Theresa Gaffney is the lead Morning Rounds writer and reports on health care, new research, and public policy, with a particular interest in mental health, gender-affirming care, and LGBTQ+ patient communities. You can reach Theresa on Signal at theresagaff.97.

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Good morning. Last night, the New York Times reported that Columbia University has agreed to pay a $200 million fine in a settlement with the Trump administration. We’re starting the day with a lot of news, and there’s more to come. Thanks for tuning in.

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HHS commits to remove preservative with no proven risk from flu vax

Yesterday, HHS Secretary Robert F. Kennedy Jr. formally accepted recommendations that would require all vaccine manufacturers to discontinue using the preservative thimerosal in influenza vaccines. A statement issued by the department categorized the move as “a commitment to restore trust with Americans by removing risk while sustaining access to vaccines.”

The practical effect of the move would be limited, STAT’s Helen Branswell reports, as only about 4% of flu vaccine doses brought to the U.S. market contain the preservative. While there’s abundant evidence that thimerosal is not a health risk, the FDA ordered manufacturers to stop using it in childhood vaccines decades ago, after it became a lightning rod for the anti-vaccine movement. Read more from Helen on what it means, as well as the two recommendations Kennedy didn’t accept.

Remote CBT works for chronic pain — if people can get it

Cognitive behavioral therapy is known to be beneficial for people with chronic pain, but accessing that care can be difficult, especially in rural areas. A new study, published yesterday in JAMA, found that remote options for CBT training on top of a patient’s regular care resulted in a significantly higher proportion of people achieving a clinical improvement in their pain as compared to the usual care alone.

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This randomized clinical trial included more than 2,300 participants, a third of whom received telephonic or video CBT training with a health coach, another third who completed a self-led online module, and a third who only continued with their typical pain care (and received a written resource guide on pain management). After three months, 32% of the first group lowered their pain severity score by at least 30% (the “minimal clinically important difference”), as did 27% in the self-led group. Just 20% of people receiving standard care had the same results. Statistically significant differences between the intervention groups and standard care continued after a year.

Chronic pain is one of the leading causes of disability in the U.S., so scalable, effective solutions like this are an exciting prospect, STAT’s chronic disease reporter Isabella Cueto told me. But implementing them may be tricky. Poor or nonexistent broadband access would be a major barrier to this approach in the places where the care is most needed. And as KFF Health News reported earlier this summer, the Trump administration has delayed national broadband buildout.

Experts say this RFK Jr. idea could be a good one

Fewer than a third of medical students in the U.S. receive the recommended minimum of 25 hours of nutrition education, and more than half report receiving no formal education on the topic at all. Kennedy wants that to change: “One of the things we’re gonna do at NIH is to really give a carrot and stick to medical schools across the country saying you gotta put in your first-year curriculum a really good, robust nutrition course,” he said in an Instagram video earlier this month.

While the specifics of this plan are unclear, the general goal is one that nutrition and food policy experts have been calling for for years, STAT’s Sarah Todd reports. And some people even see enhanced nutrition education as a way to combat the bias against higher-weight patients that’s entrenched in the medical profession. Read more from Sarah on the potential benefits.

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7,000

That’s how many daily steps are needed in order to achieve clinically meaningful improvements in certain health outcomes, including mortality, as compared to 2,000 steps. That’s according to a systematic review, published yesterday in The Lancet Public Health, that analyzed data from 57 studies on step counts and health outcomes. With 7,000 daily steps, study participants saw a 47% lower risk of both all-cause mortality and of dying from cardiovascular disease, a 25% lower risk of getting cardiovascular disease, a 14% lower risk of type 2 diabetes, a 38% lower risk of dementia, and more.

While evidence on the utility of counting steps has historically been limited, the authors find that it’s been rapidly increasing over the past decade. They believe that daily steps are a practical metric for physical activity guidelines and recommendations. Even 4,000 daily steps, they found, could improve outcomes as compared to 2,000.

Most U.S. bird flu cases have been mild so far. Why?

The H5N1 bird flu virus has historically extracted a heavy toll when it infects humans, with nearly half of confirmed cases ending in death over the past three decades. But only a single death has occurred out of the 70 cases reported in the U.S. over the past year and a half, leaving experts puzzled. A new study adds weight to an argument that the immunity people have developed to the virus that caused the most recent flu pandemic (an h2N1 virus from 2009) has induced some cross-protection that may make it harder for H5N1 to infect people, and mitigating the disease severity when it does.

Helen Branswell, who has been reporting on H5N1 bird flu for 20 years, covered the study. And while all of the outside experts she spoke to described the paper in glowing terms, not everyone is convinced by this argument. Read more from Helen on what outside experts had to say — and the one assumption that everybody agreed would be unwise to make.

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