health

rfk-jr’s-fluoride-ban-would-ruin-25-million-kids’-teeth,-cost-$9.8-billion

RFK Jr.’s fluoride ban would ruin 25 million kids’ teeth, cost $9.8 billion

dental cavities, fluoride, health, Oral health, water / /

In all, the increased decay and boosted dental costs would disproportionately affect children who are in low-income families, in rural areas, and/or on public health insurance.

The study’s findings are likely unsurprising to those in the public health community, who have consistently supported fluoridation. The practice, however beneficial, has a long history of being under attack. After its introduction in the US in 1945, conspiracy theorists claimed fluoridation was a communist plot and a form of government mind control. More recently, critics have claimed that fluoridation lowers IQ.

The data linking water fluoridation to low IQ is controversial. Many of the studies on the topic are of poor quality and have numerous confounding factors and flawed methods. Many compare IQ levels in communities in China and other countries, where there are areas with water that is naturally high in fluoride—much, much higher than what is intentionally added to US water. Further, a federal meta-analysis—a type of study that aggregates and reanalyzes data from independent studies—has been plagued by criticism for bias, poor statistical methods, and a lack of data transparency.

But despite the controversy, one thing is clear in all the data and debate: Any possible association with low IQ and fluoridation only occurs at excessive levels—levels more than twice the amount used in the US and recommended by the US Centers for Disease Control and Prevention. The CDC recommendation for water fluoridation levels is 0.7 mg/L, while potential harms are not observed until water levels exceed 1.5 mg/L. Some areas in China have natural levels as high as 11.8 mg/L.

The authors of the new study conclude that, at current US levels, the benefits are clear.

“These findings suggest that, despite the potential harms of excessive fluoride exposure, fluoridation at safe levels offers both individual and societal benefits that would be at risk.”

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RFK Jr. yanks pandemic vaccine funding as Moderna reports positive results

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The Department of Health and Human Services—under the control of anti-vaccine advocate Robert F. Kennedy Jr.—has canceled millions of dollars in federal funding awarded to Moderna to produce an mRNA vaccine against influenza viruses with pandemic potential, including the H5N1 bird flu currently sweeping US poultry and dairy cows.

Last July, the Biden administration’s HHS awarded Moderna $176 million to “accelerate the development of mRNA-based pandemic influenza vaccines.” In the administration’s final days in January, HHS awarded the vaccine maker an additional $590 million to support “late-stage development and licensure of pre-pandemic mRNA-based vaccines.” The funding would also go to the development of five additional subtypes of pandemic influenza.

On Wednesday, as news broke that the Trump administration was reneging on the contract, Moderna reported positive results from an early trial of a vaccine targeting H5 influenza viruses. In a preliminary trial of 300 healthy adults, the vaccine candidate appeared safe and boosted antibody levels against the virus by 44.5-fold.

An HHS spokesperson said that the decision to cancel the funding—which would support thorough safety and efficacy testing of the vaccines—was because the vaccines needed more testing.

“This is not simply about efficacy—it’s about safety, integrity, and trust.” HHS spokesperson Andrew Nixon told The Washington Post. “The reality is that mRNA technology remains under-tested.”

Nixon went on to claim that the Trump administration wouldn’t repeat the “mistakes of the last administration, which concealed legitimate safety concerns.” The accusation refers to mRNA-based COVID-19 vaccines, which were developed and initially released under the first Trump administration. They have since been proven safe and effective against the deadly virus.

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Healthy man goes camping—lands in ICU for 40 days with respiratory failure

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It was a diagnostic challenge, and doctors began reviewing the list of possibilities that could match his condition. The first guess of pneumonia could explain some of his respiratory findings, but he didn’t have a cough, had tested negative for common respiratory pathogens, and the lung imaging didn’t quite fit, making it seem unlikely. Blood cancers, such as polycythemia vera, might be able to explain the high concentrations of blood cells. And it might also make him more vulnerable to opportunistic lung infections, like a fungal infection that could explain the halo sign. But blood cancers were also deemed unlikely given that he didn’t have enlarged organs, which is often seen with such conditions. Another possibility was pulmonary–renal syndrome, but that also didn’t line up with the man’s case.

Diagnosis

There was one other possibility that seemed to tick all the boxes: fever, gastrointestinal symptoms, low oxygen saturation, pulmonary edema, and shock—a hantavirus infection.

