Tag Archives: Medicine

This Tiny Country Beat COVID

On the southern tip of Spain, the tiny UK territory of Gibraltar has vaccinated almost its entire population. COVID deaths have dropped to zero:

Life is beginning to get back to normal. Masks are no longer required outside, curfews are gone, and bars and restaurants are full. Even sporting events have resumed:

Events have also returned to the Rock as Gibraltar hosted what’s thought to be the first fully vaccinated major sporting fixture in the world on Saturday.

Five hundred spectators, each tested for Covid-19 prior to the event, were able to witness British heavyweight fighter Dillian Whyte claim victory over Russia’s Alexander Povetkin at Gibraltar’s Europa Sports Complex.

The fight, called the Rumble on the Rock, was originally meant to take place at the Matchroom HQ, a venue in southeastern England, but was switched to Gibraltar thanks to its Covid-19 safe environment.

Soccer fans were also allowed to witness sporting matches starting with Gibraltar’s World Cup qualifier clash against the Netherlands on Tuesday.

Victoria Stadium welcomed 600 attendees who had previously received two doses of the vaccine and tested negative for the virus on the day of the match.

Only 3% of residents refused the vaccine, which may be one reason why Gibraltar’s results are so good. That may be difficult to recreate in the US or other nations, but Gibraltar provides a welcome view of what life could look like soon as the world races to vaccinate.

I encourage you to get your shot if you haven’t already. Let’s get back to normal life!

For more on COVID and vaccines, check out these posts:

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Photo: “Gibraltar – Rosia” by Roy McGrail (krm gib) is licensed under CC BY-SA 2.0

Amazing Drugs Are Going from the University to the Graveyard, While Patients Pay the Price

Was the cure for cancer invented in a university, only to be shelved for a lack of funding?

University labs are creating incredible drugs on a regular basis. Unfortunately, most will never get to the patients that need them so desperately. This is the conclusion of an intriguing book I just read, Preserving the Promise: Improving the Culture of Biotech Investment, by Scott Desain and Scott Fishman.

The problem is that universities don’t have the massive funds it takes to bring a drug candidate through clinical trials to FDA approval. What about Big Pharma? Well, they’ve been cutting their R&D budgets drastically for years.

This leaves early stage biotech investors to fund much of the commercialization of new drugs, and there simply aren’t enough of them to fund all the good candidates. Indeed, the number of investors specializing in this area is shrinking. This doesn’t surprise me given that most early-stage investors focus on software startups and have a software background themselves.

This does leave the few angel investors who specialize in biotech in an enviable position though: more great companies out there than there are angels to fund them means big slices of great companies for less money, and thus higher returns. This is an area that I may be branching out into in the future. Being even a tiny part of creating a new lifesaving drug or medical device would be incredible.

University policies also hinder the effective commercialization of research, the book notes. Technology Transfer Offices own the patent, but sometimes are hesitant to license it unless they can get lots of revenue for it right away, which is hard for a fledgling company to provide. In other cases, they bury the patent, thinking it unpromising. And university conflict of interest policies can often stop the inventor from continuing to work on the research with company funds. This separates the technology from the person who is best positioned to advance it.

In all, this seems like a neglected area with a lot of problems. That we rely on it for virtually all new drugs is scary. But investors like myself should eye the area with interest, especially given rich valuations in software startups.

For more posts on biotech, check these out:

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Photo: The co-founders of BioNTech, a biotech success story. “Forschungszentrum der Biotech-Unternehmen BioNTech AG und Ganymed Pharmaceuticals AG” by MWKEL-RLP is licensed under CC BY-NC 2.0

What if Your Mask Could Test You for COVID?

Harvard researchers have invented a mask that can test the wearer for COVID:

Researchers at Harvard University’s Wyss Institute for Biologically Inspired Engineering have figured out how to integrate a freeze-dried diagnostic Covid-19 test into a face mask. The test reacts with exhaled particles and gives a diagnosis in 90 minutes or less.

