Category Archives: General Health

Weight Loss Efficacy of Cagrilintide and Semaglutide

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WTGarvey et al. N Engl J Med 2025;393:635-647. Coadministered Cagrilintide and Semaglutide in Adults with Overweight or Obesity

This  phase 3a, 68-week, multicenter, double-blind, placebo-controlled and active-controlled trial (REDEFINE 1) examined the efficacy of the combination of Cagrilintide and Semaglutide (known as CagriSema).  Patients had a body-mass index (BMI) of 30 or higher or a BMI of 27 or higher with at least one obesity-related complication. The combination druge was delivered as a fixed-dose in a single-dose, single-use pen device. 6.1% of trial participants had BMI <30.

Percentage of patients with at least 5% weight loss
Percentage of patients with at least 20% weight loss
  • “Gastrointestinal adverse events (affecting 79.6% in the cagrilintide–semaglutide group and 39.9% in the placebo group), including nausea, vomiting, diarrhea, constipation, or abdominal pain, were mainly transient and mild-to-moderate in severity.”
  • “Although 57.4% of the participants assigned to cagrilintide–semaglutide were receiving the maximum dose at 68 weeks, 74.7% had received the maximum dose at some point after randomization…doses below the target might be highly effective for some patients and that dose reductions based on the clinical judgment…may be appropriate.”

This same issue also examined the use of this combination in patients with type 2 diabetes (REDEFINE 2). in this study with 1206 patients, “the estimated mean change in body weight from baseline to week 68 was −13.7% in the cagrilintide–semaglutide group and −3.4% in the placebo group.”

The editorial by CM Hales (“Expanding the Treat-to-Target Toolbox for Obesity and Diabetes Care”) notes that “six deaths occurred in the two trials combined, all in the cagrilintide–semaglutide groups, including one suicide in each trial. Previous studies of suicidality with GLP-1 receptor agonist treatment have not supported a causal link,6 but it continues to be of concern.”

My take (from the editorial): “A sustainable treat-to-target approach should extend to lifelong maintenance of health gains after initial weight loss. The intensity and composition of lifestyle interventions in the context of highly effective pharmacologic therapies also need further study. The pharmaceutical pipeline is promising, with potential improvements in safety (such as preservation of lean mass) and more convenience for patients (such as oral administration and monthly dosing). Greater effects on the health of Americans may be achieved not with antiobesity medications producing ever greater magnitudes of weight loss but with expanded access to safe and effective therapies for those who would most benefit.”

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Rising Scientific Fraud: Threats to Research Integrity Plus One

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Excerpts from NY Times Article:

“A team of researchers found evidence of shady organizations churning out fake or low-quality studies on an industrial scale. And their output is rising fast, threatening the integrity of many fields…“If these trends are not stopped, science is going to be destroyed,” said Luís A. Nunes Amaral, a data scientist at Northwestern University and an author of the study”

““Science relies on trusting what others did, so you do not have to repeat everything,” Dr. Amaral said….By the 2010s, journal editors and watchdog organizations were warning that this trust was under threat. They flagged a growing number of papers with fabricated data and doctored images. In the years that followed, the factors driving this increase grew more intense.”

“As more graduate students were trained in labs, the competition for a limited number of research jobs sharpened. High-profile papers became essential for success, not just for landing a job, but also for getting promotions and grants. Academic publishers have responded to the demand by opening thousands of new scientific journals every year…”

“Organizations known as paper mills are now turning scientific fraud into a lucrative business. Scientists eager to pad out their resumes can pay hundreds to thousands of dollars to be named as an author of a paper that they had nothing to do with…paper mills often use artificial intelligence to alter the text they lift from other papers…”

“The papers that Dr. Amaral and his colleagues could study came to light only because of the work of independent sleuths. To estimate how many paper mill papers have yet to be exposed, Dr. Amaral’s team created a statistical model that accurately predicted the rate at which suspicious papers surfaced. They estimate that the number of paper mill products may be 100 times greater than the ones they have identified…”

“In their new study, they calculated that the number of suspicious new papers appearing each year was doubling every 1.5 years. That’s far faster than the increase of scientific papers overall, which is doubling every 15 years.”

““We need to stop making it profitable to game the system.”

My take: This problem has preceded the widespread use of AI, although Al makes it harder to detect. Unfortunately, fake scientific reporting appears to be worsening.

