Health Topics – Johns Hopkins Medicine Podcasts

Both Pfizer and Merck have recently revealed promising data on oral medicines for early Covid-19 infection, with both companies on the threshold of widespread use of the drugs. Brian Garibaldi, a critical care medicine expert at Johns Hopkins, says he hopes people don’t see these new medicines as a reason to forgo vaccination.

Garibaldi: I have lost the ability to predict how people are going to respond to different therapies, and the reason I say this is that there are many people who were not willing to get vaccinated but have no problem taking a monoclonal antibody. If you’re going to follow the science, millions and millions of people have gotten the different mRNA vaccines, and the Johnson and Johnson vaccine. It doesn’t make sense to choose to forgo a vaccine, take the risk of getting ill and if you get ill I’m going to take this other therapy that’s also brand new for Covid that’s been tested on less people.  :27

Garibaldi says these new oral medicines have even less of a record, so vaccination is still the best strategy to protect yourself and others. At Johns Hopkins, I’m Elizabeth Tracey.

Pfizer has asked the FDA to approve its new oral medication for Covid-19, called Paxlovid, for people in the early stages of infection. Brian Garibaldi, a critical care medicine expert at Johns Hopkins, reviews the data.

Garibaldi: From symptom onset to receipt of drug within about three days they had about 750 or so patients enrolled. This drug reduced hospitalization by almost 90%, three people who got the drug got hospitalized compared to 27 who got placebo. There were seven deaths in the placebo group and no deaths in the group that got the Pfizer drug. And then when they extended that population to look at people who got it within five days of symptoms they had similar benefits. If this pans out, having an oral treatment that can reduce hospitalizations and death would be an unbelievable addition to what we currently do for Covid outpatients.  :34

Such a medication would be a boon for low and middle income countries, where vaccines have been difficult or impossible to obtain. At Johns Hopkins, I’m Elizabeth Tracey.

More expensive analog insulins are used by the majority of people with diabetes who use insulin, a study by Rita Kalyani, a diabetes expert at Johns Hopkins, and colleagues has shown. Is this practice based in any professional society recommendations? Kalyani comments.

Kalyani: None of them preferentially recommend use of the newer analog insulins over the human insulins. So the question is why are they being prescribed so often? Some of them act much faster at mealtimes, some are much longer acting, so you have less hypoglycemia during the day and less injections during the day. So we see that the newer insulins allow greater flexibility to match the daily patterns of people with diabetes, whether its their meals or their activity, with less hypoglycemia.   :32

Kalyani notes that these conveniences do come at a price, but less hypoglycemia or low blood sugar may also avoid hospitalizations. At Johns Hopkins, I’m Elizabeth Tracey.

When someone is taking insulin for diabetes, it’s important to monitor and manage its use, but during the pandemic, that didn’t happen. That’s according to research by Rita Kalyani, a diabetes expert at Johns Hopkins, and colleagues.

Kalyani: We saw that between 2019 and 2020, when the pandemic hit, that there was an 18% decrease in visits for insulin, and as we talk about access to care during the pandemic this suggests that perhaps people using insulin weren’t coming to see their provider as often as before though they could have still been taking it at home but perhaps not having as aggressive titration or changes to their insulin regimen as they should have been.    :28

Kalyani urges anyone who postponed visits to the clinician managing their diabetes during the pandemic to try to be seen, even if it’s a telemedicine visit. People with diabetes are at higher risk for severe Covid-19 disease that may be impacted by very good blood sugar control. At Johns Hopkins, I’m Elizabeth Tracey.

Insulin costs have been cited as a case in point for out of control pharmaceutical prices. Now a study by Rita Kalyani, a diabetes expert at Johns Hopkins, and colleagues, shows that in fact, a survey of insulin use over the last five years reveals that the most expensive formulations are being used most often.

Kalyani: What we found during this five year period was that more than 80% were for analog insulin use, over the past five years. We know that analog insulins are also associated with higher costs, they are the insulins that have been found to be main drivers of price increases for insulin over the past few years. We found that insulin glargine represented the majority throughout this time period as well. And that biosimilar insulins, which have been introduced over the past two to three years have been slowly gaining in the number of insulin users.  :33

Kalyani says there are compelling reasons to use the newer insulins for many, but that cost must be weighed. At Johns Hopkins, I’m Elizabeth Tracey.