The tests and a tiny blister pack of water can be mounted on any mask. After the mask has been worn for at least 30 minutes, a person punctures the blister pack to release the water needed to rehydrate and run the reactions. The test result is indicated by one or two lines, similar to a pregnancy test

The masks will be affordable and could be useful for a lot more than COVID:

The Wyss team…expects the product to cost about $5. The technology can be targeted to identify other viruses and variants as well.

Any such masks would be subject to FDA approval. Another team at University of California, San Diego is working on a sticker that could be stuck to any mask to test the wearer. Those stickers could cost mere cents.

Incredible ingenuity!

For more on COVID, check out these posts:

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Photo: “Fit testing the N95 Mask” by AlamosaCountyPublicHealth is licensed under CC BY 2.0

For the Vaccinated, Masks May Be Over

If you’ve been vaccinated for COVID, can you finally take off the mask? Early data from Israel says yes:

Pfizer Inc and BioNTech SE said on Wednesday that real-world data from Israel suggests that their COVID-19 vaccine is 94% effective in preventing asymptomatic infections, meaning the vaccine could significantly reduce transmission.

If you don’t even have an asymptomatic infection, you shouldn’t be able to transmit the disease to others. That said, this data is preliminary and is not yet peer reviewed.

The problem with real world application of this knowledge is that anyone can say they’re vaccinated. At a grocery store, for example, it would be hard to check everyone given constraints on time and manpower. So, I expect to see masks continue in public places until case rates are very low and everyone who wants a vaccine has had a chance.

That said, this data can inform our actions in private settings. I look forward to being able to wear one less frequently!

For more posts on COVID, check these out:

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Photo:

Has Merck Found the Cure for COVID?

Merck has come out with great results from a new drug for COVID:

Over the weekend, the Big Pharma and its biotech partner Ridgeback announced their drug, molnupiravir, hit one of its secondary objectives from a new trial, namely to reduce time to negativity of infectious SARS-CoV-2 virus isolation from swabs in patients with symptomatic COVID-19.

The data show that, at Day 5, there was a reduction in positive viral culture in subjects who received molnupiravir (all doses) compared to placebo: 0% (0/47) for molnupiravir and 24% (6/25) for placebo.

These findings are preliminary, and more data will come out soon:

This is just a peek, with primary endpoints and more secondaries “to be presented at an upcoming medical meeting,” which will show a much clearer picture of how well this drug may be working.

We should know a lot more within the next few weeks:

Data from the phase 2/3 pivotal studies of the med are expected this quarter.

This drug could be great for people who are hesitant to get a vaccine, who haven’t been able to get one yet, or for whom the vaccine did not prevent infection (rare but possible). Good news!

For more on COVID drugs and vaccines, check out these posts:

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Photo: Merck CEO Kenneth Frazier, “File:Kenneth C. Frazier.jpg” by Merck (www. Merck.com) is licensed under CC BY-SA 3.0

Why Someone Dying After Getting Vaccinated Doesn’t Mean Anything

We keep hearing scary stories about people getting sick or dying shortly after getting a COVID vaccine. But we shouldn’t confuse correlation with causation. From the mathematician Gary Cornell’s excellent blog:

For example, within one week after vaccinating 10,000,000 people, you will likely have around 98 people keel over and die for no apparent reason and if all of them were pregnant women, almost 27,800 miscarriages.

In this post, he has a table with the expected rate of many diseases we often hear are associated with vaccines, such as Guillain-Barre syndrome. It turns out, a substantial number of people are going to get those illnesses anyway, with or without a vaccine.

My wife made an excellent analogy on this subject recently. “Someone might have drank tea and had a stroke in the same day. But it probably wasn’t the tea.”

Same idea here. And with the US having given out over 90 million shots, mostly to the elderly and frail, the fact is some people are going to die shortly thereafter. But it doesn’t say anything about the vaccine.

The clinical trials carefully compared the vaccinated and unvaccinated groups in the trial and found no higher rate of complications amongst the vaccinated. And that’s the data to act on.

Photo: Me getting the Moderna vaccine on February 22. I am alive and well as of this writing.

For more on COVID and vaccines, check out these posts:

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I Got The Moderna Vaccine! Here’s What It’s Like.

