Doug Collins: A Look at Trump's Pick to Head the VA

 President-elect Donald Trump has nominated an Air Force Reserve chaplain and former congressman to be the next secretary of the Department of Veterans Affairs.

Former Rep. Doug Collins, 58, a Georgia Republican who last ran for office in 2020 when he vied for a U.S. Senate seat, served two years as a Navy chaplain before joining the Air Force as a chaplain after the Sept. 11, 2001, terrorist attacks.

In his announcement Thursday, Trump said Collins, who campaigned heavily for the president-elect, would be a "great advocate for active-duty service members, veterans and military families to ensure they have the support they need."

"We must take care of our brave men and women in uniform," Trump said. "Thank you, Doug, for your willingness to serve our country in this important role."

Collins is a colonel in the Air Force Reserve. He deployed to Balad Air Base in Iraq in 2008 with the 94th Airlift Wing, based in Dobbins, Georgia, according to media reports. His most recent duty station was Robins Air Force Base, Georgia, where he served as an individual mobile augmentee to the command chaplain, according to the service.

The Air Force Reserve was asked to provide additional releasable information from Collins' service record but did not do so by publication.

On the social media platform X, Collins said Thursday that he was honored to accept the nomination, adding that veterans deserve "the best care and support."

"We'll fight tirelessly to streamline and cut regulations in the VA, root out corruption, and ensure every veteran receives the benefits they've earned," Collins wrote. "Together, we'll make the VA work for those who fought for us. Time to deliver for our veterans and give them the world-class care they deserve."

The VA provides disability compensation to more than 1 million veterans and family members, and roughly 9 million veterans are enrolled in VA health care, the country's largest integrated medical system.

Collins had previously posted on Veterans Day that he believes the VA's medical system "is broken and our veterans pay the price."

"Why does a veteran have to drive 80 miles to see a doctor when they already have trouble seeing to start with? @realDonaldTrump will drain the swamp and make America WIN again," Collins wrote.

Collins served in Congress from 2013 to 2021 but did not play a prominent role on veterans issues during that time and never served on the House Veterans Affairs Committee. Rather, he made a name for himself as a reliably conservative lawmaker and, in the last few years of his tenure, a staunch ally of Trump's.

His voting record in Congress got consistently high marks from conservative advocacy groups, including anti-abortion group Susan B. Anthony Pro-Life America giving him an A+ rating for his opposition to abortion as the top Republican on the House Judiciary Committee.

"Contending an unborn child has no life to lose becomes impossible when we reflect -- even momentarily -- on what an abortion entails," he said in 2019 at a committee hearing on reproductive health care rights. "One person's reproductive right cannot outweigh another person's right to live."

He also regularly argued against LGBTQ+ rights efforts, including contending a bill to add sexual orientation and gender identity to equal rights protections would "destroy female sports, endanger vulnerable women and promote sterilization of children in a misguided bid to privilege the rights of a few over those of the vast majority of Americans."

And after the Supreme Court ruled in 2015 in favor of marriage rights for same-sex couples, Collins said he would "strongly support a constitutional amendment defining marriage between one man and one woman."

While Collins' focus in Congress was not veterans issues, he voted in favor of major veterans bills on the House floor, including the 2014 Choice Act, the 2018 Mission Act, and the 2017 VA Accountability and Whistleblower Protection Act. A vocal proponent of gun rights, he also voted in support of a bill that wouldn't become law until after he left Congress that made it easier for some veterans to access guns.

As the ranking member of the Judiciary Committee, Collins became one of the faces of Trump's defense team during Trump's first impeachment over his efforts to pressure Ukraine to dig up dirt on now-President Joe Biden. In that capacity, Collins argued Democrats used impeachment as a political weapon to hurt Trump's chances in the 2020 election.

He's the fourth member of Trump's impeachment defense team to be rewarded with a Cabinet appointment after Trump named John Ratcliffe to be CIA director, Lee Zeldin to be Environmental Protection Agency head, and Elise Stefanik to be U.N. ambassador. Collins has continued to advise Trump on legal issues since leaving Congress, including on his efforts to overturn the 2020 election results.

In addition to his top post on the Judiciary Committee, Collins served as vice chair of the House Republican Conference, the fifth-highest position in GOP leadership.

In 2020, Collins opted to run for the Senate rather than reelection to the House. During that campaign -- which he lost in an open primary against Republican Kelly Loeffler and Democrat, now senator, Raphael Warnock -- he was warned by the Air Force against using campaign ads that pictured him in uniform but did not include a required disclaimer.

Sen. Jerry Moran, R-Kan., who is poised to be chairman of the Senate Veterans Affairs Committee next year and so will lead Collins' confirmation process, congratulated Collins in a post on social media and said he has "a strong understanding of the policies that impact veterans."

