health

explosion-of-cicada-eating-mites-has-the-state-of-illinois-scratching

Explosion of cicada-eating mites has the state of Illinois scratching

CDC, cicadas, health, itch mites, mites, outbreak, rash, Science / /

Attack of the mites —

The good news: There’s little risk beyond the rash. The bad: The rash is awful.

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A cicada from a 17-year cicada brood clings to a tree on May 29, 2024, in Park Ridge, Illinois. The state experienced an emergence of cicadas from Brood XIII and Brood XIX simultaneously. This rare occurrence hasn't taken place since 1803.

Enlarge / A cicada from a 17-year cicada brood clings to a tree on May 29, 2024, in Park Ridge, Illinois. The state experienced an emergence of cicadas from Brood XIII and Brood XIX simultaneously. This rare occurrence hasn’t taken place since 1803.

A plague of parasitic mites has descended upon Illinois in the wake of this year’s historic crop of cicadas, leaving residents with raging rashes and incessant itching.

The mighty attack follows the overlapping emergence of the 17-year Brood XIII and the 13-year Brood XIX this past spring, a specific co-emergence that only occurs every 221 years. The cacophonous boom in cicadas sparked an explosion of mites, which can feast on various insects, including the developing eggs of periodical cicadas. But, when the mites’ food source fizzles out, the mites bite any humans in their midst in hopes of finding their next meal. While the mites cannot live on humans, their biting leads to scratching. The mite, Pyemotes herfsi, is aptly dubbed the “itch mite.”

“You can’t see them, you can’t feel them, they’re always here,” Jennifer Rydzewski, an ecologist for the Forest Preserve District of DuPage County, told Chicago outlet The Daily Herald. “But because of the cicadas, they have a food source [and] their population has exploded.”

The mites are around 0.2 millimeters in length and very difficult to see with the naked eye, according to agriculture experts at Pennsylvania State University. They have four pairs of legs and are tan with a reddish tinge. Female itch mites can produce up to 250 offspring, which emerge from her abdomen as adults. Emerged adult offspring quickly mate, with the males then dying off and the newly fertilized females dispersing to find their own food source.

Itchy outbreak

Besides “itch mites” these parasites have also been called the “oak leaf itch mite” or “oak leaf gall mite,” because they have often been found feasting on the larvae of oak gall midges. These midges are a type of fly that lays eggs on oak trees. The resulting larvae feast on the tree, spurring the formation of unusual growths (galls) around the larvae.

The first known outbreak of itch mites in the US occurred in Kansas in August 2004. The Kansas Department of Health and Environment had called in the Centers for Disease Control and Prevention to help investigate a puzzling outbreak of rashes in Crawford County. At the start, 300 residents in the small city of Pittsburg reported extremely itchy rashes, primarily on the limbs, neck, and face. The rashes looked similar to those from insect bites, but few of the affected people recalled being bitten by anything.

With the help of entomologists, outbreak investigators pinned the rashes to the itch mites. The area had experienced a mild winter and cooler summer temps, leading to an explosion of oak gall midges and subsequent infestation of oak galls. A detailed investigation determined that county residents were nearly four times more likely to have an itchy rash if they had a pin oak tree on their property. Once the itch mites invade a gall-infected oak tree, more than 16,000 mites can emerge from the galls on a single leaf. The mites can then drop from trees and are even small enough to be carried by the wind, giving them ample opportunity to find their way onto humans.

By the end of the outbreak, investigators estimated that 54 percent of the roughly 38,000 residents in Crawford County—that is, around 20,500 people—had been bitten by the mites.

Profuse parasites

But oak gall midges are far from the only insect the itch mites feed upon. In 2007, the emergence of a particularly prolific brood of cicadas led to an outbreak of itch mites in the Chicago area. The Illinois Department of Public Health noted that the “proposed common name ‘oak leaf itch mite’ for P. herfsi is misleading and contributed to the delay in identifying the causative agent of the 2007 Illinois outbreak.” The department noted that at least five insect orders and nine insect families are prey to the mites.

In the US, cases of itch mite rashes have been documented in at least Illinois, Nebraska, Ohio, Oklahoma, Pennsylvania, Missouri, Tennessee, and Texas.

If bitten, humans develop an itchy red rash, typically with pimple-like bumps, which can stick around for up to two weeks. The rash develops between 10 to 16 hours after exposure, which can make it difficult to identify the source. But, the mites typically don’t produce groupings of bite marks like bedbugs or burrowing like scabies.

To try to avoid rashes, experts recommend wearing protective clothing when outside—including gloves while gardening or doing yard work—and washing clothes and showering after a potential exposure. The insect repellent DEET is often recommended, but anecdotal reports indicate DEET may not be entirely effective. If you already have a rash, the only thing to do is treat the symptoms with things like ice packs, soothing lotions (like calamine), oral antihistamines, over-the-counter hydrocortisone creams, and, if needed, prescription topical steroids. The good news is that the mites will not live on you and are not known to spread any diseases.

Explosion of cicada-eating mites has the state of Illinois scratching Read More »

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Big-name drugs see price drops in first round of Medicare negotiations

Big pharma, drug prices, health, medicare, Pharmaceutical industry, PhRMA, price negotiations, Science / /

price cut —

If the prices were set in 2023, Medicare would have saved $6 billion.

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Prescription drugs are displayed at NYC Discount Pharmacy in Manhattan on July 23, 2024.

Enlarge / Prescription drugs are displayed at NYC Discount Pharmacy in Manhattan on July 23, 2024.

