Latest / Morning Medical with Dr. Chow / Bird Flu Updates, H5N1 Transmission, and Innovations in Alcohol Use Disorder Treatments

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Bird Flu Updates, H5N1 Transmission, and Innovations in Alcohol Use Disorder Treatments · Morning Medical with Dr. Chow

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  Welcome to "Morning Medical with Dr.
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  Chow," where we bring you the latest medical and health news from around the world, powered
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  by artificial intelligence.
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  I'm your host, Dr.
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  Chi-Ming Chow, a cardiologist and Professor of Medicine at the University of Toronto.
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  Today, we're diving into the latest updates on the emergence of bird flu in Canada and what
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  experts are saying about preparedness.
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  Recently, Health Canada has authorized three influenza vaccines that could be mobilized if
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  the bird flu, also known as H5N1, were to become a pandemic.
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  The federal government has an agreement with the vaccine manufacturer GlaxoSmithKline for
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  domestic production, which could be ramped up if necessary.
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  Although there's no current indication that H5N1 will spark a pandemic, experts emphasize
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  the importance of being prepared.
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  The Public Health Agency of Canada confirmed that a teenager in British Columbia is the
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  first person to acquire H5N1 flu in the country.
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  While the source of exposure remains uncertain, this strain is linked to outbreaks in poultry
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  farms in British Columbia.
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  The teenager was critically ill in hospital as of the latest reports.
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  Human-to-human transmission of H5N1 is rare, and there's no evidence of sustained
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  transmission.
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  Most human cases globally have been due to contact with infected birds or animals.
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  However, Angela Rasmussen, a virologist at the University of Saskatchewan, warns that the more
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  opportunities the virus has to infect humans, the greater the chance it could adapt and
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  potentially spread more efficiently.
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  Experts like Dr.
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  Fahad Razak from St.
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  Michael's Hospital in Toronto argue that Canada should stockpile H5N1 vaccines, as the United
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  States has done, instead of relying solely on agreements with manufacturers.
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  This would allow for a quicker response if rapid vaccination became necessary.
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  Although the Public Health Agency of Canada cites the short shelf-life of these vaccines as
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  a reason for not stockpiling, Razak suggests that having doses available for high-risk
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  groups, such as agricultural workers, would be a prudent middle-ground approach.
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  Finland has already started offering H5N1 vaccinations to individuals at high
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  occupational risk, like dairy and poultry workers.
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  Dr.
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  Matthew Miller from McMaster University believes that similar measures could help
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  reduce the risk of a pandemic by protecting those most likely to be exposed to the virus.
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  Surveillance remains a critical component of preparedness.
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  The Public Health Agency of Canada mandates that provincial and territorial health agencies
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  report confirmed and probable H5N1 cases within twenty-four hours.
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  The National Microbiology Lab in Winnipeg is equipped to rapidly test and confirm cases for
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  regions that lack local testing capabilities.
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  Additionally, wastewater testing, a method used during the COVID-19 pandemic, is being
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  considered for bird flu surveillance.
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  While Ontario has halted its program, British Columbia continues to monitor for H5N1 in
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  wastewater.
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  Experts suggest that targeted testing, especially in areas with high human waste
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  output, could serve as an early warning system.
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  Pathobiology professor Shayan Sharif from the Ontario Veterinary College highlights the
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  importance of using wastewater testing as a screening tool to detect the presence of H5N1
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  in real-time.
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  Once detected, health officials can trace the source and take appropriate measures to
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  mitigate the spread.
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  In the wake of recent labor disputes at Canada's largest ports, concerns are mounting
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  about potential disruptions in the supply of medical goods, including medications and
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  equipment.
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  Mina Tadrous, a pharmacist and assistant professor at the University of Toronto's
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  Department of Pharmacy, points out that a significant portion of Canada's medications are
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  imported by sea.
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  This reliance on maritime transport means that ongoing port issues could affect everything
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  from over-the-counter pain relievers to critical surgical supplies.
