Week of March 3, 2025
Between the measles in Texas and the FDA canceling the 2025-26 flu vaccine planning, several patients voiced concerns about their safety this week. Most patients with kidney disease are immunosuppressed - meaning their underlying illness (or medications they take for transplanted organs or cancers) makes their immune system less able to respond to vaccines (and more susceptible to infection from viruses and bacteria). In other words, they depend on herd immunity to limit their exposure to typical vaccine-mitigated diseases. Conversely, as vaccination rates fall, my patients' risk of severe illness, hospitalization, and death rises. While it is unclear (at the moment) what the FDA will do about next year's flu vaccine, it is a good time to review the data on measles. Measles transmission is near zero when >95% of a population is vaccinated. But, thanks to vaccine skepticism, vaccination rates in some states have fallen below 95%, and cases are appearing. While the number of cases is still relatively small, CDC data indicates weekly cases have increased between 2023-2025. Helping complex and chronically ill patients navigate the changing landscape of infectious disease (separating signal from noise and suggesting practical tactics) is getting tougher.
Articles:
About the FDA flu vaccine planning meeting:
https://thehill.com/policy/healthcare/5166809-fda-cancels-flu-vaccine-strain-meeting/
and
Some reasonable advice on measles vaccines and boosters:
https://www.npr.org/sections/shots-health-news/2025/02/21/nx-s1-5304458/measles-vaccine-booster-health
and
A very readable history of measles in the U.S.
https://www.atrainceu.com/content/2-history-and-pathology-measles
and
The CDC measles website, now updated weekly, demonstrates year-to-year case volumes, state-level vaccination rates, and good clinical data.
https://www.cdc.gov/measles/data-research/index.html
The CDC .pdf vaccination schedule:
https://www.cdc.gov/vaccines/hcp/imz-schedules/downloads/adult/adult-combined-schedule.pdf
**N.B: I will be traveling through next weekend and will most likely NOT send an email on 3/10/25**
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Listen to a Google Notebook LM A.I.-generated podcast of the newsletter with two virtual "hosts."
https://drive.google.com/file/d/1CkWvrrMr_uhdcoBOUfirIZpYkggFKzhX/view
About NotebookLM: https://blog.google/technology/ai/notebooklm-audio-overviews/
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Science and Technology Trends
This study showed up in my science feeds - a follow-up article looking at now 3+ years after a phase 1 trial of autogene cevumeran, an individualized mRNA vaccine, in patients with surgically resected pancreatic ductal adenocarcinoma (PDAC). Sixteen Patients received surgery + a monoclonal antibody (atezolizumab (anti-PD-L1)) + modified chemotherapy, and a custom-made mRNA vaccine targeted to their pancreatic cancer cells. Of the 16 initial recipients in the phase 1 trial, 8 demonstrated a response with antibodies against their pancreatic cancer. The 8 "responders" had a significantly longer recurrence-free survival time than "non-responders." While this is a small, phase 1 trial (there are ongoing, more extensive, randomized trials in progress), it is an excellent example of how multi-modal therapy, INCLUDING custom mRNA vaccine technology, can treat illnesses that are often otherwise lethal.
Article:
https://www.nature.com/articles/s41586-024-08508-4#Sec7
Claude Summary:
https://claude.site/artifacts/a7f6280a-2f9d-4f85-b4ec-0454fadd1b28
About personalized mRNA vaccines in cancer:
https://investors.biontech.de/news-releases/news-release-details/three-year-phase-1-follow-data-mrna-based-individualized
Discussion:
https://x.com/TheVinodLab/status/1892245578446184873
UnReal milk is the first product from Brown Foods - a lab-produced, cow-free, cow whole milk produced using mammalian cell cultures. "Their milk replicates the nutrition, taste, and texture of traditional dairy. It can be processed into butter, cheese, and ice cream, offering a lower-carbon, cruelty-free alternative to conventional milk. Brown Foods claims its production method slashes carbon emissions by 82%, water use by 90%, and land use by 95%, without relying on livestock." I did not realize cellular agriculture was a thing and that multiple companies were working toward cow-less milk manufacturing. Brown Food's tech is, however, unique.
https://www.forbes.com/sites/daphneewingchow/2025/02/24/first-lab-grown-whole-cows-milk-to-debut-in-the-us/
Learn about lab-grown milk competitors and their technology:
https://www.perplexity.ai/search/who-are-the-companies-working-AuzfoFtORQ64T93rn6lJeQ#1
Anti- Anti-Science Articles of Note
This week, I found an excellent example of nuanced and reasonable data analysis. The Lancet Diabetes & Endocrinology published an updated systematic meta-analysis investigating whether vitamin D supplementation prevents acute respiratory infections (ARIs). The authors analyzed data from 46 randomized controlled trials (RCTs) with 64,086 participants, including three new studies published since 2021 (when the first version of this meta-analysis was published). The meta-analysis indicated that vitamin D supplementation does NOT provide statistically significant protection against acute respiratory infections in the general population. Some subgroups showed potential benefits, but these trends were not statistically significant via meta-regression analyses. The authors conclude that despite laboratory evidence suggesting vitamin D improves immune responses to respiratory viruses, the clinical evidence from randomized trials does not support routine vitamin D supplementation for preventing ARIs in the general population (though the data indicate that further research could demonstrate some specific populations would benefit.)
My takeaways:
- Keep in mind medical data is often nuanced. In this instance, the data does not support using Vitamin D to prevent respiratory infections for most individuals.
