Category Archives: General Health

More Data: COVID-19 Vaccine Effective in Patients with IBD & Maternal COVID-19 Vaccination Protects Infants

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A Jena et al. Clin Gastroenterol Hepatol 2022; 20: 1456-1479. Open access: Effectiveness and Durability of COVID-19 Vaccination in 9447 Patients With IBD: A Systematic Review and Meta-Analysis

This was a systematic review and meta-analysis that included 46 studies.

  • Key findings:
    In 9,447 subjects who were completely vaccinated, the pooled seroconversion relative risk was 0.96 (95%CI, 0.94-0.97), and was higher for mRNA vaccines (0.97, 95%CI 0.96-0.98) than for adeno-associated vaccines (0.87, 95%CI: 0.78-0.93)
  • The pooled seroconversion rates were similar regardless of IBD therapy, and ranged from 0.93 to 0.99.
  • The pooled relative risk of breakthrough COVID-19 infections in vaccinated patients with IBD was not significantly different from that of vaccinated controls. However, a decay in antibody titers after 4 weeks from vaccination appeared to be accelerated in those on anti-TNF agents, immunomodulators or their combination.

My take: IBD patients benefit from complete COVID-19 vaccination similar to healthy controls.

Related blog post: COVID Booster Advice for IBD from Dr. David Rubin (@IBDMD)

NB Halasa et al. NEJM 2022; 387: 109-119. Open access: Maternal Vaccination and Risk of Hospitalization for Covid-19 among Infants

Using a case-control design, the authors found that complete (2 dose) vaccination during pregnancy —Key findings:

  • The effectiveness of maternal vaccination against hospitalization for Covid-19 among infants < 6 months was 52% overall, 80% during the delta period, and 38% during the omicron period.

My take: Vaccination protects mother and infant. “Maternal vaccination with two doses of mRNA vaccine was associated with a reduced risk of hospitalization for Covid-19, including for critical illness, among infants younger than 6 months of age.”

Covid Updates

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Vaccines have been estimated to have saved more than 20 million deaths. The Lancet Infectious Diseases new release: COVID-19 vaccines are estimated to have prevented 20 million deaths worldwide in the first year of the vaccine program, modelling study find

Omicron has been associated with lower rates of MIS-C in children compared to other surges –95% less than alpha. WSJ: Covid-19 Complication Among Children Fades in Latest Wave of Virus.

Getting boosted is important for those >50 years. There was a 29-fold reduction when comparing 2 boosters vs unvaccinated and a 4-fold reduction when comparing 2nd booster vs 1 booster. CDC: Rates of COVID-19 Cases and Deaths by Vaccination Status

Misinformation in Medicine

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RJ Baron, YD Ejnes. NEJM 2022; 387:1-3. Physicians Spreading Misinformation on Social Media — Do Right and Wrong Answers Still Exist in Medicine?

The authors, representing the American Board of Internal Medicine (ABIM), assert that “there aren’t always right answers, but some answers are clearly wrong.” In their commentary, they note that there is “growing allegiance to crowd-endorsed ‘facts.'” Yet, they expect physicians to adhere to higher standards; however, they note the inherent conflict between speech that can be prohibited by licensing boards and speech protected by the First Amendment.

My take: While the authors state that physicians risk disciplinary action for spreading misinformation, I remain skeptical that licensing boards have the appetite to do this, particularly when it comes to disciplining high-profile offenders like Mehmet Oz or Joseph Ladapo (Florida Surgeon General) (Business Insider: Dr. Oz is running for US Senate in Pennsylvania. Here are 8 times he’s made false or baseless medical claims; Insider: Florida’s surgeon general breaks with CDC advice, says the state will be the first to ‘officially recommend against the COVID-19 vaccine for healthy children‘).

PA Cohen et al. NEJM 2022; 387: 3-5. Institutionalizing Misinformation — The Dietary Supplement Listing Act of 2022

Dietary supplements are another part of medicine with rampant misinformation. In fact, there is nearly ubiquitous misinformation through advertisements across all media segments. Americans spent ~$55 billion on dietary supplements in 2020. This commentary discusses a Senate bill, the Dietary Supplement Listing Act of 2022, which ostensibly would improve this situation.

However, this is NOT the case. This bill requires manufacturers to provide the FDA with a product’s name, ingredients and health claims. It mandates the FDA create a searchable database. What the legislation doesn’t do:

  • Provide the the FDA with a mechanism to confirm a product’s ingredients
  • Enable regulation of misleading health claims
  • Stop the promotion and sale of supplements with dangerous ingredients
  • Allow the FDA to remove products from its registry determined to have unlawful ingredients and remove products deemed hazardous

My take: This legislation needs to be strengthened to limit deception. In its current form, this registry would appear to confer FDA oversight to dietary supplements (which is minimal) and paradoxically legitimize dietary supplements .

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Vitamin Supplements and Outcomes

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EA O’Connor et al. JAMA. 2022;327(23):2334-2347. doi:10.1001/jama.2021.15650. Full text -open access: Vitamin and Mineral Supplements for the Primary Prevention of Cardiovascular Disease and Cancer. Updated Evidence Report and Systematic Review for the US Preventive Services Task Force

Key findings:

  • In pooled analyses, multivitamin use was significantly associated with a lower incidence of any cancer (odds ratio [OR], 0.93 [95% CI, 0.87-0.99]…However, the evidence for multivitamins had important limitations
  • Limited evidence suggested some supplements may be associated with higher risk of serious harms (hip fracture [vitamin A], hemorrhagic stroke [vitamin E], and kidney stones [vitamin C, calcium])
  • Vitamin and mineral supplementation was associated with little or no benefit in preventing cancer, cardiovascular disease, and death, with the exception of a small benefit for cancer incidence with multivitamin use.

