Ozempic for weight loss, Zepbound JAMA study, new sickle cell treatments and Medicare payment cuts

. 12 MIN READ

AMA Update covers a range of health care topics affecting the lives of physicians, residents, medical students and patients. From private practice and health system leaders to scientists and public health officials, hear from the experts in medicine on COVID-19, medical education, advocacy issues, burnout, vaccines and more.

Tips to stay safe this holiday season from COVID, flu and RSV, plus a look at some of the biggest stories over the last week and throughout year. AMA's Vice President of Science, Medicine and Public Health, Andrea Garcia, JD, MPH, discusses the new bill that would cancel the 2024 Medicare payment cuts for physicians, the FDA-approved sickle cell disease treatments, the CDC health alert about Rock Mountain spotted fever, the latest weight-loss drug trends and more. AMA Chief Experience Officer Todd Unger hosts.

Speaker

  • Andrea Garcia, JD, MPH, vice president, science, medicine & public health, American Medical Association

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Unger: Hello and welcome to the AMA Update video and podcast. Today, we have our weekly look at the headlines with the AMA's Vice President of Science, Medicine and Public Health, Andrea Garcia. I'm Todd Unger, AMA's chief experience Officer. Welcome back, Andrea.

Garcia: Hi, Todd. It's great to be here.

Unger: I want to start off with one of the major topics of discussion from this past year, and that is the continued decline in Medicare payment for physicians, who are looking at yet another cut in January. But a newly introduced bill could change that. Andrea, tell us more about that.

Garcia: This was a really encouraging development earlier this month. As you mentioned, physicians are facing another cut to Medicare payment in the New Year. That cut is 3.37%, and it's the result of the 2024 Medicare physician fee schedule.

The new bill is H.R. 6683. That's the Preserving Seniors' Access to Physicians Act. And that bill would eliminate the cut entirely. The AMA is in full support of the bill, and we're actively working to build bipartisan support for it.

The AMA has warned numerous times that declining Medicare payments have reached a breaking point. They're putting physicians in an impossible situation and forcing some practices to close, because they can't afford to stay open. We really encourage physicians and patients to contact their representatives and urge them to support this bill. It really only takes a couple of minutes.

In the episode description, there is a link to a page on fixmedicarenow.org. It has a draft letter to Congress about H.R. 6683. All you need to do is enter your contact information and push Send.

Unger: Thank you so much, Andrea. Of course, if you've been hearing anything coming from the AMA this year, you know that Medicare payment reform is at the top of the list on the Recovery Plan for America's Physicians. You can find out more about the work that we've been doing there at ama-assn.org/recovery.

And as Andrea said, and we've heard multiple times throughout the year, your stories and your voice matter so much. So please, go to fixmedicarenow.org and use that pre-written letter to communicate with your Congressperson about H.R. 6683. Andrea, thank you so much for that.

It really does just take a few minutes, so please take the time to do that. Andrea, let's move to another big topic that we've covered, that has been in the news for the past few weeks. And that is about sickle cell disease and an announcement from the FDA about two new treatments. Tell us more about what physicians need to know.

Garcia: Yeah, Todd, this was truly a milestone. The FDA has approved two gene therapy treatments for sickle cell disease, including the first gene therapy that uses the gene-editing technique, CRISPR. One therapy is called Casgevy, which is the CRISPR-based treatment. It's made by Vertex Pharmaceuticals and CRISPR Therapeutics.

The other is called Lyfgenia, which is made by Bluebird Bio, and it uses an older gene therapy approach. Both were approved by the FDA for people 12 and older with a history of vaso-occlusive crises, which are painful events caused by the disease. Previously, we know that the only cure for sickle cell was a bone marrow transplant.

However, more than 80% of patients were often not able to find a matching donor. So these new treatments bring a lot of hope to people who we know are suffering from this disease and offer another potential cure.

Unger: Wow, what an advance. I think we'll want to dig into that a little bit more in a future episode. Andrea, after this announcement from the FDA, there was also a lot of discussion about how accessible these treatments are going to be. Tell us more about that.

Garcia: Well, as we know, approval doesn't always equate to access. And there are a couple of things to consider here. First, these new treatments are not for everyone. Patients will have to undergo chemotherapy to rid their bodies of any native stem cells that might remain in their bone marrow to make way for the re-engineered ones, so given that this treatment might physically not be appropriate for patients that are elderly or frail.

I think second—as is often the case, there's a potential cost barrier. We know Casgevy will be priced at $2.2 million, and the wholesale price for Lyfgenia is 3.1 million. It's an open question right now, just how much insurers will cover for these treatments.

One additional complication is, over half of the people living with sickle cell are lower-income individuals on Medicaid. We do know, in September, the Biden administration did launch an effort to expand access and coverage for services related to sickle cell. That's certainly a promising development, but it's too early to know how everything will play out and this is something that we're going to have to keep an eye on in the months to come.

Unger: We certainly will keep an eye on that. Those are some big numbers. Andrea, another story that's making headlines is a new health alert from the CDC—not about COVID but about something different—Rocky Mountain Spotted Fever—unexpected. What do we need to know there?

