Coronavirus Vaccine: Expert Says, ‘We Need Time to Get This Right’

Expert Calls for Slow & Steady Approach in Vaccine Development

While the race to develop a coronavirus vaccine may seem as if it’s being run in slow motion, with most experts predicting a 2021 launch at earliest, by historical standards it’s unfolding with incredible swiftness. Looking back at timelines for other vaccines, it becomes evident that there are numerous reasons for a slow and steady approach, according to Michael Kinch, director of Washington University’s Centers for Research Innovation in Biotechnology and Drug Discovery. Kinch, who authored the authoritative book, Between Hope and Fear: A History of Vaccines and Human Immunity, cautions that vaccine development is a long, complex process requiring gathering of laboratory and real-world evidence and extensive evaluation.

“Testing for safety and efficacy requires considerable time, even with improved technology. We need to get this absolutely right, because if we panic and rush, there may be a price to be paid in terms of toxicity,” explains Kinch. “For example, in 1976, fear of a swine flu epidemic led to rapid development of a vaccine which caused Guillain-Barre syndrome [a paralyzing neurological disorder] in a small percentage of patients. That doesn’t normally happen if you take the time to check at each step.”

Lessons Learned from Past Vaccine Development

A salient lesson can be learned by going further back to the polio vaccine of the 1950s, according to Kinch. Long heralded as one of the 20th century’s landmark immunizations, it nevertheless encountered a problem when initially released. In a situation eerily similar to today’s coronavirus pandemic, the poliovirus’s paralyzing and often deadly effects were terrifying the nation, and the threat of prolonged quarantines as the only real mode of prevention had people desperate for a solution. In 1952, Dr. Jonas Salk began his clinical investigation of a polio vaccine, and the development and distribution schedule was significantly expedited to allow for release in 1955. Unfortunately, in the rush to launch, improper manufacturing of some of the early batches led to unnecessary outcomes.

The logistical challenges of rolling out a coronavirus vaccine will be significant, predicts Kinch.

“We need to manufacture enough of the vaccine to immunize 350 million Americans, but this will also require 350 million vials, syringes, stoppers and any other parts yet to be determined,” says Kinch. “This is fundamental to success, but we’re not fully looking it in the eye. And extending it to a world population of 7.5 billion makes it even more essential to address now.”

The stakes are enormous, as Kinch believes a successful coronavirus vaccine may have the power to change medicine for a generation.

“We’re going to rethink our approach just as we did with other epidemics which defined the 20th century from a scientific standpoint. Smallpox led to awareness of the importance of sanitation, and the vaccine which was developed eliminated the disease worldwide. Spanish flu gave us the structure of DNA and the foundations of biotechnology, and HIV-AIDS led us to focus on evidence-based science and government-sponsored clinical trials,” he says.

What can be learned through development of a safe, effective and scalable vaccine for the novel coronavirus may well parallel these important breakthroughs. As Kinch recently wrote: “Vaccines come with serious medical, social and political implications. If we anticipate and address them accordingly, the coming months and perhaps years could be among the finest hours for the United States and its people.”

The post Coronavirus Vaccine: Expert Says, ‘We Need Time to Get This Right’ appeared first on Specialdocs Consultants.

For more information on the benefits of Concierge Medicine, please visit Logan Square Medical Group. To enroll as a new patient, please call us directly at (773) 489-7040a>. Current patients with any health concerns, should call Dr. Brown’s office directly at (773) 489-7040a>. Thank you!

Fighting the Colonoscopy Fear Factor

Colorectal Cancer awareness could save your life.

As one of the country’s most preventable illnesses, with a readily available test that is both diagnostic and therapeutic, why does colorectal cancer (CRC) stubbornly remain the second-leading cause of cancer-related deaths in the US? The key to reducing deaths is in the colonoscopy, a direct visualization test of the entire colon that enables a physician who specializes in gastroenterology to screen for abnormal growths (polyps) and remove them before they turn cancerous. Fighting the colonoscopy fear factor through knowledge is critical.