"President Trump nominated a candidate who has demonstrated his dedication to public service and a willingness to support veterans and their families," Moran wrote. "I look forward to Congressman Collins' testimony before the Senate Veterans Affairs Committee."

https://www.military.com/daily-news/2024/11/15/who-doug-collins-look-trumps-pick-head-va.html

Food Additives Exposed: What Lies Beneath America's Food Supply

 by Charles Cornish-Dale via The Epoch Times,

Scientists at the University of Texas, Dallas recently discovered that a common food additive can make flesh translucent - literally. Applying a solution of the yellow food colouring tartrazine to the skin of live mice allowed scientists to see right through the skin, into the tissues beneath, potentially offering a simple and inexpensive alternative to conventional imaging technologies like ultrasound.

Through the skin covering the skull, the scientists could look directly at blood vessels on the surface of the murine brain, and through the skin of the abdomen they observed internal organs and even the process known as peristalsis, the contractions that move food through the digestive passage.

Pretty cool, huh?

The physics behind this discovery aren’t actually all that complicated. Basically, when added to water, tartrazine changes the water’s refractive index—the way it bends light—so that it matches the refractive index of molecules like lipids in the skin, reducing the degree to which light scatters as it passes through the skin. Instead of scattering, the light travels straight and true, meaning you get to see what’s on the other side.

The process is totally reversible. It only takes a few minutes, the tartrazine solution can be washed off, and when it is the effects disappear. What tartrazine is absorbed by the skin is metabolized and excreted through the urine.

The researchers’ next goal is to test the solution on humans. Human skin is about 10 times thicker than a mouse’s, so it’s likely a larger dose will be needed, and it’s not clear if the delivery method—just rubbing the stuff on the skin—will be adequate.

A miraculous discovery, for sure, and one that will no doubt benefit medicine. But it’s also a reminder of an unpleasant, dangerous truth about the food supply in America today: that it’s full of substances whose properties and safety we know virtually next to nothing about. There are thousands upon thousands of additives—texturizers, colorings, humectants, anti-fungals, anti-caking agents, preservatives—in Americans’ food that have never been independently tested by the Food and Drug Administration (FDA) or by scientists who aren’t employed by the companies that make those chemicals and add them to their food.

As we’re discovering, many of those additives—the ones we know about and have begun to test—turn out to be extremely harmful, with links to every single chronic health condition you could care to name, from cancer and obesity to neurological and behavioral conditions like Alzheimer’s and autism. Tartrazine, which is found in Twinkies, Mountain Dew, candy, and cereals, among other foods, has been linked to hyperactivity in children and cancer. In the European Union, foods containing tartrazine must carry a warning label: “May have an adverse effect on activity and attention in children.”

It sounds absurd—insane, actually—but it’s not a glitch or an organized system of corporate deception. We’re not talking about companies lying to regulators or acting beyond the boundaries of the law. No, this is all above board. The system even has a name. The FDA calls it “generally recognized as safe” or “GRAS” for short.

The GRAS system was first introduced by the FDA in 1958 after the passage of the Food Additive Amendments, to “grandfather” through additives that were already used in food. The new additive regulations were intended to ensure ingredients capable of causing long-term harm never entered the food supply, but something very different happened. The GRAS designation mutated into a system that allowed companies to introduce and safety-test additives themselves without the FDA ever getting a look-in.

This happened in large part because the FDA simply couldn’t keep up with demands from companies to test their new additives for the burgeoning processed-food category. So companies started testing additives themselves and adding them to their food products without any consultation with the regulator.

Companies did this for decades, and instead of stepping in to assert its authority, the FDA did what any poorly staffed, hopelessly compromised organization would do: It simply chose to regularize the process, which was completed in 2016.

According to one study, since 2000, there have been only 10 applications to the FDA for full approval of a new food additive, out of a total of 766 that have been added to the American food supply. The safety of the other 756 was self-determined by the manufacturers themselves, in secret.

And so we’ve ended up in a situation where a company can produce a new food additive, decide it’s safe by whatever means it chooses, and then bring it to market without any scrutiny at all from the FDA. Like I say, nobody knows the exact amount, but a common estimate is that there are as many as 10,000 food additives in use in the United States, compared to around 2,000—all known quantities, by contrast—that are permitted in the EU.

Thankfully, the FDA and the GRAS system are now firmly in the sights of Robert F. Kennedy Jr., who has been tasked by president-elect Trump with Making America Healthy Again.

The “FDA’s war on public health is about to end,” Kennedy said in a Tweet last month.

He listed a whole range of compounds and treatments that he claims the FDA has suppressed, from psychedelics and peptides to “sunshine, exercise, nutraceuticals and anything else that advances human health and can’t be patented by Pharma.”

“If you work for the FDA and are part of this corrupt system, I have two messages for you,” he continued.

“1. Preserve your records, and 2. Pack your bags.”

Strong stuff.

Although Trump has yet to specify exactly what role Kennedy will play in the new administration, Kennedy himself has already made clear that other priorities, beside root-and-branch reform of agencies like the FDA, the Environmental Protection Agency, and the United States Department of Agriculture, will include fluoridation of the water supply, vaccinations, environmental pollution, and processed food. This is a comprehensive program, and if Kennedy can make meaningful changes in all of these areas in four years, he will have done the American people and their health an enormous service.