Garcia: Yeah, Todd, there's been an outbreak of this among people in the U.S. who travel to Tecate, Mexico. Five patients have been diagnosed with Rocky Mountain Spotted Fever since late July. These cases were identified in southern California. All five of these patients were hospitalized. Three of them died.

Rocky Mountain Spotted Fever is a severe illness and it progresses rapidly. It's transmitted by the bite of infected ticks. It's often deadly. In this health alert, the CDC notes that doxycycline is the treatment of choice for patients of all ages. It also advised physicians to consider Rocky Mountain Spotted Fever in their differential diagnosis of patients who've recently traveled to Mexico or other areas of northern Mexico and then developed symptoms of unexplained severe febrile illness.

Unger: Absolutely. Well, thank you for that important overview, Andrea. Let's shift gears a little bit here and talk about another major topic of discussion for this entire year, and that has been weight loss drugs. Recently, a few stories shed light on the experience of patients using these drugs. Andrea, what trends are we seeing?

Garcia: Well, one trend that is playing out is in poison control centers across the country. And they're seeing a nearly 1,500% increase in calls that are related to semaglutide. And for reference, that is the drug sold as Ozempic, which we know is approved for the treatment of diabetes, and Wegovy, which is approved for weight loss.

These calls to poison control centers are because people have accidentally overdosed on the drug, such as by taking a double dose or a wrong dose. And as a result, people have needed to be hospitalized for severe nausea, vomiting and stomach pain. These cases seemed to resolve after the patients were given intravenous fluids and medications to control nausea.

Unger: All right. So important—follow those instructions. Andrea, is there another trend that you're seeing out there?

Garcia: So I think one of the main questions about these drugs has been whether you can eventually stop taking them or if they're going to be a lifelong commitment to maintain weight loss. And there was a new study in JAMA that has some initial answers. And that study looked at what happened after patients stopped taking Zepbound, which is made by Eli Lilly.

They were also the sponsor of this study. The results were inconclusive, but there were a few interesting takeaways that I think could help inform future research. After 36 weeks of using Zepbound, participants in the study saw a mean weight reduction of 20.9%.

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Those who were then switched to a placebo saw about a 14% weight regain, while those who continued taking Zepbound saw an additional 5.5% weight reduction. There's obviously a lot of nuances in those results, and the experience of people in each group was not uniform. But there certainly needs to be more research in this area, and we'll continue to share updates as we see them.

Unger: All right. We'll track that study—or story—as it develops. Andrea, last week, we also talked about a big barrier on the COVID front, which is low adoption rates for the updated COVID vaccine. But that's not the only vaccine that we're seeing low demand for. Why haven't more older adults gotten the RSV vaccine?

Garcia: That's a good question, Todd. And if we look at the latest CDC data, only about 15.9% of people in the U.S. over 60 have received an RSV vaccine. And if we want to put that vaccination rate into context, it's significantly lower than the uptake for flu vaccine and it's even lower than the vaccination rate for COVID, which is just over 17% in adults and about 36% in those 65 and older.

It's hard to see for certain why that rate is not higher. It could certainly be because the RSV vaccine is still new. A survey from the National Poll on Healthy Aging showed that half of people between the age of 60 and 80 haven't heard of the RSV vaccine.

So there's still low awareness of the vaccine itself. And beyond that, there's low awareness of the threat that RSV poses to older people. We know that historically, RSV has been talked about as a threat to infants.

It is estimated that RSV is responsible for 6,000 to 10,000 deaths per year in people aged 65 and older. So physicians should talk to their patients about the RSV vaccine if they haven't already.

Unger: Absolutely. So I think you mentioned two important things—just awareness of the risk that RSV poses for older adults and for, obviously, young children as well as the availability itself of the new vaccine. Andrea, on the topic of getting vaccinated, this is the last time we'll talk before the holidays, which are a risky time, of course, for respiratory illnesses. Do you have any final advice for folks out there on how to stay safe over the holidays?

Garcia: Well, Todd, number one is get vaccinated for flu, COVID and RSV if you are eligible. And yes, it does take time for the vaccines to take full effect. But it is absolutely not too late to get vaccinated. I think also remember the steps that we took to stay healthy during the pandemic.

If you are sick, stay at home. Test yourself for COVID. We've talked before about those best practices to get accurate results on a rapid antigen test, and we'll link to that episode in the description as well.

If you test positive, remember that there are antiviral medications for flu and COVID. And when you're in public indoor spaces, consider wearing a well-fitted mask or respirator, such as an N95. Lastly, if you're gathering with family and friends, find ways to improve ventilation if you can.

For example, if the weather permits, open a window or two. There are definitely some easy things that we can do to try and stay safe. We want everyone to have a wonderful holiday season. And taking these precautions will help you stay healthy as you celebrate.

Unger: And I'll second that for everybody out there. Have a very healthy and happy holiday season. Andrea, it's been a pleasure talking to you all year long, and thank you so much for keeping us up to date this year.

I'll see you in the New Year. If you enjoyed this discussion, you can support more programming like it by becoming an AMA member at ama-assn.org/join. That wraps up today's episode. We'll be back in the new year with another AMA Update, and in the meantime, you can find all our videos and podcasts at ama-assn.org/podcasts.

Thanks for joining us and being with us all year long. Appreciate it. Take care everyone.


Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.

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