Don’t let colonoscopy prep scare you away. Fighting the Colonoscopy Fear Factor is important to your health

For many people, the rigorous prep required to thoroughly clean out the colon the night before the test has overshadowed the colonoscopy’s lifesaving impact, resulting in a third of adults 50 or older, the group most at risk of developing colorectal cancer, to not be screened. The colonoscopy reputation deserves a major turnaround, because in 2020 the colonoscopy experience is highly manageable, with more palatable prep options, a pain-free procedure and swift reporting of results … so there’s no need to dread your colonoscopy or anxiously avoid a 10-year follow-up. You can fight the colonoscopy fear factor.

Previous prep involved drinking up to 128 ounces of salty-tasting fluid over a short time, but several new colon cleansing preparations are now available that require less fluid, according to Mayo Clinic. Products such as Prepopik, Suprep and Plenvu can be mixed with a liquid of choice, and some patients might be offered a nonprescription prep of polyethylene glycol (such as MiraLAX) followed by an electrolyte-containing drink (such as Gatorade) – but note that these lower-volume prep solutions may not be appropriate for people with heart, kidney or liver disease. If higher-volume fluid solutions are needed, a split dose makes it easier and more tolerable, with half of the laxative taken in one sitting and the other half on the morning of the procedure. Even newer possibilities are on the horizon: Keep an eye out for an edible colonoscopy prep kit that incorporates active laxative ingredients into better-tasting food bars and drinks, with final phase of trials scheduled in mid-2020.

Whatever type of solution you choose, adjust your diet a few days before your colonoscopy to include smaller portions and low-fiber foods to ensure a smoother prep. On the day before your procedure, when you’ll be on a liquid diet, treat yourself to good-tasting items like organic low-sodium broth, white grape juice, flavored sparkling waters and full-bodied coffee (without creamer). Make the prep solution more palatable by refrigerating and drinking it chilled; suck on a lemon wedge or chew a piece of gum between glasses to help mask the flavor. When the solution starts to work emptying your bowels, be prepared for your time in the bathroom with wet wipes or double ply toilet paper, a fully charged phone, and some light reading.

During the 30- to 60-minute procedure, most people will be given a mild sedative drug or an anesthetic to put them in a “twilight” sleep, while a few will require general anesthesia. A thin, flexible, lighted tube is inserted into the colon, and air, CO2, sterilized water or saline is gently pumped in to inflate the colon and allow the entire lining to be viewed. Polyps are removed if present, and biopsies are taken of any abnormal areas. After the test, you’ll recover from the sedative for about an hour before you go home and consider this mission accomplished.

Still feeling uneasy about a colonoscopy?

Noninvasive, stool-based screening tests may offer an alternative if you’re considered at average risk – that is, no family or personal history of CRC, no previous polyps, no long-standing inflammatory bowel disease or the presence of certain genetic syndromes. The most well-known is FDA-approved Cologuard, which detects DNA markers for cancer and uses fecal immunochemical testing (FIT) to find blood in the stool, with less reliable results: 92% accuracy for cancer and only 69% for advanced colon polyps, plus a 13% rate of false positives. Other options include a “virtual colonoscopy” that uses CT imaging for a detailed view of the inside of the colon and rectum or a flexible sigmoidoscopy to view the lower part of the colon, which requires the colon prep described above. However, a positive result on any of these tests will result in the need for a colonoscopy, which remains the gold standard for colon cancer testing as the most accurate way to find and remove polyps and determine the right follow-up intervals.

Under 50: Are Screenings Necessary?

For people with a family history of genetic conditions that put them at increased risk, screenings may be recommended at a younger age. Additionally, in 2018, a controversial decision was made by the American Cancer Society to lower its threshold to age 45, in response to a steady rise in the cancer’s prevalence each year since the mid-1990s among ages 20 to 54. A new 2020 study appeared to provide more evidence, showing a 46% spike in colorectal cancer incidence between ages 49 and 50 – attributed to cancer that had gone undetected in younger patients until routine screening at age 50.

Research is in progress to resolve the conflicting guidelines, but current best practices* keep 50 as the age to begin colorectal cancer screening for average-risk adults; with FIT or guaiac-based fecal occult blood testing every two years or a colonoscopy every 10 years; and no testing after age 75.

Did You Know?

More than 15 million colonoscopies are performed in the United States annually. Speaking with your doctor and being armed with the right information can make fighting the colonoscopy fear factor a little easier.

