Health Topics – Johns Hopkins Medicine Podcasts

Anchor lead: A monoclonal antibody against Covid-19 has been granted emergency use authorization, Elizabeth Tracey reports

Antibodies developed in a laboratory against a protein Sars-CoV2 uses to enter cells have been granted emergency use authorization by the FDA. Arturo Casadevall, an antibody expert at Johns Hopkins, says this is based on the evidence that the therapy works.

Casadevall: Once again you have another trial showing that administration of antibodies is an antiviral and I think everybody is expecting that if you have something that is functioning as an antiviral and you give it early, you’ll check the disease. Something that we all think happened to President Trump who basically was given antibodies early which functioned as an antiviral, and you see the rapid recovery afterward.  :20

Casadevall says its unknown whether giving antibodies will compromise someone’s own immune reponse.

Casadevall: We’ll know in a few months, but my view is that if you save people’s lives I’ll take low antibody responses, they can always be vaccinated in the future.  :09

At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: FDA regulators may have contributed to the prescription opioid epidemic, Elizabeth Tracey reports

Enhanced enrichment randomized withdrawal. Hmmm, not sure what that might sound like to you, but Caleb Alexander, a physician and researcher at Johns Hopkins, shows in a recent study that this is a study design that may have allowed quite a few opioids that have contributed to our current epidemic on the market.

Alexander: Using this trial design everybody is started on the drug. If you don’t respond to the drug or if you have a bad adverse effect, then you’re just removed from the pool of people. This is a fundamentally flawed method of studying the safety and effectiveness of these products. We found both when looking at effectiveness as well as when looking at safety that the FDA missed important opportunities to require manufacturers to generate more information at the time of market approval.  :29

Many are observing that both the opioid and Covid-19 epidemics are continuing apace, yet the former might have had less momentum with better oversight of prescription opioid medications. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: While telemedicine visits provide many advantages there are some gaps, Elizabeth Tracey reports

Telemedicine has been a lifeline for many, enabling people to see their physicians for many types of visits. Yet a Johns Hopkins study led by Caleb Alexander, a physician and researcher, shows that some fundamental metrics may be missing.

Alexander: What we found is huge changes in the structure of primary care delivery since the pandemic started, with very large shifts to telemedicine, but the content of these telemedicine visits differs a lot from those that are being performed face to face. And we find large reductions in the assessment of blood pressure, cholesterol, assessment of these basic cardiovascular risk factors.  :27

Since heart disease remains the number one cause of death, keeping an eye on those risk factors is very important. Alexander says you can help yourself by getting more involved in your own care, perhaps by keeping your own record of blood pressure, diet and exercise, and asking for cholesterol measurement. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Many nurses and other health professionals are leaving medicine in the midst of the pandemic, Elizabeth Tracey reports

Even as the nation can least afford it, nurses and other health professionals are leaving medical practice. Patricia Davidson, dean of the Johns Hopkins School of Nursing, says the reasons are multiple.

Davidson: Sadly many nurses are resigning. We know that the pandemic has hit women harder. Women are juggling multiple responsibilities of homeschooling children, taking care of elderly parents. I think this is potentially a adverse outcome of the pandemic we did not plan or consider. This is the first time in many generations where nurses have been exposed to something so infectious where it’s not their choice.  :29

Davidson says there is a bright spot, however.

Davidson: One of the really encouraging things is that enrollments across nursing schools are increasing.  :06

At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: As the country grapples with Covid-19, residential care facilities are once again a locus of infection, Elizabeth Tracey reports

Residential care facilities, which often provide both housing and healthcare to seniors, are once again seeing many of their residents developing Covid-19, with dire results. Patricia Davidson, dean of the Johns Hopkins School of Nursing, says high infection rates should not be blamed on their staff.

