As we move closer to space travel becoming more feasible for the average person (hopefully in the coming decades), physicians will have to face the reality of astronauts experiencing health problems beyond the borders of a hospital, where there is less help available. While astronauts are selected to be in good health and unlikely to develop severe health complications while traveling, one will eventually suffer an adverse event. Previously healthy athletes’ hearts have been known to stop during exercise on rare occasions, possibly due to undiagnosed heart defects, such as hypertrophic cardiomyopathy. Fortunately, it is a possibility that NASA considers.

We also need to understand more ways to prevent such an event from occurring so we do not have to rely on such contingencies. A group of Japanese researchers sought to find answers for this problem. Will it make space travel safer? Remember to give my article claps and read it all the way through to support me as a writer!

Heart attacks and strokes are ultimately caused by fat deposits in your blood vessels breaking apart, driving a series of reactions that eventually obstruct the vessel, starving your heart or brain of essential oxygen. A way to better understand this process, so we can keep you (and astronauts) safe using the wonders of modern medicine, is to know how the genes in your blood vessels are affected by external triggers, such as a fat plaque deciding it had enough or microgravity. This is where it gets interesting when considering space travel!

A group of scientists created a device called a clinostat that can mimic a low-gravity environment by rotating the cells in blood vessels at a particular rate (so less need to conduct expensive space station experiments). They found that we have gravity-sensitive genes in our blood vessels that produce more or less of their downstream products (think of DNA like a conveyor belt where DNA is used to make other things) when gravity changes! But how is this evidence convincing and exciting?

The group found that the gene SLCO2A1 appeared to be the gravity-dependent gene (stay tuned because there will likely turn out to be other gravity-dependent genes). This gene is notable because others have found its expression linked with cardiovascular disease (like heart attacks) and high blood pressure. While more research, perhaps using mathematical approaches as I use in my genetics research, will be required to clarify the intersection between this gene, heart disease, and gravity changes, it is a good step toward understanding how being in space changes our bodies! So what needs to happen now?

Due to the nature of being among the first to explore this piece of science, the group focused on genes that are more commonly expressed. Future studies could study the expression of all roughly 20,000 genes to see if there is anything else interesting that changes. This study used only cells, which can behave differently in mammals like us or mice. Finding a way to non-invasively measure blood vessel gene expression in these more complex models could further clarify the role of this gene or other genes that could be contributing. There is still a lot that we can do. That is what makes science so exciting!

Aerospace medicine and our understanding of how being in space changes the body has made progress. Unanswered questions could also help us navigate the stars while ensuring travelers are well cared for. Studies such as this help understand how being in an unfamiliar place can change our bodies, thus offering targets to monitor as they could influence astronaut health or risk of developing diseases down the road. Give it time, and we’ll have a better sense of it all, making your orbital flight that much safer.

If you liked this article, be sure to give me claps and subscribe. It would be fantastic to have you as a follower! Let me know your thoughts on aerospace medicine or your thoughts on the article in the comments. Thanks for reading! 🙂

The post Gene Expression Changes in Heart Cells: A New Threat to Astronaut Health? appeared first on Medika Life.

We will visit Mars in person in the coming decades, a months-long trip one-way. As I look forward to playing Bethesda Game Studio’s Starfield after recently finishing all nine books of Iain M. Banks’s Culture series, I think about the plans that incorporate even further destinations. Being a physician-scientist, it is hard not to think of the challenges that come from long-distance travel! While some health concerns of space travel are already reasonably well known, such as muscle deconditioning or the bombardment from cosmic radiation, several conditions have not yet been considered hazards in space travel. This is mainly because the technologies that would make them a reasonable point of alarm for an astronaut have not been invented yet!

Eventually, there will be a way for everything that a human needs to be synthesized onboard a spaceship. Means of accomplishing this are already being investigated, such as through harnessing microorganisms, like bacteria, towards producing everything a human could need, like oxygen, food, and raw materials. As for putting a human in “stasis” for a long journey, artificial hibernation has been academically engaged as a concept, making applications more feasible for the future (although it will take time to evaluate such a procedure due to ethical and safety concerns).

