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MorningMed is the best way to keep up with the world of health and medicine through curated round-ups, useful insights and other practical resources.

Following The Supreme Court decision to overturn the federal right to an abortion via Roe v. Wade, new data suggests that these recent medical restrictions are having an impact on where – and what – future doctors plan to practice. The number of residency training program applicants dropped last year, but programs within states with abortion bans dropped the most, and interest in the ob/gyn specialty took a 5% dip nationwide and 10% in states where abortion is now banned.

During the Covid-19 pandemic, people worldwide lost faith in childhood vaccines against brutal diseases such as measles and polio, according to a new report from UNICEF. The report, which surveyed 55 countries across the globe, found that in total 67 million children missed out on one or more potentially lifesaving vaccines during the pandemic.

Emergent, the maker of the opioid overdose antidote Narcan, plans to price the opioid overdose reversal medication at less than $50 for two doses. While the FDA has been hailed for its decision to approve Narcan for over-the-counter use, undoubtedly increasing access to the medication, there are fears that even the price reduction from $130 for a two-dose box may not be enough of a discount for those that need it most.

Over 14 million people, or approximately 28% of adults currently enrolled in Medicaid, will lose their dental health coverage now that the Covid public health emergency has ended. Additionally, due to this change spurring a review of eligibility, around 15.7 million people are expected to lose health coverage as a result.

Following a Friday decision by the Supreme Court, the currently contested abortion pill mifepristone will stay available on the market for now. The Supreme court opted to protect access to the abortion drug by freezing lower-court rulings that placed restrictions on its usage as appeals play out, which has the potential to last several months.

Josh Hawley wants the government to play a bigger role in lowering drug prices.

• Josh Hawley’s bills, called the Fair Prescription Drug Prices for Americans Act and the Ending the Prescription Drug Kickback Act of 2023 respectively, establishes a penalty for pharmaceutical companies that sell drugs in the United States at prices beyond their average costs across the peers of the United States in the Group of Seven major industrial countries. Additionally, the bills will collectively ban prescription drug rebates in both federal and private health plans.
  
  
• The first bill says the retail list prices for drugs sold in the U.S. may not exceed the average costs they are sold for across Canada, France, Germany, Italy, Japan and the United Kingdom. Severe fines would be levied against drugmakers who cross this established threshold.
  
  
• The second bill would remove safe harbor protections for prescription drug rebates that drug manufacturers and pharmacy benefit managers (known as PBMs) now have under a federal anti-kickback statute.

Senator Josh Hawley, R-Mo, states: “My view — and I’ve had this view for years now — is that American patients should not be bearing the cost of cheap drugs everywhere else in the world,” Hawley said in an interview. “And these pharma companies shouldn’t be able to make massive profits off the back of Americans who desperately need many of these drugs and products in order to live… So, my pitch to my fellow Republicans is listen, we need to be for people, not for pharma,” he said. “We need to be about helping patients be able to get affordable prices. And I have no interest in helping pharma further fleece these consumers to line their own pockets. And by the same token, I don’t have any interest in helping the big insurance companies keep their sweetheart deals with pharma, where they get these kickbacks for negotiating cheaper drug prices … and then passing on higher prices to consumers," he continued. "I think we should end that, too.”

Diversity in clinical trials is essential for several reasons, from ensuring that the findings of a study can be applied to everyone to promoting ethical standards and addressing health disparities. A lack of diversity in clinical trials can have significant consequences, from bias in study results to inadequate representation of certain populations.

Ongoing efforts to enhance diversity in clinical trials are crucial, and researchers, policymakers, and funding organizations must continue to work together to address the barriers that prevent underrepresented populations from participating in clinical trials. By doing so, we can ensure that the findings of clinical trials are representative of the entire population and can be applied to all individuals. This is critical to advancing medical research and ensuring that everyone has access to safe and effective treatments. With ongoing efforts to enhance diversity in clinical trials, we can create a more equitable and just healthcare system for all.

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California and other Western states see spikes in unhealthy air pollution as national levels improve.

