Health Newsfeed – Johns Hopkins Medicine Podcasts

Genetic testing of breast tumors helps determine best therapy, with a 21 gene assay commonly used for this purpose. Now a new study shows its predictive value for Black women may be less than that for Caucasians. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, explains.

Nelson: A score of 0 to 25 suggests that you will have a good outcome if you just take the hormonal treatment alone. Higher scores, so 26 to 100, you’re more likely to benefit from chemotherapy. Black women were more likely to have the higher recurrence risk score. The accuracy of predicting this was less for the African American women. African American women had a higher chance of dying of breast cancer in each group. It does look like this score appears to not perform as well for African Americans.  :32

Nelson says it’s likely the test should still be done but should be carefully interpreted for each patient. At Johns Hopkins, I’m Elizabeth Tracey.

Imagine you have moderate to severe depression. Would you stop taking your medicines to be part of a research study comparing psilocybin to a traditional antidepressant? That was a requirement for participants in a recently reported study, and Matthew Johnson, a psychedelics researcher at Johns Hopkins, says that’s not all.

Johnson: In addition to having to be free of other therapeutic interventions they had to be willing to be on their toes in terms of what to expect. I mean with psilocybin you coach people that hey, this could be one of the most intense experiences of your life potentially, here’s what we’re doing to keep you safe during that, and here’s what it may or may not be like, but be ready for it. It’s a credit to the people who are willing to do these studies, hopefully is a chance for benefit regardless of what arm they’re in.  :29

Johnson says the favorable results of this trial could offer another therapeutic intervention for people with depression, and he applauds the participants. At Johns Hopkins, I’m Elizabeth Tracey.

Psilocybin compared favorably with a traditional antidepressant for treating moderate to severe depression, a recent study found. Matthew Johnson, a psychedelics researcher at Johns Hopkins, says an entirely different clinical approach will be required to use psilocybin routinely for depression.

Johnson: That’s really for two reasons: the environment and the guide, the preparation, the monitoring are all important not only to maximize the efficacy, in other words to really help people get better, and to create a positive experience, but also for safety, because people can and they occasionally do, when they’re doing these things on their own, have an anxiety and a panic reaction which is well managed in a clinical setting but that can become harmful when someone’s left on their own.   :27

Johnson urges people with depression that doesn’t seem to be responding to traditional medicines not to simply try psilocybin or another psychedelic drug on their own. He hopes that increasingly abundant research will enable these drugs to be approved soon. At Johns Hopkins, I’m Elizabeth Tracey.

For people with depression, sometimes traditional antidepressant medicines simply don’t work. Now psychedelic medicines may be a new choice, if the results of a study comparing psilocybin to escitalopram, an antidepressant, hold up. Matthew Johnson, a psychedelics researcher at Johns Hopkins, comments.

Johnson: Traditional antidepressants help many people and I don’t think we should think about it as this versus that, ultimately we need more medicines rather than fewer, and we need more treatment options. It depends on the person what the best approach is going to be, but nonetheless I think it is true that when people get better with psilocybin they feel like they have really addressed their psychological issues. This was psilocybin compared to something we know works. The fact that psilocybin consistently trended better than it, that’s extremely promising.  :28

Johnson notes that use of psilocybin for depression is an entirely different approach from antidepressants, and may help those who’ve failed to respond to this class of medicines. At Johns Hopkins, I’m Elizabeth Tracey.

Depression can be hard to treat, with even established medicines taking time to be effective and perhaps not helping at all. Now a new study compared the psychedelic drug psilocybin with escitalopram, an established antidepressant, and the results impressed Matthew Johnson, a psychedelics researcher at Johns Hopkins, for the relief of depression.

Johnson: You also had a host of other measures such as for example a measure of mental well-being, where psilocybin not only had a statistically significant but a sizable advantage over escitalopram, the traditional antidepressant. Which to me is consistent with the idea that when people get better with psilocybin it’s a different quality, and the way I put it is people seem to be doing their own heavy lifting psychologically in terms of taking care of their own problems. People come out of these sessions with a sense of agency.  :30

Johnson notes that abundant research on psilocybin has established its benefits in a host of conditions, so he’s not surprised. At Johns Hopkins, I’m Elizabeth Tracey.