- Although Vitamin D may not help prevent respiratory infections, you may need it for other reasons (like Vitamin D deficiency, bone health, etc.).
- Vitamin D levels are measurable; therefore, one can safely use Vitamin D (when indicated) and titrate the dose. In other words, the downside risk of taking Vitamin D is manageable. So, while the general population taking Vitamin D solely to prevent ARIs is inappropriate, it is not particularly risky if you take Vitamin D for other relevant reasons and are monitored.
- Learning to think through the strengths and weaknesses of scientific literature continues to be a much-needed skill. I highly recommend using LLMs to SUPPLEMENT one's thinking - see the Claude summary highlighting the positive and negative qualities of this study:
The study:
https://www.thelancet.com/journals/landia/article/PIIS2213-8587(24)00348-6/fulltext
The Claude.AI summary and analysis:
https://claude.site/artifacts/c7e87790-1874-406c-89cb-d1f8a672e626
X commentary:
https://x.com/drsamuelbhume/status/1895221014705135891
Living with AI
New Scientist has more details on Google's AI co-scientist, including a more balanced view of AI used in research. Cautious optimism is the prevailing theme, noting that AI hype for biological science has sometimes exceeded substantive outcomes.
https://www.newscientist.com/article/2469072-can-googles-new-research-assistant-ai-give-scientists-superpowers/?utm_term=Autofeed&utm_campaign=echobox&utm_medium=social&utm_source=Twitter#Echobox=1740780630
The AI Daily Brief's weekend edition on ChatGPT-4.5, released last week to professional subscribers, discusses how LLMs are "tuned" to different functions and how to measure different versions' capabilities. While v4.5 is interesting, the discussion of speed vs. complex reasoning vs. cost vs. specific abilities (human empathy vs. coding vs. writing) is a good reminder that one must select the right LLM, depending on your goal. It is only a matter of time before layered, multi-version LLMs parse requests and send the right parts of the query to the right engine for a robust output (cascading/hierarchies of agents).
https://open.spotify.com/episode/2gPhx8B9lPCVYJPXLZl6ve?si=ToGBDNKTQySjsTd4c48Rfw
and
A 10-minute discussion on how teams of agents will permit new possibilities for work:
https://open.spotify.com/episode/4U2gjVrbk8HBjynxCiqcaR?si=kFd36MdqQl-1PdHORwv_Wg
Infographic of the Week
Fruit-filled Desserts - Cobbler vs. Crumble vs. Betty vs. Pie (oh my?!?). I didn't know there was a dessert called a Grunt.
https://edibleaustin.com/wp-content/uploads/2017/12/dessert-main.jpg
from
https://edibleaustin.com/food/techniques/a-guide-to-deciphering-dessert/
Things I learned this week
I found a 2020 article with a headline I could not make up: "Controversial study shows rats prefer jazz to classical music, when on drugs." Though the title is amusing, the underlying concerns (animal testing versus the value of accumulating data on techniques to mitigate addiction) are worthy of debate.
https://www.classicfm.com/music-news/rats-prefer-jazz-beethoven-cocaine-study/
A loyal reader suggested a book that described the long-standing Catalonian tradition of castling - large numbers of humans standing on each other's shoulders to create multi-tiered towers. I now envision a retirement plan that includes spectating a wide range of atypical sports - Irish hurling, Finnish hobby horse riding, and October in Tarragona for the Human Tower Competition.
https://www.perplexity.ai/search/what-are-castelling-competitio-dg68717RSJyKkzur_aUbdg
and
https://www.tarragonaturisme.cat/en/events/human-tower-competition
and
Castling: https://www.youtube.com/watch?v=SQM4qbwyxCM
and
hurling: https://www.youtube.com/watch?v=JZPDWH8wSiE
and
hobby horse: https://www.youtube.com/watch?v=Qf4hiaWedhk
AI art of the week.
(A visual mashup of topics from the newsletter, now using ChatGPT to summarize the newsletter, suggest prompts, and make the images.)
"Human towers (castells) being built with futuristic robotic assistants and AI-driven exoskeletons helping people climb instead of traditional methods. In the foreground, a surreal cow with mechanical limbs and a glass udder filled with lab-grown milk stands beside a group of Renaissance-era farmers who look on in awe and confusion. In the background, dramatic Baroque lighting highlights a celestial Vitamin D figure in the sky, with ancient manuscripts of meta-analyses swirling in the air. The composition is highly detailed, with a mix of medieval and futuristic elements coexisting in a whimsical yet dramatic narrative. Painted in the rich, detailed style of Pieter Bruegel the Elder."
OpenAI DALLE:
https://drive.google.com/file/d/1sI5n43F-iAr72QgbTpiCYNsUOl9qBgQu/view
X's Grok image from the prompt:
https://drive.google.com/file/d/1OktaIGfWTtv-FSar73dhnU-r0TfhZKVo/view
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RSV, norovirus, and influenza rates (as retrospectively measured in wastewater) are still high. Coronavirus rates are falling, but still higher than other times over the last 4 years.
The Pandemic Mitigation Collaborative (PMC) website uses wastewater levels to forecast 4-week predictions of COVID rates.
https://pmc19.com/data/
based upon https://biobot.io/data/
Wastewater Scan offers a multi-organism wastewater dashboard with an excellent visual display of individual treatment plant-level data.
https://data.wastewaterscan.org/
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The next update will likely be on 3/17/25.
Clean hands and sharp minds,
Adam
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