Davidson: I want to recognize the amazing care that is provided in those facilities by certified nursing assistants. Every time I hear those words ‘skilled nursing facility’ I bristle. Because I think it’s an oxymoron. The number of registered nurses in those facilities is perilously low. Instead what we are doing is placing responsibility of care on amazing individuals who are certified nursing assistants and others who really care but don’t have the training to be able to do that appropriately.  :34

Davidson says both training and proper equipment are key to stemming infections. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Nurses are at highest risk to catch Covid-19, Elizabeth Tracey reports

When it comes to healthcare professionals becoming infected with Covid-19, nurses are at highest risk, data from the Centers for Disease Control and Prevention show. Patricia Davidson, dean of the Johns Hopkins School of Nursing, says that’s just what she would have predicted.

Davidson: It’s not a surprise to me because it’s the time of exposure and the contact and the type of work nurses do that put them in the front lines. It also underscores the importance of access to adequate PPE and the training to wear that appropriately. And we know, even in the most infectious conditions such as Ebola healthcare workers are able to take care of those patients safely, if they have access to the right equipment and conditions.  :31

Davidson notes that now, as the pandemic is sweeping the country, precautions and practices to protect nurses and all healthcare workers are essential. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Should cancers be sequenced again if they recur? Elizabeth Tracey reports

When cancers recur, they are genetically different from when they were first detected, especially after many treatments. With evidence from a new federal study of tumor sequencing clearly demonstrating its benefit, William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, says sequencing recurrent cancer may also be helpful.

Nelson: As cancers appear and are treated and improve and relapse or regress even after initial improvement oftentimes that’s because of a sort of a genetic instability, they acquire new and different defects. Those defects favor the cancer growing even despite the treatment that may have been effective before. It’s very plausible that as we learn more and more about it, is that at that occasion, you’ve responded to surgery for a long time, your cancer comes back, is this a time to re-sequence it?  :30

Nelson notes that sequencing is both easier and less expensive than ever. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: A big new project shows the benefit of genetic sequencing of cancers, Elizabeth Tracey reports

Should you have your cancer sequenced? A very large new federal study suggests the answer is more convincingly than ever, yes. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, explains.

Nelson: They called it the match trial. They had gotten biopsies or tissues from almost 6000 cases and they sequenced almost all of them. They found some gene defects that matched a treatment choice in 37.6%. The most common gene defects they saw are ones that don’t have very good treatments for yet. It does suggest that DNA sequencing, there are enough reasons that guide treatment decisions that many if not most cancers will ultimately be sequenced.  :30

Nelson says common mutations or changes in DNA found in many cancers are being actively investigated as targets for new therapies, and predicts many more such agents becoming available soon. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: How might a growth factor and cancer be related? Elizabeth Tracey reports

Insulin-like growth factor or IGF1 helps kids grow, but is also implicated in the development of several types of cancer, a new large study finds. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, says levels of IGF1 rise in sedentary people who consume a lot of carbohydrates in their diet.

Nelson: The mechanism presumably is IGF1 levels are typically higher among people who are overfed, for lack of a better description, with diminished physical activity. This is one of the regulators that one gets when you consume high carbohydrate diets, and remember this is IGF1 levels being higher significantly before the cancer develops. That may be a connection by which some of those things do affect the risk for these cancers.  :26

Nelson says this may also be one reason obesity is also associated with many cancers and the good news is, it is a risk factor that can be modified in both those without cancer currently and cancer survivors. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Some cancers are associated with an increased level of a growth factor in the blood, Elizabeth Tracey reports

Insulin like growth factor one, abbreviated IGF1, is a hormone that helps children grow, but is also associated with certain cancers. Now a very large European study has shown just which cancers are impacted. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, explains.

Nelson: They looked at 30 different types of cancer. I think 23,000 or more developed a cancer in that observation time. What they found was an increased risk with higher IGF1 levels for colorectal cancer, breast cancer, and prostate cancer. Now each of these had been indicted if you will as being associated by smaller studies, so this confirms that on a larger scale. They did not see an association with lung cancer, bladder cancer, pancreatic cancer, that was one to question, endometrial cancer, that’s cancer of the uterus, or kidney cancer.  :32

Nelson notes that even the authors of the study are uncertain about why the growth factor is associated with some cancers and not others. At Johns Hopkins, I’m Elizabeth Tracey.