TELEHEALTH IMPACT ON CLINICIANS

 

Author. Beth Kutscher,  Path to Recovery

Welcome back to Path to Recovery, a newsletter that will bring you weekly conversations on how the health care profession will recover from one of the most significant crises of our time. Click "subscribe" above or follow along using #PathtoRecovery.

Here’s what we’re talking about this week.

One of the most fundamental ways that the pandemic has reshaped health care has been the rapid adoption of telemedicine. Technology is now ubiquitous and a staple of care. While the volume of telemedicine visits has come down from its April 2020 peak, virtual care leveled off at the beginning of last year at a number 38x higher than prior to the pandemic.

Not only are there practical reasons to offer telemedicine — like decreasing the no-show rate, allowing clinicians to see more patients and, of course, controlling the spread of covid — surveys show that a sizable percentage of people prefer the convenience, particularly younger patients.

The shift has given an opening to a number of direct-to-consumer companies that connect patients to clinicians. The convenience sell is three-fold: not only can patients see a doctor or nurse practitioner directly from their living room, but they can often get an appointment much faster than an in-person visit and have their medications delivered directly to their homes. In that way, DTC companies aim to take some of the pressure off stretched doctors’ offices and pharmacies. 

I sat down earlier this month with Varsha Rao, CEO of San Francisco-based Nurx, to talk about how the industry is changing. Nurx is a direct-to-consumer telehealth company focused on medications for birth control, skincare concerns and migraines. Like many of these platforms, it offers a self-pay rate for people without insurance.

Rao joined the company in 2019 after serving as chief operating officer of Clover Health. But her background spans travel, fashion and beauty. Here, she discusses why doctors and pharmacists are joining these companies and how Nurx fits into the larger health care ecosystem.

Let me know: How do you think direct-to-consumer telehealth platforms are changing the industry? What role do you think they play alongside traditional practices?

Below is an edited transcript of our conversation.

LinkedIn News: Tell me about some of your growth plans, both within women's health and outside of it.

Rao: We’ve been focused on building out areas of care that have been really important to our patients. We started off with contraception as a key area where a lot of people have had challenges accessing care. There are a lot of stigmas. It’s also the first place as a younger person where you’re really interacting with the health care system typically. Then we expanded to broader sexual health, so STI testing, HPV testing, and herpes. And then we continued to ask our patients about other areas where they needed care and so that's what led us to migraine.

About 35% of our patients experience migraines and we felt like that was really important for us to address. Over 55% of our patients have acne or rosacea challenges and so that was what led us to acne and rosacea. Coming up next we have new areas of service that we are launching this quarter. We’ll [also] look to continue to expand in dermatology like anti-aging. [Dermatology is] an area that we're going deeper in in general; our focus is really trying to be world-class in the areas that we're in. 

LinkedIn News: When you say world class, what do you mean?

Rao: In a way that is a lot more accessible from multiple dimensions. It can take people three to six months, sometimes, to get in to see a neurologist. And we are enabling people to get support within 48 hours. The price point is also very different; it can cost hundreds and hundreds of dollars to see a neurologist or a dermatologist, and for us, our migraine service is $60 for the consultation. The medication is additional. And then for dermatology, our main consultation fee is $35, so very affordable and accessible.

LinkedIn News: You said something interesting in terms of how you compare to the traditional doctor experience. How do you work with clinicians? What's their interest in working with you?

Rao: I think we've built an amazing culture for our clinicians. We have virtually no attrition. Some of them are full-time on staff as a part of a professional medical corporation, but some of them are 1099 [contractors]. But most of them are spending over 50% of their time with us because we require that in order to be familiar with our platform and our protocols. The other thing is providers want to feel like they're really working on true health care challenges. And I think when you're working on areas like contraception, PrEP for HIV prevention, and migraine and dermatology, these are really important challenges that people are experiencing and it feels like they're making a huge impact, which they are.

LinkedIn News: Do you feel like this is the future of where medicine is going in terms of these sort of direct access points for patients?

Rao: I think that telehealth is incredibly important as the first port of entry because there are so many things that are so much more efficiently done through telehealth. And then there are also so many challenges around accessing care. Those are the reasons why I’m such a big believer in telehealth. That’s not to say that I think there isn’t an important element of meeting a provider in person as well. And so I see ourselves as being part of an ecosystem, not replacing an ecosystem. There's always going to be an interplay. 

The quality of care that's delivered through telehealth is incredibly high. And so telehealth has gone from being viewed as a second or third option to really being a primary option of choice and very trusted.

Linked News: When you say you want to be part of the ecosystem, what does that mean? Are you building referral networks or how do you tap into the larger healthcare ecosystem?