So, let us say that we can keep some humans alive indefinitely in a space shuttle. What else do we need to think of? As a physician and Alzheimer’s disease researcher, I think you can guess one such thing.

Alzheimer’s disease is the most common form of dementia, typically affecting around 10% of individuals older than 65. One’s risk of Alzheimer’s increases as one gets older, with one in three over age 85 having the disease. Alzheimer’s is believed to be caused by the progressive death of neurons, the cells in your brain that contribute to memory and your ability to function.

If I were to jump on a NASA mission right now, travel time to the nearest star system, Alpha Centauri, is a greater concern (130,000 years!). In 2017, NASA proposed a new technology for space travel called solar sails, which could speed this up (44 years). Despite this design remaining a concept and its construction proposed for over 40 years from now (and likely not going to host an astronaut), what would happen if I boarded this vehicle in my seventies and placed in stasis until I arrived?

With every year of traveling, you could count on the risk of developing Alzheimer’s persisting. Unless hibernation technologies find a way to prevent neuronal cell death or the natural deposition of debris in the brain as we age, it is possible that I could wake up having Alzheimer’s! Imagine that, after traveling further than anyone ever had before? While there are “modifiable” risks for Alzheimer’s that could arguably be addressed to reduce the risk of disease, like reducing the risk of blood vessel disease through a healthy diet and exercise, one can only do so much.

One day, we will have to face the music of how we will keep our astronauts healthy on long trips. As with other health conditions, which I will touch on in future articles (be sure to give this article a clap and subscribe), medical research will have to address possible problems arising across body systems rather than a singular goal of having our own intergalactic visitor survive a long trip because there is a lot more to life than simply living, as many of us could agree.

There is reason to be optimistic! In the Alzheimer’s and Aging research fields that I am part of, energy (including mine) and money are going towards finding out how we can help people live longer and better. While science takes longer to yield results than we would like (even AI took decades to develop before it was ready for consumers as ChatGPT), progress is always happening, and getting human life out among the stars is something that people care about.

Let me know your thoughts on prioritizing traveling among the stars! Do you think we should try going as far as possible or focus more on taking it slow?

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We live in a very exciting time! Alzheimer’s medications that are more promising than past drugs are starting to hit the shelves, with others on the way. Eli Lilly’s new daratumumab medication has been suggested to slow the progression of early Alzheimer’s by up to 35%. So if it took someone five years to progress to more serious Alzheimer’s without medication, this could slow it, so it could instead take seven years, meaning more years being more present with one’s family. Lecanemab (Leqembi), from Eisei and Biogen, was also found to reduce cognitive decline, keeping our parents or ourselves fully present as we traverse life’s journey together!

In this article, I will talk about why these drugs offer society hope yet will also cause a big problem, at least in the short term (i.e., until generics become available when the drugs’ patents expire). As for my background, I earned my M.D. in the United States to soon earn my Ph.D. in Canada, focusing on Genetics. Today, I work as a postdoctoral scientist at Massachusetts General Hospital, studying the genetics of Alzheimer’s disease. In my medical training, I have seen the tragedy that can happen to people’s parents or themselves as they face newly diagnosed dementia and late-stage disease.

To be clear, these medications are a good thing. They could help many of those around us, whether a parent, sibling, or ourselves. Dementia is a horrible disease; until now, not much could be done about it. A family member is diagnosed with the disease in the office and told that they are showing signs of this illness and that very little can be done to help them. Over time, their personality changes, and they slowly become less like themselves daily, aware of what is happening.

This can cause significant distress for those with this illness and their family and friends. We spend years with these people. We are forced to watch, unable to make a difference, as they lose their ability to function and lose who they are. These medications could slow these changes, finally offering some semblance of hope for those with these diseases.

As with any medication, these drugs do not come without risks. One in four people who received Leqembi had a “transfusion reaction,” which in most people means that they may have had redness and swelling in the arm they received the medication. While such reactions can be severe, causing one’s airway to close up in an anaphylactic reaction, these responses are generally uncommon. Some individuals who received Leqembi or Donanemab experienced swelling in their brain, known as cerebral edema. While not necessarily a problem, in that it does not necessarily produce symptoms, one in four people who took Donanemab developed this swelling, one of four of which had symptoms. So if we considered a group of 1000 people who took this drug, using the study’s results, about 60 in 1000 could experience headaches or confusion. Some of these 60 individuals may develop bleeding in their brains. Around two could die from the swelling or bleeding. While concerning, 940 of these hypothetical 1000 people had no side effects. Even if you took this med and experienced side effects, you could be sure that your doctor would do everything they could to keep you safe, including discontinuing the medication that often resolves adverse effects.

