Is it true that nicotine users contract Covid-19 less?

Hello,

Numerous case studies demonstrate this unequivocal : smokers who get Covid-19 have a risk greatly increased to develop severe forms of the disease. In this work, we find that the proportion of smokers is two to four times higher in severely ill patients than in those with a moderate form of the disease.

On the other hand, several publications relayed since the beginning of April report a counterintuitive phenomenon: in several countries, the proportion of smokers infected with SARS-CoV-2 would be lower than the proportion of smokers at regional or national level. The Minister of Health, Olivier Véran, recently mentioned this data.

In France, works being published conducted on a limited number of patients at the Pitié-Salpétrière, as well as a study in a school environment in Crépy-en-Valois (prepublished this April 23), also reported this statistical trend.

Many potential limits

Note now that the link between smoking status and propensity to be infected does not appear in all research. So in a recent study published in the Jama, involving 5,700 New York patients hospitalized for Covid-19, the proportion of smokers was analogous to that observed in the regional population.

The first studies were met with skepticism, not without reason. Indeed, many of these works have sometimes significant biases.

First limitation present in all studies (with the exception of French studies): the age parameter of hospitalized patients. Indeed, a significant proportion of patients with severe forms of Covid-19 are over the age of 65. The prevalence of smokers decreases very strongly with age (for example, in France, 65-75 year olds smoke 2.5 times less than the general population).

In the study conducted at Pitié-Salpêtrière, taking into account the age and sex of the patients, smokers nevertheless appeared to be four times less likely than non-smokers to be Covid +. A rate observed both in hospitalized patients and in patients treated on an outpatient basis. However, in order to draw more solid conclusions, these results should have been put into perspective with the smoking profile of patients who usually attend this hospital, at the same periods in previous years.

Another parameter that seems to be excluded from most analyzes: the socio-economic profile of the groups studied, which can strongly influence the expected proportion of smokers. A limitation mentioned by the authors of the French study, who established their calculations “Assuming that the population studied who lives in a limited area around a Parisian hospital has the same smoking habits as the French population in general”, and who note that “Healthcare workers were overrepresented in the outpatient group due to routine workplace testing when they became symptomatic”. The study conducted at Crépy-en-Valois seems to take this parameter into account. And its results are consistent with the Pitié Salpêtrière study.

Third important pitfall: the quality of the information collected is not always there … far from it. In some studies used by epidemiologists to conduct their analyzes, the smoking status of the sickest Covid + patients was simply not informed. Commentators have also noted that one of these studies considered individuals to be “non-smokers” less than 30 packages per year – preventing any comparison with national statistics which relate to all cigarette consumers.

For its part, the study conducted at Pitié-Salpêtrière seems to consider as “former smoker” any person who had quit smoking at the time of his hospitalization … without mentioning the hypothesis that patients may have stopped smoking because of the first Covid-19 symptoms! A point which would considerably influence the results. Requested by CheckNews, Zahir Amoura, author of this work, has not yet commented on this point.

Is the phenomenon biologically plausible?

The interpretation of these statistics, as well as the extent of the associated phenomenon, are still questionable.

Researchers, however, have begun to explore the hypothesis of a direct causal link between smoking status and primary SARS-CoV-2 infection. The question arises indeed: from a physiological point of view, is it plausible that lungs exposed to tobacco are less permeable to this coronavirus? Could nicotine be involved in the phenomenon?

A possible link with the ACE2 receiver?

SARS-CoV-2 infects cells by binding to the ACE2 receptor, abundant on the surface, in particular, the cells of the mucous membranes and the alveolar pulmonary tissue. The expression of the gene corresponding to ACE2 is not identical in smokers and in non-smokers. Based on animal models, smokers have long been considered to express less ACE2 – which suggests a simple explanation for the phenomenon: less ACE2 induces a lower propensity for infection.

But recent data, which seem to be corroborated by new researchsuggest that in humans, smoking is associated with a higher expression of ACE2. A higher propensity for coronavirus infection would therefore be expected. The epidemiological observations mentioned above, suggesting a protective effect of tobacco, would therefore raise a paradox.

Several explanatory hypotheses have been formulated. Some authors have advanced that in all patients, infection with SARS-CoV-2 would decrease the availability of ACE2 receptors in the lungs. The biological processes that usually mobilize these receptors would be hindered, leading to various symptoms of the disease. People with more ACE2, even if they were infected, would develop fewer symptoms. However, this interpretation is challenged by the Crépy-en-Valois study, where the diagnosis of infection was made on a blood test, and not on a simple clinical assessment of symptoms.

