Morning Rounds: Apple Watch takes on sleep apnea and tonight’s presidential debate

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Hello, happy Tuesday. Temperatures are projected to be in the 50s every morning this week in Boston, per a glance at my phone. Is it officially fall? Where can I get a good apple cider donut? What stories should we report before the end of the year creeps up on us? Send recs for all of the above to [email protected]

Three health care issues to watch in tonight’s debate

Vice President Harris and former President Trump will battle in person this evening at the presidential debate. Here are the health care questions that STAT’s team in DC will be watching for:

On Medicare: Trump has promised he won’t cut a penny from Medicare; Harris has backed away from Medicare for All. But neither has said what they will do. What does Trump think about House conservatives’ proposal to raise the Medicare eligibility age and promote Medicare Advantage plans? How will Harris pay for her party’s platform to expand Medicare coverage of more vision, dental, and hearing services?

On drug pricing: Both candidates are eager to claim victories against the pharmaceutical industry. While Harris has touted her “tie-breaking” vote to turn Medicare price negotiation into law, Trump hasn’t said what he thinks of the program set to launch in 2026. Would Trump support Republicans’ efforts to eliminate the IRA, and what drug pricing plan would he replace it with? Will Harris explain the Medicare plan better than Biden did — and win over unaware voters?

On medical debt: Harris pledged last month that she would erase billions of dollars in Americans’ medical debt. Our question: Simply, how? And does Trump have a plan to tackle medical debt?

Check back here tomorrow for analysis on the evening from STAT’s Sarah Owermohle and Rachel Cohrs Zhang.

Teen brains aged prematurely during the Covid lockdown

We already know that the pandemic and protective measures like social isolation and school closures had detrimental effects on adolescent mental health. New research published yesterday in the Proceedings of the National Academy of Sciences found that teen brains may have actually physically matured faster in that time than usual — especially for girls.

The team had originally planned to evaluate the brains of 160 teens during “normal” adolescence. Instead, they found that during a global pandemic, the brains of teen girls in the study aged 4.2 years more than a model based on pre-pandemic brain data predicted they would. Boy brains aged 1.4 more years than predicted.

The cerebral cortex (responsible for things like language, memory, reasoning) naturally thins with age, but chronic stress and adversity are known to accelerate that process. Researchers have a general understanding that this accelerated aging poses an increased risk of conditions like mood, anxiety, and behavioral disorders. These study results show that those who were teens during the pandemic lockdowns may be more vulnerable to neuropsychiatric disorders or even neurodegenerative disorders as they age, the authors write. But they also acknowledge that it was a small study, and more research and support is needed for youths and adolescents who experienced lockdowns.

Soon, your Apple Watch could tell if you have sleep apnea

Among the news Apple announced at its big event yesterday is the debut of an Apple Watch feature that will warn users if they may have sleep apnea. It’s the latest advance in the company’s decade-long effort to sell its wearable as a tool that can help people live healthier lives, STAT’s Mario Aguilar reports.

The feature will monitor users for disturbances while they’re sleeping, then warn those who show “signs of moderate to severe sleep apnea,” Apple’s vice president of health Sumbul Desai said in a pre-recorded announcement video. It will then provide education materials and a detailed report that can be shared with a doctor. However, it’s still unclear how the feature — and data generated by wearables generally — could affect clinical practice. Read more about the feature as well as Apple’s plans to turn its AirPods into over-the-counter hearing aids.

Can changing one algorithm fix everything?

Chronic kidney disease is an epidemic in Central Brooklyn. The service area for One Brooklyn Health, a safety net hospital system serving some of New York’s poorest and sickest patients, contains 350,000 or more people who could benefit from kidney care. But often people don’t reach the clinic doors until it’s much too late. OBH, which serves a mostly Black population insured by Medicaid or Medicare, is currently treating fewer than 2,000 patients for kidney disease. 

If it sounds like this would be exactly the place to benefit most from removing race from the calculations that assess kidney disease, which can help expand the pool of patients who have access to earlier care — the hospital thought of that, too. The leaders of OBH were early adopters in the movement to eliminate race from the commonly used equation that estimates kidney function. But one updated equation can’t fix everything.

“It doesn’t change the realities on the ground,” nephrologist Puneet Bedi told STAT’s Usha Lee McFarling. People can’t always get child care or transportation to go to the doctor. When someone is struggling to pay rent, health care takes a back seat. “We have corrected the equation but it has very little impact on health outcomes.”

Read more from Usha on how one hospital system is working to stem the racial disparities that run through American kidney care.

The first face and eye transplant

Yesterday, researchers in JAMA reported the results of the first whole eye and face transplant. The surgeons were able to get blood to reach the eye, a big hurdle to helping someone regain vision in the transplanted organ, but they were not able to fully restore vision. STAT’s Anil Oza caught up with Daniel Ceradini, the lead author of the study and a plastic surgeon at NYU Langone Health.

What was the story behind this transplant?

We performed, now, four face transplants at NYU, this last one incorporating an eye. The eye had always been talked about as being “The Holy Grail of vision restoration,” but it never had been attempted successfully in the past. So this is the first report of that actually happening. The report details Aaron, who sustained an electrical injury while working, who needed both parts of his face [missing word?] as well as an eye to restore his facial aesthetics, his function, and his quality of life.

What does this mean for future eye transplants? 

The hurdles that we have to overcome are optic nerve regeneration, for one. Preventing the optic nerve from dying from ischemic injury [when blood flow is cut off] during the transplant would be another. We don’t actually know how the connections between the regrowing optic nerve and the brain will occur. That’s just something that’s never been studied. There’s no real human precedent set for it.

What do the Karate Kid and drug patents have in common?

To find out, watch the latest video in the Behind the Counter series from STAT’s Anna Yeo. In her last video, Anna explains how drug patents last for 20 years. But it wasn’t always that way: Before 1984 (hint!), those companies didn’t really have a full 20 years of patent protection. They had 20 years from the date the patent was issued, but some of that time was sucked up performing clinical trials and working toward FDA approval before a drug could actually be sold. Meanwhile, generic drugmakers couldn’t access a drug’s formula until the original patent expired. Then, they had to conduct their own clinical trials, delaying the entrance of generics onto the market.

Then came the Hatch-Waxman Act of 1984, in which legislators worked to find a balance (another hint!) that afforded both parties some protections. Watch Anna’s video to learn more.

What we’re reading

• “I don’t want to die”: Needing mental health care, he got trapped in his insurer’s ghost network, ProPublica

• A food-allergy fix hiding in plain sight, Atlantic

• Q&A: Atsena Therapeutics’ gene therapy for inherited blindness shows promise, STAT
• An anatomist of pleasure gives voice to the body in pain, New Yorker
• How much does it cost to give birth in the U.S.? STAT