Health Topics – Johns Hopkins Medicine Podcasts

Anchor lead: What makes the mRNA vaccine so effective? Elizabeth Tracey reports

With a name like Operation Warp Speed, it’s no wonder people may be feeling that the vaccines currently being used against Sars-CoV2 have been rushed into distribution. Andrew Pekosz, a vaccine expert at Johns Hopkins, says these types of vaccines have been under development for more than two decades.

Pekosz: The mRNA vaccine platform is tailor-made for a disease like coronaviruses, where we’re expecting that antibody responses to the outer proteins are going to be able to drive the vast majority of protection from disease. That’s because these mRNA vaccines are designed to do just that; to take a protein and just express a lot of it on the surface of a cell. That then leads to a nice recognition of hey, this is a foreign item and your immune response kicks right in.  :29

Pekosz predicts that many other infectious diseases will soon have vaccines against them using this same technology, and that the need to keep such vaccines extremely cold will also be overcome, making them much easier to administer. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: There’s good news for people with one type of lung cancer, Elizabeth Tracey reports

If you have non-small cell lung cancer with a receptor called EGFR, you are likely to respond to an agent called osimertinib, a new study finds. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, is excited.

Nelson: You can’t make this into anything but good news. Osimertinib is an inhibitor of this mutant epidermal growth factor receptor, EGFR, signaling system. This is an on/off switch and its stuck in the on position driving lung cancer cells to grow, so can you force it back off with a drug that’s the idea of this drug Osimertinib.  :20

Nelson says this agent is the latest of a group targeting this receptor.

Nelson: It’s the setting where these drugs and there are several of them right now might antagonize this on switch by forcing it in the off position.  :07

Nelson says the advantage to Osimertinib is it is able to penetrate the brain and spinal cord, and that’s helpful for mopping up cancer cells throughout the body. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: How does a global study of cancer inform public health? Elizabeth Tracey reports

Cancer diagnoses are up worldwide, by about a third, the Global Burden of Disease study finds. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, says there are big differences between countries on which cancers predominate.

Nelson: In the countries that have higher sociodemographic development and indices, they’ve been deploying screening, early detection, and if anything we’ve taken a while to get up to overdiagnosis and overtreatment- are we detecting cancers that aren’t very threatening, do we manage them correctly? So we’re on I think a good trajectory in the better developed counties, I think tragically what we’re seeing in the lesser developed countries is that you’re still seeing cancers that are uncommon in the developed countries. It tells you what you need to do to get those countries better off.    :30’

Nelson is confident that what he calls ‘legacy cancers’ such as cervical and liver cancer will be gotten under control soon worldwide. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: What does a new global analysis of cancer cases tell us? Elizabeth Tracey reports

The latest Global Burden of Disease study tabulates different types of cancer experienced by people worldwide, and shows a rather dramatic increase in cancer incidence overall. That’s according to William Nelson, director of the Kimmel Cancer Center at Johns Hopkins.

Nelson: In 2017 24 and a half million new cancer cases, 16.8 million were those we don’t count – non-melanoma skin cancers, the basal cell and squamous cell cancers, 17 million more or less serious cancers, 9.6 million deaths, and they estimate 223.5 million disability adjusted life years, that accounts for feeling sick or being treated so that you’re not engaged in your life more fully. Cases increased by 33% and so cancer is on the rise.  :33

Nelson says some of the rise is due to better detection and imaging methods but notes that cancer risk increases with advancing age also, so as more of us live longer some of us will develop cancer. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Black men with low risk prostate cancer need active follow-up, Elizabeth Tracey reports

Many men with prostate cancer are categorized as low risk, meaning that they can be safely watched over time, and if the disease progresses treatment may then be employed, without a compromise of safety. Now a new study establishes that approach for Black men, who have historically had worse outcomes. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, describes the results.

Nelson: This confirms the suspicion that African American men may be at slightly increased risk to sprout a more aggressive cancer and need more treatment so they need to be watched. The active surveillance needs to be active, but it was also very safe to deploy this kind of strategy for African American men, as safe as it was for European men.  :17

Nelson says disparities may be the result of when the disease is diagnosed.

