Covid booster guidance, ADHD and psychosis

Good morning. What are the best ice cream shoppes in San Francisco? Brittany Trang asked for recommendations recently in AI Prognosis in advance of this Wednesday’s  Breakthrough Summit West. She got an array of answers (Mitchell’s, Bi-Rite, Salt & Straw, Smitten Ice Cream) but the well-informed STAT crowd thought a few important options (Humphry Slocombe, Uji Time Dessert) were missing.

Anyway, it’s not too late to get your ticket to the Summit. There’s a packed agenda that you don’t want to miss.

How a laid-off government scientist is still trying to fight lead contamination

The city of Milwaukee was in the middle of a public health crisis when the Trump administration abruptly laid off 10,000 federal health workers last month. A lead crisis, to be exact: Late last year, a student had a concerning blood test, and the source turned out to be their school. The city took on the case, but investigating more than 100 schools is much more complicated than the typical exposure that occurs inside one family’s home. The local team would often turn to CDC scientists for both strategic planning and step-by-step guidance. Then the layoffs occurred, and all of those federal scientists were gone.

Weeks later, one laid-off worker reached out to the city’s public health commissioner, offering his professional expertise “as a concerned private citizen.” There were risks to offering that help, and there were risks to accepting it. “There’s this sense like, we can’t keep doing the work that is being cut, because then there’s no sign that the work has been cut,” a different laid-off worker said to STAT’s Eric Boodman. “But then all of us are public health servants, and we want to continue regardless.” Read more from Eric about the situation in Milwaukee, and the people trying to address it in the midst of this national tumult.

A consensus on Covid vaccines?

Meanwhile, health secretary Robert F. Kennedy Jr. and his lieutenants have sent multiple signals in recent weeks that they envisage a world in which far fewer people are urged to get Covid-19 shots each fall. They aren’t the first ones to suggest it.

The Advisory Committee on Immunization Practices — the expert panel that has, until now, guided the nation’s vaccine policies — is already talking about changing policy in ways that would have this exact effect. A presentation from the group’s meeting last month suggests that, if they’re allowed to meet this summer, they’ll recommend annual shots for adults 65 and older, some younger adults with medical conditions that increase their risk of severe illness from Covid infection, including pregnant people, possibly health care workers, and some very young children. Read more from STAT’s Helen Branswell on how Kennedy might have one thing in common with the committee he says he distrusts.

Correlation ≠ causation (stimulants for ADHD version)

As diagnoses of ADHD and prescriptions for drugs like Ritalin to treat it have both increased over the decades, there’s been a concern growing alongside those trends: that stimulants could increase someone’s risk for psychotic experiences like hallucinations. While some observational research has lent credence to that idea, a study published today in Pediatrics found no causal relationship between stimulants and psychosis among young people with ADHD. 

A prescription for stimulants was, indeed, a predictor for a psychotic experience. But a previous experience with psychosis was also a predictor for stimulant prescription, the researchers found. The analysis, based on data from more than 8,300 youths ages 9 to 14, suggests that characteristics like more intense ADHD symptoms or other mental health symptoms may be driving the association.

“We know that many children with ADHD can benefit from medication treatment,” lead author Ian Kelleher wrote in an email. “The results of our study are reassuring for young people and their families that routine ADHD medication treatment is unlikely to cause psychotic experiences.” 

The results also come at a time when more and more experts are questioning the way we think about defining, diagnosing, and treating the disorder. “I’ve invested 35 years of my life trying to identify the causes of ADHD, and somehow we seem to be farther away from our goal than we were when we started,” researcher James Swanson told New York Times Magazine last month in a long but compelling feature on the state of ADHD science and treatment.

‘The worst childhood illness I had’

It was after eavesdropping on a conversation at the veterinarian’s office that STAT editor Torie Bosch got the idea to solicit stories from people who have had vaccine-preventable illnesses. She ended up receiving dozens of responses, in which people wrote vividly about the pain and discomfort of even “mild” cases of measles, mumps, and pertussis. 

“I would go to bed and keep wiggling my toes in the hope that I would not get polio,” Aviva Gans Rosenberg recalled about growing up at the end of the polio epidemic. She never did contract the disease — she got vaccinated. But she did have measles as a child, and still remembers it as “the worst childhood illness” she had. “To this day, if someone says ‘measles’ something inside me cringes,” Rosenberg wrote. 

As of Friday, 1,001 measles cases have been confirmed in 31 states, according to the CDC. And while much of medicine has changed since most people were sick with these diseases, other things haven’t changed at all. Read more.

MAHA leaders move on food

You may recall that the preeminent ultra-processed food researcher in the U.S., Kevin Hall, recently left the NIH, citing concerns that the new administration was censoring and meddling with his work. Now the FDA and NIH have launched a new nutrition research program that aims to investigate questions about the health impacts of ultra-processed foods and food additives, with the goal of using findings to shape policy. What’s not clear from the Friday announcement is whether the research will be as scrupulous as Hall’s, whose controlled trials and round-the-clock monitoring of subjects’ food intake provided a level of clarity that’s rare in nutrition research. (It’s easy for people to forget what and how much they ate, or lie about it.)

In other food news, the FDA approved three natural food dyes on Friday: calcium phosphate, an algae-derived blue dye from French company Fermentalg, and expanded use of the butterfly pea flower extract already allowed in many beverages (including McDonald’s purple Grimace shake). The move is part of the broader efforts from federal and state governments to shift the food industry away from artificial dyes.

One of the food industry’s major complaints about giving up synthetic dyes is that it will take time to ramp up the supply chain for natural color sources — much longer, they say, than the end of 2026 deadline proposed by Kennedy and Marty Makary. The new approvals won’t solve that problem. But they will expand the universe of options available to U.S. companies at a time when consumers as well as policymakers are increasingly concerned about some synthetic dyes’ links to hyperactivity in kids and to cancer in animals. — Sarah Todd

What we’re reading

• Elizabeth Holmes’s partner has a new blood-testing start-up, New York Times

• Trump’s surgeon general pick is tearing the MAHA movement apart, Wired

• Chinese and Chinese-American researchers in the U.S. confront a perilous moment, STAT
• ‘I lost so much weight, my husband thought I was terminally ill’: why do people lie about taking Ozempic? The Guardian
• Science is under attack. So I’m taking RFK Jr. to court, STAT