Related article: Jessica Steier NY Times 8/19/25: The Playbook Used to ‘Prove’ Vaccines Cause Autism This article details very specifically how David Geier (now appointed by RFK Jr to evaluate vaccines and autism) and his father have produced multiple flawed studies regarding vaccine safety. This commentary takes a particularly deep dive into one of his articles on the preservative thimerosol. She shows that the authors likely used p-hacking to identify “atypical autism” since there was not a significant association with autism, compared different time cohorts (the control group was from a period with different diagnostic criteria/lower rates of autism), did not include confounders, and supported their arguments with “personal citing.”

Some excerpts:

There have been some 70 studies since Mr. Wakefield’s looking for any link between vaccines and autism. Of these, 26 have linked vaccines to autism in some way, and 43 found no connection between vaccines and autism.

A whopping two-thirds of studies that claimed to have found a link were written by  David and Mark Geier. These studies have been heavily criticized for using deceptive research techniques and flawed data.

Among the eight other studies that found a link, four were retracted for data manipulation, flawed methods or undisclosed conflicts of interest. Most of the authors have been involved in anti-vaccination campaigns and have had other papers retracted.

One such study that Mr. Kennedy referred to in his Senate confirmation hearing was published in a WordPress blog disguised as a journal and was funded by an anti-vaccine organization, among other problems.

Fortunately, independent scientists have conducted more than 40 high-quality studies since 1998 involving over 5.6 million people across seven countries. All found no connection between vaccines and autism. These studies were rigorously designed, were reviewed by independent peers and do not contain telltale signs of data manipulation, as the Geier studies do.

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Part of the Tower of London complex

Are We Giving the Right Advice on Sunlight?

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I was recently listening to a radio program (On Point) about the beneficial effects of sunlight.

The program notes that the potential beneficial effects of sunlight are much greater than the risks. Increased sunlight has been associated with lower rates of death, as well as lower rates of cardiovascular disease and autoimmune conditions like multiple sclerosis, type 1 diabetes, and Crohn’s disease.

When dermatologists recommend avoiding sunlight, they may be focused on the risks but not the benefits (though this varies among individuals). In addition, despite the more than 5-fold rise of melanoma diagnosis (especially in wealthy communities), there has not been a change in the rate of deaths due to melanoma. Skin cancers associated with sun exposure are mainly basal cell tumors and squamous cell tumors. These non-melanoma skin cancers have excellent survival rates.

Here is a link: The Healing Power of Sunlight (48 minutes) The most important part of this is in the middle, starting around 20 minutes.

My take: It’s a good idea to avoid sunburns but getting sunshine is good for health.

Related article:

  • Environ Epidemiol 2025. 9(3):e401. doi: 10.1097/EE9.0000000000000401. The association between time spent outdoors during daylight and mortality among participants of the Adventist Health Study 2 Cohort. Conclusion: “Moderate time outdoors in daylight during warmer months could be associated with lower risks of all-cause, CVD, and noncancer non-CVD mortality”

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River Cherwell in Oxford, UK
Oxford Botanic Garden

‘What Happens When the Doctors Can’t Trust the Government?’

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Danielle Ofri, NY Times 7/28/25: Doctors Have Lost Their Mount Olympus of Medicine

This entire essay is worth reading but may be behind a paywall.

An excerpt:

For most of my colleagues and me, the C.D.C. and the N.I.H. were the medical Mount Olympus, the towering pillars of medical authority. Contrary to right-wing portrayals, these were not dictatorial authorities. These were earned authorities, comprising our best, brightest and most dedicated peers. The formidable talents of these doctors and scientists would have commanded enviable salaries had they taken jobs in industry, but they chose the public sector instead — something that we clinicians were forever grateful for… 

While there are some doctors who viewed our public health institutions with disdain — some of them now are running these very organizations — most practicing physicians relied heavily on them to deliver the best care possible to their patients, despite occasional quibbles. What a relief, I always felt, that there were people organizing the things I can’t do — testing new treatments, conducting population studies, keeping tabs on worldwide diseases, issuing guidelines and more.