Can the psychedelic drug psilocybin be used to treat depression? That possibility was examined in a recent study comparing psilocybin to escitalopram, an established antidepressant, in people with moderate to severe depression. Matthew Johnson, a psychedelics researcher at Johns Hopkins, describes the results.

Johnson: I think it’s an extremely positive development. And the development of psychedelic therapeutics in this head to head comparison. Essentially what you had was statistically on the primary outcome measure for depression, the two methods, the traditional antidepressant and psilocybin roughly equivalent. However there was a strong trend for psilocybin to do better, for depression to show a greater reduction.  :28

Johnson is encouraged by the results and hopes additional studies will examine the intervention over a longer period of time and look at additional outcome measures. At Johns Hopkins, I’m Elizabeth Tracey.

Children don’t get severe Covid-19 disease as often as older people do. That assertion underpins decisions to travel with children and otherwise exercise fewer precautions against infection in this population. Yet Covid is not benign for kids. That’s according to Aaron Milstone, a pediatric infectious disease expert at Johns Hopkins.

Milstone: It’s hard for the average person to put Covid and their kids into context. When we think about influenza, there are on average somewhere between thirty-five and 180 pediatric deaths in the US every year from influenza. There have been many more than 180 deaths in pediatrics from Covid over the last year. so the risk of a child dying from Covid far exceeds, say 10 times higher, as an estimate, the risk that our children would have of dying from influenza.  :33

Milstone notes that variants are a wild card for kids and urges vigilance against infection for them. At Johns Hopkins, I’m Elizabeth Tracey.

As the Covid pandemic rages on, more younger people are becoming infected, and more variants are being reported. Aaron Milstone, a pediatric infectious disease expert at Johns Hopkins, is concerned that children might begin experiencing infections more commonly as a result.

Milstone: We’ll learn more about whether kids will be disproportionately affected by this UK variant, and the severity in kids, but our early experience over the last month or so is we’re definitely seeing kids hospitalized in this area with Covid, both acute Covid and complications of Covid, and we now know that the B117 variant is the most common variant in this area. So putting those together I am concerned that this new variant is going to have a bigger impact on pediatrics.  :30

Milstone reminds everyone that keeping up with masks and other strategies must continue until a vaccine for kids is available, since the development of variants is a consequence of new infections. At Johns Hopkins, I’m Elizabeth Tracey.

Multisystem inflammatory syndrome in children, abbreviated MIS-C, appears to be on the rise in the US. Aaron Milstone, a pediatric infectious disease expert at Johns Hopkins, says the syndrome may sneak up in unpredictable ways.

Milstone: We have a lot of people come in and they don’t understand why their kid is sick. And we say well was anyone sick a month ago? And they say ug, yeah, Covid ran through our house I was sick, my partner was sick, our other kids was sick and this child was fine, and here they are a month later in the hospital, in the intensive care unit. We’re trying to make it very clear that this MIS-C is a post infectious process. It’s associated with Covid, meaning that when kids come in we don’t think that they’re really at risk of spreading the virus at that point, they’ve already cleared the infection and now their body is just still going a little bit crazy responding to that prior viral infection.   :33

Milstone says seeking medical care promptly is important, so if you suspect your child may be exhibiting symptoms of MIS-C, bring them in right away. He notes that suspicions should definitely be raised if there’s been a history of Covid infection in the family. At Johns Hopkins, I’m Elizabeth Tracey.

MIS-C stands for multisystem inflammatory syndrome in children, and it’s on the rise in the US, recent data indicate. Aaron Milstone, a pediatric infectious diseases expert at Johns Hopkins, describes what’s known.

Milstone: This is a post-infectious phenomenon so kids can get Covid, they might even have an asymptomatic infection but then they present two, three four weeks after that with shock, and some of them have heart problems. They often will present with abdominal complaints like diarrhea, or severe abdominal pain. There have been teenagers that have very bad outcomes from this, even death. It’s not as common in younger kids but we are seeing younger kids now with this same post-infectious inflammatory syndrome.  :30

Milstone says parents must take the threat of Covid infection in their children seriously, as MIS-C is one possible consequence of infection. He notes that recent relaxation of many restrictions may result in many more cases, and urges parents to seek care if they suspect the syndrome. At Johns Hopkins, I’m Elizabeth Tracey.