Rao: We are very clear about the kinds of cases that we can handle. We refer out cases all the time for people who really need to see an in-person provider because you know they might be suffering from something that really requires a physical exam. We have relationships with providers in the community.

Pharmacists

It's incredibly challenging right now to find all kinds of health care providers who are going to be part of a new world of health care delivery. In this new world of telehealth, pharmacists have an incredible role to play. I feel that they may have been under-appreciated in working in a lot of retail environments where you’re on your feet for 12 hours a day or more. My understanding is it can be quite unpleasant in some locales where you’ve had the opioid crisis;  they've had to handle really challenging patient interactions. And then I also think that many pharmacists may not be working to the top of their license in the sense that they’re often stuck doing a lot of administrative work. My hope is that, in this kind of new world, we can empower pharmacists with more technology and more support so that they can deliver the kind of care that most of them went to school to get training for.

Pharmacists are in a multi-dimensional environment.  Many are in large chain pharmacies such as CVS, Rite Aid, Walgreens.  These organizations will be required to incorporate telehealth into their daily operations.  This will be a synchronous match to ask questions and offer information in face-to-face interaction, much like the clinician-patient telehealth contact.  Telehealth providers offer SMS links when a telehealth appointment is desired.  The integration of SMS and telehealth provides a unique connection asset.

Health Officials Monitoring 'Stealth Omicron' Variant

Stealth Omicron' Variant

The new subvariant is one of at least four omicron offshoots, and has quickly become the dominant version of the virus in Denmark.  

Health officials have been monitoring a new coronavirus subvariant that has been detected in at least 40 countries and is responsible for almost 100 cases in the U.S.

And although it is exhausting to even contemplate, a Yale researcher said it has already made its way to Connecticut.

The new flavor, BA.2, is one of at least four omicron offshoots, and has quickly become the dominant version of the virus in Denmark.  Nathan Grubaugh, an associate professor with the Yale School of Public Health, said that BA.2 is more transmissible than its parent, BA.a, moving up the charts quickly throughout Europe, and "likely will become the dominant SARS-CoV-2 in the US too."

At the moment, however, it's not even officially a new variant. Because it is more difficult to identify than the OG strain of omicron, researchers have christened it "stealth omicron."  Tom Peacock, a prominent British virologist at Imperial College London, said that BA.1 and BA.2 were alike where it counted: their vulnerability to the existing vaccines.

 

"There is likely to be minimal differences in vaccine effectiveness against BA.1 and BA.2," Peacock said on Twitter. "Personally, I'm not sure BA.2 is going to have a substantial impact on the current Omicron wave of the pandemic."

                                                                   CT COVID-19 Hospitalizations

Frequent and repetitive testing allows public health officials the data to follow infectiousness and transmissibility in a linear fashion. Generalized population sampling also allows early detection of mutant strains. It is well known that flu-like illnesses, SARS, and SARSCovid all follow these properties, and will continue to do so from season to season.  The more the virus multiplies, the more opportunity it has to mutate.  Preventive vaccination reduces the viral load, masking and distancing are two other methods of reducing viral mutations.

               

CT Health Officials Monitoring 'Stealth Omicron' Variant | New Canaan, CT Patch

Culinary medicine and why clinicians should garden

The search for good health and wellness never ends. There are many sources.  Which ones are best for you.  This post is meant for everyone providers and patients.

"For too long have gardeners allowed our food supply to be dependent on mysterious logistics. We have criminally allowed our own food growing capacity to be displaced. Growing something you eat and trading with people who grow what you don’t are ways to be less reliant on Big Food and its failed connections and also to help your neighbors.

We have the opportunity to subvert the dominant supply chain. Local gardens and gardeners should be at the center of a new, three-part food supply chain — grow, share, eat."

John La Puma is an internal medicine physician and author of ChefMD’s Big Book of Culinary Medicine. He can be reached at What is Nature Therapy?

He shares his story and discusses his KevinMD article, "Grow, share, eat: We have the opportunity to subvert the dominant supply chain."

Thanks to KevinMD for this interview with John Pluma M.D. Dr Pluma wrote the book, ChefMD's Big Book of Culinary Medicine: A Food Lover's Road Map to: Losing Weight, Preventing Disease, Getting Really Healthy Paperback – April 7, 2009

Did you know five minutes in a garden lowers your blood pressure and lowers your cortisol levels (John Pluma). Even a small herbal pot with Rosemary provides some benefits, reducing stress, pain, and burnout.  Rosemary is a rich source of antioxidants and anti-inflammatory compounds, which are thought to help boost the immune system and improve blood circulation. Rosemary is considered a cognitive stimulant and can help improve memory performance and quality. It is also known to boost alertness, intelligence, and focus.