But now that support is a shell of what it once was. I can no longer automatically rely on these institutions because their scientific North Star, even if imperfect at times, has been replaced by one that seems nakedly political. Remaining staffs are no doubt working valiantly to do their jobs, but they are hobbled by loss of colleagues, resources and reliable leadership. So when I hear that the C.D.C. has changed a vaccine recommendation, I now question whether that’s a recommendation I can trust. When the F.D.A. commissioner says he wants to change how the agency approves or rejects new treatments, I no longer feel sure that science is driving those decisions. It’s hard to convey how profoundly grieved my colleagues and I feel…

Robert F. Kennedy Jr.’s view seems to be that we doctors are shills for corporate interests and government bureaucrats, and that torching our vaunted institutions is the prescription to fix us. Mr. Kennedy’s ire seems oddly directed. I, too, am disgusted by the role of money in health care, but I see it more as a result of the system we’ve set up, rather than the people who labor within it…

Notably missing from Mr. Kennedy’s Make America Healthy Again agenda is any suggestion that we provide universal health care, as most other developed countries do. There is no push to expand Medicare and Medicaid, which help some of our sickest patients. There is no focus on expanding access to early childhood education and supplemental nutrition programs, which offer steep health benefits…[There] is a barely concealed antipathy toward the people who are the engine of these institutions — doctors, scientists, policy wonks…

Cuts to infectious-disease surveillance means that outbreaks will almost certainly creep up more stealthily on our patients. Cuts to the National Center for Chronic Disease Prevention and Health Promotion means fewer resources for prevention of cancer, heart disease and diabetes — some of the leading causes of death. Cuts to the N.I.H and the F.D.A. could drastically reduce the development and approval of new medical treatments. Add in cuts to injury-prevention research and patient safety programs, and it’s a prescription to make America sick again.

Every time you go to your doctor or get treated by a nurse, there’s a chorus of researchers, public health workers, policy experts, epidemiologists and advisory panels arrayed behind them, aided by laboratories, databases, websites, early-detection systems and clinical guidelines. Our current government seems determined to wrench this away, handicapping your health care team’s ability to care for you.

My take (borrowed in part from author): Our health care system needs to improve costs, accessibility, and outcomes. Yet, the changes to our healthcare and research under this administration are making matters worse. “So many of our resources are now gone, and those that remain no longer feel trustworthy. Americans’ health will decline at the hands of our federal government. And there’s no vaccine for that.”

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Giant Lily Pads in Oxford, UK

Health Disinformation Risks from AI Chatbots

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MD Modi et al. Annals of Internal Medicine; 2025. https://doi.org/10.7326/ANNALS-24-0393. Abstract: Assessing the System-Instruction Vulnerabilities of Large Language Models to Malicious Conversion Into Health Disinformation Chatbots

Methods: This study assessed the effectiveness of safeguards in foundational LLMs against malicious instruction into health disinformation chatbots. Five foundational LLMs—OpenAI’s GPT-4o, Google’s Gemini 1.5 Pro, Anthropic’s Claude 3.5 Sonnet, Meta’s Llama 3.2-90B Vision, and xAI’s Grok Beta—were evaluated via their application programming interfaces (APIs). Each API received system-level instructions to produce incorrect responses to health queries, delivered in a formal, authoritative, convincing, and scientific tone.

Key findings:

  • Of the 100 health queries posed across the 5 customized LLM API chatbots, 88 (88%) responses were health disinformation

Examples of how AI systems can be used to create disinformation:

My take: This study shows how easy it is to get AI systems to provide misleading information in a convincing fashion. It might be interesting to include one of these systems to provide answers for the board game Balderdash.

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Humor: When Your Dad is A Pediatrician

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These videos are on TikTok account. I do not have an account but was able to access this short video on my laptop (had trouble accessing on my mobile):

These videos are also on YouTube: Dr. Dan Short Videos on YouTube

“How to Make America Healthy: the Real Problems — and Best Fixes”

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H Pearson, Nature, 6/24/25: Partly Open Access! How to make America healthy: the real problems — and best fixes

An excerpt:

Since taking over as the top US health official in February, Robert F. Kennedy Jr has overseen radical changes that have alarmed many public-health experts…His mission, he says, is to ‘Make America Healthy Again’. “We are the sickest nation in the world,” he said in March, “and we have the highest rate of chronic disease.” His diagnosis holds some truth, say public-health specialists and analysts. Relative to other similarly wealthy nations, the United States has the shortest life expectancy despite spending the most on health care…And researchers agree that high rates of chronic disease, including heart disease and obesity, are key contributors to Americans’ higher death rates, as Kennedy emphasizes.

