Up@dawn 2.0

Tuesday, April 25, 2023

Dr. Fauci Looks Back: ‘Something Clearly Went Wrong’

In his most extensive interview yet, Anthony Fauci wrestles with the hard lessons of the pandemic — and the decisions that will define his legacy.

It was, perhaps, an impossible job. Make one man the face of public health amid an unprecedented pandemic, in a country as fractious as the United States, and there were bound to be disappointments and frustrations, and they were bound to get personal.

Still, in December, when Elon Musk joked on Twitter that his "pronouns" were "Prosecute/Fauci," it felt like the cresting of a turning tide against the man who had played essentially that role for the first three years of the pandemic. At least 30 state legislatures have passed laws limiting public-health powers in pandemics. This January, the month after Anthony Fauci retired as the four-decade head of the National Institute of Allergy and Infectious Diseases, barely half of Americans said they trusted the country's public-health institutions to manage a future pandemic. The Wall Street Journal named that as his legacy — sowing distrust about public health and vaccines. Earlier in the pandemic, the leftist magazine The Drift mocked Fauci as "Doctor Do-Little," and Representative Matt Gaetz, a Florida Republican, proposed that Fauci had "blood on his hands." Upon the announcement of Fauci's retirement, Gov. Ron DeSantis of Florida, also a Republican, celebrated: "Grab that little elf and chuck him across the Potomac."

Of course, there were mistakes and missteps, including some by Fauci: describing the threat to the country as "minuscule" in February 2020, for instance; or first advising against wearing masks, and moving slowly on aerosol spread; or playing down the risk of what were first called "breakthrough infections" in the summer of 2021. And the broader public-health establishment that Fauci came to embody made other mistakes, too, even if it wasn't always easy to know at the time or identify later who exactly was responsible. Almost certainly, schools stayed closed longer than they needed to. Very conspicuously, American vaccination rates never approached the levels of peer nations — and the problem wasn't just the anti-vaccine right. Quarantine guidance was abruptly shortened in the midst of the Omicron variant, when thresholds of community-spread levels were suddenly redefined as well. There was no effective paid sick leave instituted, and the official end of the pandemic emergency on May 11 imperils the Medicaid coverage of 15 million Americans. But three years on, whether you are focused on Covid's direct carnage or on its collateral damage, it seems irrational to pin the brutality of America's pandemic on policy failures, however much Americans want to put the blame somewhere. Or on someone…

https://www.nytimes.com/interactive/2023/04/24/magazine/dr-fauci-pandemic.html?smid=em-share

Saturday, March 18, 2023

The Aftermath of a Pandemic Requires as Much Focus as the Start

We rallied the world to invest in emergency relief. Now we must rally the world to invest in recovery. Atul Gawande

https://www.nytimes.com/2023/03/16/opinion/pandemic-recovery-primary-care.html?smid=nytcore-ios-share&referringSource=articleShare
The Aftermath of a Pandemic Requires as Much Focus as the Start

A bioethics professor weighs in on the Last of Us finale

Sunday, December 11, 2022

Anthony Fauci: A Message to the Next Generation of Scientists

 At ‌81, I still can clearly recall the first time I drove onto the bucolic N.I.H. campus in Bethesda, M‌‌d., in June of 1968 as a 27-year-old newly minted physician who had just completed residency training in ‌New York City. My motivation and consuming passion at the time were to become the most highly skilled physician I could‌‌, devoted to delivering the best possible care to ‌my patients. ‌This remains integral to my ‌‌identity, but I did not realize ‌‌how unexpected circumstances would profoundly influence the direction of my career and my life. I would soon learn to expect the unexpected.

I share my story, one of love of science and discovery, in hopes of inspiring the next generation to enter health-related careers — and to stay the course, regardless of challenges and surprises that might arise…

https://www.nytimes.com/2022/12/10/opinion/anthony-fauci-retirement.html?smid=nytcore-ios-share&referringSource=articleShare
Anthony Fauci: A Message to the Next Generation of Scientists

We Can Cure Disease by Editing a Person’s DNA. Why Aren’t We?

But for the next few years, devastating genetic ailments and cancer are where CRISPR clinical trials must remain; ethical considerations over the safety of patients being exposed to new technology dictate that. Today's tools are also the cognate of the first iPod — at the time, an exhilarating advance but still low tech compared with present-day smartphones. Everything we learn about how to gene-edit people from this work, coupled with continued CRISPR innovation in the academic and for-profit sector, will provide a foundation for more deeply understanding how to safely edit DNA to treat and potentially prevent dire common diseases.