So it sounds like my opinion is that these drugs sound promising. Why the doom and gloom article title? This is because these are or will be very expensive drugs. The price for a single person to receive enough Leqembi for a single year is forecasted to be $26,500. While Donanemab does not yet have an official cost, it is predicted to be over $26,000 annually. Think about that amount of money for a moment. The federal poverty line for a family of four, which could include a couple, a child, and a grandparent, is $30,000. More than one in 10 people in the United States are impoverished and struggling to make ends meet. This number is likely even higher, considering you do not have to be impoverished to have financial difficulty. What would happen if a couple’s loving grandmother or grandfather started showing signs of dementia?

While the elderly are entitled to Medicare, would Medicare cover such an expensive drug when it has to care for the entire country’s elderly population? Even if it pays for it, how much of it? After consulting physician colleagues of mine, we think it is unlikely that Medicare as is would pay this much. It would be great if they did, but there are likely not enough Medicare dollars to permit this.

Families could face impossible decisions or immense stress once these medications are more broadly available, and they have hope in front of them, yet this hope is financially inaccessible. While some private insurance may help pay for these cutting-edge treatments, perhaps with Medicare offering a small contribution, insurance is expensive, and we sadly do not all have health plans that enable us to not think about how we are going to make managing our health work, alongside taking care of supporting children, family, and parents.

There is also the concern that these medications may offer more benefit to those of certain ancestral groups, as reported by Reuters. This was not because the study’s designers or the company sought to exclude non-whites. For medical research to be approved, generally, one must communicate how the research will benefit a more diverse group. Describing how people are recruited into appropriately designed clinical trials and why medications may help people of European descent more than those of African descent is its own article, so I will not touch on this here. This is important because non-whites have higher rates of Alzheimer’s and have historically had less access to healthcare resources.

Such a financial predicament is not unique to these upcoming new medications (or healthcare in general in the United States). Research and development of new medications often cost over $2 billion when a new treatment is available for the general public. Companies need to give treatments a price that enables them to make up for what they spent and enable their other projects, which can also provide hope for better health management. While this approach is understandable (companies need to avoid going bankrupt. Even non-profits need to do that), it can still limit our access to treatments that could save or improve our lives.

The only fix that could address these issues is legislation, which the American Medical Association is consistently striving to improve people’s health in the United States, including driving healthcare reform and expanding (versus cutting) Medicare coverage. Your doctors are not just treating you in the office. They are going to Washington, D.C., and suffering the stresses of politics to improve your lives!

In conclusion, we have reasons to be optimistic about these new drugs. We are also facing the same problems that we have in the past, with promising treatments often being beyond the reach of those with less financial resources and those who have historically had limited access to treatments that could mitigate suffering.

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Despite knowing what we know, groups continue to publish on questions that will not necessarily translate toward more meaningful clinical solutions. Recently, a group published another article, following up on a previous article on roughly the same topic, showing yet again that ivermectin does not help COVID-19 (Source). While exploring topics towards finding solutions is essential, especially if they could translate to saved or improved lives, when should we stop asking questions that we have already gathered fairly comprehensive answers to? While the abundance of misinformation necessitates continued public engagement, why not rely on our extensive, already-collected information? Is the extra financial investment worth it?

While such articles are often delayed from when they are submitted to a journal, meaning publications are not necessarily timely when they come out, I hope that fewer and fewer articles investigate such topics moving forward. If we have robust and reproducible findings, there is little need to continue proving it is believable if experts already feel that way. Due to misinformation campaigns, we will not convince everyone that ivermectin, among other “cures,” does not help COVID. We can move forward and emphasize topics that will translate toward greater clinical care improvements versus engaging naysayers who will not be satisfied with our answers, no matter how many ways we provide information.