In the first round of direct price negotiations between Medicare and drug manufacturers, prices for 10 expensive and commonly used drugs saw price cuts between 38 percent to 79 percent compared to their 2023 list prices, the White House and the US Department of Health and Human Services (HHS) announced Thursday. The new negotiated prices will take effect on January 1, 2026.

The 10 drugs that were up for negotiations are used to treat various conditions, from diabetes, psoriasis, blood clots, heart failure, and chronic kidney disease to blood cancers. About 9 million people with Medicare use at least one of the drugs on the list. In 2023, the 10 drugs accounted for $56.2 billion in total Medicare spending, or about 20 percent of total gross spending by Medicare Part D prescription drug coverage. But in 2018, spending on the 10 drugs was just about $20 billion, rising to 46 billion in 2022—a 134 percent rise. In 2022, Medicare enrollees collectively paid $3.4 billion in out-of-pocket costs for these drugs.

The 10 drugs as well as their use, 2023 costs, negotiated prices, and savings.

Enlarge / The 10 drugs as well as their use, 2023 costs, negotiated prices, and savings.

For now, it’s unclear how much the newly set prices will actually save those who have Medicare enrollees in 2026. Overall costs and out-of-pocket costs will depend on each member’s coverage plans and other drug spending. Additionally, in 2025, Medicare Part D enrollees will have their out-of-pocket drug costs capped at $2,000, which alone could significantly lower costs for some beneficiaries before the negotiated prices take effect.

If the newly negotiated prices took effect in 2023, HHS estimates it would have saved Medicare $6 billion. HHS also estimates that the prices will save Medicare enrollees $1.5 billion in out-of-pocket costs in 2026.

The price negotiations have been ongoing since last August when HHS announced the first 10 drugs up for negotiation. Medicare said it held three meetings with each of the drug manufacturers since then. For five drugs, the process of offers and counteroffers resulted in an agreed-upon price, with Medicare accepting revised counteroffers from drugmakers for four of the drugs. For the other five drugs, Medicare made final written offers on prices that were eventually accepted. If a drugmaker had rejected the offer, it would have either had to pay large fees or pull its drug from Medicare plans.

“The negotiations were comprehensive. They were intense. It took both sides to reach a good deal,” HHS Secretary Xavier Becerra told reporters Wednesday night.

“Price-setting scheme”

Both the price negotiations and the $2,000 cap are provisions in the Inflation Reduction Act (IRA), signed into law by President Biden in 2022. In a statement Thursday, Biden highlighted that Vice President Kamala Harris cast the tie-breaking vote to pass the legislation along party lines and that they are both committed to fighting Big Pharma. “[T]he Vice President and I are not backing down,” Biden said. “We will continue the fight to make sure all Americans can pay less for prescription drugs and to give more breathing room for American families.”

“Today’s announcement will be lifechanging for so many of our loved ones across the nation,” Harris said in her own statement, “and we are not stopping here.” She noted that the list of drugs up for Medicare negotiation will increase in each year, with an additional 15 drugs added in 2025.

In a scathing response to the negotiated prices, Steve Ubl—president of the industry group Pharmaceutical Research and Manufacturers of America (PhRMA)—called the negotiations a “price-setting scheme” and warned that patients would be disappointed. “There are no assurances patients will see lower out-of-pocket costs because the [IRA] did nothing to rein in abuses by insurance companies and PBMs who ultimately decide what medicines are covered and what patients pay at the pharmacy,” Ubl said. He went on to warn that IRA “fundamentally alters” the incentives for drug development and, as such, fewer drugs will be developed to treat cancer and many other conditions.

In a December 2023 report, the Congressional Budget Office estimated that “over the next 30 years, 13 fewer new drugs (of 1,300 estimated new drugs) will come to market as a result of the law.”

The pharmaceutical industry has unleashed a bevy of legal challenges to the negotiations, claiming they are unconstitutional. So far, it has lost every ruling.

Big-name drugs see price drops in first round of Medicare negotiations Read More »

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Mpox outbreak is an international health emergency, WHO declares

africa, CDC, health, Infectious disease, mpox, outbreak, Science, WHO / /

PHEIC —

The declaration is “the highest level of alarm under international health law.”

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A negative stain electron micrograph of a mpox virus virion in human vesicular fluid.

Enlarge / A negative stain electron micrograph of a mpox virus virion in human vesicular fluid.

The World Health Organization on Wednesday declared an international health emergency over a large and rapidly expanding outbreak of mpox that is spilling out of the Democratic Republic of the Congo.

It is the second time in about two years that mpox’s spread has spurred the WHO to declare a public health emergency of international concern (PHEIC), the highest level of alarm for the United Nations health agency. In July 2022, the WHO declared a PHEIC after mpox cases had spread across the globe, with the epicenter of the outbreak in Europe, primarily in men who have sex with men. The outbreak was caused by clade II mpox viruses, which, between the two mpox clades that exist, is the relatively mild one, causing far fewer deaths. As awareness, precautions, and vaccination increased, the outbreak subsided and was declared over in May 2023.

Unlike the 2022–2023 outbreak, the current mpox outbreak is driven by the clade II virus, the more dangerous version that causes more severe disease and more deaths. Also, while the clade I virus in the previous outbreak unexpectedly spread via sexual contact in adults, this clade II outbreak is spreading in more classic contact patterns, mostly through skin contact of household members and health care workers. A large proportion of those infected have been children.

To date, Democratic Republic of the Congo (DRC), where the virus is endemic, has reported more than 22,000 suspect mpox cases and more than 1,200 deaths since the start of January 2023. In recent months, the outbreak has spilled out into multiple neighboring countries, including Burundi, Central African Republic, Republic of the Congo, Rwanda, Kenya, and Uganda.