Remember "Perfect is the enemy of the good"  Your garden can even be one herbal plant in a pot on your desk.  Seedlings can be found at Trader Joes or any garden shop.

Culinary medicine and why clinicians should garden [PODCAST]

Scientists dive deep into the different effects of morning and evening exercise.

We all exercise, some first thing in the morning, others at lunch break, and others in the evening. Our times vary due to season, weather other circumstance.  Does it matter ?

Scientific evidence reveals it makes a difference. 

It is well established that exercise improves health, and recent research has shown that exercise benefits the body in different ways, depending on the time of day. However, scientists still do not know why the timing of exercise produces these different effects. To gain a better understanding, an international team of scientists recently carried out the most comprehensive study to date of exercise performed at different times of the day.

Their research shows how the body produces different health-promoting signaling molecules in an organ-specific manner following exercise depending on the time of day. These signals have a broad impact on health, influencing sleep, memory, exercise performance, and metabolic homeostasis. Their findings were recently published in the journal Cell Metabolism.

“A better understanding of how exercise affects the body at different times of day might help us to maximize the benefits of exercise for people at risk of diseases, such as obesity and type 2 diabetes,” says Professor Juleen R. Zierath from Karolinska Institutet and the Novo Nordisk Foundation Center for Basic Metabolic Research (CBMR) at the University of Copenhagen.

Using exercise to fix a faulty body clock

Almost all cells regulate their biological processes over 24 hours, otherwise called a circadian rhythm. This means that the sensitivity of different tissues to the effects of exercise changes depending on the time of day. Earlier research has confirmed that exercise timing according to our circadian rhythm can optimize the health-promoting effects of exercise.

The team of international scientists wanted a more detailed understanding of this effect, so they carried out a range of experiments on mice that exercised either in the early morning or the late evening. Blood samples and different tissues, including brain, heart, muscle, liver, and fat were collected and analyzed by mass spectrometry. This allowed the scientists to detect hundreds of different metabolites and hormone signaling molecules in each tissue, and to monitor how they were changed by exercising at different times of the day.

The result is an ‘Atlas of Exercise Metabolism’ – a comprehensive map of exercise-induced signaling molecules present in different tissues following exercise at different times of day.

“As this is the first comprehensive study that summarizes time and exercise dependent metabolism over multiple tissues, it is of great value to generate and refine systemic models for metabolism and organ crosstalk,” adds Dominik Lutter, Head of Computational Discovery Research from the Helmholtz Diabetes Center at Helmholtz Munich.

New insights include a deeper understanding of how tissues communicate with each other, and how exercise can help to ‘realign’ faulty circadian rhythms in specific tissues – faulty circadian clocks have been linked to increased risks of obesity and type 2 diabetes. Finally, the study identified new exercise-induced signaling molecules in multiple tissues, which need further investigation to understand how they can individually or collectively influence health.

“Not only do we show how different tissues respond to exercise at different times of the day, but we also propose how these responses are connected to induce an orchestrated adaptation that controls systemic energy homeostasis,” says Associate Professor Jonas Thue Treebak from CBMR at the University of Copenhagen, and co-first author of the publication.

A resource for future exercise research

The study has several limitations. The experiments were carried out in mice. While mice share many common genetic, physiological, and behavioral characteristics with humans, they also have important differences. For example, mice are nocturnal, and the type of exercise was also limited to treadmill running, which can produce different results compared to high-intensity exercise. Finally, the impact of sex, age and disease were not considered in the analysis.

“Despite the limitations, it’s an important study that helps to direct further research that can help us better understand how exercise, if timed correctly, can help to improve health,” says Assistant Professor Shogo Sato from the Department of Biology and the Center for Biological Clocks Research at Texas A&M University, and fellow co-first author.

Fellow co-first author Kenneth Dyar, Head of Metabolic Physiology from the Helmholtz Diabetes Center at Helmholtz Munich, stressed the utility of the atlas as a comprehensive resource for exercise biologists. “While our resource provides important new perspectives about energy metabolites and known signaling molecules, this is just the tip of the iceberg. We show some examples of how our data can be mined to identify new tissue and time-specific signaling molecules,” he says.

The study is the result of a collaboration between the University of Copenhagen, Karolinska Institutet, Texas A&M University, the University of California-Irvine, and Helmholtz Munich.

Scientists dive deep into the different effects of morning and evening exercise. – Scientific Inquirer

A Personal Option for Health Care | Health Care Reimagined | Americans f...

The Covid pandemic did not produce new problems,  it pointed out many that have been in the system for decades, but did not rise to the awareness of the media.