But researchers say that Kennedy — widely known as RFK Jr — has mostly ignored other leading causes of death and ill health, including car accidents, drug overdoses and gun violence…

Life expectancy in the United States was closer to the average for its peers around 1980 and gradually improved, according to KFF’s analyses. The gains were driven partly by a drop in smoking and increased use of cholesterol-lowering drugs known as statins…

Overall, chronic conditions — heart disease, cancer, stroke and respiratory disease — take up four out of five spots on the country’s list of biggest killers…One of the biggest drivers of those deadly conditions is obesity, say researchers. As of 2022, about 42% of adults were considered obese in the United States, compared with 27% in the United Kingdom and 5.5% in Japan. Obesity increases the risks of developing diabetes, heart disease, cancer and many other conditions. “The US has, particularly around diet, obesity and overweight, adopted unhealthier lifestyles at a higher rate than our country peers,” Bollyky says…

The problems caused by chronic disease are compounded by poor health care. Compared with a group of similar high-income countries, the United States is the only one that lacks universal health-insurance coverage… Lack of health insurance, high costs and other barriers prevent people from getting diagnoses and treatment early on…

The other big contributors to lower life expectancy in the United States — and what really sets the country apart, researchers say — are high death rates from substance misuse, car accidents, suicide and homicide (see ‘Varied causes’). These tend to kill people of working age…All told, the death rates in working-age people mean that one 5-year-old out of every 20 — or roughly one in every school class — will die before the age of 45, according to Angus’s calculations. The comparable figure is one in 50 in the United Kingdom and one in 100 in Switzerland…

Health spending in the United States was about US$13,000 per person in 2023, according to a KFF analysis. That compares to an average of about $7,000 per person in similar large, well-off countries…

Boosting rather than cutting spending on disease prevention is “where the big gains are
to be made on population health” [Reginald Williams, a health-policy specialist at the Commonwealth Fund says his] first priority would be to expand health coverage. In the United States, around 8% of people lack health insurance, compared with around 1% or less in similar high-income countries. The second, he says, would be to invest more in primary care — the physicians and other health professionals who are the first port of call for patients, and who deal with disease prevention and management…

Tackling the high death rates from overdoses and guns, meanwhile, would involve
addressing entrenched social and political issues such as gun ownership, poverty,
unemployment and inequality.

My take: Despite big promises from politicians, there are no quick fixes for improving our national health. Improving health care access would help but this does not address deaths due to firearms, drug overdoses and to car accidents.

Related blog posts:

…

U.S. Doctors Leaving For Canada

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B Kelman, NPR 5/29/25: American doctors look to relocate to Canada to avoid the Trump administration

An excerpt:

Earlier this year, as President Donald Trump was beginning to reshape the American government, Michael, an emergency room doctor who was born, raised, and trained in the United States, packed up his family and left the country…”Part of being a physician is being kind to people who are in their weakest place,” Michael said. “And I feel like our country is devolving to really step on people who are weak and vulnerable…”

The Medical Council of Canada said in an email statement that the number of American doctors creating accounts on physiciansapply.ca, which is “typically the first step” to being licensed in Canada, has increased more than 750% over the past seven months compared with the same time period last year — from 71 applicants to 615. Separately, medical licensing organizations in Canada’s most populous provinces reported a rise in Americans either applying for or receiving Canadian licenses, with at least some doctors disclosing they were moving specifically because of Trump…

 While it was once more difficult for American doctors to practice in Canada due to discrepancies in medical education standards, Canadian provinces have relaxed some licensing regulations in recent years, and some are expediting licensing for U.S.-trained physicians…

Michael, the physician who moved to Canada this year, said he had long been wary of what he describes as escalating right-wing political rhetoric and unchecked gun violence in the United States, the latter of which he witnessed firsthand during a decade working in American emergency rooms…

This desire to leave has also been striking to Hippocratic Adventures, a small business that helps American doctors practice medicine in other countries…

Alison Carleton, a family medicine doctor who moved from Iowa to Manitoba in 2017, said she left to escape the daily grind of America’s for-profit health care system and because she was appalled that Trump was elected the first time. Carleton said she now runs a small-town clinic with low stress, less paperwork, and no fear of burying her patients in medical debt.

My take: There are more than one million physicians in the U.S. per AAMC data; so the absolute numbers leaving are quite small. However, this uptick in physicians leaving is another indicator of U.S. physicians being unhappy with U.S. healthcare policy and the direction in which it is headed.

