Posts tagged with "Harvard Medical School"

Take a chill pill: You actually may not be allergic to penicillin

February 1, 2019

Penicillin was the original “wonder drug”—but, today, people are wondering why, for more than half a century, doctors have warned them it’s contraindicated for their care.

Discovered in 1928 and found to “miraculously” cure infections by 1942, penicillin was the first antibiotic that many Baby Boomers were prescribed as children. However, that first dose of penicillin also turned out to be the last for many youngsters—who broke out in bumps or rashes that were diagnosed as allergic reactions.

Now there is a different school of thought. In fact, according to a study posted by the Journal of the American Medical Association in January, fully 19 out of 20 people who have been told they are allergic to penicillin actually can tolerate it well.

Indeed, The New York Times reported on January 22, millions of Americans whose medical histories document their penicillin sensitivities are not actually allergic. But they are steered away from using some of the safest, most effective antibiotics—relying instead on substitutes that are often pricier, less effective, and more likely to cause complications such as antibiotic-resistant infections.

Experts in allergy and infectious disease, including the paper’s authors, are now urging patients to ask doctors to review their medical history and re-evaluate whether they truly have a penicillin allergy.

The evaluation—which may require allergy skin testing and ideally should be done while people are healthy— is especially important, The Times reports, for pregnant women, people with cancer and those in long-term care, and anyone anticipating surgery or being treated for a sexually transmitted infection.

“When you have a true infection that needs to be treated, the physician will see you have the allergy and not question it,” said  Dr. Erica S. Shenoy, an author of  the study, and an infectious diseases specialist who is s on the staff of Harvard Medical School of Massachusetts General Hospital.

The review was carried out with input from the boards of three professional medical organizations: the American Academy of Allergy, Asthma and Immunology; the Infectious Diseases Society of America; and the Society for Healthcare Epidemiology of America. All three groups endorsed the findings.

There is no question that some patients have potentially life-threatening allergic reactions to penicillin, but the label appears to have been applied far too broadly, experts say. About 10% of Americans report having a penicillin allergy, and the rate is even higher among older people and hospital patients—15% of whom have a documented penicillin allergy.

But studies that have gone back and conducted allergy skin testing on patients whose medical records list a penicillin allergy have found that the overwhelming majority test negative. A 2017 review of two dozen studies of hospitalized patients found that over all, 95 percent tested negative for penicillin-specific immunoglobulin E, or IgE, antibodies, a sign of true allergy.

 “We used to say nine out of 10 people who report a penicillin allergy are skin-test negative. Now it looks more like 19 out of 20,” Dr. David Lang, president-elect of the American Academy of Allergy, Asthma and Immunology and chairman of allergy and immunology in the respiratory institute at the Cleveland Clinic, told the Times.

What’s more, the researchers say, many people who have avoided penicillin for a decade or more after a true, severe allergic reaction will not experience that reaction again.

“Even for those with true allergy, it can wane,” said Dr. Kimberly Blumenthal, the review’s senior author, who is an allergist and an assistant professor at Harvard Medical School. “We don’t really understand this, but once you’ve proven you’re tolerant, you go back to having the same risk as someone who never had an allergy” to penicillin.

Finally, the researchers warn, don’t challenge yourself to penicillin on your own. Patients who have been told they’re allergic to penicillin should talk to their doctors, who should take a careful history and review the symptoms of the reaction.

If the past reaction to penicillin included symptoms like headache, nausea, vomiting and itching, or the diagnosis was made based on a family history of the allergy, the patient is considered low-risk and may be able to take a first dose of penicillin or a related antibiotic, such as amoxicillin, under medical observation.

If the past reaction included hives, a rash, swelling, or shortness of breath, patients should have penicillin skin test, followed by a second test that places the reagent under the skin if the first test is negative. If both tests are negative, the patient is unlikely to be allergic to penicillin, and an oral dose may be given under observation to confirm

Research contact:  @nytimes

A long shot: Researchers speculate that a new supplement could extend our lifespan

September 5, 2018

Anti-aging products and regimens—from skin creams and vitamins, to exercise goals and diet plans—are part of an industry that is poised to generate about $200 billion by 2019, but to date, scientists have not concocted a longevity elixir that stands up to medical scrutiny. However, that may be about to change: A group of researchers is heralding a compound called nicotinamide adenine dinucleotide, or NAD+ for short, according  a recent report by TIME magazine.