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  Although the federal labor minister has stepped in to end the work stoppages at major ports in
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  British Columbia and Quebec through "final and binding arbitration," experts warn that
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  clearing the backlog of goods could take some time.
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  During the shutdowns, over $1.2 billion worth of goods were disrupted daily, and past labor
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  stoppages, like the railway shutdown earlier this year, took weeks to resolve completely.
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  While Canada does maintain stockpiles of medications and healthcare supplies, these
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  reserves are not infinite.
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  Tadrous emphasizes that if supply chain disruptions persist, shortages could become a
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  reality, especially for those living in rural areas who might also be affected by a potential
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  Canada Post strike.
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  Currently, Health Canada is closely monitoring the situation alongside industry associations
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  and manufacturers.
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  They are assessing potential risks of health product shortages resulting from these labor
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  disruptions.
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  As of now, no immediate impacts have been identified, but the department remains vigilant
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  and prepared to take action if necessary.
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  Interestingly, some manufacturers, like Novo Nordisk, have already implemented mitigation
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  strategies to minimize disruptions.
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  For instance, raw materials and active pharmaceutical ingredients are being
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  airfreighted to production sites in the United States to prevent supply chain interruptions
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  due to seaport strikes.
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  Medicines destined for Canada are also being shipped by airfreight or truck, which could
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  help mitigate the impact of these disruptions.
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  Tadrous reassures Canadians that there are still sufficient stockpiles of medicines
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  available, so there is no immediate need for concern or stockpiling at this moment.
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  However, he advises that this is an opportune time to plan ahead and ensure the supply chain
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  remains robust before potential shortages arise.
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  One reason Canada is particularly vulnerable to drug shortages is its small market size,
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  representing only about two percent of global drug and medical device sales.
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  Most drugs and devices used in Canada are imported, often from a single supplier, and
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  even domestically manufactured medications rely heavily on imported active ingredients from
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  countries like India, China, and Mexico.
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  Tadrous explains that, while there is a buffer within the supply chain with medications
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  currently on shelves, the key is to maintain this buffer and avoid panic.
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  He stresses that there are contingency plans in place, and with proper management, these
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  potential shortages can be managed effectively.
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  Today, we're exploring an insightful perspective on the language doctors use when
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  communicating with seriously ill patients.
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  A group of experts is cautioning against certain words and phrases that might
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  inadvertently close off dialogue, offend patients, or limit their ability to make
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  informed decisions.
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  This is based on a perspective paper published in the Mayo Clinic Proceedings, which argues
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  for more thoughtful communication that centers the patient and their family.
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  The authors of the paper, including Dr.
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  Rana Lee Adawi Awdish from Henry Ford Hospital in Detroit, emphasize the importance of
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  avoiding certain "never-words" in medical conversations.
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  For example, phrases like "Your mother needs to be intubated" or "she needs a transplant" can
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  shut down patients' or families' ability to consider other options.
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  Similarly, using the word "just" in phrases like, "We can continue treatment, or we can
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  just do supportive care," implies a value judgment that one option is inferior.
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  Instead, the authors suggest alternative phrasing that invites open conversation and
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  shared decision-making.
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  For instance, rather than saying "need," a doctor might say, "Her heart is getting worse.
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  May we talk about what that means and what to do next?" This approach signals openness and a
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  willingness to engage in a dialogue rather than issuing a directive.
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  The paper provides several examples of how to replace "never-words" with language that offers
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  realistic and humane support.
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  Instead of saying "There is nothing else we can do," a doctor could say, "Therapy X has been
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  ineffective in controlling the cancer, but we still have the chance to focus on treatments
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  that will improve your symptoms and, hopefully, your quality of life."
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  By suggesting the phrase "We can shift our focus to his comfort rather than persisting
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  with the current treatment, which isn't working," instead of "withdrawing care,"
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  doctors can help patients and families understand the situation without feeling
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  abandoned.
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  Similarly, rather than asking "Do you want us to do everything?" they might say, "Let's
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  discuss the available options if the situation gets worse."
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  The language we use can significantly impact a patient's experience.
