February 21, 2023
Reporter, Morning Rounds Writer
Good morning. Today, Olivia Goldhill investigates the nine-question screening tool for depression and its outsized influence on mental health care.

a stat investigation

How a depression questionnaire, developed to market Zoloft, props up a failing mental health system


Eros Dervishi for STAT 

Did you know that the nine-item depression questionnaire you fill out before your doctor’s visit was devised by a marketing maven, not a medical expert? More than 20 years ago, Howard Kroplick pitched the concept to the scientific creators of Zoloft and to Pfizer, which funded their work on one of a new generation of antidepressants called SSRIs. “It wouldn’t have happened if it wasn’t for me,” Kroplick told STAT’s Olivia Goldhill, speaking publicly for the first time about how he came up with the idea. 

What came next was beyond what he could have imagined. The quiz, called the PHQ-9, can funnel people toward antidepressant medication without evaluation that might reveal other mental health issues, like ADHD, that can lead to high scores. Read more on how this tool has become a crutch — used in place of, rather than as a gateway to — thoughtful mental health care.

in the lab

In two patients, an experimental device restored hand movement after stroke

A new study in Nature Medicine shows that stimulating the upper spine improves arm and hand movement in patients who’ve had strokes. The study had only two patients, but experts say it points to the growing potential for spinal cord stimulation. The therapy, known for easing chronic pain, has also recently been studied in patients paralyzed by spinal cord injuries

A stroke weakens connections between brain cells and spinal circuits, so the idea behind the therapy is to stimulate those circuits. After treatment, both study participants did better at tasks like grasping a soup can — but the effects wore off, meaning more research is needed. “I’ll be first in line for anything,” participant Heather Rendulic told STAT’s Lizzy Lawrence. Read more.


Cereal, pasta, and other food companies push back on what FDA calls 'healthy' 


Alissa Ambrose/STAT

Guess we should have seen this coming. Last fall, the FDA published new guidelines about which foods can be labeled “healthy,” requiring a certain amount of nutritious ingredients like fruits and vegetables, and to have little added sugar, sodium, and saturated fat. General Mills, Kellogg’s, and other cereal makers don’t like that. Packaged food companies and the pasta industry are mad at the FDA, too.

Even backers of more stringent nutrition policies acknowledge that most foods Americans eat won’t be able to earn the label. “Hardly anything would qualify, so of course food manufacturers don’t like the idea,” Marion Nestle, an emeritus professor of nutrition and public health at New York University, told STAT’s Nicholas Florko. Read more on what the backlash might mean. 

Closer Look

A battle between Vertex and insurers leaves CF patients in the middle

cysticfibrosis0610Kim Raff for STAT

Last year, Dan Brickey (above, with his 2-year-old daughter Ali) found out that the annual cost of Ali's cystic fibrosis medicine was set to climb from just $180 out of pocket to a whopping $43,600 in 2023. That’s because the drug’s maker, Vertex Pharmaceuticals, decided to slash the financial assistance it offers to patients. “They put a price on our daughter’s life,” Brickey said.

Other patients and their families may also soon encounter problems resulting from a behind-the-scenes struggle between pharmaceutical companies and U.S. health insurers. But the decision by Vertex to reduce its annual copay assistance for cystic fibrosis treatments — in this case, from approximately $100,000 a year to $20,000 — marks the first time a major pharmaceutical company has taken such a drastic step. STAT’s Ed Silverman has more on the battle to control how medicines are paid for in the U.S.


After the train crash in Ohio, concerns about 'a witch’s brew of chemicals'

If you’ve seen coverage of the train derailment in East Palestine, Ohio, then you’ve seen images of the smoke rising upward like a funnel cloud from the wreckage. In order to avoid an explosion, officials intentionally released and burned vinyl chloride gas from train cars, days after chemicals had spilled on the ground and into waterways. Two weeks later, many questions are still unanswered about exposure to toxic chemicals in the small town and along the Ohio River.

STAT contributor Jill Neimark breaks down what chemicals the train was carrying, what happened when they burned, and what harm they may pose. Among those causing concern is the carcinogen dioxin. “I’m certain from the view of that black smoke plume that it was a witch’s brew of chemicals on fire, and I’m quite certain dioxins would be among them,” said Ted Schettler, science director at the environmental nonprofit Science and Environmental Health Network. Read more. 


Disordered eating behaviors show up in 1 in 5 children and teens, analysis says

More than 1 in 5 children and adolescents have eating behaviors that could evolve into eating disorders, an analysis of 32 studies including 63,000 participants in 16 countries on five continents concludes. The study in JAMA Pediatrics is based on responses to a five-question screening tool that asks if young people make themselves sick if they feel too full or if they think they’re fat when others say they’re too thin, for example. 

The diagnostic bible known as the DSM-5 says the prevalence of eating disorders among 11- to 19-year-olds is 1.2% for boys and 5.7% for girls. The new study also showed disordered eating was more common among girls, older children, and those with higher BMIs. Emphasizing that these behaviors aren’t the same as eating disorders, the authors do say they lead to greater risk of poor health and psychiatric problems.

by the numbers

feb. 20 cases covid-chart-export - 2023-02-20T124237.184

feb. 20 deaths covid-chart-export - 2023-02-20T124307.749


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