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As a physician and geneticist-in-training studying the human genetics of COVID-19, I remain cautious about where the pandemic will go from here. At this point in the pandemic, there are few if any policies requiring one to wear a mask in public areas. Many hospitals still have masking policies, appropriately, although Quebec has recently lifted its mask mandate from public transportation.

Individuals riding the at-times crowded buses have no legal obligation to wear a mask to protect themselves and others from COVID-19. This is the case even when there is poor ventilation, such as when windows are closed when it rains. Fortunately, I see that there are still a reasonable number of individuals opting to mask up in crowded areas, even when it is not required.

This article is not about arguing whether restrictions were lifted too soon. Let me know in the comments your thoughts on restrictions being lifted. Given much less politicization of public health measures in Canada versus the United States, even in the Nationalist-led province of Quebec, I trust that the decision was made with close guidance from public health experts. The reasoning appears sound, given that there are more opportunities for ventilation in the warmer months, and a large proportion of Canadians are fully vaccinated against COVID-19 (83%, per OurWorldInData). This article is about individuals considering wearing a mask even when they are not obligated to in crowded public areas.

As the case, hospitalized, and death statistics demonstrate, COVID-19 is still with us. While some argue that COVID today is milder than at the beginning of the pandemic, individuals with comorbidities or risk factors for severe disease can still get very ill, even when fully vaccinated with access to therapeutic agents like Paxlovid. The best treatment for COVID-19 is not getting it all. Voluntarily continuing prevention measures when they make sense, such as when one is in a crowded bus where others may be at higher risk of severe disease than you, could save a life. Wearing a mask for 15–30 minutes is a pretty minor inconvenience. Considering how much good it can do, it seems like a good trade-off to me.

In summary, we have an opportunity to relax with the COVID-19 pandemic. We can expect it to again rise to prominence this coming winter. There are steps that we can do, at minimal inconvenience to ourselves, that will protect ourselves, our loved ones, and our neighbors. If you liked this article, be sure to give me some claps, it will help more see my writing so we can all think more deeply about health together.

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The past week has been difficult for liberally-minded individuals in the United States. Through a series of Supreme Court rulings, citizens lost several fundamental rights. Miranda rights, mandating that those arrested are informed of their rights, and Roe v Wade, giving women freedom in their reproductive health choices, were both repealed. The latter is particularly troubling for me as a physician, given the substantial evidence of harm when women’s bodies are under the state’s control rather than a woman’s (read a detailed statement by the Journal of the American Medical Association here). Why would someone ignore clear evidence that something can overall improve the lives of citizens?

These next few years will see an increase in women dying from complications of forced pregnancies and poverty. Pregnancy can be hazardous for some women, such as those at risk of blood clots. Being prevented from having an abortion can leave a woman (and her fetus) vulnerable to permanent disability from a stroke and blood clot, even if put on anticoagulants. Women with chronic conditions could be required to stop their medications if they accidentally become pregnant due to known toxicity against the fetus, exacerbating health crises that could harm both the woman and her fetus. Finally, women without the financial resources to support the medical appointments required for a healthy pregnancy, not to mention helping a born child and subsequently affording pediatrician appointments, will often have to take on debt, limiting their and their child’s lifetime achievement. Why restrict family planning methods while at the same time opposing funding towards supporting those with less financial resources?

This article is not about showcasing this decision placing discriminatory burdens overwhelmingly on the poor and people of colour. It is about finding peace today, so together, we can maintain a state of mind needed to ensure women regain the rights they lost and gain even more, given that women were not treated as equals to men even before this decision. Read on to learn how you can find peace in our more troubled world.

There are many ways that one can respond to life stressors. In psychiatry, they are classified as mature and immature ego defences, briefly summarized by Psychology Today here. Mature defences typically lead to more lasting relief of suffering, whereas immature ones can propagate it. Examples of mature defences include using humour, converting one’s suffering into doing good (altruism), and converting one’s suffering into a passion for one’s work or hobbies. Examples of immature defences include passive aggression that can harm one’s interpersonal relationships, acting out where one may seek peace through purchasing copious amounts of financial goods or excess consumption of alcohol, or denial where one cannot acknowledge the reality of a given situation.

