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That Backfired

Reading Time: 9 Minutes

Published July 1, 2023

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As we’re slicing into flag cakes and toasting the birth of our nation this weekend, let’s consider how far healthcare has come since the signing of the Declaration of Independence. Here’s a peek into your 18th-century counterparts’ medical toolbox:

Leeches: Harness their sucking power for bloodletting, the best way to purge any illness from the body.
Worms: Mix crushed worms with milk for a sure-fire, cure-all tonic.
Hog’s lard: Keep this healer handy for bruises, arthritis, scrofula, and whooping cough.
Mercury: Prescribe this liquid metal freely when treating emesis, hysterical disorders, hypochondria, asthma, and syphilis (ignore the black box warnings).
Electricity: Apply a few hardy jolts to restart malfunctioning bodily systems; it’s ideal for toothaches, headaches, blindness, earaches, and cramps. mRNA Vaccine Sets Sights on Pancreatic Cancer

CANCER CONCLUSIONS

Scientists have known about the power of mRNA technology to target individual cells since the Ford administration, when corduroy pants and Queen’s rock operas ruled the day. But as we all know, it took a global pandemic for mRNA to finally become a household molecule. Now this COVID-era hero is under pressure to take on all comers, and its latest target is another behemoth: pancreatic cancer.

A recent small-scale study of a novel mRNA vaccine for pancreatic cancer has offered a glimmer of hope in the fight against this formidable disease. The personalized mRNA vaccine doses contain each participant’s genetic sequence, programmed and ready to instruct the immune system about which cells need to bite the dust. Researchers aggressively pursued the cancer through a regimen of eight vaccine doses, followed by six months of chemotherapy, and a vaccine booster to close out. Half of the participants showed no signs of recurring disease after 18 months of observation—a significant achievement considering pancreatic cancer’s 90% relapse rate at seven to nine months.

Key takeaway

This study’s limited size may temper our excitement, but we’re optimistic that these preliminary findings signal future success. It’s certainly an auspicious start, much like the opening harmonies of rock masterpiece Bohemian Rhapsody. Good things to come. And the rapid development and observation schedule suggests we won’t have to wait long for more data.

While the study represents one small step in the quest to find effective treatments for pancreatic cancer, any progress in this area is a giant leap, given the lives saved in the process. mRNA technology’s long journey accelerated rapidly in recent years, and its potential for cancer vaccines may end up being the silver lining of the pandemic.

Stimulants in Those Without ADHD—Brain Boost or Botch?

NEURO NEWS

It seems like a reasonable idea—at least on paper. People without attention-deficit/hyperactivity disorder (ADHD) have been recasting prescription stimulants as cognitive enhancers to level up in the classroom and the boardroom. But according to a new study, this tactic may be backfiring like the opening of a Jurassic Park.

May cause people to think harder, not smarter

In a small, double-blind randomized trial, researchers investigated the effect of methylphenidate, dextroamphetamine, and modafinil on cognitive performance in neurotypical employees and students. Participants took each of the three drugs or a placebo before tackling a knapsack optimization problem, a strategic task that mimics real-world challenges. Not surprisingly, the drugs—which induce dopamine—led to an uptick in motivation. But in a plot twist, the “smart” pills seemed to sabotage the quality of the cognitive effort, as indicated by the slight decrease in accuracy and the substantial jump in number of steps taken. For example, individuals on methylphenidate (vs placebo) doubled their test-taking time. Think greater effort, worse results. The authors wonder if enhanced motivation prompted more scattered thinking.

Key takeaway

Individuals looking to juice up for their next sales pitch or chem test may find that misusing prescription stimulants could derail their performance and slow their productivity. Study co-author Peter Bossaerts, PhD, reported, “The drugs have [a positive] impact on motivation, attention, and maybe working memory, but a combinatorial task requires one to approach a problem in systematic ways. You don't solve jigsaw puzzles by randomly throwing pieces in the air until they accidentally fall into place.” But according to recent studies, students and professionals are increasingly using these drugs for similar purposes. The drugs appear to diminish cognitive output and come with a slew of adverse effects—a lose-lose endeavor.

We hope patients will see how taking these smart drugs can backfire, and they will correct course (unlike Jurassic Park filmmakers—still bringing destructive dinosaurs to life 30 years later).

