From Washington, DC,

• The Senate and the House of Representatives will be out of town for this Fourth of July holiday week.

• The Supreme Court will end its October 2023 term tomorrow by releasing a final batch of three opinions.

• The New York Times reports,
  • “The Biden administration said this week that it opposed gender-affirming surgery for minors, the most explicit statement to date on the subject from a president who has been a staunch supporter of transgender rights.
  • “The White House announcement was sent to The New York Times on Wednesday in response to an article reporting that staff in the office of Adm. Rachel Levine, an assistant secretary at the Department of Health and Human Services, had urged an influential international transgender health organization to remove age minimums for surgery from its treatment guidelines for minors.” * * *
  • “The Supreme Court agreed on Monday to hear a challenge — brought in part by the Biden administration — to a Tennessee law that bans treatments including puberty blockers, hormone therapy and surgery for transgender minors. This will be first time the justices will decide on the constitutionality of such statewide bans.”

• The Washington Post lets us know,
  • House Republican leaders are asking government watchdogs to investigate health insurance sign-ups through the Affordable Care Act, citing reports that allege insurance brokers are fraudulently enrolling customers into some ACA health plans and that millions of Americans may be wrongly benefiting from federal insurance subsidies.
  • The House Energy and Commerce, Ways and Means, and Judiciary Committees requested Friday that the Government Accountability Office and the inspector general at the Department of Health and Human Services open investigations into the “astonishing level” of potential enrollment fraud, according to letters shared with The Washington Post.

From the public health and medical research front,

• Reuters tells us,
  • “The U.S. Food and Drug Administration has begun testing more dairy products for evidence of the bird flu virus as outbreaks spread among dairy herds across the country.
  • “More than 120 dairy herds in 12 states have tested positive for bird flu since March, according to the U.S. Department of Agriculture. Federal officials have warned that further spread among dairy cows could heighten the risk of human infections.
  • “The focus of additional testing is to ensure that pasteurization inactivates the virus, said Don Prater, acting director of the FDA’s Center for Food Safety and Applied Nutrition, on a call with reporters.
  • “Prior FDA testing of 297 retail dairy samples came back negative for evidence of the virus.
  • “The agency continues to strongly advise against consumption of raw milk products, Prater said.”

• The Washington Post informs us,
  • “People over 50 with anxiety may be up to twice as likely to develop Parkinson’s disease as their peers without anxiety, a new analysis suggests.
  • “The study, published in the British Journal of General Practice, looked at primary care data from the United Kingdom. Researchers compared a group of 109,435 people 50 and older who were diagnosed with a first episode of anxiety between 2008 and 2018 with a control group of 987,691 people without anxiety.
  • “Researchers said, of those in the study, 331 patients with an anxiety diagnosis developed Parkinson’s disease over the decade, and the average patient who developed the disease did so 4.9 years after their first anxiety diagnosis.
  • “After adjusting for age, lifestyle factors, mental illness and other factors, people with anxiety were still twice as likely to develop Parkinson’s disease than those without an anxiety diagnosis. Those who developed the disease were also likelier to be male and in higher socioeconomic groups.”

• STAT News adds,
  • “Fighting Alzheimer’s disease is a race against time. By the time most patients are diagnosed and treated, their cognitive symptoms have already advanced significantly.
  • “New research, though, pinpoints protein changes in cerebrospinal fluid highly associated with the development of Alzheimer’s disease. A better biological understanding of the brain disorder could foster new treatments and earlier intervention — as early as 20 years before onset of symptoms according to models from the study.
  • “The findings, published Wednesday in Science Translational Medicine, coincide with revised criteria from the Alzheimer’s Association that lean into the need for biology-based diagnosis and staging of the disease. The underlying biology of Alzheimer’s is still a scientific conundrum, but the approval of a drug targeting the disease’s amyloid pathology has sparked a push for blood and other tests to detect proteins associated with disease progression earlier, when treatment can be more successful.
  • “The study tracked upwards of 5,000 proteins to capture a dynamic picture of protein activity in patients with Alzheimer’s. “We take all these different proteins that we measure and we cluster them into these things called modules, that reflect different biological pathways, or processes, or cell types,” said study author Erik Johnson, assistant professor of neurology at Emory University. Those clusters of protein activity can serve as a springboard for both disease prediction and drug treatment experiments, he said.