If anybody can get to the bottom of why Americans are so sick, it’s Robert F. Kennedy Jr., a man who has spent decades campaigning on environmental and health issues, and suffered personal loss and public vilification as a result—but still kept on going.

He knows as much as anybody the corruption that lies beneath the façade of public health in America, and now, at long last, he’s in a position to do something about it.

https://www.zerohedge.com/medical/food-additives-exposed-what-lies-beneath-americas-food-supply

City of Hope recruiting for mushroom supplement prostate cancer trial

 Researchers at City of Hope®, one of the largest and most advanced cancer research and treatment organizations in the United States, ranked among the nation’s top 5 cancer centers by U.S. News & World Report and a national leader in providing cancer patients with best-in-class, integrated supportive care programs, now understand why taking an investigational white button mushroom supplement shows promise in slowing and even preventing prostate cancer from spreading among men who joined a phase 2 clinical trial studying “food as medicine.” Looking at preclinical and preliminary human data, the City of Hope scientists found that taking white button mushroom pills reduces a class of immune cells called myeloid-derived suppressor cells (MDSCs), which has been linked to cancer development and spread.

“City of Hope researchers are investigating foods like white button mushroom, grape seed extract, pomegranate, blueberries and ripe purple berries called Jamun for their potential medicinal properties. We’re finding that plant-derived substances may one day be used to support traditional cancer treatment and prevention practices,” said Shiuan Chen, Ph.D., the Lester M. and Irene C. Finkelstein Chair in Biology, professor and chair of the Department of Cancer Biology and Molecular Medicine at Beckman Research Institute of City of Hope, and senior author of the new Clinical and Translational Medicine study. “This study suggests that ‘food as medicine’ treatments could eventually become normal, evidence-based cancer care that is recommended for everyone touched by cancer.”

The use of naturally derived therapies for cancer treatment — called integrative oncology — is growing in popularity as people become more health conscious and aware of the benefits of whole-person cancer care. Supported by a $100 million gift from Panda Express Co-CEOs Andrew and Peggy Cherng, City of Hope’s Cherng Family Center for Integrative Oncology is accelerating the research, education and clinical care needed to ensure cancer patients and their doctors have access to safe, proven approaches.

At City of Hope, lab researchers work closely with physicians, allowing for streamlined bidirectional research so that laboratory findings can be taken to patients and what is observed in patients can be taken and put back under the microscope for the development of expedited, more effective cancer treatments.

In mouse models, researchers found that administration of white button mushroom extract significantly delayed the growth of tumors and extended the survival of mice. It also improved T cell immune response through the reduction of MDSC levels in animal models, meaning it improved the immune system’s ability to kill cancer.

The researchers profiled blood draws from some of the men participating in City of Hope’s phase 2 clinical trial. The men were under active surveillance as they took white button mushroom supplements. Focusing on eight participants’ samples before and after three months of white button mushroom treatment, the scientists found that there were less tumor-creating MDSCs and more anti-tumor T and natural killer cells, suggesting white button mushroom rebuilds anti-cancer immune defense and slows cancer growth.

“Our study emphasizes the importance of seeking professional guidance to ensure safety and to avoid self-prescribing supplements without consulting a health care provider,” said Xiaoqiang Wang, M.D., Ph.D., City of Hope staff scientist and first author of the study. “Some people are buying mushroom products or extract online, but these are not FDA-approved. While our research has promising early results, the study is ongoing. That said, it couldn’t hurt if people wanted to add more fresh white button mushrooms to their everyday diet.”

People interested in joining the National Cancer Institute-funded phase 2 clinical trial should visit https://www.cityofhope.org/research/clinical-trials. City of Hope researchers are now focusing on whether the reduction in MDSCs is associated with improved clinical outcomes in patients with prostate cancer.  

https://www.cityofhope.org/city-of-hope-researchers-discover-why-taking-a-mushroom-supplement-slows-or-prevents-prostate

Update on Therapeutics for COVID-19

 Although the general population now has at least some immunity against COVID-19, the consequences of severe disease are frequently overlooked for certain patient populations, such as those with comorbidities or immune compromise. However, new research into COVID prophylaxis and therapeutics offers some hope that novel treatments may be on the horizon.

Is Paxlovid Still Useful?

The original phase II/III EPIC-HRopens in a new tab or window trial showed that nirmatrelvir/ritonavir (Paxlovid) was nearly 89% effective for preventing COVID hospitalization and all-cause death in unvaccinated high-risk patients.

"These were remarkable findings, but this trial was conducted early on in the pandemic among unvaccinated high-risk patients and the applicability of these findings to current settings of high population immunity are not well-understood," John McLaughlin, PhD, of Pfizer, said at this year's IDWeek annual meetingopens in a new tab or window.

Final results from the phase II/III EPIC-SRopens in a new tab or window trial, published earlier this year, were not so impressive. The study, enrolling people at standard risk for severe COVID, as well as vaccinated people with at least one risk factor for severe disease, found that nirmatrelvir/ritonavir failed to shorten COVID symptom duration in those populations. There was, however, a nonsignificant trend toward fewer hospitalizations and deaths among participants who took nirmatrelvir/ritonavir versus those who took placebo.

