Medicare, Covid boosters, cancer follow-ups

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It’s Sarah checking in with three springtime recommendations this Monday: this recipe for creamy artichokes and peas, the zippy Steven Soderbergh spy movie Black Bag, and the wildlife portraits of Amy Jean Porter. (I’m partial to the grey seal.)

Approval process for Covid boosters thrown into question

Earlier this month, the FDA delayed a decision on whether to grant full approval to Novavax’s Covid-19 vaccine, and over the weekend comments by FDA Commissioner Marty Makary and an HHS official suggested that the annual process for approving updates for Covid boosters might require manufacturers — possibly including Pfizer and Moderna as well — to undertake new effectiveness studies.

By the time such studies are completed, say infectious disease experts, it would be too late to get the vaccine out. “It makes no sense at all,” said Michael Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy. “Unfortunately we’ve got a combination of government scientists and public relations people who don’t understand what they don’t understand. And this is potentially a very dangerous concern.”

Manufacturers of Covid vaccines need to regularly update the strains their vaccines target, just as they do with annual flu shots, and the FDA’s strain change rule has allowed these updates in the absence of additional effectiveness studies. Read Helen Branswell’s story to learn more.

How Republicans will try to cut Medicaid

 Congress is back in session, and Republicans are expected to try to slash Medicaid in order to pay for Trump’s $5 trillion in tax cuts. John Wilkerson takes a look at how they might go about reducing spending. One thing they’re likely to try: Adding work requirements to Medicaid, which would lead 600,000 people to lose their coverage and save more than $100 billion in the process.

Also on STAT’s mind going into this session: When will Robert F. Kennedy Jr. testify, and will Congress rescind federal funding it’s already allocated to the health department? Read more from John.

The case against cancer surveillance — for some

Many doctors recommend routine follow-up tests for cancer patients after they’ve completed a course of treatment, with the hope of catching early signs the disease has spread. But for patients who are asymptomatic, all those CT scans and MRIs may do more harm than good, according to a new perspective in the New England Journal of Medicine.

Not only can patients wind up paying thousands of dollars out of pocket for tests every six months, the toll of “scanxiety” means otherwise healthy people spend a lot of time worrying about what tests will find, the authors argue. And those whose tests do turn up abnormalities may enter into the world of surgeries and chemo earlier than they would otherwise, without evidence that shows they wind up living longer than people who start treatments only once symptoms emerge. For a related story on the costs and benefits of prostate cancer screenings, check out this story from our archives by Angus Chen.

The new head of Medicare loves a bargain

The new head of Medicare is famously thrifty. When Chris Klomp was CEO of health IT company Collective Medical, he bought office snacks from Costco and boasted about sleeping in his rental car to save money on business trips. Now his former colleagues and business associates expect he’ll try to save Medicare money with tech upgrades (in keeping with the Trump administration’s cost-cutting priorities) while making crucial decisions about whether to cover GLP-1 weight loss drugs and rein in private Medicare Advantage plans’ abusive denials practices.

“Because of Medicare’s reach, other insurers often follow its lead on payments and other policies, putting Klomp in a position to significantly influence the entire American health care system,” Mario Aguilar writes in a meaty profile this morning. Read more to find out what we might expect from Klomp — a fairly nonpartisan figure with scant experience in government but big goals around modernizing the trillion-dollar program.

What poetry and therapy have in common 

“Any good poem is asking you simply to slow down,” poet Dorianne Laux once said. The same is true of practicing psychotherapy, psychiatrist Owen Lewis writes in a First Opinion: Both involve the pursuit of meaning, learning to carefully parse words as well as the pauses, pacing, and emphases that convey what language alone cannot.

Lewis, who is also a poet, approaches both practices with the goal of creating a “container” for thoughts and emotions that need release. Check out his lovely essay, and his new book of poems, too.

A new “limit of viability” for premature infants

Between 2014 and 2023, survival rates for infants born at 22 weeks who received active treatment increased from 26% to 41%, according to a research letter published over the weekend in JAMA. That means factors like advancements in medical technology and updated clinical guidelines have “collectively shifted the limit of viability,” according to the authors, who also presented their findings at the Pediatric Academy Societies meeting in Honolulu. Survival rates among infants born at 23 weeks who received active treatment also went up, from 54% to 58%. 

The study looked at data from nearly 59,000 U.S. infants born between 22-25 weeks at hundreds of NICUs. It follow what happened after infants were discharged from the hospital, so it’s not clear what kinds of health problems, if any, they may have later on. But we do know there is “a growing willingness among clinicians to intervene aggressively at the earliest stages of prematurity,” the study’s lead author Nansi Boghossian told MedPage Today. 

What we’re reading

•  Healthy sodas like Poppi, Olipop are drawing PepsiCo’s and Coca-Cola’s Attention, Bloomberg
• Major tuberculosis vaccine trial completes enrollment faster than expected, STAT
• Suicide reverberates among young doctors, Wall Street Journal
• Nurse-scientists shouldn’t have to choose between research and caring for patients, STAT
• Rural health study is told it’s losing federal funds, and other major heart studies are worried, STAT