According to other works, the nAChR nicotinic receptor could modulate the activity of ACE2. Could stimulating nAChR make infection through ACE2 more difficult? This fact is not yet proven. “The possibility of a reciprocal modulation between ACE2 and the nicotinic receptor is an interesting scientific question for which we have no answer”, insists Professor Jean-Pierre Changeux, co-author of a scientific article inviting this hypothesis to be explored.

La Pitié-Salpêtrière has announced the launch of several clinical trials in this direction. The first, conducted on caregivers, aims to compare the infection rate between a group carrying nicotine patches and a group carrying placebos patches. More trials need to be done on Covid + patients in hospital to assess whether nicotine affects the course of the disease – especially in smokers who are forced to quit as a result of hospitalization.

Nicotine and vaping: preliminary data not very encouraging

The return of associations of electronic cigarette users does not seem to go in this direction, however. According to the analysis of a questionnaire sent in early April to several thousand members of the AIDUCE and SOVAPE associations, the rate of patients suspected of being Covid + was similar whether or not there was nicotine consumption – around 2.5 %. “Although it concerns nearly 10,000 people, this citizen survey is inconclusive on a major protective effect of nicotine, note the associations in a press release. The first data show no major positive or negative effect of vaping when faced with the risk of contracting Covid-19 for vapers and their entourage. ”

Tobaccoologist Bertrand Dautzenberg, who had encouraged these associations to explore this hypothesis, notes on Twitter that the data was not collected under conditions “Respecting all the obligations of scientific studies”. He nevertheless considers that they are not showing strong signs of a beneficial effect of nicotine in reducing Covid-19 levels. ” He invites an analysis of the Health Database to further explore this hypothesis.

No reason to start smoking

The tobacco specialist recalls “That tobacco certainly brings a negative effect greater than that of a small benefit which is not confirmed at all”. “This leads to encouraging all doctors to advise and support smoking cessation for all smokers.” The authors of the Crépy-en-Valois study abound in this sense, recalling that tobacco is responsible for 75,000 deaths per year in France. “Smoking cannot therefore be offered as a way of protecting oneself against the new coronavirus”, they insist.

Unsurprisingly, this finding is similar to that of the authors of a review on the complications of Covid-19 related to smoking. “Risk factors for severe forms of Covid-19 (pulmonary and cardiovascular disorders, diabetes, etc.) are more common in smokers. Smokers with comorbidities should quit smoking by all means. ” They also observe that confinement can lead to social isolation and psychological distress that increase the need for smoking. [En outre], smoking is more prevalent among the economically less advantaged groups, and they are potentially more at risk for Covid-19. ”

For its part, the association Alliance contre le tabac urged the greatest caution with regard to speculative information in circulation. In the absence of more evidence, nicotine users, “Should not expect to be more protected than the population from the current epidemic”, she recalls. In addition, she advises non-smokers to use nicotine substitutes. A warning also formulated by the promoters of the Pitié-Salpétrière study or by the Minister of Health.

In summary

Although well publicized, epidemiological observations associating smoking and the risk of developing the symptoms of Covid-19 are difficult to interpret at this time. Under the hypothesis of a real cause and effect link, the biological mechanisms mentioned in the press are still hypothetical. None have yet been formally tested.

Listen to the weekly behind the scenes podcast of CheckNews. This week: Covid-19: what are the real figures for deaths in intensive care?

Jérôme Salomon, the Director General of Health, mentioned a mortality of 10% in intensive care of patients hospitalized for Covid-19. In this episode, Luc Peillon explains why this figure is largely underestimated.


Florian Gouthière

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Chloroquine, the presumption of antidote – Release

We only talk about her, we believe strongly. And in this second week of general confinement, while France now has 860 dead (186 more in twenty-four hours) and more than 2,000 patients in intensive care, chloroquine is on the verge of being presented as the miracle cure against the coronavirus, and the grumpy would delay its distribution guilty as the massacre continues. Thus, all this weekend and again Monday, definitive declarations have multiplied on this molecule widely used around the world for fifty years for its antimalarial virtues, as well as for the treatment of autoimmune diseases like lupus or polyarthritis rheumatoid. The boss of LR senators, Bruno Retailleau, on Sunday urged the government not to “Fall behind” and prescribe the drug “In a hospital environment”. The mayor of Nice, Christian Estrosi (LR), himself infected with the coronavirus, said the same day that he had “Want that

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What scientists are working on to find a cure for the coronavirus COVID-19 – Health

COVID-19 is caused by a new virus, which means that no one has any immunity when exposed for the first time as it could be with other viruses.