Fortunately, through mindfulness and practice, one can learn to replace immature ego defences with mature ones, as I have done throughout my adult life. While it took effort, feeling at greater peace with myself and my life choices affords me more energy to invest in others and my hobbies. It has helped me pursue advocacy work with global health and challenge COVID-19 misinformation. But how does one foster these mature ego defences?

Altruism:

Altruism is where one challenges their suffering by doing kind things for others. So when one is perhaps facing guilt over harmful comments said to a romantic partner or friend during a disagreement, one could challenge this by doing something nice for them or simply apologizing. In another scenario, when one is worried about their parents getting older or an illness in the family, one could pursue volunteer work at their local hospital or homeless shelter. Lastly, if one is feeling hopeless, given the recent Supreme Court rulings, one could become an advocate for those seeking to exercise autonomy over their reproductive choices. There is much one could do towards this principle, with one simply needing to feel like they are improving another person’s life. Tell me in a comment the ways you like to help others.

Humour:

Humour is when one can attempt to make light of difficult situations to ease the felt burden. For students or working professionals, one could make jokes about how a pressing deadline was good for their skin because they did not have much time for showering. However, one should be careful about humour because it can be easy to tell a “joke” that hurts someone’s feelings or propagates harmful ideas, which could lead to a disagreement and more suffering. Making jokes about your boss due to an increased workload or being required to work on weekends could easily strain that relationship, potentially leading to one becoming unemployed. Suggesting calls for violence are “jokes” can make others feel unsafe, causing others to suffer and fear for their lives. Such logic was used by individuals who stormed the Capital on January 6, 2021.

Sublimation and Suppression:

Sublimation is where one converts the energy or suffering from an “unacceptable action” into an action that is more acceptable. So instead of shouting at a driver who cut you off in traffic, you put those feelings on hold (suppression) and bring all that energy out in your video game or gym/sports session later that day. Rather than sending a passive-aggressive message to a friend who you feel did not return your call or text message fast enough, you can take care of chores in your apartment or house instead. Rather than telling people on the internet who do not share your views that they and their opinions are worthless, regardless of the topic, one can volunteer with organizations that advance the issue you care about. Clearly, these mature defences can overlap.

Sometimes it can feel like the world is collapsing around us. There is a certain amount of truth to this as the status quo seemingly continues with the rich getting richer, the poor getting poorer, and inequality becoming more of a norm than the exception. Like Siddhartha Gautama, I too find it startling, for example, that wealth can be juxtaposed on the same street with poverty. In Montreal, I see beggars looking for donations on the side of the road as Ferraris drive by. That suggests that something is not right with our society as it stands. Feeling frustration is a perfectly acceptable reaction. What is important is what we do with those feelings. We can react to our world in a way that harms us and others, or we can face our challenges in a way that motivates equality and prosperity. We can wallow in fear and misery, or we can take those feelings and make something better of them. It is not always easy to do the latter. We can get stuck with the former. What is important is that we ultimately find the strength inside ourselves to overcome our limitations and create a more equal world collectively.

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FOR THE INDIVIDUAL:

Most home COVID tests are known as “rapid” tests, which means that results are typically available in less than an hour. They vary from the less rapid “diagnostic” tests in that they detect viruses differently. The rapid tests, antigen testing, check for evidence of viral particles in your nose/mouth. In contrast, the diagnostic tests, PCR, check if there is evidence of the material that the virus uses to replicate itself. PCR is considered higher quality as it can give a positive test earlier in infection when there is less virus floating around in a person’s body. It is also more expensive and requires more specialized laboratory equipment to do. Home tests are thus attractive, although they come with caveats.

Home tests are less accurate where not all people who are truly COVID positive will test positive, and not all people who are COVID negative will test negative. If one communicates with their healthcare provider, one should be able to work around this to an extent. If you have an unexpected test result, a “confirmatory” PCR may be done. There may also be sufficient clinical evidence for your provider to recommend a quarantine regardless or suggest that it would not be needed. Talking with your provider is the best thing you can do with these tests because medical science is complicated, and it is hard to make sense of it, even for healthcare professionals.

