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Obesity treatment shake-up

Delivered daily by 10 a.m., Pulse examines the latest news in health care politics and policy.
Aug 21, 2023 View in browser
 
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By Chelsea Cirruzzo and Ben Leonard

Driving the Day

Instruments sit on a table in an operating room.

Some doctors say that weight-loss drugs are more likely to be tools used alongside weight-loss surgery than treatments that replace the procedure. | Mark Humphrey/AP

WHERE WEIGHT-LOSS DRUGS FIT — Promising results from new weight-loss drugs may be shaking up obesity treatment, but that doesn’t mean current treatments are going away, POLITICO’s Daniel Payne reports.

Doctors who specialize in weight-loss treatments — both surgical and pharmacological — told Daniel that the new drugs, while promising, are more likely to be added to treatment for patients undergoing bariatric surgery.

Far from being the end of established treatment options like surgery, the drugs — and the buzz around them — could bring new interest to all medical options available for obesity.

“If it drives more people to have that conversation, either with their primary care professional or a specialist, I think the chances are that people will understand the value of bariatric surgery and may elect to do that where they never would have before,” Dr. Robert Kushner, medical director of the Center for Lifestyle Medicine at Northwestern Medicine and professor at Northwestern University, told Pulse.

But the drugs still have huge potential, doctors said — because of their place as one of many tools available. They could also open the possibility of more effective weight-loss treatments for a new patient population.

To be eligible for bariatric surgery, a patient must either have a body mass index of 35 or higher or have a BMI of 30 or higher with an obesity-related condition, such as heart disease. More people are eligible for glucagon-like peptide-1 (GLP-1) agonists, including those with a BMI of 30 or higher or a BMI of 27 or higher with a related condition.

Some patients interested in the new drugs aren’t interested in surgery, seeing it as too invasive or too risky.

While health experts consider the drugs’ potential effect on usage rates of weight-loss procedures and treatments, insurers, regulators and lawmakers are grappling with the prospect of paying for new treatments with huge price tags that could be helpful for a large portion of Americans.

WELCOME TO MONDAY PULSE. Just two more weeks of recess remain. We hope your vacations have been restful. But don’t forget to send your tips, scoops and feedback to bleonard@politico.com and ccirruzzo@politico.com and follow along @_BenLeonard and @ChelseaCirruzzo.

TODAY ON OUR PULSE CHECK PODCAST, host Kelly Hooper talks with Daniel Payne, who shares more insight about the potential effects of the availability of weight-loss drugs on bariatric surgery, like increased patient awareness and demand for weight-loss procedures overall.

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Abortion

People attend the March for Life rally on the National Mall.

Anti-abortion organizations have lobbied lawmakers on PEPFAR reauthorizations in the past, but Susan B. Anthony Pro-Life America is the most prominent. | Anna Moneymaker/Getty Images

ANTI-ABORTION GROUP LEAN INTO PEPFAR — Susan B. Anthony Pro-Life America, the most well-heeled anti-abortion group in the country, has jumped into the fray over reauthorizing the 20-year-old President’s Emergency Plan for AIDS Relief as abortion politics on Capitol Hill imperil the program’s future, POLITICO’s Megan R. Wilson reports.

It marks the first time the group has lobbied on the bill, which must be reauthorized every five years, according to disclosures. The activity signals the intensifying pressure on Congress from SBA and similar conservative groups to pass legislation that would ban PEPFAR funding from going to any organizations that support abortion rights.

The proposal has support from many Republicans — including Rep. Chris Smith (R-N.J.), who wrote the 2018 reauthorization bill — while Democrats oppose efforts to restrict funding and point to a current law that prohibits foreign aid from being used for abortion services.

PEPFAR, initially spearheaded by then-President George W. Bush, has reportedly saved 25 million lives and has many provisions that expire on Sept. 30 absent congressional action.

But that’s not all: In an effort to save the program, UNICEF USA recently hired top lobbying firm Akin Gump Strauss Hauer & Feld. On the contract is former Rep. Ileana Ros-Lehtinen (R-Fla.), an original PEPFAR architect, and former Obama White House official Ed Pagano. The firm declined to discuss its advocacy strategy. 