At 1:48pm today New Jersey time, I got my vaccine!

I’ve been waiting for this moment for many months, and I’m so grateful to have a chance to get it. It was the Moderna vaccine and I got it through the Hudson County vaccination site. So far, I feel 100%!

Having lived through the dark period of spring 2020 in the New York City area, when sirens were almost constant and my neighbors were dying in huge numbers, reaching this moment is cathartic. It prompted a lot of feelings for me: relief, gratitude, and hope!

So, what’s it like? This is a drive through site, and I don’t own a car, so I took an Uber. The driver very patiently waited with me in the lengthy line to get the jab. Many cars slowly snaked ahead in the cold snow.

Once we finally made it to the front, I showed a QR code on my phone that the county had e-mailed me. Shortly therafter, the nurse came up and asked if I had been feeling sick today. Then, she gave me the shot!

I barely felt a thing, which was surprising. Since then, I’ve had no side effects that I can discern. I hope it stays that way!

Just after the shot, we took the picture above. It’s actually staged…she had already given me the jab before we ever thought to document the moment for posterity! So she posed with the needle near my arm, and I took a snap to record this wonderful moment in my life that I’ve waited so long for.

“This is a historic moment,” she said. I agreed.

If you’re still trying to get an appointment, don’t give up! I’ve been checking every area provider’s website repeatedly for months. And I almost wasn’t going to check again today, but I did, and found an appointment for just 90 minutes away! Perhaps someone cancelled last minute. The best strategy seems to be to check over and over.

Now, I can begin to plan for a life after COVID. A week after the 2nd dose, which will be around the end of March, it should have achieved its full 94% efficacy. I will finally be able to get on a plane and visit my mom for the first time since December 2019! And I’m looking forward to getting some great protection even sooner: just 2 weeks after the first dose, the vaccine is 80% effective.

I really encourage everyone to get this vaccine, although I know each person has to make their own decision. COVID may be something to fear, but this really isn’t! If I didn’t keel over after, you won’t either! 🙂

The Miracle Particles Behind COVID Vaccines

The particles that the Pfizer and Moderna vaccines rely on are 1/1000th the width of a human hair. They’re called lipid nanoparticles, and they’re revolutionizing medicine as we speak.

The Pfizer and Moderna COVID vaccines work by sending mRNA to your cells. The mRNA tells the cells how to make proteins that block the virus. But you can’t send the mRNA on its own, because it would be repelled and flushed out through the kidneys.

The mRNA needs a wrapper, and that’s where the lipid nanoparticle comes in. The mRNA molecules are negatively charged and so are our cells. These two negatives push each other away. But, the nanoparticle can make it inside the cell.

Once inside the cell, the particle faces another barrier. The cell wraps it in a container called an endosome, because the cell doesn’t want to be contaminated. So, the lipid nanoparticle has to be specially designed to escape that endosomal prison.

Decades of research has gone into these particles, and they can now escape and spread the necessary information into the watery substance inside the cell (called the cytoplasm). Our commitment to funding basic science decades ago is paying off today in ways we could never have anticipated.

I learned a great deal about these incredible particles today at an online seminar hosted by the journal Nature with Kathryn Whitehead of Carnegie Mellon University and Yizhou Dong of Ohio State University. They gave some great perspective on the development of this amazing technology.

One thing Professor Whitehead mentioned was that despite concerns that the mRNA vaccines are too new and unproven to be safe, the lipid nanoparticles they use have existed for decades. In fact, she said she’s had research rejected for publication because these particles are considered too old hat!

I also finally learned why the vaccines have to be stored at such cold temperatures: molecules will start moving around too much once the temperature rises, so the lipid nanoparticles could come apart. Perhaps one reason Moderna’s vaccine doesn’t need quite as cold of storage is that they’ve been researching these particles for much longer than Pfizer/BioNTech, so their particles may be a bit more stable.

Beyond COVID, lipid nanoparticles and the mRNA therapies they’re a part of could be used for other viruses like the flu, Zika and Ebola. They may also be used as cancer immunotherapies. (This echoes what the co-founders of BioNTech said recently.)