The accuracy of home testing can also vary between brands. Naturally, all tests are designed to make the best test possible. Unfortunately, consumer technique, virus, or manufacturing/storage variation can deter this desirable perfection. Fortunately, most brands are pretty good, though this illustrates the importance of communicating with your healthcare provider to ensure that you or your family members make the best healthcare decisions possible.

FOR PUBLIC HEALTH PURPOSES

Over-the-counter testing is attractive because it improves the accessibility of healthcare information. Individuals can obtain information needed to guide their actions and support public health measures flexibly and cost-effectively. While a clear advantage, there are issues with this. One could argue that consumers may not respect test results or use them as a means to justify risky behaviour. Surely now that we are over two years into the pandemic, we all understand the profound implications of the virus on ourselves and those with whom we come into contact.

A point of contention that is unfortunately not resolved is the impact on public health tracking of the disease. Many of these at-home tests lack any result reporting methods. While this should arguably be inconsequential given that those who test positive can be assumed to reach out to their healthcare providers or employers and report their status, which should then be reported to public health, valuable data can be lost in this pipeline.

Knowing the number of individuals concerned enough about COVID to test themselves, the number of tests that are positive out of all tests, and the geographic distribution of these statistics could guide public health efforts to focus on the communities that need more attention. While the number of positive tests can be used to direct resources, there is value in a more complete picture that would require these at-home tests to inherently involve result reporting, regardless of the outcome.

Fortunately, some tests already do this where one must use a mobile app to get the result or at least an “official” result. However, some tests do not involve this. While not requiring a smartphone to get one results improves the accessibility of diagnostic care because not everyone has or can afford a smartphone, it, regardless, leads to loss of information.

COVID-19 has improved the availability of medical diagnostics for the average individual. Inexpensive or free diagnostics have become widely accessible and offer flexibility that was not present in the past. While at-home COVID-19 tests are helpful, they are imperfect, and they are best used as adjunctive tools to services offered by healthcare providers. They also have their uses on the public health level, though they come with caveats considering that not all results are reported to epidemiology offices.

When the next pandemic rolls along, as we know that it will an undefined amount of time from now, hopefully, manufacturers and public health groups will take the lessons learned from our current pandemic to produce a more effective and cohesive response.

Reference: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8196235/

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Science journalism paints a rosy picture of the advances of medical research. A quick look at the “Health and Medicine News” section from Science Daily communicates optimism on our understanding of aging, pain relief, depression, and cancer. If one were to read these articles, one could expect an experience that gives the impression that the future is today and that the cure for cancer is just around the corner.

Such a writing style has its benefits, and I admittedly seek to impart a sense of hope in my writing. We do not understand many things, and hearing someone confidently communicate solutions to our big questions helps one sleep better at night. Touching on an article that I wrote earlier in the pandemic on the efficacy of vaccines against COVID-19 in November 2020, I would imagine most would agree that they would rather hear of how a therapy could turn our lives around versus portraying a cynical picture.

Writers must still inform individuals accurately. If an asteroid were headed for Earth, writers claiming that this was false would be acting in an unethical manner, even if they were motivated by helping readers sleep at night. Science must be communicated poignantly because information that stretches or does not represent the whole truth can cause harm, as observed with individuals taking overdoses of ivermectin trying to treat/prevent COVID-19 and, instead, making themselves very sick. This illustrates the importance of objectivity in science writing.

Going off on science articles discussing an investigative treatment for leukemia, science writing must be communicated considering its relevance. New therapies, such as the big new cancer drug, that show promise are well and good. Their significance for the audience of families looking for hope must be considered.

Losing hope can be traumatic, as many can attest. As seen in numerous examples of animal cancer models, experimental findings in a non-human do not necessarily translate to improved clinical care. The relationship is even more strained if the result was observed in a test tube or a dish. A great example of the latter is ivermectin’s observed effectiveness in ridiculous doses against SARS-CoV-2 in a test tube. The therapy ultimately proved to provide no clinical benefit for individuals with COVID-19, and prescribers have already appropriately started to lose their jobs for issuing it.