• Per NPR Shots,
  • “About 170 billion cells are in the brain, and as they go about their regular tasks, they produce waste — a lot of it. To stay healthy, the brain needs to wash away all that debris. But how exactly it does this has remained a mystery.
  • “Now, two teams of scientists have published three papers that offer a detailed description of the brain’s waste-removal system. Their insights could help researchers better understand, treat and perhaps prevent a broad range of brain disorders.
  • “The papers, all published in the journal Nature, suggest that during sleep, slow electrical waves push the fluid around cells from deep in the brain to its surface. There, a sophisticated interface allows the waste products in that fluid to be absorbed into the bloodstream, which takes them to the liver and kidneys to be removed from the body.
  • “One of the waste products carried away is amyloid, the substance that forms sticky plaques in the brains of patients with Alzheimer’s disease.

• Medscape notes,
  • “Certain medications that are used to treat benign prostatic hyperplasia (BPH) are associated with a reduced risk for dementia with Lewy bodies (DLB), the second most common neurodegenerative type of dementia after Alzheimer’s disease. 
  • “Investigators found older men taking alpha-1 blockers terazosin, doxazosin, or alfuzosin (Tz/Dz/Az) were 40% less likely to develop DLB than those taking tamsulosin and 37% less likely than men taking the 5-alpha reductase inhibitors (5ARI) finasteride and dutasteride.
  • “These results are exciting because right now there are no drugs to prevent or treat dementia with Lewy bodies,” study investigator Jacob E. Simmering, PhD, of the University of Iowa in Iowa City, said in a press release. “If we can determine that an existing drug can offer protection against this debilitating disease, that has the potential to greatly reduce its effects.”
  • “The findings were published online on June 19, 2024, in Neurology.”

• BioPharma Dive discusses “microscopic tunnels [which] are a goldmine for new medicines. Ion channel research made Vertex Pharmaceuticals one of the world’s most valuable biotechs. Now, other drug hunters have joined in, betting the field is ready to treat an array of illnesses.”
  • “It can be difficult to picture just how small a human cell is. On average, it’s one-tenth as wide as a strand of hair and 25 times smaller than a grain of salt. Tinier still are the thousands of ion channels anchored into the fluid, oily shell that encases these microscopic worlds.
  • “The channels act as canals; though, instead of water, they control the movement of electrically charged particles like sodium, potassium, calcium and chloride. When cells are stimulated in certain ways, the canals open, permitting ions to flood in or out. They then shut and return to a “resting” state. The opening and closing happens hundreds of times a second and actually jolts the cell, in essence telling it, “Something is happening, react!”

• STAT News points out,
  • “A few years ago, the Centers for Medicare and Medicaid Services launched a big experiment. The agency wanted to see if financial incentives and penalties would improve care for people with end-stage kidney disease. So far, it hasn’t worked, a new study finds.
  • “The End-Stage Renal Disease Treatment Choices (ETC) model is a historic effort, both because it’s the largest such experiment in the history of American health care and because, unlike previous CMS Innovation Center pilot programs, it’s mandatory. About 30% of dialysis providers in the country participate, while the other 70% are used as a control group. It’s shaped like a gold-standard, randomized control trial, and run by the entity that covers the majority of health care related to end-stage renal disease, including dialysis. 
  • “Each year, providers are graded on how many patients they can move to home dialysis, which is more affordable for the health care system, and how many people go on to receive kidney transplants, among other metrics. If they do well, they receive some extra money. Those who don’t do well face financial penalties. Both amounts increase with each year of the experiment, up to an 8% bonus or 10% penalty by the end of the program.
  • “Those sticks and carrots don’t seem to be doing much. In a paper published in JAMA Health Forum on Sunday, researchers report a null effect: Providers enrolled in the experiment aren’t moving more patients to home dialysis or transplant than those in the control group.”