Results such as these have "created some debate about the utility of Paxlovid therapy in the current background of high population-level SARS-CoV-2 immunity," McLaughlin said.

To further explore this issue, McLaughlin and investigators conducted an analysis of pooled data from both of those trials. They found that nirmatrelvir-ritonavir was, in fact, effective at reducing several COVID-related outcomes in high-risk vaccinated or previously infected patients.

Most notably, the proportion of participants in the nirmatrelvir-ritonavir group who were hospitalized or died was 0.5% versus 1.9% in the placebo group, representing a relative risk reduction of 73.7% (95% CI 21.4-91.3).

There was also a 65% relative reduction in COVID-related medical visits (95% CI 24.4-83.8) with nirmatrelvir-ritonavir versus placebo, and a 46.6% relative reduction in severe COVID symptoms 7 to 28 days after treatment initiation (95% CI 22.1-63.4).

McLaughlin and colleagues also calculated the number needed to treat (NNT) to prevent one occurrence of each of these outcomes. "Even in a population with pre-existing immunity," the NNT to prevent one hospitalization or death was 71. The NNT to prevent a COVID-related medical visit was 24, and the NNT to reduce severe COVID symptoms 7 to 28 days after starting treatment was 16.

The researchers noted that there were a limited number of Omicron infections in the study groups and the trials included no data from the 2022-2023 and 2023-2024 seasons. However, the study's findings were consistent with real-world observational studies that have since been conducted in the Omicron era, McLaughlin pointed out.

"Taken together, these findings underscore the continued utility of Paxlovid treatment in high-risk patients, even in the context of baseline SARS-CoV-2 immunity," he concluded.

An Unmet Need in COVID Prevention

New COVID prophylaxis and treatment options are especially needed for highly immunosuppressed people and those undergoing certain types of cancer treatment, said Dinesh De Alwis, PhD, of Generate:Biomedicines in Somerville, Massachusetts, during a presentation at IDWeek.

In particular, "there remains a significant need to treat persistent SARS-CoV-2 infection in B-cell-depleted oncology patients," he said.

In a meta-analysis including over 7,600 patientsopens in a new tab or window on B-cell-depleting CAR-T therapy, "over 50% of non-relapse deaths in these patients are due to infections, of which COVID-19 is the main cause," he noted. Infection, including COVID, is also a major cause of morbidity and mortality in patients treated with T-cell engagers in cancer immunotherapy. Moreover, vaccine responses "are suboptimal to nonexistent in these patients, and chronic COVID infection is often unresponsive to monotherapy antiviral treatments," he said.

For people with immune compromise, monoclonal antibodies may prevent severe illness. However, their effectiveness has varied widely throughout the pandemic, depending on circulating SARS-CoV-2 variants.

GB-0669, developed by Generate:Biomedicines, is a novel monoclonal antibody that appears to be effective against diverse sarbecoviruses (i.e., the viral subgenus containing SARS-CoV and SARS-CoV-2), including multiple SARS-CoV-2 variants. Of note, GB-0669 was developed using a novel machine learning platform that focused on identifying antibodies less prone to immune escape.

The key difference between GB-0669 and other monoclonal antibodies against SARS-CoV-2 is that it binds to the S2 stem helix (S2-SH) of the virus, whereas other antibodies target the receptor-binding domain (RBD) of the virus' spike protein. However, the RBD is highly immune-dominant, and normal antibody response drives evolution at this site, leading to resistance over time.

In contrast, lack of selective pressure at the S2-SH site "means resistance mutations have not been seen to date" with GB-0669, De Alwis said.

A small first-in-human phase I studyopens in a new tab or window found that the antibody was well-tolerated in healthy participants, with no serious adverse events, he reported. An analysis of pharmacokinetics demonstrated that the activity of GP-0669 had low intersubject variability and the antibody had a half-life of 55 days. The researchers identified the optimal therapeutic dose to be 1,200 mg IV, providing an approximate 10-fold increase in neutralizing titers against SARS-CoV-2 in healthy participants who had pre-existing titers (XBB.1.5 and BA.5.5).

Based on established data about passive antibody efficacy in SARS-CoV-2, a single dose of GB-0669 should provide protection against hospitalization from COVID over a period of 60 days in patients with low baseline titer levels, De Alwis said.

"This data supports advancement of GB-0669 to phase II, especially in highly immune-compromised patient populations who have the greatest need," he concluded.

A Novel Antiviral for COVID?

Currently, nirmatrelvir-ritonavir, remdesivir (Veklury), and molnupiravir (Lagevrio) are the only available antivirals for the treatment of COVIDopens in a new tab or window.

Obeldesivir is an investigational antiviral with activity against SARS-CoV-2. It is an oral prodrug of the parent nucleoside GS-441524, targeting the highly conserved RNA-dependent viral RNA polymerase. The efficacy and safety of obeldesivir for the treatment of COVID in people with risk factors for severe disease was evaluated in the phase III BIRCH trialopens in a new tab or window.