Nelson: The bias that leads to increased mortality among African Americans is many of them when they’re first diagnosed have more aggressive prostate cancer.  :08

At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Do different ethnic groups have different risks for prostate cancer to recur? Elizabeth Tracey reports

When Black and Caucasian men develop low risk prostate cancer, does active surveillance yield equal risk for progression? William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, says Black men in this large VA study did indeed develop more aggressive disease more often.

Nelson: They had a significantly increased chance that the disease would sprout something more aggressive. So about 59% versus 48.3% would need some more aggressive treatment. They did not find any difference in the propensity to develop metastatic disease; it was incredibly low. One and a half percent basically. It was very safe to do this, but African American men had a slightly higher chance to perhaps need more aggressive treatment at some point in the future.  :31

Nelson says this study confirms the safety of this approach for men of different ethnicities, and notes it underscores the need to be vigilant for signs of accelerating prostate cancer. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: While most HIV news nationally is good, troublesome pockets remain, Elizabeth Tracey reports

Deaths related to HIV have dropped beyond expectation, CDC data indicate. That’s great, and we still have work to do, says Joseph Cofrancesco, an HIV expert at Johns Hopkins.

Cofrancesco: If you’re treated early you do well. If you are delayed in that treatment you will not do well, so it’s incumbent upon public health, medicine, how to get back to this idea of universal testing. The other thing that was worrisome was that the greatest ethnicity deaths were among black persons in the US in the South. Public health experts, providers, politicians, all need to recognize that in their area, people are not having the same degree of progress that people in other parts of the country are.   :34

Cofrancesco says continuing effort must be put into removing barriers to early and frequent testing among those at risk, as well as those that stand in the way of effective and ongoing treatment for HIV infection. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: HIV numbers nationally have some sweet spots, Elizabeth Tracey reports

We’re ahead of the game nationally when it comes to getting HIV infection under control, the most recent data from the Centers for Disease Control and Prevention indicate. Joseph Cofrancesco, an HIV expert at Johns Hopkins, reviews the numbers.

Cofrancesco: HIV related deaths have decreased almost 50%, exceeding the expectations of what we hoped to obtain by 2017. If you look at gender, age, race, ethnicity, there were decreases and disparities were shrinking. The disparities between Latinx and whites basically was eliminated in terms of survival. We are getting to people earlier and treating them, you can then really expect that we are going to control this disease and have people have full and normal life expectancy.  :33

Cofrancesco notes that these numbers are the good news, but there are variations around the country in both deaths and disparities among different groups of people. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: New research is trying to tease out why young black women in the US may experience higher rates of cardiovascular problems. Elizabeth Tracey reports.

Black women experience higher rates of preeclampsia, a dangerous condition affecting blood pressure, while pregnant than other ethnicities. Garima Sharma, a cardiologist at Johns Hopkins, is trying to find out why.

Sharma: We looked at the rates of cardiovascular risk factors and preeclampsia in non-Hispanic black women. We differentiated non-Hispanic black women into US born black women and foreign born black women. The US born black women had more preeclampsia, worse cardiovascular health. We also found that when these foreign born black women had lived in the US for greater than 10 years their risks of preeclampsia and cardiovascular risk factors were closer to US born women than those that were in the US for less than 10 years.  :32

Sharma notes that many things change with immigration, often including diet, exercise, social support, and stress. She says for now, all black women should be carefully monitored while pregnant for the development of preeclampsia. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: The pandemic brings to light health burdens that have been around for some time, Elizabeth Tracey reports

Deaths from Covid-19 continue to rise, and people with existing cardiovascular disease remain in a heightened risk group. Garima Sharma, a cardiologist at Johns Hopkins, says this fact points to cardiovascular disease as an ongoing problem.

Sharma: It puts into context the overall burden of cardiovascular disease that we’re dealing with in our country. I mean let’s not forget that. Even during Covid the largest killer still is cardiovascular disease. Trials like this ground us in some ways to the reality of working in a post-pandemic world, where you’ll have Covid, and that will kind of just hang out in the background, and you’re still dealing with cardiovascular deaths, day to day cardiovascular issues. Because of this controversy it helps us not lose sight of what has been an underlying problem for decades.  :33

Sharma says the best strategy remains prevention, and notes that reducing one’s risk for cardiovascular disease is largely within an individual’s control. At Johns Hopkins, I’m Elizabeth Tracey.