The Rundown | Week of 5.21.2018

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The Microbiome Under the Microscope
The phrase “trust your gut” may just have a little more credence following a recent study that linked mental health and gut bacteria. “There’s a complex interplay between the microbes in our intestines and most of the systems in our bodies,” says Dr. JoAnn Manson, professor of medicine at Harvard Medical School. The “citizen science” study amassed data from 11,336 subjects from 45 countries, using an innovative DNA-sequence analysis termed “shotgun metagenomics.” Evidence suggests that a diet diverse in plant-based foods exhibits a greater diversity among the trillions of gut bacteria as well as a lower resistance to antibiotics. Mental health disorders, such as anxiety and depression, all shared similar bacterial profiles among the population despite differences in gender, age, and location. Conclusions are still forthcoming, but in the meantime, maybe consider reminding your patients to add a bowl of yogurt at breakfast!

>>Read More: ‘Largest’ microbiome study weighs in on our gut health
A Busy Week for Veterans Affairs
Last Wednesday, the $51 billion VA MISSION Act (check out our recap here) sailed through the House’s vote of 347-70. One week later, the Senate passed the bill 92-5, and President Trump is expected to ratify the bill within days. Proponents argue the bill minimizes coverage gaps for veterans while opponents argue the bill engenders privatization. A statement from the White House said the act “will strengthen the VA and provide timely and seamless care to VA patients, modernize VA health care by making investments in VA assets, and provide $5.2 billion in urgently needed funds in order to prevent interruption of Veterans currently using the Choice Program.”

>>Read More: Trump names Robert Wilkie as new VA secretary nominee
Ebola Spreads, As Does Hope in Vaccination Strategy
The largest outbreak of Ebola since 2014, which killed more than 11,000 people, has spread to the city of Mbandaka in the Democratic Republic of Congo (DRC), where officials have confirmed four cases of the virus. So far this outbreak is responsible for 26 deaths. The World Health Organization’s (WHO) response to the 2014 outbreak was widely criticized for failing to provide early warnings, mobilize resources, establish technical norms, and build nations’ healthcare capacity. However, with this outbreak, the WHO is prepared with an experimental vaccine from Merck, which has an estimated efficacy of 100 percent, as well as a “ring strategy.” Health workers and buriers, those most likely to risk virus-exposure, are vaccinated, then their immediate contacts, then the contacts’ contacts, and so on. By vaccinating concentric “rings” of approximately 150 people, epidemiologists hope to inhibit the highly contagious virus. However, logistical problems such as language barriers, transportation, and humidity (the vaccine is stored at -122°F) may decrease the plan’s efficacy.

>>Read More: ‘Major, major game-changer’: Ebola spreads to big Congo city
Why is America’s Birth Rate So Low?
The Centers for Disease Control and Prevention (CDC) reported that last year saw the fewest babies born in America in 30 years. Births among women between 15 and 44 decreased 3 percent from 2016, down to 60 births per 1,000 women, the lowest rate since data collection began in 1909. Experts speculate that economic uncertainty is a leading cause, a factor compounded by the absence of a government-subsidized maternity leave. The total fertility rate is 1.76 births per woman, 16.9 percent below the “replacement” threshold of 2.1. John Rowe of the Mailman School of Public Health at Columbia University says, “Rapidly declining fertility today matters not just because of its immediate impact on our economy, but because of its reverberating effects on every aspect of our society for the remainder of this century.” Programs such as Medicaid and Social Security are particularly sensitive to fluctuations in population density.

>>Read More: US birth rate hits all-time low: what’s behind the decline?
A Cure for EHR-related Woes
The doctor’s office is notoriously full of contagions: germs, colds, viruses, and … frustration? Apparently so, according to a new study from JAMA. The statistics of physician burnout are staggering and well-documented. A leading culprit is computerization and electronic health record (EHR) maintenance. From 2004 to 2015, EHRs among office-based physicians skyrocketed from 20.4 percent to 96 percent. Sadly, proper training couldn’t keep up. To combat this, the American Medical Association’s Accelerating Change in Medical Education Consortium has updated and revitalized medical-school curricula to emphasize population health, patient-centered care, and care coordination, and EHR training. Partners at the Indiana School of Medicine developed a teaching electronic medical record (tEMR) clone so students may “experience firsthand the utility, power, versatility, and challenges of using health information technology to deliver cost-effective, quality healthcare.” The end-goals are to boost patient satisfaction and that X-factor that athenahealth co-founder Jonathan Bush labeled “capability,” or, the “measure of how much workers feel like they have the support they need to effectively serve their customers and feel fulfilled doing so.” Studies indicate this measure is the leading cause of workplace enjoyment as well as a burnout-deterrent.

>>Read More: Doctor EHR frustration can influence patient satisfaction, study finds
Right-to-Try Act Moves Right Along
The Right to Try Act of 2017 passed the House vote 250-169 this week. The bill, which the Senate approved unanimously, aims to open experimental treatment options to patients with serious conditions who are not part of clinical trials. While opponents contend the bill skirts necessary safety measures, supporters such as Vice President Mike Pence counter that “this important policy will give hope to the those who need it most — by allowing seriously ill patients a fighting chance to access experimental treatment.” The House passed a similar bill in March that stipulated eligible patients must be at “a stage of a disease or condition in which there is reasonable likelihood that death will occur within a matter of months.” The more recent Senate bill has a broader definition, as life-threatening could encompass chronic—though not fatal—conditions. President Trump is projected to sign the bill into law.

>>Read More: Congress passes “right-to-try” bill