first opinion

How one doctor incorporates his own cancer into teaching

Adobce

David Elkowitz was diagnosed with thymic cancer in 2017. For three days after his first biopsy, he was silent, unable to speak. Only after his oncologist opened up about her cancer was Elkowitz able to communicate again. “She was not obligated to be so open, but her humility unlocked me,” he writes in a new First Opinion essay. “From that moment, it became a no-brainer to present my own journey to medical students.”

Nearly a decade later, Elkowitz shares his personal experience when he teaches first years about the structure of cancer. He presents his own tumors, test results, and treatments. Read more about how he tries to make medicine feel real to future physicians.

notable quotable

‘It will knock you out no matter what, you couldn’t even fight it’

That’s how a 31-year-old woman described medetomidine, a sedative that has been increasingly contaminating the illegal fentanyl drug market for the past two years. A paper published Monday in the Annals of Internal Medicine recounts 16 patient experiences with the tranquilizer. Participants told researchers the drug is so powerful, it’s typical to pass out after using. In public, this increases a person’s risk of being robbed or assaulted. Medetomidine withdrawal is known to be excruciating, with an elevated heart rate and blood pressure that can, in severe cases, be life-threatening.

These are not particularly novel findings — in my first week on the addiction beat, I’ve learned that research is often a few steps behind drug users and clinicians when it comes to identifying such trends. That problem is intensified by the rapid shifts in the illegal drug supply. “It is the constant change of molecules that resets the harm for every generation, every few years,” epidemiologist and harm reduction advocate Nabarun Dasgupta recently told me. Re-read Lev Facher’s explainer on medetomidine from last year, and another great piece from STAT contributor Hannah Harris Green on how jails are on the front line of addressing this new, complicated type of withdrawal.

health tech

Medicare expands experimental tech program

Last year, Medicare officials announced a new, experimental program that will pay approved technology companies to manage chronic conditions like diabetes, high blood pressure, depression, and anxiety. It’s barely begun, but as STAT’s Mario Aguilar reported yesterday, regulators are already moving to expand the conditions eligible for the model. Yesterday, they announced the addition of substance use disorder, heart failure, tobacco use, and more.

The idea behind the model is to introduce outcome-aligned payments, in which providers are paid more if their patients’ conditions improve. Read more on which providers have been approved to participate so far, and which opted not to enroll.