From the public health front —

• The Wall Street Journal explains why the new Covid variant BA 2.86 nicknamed Pirola is worth watching.
  • “BA.2.86—dubbed “pirola” by a group of scientists on social media who name notable variants—has been detected in only about a dozen people but it has surfaced in all corners of the world. What’s troubling about this variant, scientists say, is that it contains more than 30 mutations on the spike protein, which is what helps the virus enter cells and cause an infection. This means it might be able to evade current vaccines and previous infections more easily, and it likely won’t be a great match with the fall booster expected to be approved soon.
  • “[Reassuringly,] Scientists say treatments such as the antiviral Paxlovid should still remain effective even with such a highly mutated virus because they target a different part of the virus, not the spike. Rapid antigen tests, often used to test for Covid-19 at home, also should be able to detect the new variant, the CDC said last week.”

• The Wall Street Journal reports,
  • “Dr. Shoshana Ungerleider knew what her father’s pancreatic cancer diagnosis meant for his future. She didn’t realize what it meant for her own cancer risk. 
  • “Steven Ungerleider’s doctors ordered genetic testing in 2022 to see if his cancer might respond to a new treatment. They found he had a mutation in the BRCA2 gene, which raises risks for cancers including pancreatic, breast and ovarian—and can be passed from parents to children. 
  • “Ungerleider and her sister got tested and discovered they had the same mutation. 
  • “I had no idea that this was possible for me,” said Ungerleider, 43, an internal medicine doctor and founder of End Well, a nonprofit focused on end-of-life care. 
  • “Doctors are recommending genetic tests to more cancer patients and their families. Testing costs have dropped, and the results are helping doctors choose newer targeted drugs and encourage relatives to confront their own cancer risk. 
  • “We can test you for dozens of genes at the same time, and it’s going to influence your treatment,” said Dr. Jewel Samadder, co-leader of the Office of Precision Medicine at the Mayo Clinic Comprehensive Cancer Center in Phoenix.
  • “But few patients or their relatives get tested. Genetic counselors are scarce, and some doctors aren’t up-to-date on genetics training or guidance. After a cancer diagnosis, inherited risk isn’t a priority for many patients. 
  • “It’s an implementation fail,” said Dr. Deborah Schrag, chair of the department of medicine at Memorial Sloan Kettering Cancer Center in New York.”

• This week, “Oncologist and epidemiologist Vinay Prasad of the University of California, San Francisco, talks to EconTalk’s Russ Roberts about why many tests to detect cancer do little or nothing to extend lifespan.”  The bottom line in 2023 is a point that Russ Roberts makes
  • “I think one of the reasons people screen, even when it’s, quote, “not rational,” or the expected value is zero, is they want to be proactive. They don’t want to have to regret later. They’re afraid that if they don’t screen and then they get terminal cancer, they’ll feel like they were foolish and they made a mistake.”

• HealthDay informs us,
  • “New research shows that four gut conditions (gastroparesis, dysphagia, constipation and irritable bowel syndrome without diarrhea) are associated with a higher risk of Parkinson’s disease up to five years before diagnosis.
  • “Study findings also suggested that appendix removal may be protective against Parkinson’s.
  • “Researchers noted that the gut conditions implicated are also more prevalent before the onset of Alzheimer’s or cerebrovascular disease.”

• The American Medical Association tells us what doctors want their patients to know about rheumatoid arthritis.

From the telehealth front,

• Per Healthcare Dive,
  • In-person and telehealth mental healthcare utilization increased during the COVID-19 pandemic, according to a study of insurance claims published on Friday in JAMA Health Forum.
  • Spending on mental health services increased by 54%, and utilization soared by nearly 40% among commercially insured adults between January 2019 and August 2022.
  • Whether the “disproportionate increase in spending” will remain is an open question, the authors note. Now that the public health emergency has ended, economists are eyeing insurers’ next move to determine whether they will continue or stop coverage for telehealth mental health visits. 
• As hub-and-spoke-telehealth visits are per se in-network, and only one fifth of mental health providers are in-network, it would be nuts for an insurer to curb telemental visits.

• mHealth Intelligence reports,
  • “While the majority of telehealth visits do not result in in-person follow-ups within a week, the fraction [11%] of virtual visits that do are for behavioral health and chronic condition issues, new research shows.
  • “Conducted by market research firm Trilliant Health, the analysis aimed to examine the extent to which virtual care is disrupting the patient care journey. The researchers assessed data from the firm’s national all-payer claims database. They determined the percentage of patients who utilized telehealth and had a follow-up visit in person for the same clinical reason within one week.”

