HEALTH TRAIN EXPRESS Mission: To promulgate health education across the internet: Follow or subscribe to Health Train Express as well as Digital Health Space for all the updates for health policy, reform, public health issues. Health Train Express is published several times a week.Subscribe and receive an email alert each time it is published. Health Train Express has been published since 2006.
Listen Up
Monday, September 26, 2022
Psychedelics Stocks to Watch (Updated 2022)
Monday, September 19, 2022
Sunday, September 18, 2022
To boost or not to boost - by Eric Topol - Ground Truths
The reluctance for Americans to get a booster shot has been striking. The United States currently ranks 73rd among countries for its uptake of boosters at 33% of its population. All peer, rich countries around the world are at least double that rate. Countries ranking above the US now include Rwanda, Uzbekistan, Iran, Honduras, and Azerbaijan. Seemingly, you’d have to work very hard to show up this poorly as the country that first validated the vaccines, manufactures them, and has had such a surfeit supply that it has >50 million shots it can’t get anyone to take. Nonetheless, it has maintained optimism and purchased 171 million new Omicron BA.5 variant bivalent shots.
So why is the rate of immunization so low in the United States? It is not about science. Eric Topol M.D. is a well-respected authority. Precision Medicine is touting how we need another booster shot. It is also not a political issue. Americans no longer have faith in government recommendations. During the last several decades the U.S. government made many poor choices, including severe restrictions, social distancing, personal protective equipment, and shutting down the economy, as well as promoting major wars in Iraq and Afghanistan.
In other countries that may be less developed, people accept government decisions, not knowing the details about vaccines. %10%1
Our current rate of inflation (about 10%) is largely due to the stimulus packages. That was money we printed, for which there is no real backing.
On the one hand, according to Topol, there is incontrovertible evidence for the benefit of a booster.
Very strong evidence supporting boosters dates back to October 2021, when the results of the only large (~10,000 participants) (1st) booster randomized trial were released and later published, with a 95% reduction of symptomatic infections across all age groups, through the Delta wave, durable at that level for at least 4 months. There were no safety concerns or myocarditis. The efficacy level was fully restored to the original randomized trial (95%) reports in November 2020.
The right question
Boosters provide substantive and unequivocal benefits for protection from severe Covid and are likely to help, to at less some degree, reduce Long Covid, and certainly have some early (2 months) effects for reducing infection and transmission. We don’t know yet if the BA.5 bivalent booster is any better than the BA.1 or the original booster. Based on the evolution of the virus through Omicron and its subvariants, it appears unlikely the new vaccine will have a major or important impact on reducing infection or transmission (we got a hint of that from the new BA.1 NEJM study above). There’s ample evidence from multiple studies that mucosal IgA antibodies are what will be needed to help block infections and transmission, such as this NEJM new report with 60-80% reduction of breakthrough infections (and reduced viral load, higher Ct, Tables below) as a function of mucosal IgA antibodies, not related to IgG antibodies. While they were formed in some health care workers as a response to vaccination and or infection, there is a way to induce them via nasal or oral vaccines. The durability of this effect isn’t yet known, but it would be far easier to take a nasal spray repetitively, with the expectation of much fewer side effects, than shots. Certainly encouraging data from CanSino’s newly approved inhaled vaccine vs Omicron is a solid precursor for the many programs that are in advanced clinical trials.
The right question is about the future. We can’t go on getting boosters every 4 to 6 months and the premise of an “annual” shot is that the virus exhibits seasonality like flu, which certainly isn’t the case.
Economics play a large role in who gets vaccines. In poor countries, it is often not available. In developed countries including the U.S. that is not a limiting factor.
The truth lies somewhere in the statistics which can be read below.
This reminds me of what a professor told me a long time ago. Beware! Statistics often lie!
To boost or not to boost - by Eric Topol - Ground Truths: Should that be the question?
The Truth About the Flu Shot
What’s in the Regular Flu Shot?
- Egg protein and avian contaminant viruses
- Thimerosal (mercury): in multi-dose vials
- Polysorbate 80:allergen; infertility in mice
- Formaldehyde: carcinogen
- Triton X100: detergent
- Sucrose: table sugar
- Resin: known allergen
- Gentamycin: antibiotic
- Gelatin: known allergen
Not in adults: In a review of 48 reports (more than 66,000 adults), “Vaccination of healthy adults only reduced risk of influenza by 6% and reduced the number of missed work days by less than one day (0.16) days. It did not change the number of people needing to go to hospital or take time off work.”
Not in the Elderly: In a review of 64 studies over 98 flu seasons of elderly living in nursing homes, flu shots were non-significant for preventing the flu. For elderly living in the community, vaccines were not (significantly) effective against influenza, ILI or pneumonia.
Saturday, September 10, 2022
Amazon plans job cuts in health-care unit after shuttering telehealth
Journal of Medical Internet Research - A Revised Hippocratic Oath for the Era of Digital Health
Thursday, September 8, 2022
Apple watch NIH STUDY
Researchers at Northwestern University and John Hopkins University plan to study if an Apple Watch app can help prevent strokes.