Most of us are too busy with other daily problems of life and have little idea of how the health system is not functional, until they are faced with a serious illness, and get a bill.

Federal Involvement in Health Care Drives Treatment Choices

'Doctors cannot question the federal government. That's how health care works in the United States right now.

Around the United States, in numerous cases, hospitalized COVID-19 patients have asked for Ivermectin but were denied the drug, and then sought a court order forcing the hospital to provide the requested medication. Ivermectin, which has been used safely in humans since 1985, has shown promise in treating the virus, especially when taken early. Although it is an off-label use and not guaranteed to work every time, it is legal for doctors to prescribe Ivermectin for COVID-19, and many patients, some desperate and dying, want to give it a try.

Why are so many hospitals opposed to trying safe, inexpensive Ivermectin? The answer is tied to the complicated financial house of cards covering the entire health care system.

This isn’t a story about Ivermectin; it’s about what COVID-19 exposed in America’s health care system. The federal government, pharmaceutical, and insurance companies hold the reins on what care hospital administrators can offer. They never looked at your chart, but have a say in your treatment, and doctors who stray from administrative protocol can kiss their careers goodbye.

Here is a look at the many forces driving health care decisions outside the doctor-patient relationship.

Sick People Are Profitable

Indiana-based Dr. Dan Stock is a family medicine physician connected to America’s Frontline Doctors, a medical freedom organization promoting treatments such as Ivermectin for COVID-19. He says finances guide much of today’s health care landscape.

“Almost no one pays for direct care anymore,” Stock told The Epoch Times. “You pay for your care as you give your money to the federal government through taxes, or to an insurance company through premiums.”

The insurance company or the government buys the service for you as a third party. That’s a problem, Stock says, because “The federal government never has paid its bills. Every doctor and every hospital lose money on every Medicare and Medicaid patient who comes in the door.” And to make up the loss, he says, the cost of health care is inflated for those with private insurance.

A 2017 fact sheet produced by the American Hospital Association said the annual shortfall borne by hospitals is $57.8 billion, and privately insured patients and others make up the difference.

Nonprofit hospitals are federally required to accept Medicare, Medicaid, retired military insurance, Indian Health Services, and all federal insurance programs.

This cost-shifting caused inflation of medical prices and that sparked increases in private health insurance premiums.

“Employers started screaming about it, people started dropping their private insurance because it just wasn’t worth the money anymore, so that’s why the Affordable Care Act got passed,” Stock said. “The idea was, look, market forces won’t make you join in and buy through the third-party payment scheme to keep Medicare and Medicaid afloat. Hospitals are screaming ‘we’re going to go bankrupt.’ So the Affordable Care Act comes out, which says that everybody in the country has to buy insurance, and if you’re an employer, you have to buy it for your employee. You’re not allowed to say no. If you do, we give you a great big tax.”

That kept Medicare and Medicaid funded, Stock says.

“But there was a problem with the Affordable Care Act. They have this thing called Medical Loss Ratio,” Stock said. “Somebody talked to these idiots in our federal government into saying, hey, if you’re a private insurance company, you have to spend 80–85 percent of the premiums you take in on medical supplies and services. Only 15–20 percent of it can be given to the stockholders or be used to pay administrative fees.”

 Health Care Systems and Codes

How do insurance companies predict the public’s health?

Electronic records, developed around 20 years ago, helped doctors track patient data such as sodium level, blood sugar, and kidney function. About five years later the government realized hospitals and independent doctors were tracking that information but couldn’t share data with each other because of privacy rules associated with the HIPAA Law.

That is why, in 2012, Accountable Care Organizations (ACO) were formed. Doctors and hospitals that join an ACO are now working for one big employer.

Medicare and Medicaid said anybody who is not part of an ACO would have their reimbursement cut by 3 percent. It also offered a 2 percent increase to those who did join an ACO, Stock said.

“You’ve got to know that the margins in medicine are really narrow. Most hospitals have a one or two percent margin,” Stock said.

“The federal government then said, to get that 2 percent and to maintain your reimbursement, there are two other things you have to do,” Stock said.

First, ACOs became obligated to use an electronic medical record system and report data back to the feds and insurance companies.

The data doesn’t drill down to the level of “John Smith has asthma,” but it does tell what percentage of coronary artery disease patients are on a statin drug, or what percent of people with COVID-19 are being treated with respirators.

To enter the information into the computer system, doctors must link a treatment to a diagnosis. They must link a Current Procedural Terminology (CPT code) with an International Classification of Diseases (ICD diagnosis code).