Earlier on Wednesday, the WHO convened an emergency committee to review the situation, in which experts from affected countries presented data to independent international experts. The committee concluded that the outbreak constituted a PHEIC, and WHO Director-General Dr. Tedros Adhanom Ghebreyesus followed their recommendation.

“The emergence of a new clade of mpox, its rapid spread in eastern DRC, and the reporting of cases in several neighboring countries are very worrying,” Tedros said in a statement announcing the PHEIC. “On top of outbreaks of other mpox clades in DRC and other countries in Africa, it’s clear that a coordinated international response is needed to stop these outbreaks and save lives.”

On Tuesday, the Africa Centers for Disease Control and Prevention declared a similar emergency. Africa CDC Director General Dr. Jean Kaseya said the declaration will “mobilize our institutions, our collective will, and our resources to act—swiftly and decisively. This empowers us to forge new partnerships, strengthen our health systems, educate our communities, and deliver life-saving interventions where they are needed most.”

For now, the US Centers for Disease Control and Prevention assess the risk to the US public to be “very low,” given that there is limited and no direct travel between the US and the epicenter of the outbreak. So far, no clade I cases have been detected outside of central and eastern Africa.

Mpox outbreak is an international health emergency, WHO declares Read More »

31%-of-republicans-say-vaccines-are-more-dangerous-than-diseases-they-prevent

31% of Republicans say vaccines are more dangerous than diseases they prevent

CDC, Democrat, health, pandemic, partisan, Republican, Science, vaccines / /

Vaccines save lives —

The partisan divide on vaccine falsehoods threatens the health of children nationwide.

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Polio victim Larry Montoya is at the airport for the arrival of cases of vaccine, which were distributed as part of the KO Polio campaign, September 5, 1962.

Enlarge / Polio victim Larry Montoya is at the airport for the arrival of cases of vaccine, which were distributed as part of the KO Polio campaign, September 5, 1962.

Public sentiment on the importance of safe, lifesaving childhood vaccines has significantly declined in the US since the pandemic—which appears to be solely due to a nosedive in support from people who are Republican or those who lean Republican, according to new polling data from Gallup.

In 2019, 52 percent of Republican-aligned Americans said it was “extremely important” for parents to get their children vaccinated. Now, that figure is 26 percent, falling by half in just five years. In comparison, 63 percent of Democrats and Democratic leaners said it was “extremely important” this year, down slightly from 67 percent in 2019.

Overall, only 40 percent of Americans now say it is extremely important for parents to vaccinate their children, down from 58 percent in 2019 and 64 percent in 2001.

More broadly, 93 percent of the Democratic group said it was “extremely” or “very” important for parents to vaccinate their children this year, while only 52 percent of the Republican group said the same.

On the other end of the spectrum, 11 percent of the Republican group said vaccinating children was “not important at all,” and an additional 8 percent said it was “not very important.” For the Democratic group, only 1 percent was reported in each of those categories.

Dangerous disinformation

Perhaps most concerning, the data indicated that a growing number of Americans view vaccines as more dangerous than the diseases they prevent—including polio, measles, tetanus, rotavirus, diphtheria, whooping cough, meningitis, and RSV, among others. Now, 20 percent of Americans overall think vaccines are more of a threat than the dangerous diseases they effectively prevent.

The partisan divide is most stark on this sentiment. In 2019, the two parties were about the same. Twelve percent of the Republican group and 10 percent of the Democratic group held this erroneous belief. But now, a whopping 31 percent of the Republican group say vaccines are a more significant threat than dangerous diseases, while the percentage among the Democratic group fell to 5 percent.

Republicans and Republican leaners are much more likely than Democrats and Democratic leaners to believe the false and debunked claim that vaccines are linked to autism—19 percent of the Republican group believe this falsehood compared to 4 percent of the Democratic group.

The polling data aligns with national vaccination trends tracked by the Centers for Disease Control and Prevention. During the pandemic, rates of routine vaccination among kindergartners slipped from the protective target of 95 percent—which prevents infectious diseases from spreading widely—to 93 percent. Additionally, nonmedical exemptions from vaccinations have reached an all-time high of 3 percent nationally. At least 10 states have exemption rates at or above 5 percent, preventing them from reaching the protective target of 95 percent vaccination coverage.

31% of Republicans say vaccines are more dangerous than diseases they prevent Read More »

troubling-bird-flu-study-suggests-human-cases-are-going-undetected

Troubling bird flu study suggests human cases are going undetected

bird flu, CDC, dairy, H5N1, health, human infections, Infectious disease, outbreak, poultry, Science, vaccine / /

Poor surveillance —

A small sample of farm workers is enough to confirm fears about H5N1 outbreak.

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Troubling bird flu study suggests human cases are going undetected

Tony C. French/Getty

A small study in Texas suggests that human bird flu cases are being missed on dairy farms where the H5N1 virus has taken off in cows, sparking an unprecedented nationwide outbreak.

The finding adds some data to what many experts have suspected amid the outbreak. But the authors of the study, led by researchers at the University of Texas Medical Branch in Galveston, went further, stating bluntly why the US is failing to fully surveil, let alone contain, a virus with pandemic potential.

“Due to fears that research might damage dairy businesses, studies like this one have been few,” the authors write in the topline summary of their study, which was posted online as a pre-print and had not been peer-reviewed.

The study authors, led by Gregory Gray, were invited to two undisclosed dairy farms in Texas that experienced H5N1 outbreaks in their herds starting in early and late March, respectively. The researchers had a previously approved research protocol to study novel respiratory viruses on dairy farms, easing the ability to quickly begin the work.