“With Flus they all come from very similar types of viruses, while it is a new virus in which everyone is naive [it]”said evolutionary biologist Jemma Geoghegan of the University of Otago, who studies the emergence and evolution of viruses.

This means that when it comes to cures for COVID-19, while scientists can tap into what we know of other viruses, in many ways they are starting from scratch.

Viral infections are often more difficult to treat than bacterial infections because they cannot be treated with antibiotics, although antiviral drugs are available for some infections.

The treatments could be used to relieve the symptoms of the infection while the immune system is fighting the virus.

On the contrary, vaccines are designed to prevent people from getting infected in the first place.

They do this by mimicking the infection, so that the body’s immune system knows how to fight that particular infection and protect you from getting it in the future.

Here is what we know about how our bodies manage COVID-19 and what is in the pipeline to cure it so far.

How does your body’s immune system fight COVID-19?

Australian researchers have discovered that our immune system responds to this coronavirus in the same way as influenza.

The immune cells that emerge in the blood before patients recover from COVID-19 are the same cells that we see in people before they recover from the flu.

Calling the Coronavirus app

Stay up to date on the coronavirus epidemic

Peter Doherty Institute for Infection and Immunity researchers were able to solve it by examining multiple blood samples from one of the first Australian patients diagnosed with COVID-19.

Importantly, the research published in Nature Medicine is “the first document showing that the body can give immunity, fight and recover,” said researcher Carolien van de Sandt.

Based on their experience with flu patients, it also allowed researchers to accurately predict the time it takes for the patient to recover from COVID-19.

But it’s still too early to say whether contracting the coronavirus once would give you immunity to stop you from taking it again.

However, the research could also assist in the development of a vaccine and other treatments to combat COVID-19.

Could existing medications treat COVID-19 infections?

The first signs are promising, after Australian researchers revealed this week that they are ready to begin clinical trials on a potential treatment for COVID-19 – using two existing drugs.

The drugs in question are an old HIV drug and an anti-malaria drug called chloroquine, which is now rarely used because the malaria pathogen has become resistant to it.

“There are definitely positive signs for both this HIV drug and this anti-malaria drug that work really well against COVID-19,” director of the Center for Clinical Research at the University of Queensland told David Project Paterson. .

“We know that in the test tube and in the patients that have been studied so far they have been able to recover and there is no more evidence of viruses in [their] system, “said Professor Patterson.

The next step in this research is to compare HIV, the malaria drug and a combination of the two, to see which treatment is most effective.

This phase of the process could take only three months, said Professor Paterson, but it would take longer to distribute the treatment to the community if it proves effective.

Worldwide, Chinese doctors are completing clinical trials to evaluate the efficacy of a combination of two HIV drugs, lopinavir and ritonavir, in the treatment of COVID-19, according to New Scientist reports.

They will also soon start testing a drug called remdesivir originally developed for Ebola.

When will we have a vaccine for COVID-19?

Many different groups around the world are working on possible COVID-19 vaccines.

“There are currently 15 potential vaccine candidates in the pipeline globally using a wide range of technologies[ies]: mRNA, DNA, nanoparticles, virus-like synthetic and modified particles, “said University of Queensland microbiologist Ian Henderson.

The U.S. National Institutes of Health has announced that it has funded phase 1 clinical trials of a potential COVID-19 vaccine, called mRNA-1273, which started this week.

The vaccine was able to be brought to clinical trials so quickly because researchers had already worked on one vaccine to protect themselves from another coronavirus, which causes Middle East respiratory syndrome (MERS).

Although the results of this first study may be available within three months, it will still take at least a year and probably more time for a resulting vaccine to be widely available to the public.

Answers to your questions about the coronavirus

Your coronavirus questions answered:

Closer to home, Queensland researchers were ready to start testing another potential COVID-19 vaccine on animals last month and hope to begin human testing by mid-year.

But getting to clinical trials and proving that your vaccine is both safe and effective isn’t the only challenge scientists develop to tackle these vaccines.

“The next challenge will be to find sufficient production capacity globally to produce these competing vaccines, on a scale that millions or even billions of people can be vaccinated,” said Professor Henderson.