“For instance,” Stock said. “I’m not allowed to just go write somebody a prescription for Losartan. I have to write a prescription for Losartan and link it to a diagnosis, in this case blood pressure, so they can tell what I did.”

If a doctor were to link a treatment like Ivermectin to an off-protocol diagnosis, such as COVID-19, the ACO will be financially punished and the doctor would face consequences, Stock said. To change the diagnosis code to a government acceptable code but use the medicine for something else would be fraud. The prescription must match the diagnosis in the protocol.

Here’s the second thing the government said you had to do to maintain your 2 percent reimbursement: the government and insurance companies came up with a Pay for Performance plan, also known as value-based programs.

“These programs reward health care providers with incentive payments for the quality of care they give to people with Medicare,” the Centers for Medicare and Medicaid Services (CMS) website says. “Our value-based programs are important because they’re helping us move toward paying providers based on the quality, rather than the quantity of care they give patients.”

The CMS website lists “quality improvement organizations” that develop and implement these programs, including the National Quality Forum; the Joint Commission of the Accreditation of Health Care Organizations; the National Committee for Quality Assurance; the Agency for Health Care Research and Quality; the American Medical Association. Some of these groups are led by former insurance, pharmaceutical or CMS executives.

Now the government, advised by insurance and drug companies, defines what good medicine is, Stock says. Doctors must make a diagnosis and provide the protocol code of care.

CMS bases reimbursements on how well health care systems meet these guidelines.

Like a social credit score, individual health care providers are being scored by their performance.

Federal Involvement in Health Care Drives Treatment Choices

COVIDtests.gov - Free at-home COVID-19 tests

COVIDtests.gov - Free at-home COVID-19 tests: Every home in the U.S. can soon order 4 free at-home COVID-19 tests. The tests will be completely free—there are no shipping costs and you don't need to enter a credit card number.

How Soon Will COVID Be “Normal”? |

On Thursday, six medical experts close to the White House published three op-eds in the Journal of the American Medical Association, arguing that the time had come for a new approach to the pandemic—one that sets aside the campaign for eradication in favor of living with the disease. covid-19, one op-ed argued, should no longer even be tracked on its own but monitored together with other respiratory viruses, such as the flu—the sort of thing that might be done by epidemiologists rather than by all of us refreshing graphs on the Times’ Web site day and night. The argument was particularly notable because the six experts had all been advisers to President Joe Biden’s covid-19 transition team. “A ‘new normal with COVID’ in January 2022 is not living without COVID-19,” Ezekiel Emanuel, of the University of Pennsylvania, Celine Gounder, of N.Y.U., and Michael Osterholm, of the University of Minnesota, wrote. But they believed that the long era of emergency—the one defined by a wartime feeling and frequent briefings from Anthony Fauci—should draw to a close.

“The Biden Administration’s intentions are usually quite good, but it's messaging is often contradictory,” the epidemiologist William Hanage said.

Even as the Omicron wave spikes, some outside experts believe that the time has come for Anthony Fauci and the White House to declare a new phase in the pandemic.

How Soon Will COVID Be “Normal”?

“A ‘new normal with COVID’ in January 2022 is not living without COVID-19,” Ezekiel Emanuel, of the University of Pennsylvania, Celine Gounder, of N.Y.U., and Michael Osterholm, of the University of Minnesota, wrote. But they believed that the long era of emergency—the one defined by a wartime feeling and frequent briefings from Anthony Fauci—should draw to a close.

That same morning, I spent half an hour interviewing Fauci by Zoom, to try to understand how the Administration saw the current state of the pandemic. Lately, he had been dropping some hints that his view might not be too different from that of the JAMA experts: on ABC last Sunday, he’d said that it might make sense at some point to focus not on covid cases but on hospitalizations, a change that would organize policy around the medical effort to identify and treat the very sick rather than a social campaign to stop the spread of the disease. I asked him what time line he had in mind. “It’s not necessarily something that we’re going to do—or even seriously consider doing—tomorrow,” 

Fauci said. But eventually the Omicron wave would come to an end, 

How Soon Will COVID Be “Normal”? | 

‘Killer’ immune cells still recognize Omicron variant

It is important to remember that most serious complications from a Covid 19 infection are due to immune reactions that result in inflammation in the lung and other vital organs such as the heart, and kidneys.

The body's defense mechanism also includes "killer T cells" a type of white blood cells that capture and destroy foreign organism including bacterira, viruses and other microbial organisms.  This takes place with the assistance of antibodies, and can also take place without antibodies.  The most effective response is to due the synergy of both working together.

In the race against emerging coronavirus variants, researchers are looking beyond antibodies for clues to lasting protection from COVID-19.