What is the data to show that electronic cigarettes help people to stop smoking combustible cigarettes? Michael Blaha, a cardiologist at Johns Hopkins and antismoking activist, explains.

Blaha: The randomized control trial data shows moderate evidence that e-cigarettes can help with smoking cessation. However they also show people who start e-cigarettes to quit smoking but fail to quit, tend to become long term users of both products. Also the people who quit smoking using e-cigarettes tend to become long term users of e-cigarettes. In other words they don’t get rid of their nicotine addiction, they just have shifted their nicotine addiction to a product that may be less toxic.    :26

Blaha says the data that convinced the FDA to allow one brand of electronic cigarette to market itself as helpful in smoking cessation hasn’t been revealed but that a wealth of other studies are in the public venue. He notes that the data also show that quit attempts are much more successful when a constellation of methods are employed. At Johns Hopkins, I’m Elizabeth Tracey.

One brand of electronic cigarette can now be marketed to help people quit smoking combustible cigarettes, the FDA has decided. Michael Blaha, a cardiologist at Johns Hopkins and antismoking activist, says this does not mean the agency is advocating for use of this produce.

Blaha: I want to emphasize that the FDA has not endorsed this as a smoking cessation product. This decision only reflects the authorization of marketing of this product. Only nicotine replacement products, and pharmaceuticals like Chantix for example are approved for smoking cessation. The implications of this decision are complicated and won’t be known probably for a few years. But I think the FDA is making the decision that by authorizing a particular tobacco product for example they can also deny all the applications for flavored tobacco products.  :30

Flavored tobacco products are well-known to appeal to young users, including children, and act as a gateway to nicotine addiction, Blaha says, so keeping them out of the market is a goal well worth supporting. At Johns Hopkins, I’m Elizabeth Tracey.

At least one brand of e-cigarette seems to have convinced the FDA that its product can help people quit smoking combustible cigarettes, according to the agency’s recent decision. Michael Blaha, a cardiologist at Johns Hopkins and antismoking activist, offers his opinion.

Blaha: Recently the FDA issued an authorized marketing decision for Vuse solo brand and its tobacco flavored pods because the company was able to demonstrate data that adults decreased smoking with very little uptake by kids because kids tend not to prefer tobacco flavored products. This is a complicated decision from the FDA to look at products both in terms of their ability to help adults quit smoking, but also their risk of having young adults and children uptake electronic cigarettes as their first tobacco products.  :34

Blaha says only time will tell if the strategy succeeds in reducing the number of young people taking up the habit. At Johns Hopkins, I’m Elizabeth Tracey.

Women are diagnosed with thyroid cancers much more often than men, but a recent study finds that examination of the thyroid gland itself in men and women finds there is little difference in the actual rate of these cancers. Lilah Morris-Wiseman, an endocrine surgeon at Johns Hopkins, shares her thoughts.

Morris-Wiseman: I think that what is happening, and we have some data to support this, that women are coming to their physicians and saying I have these symptoms, there’s something wrong with my thyroid. The easiest thing to say is well let’s get an ultrasound. Thyroid nodules are extremely common, maybe it’s not the thyroid. I’ve diagnosed anemia, I’ve diagnosed B12 deficiency, and a lot of people come in and say it’s my thyroid but to push to say what is it really? :29

Morris-Wiseman encourages everyone who’s been told they have a thyroid nodule to consider second opinions and the full range of explanations for their symptoms before choosing a procedure or treatment. At Johns Hopkins, I’m Elizabeth Tracey.

Despite vastly different rates of thyroid cancers diagnosed in men and women, a recent study concludes the actual rates are really quite similar. Lilah Morris-Wiseman, an endocrine surgeon at Johns Hopkins, explains the findings.

Morris-Wiseman: Women are being diagnosed far more than men with what we think are indolent thyroid cancers, papillary thyroid cancer typically, in many patients overall slow growing and excellent prognosis. The JAMA Internal Medicine study compared the rates of diagnosis of these small thyroid cancers over time and then looked at autopsy studies to see the true rate of small indolent thyroid cancers, and found that actually the rates in women and men are not significantly different.  :32

Morris-Wiseman says it’s unclear why so many more women are diagnosed with these cancers, but suggests that some may be due to women simply seeking medical care more often than men. She advocates for second opinions always before choosing any treatment. At Johns Hopkins, I’m Elizabeth Tracey.