Rare study

“Farm A” had 7,200 cows and 180 workers. Illnesses began on March 6, and nearly 5 percent of the herd was estimated to be affected during the outbreak. “Farm B” had 8,200 cows and 45 workers. After illnesses began on March 20, an estimated 14 percent of the herd was affected.

The researchers first visited Farm A on April 3 and Farm B on April 4, collecting swabs and samples at each. Based on the previously approved protocol, they were limited to taking nasal swabs and blood samples from no more than 10 workers per farm. On Farm A, 10 workers provided nasal swabs and blood samples. On Farm B, only seven agreed to give nasal swabs, and four gave blood samples.

While swabs from cows, milk, a dead bird, and a sample of fecal slurry showed signs of H5N1, all of the nasal swabs from the 14 humans were negative. However, when researchers looked for H5N1-targeting antibodies in their blood—an indicator that they were previously infected—two of the 14, about 14 percent, were positive.

Both of the workers with previous infections, a man and a woman, were from Farm A. And both reported having flu-like symptoms. The man worked inside cattle corrals, close to the animals, and he reported having a cough at the time the samples were taken. The woman, meanwhile, worked in the cafeteria on the farm and reported recently recovering from an illness that included fever, cough, and sore throat. She noted that other people on the farm had similar respiratory illnesses around when she did.

The finding suggests human cases of H5N1 are going undetected. Moreover, managing to find evidence of two undetected infections in a sample of just 14 workers suggests it may not be hard to find more. The Centers for Disease Control and Prevention estimates that around 200,000 people work with livestock in the US.

A “compelling case”

To date, the virus has infected at least 175 dairy farms in 13 states. The official tally of human cases in the dairy outbreak is 14: four in dairy farm workers and 10 in workers on poultry farms with infections linked to the dairy outbreak.

“I am very confident there are more people being infected than we know about,” Gray told KFF, which first reported on the study. “Largely, that’s because our surveillance has been so poor.”

Known infections in humans have all been mild so far. But experts are anxious that with each new infection, the wily H5N1 virus is getting new opportunities to adapt further to humans. If the virus evolves to cause more severe disease and spread from human to human, it could spark another pandemic.

Federal officials are also worried about this potential threat. In a press briefing Tuesday, Nirav Shah, the CDC’s principal deputy director, announced a $5 million effort to vaccinate farm workers—but against seasonal flu.

Shah explained that the CDC is concerned that if farm workers are infected with H5N1 and the seasonal flu at the same time, the viruses could exchange genetic segments—a process called reassortment. This could give rise to the pandemic threat experts are worried about. By vaccinating the workers against the seasonal flu, it could potentially prevent the viruses from comingling in one person, Shah suggested.

The US does have a bird flu-specific vaccine available. But in the briefing, Shah said that the use of that vaccine in farm workers is not planned for now, though there’s still active discussion on the possibility. The lack of severe disease and no documented human-to-human transmission from H5N1 infections both argue against deploying a new vaccine, Shah said. “There has to be a strong and compelling case,” he added. Shah also suggested that the agency expects vaccine uptake to be low among farm workers.

Troubling bird flu study suggests human cases are going undetected Read More »

7-million-pounds-of-meat-recalled-amid-deadly-outbreak

7 million pounds of meat recalled amid deadly outbreak

CDC, deaths, health, Infectious disease, listeria, Listeria monocytogenes, Meat, outbreak, recall, Science, USDA / /

7 million pounds across 71 products —

Authorities worry that the contaminated meats are still sitting in people’s fridges.

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Shelves sit empty where Boar's Head meats are usually displayed at a Safeway store on July 31, 2024, in San Anselmo, California.

Enlarge / Shelves sit empty where Boar’s Head meats are usually displayed at a Safeway store on July 31, 2024, in San Anselmo, California.

Over 7 million pounds of Boar’s Head brand deli meats are being recalled amid a bacterial outbreak that has killed two people. The outbreak, which began in late May, has sickened a total of 34 people across 13 states, leading to 33 hospitalizations, according to the US Department of Agriculture.

On June 26, Boar’s Head recalled 207,528 pounds of products, including liverwurst, beef bologna, ham, salami, and “heat and eat” bacon. On Tuesday, the Jarratt, Virginia-based company expanded the recall to include about 7 million additional pounds of meat, including 71 different products sold on the Boar’s Head and Old Country brand labels. The products were sold nationwide.

The meats may be contaminated with Listeria monocytogenes, a foodborne pathogen that is particularly dangerous to pregnant people, people over the age of 65, and people with compromised immune systems. Infections during pregnancy can cause miscarriage, stillbirth, premature delivery, or a life-threatening infection in newborns. For others who develop invasive illness, the fatality rate is nearly 16 percent. Symptoms of listeriosis can include fever, muscle aches, headache, stiff neck, confusion, loss of balance, and convulsions that are sometimes preceded by diarrhea or other gastrointestinal symptoms.

The problem was discovered when the Maryland Department of Health—working with the Baltimore City Health Department—collected an unopened liverwurst product from a retail store and found that it was positive for L. monocytogenes. In later testing, the strain in the liverwurst was linked to those isolated from people sickened in the outbreak.

According to the Centers for Disease Control and Prevention, six of the 34 known cases were identified in Maryland, and 12 were identified in New York. The other 11 states have only reported one or two cases each. However, the CDC expects the true number of infections to be much higher, given that many people recover without medical care and, even if people did seek care, health care providers do not routinely test for L. monocytogenes in people with mild gastrointestinal illnesses.

In the outbreak so far, there has been one case in a pregnant person, who recovered and remained pregnant. The two deaths occurred in New Jersey and Illinois.