Fortunately for patients and their families, clinical trials are strictly moderated, and participants must be informed to make an educated decision on what they want to do. So for a new chemotherapy agent, individuals in a randomized control trial would be told that there is the possibility that they would not receive the experimental therapy and would instead receive the routine “standard of care.” They would be advised that it is possible that the new treatment would not be more effective than existing therapy while stating the experimental evidence that makes them believe that there is reason to be optimistic. Most importantly, they would be advised of their option to withdraw from the study at any time without any repercussions.

Most science writers that I have seen have acted ethically, and I am proud to write alongside them. Nonetheless, science writers have a responsibility to readers. They are obliged to present factual and holistic stories to allow readers to decide for themselves how they feel about the state of the field they are reading about.

While there may be reasons for authors to go beyond their expertise or data, stretch the truth, or find a way to maximize their views, what we say matters. We have a responsibility to maximize our readers’ ability to think and behave in a consistent manner with their identities as individuals.

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I am sick and tired of the pandemic. Many others share the sentiment based on several high-profile recent news stories, albeit for different reasons. Neil Young has recently had his music pulled from Spotify, given the platform’s refusal to screen its content for COVID-19 misinformation effectively. Meanwhile, truckers in Canada have protested what is becoming a nationwide vaccine mandate by trekking across Canada in a convoy while blockading a border crossing and Ottawa, the Canadian capital.

What we all need is for the pandemic to end. Progress has been made in understanding the pandemic, the virus, and how to treat the disease, speaking as a physician and medical researcher. However, relying solely on the medicine is not enough when considering a resolution, as we can all appreciate as we feel the fallout from a COVID-heavy winter despite a vaccine being available for the past year.

I have become more involved in understanding why we are still here in recent weeks. On attending conferences oriented on pandemic-related global health inequity while keeping up with research and international news, it is evident that we are stuck because of global deficiencies in working together. While many can attest to this emotionally, whether perhaps feeling heartfelt frustration against anti-vaxxers or feeling like one’s concerns about vaccines are not being heard or effectively addressed, the issue involves multiple systems.

While many Western countries have made pledges of helping developing nations fight the pandemic by offering vaccines, the reality is that not enough of these doses have made their way to where they are needed. If we take a quick look at Our World in Data, the difference in vaccination rates among African nations and places like Canada is striking.

While this is likely partly due to supply and shipping issues, some are due to inefficiency. At a conference I attended, one of the physicians discussed how Canada delivered several million doses to Africa very close to their expiration date. While African countries have effective vaccine rollout programs, few of these doses could reach arms because of the short deadline.

Naturally, we cannot blame governments and be done with it. Individuals have responsibility for the situation as well. Individuals who knowingly spread COVID-19 misinformation, regardless of the reason, are responsible for a significant proportion of the suffering and death of this pandemic. Individuals who seek to challenge misinformation, such as myself, who disrespectfully address or ignore reasonable safety concerns also hold some responsibility. While some arguments posed by opponents of the COVID-19 vaccines or pandemic measures are not based on reality, it is valid for your average neighbour to want to be sure they are not going to have an anaphylactic reaction when they get the shot. Calling individuals with valid concerns names would certainly not make me want to consider another person’s viewpoints. Insults are generally not appropriate and do not accomplish much, regardless.

Back to the headlines, was Neil Young right? I argue that he was because the only adequate response to adversity, whether hate or a platform’s unwillingness to challenge harmful rhetoric because of its financial profit, is to stand up and hold parties accountable for action and inaction.

This being said, there is a right and a wrong way to challenge what we identify as needing to be improved. In honour of Black History month, we could all take a lesson from the late Martin Luther King Jr. in that “we must learn to live together as brothers or perish together as fools.” “We may have all come on different ships, but we’re in the same boat now.” “Darkness cannot drive out darkness; only light can do that. Hate cannot drive out hate; only love can do that.”

The world may feel more divided than ever, but it does not have to be that way. Every one of us has the ability to shine light into our dealings with others. It may not be received well by all. It does not make it any less valuable.

The post Was Neil Young Right? Fighting COVID-19 Misinformation Two Years In appeared first on Medika Life.

My medical training has made me a skeptic. When one learns of the limitations of diligently-studied therapeutics, one understandably is cautious about therapies that lack or have been minimally investigated. Metformin is a wonder drug for diabetes; hence, it is often the first therapy recommended to patients with newly-diagnosed diabetes. It does not replace lifestyle factors, such as exercising and eating a predominantly wholesome diet.