ENVIROS EYE ROLL ABORTION RULING — The newest federal court ruling on abortion pills is gaining attention for one judge’s unorthodox argument — which equates anti-abortion activists to wildlife lovers, POLITICO’s Pamela King reports.

Judge James Ho of the 5th U.S. Circuit Court of Appeals borrowed from environmental case law to contend that medical providers challenging abortion care suffer “aesthetic injury from the destruction of unborn life.”

What he wrote: “It’s well established that, if a plaintiff has ‘concrete plans’ to visit an animal’s habitat and view that animal, that plaintiff suffers aesthetic injury when an agency has approved a project that threatens the animal,” Ho wrote.

What environmental activists think: Legal experts say they doubt the Supreme Court — expected to take up the case over mifepristone pills — would latch on to Ho’s comparison. But they suggested that a Trump-appointed judge on a conservative-dominated court, normally hostile to environmental challenges, might have helped build a stronger foundation for green activists seeking to protect treasured landscapes and vulnerable species.

“The first thing that struck me was the irony of the 5th Circuit relying on standing in environmental cases,” said Eric Glitzenstein, director of litigation at the Center for Biological Diversity.

He later added: “It’d be more gratifying to see them do that in environmental cases.”

 

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IN THE STATES

MALARIA CASES MYSTIFY FLORIDA — Seven cases of locally transmitted malaria in Florida and one in Texas are baffling officials, POLITICO’s Mia McCarthy reports.

Why it matters: Malaria infections in the U.S. are often tied to travel abroad. The last time locally transmitted cases were reported was in 2003.

“We don’t think this is going to go into a big nationwide outbreak,” Dr. Monica Parise, director of the Centers for Disease Control and Prevention’s Division of Parasitic Diseases and Malaria, told POLITICO. “It’s fairly localized, and in general, when we’ve had these outbreaks before, they have tended to be quite localized.”

Why now? Experts don’t know. In the Florida case, it’s possible someone was infected in another country and unwittingly spread it in the U.S. after being bitten by a local mosquito.

Still, Florida’s health department is less focused on the why and more focused on the response: Eradicate the mosquitoes, encourage people to wear clothing that covers them up and drain sitting water.

Around the Agencies

PREP FUNDING COMING TO HEALTH CENTERS — The Health Resources and Services Administration will award millions of dollars to community health centers as part this week of a program to reduce HIV infections.

Since 2020, HRSA has awarded annual grants to community health centers to expand access to testing for HIV, treat infections and prescribe PrEP, a drug used to prevent HIV infections. Last August, $20 million went toward 64 health centers.

The latest round of funding — $18 million — will go to 46 community health centers. Another $17 million will go to health centers awarded grants in previous years to sustain their programs.

In 2022, health centers conducted more than 3.4 million HIV tests, up 40 percent since 2020, and served 200,000 patients with HIV, HRSA says. Eighty-four thousand patients have received PrEP management services, up 7 percent since 2021.

Public Health

HOME HEALTH PATIENTS FACE IMPROVEMENT DISPARITIES — Low-income Medicare-enrolled patients and patients of color are more likely to be discharged from home health care without functional improvement than white and higher-income patients, says a new study in the journal Health Services Research.

Why it matters: The home health industry is booming with the employment of home health aides and expected to grow 25 percent from 2021 to 2031, per the U.S. Bureau of Labor Statistics.

Researchers at the University of Minnesota School of Public Health looked at how a patient’s race, ethnicity and income level are linked to disparities in their improvement, including clinical improvement in daily activities and a reduced dependency on aides.

Seventy-nine percent of white and higher-income patients had functional improvement compared with 76 percent for Asian American Pacific Islanders, 72 percent for Black and American Indian and Alaska Native patients, 71 percent for low-income and 70 percent for Hispanic patients.

Black, Hispanic, American Indian and Alaska Native patients plus those with low incomes were more likely to be discharged without functional improvement than white and higher-income patients, the study said. Researchers pointed to access to quality home health agencies to explain the racial inequities but said low-income patients have less improvement than their higher-income counterparts within the same agency.

What We're Reading

The Washington Post reports on state laws that are changing which providers can call themselves doctors.

The Wall Street Journal reports on the sharp drop in China’s fertility rate.

The New York Times reports on calls for reforms in nursing homes before the next pandemic.

 

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