In a statement on the company’s website, Boar’s Head said that it learned from the USDA on Monday night that L. monocytogenes strain in the liverwurst linked to the multistate outbreak. “Out of an abundance of caution, we decided to immediately and voluntarily expand our recall to include all items produced at the Jarratt facility. We have also decided to pause ready-to-eat operations at this facility until further notice. As a company that prioritizes safety and quality, we believe it is the right thing to do.”

The USDA said it is “concerned that some product may be in consumers’ refrigerators and in retail deli cases.” The USDA, the company, and CDC warn people not to eat the recalled products. Instead, they should either be thrown away or returned to the store where they were purchased for a full refund. And if you’ve purchased one of the recalled products, the USDA also advises you to thoroughly clean your fridge to prevent cross-contamination.

7 million pounds of meat recalled amid deadly outbreak Read More »

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People are overdosing on off-brand weight-loss drugs, FDA warns

diabetes, fda, GLP-1, health, Science, semaglutide, weight loss / /

Dosage disarray —

Bad math and unclear directions are behind overdoses of up to 20 times the normal amount.

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Wegovy is an injectable prescription weight-loss medicine that has helped people with obesity.

Enlarge / Wegovy is an injectable prescription weight-loss medicine that has helped people with obesity.

The US Food and Drug Administration has approved two injectable versions of the blockbuster weight-loss and diabetes drug, semaglutide (Wegovy and Ozempic). Both come in pre-filled pens with pre-set doses, clear instructions, and information about overdoses. But, given the drugs’ daunting prices and supply shortages, many patients are turning to imitations—and those don’t always come with the same safety guardrails.

In an alert Friday, the FDA warned that people are overdosing on off-brand injections of semaglutide, which are dispensed from compounding pharmacies in a variety of concentrations, labeled with various units of measurement, administered with improperly sized syringes, and prescribed with bad dosage math. The errors are leading some patients to take up to 20 times the amount of intended semaglutide, the FDA reports.

Though the agency doesn’t offer a tally of overdose cases that have been reported, it suggests it has received multiple reports of people sickened by dosing errors, with some requiring hospitalizations. Semaglutide overdoses cause nausea, vomiting, abdominal pain, fainting, headache, migraine, dehydration, acute pancreatitis, and gallstones, the agency reports.

Bad math

In typical situations, compounding pharmacies provide personalized formulations of FDA-approved drugs, for instance, if a patient is allergic to a specific ingredient, requires a special dosage, or needs a liquid version of a drug instead of a pill form. But, when commercially available drugs are in short supply—as semaglutide drugs currently are—then compound pharmacies can legally step in to make their own versions if certain conditions are met. However, these imitations are not FDA-approved and, as such, don’t come with the same safety, quality, and effectiveness assurances as approved drugs.

In the warning Friday, the FDA said that some patients received confusing instructions from compounding pharmacies, which indicated they inject themselves with a certain number of “units” of semaglutide—the volume of which may vary depending on the concentration—rather than milligrams or milliliters. In other instances, patients received U-100 (1-milliliter) syringes to administer 0.05-milliliter doses of the drug, or five units. The relatively large syringe size compared with the dose led some patients to administer 50 units instead of five.

The figure demonstrates how syringe size could lead some to an incorrect dosage.

Enlarge / The figure demonstrates how syringe size could lead some to an incorrect dosage.

FDA-approved semaglutide drugs, meanwhile, are dosed in milligrams and come in standardized concentrations. The agency received several reports of health care providers incorrectly converting from milligrams to units or milliliters, leading them to calculate the wrong dosages. With these math errors, some patients administered five to 10 times more semaglutide than intended.

“FDA recognizes the substantial consumer interest in using compounded semaglutide products for weight loss,” the agency wrote. “However, compounded drugs pose a higher risk to patients than FDA-approved drugs.” The agency urged patients and prescribers to only use compounded versions when absolutely necessary.

People are overdosing on off-brand weight-loss drugs, FDA warns Read More »

barbie-movie-“may-have-spurred-interest-in-gynecology,”-study-finds

Barbie movie “may have spurred interest in gynecology,” study finds

Barbie, culture, gynecology, health, Popular Culture, Science, women's health / /

Do you need a gynecologist? —

The movie apparently sparked some questions.

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A digital advertisement board displaying a Barbie movie poster is seen in New York on July 24, 2023.

Enlarge / A digital advertisement board displaying a Barbie movie poster is seen in New York on July 24, 2023.

This post contains spoilers—for the movie and women’s health care.

There’s nothing like stirrups and a speculum to welcome one to womanhood, but for some, the recent Barbie movie apparently offered its own kind of eye-opening introduction.

The smash-hit film ends with the titular character making the brave decision to exit Barbieland and enter the real world as a bona fide woman. The film’s final scene follows her as she fully unfurls her new reality, attending her first woman’s health appointment. “I’m here to see my gynecologist,” she enthusiastically states to a medical receptionist. For many, the line prompted a wry chuckle, given her unsuspecting eagerness and enigmatic anatomy. But for others, it apparently raised some fundamental questions.

Online searches in the US for “gynecologist”—or alternate spellings, such as “gynaecologist”—rose an estimated 51 percent over baseline in the week following Barbie‘s July 21, 2023 release, according to a study published Thursday in JAMA Network Open. Moreover, searches related to the definition of gynecology spiked 154 percent. Those search terms included “gynecologist meaning,” “what is a gynecologist,” “what does a gynecologist do,” “why see a gynecologist,” and the weightiest of questions: “do I need a gynecologist.”