From the U.S. healthcare business front,

• According to Beckers Hospital Review,
  • Rite Aid is preparing to file for Chapter 11 bankruptcy this fall as it faces numerous lawsuits over its alleged role in the opioid epidemic, people familiar with the matter told The Wall Street Journal. 
  • A Chapter 11 bankruptcy filing could alleviate the pharmacy chain’s $3.3 billion debt and legal costs for ongoing opioid lawsuits from private plaintiffs, states and the federal government, according to the Aug. 25 report. Chapter 11 bankruptcies are commonly used to reorganize a company’s structure to continue its business while paying creditors, such as plaintiffs, over time. 
• The FEHBlog recalls that other large pharmacy chains, including CVS Health, Walgreens and Walmart, settled these class action claims late last year.

• Becker’s also notes,
  • “Alaska tops the charts when it comes to healthcare costs, with an average yearly expenditure of $13,188 per resident. [Utah comes in at number 50 with an AYE of $7,241 per resident.]
  • “That number comes from Forbes Advisor, which updated its “cost of living by state” analysis on Aug. 23. To determine each state’s average annual healthcare cost, the publication referred to KFF.org’s available healthcare expenditure data, which it averaged from 2018 to 2020. Annual costs refer to the combined price of one’s insurance premium, deductible, copayments, coinsurance and out-of-pocket expenses.” 

• STAT News points
  • “Over the past year, weight loss drugs have captured the public’s imagination but also raised existential questions about the future of bariatric surgery.
  • “For obesity, surgery has long been — and continues to be — the most effective treatment, reducing patients’ risk of sleep apnea, diabetes, cancer, cardiovascular disease, and death. However, the gap between weight loss drugs and bariatric surgery is starting to narrow after Wegovy cut the risk of major heart complications by 20% in Novo Nordisk’s SELECT trial.
  • “Personally, I would have taken a 5% reduction,” said Angela Fitch, president of the Obesity Medicine Association, emphasizing that these results symbolize a paradigm shift in obesity medicine. With even more effective weight loss drugs already emerging and other clinical trial evidence on the horizon, the hope is that, with medication, “we would see similar sorts of outcomes that we see with surgery,” said Fitch.”

• Per Fierce Healthcare,
  • “Nationwide hospital finances hit a rough patch in July as reduced patient volumes, a bump in bad debt and charity care whittled operating margins.
  • “That’s the latest from healthcare consulting firm Kaufman Hall, which reported a -1.6% median single-month operating margin index for the industry in July. The decline drove a slight dip in hospitals’ median year-to-date operating margin index to 1.3%.
  • “Still, the firm was quick to note that the hospital industry’s tough month is still a “slight improvement” over the operating margins of 2022.
  • “It’s clear that today’s challenging financial environment is here to stay, and hospital leaders must be proactive in seeking out opportunities to refine their operations and remain competitive,” Erik Swanson, senior vice president of data and analytics with Kaufman Hall and an author of the report, said in a release.
  • “Hospitals’ daily net operating revenues declined 9% from June to July but remain up 7% compared to July 2022. Month-over-month declines to daily inpatient revenue (-3%) paled in comparison to those of daily outpatient revenue (-8%) and were mirrored by reductions in daily adjusted discharges (-7%) and daily operating room minutes (-3%).”

• BioPharma Dive relates,
  • Danaher plans to buy Cambridge, England-based Abcam for about $5.7 billion in cash, the companies announced on Monday.
  • The acquisition would bring together two firms that make equipment and supplies for life sciences companies. Abcam, with a market capitalization of $5.2 billion, would operate as a standalone company under Washington, D.C.-based Danaher, which has a market cap of $191.7 billion. 
  • Danaher reportedly outbid other companies including Agilent Technologies, Reuters wrote on Friday, citing people familiar with the matter.

In Postal Service news,

• Govexec reports,
  • “The U.S. Postal Service has begun insourcing some of its trucking operations, opening the possibility of bringing back in-house thousands of jobs that are currently contracted out. 
  • “The pilot program started in Oklahoma City with 125 insourced jobs late last year and has since expanded to the larger Richmond, Virginia, area, including Charlottesville, according to officials involved in the initiative and public job postings. The Postal Service is actively looking for areas to expand the program, though it is so far relaying few details about its long-term plans to stakeholders or the public. 
  • “The Oklahoma City pilot was set to last at least six months, but is still in effect nine months later. USPS signed a memorandum of understanding with the American Postal Workers Union to create a new job series—postal vehicle operator—as part of the initiative. The Richmond expansion coincided with the Postal Service revamping its mail transportation in that metro area, as the city will host one of the agency’s first new, all-inclusive Regional Processing and Distribution Centers. 
  • “It also coincides with Postmaster General Louis DeJoy’s plan to significantly reduce the agency’s reliance on air transportation. USPS has saved $1 billion by slashing its chartered mail flights by 90% over the last two years. and it now ships 95% of its mail and packages on the ground.”