“NAD+ is the closest we’ve gotten to a fountain of youth,” says David Sinclair, co-director of the Paul F. Glenn Center for the Biology of Aging at Harvard Medical School. “It’s one of the most important molecules for life to exist, and without it, you’re dead in 30 seconds.”

NAD+ is a molecule found in all living cells and is critical for regulating cellular aging and maintaining proper function of the whole body. Levels of NAD+ in people and animals diminish significantly over time, and researchers have found that re-upping NAD+ in older mice causes them to look and act younger, as well as live longer than expected. In a March 2017 study published in the journal Science, Sinclair and his colleagues put drops of a compound known to raise levels of NAD+ into the water given to a group of mice.

Within a couple of hours, the NAD+ levels in the mice had risen significantly. In about a week, signs of aging in the tissue and muscles of the older mice reversed to the point that researchers could no longer tell the difference between the tissues of a two-year-old mouse and those of a four-month-old one.

Now, Time reports,  scientists are trying to achieve similar results in humans. A randomized control trial (considered the gold standard of scientific research) from a different group of researchers published November 2017 in the journal Nature found that people who took a daily supplement containing NAD+ precursors had a substantial, sustained increase in their NAD+ levels over a two-month period.

Sinclair takes an NAD+ upper daily. Anecdotally, he says he doesn’t experience hangovers or jet lag like he used to, he talks faster, and feels sharper and younger. His father takes it too: “He’s 78, and used to act like Eeyore,” Sinclair told the news outlet. “Now he’s going on six-day hikes and traveling around the world.

“I’m not saying we’ve proven it works,” Sinclair adds. “But I can say that if it’s going to work, I hope to be the one to prove it.”

He has competition. Sinclair plans to take his NAD+ research through the U.S. Food and Drug Administration (FDA) approval process and eventually create a pill that could be prescribed by a doctor or purchased over the counter, but another company, called Elysium, is already selling a supplement called Basis that contains compounds known to boost NAD+ levels. (Basis is the supplement tested in the 2017 Nature study.)

Leonard Guarente, Elysium’s chief scientist and co-founder—who also directs the Glenn Center for Biology of Aging Research at MIT—says Basis is not intended to extend people’s life spans, but to help them stay healthier for longer.

Eight Nobel laureates are on the company’s scientific advisory board. “I don’t really mind how long I live provided the life is as good as it is now,” says board member Sir Richard Roberts, winner of the 1993 Nobel Prize in Physiology or Medicine (who is 74). “The only difference I’ve noticed is that the skin on my elbows is smoother than it used to be. Whether it’s Basis or something else, I have no idea.”

Elysium has chosen a faster path to market: By bringing Basis to market as a supplement, and not a drug, Elysium is not required to undergo years of clinical research and FDA approval processes. That decision, and the support of prominent scientists, has stoked criticism from some medical-community experts who wonder why Nobel laureates would attach their names to a supplement without much human research behind it. Elysium declined to confirm if the scientific advisory board members are paid.

Although Basis is already available for purchase, Elysium recognizes that further evaluation of its effects on the human population may be warranted—and the company currently is conducting clinical trials of the supplement.

Still to be determined: Whether NAD+ or Basis—or some other formulation still out there—will “live up to” their spreading word-of-mouth.

Research contact: david_sinclair@hms.harvard.edu

Harvard Med creates more diverse image by taking down 31 portraits

June 20, 2018

Harvard Medical School is doing a different kind of “scrubbing up” these days, according to a June 15 report by Campus Reform. The school is “cleaning up” its professional and public image—and promoting diversity—by removing 31 portraits of former department heads from a lecture-room wall where they have been hanging for decades. The reason? All of the paintings are of men. And 30 out of 31 of those men are white, while one is Asian.

That made for an uncomfortable contrast, as the Boston Globe noted in its own story on June 14, because the employees and students who regularly gather there include women, blacks, and Hispanics.