However, the trial was halted earlyopens in a new tab or window because there was a lower-than-expected event rate for the primary outcome of COVID-related hospitalization or all-cause death, said Lauren Rodriguez, PhD, of Gilead Sciences, at IDWeek. (There were zero hospitalizations or deaths in the obeldesivir group [n=211] versus one in the placebo group [n=207]).

Nonetheless, some secondary and exploratory endpoints pointed to potential efficacy of the novel antiviral. Obeldesivir resulted in greater reduction in SARS-CoV-2 viral load at day 5 when compared with placebo (-0.58 log₁₀ copies/mL, P<0.0001) and also led to significantly greater reductions in infectious titers on day 3 (-0.54 log₁₀ plaque-forming units [PFU]/mL, P=0.0003) and day 5 (-0.17 log₁₀ PFU/mL, P=0.0014).

At day 3, 80% of participants in the obeldesivir group and 49% in the placebo group were negative for infectious virus (P=0.0049), and at day 5, 100% and 81%, respectively, were negative (P=0.0001). At day 10, nearly all participants were negative for infectious virus, with no differences between the two groups.

Although the BIRCH trial has been halted, the phase III OAKTREE studyopens in a new tab or window, evaluating obeldesivir as a COVID treatment for people without risk factors for developing severe disease, is ongoing.

Disclosures

McLaughlin is an employee of Pfizer.

De Alwis is an employee of Generate:Biomedicines.

Rodriguez is an employee of Gilead Sciences.

https://www.medpagetoday.com/spotlight/covid/112931

How Often Do Doctors Use New Weight-Loss Drugs in Kids?

 When Fatima Cody Stanford, MD, MPH, MPA, attended a holiday party thrown by two patients she was treating for obesity, she noticed something unusual about the way their 6-year-old daughter gave the house tour.

"She would take me to a room, and she's like, 'OK, the quickest way to the kitchen from here is this way,'" said Stanford, of Massachusetts General Hospital in Boston. "Her entire focal point ... was, 'How's the quickest way to the kitchen.'"

Stanford now treats the girl, who is around 13 years old, for obesity. "She's just wired a different way," Stanford told MedPage Today, noting part of the consideration for using new GLP-1 agonists in this patient.

The girl responded better than expected, first with liraglutide (Saxenda), then with semaglutide (Wegovy), losing 23% of her body weight. Stanford said she has been enjoying sports for the first time and carries a newfound confidence.

"It's been interesting to watch her trend down the growth chart to being a kid without obesity," she said.

As optimism for GLP-1 receptor agonists for weight loss has grown, so too has their use in children. Currently, liraglutide and semaglutide are the only two GLP-1 drugs FDA-approved to treat obesity in kids ages 12 and up.

Total prescriptions for those two drugs written by pediatric and adolescent medicine specialists rose from 3,448 in October 2022 to 24,435 in September of 2024 -- about a sevenfold increase in 2 years -- according to a MedPage Today analysis of data from Symphony, a prescription drug database.

Total prescriptions for all GLP-1 drugs prescribed by pediatric and adolescent medicine specialists have more than doubled during that time, from 59,868 to 125,538. These numbers reflect 11 GLP-1 drug brands, many of which are approved for type 2 diabetes, and do not include GLP-1 drugs prescribed to children by primary care physicians or family medicine practitioners, or at compounding pharmacies.

Many obesity specialists told MedPage Today they generally feel comfortable prescribing GLP-1 drugs to children if they have ruled out most other options, and if the family is involved in ongoing lifestyle interventions.

However, they acknowledged the uncertainties of putting kids on a drug regimen that may last a lifetime, and that lacks long-term data -- especially on critical questions like effects on bone density. And other experts remain entirely uncomfortable with these rapid changes in obesity treatment.

Proceeding With Caution

Both liraglutideopens in a new tab or window and semaglutideopens in a new tab or window were shown in clinical trials to reduce body mass index (BMI) in kids ages 12 to 17 to a greater extent than placebo. Liraglutide won a pediatric obesity indication for kids 12 and up in December 2020opens in a new tab or window, and semaglutide did so in December 2022opens in a new tab or window.

In September, results from the SCALE Kids trialopens in a new tab or window showed liraglutide cut BMI in kids ages 6 to 11 better than placebo, and Novo Nordisk is seeking to expand approval of the drugopens in a new tab or window to kids in this age group. Novo Nordisk and Eli Lilly have ongoing trials of semaglutideopens in a new tab or window and tirzepatideopens in a new tab or window (Zepbound), respectively, in this age group underway.

Last year, the American Academy of Pediatrics (AAP) issued an updated Clinical Practice Guidelineopens in a new tab or window for children and adolescents with obesity, recommending the use of pharmacotherapyopens in a new tab or window for adolescents 12 and up, including GLP-1 agonists. In certain circumstances, they wrote, healthcare professionals may offer them to children 8 and up.

Sarah Hampl, MD, of the University of Missouri-Kansas City School of Medicine and lead author of the AAP guidelines, emphasized the role of other interventions that accompany medication.

