t had their first procedure.)
Women should be screened for incontinence. Why not?
Did you know that more than half of adult women in the US suffer from bladder and/or bowel leaks? Here’s another fact I didn’t know: incontinence is a progressive condition, meaning it can get worse without treatment. Almost every relevant medical profession recommends screening women for incontinence, but this is rarely done. Why?
“The reasons are inherent in the structure of our health care system,” two doctors write in a new First Opinion essay. And there are more consequences than shame or embarrassment: if incontinence is left untreated, it is associated with major negative health consequences. Advertisements for adult diapers and other quick fixes may normalize the experience, but effective treatments exist. Read more about why the US healthcare system needs to think differently about women’s pelvic floors.
A record-breaking kidney transplant chain
Last week surgeons from State of Ohio‘s transplant center set an institutional record for a synchronized chain of kidney transplants. Over two days they transplanted the kidneys from ten donors to ten recipients. The ‘chain’ begins when one person donates their kidney to an unknown recipient. Each of the recipients had a loved one whose organ was not suitable for them, but who matched someone else in need of a kidney in the chain.
Nationally, there are currently more than 90,000 people on the waiting list for transplants needing a kidney. “This kidney chain removed 10 patients from the transplant waiting list, which will hopefully shorten the wait for others,” Amer Rajab, the surgical director of kidney transplantation who led the chain and performed six of the donor surgeries, said in a news release. The successful living donor transplants took place just days after the third completed pig-to-human kidney transplant was announced in New York.
What we read
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Louisiana bans public health workers from promoting COVID, flu and MPox shots, NPR
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They needed psychiatric care. Instead, they died after confrontations with NH corrections officials, New Hampshire Public Radio
- “We point out people like RFK Jr. just finish.’: infectious disease expert on how – and how not – to rebuild trust, STAT
- ‘I thought he was helping me’: Patient underwent nine years of chemotherapy for cancer he never had ProPublica
- How little-noticed measures to help children with cancer became a major line of attack on GOP spending bill, STAT