That’s why we’re still feeling that it will take at least 12-18 months for a COVID-19 vaccine to be widely available.

Follow our coronavirus coverage

What coronavirus experts say:

ABC Health and Wellness newsletter teaser

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The coronavirus vaccine study starts on Monday

WASHINGTON (AP) – A clinical trial to evaluate a vaccine designed to protect against the new coronavirus will begin Monday, according to a government official.

The first participant in the trial will receive the experimental vaccine on Monday, the official said, speaking on condition of anonymity because the trial has not yet been publicly announced. The National Institutes of Health is funding the process, which is taking place at the Kaiser Permanente Washington Health Research Institute in Seattle, the official said.

Public health officials say it will take anywhere from a year to 18 months to fully validate any potential vaccines.

The tests will begin with 45 healthy young volunteers with different doses of strokes co-developed by NIH and Moderna Inc. It is not possible for participants to become infected with the strokes because they do not contain the virus itself. The aim is purely to verify that vaccines do not show worrying side effects, laying the foundation for larger tests.

Dozens of research teams around the world are rushing to create a vaccine as COVID-19 cases continue to grow. Importantly, they are pursuing different types of vaccines: shots developed by new technologies that are not only faster to produce than traditional inoculations, but may prove more powerful. Some researchers even target temporary vaccines, such as shots that could protect people’s health a month or two at a time as longer lasting protection is developed.

For most people, the new coronavirus causes only mild or moderate symptoms, such as fever and cough. For some, especially older adults and people with existing health problems, it can cause more serious illnesses, including pneumonia. The global epidemic has sickened more than 156,000 people and left over 5,800 dead. The death toll in the United States is over 50, while infections have approached 3,000 in 49 states and the District of Columbia.

The vast majority of people recover. According to the World Health Organization, people with mild illness recover in about two weeks, while those with more serious illness can take anywhere from three weeks to six weeks to recover.

___

The Associated Press receives support for health and scientific coverage from the Howard Hughes Medical Institute’s Department of Education. The AP is solely responsible for all content.

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Coronavirus is not a flu

Coronavirus, a “flu”? the doctors who claimed it two months ago have changed their tone. “When the first Chinese patient was diagnosed with coronavirus, a colleague told me” don’t forget to tell the nurses that this is a flu! “ Today he’s one of the most worried, “ says Professor Gilles Pialoux, head of department of the infectious and tropical diseases unit at Tenon hospital (Paris XXe).

The tension rose several notches with the publication on February 28 in The New England Journal of Medicine, a benchmark review in the medical community, for a study detailing the characteristics of Covid-19. For good reason, the clinical picture that Chinese researchers draw of the new viral pneumonia is very far from that of the seasonal flu.

Their conclusion, based on an analysis of 1,099 medical records from patients diagnosed with Covid-19, clears up some misunderstandings. Thus, the Chinese virus is not only dangerous for the elderly. With the exception of those under 15 who are almost unaffected, severe forms of viral pneumonia are seen in all age groups, although the risks increase with aging.

25% of patients who had no co-morbidities developed a severe form of the disease

Ten times more lethal than the flu (1.4% of infected people die from it), Covid-19 can especially be fatal well before the age of 70. “The relationship between age and lethality is less clear with the coronavirus than with the flu”, confirms Professor Xavier Lescure, infectious disease specialist at Bichat Hospital. “About 86% of people who die from the flu are over 70 years old, but only 50% with coronavirus. From an individual point of view, it’s more worrisome. “ Contrary to a widespread idea, the coronavirus does not strike only people weakened by preexisting pathologies (hypertension or diabetes type): according to the study of Chinese researchers, a quarter of the patients who presented no comorbidity developed a severe form of illness… Professor Pialoux agrees: “The coronavirus seems more serious than what we thought at the start: 16% of patients need to be hospitalized, 5% must be placed on artificial ventilation and above all in a sustainable manner: twenty days on average is very long.”

Read also Covid-19: in France, are deaths solely linked to the virus?

Another notable difference from the flu: infected people are very often asymptomatic (56% of them have no fever in the first days, and only 68% have fits of cough). On an individual scale, these few symptoms are rather good news: according to the study, 84% of those infected live only with a mild form of the disease. However, the medal has its downside: the pathogen does not manifest itself, its circulation is difficult to control because it cannot identify the contagious carriers. What also complicate the task of hospital. “We are going to have a hard time identifying the people who are really at risk among those who come to the emergency room or in dedicated units”, reports Professor Pialoux. “This is all the more problematic since there can be a sharp worsening of the disease between the 7the and the 10e day.”