"It was recommended, not in isolation or not as a monotherapy, but as adjunct or addition to intensive health behavior and lifestyle treatment," Hampl told MedPage Today.

She said AAP "needed to comment on [pharmacotherapy], because it can be a very effective form of treatment -- again, as an adjunct -- and these kids, especially with severe obesity, they have some really serious and real comorbidities right here and now, in their childhood."

Stanford, for her part, does not prescribe GLP-1 agonists earlier than age 12, she said. If she had a younger patient with hyperphagia -- a condition marked by extreme and persistent feelings of hunger -- she said she would "still have some significant discomfort" prescribing GLP-1 agonists.

"I would still probably use my other drugs where we do have some data, like a topiramate or metformin, or if they have very severe obesity, I would wonder if they had something else," such as proopiomelanocortin (POMC) deficiency or leptin receptor deficiency, she said.

A child visiting her center would work with dietitians and a psychology team so that "we're doing all the behavioral things that are not really on the biology side," she said.

Stanford monitors her adolescent patients on GLP-1 agonists carefully. In the absence of long-term data, bone quality in particular is something she keeps an eye on. Bariatric surgery, which brings on a similar degree of weight loss as GLP-1 agonists, can lead to cortical bone lossopens in a new tab or window, and she wondered if similar effects will emerge with the GLP-1 drugs.

Family medicine doctors may take an even more cautious approach, using weight-loss drugs as a last resort.

Tochi Iroku-Malize, MD, MPH, MBA, president-elect of the American Academy of Family Physicians, told MedPage Today that the group's position mostly aligns with that of the U.S. Preventive Services Task Force, which this year recommended comprehensive, intensive behavioral health interventionsopens in a new tab or window for children 6 and older with obesity instead of weight-loss medication.

"When we're starting with children, they have a longer way to go than adults when it comes to using these medications," Iroku-Malize told MedPage Today. Children's bodies are still growing and developing, "so we don't yet know what the long-term effects of taking the weight-loss medications are, and whether the young patients would have to continue taking them indefinitely to maintain their weight," she said.

Still, she said using medication to treat pediatric obesity is not out of the question. "On the other side of it is that for those children who have obesity, and to the point that they are at risk of developing some other condition that could increase their morbidity and mortality, and they've tried the other methods and it's not working, and they're still at risk, then this may be an option," Iroku-Malize said. "But we have to pay attention to what's going on and not use it lightly."

Emphasizing Lifestyle Changes

Others stress a bigger focus on root issues, like physical activity and nutrition -- including Dan Cooper, MD, a pediatrician at the University of California Irvine. Cooper and colleagues have published on the unintended consequences of GLP-1 medicationsopens in a new tab or window in children, including possible long-term effects on growth and development, abuse among patients with eating disorders or in competitive sports, and insufficient or excessive prescription in populations with high rates of obesity and poor fitness.

Though he has not ruled out the use of GLP-1 drugs in kids, he said there's an urgent need to engage with lifestyle and behavioral interventions more meaningfully.

Experts were careful in interviews to emphasize the role of diet and exercise for anyone who starts a GLP-1 drug. The trials that led to approval of semaglutide and liraglutide to treat obesity in adolescents provided regular nutrition and physical activity counseling, and in both trials, participants were "encouraged" to get 60 minutes of daily moderate- to high-intensity physical activity, they said.

But few children have access to lifestyle interventions like those used in the trials, and in real life, they often fall short, Cooper said.

He explained that even when a physician tells a pediatric patient to exercise, specific instructions are rarely given, and there's not usually much follow-up. There are other barriers at play too, he said.

He noted that in his community in Santa Ana, California, there are very few parks. "Parents don't want the kids to play because it's unsafe on the streets," he said. "The schools don't have the budget for after-school programs."

"Don't get me wrong, I'm not blaming the pediatricians. I'm a pediatrician," he said. "I mean, we're the best doctors on the planet. But it's very, very tough to do these things."

Scott Bowman, a friend of Cooper's, is a physical education specialist and the author of the state's Content Standards for Physical Educationopens in a new tab or window. He agreed that GLP-1 agonists don't get at the root of a complicated systemic problem: a tenuous relationship between kids and exercise.

Bowman has helped schools organize family "Olympics," and thinks professional sports teams should channel their excess funds into more community fitness programs.

While he says it's not an either-or decision, Bowman would rather have "lifelong physical activity than lifelong medication," he said. "We just have to start thinking outside the box."

https://www.medpagetoday.com/special-reports/exclusives/112937

Physician Groups Quiet on RFK Jr. Nomination for HHS Secretary

 The response from physician groups to President-elect Donald Trump's nomination of Robert F. Kennedy Jr. for HHS secretary has been rather measured so far.

Take for example the American Academy of Pediatrics (AAP). "[This] nomination ... offers an important opportunity to share the settled science on vaccines with government leaders, policymakers, and the American public," AAP President Benjamin Hoffman, MD, said in a statement. "This is a conversation pediatricians have every day with families, and we welcome the chance to do the same with national leaders."

