Tag Archives: health

Calamitous Impact of U.S. Withdrawal from Gavi Funding

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Stephanie Nolen, NY Times 6/25/25: Kennedy Withdraws U.S. Funding Pledge to International Vaccine Agency

An excerpt:

The United States will withdraw its financial support of Gavi, the global organization that helps purchase vaccines for children in poor countries, Robert F. Kennedy Jr., the United States secretary of Health and Human Services, told the group’s leaders on Wednesday, accusing them of having “ignored the science” in immunizing children around the world…

“Any decision made by Gavi with regards to its vaccine portfolio is made in alignment with recommendations by the World Health Organization’s Strategic Advisory Group of Experts on Immunization (SAGE), a group of independent experts that reviews all available data through a rigorous, transparent and independent process,” Gavi’s statement said…

Dr. Atul Gawande, a surgeon who led global health work in the Biden administration, called Mr. Kennedy’s remarks “stunning and calamitous…”

The United States was the largest donor to Gavi, whose work is estimated to have saved the lives of 17 million children around the world over the past two decades…

Gavi had hoped to raise $9 billion for the 2026-30 period, funds the organization said would allow it to purchase 500 million childhood vaccinations and to save at least eight million lives by 2030. ..

The decision to end U.S. support for Gavi — which was included in the rescission package passed by Congress and now being considered by the Senate — leaves the organization with an immense hole in its budget…The Gates Foundation is maintaining its funding at a stable level from previous years — about $350 million in each of the next four years — as is the United Kingdom.

My take: It is no exaggeration to say that the shift in U.S. vaccine policy may result in hundreds of thousands of deaths every year. In addition, U.S. travelers will be more likely to be exposed to vaccine-preventable illnesses as well.

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Non-Invasive Studies Often Fail to Detect Advanced Liver Fibrosis in Steatotic Liver Disease

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N Ravanbakhsh et al. JGPN 2024; https://doi.org/10.1002/jpn3.12368. Comparing imaging modalities in the assessment of fibrosis in metabolic dysfunction-associated steatotic liver disease

Key findings:

  • TE and MRE did not have high correlation with liver biopsy in the detection of high-grade fibrosis
  • Fibrosis was identified in 90% of liver biopsies with bridging fibrosis in 15 (19%) and cirrhosis in 1 (1%)
  • AUROC curves of MRE and TE for detection of high-grade fibrosis were 0.817 and 0.750, respectively, and not significantly different.

The authors note that previous adults studies suggest that MRE is more accurate in the identification of liver fibrosis than TE (MRE detected ≥ F1 fibrosis with an AUROC of 0.82, while TE detected fibrosis with an AUROC of 0.67).20 

My take: Trying to identify accurate non-invasive testing is crucial to help identify patients most in need of treatment and for limiting costs.

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Opportunity Costs with Auricular Stimulation in Adolescents with Irritable Bowel Syndrome

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E Shah et al. JPGN 2024; 78: 608–613. Percutaneous electrical nerve field stimulation for adolescents with irritable bowel syndrome: Cost‐benefit and cost‐minimization analysis

Background: “Despite its favorable efficacy and safety profile, access to PENFS and other modalities in IBS can be limited by insurance coverage.”

Methods: The authors performed an economic analysis to estimate cost‐savings for patients’ families and healthcare insurance, and health outcomes, based on abdominal pain improvement with percutaneous electrical nerve field stimulation (PENFS) with IB‐Stim® (Neuraxis). The authors created a a Markov model.

Key findings:

  • PENFS was associated with 18 added healthy days over 1 year of follow‐up, increased annual parental wages of $5,802 due to fewer missed work days to care for the child, and $4744 in cost‐savings to insurance
  • Important Limitation: The economic benefits that derive from the clinical improvements used in this analysis are based on a small prospective cohort study of 20 patients with up to 1 year of follow‐up

My take: It appears that auricular stimulation should be positioned earlier in treatment algorithms for adolescents with IBS based on safety, and efficacy, especially if cost is not prohibitive.

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An easy tool to assess cardiometabolic risk

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There are a large number of anthropometrics to assess nutrition; however, simplifying the assessment would facilitate broader usage.  To that end, a recent publication suggests that checking triglyceride level and waist circumference is helpful to identify cardiometabolic risk (J Pediatr 2013; 162: 746-52).

This study used a cross-sectional design; anthropometrics, biochemistries, and cardiorespiratory fitness were assessed in 234 participants between 10-19 years of age.

Specific measurements included the following: weight, height, waist-to-height ratio (WHTR), lipid panel, blood pressure, and a cardiorespiratory fitness (CRF) as assessed by a progressive cycle ergometer tests.  The authors defined a HW or hypertriglyceridemic waist phenotype characterized as having a triglyceride ≥110 mg/dL and a waist circumference ≥ 90% for age/sex.

Key findings:

  • Participants with the HW phenotype were unlikely to have a high CRF (OR 0.045).  In addition, they had a high likelihood of elevated LDL (OR 4.41), impaired fasting blood glucose (OR 3.37).
  • Those with high WHTR were at higher odds for having low HDL (OR 2.57), high diastolic BP (OR 3.21) compared with normal WHTR participants.