These particles seem likely to underlie an entire new generation of medicines. I’ll be keeping a close eye on them, microscopic as they are!

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Photo: “2020_06_020100 – a human cell attacked by Covid-19” by Gwydion M. Williams is licensed under CC BY 2.0

Numerous COVID Vaccines are 100% Effective at Preventing Death

Of all the possible outcomes from COVID infection, clearly death is the one we want to prevent above all. We commonly see vaccine efficacy numbers from the 60’s to the 90’s, but that figure generally refers to how successful the vaccine is at preventing a COVID infection with any symptoms.

How effective are the vaccines at preventing you from dying of COVID? Turns out, regardless of whether you look at trial data from Pfizer, Moderna, AstraZeneca, Johnson & Johnson, Novavax or the Russian Sputnix V vaccine, you don’t see a single COVID death.

I came across this information in fascinating Twitter thread today from the eminent Yale virologist Dr. Akiko Iwasaki:

This is a simple and highly relevant message I’d like to see broadcasted far and wide…vaccinated people don’t die of COVID. Period.

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What If Homelessness Is Caused by Brain Injuries?

A couple of months ago, a man approached me on the street near my home. He asked for a bit of money, and although I usually never do, for some reason I gave it to him. I later saw him on a regular basis near the neighborhood grocery. I found out his name was John* and he used to work in construction. Several times a week, I’d run into him and stop and chat for a few minutes.

One day, I noticed he had large purple bruises on his forehead. He told me he had tripped over his shoelaces and gone down hard. Especially if someone is exhausted and cold, it’s easy to see how this could happen. He had been to the hospital, but they dismissed him quickly, perhaps because he was homeless.

He had lived in our town for 48 of his 53 years, and only become homeless recently after losing his job, like so many others. It troubled me to think that after a lifetime of contribution, our town had cast him aside so readily.

I was reminded of John yesterday when I heard that over half of homeless people may have brain injuries. Skeptical, I decided to do some digging. I found a metanalysis in The Lancet that confirmed this astounding figure:

The lifetime prevalence of any severity of TBI [traumatic brain injury] in homeless and marginally housed individuals (18 studies, n=9702 individuals) was 53.1%

This is much greater than the general population:

The lifetime prevalence of TBI in homeless and marginally housed individuals is between 2.5-times and 4.0-times higher than estimates in the general population. Moreover, the lifetime prevalence of mo­derate or severe TBI in this population is nearly ten-times higher than estimates in the general population.

It’s difficult to say whether the brain injuries are a cause or effect of homelessness. But, homeless people tended to have their first TBI at a young age. To me, this argues that brain injuries are a cause of homelessness:

Age at first TBI ranged from 15 years to 19.9 years, and we calculated a weighted mean age of first TBI of 15.8 years.

Perhaps the relationship works both ways:

TBI could increase the risk for homelessness, and homelessness could increase the risk for incident TBI.

It’s common for us to blame the homeless for their condition. After all, many are addicted to alcohol and drugs, aren’t they? But that too may be related to head trauma:

several characteristics of homeless and marginally housed populations (eg, residential instability or substance use) were associated with sustaining TBI

Another study from Canada found similar figures, and noted that the first TBI usually happened before they became homeless:

The lifetime prevalence among homeless participants was 53% for any traumatic brain injury and 12% for moderate or severe traumatic brain injury. For 70% of respondents, their first traumatic brain injury occurred before the onset of homelessness.

A British study found that homelessness was not a significant predictive factor for head injuries. However, it didn’t address the question of whether the homeless had a TBI before becoming homeless.

Imagine two people, one with an stable and well-off family and one with a chaotic and impoverished family (or no family at all). They both hit their heads. One gets support and good medical care, but the other may wind up homeless.

I sometimes wonder if that’s what happened to John. Did he get hurt, wind up homeless, and then find himself in a position to get hurt again?

I haven’t seen him lately, despite looking for him over and over. I hope he found a nice place to stay this winter, and I hope to see him again.

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*Not his real name

Photo: “Thomas (Tomaso) is Homeless” by Franco Folini is licensed under CC BY-SA 2.0