Related topic of physicians choosing alternative practice setting while staying in U.S.: YouTube: NEJM Interview: Zirui Song on the rise of concierge and direct primary care practices (13 minutes)

Related article: Z Song et al. N Engl J Med 2025;392:1977-1979. Primary Care — From Common Good to Free-Market Commodity

Throughout the United States, PCPs have been leaving traditional practices for concierge and direct primary care (DPC) practices, in which patients are offered personalized and more accessible primary care in exchange for membership or retainer fees… these models can offer physicians notable advantages over traditional primary care models, including greater clinical autonomy, more take-home pay, and improved work–life balance and job satisfaction.4,5 Less burdened by prior authorizations, insurance denials, billing and coding tasks, and other demands in traditional practices — including the need to adhere to regulatory requirements under alternative payment models — physicians often have more time for direct patient care...Yet trade-offs — in the form of decreased access for patients [without a concierge physician] and increased strain on PCPs in traditional primary care — are borne by the rest of society.

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RSV Vaccine and Treatment Lowered Hospitalizations in Infants

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Beth Mole, Ars Technica 5/08/25: New RSV vaccine, treatment linked to dramatic fall in baby hospitalizations

An excerpt:

RSV, or respiratory syncytial (sin-SISH-uhl) virus, is the leading cause of hospitalization for infants in the US. An estimated 58,000–80,000 children younger than 5 years old are hospitalized each year. Newborns—babies between 0 and 2 months—are the most at risk of being hospitalized with RSV…

But the 2024–2025 season was different—there were two new ways to protect against the infection. One is a maternal vaccine, Pfizer’s Abrysvo, which is given to pregnant people when their third trimester aligns with RSV season (generally September through January)…the other new protection against RSV is a long-acting monoclonal antibody treatment, nirsevimab, which is given to babies under 8 months old as they enter or are born into their first RSV season and may not be protected by maternal antibodies.

For the new study, CDC researchers looked at RSV hospitalization rates across two different RSV surveillance networks of hospitals and medical centers (called RSV-NET and NVSN)…

The analysis found that among newborns (0–2 months), RSV hospitalizations fell 52 percent in RSV-NET and 45 percent in NVSN compared with the rates from the 2018–2020 period.However, when the researcher excluded data from NVSN’s surveillance site in Houston—where the 2024–2035 RSV season started before the vaccine and treatment were rolled out—there was a 71 percent decline in hospitalizations in NVSN.

For a broader group of infants—0 to 7 months old—RSV-NET showed a 43 percent drop in hospitalizations in the 2024–2025 RSV season, and NVSN saw a 28 percent drop.Again, when Houston was excluded from the NVSN data, there was a 56 percent drop.

Lastly, the researchers looked at hospitalization rates for toddlers and children up to 5 years old, who wouldn’t have been protected by the new products. There, they saw RSV hospitalization rates were actually higher in the 2024–2025 season than in the pre-pandemic years.

Related CDC link: Healthcare Providers: RSV Immunization for Infants and Young Children

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Calamitous Impact of U.S. Withdrawal from Gavi Funding

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Stephanie Nolen, NY Times 6/25/25: Kennedy Withdraws U.S. Funding Pledge to International Vaccine Agency

An excerpt:

The United States will withdraw its financial support of Gavi, the global organization that helps purchase vaccines for children in poor countries, Robert F. Kennedy Jr., the United States secretary of Health and Human Services, told the group’s leaders on Wednesday, accusing them of having “ignored the science” in immunizing children around the world…

“Any decision made by Gavi with regards to its vaccine portfolio is made in alignment with recommendations by the World Health Organization’s Strategic Advisory Group of Experts on Immunization (SAGE), a group of independent experts that reviews all available data through a rigorous, transparent and independent process,” Gavi’s statement said…

Dr. Atul Gawande, a surgeon who led global health work in the Biden administration, called Mr. Kennedy’s remarks “stunning and calamitous…”

The United States was the largest donor to Gavi, whose work is estimated to have saved the lives of 17 million children around the world over the past two decades…

Gavi had hoped to raise $9 billion for the 2026-30 period, funds the organization said would allow it to purchase 500 million childhood vaccinations and to save at least eight million lives by 2030. ..

The decision to end U.S. support for Gavi — which was included in the rescission package passed by Congress and now being considered by the Senate — leaves the organization with an immense hole in its budget…The Gates Foundation is maintaining its funding at a stable level from previous years — about $350 million in each of the next four years — as is the United Kingdom.

My take: It is no exaggeration to say that the shift in U.S. vaccine policy may result in hundreds of thousands of deaths every year. In addition, U.S. travelers will be more likely to be exposed to vaccine-preventable illnesses as well.

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