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The physicians, at Allina Health in Minnesota and Wisconsin, appear to be the largest group of unionized doctors in the private sector.In the latest sign of growing frustration among professionals, doctors employed by a large nonprofit health care system in Minnesota and Wisconsin have voted to unionize.The doctors, roughly 400 primary and urgent-care providers across more than 50 clinics operated by Allina Health, appear to be the largest group of unionized private-sector physicians in the United States. More than 150 nurse practitioners and physician assistants at the clinics were also eligible to vote and will be members of the union, which will be represented by a local of the Service Employees International Union.The result was 325 to 200, with 24 other ballots challenged, according to a tally sheet from the National Labor Relations Board, which conducted the vote. Allina Health did not immediately comment.The doctors complained that chronic understaffing was leading to burnout and compromising patient safety.“In between patients, your doctor is dealing with prescription refills, phone calls and messages from patients, lab results,” said Dr. Cora Walsh, a family physician involved in the organizing campaign.“At an adequately staffed clinic, you have enough support help take some of that workload,” Dr. Walsh added. “When staff levels fall, that work doesn’t go away.”Dr. Walsh estimated that she and her colleagues often spend an hour or two each night handling “inbox load” and worried that the shortages were increasing backlogs and the risk of mistakes.The union vote follows recent walkouts by pharmacists in the Kansas City area and elsewhere over similar concerns.A variety of professionals, including architects and tech workers, have sought to form unions in recent years, while others, like nurses and teachers, have waged strikes and aggressive contract bargaining campaigns.Some argue that employers have exploited their sense of mission to pay them less than their skills warrant, or to work them around the clock. Others contend that new business models or budget pressures are compromising their independence and interfering with their professional judgment.Increasingly, doctors appear to be expressing both concerns.“We feel like we’re not able to advocate for our patients,” said Dr. Matt Hoffman, another doctor involved in the organizing at Allina. Dr. Hoffman, referring to managers, added that “we’re not able to tell them what we need day to day.”Consolidation in the health care industry over the past two decades appears to underlie much of the frustration among doctors, many of whom now work for large health care systems.“When a physician ran his or her own practice, they made the decisions about the people and technology they surrounded themselves with,” Dr. Robert Wachter, chair of the department of medicine at the University of California, San Francisco, said in an email. “Now, these decisions are made by administrators.”Doctors at Allina say that staffing was a concern before the pandemic, that Covid-19 pushed them to the brink and that staffing has never fully recovered to its prepandemic levels.Relatively low pay for clinical assistants and lab personnel appears to have contributed to the staffing issues, as these workers left for other fields in a tight job market. In some cases, doctors and other clinicians within the Allina system have quit or scaled back their hours, citing so-called moral injury — a sense that they couldn’t perform their jobs in accordance with their values.“We were promised that when we get through the acute phase of the pandemic, staffing would get better,” Dr. Walsh said. “But staffing never improved.”Allina, which takes in billions in revenue but has faced financial pressures and recently eliminated hundreds of positions, did not respond to questions about the doctors’ concerns.Joe Crane, the national organizing director for the Doctors Council of the S.E.I.U., which represents attending physicians, said that before the pandemic, he would receive about 50 inquiries a year from doctors interested in learning more about forming a union. He said he received more than 150 inquiries during the first month of the pandemic. (Mr. Crane was with another physicians’ union at the time.)Mr. Crane, citing the siloed nature of the medical profession, said that unionization among attending physicians had nonetheless proceeded slowly, but that the victory at Allina could create momentum.In March, more than 100 doctors voted to unionize at another Allina facility, a hospital with two locations. Dr. Alia Sharif, a physician involved in that union campaign, said doctors were under pressure there not to exceed length-of-stay guidelines for patients, even though many suffer from complex conditions that require more sustained care.Allina is appealing the outcome of that vote to the National Labor Relations Board in Washington; a board official rejected an earlier appeal.Even as rates of unionization have languished among attending physicians, they have increased substantially among medical residents. A sister union within the S.E.I.U., the Committee of Interns and Residents, has added thousands of members over the past few years.Dr. Wachter said this could herald an increase in unionization among doctors outside training programs. “When these physicians finish training and enter practice, they are more comfortable with a world in which unionization doesn’t automatically conflict with their notions of being a professional,” he wrote.

