The Covid-19 pandemic killed at least 7 million people across the globe, but the world could be faced with an even more devastating outbreak in the future, warns John Bell, the former U.K. testing czar. An avian flu pandemic could kill 15 times more people than Covid, according to one projection, the Oxford University Regius professor of medicine told Carmen in a recent interview.

He’d like governments to work on three things to prepare for the next major disease outbreak:

— Surveil disease pathogens. There’s still no agreement on what surveillance should look like, Bell said.

The U.S. has been testing wastewater to track Covid, but it can’t be linked to the people who are sick.

It must be complemented, he said, by metagenomic sequencing capability, a technique that analyzes all genomic material in a sample and can identify pathogens never seen before. This method can also be used to identify other diseases, such as drug-resistant tuberculosis in a patient, who can then be treated immediately with the appropriate antibiotics.

— Develop a routine adult vaccination program that could be used to roll out vaccines in a pandemic. No country, from rich to poor, had such a program and adequate infrastructure in place when Covid hit, Bell said.

“You can imagine a place where people get summoned and get vaccinated against a wide range of different adult pathogens,” he said. That could be shots for respiratory syncytial virus, shingles and other diseases. This public health infrastructure could also be used to deliver other regular treatments like injectable drugs to lower cholesterol, long-acting contraception or long-acting antiretrovirals for HIV.

— Build a clinical trial network in Africa to test vaccines and treatments.

“If you develop a vaccine in a company anywhere in the world, you might well want to test it in an African network partly because it may well be that’s where the pathogen appears first,” he said. It could also help fight vaccine hesitancy on the continent, Bell believes.

The network would also be useful in testing drugs for chronic conditions such as diabetes and heart disease, he said. “Africa has never been a source of clinical trial patients and functions, and they do have 1.4 billion people,” Bell said.

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What a trip. Janet Yellen says she accidentally ate magic mushrooms during a recent trip to Beijing. “There was a delicious mushroom dish. I was not aware that these mushrooms had hallucinogenic properties. I learned that later,” Yellen told CNN.

If cooked properly, the mushrooms have no impact, the treasury secretary added, noting that no one in her group felt any ill effects after eating at the restaurant where the mushrooms were served.

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Today on our Pulse Check podcast, host Alice Miranda Ollstein talks with Lauren Gardner, who sorts through HHS’ motion to dismiss a lawsuit by the U.S. Chamber of Commerce challenging the agency’s new-found authority to negotiate drug prices through Medicare and the legal challenges facing the Biden administration’s efforts to lower drug costs.

The degree to which doctors are disciplined by their state’s medical boards varies significantly across the country, with physicians in some states facing serious consequences for negligent or dangerous care at a rate that’s just a fraction of what their peers face elsewhere.

According to a new analysis from Public Citizen, a liberal-leaning consumer rights group, doctors in states like Colorado, Michigan, North Dakota and Ohio are subject to serious disciplinary action more than five times as often as those in the District of Columbia, Georgia, Nevada and New Hampshire.

Those actions, tracked from 2019 to 2021 through the National Practitioner Data Bank, could include doctors’ licenses being revoked or suspended or other actions that would seriously impede their ability to practice.

Some state medical boards are “doing a dangerously lax job” in responding to dangerous behavior, the report’s authors wrote.

The analysis found that about half of the doctors who had their clinical privileges changed by hospitals or other organizations reported to the NPDB had been disciplined by state boards.

The authors said there’s no evidence that the difference in disciplinary actions stems from different levels of competence or negligence by states.

And the analysis called for governors, who usually appoint members of the boards responsible for overseeing doctors, to choose members who will uphold high standards for physicians and appropriately respond to dangerous physician behavior.

Early-onset cancer became more prevalent in the U.S. from 2010 to 2019, according to a new analysis published in JAMA Network Open.

Researchers found that incidence rates for cancers in people under age 50 grew over that time, largely driven by an increase in cancers in individuals ages 30 to 39.

Over the same period, the incidence rate of cancers in people 50 and over declined.

Why this matters: Cancer mortality rates have fallen steadily over the last two decades, but cancer remains a leading cause of death in the U.S. Early-onset cancer is particularly associated with higher mortality and morbidity.

The fastest-growing incidence rates reported were in gastrointestinal cancers. Both the overall analysis and that specific finding confirm existing evidence of rising rates of early-onset cancers — and specifically ones affecting the digestive system — in many countries.

In the paper, the researchers point to the literature for possible reasons behind this dynamic, from increasing obesity and exposure to smoke to changes in sleep patterns and diets.

Even so: While the overall incidence rate of early-onset cancer increased from 2010 to 2019 in the U.S., the phenomenon was stratified by sex. Females saw an increase in the incidence rate, while males saw a decrease.

This dynamic could be explained by increases in the prevalence of early-onset breast and female reproductive cancers paired with a decrease in the prevalence of early-onset male reproductive cancers.