"Vaccines are the safest and most cost-effective way to protect children, families, and communities from disease, disability, and death," he continued. "Continuing national investment in vaccine access is absolutely essential to support healthy communities ... As pediatricians, we firmly believe the most effective way for HHS to ensure the future health of our nation is to protect and support the health of our children: by ensuring that science continues to underpin all decision making, policies, and programs."

Kennedy's selection has been a controversial one largely because of his skepticism on the safety and value of vaccinesopens in a new tab or window. He also has said he supports getting rid of fluorideopens in a new tab or window in the drinking water supply. Fluoride strengthens teeth and reduces cavities by replacing minerals lost during normal wear and tearopens in a new tab or window, according to the CDC. The addition of low levels of fluoride to drinking water has long been considered one of the greatest public health achievements of the last century.

Kennedy, also known as RFK Jr., additionally has made no secret of his disdain for the agencies under the HHS secretary's purview. In a videoopens in a new tab or window for the Make America Healthy Again initiative that he leads, Kennedy said his "big priority will be to clean up the public health agencies like CDC, NIH, FDA, and U.S. Department of Agriculture."

But despite holding these controversial views, Trump's choice of Kennedy has garnered little response from physician organizations, possibly because, if confirmed, he would hold enormous sway over issues that physician groups care about. Several major physician organizations did not respond at all by press time when contacted by MedPage Today for comment on the nomination.

The American College of Physicians (ACP) did not comment directly on the nomination but instead issued a statement in support of vaccines. "Vaccines are vital to our ability to prevent diseases that threaten public health," said ACP President Isaac Opole, MBChB, PhD. "The ACP remains concerned about the spread of disinformation and misinformation regarding vaccination ... It is critical that policymakers and government officials understand the importance of vaccines, evidence-based medicine, and other ways that our public health infrastructure protects all of us."

Some other interest groups, however, did not hold back. "Robert F. Kennedy, Jr., is not remotely qualified for the role and should be nowhere near the science-based agencies that safeguard our nutrition, food safety, and health," said Peter Lurie, MD, president of the Center for Science in the Public Interest (CSPI). "Nominating an anti-vaxxer like Kennedy to HHS is like putting a flat Earther at the head of NASA. CSPI opposes this nomination and any other nominees who are a direct threat to science and evidence-based solutions. If unassuming little viruses could talk, measles, mumps, and rubella would be loudly cheerleading for the nomination of this prolific spreader of scientific misinformation."

"RFK Jr. is an unfit, unqualified extremist who cannot be trusted to protect the health, safety, and reproductive freedom of American families," Mini Timmaraju, JD, president and CEO of Reproductive Freedom for All, a pro-choice group, said in a statementopens in a new tab or window. The organization noted that Kennedy "has gone on record supportingopens in a new tab or window a national abortion ban and has spread dangerous disinformation and conspiracy theories."

Interestingly, Mike Pence, Trump's former vice president, also opposed Kennedy's nomination but had a completely opposite take on Kennedy's abortion views. "For the majority of his career, RFK Jr. has defended abortion on demand during all 9 months of pregnancy, supports overturning the Dobbs decision, and has called for legislation to codify Roe v Wade," Pence said in a statementopens in a new tab or window. "If confirmed, RFK Jr. would be the most pro-abortion Republican-appointed secretary of HHS in modern history ... I respectfully urge Senate Republicans to reject this nomination and give the American people a leader who will respect the sanctity of life as secretary of Health and Human Services."

Former CDC director Tom Frieden, MD, did not weigh in one way or the other on the nomination but said it carried enormous weight. "Whoever becomes HHS secretary has a life-and-death responsibility to protect Americans' health -- not only from the threat of another pandemic but also from the chronic disease epidemic that plagues our country," Frieden, now president and CEO of Resolve to Save Lives, said in an email. "A litmus test will be whether the incoming secretary uses proven strategies to stop the known and leading causes of most chronic disease: tobacco, alcohol, junk food, and PM2.5 [particulate] pollution."

Zeke Emanuel, MD, PhD, former chief of bioethics at the NIH Clinical Center, was more blunt about the nomination. "Vaccines have saved 154 million lives globally," he said in an email. "And more than 100 million of those lives were infants. Appointing a known anti-vaxxer as the head of HHS threatens all the progress we've made. Eroding the trust in or access to vaccines will lead to an increase in serious illnesses, hospitalization, and even deaths."

Physician members of Congress are divided in their views along party lines. "As an emergency medicine physician and public health expert, I know how essential it is for our public health leaders to take an evidence-based approach and rely on rigorous science," Rep. Raul Ruiz, MD (D-Calif.) said in an email to MedPage Today. "I'm concerned that Robert F. Kennedy Jr.'s anti-vaccination rhetoric, which has no scientific basis, will undermine trust in vaccinations at a time when our nation is already experiencing an increase in measles outbreaks, the reemergence of polio, and the fivefold rise in whooping cough. Vaccines are essential in protecting our communities from preventable diseases, and any false rhetoric that erodes this trust could result in dire consequences."