Tim Cook at the annual WWDC in Cupertino unveiled the new iPhone 14 along with the latest iteration of the Apple Watch. The Cupertino team carefully follows developments in remote monitoring. This iteration of the Apple Watch is quickly becoming a new 'carry' and/or the Leatherman tool for techies. Numerous studies are forthcoming. While the Apple Watch is not yet approved by the FDA it offers state of the art monitoring, notifications, alerts, and emergency notifications.
The National Heart, Lung, and Blood Institute, a National Institutes of Health division, awarded a $37 million grant for researchers to test whether Apple Watches can be used as part of a strategy to cut down the use of expensive blood thinners used to prevent strokes from atrial fibrillation.
The American Heart Association, Johns Hopkins, Stanford, and the University of California, San Francisco, are also partners on the study,
Afib is the most common heart rhythm disorder in adults, affecting 2.5 to 5 million Americans. That number is estimated to grow to 12.1 million by 2030. Worldwide, the estimated number of individuals with afib in 2010 was 33.5 million, according to a 2013 study.
The new NIH-funded trial will incorporate the use of an app on Apple Watch to monitor afib to attempt to reduce patients’ continuous and lifelong reliance on blood-thinning medication.
The seven-year study, expected to launch next spring, will recruit 5,400 patients who will receive standard afib care of blood thinners or Apple Watch-directed treatment.
The trial will also examine whether the app can reduce major bleeding events compared to continuous therapy, according to a Northwestern press release.
Using the app on Apple Watch and an accompanying app on iPhone, patients in the trial will be able to target blood-thinning medication use for a limited period of time and only in response to a prolonged episode of afib. The study could ensure patients only take blood thinner medication when they’re at a high risk of stroke, according to researchers.
RELATED
Apple plans to add blood pressure monitoring, thermometer to smartwatch: report
“If proven effective, this new treatment paradigm will fundamentally change the standard of care for the millions of Americans living with AFib,” said principal investigator Dr. Rod Passman, director of the Center for Arrhythmia Research and a professor of medicine in the division of cardiology at Feinberg, in a press release.
“Many of these patients are on blood thinners for the rest of their lives even if they have infrequent episodes of atrial fibrillation,” Passman said. “If we can show this strategy is equally protective against stroke and reduces bleeding, that could save lives, reduce cost and improve quality of life.”
For eight years, Passman has been studying solutions to end the standard “one-size-fits-all” practice of prescribing lifelong blood thinners (anticoagulants) to everyone with afib.
Afib is a heart rhythm disorder characterized by fast and irregular heartbeats from the upper chambers of the heart. People with afib have increased risk of stroke, so many are continuously treated with blood-thinning medication to reduce that risk. But this treatment also raises the risk of bleeding, according to Passman, and balancing the risks and benefits can be challenging for both patients and physicians.
However, some patients with afib have infrequent episodes of irregular heart rhythm either on their own or as the result of medications or procedures. Current evidence suggests the risk of stroke increases in the weeks following an episode of afib then returns to a baseline, raising the possibility of intermittent blood-thinner treatment.
Since many individuals have no symptoms during an episode of afib, the new trial will employ Apple Watch to monitor heart activity, notify patients when they’re entering an afib episode and limit the length of time on blood thinners only to the high-risk period for stroke
This “pill-in-pocket” approach could protect patients against stroke while reducing bleeding events and the cost of afib treatment, Passman said.
“We think advances in technology will allow us to personalize this care,” Passman said. “Why should patients expose themselves to the risk and cost of these drugs when they may not be benefiting?”
Tool to spot breast cancer at home wins UK Dyson award - BBC News
A device to help detect breast cancer has won the prestigious UK James Dyson Award.
The Dotplot aims to help women self-check at home and track any changes they may find on an app.
Breast cancer is the second most common cause of cancer death in the UK but many women do not carry out regular self-examinations.
Medical professionals have welcomed the invention but warn it is no substitute for going to the doctor.
Users build a personalised map of their torso by inputting their breast size and shape and pressing the handheld device over their chest.
Once a month, soundwaves are used to record tissue composition - and if there are any suspicious changes or abnormalities, users are advised to see a healthcare professional.
The technology is very similar to mammograms for over-50s or ultrasound scans offered to women worried about a lump.
Oncologist Dr Frankie Jackson-Spence said: "Obviously, it's in the early stages of development, so it does need to go through medicine regulatory device checks to make sure that it is actually adequate at detecting breast cancers.
"It isn't a substitute for going to your doctor - it doesn't diagnose anything."
Survival rate
The earlier cancerous tissue is detected, the better.
The five-year survival rate for stage-one breast cancer is about 95%, which drops to about 25% by the time the cancer is in stage four.
Every year, there are 11,500 breast-cancer deaths in the UK.
Only 1% of cases are in males.
But 64% of women aged 18-35 fail to regularly check their breasts, according Cancer Research UK and CoppaFeel.
"It's important that you check all over the breast - including up into the armpit and up to the collarbone," Dr Jackson-Spence said.
Nipple discharge
But it is not just about looking for lumps.
Manveet Basra wellbeing head at charity Breast Cancer Now, told BBC News: "There are other signs of the disease to look for.
"These include nipple discharge or dimpling or puckering of the skin of the breast.