A novel therapeutic approach that combines human epidermal growth receptor factor 2 (HER2)-targeted therapies with the cholesterol-lowering drug lovastatin can reduce the number of cancer treatments required to prevent tumor growth. Monitored by immuno-PET scans, this combination therapy has the potential to personalize treatment for cancer patients and spare them from harmful side effects. This research was published in the October issue of The Journal of Nuclear Medicine.
Antibody-drug conjugates (ADCs) have become an eminent cancer treatment because of their ability to precisely target tumors with potent efficacy. HER2-ADC therapies have been effective in treating breast, lung, bladder, and stomach cancers. Although they are usually well-tolerated, multiple doses of the drugs can result in severe side effects, including low blood counts, liver damage, and lung damage. Strategies that reduce toxic side effects caused by ADCs and predictive biomarkers of ADC toxicity are currently an unmet clinical need.
“In this study, we sought to determine whether a single dose of HER2-ADCs could be administered in combination with lovastatin (which temporarily elevates cell-surface HER2) to achieve therapeutic efficacy similar to that of a multiple dose regime,” said Patricia Pereira, PhD, assistant professor at the Mallinckrodt Institute of Radiology at the Washington University School of Medicine in St. Louis, Missouri. “We also used HER2-targeted immuno-PET to monitor changes in HER2 expression after ADC therapy.”
Researchers injected mice with cultured gastric cancer cells and patient-derived gastric cancer cells. When tumors grew sufficiently, the mice were divided into groups and received various treatment schedules (no treatment, multiple doses of ADC, multiple doses of ADC with lovastatin, single dose of ADC, or single dose of ADC with lovastatin). Immuno-PET was used to investigate the dosing regimen and the efficacy of the treatment schedules.
A single dose of ADC therapy combined with lovastatin was found to reduce tumor volume at rates similar to those resulting from multiple doses of ADC in a preclinical setting. The study results showed that immuno-PET can noninvasively monitor HER2 tumor levels after treatment with HER2-targeted ADC therapies.
“This preclinical work is significant because it has the potential to improve therapy for patients with HER2-positive cancers,” noted Pereira. “It not only simplifies treatment by exploring single-dose schedules of antibody-drug conjugates but can also reduce side effects by minimizing the number of doses required. Additionally, it personalizes therapy using molecular imaging, enhancing treatment efficacy.”
She continued, “The findings suggest a future where molecular imaging techniques play a critical role in guiding drug development and cancer treatment decisions, particularly as various ADCs are being tested and approved for cancer treatment. Currently, there is no perfect way to select tumors or monitor their response to ADCs. This research indicates that molecular imaging can bridge this gap by providing real-time insights into therapy response.”
This study was made available online in June 2023.

Does this sound like you? You wake up at the same time each morning, get the kids out the door, and rush to catch the subway to work. But at night, maybe you stay up until midnight doing laundry or 1 a.m. to catch up on the bills.
Lots of Americans — about one-third of us — are in the same situation and habitually get only five to six hours of sleep instead of the recommended seven to eight hours.
But even a mild chronic sleep deficit may heighten the risk of developing heart disease later in life: Surveys of thousands of people have found that people who report mild but chronic sleep deficits have more heart disease later in life than people who get adequate sleep.
A new Columbia study of women now shows what’s happening in the body during chronic mild sleep deprivation.
After just six weeks of shortened sleep, the study found, the cells that line our blood vessels are flooded by damaging oxidants. And unlike well-rested cells, sleep-restricted cells fail to activate antioxidant responses to clear the destructive molecules.
The result: cells that are inflamed and dysfunctional, an early step in the development of cardiovascular disease.
“This is some of the first direct evidence to show that mild chronic sleep deficits cause heart disease,” says study leader Sanja Jelic, MD, director of the Center for Sleep Medicine at Columbia and professor of medicine in the Division of Pulmonary, Allergy, and Critical Care Medicine at Columbia University Vagelos College of Physicians and Surgeons.

University of Maryland School of Medicine (UMSOM) researchers conducted a statewide survey of all patients on breathing machines in hospitals and long-term care facilities and found that a significant percentage of them harbored two pathogens known to be life-threatening in those with compromised immune systems. One pathogen, Acinetobacter baumannii, was identified in nearly 31 percent of all patients on ventilators to assist with their breathing; Candida auris was identified in nearly 7 percent of patients on ventilators, according to the study which was published this week in the Journal of the American Medical Association.
They conducted the study with colleagues at the Maryland Department of Health and presented their findings at this week’s Infectious Disease Society of America annual meeting in Boston.