The invention of CRISPR gene editing gave us remarkable treatment powers, yet no one should do a victory lap. Scientists can rewrite a person's DNA on demand. But now what? Unless things change dramatically, the millions of people CRISPR could save will never benefit from it. We must, and we can, build a world with CRISPR for all.


https://www.nytimes.com/2022/12/09/opinion/crispr-gene-editing-cures.html?smid=nytcore-ios-share&referringSource=articleShare
We Can Cure Disease by Editing a Person's DNA. Why Aren't We?

Sunday, October 2, 2022

America Is Choosing to Stay Vulnerable to Pandemics - The Atlantic

Recently, after a week in which 2,789 Americans died of COVID-19, President Joe Biden proclaimed that "the pandemic is over." Anthony Fauci described the controversy around the proclamation as a matter of "semantics," but the facts we are living with can speak for themselves. COVID still killsroughly as many Americans every week as died on 9/11. It is on track to kill at least 100,000 a year—triple the typical toll of the flu. Despite gross undercounting, more than 50,000 infections are being recorded every day. The CDC estimates that 19 million adults have long COVID. Things have undoubtedly improved since the peak of the crisis, but calling the pandemic "over" is like calling a fight "finished" because your opponent is punching you in the ribs instead of the face...

https://www.theatlantic.com/health/archive/2022/09/covid-pandemic-exposes-americas-failing-systems-future-epidemics/671608/

Scientists Knew More About Covid-19 Than We Think. And They Still Do.

"Nobody," Donald Trump claimed in a March 2020 address, "had any idea." He was talking about the Covid virus — which had, seemingly overnight, sparked a global pandemic. In his compelling and terrifying new book, "Breathless: The Scientific Race to Defeat a Deadly Virus," the veteran science journalist David Quammen demonstrates just how much was known — and expected — by infectious disease scientists long before patrons of the Huanan Seafood Wholesale Market fell ill in December 2019 with a pneumonia-like virus.

"Soothsayer" isn't on Quammen's extensive résumé, but he was among those who had long predicted this kind of catastrophe. In 2012 he provided a field guide to the future, "Spillover," whose subtitle — "Animal Infections and the Next Human Pandemic" — explains exactly what the scientific community had long been expecting.

"This is a book about the science of SARS-CoV-2," he specifies in his new book. "The medical crisis of Covid-19, the heroism of health care workers and other people performing essential services, the unjustly distributed human suffering, and the egregious political malfeasance that made it all worse — those are topics for other books." Instead, he focuses his informed attention on the unsung heroes who dare to wrestle with viruses, those strange entities he calls "the dark angels of evolution." Human beings are part of a sprawling family of interconnected species who can share illness because they all grew up together. It is our common ancestry and related bodily ecology that makes spillover possible between, say, bats and Earth's (currently) dominant mammal.

Covid is, after all, as natural as a wolf cub or David Attenborough, and its thriller-level rate of evolution is part of its danger. "A virus is a parasite, yes," writes Quammen, "a genetic parasite, to be more precise, using the resources of other organisms to replicate its own genome." He demonstrates the sheer weirdness of viruses when he explains how difficult it is to even define them...

https://www.nytimes.com/2022/10/01/books/review/breathless-david-quammen.html?smid=nytcore-ios-share&referringSource=articleShare

Tuesday, September 20, 2022

‘Very Harmful’ Lack of Data Blunts U.S. Response to Outbreaks

'Very Harmful' Lack of Data Blunts U.S. Response to Outbreaks

Major data gaps, the result of decades of underinvestment in public health, have undercut the government response to the coronavirus and now to monkeypox.

https://www.nytimes.com/2022/09/20/us/politics/covid-data-outbreaks.html?smid=nytcore-ios-share&referringSource=articleShare

Sunday, August 21, 2022

Her Discovery Changed the World. How Does She Think We Should Use It?

…What about the ethics of all those gene-editing possibilities? That's something you've been talking about for years now, but what would it look like to actually resolve those ethical issues? What is the green light we'd be waiting for that would make us say, "This form of gene editing was not OK yesterday, but it is OK today?" Maybe let's start with, "Where are the ethical boundaries right now for CRISPR technology?" Two come to mind…
https://www.nytimes.com/interactive/2022/08/15/magazine/jennifer-doudna-crispr-interview.html?smid=nytcore-ios-share&referringSource=articleShare

Sunday, August 14, 2022

A huge side benefit of the new climate bill

Air pollution sickens and kills millions every year. Here’s how the new measure will help tackle the problem.

...the law will avert heart attacks, lower emergency room visits of people suffering from respiratory problems and reduce hospital admissions by people with cardiovascular disease...
https://www.nytimes.com/2022/08/12/climate/climate-air-pollution-health.html?smid=em-share

Saturday, July 23, 2022

Why Storytelling Is Part of Being a Good Doctor

Doctors are people too.

