Plague Rumors, Paperwork Cuts and Slower Clocks

This is the show-notes page for a podcast episode, not a written article. In episode XXXV of This Fortnight in Medicine, a 38-minute audio discussion, Adam Cifu, John Mandrola and Andrew J Foy take on two recent studies. The page gives the studies' titles and two linked commentary headlines. It has no effect sizes, sample sizes or conclusions, so this summary can only say what the episode covers and which way the hosts appear to lean.

Topic 1: Stopping colon cancer screening

The first paper is titled Colorectal Cancer and Mortality Risk Among Older Adults With vs Without Adenoma on Prior Colonoscopy. From the title, it compares later colorectal cancer and death rates in older adults by whether their earlier colonoscopy found an adenoma, a precancerous polyp. The clinical question behind it is whether an older patient's past findings should decide when surveillance colonoscopy can end. The episode summary frames this as "discontinuing colon cancer screening."

The hosts pair it with a commentary titled "The Hubris of Screening for Disease — Again." That title suggests they are skeptical of screening for its own sake. They probably lean toward screening older adults less, not more. The page doesn't give the study's results, so it can't tell you how much an earlier adenoma changes later risk.

The confirmed facts are limited. A scientist who worked in a Russian anti-plague lab died of pneumonia of unknown cause. Plague has not been confirmed, and Russia has released almost no official information. In Your Local Epidemiologist, Katelyn Jetelina and her colleagues Marisa Donnelly (an epidemiologist) and Liz Marnik (an immunologist) answer the questions circulating online.

On a 0–10 scale, the authors put their worry that this becomes something big at 1. Epidemiologists and biosecurity experts are concerned mainly about Russia's lack of transparency, not the pathogen itself. The authors say they would revise that number if more cases appear or if the organism turns out to have been altered in the lab.

How plague spreads and how it's treated

All three forms of plague are caused by the bacterium Yersinia pestis. Which form a person gets depends on how they were exposed. If the lab worker had plague, the suspected form is pneumonic plague. Plague still infects an estimated 1,000–2,000 people a year worldwide. It is endemic in places like Madagascar and occurs sporadically in the U.S.

Pneumonic plague is contagious, but it is not highly transmissible. It spreads through close or direct contact, such as caring for a sick person, and not through simply sharing a room. On average, each case infects one to three others. The standard public health response is:

Clinicians have said for months that immigrant patients are avoiding medical care during mass ICE raids, rising arrests and deadly encounters with federal agents. In February, a Minneapolis pediatrician told STAT there had been "a huge lapse in care." A study published Monday in JAMA Network Open tries to measure that.

What the study found

Researchers looked at visits to three Los Angeles emergency departments. Visits by people born outside the U.S. dropped "precipitously" after immigration enforcement increased last year. Over the same period, hospital admissions in that population rose.

Taken together, the two trends suggest people stayed away from the ER until their conditions were serious enough to need admission. The authors conclude that "heightened immigration enforcement may lead to avoidance of acute care among immigrant patients, with potential negative health and economic consequences for patients and the systems who care for them."

The limits matter. STAT's newsletter item gives no effect sizes, time windows or patient counts. The data cover only three hospitals in one city. The design is observational and compares before and after enforcement increased, so it shows timing, not proven cause. The authors' own wording ("may lead to") is appropriately cautious. Anyone who wants the actual figures will need the JAMA Network Open paper.

Also in the same STAT briefing

• Duchenne exon skipping: STAT's Jason Mast profiles two boys with Duchenne muscular dystrophy, ages 13 and 12. Only one is getting a newer Avidity therapy. It makes the cell's protein-building machinery skip the faulty exon, so each drug works only for patients with a specific mutation. The company delayed a trial of a candidate that would fit the other boy's mutation, and he is losing function.

National enrollment in the Supplemental Nutrition Assistance Program (SNAP) fell by about 5 million people, or 13%, between July 2025, when the One Big Beautiful Bill Act was signed, and June 2026. That figure comes from a Center on Budget and Policy Priorities analysis of federal data. Louisiana's drop was among the steepest: about 170,000 people, or 21% of enrollees. "We haven't seen a decline of this magnitude in about three decades," said CBPP's Joseph Llobrera. Over roughly the same period, USDA data show food prices rose nearly 3%.

How the law shrinks the rolls

The law widened work requirements, made those requirements harder for states to waive, and removed eligibility for many noncitizens with legal status. It also shifts costs to states, and that cost shift drives much of the decline.

• Starting Oct. 1, 2026, states pay 75% of administrative costs, up from a 50-50 split with USDA.
• Starting October 2027, some states will also pay part of the benefit costs, which the federal government has covered in full until now. A state's share rises with its payment error rate, meaning how often it overpays or underpays enrollees. Louisiana's error rate went from 6.62% in FY2024 to 8.14% in FY2025. The Food Research & Action Center estimates Louisiana could owe up to $199 million.

To push error rates down, states are asking applicants for more verification and asking more often. Llobrera argues this gives states a reason to deny applications. Understaffed agencies handling more paperwork on tight deadlines also make more processing mistakes. In Louisiana, 75% of people who lost SNAP from July 2025 to June 2026 lost it for : missed forms or interviews, failure to recertify, notices that arrived late by mail or went to the wrong address, and caseworker backlogs. Tia Fields of Invest in Louisiana says many of these families are still eligible.

The study was a randomized trial in sedentary breast cancer survivors diagnosed within the previous five years. One arm got a remotely delivered exercise program. The other got a health and wellness program with the same amount of contact. Researchers took blood samples and ran cognitive tests at baseline, 6 months and 12 months.

What the trial found

This paper is a secondary analysis of a subsample of 124 participants who had complete data. Over 12 months, the exercise arm showed slower epigenetic aging than the control arm on two DNA-methylation clocks: GrimAge2, which was built to predict mortality, and DNAmFitAge, which is calibrated to markers of physical fitness.

Changes in epigenetic age tracked changes in cognition. Participants whose clocks sped up more had larger declines in attention and in self-reported cognitive function. A genome-wide scan of blood methylation also found CpG sites that differed between the arms. Some of them map to genes enriched in brain-derived neurotrophic factor (BDNF) signaling, a pathway involved in neuron growth and survival. That gives a possible biological link between the methylation changes and the cognitive results.

Caveats

The summary reports no effect sizes, either in years of epigenetic age or in cognitive test points, so the size of the benefit is unknown. The analysis covers only completers from a larger trial, which can bias results. Epigenetic clocks are surrogate markers. Slowing them has not been shown to extend life or prevent disease. The link between clock changes and cognition is a correlation, even though the exercise assignment itself was randomized.