The “Barbie effect”

The study’s authors, led by researchers at Harvard Medical School, assessed 34 query terms that fit into six categories of searches, including “gynecologist,” “gynecologist definition,” “gynecologist appointment,” “doctors,” “doctor’s appointment,” and “women’s health.” The last three served as controls for more general interest in medical information. As the authors put it, the three control searches helped establish “whether unobserved contemporaneous factors influencing health-seeking behavior more generally may have contributed to gynecologic-related search volume.”

While the researchers noted clear spikes in “gynecologist” and “gynecologist definition” searches, they saw no changes in search trends for the three control search categories during the week after the movie’s release: “doctors,” “doctor’s appointment,” and “women’s health.” This suggested that the increase in gynecology-related searches may, in fact, be linked to the movie rather than some increased interest in health care generally.

The researchers also did not see a corresponding increase in searches related to gynecology appointments, suggesting that the transient online interest in gynecology didn’t translate to online searches for actual gynecological care, with queries such as “gynecologist near me.” The researchers speculate that two factors might explain this. For one, there’s the possibility that the data couldn’t capture care-seeking decisions. It may be that there’s a longer, variable time gap between newfound awareness of gynecology and the decision to seek care. The second possibility is that the people searching for basic information about gynecology may not need gynecological care themselves.

Overall, the authors conclude that “Barbie’s closing line may have spurred interest in gynecology.” The finding is supported by earlier work that also suggests popular culture can have measurable influences on health literacy and awareness among the general public, the authors conclude. For instance, when journalist Katie Couric live streamed her colonoscopy, there was a transient 21 percent increase in colonoscopies, and when actress Angelina Jolie penned an editorial about her experience with breast cancer, there was a transient 64 percent increase in genetic testing for breast cancer risk (BRCA testing). But while the “Barbie effect” seems to have raised some awareness of gynecology, it remains unclear if it will lead to a measurable improvement in health outcomes.

Barbie movie “may have spurred interest in gynecology,” study finds Read More »

long-covid-rates-have-declined,-especially-among-the-vaccinated,-study-finds

Long COVID rates have declined, especially among the vaccinated, study finds

covid-10 vaccines, COVID-19, Delta, health, long COVID, omicron, SARS-CoV-2, Science, vaccinated, variants / /

Good news —

In large study, rates of long COVID fell from 10% to 3.5% for the vaccinated.

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Long covid activists attend the Senate Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies hearing on the

Enlarge / Long covid activists attend the Senate Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies hearing on the “Fiscal Year 2025 Budget Request for the National Institutes of Health,” in Dirksen building on May 23, 2024.

As a summer wave of COVID-19 infections swells once again, a study published this week in the New England Journal of Medicine offers some positive news about the pandemic disease: Rates of long COVID have declined since the beginning of the health crisis, with rates falling from a high of 10.4 percent before vaccines were available to a low of 3.5 percent for those vaccinated during the omicron era, according to the new analysis.

The study, led by Ziyad Al-Aly, chief of research at the VA Saint Louis Health Care System, used data from a wealth of health records in the Department of Veterans Affairs. The researchers ultimately included data from over 440,000 veterans who contracted COVID-19 sometime between March 1, 2020, and January 31, 2022, as well as over 4.7 million uninfected veterans who acted as controls.

Al-Aly and colleagues divided the population into eight groups. People who were infected during the study period were divided into five groupings by the dates of their first infection and their vaccination status. The first group included those infected in the pre-delta era before vaccines were available (March 1, 2020, to June 18, 2021). Then there were vaccinated and unvaccinated groups who were infected in the delta era (June 19, 2021, to December 18, 2021) and the omicron era (December 19, 2021, and January 31, 2022). The uninfected controls made up the final three of eight groups, with the controls assigned to one of the three eras.

On the decline

In the pre-delta/pre-vaccine era, 10.42 out of 100 unvaccinated people infected developed long COVID in the year after their infection, which the researchers referred to as PASC, or postacute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In the delta era, the rate of long COVID among the unvaccinated fell slightly to 9.51 out of 100. But for the vaccinated, the rate fell much further, to 5.35 out of 100. A similar pattern was seen in the omicron era. For the unvaccinated, the rate of long COVID again fell slightly to 7.76 per 100 people, while the vaccinated saw their rate fall to 3.5 per 100.

In a secondary statistical analysis, called a decomposition analysis, the researchers found that vaccines could explain about 72 percent of the cumulative decline in long COVID rates across the eras, while era-related factors explained about 28 percent. Those era-related factors could include differences in the virus, improved treatments, and use of anti-viral medications.

Further, looking at data on the disease categories related to long COVID cases, the researchers also did an analysis finding a shift in symptoms over the eras. The researchers looked at over 10 disease categories: cardiovascular, coagulation and hematologic, fatigue, gastrointestinal, kidney, mental health, metabolic, musculoskeletal, neurologic, and pulmonary. Compared to the two earlier eras, the researchers noted an increase in gastrointestinal, metabolic, and musculoskeletal diseases involved in long COVID cases in the omicron era.

Overall, the study points to a welcomed decline in the rates of long COVID among the infected, particularly for those who are vaccinated. But, it also makes clear that long COVID isn’t a thing of the past: “a substantial residual risk of PASC remains among vaccinated persons who had SARS-CoV-2 infection during the omicron era,” Al-Aly and his colleagues conclude.

The study also has some limitations, leaving lingering questions for further study. One is whether the type or number of vaccines affect the risk of long COVID—that was not included in the study. The study also didn’t allow researchers to assess whether repeat infections increase the burden of long COVID.

Long COVID rates have declined, especially among the vaccinated, study finds Read More »

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Illegal drug found in Diamond Shruumz candies linked to severe illnesses

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More drugs —

New testing finds psilocin, related to psilocybin, in gummies purchased in 2023.