FDA Clears First OTC Erectile Dysfunction Gel

MEN'S HEALTH MUSINGS

Timing is everything. It’s critical in business (as any of Logan Roy’s opportunistic children will attest), and it’s essential in the bedroom. That’s why a first-of-its-kind topical gel for erectile dysfunction (ED) may soon rise above the competition. Men who properly apply the gel (MED3000) may experience an erection within 10 minutes, roughly the time it takes to cue up the perfect Marvin Gaye song. Compare that with the gel’s oral competitors (PDE5 inhibitors) at >30 to 60 minutes. And in another ED treatment first, the gel—already approved in the European Union—clinched FDA clearance last month for over-the-counter use.

I’ll have what he’s having

What the gel—trade name Eroxon—lacks in name subtlety, it makes up for in solid efficacy and safety data. In clinical trials, 65% of participants using the gel achieved sexual intercourse. A scattering of participants noted headaches, mild burning, and nausea, but the gel proved safer than its competitors. And no sexual partners were harmed in the conducting of this study.

How does the gel work? It jump-starts the traditional chain of events via an “icy hot” method—first it drops and then raises the temperature to quickly activate nerve endings and trigger an erection. The effect lasts just long enough to have sex, so prescribing information won’t include ominous warnings about erections “lasting more than four hours.”

Key takeaway

This topical gel is safe, effective, fast-acting, and FDA approved for over-the-counter treatment of ED. So, naturally, it shouldn’t be a hard sell for the 30 million US men with ED, especially those whose current medication regimen precludes them from taking PDE5 inhibitors. But unfortunately, this summary is anticlimactic. The gel may not reach US store shelves until 2025 because the manufacturer has set neither a launch timeline nor pricing. “Unacceptable,” declares Kendall Roy, who—sniffing an opportunity and a Succession spinoff—has outlined an accelerated product rollout and a five-point marketing strategy. Timing is everything.

Guideline Spotlight

Sticking It to Peanut Allergies in Toddlers

PEDIATRIC PERSPECTIVES

It’s a parent’s nightmare. Faster than you can say, “Be back in a Jif,” a toddler with a peanut allergy inadvertently ingests a nutty snack. But a new paper in NEJM suggests a wearable patch may protect against these accidental peanut exposures. If the favorable findings lead to FDA approval, parents of the one in 50 US children with a peanut allergy may need to find something else to worry about. “Not a problem,” respond all parents.

Researcher tested, mother (and father) approved

A well-designed albeit small, phase 3 clinical trial revealed newsworthy findings for an experimental immunotherapy skin patch for 1-to-3-year-old children afflicted with peanut allergies. Investigators randomly assigned this patient group (notably excluding children with severe allergies) to wear either the real patch or a placebo patch between their shoulders nearly all day every day for one year. The real patch, laden with peanut proteins, ideally triggers an immune response once cells relay the protein from the skin to other areas of the body. It seemingly works; after treatment, 67% of toddlers in the intervention group could tolerate one to four peanuts (up from zero), while only 33% in the placebo arm increased their tolerance (NNT = 3). Those wearing the real patch experienced less-severe reactions. But neither group saw immunity from adverse effects (mostly skin irritation). Treatment-related anaphylaxis did occur in 1.6% of children wearing the real patch but in none wearing the placebo patch.

Key takeaways

Researchers point out that this immunotherapy patch is not a cure for peanut allergies. It’s a potentially lifesaving tool against accidental exposure in an unprotected population. Treatment of children aged 1 to 3 years has been a tough nut to crack. This age group does not benefit from the only currently available peanut allergy treatment (Palforzia, for ages 4-17 years), and toddlers have the least discriminating fingers and mouths, making an accident more likely. A daily stick-it-and-forget-it patch that suppresses severe allergic reactions could soon untether toddlers from their day care’s peanut-free zone and parents from the worry zone.

Interested in more healthcare news? Here are some other articles we don’t want you to miss:

Morning Report is written by:

Alissa Scott, Lead Author
Emily Ruge, Author, Editor
Aylin Madore, MD, MEd, Editor
Ariel Reinish, MD, MEd, Editor

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