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  Instead of saying "Everything will be fine," which may offer false reassurance, doctors can
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  express support by saying, "I'm here to support you throughout this process." Additionally,
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  replacing combative terms like "fight" or "battle" with "We will face this difficult
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  disease together" can foster a sense of partnership and shared struggle.
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  Dr.
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  Robert Arnold from the University of Pittsburgh, who specializes in teaching
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  communication skills for difficult patient conversations, highlights the importance of
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  providing clinicians with the necessary training and support to improve their
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  communication skills.
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  He suggests that focusing on what we want physicians to do, rather than what they should
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  avoid, can be more effective from an educational standpoint.
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  Dr.
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  Arnold also points out that while it's useful to have prepared phrases, these should be
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  adapted to fit the clinician's personal style.
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  He shares that even he has made mistakes in the past by using some of these "never-words," but
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  emphasizes that when spoken from a place of care, the impact can be mitigated.
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  Building a strong relationship with patients allows them to provide feedback and foster
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  trust, even when the conversation doesn't go perfectly.
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  Today, we're exploring a fascinating area of research that could potentially transform how
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  we approach the treatment of alcohol use disorder.
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  A recent Swedish observational study has highlighted the potential benefits of using
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  certain glucagon-like peptide-1 receptor agonists, specifically semaglutide and
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  liraglutide, as treatments for alcohol use disorder.
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  These findings were published in the journal JAMA Psychiatry, and they suggest that these
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  drugs might significantly reduce the risk of alcohol use disorder-related hospitalizations.
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  The study involved more than two hundred thousand individuals with alcohol use disorder,
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  and it found that those taking semaglutide, which is marketed under the names Ozempic and
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  Wegovy, had a thirty-six percent reduced risk of hospitalization related to alcohol use
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  disorder compared to those not taking a glucagon-like peptide-1 agent.
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  Similarly, liraglutide, known as Victoza and Saxenda, was also linked with a significant
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  reduction in hospitalization risk.
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  Interestingly, the researchers noted that these glucagon-like peptide-1 receptor agonists
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  appeared to offer a greater risk reduction than traditional alcohol use disorder medications
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  like naltrexone, disulfiram, and acamprosate.
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  However, they cautioned that these comparisons should be viewed cautiously, given the
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  differences in how the study compared the use of these drugs.
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  Semaglutide and liraglutide are already approved for treating type two diabetes and
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  obesity.
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  However, there's been growing interest in their potential benefits beyond these conditions.
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  For instance, some data suggest they might also help in reducing the risk of Alzheimer's
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  disease, glaucoma, and various addiction-related disorders, including opioid
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  and tobacco use disorders.
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  The researchers believe that the glucagon-like peptide-1 receptor may play a role in pathways
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  related to craving and reward, which could make these drugs effective for a wide range of
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  addictions.
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  They highlighted that genetic variations in the glucagon-like peptide-1 receptor have been
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  linked to an increased risk of alcohol use disorder, supporting the idea that these drugs
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  might modify addictive behaviors through effects on dopamine modulation.
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  The study utilized real-world data from Swedish registries covering inpatient and specialized
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  outpatient care, sickness absence, and disability pensions over a period from January
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  two thousand six to December two thousand twenty-three.
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  The researchers found that, during a median follow-up of eight-point-eight years, nearly
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  fifty-nine percent of individuals with alcohol use disorder experienced a related
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  hospitalization.
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  Among those using glucagon-like peptide-1 agonists, semaglutide users had a thirty-two
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  percent reduced risk for any substance use disorder-related hospitalization compared to
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  nonusers, while liraglutide also showed a significant reduction, albeit to a lesser
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  extent.
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  However, the researchers noted that the majority of these hospitalizations were
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  alcohol-related, so these findings should be interpreted carefully.
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  Interestingly, another part of the study found that these drugs were not associated with an
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  increased risk of suicide attempts, unlike some traditional alcohol use disorder medications
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  which were linked to a slightly higher risk.
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  This is noteworthy, as there has been some debate over whether glucagon-like peptide-1
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  drugs might be linked to suicidal thoughts, but recent data suggests otherwise.
