Health Topics – Johns Hopkins Medicine Podcasts

Anchor lead: Should anyone who’s had a heart attack take purified fish oil? Elizabeth Tracey reports

Purified fish oil, when compared to corn oil, did not show a benefit in people who had cardiovascular risk factors, a recent study shows. Garima Sharma, a cardiologist at Johns Hopkins, says adding fish oil to drugs such as statins in those already at risk is known as secondary prevention.

Sharma: By the time it comes to secondary prevention its already kind of late, that’s why I think primary prevention primordial prevention, ranging from childhood, reduction of childhood obesity. I think those things are where most of our public health resources and public health dollars should be focusing on.  :17

Sharma notes that reducing risk factors for heart disease is mainly under your control.

Sharma: A sizeable portion of them are lifestyle related. Smoking, and diabetes, and eating poorly, and physical inactivity. In some ways it just tells us the amount of challenges that we have in trying to really change the trajectory of these patients.   :14

At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Even prescription fish oil may not reduce the risk for heart problems, Elizabeth Tracey reports

When compared to mineral oil, highly purified prescription fish oil seemed to reduce cardiovascular events among those at risk, but the most recent study comparing it to corn oil failed to show a benefit. Garima Sharma, a cardiologist at Johns Hopkins with a special interest in this area, says right now the solution may be more studies.

Sharma: It’s a challenging population. These people have diabetes, they have had heart attacks, they have had MIs, and they still have multiple components of their lipid panel that in spite of statins are not under control. You would like them to get that and the other kid on the block is the PCSK9 drugs, which are also very expensive. And so when we’re looking at choosing the right therapies for the patient we’ve got to do our due diligence in trying to make sure that our patients are being benefited by the therapies.  :29

Sharma notes that a study comparing these therapies to further reduce cholesterol would likely have to be federally funded. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: A new study seems to pan even purified fish oil in improving cardiovascular disease risk, Elizabeth Tracey reports

Does fish oil help people at high risk for cardiovascular events avoid them? The most recent study comparing a highly purified prescription fish oil against corn oil seems to conclude no. Garima Sharma, a cardiologist at Johns Hopkins with a special interest in this area, explains why this issue is important.

Sharma: From a clinical perspective, from a patient’s perspective, people who are at high risk of having heart disease, recurrent heart attacks, who are diabetic, who have a very high risk of cardiovascular events, continue to have those events even when they are on really good statin drugs. And that’s the context of why we’re even debating fish oil, because we know that maximally tolerated statins can get your LDL cholesterol down, but then there still continues to be a risk.  :29

Sharma says looking carefully at purified fish oil is also important because when people take the recommended amount they may develop gastrointestinal symptoms, so the risks and benefits must be weighed. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Reducing healthcare costs at end of life can result in substantial boosts elsewhere, Elizabeth Tracey reports

Failure to make your own preferences known at the end of life isn’t just a personal decision, a new book called Preparing for a Better End, written by Dan Morehaim, an emergency medicine physician and former professor in the Johns Hopkins Bloomberg School of Public Health argues, it also has enormous societal costs.

Morehaim: Medicare is $900 billion dollars, $300 billion is end of life care. If you save 10% you’d save a lot of money by respecting people’s rights and empowering them to have their values observed as opposed to the usual way we cut healthcare costs. We burden employers, taxpayers, employees, we raise copays. For no cost/low cost and respecting people’s values you could save a lot of money for the nation and then put that money into preventive healthcare, pediatrics,  underserved populations, disabled, mental health, substance abuse, that would be a good way to get those funds. We’ve got to talk about it.  :32

Morehaim notes that we’re all vested in these outcomes, so we all need to consider advance directives. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: How can you prepare better for end of life? Elizabeth Tracey reports

Considering circumstances you’d choose surrounding your own death is a topic many avoid. Now a new book called Preparing for a Better End may help. Written by Dan Morehaim, an emergency medicine physician and former professor in the Johns Hopkins Bloomberg School of Public Health, the book takes a comprehensive approach to issues we all should consider.

