The U.S. Food and Drug Administration is poised to regulate a "potential first-in-class antipsychotic" known as KarXT, said Medscape. About one in 300 people worldwide are affected by schizophrenia, but for decades, treatment options have been both static and limited. 

If the FDA approves the twice-daily pill in a decision due on Thursday, it will be the "first truly novel treatment" for schizophrenia in more than 70 years, said the Financial Times, and could "pave the way for its rollout in global markets." 

What is schizophrenia? 
Schizophrenia is a "long-term mental health condition" often described as a "type of psychosis" that may leave the patient unable to "distinguish their own thoughts and ideas from reality," according to the NHS. The disorder is thought to result from "genetic predisposition" and can be exacerbated by environmental factors such as stress or drug use, said the FT. 

The worst flare-ups can cause "psychotic breakdowns that last for weeks." Sufferers are highly stigmatized and "frequently pushed to the fringes of society." They are also "vastly overrepresented" in the unemployed, homeless and prison populations in the US. 

How is it treated? 
The development of antipsychotics in the 1950s was a "milestone" in schizophrenia management, said The Lancet. But these treatments come with "extensive side effects," including listlessness, movement disorders and heart disease. That contributes to "underprescribing" by doctors. Nonadherence rates among patients are also incredibly high; about 75% are thought to discontinue treatment. And about a third of people with schizophrenia are resistant to conventional antipsychotic treatment. 

How is KarTX different? 
KarXT essentially combines an experimental drug for Alzheimer's (xanomeline) with another drug (trospium). It works by targeting receptors in the brain that modulate dopamine release, rather than blocking it directly like existing antipsychotics. 

Results of the latest KarXT trial, published in January, showed that it significantly reduced acute psychotic symptoms. "You get the high levels of efficacy that you anticipated with the [antipsychotics]," Carlos Dortrait, a senior vice president at Bristol Myers Squibb, which is developing the drug, said to BioSpace. "However, you don't get the consequence that comes with it."

A Michelin star may be the ultimate fine-dining accolade, but recently updated research in the Strategic Management Journal suggests restaurants "might be better off remaining starless," said The Economist. University College London School of Management researchers tracked highly reviewed New York City restaurants that opened between 2000 and 2014. They found those that earned a Michelin star were more likely to close than those that didn't, even allowing for location, price and type of cuisine. By the end of 2019, 40% of the restaurants awarded Michelin stars from 2005 to 2014 had closed. Fame, it seems, "comes at a price." 

Star-shaped target 
Being in the limelight "puts a star-shaped target" on restaurants' backs, said The Economist. Receiving Michelin star status "intensified bargaining problems with landlords, suppliers and employees," according to researcher Daniel Sands, all of which push up costs. This, combined with "heightened consumer expectations," makes staying in business tougher. 

Five of the "highest-awarded fine-dining restaurants" in Berlin have closed in the past year, said Euronews. Still reeling from the pandemic, restaurants were "hit by soaring inflation," with no choice but to pass on those higher costs to customers. People's willingness to spend has "significantly changed," said Sebastian Frank, the head chef at double-Michelin-starred restaurant Horváth. 

From fine dining to food truck 
For some in the culinary world, stars have begun to "seem more of a burden than a blessing," said CNN, and several chefs have even "handed back their Michelin status." In 2018, Spanish chef Dani García announced the closure of his eponymous restaurant in Andalusia just 22 days after it received a third Michelin star — the "shortest triple-Michelin-star period" in the world, said Eater. García told staff that he doubted he could "continue to devote the focus required" to maintain the stars. "This achievement could undermine my freedom to do new things," he said to Eater. 

There's a financial as well as personal advantage to such a move too. Announcing the closure of a restaurant during the "height of its acclaim" can yield even more headlines and good publicity for a chef's next venture.