Sen. Bill Cassidy, MD (R-La.), had a differing opinion, saying in a tweetopens in a new tab or window that Kennedy "has championed issues like healthy foods and the need for greater transparency in our public health infrastructure. I look forward to learning more about his other policy positions and how they will support a conservative, pro-American agenda."

Washington Correspondent Shannon Firth contributed to this story.

Disclosure: Former CDC Director Tom Frieden is a cousin of the author, but she did not contact him for this story. His statement was obtained by Shannon Firth.

https://www.medpagetoday.com/publichealthpolicy/healthpolicy/112945

'Nurse Suicides High During the Pandemic, but Feared Surge Never Materialized'!!

 Female nurses' suicide risk remained higher but didn't worsen through the COVID-19 pandemic compared with other women, according to a large retrospective cohort study.

Female nurses had 21% and 41% higher suicide rates than their general population counterparts in the pre-pandemic years of 2018 and 2019, respectively, found researchers led by Judy E. Davidson, DNP, RN, of the University of California San Diego.

During the pandemic, incidence rate ratios were in the same range, elevated 26% for female nurses versus female non-nurses in 2020 and 35% in 2021. All comparisons between the two groups were statistically significant.

In comparison, male nurses' suicide rates were comparable with those of male non-nurses across the period covered by the study published in the Journal of Nursing Administrationopens in a new tab or window.

Given the overwhelming stress of the pandemic, "we had anticipated a rise," Davidson said via email. The lack of a pandemic-related surge in female nurse suicides may be due to a host of factors, she said.

"You can imagine from the early pandemic that there was a lot of angel/hero praise ... that might have been temporarily protective," Davidson told MedPage Today. Additionally, "those that 'ran into the fire' might have been hardier, less burned out, and diluted the overall risk of others," she noted.

Another "troubling possibility" is a potential protective effect from courts being closed early in the pandemic, temporarily pausing nurse discipline, she said.

In her group's study of the CDC's National Violent Death Reporting Systemopens in a new tab or window (NVDRS) data, nurses had a higher chance of mental health problems, job problems preceding suicide, and of poisoning themselves, with adjusted odds ratios of 1.28, 1.60, and 1.54, respectively (all P<0.001 compared with non-nurses). Nurses were also more likely to use opioids, cardiovascular or diabetic agents, and drugs not prescribed for home use.

Job-related problems, which have been linked with suicide among nursesopens in a new tab or window in prior studies as well, often involve discipline by nursing boards or employers and premature separation from the workforce, Davidson pointed out.

She questioned whether more "holistic treatment-first" approaches, for example those involving a leave of absence for treatment, would decrease suicides associated with substance use disorder and the disciplinary process.

An important next step will be to study treatment-first policies versus termination, she said.

Davidson also urged reauthorization of the "Dr. Lorna Breen Health Care Provider Protection Actopens in a new tab or window" to renew its funding of evidence-informed strategies to prevent suicide and address burnout, mental health conditions, and substance use disorders.

At a minimum, all drug diversion disciplinary policies need a "baked in" suicide prevention plan and psychological support for anyone involved in an investigation, she said.

In addition, she urged nursing boards to adopt licensing questions that are compliantopens in a new tab or window with Americans With Disabilities Act (ADA) protections against discrimination around physical and mental disabilities. A 2019 studyopens in a new tab or window found that 22 of 30 nursing boards ask non-ADA-compliant questions, and a 2024 studyopens in a new tab or window found the situation hasn't improved.

K. Jane Muir, PhD, RN, FNP-BC, of the University of Pennsylvania School of Nursing in Philadelphia, stressed the need to strengthen safeguards for nurses given their higher rates of suicide than the general population.

"Employer support of nurses through safe patient-to-nurse staffing ratios and improving the reporting and prevention of workplace violence are actionable solutions," she noted, as are flexible schedules, generous family leave policies, and financial incentives for hard-to-staff shifts.

The retrospective cohort study relied on suicide data from the NVDRS from 2017 to 2021, which draws from death certificates, medical examiner, and law enforcement reports for an anonymous data set detailing demographics and substances used in suicide.

Altogether, 1,368 nurse and 104,576 general population suicides among individuals ages 21 years and older were identified by reported sex and state. Decedents whose sex data was missing were excluded.

A study limitation was that the analysis included limited jurisdictions that met the NVDRS reporting threshold -- 30 states -- and only limited information collected from death investigations, therefore it might not be nationally representative. Additionally, the normal sources of NVDRS data might have been overwhelmed during the pandemic, leading to coding errors or underreported suicides.

The authors suggested that further research on suicide attempt survivors could help clarify risk and protective factors.

Disclosures

The authors reported no conflicts of interest.

Primary Source

Journal of Nursing Administration

Source Reference: opens in a new tab or windowDavidson JE, et al "National incidence of nurse suicide and associated features" J Nurs Adm 2024; DOI: 10.1097/NNA.0000000000001508.

https://www.medpagetoday.com/nursing/nursing/112929