FDA CBER, ACA subsidy fallout, cyclosporiasis: Morning Rounds

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Good morning. I dedicate the first item in today’s newsletter to a friend who is suffering from what she suspects to be cyclosporiasis. Feel free to forward this email to your friends who need information but are scared to wade through online discussions on the outbreak. 

What to know about the parasitic diarrhea outbreak

You’ve probably seen the memes about a parasitic illness called cyclosporiasis, better known for its accompanying intestinal unrest and diarrhea. As of yesterday, 1,645 cases have been lab-confirmed in the U.S., with more than 5,100 cases pending further analysis, according to the CDC — substantially higher than normal. Federal health officials still do not know what type(s) of produce or which suppliers the outbreak may be linked to, but going forward will offer updates “at least weekly,” according to Gwen Biggerstaff from the agency’s Division of Foodborne, Waterborne, and Environmental Diseases.

Part of the trouble with tracing potential sources of the illness is that it can take up to two weeks after exposure for symptoms to appear. Officials in Michigan (one of four states the CDC suspects to be part of a major cluster in the outbreak) issued a tentative warning this week that lettuce or salad greens may be involved. The Washington Post reported yesterday that Taco Bell is being investigated. Generally, federal officials advise that people rinse and cook their fresh produce before consuming to stay safe. Read more in a new First Opinion essay about why we still don’t know the source of the outbreak and how consumers may be haphazardly filling the information vacuum.

The fallout from the end of extra ACA subsidies

The country’s biggest hospital chain lowered its profit outlook for the year yesterday after treating more uninsured patients than expected in the second quarter. Many of those patients had dropped their Affordable Care Act plans after losing enhanced subsidies, HCA Healthcare said, an early indicator of the fallout from the expiration of ACA enhanced premium tax credits in January.

The company said it lost roughly $400 million in income because of the expiration of the ACA subsidies in the second quarter alone. Read more from STAT’s Tara Bannow on what this signals for hospital profits in the future, especially with looming Medicaid work requirements.

‘I am with you on planet Earth’

That was Karim Mikhail, acting director of the FDA’s Center for Biologics Evaluation and Research, speaking to staff at a recent town hall. It’s not something a federal official would normally need to say explicitly, but the previous CBER leader, Vinay Prasad, was a mercurial leader who operated decidedly outside the norm. Read more from STAT’s Lizzy Lawrence on Mikhail’s more even-keeled approach to drug regulation, and how he’s been received by staff so far.

Scientists rebuke proposed changes to grant funding

In late May, the White House released a sweeping proposal to overhaul how federal grants and contracts are doled out. The new rules would empower the Trump administration to override the recommendations of peer reviewers, terminate grants at will, and exercise more latitude in the type of research federal agencies support. Nearly half a million public comments were submitted on the proposal before a Monday deadline. An analysis of a portion of those comments, done by researchers at the University of North Carolina in partnership with STAT, found that 95% were in opposition to the changes.

“When you end up in a place where, with every new administration, you’re going to start all over on what the priority is, you are not going to be able to catch up with China,” said Sudip Parikh, head of a leading advocacy group. “You’re not going to be able to cure disease, and you’re not going to be able to grow the economy.” The administration is required to respond to substantive public comments, though it is not required to incorporate that feedback. Read more from STAT’s Anil Oza and J. Emory Parker on the overwhelming opposition to the proposal and what could happen next.

90%

That’s the percentage of infants globally who received at least one dose of the diphtheria, tetanus, and pertussis vaccine last year, according to annual WHO and UNICEF estimates. Eighty-five percent completed a full three-dose series. Both numbers are a small increase from 2024 but still below 2019 levels. While fewer children received zero shots, there were more children who started the series but didn’t complete it.

What we’re reading

  • Majority of new Ebola cases in eastern Congo are from unknown chains, as outbreak outpaces response, AP
  • Tia promises women higher quality, personalized healthcare. Patients report missed pregnancies, surprise bills and upselling of alternative medicine, LA Public Press
  • A new biotech startup tries to tackle obesity, but not in the way you might expect, STAT
  • Could this mysterious disappearing organ hold the key to longevity? Nature
  • Exclusive: Medicare Advantage insurers face new bipartisan scrutiny over AI and care denials, STAT

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A Private Blog Network (PBN) is a collection of websites that are controlled by a single individual or organization and used primarily to build backlinks to a “money site” in order to influence its ranking in search engines such as Google. The core idea behind a PBN is based on the importance of backlinks in Google’s ranking algorithm. Since Google views backlinks as signals of authority and trust, some website owners attempt to artificially create these signals through a controlled network of sites.

In a typical PBN setup, the owner acquires expired or aged domains that already have existing authority, backlinks, and history. These domains are rebuilt with new content and hosted separately, often using different IP addresses, hosting providers, themes, and ownership details to make them appear unrelated. Within the content published on these sites, links are strategically placed that point to the main website the owner wants to rank higher. By doing this, the owner attempts to pass link equity (also known as “link juice”) from the PBN sites to the target website.

The purpose of a PBN is to give the impression that the target website is naturally earning links from multiple independent sources. If done effectively, this can temporarily improve keyword rankings, increase organic visibility, and drive more traffic from search results.

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