Recommendation:

We recommend all adults over the age of 40, with anemia, have a gastroenterology evaluation including colonoscopy. Please call our office for more information.

*American College of Physicians

The post Fighting the Colonoscopy Fear Factor appeared first on Specialdocs Consultants.

For more information on the benefits of Concierge Medicine, please visit Logan Square Medical Group. To enroll as a new patient, please call us directly at (773) 489-7040a>. Current patients with any health concerns, should call Dr. Brown’s office directly at (773) 489-7040a>. Thank you!

20,000 and You: Unlocking the Genetic Code

In just the past few years, there has been a significant shift in the practical uses of genetic testing, which examines changes, or variants, in your genes that may lead to illness or disease. Once considered more of an investment in the future and less applicable to individual patient care, opportunities to guide health and lifestyle decisions in the here and now may be tantalizingly close at hand.

“Genetic testing is progressing from an occasionally deployed diagnostic tool to becoming the new founding architecture of a personal health record, and may ultimately become a vital addition to a patient’s clinical portfolio,” explains Calum MacRae, MD, geneticist, Chief of Cardiovascular Medicine at Brigham and Women’s Hospital and in private practice at Boston’s AllCare Medical, whose decades-long focus has been on how to systematically implement genomics discoveries into clinical care.

In broad strokes, three areas are identified through genetic testing: disease carrier states for genes, important to the patient’s immediate family; inherited diseases such as heart disease or cancer; and an emerging predictive utility for drug responses and risk of common diseases. This information forms the foundation of personalized medicine, targeted to a patient’s specific genetic profile. According to Dr. MacRae, a holistic approach will optimize the enormous potential of genetic testing, allowing physicians to engage all their patients to understand their own genomes and build collaborative plans for lifestyle modification, nutritional choices and medications that may prevent or delay disease.

Direct-to-consumer (DTC) testing such as 23andMe has become ever more mainstream and is predicted to grow to a $340 million industry in the next five years. In fact, earlier this year, the FDA began allowing 23andMe to provide DTC testing for increased risk of 10 conditions, including celiac disease, hereditary hemochromatosis, Parkinson’s, alpha-1 antitrypsin deficiency and late-onset Alzheimer’s disease.

However, experts cast a wary eye on DTC testing for a number of reasons. Genetic testing is highly technical and complex and it is still hard to predict who will actually develop common diseases such as diabetes, hypertension, and many cancers from genes alone. For many conditions, a negative DTC test result does not necessarily guarantee low risk because it is believed to be the interaction of complex environmental factors with genes that cause disease. That means all information must be considered in the context of a patient’s environment, lifestyle and family medical history, ideally explored during a one-to-one consultation with a primary care physician.

While there is still much to be uncovered, there is no denying the desire to incorporate personalized medicine in clinical practice is increasing. Scientists are beginning to understand the interplay of genes and environment on disease for about one third of the roughly 20,000 genes we all possess, and the portfolio of knowledge continues to grow rapidly. Even more comprehensive tests that examine numerous genes and variants in an individual’s exome (the protein-making part of the gene), known as next generationgeneration sequencing, will gradually become accessible as the costs associated with them continue to fall. Technologies that enable scientists to alter an organism’s DNA (see below) are being refined. With every advance, we may come closer to realizing the vision of Dr. J. Craig Venter, one of the primary forces behind the original Human Genome project, who said in 2015: “I’m hoping that these next 20 years will show what we did 20 years ago in sequencing the first human genome was the beginning of the health revolution that will have more positive impact in people’s lives than any other health event in history.”

Coming to Terms with Genetic Testing

• Chromosomal microarray: looks for genetic changes in the genome, sometimes caused by an existing medical condition.
• Genome editing: technologies that enable scientists to change an organism’s DNA by adding, removing or altering genetic materials at particular locations in the genome. Gaining favor is the newest CRISPR technology, less expensive and more accurate than other genome editing methods.
•  Single nucleotide polymorphisms or SNPs: the most common type of genetic variation among
  people. They can act as biological markers, helping locate genes associated with disease, and may help predict an individual’s response to certain drugs, susceptibility to environmental factors such as toxins and risk of developing particular diseases.  SNPs can also be used to track inheritance of disease genes within families.
• Genotyping panels of selected susceptibility variants: often used in DTC genetic tests, and include SNPs that have been associated with common, complex diseases such as type 2 diabetes, autoimmune disease and metabolic traits.
• Specific single gene tests: performed as part of a focused risk evaluation for heritable disease or for diagnostic considerations e.g. BRCA1 and BRCA2 gene sequencing for carrier identification in at-risk individuals with a strong family history of breast cancer.

