Book Review: Frank Huyler, White Hot Light: Twenty-Five Years in Emergency Medicine

Frank Huyler is an emergency physician, father, author, and poet who has spent the last quarter century working in the ER of a large teaching hospital in Albuquerque, NM. White Hot Light consists of 30 vignettes; most involve patient encounters, but not all. He also writes about his wife’s labor pain, his father’s heart disease, a prospective medical student he interviewed, and several people he encountered while attending high school in Japan. Continue reading

Book Review: Matthew McCarthy, Superbugs: The Race to Stop an Epidemic

I am a seasoned physician, thirty years into my career. During COVID, with time on my hands, I re-read Samuel Shem’s (aka Stephen Bergman) seminal book about medical internship, The House of God, published in 1978, a book I’d first read during my own internship in the late 1980s. For balance, I simultaneously read Matt McCarthy’s internship memoir, The Real Doctor Will See You Shortly, written in the aftermath of his internship in 2008-09. Continue reading

I’m optimistic about … COVID-19 vaccines (part 2).

Vaccine Approval.

 The approval process for vaccines is arduous and involves the following steps:

  1. Preclinical: Laboratory and animal testing to determine potential use in humans.
  2. IND (Investigational New Drug) Application: Submission of R&D and preclinical data to the FDA for review and initiation of human trials.
  3. Phase 1: Generally, a small trial conducted in 20-100 healthy people to determine safety, dosage, and immune response.
  4. Phase 2: Mid-range trial conducted in several hundred people to assess dose-response and adverse events associated with the vaccine.
  5. Phase 3: Large RCT (Randomized Controlled Trial) involving thousands of people to assess efficacy (does the vaccine work under ideal conditions?) and safety (does the vaccine cause harm?) versus a placebo.
  6. BLA (Biologics Licensing Application): Comprehensive submission of all preclinical and clinical data to the FDA for review. There is no timeline for approval. In emergency situations like the COVID-19 pandemic, approval may be granted under an EUA (Emergency Use Authorization).
  7. Phase 4: Post-approval oversight and ongoing monitoring that may require post-marketing studies to further assess known or potential serious risks. Vaccines are closely monitored using multiple surveillance systems including: VAERS (Vaccine Adverse Event Reporting System), BEST (Biologics Effectiveness and Safety) program, the FDA Sentinel Program, the FDA and CMS (Centers for Medicare & Medicaid Services) partnership program, the V-Safe phone app, and the CDC Vaccine Safety Datalink.

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COVID-19 Update – Remdesivir.

The pharmaceutical landscape for COVID-19 treatments is rapidly changing. Since my post last week on hydroxychloroquine, three new reports have come out regarding the drug’s use: two related to cardiac side-effects, and a separate randomized controlled trial on the drug’s capacity to clear the virus and improve blood markers of infection and inflammation. Continue reading

I’m skeptical about … hydroxychloroquine.

March 21, 2020, Trump tweet: “HYDROXYCHLOROQUINE & AZITHROMYCIN, taken together, have a real chance to be one of the biggest game changers in the history of medicine. The FDA has moved mountains.”

The bully pulpit of the president still carries a lot of weight, and Trump’s repeated touting of the anti-malarial drug hydroxychloroquine for the treatment of COVID-19 provided incentive for FDA officials to approve its use under the Emergency Use Authorization section of the Federal Food, Drug, and Cosmetic Act one week after the above tweet. Continue reading

I’m skeptical about … CBD (cannabidiol).

     With passage of the Farm Bill in 2018, CBD (cannabidiol) products became legal in all states under federal law, provided they are derived from hemp containing less than 0.3% THC. But just as multiple states have legalized cannabis in opposition to federal laws that prohibit physicians from prescribing it, there are still several states where cannabis products including CBD remain illegal irrespective of federal laws to the contrary. Continue reading

I’m skeptical about … cannabis (part 2).

Most people harbor guilty pleasures. Mine have nothing to do with marijuana, but I do admit to a weakness for good spy thrillers, and it’s my interest in the latter that led me to write this post about the former. Alex Berenson, an ex-New York Times reporter, is the author of my favorite spy series about a CIA operative named John Wells. You can learn a lot about covert operations from reading this series, so when Berenson turned his attention to a non-fiction book warning about the dangers of cannabis called, Tell Your Children: The Truth About Marijuana, Mental Illness, and Violence, it got my attention. Continue reading