Less American citizens are breathing unhealthy air now compared to years past, but many Western states and especially California are seeing more dramatic short-term spikes in air pollution, according to a recently released report from the American Lung Association. Ozone smog is improving, but wildfires in the West continue to expose people to dangerous pollutants, according to a new report.

Key takeaways

• According to an analysis of data by the American Lung Association, air pollution remains a problem in many parts of the United States, with California continuing to see some of the highest levels of pollution in the country. While air quality has improved overall in recent years due to efforts to reduce emissions, climate change is exacerbating the problem in some regions. Wildfires, which are becoming more frequent and intense due to climate change, are a major contributor to poor air quality in California and other parts of the western US. Despite some progress, more action is needed to address air pollution and its impact on public health.
  
  
• The American Lung Association (ALA) has released its annual report on air quality in the United States, and it indicates that over 43% of the U.S. population is breathing unhealthy air. This is despite the country's progress in reducing pollution over the past few decades. The report found that climate change continues to be a significant factor in declining air quality, with wildfires and dust storms becoming more frequent due to rising temperatures and drought conditions.
  
  
• Additionally, the ALA says that the Trump administration's rollbacks of environmental regulations contributed to a decline in air quality during his time in office. The report calls on the Biden administration to strengthen air pollution regulations and to accelerate the transition to clean energy.

By the digits

• 1 in 4 Americans, more than 119 million residents live with air pollution that can hurt their health and shorten their lives.
  
  
• 78% reduction of emissions of outdoor air pollutants since President Richard Nixon signed the Clean Air Act in 1970.
  
  
• Around 25% more got an A grade in the report for lower levels of ozone pollution.
  
  
• More than 100 million people live in counties that get an F for ozone smog, the report says.
  
  
• 6.7 million premature deaths annually are associated with the combined effects of ambient air pollution and household air pollution, according to the WHO.

Is There a Doctor in the House?

A 45-year-old woman comes to the office because she has noticed during the past several months that her fingernails have become white, increasingly brittle, and seem to lift off her nail beds easily. During this time, she also has had episodes of feeling warm and perspiring. Medical history is remarkable for intravenous drug use 25 years ago. The patient takes only a multivitamin. Last menstrual period was 3 weeks ago. She appears thin and mildly anxious. She is 170 cm (5 ft 7 in) tall and weighs 48.5 kg (107 lb); BMI is 17 kg/m2. Vital signs are temperature 37.0°C (98.6°F), pulse 106/min, respirations 20/min, and blood pressure 136/92 mm Hg. Physical examination of the hands shows a white discoloration of the nail beds. The remainder of the examination shows no abnormalities. Which of the following is the most likely diagnosis?

Up to 1 in 4 students from middle school to high school are misusing ADHD prescription drugs, meaning they used the medications without a doctor’s prescription or for nonmedical reasons according to a new study published by JAMA. The study findings were based on survey collections made between 2005 and 2020 including above 231,000 students in 8th, 10th, and 12th grade across over 3,200 public and private schools.

Weight loss drugs such as Ozempic, Wegovy, and Mounjaro are resulting in temporary hair loss for some users. In clinical trials for Wegovy and tirzepatide, there was a respective 2% and 5% increase in reports of hair loss or alopecia between the groups receiving the drug versus placebo.

Study finds that early treatment prior to the start of symptom onset could curb the delay of onset of the condition multiple sclerosis. Early results of a phase 3 clinical trial have shown that a drug called teriflunomide may delay or prevent MS symptoms in people who have what’s known as radiologically isolated syndrome, which causes the same brain and spinal cord lesions seen in people with MS.

In the journal Addiction, several studies found that getting high off of marijuana can harm cognitive function and is especially detrimental to the cognitive development of adolescents. Along with those findings, other effects of marijuana include the ability to think, plan, concentrate, remember, and learn new things.

Thank you for reading! More next week,

My best wishes for a productive and idea-filled week ahead. Thanks for your ongoing efforts to improve the lives of the patients we all serve. Please send any news, comments, suggestions and ideas to hello@morningmed.email.

Quiz answer: The correct answer is C) "Hyperthyroidism"

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