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Illegal drug found in Diamond Shruumz candies linked to severe illnesses

Newly released testing data of Diamond Shruumz-brand gummies purchased in 2023 identified the presence of psilocin, a hallucinogenic drug closely related to the magic-mushroom drug psilocybin that is classified as a Schedule I drug, alongside psilocybin, heroin, and LSD.

The finding comes as Diamond Shruumz’s current line of gummies, chocolates, and candy cones is being recalled and are under active investigation in connection to a nationwide rash of severe illnesses, which have involved seizures, intubation, and intensive care. As of the latest update on July 15, 69 people in 28 states have been sickened after eating a Diamond Shruumz product. Sixty of the 69 sought medical care, 36 were hospitalized, and there is one potentially associated death under investigation.

The new finding of psilocin in the products, published by researchers at the University of Virginia, adds to growing concern about psychedelic mushroom candies generally. Although the candies are marketed as being legal, they have often been found to contain various undisclosed illegal drugs, gray market synthetic versions of drugs, as well as dangerous adulterants and contaminants.

In the ongoing investigation of Diamond Shruumz candies—led by the Food and Drug Administration and the Centers for Disease Control and Prevention, with the help of America’s Poison Centers and state and local partners—researchers have not identified psilocin in products linked to the illnesses. Instead, they have found a closely related synthetic hallucinogenic compound called 4-acetoxy-N,N-dimethyltryptamine, also known as psilacetin or 4-AcO-DMT. Psilacetin is thought to be metabolized into psilocin in the body and is said to have similar effects as taking magic mushrooms or psilocybin. The different testing results between the FDA-led investigation and the new UVA study may be due to possible formulation changes between 2023 and 2024 or simply differences in the products or batches of candies tested so far.

The UVA researchers, who published their findings in the CDC’s Morbidity and Mortality Weekly Report, looked into the mushroom candies after four adults reported illnesses to a local poison control center between September and November 2023. The people went to the emergency department with tachycardia, confusion, anxiety or somnolence, and nausea after eating gummy candies labeled as containing Amanita muscaria mushrooms. Amid their investigation into those cases, a 3-year-old also fell ill in June 2024 after accidentally eating two gummies sold as containing A. muscaria. All of the adults and the toddler recovered from their illnesses quickly, though the toddler was hospitalized for a day for observation.

Not legal or safe

A. muscaria is a legal hallucinogenic mushroom that contains psychoactive compounds ibotenic acid and muscimol. These resemble neurotransmitters in the brain and can cause gastrointestinal symptoms, agitation, and seizures.

The UVA researchers couldn’t track down the specific brands or products the sickened adults took, but they collected six similar products from nearby gas stations and smoke shops. Those six products included two Diamond Shruumz products, which were not sold as containing A. muscaria. Using liquid chromatography-mass spectrometry, the researchers found that the two Diamond Shruumz gummy products (Sour Peach Apple and Rainbow flavors) contained psilocin. The Rainbow flavor also contained caffeine.

In addition, a product labeled as “Wonderland Legal Psychedelics Cherry Nirvana” contained psilocin, the synthetic hallucinogen N,N-dimethyltryptamine, a compound found in kratom called mitragynine, and caffeine.  A product labeled as “Urb Magic Amanita Mushroom Watermelon” contained psilocybin, psilocin, and the stimulant 2-phenethylamine. A product called “Psilly’s Legal Psychedelic Mushrooms Fruit Punch” contained the stimulant ephedrine, and the product “Tryp mushroom gummies” wasn’t found to contain any concerning compounds.

The UVA study was not able to test for ibotenic acid or muscimol. In Diamond Shruumz’s recall notice, the company said it had found higher than normal levels of muscimol in its products. FDA testing has not identified muscimol in product testing, according to results released so far.

“People tend to equate ‘legal’ with ‘safe,’ which is not necessarily the case. These products are not regulated and can contain any number of unlabeled substances which, when consumed, can cause undesired symptoms,” lead author of the UVA study Avery Michienzi said in a statement. “Some packages will have QR codes showing that the products were tested in a lab and contain only what they are labeled to contain. These have been found to be inaccurate.”

The FDA this week warned that even though all of Diamond Shruumz’s products have been recalled, they remain on the shelves of stores nationwide. The agency said it is reaching out to industry partners to raise awareness of the recall and monitoring the effectiveness of Diamond Shruumz’s recall efforts.

Illegal drug found in Diamond Shruumz candies linked to severe illnesses Read More »

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Five people infected as bird flu appears to go from cows to chickens to humans

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Cows and chickens and humans, oh my! —

High temperatures made it hard for workers to use protective gear during culling.

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Five people infected as bird flu appears to go from cows to chickens to humans

The highly pathogenic avian influenza H5N1 virus that spilled from wild birds into US dairy cows late last year may have recently seeped from a dairy farm in Colorado to a nearby poultry farm, where it then infected five workers tasked with culling the infected chickens

In a press briefing Tuesday, federal officials reported that four of the avian influenza cases have been confirmed by the Centers for Disease Control and Prevention, while the fifth remains a presumptive positive awaiting CDC confirmation.

All five people have shown mild illnesses, though they experienced variable symptoms. Some of the cases involved conjunctivitis, as was seen in other human cases linked to the H5N1 outbreak in dairy cows. Others in the cluster of five had respiratory and typical flu-like symptoms, including fever, chills, sore throat, runny nose, and cough. None of the five cases required hospitalization.

The virus infecting the five people is closely related to the virus infecting the chickens on the poultry farm, which, in turn, is closely related to virus seen in infected dairy herds and in other human cases that have been linked to the dairy outbreak. The affected poultry farm is in Colorado’s northern county of Weld, which has also reported about two dozen outbreaks of avian influenza in dairy herds.