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  The researchers emphasized that while the observational nature of the study prevents any
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  definitive causal conclusions, these findings pave the way for further investigation.
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  They suggest that future randomized clinical trials could help establish glucagon-like
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  peptide-1 agonists as viable treatments for alcohol use disorder and other substance use
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  disorders.
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  Today, we're delving into a critical topic that's gaining more recognition in the medical
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  community: the impact of respiratory syncytial virus, commonly known as RSV, on adult
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  populations.
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  Historically, RSV has been associated more with pediatric cases, but new data is shining a
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  light on its significant burden among adults, particularly older individuals.
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  A recent cross-sectional analysis using data from the Centers for Disease Control and
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  Prevention has revealed that, before the introduction of RSV vaccines, the virus was
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  responsible for numerous hospitalizations, intensive care unit admissions, and in-hospital
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  deaths among adults.
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  The analysis, led by Dr.
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  Fiona Havers from the National Center for Immunizations and Respiratory Diseases,
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  highlighted that RSV-associated hospitalization rates among adults ranged from nearly 49 per
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  100,000 during the 2016-2017 respiratory season to over 76 per 100,000 in 2017-2018.
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  The impact was particularly pronounced among adults aged seventy-five and older, with
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  hospitalization rates soaring as high as 411 per 100,000 in certain seasons.
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  In fact, the data suggests that RSV severity in hospitalized adults could be on par with, or
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  even exceed, that of influenza and COVID-19.
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  Approximately nineteen percent of adults hospitalized with RSV required intensive care,
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  and about four-point-three percent died during their hospital stay.
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  These numbers underscore RSV as a substantial contributor to respiratory illness in the adult
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  population.
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  Interestingly, the study also found that RSV-related hospitalizations and deaths in
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  older adults were comparable to those associated with milder influenza seasons.
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  The burden was notably high for those aged seventy-five and older, who accounted for
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  nearly forty-six percent of RSV-related hospitalizations and fifty-nine percent of
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  in-hospital deaths.
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  These statistics may even underestimate the true impact, as the analysis did not account
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  for deaths occurring post-discharge.
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  In response to this underrecognized burden, the first-ever RSV vaccines, Arexvy and Abrysvo,
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  were approved in 2023, followed by an mRNA-based vaccine earlier this year.
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  Current recommendations from the Centers for Disease Control and Prevention advise that
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  adults aged seventy-five and older receive a single dose of an RSV vaccine.
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  Those aged sixty to seventy-four who are at increased risk of severe RSV disease are also
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  encouraged to get vaccinated.
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  The introduction of these vaccines is a significant step forward in reducing
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  potentially preventable hospitalizations and deaths related to RSV.
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  However, it's crucial to increase vaccine coverage among adults at the highest risk to
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  mitigate severe clinical outcomes.
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  The atypical patterns of RSV circulation observed during the COVID pandemic, with lower
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  hospitalization rates in some years, highlight the importance of continued surveillance and
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  vaccination efforts.
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  Despite these advancements, there's still a gap in awareness about RSV as a significant
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  pathogen in adults.
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  Historically, clinicians have not frequently tested for RSV in hospitalized adults with
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  respiratory illnesses, partly due to limited awareness and the perception that test results
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  wouldn't alter management.
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  However, standard tests are now known to have lower sensitivity than previously thought,
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  which may have contributed to underdiagnosis in the past.
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  The analysis had its limitations, such as the potential lack of generalizability to the
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  entire country and assumptions that may have led to over- or underestimation of RSV's
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  burden.
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  Yet, this data provides a valuable perspective on the importance of recognizing RSV as a
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  serious health concern for adults, especially as we continue to navigate the post-pandemic
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  landscape.
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  As we wrap up today's episode, it's clear that understanding and addressing the challenges
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  posed by RSV in adult populations is crucial for improving public health outcomes.
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  The advent of vaccines offers hope for better management and prevention, but awareness and
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  proactive healthcare measures remain key.
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  Thank you for joining me on "Morning Medical with Dr.
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  Chow." Until next time, stay informed and take care.