How ‘killer’ T cells could boost COVID immunity in face of new variants

Concerns about coronavirus variants that might be partially resistant to antibody defences have spurred renewed interest in other immune responses that protect against viruses. In particular, scientists are hopeful that T cells — a group of immune cells that can target and destroy virus-infected cells — could provide some immunity to COVID-19, even if antibodies become less effective at fighting the disease.

Researchers are now picking apart the available data, looking for signs that T cells could help to maintain lasting immunity.

“We know the antibodies are likely less effective, but maybe the T cells can save us,” says Daina Graybosch, a biotechnology analyst at investment bank SVB Leerink in New York City. “It makes sense biologically. We don’t have the data, but we can hope.”

Coronavirus vaccine development has largely focused on antibodies, and for good reason, says immunologist Alessandro Sette at the La Jolla Institute for Immunology in California. Antibodies — particularly those that bind to crucial viral proteins and block infection — can hold the key to ‘sterilizing immunity’, which not only reduces the severity of an illness, but prevents infection altogether.

That level of protection is considered the gold standard, but typically it requires large numbers of antibodies, says Sette. “That is great if that can be achieved, but it’s not necessarily always the case,” he says.

A T cell targeting coronavirus particles (illustration).

Killer cells

Alongside antibodies, the immune system produces a battalion of T cells that can target viruses. Some of these, known as killer T cells (or CD8+ T cells), seek out and destroy cells that are infected with the virus. Others, called helper T cells (or CD4+ T cells) are important for various immune functions, including stimulating the production of antibodies and killer T cells.

T cells do not prevent infection, because they kick into action only after a virus has infiltrated the body. But they are important for clearing an infection that has already started. In the case of COVID-19, killer T cells could mean the difference between a mild infection and a severe one that requires hospital treatment, says Annika Karlsson, an immunologist at the Karolinska Institute in Stockholm. “If they are able to kill the virus-infected cells before they spread from the upper respiratory tract, it will influence how sick you feel,” she says. They could also reduce transmission by restricting the amount of virus circulating in an infected person, meaning that the person sheds fewer virus particles into the community.

T cells could also be more resistant than antibodies to threats posed by emerging variants. Studies by Sette and his colleagues have shown that people who have been infected with SARS-CoV-2 typically generate T cells that target at least 15–20 different fragments of coronavirus proteins1. But which protein snippets are used as targets can vary widely from person to person, meaning that a population will generate a large variety of T cells that could snare a virus. “That makes it very hard for the virus to mutate to escape cell recognition,” says Sette, “unlike the situation for antibodies.”

So when laboratory tests showed that the 501Y.V2 variant identified in South Africa (also called B.1.351) is partially resistant to antibodies raised against previous coronavirus variants, researchers wondered whether T cells could be less vulnerable to its mutations.

Early results suggest that this might be the case. In a preprint published on 9 February, researchers found that most T-cell responses to coronavirus vaccination or previous infection do not target regions that were mutated in two recently discovered variants, including 501Y.V22. Sette says that his group also has preliminary evidence that the vast majority of T-cell responses are unlikely to be affected by the mutations.

If T cells remain active against the 501Y.V2 variant, they might protect against severe disease, says immunologist John Wherry at the University of Pennsylvania in Philadelphia. But it is hard to know from the data available thus far, he cautions. “We’re trying to infer a lot of scientific and mechanistic information from data that doesn’t really have it to give,” he says. “We’re kind of putting things together and building a bridge across these big gaps.”

Updating vaccines

Researchers have been analysing clinical-trial data for several coronavirus vaccines, to look for clues as to whether their effectiveness fades in the face of the 501Y.V2 variant. So far, at least three vaccines — a protein vaccine made by Novavax of Gaithersburg, Maryland, a single-shot vaccine made by Johnson & Johnson of New Brunswick, New Jersey, and a vaccine made by AstraZeneca of Cambridge, UK, and the University of Oxford, UK — were less effective at protecting against mild COVID-19 in South Africa, where the 501Y.V2 variant dominates, than in countries where that variant is less common.

In the case of AstraZeneca’s vaccine, the results were particularly striking: the vaccine was only 22% effective against mild COVID-19 in a sample of 2,000 people in South Africa. However, that trial was too small and its participants too young for researchers to draw any conclusions about severe disease, says Shane Crotty, an immunologist at the La Jolla Institute for Immunology.

Could mixing COVID vaccines boost immune response?

Some coronavirus vaccine developers are already looking at ways to develop next-generation vaccines that stimulate T cells more effectively. Antibodies detect only proteins outside cells, and many coronavirus vaccines target a protein called spike that decorates the surface of the virus. But the spike protein is “quite variable”, suggesting that it might be prone to mutating, says Karlsson, and raising the risk that emerging variants will be able to evade antibody detection.