Hantaviruses are RNA viruses that infect rodents worldwide. They typically cause asymptomatic, chronic infections in the animals, which spread the virus widely into their environments through their urine, feces, and saliva. Humans get infected when virus particles from rodent-contaminated areas are stirred up into the air and inhaled or through direct contact with the virus via the eyes, nose, mouth, or cuts.

In humans, the viral infection is anything but asymptomatic. While the disease mechanism isn’t entirely understood, the virus appears to be able to modulate immune responses in humans, causing blood vessels and capillaries in various places in the body to start leaking plasma. This leads to fluid building up in the lungs (the pulmonary edema) and systemic circulatory collapse.

A cardiopulmonary hantavirus infection typically has four stages: the incubation period, which can last up to 45 days after virus exposure; a prodromal phase of up to 12 days, which is marked by fever, fatigue, and pains; the cardiopulmonary phase, where breathing trouble, low oxygen saturation, and shock can develop; then, if you make it, the fourth stage, in which respiratory symptoms improve, but there’s lingering fatigue and the kidneys make abnormally large amounts of urine.

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CDC can no longer help prevent lead poisoning in children, state officials say

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Amid the brutal cuts across the federal government under the Trump administration, perhaps one of the most gutting is the loss of experts at the Centers for Disease Control and Prevention who respond to lead poisoning in children.

On April 1, the staff of the CDC’s Childhood Lead Poisoning Prevention Program was terminated as part of the agency’s reduction in force, according to NPR. The staff included epidemiologists, statisticians, and advisors who specialized in lead exposures and responses.

The cuts were immediately consequential to health officials in Milwaukee, who are currently dealing with a lead exposure crisis in public schools. Six schools have had to close, displacing 1,800 students. In April, the city requested help from the CDC’s lead experts, but the request was denied—there was no one left to help.

In a Congressional hearing this week, US health secretary and anti-vaccine advocate Robert F. Kennedy Jr. told lawmakers, “We have a team in Milwaukee.”

But Milwaukee Health Commissioner Mike Totoraitis told NPR that this is false. “There is no team in Milwaukee,” he said. “We had a single [federal] staff person come to Milwaukee for a brief period to help validate a machine, but that was separate from the formal request that we had for a small team to actually come to Milwaukee for our Milwaukee Public Schools investigation and ongoing support there.”

Kennedy has also previously told lawmakers that lead experts at the CDC who were terminated would be rehired. But that statement was also false. The health department’s own communications team told ABC that the lead experts would not be reinstated.

CDC can no longer help prevent lead poisoning in children, state officials say Read More »

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Uncertainty loomed as FDA advisors met to discuss this year’s COVID shot

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Calling it a “practical question,” he asked, “If we were to change strains, can we assume that age-specific licensure won’t change for any of these [vaccine] products?” Currently, COVID-19 boosters are accessible to those aged 6 months and up.

Weir reiterated that there was no answer. Another FDA official, David Kaslow, chimed in to say only, “Rest assured that we’re engaging with the manufacturers on this topic.”

As a follow-up to that exchange, VRBPAC member and infectious disease expert Eric Rubin of Harvard, shot down the FDA’s plan to use randomized placebo-controlled trials for licensure for healthy children and adults. The plethora of observational data—aka real-world data—on the boosters shows clear efficacy, Rubin pointed out. That suggests that requiring people in a trial to take placebos despite the availability of a clearly effective treatment could be unethical.

It suggests “that a randomized controlled trial (RCT) has no equipoise right now, and that you cannot do one,” Rubin said. “I don’t think the RCT is feasible,” he added.

The selection

While the pushback and the questions lingered, the committee still had to select a strain. For now, omicron still reigns, and variants in the JN.1 lineage are still dominant. That is largely unchanged from last year, when vaccine makers were advised to target their seasonal shots against the JN.1 lineage generally, or KP.2, the leading variant in the JN.1 lineage at the time, specifically.

This year, advisors unanimously voted to stick with vaccines that target the JN.1 lineage, in line with recommendations from the World Health Organization. The question of targeting the JN.1 lineage was the only voting question the FDA tasked them with. But there was open discussion on a more specific recommendation. Given the regulatory uncertainty, advisors were divided on whether to stick with the JN.1 and KP.2 formulations from last year or recommend switching to the latest leading variant in the JN.1 family, LP.8.1.

