Inside Medicine: Five on Friday (April 5, 2024).

This week in medicine, what I'm thinking about, etc. You know, an actual newsletter.

We are back with “Five on Friday", the feature where Inside Medicine behaves like an actual medical/health/science newsletter. Below are top-of-mind things that I’m thinking about right now. And please vote in the poll at the end!

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If you value this feature—and Inside Medicine in general…

Here we go…

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Item 1. Bird flu infects a US resident.

For the second time ever, H5N1 influenza (“bird flu”) has infected someone on US soil. The patient works with cows, where the disease has been found. The case occurred in Texas and the symptoms were described as mild, with eye redness as the only outward sign of illness. The previous case was in 2022—a Colorado man who worked with poultry—and was also mild.

While it’s nice to hear that two cases were basically clinically forgettable, we don’t know how many cases out of 100 would be serious. Remember, Covid-19 probably had a fatality rate of around 1 in 200 prior to vaccines and therapeutics. But, as my friend Dr. Jen Brokaw reminded me early in the Covid-19 outbreak, a huge number (the world population) multiplied by a small one (the case fatality rate) equals a pretty large one.

The CDC is expressing confidence. In reality, nobody knows anything about what will happen next. This could be a harbinger of something bad, or merely a warning shot. Watching and waiting.

Item 2. How to use ERs to increase flu shot uptake.

Meanwhile, seasonal flu shots are good. There has been a lot of discussion over how to increase uptake. New research led by Dr. Robert Rodriguez at UCSF reports that simply asking ER patients if they’d like a flu shot increased the rate of uptake (within 30 days) by over 30%. A little education video (another thing they tried) got that number to over 40%. I love simple ideas like this. (And it was nice to see that some of the co-authors included a great former colleague of mine here in Boston, and a former star ER resident I helped train.) You also might remember Dr. Rodriguez’s name from 2020-2021, as he was a member of the Biden Covid-19 Advisory Board during the Presidential transition. For more on this nicely done flu vaccine study, you can check out a great story on it in MedPage Today.

Item 3: Doctors are not as politically active as you might expect.

Doctors are voters. But we are often somewhat fearful of being seen as too political. A new study in the Journal of the American Medical Association basically reaffirms that. Physicians were about as likely to participate in political activities as peers (when adjusted for certain variables that are known drivers of political involvement like age, sex, race, ethnicity, education, income, and location). Docs were a bit more likely to participate in boycotts and making political donations than matched peers. But the authors expressed a little bit of disappointment. “Physicians might be expected to be more politically engaged, as several policy issues directly influence patient health and medical practice,” they wrote.

Oh, and in keeping with the apparent theme of the day: one of the co-authors of this study is another fantastic former ER resident I helped train (albeit, as above, the learning always went in both directions).

Item 4: National Public Health Week, 2024.

Happy National Public Health Week, to those who celebrate! Yes, President Biden issued a proclamation on this a few days ago. Per the American Public Health Association, top of mind issues include climate change (as a healthcare topic), emergency preparedness, reproductive health, and more.

Item 5. Poll of the Week results.

Last week, I asked how you felt about ads supporting Inside Medicine. Most of you were supportive (85%) or unsure (7%). If and when I do this, I’ll take steps to make sure it won’t be cumbersome. I appreciate your support.

Item 5a. Poll of the Week for this week!

Yesterday, I wrote about the new Paxlovid trial from Pfizer that finally showed that symptoms were not reduced among standard-risk Covid-19 patients, or high-risk (but vaccinated) ones. I also discussed the findings that showed that severe outcomes were not shown to be statistically improved by Paxlovid in this study, albeit the data are not definitive on that question. So, all things equal…

Thanks for chiming in.

That’s it. Your “Friday Five!”

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Feedback! Do you like the “Five on Friday” format? Have any ideas for next week’s Poll of the Week? Any great articles you read elsewhere that you want to share with the Inside Medicine community? Other musings or thoughts?

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