“We found patients in long-term care facilities, like skilled nursing homes, were more likely to be colonized with these pathogens than those getting treated in hospitals,” said study leader Anthony Harris, MD, MPH, Professor of Epidemiology & Public Health at UMSOM and infectious disease specialist at University of Maryland Medical Center. “We were the first in the nation to get a statewide survey of all ventilated patients, and I think it points to the stringency of the infection control programs in place in the state of Maryland and the excellent collaboration between the University of Maryland and the State Health Department.”
Both A. baumannii and C. auris have been highlighted by the federal Centers for Disease Control and Prevention (CDC) as emerging pathogens that present a global health threat. C. auris is a fungus that spreads within and among local healthcare facilities — usually in those hospitalized and on breathing machines (ventilators). Older people with weakened immune systems are particularly susceptible to this infection, which resists treatment with common anti-fungal medications. A. baumannii, a bacteria, also poses a threat to these same types of patients and has become very resistant through the years to treatment with most antibiotics.
To conduct the study, Dr. Harris and his colleagues obtained culture swabs from all 482 patients receiving mechanical ventilation in Maryland healthcare facilities between March and June of this year. All eligible healthcare facilities, 51 in total, participated in the survey. They identified A. baumannii from at least one patient in one-third of the acute care hospitals and from 94 percent of the long-term care facilities. They identified C. auris in nearly 5 percent of hospitalized patients and in 9 percent of patients in long-term care facilities.
“Testing positive, however, does not mean that patients have symptoms or active infections that are potentially life-threatening,” said study co-author J. Kristie Johnson, PhD, Professor of Pathology at UMSOM whose lab did the A. baumannii testing for the study. “But knowing which patients are colonized with these pathogens can help contain their spread to other patients.”
Over the course of 2022, state and local health departments around the country reported 2,377 clinical cases, according to the CDC, nearly five times the number infections in 2019, which was less than 500 cases. Maryland alone had 46 cases in 2022. While these infections don’t normally pose much of health risk to hospital workers, they pose a significant risk of death in patients with weakened immune systems. Often the infections can be spread from patient to patient by health care workers carrying the germs on their hands, equipment or clothing.
“There is a need for more health care facilities nationwide to be aware of the extent of the problem through surveillance testing,” Dr. Harris said.Certain measures can be implemented to help reduce spread of these pathogens includingmore stringent use of disposable gloves and gowns between patients and the use of chlorhexidine bathing of the critically ill to disinfect their skin.
“Emerging pathogens that are resistant to available therapeutics present a growing challenge in our country, especially with a projected increased growth in our aging population entering long term care facilities,” said UMSOM Dean Mark Gladwin, MD, who is also Executive Vice President for Medical Affairs, UM Baltimore, and the John Z. and Akiko K. Bowers Distinguished Professor at UMSOM. “Nearly half of patients who contract C. auris infections die within 90 days, according to the CDC, and this pathogen is now found in nearly 50 states. This is why it is critical for these surveillance studies to be conducted nationwide, not just in Maryland.”
UMSOM faculty members Lisa Pineles, MA, Lyndsay O’Hara, PhD, Leigh Smith, MD, and Indira French, MS, were co-authors on this study. The study was funded by a grant from the CDC (1U54CK000450-01).

Reducing overall calorie intake may rejuvenate your muscles and activate biological pathways important for good health, according to researchers at the National Institutes of Health and their colleagues. Decreasing calories without depriving the body of essential vitamins and minerals, known as calorie restriction, has long been known to delay the progression of age-related diseases in animal models. This new study, published in Aging Cell, suggests the same biological mechanisms may also apply to humans.
Researchers analyzed data from participants in the Comprehensive Assessment of Long-Term Effects of Reducing Intake of Energy (CALERIE), a study supported by the National Institute on Aging (NIA) that examined whether moderate calorie restriction conveys the same health benefits seen in animal studies. They found that during a two-year span, the goal for participants was to reduce their daily caloric intake by 25%, but the highest the group was able to reach was a 12% reduction. Even so, this slight reduction in calories was enough to activate most of the biological pathways that are important in healthy aging.
“A 12% reduction in calorie intake is very modest,” said corresponding author and NIA Scientific Director Luigi Ferrucci, M.D., Ph.D. “This kind of small reduction in calorie intake is doable and may make a big difference in your health.”
The research team next sought to understand the molecular underpinnings of the benefits seen in limited, previous research of calorie restriction in humans. One study showed that individuals on calorie restriction lost muscle mass and an average of 20 pounds of weight over the first year and maintained their weight for the second year. However, despite losing muscle mass, calorie restriction participants did not lose muscle strength, indicating calorie restriction improved the amount of force generated by each unit of muscle mass, called muscle specific force.
