Inside Medicine: Five on Friday (March 29, 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!
If you value this feature—and Inside Medicine in general…
Here we go…
Item 1. NIH sunsets Covid-19 guidelines.
Since shortly after the Covid-19 pandemic began, the National Institutes of Health (NIH) has maintained a website with up-to-date evidence-based treatment guidelines. No more. The NIH has announced that it will sunset the website.
I’m on the fence on whether this is a disappointing development. During the emergency phase of the pandemic, it was nice to have a central place to consult from a trusted source—even if the recommendations were not always perfect (in my view). But as we move further into the era in which most people have some degree of immunity to Covid-19, it’s less clear which evidence from 2020 and 2021 remains applicable in 2024. To keep such a website current (and accurate), it would require a great deal of upkeep.
The NIH may be wise here, then, in exiting the game. Covid-19 guidelines from expert bodies should be created and updated on a routine schedule, just like we do for a wide spectrum of conditions, like heart attacks and strokes.
Item 2. What I’m reading: “Kate Middleton's Cancer: What to Know About 'Preventative' Chemotherapy”
When I saw Kate Middleton’s announcement about her cancer diagnosis, I had many reactions—and I don’t even really follow the British royals. Without speculating too specifically in public, I’ll just say that I’m quite concerned for her and her family.
One thing that jumped out at me, though, was Middleton’s use of the word “preventative chemotherapy.” I work in a hospital that is attached to one of the more prestigious cancer centers in the world, and “preventative chemo” is not a term I’ve heard much, if ever.
To me, the term “preventative” means to take action before something happens. The term that Middleton seemed to be replacing is what physicians know as “adjuvant chemotherapy.” That is, chemo that is meant to knock out any tiny bits of cancer that may remain after an initial treatment, such as a surgery. I was happy to see that MedPage Today’s Kristina Fiore wrote a great explainer on this.
Item 3: What I’m reading: Cancer and the pandemic.
Speaking of cancer….Four years ago, most of the US was under shelter-in-place orders. A concern at that time was that cancer screening had ground to a halt. People often wondered if that meant that we’d see an uptick in later stage cancers diagnosed down the road.
My take at the time was that, yes, we might see that. But I also believed that Covid-19 might unveil a lot of cancers that might have gone undetected otherwise. Here’s how that might have gone: a person had cancer, but did not know it. They caught Covid-19 and got far sicker than expected. In seeking Covid-19 care at the hospital, their under-the-radar cancer was diagnosed. So, my contention was that a cancer that might have been picked up on, say, a routine colonoscopy, might have instead been diagnosed when a person got sick with Covid-19 and had a much worse outcome than they might have anticipated. In other words, people who missed their cancer screenings in 2020 may have already been identified by virtue of an unexpectedly bad Covid outcome.
Relatedly, my colleagues Dr. Kristen Panthagani and Dr. Katelyn Jetelina have a nice post that debunks the so-called “turbo cancer” myth. The piece, in part based on some new research in Lancet Oncology, delineates the relatively expected effects of delayed screenings that the pandemic caused.
Item 4: Voices: Q&A *today* with Dr. Monica McLemore live on Instagram.
As per yesterday’s post, I’ll be speaking with Dr. Monica McLemore today at 2pm ET in a Live Q&A on Instagram. To tune in, follow @medpage on IG and browse over to the account at 2pm: https://www.instagram.com/medpage/
Item 5. Poll of the Week results.
Here are the results of last week’s Inside Medicine poll. I’m genuinely impressed with you all!
Item 5a. Poll of the Week for this week!
This week’s poll is a little bit of housekeeping. Sometime soon you’ll see a couple of ads at the top of Inside Medicine (unless you’re a premium subscriber). This is something I’m trialing as a way to keep all of the weekday content free. Any ads that appear will never push any medicine or pharmaceutical product. (The trial ads you’ll see will be for a nice app that helps clinicians make evidence-based decisions). So, Inside Medicine community, I’d like to take your temperature on this.
Thanks for chiming in.
That’s it. Your “Friday Five!”
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The Oxford English Dictionary says that preventative is the “corrupt form” of preventive. Would have liked to have seen Kate Middleton use the more proper term, even if she didn’t say “adjuvant.”
Dr. Faust, I really look forward to Inside Medicine and appreciate your perspective and the topics discussed. And just wanted to say, "thank you!"
With respect to sunsetting Covid-19 guidelines, where will we look for treatment guidance? Will another group take it over? It's not like Covid is going to go away anytime soon, how do those of us interested keep up with current or changing recommendations? While I get we aren't in the crisis times of 2020, will accepting, "we're in a much different place now" and "we have the tools," set us up for unmitigated gamble?
Will you help me better understand, "most people have some degree of immunity to Covid-19." Honestly, it's confusing to me when the consensus of research I've seen agrees that after vaccination or infection, the immunity wanes and the risk of reinfection returns. Wastewater is currently showing infections are decreasing, but most places are still "medium," not "low." And Easter and Spring Break are here. What are cases going to look like in a few weeks? Covid appears to be evolving to no distinct seasonality, and people are still definitely developing re-infections. Are NIH and CDC moving toward a "herd immunity" approach? That seems impossible to achieve given a constantly adapting, mutating virus like Covid-19. Taking away guidelines, dropping isolation and no masking in healthcare... It's making it harder not easier to protect myself and leaves me feeling more vulnerable and less safe.