"…the word 'doctor' comes from the Latin 'to teach.' By writing stories, we as doctors aim to teach others about our patients while learning about ourselves."

https://www.newyorker.com/magazine/2022/07/25/why-storytelling-is-part-of-being-a-good-doctor-all-that-moves-us-jay-wellons

Sunday, July 17, 2022

Time for a national public health system

Since the early months of the covid-19 pandemic, it's been clear that the U.S. public health system needs major improvements. Now, a blue-ribbon commission assembled by the Commonwealth Fund has issued a reportwith a rather provocative conclusion: The United States needs a Since the early months of the covid-19 pandemic, it's been clear that the U.S. public health system needs a national public health system.... Leana Wen

https://www.washingtonpost.com/opinions/2022/07/05/is-it-time-national-public-health-system/

Wednesday, July 13, 2022

BCSP/HT Change Your Mind

Berkeley Center for the Science of Psychedelics 

Friends, readers, viewers, 

I’m happy to share that the four-part Netflix series based on How to Change Your Mind is streaming beginning today. 

I’m grateful to the whole crew at Jigsaw Productions for their brilliant work in bringing the book to the screen. You can read a review of the series here.

I’m also pleased to announce the launch, today, of a new psychedelic resources website from the Berkeley Center for the Science of Psychedelic (BCSP). The inspiration for the website was our concern that the Netflix series would create a wave of interest and curiosity about psychedelic therapy. We decided that it would be helpful if these viewers had a one-stop site that could answer their questions—including descriptions of the various substances; their risks and benefits; advice for people seeking psychedelic therapy, and much more, all written and edited by a team of journalists.

Thanks to the crew at the BCSP, as well as the teams at Pentagram and Wordpress, for the inspired work that went into building the site. 

I hope you’ll get a chance to explore the site as well as watch the series. Do let me know what you think!

Best,

Michael Pollan


Friday, July 8, 2022

 

CRISPR cure for sickle cell nearly 100% effective after three years

Newly released data shows nearly universal efficacy with no drop in effectiveness.

By B. David Zarley

June 25, 2022

When CRISPR Therapeutics and Vertex used gene editing to try to cure heritable blood disorders in 2019, it marked the first CRISPR trial outside of China.

A year later, the trial — using the CRISPR gene editor to treat sickle cell disease and beta thalassemia — showed promising results, Freethink reported in 2020. 

Now, three years after the trial began, the researchers have presented new data showing that the treatment continues to be effective. 

“These data provide further evidence that this treatment has the potential to be transformational for patients with sickle cell disease and beta thalassemia,” trial abstract author Stephan A. Grupp of the Children’s Hospital of Philadelphia said in a statement. 

New data shows that the CRIPR sickle cell and beta thalassemia treatment continues to be effective even three years out.

The diseases: Severe sickle cell disease (SCD) and transfusion-dependent beta thalassemia (TDT) are both caused by genetic mutations impacting hemoglobin, the molecule red blood cells use to carry oxygen throughout the body. 

In SCD, atypical hemoglobin causes the red blood cells to twist out of shape, contorting into crescents — or sickles — that cannot deliver oxygen as well. The disease can cause tiredness and shortness of breath, and periodic sickle cell crises cause intense pain.

 

In TDT, patients do not produce enough hemoglobin at all, sometimes requiring repeated blood transfusions, which have their own risks and side effects.

Both can be treated by a stem cell transplant from a suitable donor, which not only requires finding a good match but may also require suppressing the patient’s immune system.

The therapy: The CRISPR treatment, originally dubbed CTX001 and now called exa-cel, is a one-time treatment that genetically alters the patient’s own cells to produce the kind of hemoglobin found at birth, which isn’t distorted, allowing red blood cells to work properly.

The new data, presented at the European Hematology Association Congress but yet to be published in a peer-reviewed journal, reported results from 75 patients. 

Of the TDT patients, 42 out of 44 were blood transfusion-free up to 37.2 months after their exa-cel infusion, according to CRISPR Therapeutics and Vertex. They are essentially cured of the disease. 

The CRISPR therapy is a one-time treatment that genetically alters the patient’s own cells.

The remaining two patients needed much less transfusion volume, and all of the TDT patients had elevated levels of fetal hemoglobin and total hemoglobin in their blood.

All of the SCD patients were free from sickle cell attacks, up to 32.3 months later.

Two of the TDT patients suffered adverse effects possibly related to exa-cel, including delayed growth of white blood cells and a low blood platelet count, both of which resolved on their own.

Importantly, the team found no evidence of exa-cel’s effectiveness waning over time, even three years after infusion. 

“Although we must continue to investigate the durability of these results, I am excited about the current data,” Grupp said.