Published June 3, 2023
Morning Report — Not Your Typical Medical Newsletter
We get it, you see a lot of medical newsletters, so hear us out. Once a month, we’ll highlight important medical news sprinkled with witty commentary, fun facts, giveaways, and more… because learning should be fun! Subscribe to receive the Morning Report directly.
Good morning and happy upcoming Father’s Day to all the clinician dads reading this. In honor of you, we’re sharing our favorite medical dad joke:
Son: “Dad, how can I hear the blood in my veins?”
Dad: “You have to listen varicosely.”
Apologies for that. If only we could promise that was the only dad joke in this newsletter …
FDA Approval of First C diff Pill Could Gut the Competition
INFECTIOUS FINDINGS
“Te efficacy is so good, I don’t know that there’s much room for others to compete …" That’s Oppenheimer analyst Mark Breidenbach shortly before the FDA approved Vowst, a fecal microbiota product that helps prevent recurrent Clostridioides difficile infection (CDI). What’s behind the bold claim? Impressive RCT results and a delivery mechanism that doesn’t call for an enema.
Flushing away the competition
The FDA approved the first oral therapy that harnesses healthy bacteria from human waste to potentially sidestep a CDI recurrence. Findings from a small, randomized study made FDA approval inevitable: 88% of people who ingested the capsule remained CDI-free after eight weeks, while only 60% in the placebo arm could say the same (number needed to treat = 3.6). Adverse effects included the triumvirate of GI malfunctions: abdominal swelling, constipation, and diarrhea. Vowst’s sole rival on the market, Rebyota, a rectally delivered product, can only tip its hat to this effective oral alternative. And the stool banks that resource traditional fecal transplants could soon see less demand and start shutting down like a US regional bank.
The FDA approval does include cautions: infectious agents and food allergens may travel with the fecal microbiota. In other bad news, the therapy values at $17,500—a drop in the bucket compared to a prime Taylor Swift ticket but a hefty load given that human waste is a bottomless resource. We hope insurance foots most of the bill so patients won’t be feeling the pinch.
Key takeaway
This new oral medication may alter the trajectory of the common CDI hamster wheel: (1) patient develops CDI, (2) antibiotics clear the infection but disrupt the gut microbiome, (3) another round of CDI emerges. This product may help replenish the patient’s good gut bacteria and return the gut microbiome to homeostasis. Our gut reaction is that patients will prefer the less invasive oral delivery method. Patients ≥18 years of age who have already taken antibiotics for CDI can take four capsules daily for three days. If patients find fecal tablets figuratively hard to swallow, assure them that fecal donors are thoroughly screened and each stool donation undergoes a rigorous purification process to extract the healthy bacteria from the waste.
Study Beefs Up Evidence Linking Fried Foods with Depression
DIETARY DIGEST
Saying fried food is bad for you is like saying a McDonald’s PlayPlace ball pit is a germ paradise—McDuh. Although numerous studies have laid out the cardiometabolic risks associated with fried food (and fast food in general), the connection between fried food consumption and mental health is less established by scientific evidence.
The not-so-happy meal
A new population-based study analyzing >140,000 people over an 11-year span found a possible link between regularly consuming fried foods, especially fried potatoes, and increased anxiety and depression (12% higher relative risk of anxiety and 7% for depression). Notably, the study showed a more prominent association in men and younger people.
This is a preliminary and retrospective study, so we hear your skepticism. It’s a which-came-first situation: the (crispy) chicken or the egg (McMuffin)—feeling low from eating greasy fries or reaching for that food out of a desire for comfort. That’s where zebrafish come in. The study authors cited a separate study in which these fish were exposed to acrylamide, a chemical formed during the frying process. The affected fish of this typically social species were found isolated in the tank’s corner, scream-singing along to Fall Out Boy’s new tear-infused vinyl record.
Key takeaway
Although the zebrafish’s sullen behavior can lend credence to the theory that acrylamide-producing fried foods may lead to increased anxiety and depression, the chemical is not solely produced by frying and can be found elsewhere, like in cereal and coffee. We’ll need more evidence-based analyses to examine the link between fried food and depression/anxiety and to determine a causal relationship. But this super-sized study (with a side of zebrafish) strengthens the link between a patient’s diet and their mental health and hopefully gives your patients one more reason to skip the drive-thru.