T cells, by contrast, can target viral proteins expressed inside infected cells, and some of those proteins are very stable, she says. This raises the possibility of designing vaccines against proteins that mutate less frequently than spike, and incorporating targets from multiple proteins into one vaccine.

Biotechnology firm Gritstone Oncology of Emeryville, California, is designing an experimental vaccine that incorporates the genetic code for fragments of several coronavirus proteins known to elicit T-cell responses, as well as for the full spike protein, to ensure that antibody responses are robust. Clinical trials are due to start in the first quarter of this year.

But Gritstone president Andrew Allen hopes that current vaccines will be effective against new variants, and that his company’s vaccine will never be needed. “We developed this absolutely to prepare for bad scenarios,” he says. “We’re half hoping that everything we did was a waste of time. But it’s good to be ready.”

Nature 590, 374-375 (2021)

doi: https://doi.org/10.1038/d41586-021-00367-7

References

Killer’ immune cells still recognize Omicron variant

9 Schema That Change The Way You See The World, and will effect your Health

About the Author

Dr. Monica Johnson

Dr. Monica Johnson is a clinical psychologist and owner of Kind Mind Psychology, a private practice in NYC that specializes in evidenced based approaches to treating a wide range of mental health issues (e.g. depression, anxiety, trauma, and personality disorders). Additionally, she has a focus on working with marginalized groups of people including BIPOC, LGBTQ+, and alternative lifestyles to manage minority stress. She is also dedicated to contributing to her field professionally through speaking, training, supervision, and writing. She routinely speaks at conferences, provides training and workshops at organizations, supervises mental health trainees, and co-authored a book for professionals on addressing race-based stress in therapy.

Dr. Johnson earned her bachelor's degree from the University of South Carolina, completed her Psy.D. at the Arizona School of Professional Psychology, and completed her postdoctoral training year at Cherokee Health Systems in Knoxville, TN. She currently lives in Manhattan where she indulges in horror movies, sarcasm, and intentional introversion. You can find her on Instagram and online at kindmindpsych.com. 

Schemas are not obvious Social Determinants of Health (SDOH). 

THE QUICK AND DIRTY

There are 18 different schemas that can develop in childhood that may have an adverse effect on how you view the world. You may not even realize you have one of the schemas—in fact, the belief system may feel entirely normal to you. That's why awareness of a schema is the first step towards changing it.For instance, children who develop a schema that they aren’t good enough rarely challenge this belief, even as adults. They can be the CEO of a Fortune 500 company and still go home feeling as though they're inadequate. Schemas, like emotions, are self-serving. They attempt to mold your experiences and encourage you to engage in actions that keep them around.  Today, we're going to discuss early maladaptive schemas. There are so many of them that this will be a 2-part episode, so listen through to the end and make sure you're ready for next week!

Have you ever heard of a schema before? A schema is a stable and enduring negative pattern that develops during childhood or adolescence. It persists and expands throughout our lives.

We view the world through the lens of our schemas. Schemas are closely held beliefs and feelings about yourself, others, and the world. Typically, you accept these beliefs without question and many people are not aware that they have them. They are self-perpetuating and are very resistant to change, but with appropriate treatment, you can change them!

For instance, children who develop a schema that they aren’t good enough rarely challenge this belief, even as adults. They can be the CEO of a Fortune 500 company and still go home feeling as though they're inadequate. Schemas, like emotions, are self-serving. They attempt to mold your experiences and encourage you to engage in actions that keep them around.

Usually, schemas operate in subtle ways, outside of our awareness. However, when a schema is triggered by stimuli in our environment, our thoughts and feelings are dominated by schema-related content. In these moments we may experience maladaptive thinking, extreme and/or intense emotions, and have urges to act in ways that might not be in the interest of our psychological well-being.

(1) An Upgraded Hippocratic Oath Is Needed In The Digital And A.I. Era | LinkedIn

The Hippocratic Oath is the most famous text in Western medicine. It constitutes the ethical basis of the medical profession. For centuries, it has provided an overview of the principles of this noble mission and doctors’ professional behaviour. At the dawn of a new era in medicine, it is high time to rewrite the Oath so that it would reflect the state of technological development, changes in social structures and in general, the requirements of the 21st century.

What is the Hippocratic Oath?

Used by many medical schools at graduation ceremonies, the medical profession adopted the Oath of Hippocrates as its ethical code of conduct centuries ago. That’s not a mere chance. The text articulates perfectly what the noble profession of being a doctor entails and in a compact overview takes a side in every major ethical issue a physician might encounter during their career.

