Same Evidence, Opposite Conclusions

Sensible Medicine ran a written debate, introduced by Adam Cifu, after Vinay Prasad said in an FAQ that a healthy pregnant woman in 2026 should "absolutely not" get a COVID-19 vaccine. David Rind, an internist at Beth Israel Deaconess and chief medical officer of the Institute for Clinical and Economic Review (ICER), disagreed.

Rind: small benefit, a plausible mechanism, and better timing

Rind says the mRNA vaccines saved lives in 2021, but most people now have some immunity, so the absolute benefit today is much smaller. ICER's July 2026 report estimated that vaccination might cut hospitalizations among younger adults from about 20–40 per 100,000 by roughly 6 per 100,000. For adults over 65, the estimate is a reduction of 75 hospitalizations and 22 deaths per 100,000. Rind calls the evidence that vaccination reduces transmission "relatively unconvincing."

His case for pregnancy rests mostly on protecting infants under 6 months, who are hospitalized for COVID at higher rates than any age group until 75. He admits the support is , which ranks low as evidence. Vaccinating early in the third trimester gives the highest antibody levels in cord blood. Higher antibody levels track with better infant protection, a dose-response pattern. Observational data also show that flu and pertussis vaccines given in pregnancy protect young infants.

Los Angeles County's public health department treats medical debt the way it treats tuberculosis, as something to stop before it spreads. It is now working with local hospitals on a shared system that would screen every patient for financial aid automatically, with no application needed. Naman Shah, the physician and epidemiologist leading the effort, estimates it could prevent several hundred million dollars of medical debt a year. That figure is his projection, not a measured result.

The problem and the mechanism

About 100 million US adults have some healthcare debt. County officials estimate 800,000 LA residents have medical bills they can't pay, which Shah says is more people than are affected by asthma or tobacco use. Hospitals usually offer charity care to low-income patients, but research shows many eligible people never apply. The information is hard to find and the forms are cumbersome. Hospitals then spend money chasing debt they will never collect. "They're turning their wheels," said Adena Tessler of the Hospital Association of Southern California.

The fix is presumptive eligibility. Software checks public data such as credit history to estimate whether a patient qualifies, and grants aid without an application. Shah says hospitals that use it have reported up to a 50% increase in the financial aid they give out. A California law passed last year requires every hospital in the state to screen this way by next July. Today only about 1 in 5 LA County hospitals do, mostly because the systems are expensive and hard for smaller hospitals to set up.

How the county is paying for it

This is an opinion piece by three Rhode Island public health clinicians and leaders: Philip Chan, Alan Epstein and Amy Nunn. Their case is that the U.S. has the same hepatitis C cure as Europe but has fallen behind on getting it to patients.

The tools exist

Hepatitis C is a bloodborne virus that infects the liver. Some people clear it on their own. Most who don't face a real risk of cirrhosis and end-stage liver disease, and hepatitis C is the second most common reason for a medically necessary liver transplant, after alcohol-related liver disease. Infection is often silent for years, so many people are diagnosed only once serious damage shows up. Today's once-daily pills have few side effects and cure more than 95% of chronic infections in 8 to 12 weeks.

What England did

The authors say successful national campaigns, including those in England, Egypt and Norway, did two things: more routine testing, aimed especially at high-risk groups, and cheap or free medication. England's version included:

• Opt-out testing for HIV, hepatitis B and hepatitis C in emergency departments
• Mobile testing vans and care teams sent to underserved communities
• Free at-home test kits for anyone who asks
• Free, fast prescriptions through the NHS for anyone who tests positive

England is aiming for elimination by 2030 and has already hit its goal of treating 80% of infections. Hepatitis C deaths have dropped 36% over the past decade. Among people who inject drugs, prevalence fell from 28.6% in 2015 to 5.2% in 2024.

Where the U.S. stands

The CDC has named Dr. Mina Zadeh acting chief of staff. Her leadership page was updated October 7. On paper she is a longtime career official, with a doctorate in evaluation, an MPH in international health and epidemiology, and a microbiology degree. Six current and former colleagues interviewed by Jeremy Faust of Inside Medicine describe her differently. In their account, she rose quickly from mid-level staff to agency leadership because she was willing to carry out HHS Secretary Robert F. Kennedy Jr.'s agenda. Most of these sources are anonymous. The one named critic is Dr. Demetre Daskalakis, former director of the CDC's National Center for Immunization and Respiratory Diseases.

The ACIP record

Last year Zadeh was the Designated Federal Official for the Advisory Committee on Immunization Practices (ACIP) after Kennedy replaced its members. That made her the CDC's liaison to the committee and its outside partners. Those members and their changes to pediatric vaccine recommendations have since been removed, on the grounds that the appointees were not screened for qualifications as the law requires.

While she held the role, two things happened:

• Kennedy's office ordered the CDC to pull a report by its own scientists that found thimerosal in vaccines was not harmful.
• A longtime anti-vaccine ally of Kennedy gave a presentation to the committee that skipped the CDC's required fact-check by subject-matter experts. It reached the opposite conclusion on thimerosal.

The adult mammalian heart barely regenerates. After a heart attack cuts off blood supply to part of the muscle, the damaged area heals as fibrotic scar. The scar disrupts the heart's structure and function and starts many patients on a decline toward death. A new paper looks at one metabolic control point in that healing process: succinate dehydrogenase (SDH), the mitochondrial enzyme complex that links the TCA cycle to the electron transport chain.

What the researchers did

The group had already reported that briefly blocking SDH with the drug malonate promotes regeneration after myocardial infarction. Malonate is already known from ischemia-reperfusion research, where it limits succinate buildup and the burst of mitochondrial reactive oxygen species when blood flow returns. The group's reasoning came partly from cancer: tumours with SDH mutations switch to glycolysis-heavy, Warburg-like metabolism. They hypothesised that a short SDH block might push heart cells into a similar, more regenerative state.

To find out which cells matter, they deleted the Sdhb subunit of SDH in one cell type at a time:

• Cardiomyocyte-only deletion briefly increased heart muscle cell proliferation but did not improve heart function after infarction.
• Myofibroblast-only deletion reduced myofibroblast activation and fibrosis, and did improve cardiac function.

Mechanism

The team combined single-nucleus RNA sequencing, ATAC-seq for chromatin accessibility, and CUT&RUN for histone marks. They found that SDH inhibition pushes mitochondria toward reductive metabolism and changes chromatin marked by H3K4me3 and H3K27me3 in both cardiomyocytes and fibroblasts. The authors describe this as a metabolic-epigenetic switch: a change in mitochondrial metabolism alters which genes are open for transcription, and this differs by cell type. They call SDH a "multicellular regulator" of cardiac repair.