Thursday Shorts: MH parity, mpox, RSV, race-based algorithms and Body Roundness Index

September 19, 2024

1. Final mental health parity regulations published

The Biden Administration published new mental health and substance use parity regulations under the Mental Health Parity and Addiction Equity Act (MHPAEA) on Monday. These focus on network adequacy and prior authorization, and subjects non-federal government employers to these regulations. Here is the fact sheet from the Department of Labor.

2. RSV vaccine is highly effective

A study in JAMA last week demonstrated that the new respiratory syncytial (RSV) vaccine is 79% effective in preventing hospitalizations in those over age 60. The vaccine is recommended for those over 75 or those over 60 at increased risk of respiratory complications and does not require a booster at this point. RSV vaccine is also recommended for women between 32-36 weeks of pregnancy from October to January. This offers the newborn protection against RSV, a major cause of hospitalization of infants each winter. The vaccine is safe in pregnancy and is less expensive - and about as effective - as treating babies with a monoclonal antibody to protect them from RSV.

3. Mpox mRNA vaccine promising in early trials

A messenger RNA vaccination to prevent transmission of mpox was more effective in preventing transmission of mpox among primates than the Jynneos vaccine in current use. It will still be a long time before this vaccine will be available for use in humans. Manufacturers can more quickly ramp up production of the mRNA vaccines, so this is welcome news.

Here’s a link to a recent post and an article we published on mpox in Harvard Business Review in 2022.

4. More reporting on the adverse effect of race-based algorithms on health equity

Race-based clinical treatment algorithms have historically made health equity worse for minorities. I wrote about this in June, when a study was published that showed race-based algorithms led to Black veterans receiving lower (or no) disability payments. StatNews has done excellent reporting on this issue, and last week had an another insightful article on a race-based algorithm that has led to underdiagnosis of urinary tract infection in Black infants. The US Department of Health and Human Services will prohibit the use of race-based algorithms in hospitals that receive federal funds as of May, 2025, although it’s not clear how this will be enforced.

StatNews has also published a database of race-based algorithms. This is incomplete, as many clinical rules were developed locally in different health care delivery systems but gives us a sense of how much work needs to be done.

5. Body Roundness Index for obesity

The Body Mass Index (BMI) is a deeply flawed measure for obesity, but I noted in a July post that the alternatives were problematic. Here’s a link to an article from the New York Times on growing support for adopting the Body Roundness Index (BRI) as an alternative to BMI. The formula is complex and not in wide use at this point. Here is a calculator.

Thanks for reading! Hope you’ll subscribe to this newsletter,  and please hit the "like" button.  Please also recommend to friends and colleagues - it's free. You can find previous posts at this link. 

I’m on vacation (in Yellowstone), so my next regular post will be on September 27.
Thanks for reading!