Morning Rounds: Our newsroom’s favorite stories of 2023

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Health data breaches set a record this year

“We’re writing to inform you of a cybersecurity incident”: If you’ve gotten a message like this from your health care organization, you’re not alone. As many as 116 million people were hit by large health data breaches this year, according to records from the HHS Office for Civil Rights as of December 21. That’s more than double recent counts, mostly spurred by a surge in hacking and ransomware attacks on health care groups regulated by HIPAA.

The last record enshrined on the office’s “wall of shame” was set in 2015, when three data breaches at health plans Anthem, Premera Blue Cross, and Excellus affected tens of millions of patients each. This year, breaches and hacks were more scattered. Between 2018 and 2022, large breaches involving ransomware increased 278%. STAT’s Katie Palmer has more dismal details, plus insights into the use of third-party tracking technologies. Read more.

How structural racism impairs long-term health

It’s long been known that Black, Hispanic, and Indigenous people in the U.S. have higher rates of chronic disease. A study published yesterday in JAMA Network Open ties those health disparities to structural racism — discriminatory policies in housing, education, employment, and criminal justice, STAT’s Usha Lee McFarling tells us. “These systems cascade into discriminatory beliefs, values, and the distribution of resources,” said L. Ebony Boulware, the study’s senior author and dean of the Wake Forest University School of Medicine.

In what is a budding area of research, scholars have been trying to understand just how policies such as redlining or policing practices, and their legacies of poverty, unemployment, and incarceration, work to impair long-term health. The study found that high rates of chronic kidney disease, diabetes, and hypertension were consistently associated with neighborhoods in Durham County, N.C., that had global measures of structural racism — low populations of white residents and high area deprivation, or socioeconomic disadvantage.

The study also looked at discrete measures of structural racism within neighborhoods — from violent crime, high eviction rates, low tree cover, and police shootings — and found a higher burden of chronic disease in neighborhoods with more of these issues. The study, said lead author Dinushika Mohottige of the Icahn School of Medicine at Mount Sinai, “helps us identify factors which might be targeted to address community health inequities.”

The high cost of childbirth

Childbirth is expensive, and can lead to medical debt even among patients with insurance. New research in the upcoming issue of Obstetrics and Gynecology found that postpartum adults had higher rates of medical debt in collection compared to pregnant individuals, suggesting that the out-of-pocket expenses incurred during or after delivery were higher than they could afford. The study looked at 14,560 postpartum people and 12,157 pregnant people, all of whom had commercial insurance.

The issue is especially pronounced among people living in low-income neighborhoods, STAT’s Annalisa Merelli tells us. Among that group, those who were postpartum had a nearly 30% predicted probability of having medical debt in collection — a percentage nearly twice as high as those in higher-income neighborhoods. This, the authors write, points to the need for policies that reduce maternal and infant spending, especially in order to mitigate inequities.

Spending Christmas with your child in the PICU

If you’ve never been in a pediatric intensive care unit with your child, over the holidays or ever, this piece by Maria Kefalas will help you understand what it’s like. If nurses standing by your child’s bed have never said, “Don’t panic unless we do,” she will explain why they make that warning. And if your child, like her Cal (above), is not paralyzed, feeding tube-dependent, and nonverbal, you will learn why the PICU can be a respite for families, especially during Christmas.

Writing in a STAT First Opinion, Kefalas relates how hospital staffers try to make a place filled with monitors, ventilators, and hospital beds feel festive:  “No one believes in Santa in the PICU, but the nurses and doctors try to pretend magic and miracles are real.” A social worker once told her they see working Christmas as an honor, and this year, Kefalas longs to return the PICU, too. Read more.

STAT story highlights from 2023

The Morning Rounds team is taking a break until Jan. 3, but before we say goodbye to 2023, some reporting that struck a chord with me — and you.

What a year for the Obesity Revolution. Elaine Chen and Matthew Herper offered a big-picture take with their story New weight loss drugs are changing the narrative on obesity, with a push from pharma. Also not to be missed:

• Isabella Cueto, whose Living With series on chronic diseases stirs many newsletter readers, brought us this: For a 9-year-old patient at a Los Angeles obesity clinic, barriers to health are everywhere.
• Megan Molteni’s The new weight loss drugs are revolutionizing our understanding of desire. Food cravings could be just the beginning.
• In this video, Alex Hogan wondered: How do the new obesity drugs work?

This month the first CRISPR therapy was approved — one that targets sickle cell disease but with high costs.

• From Megan: New gene therapies confront many sickle cell patients with an impossible choice: a cure or fertility.
• From Jason Mast: How sickle cell became the first disease treated by CRISPR.
• Brittany Trang reported on another gene therapy: Gene therapy offered this 7-year-old freedom. The price: a grueling year.

We are still feeling reverberations from last year’s Dobbs decision.

• Eric Boodman showed us How a conservative, gun-toting doctor defended abortion access in Appalachia.
• Olivia Goldhill explained how Mexico’s activist ‘companion networks’ quietly provide abortion pills and support to U.S. women.

Usha Lee McFarling’s reporting on racism in medicine both dismays and inspires. Be sure to read Carrying the torch of his slain brother, a Chicago ER doctor struggles against the violence around him and How one medical school became remarkably diverse — without considering race in admissions.

Andrew Joseph wrote about what nurses have endured during the pandemic: A year after a nurse’s loss to suicide, his friends are building out a peer support network.

Helen Branswell, always on top of the infectious diseases beat: Respiratory viruses, thrown out of whack by Covid, appear to be falling back into seasonal order.

Nicholas Florko reported on state prisons’ failure to provide the cure for hepatitis C to incarcerated people in Death Sentence.

Lev Facher revealed How the Bad River Tribe flipped the script on the Native American opioid crisis.

Don’t miss Hyacinth Empinado’s documentary series on Treating Rural America.

Jonathan Wosen has his finger on the pulse of science in academia: Life scientists’ flight to biotech labs stalls important academic research

Rachel Cohrs dived deep: The NIH has poured $1 billion into long Covid research — with little to show for it.

Katie Palmer uncovered this uncomfortable truth: ‘Out of control’: Dozens of telehealth startups sent sensitive health information to big tech companies

And let’s end with this hit from Jason Mast: What the dogs of Chernobyl can teach us about life at the edge. It starts this way: “You’d think an irradiated wasteland would be a poor place to make a home, but some animals beg to differ.”

What we’re reading

• One day, he was safe in a nursing home. The next, he was homeless, Washington Post

• A law to help neglected diseases is giving billion-dollar drugs government freebies, Bloomberg
• AAFP’s CEO on how to keep primary care doctors in the field, STAT

• Teens in search of birth control have embraced the hormonal Implant, New York Times

• Patent thickets and terminal disclaimers: How pharma blocks biosimilars from the marketplace, STAT