Source: Up to Date

The post 20,000 and You: Unlocking the Genetic Code appeared first on Specialdocs Consultants.

For more information on the benefits of Concierge Medicine, please visit Logan Square Medical Group. To enroll as a new patient, please call us directly at (773) 489-7040a>. Current patients with any health concerns, should call Dr. Brown’s office directly at (773) 489-7040a>. Thank you!

Genetic Testing and Your Health

20,000 and You: Unlocking the Genetic Code

In just the past few years, there has been a significant shift in the practical uses of genetic testing, which examines changes, or variants, in your genes that may lead to illness or disease. Once considered more of an investment in the future and less applicable to individual patient care, opportunities to guide health and lifestyle decisions in the here and now may be tantalizingly close at hand.

“Genetic testing is progressing from an occasionally deployed diagnostic tool to becoming the new founding architecture of a personal health record, and may ultimately become a vital addition to a patient’s clinical portfolio,” explains Calum MacRae, MD, geneticist, Chief of Cardiovascular Medicine at Brigham and Women’s Hospital and in private practice at Boston’s AllCare Medical, whose decades-long focus has been on how to systematically implement genomics discoveries into clinical care.

In broad strokes, three areas are identified through genetic testing: disease carrier states for genes, important to the patient’s immediate family; inherited diseases such as heart disease or cancer; and an emerging predictive utility for drug responses and risk of common diseases. This information forms the foundation of personalized medicine, targeted to a patient’s specific genetic profile. According to Dr. MacRae, a holistic approach will optimize the enormous potential of genetic testing, allowing physicians to engage all their patients to understand their own genomes and build collaborative plans for lifestyle modification, nutritional choices and medications that may prevent or delay disease.

Direct-to-consumer (DTC) testing such as 23andMe has become ever more mainstream and is predicted to grow to a $340 million industry in the next five years. In fact, earlier this year, the FDA began allowing 23andMe to provide DTC testing for increased risk of 10 conditions, including celiac disease, hereditary hemochromatosis, Parkinson’s, alpha-1 antitrypsin deficiency and late-onset Alzheimer’s disease.

However, experts cast a wary eye on DTC testing for a number of reasons. Genetic testing is highly technical and complex and it is still hard to predict who will actually develop common diseases such as diabetes, hypertension, and many cancers from genes alone. For many conditions, a negative DTC test result does not necessarily guarantee low risk because it is believed to be the interaction of complex environmental factors with genes that cause disease. That means all information must be considered in the context of a patient’s environment, lifestyle and family medical history, ideally explored during a one-to-one consultation with a primary care physician.

While there is still much to be uncovered, there is no denying the desire to incorporate personalized medicine in clinical practice is increasing. Scientists are beginning to understand the interplay of genes and environment on disease for about one third of the roughly 20,000 genes we all possess, and the portfolio of knowledge continues to grow rapidly. Even more comprehensive tests that examine numerous genes and variants in an individual’s exome (the protein-making part of the gene), known as next generationgeneration sequencing, will gradually become accessible as the costs associated with them continue to fall. Technologies that enable scientists to alter an organism’s DNA (see below) are being refined. With every advance, we may come closer to realizing the vision of Dr. J. Craig Venter, one of the primary forces behind the original Human Genome project, who said in 2015: “I’m hoping that these next 20 years will show what we did 20 years ago in sequencing the first human genome was the beginning of the health revolution that will have more positive impact in people’s lives than any other health event in history.”