Shortly after the meeting, the FDA announced that it would essentially leave it up to manufacturers; they could stick with JN.1 or KP.2 but, if feasible, switch to LP.8.1.

“The COVID-19 vaccines for use in the United States beginning in fall 2025 should be monovalent JN.1-lineage-based COVID-19 vaccines (2025–2026 Formula), preferentially using the LP.8.1 strain,” it said.

Uncertainty loomed as FDA advisors met to discuss this year’s COVID shot Read More »

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RFK Jr. calls WHO “moribund” amid US withdrawal; China pledges to give $500M

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“WHO’s priorities have increasingly reflected the biases and interests of corporate medicine,” Kennedy said, alluding to his anti-vaccine and germ-theory denialist views. He chastised the health organization for allegedly capitulating to China and working with the country to “promote the fiction that COVID originated in bats.”

Kennedy ended the short speech by touting his Make America Healthy Again agenda. He also urged the WHO to undergo a radical overhaul similar to what the Trump administration is currently doing to the US government—presumably including dismantling and withholding funding from critical health agencies and programs. Last, he pitched other countries to join the US in abandoning the WHO.

“I would like to take this opportunity to invite my fellow health ministers around the world into a new era of cooperation…. we’re ready to work with you,” Kennedy said.

Meanwhile, the WHA embraced collaboration. During the assembly this week, WHO overwhelmingly voted to adopt the world’s first pandemic treaty, aimed at collectively preventing, preparing for, and responding to any future pandemics. The treaty took over three years to negotiate, but in the end, no country voted against it—124 votes in favor, 11 abstentions, and no objections. (The US, no longer being a member of WHO, did not have a vote.)

“The world is safer today thanks to the leadership, collaboration and commitment of our Member States to adopt the historic WHO Pandemic Agreement,” WHO Director-General Tedros Adhanom Ghebreyesus said. “The Agreement is a victory for public health, science and multilateral action. It will ensure we, collectively, can better protect the world from future pandemic threats. It is also a recognition by the international community that our citizens, societies and economies must not be left vulnerable to again suffer losses like those endured during COVID-19.”

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Biotech company Regeneron to buy bankrupt 23andMe for $256M

23andme, DNA, genetic data, health, Policy, regeneron, Science / /

Biotechnology company Regeneron will acquire 23andMe out of bankruptcy for $256 million, with a plan to keep the DNA-testing company running without interruption and uphold its privacy-protection promises.

In its announcement of the acquisition, Regeneron assured 23andMe’s 15 million customers that their data—including genetic and health information, genealogy, and other sensitive personal information—would be safe and in good hands. Regeneron aims to use the large trove of genetic data to further its own work using genetics to develop medical advances—something 23andMe tried and failed to do.

“As a world leader in human genetics, Regeneron Genetics Center is committed to and has a proven track record of safeguarding the genetic data of people across the globe, and, with their consent, using this data to pursue discoveries that benefit science and society,” Aris Baras, senior vice president and head of the Regeneron Genetics Center, said in a statement. “We assure 23andMe customers that we are committed to protecting the 23andMe dataset with our high standards of data privacy, security, and ethical oversight and will advance its full potential to improve human health.”

Baras said that Regeneron’s Genetic Center already has its own genetic dataset from nearly 3 million people.

The safety of 23andMe’s dataset has drawn considerable concern among consumers, lawmakers, and regulators amid the company’s downfall. For instance, in March, California Attorney General Rob Bonta made the unusual move to urge Californians to delete their genetic data amid 23andMe’s financial distress. Federal Trade Commission Chairman Andrew Ferguson also weighed in, making clear in a March letter that “any purchaser should expressly agree to be bound by and adhere to the terms of 23andMe’s privacy policies and applicable law.”

Biotech company Regeneron to buy bankrupt 23andMe for $256M Read More »

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RFK Jr’s plan to ban fluoride supplements will “hurt rural America,” dentists say

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“Harmful”

While fluoride can kill bacteria, particularly at high levels, it’s used in oral health to inhibit the demineralization of tooth enamel while enhancing the remineralization of tooth surfaces, the ADA clarifies.

The best way to get fluoride is through drinking water, the ADA says. But supplements are a safe alternative if a child lives in an area without fluoridated water or if they mostly drink bottled water. Given rampant false and controversial claims about fluoride, more communities are now abandoning it. This week, Florida became the second state after Utah to ban fluoridation state-wide.