Guideline Spotlight
The past several weeks have ushered in a veritable parade of guideline updates. We don’t have the newsletter real estate to cover all of them here, but we want to link to a few that will surely affect your primary care practice:
Internet Use May Provide Web of Protection Against Dementia
NEURO NEWS
When it comes to long-term effects of internet use on cognition, research has historically focused on the developing rather than the aging brain. But taking a cue from ABC’s The Golden Bachelor, researchers have now pivoted from Gen Zers to Boomers. “What is the net effect of long-term internet use on cognitive function in older adults?” they wondered.
A longitudinal study of >18,000 older adults tracked for a maximum of 17 years showed that self-reported, consistent internet use (compared with no internet use) corresponded with about a 50% lower risk of dementia, as determined from the TICS-M test. But everything in moderation (including binge-watching the aforementioned Bachelor franchise). While one to two hours/day of clicking and scrolling may create the strongest firewall against dementia, excessive internet use (peaking at 6-8 hours) was linked to an increase in dementia risk.
Key takeaway
Experts conclude from this study that internet use may be a modifiable risk factor for dementia. But they also acknowledge the chicken-or-the-egg debate (which is getting ample play in this newsletter): Does dementia risk reduction result from cognitive stimulation with internet use or are older adults with lower dementia risk more apt to use the internet? The other question: What are web-surfing seniors clicking on? That may sound like an SNL game show, but it’s the crux of the takeaway. If internet use truly confers cognitive benefit, we’ll need to know if the benefits derive from brain boosts like engaging in virtual social interaction, solving puzzles (eg, Sudoku), or—fingers crossed—consuming Pri-Med's Morning Report. In the meantime, consider encouraging older patients to enjoy moderate, sensible internet activity to help retain their cognitive function.
Can AI Crack the Superbug Code?
EMERGING TRENDS
AI’s resume now includes an absurd number of bullet points, ranging from creating art to diagnosing myocardial infarctions to even moonlighting as your girlfriend. So, it’s natural to wonder, “Will AI soon take my job?” Hard to predict, but as of now, it’s more akin to having Johnny 5 as your speed-reading intern. And it just nailed its year-end project: screening thousands of molecules to determine which ones inhibit the growth of the deadly bacteria Acinetobacter baumannii.
Conventional methods have failed to identify new antibiotics effective against A baumannii, one of three multidrug-resistant pathogens the WHO labeled a “critical” threat. So, scientists opted for an unconventional approach: teach AI the chemical makeup of drugs that could combat the pathogen and then let the tool sift through 6,680 compounds in search of said makeup. In an “I belong here” intern move, the AI took <90 minutes to whittle down the list to a mere handful of viable compound candidates. One of those was the antibiotic abaucin, which then aced preliminary lab tests. Of note, abaucin showed precision in killing only the A baumannii bacteria.
Key takeaway
Robust studies may ultimately demonstrate the efficacy of abaucin against A baumannii bacteria, and while that’s encouraging, it’s not the salient message here. MIT Professor James Collins summed it up best: “This finding further supports the premise that AI can significantly accelerate and expand our search for novel antibiotics.” What’s next for the AI intern already eyeing the corner office? Researchers have added “tackling superbugs Staphylococcus aureus and Pseudomonas aeruginosa” to AI’s to-do list.
Like any good intern, AI can flourish with the right guidance, and it holds particular promise for improving efficiency in medicine. We’ll just need to proceed cautiously...
In other AI news
- AI can run a million microbial experiments per year
- AI could improve heart attack diagnosis to reduce pressure on EDs
- AI in medical imaging could magnify inequities
- AI helpful in triaging breast masses in low-resource areas
Interested in more healthcare news? Here are some other articles we don’t want you to miss:
-
Low vitamin D levels are associated with long COVID in COVID-19 survivors
- Race and ethnicity–adjusted age recommendation for initiating breast cancer screening
- FDA approves first-ever RSV vaccine
- Acute thalamic connectivity precedes chronic post-concussive symptoms in mild traumatic brain injury
- Hoarding disorder: evidence and best practice in primary car
- FDA expands use of dapagliflozin to broader range of HF
Morning Report is written by:
- Alissa Scott, Lead Author
- Emily Ruge, Author, Editor
- Aylin Madore, MD, MEd, Editor
- Margaret Oliverio, MD, Author, Editor
- Ariel Reinish, MD, MEd, Editor