“School officials confirmed … that the portraits of 31 medical school deans—which formerly hung in the school’s Louis Bornstein Family Amphitheater [at Brigham and Women’s Hospital]— have been ‘dispersed’ to various lobbies and conference rooms,” Campus Reform disclosed.

The move may have been prompted by a recent call to action by WhiteCoats4BlackLives,a national activist group that aims to eliminate racial bias in the practice of medicine. The group recently targeted Harvard Medical School for allegedly promoting racial bias, the Globe also reported—claiming that there were a “dearth of plaques, statues, portraits, and building names on campuses that acknowledge contributions from physicians of color.”

Indeed, the group published a Racial Justice Report Card this year that found that only 10.7% of medical school graduates in 2016 were Black, Latinx, or Native American.  This represents a major issue because medical schools are the gatekeepers to the health professions

What’s more, the group says, patients of color often are unable to access care at academic medical centers in their communities. For example, black patients in New York City are less than half as likely as white patients to receive care at academic medical centers.

The Racial Justice Report Card, compiled for the first time this year, grades ten major medical schools on 15 anti-racism factors—and provides an overall grade for each institution, as follows: Harvard: B; Johns Hopkins: C+; Mt. Sinai: B-; University of Pennsylvania: C; Thomas Jefferson University: C; UC-San Francisco: B-; University of Michigan: B-; University of Pittsburgh: B-; Washington University in St. Louis: B-; and Yale: C. Not one of them came in with a B+ or an A.

The hospital’s president, Dr. Betsy Nabel, told the Globe that she had considered ending the tradition of hanging pictures of retired chairs in the auditorium for several years, especially as more women and minorities train as doctors at the hospital. “I have watched the faces of individuals as they have come into Bornstein,’’ Nabel said in an interview. “I have watched them look at the walls. I read on their faces ‘Interesting. but I am not represented here.’ That got me thinking maybe it’s time that we think about respecting our past in a different way.’’

Research contact: national@whitecoats4blacklives.org

Put down the coffee: Workers are using caffeine and sugar to combat stress

March 23, 2018

There is an epidemic of stress nationwide today, with the vast majority of U.S. workers—80%, according to the American Institute of Stress—experiencing on-the-job tension and anxiety.

What they are doing about it, U.S. News reports—chugging coffees (34%) and handfuls of candy, downing alcoholic drinks, resorting to prescription and recreational drugs, and acting out—may exacerbate the problem rather than help to solve it.

In a poll of 751 adult American workers sponsored by The Marlin Company, conducted by The Harris Poll, and cited by the institute, fully 25% of respondents admitted that job-related stress makes them feel like screaming, and 14% said that their stress levels have made them feel like hitting a coworker.

Thus, it is no surprise that 10% of respondents expressed fear that someone they know at work actually could turn violent, with another 18% reporting that they had experienced a threat or verbal intimidation within the past year.

Now, a survey sponsored by Salt Lake City-based Bridge has found that the pressures are growing worse, instead of being ameliorated. The study has found that the 24/7 culture of many companies may be adding to the stress.

Only 33% of the 1,000 U.S. office workers who participated in the study said they are encouraged by their employer to take paid time off, and only 11% are encouraged to take mental health days as part of their sick leave. Most (78% of workers) were convinced that working more hours would be crucial to getting ahead and about 50% reported feeling like they have to engage in workplace politics.

However, U.S. News cautions, be careful what you wish for—and what methods you use to relieve the stress that is generated along the path to achievement. Even coffee, which has some proven health benefits, can cause unpleasant symptoms like headaches and irritability if you drink too much of it, according to the Mayo Clinic.

And Harvard Medical School has warned that, if you eat too much added sugar—in the form of those M&Ms or candy bars—it boosts your risk of dying from heart disease. Plus it goes without saying that alcohol and drugs do not mix well with work.

Instead, experts advise, take paid time off, even if it is not encouraged by your company; unplug and de-stress for a few minutes every hour, exercise for anxiety relief—and plan ahead. Starting the day worried and disorganized can only set you up for more stress; while planning your calendar will enhance feelings of control and competence.

Research contact: info@getbridge.com