“Yes, use fluoride for your teeth, that’s fine,” Florida Gov. Ron DeSantis said at a news conference after signing the ban into law. “But forcing it in the water supply is basically forced medication on people. They don’t have a choice.”

ADA President Brett Kessler worries what children in places such as Utah and Florida will do to get adequate fluoride if the ban on supplements goes through. “In non-fluoridated communities, especially rural areas, fluoride supplements are the only chance for individuals to get the appropriate amount of fluoride to prevent tooth decay,” Kessler said in the statement. The move will be “particularly harmful to the most vulnerable and those who lack access to care,” he added.

While Makary said that the FDA will conduct a safety review of  fluoride supplements, the conclusion seems to be foregone, with the HHS writing that it is already “initiating action to remove” the products.

The ADA noted that places that have removed fluoride from drinking water, such as Calgary, Canada, and Juneau, Alaska, have seen increases in dental decay, particularly among children and low-income populations.

“Proposals like this stand to hurt rural America, not make them healthier,” Kessler said.

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From birth to gene-edited in 6 months: Custom therapy breaks speed limits

clinical trial, CRISPR, fda, gene therapy, health, mutation, Science / /

In the boy’s fourth month, researchers were meeting with the Food and Drug Administration to discuss regulatory approval for a clinical trial—a trial where KJ would be the only participant. They were also working with the institutional review board (IRB) at Children’s Hospital of Philadelphia to go over the clinical protocol, safety, and ethical aspects of the treatment. The researchers described the unprecedented speed of the oversight steps as being “through alternative procedures.”

In month five, they started toxicology testing in mice. In the mice, the experimental therapy corrected KJ’s mutation, replacing the errant A-T base pair with the correct G-C pair in the animals’ cells. The first dose provided a 42 percent whole-liver corrective rate in the animals. At the start of KJ’s sixth month, the researchers had results from safety testing in monkeys: Their customized base-editing therapy, delivered as mRNA via a lipid nanoparticle, did not produce any toxic effects in the monkeys.

A clinical-grade batch of the treatment was readied. In month seven, further testing of the treatment found acceptably low-levels of off-target genetic changes. The researchers submitted the FDA paperwork for approval of an “investigational new drug,” or IND, for KJ. The FDA approved it in a week. The researchers then started KJ on an immune-suppressing treatment to make sure his immune system wouldn’t react to the gene-editing therapy. Then, when KJ was still just 6 months old, he got a first low dose of his custom gene-editing therapy.

“Transformational”

After the treatment, he was able to start eating more protein, which would have otherwise caused his ammonia levels to skyrocket. But he couldn’t be weaned off of the drug treatment used to keep his ammonia levels down (nitrogen scavenging medication). With no safety concerns seen after the first dose, KJ has since gotten two more doses of the gene therapy and is now on reduced nitrogen scavenging medication. With more protein in his diet, he has moved from the 9th percentile in weight to 35th or 40th percentile. He’s now about 9 and a half months old, and his doctors are preparing to allow him to go home from the hospital for the first time. Though he will have to be closely monitored and may still at some point need a liver transplant, his family and doctors are celebrating the improvements so far.

From birth to gene-edited in 6 months: Custom therapy breaks speed limits Read More »

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Germ-theory skeptic RFK Jr. goes swimming in sewage-tainted water

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When you don’t believe in germ theory, the world is your oyster—or maybe your bathtub.

Over the weekend, America’s top health official, Robert F. Kennedy Jr., shared pictures on social media of himself fully submerged in the sewage-tinged waters of Rock Creek in Washington, DC. His grandchildren were also pictured playing in the water.

The creek is known for having a sewage overflow problem and posing a health hazard to any who enter it. The National Park Service, which manages the Rock Creek Park, strictly bars all swimming and wading in Rock Creek and the park’s other waterways due to the contamination, specifically “high levels of bacteria.”

A notice on the NPS website advises “Stay Dry, Stay Safe,” warning, “Rock Creek has high levels of bacteria and other infectious pathogens that make swimming, wading, and other contact with the water a hazard to human (and pet) health. Please protect yourself and your pooches by staying on trails and out of the creek. All District waterways are subject to a swim ban—this means wading, too!”