Coming to Terms with Genetic Testing

• Chromosomal microarray: looks for genetic changes in the genome, sometimes caused by an existing medical condition.
• Genome editing: technologies that enable scientists to change an organism’s DNA by adding, removing or altering genetic materials at particular locations in the genome. Gaining favor is the newest CRISPR technology, less expensive and more accurate than other genome editing methods.
•  Single nucleotide polymorphisms or SNPs: the most common type of genetic variation among
  people. They can act as biological markers, helping locate genes associated with disease, and may help predict an individual’s response to certain drugs, susceptibility to environmental factors such as toxins and risk of developing particular diseases.  SNPs can also be used to track inheritance of disease genes within families.
• Genotyping panels of selected susceptibility variants: often used in DTC genetic tests, and include SNPs that have been associated with common, complex diseases such as type 2 diabetes, autoimmune disease and metabolic traits.
• Specific single gene tests: performed as part of a focused risk evaluation for heritable disease or for diagnostic considerations e.g. BRCA1 and BRCA2 gene sequencing for carrier identification in at-risk individuals with a strong family history of breast cancer.

Source: Up to Date

The post Genetic Testing and Your Health appeared first on Specialdocs Consultants.

For more information on the benefits of Concierge Medicine, please visit Logan Square Medical Group. To enroll as a new patient, please call us directly at (773) 489-7040a>. Current patients with any health concerns, should call Dr. Brown’s office directly at (773) 489-7040a>. Thank you!

The Zika Virus: Prevention is the First Line of Defense

As the Zika virus continues to make headlines daily, it is essential to know who is at risk, how it is transmitted and most importantly, to understand strategies for prevention. Following are the latest findings on Zika, according to experts at the Centers for Disease Control and the World Health Organization.

How does Zika spread?

Most people get Zika from a mosquito bite, but it can also be passed through sexual contact, blood transfusion or during pregnancy to a fetus.  Zika is spread primarily by Aedes aegypti mosquitoes, which breed in areas with small pools of water, even as small as a coffee cup.  When a mosquito bites a person with Zika, the virus travels from its gut to its salivary glands and is then injected into the next human it bites.

Who is at risk?

Almost no one is immune to the virus.

How serious is the Zika virus?

If Zika is transmitted to a fetus during pregnancy, it can cause microcephaly, a birth defect that is a sign of incomplete brain development. Babies with microcephaly have extremely small heads, and the nerves connecting the eyes and ears to the brain may be permanently damaged. Therefore, pregnant women should avoid traveling to destinations with outbreaks of the virus, and should take extra precautions to protect themselves from mosquito bites. In addition, current research links Guillain-Barre syndrome (GBS), an uncommon sickness of the nervous system in which a person’s own immune system damages the nerve cells, to Zika; however, only a small proportion of people with recent Zika virus infection get GBS.

What parts of the US is Zika most likely to reach?

The Aedes aegypti mosquito is most common in Florida and along the Gulf Coast, but can travel much farther north in summer. In July, the first cases of Zika caused by mosquitoes in the U.S. (versus those cases acquired by people who traveled outside the country) were reported in the Miami area; in August several more were reported in Miami Beach. However, the CDC indicates clusters of cases are to be expected and does not signal the virus is spreading throughout the state. Experts say Zika is not as likely to spread in the U.S. as it did in Central and South America, because our living conditions are very different (air conditioning, closed windows in the summer and use of window screens) and tracking and treatment of infections is more effective.

What are the symptoms of Zika virus?

The illness is usually mild, lasting about a week with symptoms that include fever, rash, joint pain and red eyes. Only one in five people infected with the virus exhibits symptoms.

What can I do to protect myself?

First, decrease your risk of being bitten by a mosquito:

• Use an EPA-approved insect repellant that contains DEET.
• Wear clothing that provides coverage, such as long-sleeved shirts and long pants.
• Treat clothing with permethrin, an insecticide.
• At home, eliminate any areas of standing water outside that can provide a breeding ground for mosquitoes, including small containers, even a birdbath. Keep in mind that mosquitoes do not travel far once hatched, and will bite whoever is in close proximity.
• If mosquitoes can reach where you are sleeping, put up a bed net.

Additionally:

• Prevent transmitting or receiving the virus by practicing safe sex (use a condom).
• When traveling, check travel advisories to identify areas with known cases of Zika, and avoid if possible. In the U.S., this now includes Miami-Dade County.

How is it treated? Is there a vaccine?