Only a few know that although the oath bears the name of Hippocrates, the well-known Greek physician, there is no evidence that he wrote it. It is claimed that the document was created 100 years after his death; still some 2500 years ago.

The intimacy of a doctor patient encounter has changed since telehealth, electronic medical records have increased social distancing in the past 20 years.  Many people now have access to the medical record, given implied consent to perform their duties.  Can patients still be assured of their privacy and confidentiality of the visit with their physician(s)?  What do physicians think of the HIPPOCRATIC OATH?  As in other modern interpretations of oaths and features of the U.S. Constitution the interpretation varies widely among today's physicians. Some (few) take it's meaning literally.  Others have been influenced by bureaucracy, regulations and common peer behavior to abandon it's meaning as written by our forefathers Upon graduation, many medical students take a modern version of the oath written by Louis Lasagna in 1964.  

MODERN VERSION.  Upon graduation, many medical students take a modern version of the oath written by Louis Lasagna in 196

4. 

CLASSICAL VERSION

The bottom line for patients is do your trust your physician, and will he keep your innermost secrets, sins and indiscretions.  Most will, and will not include any specifics in the electronic medical records. It is up to you to instruct him to not include that which  you do not want passed along.  Most will do so.

Digital Health Space advises. you to not disclose sensitive information on a telehealth visit, nor to an assistant.

Our message to you, get vaccinated against Covid 19 and have a Happy and safe New Year, 2022

1) An Upgraded Hippocratic Oath Is Needed In The Digital And A.I. Era | LinkedIn

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Thanks to Peter Diamandis, these suggestions for 2022 could turn your life around.

My first suggestion is to ignore the media blitz about Covid.  Get your vaccination, and wear a mask where it is required. Most of what you read or hear about Covid is hype and is aimed at you to maximize readership. Boosters are important as recommended. Reduce your anxiety and focus on your own health.  Do not postpone important doctor visits, and avoid delaying needed treatments.  Use telehealth as your first go to for doctor visits.

VIOME: IMAGINE NO CHRONIC DISEASES OR CANCER

This is a bit far-fetched, aging will always take place, however we can slow it down.

What if we could reverse or even prevent chronic diseases such as heart disease, Alzheimer’s, and cancer?

That’s the mission of Viome: a revolutionary biotech company that uses an AI-driven platform to analyze the biochemical activity in your body by looking at your saliva, blood, and stool. Their goal is to give you an accurate picture of your unique health, and what you can do to optimize it through food and made-to-order, precision supplements and probiotics. (Full disclosure: my venture fund BOLD Capital is an investor in Viome.The web site offers you the opportunity to purchase supplements.  None of these are FDA approved and peer reviewed studies are limited.  Remember the supplement industry is a multibillion dollar business.  If you spend $150 a month on these products you will feel better whether you are or not.  Many studies have shown antioxidants are worthless.  Many natural foodstuffs that contain bioflavonoids in a natural vegetable or fruit are healthy. Hard evidence reveals that vegetarians do live longer. (studies at Loma Linda University, where a vegetarian life style predominants reveal longer life spans in that region. (Loma Linda, California). The University in Loma Linda teaches this nutritional lifestyle. The students and medical staff live this on a daily basis.  My observation as an outsider M.D. that taught there is it is a lean healthy demographic that age well without many chronic illnesses.

Here are some claims Viome makes,

"Viome recently did a study of 10,000 people to measure the effects of receiving Viome’s recommendations of supplements over a period of 4 months.

Here are some of the findings:

Clinical scores of irritable bowel syndrome (IBS) came down by 40%;

Depression among participants decreased by 36%;

The participants’ diabetes risk score also decreased by 30%--simply with changes to diet and recommended supplements.

In another study, 550 people in Japan and 500 people in the United States were put on continuous glucose monitoring and then given 35,000 different types of food.

Viome then used a machine learning model that analyzed microbial activity, which was able to actually predict the glycemic response of different foods: if you eat this food, then this will be your body’s sugar response in your blood.

Viome then combines this analysis with predictive biomarkers and precision diagnostics to detect cancers, metabolic and autoimmune disease, inflammation, and other chronic conditions."

Our current healthcare is actually “sick care”—passive, reactive, and focused on damage control. It is "revenue based care".

Our goal needs to actually be “healthcare.” wherein we use advanced diagnostics and exponential tech to achieve an outcome that is personalized, precise, predictive, and preventive. (probably a well meaning hype).

More food for thought and perhaps good health are Peter's Laws.  Some of this post must be taken with a grain of salt and perhaps a modicum of supplements. Peter Diamandis is an excellent speaker and a visionary of things which have taken place and to come.

I recommend his books

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