In images shared on social media, Kennedy can be seen getting fully underwater, including his head, and then splashing around with several of his grandchildren. Kennedy, who does not have any background in medicine or science, was a long-time anti-vaccine advocate before President Trump appointed him to be health secretary. In a 2021 book, Kennedy indicated that he does not believe in germ theory, the fundamental concept that microscopic pathogens, such as those abundant in sewage, are the cause of disease.

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A new era in cancer therapies is at hand

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New therapeutic strategies build on the success of immunotherapy.

In 2012, clinicians at the Children’s Hospital of Philadelphia treated Emily Whitehead, a 6-year-old with leukemia, with altered immune cells from her own body. At the time, the treatment was experimental, but it worked: The cells targeted the cancer and eradicated it. Thirteen years later, Whitehead is still cancer-free.

The modified cells, called CAR-T cells, are a form of immunotherapy, where doctors change parts of the immune system into cancer-attacking instruments. About five years after Whitehead’s treatment, the first CAR-T drugs were approved by the FDA and were heralded, along with immunotherapy more broadly, as one of the most promising modern cancer treatments. Today, there are seven FDA-approved CAR-T therapies, including the one used to treat Whitehead.

Since then, however, studies have linked CAR-T to fatal complications due to treatment toxicity, and the treatment has had a harder time addressing certain types of cancers, particularly solid tumors affecting the breast and pancreas, although some small clinical trials have been starting to show positive results for solid cancers. “After a decade, a decade and a half, we arrive at the point that there are patients who answer, most of the patients still do not answer,” said George Calin, a researcher at University of Texas MD Anderson Cancer Center.

Now experts say that new therapies are beginning to surpass challenges that previous treatments couldn’t, providing safer, more targeted delivery directly to tumors. These include drugs that contain radioactive substances, called radiopharmaceuticals, which are used to diagnose or treat cancer; medications that can influence the genes that spur or suppress tumor growth; and therapeutic cancer vaccines.

These approaches have shown promise in the lab, and researchers and companies are now conducting various stages of human clinical trials to explore their effectiveness. And some promising treatments have even gained approval by the Food and Drug Administration. The hope is that improving on these strategies will ultimately help treat even the most resistant types of cancer.

Despite researchers’ excitement for innovative treatments, there is rampant online misinformation and there are occasions in which companies have been found to tout and sell fake cures, said Kathrin Dvir, an oncologist and researcher at Moffitt Cancer Center.

But other scientists remain optimistic about the future of cancer research, Calin said: “All the time in science, you have to open the door with something new.”

Targeting is tough

Historically, one of the biggest challenges in cancer treatments has been the lack of specific targets. The typical standards of care — chemotherapy and radiation — kill off not only cancer cells, but also healthy ones. (This is one reason why cancer patients on these treatments experience hair loss, nausea, and other symptoms.) In recent years, scientists have thus aimed to develop therapies that only attack cancer cells, leaving the rest of the body unharmed.

One way to achieve this is through more precise targeting of the tumor. In one of these approaches, drugs act as a ferry, delivering radioactive molecules directly to the cancer. They do this by targeting proteins that are only present on the surface of specific tumors.

Take, for example, prostate cancer. Here, the cancerous cells are sensitive to radiation, so some researchers are working on drugs containing unstable chemical elements that emit radiation — radioactive isotopes, or radiopharmaceuticals — to facilitate imaging of the tumors and provide enough radiation to treat them.

Already, the field of radiopharmaceuticals has seen growth following successes like the brand name drugs Pluvicto for prostate cancer and Lutathera for neuroendocrine tumors, which reportedly offer improved quality of life compared to traditional treatments. Additionally, using radioisotopes for imaging could also allow researchers to diagnose and classify patients much better to provide personalized care, said Jason Lewis, a radiochemist at Memorial Sloan Kettering Cancer Center. And while radiopharmaceutical therapy can have side effects, he added, it’s “designed to minimize radiation to healthy tissues.”

Other therapies, called antibody-drug conjugates, act similarly: They shuttle molecules that can kill the cancer cells via antibodies that can dock on tumors. About a dozen of such drugs have been approved by the FDA for various types of cancer.