For the current study, scientists used thigh muscle biopsies from CALERIE participants that were collected when individuals joined the study and at one-year and two-year follow ups.
To figure out which human genes were impacted during calorie restriction, the scientists isolated messenger RNA (mRNA), a molecule that contains the code for proteins, from muscle samples. The team determined the protein sequence of each mRNA and used the information to identify which genes originated specific mRNAs. Further analysis helped the scientists establish which genes during calorie restriction were upregulated, meaning the cells made more mRNA; and which were downregulated, meaning the cells produced less mRNA. The researchers confirmed calorie restriction affected the same gene pathways in humans as in mice and non-human primates. For example, a lower caloric intake upregulated genes responsible for energy generation and metabolism, and downregulated inflammatory genes leading to lower inflammation.
“Since inflammation and aging are strongly coupled, calorie restriction represents a powerful approach to preventing the pro-inflammatory state that is developed by many older people,” said Ferrucci.
This research was supported by the NIA Intramural Research Program and the following NIH grants: R01AG061378, P30AG028716, R01AG054840, U01AG060906, R01AG071707, R33AG070455, U01AG020478, U01AG020480, U01AG020487, U01AG022132.

It can be a relief to scratch the occasional itch, but when itch gets out of control, it can become a serious health problem. How does the body know when to stop?
Scientists at UC San Francisco are getting close to an answer. In a breakthrough that could transform how doctors treat conditions from eczema to allergies, they have discovered a feedback loop centered on a single immune protein called IL-31 that both causes the urge to itch and dials back nearby inflammation.
The findings, published on October 13th in Science Immunology, lay the groundwork for a new generation of drugs that interact more intelligently with the body’s innate ability to self-regulate.
Previous approaches suggested that IL-31 signals itch and promotes skin inflammation. But the UCSF team discovered that nerve cells, or neurons, that respond to IL-31, triggering a scratch, also prevent immune cells from overreacting and causing more widespread irritation.
“We tend to think that immune proteins like IL-31 help immune cells talk to one another, but here, when IL-31 talks to neurons, the neurons talk right back,” said Marlys Fassett, M.D., Ph.D., UCSF professor of dermatology and lead author of the study. “It’s the first time we’ve seen the nervous system directly tamp down an allergic response.”
The discovery could eventually change how asthma, Crohn’s and other inflammatory diseases are treated, due to IL-31’s presence throughout the body.
“IL-31 causes itch in the skin, but it’s also in the lung and in the gut,” said Mark Ansel, Ph.D., UCSF professor of immunology and senior author of the study. “We now have a new lead for fighting the many diseases involving both the immune and nervous systems.”
More than an itch

R.J. Reynolds menthol e-cigarettes are top sellers with an estimated $1.6 billion in annual sales. The company vowed to fight the ruling in court.The Food and Drug Administration has ordered R.J. Reynolds to stop selling its popular Vuse Alto menthol e-cigarettes, a decision Reynolds immediately said it would challenge in court.On Thursday, the agency denied applications by Reynolds to keep its top-selling menthol products permanently on the market, saying that the company did not meet the federal standards that require the e-cigarettes to provide more of a health benefit than a risk. In the case of the Vuse vapes, the F.D.A. said the risks of attracting young people to the popular menthol and flavored products outweighed the potential for helping traditional smokers quit.The decision does not apply to the company’s tobacco-flavored products.Some public health experts have viewed the federal agency’s most recent rejections of menthol e-cigarettes as an indication that the agency is more strictly limiting menthol products. The F.D.A. is expected, perhaps by the end of this year, to move toward outlawing all menthol cigarettes, including Newports, a top seller for Reynolds with $7.5 billion in annual sales, according to Goldman Sachs research.British American Tobacco, the parent company of R.J. Reynolds, said in a statement that the F.D.A.’s latest ruling “flies in the face of proven science.” The company said it would fight the decision in court, which could allow Reynolds to keep the disputed Vuse products on the market indefinitely.Juul and other e-cigarette makers that are appealing similar agency decisions have been permitted to keep their vaping products on the shelves during litigation.If the F.D.A. were to succeed in court against Reynolds, the company would be dealt a severe financial blow. Market data analyzed by Goldman Sachs indicates that the menthol variety is the top seller of Vuse products, and those menthol vapes make up about 29 percent of the U.S. e-cigarette market, representing $1.6 billion in sales. Overall, Vuse products, including tobacco-flavored products, comprise 40 percent of the market.The F.D.A. has had the authority to determine the sale of e-cigarettes since 2016. It has denied millions of applications either for products to stay on the market or for the sale of new vaping devices. The agency has pledged to decide every application by the end of this year.Antismoking groups and others have urged the F.D.A. to more tightly regulate the e-cigarette market, and noted that a recent survey of middle and high school students showed that Vuse vapes were a popular choice among those who used e-cigarettes.Reynolds has tried to position its products to regulators as legitimate alternatives for adults in an e-cigarette space flooded with illicit products. The company volunteered to stop selling its mixed berry flavor, which was also denied marketing authorization by the F.D.A. on Thursday.“Central to the efficacy of any regulated market is the rule of law — where good behavior is encouraged, and bad behavior punished,” Kingsley Wheaton, a British American Tobacco executive, said in the company’s statement. “We also remain deeply concerned that the F.D.A. continues to allow the proliferation of youth-appealing vapor products like Cotton Candy and Peanut Butter Cookie, which are flooding U.S. retail shelves. Companies in open defiance of the agency must be held accountable.”But Reynolds is contesting other restrictions. It has filed suit in California against the state’s new ban on flavored tobacco, after the state attorney general warned the company and another about marketing products that were said to have a “cooling” flavor.Yolonda Richardson, president of the Campaign for Tobacco-Free Kids, applauded the F.D.A.’s decision on Vuse, saying it was “one of the strongest actions the F.D.A. has taken to rid the market of illegal, flavored e-cigarettes and is a necessary step toward ending the youth e-cigarette crisis in the United States.”Alex Liber, a Georgetown University assistant professor and tobacco control policy researcher, recently worked on a paper linking flavored-vape bans to an increase in cigarette sales.He said the F.D.A. appeared to be on a path of authorizing only vapes that taste like a cigarette. The agency has rejected other menthol e-cigarette applications, deeming them too alluring to adolescents to outweigh the benefit to adults.“Whatever that bar and evidence is, I don’t think anyone has hit it,” Dr. Liber said. “I don’t know if F.D.A. knows what it looks like. I don’t know what that would be.”

Fecal microbe transplants from healthy donors can treat patients with recurrent Clostridium difficile infections. However, after tens of thousands transplants, little was known about which donor strains provide long-term engraftment, and which engraft early after the transplant. Most failures of fecal microbe transplantation occur in the first four weeks.
Recurrent C. difficile infections occur after suppressive antibiotic treatments that knock out almost all of the normal gut flora. Patients suffer watery diarrhea, painful abdominal cramps, a feeling of sickness, fevers and weight loss.
In 2021, researchers at the Icahn School of Medicine at Mount Sinai, New York, gave precise quantification of 150 bacterial strains belonging to 42 bacterial species that showed frequent engraftment after fecal microbial transplants. Importantly, they also tested for engraftment soon after transplant — 36 hours to four weeks — as well as later after transplantation, eight weeks to five years.
Now microbiome experts at the University of Alabama at Birmingham have taken that 2021 study, and a similar study for children who had C. difficile infections, a step further. UAB researchers Hyunmin Koo, Ph.D., and Casey D. Morrow, Ph.D., focused on the commensal microbe Bacteroides vulgatus, one of the most common species found in healthy guts. Using DNA sequences from the two studies and powerful bioinformatics analysis, Koo and Morrow searched for genes, out of a total of 4,911 protein-encoding genes in the B. vulgatus strains, that were unique to the three B. vulgatus donors in the two studies that showed early colonization, as opposed to seven other B. vulgatus strains in the studies that did not show early colonization.
“Analysis of the common genes between the three donors revealed that only 19 were in common out of 4,911 genes encoding known and hypothetical proteins,” Morrow and Koo write in the Scientific Reports study. “The result from our analysis supports the screening of donor B. vulgatus for this gene consortium to enhance colonization following a fecal microbe transplant.”
Morrow and Koo identified two of the 19 genes.
One is a putative chitobiase that the UAB researchers found was located next to genes encoding SusD, SusC, putative anti-sigma factor and RNA polymerase ECF-type sigma factor. Others previously have identified these genes as components of a commensal colonization factor complex in Bacteroides fragilis and B. vulgatus. This complex promotes a specific interaction with the host that facilitates stable, resilient colonization in mice.