Considerable progress is being made in the development of a vaccine, but none is available yet, and health experts warn that it may take years before one is commercially available. Treatment today focuses on relieving symptoms and includes rest, rehydration, and acetaminophen for fever and pain.

For more information, check our website for updates and/or visit http://www.cdc.gov/zika/whats-new.html

The post The Zika Virus: Prevention is the First Line of Defense appeared first on Specialdocs Consultants.

For more information on the benefits of Concierge Medicine, please visit Logan Square Medical Group. To enroll as a new patient, please call us directly at (773) 489-7040a>. Current patients with any health concerns, should call Dr. Brown’s office directly at (773) 489-7040a>. Thank you!

The Zika Virus: Prevention is the First Line of Defense

As the Zika virus continues to make headlines daily, it is essential to know who is at risk, how it is transmitted and most importantly, to understand strategies for prevention. Following are the latest findings on Zika, according to experts at the Centers for Disease Control and the World Health Organization.

How does Zika spread?

Most people get Zika from a mosquito bite, but it can also be passed through sexual contact, blood transfusion or during pregnancy to a fetus.  Zika is spread primarily by Aedes aegypti mosquitoes, which breed in areas with small pools of water, even as small as a coffee cup.  When a mosquito bites a person with Zika, the virus travels from its gut to its salivary glands and is then injected into the next human it bites.

Who is at risk?

Almost no one is immune to the virus.

How serious is the Zika virus?

If Zika is transmitted to a fetus during pregnancy, it can cause microcephaly, a birth defect that is a sign of incomplete brain development. Babies with microcephaly have extremely small heads, and the nerves connecting the eyes and ears to the brain may be permanently damaged. Therefore, pregnant women should avoid traveling to destinations with outbreaks of the virus, and should take extra precautions to protect themselves from mosquito bites. In addition, current research links Guillain-Barre syndrome (GBS), an uncommon sickness of the nervous system in which a person’s own immune system damages the nerve cells, to Zika; however, only a small proportion of people with recent Zika virus infection get GBS.

What parts of the US is Zika most likely to reach?

The Aedes aegypti mosquito is most common in Florida and along the Gulf Coast, but can travel much farther north in summer. In July, the first cases of Zika caused by mosquitoes in the U.S. (versus those cases acquired by people who traveled outside the country) were reported in the Miami area; in August several more were reported in Miami Beach. However, the CDC indicates clusters of cases are to be expected and does not signal the virus is spreading throughout the state. Experts say Zika is not as likely to spread in the U.S. as it did in Central and South America, because our living conditions are very different (air conditioning, closed windows in the summer and use of window screens) and tracking and treatment of infections is more effective.

What are the symptoms of Zika virus?

The illness is usually mild, lasting about a week with symptoms that include fever, rash, joint pain and red eyes. Only one in five people infected with the virus exhibits symptoms.

What can I do to protect myself?

First, decrease your risk of being bitten by a mosquito:

• Use an EPA-approved insect repellant that contains DEET.
• Wear clothing that provides coverage, such as long-sleeved shirts and long pants.
• Treat clothing with permethrin, an insecticide.
• At home, eliminate any areas of standing water outside that can provide a breeding ground for mosquitoes, including small containers, even a birdbath. Keep in mind that mosquitoes do not travel far once hatched, and will bite whoever is in close proximity.
• If mosquitoes can reach where you are sleeping, put up a bed net.

Additionally:

• Prevent transmitting or receiving the virus by practicing safe sex (use a condom).
• When traveling, check travel advisories to identify areas with known cases of Zika, and avoid if possible. In the U.S., this now includes Miami-Dade County.

How is it treated? Is there a vaccine?

Considerable progress is being made in the development of a vaccine, but none is available yet, and health experts warn that it may take years before one is commercially available. Treatment today focuses on relieving symptoms and includes rest, rehydration, and acetaminophen for fever and pain.

For more information, check our website for updates and/or visit http://www.cdc.gov/zika/whats-new.html

The post The Zika Virus: Prevention is the First Line of Defense appeared first on Specialdocs Consultants.

For more information on the benefits of Concierge Medicine, please visit Logan Square Medical Group. To enroll as a new patient, please call us directly at (773) 489-7040a>. Current patients with any health concerns, should call Dr. Brown’s office directly at (773) 489-7040a>. Thank you!