Supplements are marketed as magic, readily-available without prescription life changers. While they come with bulletins on the bottle that they are not indicated to treat disease, it can be easy to place weight on claims that a substance “helps balance blood sugars” or “could help with weight loss.” One may even be inclined to solely rely on supplements given that they must be safer than prescription medications because no prescription means it has to be safe, right?

The reality of supplements is that their therapeutic potential is typically meagre at best. They also can come with adverse effects that rival or exceed prescription medications. Today, I will discuss apple cider vinegar’s impact on weight loss with the critical lens required to sift through the often overzealous marketing.

Apple Cider Vinegar and Weight Loss

Given the prevalence of obesity and all of us knowing that excess weight (i.e. BMI > 25) is not the best, marketing for weight loss is an attractive strategy. Heck, it gets attention, as my Medium readers can attest seeing how many articles on this platform have something to do with the topic. But what does the data show?

I identified two clinical trials investigating the relationship, one with 175 obese Japanese individuals and another including 39 overweight/obese Iranian individuals. The investigators were affiliated with the Mizkan Group Corporation, a company that sells food products such as vinegar. This is a major red flag for trusting the study’s results, given how such an affiliation could bias what is reported.

The Iranian study readily disclosed its funding source and lack of conflicts of interest, making it seem like a reasonably trustworthy study. While they did not blind their participants in the placebo group, i.e. individuals who did not receive the apple cider vinegar, contrary to the Japanese research, the randomized study design affords credibility to their findings.

Onto the results. The Japanese study found that those individuals who consumed apple cider vinegar had a slightly lower BMI than those who did not. The placebo group started at an average 26.9 finishing at 27.1. Those individuals that took “high dose” vinegar, i.e. 30 mL of vinegar at meals, finished with an average BMI of 26.3 at week 12 of the study compared to an average BMI of 27.0 at week zero. Their BMI rebounded to 26.8 four weeks after the termination of the study. While the authors found a “statistically significant” decrease of the BMI at the end of the study, a BMI change of 0.7 is not a lot, and one will be bound to get a “significant” result just by nature of having a large number of individuals in the study when one considers the math.

A rebounding BMI back to roughly where individuals started is also concerning. The authors were unclear on their study protocol in the four weeks post-study. The protocol suggested that participants were kept from consuming non-study vinegar products during the study, but it is unclear if this was followed in the four weeks afterwards. This makes it hard to place the rebound BMI gain in perspective. My overall opinion is that while apple cider vinegar may facilitate weight loss in overweight/obese individuals, the effect is small if it exists at all. The effect seems limited to when individuals are consuming the product. Thus, it does not appear to translate to permanent weight loss. Therefore, this study does not give a lot of confidence that apple cider vinegar will magically make you thin.

What about the Iranian study? First off, this is a smaller study, making the results a bit less trustworthy. The study was set up similarly to the Japanese research, where individuals were tracked over 12 weeks, except individuals were not followed up four weeks afterwards. The study had similar findings with a statistically significant decrease in BMI over the twelve weeks for those who received the apple cider vinegar. The BMI in the vinegar group went from an average of 32.0 to 30.3 compared to the no-vinegar group going from 32.2 to 31.4.

This change is more pronounced than in the Japanese study, which could be due to the population, that apple cider vinegar offers a more significant effect for individuals with a higher BMI, or there is something special about the apple cider vinegar used in the study.

Similar to the Japanese study, there are issues with the statistics. The confidence intervals, which provide a measure of how sure we can be of these results, are a major point of concern. The confidence intervals are very broad, suggesting we should be more skeptical of the results.

Supplements have become mainstream, for better or worse. Many come with tempered claims that, regardless, make them sound like a great addition to our lives. As we observed in these two papers, the therapies tend to have minimal if any effect. While BMI was observed to decrease in these studies, it did not change much when comparing the groups who received vinegar with those who did not. The statistics did not strike me as particularly convincing. As is so often iterated, a healthy diet and exercise are typically the best treatment for extra weight. Magic pills are unfortunately not based on enough reality to make a difference for the average consumer.

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