“What do you do with a positive patient who has a pregnant woman at home?”

In Paris hospitals, there is no longer any question of hospitalizing all the patients who present themselves. “We only take serious or risky cases to avoid saturating the beds in the room as in intensive care; the rest are sent home, “ explains Tenon’s infectious disease specialist. “But there are quite a few exceptions to this rule. Concretely, what do you do with a positive tested patient who does not speak French and lives in close proximity with 15 other people in unsanitary housing? Who has a cancerous child or a pregnant woman at home? Another who has comorbidities, such as heart or respiratory failure? At the moment, we are also keeping them in the hospital. “

At this stage, the capacities of Parisian hospitals are not saturated. Referral facilities, like Bichat, are doubling the number of beds available for coronavirus patients in intensive care and in the ward. An imperative to deal with a number of cases which, probabilistically, doubles every five days, despite the containment measures. “We are doing everything to spread the epidemic peak over time, and avoid saturation of the care system, says Professor Lescure. To get there, on already working from sixteen to eighteen hours a day, including weekends. We are focused and as calm as possible. But nobody doubts it anymore: it will shake up. “


Nathalie Raulin

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Coronavirus from A to Z – Release

like animal

The World Health Organization (WHO) reminded him as early as January 12: “The data seem to clearly indicate that the outbreak is associated with exposures at a fish market in Wuhan” (see: Hubei). The hypothesis of a zoonosis, a disease transmitted by animals, is therefore preferred. February 7, the scientific journal Nature asks: “Has the pangolin spread the coronavirus to humans”? But nothing yet formally attests to this. Since there is nothing to certify that Sars-CoV-2, another name for Covid-19, very close to a virus detected in bats, comes from animals. The SARS coronavirus was transmitted from the civet to humans in China in 2002 and that of the Dromedary Sea to humans in Saudi Arabia in 2012.

as a balance sheet

As of Wednesday, almost two months after the virus appeared, 81,191 cases have been confirmed, including 78,064 in China. 39 countries have known or are experiencing cases. 2,728 people died, 30,310 were treated

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Catherine Mallaval

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Twitter, Kardashians and the democratization of the clinical debate

One of the country’s leading doctors used an old-school editorial to evaluate Twitter’s potential and its ideal role in public discussion of medical research and to outline its influence on the influence that some users acquire – deservedly or not – from legions engaging “followers”.

Twitter and other forms of social media have the potential to “democratize both the dissemination and criticism” of clinical trials, their results and their lessons, “thus bringing a wide range of clinical practice and the scientific community” to public debate , Robert M. Califf, MD, Duke University, Durham, North Carolina (@ Califf001), notes in the comment.

But the comment of a respected clinical investigator, renowned health outcomes and quality of care expert, and former Commissioner of the Food and Drug Administration have lined up a number of clinicians who are regular Twitter entries.

I agree that it is a revolutionary medium for sharing valuable information that otherwise could never be heard, but have seen themselves and others on the pervasive microblogging platform as editorial goals.

Twitter, Califf writes, “suffers from brevity and domination on Twitterati”, that is, “people with a gift for promoting their ideas using short sentences” that can potentially attract a large number of followers.

In an ideal world, he argues, researchers with the largest number of publications and citations, that is, those “with the most important contribution of original knowledge, would have the largest Twitter following” in proportion to their influence on Twitter.

But in reality, “experts with few impactful publications and a large Twitter following can be expert commentators and analysts or they can represent” crackpots “with little real knowledge of the topics they are commenting on,” Califf writes in the editorial, published online February 5 a JACC: case report.

The editorial accompanied an analysis, which was framed as a satire, which makes use of something called the Kardashian Index, or K Index, a metric for influence on Twitter as a function of influence in scientific literature, and which has been named for a pop-celebrity culture.

The medical discussion on Twitter appears to be following two distinct paths, Califf said theheart.org | Cardiology Medscape. One, “I think it’s good for speech and debate. Its biggest value right now, I think, is for the organization of knowledge.”

He said it refers to when, for example, an experienced and respected scientist uses Twitter to curate and comment on important research progress, perhaps even by providing links to relevant publications.

Califf identifies Eric J. Topol, MD, Scripps Research and Scripps Clinic, La Jolla, California (@EricTopol), who has approximately 190,000 followers as a professional master of this approach.