Summary of this study –USA Today (6/30/22): Are common multivitamins worth the money? New study explores the benefits, harms. In this “massive meta-analysis from JAMA of 84 studies on vitamins and supplements, …

  • Beta-carotene: supplementation associated with increased risk of lung cancer and cardiovascular mortality.
  • Vitamins D and E: not associated with increased or decreased risk of all-cause mortality, cardiovascular disease or cancer. In summary, no benefit.
  • Based on these findings, the United States Preventive Services Taskforce 1) recommends against the use of beta-carotene or vitamin E supplements for the prevention of cardiovascular disease or cancer and 2) states that there’s insufficient evidence to assess the benefits or harms of multivitamins or other single or paired nutrient supplements for the prevention of cardiovascular disease or cancer.
  • Americans spent $50 billion on multivitamins and supplements in 2021.

My take: Most people will not benefit from vitamin supplements and should focus on developing a healthy diet. Certain populations, including pregnant women and those with intestinal disorders, do need additional vitamins.

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The Relief Room

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This weekend, on “Wait, Wait, Don’t Tell Me” (Transcript July 2) on their ‘Bluff the Listener’ game, they highlighted three stories of a new Philadelphia tourist attraction. The true (very funny) story was regarding “The Relief Room.” A bathroom (suitably) dedicated to Philadelphia pitcher relievers and covered in memorabilia.

GONDELMAN: 45-year-old Matt Edwards, has gone above and beyond turning his home’s downstairs bathroom into a monument to his beloved Phillies.

GONDELMAN: The Relief Room, as Edwards calls the commode, is a celebration of retired Phillies relief pitchers.

GONDELMAN: Though the room is jampacked with Phillies ephemera, such as signed photographs and figurines, the area above the toilet remains largely empty. That’s because it’s reserved especially for pitchers who have played for Phillies championship teams.

GONDELMAN: Edwards did miss an opportunity for guests to declare their need for personal relief the same way that catchers deliver signals to a pitcher – throw down one finger if you need to do what the Phillies do with a late-inning lead…

GONDELMAN: …Two fingers if you need to do what the team is playing like overall.

Here’s a link to a very descriptive NY Times article/pictures: When Nature Calls, Phillies Relievers Have a Place to Go

Apple Adding Medication Tracker to iPhones

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The Verge: Apple adds medication tracking feature to the Health app (6/6/22)

An excerpt:

Apple is adding a new tool to remind people to take medications to the iPhone health app, the company announced today…will let users add any drugs they take by either scanning a label on a medication bottle or searching through a list of medicines. People can create custom schedules for each drug they are taking and receive alerts to remind them when it’s time to take one.

In the United States, the app will also alert users if there are any dangerous interactions between the drugs that they take.

Related blog post: Presorted Pills -A Good Idea

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Genomic Sequencing At Birth

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The Economist (5/13/22): Full-genome screening for newborn babies is now on the cards (Behind a paywall).

This article delves into the topic of genome screening at birth and its potential role in supplanting current newborn screening.

Rationale: “Doctors have described more than 7,000 rare diseases, generally defined as those affecting fewer than one in 2,000 people. So, though individually unusual, such illnesses are collectively a serious problem—a long-tail of need which is hard to treat because patients are few in number and their symptoms often picked up too late.”

Background: “A government-owned company called Genomics England … will soon start a pilot project intended to sequence the genomes of 200,000 babies. That could presage a national programme.”

Key points:

  • “On May 4th, at a meeting held in London by Genomics England, Rick Scott, the organisation’s chief medical officer, said discussions with parents and doctors had led his team to conclude that people want any genomic-screening programme for newborns to look for a far narrower set of conditions than BabySeq sought. The most appealing tests were for variants associated with a high probability of childhood illness, and which would benefit from early treatment.”
  • “One particular finding, according to David Bick, a clinical geneticist who advises Genomics England, is that parents want certainty. They feel it is no use being told that a child is “fairly likely” to have a condition. Rather, they want a pretty clear “yes” or “no”.”
  • “Many also do not want to know of adult-onset illnesses that their children may one day suffer. This means rejecting tests which might indicate a newborn’s risk, later in life, of contracting cancer, diabetes or Alzheimer’s disease.”
  • Potential problems: learning about degenerative diseases & mental health problems without suitable treatments, data security, mutations with variable phenotypes (variable age of onset and severity)

My take: Genomic screening could broaden the benefits of newborn screening but identifying all of an individual’s genetic flaws is likely to be more detrimental than beneficial at this point.

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Tired of Seeing This Headline

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The Onion has used the same headline 21 times since 2014. The article was first published on May 27, 2014, following the Isla Vista killings.

Milwaukee, El Paso, Dayton,

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Partisan Divide, Misinformation and Risk of COVID-19 Death

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NPR: Pro-Trump counties continue to suffer far higher COVID death tolls

Since May 2021, “those living in counties that voted 60% or higher for Trump in November 2020 had 2.26 times the death rate of those that went by the same margin for Biden. Counties with a higher share of Trump votes had even higher mortality rates…. previous polling has shown that belief in misinformation is highly correlated with being unvaccinated. Kaiser examined several common pieces of misinformation such as the idea that the government is exaggerating the severity of the pandemic, or that the vaccines contain a microchip. Kaiser’s poll found that 94% of Republicans believed one or more false statements about the vaccines.”

Related blog post: Perception of COVID-19 Risk, Vaccine Uptake and Media Source