AT THIS HOUR

82: The percent of 50-65 year olds who admit they are very interested in getting testing to help get a baseline for heart attack risk. Some tests are still not covered by insurance, like the CT calcium score, but there is progress in these predictive analytic tests that suggests coverage will expand. People with no doubt get the tests and doctors will prescribe them, the question is will behavior change based on the answers? One test analyzes changes in fat surrounding the heart on a routine cardiac CT scan. The test uses artificial intelligence to generate an individualized heart-failure risk score at least five years before onset, according to University of Oxford researchers. In a cohort of 70,000 patients, the highest-risk group was about 20x more likely to develop heart failure than the lowest-risk group. 

Science: In 2025, the FDA approved the first blood tests for diagnosing Alzheimer’s disease in adults 55+ with cognitive symptoms. These ~90-95% accurate tests detect amyloid plaques, reducing reliance on invasive spinal taps or expensive PET scans. The tests are becoming popular, prescribed sometimes without meaningful symptoms by some doctors and telehealth companies for as little as a few hundred dollars. “People are concerned about their memory - it’s become a consumer test - and there is growing concern among clinicians, health insurers and advocacy groups that the overuse of testing is leading or will lead to unnecessary use of infusion treatments. The story here.

Sport: In my run at the Boston Marathon this Monday I’ll be playing this 8-minute documentary clip over and over to help me make it through the pain of each mile. It’ll be a good reminder why I’m running to begin with:

Policy: There is growing support for doing transcranial magnetic stimulation (TMS) to address severe depression over an accelerated 1 week period, using about 35-50 short sessions that help patients get to a better place without reliance on antidepressants. There are usually steps before insurance will cover the therapy - which can cost around $12,000 - but some of those steps are eroding. Cigna, for one, has removed pre authorization, while some insurers now allow TMS for people with OCD and even older teens, if necessary.

Perspective: About this time each year I’d sit down over a beer and a pretzel to talk shop with James - he was a good man, remarkable in many ways, and an advocate for helping kids change behavior for good, and manage through their early years with an autism spectrum disorder. Essay here.

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