On the other hand, “Busy practitioners who comment on the relevance of a study’s results to their practice and interpretation – I think it’s a fair game,” said Califf, who has nearly 10,000 followers.

“The most annoying thing for me are the people who pontificate on the methods but they haven’t actually done tests on their own and aren’t participating so much. I think we have to reward the people who really participate,” he said.

“My point was that it would have been nice if the people who followed Twitter at the top were really part of the process of completing the studies they’re commenting on.”

To this end, Califf said, one of the editorial’s aims was to promote a sense of common purpose between the research community in cardiology and cardiologists at the forefront of clinical practice who do not participate in much research or contribute to literature.

In cardiology, “90% of our main recommendations are not based on high-quality evidence,” said Califf. This indicates the need for more aggressive research efforts which will need to involve doctors in practice to be successful.

“We have a huge knowledge gap and we need more people to participate,” he said. “An indicator of participation is the enrollment of people in tests or participation in the drafting of manuscripts that are published with peer review.”

He added: “The more people know about how tests are conducted, the more they are able to discuss their meaning and how they can be done better.”

But the editorial, say some observers, argues that the doctors with the greatest contribution to the medical literature are the most qualified to criticize medical research, especially clinical tests.

Furthermore, they see the editorial as a specific purpose for them and for other medical users who are primarily in clinical practice and therefore do not have many publications.

Among these is Ryan P. Daly, MD, Indiana Heart Physicians in Indianapolis (@DrRyanPDaly), who opposes the editorial “tone”, he explained to theheart.org | Cardiology Medscape. “He was actually scolding some of the people who used Twitter as a forum,” he said.

“It basically alienated many people who use Twitter and downplayed the contributions of some younger people who are very easy on it.”

In a tweet referring to the editorial Califf, Daly said he had sent a “Stay in your lane” message.


It’s important that clinicians primarily in clinical practice share public debates about studies that will inevitably influence patient care, said Daly, who has over 3700 Twitter followers.

“I just don’t think we should try to censor or marginalize the people who posted the least,” he said. Such doctors should have a forum where they can “reject” and explore if the research is valid, he added. “And if the data is strong, what do they have to worry about?”

In his blog, statistician Darren L. Dahly, PhD, University College Cork, Ireland (@statsepi), expressed a similar interpretation of the editorial.

“Citation-based metrics, whether applied to people, documents or magazines, are a poor demonstration of the scientific contribution.” Among other issues, “they confuse quantity with quality,” writes Dahly, who has around 10,500 followers.

“My biggest objection, however, is the general tone of the editorial gate. The argument seems to be that the people who conduct a lot of research are the ones whose opinions matter most, and apparently anyone else can simply be ignored.”

The idea that “people who don’t have a high number of citations are undeserving of counting followers” is “ignorant, arrogant and even anti-academic,” tweeted Venkatesh L. Murthy, MD, PhD, University of Michigan, Ann Arbor (@venkmurthy), who has around 10,300 followers and declined to be interviewed.


In addition, the editorial has a subtext that could be in step with the times, suggests a blog post by pediatrician Bryan Vartabedian, MD, Baylor College of Medicine and Texas Children’s Hospital, Houston (@Doctor_V).

“Buried between the lines is the fear that a dark horse may emerge that influences the trajectory of medical thought, a trajectory once shaped and controlled by a select group of doctors,” writes Vartabedian, who has more than 33,000 followers.

“This perspective perpetuates the idea that the ability to comment should be based on the pedigree rather than the originality of one’s thinking. Unfortunately, this way of seeing the world is at odds with the way the medical profession is starting to share information. and build new ideas. “

A similar interpretation of the Califf editorial comes from John M. Mandrola, MD, Baptist Medical Associates, Louisville, Kentucky (@drjohnm), who said he was considered one of his goals.

The editorial highlights the friction between traditional hierarchical channels through which new data and insights used exclusively to reach the medical community in general, and the democratizing effect of social media, says Mandrola, who is the main correspondent of cardiology and columnist for theheart.org | Cardiology Medscape and has over 35,000 Twitter followers.

His argument is therefore “the tension between the new platform that digital media offer compared to the old platform and who manages to control the narrative,” he said. “You no longer have to go into the rankings.”

Furthermore, “much of the editorial pushback was on the idea that if you are critically evaluating a process – let’s say you’re a doctor, or a patient, or maybe a regulator or a payer – that it is somehow personal and you should respect the people who did the trial, “said Mandrola. “I just think it’s a wrong idea. Critical evaluation is not personal.”