There are also new vaccines to help the immune system ward off cancer, using the key approach behind a type of COVID-19 vaccine — mRNA technology. For example, one of the companies that developed one of the COVID-19 shots, BioNTech, is working on a vaccine called BNT116 designed to elicit immune reactions to treat a type of lung cancer, which is currently recruiting about 150 participants across the world to undergo safety testing.

mRNA therapeutic vaccines for cancer, which use messenger RNA as blueprint material so the body can create proteins that are unique to the tumor to help elicit an immune response, may offer several advantages. The shots can be personalized, for instance, to the patients’ own tumors, said Siow Ming Lee, an oncologist at University College London Hospitals and one of the lead researchers of the trial. Other vaccines are also in the works. “We are in this sort of new era now,” he said.

Another type of genetic molecule could also be a target to help treat cancer. Some RNAs, called microRNAs, can act on genes that are responsible for tumor growth. Researchers like Calin are developing small molecules that bind to cancer-related microRNAs, to turn them off and try to halt the disease’s spread.

With FDA approvals, human clinical trials underway and, with promising preclinical data for many of these therapies, the researchers who spoke to Undark said that the future appears bright. “We’re not just seeing these dramatic improvements in outcomes and survival for patients with some indications, but the quality of life,” Lewis said.

New approaches, new problems

As more of these latest cancer technologies do get approved for treatment, new approaches can bring new problems, experts say. For example, with radiotherapeutics, one big challenge is to source enough radioisotopes for the drugs, and have a specialized workforce to handle radioactivity, said Lewis. For microRNAS, it’s tricky to identify exactly which type to target for a particular cancer, Calin emphasized.

And there are also companies that are trying to capitalize on new, unproven technologies and drugs prematurely. The company ExThera Medical, for instance, has been charging patients tens of thousands of dollars for unproven therapies, according to a recent report by The New York Times.

“All over the world, there are many so-called new therapeutics that are not well-tested and not well-developed,” said Calin. Dvir encounters misinformation at her clinic almost daily, she said. “Maybe some of those have some data in the preclinical, in animal studies — it doesn’t mean that it works on the human because we need data before you expose people to those therapies.”

Although the FDA faces budget cuts, some of the researchers and clinicians that Undark spoke to insist that the agency will weed out bad science. If not, the clinicians that Undark spoke with said that they can also help guide patients toward evidence-based treatments.

Ultimately, researchers want to continue to improve these treatments to see if they might work in tandem. “I think the name of the game in the next five to 10 years is combinations,” said Dvir. Already, there are trials looking at precisely how using different approaches together might boost their ability to treat cancer, she adds. “We know that these drugs work in synergy. It’s just finding the right combination that is effective but not too toxic.”

This article was originally published on Undark. Read the original article.

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When doctors describe your brain scan as a “starry sky,” it’s not good

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A starry sky can be stunning—even inside a hospital emergency room.

But instead of celestial bodies sparkling in the night, doctors in South Korea were gazing at bright brain lesions punctuating a magnetic resonance imaging (MRI) scan. The resulting pattern, called a “starry sky,” meant that their 57-year-old patient had a dangerous form of tuberculosis. The doctors report the case in this week’s issue of the New England Journal of Medicine.

The man had previously been treated for the infection in his lungs but came into the hospital’s emergency department after two weeks of unexplained headaches, neck pain, and tingling in his right hand. The MRI and Computed-Tomography (CT) scans clearly revealed the problem: rare nodules and lesions, called tuberculomas, speckling his lungs and central nervous system, including both cerebral hemispheres, the basal ganglia deep inside the brain, the cerebellum at the back of the brain, the brain stem, and the upper spinal cord.

Magnetic resonance imaging (MRI) of the head with gadolinium enhancement revealed numerous small, spherical, peripherally enhancing nodules in the cerebral hemispheres (Panels A and B), basal ganglia, cerebellum, and brain stem, as well as in the upper spinal cord with surrounding edema (Panel C). Credit: NEJM, 2025

The condition, called CNS tuberculoma, is a relatively rare manifestation of tuberculosis, which typically infects the lungs but can invade any part of the body. It’s unclear exactly how tuberculomas form, but evidence suggests that the bacteria that cause tuberculosis—Mycobacterium tuberculosis—can spread around the body via the blood. M. tuberculosis can get past the blood-brain barrier, possibly by hiding inside a type of white blood cell called a macrophage, in a “Trojan horse” mechanism or by breaking through the barrier. Tuberculomas are thought to form when bacteria and macrophages clump together into masses that may contain calcifications or cheese-like dead tissue called caseum.

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