Dairy to poultry hypothesis

In one fell swoop, Colorado’s poultry farm outbreak has more than doubled the number of human avian influenza cases linked to the dairy cow spillover, bringing the previous tally of four cases to nine. While officials have previously noted instances where it appeared that H5N1 on dairy farms had moved to nearby poultry farms, this appears to be the first time such spread has led to documented human infections.

The link between the poultry farm cases and neighboring dairy farms is still just a hypothesis, however, Nirav Shah, the principal deputy director at the CDC, emphasized to reporters Tuesday. “It is a hypothesis that needs and requires a full investigation. But that is a hypothesis at this point,” he said of the link between the dairy farms and the poultry farm. So far, there is no direct evidence of a specific source of the poultry farm’s infection, and the route of infection is also unclear.

Throughout the outbreak of H5N1 on dairy farms, officials have noted that the primary way the virus appears to spread to new farms is via the movement of cows, people, and machinery between those facilities. There remains no evidence of human-to-human transmission. But milk from infected cows has been found to be brimming with high levels of infectious virus, and milk-contaminated equipment is a prime suspect in the spread.

In the press briefing Tuesday, Eric Deeble, acting senior advisor for H5N1 response with the US Department of Agriculture, noted the poultry are very susceptible to avian influenza and are easily infected. “It does not take much to introduce this into a flock,” Deeble said. The USDA is now working on a “trace-back” investigation on how the Colorado poultry farm was infected.

Searing spread

As for how the farm workers specifically became infected with the virus, health officials pointed to high temperatures that prevented workers from donning protective gear. The poultry farm is a commercial egg layer operation with around 1.8 million birds. Given the presence of bird flu on the premises, all 1.8 million birds need to be culled, aka “depopulated.” This is being carried out using mobile carts with carbon dioxide gas chambers, a common culling method. Workers are tasked with placing the birds in the chambers, which only hold a few dozen birds at a time. In all, the method requires workers to have a high degree of contact with the infected birds, going from bird to bird and batch to batch with the carts.

Amid this grim task, temperatures in the area reached over 100° Fahrenheit, and massive industrial fans were turned on in the facility to try to cool things down. Between the heat and the fans, the approximately 160 people involved in the culling struggled to use personal protective equipment (PPE). The required PPE for the depopulation involves a full Tyvek suit, boots, gloves, goggles, and an N95 respirator.

“The difficulty with wearing all that gear in that kind of heat, you can imagine,” said Julie Gauthier, executive director for field operations at the USDA’s Animal and Plant Health Inspection Service (APHIS). The industrial fans blowing large amounts of air made it yet more difficult for workers to keep goggles and respirators on their faces, she said.

The CDC and the USDA are both involved in further investigations of the poultry farm outbreak. CDC’s Shah noted that the team the agency deployed to Colorado included an industrial hygienist, who can work on strategies to prevent further transmission.

To date, at least 161 herds in 13 states have tested positive for avian influenza since the dairy outbreak was confirmed in March. Since January 2022, when US birds first tested positive for the H5N1 virus, 99 million birds in the US have been affected in 48 states, which involved 1,165 individual outbreaks.

Five people infected as bird flu appears to go from cows to chickens to humans Read More »

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What we know about microdosing candy illnesses as death investigation underway

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The Birthday Cake flavored bar.

Enlarge / The Birthday Cake flavored bar.

One person may have died from eating Diamond Shruumz microdosing candies, which were recalled last week amid a rash of severe illnesses involving seizures, intubation, and intensive care stays.

According to an update this week from the Food and Drug Administration, the cluster of cases continues to increase across the country. To date, 48 people across 24 states have fallen ill after eating the candies, which include chocolate bars, gummies, and candy cones that were sold online and in retail locations, such as smoke and vape shops. Of the 48 people sickened, 46 were ill enough to seek medical care, and 27 were admitted to a hospital.

For now, the death noted in the FDA’s latest update is only “potentially associated” with the candies and is still under investigation. No other information is yet available.

But in an interview with Ars, medical toxicologist Michael Moss was not surprised that the candies may have turned deadly. Moss, who is the medical director of the Utah Poison Control Center, cared for one of the first people reported to be sickened in the cluster.

An early case

The person was sickened in Nevada and transferred to a hospital in Utah, where Moss was a member of his care team. After the person came out of intensive care, Moss sat down with him and tried to piece together what happened. According to Moss, the person had bought a Birthday Cake-flavored chocolate bar at a local store. The bars are sold as “microdosing” candies, suggesting they contain psychedelic compounds, but the exact components and dosages aren’t listed.

Though the person told Moss he had some experience with psychedelics before, it was only with actual mushrooms. This was the first time he had eaten such a bar. And the bar’s packaging had only vague instructions of how much to eat at one time to achieve certain effects. For instance, eating nine or more squares of the bar was described with an image of an eye with lots of rainbow colors.

“What does that dose mean? And how many milligrams of what is that? Nobody knows,” Moss said. “So, he decided, ‘It’s a chocolate bar.’ So why wouldn’t you just eat the chocolate bar? Pretty reasonable thing to do.”

But, within minutes of eating the bar, the person felt nauseated and very dizzy and tired. He went to lie down and doesn’t remember much after that. Fortunately, a family member came home soon after and found him. The family member saw that he had vomited and was possibly aspirating or choking. By the time paramedics arrived, he was having a seizure. He had another in the emergency room. Doctors gave him anti-seizure medications and a breathing tube and put him on ventilation before transferring him to the hospital in Utah.

What we know about microdosing candy illnesses as death investigation underway Read More »