In fact, it could be one of Twitter’s strengths. “Twitter imperfectly offers the wisdom of the crowd. Everything on Twitter is peer-reviewed by the public,” said Mandrola. “This is a huge advantage.”

Another virtue of medical Twitter, he notes, is that commentators usually own what they tweet. The most serious posts on Twitter, those that guide the discussion, have a real name attached to them. This is in contrast to peer-reviewed journals, whose reviewers are rarely identified.

“Anonymous peer review: I understand that, but it’s a real weakness,” said Mandrola. “It is true that there are far from experts on Twitter. But I think, in general, its filtering aspect is a counterforce. If you have stupid ideas, you will be called to the task. I am not claiming that Twitter or a blog or podcasts should be the only type of peer review, but it’s a different type. “

https://twitter.com/RoxanaDaneshjou/status/1226651299216650240?ref_src=twsrc^tfw|twcamp^tweetembed|twterm^1226651299216650240&ref_url=https://publish.twitter.com/%3Fquery%3Dhttps%253A%252F%252Ftwitter.com % 252FRoxanaDaneshjou% 252Fstatus% 252F1226651299216650240% 26widget% 3DTweet

In fact, Twitter “has some real advantages over waiting for the peer review journal to be published and therefore waiting to go to a meeting,” Califf acknowledged. “I mean, you can absorb and listen to what different people think. It’s democratizing. I think part of it is good.”

On the other hand, a strong Twitter voice, measured by the number of followers, “does not necessarily identify with a work of greater impact”, concludes the main article in JACC: Case Reports, for which Califf wrote the accompanying editorial.

That main report took a satirical approach to conveying the message that science and its traditional dissemination should gain more respect and recognition beyond any measure of activity on social media, Ankur Kalra, MD, Cleveland Clinic, Ohio (@AnkurKalraMD), one of the authors of the article said theheart.org | Cardiology Medscape.

It was supposed to be “humiliating, for all including ourselves,” said Kalra, who has more than 5600 followers. “All we really wanted to say was that the level of scientific importance shouldn’t be equated with Twitter’s followership.”

On the other hand, “I think people who publish good science should also be active on social media, because once they become active, they will automatically have a following only because they published the science that changed the field.”

And this, Kalra said, “offers the rest of us the opportunity to speak directly to them about questions and problems. Twitter has given a voice to many of us and has somehow leveled the playing field.”

The authors of the report, led by Muhammad Shahzeb Khan, MD, Stroger Hospital of Cook County, Chicago, Illinois, described their use of the previously defined K index, the relationship between the number of Twitter followers that a person has accumulated and the number theoretically deserved on their number of literary quotations.

In their sample of 1,500 leading cardiologists, only about 16% were on Twitter. Of these, about two thirds scored a K of 2 or less, indicating a low level of influence through the service.

The analysis, which was to be playful, Kalra said, showed that only about 10% of the 238 cardiologists on Twitter had a K index greater than 5 and could therefore be considered Kardashian. It was an unscientific suggestion that perhaps the follow-up of their social media was disproportionate to their influence in the literature.

“Our work reinforces the fact that very few cardiologists are” Kardashians “of social media,” concludes the report.

Kalra said the report was intended to urge cardiologists on Twitter, “including myself”, to question the value of their influence on social media relative to the results of their research. “And if the answer is something we’re not proud of, then maybe we should strive to be better scientists than better Twitterati.”

https://twitter.com/VPrasadMDMPH/status/1226717909596008448

In his editorial, Califf describes Index K as “an oblique way of dealing with a problem that disturbs researchers who have paid the hard price of designing, conducting, analyzing.”

When the research is discussed on Twitter, Califf writes: “Another person who can only have a random knowledge of what is involved in the research can therefore make a comment that attracts enormous attention. People with a high K index may be those who thrive by commenting on the work of others rather than doing their job. “

The medical community “will have to deal with the right balance between doing research and interpreting and commenting on research. We need both,” notes the editorial.

“We should hope for a few Kardashian-style commentators and many other professionals who do hard work and then use social media to develop a mutual understanding of what it means.”

The public’s heated response to Kalra’s report and the Califf editorial may have been based on misunderstandings about the K index that they show so clearly. Some have interpreted their arguments as inappropriate uses of a bogus metric.

