This week on Diagnostocracy, Ti and Keifer welcome students Jennifer Fields and Jesse Aquino to review the March for Science and the inevitably partisan role of science in politics. Jennifer and Jesse then discuss their experience advocating health policy while at DO Day on Capitol Hill earlier this month.
Welcome to Diagnostocracy’s first podcast episode! Today Ti and Keifer introduce you to the pod. Then their fellow classmate, Leigh Graziano, joins them as they discuss the American Health Care Act (AHCA) and the court battles happening in Arkansas over lethal injection.
We’ve all seen the commercials. “Prevagen, a dietary supplement shown to improve memory, contains a unique ingredient originally discovered in jellyfish.*” What we often miss is the clarifying asterisk, that “these statements have not been evaluated by the Food and Drug Administration (FDA)” and that “this product is not intended to diagnose, treat, cure or prevent any disease.” The truth is that the supplement industry is built on the premise that you can equate supplements wit FDA-approved drugs which have been subjected to the rigors of research, development and clinical testing (or at least that you won’t be able to distinguish between the two).
Like Prevagen, only some of these false claims are charged as fraudulent—and often years after many hopeful Americans have been conned into buying the product. An article in The Atlantic this week discusses the booming dietary-supplement industry and its unencumbered sprint to free-market success at the cost of both credible science and our wallets. Dr. James Hamblin explains the case that many supplemental companies make when selling their product:
A metabolite that no one could ever get from food, and in which nearly 100% of people are deficient, represents a big market. And while consumers are waiting for clinical trials to play out, people don’t need to wait to buy [it].
What’s scary is that supplements are treated more like foods than like drugs by the FDA. They can go straight to market without requiring evidence of efficacy. When provoked, the men in suits pushing supplements will admit that their product is not a drug, but will often continue to make the argument that it is better than food. Again, Dr. Hamblin:
I reacted by asking him about broccoli and salads, and why those aren’t medical foods. They make people with diabetes and heart disease less sick, when used regularly. Conversely, chronic abuse of Pop-Tarts and Pepsi contributes to lethal disease. Eating mostly whole plants will protect most hearts more effectively than the most widely prescribed cardio-protective pharmaceuticals, statins, and yet food is not medication.
So a product that is treated like food—while claiming to be better than food—lacks credibility to be a drug. What can be done?
The future of the dietary-supplement industry might lie in the hands of Dr. Scott Gottlieb, President Trump’s pick to lead the FDA. Gottlieb has received criticism for taking millions of dollars from nearly 20 biopharma and health firms while vowing to fight the opioid crisis. He stands for a libertarian, regulation-free approach and even accused the FDA of evading the law.
But how can a free-market approach to supplements succeed when consumers in the marketplace are unable to tell when a product is actually helpful? As a future physician, I am terrified by the idea that a low-budget commercial for a product with no clinical evidence for efficacy can bear the same weight as my own medical advice developed over years of grueling education.
I’d like to believe that the answer is adequate patient education and more deliberate communication. I learned a lot about the power of “fake news” recently; but unfortunately, convincing those around me that the facts still matter may be one of the toughest tasks in my own career down the road.
Image: Harvard Health
This week, Katie Falkenberg, a photographer for the LA Times, was named a Pulitzer finalist for Motherhood in the Time of Zika. Not only is her work stunning, but it captures the very honest, everyday tragedy of an incurable and unpreventable disease.
Zika infection is usually harmless in healthy adults and children. The risk of fetal developmental disorders like microcephaly strikes fear in pregnant women and devastates those affected, as described in Falkenberg’s Times profile:
As many as a third of mothers are unmarried in [Brazil], where the rate is highest in impoverished rural villages and crowded slums. Even mothers who have a partner have found themselves suddenly abandoned as their relationships crumble under the emotional strain, economic burden and social stigma that come with raising a child who may require almost constant attention. Many [of these babies] develop severe cognitive and physical disabilities that require expensive therapy and monitoring by specialists.
Meanwhile, Washington endured an embarrassing fight over a spending bill to provide relief in both domestic and international efforts to handle Zika. The Obama White House requested emergency funding when the World Health Organization declared the outbreak a Public Health Emergency of International Concern. Over the next 6 months, these funds were held hostage in a bill that also addressed things like defunding Planned Parenthood and allowing Confederate flags to be flown at cemeteries. That is, the Zika outbreak fell victim to the reality of 21st century U.S. politics: sometimes even tragedy and epidemic are insufficient pressure for political action.
Now, nearly half a year after the $1.1 billion bill was finally signed into law, the first live-attenuated vaccine candidate was found to show complete protection from Zika infection. Pei-Yong Shi, author of a study published in Nature:
A successful vaccine requires a fine balance between efficacy and safety. Vaccines made from attenuated live viruses generally offer fast and durable immunity, but sometimes with the trade-off of reduced safety.
Shi’s study shows what he believes is sufficient safety testing to warrant further development of the candidate vaccine. There are dozens of Zika vaccines in the pipeline, but most require several rounds of shots—a potential obstacle in countries like Brazil where access and delivery may be difficult.
Such live-attenuated vaccine has the advantage of single-dose immunization, rapid and strong immune response and potentially long-lived protection. Therefore, a safe live-attenuated vaccine will be ideal in prevention of Zika virus infection, especially in developing countries.
In the U.S., nearly every state has at least one expecting mother with the disease. Now that we’re on our way into spring, many high-risk areas like southern Texas are taking extra precautions to defend against the mosquito-borne disease. This week, the Texas Department of State Health Services recommended testing all pregnant residents in certain counties and all residents showing certain symptoms of Zika infection.
Twice in the past month, President Trump has called for crippling cuts to the budget of the NIH, the primary funding agency for health-related research in the U.S. Research in medicine is patchwork, and the message of its results is often muddied by conflicting studies. But adequately funding these projects helps us to answer questions that give context and hope to Falkenberg’s images.
Image: Katie Falkenberg
Keifer and Ti welcome you to the official blog of the Diagnostocracy podcast! Each week we’ll recap a few hot headlines in health policy with other students, physicians, issue advocates and special guests. Don’t have enough time to get through an entire episode? We’ll be putting out 5-minute Vitals episodes anytime something goes down in DC that we think is a need-to-know.
Be sure to subscribe on iTunes and to tune in on April 19 for our first episode. Take a few minutes to check out the blog, follow us on Facebook, Twitter and Instagram, and let us know what you think. Finally, if you subscribe to our blog, you will receive a “Weekly Differentials” email every week from Diagnostocracy.
Thanks for reading!