Snowstorms-a-Plenty ID Link-o-Rama

February 8th, 2015

Snowstorms-a-Plenty ID Link-o-Rama

A few items to discuss as we settle in for yet another Boston megastorm:

The measles outbreak continues to bring forth excellent commentaries on the selfishness of vaccine-refusers, with this one from Frank Bruni one of my recent favorites. Question: Will it take a hospitalization — or even worse, a death — of an American child with measles to stop this ridiculousness?
This piece in the Wall Street Journal describes the negotiations going on behind the scenes between pharmaceutical companies and payers regarding HCV therapy. I’m sure something like this has happened before in non-ID fields (Oncology or Rheumatology would be my best bet), but I have never experienced anything like this as an ID doctor — meaning, both the clinician and the patient seem to be completely left out of the discussion. Hello? Can anyone hear us?
Can a fecal microbiota transplant from an overweight donor lead to obesity in the recipient? That’s the implication in a case report over in Open Forum infectious Diseases. While the case does not prove causality (other factors could have contributed to the weight gain), the plausibility of the FMT leading to obesity is at the very least suggested in the clinical course and supported by animal data where indeed the microbiome plays a major role in metabolism. Don’t miss this excellent editorial from real experts in the field.
More evidence that booster vaccines for hepatitis B are probably not needed, at least according to a study in health care workers. It’s that “long-lasting amnestic response” — meaning even when antibodies decline, exposure to the antigen is rapid and protective. The hepatitis B vaccine was an extraordinary and unheralded major advance in safety for healthcare workers.
There are lots and lots of strange bacteria in the NYC subway, says this fascinating, much-publicized and (let’s face it) extremely unsurprising report published in Cell. Best part: “Almost half of all DNA present on the subway’s surfaces matches no known organism.” If I might make a personal comment: when my family moved to New York City in the 1970s, there were no doubt even more bizarre microbes living down there. Anyone have a spare autoclave?
The coformulations of atazanavir/cobicistat and darunavir/cobicistat are now available. Definitely more convenient to have them together (avoiding selective skipping of ritonavir), and if they’re price-equivalent to the separate dosing of the drugs, then they eventually will be widely adopted. Otherwise — and especially with the approval of generic ritonavir — they could face a tricky pharmacoeconomic challenge. Now throw in 300 mg of lamivudine and pull of a GARDEL study equivalent, now that could be transformative.
Wonderful “Call to Arms” about the crisis facing Infectious Diseases by Ron Nahass, who in our field is something of a true visionary: He understands — and fortunately can communicate — the value of ID doctors independent of billing units in a fee-for-service environment. Required reading for the gloomy ID doc (and there are lots of us out there). My favorite line: “Develop a true value of our intellectual capital.” In other words, get paid for being smart, not for doing a procedure.
Being cold could increase the chances of catching a cold. Score one for common wisdom!

As the latest storm intensifies up here in Boston, it’s worth disabusing the world at large of the perception that the whole Northeastern United States has the same weather. Today the high temperature in Washington DC was 68 — yes, you read that right — Philadelphia had high 40s and obviously no snow, and New York (funky subway bacteria notwithstanding) had a dreary but otherwise very manageable winter day.

Here, it’s 15 degrees, and 12-18 inches of snow are expected over the next 24 hours.

Speaking of snow — here’s something to do in your spare time:

Snow Circles from Beauregard, Steamboat Aerials on Vimeo.

HIV and ID Observations

An ongoing dialogue on HIV/AIDS, infectious diseases,
all matters medical, and some not so medical.

February 8th, 2015