When interviewed, Califf recognizes the playful nature of the K index. “The Kardashian index is ironic, but, like a lot of almost humor, it actually indicates something we should pay attention to.”

But not everyone was willing to laugh at the editorial use of the index. “The very idea that the K index is actually a measure of nothingmuch less anything anyone would be interested in is ridiculous, “says Dahly in her blog.

“It’s a parlor trick,” he writes. “The idea that intelligent people are arguing seriously amazes me.”

Interviewed, Daly called Kalra’s main relationship “carefree and fun. I actually thought he was making fun of us.” As for the editorial, “I find it unpleasant to call the other cardiologists and colleagues” Kardashians “. In the worst case it is disparaging.”

The editorial did not include any Twitterati names he could have referred to, Daly observed, “but you can understand who he is talking about.”

But the K index “always had to be a kind of joke with a small dot associated with it,” said its inventor, genomics researcher Neil Hall, PhD theheart.org | Cardiology Medscape. “It shouldn’t have been taken literally!”

In his 2014 “proof of concept” study, Hall tracked the number of citations by 40 scientists against the number of followers on Twitter. From this came a formula for the Kardashian index, “which allows for a simple quantification of a scientist’s superior or inferior performance on social media,” writes Hall, who heads the Earlham Institute, Norwich, UK.

Hall had hoped that satire was evident from multiple, sometimes obvious clues in the text of the report. About his selection of cohorts, for example, he writes: “I didn’t come up with an intelligent way of doing it randomly (after all this is just a little fun)”.

Another clue: the unlikely name of the index borrowed from popular culture. Reality television star and entrepreneur Kim Kardashian West (@KimKardashian) “comes from a privileged background and, despite not having achieved anything consequential in the scientific, political or artistic fields,” writes Hall, is one of the most follow on Twitter and among the most searched people on Google. “

Kardashian West has 63.5 million Twitter followers.

As for his self-titled index, “I’m a big skeptic of any simple metric like this,” Hall said during the interview. “It is easy today, when there is so much information and opinion out there, to look for something simple to filter what you consume. My concern is that it can be self-satisfying, that people with many quotes will be heard and more will be mentioned. And then we’ll get stuck in dogma. “

Califf is an employee and shareholder of Verily Life Sciences and Google Health. He reports that he receives administration fees, is a member of the board of directors and a shareholder of Cytokinetics. Topol is the editor of Medscape. Kalra and her co-authors did not disclose relevant financial relationships. Mandrola did not disclose any relevant financial reports.

JACC: case report. Published February 5, 2020. Report, Editorial

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Quadrivalent adjuvanted influenza vaccine, approved by the FDA for the elderly

The U.S. Food and Drug Administration (FDA) has approved the first quadrivalent adjuvanted influenza vaccine (Fluad Quadrivalent, Seqirus) to protect adults aged 65 and over from seasonal flu.

Fluad Quadrivalent uses the same MF59 adjuvant as Seqirus’s trivalent Fluad vaccine, “which has an extensive clinical legacy, with over 114 million doses distributed and licensed in 29 countries since its first approval in 1997,” the company said in a statement. printing.

The adjuvant is designed to generate a strong, broad and long-lasting immune response.

Approval of the quadrivalent version of Fluad is supported by data from numerous clinical trials that have demonstrated safety and efficacy in adults aged 65 years and older against the flu strains included in the vaccine, the company said.

Fluad and Fluad Quadrivalent are inactivated vaccines indicated for immunization against the flu caused by the virus A and B subtypes contained in the vaccine.

During the 2018-2019 flu season, up to 647,000 people in the United States were hospitalized due to complications related to the flu, according to preliminary estimates by the Centers for Disease Control and Prevention (CDC).

Seasonal flu hospitalization and death rates are higher in older adults than in healthy young adults. During the 2017-2018 flu season, according to the CDC, 70% of hospital admissions and 90% of flu deaths occurred in this age group.

The effectiveness of the flu shot tends to be lower in older people due to the decline in age-related immunity.

“Adults 65 and older are at high risk of flu-related complications each year and it is important to have flu shots to protect this vulnerable population,” said Anjana Narain, executive vice president and general manager of Seqirus.

Fluad Quadrivalent offers “another seasonal vaccine option for healthcare professionals and their patients to fight the flu,” said Narain.

The CDC recommends that all children 6 years of age and older receive an annual flu shot, but it is especially important for those 65 and older who are at risk of developing serious complications from the flu.

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