Morehaim: My hope is that advance directives and advanced care planning become normative in our society for everybody over the age of 18. That was actually done in La Crosse, Wisconsin. People had a more complete life cycle of end of life care. It was greater support at home, it reduced their healthcare costs dramatically. What I want is people to feel empowered and valued.  The main things that people fear are isolation and pain. And both of those can be managed.  :26

Morehaim says many experiences in the emergency department brought him awareness of how poorly most people prepare for end of life, and what a toll that takes on survivors. He hopes that the book will help people realize what a gift advance directives are for their survivors. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Now it’s more important than ever to have advance directives, Elizabeth Tracey reports

Preparing for a Better End is the title of a timely new book by Dan Morehaim, an emergency medicine physician and former professor in the Johns Hopkins School of Public Health, and it’s timely because of the pandemic.

Morehaim: It’s always apt because people are always going to be dying. But it’s particularly apt now in Covid for two reasons: one of course is that more people are at risk but also because the nature of the Covid illness and the circumstances around it are that people can become fairly incapacitated in terms of their ability to communicate what they want pretty quickly. And historically we usually rely on the family at the bedside. So if the patient can’t connect you’ve got the spouse or the children or somebody there. Families are not at the bedside; in fact its even more challenging because you don’t even know who to call.   :30

Morehaim advocates for current advance directives for everyone who’s older than 18 years and also believes people should prepare a document for any hospitalization they may experience that also has a complete medical history, medications, and a current EKG if possible. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Psilocybin may help depression when other therapies fail, Elizabeth Tracey reports

A small Johns Hopkins study led by Alan Davis has shown that some people with depression that hasn’t responded to other types of intervention may respond to psilocybin therapy.

Davis: Many of them had had depression, on average, for decades. Most of them had tried several trials of antidepressants, several times had been in therapy, some of them reported benefit to that but never complete remission. Some of them said that nothing ever helped. This was not what would be considered an easy to treat population of people with depression. These people had not really responded to other attempts at helping their depression and so the fact that we saw so many of them improve was really quite exciting.   :31

More than half of study participants experienced remission of their depression symptoms and remained that way for at least four weeks after the intervention. Davis says these results add to the growing body of evidence for a clinical role for psilocybin and bring hope to the millions of people worldwide who experience depression. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Can psilocybin help depression? Elizabeth Tracey reports

Psilocybin-assisted therapy helped the majority of participants with major depressive disorder experience resolution of their symptoms, a small study led by Alan Davis and colleagues at Johns Hopkins has found. Davis says that initially half the group was offered therapy, then everyone was. 

Davis: Once everyone had the treatment, we found that one week after treatment, we had 67% who had a clinically significant response to the treatment. And at four weeks that was 71%. We defined a clinically significant response as a drop by more than half of their baseline depression scores. In terms of complete remission of depression, at one week after treatment, 58% were in remission. And at four weeks after treatment, 54% were still in remission.   :30

Davis says the treatment involved two five-hour psilocybin sessions at the medical center and results persisted at least four weeks. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: More cases of reinfection with Sars-CoV2 are turning up, Elizabeth Tracey reports

More than a dozen cases of reinfection with Sars-CoV2 have been reported worldwide, causing alarm over just how protective antibodies to the virus are and how long they remain that way. Arturo Casadevall, an antibody expert at Johns Hopkins, says almost everyone who is infected is protected for a time.

Casadevall: If the antibody responses do drop, to a point at which they’re no longer measurable, or they’re not made, we should consider as to whether they’re candidates for vaccination. The same thing can be said for the asymptomatic individuals, who got through it but mount a very weak response. We don’t really know what is protection, now, I am very encouraged that the reinfections are going to be the exception rather than the rule, at least in the short term, because these antibodies that are being made in this infection they are neutralizing. The evidence is that they’re making good reponses.  :31

Casadevall says many details of reinfection cases are unknown, so research is ongoing. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Should we be concerned about immunity when antibodies are given as therapy? Elizabeth Tracey reports

At least two types of antibody therapy are now being used for Covid-19, yet some concerns remain about whether such therapy will compromise the patient’s own immune response. Arturo Casadevall, an antibody expert at Johns Hopkins, says only following such patients over time will provide an accurate answer.

Casadevall: We need to do one thing first. We need to study those who are treated, and we need to see what happens to their antibody responses. There is a lot of noise out there that these antibody responses go all the way down, and people are making what I think are the association of low antibody response increases susceptibility. We don’t know that. The amount of antibody that is needed to protect you may be a minute amount, compared to the amount that you make right after.  As these patients get treated, they go home, they recover, some of them need to be studied to see what happens to their antibody responses.  :32

Casadevall says what is known is that when antibodies are given early they help. At Johns Hopkins, I’m Elizabeth Tracey.